The Louvre

With a surface of 210,000 m2 of them are devoted to exhibitions. This museum holds 35,000 masterpieces and eight different collections. To be able to visit the entire museum I had to go several times and take over from where I left. What really fascinated me and grab my attention is the Egyptian antiquity section. I was charmed about this because it had all the details about the volution and life style of this wonderful and fascinating culture and civilization.I'm personally very interested in studying the Egyptian civilization and knowing all the aspect of this culture and this exhibition gathered all the necessary information that I needed and I asked to have. The evolution of this civilization was in front of me in the same place. It was a dream that became a reality. I had all the tools that they used In their dally lives In front of me, I couldn't believe my eyes. I was watching their dresses and their makeup and Jewelry.I was fascinated about their Inventions and creations that Inspired us and still Inspiring us till today. The Department of Egyptian Antiquities at the Louvre museum houses a major Egyptologlcal collections of the world with 50,000 rooms. This section covered every single detail about this amazing people. The collection covers all periods of ancient Egyptian civilization since the time of Nagada to the Roman and Coptic Egypt. Among the most famous exhibits found at the time of Nagada knife Gebel el-Arak and the range of hunting.The major piece of art illustrating the time thinite is the stele of King Snake. Among all exposed sarcophagi, one finds that of Dioscorides, a Greek general during the reign of Ptolemy VI who decided to be buried according to ancient Egyptian local customs, choosing to do make a sarcophagus. This proved the power of this civilization and how It Influenced others clvlllzatlons. I also liked the Islamic art section since It's about my religion.The Department of Islamic Art from the Louvre, stablished in August 2003, brings together the collections from an area between Spain and India, dating from the origins of Islamic civilization (622) until the nineteenth century. This department includes several gems of Islamic art: the al- Pyxis Mughira an ivory box dated Spanish 968, the flat peacock, an important Ottoman ceramics, especially the baptistery of St. Louis, one of the most famous pieces and most enigmatic of all Islamic art, created by Muhammad ibn al-Zayn the early fourteenth century.Since 22 September 2012, Islamic art are exhibited at the Louvre in the Cour Visconti. This space allows the display of 3000 works from the collections of the Louvre, but also the Mus ©e des Arts d ©coratifs. It is remarkable how this section take place under a canopy with undulating shapes, recalling from the architects Marlo Belllnl and Rudy Ricclottl a â€Å"dragonfly wing† or a â€Å"flying carpet†. Vlsltlng this museum was a very enriching and fascinating experience where I learned a lot of new things about the civilization that I'm most passionate about and my own rellglon

Widespread use of renewable energy

The first oil daze in 1973 raised worldwide concern about dwindling energy supplies. High oil monetary value was a mark of depletion worldwide energy beginnings. Since 1960s no large oil resources have been discovered in the universe. It suggested that universe oil production will make its extremum within one or two decennaries ( Lauber, 2005 ) . The rise in oil monetary values besides affected the developing states ‘ development programs, which demand big sums of energy for their early procedure of industrialisation. For developed states, the fluctuation in oil monetary values caused economic and societal jobs such as unemployment, trade shortages and higher rising prices due to their great dependence on oil import ( Seitz, 2008 ) . Since the industrialised revolution the ingestion of universe energy has been uninterrupted. With the modern-day universe population growing, energy demand is lifting at a rapid rate, particularly in many developing states with a deficiency of reso urces on their ain land. It is predicted that between 1997 and 2020 energy demand will increase 60 per centum, 120 per centum growing will happen in developing states, particularly in Asia ( Hill, 2004 ) . If this tendency continued, the environmental jobs would necessarily deteriorate even farther. As a considerable proportion of the universe energy, fossil fuels account for the premier beginnings of C dioxide emanations, which are chief subscribers to the planetary heating. Acid rain concentrated by acerb gases from fossil fuels, amendss ecosystems and corrodes human edifices. It is going a terrible job in Asia with the turning ingestion of fossil fuels as the procedure of industrialisation accelerates ( Seitz, 2008 ) . The quickly spread outing usage of gasoline-powered vehicles could do terrible urban smog and spit little particulates, which are the greatest menace to people ‘s wellness ( Jaccard, 2005 ) . Sanderson and Islam ( 2007 ) maintain that the way of economic development necessarily caused environmental jobs related to the overly usage of environmental resources and clime can besides impact some sectors of the economic system such as H2O resources, agribusiness, conv eyance and touristry, which are vulnerable to climate alteration. In general there are three major solutions for the turning energy demand and world-wide environmental jobs, each of which has its attractive forces. First fossil fuels can be used more cleanly and expeditiously, which could lend to a decrease in energy strength and cut down the emanations of nursery gases. Energy preservation can take consequence in short term and straight execute on present energy system without great passage. The economic system in the United States increased 30 per centum while the oil ingestion declined 20 per centum between 1977 and 1985 because the state used energy much more expeditiously ( Seitz, 2008 ) . Second, atomic power emits no air pollution which could greatly turn to the environmental jobs. France shifted to atomic as its major power of electricity in response to the energy crisis, and by 2005 it reached one of the universe highest rates by supplying 80 per centum of its electricity from atomic beginning ( ibid ) . Third renewable energy involves uni nterrupted energy beginnings and produces small pollution to the environment. There is immense potency in this new energy beginnings to run into much of the turning energy demand and bit by bit replace fossil fuels with equal support ( Middleton, 2003 ) . For every bit long as the planetary economic system continues to development and operate on the footing of limited energy supplies, the great demand for energy services in the hereafter would do terrible energy crisis. Increasing energy efficiency can assist to countervail the rise in energy demand, but it is improbable to turn to all the extra demands ( ibid ) . Furthermore, the environmental taint caused by fossil fuels will go on to necessitate options. Lauber ( 2005 ) maintains that while the present cost of salvaging one ton of C by increasing energy efficiency is well lower than by utilizing renewable energy to avoid emanations, renewable power will play a function in the long tally, energy efficiency can merely work out short term job. Besides the safety and atomic waste jobs, a important growing in atomic power usage would increase trust on imported U. Dependence on energy imports would still be a first job for states with a deficiency of resources. In add-on, the atomic begi nnings besides face energy crisis as it is shown that the known militias of U will merely last for 60 old ages by present counts. ( Traube, 2004, cited Lauber, 2005 ) . Therefore, renewable energy seems to be a better option based on its two outstanding advantages: infinite beginnings and small pollution. Renewable energy may be defined as energy generated from natural resources in the environment such as sunshine, air current, tides and geothermic heat, which are continuously replenished. Harmonizing to the definition renewable energy will ne'er run out. For this ground, renewable energy could be an ideal solution to the energy deficit job. Additionally, renewable energy does non bring forth pollution straight, which will relieve the serious planetary environmental impairment. Renewable energy is really already in widespread usage: approximately 20 per centum of universe ‘s electricity production comes from hydroelectric dikes ; in many developing states biomass provides the lone power for cookery and warming ; India and China both have primary air current power electricity programs, with 2,000 megawatt marks ; Some Middle Eastern states are seeking to research the H production powered by solar energy as a long-run option to dependence on exporting oil ; The large-scale federal authorities in the United States received increasing R & A ; D support for renewable energy after the 1974 oil daze ( Elliott, 1997 ) . The widespread usage of renewable energy in many states clearly shows that the publicity of renewable energy engineerings provides great advantages for both rich and hapless states. In industrialised states, solar or weave energy necessitate extremely skilled and knowledge-intensive employers, which will be an drift to a new occupation hunting inclination. Using biomass with more efficient engineerings for cookery and warming in developing states where the biomass is normally used inefficiently and prodigally can convey big benefits such as a decrease in deforestation. Examples are the widespread usage of improved wood and wood coal cooking ranges in Kenya every bit good as the production of ethyl alcohol from sugar cane in Brazil ( Aˆmann, Laumanns and Uh, 2006 ) . However, â€Å" one renewable beginning may bring forth small or no pollution, but have other inauspicious environmental and societal consequence † ( Hill, 2004, p.325 ) . Hydroelectric dikes generate low nursery gas emanations but affect both up- and down-stream ecosystems and coerce many people who live along the river into taking from their places. Solar power does non bring forth direct pollution. During the procedure of fabrication and transporting solar panels, energy storage and keeping machines, nevertheless, pollution will be generated. Renewable energy has to confront three challenges in its practical application. First, the beginnings of energy are non uninterrupted. For illustration solar power can non be accumulated at dark and lupus erythematosus is generated on cloudy or showery yearss with small sunshine ( Hill, 2004 ) . The job with air current power is that the air current may non be blowing when and where it is needed. Therefore the large-scale storage of solar and weave energy is necessary and needs both proficient and fiscal support. Second, renewable energy has comparatively low energy denseness. Take the instance of solar energy, to run into the big energy demand, big countries of land are required to be covered with solar panels. Harmonizing to the US Electric Power Research Institute, to run into 25 per centum of America ‘s electricity demand about 6000 square stat mis of solar farms, an country peers to the Connecticut State, are needed ( Hill, 2004 ) . Biomass energy will confront the same ch allenge. Large land countries used for biomass energy demand to stay forested. This could do land-use struggles because the important growing of the universe ‘s population will necessitate increasing nutrient production and more land dedicated to agribusiness. There is a tradeoff between the two methods of land usage ( Jaccard, 2005 ) . The 3rd challenge involves inconvenient location of power workss. Large-scale solar power workss need to be located in countries with plentiful and long-time sunshine. The best air current power need the energy sites with reliable and strong air currents. These locations are normally far from energy ingestion centres. Transporting the power to clients requires substructures and complicated power line organisation. Peoples normally do non desire power lines near their places or schools and a deficiency of transporting substructures are all obstructions to the existent feasibleness. There are besides political and finicky barriers to the acceptance of renewable energy system. Many authoritiess prefer conventional fossil fuels to renewable energy â€Å" due to tradition, acquaintance, and the size, economic strength, and political clout of the conventional energy industries † ( Geller, 2002, p. 43 ) . In developing states loans for building renewable energy undertakings have been rejected by the World Bank and many-sided development Bankss due to their little undertaking graduated table, strangeness with the engineerings and higher investing hazard ( Martinot, 2001, cited in Geller, 2002 ) . In decision, despite those barriers and disadvantages, the widespread usage of renewable energy meets the demands of sustainable development in a long term. Whether in footings of increasing energy efficiency, switching to atomic power or developing renewable energy beginnings, the future effects can non be evitable. Even though renewable power engineerings were in most instances non to the full competitory commercially and the switch to renewable energy system will take a long period, their costs had the possible to fall quickly, and by 2020 should be able to surpass fossil fuels ( Lauber, 2005 ) . Nuclear power was evaluated as being more expensive than renewable energy and as keeping small opportunity of cost decreases in the hereafter. At the present phase different beginnings should be used together and the development of renewable energy should be given more accent.MentionsAˆmann, Dirk, Laumanns, Ulrich and Uh, Dieter ( 2006 ) Renewable Energy: a planetary reappraisal of en gineerings, policies and markets London: Sterling, VA: Earthscan.Elliott, D. ( 1997 ) Energy, Society and Environment: Technology for a Sustainable Future. New York: Routledge.Geller, Howard ( 2002 ) Energy Revolution: Policies for a Sustainable Future. Washington, DC, USA: Island Press.Hill, Marquita K. ( 2004 ) Understanding Environmental Pollution ( 2nd ed. ) . Cambridge, UK: Cambridge University Press.Jaccard, Mark Kenneth ( 2005 ) . Sustainable fossil fuels: the unusual suspect in the pursuit for clean and digesting energy Cambridge, UK: Cambridge University Press.Jamie Sanderson and Sardar M.N. Islam ( 2007 ) Climate alteration and economic development: SEA regional modeling and analysis. Basingstoke: Palgrave Macmillan.Lauber, V. ( Ed. ) ( 2005 ) Switch overing to Renewable Power: A model for the twenty-first Century. London, GBR: Earthscan Publications.Middleton, Nick ( 2003 ) The planetary casino: an debut to environmental issues ( 3rd ed. ) London: Arnold.Seitz, J L ( 2008 ) Global Issues ( 3rd ed. ) . Blackwell: Malden MA ( USA ) .

The Cabinet Essay Example | Topics and Well Written Essays - 500 words

The Cabinet - Essay Example The 1962 cabinet represented high family-based ties in the political arena. Even though members of the cabinet had different personalities and backgrounds, they share close family relationships in one way or another. For example, the Al-Asabah family and the larger Asil family held a significant proportion of the cabinet over the aforementioned period. Majority of cabinet members came from influential Kuwaiti families. In this respect, dominant cabinet ministers also represented some of the most influential families in the history of Kuwait. Over and above family-based monopoly in the cabinet, a significant number of cabinet members were well off compared to the rest of the population. Majority of cabinet ministers came from wealthy families, and most importantly, they were wealthy themselves. This made them even more influential as far as the politics of the country were concerned. In addition, more than 50% of ministers in Kuwait were in their 30s or 40s in terms of age. This made the 1962-1988 Kuwait cabinet one of the most youthful around the world. Even as Kuwait made critical progress politically, education and literacy levels were still a challenge to the larger populace. Cabinet members had basic education, but most of them lacked advanced academic and professional experience. For example, the number of engineers in Kuwait was significantly low at a time when the newly independent nation was striving to invest heavily in technological development. In 1962, engineers were less than ten in the entire Kuwaiti population. Critical disparities were also evident in regards to where ministers attended their school. Cabinet members with basic primary education attended school locally, and so did members who had secondary education. College and university degrees, however, required that education be accessed outside Kuwait. This shows that some Kuwaiti

Public vs. Private school Essay Example | Topics and Well Written Essays - 1000 words

Public vs. Private school - Essay Example Moving further ahead, one should believe that the private schools are faring better than the public schools because the private entities work to provide benefits to a select mix of students and thus the community premise is pretty apparent within the same. The public and private schools are different in their manifestations and this is the most basic reason why the public and private schools are seen with a sense of skepticism when the talk goes out loud regarding their combination at certain places (Fabry, 2001). What needs to be understood here is the fact hat both public and private schools will have to play a larger role than just getting combined for no solid reason. It is a fact that the combination might not bring the value that is expected out of their entireties but what it shall do is to form a core syllabus or curriculum for them, which will in return mean that both the public and private school mechanisms have a sense of uniformity within their aegis. The need is to prope rly combine the two so that the alignment factor does not seem to be a missing one, because this is important at the end of the day. The reason why private schools seem to work better for the students and the entire community in meticulous is because the private schools are geared to look after the selected few and does not take into consideration just about any segment of the society, which wants to attain education (Wang, 2001). Also the private schools are very much inclined towards quality which seems to be a problem for the public school enterprises – focusing more on quantity than the other way around. The private schools look after the needs and requirements of the students in a proactive way. What this means is the fact that the private schools are focusing on the quality tangent and are relying on how the students will advance into their professional domains over a period of time. Since the private schools do not require governmental funding, it becomes easier for th ese schools to bring about their thoughts into serious actions (Burke, 2003). This is not the case with the public schools where even the smallest of actions and steps take maximum amount of time. The public schools therefore lose out on a number of contexts when it comes to understanding their nuances in light of the private schools, and more specifically in the time and age of today. The argument for the sake pf the private schools seem to be a winning one because the private schools look to hire the best faculties, train teachers whilst they are on the job and give infrastructure and support to the students which seem unheard of when one compares the same with the public schools. However many public schools do seem to come up with different grants and scholarships for their students, the fact of the matter is that nepotism and like-mindedness seem to rule the roost there. These are some of the most depressing scenarios and situations that one can easily witness within the folds o f the public schools (Smith, 1949). The argument gains weight when one comes to the reckoning that the quality education does come with a price on its head. This means that the private

Observance of Religious Holidays Research Paper

Observance of Religious Holidays - Research Paper Example Research Problem The research problem is, â€Å"Study the history of observance of religious holidays. Explore the pros and cons of observing religious holidays, the policies of the schools and educational institutions, the legal issues involved and the steps taken by the administrators in observing religious holidays†. Literature review According to the pages of history, United Sates which was a land of few religions in 1776 developed into a country that professes countless religious beliefs throughout the nation. The children reading in the schools and colleges, staffs working in the offices are of different religions and vary largely from each other. The observance of religious holidays has thus turned into an area of concern for the college and the society. There are various pros and cons related to the observance of religious holidays. The observance of religious holidays is a sentimental issue and is dealt with sensitivity towards the people of different religions. The r eligious holidays observed by the different religions are creating a situation of conflict and confusion (American Academy of Religion, 2013). The increase in the number of religions leads to the increase in the number of religious holidays which is a point of concern as it poses a problem in the daily work of the schools and in the process of public education. The only way to bring a common solution to the problem of observing religious holidays in schools is to undertake a discussion that takes into account the points of similarity and differences in all the religions. The school must undertake policies to show respect to all the religions and display a... This paper approves that the increase in the number of holidays leads to the loss of working days which impacts the delivery of academic curriculum. Apart from this, the grant of excusal requests by the students and parents for absence on religious occasions is difficult to deny as this might create discontent among a section of the population. The teachings on the ideas of different religions and the observance and understanding of the respect shown to the religious ideas and beliefs could create misimpression and biased behavior among a certain segment of the students and the teachers. This report makes a conclusion that the schools and the institutions determine the policies on the observance of the religious holidays which is in line with the legal regulations in the field. The policies of the school endorse secular attitude with equal importance and respect to all the religions. The administrators play an important role in executing the policies. The administrator is responsible to conduct a survey on religious sentiments of the population and display sensitivity in dealing with the religious idea and beliefs. The inclusion of the religious learning and observance of religious holidays in the academic curriculum helps in development of understanding of the culture and history of the land. The observance of religious holidays is also done in a manner that it do not interfere the main goal of academic process in the schools. Thus observance of religious holidays in a tactical manner helps in maintaining a healthy learning environment and fosters the growth of educ ation process in the schools and the institutions.

Their Eyes Were Watching God Essay Example | Topics and Well Written Essays - 500 words

Their Eyes Were Watching God - Essay Example I must admit that it was a little hard for me to get used to the dialect used by the African characters, however one must praise the writer for the brilliance with which she is able to sway the tone and feel of the book from beautifully written English imagery and very apt descriptions of the plight and the emotions of the characters, to the crude and unstructured for of the African dialect and variant of the English language. Another interesting aspect of the book is that it is written as a flashback of Janie’s life as she reflects upon it to tell her story to her friend Pearl, since she needed consolation after the tough journey and experiences of her life. The book starts in a very interesting way with Janie’s return to her second husband’s town, which she had left after his death to get married to a boy younger than her, popularly known in the town as â€Å"Tea Cake.† Hurston has very skillfully depicted the insatiable curiosity that is inherent in hum an nature, this she managed to convey through the conversations that passed between people of the neighborhood on Janie’s return and how they were gossiping about what might have happened which made her return to her Ex- husband’s town and that too penniless, when she left the town wealthy.

Logics and Supply Chain Management Essay Example | Topics and Well Written Essays - 2000 words

Logics and Supply Chain Management - Essay Example Most of its large and well established centers are located in the UK, Germany and Italy among other large developed nations (Frazelle, 2001, p. 54). The company has a large and able management team that has is motivated by the desire to propel the firm to great profit margins. For example, a Manager who is answerable and reports to overall regional managers head each of its magnificent plants (Great Britain, 2011, p. 37). In an effort to ensure excellence and efficiency in Euro Cast’s supply chain, the management of the company has managed to place a lot of emphasis on the improvement of the distribution networks within the company. The company has established a number of bureaucratic procedures aimed at enhancing efficiency in its supply chain networks (Jonsson, 2008, p. 145). To start with, the top management is concerned with the company’s supply department and has to report directly to the CEO (Ketz & Schwartz, 2006, p. 145). Other professionals lower in the supply ladder are supposed to respond to other superior executives within the firm. The entire supply team and the organization as a whole are committed to expanding the company’s operations (Long, 2004, p. 123). ... 356). Another supply strategy was the sales and operations planning strategy. The strategy has been lengthy but effective in the long run to those companies that have had their hands on it. A beverage company that had tried on the strategy advised that the company intending to adopt the strategy required implementing organizational and cultural changes first (Christopher, 2005, p. 100). Demand creating and product shaping strategy is the other strategy that characterizes the supply chain (Jonsson, 2008, p. 45). The chain is complex in the numerous ways and all are in place to ensure that the desired performance attained (Asumang & Astill, 2002, p. 67). Euro Cast has other complicated ways of increasing the chain’s efficiency (Moreno, Pichler & Quesada-Arencibia, 2012, p. 145). For instance, the company has outsourced its supply chains in order to increase its relations. Third party relations in the supply chain are encouraged give as they insights into new ideas (Bowersox, Coo per & Closs, 2007, p. 356). Euro Cast’s chain of supply is effective also due to delegated roles and duties. Breakdown duties and responsibilities ensure that each worker is allocated responsibilities according to capabilities. All this measures form a complex but effective and productive system (Great Britain, 2011, p. 104).Supply chains at Euro Cast are better defined as by the smooth flow of information and currency exchange. The supply chain managing has achieved milestones for it to achieve its present status (Mothobi, 2002, p. 99). Integration of technology in the supply chain management at Euro Cast In the modern world, internet has played a great role in changing people’s life and

To what degree should the Decalogue ( Ten Commandments ) be followed Essay

To what degree should the Decalogue ( Ten Commandments ) be followed by Amer. Christians - Essay Example ommandments impose certain spiritual and moral obligations upon the believers – as well as to arrive at the conclusion whether or not they still should guide a life of the New Testament Christians in modern America. The Exodus presents Ten Commandments as instructions by the God to His chosen people, the people of Israel, which they should follow due to the fact that God â€Å"brought [them] out of Egypt, out of land slavery† (Exodus The New International Version 20:2). These Commandments may be viewed as covering several inter-relating areas of concern: The worship of One God (Exodus The New International Version 20:3-7). The issues that are addressed here include the prohibition of veneration of images of bodies both earthly and heavenly (20:4-6), of the misuse of the Divine Name in public and private conversations (20:7), and maintenance of the Sabbath as the holy day reminding the believers of the rest taken by God on the seventh day of the Creation; The issues of public law and order (Exodus The New International Version 20:13-17). These include such Commandments as the prohibition of murder (20:13), adultery (20:14), robbery and theft (20:15), false testimony (20:16), as well as the desire towards the other’s property in general (20:17). In Deuteronomy, some further clarifications on this matter are given, with Moses emphasizing the prophetic and divine nature of his act of receiving of the tablets with Commandments (Deuteronomy 5:22 The New International Version). Moses reiterates the Commandments, while the text of Deuteronomy places still further emphasis on God delivering the Israelites from the Egyptian slavery as the reason they should be grateful to Him, and observe His Commandments (Arnold & Beyer, 2008, p.143). Having analyzed the Commandments and the act of their giving, one should now review the attitude that the New Testament Christians should exhibit towards them. The nature of the majority of the Commandments is such that they are

Personal Perceptions of American Revolution Essay

Personal Perceptions of American Revolution - Essay Example Going further back in history, I am now able to view the European colonization of the Western Hemisphere as inclusive of invasion, conquest, and genocide. I now look back with embarrassment about constitutional settlements that protected trade in slaves, committed government to helping slave catchers, and gave extra votes in Congress to slave owners. The moral perceptions  that underpin those reappraisals oblige us to go further. In other words, it made me realize that there is good reason to question whether the American Revolution --the British colonies' fight for freedom from the Crown--was morally justifiable. At the beginning of the course I thought of the revolution in transatlantic terms, springing forth as a result of colonial domination. The initial perception was that the colonists were taxed without due representation in Parliament, their endeavor to gain autonomy promptly suppressed by the Crown, their reluctance to act subservient to unresponsive masters leading, justi fiably, to the sweeping revolution. It is not that these initial conceptions were disproved during the course, but some of them were rectified. There is some veracity to the standard version of the War of Independence, for the colonists had genuine grievances against the British Monarchy. But, as I learned during the course, this version either colors or ignores certain obvious facts. Take say the plight of oppressed groups long inhabiting the vast North American landscape. Their voice was totally unrepresented in the discourse related to the revolution. According to the doctrinaire version of the revolution, the colonists were regarded as the primary victims of injustice. This is blatantly false, because the principal victims were the colored people, including Native Americans, whose generosity and hospitality were grossly abused by the European settlers. Contrary to the belief that European Americans have been all too willing to accept, European emigres came to inhabited territory in North America. Native Americans were populous and many dwelt in stable and structured communities. They had cleared land on the eastern seaboard and cultivated vast terrains. Their nations had established territories which were vital to the hunting component of their economies. These facts were evident to European settlers---especially to those who escaped starvation by accepting as gifts the fruits of Native American agriculture. Yet, distilled history of colonization largely neglects this aspect of early settlements. I also learnt during the course that African Americans are another community that bore the brunt of injustice - as they came to the continent tied in chains and were forced to slog as slaves. In this backdrop, the European frontiersman’s basic grievance was that he was restricted in robbing the already wretched natives and black slaves. Their cry for freedom and liberty was nothing more than a clamor for more control over the disadvantaged slaves and native s. This state of institutionalized injustice was accentuated further during the years of the revolution, diminishing the aura surrounding it even more. In other words, the injuries and sufferings associated with the revolution were apportioned unequally between the colonialists and other colored groups. These darker facets of the American Revolution were not cognizant to me prior to taking the course. And taking the course has made

Computer and Network Hardware Assignment Example | Topics and Well Written Essays - 750 words - 1

Computer and Network Hardware - Assignment Example This issue will have a great disadvantage on centralized management as well as security of a network system. Multiple domain controllers may also lead to fault tolerance within an Active Directory environment. DNS servers are installed in computer networks to provide fault tolerance, traffic loads as well as replication. DNS servers therefore have to be planned with care to ensure that the required number of zones and requests from clients are included. In a case where a DNS server records low performance, additional RAM can be added to the server to improve its performance. In installation of a DNS server, a primary server, backup as well secondary server will be required to ensure high availability (Technology facts, 2012). A DNS server is standardized by application of a set of Request for Comments to ensure it provides interoperability with other implementations of network servers. These system capabilities enable it to work successfully with other DNS server implementations. A high application Director DNS can be replicated to provide a high availability of the server as it monitors the DNS application processing. A terminal access gateway authorizes remote network users to establish a connection to a private or internal corporate network from any device that is internet enabled. Resources of this network can include computers in which Remote Desktop has been enabled, terminal servers or terminal servers that run Remote Application programs. It should be installed in a different cluster in which a web service has been installed. A terminal access gateway establishes an encrypted and secure connection for remote users through the uses of a Remote Desktop Protocol. A connection will also be developed between the remote users and the internal network resources in which their applications run. A web server responds to a user’s

Business and Research Project Essay Example for Free

Business and Research Project Essay JC Penny has been running successfully for close to 90 years. Most entrepreneurs and managers face the same dilemmas at times. The choices one makes are the basis for his or her company success. The CEO of JC Penny Ron Johnson was faced with many management dilemmas. The first of many dilemmas that Ron Johnson was faced with was to innovate or conserve JC Penny. Innovation is important, but one should also focus on new applications and new markets as well. However, the revenues of innovations are in the future. One needs also to get the maximum out of one’s current business. According an article published by Forbes â€Å"Ron Johnson did not try and solving the real problem with JC Penny. Sales fell some 25%. The stock dropped 50% He spent lavishly trying to remake the brand. He modernized the logo, upped the TV ad spend, spruced up stores and implemented a more consistent pricing strategy. But that all was designed to help JC Penney competes in traditional brick-and-mortar retail. Against traditional companies like Wal-Mart, Kohl’s, Sears, etc† (Hartung, 2014). If the leader or manager does not invest there comes a time when the current business declines without new innovation to take over JC Penny revenues. If a manager invests too much, it may end up endangering the continuity of the current business. According to Joshua Kennon â€Å"J.C. Penney saw sales fall from $19.903 billion in 2007 to $12.985 billion in 2013. This caused the firm to go from a pre-tax profit of $1.792 billion to pre-tax losses of $1.536 billion, a staggering swing of $3.328 billion. Dividends were slashed, book value destroyed. There were rumors the company was surviving by pushing payable bills and hoarding cash† (Kennon, 2013). The purpose of learning team C’s research is to identify the most important factors to customers that are considering shopping at J.C. Penney. This statement speaks to the researcher’s attention and states goal or objective of the research. This statement will evaluate errors that were made J.C.  Penny’s top management, putting the company into a very vulnerable predicament with the core customers. The factors that will be considered are directly associated with management errors such as: †¢Misreading what shoppers want- coupons, sales price/clearance items †¢Not testing the ideas in advance- assuming the culture was the same as other companies †¢Alienated the core customers †¢Misreading the JC Penney brand †¢Not respecting the JC Penney company overall From these errors the team will provide research questions to include in the paper, gather the information the is related to the customer most recent shopping experience with the company to develop a proposed research plan to address the most management dilemmas. Draft of Research Questions Learning team C intends to research the reasons J.C. Penney had a decline in customer core base and sales which almost led to the demise of the company. This research will be conducted via survey with the intent of possibly salvaging the creditability of the company. Our learning will provide surveys to adults that have shopped J.C. Penny either online or in the store within the last two years. The survey questions used would supply management with opportunities to test potential marketing strategies to revive sales and retain the company’s initial core customer base. LTC will provide the following questions to gather data for research in the survey: †¢What is the age group/gender of the participant †¢How far from home will he or she be willing to drive to the store †¢What is the importance of coupons and sales price/clearance items †¢How frequent does the participant shop online or in the store †¢How important is the brand name that is provided by the company †¢How important is the atmosphere of the store (i.e. Arizona, IZOD, Dockers, etc) †¢How important is the culture of store (i.e. is food courts or specialty boutiques important) After compiling a more precise list of question to provide for the survey, we will rank the factors from least to greatest importance to determine the  decision making process for J.C. Penney current dilemma. Conclusion Eventually, JC Penny did fire Ron Johnson and rehired the previous CEO Mike Ullman, who stills faces big challenges. JC Penny has posted sales drops and losses in its first three quarters. As JC Penny attempts to recover from its dilemmas from the period in which it alienated consumers, and infuriated its employees, its new CEO Mike Ullman, is making headway in trying to purge corporate ranks and bring the customers back to shopping at JC Penny. In business leaders or managers all face some challenges that if left unaddressed such as JC Penny dilemma can massively affect the business. The good news is that there is now a solution in place to help JC Penny return to being successful. References Hartung, A. (2014). Two Wrongs Wont Fix JC Penney. Retrieved from https://ecampus.phoenix.edu/secure/aapd/cwe/citation_generator/web_01_01.asp Kennon, J. (2013). The Collapse of J.C. Penney – What Caused It and Can It Be Fixed?. Retrieved from http://www.joshuakennon.com/the-collapse-of-jc-penney-what-caused-it-and-can-it-be-fixed/

User Adoption Momentum of E Banking In Malaysia

User Adoption Momentum of E Banking In Malaysia In the era of globalization and with the increasing competition in all the fields around the world many companies have modified their strategies so they can reach their customers around the world easier and cheaper. However the rapid growth of systems that rely on electronic technology especially those relating to the Internet and personal computer- led to a significant change in the exchanging of products and services. Many  Service organizations have adopted modern technology to reduce costs and enhance customer service quality, delivery, and standardize core service offerings. In addition a lot of non-banking companies entered the banking industry by offering products and financial services, giving the customers a lot of options and alternatives to carry out their banking transactions, this difficulty of the business process in the financial sector forces the banks to develop an alternative technological channel to attract customers and improve their perception. The rapid technological diffusion makes the internet the best way to provide customers with banking services regardless of the limits of time and geography. And thats what makes banks  consider the  internet as an important part of their strategic plans. Internet technology has changed the design and the way of delivering the financial services and as a result the banking industry has made continuous innovations especially in the field of communications and information technology that ultimately led to the emergence of the idea of what is known as the online banking. Banking services through the internet is a way to keep the existing customers and attract others to the bank, In this paper we define online banking as an internet portal, through which customers can use different kinds of banking services ranging from bill payment to making investments (Pikkarainen et al., 2004). Compared to the traditional approach, online banking is an inexpensive straightforward way to conduct banking business, exchange of personalized information and buying and selling goods and services from any place at any time. Despite the many benefits provided by this service to the bank and its customers, it remains a double-edged sword and not used by every customer, because the increasing distance between the bank and customers may lead to lack of confidence and an increasing in security concerns. As a result, the quality of electronic banking services become an important area of attention among the researchers and banks managers due to its strong influence on the business performance, lower costs, customer satisfaction, customer loyalty, and profitability (Seth et al., 2004). The main objective of this study is to focus on the importance of understanding the customers perception about internet banking by investigating and measuring the impact of selected factors such as perceived usefulness (PU), perceived ease of use (PEOU), security and privacy (PC) and how they can influence the customer acceptance to conduct banking transactions via the internet, Based on the empirical data collected from individual customers in Bahrain. In the next section we will give some background information about the internet banking sector and review the relevant literature in this area, the following section describes the research methodology, which is then followed by the data analysis and the results from the survey, The paper concludes with a discussion, outlining the implications of the findings and the limitations of the study. 2.0 LITERATURE REVIEW Technology Acceptance Model (TAM) External variables Perceived usefulness Perceived ease of use Behavioral intention Actual system use Figure 1: The original Technology Acceptance Model (Davis, 1989) The Technology Acceptance Model (TAM) is a perfect model which show how users accept and use a technology. In (TAM) the main determinants of users acceptance of new technology are perceived usefulness (PU) and perceived ease of use (PEOU) (Davis, 1989). Although (Chen and Barnes 2007; T.C. Edwin Cheng et al. 2006) found that perceived ease of use, perceived usefulness and security and privacy affect customer adaptation intentions, Qureshi et al., (2008) claimed that Perceived usefulness, security and privacy are the main perusing factors to accept online banking system. Celik (2008) stated that perceived usefulness and perceived ease of use are direct determinants of customers attitudes towards using internet Banking. Traditional service quality and website features (PU, PEOU and PC) that give customers confidence build trust in e-banking (Yap, K et al. 2010). Aderonke and Charles. (2010) found that Banks customers who are active users of e-Banking system use it because it is convenient, easy to use, time saving and appropriate for their transaction needs. Also the network security and the security of the system in terms of privacy are the major concerns of the users and constitute hindrance to intending users. Yap, K et al. (2010) claimed that Traditional service quality and website features that give customers confidence build trust in e-banking. Sadeghi and Hanzaee. (2010) found that According to the model of seven factors on the following dimensions: convenience, accessibility, accuracy, security, usefulness, bank image, and web site design. Some of these factors illustrate a significant statistical difference between males and females. Safeena et al. (2009) found that perceived usefulness, perceived ease of use, consumer awareness and perceived risk are the important determinants of online banking adoption. These factors have a strong and positive effect on customers to accept online banking system. Alda ´s-Manzano et al. (2009) found that TAM beliefs and perceived risks (security, privacy, performance and social) have a direct influence on e-banking adoption. Trust appears as a key variable that reduces perceived risk. Involvement plays an important role in increasing perceived ease of use. Riyadh et al. (2009) stated that Seven variables affecting e-banking adoption by SMEs are identified. They are: organizational capabilities, perceived benefits, perceived credibility, perceived regulatory support, ICT industries readiness, lack of financial institutions readiness and institutional influence. Al-Somali et al. (2009) found that the quality of the Internet connection, the awareness of online banking and its benefits, the social influence and computer self-efficacy have significant effects on the perceived usefulness (PU) and perceived ease of use (PEOU) of online banking acceptance. Education, trust and resistance to change also have significant impact on the attitude towards the likelihood of adopting online banking. Jahangir N. and Begum N. (2008) noted that perceived usefulness, ease of use, security and privacy, and customer attitude are significantly and positively related to customer adaptation. Hanudin Amin. (2007) found that perceived usefulness, perceived ease of use and perceived credibility had a significant relationship with behavioral intention. Further, these measures are good determinant for undergraduate acceptance for internet banking. Results also suggest that PU and PEOU had a significant relationship with computer self-efficacy. Z Liao and WK Wong. (2008) found that perceived usefulness, ease of use, security, responsiveness and convenience significantly influence customer interactions with Internet e-banking. In particular, individuals would place a great emphasis on the security of Internet-based financial transactions. As a conventional practice, commercial banks and financial institutions must continuously review security policy and strengthen the security control of Internet e-banking Wai-Ching Poon. (2008) found that all elements for ten identified factors are significant with respect to the users adoption of e-banking services. Privacy and security are the major sources of dissatisfaction, which have momentously impacted users satisfaction. Meanwhile, accessibility, convenience, design and content are sources of satisfaction. Besides, the speed, product features availability, and reasonable service fees and charges, as well as the banks operations management factor are critical to the success of the e-banks. WAP, GPRS and 3G features from mobile devices are of no significance or influence in the adoption of e-banking services in this study. Results also reveal that privacy; security and convenience factors play an important role in determining the users acceptance of e-banking services with respect to different segmentation of age group, education level and income level. Padachi et al. (2007) found that the most significant factor is ease of use and that other important elements featured reluctance to change, trust and relationship in banker, cost of computers, internet accessibility, convenience of use, and security concerns. Chen, Y. H. and Barnes, S. (2007) pointed out that perceived usefulness, perceived security, perceived privacy, perceived good reputation, and willingness to customize are the important antecedents to online initial trust. It is also discovered that different levels of trust propensity moderate perceptions toward the web site and online with respect to online initial trust, including perceived usefulness, perceived security, perceived privacy, perceived good reputation, and willingness to customize. Both online initial trust and familiarity with online purchasing have a positive impact on purchase intention. T.C. Edwin Cheng et al. (2006) found that The results provide support of the extended TAM model and confirm its robustness in predicting customers intention of adoption of IB. This study contributes to the literature by formulating and validating TAM to predict IB adoption, and its findings provide useful information for bank management in formulating IB marketing strategies. We analyzed the data using Structured Equation Modeling (SEM) to evaluate the strength of the hypothesized relationships, if any, among the constructs, which include Perceived Ease of Use and Perceived Web Security as independent variables, Perceived Usefulness and Attitude as intervening variables, and Intention to Use as the dependent variable. The results provide support of the extended TAM model and confirm its robustness in predicting customers intention of adoption of IB Moutaz Abou-Robieh. (2005) found that there was a correlation between respondents attitudes towards e-banking and their comfort level and feeling of security with regard to their age, level of education, and annual salary. 2.1 Perceived ease of use (PEOU) Safeena et al. (2009), Jahangir N. and Begum N. (2008), Z Liao and WK Wong. (2008) and Amin. (2007) stated that perceived ease of use have a strong and positive influence on customers intention to adopt and use internet banking. 2.2 Perceived usefulness (PU) Several studies showed that perceived usefulness influence customer interactions with internet banking, which effect the adoption of e-banking services (Sadeghi and Hanzaee. 2010; Safeena et al. 2009; Al-Somali et al. 2009; Jahangir N. and Begum N. 2008; Hanudin Amin. 2007, Z Liao and WK Wong.2008 ). 2.3 Perceived credibility (PC) Previous research has shown that security and privacy are the most concern for consumer, which have a direct or indirect influence on e-banking adoption (Aderonke and Charles, 2010; Sadeghi and Hanzaee, 2010; Alda ´s-Manzano et al., 2009; Riyadh et al. 2009; Jahangir N. and Begum N., 2008; Z Liao and WK Wong., 2008). Privacy put barriers on using online services (Hernandez and Mazzon, 2007). Moreover, Wai-Ching Poon. (2008) and Moutaz Abou-Robieh. (2005) noted that privacy and security factors play an important role in determining the users acceptance of e-banking services with regard to age, education level and income level. 3.CHALLENGES 4.1 RESEARCH MODEL AND HYPOTHESES The model of the study is presented below: Perceived usefulness Perceived ease of use Perceived credibility Intention to use Electronic Banking The representation of the proposed framework depicted the pattern and structure of relationships between the set of the measured variables. The purpose of the study is to measure correlations among variables and then use it to identify whether any relationships exists between these measured variables or not. We will extended TAM and add PC into the framework to test the effect of these three factors on e-banking adaption. In the extended model of TAM study, like (Safeena et al. 2009; Alda ´s-Manzano et al. (2009); Hanudin Amin, 2007), the attitudes factor has been neglected to simplify the model. The present study investigated the relationship between perceived usefulness, perceived ease of use, perceived credibility and customer intention to use electronic banking in Bahrain. Here perceived usefulness, perceived ease of use and perceived credibility, were being considered as independent variables and customer intention to use electronic banking was being considered as a dependent variable. Perceived usefulness According to the Davis (1989) and Davis et al. (1989), perceived usefulness is the degree to which a person believes that using a particular system would enhance his or her job performance. Perceived usefulness is defined as the individuals perception that using the new technology will enhance or improve her/his performance (Davis,1993). In Addition, Laforet and Li, (2005) and Eriksson et al., (2005) defined the term perceived usefulness as the subjective probability that using the technology would improve the way a user could complete. We hypothesize that People tend to use an application to the extent they believe it will aid their performance. H1: Perceived usefulness (PU) has a positive effect on customer Intention to use Electronic banking. Perceived ease of use According to Davis (1989) perceived ease of use refers to the degree to which a person believes that using a particular system would be free of effort. The most significant factor on adoption Internet Banking is ease of use. (Padachi et al., 2007). Hence an application perceived to be easier to use than another is more likely to be accepted by users. And By applying these to electronic banking context we can hypothesize that: H2: Perceived ease of use (PEOU) has a positive effect on customer Intention to use Electronic banking. Perceived Credibility Perceived credibility is defined as the degree to which a user feels the certainty and pleasant consequences of using an electronic application service, when there is no financial risk, physical risk, functional risk, social risk, time-loss risk, opportunity cost risk, and information risk Jacoby and Kaplan (1972). However, (Ganesan,1994) present another definition of PC stating it as the extent to which one partner believes that the other partner has the required expertise to perform the job effectively and reliably. PC is usually impersonal and relies on reputation, information and economic reasoning (Ba and Pavlou,2002). Wang et al. (2003) stated that perceived credibility is consists of two important elements namely privacy and security, which affect directly consumer adaptation of electronic banking systems. Security refers to the protection of information or systems from unauthorized intrusions (Egwali, 2008). For the purpose of this research, perceived credibility (PC) is defined as users perception of protection of their transaction details and personal data against unauthorized access. Therefore, for studying the effect of perceived credibility on users acceptance in Bahrain electronic banking services, we pose the following hypothesis to determine it effect on users intention H3: perceived credibility has positive effect on customer Intention to use Electronic banking. 4. Methodology To assess the factors influencing the intention to use internet banking in Bahrain, a survey was conducted during the last quarter of year 2010. A Questionnaire were designed and distributed to retail users of banking services of different age group and of different educational level attained across the island. Survey Instrument The questionnaire we prepared for this exercise was divided into 2 sections. The first section concentrates on the general profile of the respondent including his/her age group, education level and profession and income group. In the second section we were interested in finding the factors affecting the customer intention to use internet banking in Bahrain. The respondents were provided with a list of 10 questions; 4 questions on perceived usefulness, 2 questions on perceived ease of use, 3 questions on perceived credibility and finally 1 question on intention to use. The participants were asked to indicate their perception on a likert scales (1- 5) with response ranging from strongly disagree to strongly agree. The collected data were analyzed based on correlation and regression analyses using the statistical package for social sciences (SPSS) version 17computer program. Data collection The questionnaires were distributed directly among the customers through the researchers friends and relatives, a sample of 400 people was randomly chosen from the Bahraini community, all participants were bank customers selected randomly from universities, malls, Internet cafÃÆ' ©s and businessmen from private and public sectors. Also A digital online form was created using Google Documents in the same questionnaire style, Then the link was shared and publicized to Bahrainis through email as well as posting it on discussion forums. Once a subject would answer the questionnaire, the raw data will automatically be logged in a spreadsheet which can be only accessed and downloaded by the researcher. Since the questionnaire form was to be submitted online it guaranteed two things: First, it targeted people who really access the internet. Second, because all questions are need to be answered before submitting. The collection of data will be done automatically, efficiently and there wont be any loss of data The questionnaire we prepared and used had been pre-tested initially with a few number of people (5 users) working in different sectors to ensure consistency, clarity and relevance to the Bahraini case, Minor changes (related to the questions content, wording, sequence) were requested by those people, which we implemented before carrying out the final copy. A total of 200 useable responses were obtained yielding a response rate of 50% (200/400). Demographic profile of respondents: variable category Frequency Valid Percentage Age 18 25 25 35 35 45 45 yrs and above Gender Male Female Education Secondary and below Diploma Bachelor High studies Occupation Government sector Private Sector Self-employment Others Monthly Income in BD Less than 500 500-1000 1000 and above Assumptions or Limitations For this research, the following limitation existed in the collection of data, the survey assumed that the respondents have some familiarity with banks and banking transactions and have been exposed to or have knowledge of the existence of e-banking alternatives. For these responses in particular, it was difficult to ensure the true validity of the responses or the identity of the respondent. REFERENCES Aderonke and Charles. (2010). An Empirical Investigation of the Level of Users Acceptance of E-Banking in Nigeria. Journal of Internet Banking and Commerce, vol. 15 (1). Al-Somali, S.A., Gholami, R. and Clegg, B.(2009). An investigation into the acceptance of online banking in Saudi Arabia. Technovation, vol. 29, pp.130-141. Al Nahian Riyadh, Md. Shahriar Akter , Nayeema Islam. (2009). The adoption of e-banking in developing countries: A theoretical model for SMEs. International Review of Business Research Papers, vol. 5 (6), pp.212-230. Ba, S. and Pavlou, P.A (2002). Evidence of the effect of trust building technology in electronic market: price premiums and buyer behavior.MIS Quarterly, vol. 26 (3), pp. 243-68. Celik, H. (2008). What Determines Turkish customers acceptance of internet banking? International Journal of Bank Marketing. Vol. 26 (5): 353-370. Chen, Y. H. and Barnes, S. (2007), Initial Trust and Online Buyer Behaviour, Industrial Management Data Systems, 107(1): 21-36. Davis, F. D. (1989), Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology, MIS Quarterly,13 (3): 319-339. Davis, F. D., Bagozzi, R. P. and Warshaw, P. R. (1989), User Acceptance of Computer Technology: A Comparison of Two Theoretical Models, Management Science, 35(8): 982-1003. Davis, F. D. (1993). User acceptance of information technology: system characteristics, user perceptions and behavioral impacts. International Journal of Man-Machine Studies,38, 475-487. Davis, F. D., Bagozzi, R. P., Warshaw, P. R. (1992). Extrinsic and intrinsic motivation to use computers in the workplace. Journal of Applied Social Psychology, 22(14), 1109-1130. Egwali A. O., Customer Perception of Security Indicators in Online Banking Sites in Nigeria, Journal of Internet Banking and Commerce, December 2008, vol. 13, no.3. Eriksson K, Kerem K, Nilsson D (2005). Customer acceptance of internet banking in Estonia, International Journal of Bank Market, vol. 23 (2), pp. 200-216. Ganesan, S.(1994), Determinants of long-term orientation in buyer-seller relationships. Journal of Marketing, Vol.58 (2), pp.1-19 Hanudin Amin (2007). Internet Banking Adoption Among Young Intellectuals. Journal of Internet Banking and Commerce, December 2007, vol. 12 (3) Jacoby, J., Kaplan, L. B. (1972). The components of perceived risk. Paper presented at the Proceedings of the 3rd Annual Conference of the Association for Consumer Research, College Park, MD. Joaquin Alda ´s-Manzano, Carlos Lassala-Navarre, Carla Ruiz-Mafe and Silvia Sanz-Blas. (2009). Key drivers of internet banking services use , Online Information Review, Vol. 33 (4), pp. 672-695. Laforet S, Li X (2005). Consumers attitudes towards online and mobile banking in China. International Journal Bank Market vol. 23 (5), pp. 362-380. Moutaz Abou-Robieh. (2005). A Study of E-Banking Security Perceptions and Customer Satisfaction Issues. Nadim Jahangir and Noorjahan Begum. (2008). The role of perceived usefulness, perceived ease of use, security and privacy, and customer attitude to engender customer adaptation in the context of electronic banking. African Journal of Business Management, vol.2 (1), pp. 032-040. Padachi, Rojid, Seetanah.(2007). Analyzing the Factors that Influence the Adoption of Internet Banking in Mauritius. Patrick, T. (2002). Corporate Privacy Credibility Crumbles. Computer world, March, 4(10). Pikkarainen, T., Pikkarainen, K., Karijaluoto, H. and Pahnila, S. (2004), Customer acceptance of on-line banking: an extension of the technology acceptance model, Internet Research, vol. 14(3), pp. 224-235 Qureshi, T.M., Zafar, M.K and Khan, M.B. (2008). Customer Acceptance of Online Banking in Developing Economies. Journal of Internet Banking and Commerce, Vol. 13 (1). Safeena, Abdullah and Hema. ( 2010). Customer Perspectives on E-business Value: Case Study on Internet Banking. Journal of Internet Banking and Commerce, vol. 15 (1). Seth, N., S.G. Deshmukh and P. Vrat, 2004. Service quality models: A review, International Journal Quality and Reliability Management, vol. 22(9), pp. 36-51. T.C. Edwin Cheng, David Y.C. Lam and Andy C.L. Yeung. (2006) Adoption of internet banking: An empirical study in Hong Kong. Decision Support Systems, vol. 42 (3), pp 1558-1572 Tooraj Sadeghi and Kambiz Heidarzadeh Hanzaee. (2010). Customer satisfaction factors (CSFs) with online banking services in an Islamic country I.R. Iran. Journal of Islamic Marketing, vol. 1 (3), pp. 249-267 Wai-Ching Poon . (2008). Users adoption of e-banking services. Journal of Business Industrial Marketing, vol. 23 (1), pp. 59-69 Wang, Y., Lin, H., Tang, T. (2003). Determinants of user acceptance of internet banking: an empirical study. International Journal of Service Industry Management, 14(5), 501-519 Yap, K., D. Wong, C. Loh, and R. Bak (2010). Offline and online banking where to draw the line when building trust in e-banking. International Journal of Bank Marketing, 28(1), p.27-46 Z Liao and WK Wong. ( 2008). The determinants of customer interactions with internet-enabled e-banking services. Journal of the Operational Research Society, vol. 59 (9). User Adoption Momentum of E Banking In Malaysia User Adoption Momentum of E Banking In Malaysia In the era of globalization and with the increasing competition in all the fields around the world many companies have modified their strategies so they can reach their customers around the world easier and cheaper. However the rapid growth of systems that rely on electronic technology especially those relating to the Internet and personal computer- led to a significant change in the exchanging of products and services. Many  Service organizations have adopted modern technology to reduce costs and enhance customer service quality, delivery, and standardize core service offerings. In addition a lot of non-banking companies entered the banking industry by offering products and financial services, giving the customers a lot of options and alternatives to carry out their banking transactions, this difficulty of the business process in the financial sector forces the banks to develop an alternative technological channel to attract customers and improve their perception. The rapid technological diffusion makes the internet the best way to provide customers with banking services regardless of the limits of time and geography. And thats what makes banks  consider the  internet as an important part of their strategic plans. Internet technology has changed the design and the way of delivering the financial services and as a result the banking industry has made continuous innovations especially in the field of communications and information technology that ultimately led to the emergence of the idea of what is known as the online banking. Banking services through the internet is a way to keep the existing customers and attract others to the bank, In this paper we define online banking as an internet portal, through which customers can use different kinds of banking services ranging from bill payment to making investments (Pikkarainen et al., 2004). Compared to the traditional approach, online banking is an inexpensive straightforward way to conduct banking business, exchange of personalized information and buying and selling goods and services from any place at any time. Despite the many benefits provided by this service to the bank and its customers, it remains a double-edged sword and not used by every customer, because the increasing distance between the bank and customers may lead to lack of confidence and an increasing in security concerns. As a result, the quality of electronic banking services become an important area of attention among the researchers and banks managers due to its strong influence on the business performance, lower costs, customer satisfaction, customer loyalty, and profitability (Seth et al., 2004). The main objective of this study is to focus on the importance of understanding the customers perception about internet banking by investigating and measuring the impact of selected factors such as perceived usefulness (PU), perceived ease of use (PEOU), security and privacy (PC) and how they can influence the customer acceptance to conduct banking transactions via the internet, Based on the empirical data collected from individual customers in Bahrain. In the next section we will give some background information about the internet banking sector and review the relevant literature in this area, the following section describes the research methodology, which is then followed by the data analysis and the results from the survey, The paper concludes with a discussion, outlining the implications of the findings and the limitations of the study. 2.0 LITERATURE REVIEW Technology Acceptance Model (TAM) External variables Perceived usefulness Perceived ease of use Behavioral intention Actual system use Figure 1: The original Technology Acceptance Model (Davis, 1989) The Technology Acceptance Model (TAM) is a perfect model which show how users accept and use a technology. In (TAM) the main determinants of users acceptance of new technology are perceived usefulness (PU) and perceived ease of use (PEOU) (Davis, 1989). Although (Chen and Barnes 2007; T.C. Edwin Cheng et al. 2006) found that perceived ease of use, perceived usefulness and security and privacy affect customer adaptation intentions, Qureshi et al., (2008) claimed that Perceived usefulness, security and privacy are the main perusing factors to accept online banking system. Celik (2008) stated that perceived usefulness and perceived ease of use are direct determinants of customers attitudes towards using internet Banking. Traditional service quality and website features (PU, PEOU and PC) that give customers confidence build trust in e-banking (Yap, K et al. 2010). Aderonke and Charles. (2010) found that Banks customers who are active users of e-Banking system use it because it is convenient, easy to use, time saving and appropriate for their transaction needs. Also the network security and the security of the system in terms of privacy are the major concerns of the users and constitute hindrance to intending users. Yap, K et al. (2010) claimed that Traditional service quality and website features that give customers confidence build trust in e-banking. Sadeghi and Hanzaee. (2010) found that According to the model of seven factors on the following dimensions: convenience, accessibility, accuracy, security, usefulness, bank image, and web site design. Some of these factors illustrate a significant statistical difference between males and females. Safeena et al. (2009) found that perceived usefulness, perceived ease of use, consumer awareness and perceived risk are the important determinants of online banking adoption. These factors have a strong and positive effect on customers to accept online banking system. Alda ´s-Manzano et al. (2009) found that TAM beliefs and perceived risks (security, privacy, performance and social) have a direct influence on e-banking adoption. Trust appears as a key variable that reduces perceived risk. Involvement plays an important role in increasing perceived ease of use. Riyadh et al. (2009) stated that Seven variables affecting e-banking adoption by SMEs are identified. They are: organizational capabilities, perceived benefits, perceived credibility, perceived regulatory support, ICT industries readiness, lack of financial institutions readiness and institutional influence. Al-Somali et al. (2009) found that the quality of the Internet connection, the awareness of online banking and its benefits, the social influence and computer self-efficacy have significant effects on the perceived usefulness (PU) and perceived ease of use (PEOU) of online banking acceptance. Education, trust and resistance to change also have significant impact on the attitude towards the likelihood of adopting online banking. Jahangir N. and Begum N. (2008) noted that perceived usefulness, ease of use, security and privacy, and customer attitude are significantly and positively related to customer adaptation. Hanudin Amin. (2007) found that perceived usefulness, perceived ease of use and perceived credibility had a significant relationship with behavioral intention. Further, these measures are good determinant for undergraduate acceptance for internet banking. Results also suggest that PU and PEOU had a significant relationship with computer self-efficacy. Z Liao and WK Wong. (2008) found that perceived usefulness, ease of use, security, responsiveness and convenience significantly influence customer interactions with Internet e-banking. In particular, individuals would place a great emphasis on the security of Internet-based financial transactions. As a conventional practice, commercial banks and financial institutions must continuously review security policy and strengthen the security control of Internet e-banking Wai-Ching Poon. (2008) found that all elements for ten identified factors are significant with respect to the users adoption of e-banking services. Privacy and security are the major sources of dissatisfaction, which have momentously impacted users satisfaction. Meanwhile, accessibility, convenience, design and content are sources of satisfaction. Besides, the speed, product features availability, and reasonable service fees and charges, as well as the banks operations management factor are critical to the success of the e-banks. WAP, GPRS and 3G features from mobile devices are of no significance or influence in the adoption of e-banking services in this study. Results also reveal that privacy; security and convenience factors play an important role in determining the users acceptance of e-banking services with respect to different segmentation of age group, education level and income level. Padachi et al. (2007) found that the most significant factor is ease of use and that other important elements featured reluctance to change, trust and relationship in banker, cost of computers, internet accessibility, convenience of use, and security concerns. Chen, Y. H. and Barnes, S. (2007) pointed out that perceived usefulness, perceived security, perceived privacy, perceived good reputation, and willingness to customize are the important antecedents to online initial trust. It is also discovered that different levels of trust propensity moderate perceptions toward the web site and online with respect to online initial trust, including perceived usefulness, perceived security, perceived privacy, perceived good reputation, and willingness to customize. Both online initial trust and familiarity with online purchasing have a positive impact on purchase intention. T.C. Edwin Cheng et al. (2006) found that The results provide support of the extended TAM model and confirm its robustness in predicting customers intention of adoption of IB. This study contributes to the literature by formulating and validating TAM to predict IB adoption, and its findings provide useful information for bank management in formulating IB marketing strategies. We analyzed the data using Structured Equation Modeling (SEM) to evaluate the strength of the hypothesized relationships, if any, among the constructs, which include Perceived Ease of Use and Perceived Web Security as independent variables, Perceived Usefulness and Attitude as intervening variables, and Intention to Use as the dependent variable. The results provide support of the extended TAM model and confirm its robustness in predicting customers intention of adoption of IB Moutaz Abou-Robieh. (2005) found that there was a correlation between respondents attitudes towards e-banking and their comfort level and feeling of security with regard to their age, level of education, and annual salary. 2.1 Perceived ease of use (PEOU) Safeena et al. (2009), Jahangir N. and Begum N. (2008), Z Liao and WK Wong. (2008) and Amin. (2007) stated that perceived ease of use have a strong and positive influence on customers intention to adopt and use internet banking. 2.2 Perceived usefulness (PU) Several studies showed that perceived usefulness influence customer interactions with internet banking, which effect the adoption of e-banking services (Sadeghi and Hanzaee. 2010; Safeena et al. 2009; Al-Somali et al. 2009; Jahangir N. and Begum N. 2008; Hanudin Amin. 2007, Z Liao and WK Wong.2008 ). 2.3 Perceived credibility (PC) Previous research has shown that security and privacy are the most concern for consumer, which have a direct or indirect influence on e-banking adoption (Aderonke and Charles, 2010; Sadeghi and Hanzaee, 2010; Alda ´s-Manzano et al., 2009; Riyadh et al. 2009; Jahangir N. and Begum N., 2008; Z Liao and WK Wong., 2008). Privacy put barriers on using online services (Hernandez and Mazzon, 2007). Moreover, Wai-Ching Poon. (2008) and Moutaz Abou-Robieh. (2005) noted that privacy and security factors play an important role in determining the users acceptance of e-banking services with regard to age, education level and income level. 3.CHALLENGES 4.1 RESEARCH MODEL AND HYPOTHESES The model of the study is presented below: Perceived usefulness Perceived ease of use Perceived credibility Intention to use Electronic Banking The representation of the proposed framework depicted the pattern and structure of relationships between the set of the measured variables. The purpose of the study is to measure correlations among variables and then use it to identify whether any relationships exists between these measured variables or not. We will extended TAM and add PC into the framework to test the effect of these three factors on e-banking adaption. In the extended model of TAM study, like (Safeena et al. 2009; Alda ´s-Manzano et al. (2009); Hanudin Amin, 2007), the attitudes factor has been neglected to simplify the model. The present study investigated the relationship between perceived usefulness, perceived ease of use, perceived credibility and customer intention to use electronic banking in Bahrain. Here perceived usefulness, perceived ease of use and perceived credibility, were being considered as independent variables and customer intention to use electronic banking was being considered as a dependent variable. Perceived usefulness According to the Davis (1989) and Davis et al. (1989), perceived usefulness is the degree to which a person believes that using a particular system would enhance his or her job performance. Perceived usefulness is defined as the individuals perception that using the new technology will enhance or improve her/his performance (Davis,1993). In Addition, Laforet and Li, (2005) and Eriksson et al., (2005) defined the term perceived usefulness as the subjective probability that using the technology would improve the way a user could complete. We hypothesize that People tend to use an application to the extent they believe it will aid their performance. H1: Perceived usefulness (PU) has a positive effect on customer Intention to use Electronic banking. Perceived ease of use According to Davis (1989) perceived ease of use refers to the degree to which a person believes that using a particular system would be free of effort. The most significant factor on adoption Internet Banking is ease of use. (Padachi et al., 2007). Hence an application perceived to be easier to use than another is more likely to be accepted by users. And By applying these to electronic banking context we can hypothesize that: H2: Perceived ease of use (PEOU) has a positive effect on customer Intention to use Electronic banking. Perceived Credibility Perceived credibility is defined as the degree to which a user feels the certainty and pleasant consequences of using an electronic application service, when there is no financial risk, physical risk, functional risk, social risk, time-loss risk, opportunity cost risk, and information risk Jacoby and Kaplan (1972). However, (Ganesan,1994) present another definition of PC stating it as the extent to which one partner believes that the other partner has the required expertise to perform the job effectively and reliably. PC is usually impersonal and relies on reputation, information and economic reasoning (Ba and Pavlou,2002). Wang et al. (2003) stated that perceived credibility is consists of two important elements namely privacy and security, which affect directly consumer adaptation of electronic banking systems. Security refers to the protection of information or systems from unauthorized intrusions (Egwali, 2008). For the purpose of this research, perceived credibility (PC) is defined as users perception of protection of their transaction details and personal data against unauthorized access. Therefore, for studying the effect of perceived credibility on users acceptance in Bahrain electronic banking services, we pose the following hypothesis to determine it effect on users intention H3: perceived credibility has positive effect on customer Intention to use Electronic banking. 4. Methodology To assess the factors influencing the intention to use internet banking in Bahrain, a survey was conducted during the last quarter of year 2010. A Questionnaire were designed and distributed to retail users of banking services of different age group and of different educational level attained across the island. Survey Instrument The questionnaire we prepared for this exercise was divided into 2 sections. The first section concentrates on the general profile of the respondent including his/her age group, education level and profession and income group. In the second section we were interested in finding the factors affecting the customer intention to use internet banking in Bahrain. The respondents were provided with a list of 10 questions; 4 questions on perceived usefulness, 2 questions on perceived ease of use, 3 questions on perceived credibility and finally 1 question on intention to use. The participants were asked to indicate their perception on a likert scales (1- 5) with response ranging from strongly disagree to strongly agree. The collected data were analyzed based on correlation and regression analyses using the statistical package for social sciences (SPSS) version 17computer program. Data collection The questionnaires were distributed directly among the customers through the researchers friends and relatives, a sample of 400 people was randomly chosen from the Bahraini community, all participants were bank customers selected randomly from universities, malls, Internet cafÃÆ' ©s and businessmen from private and public sectors. Also A digital online form was created using Google Documents in the same questionnaire style, Then the link was shared and publicized to Bahrainis through email as well as posting it on discussion forums. Once a subject would answer the questionnaire, the raw data will automatically be logged in a spreadsheet which can be only accessed and downloaded by the researcher. Since the questionnaire form was to be submitted online it guaranteed two things: First, it targeted people who really access the internet. Second, because all questions are need to be answered before submitting. The collection of data will be done automatically, efficiently and there wont be any loss of data The questionnaire we prepared and used had been pre-tested initially with a few number of people (5 users) working in different sectors to ensure consistency, clarity and relevance to the Bahraini case, Minor changes (related to the questions content, wording, sequence) were requested by those people, which we implemented before carrying out the final copy. A total of 200 useable responses were obtained yielding a response rate of 50% (200/400). Demographic profile of respondents: variable category Frequency Valid Percentage Age 18 25 25 35 35 45 45 yrs and above Gender Male Female Education Secondary and below Diploma Bachelor High studies Occupation Government sector Private Sector Self-employment Others Monthly Income in BD Less than 500 500-1000 1000 and above Assumptions or Limitations For this research, the following limitation existed in the collection of data, the survey assumed that the respondents have some familiarity with banks and banking transactions and have been exposed to or have knowledge of the existence of e-banking alternatives. For these responses in particular, it was difficult to ensure the true validity of the responses or the identity of the respondent. REFERENCES Aderonke and Charles. (2010). An Empirical Investigation of the Level of Users Acceptance of E-Banking in Nigeria. Journal of Internet Banking and Commerce, vol. 15 (1). Al-Somali, S.A., Gholami, R. and Clegg, B.(2009). An investigation into the acceptance of online banking in Saudi Arabia. Technovation, vol. 29, pp.130-141. Al Nahian Riyadh, Md. Shahriar Akter , Nayeema Islam. (2009). The adoption of e-banking in developing countries: A theoretical model for SMEs. International Review of Business Research Papers, vol. 5 (6), pp.212-230. Ba, S. and Pavlou, P.A (2002). Evidence of the effect of trust building technology in electronic market: price premiums and buyer behavior.MIS Quarterly, vol. 26 (3), pp. 243-68. Celik, H. (2008). What Determines Turkish customers acceptance of internet banking? International Journal of Bank Marketing. Vol. 26 (5): 353-370. Chen, Y. H. and Barnes, S. (2007), Initial Trust and Online Buyer Behaviour, Industrial Management Data Systems, 107(1): 21-36. Davis, F. D. (1989), Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology, MIS Quarterly,13 (3): 319-339. Davis, F. D., Bagozzi, R. P. and Warshaw, P. R. (1989), User Acceptance of Computer Technology: A Comparison of Two Theoretical Models, Management Science, 35(8): 982-1003. Davis, F. D. (1993). User acceptance of information technology: system characteristics, user perceptions and behavioral impacts. International Journal of Man-Machine Studies,38, 475-487. Davis, F. D., Bagozzi, R. P., Warshaw, P. R. (1992). Extrinsic and intrinsic motivation to use computers in the workplace. Journal of Applied Social Psychology, 22(14), 1109-1130. Egwali A. O., Customer Perception of Security Indicators in Online Banking Sites in Nigeria, Journal of Internet Banking and Commerce, December 2008, vol. 13, no.3. Eriksson K, Kerem K, Nilsson D (2005). Customer acceptance of internet banking in Estonia, International Journal of Bank Market, vol. 23 (2), pp. 200-216. Ganesan, S.(1994), Determinants of long-term orientation in buyer-seller relationships. Journal of Marketing, Vol.58 (2), pp.1-19 Hanudin Amin (2007). Internet Banking Adoption Among Young Intellectuals. Journal of Internet Banking and Commerce, December 2007, vol. 12 (3) Jacoby, J., Kaplan, L. B. (1972). The components of perceived risk. Paper presented at the Proceedings of the 3rd Annual Conference of the Association for Consumer Research, College Park, MD. Joaquin Alda ´s-Manzano, Carlos Lassala-Navarre, Carla Ruiz-Mafe and Silvia Sanz-Blas. (2009). Key drivers of internet banking services use , Online Information Review, Vol. 33 (4), pp. 672-695. Laforet S, Li X (2005). Consumers attitudes towards online and mobile banking in China. International Journal Bank Market vol. 23 (5), pp. 362-380. Moutaz Abou-Robieh. (2005). A Study of E-Banking Security Perceptions and Customer Satisfaction Issues. Nadim Jahangir and Noorjahan Begum. (2008). The role of perceived usefulness, perceived ease of use, security and privacy, and customer attitude to engender customer adaptation in the context of electronic banking. African Journal of Business Management, vol.2 (1), pp. 032-040. Padachi, Rojid, Seetanah.(2007). Analyzing the Factors that Influence the Adoption of Internet Banking in Mauritius. Patrick, T. (2002). Corporate Privacy Credibility Crumbles. Computer world, March, 4(10). Pikkarainen, T., Pikkarainen, K., Karijaluoto, H. and Pahnila, S. (2004), Customer acceptance of on-line banking: an extension of the technology acceptance model, Internet Research, vol. 14(3), pp. 224-235 Qureshi, T.M., Zafar, M.K and Khan, M.B. (2008). Customer Acceptance of Online Banking in Developing Economies. Journal of Internet Banking and Commerce, Vol. 13 (1). Safeena, Abdullah and Hema. ( 2010). Customer Perspectives on E-business Value: Case Study on Internet Banking. Journal of Internet Banking and Commerce, vol. 15 (1). Seth, N., S.G. Deshmukh and P. Vrat, 2004. Service quality models: A review, International Journal Quality and Reliability Management, vol. 22(9), pp. 36-51. T.C. Edwin Cheng, David Y.C. Lam and Andy C.L. Yeung. (2006) Adoption of internet banking: An empirical study in Hong Kong. Decision Support Systems, vol. 42 (3), pp 1558-1572 Tooraj Sadeghi and Kambiz Heidarzadeh Hanzaee. (2010). Customer satisfaction factors (CSFs) with online banking services in an Islamic country I.R. Iran. Journal of Islamic Marketing, vol. 1 (3), pp. 249-267 Wai-Ching Poon . (2008). Users adoption of e-banking services. Journal of Business Industrial Marketing, vol. 23 (1), pp. 59-69 Wang, Y., Lin, H., Tang, T. (2003). Determinants of user acceptance of internet banking: an empirical study. International Journal of Service Industry Management, 14(5), 501-519 Yap, K., D. Wong, C. Loh, and R. Bak (2010). Offline and online banking where to draw the line when building trust in e-banking. International Journal of Bank Marketing, 28(1), p.27-46 Z Liao and WK Wong. ( 2008). The determinants of customer interactions with internet-enabled e-banking services. Journal of the Operational Research Society, vol. 59 (9).

Congestive Cardiac Failure: Causes and Effects

Congestive Cardiac Failure: Causes and Effects Analyse Health Information – Case study The scenario relates to Mr Alby Wright who has been admitted into your ward. His patient history and admission form is available for you to review. Mr Wright’s admission states that he has heart failure (congestive cardiac failure). Clearly define heart failure. What organs and which body systems are affected by this disorder? Congestive heart failure is a condition where the heart muscle becomes less strong and is unable to pump as well as it usually would. The ventricles which most important pumping chambers become bigger or thicker and aren’t able to squeeze or relax as well as they should be able to. This makes it easy for fluid retention to occur especially in the legs, abdomen and lungs (better health channel. 2013). This is all usually caused by diabetes, coronary heart disease, previous heart attack, high blood pressure and or other conditions that have damaged the heart and made it weak. Sometimes the fluid that gets in the lungs and it makes it uneasy to breathe and causes shortness of breath when the person is lying down on their back. This is called pulmonary oedema and can cause other respiratory issues if it not treated (American heart association. 2012). Generally if someone was to have heart failure, it would occur on the left side first mostly but can occur in both sides. If someone is experiencing left side heart failure, the left ventricle doesn’t fully empty and is unable to distribute enough oxygen rich blood around the body which causes heightened pressure in the upper chambers of the heart and the veins that are close to the area which is called systolic failure. Because of the build-up of blood in there, it can cause oedema in the legs, lungs and abdominal organs. The kidneys are affected by this hinders the way that they work and it leads to salt and water retention which causes further oedema. In some cases of heart failure, instead of not being able to pump blood around properly out of the left ventricle there is also unsuccessful relaxation of the left ventricle because the muscle has gone stiff which leads to blood pooling (better health channel. 2013) and also that the heart isn’t able to fully fill with blood during the resting period between each heartbeat (American heart association. 2012). Right sided heart failure usually happens because of left sided failure. When the left ventricle has failed, more fluid pressure is then transferred back through the lungs which damages the right side of the heart. When the right side of the heart loses the strength to properly pump, blood builds up in the veins and that causes swelling in the legs and ankles. The cardiovascular system is affected the most by congestive heart failure. The heart has been weakened and is unable to pump blood efficiently and doesn’t function properly in general and the muscle is also weakened. The respiratory system is affected because of the fluid in the lungs which is also known as pulmonary oedema. This can affect your breathing and leave you short of breath. Fluid may also build up in the liver resulting in an impaired capability to get rid of the body’s toxins and to produce the proteins that the body needs to live. The intestines can become not as good at absorbing nutrients and medicines as that would have when they were healthy (providence health network. 2014) Give a brief overview of the normal function of the body systems affected by this disorder. Cardiovascular system is most affected by this disorder. The functions of this system are to basically keep the blood running and pumping through by the arteries, veins, and capillaries (cliffs notes. 2013). The blood carries important nutrients around the body and helps to remove metabolic waste. The heart, blood vessels and blood help to regulate body temperature by controlling the blood flow to the surface of the skin. The white blood cells help to protect the body from foreign toxins and pathogens. Platelets help to clot blood so that you won’t have excessive blood loss and stop bleeding (cliffsnotes. 2013). Respiratory system function is so you can breathe and supply oxygen to your whole body (how stuff works. 2014). This works by breathing; inhaling oxygen filled air and exhaling carbon dioxide air. First you breathe in air through your nose and mouth and it travels down the windpipe and through the bronchial tubes then into the lungs. The diaphragm and abdominal muscles and make the lungs contract and expand so that you are able to breathe in and out. The bronchial tubes connect to blood vessels which carry blood through your body and exchange gases. The digestive system absorbs and moves the nutrients around the body that it needs to work well and gets rid of what the body doesn’t need as waste. First there is ingestion which is when eaten and then makes its way down into the stomach to be stored and waits for digestion. It then moves into the small intestines where the enzymes and bile work to break down the food where the body can absorb more nutrients that it needs and it continues on its way to the large intestine where it absorbs more fluid to make the solid faeces and moves through and gets excreted as waste (how stuff works. 2014). The liver aids in breaking up fats, absorbing them and digesting them. Urinary system works along with other parts of the body such as skin, lung and intestines to keep up the stability of chemicals and water in the body (live science. 2013).This system’s role is to filter and excrete. Kidneys work at reducing blood pressure by reducing the blood volume. The body filters blood to create urine which goes into the bladder and the bladder fills up until it is full and ready to excrete waste that the body does not need which is urination (live science. 2013). 3. Define the signs and symptoms of heart failure, and explain why these signs and symptoms occur. Breathlessness or shortness of breath is a symptom because when the heart starts failing, the blood in the veins gets backed up in the pulmonary veins because it cannot cope with the supply while trying to carry oxygenated blood from the lungs to the heart. At this point, the fluid is starting to pool in the lungs which hinders regular breathing. A person suffering heart failure may suffer with breathlessness upon exertion including exercise or other activities. As the condition progresses, breathlessness or shortness of breath may even be present while at rest or even sleeping which may cause the person to wake up (USCF medical center. 2014). Fatigue occurs when heart failure develops and worsens; the heart cannot pump the adequate volume of blood that is needed to meet all of the body’s needs. To make up for this, the blood is taken away from less vital such as the limbs to supply the heart and brain. Because of this, people suffering with heart failure usually feel tired, w eak and have difficulty doing normal tasks such as walking, going up stairs, or even carrying items. (USCFmedicalcenter.2014). Someone suffering shortness of breath as a symptom of heart failure will also experience fatigue if they are being woken up with breathing difficulties while they are sleeping. Chronic coughing and wheezing is a symptom because of the fluid backup in the lungs which may cause a thick, whitish mucus like substance called phlegm to be coughed up from the lungs which may even be tinged pink from traces of blood (USCFmedicalcenter.2014). Rapid or irregular heartbeat is a symptom because it may speed up to make up for its inability to pump blood around the body properly. People suffering this in heart failure may experience a fluttering sensation of heart palpitations, or a heartbeat that they are aware of and seems irregular or out of the normal rhythm. It may feel like the heart is racing or pounding hard (USCF medical center. 2014). Lack of appetite/ nausea be cause the digestive system isn’t as vital as the heart or brain so the blood has been pulled away from the digestive systems to these areas instead which means there will be problems with digestion including the feeling of fullness or sickness even though they have not eaten anything (USCF medical center. 2014). Confusion/ impaired thinking because unusual sodium levels in the blood and lessened blood flow to the brain can cause bafflement or memory loss even know the person suffering with this may not even realise, and someone else may pick up on this sign before they do (USCF medical center. 2014). Oedema or swelling due to restricted blood flow to the kidneys which means that they produce hormones which lead to the retention of salt and water. This causes swelling of (most often) in the legs, ankles, and feet. Oedema may also cause weight gain (USCF medical center. 2014). Rapid weight gain can occur as a result of oedema and the fluid retention (USCF medical center. 2014). Heart grows in size because it wants to make its pumping power greater so the muscle mass in the heart gets bigger to make this happen. The chambers inside of the heart also grow larger and stretch so that they can fit more blood in. While the heart grows in size, the cells that control its contractions also grow with it. An enlarged heart does not function as well as a normal sized one and the added muscle mass puts stress on the whole cardiovascular system (USCF medical center. 2014). The heart pumps faster as it tries to circulate more blood around the body. If the heart pumps blood too fast for a long period of time, it can damage the heart muscle and hinder its regular electrical signals, which can cause an unsafe heart rhythm disorder (USCF medical center. 2014). Blood vessels narrow because less blood is flowing through the veins and arteries and that means blood pressure can drop to seriously low levels. Because of this, the blood vessels narrow which keeps the blood pressure higher while the hearts power decreases. Narrowing of the blood vessels also limits the amount of blood that can flow through which may contribute to other conditions such as heart disease, clogged or blocked vessels in the legs or other body parts, or stroke (USCF medical center. 2014). Blood flow is diverted away from less vital areas such as the limbs when there is not enough of it to meet the body’s needs and gets given to more crucial organs such as the heart and brain which are the most important for survival. This can cause limb weakness due to lack of blood in the areas. The areas where the blood is diverted from may deteriorate over time from a lack of oxygen (USCF medical center. 2014). Increased urination at night because if the patient suffering heart failure lays down all day, the fluid that has been accumulating in their legs all day may move back up into the blood stream and gets taken to the kidneys and is excreted as urine (heart failure matters. 2014). Low blood pressure because the hearts power has decreased and the veins have narrowed. Chest pain if your heart failure is due to a heart attack. List the information taken on his admission that demonstrates these signs and symptoms. Cyanotic Appetite loss Confusion and anxiety Low blood pressure Temperature below 35.8 degrees Sa02: 87% on air Respirations: 32 Low blood pressure Constipation Do you think his diabetes is related to his leg ulcer and amputated left toe? Explain. Yes. High blood sugar levels in diabetic patients damage nerves and blood vessels which results in poor circulation to the feet and may cause ulcers, infection, and amputation. This is more likely to happen if the patient has had diabetes for a long amount of time, they smoke, they don’t move around much, or their blood glucose levels have been high for an extended period of time (diabetes Australia. 2014). One of the medications he is taking is Lasix. What is the action of Lasix? Which body systems are affected by it? Explain why you think Mr Wright is ordered Lasix. Lasix is a diuretic. It increases the amount of urine that is made in the kidneys and excreted as waste (c health. 2014). It is also used to regulate and control slight to moderate high blood pressure. It affects the urinary system because it involves the kidneys and the cardiovascular system because it involves the heart. I think that Mr. Wright is ordered Lasix to get rid of the excess fluid that would be built up in his body and to lessen the oedema. List three conditions in Mr Wright’s relevant medical history that are commonly associated with ageing. Glaucoma Type 2 diabetes Arthritis Using Mr Wrights admission history and assessment, list the factors that may impact on his safety whilst in hospital and when he returns home. Hypotensive- low blood pressure He needs a walking stick because he is unsteady on his feet He gets anxious, especially about his dog. This can sometimes cause an asthma attack. He gets confused His vision is impaired and gets blurry after he has eye drops and he also needs reading glasses. What other health professionals will be involved in his care and what services can they provide for Mr Wright. Paramedics will care for Mr Wright in the ambulance and pass him over to emergency. Mr Wright needs a doctor to in emergency to diagnose him. General Nurses will be involved to provide care for him and to care for his wounds. A diabetes educator can be involved to help him to understand the needs of his condition and set up an action plan and give him support. A dietician can also help with this condition and set up meal and nutrition plans etc. Exercise physiologist assists patients to have a physical lifestyle to prevent and manage chronic conditions. A pharmacist will dispense his prescriptions so he can have medications and to give information on them. He may be able to talk to a psychologist to improve his anxieties, especially about his dog (better health. 2013). List the nursing documentation you would expect to be used in the care of Mr Wright. Progress notes Medication chart Vital signs chart Nursing history and assessment Care plan Asthma action plan FBC- fluid balance chart Wound monitoring chart Falls risk assessment (tafesa. 2014) UCSF medical center. 2014. heart failure signs and symptoms. [ONLINE] Available at: http://www.ucsfhealth.org/conditions/heart_failure/signs_and_symptoms.html. [Accessed 04 April 14]. heart failure matters. 2014. need to urinate at night. [ONLINE] Available at: http://www.heartfailurematters.org/en_GB/Understanding-heart-failure/Need-to-urinate-at-night. [Accessed 08 April 14]. better health channel. 2013. congestive heart failure. [ONLINE] Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Congestive_heart_failure_%28CHF%29. [Accessed 08 April 14]. American heart association. 2012. types of heart failure. [ONLINE] Available at: http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Types-of-Heart-Failure_UCM_306323_Article.jsp. [Accessed 08 April 14]. c health. 2014. drug factsheets. [ONLINE] Available at: http://chealth.canoe.ca/drug_info_details.asp?brand_name_id=210#Indication. [Accessed 09 April 14]. providence healthcare network. 2014. congestive heart failure. [ONLINE] Available at: http://providence.net/facilities/heart-failure.html. [Accessed 09 April 14]. pt direct. 2014. major functions of the cardiovascular system. [ONLINE] Available at: http://www.ptdirect.com/training-design/anatomy-and-physiology/cardiovascular-system/major-functions-of-the-cardiovascular-system-2013-a-closer-look. [Accessed 09 April 14]. diabetes australia. 2014. diabetes and your feet. [ONLINE] Available at: https://www.diabetesaustralia.com.au/Living-with-Diabetes/MindBody/DiabetesYour-Feet/. [Accessed 09 April 14]. TafeSA, 2014. Acute Care Flow Charts. In: Flow Charts. s.l.:Government of South Australia. better health . 2013. allied health. [ONLINE] Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Allied_health. [Accessed 10 April 14]. cliffs notes. 2013. functions of the cardiovascular system. [ONLINE] Available at: http://www.cliffsnotes.com/sciences/anatomy-and-physiology/the-cardiovascular-system/functions-of-the-cardiovascular-system. [Accessed 10 April 14]. how stuff works. 2014. what is the function of the respiratory system?. [ONLINE] Available at: http://health.howstuffworks.com/human-body/systems/respiratory/function-respiratory-system.htm. [Accessed 10 April 14]. how stuff works. 2014. how the digestive system works. [ONLINE] Available at: http://health.howstuffworks.com/human-body/systems/digestive/digestive-system2.htm. [Accessed 10 April 14]. live science. 2013. urinary system. [ONLINE] Available at: http://www.livescience.com/27012-urinary-system.html. [Accessed 10 April 14]. Chikungunya Fever: A Review Of The Literature Chikungunya Fever: A Review Of The Literature The Newala and Masasi Districts of the Southern Province, Tanzania, reported its first dengue-like outbreak in 1952-1953, on the basis that this epidemic involved debilitating joint pains and shorter incubation period, thereby excluding dengue (Robinson 1955). The infection was called chikungunya; a word from the Makonde dialect describing patients contorted posture (Lumsden 1955). Chikungunya is an arthropod borne virus (arbovirus) of the genus: Alphavirus from Togaviridae family. It is transmitted to humans mainly by the day biting mosquito species Aedes aegypti and Aedes albopictus (Townson and Nathan 2008). Moreover, Aedes aegypti eggs collected from the Tanzanian outbreak were used for the first isolation of Chikungunya virus (CHIKV) (Ross 1956). CHIKV contains a positive-sense single stranded RNA genome, enclosed in an icosahedral nucleocapsid, all enclosed in a phospholipid bilayer envelope. Embedded in the envelope are multiple copies of two encoded glycoproteins E1 and E2, a small glycoprotein E3, and a hydrophobic peptide 6K (Strauss and Strauss 1994). However, the roles of these glycoproteins are not elucidated, but it can be assumed that it could facilitate the attachment of the virus to host cell. History Subsequent to the Tanzanian epidemic, several outbreaks have been reported worldwide, including the Indian Ocean Islands; La Reunion (Renault et al. 2007), Mayotte (Sissoko et al. 2008), and the Maldives (Yoosuf et al. 2008). There were outbreaks whereby Chikungunya had concurrence with other infections; with Dengue (Ratsitorahina et al. 2008, Yoosuf et al. 2008) and with Plasmodium falciparum infection (Pastorino et al. 2004). Moreover, Chikungunya have been imported into several European countries; United Kingdom (HPA 2007), France (Hochedez et al. 2007), Germany, Switzerland, Denmark, Poland (Panning et al. 2008), with Italy witnessing its first CHIKV outbreak in 2007 (Rezza et al. 2007). Aim of review The Italian outbreak has demonstrated that only one viraemic person was required to instigate an outbreak and due to increased population movement worldwide, CHIKV could extend to pandemic proportions (Rezza et al. 2007). Furthermore, the outbreaks could have been underestimated due to its concurrence with other infections. Thus, this literature review will demonstrate to the reader that the Western medicine should be planning for CHIKV outbreaks which are becoming increasingly possible due to world climate change. Clinical Features Chikungunya is a mild and self limiting infection (Rezza et al. 2007) with incubation period of 2-7 days (Robinson 1955). Patients usually presents with a number of clinical features, with fever, fatigue, joint pain, anorexia, and nausea presenting as common clinical features (Table 1). Arthalgia and myalgia mainly involves the extremities of wrists, ankles, hands, feet and phalanges, while skin rash and petechiae are manifestations of haemorrhage (Kannan et al. 2009). During the La Reunion outbreak, Gà ©raldin et al. (2008) observed vertical transmissions from mother to child, with newborns presenting with chikungunya infection without prior mosquito bites. These neonates became symptomatic between 3-7 days postpartum, with presentation of fever, pain, poor feeding, disseminated intravascular coagulation (DIC) with gastrointestinal and cerebral bleeding, petechiae, and distal joint oedema. Encephalitis, thrombocytopenia and haemorrhagic fever were presented as severe neonatal infec tions; however, no fatalities were reported (Gà ©rardin et al. 2008). Transmission of CHIKV CHIKV requires two types of hosts to complete its replication cycle. Firstly, Aedes mosquito species transmits the virus to animals, and act as definitive hosts. Secondly, humans and other animals become infected with the virus and act as intermediate hosts. The transmission between the natural hosts (primates, birds, rodents and others) and the definitive hosts involves the sylvatic (main) cycle (Pardigon 2009). By disrupting this cycle, humans became incidental hosts, resulting in urban transmission cycles yielding epidemics. These humans could transmit CHIKV directly to domestic mosquitoes (Gould and Higgs 2009) and indirectly to domestic animals such as fowl, pigeons and goats (Lumsden 1955). When an Aedes mosquito ingests viraemic blood meal, CHIKV replicates in the salivary glands and ovaries, sites where it can be excreted. Upon another blood meal, the mosquito injects the viraemic saliva into a susceptible host. Contrary, within the ovaries, CHIKV is transmitted to the mosqui toes eggs by vertical transmissions (Figure 1). The desiccated nature of these eggs enables it to survive longer periods in the environment, where they are hatched during the rainy season (Gould and Higgs 2009). Figure 1. The overview of CHIKVs transmissions cycle in mosquito and human (Evenor 2010). Aedes mosquito becomes infected after taking a blood meal from an infected intermediate host Upon another blood meal, the Aedes mosquito injects viraemic saliva into a susceptible host The viraemic blood travels to the gut, where CHIKV undergoes replication within the gut wall The egg later developed into a mosquito infected with CHIKV CHIKV travels to the ovaries, where it is transmitted to the mosquitos eggs by vertical transmission The intermediate host becomes viraemic with presentation of clinical features CHIKV penetrated the gut wall, where it is disseminated through the bloodstream CHIKV travels to the salivary glands, where it undergoes replication Distributions of Aedes albopictus and Aedes aegypti Aedes aegypti was the predominant vector during earlier outbreaks in Africa (Lumsden 1955), and it has been implicated in some recent outbreaks in Africa (Gould et al. 2008) and Indonesia (Laras et al. 2005). However, Aedes albopictus have been described as the main vector implicated in a number of recent outbreaks, between 2005 to 2007 (Leroy et al. 2009, Pagà ¨s et al. 2009, Ratsitorahina et al. 2008, Renault et al. 2007, Sissoko et al. 2008). In the Gabonese outbreak involving both vectors, Vazeille et al. (2008) hypothesised that Aedes albopictus is a more suitable vector for CHIKV than Aedes aegypti, as it has a higher susceptibility for the virus. The two vectors have been recovered from several breeding sites with some overlap (Table 2). Tyres have been the main source of Aedes albopictus larval importation into Italy, in 1992, from Atlanta, USA. Consequently, the trade of these used tyres within Italy had caused large infestations of Aedes albopictus in Linguria, Veneto, Lom bardy and Eimlia-Romagna regions, by the end of 1995 (Knudsen et al. 1996). Aedes aegypti larvae predominate inside home, whereas Aedes albopictus larvae predominate outside home (Preechaporn et al. 2006). Table 2. The natural and artificial breeding sites for Aedes aegypti and Aedes albopictus larvae. Natural and artificial breeding sites Incidence of Aedes aegyptilarvae Incidence of Aedes albopictus larvae References Barrels X Gould et al.2008 Drums X X Gould et al.2008, Ratsitorahina et al.2008 Buckets X Ratsitorahina et al.2008 Flower pots X Gould et al.2008 Discarded cans X X Preechaporn et al.2006, Ratsitorahina et al.2008 Coconut shells X Preechaporn et al.2006, Ratsitorahina et al.2008 Clay water jars X Gould et al.2008 Mango tree holes X Lumsden 1955 Wetlands X X Vazeille et al.2008 Discarded tyres X X Preechaporn et al.2006, Ratsitorahina et al.2008 Plant pots X X Preechaporn et al.2006, Ratsitorahina et al.2008 Gardens X Adhami and Reiter 1998 Discarded plastic bottles X Adhami and Reiter 1998, Preechaporn et al.2006 Wet containers X Ratsitorahina et al.2008 Banana trees X Preechaporn et al.2006 Plant axils X Preechaporn et al.2006 Animal pans X X Preechaporn et al.2006 Plastic containers X X Preechaporn et al.2006 Cement tanks X X Preechaporn et al.2006 Ant guards X Preechaporn et al.2006 Preserved areca jars X Preechaporn et al.2006 Small and large earthen jars X X Preechaporn et al.2006 Key: (X):- present, (-):- absent. Effect of climate change Outbreaks have been associated with climatic conditions such as temperatures and high rainfall. Temperatures influence the developmental rate of Aedes albopictus larvae to adult mosquitoes, with the rate optimising at temperatures between 25 to 30oC (Straetemans 2008). Thus, Tilson et al. (2009) argued that mean monthly temperatures above 20oC are required to initiate an outbreak, as illustrated by the Italian outbreak that was initiated in June and subsided in September when the monthly average temperatures were 22oC and fell below 20oC. Mean annual rainfalls over 500mm is required (Straetemans 2008) to provide suitable breeding environment for the mosquitoes to expand their population (Lumsden 1955); as a result, most outbreaks have been associated with high rainfall (Lumsden 1955, Pastorino et al. 2004, Renault et al. 2007, Sissoko et al. 2008, Yoosuf et al. 2009) as illustrated in Table 3. In 2009, the UK Met office (2010) recorded a mean annual rainfall and temperature of 1201.3 mm and 9.2oC, respectively. The rainfall is sufficient to initiate an outbreak; however, the low temperature is insufficient to support the mosquitoes life cycle. Therefore, the question is what would the impact be to the UK if the climatic condition changes to favour this mosquito? Table 3. Mean temperature and the amount of rainfall that were reported during several outbreaks. Country Duration of the outbreak Mean monthly Temperature (oC) Months mean monthly temperature were collected Amount of Rainfall (mm) Months high rainfall were recorded Reference Tanzania 1952 1953 21.8 28.5 Jun Nov 1203 Jan Dec 1952 Lumsden 1955 Bogor Aug Dec 2001 24 26.2 Jan 2000 Dec 2001 NA Laras et al.2005 Bekasi Jan 2002 26.2 29.6 Jan 2001 Dec 2002 1931 Jan Feb 2002 Laras et al.2005 Maldives 2006 2007 NA NA 970 Nov Dec 2006 Yoosuf et al.2009 Key: NA- not available Distribution of Chikungunya outbreak Mayotte (French Overseas Territory), an island of the Comoros archipelago, encountered its first CHIKV outbreak imported from Grand-Comore in mid-April 2005 (Renault et al. 2007), with 6346 reported cases (in two waves), observed by the surveillance system implemented throughout the island by the local French Health Authority, Dass (Direction des affaires sanitaires et socials) Mayotte. The first (minor) wave commenced in April 2005, it later peaked in week 18 and the infection rate diminished in June, with the virus maintaining low levels thereafter, during the temperate and dry season. However, the second (major) wave began during the first week of May 2006, peaked during the hottest and rainiest months around March/April 2006 and reduced to control levels by July 2006 (Sissoko et al. 2008). In March 2005, a chikungunya infection which started in Grande-Comorre was imported into La Reunion (French Overseas Territory), becoming its first severe reported case involving two waves of outbreak, as observed by the epidemiological surveillance system implemented by the islands local Health Authorities (Renault et al. 2007). Firstly, a (minor) wave commenced in March 2005, peaked in May 2005 and decreased at the beginning of July to approximately 100 cases where the level was maintained during the austral winter. By December 2005 the second (major) wave began; however, the capacity of the surveillance system at the time was insufficient to evaluate the number of cases, as the number of cases was increasing exponentially. This resulted in an underestimation of the number of reported cases with possible misdiagnosis with Dengue fever which circulated the island the previous year (Renault et al. 2007). By April 2006, the Regional Health and Welfare Office reported 203 deaths that w ere directly (due to low immune status) or indirectly (in associations with other underlying conditions) attributed with chikungunya infection, with a low mortality rate of 0.3/1000 people (Renault et al. 2007). The Maldives encountered its first CHIKV outbreak involving 11879 confirmed and suspected cases on 121 of the 197 inhabited islands, observed by the surveillance system implemented by the Epidemiology Unit of the Department of Public Health (DPH), from December 2006 to April 2007 (Yoosuf et al. 2008). The outbreak commenced at the beginning of December 2006, peaked in week 6 and subsided to control levels by week 11 before halting in April 2007. The epidemic was thought to be associated with post-tsunami construction activities which provided breeding sites for mosquitoes. Moreover, approximately five to six elderly patients died as result of co-morbidity and other conditions (Yoosuf et al. 2008). Figure 2: Global Distribution of chikungunya virus, 1952 to 2009. The cases represented on the map are either confirmed cases or suspected cases (Evenor 2010). References: 1 Krastinova et al. 2006, 2 Rezza et al. 2007, 3 Pastorino et al. 2004, 4 Sissoko et al. 2008, 5 Lumsden 1955, 6 Tamburro and Depertat 2009, 7 CDC 2009, 8 WHO 2008, 9 Yoosuf et al. 2009, 10 Leroy et al. 2009. Importation into Europe England In 2006, the United Kingdoms (UK) Health Protection Agencys (HPA) Special Pathogens Reference Unit (SPRU) reported 133 imported cases of chikungunya (Table 4). The majority of these tourists had travelled to the Indian Ocean islands (68), between March and August 2006, where outbreaks were circulating, with Mauritius being the main destination site involving 58 imported cases, followed by 6 in the Seychelles, and 4 in Madagascar. However, when the outbreaks were in decline, only one case was detected in December (HPA 2007). Between August and December, 44 cases were imported from India and 10 cases were imported from Sri Lanka, between November and December; countries with reported recent chikungunya outbreaks. Also imported into the UK, where one case from Nigeria, one from Tanzania, one case from Kenya, and one case from Australia. There had been no mention of chikungunya outbreak in these countries. However, the article did not state whether there had been reported sightings of Ae des mosquitoes in UK (HPA 2007). Table 4. The number of cases was identified by different methods from the 133 imported cases, in the UK. Identification of the imported cases Number of cases Laboratory confirmed case 45 Probable case 30 Suspected case 35 Past exposure 23 France The Pitià ©-Salpà ªtrià ¨re Hospital in Paris, France, reported 80 cases of Chikungunya infection imported by tourists who recently visited the Southwest Indian Ocean region, between March 2005 and August 2006. The majority of cases (52) were imported from La Reunion (Hochedez et al. 2007), a popular destination site for French tourists (HPA 2006). Other destination sites reported were; Mauritius with 18, Comoros with 4, Madagascar with 3, and Mayotte with 2 cases (Hochedez et al. 2007). Within the same period, Metropolitan France reported 766 imported cases, which correlated with the two waves of the La Reunion outbreak (Figure 3). At the peak of the first La Reunion outbreak, an average of 20 cases was imported to France monthly. However, between August and November 2005, during the Southern Hemisphere winter, the cases decreased (Krastinova et al. 2006). A month after the peak of the second outbreak, the number of imported cases drastically increased. It can be argued that Fran ce is at risk of future outbreaks, in view that some of its inhabitants are constantly visiting the Southwest Indian Ocean regions (Hochedez et al. 2007), mainly La Reunion and also due to the inhabitation of Aedes albopictus (Krastinova et al. 2006). Figure 3: Correlation between imported cases of Chikunugunya in metropolitan France to the estimated number of cases in the La Reunion outbreak (Krastinova et al. 2006). Italy Chikungunya was apparently imported into Italy by a male tourist coming from the Kerala province in India, who developed febrile illness two days into his holiday. The region he visited was Castiglonia di Cervia in June 2007. This was recorded by Ravenna provinces local health unit in the Emilia Romagna region, northeastern Italy where 205 people developed CHIKV infection (Rezza et al. 2007). The vector, Aedes albopictus, was implicated in the spread of the virus which was then imported from Castiglione di Cervia into Castiglione de Revenna two villages separated by a river. Mosquito control measures implemented in the area resulted in a reduction in chikungunya infection. However, the control measure was not implemented in other villages and therefore a new wave occurred. The virus isolated from the outbreak contained the same mutational change (Ala226Val) in the membrane fusion E1 glycoprotein as the Indian Ocean variant, thereby suggesting that the Kerala strain could have origina ted from the Indian Ocean outbreak (Rezza et al. 2007). Other European Countries Tourism has been one of the main methods of CHIKV distributions worldwide, including its importation into several European countries. In 2006, the Bernhard-Nocht Institute for Tropical Medicine in Hamburg, Germany examined 720 samples from 680 European patients who became symptomatic upon return to Germany, Belgium, Switzerland, Denmark, and Poland from several destinations (Table 2) (Panning et al. 2008). The majority of patients had recently visited countries in the Indian Oceans; Mauritius, the Seychelles, La Reunion and Madagascar, and other countries; Bali, Indonesia, Sri Lanka, India, Malaysia, Kenya and Thailand. Moreover, most of these countries have been implicated in recent CHIKV outbreaks. No outbreaks were reported in these European countries; however, future outbreaks can be hypothesised (Panning et al. 2008). Table 5. The country of origin and the holiday destinations of patients presented at the Bernhard-Nocht Institute for Tropical Medicine in Hamburg, Germany. Exact destinations were only available for 27.8% of patients, and exact itinerary were not available (Panning et al. 2008). Country of origin Number of patients Germany 515 Belgium 99 Switzerland 42 Denmark 22 Poland 2 Total Nos. of patients 680 Holiday Destinations (Regions with Chikungunya Epidemic) Number of patients Mauritius 92 The Seychelles 23 La Reunion 18 Madagascar 9 Bali 2 Indonesia 6 Sri Lanka 5 India 28 Malaysia 2 Kenya 1 Thailand 3 Concurrence with Dengue Fever and Malaria In 2006 and 2007, Madagascar and Gabon reported co-infections between Chikungunya and DENV-1 or DENV-2 respectively (Ratsitorahina et al. 2008, Leroy et al. 2009). Contrary to CHIKV, dengue virus (DENV) is of Flavirivirus genus from Flaviridae family; consisting of four antigenically distinct but closely related serotypes (DENV1-4). It is transmitted by Aedes aegypti and Aedes albopictus, also CHIKV transmission vectors (Cook and Zumla 2009). DENV and CHIKV have similar clinical features (Yoosuf et al. 2008). However, the only difference is that CHIKV has arthalgia (). The extended incubation period of DENV (5-8 days) differentiated it from CHIKV (2-7 days); however, the difference is insignificant (Cook and Zumla 2009). Thus, serological diagnosis can be used to differentiate DENV to CHIKV (Ratsitorahina et al. 2008). Ratsitorahina et al. (2008) and Leroy et al. (2009) confirmed Aedes albopictus as the predominating transmission vector of both CHIKV and DENV1 or 2. However, neither study stated whether the vector could simultaneously harbour both viruses. Moreover, the study by Vazeille et al. (2008) demonstrated that Aedes aegypti has a higher susceptibility to DENV-2 virus and a lower susceptibility to CHIKV; whereas Aedes albopictus is a more efficient vector for CHIKV than DENV-2 (Vazeille et al. 2008 and Moutailler et al. 2009). Leroy et al. (2009) further demonstrated this theory in the Gabon outbreak, as the majority of the patients had CHIKV compared to DENV-2. In May 1999 and February 2000, the Matete and Kingabwa quarters of Kinshasa in the Democratic Republic of Congo (DRC) reported two Chikungunya outbreaks. CHIKV was the main contributing factor in the first outbreak; however, during the second outbreak, evidence confirmed possibility of co-infections between CHIKV and Plasmodium falciparum (Pastorino et al. 2004). Malaria is a parasitic infection, of the Apicomlexa phylum, that mainly infects hosts red blood cells. It is transmitted by Anopheles species, whereas CHIKV is mainly transmitted by Aedes species. Plasmodium falciparum is one of the four species of Human Malaria (including Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale). However, Plasmodium falciparum is the most severe form of Malaria (Cook and Zumla 2009). Pastorino et al. (2004) hypothesised that co-infections could be due to long term latency of Plasmodium falciparum, the presence of both transmission vectors in the area or the pathogens sharing the same vec tors. An experimental investigation by Yadav et al. (2003 as cited by Pastorino et al. 2004) demonstrated that urban Anopheles stephensi (Plasmodium falciparum vector) could transmit CHIKV. Lack of Research We are still in the preliminary stages of understanding the interaction between CHIKV and host immunity (Kam et al. 2009), despite increasing number of reported outbreaks, there are insufficient evidences of up-to-date quality research (Panning et al. 2008). Therefore, outbreaks should be utilised to implement entomological and epidemiological system in improving our poor knowledge of the virus (Pialoux et al. 2007). Chretien and Linthicum (2007) argued that the Italian outbreak should provide opportunities for developed countries to strengthen the public-health system of developing countries in order to reduce the worldwide spread of outbreaks. These can be done by implementing Entomological and Virological surveillance in Aedes albopictus infested areas (Charell et al. 2008). Renault et al. (2007) utilised Deltamethrin insecticides to eradicate adult mosquitoes, whereas Rezza et al. (2007) utilised synergised pyrethrins. Furthermore, both authors utilised the biological larvicide, Bacillus thuringiensis israelensis, to destroy breeding sites (Renault et al. 2007, Rezza et al. 2007); however, Renault et al. (2007) later utilised Fenitrothion and temephos. Other control measures include educating the community on personal protection (Ratsitorahina et al. 2008). Although, no commercial vaccine has been approved, several candidates have been tested including the Formalin inactivated CHIKV vaccine for the Indian strain, DRDE-06, ECSA genotype (Tiwari et al. 2009). Therefore, the author believes that future outbreaks can be avoided if more research on CHIKV is undertaken, and a worldwide surveillance system is implemented. Conclusion This review has demonstrated that tourism is one of the main methods of CHIKV distributions worldwide, as it was the reason of several outbreaks. CHIKV was transported throughout the Southwestern Indian Ocean islands by viraemic tourists visiting different islands (Figure 2) and Kerala, India, which was then imported into Italy (Renault et al. 2007, Rezza et al. 2007, Sissoko et al. 2008, Yoosuf et al. 2008). However, outbreaks require temperatures above 20oC and annual rainfall over 500mm to maintain Aedes mosquitoes populations (Straetemans 2008, Tilson et al. 2009). Therefore, England is one of the least at risk country, as Aedes albopictus is not present, and the temperature is unfavourable to maintain mosquitoes life cycle (HPA 2007, Met Office 2010). Countries such as France and Italy are at high risk, due to the presence of Aedes albopictus and the introduction of CHIKV; although, Italy is the most at risk due to a recent outbreak (Krastinova et al. 2006, Rezza et al. 2007). T he eminent climatic changes could result in rising temperatures and increased rainfall that would favour the establishment of Aedes albopictus worldwide. All these emphasises the need for Western medicine to plan for future CHIKV outbreaks, by implementing a worldwide surveillance system in order to monitor outbreaks and to perform vector control measures (Charell et al. 2008). Chikungunya have concurrence with Malaria and Dengue Fever (Leroy et al. 2009, Ratsitorahina et al. 2008); furthermore, evidence suggests wrong classification of Chikungunya due to its resemblance to Dengue fever. CHIKV is constantly mutating, thus constant development of a new vaccine is required (Tiwari et al. 2009). Thereby, further researches are needed.