Haemolytic Disease of the Fetus and Newborn (HDFN)

Haemolytic Disease of the Fetus and Newborn (HDFN) List and briefly describe three clinical signs for Haemolytic Disease of the Fetus and Newborn (HDFN) Haemolytic disease of the fetus and newborn (HDFN) is a rare disease that occurs when maternal alloantibodies cross the placenta during pregnancy and cause the destruction of fetal red blood cells (RBCs) (Delaney and Matthews, 2015; Haas et al., 2015). HDFN can result in fetal anaemia with progression to severe morbidities, such as ascites, hydrops fetalis, heart failure, kernicterus, and death (Delaney and Matthews, 2015). The clinical presentation of HDFN is variable, in which there are several manifestations that may occur (Murray and Roberts, 2007). Three of the most prevalent clinical signs that allows for neonatal paediatricians to suspect HDFN includes splenomegaly, oedema, and jaundice. HDFN is characterised by the accelerated destruction of RBCs, which results in differing rates of haemolysis and fetal anaemia (Urbaniak and Greiss, 2000). The continuous and rapid process of haemolysis causes extramedullary haematopoiesis, a result of erythropoiesis failing in the bone marrow, in the fetal liver and spleen (Dean, 2005). Organs, such as the liver and spleen, that are involved in the synthesis of RBCs increase the production to combat the rate of destruction and counteract the overall loss (Dean, 2005). The increased workload of the spleen results in its enlargement, termed splenomegaly (Bowman, 1997; Dunn, 1963).          Oedema is an important clinical sign of HDFN that is also associated with the degree of haemolysis and anaemia (Delaney and Matthews, 2015). Oedema can occur due to low levels of serum albumin through a decrease in osmotic pressure (Dean, 2005). Moreover, as the body compensates for fetal anaemia, the fetus can develop a hyperdynamic circulation (Haas et al., 2015). This can result in hydrops fetalis, a severe and life-threatening condition in which there is widespread oedema in the fetal and skin and serous cavities (Haas et al., 2015). A further clinical sign of HDFN is jaundice. Jaunice may occur as a result of haemolysis, in which there is an increase in the level of bilirubin within the body (Urbaniak and Greiss, 2000). Throughout pregnancy, bilirubin is removed via the maternal circulation by the placenta (Dean, 2005). Therefore, a high level of haemolysis may be present with a low level of bilirubin (Murray and Roberts, 2007). However, after birth the haemolytic process continues. At this stage of development, the liver of the neonate is immature and unable to conjugate the excess bilirubin (Urbaniak and Greiss, 2000). The unconjugated bilirubin begins to build and accumulate in the blood of the neonate, causing the skin and whites of the eyes to turn yellow (Dean, 2005). Within 24 to 48 hours after delivery, the level of bilirubin may increase substantially (Urbaniak and Greiss, 2000). Left untreated, this can lead to the development of kernicterus, a condition in which bilirubin deposits form in the basal ga nglia and brain stem nuclei (Haas et al., 2015). Describe the progression of HDFN, from sensitisation to fetal red cell destruction, in a D negative mother carrying a D positive fetus that has not received RhIg. Throughout pregnancy, antibodies from the maternal circulation play a vital role in providing protection for neonates; crossing the placenta from the maternal to the fetal circulation (Dean, 2005). This is essential for the fetus, as by delivery newborns have a relatively immature immune system (Murray and Roberts, 2007). Although the presence of maternal antibodies provides protection, the active transporting of antibodies across the placenta can result in HDFN (Dean, 2005). HDFN is triggered by a sensitisation event. This most often occurs during the first pregnancy; however, it can also arise from a blood transfusion or organ transplant (Delaney and Matthews, 2015). During the course of pregnancy, the maternal and fetal circulations gradually mix with each trimester (Delaney and Matthews, 2015). This results in maternal alloimmunisation, as the maternal circulation has been exposed to foreign RBCs (Haas et al., 2015). Despite the relatively small amount of fetal blood that passes into the maternal circulation, only a small amount is needed for sensitisation to occur (Dean, 2005). This is typical for an RhD negative mother carrying an RhD positive fetus. Sensitisation frequently transpires during the birth of the firstborn RhD positive child, where fetal maternal haemorrhage (FMH) is common (Delaney and Matthews, 2015). However, the risk of sensitisation increases in complicated and extensive labours (Dean, 2005). Sensitisation can also occur through earlier  events in pregnancy, such as a prenatal bleed, trauma, termination of pregnancy, chronic villus sampling, and miscarriage (Sebring and Polesky, 1990). The greatest risk of developing FMH is during the process of labour (Murray and Roberts, 2007). Subsequently, alloantibodies are most likely to form after delivery (Delaney and Matthews, 2015). After sensitisation of an RhD negative mother carrying an RhD positive fetus, the mothers serum will contain anti-D (Dean, 2005). Importantly, the maternal anti-D that is formed is of the IgM class and unable to effectively cross the placenta (Delaney and Matthews, 2015). As a result, HDFN is rare in first-born children and unlikely to have any clinical consequence or significance (Dean, 2005). However, once the maternal circulation has been exposed to the fetal circulation the maternal immune system has the potential to respond to foreign red cell antigens (Delaney and Matthews, 2015). Through extensive research and cohort studies, it has been established that HDFN is most likely to effect subsequent pregnancies (Dean, 2005). Maternal alloantibodies of the IgG1 and IgG class cause significant haemolysis, thus the most clinically significant forms of HDFN (Roberts, 2008). In the event that an RhD negative mother becomes pregnant for a second time, interaction with the RhD antigen stimulates the production of IgG type anti-D, which can be transported across the placenta into the fetal circulation (Delaney and Matthews, 2015). Once anti-D has entered the fetal circulation, it binds to the RhD antigens found on fetal RBCs and labels them to be destroyed (Delaney and Matthews, 2015). From here, the pathophysiology of the disease ensues, as illustrated in figure 4. Explain the action of RhIg in a D negative mother that has a D positive fetal bleed. Rh immunoglobulin (RhIg) is routinely used in clinical practice to prevent HDFN. RhIg is prepared from human plasma that has been immunised to the D antigen and functions by targeting RBCs that are positive for the D antigen (Brinc and Lazarus, 2009). The use of prophylactic anti-D remains the gold standard approach of antibody-mediated immunosuppression, having been used for several decades (Giancarlo et al., 2010). However, the mechanism of action of RhIg is not fully understood and there are three key hypotheses that have been proposed to explain its method of action. Antigen Clearance Hypothesis The first hypothesis is the antigen clearance hypothesis and is considered the main mechanism of action. Here, IgG is understood to prevent an antibody response by increasing the rate of phagocytosis and the removal of RBCs from circulation via the mononuclear phagocytic system, prior to recognition by the immune system (Brinc and Lazarus, 2009). IgG opsonised RBCs are believed to engage in the activation of IgG receptors (FcÃŽÂ ³Rs) on effector cells, stimulating phagocytosis. IgG is also suspected to increase the clearance of RBCs through the stimulation of complement activation on the RBC surface. Anti-D does not activate complement and therefore it is believed that FcÃŽÂ ³R-mediated phagocytosis is the mechanism by which anti-D is cleared (Brinc and Lazarus, 2009). FcÃŽÂ ³RIIB mediated B-cell inhibition hypothesis This mechanism is the most recently proposed and came about through the discovery of increased levels of transforming growth factor-ÃŽÂ ² and prostaglandin E2 in a number of pregnant women who were given RhIG. This mechanism proposes that RBCs and IgG form a complex in which a negative signal is delivered to inactivate antigen-specific B cells. However, mice models deficient in FcÃŽÂ ³RIIBhave shown that the involvement of FcÃŽÂ ³RIIB is not needed to induce antibody-mediated immune suppression. Furthermore, FcR-like molecules have been discovered in both mice and humans. It is believed that the FCRLs mediate the B-cell inhibition, however, this has yet to be demonstrated (Brinc and Lazarus, 2009). Steric Hindrance Hypothesis The Steric hindrance hypothesis proposes IgG binds the antigen, preventing the B-cell receptor from recognising the corresponding epitopes. Most anti-D epitopes are not blocked by RhIg. This allows free D epitopes to be detected after administration of RhIg. Monoclonal anti-D has been shown to prevent antibody responses by binding 10-15% of epitopes. This pathway has not been studied in detail and therefore knowledge of the immunobiology is limited. However, it is believed that IgG binding of D epitopes allows a formation between RBCs and B cells, in which this prevents B-cell activation (Brinc and Lazarus, 2009). The established methodology in the UK for the Quantification of a D positive fetal bleed is via flow cytometry with FITC-anti-D (FITC-BRAD3). Name and describe 3 alternative methods used worldwide to detect fetal bleeds In addition to the use of flow cytometry, several alternative screening methods are available to determine and quantify FMH (Kim and Makar, 2011). Three screening methods that are used worldwide include the rosette screen, Kleihauer-Betke acid elution test, and flow cytometry using anti-fetal haemoglobin antibodies. The rosette test is a screening method that is used to qualitatively detect fetal bleeds equal to or greater than 10 mL and 0.2% of fetal cells present in the maternal circulation (Kim and Makar, 2011). The rosette test works by indirectly identifying the presence of D positive fetal RBCs in D negative mothers (Solomonia et al., 2012). To perform this test, a maternal blood sample is collected, incubated with exogenous anti-D, and washed. D positive RBCs are added and are key as they act as an indicator. The sample is examined using a light microscope. In the presence of fetal D positive cells, the indicator RBCs form aggregates or rosettes around the coated fetal RBCs (Solomonia et al., 2012). A positive result is indicative of an FMH greater than 10 mL and requires quantification by Kleihauer-Betke acid elution test or flow cytometry to determine the dose of RhIg to administer (Kim and Makar, 2011). This test can encounter and produce false-positive results. This largely occurs if the mother of fetus is weak D. Furthermore, in the presence of a direct antiglobulin test (DAT), the rosette test may produce a false-negative result. This can be attributed to crosslinking and agglutination of the mothers antibody coated cells (Kim and Makar, 2011). The Kleihauer-Betke acid elution test is a screening method that differentiates between fetal haemoglobin (HbF) RBCs and adult Hb (Bromilow and Duguid, 1997). The underlying notion of this test is fetal RBCs largely contain HbF and are resistant to acid elution, whereas in contrast, adult Hb is acid-sensitive (Kim and Makar, 2011). To perform this test, a maternal blood sample is taken to prepare a thin peripheral smear. The peripheral smear is dried, immersed in fixative, exposed to and incubated with an acid buffer, and stained with eosin. Under a microscope, the test reveals fetal cells to be stained a dark pink-red colour, whilst adult red cells appear pale or as uncoloured ghost outlines (Kim and Makar, 2011). Under a microscope, the fetal cells are counted and reported as a percentage of adult cells (Kim and Makar, 2011). Flow cytometry using anti-fetal haemoglobin antibodies is a variant of flow cytometry that detects RhD positive fetal cells (Kim and Makar, 2011). In this method, monoclonal antibodies are directed against HbF (Davis, 2007). A maternal blood sample is collected and an RBC count is performed (Davis, 2007). Cells are then fixed and permeabilised with detergent to enable antibodies to enter the cellular membrane and bind HbF (Davis, 2007). A flow cytometer is used to analysed the antibody stained cells (Davis, 2007). This method uses positive and negative controls simultaneously to differentiation between fluorescence from fetal RBCs and non-specific background staining (Kim and Makar, 2011). The positive control is also highly important in setting out the parameters for gating a sample (Kim and Makar, 2011). Rosette test Kleihauer-Betke acid elution test Flow cytometry using anti-fetal haemoglobin antibodies Advantages: Commercial kits Widley available Simple to use Fast Inexpensive Advantages: Not dependent on presence of RhD antigen Requires only basic laboratory equipment Inexpensive Can be used to assess fetal welfare in RhD positive patients Advantages: Quantitative Automated good precisions, sensitivity, accuracy, and reproducibility Cost-effective Less labour intense Disadvantages: Only applicable to RhD negative mothers carrying RhD positive fetus Qualitative only not quantitative Disadvantages: Laborious to perform Accuracy and precision limited due to variation in test characteristics Poor reproducibility Subjective Disadvantages: If mother and fetus have the same RhD type or mother is RhD positive cannot be used to determine FMH False positives due to hereditary persistence of fetal Hb, increased levels of Hb in pregnancy and certain disease states a) A >2mL bleed is detected via acid elution test in a sample taken from a D negative mother. Quantification via anti-D flow cytometry results in a zero bleed. Explain two possible reasons for the opposing results. The differing results of the acid elution test and anti-D flow cytometry may be explained by the RhD status of the mother and fetus. If the mother is not RhD negative and is carrying an RhD positive fetus, this test would not reproduce the results of the acid elution test. Additionally, if the fetus has an RhD negative status, this would also cause the test to fail and detect a zero bleed. Furthermore, flow cytometry cannot accurately detect weak and partial D variants, resulting in a false negative result. Therefore, if the mother or fetus has either of these D variants, FMH would not be detected via flow cytometry. An alternative reason for the differing results between the two tests could be attributed to haemoglobinopathies, in which the flow cytometer detects HbF. Lastly, there could be a mistake in the tube, such that the antibody was not detected, causing an incorrect result. b) Suggest a suitable test alternative to those already conducted to investigate the sample further and explain your reasoning for the alternative test. The use of flow cytometry using anti-fetal haemoglobin antibodies would be a beneficial test to implement in order to clarify the results and detect if a bleed is present. This is important to ensure the appropriate and correct dose of RhIg is administered. Testing the sample using HbF flow cytometry would be useful as flow cytometry using anti-D failed to reproduce the results of the acid elution test. There is a possibility that the acid-elution test produced a false positive result. The acid-elution test is limited in that is has poor accuracy and is prone to variations. The false positive may arise as a result of adult hereditary persistence of HbF, which is known in 1 to 2% of the population. Furthermore, during pregnancy the level of HbF rises by 25%. Therefore, the use of HbF flow cytometry would be able to detect if this is what caused the result. The following bleeds were detected via anti-D flow cytometry in a D negative woman. Using the Mollison calculation work out: The bleed volume in mL The total RhIg dose in each case to the nearest 500 IU The top up RhIg dose required in each case to the nearest 500 IU The Mollison calculation is used to calculate the volume of bleed. To do this, the background of the isotope matched control is subtracted from the number of events obtained in the D positive region, as recommended in the BCSH guidelines. The Mollison equation is as follows: D (+) events D (-) events1800FMH = X -ml X 1.22 Total number of events 1 The equation can be simplified to the following: FMH = % of D positive events x 18 x 1.22 0.81% x 18 x 1.22 = 17.79 mL 18 ml bleed* = 18 x 125 = 2250 IU Rounded to nearest 500 = 2500 IU 2500 IU 500 IU = 2000 IU 0.45 x 18 x 1.22 = 9.88 mL 10 mL bleed = 10 x 125 = 1250 IU Rounded to nearest 500 = 1500 IU 1500 IU 500 IU = 1000 IU 0.091 x 18 x 1.22 = 1.99 mL 2 mL bleed = 2 x 125 = 250 IU Rounded to nearest 500 = 500 IU 500 IU 500 IU = 0 IU This bleed is under 4 mL and therefore no top up is required as 500 IU is routinely administered for a bleed of up to 4 mL. 1.09 x 18 x 1.22 = 23.94 mL 24 mL bleed = 24 x 125 = 3000 IU Rounded to nearest 500 = 3500 IU 3500 IU 500 IU = 3000 IU 0.02 x 18 x 1.2 = 0.43 1 mL bleed = 1 x 125 = 125 IU Rounded to nearest 500 = 500 IU 500 IU 500 IU = 0 IU This bleed is under 4 mL and therefore no top up is required as 500 IU is routinely administered for a bleed of up to 4 mL. References Brinc, D. and Lazarus, A. (2009). Mechanisms of anti-D action in the prevention of hemolytic disease of the fetus and newborn. Hematology, [online] 2009(1), pp.185-191. Available at: http://asheducationbook.hematologylibrary.org/content/2009/1/185.long [Accessed 6 Mar. 2017]. de Haas, M., Thurik, F., Koelewijn, J. and van der Schoot, C. (2015). Haemolytic disease of the fetus and newborn. Vox Sanguinis, [online] 109(2), pp.99-113. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25899660 [Accessed 6 Mar. 2017]. Dean, L. (2005). Blood groups and red cell antigens. 1st ed. [Bethesda, Md.]: NCBI. Delaney, M. and Matthews, D. (2015). Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn. Hematology, [online] 2015(1), pp.146-151. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26637714 [Accessed 6 Mar. 2017]. Giancarlo Maria Liumbruno, Angelo DAlessandro, Federica Rea, Vanessa Piccinini, Liviana Catalano, Gabriele Calizzani, Simonetta Pupella, Giuliano Grazzini (2010). Blood Transfus. 2010 Jan; 8(1): 8-16. doi: 10.2450/2009.0108-09 Kim, Y. and Makar, R. (2012). Detection of fetomaternal hemorrhage. American Journal of Hematology, [online] 87(4), pp.417-423. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22231030 [Accessed 6 Mar. 2017]. Murray, N. and Roberts, I. (2007). Haemolytic disease of the newborn. Archives of Disease in Childhood Fetal and Neonatal Edition, [online] 92(2), pp.F83-F88. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2675453/ [Accessed 6 Mar. 2017]. Roberts, I. (2008). The changing face of haemolytic disease of the newborn. Early Human Development, [online] 84(8), pp.515-523. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18621490 [Accessed 6 Mar. 2017]. Urbaniak, S. and Greiss, M. (2000). RhD haemolytic disease of the fetus and the newborn. Blood Reviews, [online] 14(1), pp.44-61. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10805260 [Accessed 6 Mar. 2017].      Ã‚  

Dogma :: essays papers

Dogma Dogma is the latest movie from director Kevin Smith, whose previous movies Clerks, Mallrats, and Chasing Amy have become cult hits. This movie should be no different from the last three. Smith has more star power then ever to work with in this movie with such stars as Ben Affleck (who had a part in the Mallrats), Matt Damon, Chris Rock, Linda Fiorentino, Salma Hayek, and even rocker Alanis Morissette as God. The story is about two fallen angels, Affleck, and Damon, who has spent the last two thousand years on Earth and are looking to find their way back to heaven. But if they get their wish and pass through the archway of St. Michael’s Church history would be reversed and mankind will be destroyed. So God picks an abortion clinic worker, Fiorentino, along with the 13th apostle, Rock, and two profits, Jay and Silent Bob (both from Clerks, and Mallrats) to stop the two angels. Smith knows how to direct a great movie with out the high budget explosive action, and special effects. He can draw you in with great dialogue, and funny everyday situations. Smith can take a serious subject matter, such as Christianity in America today, and turn it into a funny comedy without coming off harsh. Smith first broke onto the scene with Clerks, A funny story of a convenient store worker who is called in on his day off, and a video store worker who wants nothing to do with the public he so poorly serves. The movie is shot in black and white, but you’ll soon find yourself not even noticing it once you get locked into a great story. In Smiths’ next movie, Mallrats, Smith directs a story about a man who breaks up with her girlfriend because her father wants her to be a contestant on his new dating show on public access TV. But soon all hell breaks loose when the Mall security guard has other plans, but with the help of Jay and Silent Bob things at the mall are about to change. Chasing Amy was Smiths last movie before

The Stresses of War Affecting the Characters in Regeneration and Journe

The Stresses of War Affecting the Characters in Regeneration and Journey's End 'Regeneration' is a fictional novel written by by Pat Barker. However, some of her characters in the novel like Owen and Sassoon did exist. The play 'Journeys End' is also fictional and all the characters are Sheriffs creation. 'Regeneration' is a serious and moving novel typical of war, as it shows war in a realistic way, whereas 'Journeys End' is full of black humour, in an attempt to make the play less morbid then it actually is. The writers are trying to achieve the views of the officers; they never actually saw mental ill health as serious as it was. They kept sending men back to war whether they had recovered or not. In the first chapter of 'Regeneration' we learn of the 'soldier's declaration' written by Sassoon. "I believe the war is being deliberately prolonged by those who have the power to end it". To other men in war this would be seen as "wrong and wimpish" because men weren't expected to do that, if you went to war you weren't seen as a coward. To Sassoon this declaration was the bravest thing he had ever done. For someone in war to write this they must have had enough and this shows the stress he was under. Barker could have used the declaration to portray her point on the futility of war. Another example of the stresses of war on Sassoon in the first chapter is when he throws away his medal for 'saving lives'. To receive a medal in war is widely regarded as a great honour to any man. Sassoon may have threw it away as he may feel that its ironic and degrading that he risks his and saves others lives, and all he gets in return is a medal. However, the beginning of 'Journey's End' is very different "he ca... ... learn of the death of Raleigh. Stanhope sits with him until he dies. Even though all of the soldiers are stressed about the war they still look after their men at times of need. This is in contrast with 'Regeneration' as Rivers looks after his men all throughout the novel, not just at times of need. "The point of the meeting is to protect the soldiers". In 'Regeneration' Burns leaves the hospital in an impulse, he doesn't know where he is going to go, or what he is going to do. His mental state is extremely fragile. Burns has desire for escape out of the hospital and away from human beings. This is in contrast with 'Journey's End' as Stanhope is ill but refuses to give up. "Young Stanhope goes on sticking it month in, month out". Considering all the stress that he is under, and how hard it must be, he is seen as being a bit of a hero to the audience.

Starbucks Essay -- Business, Supply Chain, Coffee Company

In a supply chain, distribution means the steps required to move and store a product from supplier stage to customer stage. It is an important driver for overall profitability of a company because it affects both the supply chain cost and the customer experience directly. (Chopra and Meindl, 2010, p68) A typical distribution network of coffee distribution system is like this (Starbucks Coffee Company, p22): In order to enforce its exacting coffee standards, Starbucks tries its best to control the whole supply chain. The company works with growers in various countries to purchase green coffee beans, oversees the custom-roasting process for the company's various blends and single-origin coffees, and controls the distribution to retail stores in the U.S. and around the world. Starbucks engages in a wide range of distribution including partnership, its company-owned stores and licensed products. Since Starbucks is a well-known brand, they use the third party relationships to attract other companies and expand their business. While licensed product part is not a large portion of the company’s revenues (4% in 2008), these items are an integral part of familiarizing customers with the Starbucks name and developing brand loyalty. (Crowe Remle, 2010) Starbucks not only sells coffee and some simple food to consumers, it also sells beans and ground coffee to businesses such as airlines, supermarkets, department stores, and ice-cream makers. In a complex distribution network, information technology helps a lot. Starbucks successfully integrates all sources of demand and matches it with the supply by using Oracle’s automated information system for manufacturing (GEMMS). The GEMMS system handles distribution planning, manufacturing scheduli... ...rbucks locations in 14 markets including Thailand, Korea, Beijing, Shanghai and Hong Kong. (Starbucks entry into China, p12). Starbucks also has a partnership with the Chinese government and local universities to grow coffee in Yunnan province. (Starbucks entry into China, p13) Starbucks also has its first entry into European coffee market. Starbucks has a partnership with Arla Foods as its licensed partner to manufacture, distribute and market the premium ice coffee products for supermarkets, convenience stores as well as Starbucks’ own coffee shops in Europe. Arla Food is one of the largest dairy companies in Europe and provides a highly developed distribution network for ready-to-drink products on key markets for Starbucks in Europe. As we see, Starbucks expands their distribution network by building up partner relationship with other organizations overseas.

Cry Freedom

Donald Woods is an editor of the Daily Dispatch, a Journal in East London, South Africa. One morning he gets news of a police raid in the black township Crossroads which lies in Cape Town. He also gets photos of the raid and he decides to print them although the government doesn ‘t allow to print such photos. Woods doesn t believe the demand of the black people but he is trained as a lawyer and doesn ‘t like police brutality against black people. So he also writes an editorial about a Biko, the leadership of ?The SC†. The next day Dr.Mamphela who works for Biko in is clinic, comes to Woods office to speak to him, about this article. She is very angry, because she thinks, that Woods has printed rubbish about Biko and that he is uninformed about the ideas that Biko has. So she invents him to meet Biko in his banning area. chapter 2 and 3: Some days later Woods meets Steven Biko in an old church were he wants to make a centre for black people. First he is critical agai nst Biko, but then he listens to Biko's opinion and they mentally changed the roles. Biko also goes with Woods to the clinic, which Biko has built.The clinic is only for black people, with black workers and a black doctor. But Woods already think that black and whits should work together, but he also understands, that the blacks wants something that they put up themselves. At the end Biko invites Woods to come and see how black people in South Africa really live. chapter 4 and 5: In the black township, they eat with a black family. Biko, the family and are discussing about the system, the history how the white came to South Africa and how the black people got their bad situation which they have now.After this visit Woods change his mind, because he sees for the first time how worse the black has to live, how big their espair is but also how strong their togetherness stay. At the end of this day Biko and Woods become friends. chapter 6: Six weeks later Woods gives TenJy and Mapetla, two friends of Biko, a Job in his newspaper. Mapetla takes Woods and Ken to a footballmatch of the black. Instead of the match Biko helds a speech. Ken and Woods were convinced by this speech and the ideas Biko represent. hapter 7: After the match Biko is caught by the police because an informer of the government had told the police about the speech. In the police office Biko gets hit by Captain De Wet. After he fght between Biko and De Wet two policemen throw Biko out of the office. Two weeks later Biko is a main witness for the defence of two student organizations who arranged two years before a large meeting in support of the new government in Mozambique. Woods prints the words of Biko although it is against the law. chapter 8: In this night Captain De Wet and two other policemen smash all things of value in the church.Donald Woods cannot print this in his newspaper because the witness is a black man called Dilima and if Woods prints his name, Dilima would kill by the police. So Woods approach to Kruger, the Minister of Police, and speaks with him about the incident. The minister declares him that he will pursues that matter because he doesn ‘t want that such sort of things happen. Woods thinks that the police men aren't as worse as many blacks think, Woods unfortuantely trust him. chapter 9: But on sunday afternoon two policemen come and want to know the name of the witness from Woods.Woods explains them that he was by Kruger and he gets angry because Kruger had betrayed him. Because the two havent a warrant Woods could send them away without saying the name. It does not happen anything for weeks and Woods thinks that it is alright. But it is not. chapter 10: One night the two policemen check the passport of Woods black housekeeper Evalina. Woods throws them out of his property. The next day, the police take revenge: Three men jump out of a car and take Mapetla in it. Donald Woods thinks that Mapetla gets beaten by them and that they make an example so that no other black person will dare him.Two days later TenJy gets arrested without any charges. After a week Mapetla is dead. The official explanation of the death from Mapetla is, that he anged himself. But Biko and Woods cannot believe that, so Biko demands a inquest. TenJy is the main witness at the inquest but the Judge closes the inquest without fix the death of Mapetla on anybody. chapter 1 1: Biko drives to Cape Town to speak in an important meeting of black students although he knows that it's forbidden for him. On the way back form Cape Town the car was stopped by the police and they want to see the papers from Biko.As they recognize the person in the car, they arrest him promptly to the prison in Port Elizabeth. Six days later the police call a doctor to look at Biko. The body is covered with bruises, the forehead and eyes seriously injured. On the chest and lips are cuts. The doctor orders to bring Biko in a hospital. Although the doctor tells them that Biko possible has a brain damage they want to bring him to the police hospital in Pretoria a 1000 kilometres away and not to Port Elizabeth Wich is only 4 kilometres away because they would have the control about him.The doctor cannot do anything against the police and so they put Biko on a blanket at the floor in the back of a Land Rover. Then they drive with Biko on thousand km rough country roads and during the Journey Biko's head is bumping on he floor. chaper 12: Biko dies and Woods prints a article about him with the headline â€Å"BIKO DIES IN CUSTODY†. The Minister of Police denies police responsibility and he says that Biko has been arrested outside his banning area and died because he starved himself to dead.One day after Bikos dead Ntsiki, who is the wife of Biko, Woods and Ken go to the mortuary to find out how Biko actually died. They were all shocked by the appearance of Biko's body, the lips are swollen, a huge lump on the forehead and many bruises around his eyes. Ken sudde nly puts out a small camera and makes photos of Biko's body. Woods and his wife arrive at the funeral and they see thousands of black people with pictures of Biko. There would come more black people but there are road-blocks of the police. The mood of the crowd is angry but also sorrowful.After a speech the crowd begin to sing the African Song which Steven Biko loved. chapter 13: Woods wants that other newspapers write about Biko's death, because if he does, the government would shut the Daily Dispatch. But all the other newspapers are also afraid and wouldn't fight the system this way. So Woods decides to fly to New York under a false name. The day he leave he sends the photos to England an America printed the pictures of Biko's body and demands on an inquest. But on the airport two securitys stopp Woods and bring him in an office.There Lieutnant Beukes reads from a warrent to Woods that he becomes a banning person for five years. chapter 14: Although the police forbid Woods to wri te he starts to write a book about Biko ‘s life, because he thinks that Bikos ideas have to live on. family has to escape from South Africa if they don ‘t want to get killed. Wendy first doesn't agree with this idea and the two have a big conflict. A few days later, the hildren of Woods reached a anonym parcel with poissoned Shirts. After this awful experience Wendy also wants to publish the book. hapter 15: So Woody quickly begins to plan the escape with Father Kani and Bruce McCullough. The 31st December in the night Woods escape begins: He disguise himself in father Curren and Wendy drives Woods to King Williams town, from where he hitch-hike to a place beyond Queenstown. There he meet Father Kant, who drives him to the edge of the river Telle. In the early morning of the 1st January Woods should crossover the river but it doesnt work because the river was too wide and deep. So he went back to the edge of the river. chapter 16: Woods knows that Tami, a friend of Biko lives near, so he walks to him.Tami brings him by car to the Telle Bridge, when Woods wants to open the gate, a Land Rover stopp in front of him. Fortunately the man, called Moses, was from the postal service and he even take Woods to Maseru. At the passport station he has no problems, so he gets to Lesotho without more problems. There he quickly phones to his family, they also follow. chaper 17: Moses brings Woods to the point where he meets Bruce, who brings him to Maseru, where he talks to the Brithis cting high Cmmisioner to ask him to enter their country. chapter 18: The next morning Woods family also arrives in Lesotho.The whole family gets passports from the United Nations and flyes with a private pilot, who wills to fly over South Africa without landing. Woods felt a little sad when he sees his homeland because he might never see it again. But he was also happy, because he will publish his book and show Biko's ideas to the whole world. He hopes that men's minds could be chan ge, before the price become too high. In his mind he hears the crowd of thousands singing at Biko's funeral. Donald Woods is one of the important persons in the story. He is married with Wendy and has five children.Woods is 42 and the editor of the Daily Dispatch. In the beginnig of the book he doesn t believe that black people should be allowed to vote and he also accepts the laws that forced blacks and whites to live in separate areas. He only disagree the police brutality against the black. The meeting with Biko in the curch, when they change the roles mentals, the speech of Biko at the stadium and his first view of the township, when he feels the strong sense of togetherness Woods change his mind about his political ideas. He becomes a good friend of Biko and he helps him to fght for more rights for the black.So he gets troubles with the government and in the end he has to escape of the country where he has born, because he wants to publish the book about Biko. Stephan Biko is a serious, intelligent and handsome young black man. He is a warm and gently person. Stevenn is married with Ntsiki and has two children. He is a banned person which means that he can only be in his banning area and he is able to speak only with one person except his family. Biko gets in this situation because he fghts for more rights for the black. He is one of the most important leader of the Black Consciousness.Steven often goes out of his banning area and so once he gets caught and finally kill by the is dedicated to the struggle for black rights. For him South Africa was for black and white, they only had to find a way to live together without violence. Biko is banned because of his leadership of a movement called â€Å"The Black Consciousness† (equal rights for blacks and whites, live together without violence, black should be proud of being black, blacks should know their history, not anymore accept the handship imposed by the system, confrontation without violence)

How to Stop Drug Trafficking in Our Country

The paper is to open people eyes about drug trafficking in our country. Where do you think the drugs are coming in from? Some say from Cuba. Others say from Mexico. I believe that the majority of drugs come from Mexico. It is okay to say that we cannot track down where all of the drugs are coming from but we can try to prevent our children, the next generation, from having access to these drugs. I would like to talk about legal drugs that are in our children’s schools. Even if we can stop illegal drugs from entering into our schools, legal drugs can also be use to get high (American Psychological Association (http://www. apa. org/) In the past, there were organizations, mostly in Mexico, that were involved in cultivating marijuana and opium. Over the past decade, however, Mexican drug organizations secured a particular position in drugs like cocaine market that was formerly dominated by Colombian drug lords, and opened the doors for Mexican groups to dominate the drug trafficking market. Not only Mexican, but African Americans, Cubans and other cultures who want to make some extra cash in the drug selling business. In the late 1980s, Mexican traffickers were middlemen for the Colombian cartels. Traffickers would receive shipments of cocaine in northern Mexico, smuggle the drugs across the border, and leave stashes in specified locations where Colombian distributers would retrieve the cocaine and transport it to destinations across the U. S. In 1989, traffickers who were annoyed at delinquent service payments from Colombian suppliers retained shipments of cocaine in extortion until payments were made. During the same year, in a stroke of good fortune for U. S. law enforcement, a massive stockpile of these shipments amounting to over forty thousand pounds of cocaine was discovered in an industrial warehouse in the vicinity of Los Angeles, California. This pivotal event forced the hand of the Colombian drug barons and led to a business arrangement that presently gives the Mexican traffickers as much as half of all the cocaine that they ransport (United Nations activities). In Texas the Mexican traffickers kidnapped people who live on the border line that mean between Mexican and U. S. The drug traffickers look for people who were or are on spring break or vacations in Mexican. They use young foreigners to get the drugs here. According to Sonia Perez, the flood of drugs and money have intensified, first with security crackd owns in the U. S. after the Sept. 11, 2001 attacks and later with Mexico's assault on organized crime beginning in 2006. (2009). Also according to Ms Perez, authorities mark the worst crime waves with the arrival of the Zetas cartel in Central America in 2008, about the same time Mexican cartels started to pay their collaborators on the ground in drugs instead of cash – creating a boom in local drug sales and violent street crime. (2009) As you can see, this paper is beginning to sound like it is pointing at foreign people smuggling drugs. Although foreigners are trying to survive financially illegally, they do not know where these drugs go to. Some will probably go to the schools to sell to children and teenagers all around the US. In conclusion, it is important to prevent drugs, illegally and legal, from our children to use illegally. Our children are our future and we need to find ways to help our children succeed in life without the use and selling of legal and illegal drugs. In the U. S. children are exposed to illegal drugs by family and a good friend or hanging out with a lot of friends. Some kids start to smoking by age 14 years old they think it cool but not. Kids and teens continue to smoke and some are trying chewing tobacco. Many young people pick up these bad habits in one year. Right now you see a man or woman smoking they started when they were kids. So it's important to make sure kids understand the dangers of tobacco use. Smoking is the leading cause of preventable deaths in the United States, and can cause cancer, heart disease, and lung disease. Chewing tobacco (smokeless or spit tobacco) can lead to nicotine addiction, oral cancer, gum disease, and an increased risk of cardiovascular disease, including heart attacks. (Kids Health 2011) Teenagers trying drugs in order to fit in. hey are trying real bad to be accepted by their peers. The teen sees drugs being used at a party or among a common group of friend. Teens between the ages of 13 and 17 have tried alcohol. Some teens and young people tried use of cocaine for the first time. Some kids may lead to criminal penalty in addition to possible physical social and psychological harm both strongly depending on local jurisdiction. In conclusion, Unite d States is working with Canada, Mexico and Colombia in the border protection to stop drug from coming in the United States. References Retrieved on April 2, 2011 at www.apa.org Sonia Perez, Associated Press (2009) Retrieved on April 2, 2011 at www.ksat.com/news/27378488/detail.html Parquets search J. Blum retrieved on April 2, 2011 at www.mctinfoservices.com Kids Health Retrieved (1995-2011) at www.kids health.org /parent/positive/positive/talk/smoking.html

Company overview

British petroleum (BP) is one of the largest energy companies dealing in fuel for transportation, energy for heat and light, retail services and petroleum products. The company’s international headquarters is in London. The company has operations in more than 100 countries and employs over 96,000 people. The company has products under the BP, Castrol, Arco, am/pm, and Wild Bean Cafe brand (BPplc, About Bp, 2009). The company operates under two major business segments; exploration and production, refining and marketing and BP alternative energy.The company basically finds, extract, move oil and gas. The company also makes fuels and products, sells fuels and products as well as generating low carbon energy in a responsible way. The company operates in six continents; South America, North America, Europe, Australasia, Asia and Africa (Vault. com, 2009). BP is also well known for its innovative technology which aims at providing energy to meet the customers demand through efficien t products. Investing in low carbon energy is also another option that the company is exploring (BPplc, About Bp, 2009). Strategic auditThe strategic audit of a corporation is an eight step process that generally encompasses a holistic analysis of the company. The basic aim in strategic audit is to establish the current position which will help the company chart the way forward. A strategic audit helps the company to formulate strategies and select the best strategic alternative(s) for implementation. The first step is the analysis of the current situation. This involves the audit of the current performance and strategic posture. Current performance is evaluated in terms of profitability, market share, and return on investment.Strategic posture looks at the mission, objectives, strategies and policies (BPplc, 2009 Strategy presentation, 2009). The second step is a look at the corporate governance. This means analysis of the board of directors and top management in terms of their str ucture, names and contribution to the company Scanning the external environment for opportunities and threats is the next step of a strategic audit. Under this stage, the company looks at the societal environment, task environment and finally listing all the above factors.The next step is the analysis of the internal environment i. e. strengths and weaknesses. Here, the corporate structure, culture, resources (marketing, finance, research and development, operations and logistics, human resource management and information systems) is looked into. A summary of these factors is then prepared (BPplc, 2009 Strategy presentation, 2009). After looking at the external and internal environments, the company then analyses its strengths, weaknesses, opportunities and threats (SWOT).These are then linked to the company’s mission and objectives to establish any relevance. The next step of the strategic audit is the analysis of the strategic alternatives in order to select the best strate gy (ies) to be recommended. The recommendation should be justified by looking at the potential, changes and impacts of the strategy. After making the recommendations, the next step is the implementation of the proposed strategy (ies). The implementation will include assigning duties on who is to develop these strategies. The financial aspect and operating procedures should be analyzed.The last step of the strategic audit is the evaluation and control. Evaluation and control involves a look at the current information system i. e. whether it can provide sufficient feedback and whether there are enough controls (BPplc, 2009 Strategy presentation, 2009). Strategic Alternatives In formulating the best strategic alternatives, the company has to consider the economic, socio-cultural, political-legal, technological and financial strengths and challenges facing the company. Economic environment This involves looking at the economic environment.The company operates in an industry that has oth er large companies e. g. Shell, Chevron, Exxon Mobil, Total and other smaller companies. All these companies have the resources and technical ability to compete at the same level as BP Plc. This is why the company has focused on cost reduction through measures like staff reduction and efficient production. The company has also focused on alternative energy e. g. solar and wind. This is as a result of the challenging operating environment where there has been a growing shift to green energy that has minimal pollution.In an industry faced with rising production costs, the company has been on track by focusing on means and ways of reducing their costs. The focus has been on reducing the number of staff and reducing the number of senior positions in the company by 20%. This strategy has borne fruit with the flattening of the cost curve of the company while those of the competitors keep on rising. The company’s focus on new technologies has resulted into improved production capaci ty. In fact the overall production trend for all the major companies has been declining. BP Plc.has defied this trend by increasing its production in the year 2007-2008. The technology used by the company includes Advanced Gas Injection and Water flood technologies that have enabled the company to push the limits of the reservoirs. The drop in oil prices means declining revenues. In order to increase revenues, the company has focused on reducing the performance gap by restoring revenues in areas like Toledo, improving supply optimization in petrochemical and marketing. The company area of focus for petrochemicals is Asia where there is rising demand. The company has also established value chains for its fuel production.Value chains are those activities that create value from the supply to the final delivery to the consumer. This has been achieved through integrated supply and trading which has lead to more revenues. In a bid to increase its oil reserves, the company has also partner ed with TNK of Russia. The partnership has resulted in 30% increase in production. Socio-cultural The company has tried to endear itself to the community in which it operates. BP achieves this through training and employing local staff at all levels. The aim here is to be a local company by creating partnerships with the local community.BP strategic aim is to reduce the levels of resistance to its operations by avoiding cultural conflicts as well as social effects. The company has entered into partnerships with the local community in terms of education, encouraging enterprise, fostering good governance, partnership in public health, access to energy, giving and volunteering, safeguarding human rights, as well as development through community case studies. All these activities are targeted at enhancing and fostering the relationship between the company and all the community in which it operates thus reducing conflicts between the community and the company.Political-legal Some of the challenges that the company could face are the political/ legal. This is because the company has operations in many countries that may be subject to political instability. To mitigate this, the company has formed partnerships with local companies and thus reduces resistance towards the company consequently the company is able to increase its operations and revenues. Rigid legal regimes concerning the operations of foreign companies may negatively impact the operations of the company. The company has reduced this by engaging in partnerships with local companies.Taxation and licensing may vary from country to country. This may have negative impacts on the company’s operations. Exploration and production rights may not be granted to the company. BP has overcome this challenge by partnering with the governments of respective countries through agreements. Technological In a bid to improve its operations and increase productivity, the company has adopted innovative technologies. So me of these technologies include the Bright water which uses new inter-well polymer treatment which ultimately improves water flood Recovery.The Company has focused on technology to come up with innovative approaches that can increase production as well as solve energy challenges Financial information BP plc has been able to grow its net income by 39% to $26. 2 billion which is the highest growth rate registered by major energy companies. Cash flow from operations also grew 54% to $ 38. 1 billion on a year on year percentage basis. The company was also the only super major to register growth in reported volumes in new reserves. The company registered a growth of 1% on year on year percentage basis. Apart from operations, the company utilizes debt to finance its activities.The debt is at the rate of 20-30%. All these financial data indicates that the company is focused on growth by efficiently using its cash resources to generate more sales and improve on the shareholders wealth by e ngaging in share buy backs. Recommended strategy Based on the analysis of all the above factors, some of the available strategies are; – Cost reduction strategies – Alternative energy by diversification – Focus on growing markets growth – Creating value on existing products – Partnership to grow – Technology leadership – Continuous improvement These strategies can be broadly classified into two directional i.e. growth and retrenchment strategies. The company can utilize the growth strategies in its upstream segment (exploration and production) and retrenchment strategies on its down stream business (refining, convenience, refining) (Wheelen, 2006) Implementation of the strategy Strategy implementation involves all the activities and choices that are required for the execution of a strategy. The implementation process basically deciding who is to carry out the plan what must be done and how are the selected people selected to carry out the strategic plan going to do it (Wheelen, 2006).These strategies are normally executed by various heads of business segments subordinated by other employees within the business segments. This has been done through budget allocations, programs that indicate the time frame in which the various strategies need to be implemented and the use of procedures e. g. the Operating Management System that covers employee capabilities to risk assessment. Some of the programs used by the company are those of closing the performance gap which runs from 2008 to 2011, and the reduction of the number of employees in refining and marketing from mid 2007 to the end of 2009 by 3,500.After deciding on who and what must be done, the company must decide on how the strategy is going to be implemented. How a strategy is to be implemented might involve developing new organizational structure. For BP plc, to implement some of its strategies, the company has decided to eliminate certain senior and junior posi tions. Evaluation and control This is the process by which a company can monitor its corporate activities and performance results in order to compare the actual performance with the desired performance. Evaluation and control provides a feedback mechanism where corrective measures can be taken where necessary (Wheelen, 2006)Evaluation and control can be summarized into the following 5 steps – Determine what to measure – Establish standards of performance – Measure actual performance – Compare actual performance with the standards – Take corrective action The company has set out plans to reduce costs and improve on efficiency on its operations. The company wants to grow its upstream business (exploration and production) while at the same time turning around its downstream business. Upstream business growth is measured by growth in reserves, increased replacement percentage, and getting more out of reservoirs.Downstream business is to be improved thr ough cost reduction by restructuring the company’s operations e. g. by downsizing and recapitalizations Improved bottom-line, high reserve replacement percentages, efficient operations, growth in reserves are some of the standards of performance that the company uses to gauge performance. Actual performance is measured at specified times e. g. for BP plc, restoring revenues from refining performance, improved supply optimization and margin capture in petrochemical and marketing has a time frame of 2008-2011The comparison of actual performance against standard performance has to be done in order to establish the current position for example in 2008; the production grew 1. 5% while the replacement reserve was 136% which was more than the minimum 100% replacement. If the actual performance does not match the expected results, then corrective action needs to be taken. An example is the restoration of capacities in Texas City so as to boost refining and consequently revenues. Refe rences BPplc. (2009, March 3rd). 2009 Strategy presentation. Retrieved April 15th, 2009, from Bp. com: http://www. bp.com/liveassets/bp_internet/globalbp/STAGING/global_assets/downloads/I/IC_bp_strategy_presentation_march_2009_script. pdf BPplc. (2009, March 3rd). About Bp. Retrieved April 15th, 2009, from Bp. com: http://www. bp. com/marketingsection. do? categoryId=2&contentId=7013628 Vault. com. (2009, April 14th). Indusrty Overview. Oil and Gas. Retrieved April 15th, 2009, from Vault. com: http://www. vault. com/nr/main_article_detail. jsp? article_id=22843159&cat_id=0&ht_type=7. Wheelen, J. D. (2006). Essentials of Strategic Mnagement. New Jersey: Prentice Hall. (BPplc, 2009 Strategy presentation, 2009)