High School Prophecy Essay

Life is an exciting, mystical, powerful and romantic adventure in the modern WORD. As we face life, how would we imagine the success of ourselves? We should prepare to face another chapter of our life in the future. Ten years from now I can imagine myself being an administrator of a famous school waiting for my promotion as a division superintendent staying in my own beautiful mansion — living in a comfortable life. As I traveled along the shores of the Philippines I couldn’t shut my ears off listening to a beautiful voice inside araneta coliseum— oh! It is the nightingale of our school way back when I was in high school, Beverly Rose Mangubat. I couldn’t believe she is now one the most popular singers in the Philippines. Then when I went back to the cruise ship where I am riding I saw a beautiful woman, my eyes sparkled as I saw Ann Maurice Branzuela now a very successful maritime officer. Then I departed the ship and preparing myself to drive off the road with my beautiful BMW. I went on a conference with the different school administrators in the province; I couldn’t help but laugh watching the one and only guy during our high school days who is now an administrator of the newest university in the province— Jhon Oneal Collamat, so called to be one the most eligible bachelor in the Country. As I traveled the road way back home, I suddenly stopped and glanced at a huge skyscraper; which is also a bank, and my heart was jumping when I found out that it was Carlyn Mae Tamayo who owns it— the math wizard during our time. As I opened my computer at home a new webpage was found, I couldn’t get my eyes staring on the screen as I read the name Jesha Mae Roflo— she was the founder. Don’t even think about it when she even made a virus to hack computers herself. Wow! Life is really amazing. We need to imagine our success to have an excellent future!

Challenges/ Problems facing Air Cargo

I had the opportunity of talking to Mark Peterson an employee of National Air Cargo working in the Marketing and planning department and ask him some of the challenges the company is facing and what can be done to solve the problems.National air cargo is a worldwide air cargo service provider that is committed to delivering its clients goods in a fast, efficient and reliable way. As much as it is renowned for the good work it does, it is faced with several challenges that need to be addressed for it to be the very best in this field.The most critical problems/Challenges facing National Air cargoThe fluctuations in the oil prices especially the threats of increasing the global oil prices has seriously affected the air cargo business. National air cargo is feeling this impact as a lot of money is now being spent on fuel and this has led to cuts in various operations and the budget.The impact of this is a reduction in the number of flights so as to meet their budget requirements and mak e profits, some workers being laid off and less profit for the company.Another problem is the Air cargo security risks. National air Cargo is facing potential risks that come in the form of the ever increasing cases of theft and smuggling and the shipping undetected materials so as to meet strict deadlines.This poses a great danger in that one can never be sure of what is being transported and there are possibilities of carrying explosive devices that will not only destroy goods but endangering the lives of all those on board.The future of National air cargoThe future of National Air Cargo will be better and brighter because it aims at expanding its cargo facilities, improving baggage handling equipment as it embraces new technologies and making sure that it retains its employees and even recruit more qualified personnel.All this can and will be achieved if the current leaders take it upon themselves to make sure that they can forecast better on what lies in the future so that when plans are made, they can have allowances for uncertainties and this will ensure that the impact of the uncertainties will not be as harsh as we see now.More attention should also be placed on integrating technology into the system so that there is better advanced ways of tracking cargo as it departs from the ports to their arrival destinations and also to be used in cargo inspection. So that our clients receive the services they are supposed to in a more qualified, responsive and personalized smooth way.Comments or suggestions for members in an air cargo management classManagers and future managers in the air cargo business need to be sufficiently self aware, cognitive and morally developed in order to understand not only how to develop a shared vision within their organizations but also how to effectively communicate and implement the necessary skills, policies and plans that are of use to their businesses.The members attending the air cargo management class should be aware of air operations, be risk takers and listen to their fellow workmates so that they can get to know their views and opinions in certain issues as this will broaden their ways on thinking and even get solutions to the various problems that affect the company.In doing so, they will become better leaders and colleagues who have the best interest of their organization at heart.ReferencesInterview with Mark Peterson, National Air Cargo: Marketing and Planning Department

Ambulatory Care

Ambulatory Care Essay Ambulatory health care has definitely been a type of health care that has benefited a lot of Americans since it became of existence. There are several health care clinics available in every city that helps the people on a daily basis. Its not as costly as the ER and you can receive just about the same kind of service as if your were going to the Hospital just in a faster time in some cases. There is a need to sometimes get further assistance, meaning that the particular outpatient service was not able to assist the patient fully and needs some additional help in diagnosing the problem. A visit to the doctors office provides someone with a sense of calmness to be able to have a one on one relationship with their private doctor, as opposed to going to the a large place like the hospital to see a doctor, any doctor at that. When I think of Ambulatory care I think of a one and done type of scenario, in some cases. The patient is able to see the doctor get a diagnosis and prescription at one time, without the need of visiting several doctors. In most cases, now there are times when the patient would need to visit different specialists for their care. With the upbringing of ambulatory care systems, there is a less need for someone to have to be in the ER waiting for hours unless it is a real emergency and the regular office is closed. Ambulatory Care. (2018, Nov 06).

Low Visibility Operations in Dubai Airport Dissertation

Low Visibility Operations in Dubai Airport - Dissertation Example In the case of Indira Gandhi International Airport, the Airport Technology (2010) reports that the foggy weather condition â€Å"causes visibility to drop below 50m, (CAT III C conditions) lasting approximately ten hours, thus affecting airport operations.† The situation of low visibility is no different in the Dubai Airport. One reason why the problem of low visibility has become a topical issue of late is the inconvenience low visibility operations cause airline operators and customers. Apart from the fact that low visibility is commonly associated with flight diversions and delays, The Office of the Federal Coordinator for Meteorology (2011) laments on issues of safety and efficiency saying â€Å"Weather alone is a significant cause of aircraft accidents and a contributing cause in many accidents with other main causes.† Happily, low visibility in airports and in aircraft operation is a problem that can be tackled. The problem statement for this dissertation therefor e is the issue of low visibility operations in Dubai Airport and how the problem can be solved to reduce flight diversions and delays. ... These objectives have been termed ‘specific objectives’ and outlined below. Specific Objectives The researcher hopes to achieve the following specific objectives in a bid to achieve the ultimate aim, which is to reduce the chances of the flights diversions and delays departing flights during low visibility operations at the Dubai Airport. The objectives are: 1. To explain the impact and effect of bad weather on aviation services with specific reference to low visibility caused as a result of foggy weather conditions. 2. To critically examine the International Civil Aviation Organization (ICAO) requirements for airlines and how these requirements help in the daily operation of aircrafts 3. To outline the effects of bad weather and low visibility on aircraft operations 4. To find out how airside operations can be improved at the Dubai Airport 5. To examine the works and duties of air traffic services including air traffic controllers, air traffic engineers and meteorologis ts and how these duties impact on airline services. 6. To critically evaluate the training and qualification program of airport staff and how these training and qualification programs can be improved to better future airline operations. 7. To find workable strategies and models for equipping airports for low visibility operations Justification of the Research The United Arab Emirates is one of the World’s busiest air travel destinations. Specifically, Dubai is known to house a good number of people who travel to the emirate for trade and tourism purposes (Ankoma, 2010, p.18). This makes the Dubai Airport of the busiest Airports in the world. According to the Dubai Airport Media Centre (2011), â€Å"Aviation began in Dubai in 1937 when the first Imperial Airways

Contemporary Issues in Financial Services Essay - 2

Contemporary Issues in Financial Services - Essay Example This paper will, therefore, identify and discuss some of the key and contemporary issues that have emerged in the financial services sector. The main aim will be to bring into focus some of the key issues in the nature and functionality of financial systems that continue to influence the economy and other financial service operations. To begin, it has been noted that the financial systems in the contemporary society have increasingly been associated with a linkage to overall economic conditions of nations. This will be discussed in the section that follows. Links between the Financial System and the Real Economy The relationship between a financial system and the real economy can be clearly understood in three components. They include the composition of aggregate demand, level of aggregate demand and allocation of resources. Composition of Aggregate Demand The financial system plays an important role in the economy in various ways. At the beginning, one should mention aggregate deman ds in relation to the total expenditure of goods and services of an economy for a specified period for a specified price (McEachern, 2011). The financial system of an economy has a bearing on the way its aggregate demand is constituted. One of the ways it influences economic dynamism is in the way it acts as a facilitator of lending on the one hand and borrowing on the other. Since scarcity is one of the great hindrances to economic growth, by providing a means of obtaining extra resources to offset deficits, the financial sector is therefore a good linkage to economic growth (Burton and Brown, 2009). In effect, the financial sector plays a direct role in the effective planning of expenditure independent of an individual or organization’s present income. A good example is the way creditors or lending institutions are able to store wealth for future consumption through giving out at certain levels of interest whereas borrowers are able to acquire finances to make purchases in advance of income. The result of positive influence of a well regulated and efficient financial system will lead to a relatively higher investment rate than that of consumption in the given economy. Since economic growth relies on investment levels, a financial system is, therefore, a necessary component of the economy. Level of Aggregate Demand Financial development levels may also have an influence on the level of aggregate demand. The level of agreement is subject to the rate of flow of the finances or money in the financial system. A high flow, or otherwise referred to as velocity, is a great determinant of the level of aggregate demand. In a financial system, individuals or lending institutions may decide to retain the cash they have at their disposal as a result of taking precautions for speculative purposes or by having them in solid assets. As a result, the flow or velocity of finances may be lowered as a consequence of decreased liquidity. On the other hand, a well function ing financial system that is able to effectively produce a range of assets that are liquid in nature may help reduce the amounts held by the said parties in the financial markets. The resultant effect will be that of increased velocity of money in the economy which is healthy for economic growth enhancement. The level of aggreg

Operations management Essay Example | Topics and Well Written Essays - 10000 words

Operations management - Essay Example which attempted to retain market leadership by focussing solely on improvement of operational effectiveness without paying adequate attention to the overall business strategy of brand positioning and other very important human resource issues as job satisfaction, aggressiveness, motivation, performance, trust and commitment. Both made the same mistake of forgetting the broader perspective and tried to tackle an economic and marketing issue in isolation. It was only natural that both the attempts ended in failure. There were several different types of issues that had to be resolved as the project developed. At one end was the difficulty in transposing the theoretical knowledge acquired from study modules to the practical context of the project. At the other end was the lack of skill in identifying broad trends that generally tend to affect business mandarins all over the world. There surely is a trend-setter like Toyota, but it requires the experience of a veteran researcher to be able to identify a new trend and forecast a phenomenon that will sweep the world in days to come even when it is in its nascent stage and is being experimented and fine tuned by the trend setter. This ability to immediately spot an idea that would shape tomorrow’s business and commerce can only be acquired through years of patient research and, quite obviously, is not visible in the current project. At this stage, it must be admitted that the in-depth graphical analysis of the operational wheel of Tesco or a thorough examination of the technology and production processes adopted by Morgan car manufacturing company helped the researcher to attain that analytical frame of mind. The extensive knowledge (albeit theoretical) about not only lean but also agile supply chains that the researcher obtained by undertaking several projects on this topic made him fully realise the necessity of the decoupling point

German Student Movement of the Late 1960s Essay Example | Topics and Well Written Essays - 750 words

German Student Movement of the Late 1960s - Essay Example The young Germans were of the view that the government failed to act and get over the post Nazi era. The students held that Nazi sympathizers were going unpunished and the people in authority had mentalities that were similar to those used to create the Nazi government. This and along with the many problems that existed in the university systems evoked sentiments of distrust and fear of the authorities among students. The grievances in the university system were associated with unfair representation of the students in their unions and university panels. The ex-Nazi professors brought the view that the administration was reminiscent of the infamous third Reich of the Nazi regime. The United States of America played a major role in influencing and determining the outcome of the 68er –Bwegung in West Germany. Though not physically, the United States clearly determined a clear path followed by the movement and contributed to the start of the riots. West Germany and America had clo se cultural and social relation after the war that helped in transnational exchange. The anti war movement in America instituted teach-ins that influenced the German student movement. The teach-ins produced intellectuals who shared an opinion that was in opposition to the Vietnam War. The war illustrated the worldwide spread of imperialism by America to the West German student organization, SDS, who saw the need for a global revolutionary alliance of activists of the first world against the cynical democracy that was the United States. Though the movement focused on the national grievances and problems in the university system at the time (Turner 166), the Vietnam War was a fundamental issue that was associated with the formation and sustaining of the German student movement. The transnational exchange system allowed the exchange of views as well as a sneak peak of the American society to Germans. This generated a part of the population that had more awareness of their rights and in creased civil rights actions. The increased popularity of left extremist movements converted many universities in West Germany into battlefields for ideas (Turner 166). The perception of the US government by the young generation started changing as they share views that are more liberal. The generation had a negative view of the occupation and thought their nation had not mastered its legacy in the post war period as because of the United States political influence. The students turned into critiques of the United States who joined the growing movements around the globe that were anti-America. Therefore, America through its social and cultural relation and activities with West Germany facilitated the arising of the German student movement as it resulted in creating intellectuals with more liberal views and civil rights awareness. The powerful uprisings in the united states in the 1950’s were significant in the emergence of the German student movement. Movements like the Afric an-American civil rights movement had strategies that advocated denunciation of a system and civil disobedience in order to attain equal rights for everyone. These beliefs and strategies motivated protesters, mostly students, to change their approach in protesting. They adopted methods that were more political, violent, and militant (Turner 171). The end of the Second World War saw the occupation of West Germany by the United States. The United States supported the government of Federal Republic of Germany, through the marshal plan, in its attempt to rebuild the economy and infrastructure. This resulted in developing a good relationship between the two nations and in the citizens of West Germany having a good opinion of America. The

Comparison of Martin Scorsese's On-screen adaptation and Edith Essay

Comparison of Martin Scorsese's On-screen adaptation and Edith Wharton's Age of Innocence - Essay Example The partners are thrown into a depth of intimacy no one can imagine who has not experienced it. Thesis The film treats the theme of innocence as a minor one while the novel treats innocence as core of moral values and social traditions. Both film and novel concentrates on the theme of marriage and its relation to innocence and moral values. Marriage is dangerous precisely because it can release and feed as many urges as it satisfies — one reason, perhaps, that divorce is rarely the simple matter it promises to be. theme are governed by the strong sense - common to many writers at the time - that one must be sacrificed to the other, that art can only be bought at the price of life. Like the novel, the film directors saw art as at once the extinction and the glory of existence. Wharton depicts Newland’s marriage as: Of course such a marriage was only what Newland was entitled to; but young men are so foolish and incalculable--and some women so ensnaring and unscrupulous--that it was nothing short of a miracle to see ones only son safe past the Siren Isle and in the haven of a blameless domesticity (Wharton 22). Martin Scorsese creates vivid and bright image of the main characters and follows Wharton’s feelings and passion related to innocence. In both works, the central figure in The Age of Innocence is Newland Archer. Like Lily Bart, Archer is by no means altogether likeable or admirable - and it is one of Whartons greatest strengths that she makes us respond to such characters by presenting them with a sort of luminous completeness. Wharton describes his family: "Ah, how your grandfather Archer loved a good dinner, my dear Newland!" he said, his eyes on the portrait of a plump full-chested young man in a stock and a blue coat, with a view of a white-columned country-house behind him (Wharton 17). Fundamentally amiable, Archer is also snobbish, vain, lazy and at times almost fatuous. If the coincidence of names with

Moderen addictions, especially develop the potential dangerous of Essay

Moderen addictions, especially develop the potential dangerous of video and internet games - Essay Example question also remains whether there are similarities between traditional and modern addictions to gain such acceptance as a disorder by mental health community. It is found that both traditional addiction and modern addictions like internet addiction has four main factors: withdrawal, excessive use, negative repercussions and tolerance (Dillon, E. 2008). Substances such as alcohol, drugs and tobacco are abused by people for a number of complicated reasons and it is evident that our society has to pay a significant cost for these addictions. The extent of addiction is visible in the emergency departments of hospitals and rehabilitation centers that treat direct health damage caused by substance abuse and the related physical trauma. Another negative outcome of substance abuse is drug dependence and associated crime that end up a number of individuals in prisons and jails. Though the use of drugs like cocaine has decreased, the use of ‘club drugs’ and heroin has considerably increased among drug abusers. The task of preventing substance abuse and imparting an effective treatment has remained a difficult process. Various researches has resulted in a better understanding of substance abuse behavior and reveals that drug education to prevent abuse among adolescents and children provides the best opportunity to curb the addiction nationally. A National Household Survey in 1996 estimated the use of illicit drug users in the United States at 13 million. The survey concluded that around 10 percent Americans abuse substances or is addicted to alcohol while 25 percent of the population smokes cigarettes. The substances that are abused produce different types of intoxication in a person that alters perception, judgment, physical control or attention. Many substances can result in withdrawal caused by the reduction in the quantity of the substance or cessation of substance use. The symptoms of withdrawal are hallucinations and ranges from slight anxiety to seizures. The

Microeconomics Assignment Example | Topics and Well Written Essays - 500 words - 1

Microeconomics - Assignment Example However with the reduction of trade barriers in the American market during the 1980’s, the luxury automobile market saw increased competition from European and Japanese automobile makers. In terms of a supply and demand analysis, it is likely that there would be increased variety in the market of luxury automobiles and an overall increase in the supply of vehicles. It stands to reason that there must be a reduction the in price of American luxury automobiles to help increase quantity demanded to meet the new market equilibrium or improvements must be made to reduce the costs of manufacturing vehicles so that company profits can remain the same with a lower unit volume sale. The same kind of situation has occurred in Europe, with an over-supply of vehicles. In Europe, the market appears to be flooded with automobiles now. The supply is high. In order to compete in this crowded market, companies will have to reduce their prices. Demand simply does not match the supply, therefore prices must be lowered. Europe has almost 300 car and engine plants, according to the European Automobile Manufacturers’ Association (known as ACEA). Their collective capacity is thought to be about 27 million vehicles a year. Sales of new cars last year were just under 16 million and are expected to fall to as low as 14.5 million this year, according to Ford. The capacity was established when demand was high, before the recession. Because car manufacturing is so capital intensive it is harder than other industries to be flexible to economic downturns. Manufacturers are therefore more vulnerable. They will make cars based on information from a year earlier and scale up their factories to do so, when it turns out demand is not as high as they thought it was because people are scaling back their spending on things like cars, they will produce an over-supply. They will then

Tax Returns Essay Example for Free

Tax Returns Essay Consider an accountant who prepares tax returns. Suppose a form 1040EZ requires $12 in computer resources to process and 22 minutes of the accountant’s time. Assume a form 1040A takes $25 in computer resources and needs 48 minutes of the accountant’s time. If the accountant can spend $630 on computer resources and has 1194 minutes available, how many forms of 1040EZ and 1040A can the accountant process? Solution: Let   Ã‚  Ã‚  Ã‚  Ã‚   x be the number of form 1040EZ that the accountant can process y be the number of form 1040A that the accountant can process The system of equation required for this problem is 12x + 25y ≠¤ 630 22x + 48y ≠¤ 1194 In augmented matrix form: The reduced form gives us the following set of equations:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   x + 2. 5y ≠¤ 52.5  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   x + 2.5(4.3) ≠¤ 52.5   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   x ≠¤ 41.7   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   y ≠¤ 4.3 Answer: The accountant can process at most 41.7 ( or 41) 1040EZ forms and at most 4.3 (or 4) 1040A forms. You are given the following system of linear equations: x – y + 2z = 13 2x + y – z = -6 -x + 3y + z = -7 a. Provide a coefficient matrix corresponding to the system of linear equations. What is the inverse of this matrix? What is the transpose of this matrix? d. Find the determinant for this matrix. det(A) = (1)(1)(1) + (-1)(-1)(-1) + (2)(2)(3) – (2)(1)(-1) – (-1)(2)(1) – (1)(-1)(3) det(A) = 19 Calculate the following for a. A * B b. -4A c. AT Solve the following linear system using Gaussian elimination. Show work. 3x + y – z = -5 -4x + y = 6 6x – 2y + 3z = 2 Solution: Backward substitution: 19/7 z = 76/7   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   z = 4 y – 4/7 z = -2/7  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   y = 2 x+1/3 y – 1/3 z = -5/3  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   x = -1 Solve the following linear system for x using Cramer’s rule. Show work. x + 2y – 3z = -22 2x – 6y + 8z = 74 -x – 2y + 4z = 29 Solution: The coefficient matrix corresponding to the given system is and the answer column is det(A) = (1)(-6)(4) + (2)(8)(-1) + (-3)(2)(-2) – (-3)(-6)(-1) – (2)(2)(4) – (1)(8)(-2)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   = -10 Plug-in the answer column to x column and get the determinant det(X) = (-22)(-6)(4) + (2)(8)(29) + (-3)(74)(-2) – (-3)(-6)(29) – (2)(74)(4) – (-22)(8)(-2)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   = -30 Plug-in the answer column to y column and get the determinant det(Y) = (1)(74)(4) + (-22)(8)(-1) + (-3)(2)(29) – (-3)(74)(-1) – (-22)(2)(4) – (1)(8)(29)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   = 20 Plug-in the answer column to z column and get the determinant det(Z) = (1)(-6)(29) + (2)(74)(-1) + (-22)(2)(-2) – (-22)(-6)(-1) – (2)(2)(29) – (1)(74)(-2)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   = -70 By Cramer’s rule, the solution to the system is x = -30 / -10 = 3 y = 20 / -10 = -2 z = -70 / -10 = 7

Analysis The Four Idols Essay Example for Free

Analysis The Four Idols Essay Francis Bacon’s in his essay named as â€Å"The Four Idols† is derived from the historical expression Novum Organum (1620). In the essay, he attempts to investigate the perception of an individual of reality based on their reasoning fallacies by extensive examples and thorough analysis. Francis Bacon has been credited through creating the scientific techniques, illustrations of this are apparent the presented literature. Bacon in his essay notes the four idols of cave, tribe, theater and marketplace are accountable for hindering the understanding of individuals of the world that surrounds them. The four idols are broken down to logical fallacies founded on: individual shortcomings, human nature, and philosophy ad language. Through his works, he writes to a vast audience in the early seventeenth century with a particularly insistent tone. Bacons ideas have withstood the time test and are still prevalent in the contemporary words. The 4 idols of tribe are significantly misunderstandings founded on the human nature unconscious tendencies. Bacon (548) asserts that human understanding usually proceeds from the incompetence, dullness, as well as, senses deceptions. There is usually more to what a person experience compares to what they sense physically, illustrating a sense to a person who is blind is not as fulfilling compared to witnessing it firsthand. Moreover, a person is not able to perceive fully anything in this globe, and this entails the most core ideas. Bacons continue through describing the beliefs which are erroneous; Bacon (546) notes that even though there shall be a vast numbers as well as, weight of instances to be found on the other side, it either despises or neglects. An additional misunderstanding of the tribe is that humans have tendencies of neglecting data, which does not support what they want so as to reach at desired conclusions. Therefore, humans are faced with misleading information based on their human nature. Francis progresses to explain the idols of the cave that are essentially misunderstanding, which are based on the individual preferences. Bacon (544) notes that for every person (notwithstanding the errors which are common to the human nature) has a den or a cave of their own, which discolors and refracts the light of the nature. Every person has their own preferences and tastes, and this can easily refract their facts perception. Moreover, Bacon (549) writes â€Å"men usually become attached to specific speculations and particular sciences. In his later years, Einstein worked is searching a correlation amid electromagnetism and gravity whilst ignoring the quantum mechanics due to the verity that it was not fitting into his nature perception. Presently, the theories of quantum mechanical theories are in essence unquestionable. This Provides a very good illustration of viewing the globe how one would prefer it rather than how it actually operates. The shortcomings of a person ought to be taken into consideration when observing nature and society. The Market place idol is illustrated as a logical hindrance that is based on language, especially word. Bacon describes the hindrances (545) to be established through the association of men with one another ad the unfit and ill words choice to a greater extent acts as an obstruction to understanding. This clearly indicates that the general populace can be misleading easily through the simple word choice that one uses in describing a specific topic. This is vital since as is seen the cotemporary world. A popular saying regarding the 9/11 attacks include â€Å"one man’s terrorist is the freedom fighter for the other†. This indicates how easily illustrated words can to a greater extent affect judgment. Correspondingly, words cannot illustrate someone or something exclusively. Lavinson indicates in the way to illustrate a flower. He notes that (255) when applying words, people should not fool themselves into deliberating that they are describing fully a real flower this is due to the fact that the word is not thing since one does not have the capability to describe anything completely. This is indeed powerful words which should be actualized. Whilst illustrating anything, there shall be always details that are going to be omitted either intentional or not, the only means through which one can understand truly anything is experiencing it. Hence, words are obstructive and misleading. Moreover, Francis describes the idols of the theater especially understanding founded on tradition, philosophy, or theology. Specifically, Bacon describes which through credulity, tradition, as well as, intelligence has to be attained (545) and later on minds of individuals who have been bruised with theology and religion. This indicates that the general population reality perception is sheltered to their culture and the means of thinking. In his article Villareal starts through describing the similarities amid Buddhist hell and Greek Valhalla (230) He argues â€Å"230† how another person culture can be hell to the other. He describes later that every point of reference of a culture is unique, and the definition of a specific event shall be very different compared to those observing that fundamentally, the means through which individuals usually perceive an event is entirely distinct compared to the culture that is far and different. Everything ranging from education, religion to the media usually affects the individual’s point of reference or the consciousness state. Villareal and Bacon indicate that the barrier can be broken through open-mindedness and awareness. At a first glance, the Ancient philosophies appear irrelevant to the contemporary times, but by media analysis and personal revelation, it is the modern thought backbone. Fundamentally, Human perception shall be at most times limited. To experience nature entirely one must take into consideration all the idols that hide them that govern the incapability of a person of possessing infinite knowledge appears unrealistic. Nonetheless, the attempt by Bacon is not fully in vain. The general populace should realize that there exist limits to their apprehension and should at all times be opening minded.

Production Capacity of Jersey Cows

Production Capacity of Jersey Cows The aim of this study to look up at production capacity of Jersey cows in Malaysia including environment factors effecting milk production Jersey cows. This study to estimated production capacity Jersey cows at state of Keratong, Muadzam, Pahang at longitude 103.4833 °T and latitude 2.8167 °U in closed house system with temperature 24 °C. The milk production of Jersey cows not only referring to genetic makeup but also another environment factors must be consider. The patent climate in Malaysia is hot and humid and Malaysia in tropical region because of this kind of climate the performance Jersey cows not equivalent as Jersey cows performance at temperate country. A good and practical farm management effluence performance of Jersey cows, if a good farm management practice not seriously consider it effect performance Jersey cows milk yield decreases or cannot reach as usual. Because of differences between Malaysia climate and temperate country resulting Jersey cows performance an d milk production. Data collecting from farm record which is Makmur Dairy Sdn Bhd under LKPP (Lembaga Kemajuan Perusahaan Pertanian) corporation. Data collecting including milk production milk yield, lacataion length, dry off period, animal identification and date of giving birth. In this study, research done in the area on milk production was reviewed. Constraints to increase production were summarized and proposals are made for the sustainable development of the dairy sector in Malaysia. CHAPTER 1: INTRODUCTION 1.1 Malaysias Geography Malaysia in the south east part of Asia has a geographic coordinate that reads 2 ° 30 north latitude and 112 ° 30 east longitude. Malaysia country classified as hot and high humid climate and has tropical weather influenced by monsoonal climate because of its latitude and longitude. But the weather in general in Malaysia is without extremities. Monsoon comes twice a year, during the summer season and the other during winter. Summer monsoon brings lots of downpour in Malaysia. Winter monsoon does not cause that much rain and is generally dry. 1.2 Malaysia Self-Sufficiency In Malaysia agriculture history, Malaysia produce milk product at insufficient level and cannot supporting demand from consumer because this may attributed to poor production local dairy animals. The demand for milk from consumers increased each year. In last decade, Malaysia almost depends on milk importation from other countries to fulfill the demands from consumers, about 95% is imported. The statistics from the Department Veterinary of Services in year 2008 for milk product in Malaysia recorded 56.49 million liters of milk was produced in that year and the self-sufficiency in livestock recorded 4.89%. In year 2010, the government target output of milk is 65 million liters and at least 10% self-sufficiency. Malaysia Dairy Industries The cattle population in Malaysia home 900,000 cattle and the large population at northern state of Kelantan 141,502 of cattle and in the southern state of Johor 111,000 of cattle. From the total population only 4% are dairy cattle (DVS, 2008). The total dairy farmer in Malaysia categorize to three structure; smallholder, semi-commercial and commercial. Dairy farm at smallholder level in Malaysia is recorded 519 and has least than 30 number of breeder (DVS, 2008). Meanwhile, 32 semi-commercial dairy farm levels have recorded and have 30 to 50 numbers of breeders (DVS, 2008). The commercial level dairy farms were recorded 28 of them and have more than 50 numbers of breeders (DVS, 2008). Reported milk yield of Malaysia 2631.3 kg per year (DVS, 2008) compared from central of Thailand produced yield from Malaysia that is 3500 kg per year (Kasetsart J, 2009). 1.4 Fact of Jersey Cows The term production indicates something going to be produced or an output product. Meanwhile, capacity is describing the total amount of production at maximum or optimum level. Production capacity of Jersey cow can be measured from the total amount of milk yield. In dairy cattle, Jersey is one of the popular breeds. The origin Jersey cows are from the small British Island of Jersey in the English Channel. A Jersey also known as Alderney cattle at island of Jersey. The colour of Jersey varies, usually light gray to a dark fawn, being darker around the head and hips. Jerseys are noted for the highest milk fat of all dairy breeds. The body of Jersey is at medium ranking categories. An average weight excellent Jersey cows is around 408 to 544 kg. The milk yields of Jersey cow be able to categorize under intermediate milk producer can reach up to 13 times from their own body weight in milk. 1.5 Factor Affecting Production Capacity of Jersey Cows There are two major factors which can influence production of dairy cows, the main quantitative factor is genetics of the breed and the second qualitative factor is environmental. Under normal situations, milk production increasing during the first six week of lactation and then gradually decreases. Breed of cow effluence milk yield, in North America Holstein cow has the highest volume of milk production and total production 7073 kg per year and Jersey cows 4444 kg per year. A dry off period usually practices for two months to the next calving. Milk yield usually reduced when dry period is less than 40-60 days (25-40% less milk). Meanwhile, dry period longer than 60 days in length does not result in a significant increase in milk production. For effective management is accurate quantitative knowledge of factors affecting productive performance of animal (Bagnato and Oltenacu, 1994). The actual amount of milk production affected by several factors of parity, geographic region and mana gement factors. The environment factor is in terms of nutrition intake of cows in the feed ration. Stage of lactation and persistency can be determined by different stages of lactation phase. Management factors consider as feed and water supply the cows consume, insufficient water supply for few hours will result in a rapid drop in milk yield. Milking intervals practices at farm may result milk production. An unequal milking interval produces less milk than those milked at equal intervals. Milking frequency twice a day yields at 40% more milk than once a day. 1.6 Objectives Information on production capacity Jersey cows in Malaysia is still unpublished therefore the present of study was designated by following objective: To measure production capacity Jersey cows at state of Keratong, Muadzam, Pahang at longitude 103.4833 °T and latitude 2.8167 °U in closed house system with temperature 24 °C is . Study various environmental factors affecting performance of Jersey cows in Malaysia Adaptability of Jersey cows in Malaysia climate CHAPTER 2: LITERATURE REVIEW A research regarding Jersey cows performance has been conducted in various part of the world. There are two major factor affecting milk productions in dairy cattle. First are quantitative factors referring to genetic of dairy breed and the second is qualitative factors referring to environmental factors such as nutrition, stage of lactation and persistency, milking practices, age and size of cow, dry period, estrous cycle and pregnancy, environment. An environmental factor has been stated are known to exert influence on the performance dairy cattle (Javed et al, 2000). A study of factors affecting milk yield in dairy cattle has conducted many people for many years and until now. For next paragraph is the review of studies regarding factors affecting milk yield from various part of the world. These reviews are indicated large differences in performance different of breed in different environment. These variations may be either due to breed, herd, location and environmental differences. 2.1 QUANTATIVE FACTORS 2.1.1 Genetics Differences of dairy breed may reflex on different of milk yield. Comparison between two breed dairy cattle Holstein and Jersey, Holstein has ability to produce more milk higher than Jersey breed. The review of literature revealed that lactation milk yield in Holstein cows can produce up to 5,902 kg and Jersey cows 3,797kg (Gacula et al, 1968). The fat contain in milk composition of Jersey cow is higher than Holstein cows also higher than others dairy breed. Fat percentage in milk composition of Jersey cows is 5.01% and Holstein 3.35% (Sharma et al, 1988). Jerseys had the highest fat content, followed by Guernseys, Brown Swiss, Ayrshires, and Holsteins (Gacula et al, 1968). 2.2 QUALITATIVE FACTORS 2.2.1 Nutrition A nutrient value content for dairy performance in dry matter intake is 89.5%, crude protein 16.6%, crude fiber 10.1%, energy expenditure 3.8%, ash 6.1%, nitrogen free extract 63.4%, total digestible nutrients 72.8%, metabolism energy 11.10%, calcium 0.77% and 0.66% of phosphorus (DVS, 2000). The recommended rates of concentrate feeding for lactating cows from department of veterinary services ministry of agriculture Malaysia suggest for uniformity a concentrate feeding is assumed to be a mixture of feed materials containing a minimum of 15% crude protein, 10.6 MJ/kg metabolize energy, 0.60% calcium, 0.4% phosphorus and 1.0% salt show at table 2.2.1, appendix. Knowledge of feed quality and intake, the extent of cows nutrient reserves that can be used to support milk production can now estimated (Alderman and Corttrill, 1993) Several nutritional factors can influence milk composition. These include plane of nutrition or underfeeding affect milk composition. Under feeding dairy cows can reduces lactose percentage and increasing milk fat percentage. Negative energy balance increasing milk fat Imbalance rations on animal feed (low energy and protein) resulting milk fat decrease and protein percentages (Petersen et al, 1986). Effects on ISO (isometric) on milk fat can probably explain by two factors. First, primiparous cows of high groups of lost substantial body weight during lactation induce negative energy balance and second factors high: moderate of groups produce less milk content higher milk fat because milk production and milk fat are negatively correlated (Pierre et al, 2003). As the proportion of the concentrate in ration increases above 50-60% milk fat percentage tends to decline. These conditions happen because of lower ruminal production of acetate and butyrate (function to synthesis milk fatty acid in mammary gland) associated with high concentration diets in feeding rations. A feeding system may effect on mammary gland health have been studies recently (Ouweltjes et al., 2007). Furthermore, there are interactions between breed and feeding system in dairy cattle may contributed mammary gland health status and milking characteristics (Ouweltjes et al., 2007). A grass feeding system and different level of concentrate offered to animals, (Turner et al., 2003; McCarthy et al., 2007) not effecting lactation stage and somatic cell count. A grazing system applied on dairy cattle (McCarthy et al., 2007), with high concentrate diet have influence average milk flow and milk duration. The extent of lactation period of milk depression is subjective by other feedi ng regime such as rate of feeding and feeding system. In wide-ranging, the impact of feeding high levels of concentrates on milk fat percentage will be less where total mix rations are fed and if feed is offered three or more times daily. There are about 30 nutrients essential for dairy cattle performance, maintenance, reproduction, growth, and lactation. The good quality of feedstuff in ration is to make sure the animal get enough supply for those 30 nutrients, lacking with nutrient in feed can corrected in giving additional supplement to animal. With intensive herd management, deficient nutrients such as those providing energy, protein, minerals or vitamins can be supplied by forage and supplements of adequate quality to produce acceptable gains in milk yield and weight gain (National Research Council, 1971; Bath  et al.,  1978; Ranjhan, 1981). Miller and Dickinson (1968) and Miller (1969) in their studies has found that management practices related to feeding, particularly amounts of concentrate, and reproductive efficiency (percentage days in milk) have the greatest value in predicting herd average milk production and are the most important characteristics common to higher producing herds. McCullough (1969), V erità © and Journet (1971), Ekern and Sundstol (1974), Ekern, Save and Vik-Mo (1975) and Wilkinson (1983) have also shown that intensive feeding of ensiled forages and hay, containing appropriate grain and protein requirements and fed free choice, increases and/or maintains milk production at a higher level by providing the opportunity for animals to be fed the conserved products with minimal loss of nutrients during periods of inadequate forage supplies. 2.2.2 Stage of Lactation and Persistency The animals become profitable when the animal can produce milk at maximum level of lifetime. An earlier selection of animals for their productivity should lead to maximum output in total lifetime (Murdia and Tripathi, 1993). Milk production increases with lactation number and is maximized in the fourth or the fifth lactation. According to Walsh et al, (2007) reported all breed reached average milk flow at week fifth to eight lactation, followed by a gradual decline until lowest point average milk flow at the end of lactation. This is result of the increasing development and size of the udder and the increasing body size over that of the first lactation dairy animal. The expected mature yield (mature equivalent) of primiparous cow calving at two years of age can be estimated by multiplying yield of first lactation by 1.3. Persistency of lactation refers to the ability of the cow to maintain production after peak milk yield; persistent cows consider when the cow tends to maintain their peak yield within a lactation period (Togashi and Lin, 2003; Kamidi, 2005). The cost of the production system can reduce if practice persistency of lactation these is associated with feeding and health costs, reproductive performance, resistance to diseases and the return from milk considering a 305 days production cycle (Solkner and Fuchs, 1987; Dekkers  et al., 1996, 1998). Persistent animals require less energy in early lactation, allowing greater utilization of cheap roughage (Solkner and Fuchs, 1987). All farmer desires their animal given profit in return, according to Dekkers et al. (1997) dairy cow with greater lactation persistency tend to be more profitable than average dairy cows when yield and lactation persistency are correlated, even though the differences are relatively small unless reproductive performan ce is very poor. Other studies however have identified a greater difference in production between once and twice daily herds during late lactation than in early lactation (Claesson et al., 1959), indicating that the persistency of cows milked once daily is less than that of cows milked twice daily. Muir et al. (2004) reported favorable relationships among lactation persistency and some measures of fertility and poor relationships with others (e.g., calving interval). Appuhamy et al. (2007, 2009) reported that diseases tend to significantly affect lactation persistency, rather than persistency affecting disease occurrence, and that there are undesirable genetic correlations among persistency of milk and fat yields and several metabolic diseases. Harder et al. (2006) also reported unfavorable genetic correlations among persistency and metabolic diseases. Lactation persistency as defined by Cole and Van- Raden (2006) is useful as a measure of the shape of the lactation curve independen t of 305-d yield. The results of Jamrozik et al. (1998) and van der Linde et al. (2000) suggest that lactation curves and persistency differ between lactations, and differences probably exist between early- and late-maturing breeds. This was confirmed by Cole et al. (2009), who estimated lactation curves for first and later parities in 6 breeds of dairy cattle and found that parameters describing the shapes of the curves can vary considerably. 2.2.3 Milking practices Milking Jersey cows three times daily results in an average increase. The increase in yield due to milking three times daily varies greatly with the producing ability of the animal on twice a day milking and is inversely proportional to such ability. High producing cows show a smaller increase in yield when milked three times daily than do cows with a lower inherited producing ability. Milking heifers three times daily on test results in a slightly greater development than when the initial records are made on twice a day milking of approximately 19 per cent in butterfat and 21 per cent in milk yield. In addition, positive correlations have been reported between milk yield and MD (Petersen et al, 1986; Weiss et al., 2004). Similarly, results from this study indicate positive correlations for milk yield with average milk flow and milk duration suggest that these correlations differ depending on breed. 2.2.4 Dry period Dry period is non-lactating days between lactations. This non lactation time is generally a 5 to 6 weeks rest period before freshening. The duration of dairy cattle stop from lactating. This duration is needed for regression of mammary gland. During this period, mammary gland starts to repair or develop back imbalance tissues to normal. To induce this process of repairing a special treatment is applied to cow called dry cows therapy. The dry cows therapy is a treatment for controlling bovine mastitis from intact to mammary gland. Usually the recommended dry period practices for about 45-50 days. A practices dry period is less than 40 days, can effect on decreasing of next lactation (Swanson 1965; Coppock et al. 1974; Dias and Allaire, 1982). According to Capuco et al. (1997) the cows given 60 days dry period can increasing mammary DNA synthesis begin occurring about 2.2.6 Calving Interval and Parity Breeding efficiency can be measured by looking to calving interval and age at first calving, although they are not the only measures of herd performance. Speicher and Meadows (1967) have suggested the correct calving interval is 12 months (365 days), the longer calving interval more than 12 months can lose the profit in overdue of feed cost. McDowell (1971) considers the following factors adequate for successful dairying: a calving interval between lactations of less than 450 days; an excess of 200 days in lactation; less than 30 percent female mortality; and proper management. According to Murdia and Tripathi, 1993 a good calving interval for cows at range of 360 to 390 day (12 month to 13 month), if the calving interval shorten than 360 days it can give impact on milk production decline 3.7 to 9 percent in lactation length. If the condition vice versa having longer calving interval more than 450 days (15 months) it will increasing milk yield production for 3.5 per cent. Although, the longer calving interval more 15 months increased milk production this situation may reflect on farmer profit because the milk has been produced not equivalent to feed has been giving to the cows. A study from I.R. Bajwa et al, 2004 the effect of average lactation length on parity is decreased begin at parity 4th and 5th, after parities 5th the milk yield and lactation length start to increased back until parties 8. Both breed and parity effects have been shown to exist on lactation curves (e.g. Wood, 1980; Collins-Lusweti, 1991; Friggens et al., 1999; Rekaya et al., 2001) and can now easily be included as fixed factors in test-day models and other linear models that incorporate time trends (Van der Werf et al., 1998; Macciotta et al., 2005). 2.2.7 Environment Results to characterize effects of climate on milk production are important for commercial milk production, perhaps particularly under circumstances where climate is a limiting factor (Sharma et al, 1988). Major benefits of shade management on milk yield appear to be related to indirect effects such as feed intake and digestive tract performance rather than direct effects on ability of the mammary gland to synthesize milk (Collier et al, 1981). Cows calving from November through March yielded more milk and fat than cows that calved in July and August. These results are similar to those reported by Blanehard etal. (3), Frick et al. (6), Gaunt et al. (7), and Wunder and McGilliard (22). Seasonal variation in animal performance in tropics is expected to be primarily a manifestation of variation in feed quality and quantity (Javed et al., 2000). The animals of temperate regions maintained in tropical conditions cannot behave similarly in both the environments (Javed et al., 2002). This i ndicated that the animals of temperate zone did not adapt to the harsh environments of tropics and could not perform satisfactorily (Javed et al., 2004). CHAPTER 3: MATERIALS AND METHODS 3.1 Source of Data The data on 233 performance records of 170 Jersey heifers, five bulls for natural mating purpose and 58 are in calves stages during the period of 2007 through 2009 were utilized for present study. All Jersey breed at this farm are pure and imported from Australia. After editing 3.2 Background and Location of Farm The data sources are from farm dairy at state of Keratong, Muadzam, Pahang at longitude 103.4833 °T and latitude 2.8167 °U in closed house system with temperature 24 °C. The sources of data are from Makmur Dairy Sdn Bhd. The Makmur Dairy Sdn Bhd was established under LKPP (Lembaga Kemajuan Perusahaan Pertanian) Corporation Sdn Bhd in May 2006. At beginning farm opening, 300 Jersey animals were imported from Australia. This farm not only focusing on dairy animal but also doing multiple ranches including feedlot cattle, dual purpose goat Shami breed. 3.3 General Management and Feeding Practice This farm practices cut and carry feeding (Guinea and Napier grass) system 40kg/head and concentrate 5-10kg/ head. This farm practices machine milking two daily routine, first at 7.00am and 4.00pm at evening. The entire animal at this farm are under intensive system. After milking process, the animal allow to free-range at paddock from 9.30 am until 10.00am. In this farm consist with two animal barns, barn A and barn B. Inside barn B; it completely closed house system provided with cooling pad and seven fans for cooling purpose. At this farm, they practices animal bedding using sand. 3.4 Data Record Extraction and Editing The following data will be collected: animal identification, date of calving, lactation milk yield, lactation length, lactation stage, parity, dry period, calving interval and nutrition value on concentrate feed. Following performance traits will be recorded/analysis and utilized in the present study. The data analyzed starting from year 2007 until 2009. 3.4.1 Lactation Milk Yield and Milk Yield per Day Total milk produced during a given lactation which terminated normally was considered as lactation milk yield. Lactation milk yield Effects of lactation length; calving interval and service period on lactation milk yield also estimated. Two lactation milk yields was grouped to three classes, this is because the farm newly established for about four years. The mean value, average and standard deviation is counted for lactation milk yield and milk yield per day beginning from 2007 until 2009. 3.4.2 Lactation Length Lactation period each cows is counted start from calving until the cows has dried up. Each of lactation length of cows is counting on average and mean value. The length of lactation period depends on production level and open period of each cow. 3.4.3 Lactation Stage In analyzed the data lactation stage has categorized to three sub classes the three sub class are 1 early lactation stage between 14 to 100 days, 2 mid lactation stage between 100 to 200 days and 3 late lactation stage between 200-350 days. The data regarding from 2007 to 2009 record farm keeping. 3.4.4 Parity The date of calving from first calving at years 2007 until 2009 is record for analyzing the data. Parity if a one major factors effect on lactation milk yield. More parity indicated lower of milk yield in dairy cattle especially in parities 4th and 5th (I.R Bajwa, 2004). The parities are divided into three group first is one for first parity, second is two for second parity and third is three for third parity. 3.4.5 Dry Period The right and proper management of dry period is one of keywords to make sure the milk production can stand in a high amount production. The data regarding dry period is going to make three sub class 1 dry period for 0 to 40days, 2 dry period 40 to 70 days and 3 dry period above 70 days. 3.4.6 Calving Interval The data from date of parturition is used for calculating calving interval, the means, standard deviation and standard error are applied to summarize the data. Because of the cows only have three parities, the calving interval is calculated based on first parities and second parities. The calving interval is divided into four categories that is zero represented for no calving interval, one is below than 360days, two for calving interval at range 360 to 390days and three is above 390. 3.4.7 Nutrition Value on Concentrate feed Proximate analysis of concentrate feed from the farm record is taking up for comparing the nutrition value concentrate feed at farm with recommended nutrient requirements for dairy cattle in different lactation stage. Nutrition is a factors effecting milk production of dairy animal. In different year the nutrition value is different in each year. The lactating ration and the basal ration nutrition value are taking up for comparison on effecting milk yield. 3.5 Data Analysis Analyzing data with unequal parameters and disproportionate sub class analyzed using statistical analysis software SAS 9.0. The data will be analyzed using SAS software with analysis of variance (ANOVA). The two independent variables in ANOVA are called factors, the factors are genetic and environment which can influence milk yield of Jersey cows. Mean values of several factors effecting on milk production capacity of Jersey cows were analyzed on analysis of variance (ANOVA): Production Capacity Based on Year 2007-2009 relating nutrient value on concentrated feed. Production Capacity Based on Parity, Lactation Stage, Dry Period, and Calving Interval. CHAPTER 4: RESULTS AND DISCUSSION The analysis performance groups of Jersey cows productivity from 2007-2009 in various responses factors is interpret. 4.1 Production Capacity Patterns 4.1.1 Production Capacity Based on Year 2007-2009 Relating with Nutrient Value on Concentrated Feed Calculating mean of milk yields begin from year 2007 to 2009 for 126 milking cows was 906.15 ±63.32 liters with a coefficient of variation 78.4%. The highest yield was 949.91 liters at year 2009. In year 2007, the mean milk yield is 615.46  ±85.23liters with coefficient variations 57%. In the next year 2008 the mean milk yield is 953.27 ±99.44liters with coefficient variations 74%. In year 2009 the mean milk yield is 949.91 ±101.84 with coefficient variations 81.4%. The mean lactation length of all cows was 166 ±7.71days, with a coefficient variation 52.2%. For year 2007 it was 166 ±13.19days of lactation length with coefficient variations 32.8%. In year 2008 the mean lactation length is 165 ±12.57days with 54.4% coefficient variations. In year 2009 the mean lactation length is 167 ±12.13days with 55.3% coefficient variations. The milk production and lactation days based on year are shown in table 4.1.1(a) and fig 4.1.1(a). The analysis of variance on milk yield based on nutrient value of year has no significant different effect (P1.66). Nutrient value may effect on milk yield (liters), in nutrient value based on year one the NFE amount around 43-38%, for year two the amount of NFE is around 52-49% and third year the amount of NFE in range 48-52%. The requirement of nitrogen free extracts (NFE) not enough for supporting milk production as recommended value is 63.4% NFE. In year 2007-2008 the amount of total digestible nutrient (TDN) is in rage 56-68% only and it not enough for supporting milk production as recommended amount 72.8%. In year 2007-2009 value of metabolisms energy is sufficient for supporting milk yield because the recommended amount of metabolism energy in ration must be 11.10%. 4.1.2 Production Capacity Based on Parity, Lactation Stage, Dry Period, and Calving Interval. Number of 30 heads milking cow have been observed on the means milk yield (liters) of cows in parities one is 1219.51 ±126.17 with coefficient variance 56.7% and means value for second parities is 1403.22 ±101.02 with 26.9% of coefficient variance in fourteen cows been milking. The third parities for means value of milk yield is 1153.74 ±162.08 liters with 34.4% with six heads milking cows. Analysis of variance (ANOVA) on factor effecting milk yield on parity one, parity two and parity three are significantly different (P Lactation stage are divided to three sub classes, the sub classes are lactation stage one considering as early lactation for 14-100days, second lactation stage is a mid lactation in range of 100-200days and third lactation stage with range of days 200-305days. The mean value for lactation stage one is 160 ± 251.29 with coefficient variance 14.4%. In second lactation stage the mean value is 777.10 ± 92.04 with coefficient variance 45.87%. The third lactation stage the men value is 1550.80 ± 77.91 with coefficient variance 28.86%. The analysis of variance (ANOVA) is lactation stage one, two and three have significantly (P Mean value in first dry period is 2266.42 ± 221.66 with coefficient variance 19.56% and second dry period on mean value 1362.10 ± 163.19 with coefficient variance 23.96%. The last, third dry period on mean value is 1158.10 ± 81.58 with coefficient variance 45.65%. The number one, two and three is representing on 1 for 0 to 40days, 2 for 40 to 70days and 3 for above 70days dry period. The analysis of variance (ANOVA) in dry period are significantly (P The mean value for calving interval on zero is 1229.70 ± 130.17 with 57% and second calving interval the mean value is 1605.20 ± 76.88 with coefficient variance 6.8%. The third calving interval is 1300.30 ± 129.46 of mean value and 29.86% of coefficient variance. The calving interval in one and three have not significantly (P Relating all factor effect on milk yield from analysis of variance they are significant between lactation stage and dry period (P CHAPTER 5: CONCLUSION After al

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Medical Tourism: Study Case of Ijn

Medical Tourism Sustainability through the Export Market Orientation Behaviours: The Case Study of Institut Jantung Negara (IJN) Ili-Salsabila Abd-Razak1 and Asmat Nizam Abdul Talib Universiti Utara Malaysia, Kedah, MALAYSIA The inclusion of tourism sector as one of the 12 recognized national key economic areas (NKEA) for the 10th Malaysia Plan represent the sector’s prospect in not only driving the nation’s economy, but also transforming the country into a high-income economy by 2020. With approximately 10 years left, many concerned groups are keen to know how this will be achieved.This paper aims at exposing the prospects of medical tourism as an essential subsector of tourism which would offer a number of proven benefits, and hence contribute to accomplishing the government aspiration of transforming the nation’s economy via the said sector. In discussing the subject, the case study method is employed involving Institut Jantung Negara (IJN) as an emerging medi cal tourism provider in the country. Findings of the case study are presented herein. Key words: medical tourism, economy, Institut Jantung NegaraIntroduction The promising prospect of tourism as an economic stimulator has enabled it to be included in the list of 12 National Key Economic Areas (NKEA), which has been specifically drafted to transform the Malaysian economy into high-income economy by year 2020. While there are tremendous numbers of tourism categories, ranging from environment, cultural, sports, and entertainment, to name a few, this paper intend to highlight on the prospects of medical tourism as a significant tourism-related economic contributor in this country. Connell (2006) defined medical tourism as health-related tourism involving specific medical intervention. Among the most popular medical tourism products are orthopaedic and cardiac surgery, which are very popular among Asian medical tourism providers, as well as executive health evaluations, cosmetic surgery , joint replacement, and similar complex medical, surgical and dental procedures (Horowitz and Rosensweig, 2007).Therefore this is a distinguished industry than that of the wider health tourism industry which involves tourists travelling to search for spas, yoga and meditation, or any other forms of health tourism (Connell, 2006; Garcia Altes, 2005). 1 Email: ili. [email  protected] com 169 In a relatively detailed account of medical tourism development which began in 1800s, Schroth and Khawaja (2007) proposed that the current phenomenon is different due to the unique combination of global demand and supply within the international medical market.As observed in the region, this proposition is regarded as well-founded. The present development of medical tourism in the international market is very unique, manifested by the escalating statistics of players, patients and revenues generated around the globe of late. How Malaysia is positioned within this backdrop, and how it would affe ct the development of this fast emerging economy, are among the focus of discussion of this paper. The Statistical Development of Medical Tourism Medical tourism has been a very significant industry over the years.By judging from its health travel umbrella, the sector is expected to generate some handsome revenue of RM240 billion (roughly USD73 billion) in 2010, with ASEAN contributing RM9. 6 billion (roughly USD3 billion) (PEMANDU, 2010). Specifically focusing on medical tourism industry, the anticipated revenue to be generated in Asia is RM14. 2 billion by 2012 (roughly USD4. 3 billion), with Malaysia is expected to bring in RM2. 1 billion (roughly USD64 million) from that amount (Ang, 2009).As a comparison, India, another top Asian medical tourism destination, expects to gain USD2 billion by the same year (Connell, 2006; Horowitz and Rosensweig, 2007). These statistics surely are translated by a growing number of medical tourists around the globe. The movement of medical tourists is another significant indicator of this trend. At the global stage, approximately 350 000 medical tourists moved from developed nations to less developed countries for treatment in 2003, while a year later 1. 18 million patients travelled to India alone and another 1. million to Thailand for the same reason (Horowitz and Rosensweig, 2007). Glancing at the local development, the Association of Private Hospitals of Malaysia (APHM) has been projecting for a stable 30% growth of takings from foreign patients until 2010. This is apparent from the steady increase of foreign patients to Malaysia which recorded a total of 39 114 patients in 1998 and 374 063 patients ten years later (APHM; Liow, 2009). In terms of revenue, RM14. 1 million was documented in 1998 before jumped to RM299. million in 2008 (APHM; Liow, 2009), and is expected to contribute to another RM540 million in 2010 (Leonard, 2009). The revenue per patient has almost tripled from RM360 in 1998 to RM800 in 2008 (Choy, 2010). In the latest development, medical tourism is expected to generate RM4294. 4 million of Gross National Income, together with 5295 jobs in 2020 (PEMANDU, 2010). This occurrence has readily attracted a number of giant MNCs with diversified structure such as General Electric (GE) to invest further in the industry (Panjanadan, 2010). The Revolution of Medical TourismThe presented statistics did not appear by chance. The numbers occurred out of plausible factors. The development of medical tourism industry is indeed different (Horowitz and Rosensweig, 2007). As mentioned earlier, Schroth and Khawaja attributed the uniqueness of the industry’s current development to the forces of market’s demand and supply, which is in resonance with Horowitz and Rosensweig (2007) who ascribed it to the movement of patients from industrialized nations to less developed countries. Connell (2006) argued that medical tourism is a niche which 170 xperienced rapid growth and has become an indust ry. The said paper also enlisted several factors promoting the development of medical tourism, such as the low costs factor, the long waiting list, the relatively affordable international air travel and favourable exchange rate, plus the aging of the baby boomers generation. These factors are also often cited in a number of studies regarding medical tourism such as Hansen (2008), Herrich (2007), Horowitz and Rosensweig (2007), Garcia Altes (2005), Marlowe and Sullivan (2007), and Schroth and Khawaja (2007), to name a few.Apart from these popular factors, other notable factors motivating the development of the industry spotted in the literature extent are the use of internet and mobility of technology, the unavailability of certain procedures in the local market, and the reduced trade barriers encouraging the mobility of workforce. Hansen (2008) argued that the revolution in medical tourism today is consumer-driven. This is in line with Horowitz and Rosensweig (2007) who argued that the industry is market driven with complex involvement of multitude medical, economic, social and political factors.While the progress of the industry seems to be very promising, the general overview of Malaysia’s involvement at the international level is not very charming. Even though medical tourism experienced an astounding per annum growth of 22% from 2004 to 2009, the global share is still considered as small with RM350 million in 2010 (PEMANDU, 2010). Furthermore, PEMANDU also reported that while the global healthcare travel is a multi-million dollar industry, Malaysia is yet to get a sizeable share.The said industry is expected to generate USD75 billion of revenue in 2010 at the global level, while Malaysia is expected to make about USD0. 1 billion. The statistics provide a brief sight on the development in the country weighted against the global development. Malaysia should therefore be proactive enough to catch up with the global progress to stay competitive in the i ndustry. To enable this, the players and responsible parties must quickly recognize potential constraints that can hamper the development and address the issues well.The Required Expertise and the Potential Economic Opportunities Based on previous arguments, medical tourism offers bountiful opportunities and chances. In order to remain competitive at the global stage, marketing strategies should be revised against the present circumstances. Marketing the medical expertise and offerings should be distinctively conducted. The primary concern of assessing an excellent marketing strategy is the effectiveness of the strategies implemented.StuartKregor (2005) argued that defining marketing excellence for medical-related industry is different with that of the commercial-based industry. As customer is the centre of marketing excellent in the industry, the paper suggested that the effectiveness of marketing strategies should then be done by measuring the customer’s satisfaction over t he service provided. Therefore, all other marketing excellence measured by considering the profit, return on investment or sales as in any other commercial industries should be changed to be more customer-oriented rather than organizationaloriented. Building he strategies can be done by â€Å"developing, communicating and delivering the right emotional benefits to the targeted customers† (Stuart-Kregor, 2005, pp. 117). The right emotional benefit here is viewed as brand by Stuart-Kregor (2005). This paper is in agreement with the argument, which is to develop the marketing strategies by focusing on the emotional benefits (brands), and assess the effectiveness of the strategies by measuring the satisfactions of the customer. Further discussion on this is available in the next section. 171 The science of excellent marketing strategies would be wasted without a good delivery system.The state of local expertise, technologies and facilities must be attended to in order to assess t he quality of the service offered against the global level. This is where the industry should strive to be as similar as other excellent providers. The commodification of medical tourism (Chee, 2007) is an evident of this occurrence. Dunn (2007) argued that patients are making choices on medical tourism destinations based on how similar is the service delivered, especially concerning patients from industrialized nations, and the service is expected to come with much lower price.Consequently, it is observed that patients are not looking for low cost products at the expense of the quality in the industry. Successful players realize this and capitalize on the factors well. This explains the rapid movement of workforce and technologies across the four corners of the world. India as an example has been successful in luring its medical doctors who have been trained and worked abroad to return with their internationally recognized expertise and work in the country.Thailand and United Arab Emirates have been successful in rearranging for international collaboration in the industry (Schroth and Khawaja, 2007). Through these strategies, the countries have been able to keep their expertise, technologies and facilities up with the global standard. Proposed Strategies of Reviving and Sustaining Medical Tourism: The Case of IJN With the national governments’ involvement recently (Chee, 2007; Noor Hazilah, Roslan Johari and Kadar, 2010; PEMANDU, 2010), the industry has been attracting the interest of many concerned parties.Since the medical tourism is fast becoming a commodity (Chee, 2007), its marketing strategies should be focusing more on brands and less on products to be distinctive than other providers. As in Malaysia, the country is capable of offering similar products with the rest of other players in the world. While Malaysia has been focusing on cost all this while, it is suggested then for the country to deliver a unique brand which is capable of attracting the interest of potential medical tourists, without desecrating the cost advantage.In order to do so, it is particularly important for the players to implement the export market orientation behaviours within their organization, which are generating, disseminating and responding to the export market intelligence (Cadogan, Diamantopoulos and de Mortanges, 1999). Consequently, Malaysia is expected to be able to woo medical tourism patients even more. Hazilah et al. (2010) reported that a medical tourist spends double than a regular tourist while they are in the country. This high buying power therefore is capable of generating more economic opportunities.The medical tourist needs are also offering a lot of opportunities for Malaysian. Apart from medical attention, they need to have accommodation for their accompanying family members. New jobs have been underway to better serve the medical tourists, such as the healthcare broker. A healthcare broker assists the patient to choose a medic al institute and arrange for the patient’s needs while in here, including visa, accommodation and holiday arrangement. Thanks to the internet, these can be arranged prior to the patient’s arrival in the country.To describe more of these strategies and opportunities, this paper choose to present the IJN as a case study merit the discussion. The National Heart Institute or Institut Jantung Negara (IJN) has been established in 1992. The privatization of the institute was done on many premises, especially concerning the potential it has to expand its expertise and to liberalize the 172 financial capabilities of the institute. IJN did not take long to materialize that. A year after its privatization the institute has been able to be financially liberalized and hence reduce the government intervention in its administration.By now, IJN has accomplished a great number of medical milestones recognized not only in the country and the region, but also internationally. To further advance ahead in medical industry, IJN is joining its local peer private institutions to take part in the global medical tourism industry. The previous mentioned factors of global medical tourism industry’s progressive development served as the basis for IJN to be a part of the industry. Besides, like Singapore, the medical tourism industry in Malaysia is receiving a lot of government’s assistants.Being a nationally structured industry, medical tourism therefore is regarded as a potential industry in which would be able to position IJN better. The Malaysian government has been playing an active role in developing the industry in Malaysia since 1998. The main driver of this is to revive the private medical industry after the 1997 Asian economic downturn which has affected the industry very badly. The success story of Thailand which managed to get the industry out of the crisis by focusing on delivering the service to foreign patients has prompt the government to encoura ge private players to do the same.Consequently, while Thailand has been restructuring the industry without much government involvement, Malaysia and Singapore has been leveraging the industry well with cooperation between the public and the private sectors. IJN has been viewing this very positively and has since become a significant player in the region. While being rapidly developing the industry, the players recognized several major constraints which are able to slow down the progress. Coordination is a key constraint. To increase coordination, the Association of Private Hospitals of Malaysia (APHM) was formed to increase coordination between the private players.The steadily increasing number of foreign patients and revenues generated since 1998 as shown in Table 1 is an evident of the successful strategies implemented. However the industry, weighted against the global development, was still considered as insignificant. Resulting from the government’s enthusiasm towards med ical tourism as a prospective economic driver industry, and the intensity and potentials portrayed by private sectors, the Malaysia Healthcare Travel Council (MHTC) was established in July 2009.The main purpose of the council is to coordinate promotional activities of medical and healthcare tourism industry in the country. As a part of the economic transformation program, the industry is expected to shift their attention to generate higher patients’ volume, expand the target market beyond Indonesia which is currently the main market of the industry, create alliance across border, and enhance customer experience in the first phase of the strategy. In the following phase, more attention is given on mproving the infrastructure and specialists capacity to attract the more profitable in-patient segment (PEMANDU, 2010). 173 Table 1. The Volume of Foreign Patients and Revenue Generated by Medical Tourism Industry in Malaysia Year 1998 2001 2002 2003 2004 2005 2006 2007 2008 Medical Tourists/Foreign Patients 39,114 75,210 84,585 102,946 174,189 232,161 296,687 341,288 374,063 Revenue (RM million) 14. 1 n/a 35. 9 58. 9 105. 0 150. 9 203. 66 253. 84 299. 1 Another strategy to improve the medical tourism performance is through focusing on specific players.There are approximately 223 private hospitals operating in the country in 2008 (Frost & Sullivan, 2009). Of this number, the government has decided to focus on 35 private hospitals to capitalize on the industry with several characteristics outlined. The characteristics include being a member of APHM, has obtained the Malaysian Society for Quality in Health (MSQH), ISO or other international accreditations, offers major specialties and/or some sub-specialties, provides for a minimum 50 beds, and has its own websites.IJN has been one of the selected 35. The commitment demonstrated by IJN towards the industry is paramount. In order to be internationally recognized, the institute has been striving hard to be in the s ame par with the other international organizations. IJN has been accredited by JCI in 2009, which is a recognition of the strong culture of safety and quality within the organization. The internationally recognized accreditation is expected to improve IJN’s international positioning in the future.IJN realizes that in order to make the most of the industry, it needs to build a customer-oriented system. Beginning in 2006, the institute has been conducting the Customer Focused Program. The program was aimed at transforming IJN into a global centre of excellence by ensuring customers’ satisfaction. In 2008, the institute launched what was designed as the second phase of the program, called Customer Focused Culture. While the CFP was initiated to increase awareness of ensuring customers’ satisfaction, the CFC aimed at internalizing the institute’s shared values across the rganization. IJN also comprehend its capacity constraint which is becoming the largest hi ndrance from going big in the global medical tourism industry. Apart from improving on its culture system, the institute has been adamant in enhancing its infrastructure capabilities. A major extension work has been carried out at IJN to expand its capacities from 270 beds to 432, eight wards to 13, 23 outpatient clinic rooms to 59, and an international patient centre, to improve its service for customers.This is in line with numerous governments’ incentives offered to the private hospitals embarking on medical tourism industry to expand their infrastructure capacities. In August 2009, IJN has its new wing officiated by the Malaysian Prime Minister, who acknowledged that the institute has undergone RM230 million expansion program since 2005. In the same ceremony, the Prime Minister has also announced the proposal for IJN to become a research and development institute, measuring itself against the international best heart institute such as the Cleveland Clinic Heart Centre in the US.These are all evidences of how IJN has been greatly employing the export market orientation behaviors within its organization. In commenting the current development of the industry, IJN has expressed its concern for the country to be more progressive towards promoting medical tourism. 174 The IJN Holdings Group Managing Director, Datuk Mohd. Radzif Mohd. Yunus mentioned that the failure for Malaysia to capitalize on its capabilities in the industry would result to the loss of human capital as they will migrate to other countries with better offers.This is also reiterated by Datuk Syed Hussien Al-Habshee, the Secretary General of National Chambers of Commerce and Industry Malaysia (NCCIM) who said that the country need to step up its marketing efforts of medical tourism if it wants to catch up with Thailand and Singapore. PEMANDU (2010) has confirmed the assertion by reporting on the stronger growth of the industry by neighboring Thailand and Singapore. The set up of MHTC and several other initiatives are therefore deemed as timely to help Malaysia to rise in the industry at the global stage.Conclusion and Recommendation As exemplified in the discussion, medical tourism offers a lot of economic opportunities and hence is indeed a potential contributor to economic growth. However, Malaysia, while has been enjoying the growth of the industry vehemently over the pass few years, has not been capitalizing the industry well compared to the other global players. Therefore, the Malaysian players need to revise their marketing strategies and delivery system, as represented by IJN.The cooperative efforts between the public (government) and the private sectors too must be further carried on, especially for the sake of protecting the interests of the local society and the survival of the medical tourism players. It is strongly suggested for medical tourism players in the country to leverage on their expertise by focusing the marketing strategies on brands rather tha n on products, as well as enhancing on their infrastructure and culture systems to be more export market-oriented. In doing so, however, the players must not disregard the country’s current edge, which is the competitive cost.In terms of theoretical development, this paper is believed to be able to expose the medical tourism niche and its economic opportunities, as well as the marketing strategies fitting the industry. Quite a number of studies involving Malaysian medical tourism industry have been conducted. Nonetheless, this paper presents the scenario from the view of a single case study. It is highly suggested for similar studies to be conducted with the presence of empirical data to see the quantifiable aspects of the industry in the future.With such studies, it is expected that further theoretical contributions can be made, and hence the progress of the industry can then be expedited even more. Reference Ang, Elaine. Malaysian Medical Tourism Growing. The Star, February 14, 2009. Cadogan, J. W. , Diamantopoulos, A. , & de Mortanges, C. P. (1999). A measure of export market orientation: Scale development and cross-cultural validation. Journal of International Business Studies, 30(4), 689-707. Chee, H. L. (2007, January). Medical tourism in Malaysia: International movement of healthcare consumers and the commodification of healthcare. ARI Working Paper, No. 3. Retrieved from www. ari. nus. edu. sg/pub/wps. htm Choy, L. B. (2010, April 13). Medical tourism good for Malaysia’s health. News Straits Times. Retrieved from http://findarticles. com/p/news-articles/newstraits-times/mi_8016/is_20100413/ medical-tourism-malaysias health/ai_n53130944/ 175 Connell, J. (2006). Medical Tourism: Sea, sun, sand and †¦ surgery. Tourism Management, 27. 1093-1100. Dunn, P. 2007. Medical Tourism Takes Flight. Hospitals and Health Networks, 81(11): 40-44. Frost & Sullivan (2009, October 28). Frost & Sullivan: Growing healthcare tourism in Malaysia. Retrieved from http://www. alaysiahealthcare. com/ Garcia-Altes, A. (2005). The development of health tourism services. Annals of Tourism Research, 32 (1): 262-266. Hansen, F. (2008). A revolution in healthcare. Review-Institute of Public Affairs, 59(4), 43-45. Health and medical tourism will boost growth: Datuk Liow Tiong Lai. The Star, November 08, 2008. Retrieved from http://www. wellnessvisit. com/liowhealth-and-medical-tourism-will-boost-growth. php Herrick, D. M. (2007, November). Medical tourism: Global competition in health care. NCPA Policy Report, No. 304. Retrieved from www. ncpa. org/pub/st/st304 Horowitz, M. D. Rosensweig, J. A. , & Jones, C. A. (2007). Medical tourism: Globalization of healthcare marketplace. Medscape General Medicine, 9(4), 33. Leonard, T. (2009, October 28). Medical tourists to bring in RM540mil by 2020. Retrieved from http://www. malaysiahealthcare. com/ Marlowe, J. , & Sullivan, P. (2007). Medical tourism: The ultimate outsourcing. HR. Human Resource Planni ng, 30(2), 8-10. Noor Hazilah Abd Manaf, Roslan Johari Dato’ Mohd Ghazali, & Kadar Marikar. (2010). â€Å"Positioning Malaysia in Medical Tourism†. Paper presented at the International Conference on Marketing (ICMAR), June 2010, in Kuala Lumpur.Panjanadan, S. (2009, August 9). GE looking into enhancing presence in tourism Retrieved from healthcare. http://bernama. com/bernama/v5/newsbusiness. php? id=519842 PEMANDU (2010, September 21). Healthcare-EPP Panels. Retrieved from http://www. pemandu. gov. my/index. php? option=com_content&view=article&i d=619&Itemid=139&lang=en Schroth, L. , & Khawaja, R. (2007). Globalization of healthcare. Frontiers of Health Services Management, 24(2), 19-30. Speech by YB Dato’ Sri Liow Tiong Lai, Minister of Health Malaysia, at the APHM International Healthcare Conference and Exhibition at KLCC,

Non-Hodgkin’s Lymphoma Disease

Non- Hodgkin’s Lymphoma or NHLs are a heterogenous group of cancers that originate from the neoplastic growth of lymphoid tissue. As in CLL, the neoplastic cells are thought to arise from a single clone of lymphocytes; however, in NHL, the cells may vary morphologically. Most NHLs involve malignant B lymphocytes; only 5% involve T lymphocytes. In contrast to Hodgkin’s disease, the lymphoid tissues involved are largely infiltrated with malignant cells. The spread of these malignant lymphoid cells occurs unpredictably, and true localized disease is uncommon. Lymph nodes from multiple sites may be infiltrated, as may sites outside the lymphoid system (extra nodal tissue). The incidence of NHL has increased dramatically over the past decade; it is now the fourth most common type of cancer diagnosed in the United States and the fifth most common cause of cancer death.   The incidence increases with each decade of life; the average age at diagnosis is 50 to 60 years old. Although no common etiologic factor has been identified, there is an increased incidence of NHL in people with immunodeficiencies or autoimmune disorders, viral infections including Epstein- Barr virus and HIV, or exposure to pesticides, solvents, dyes, helicobacter pylori, human T cell leukemia, and hepatitis C virus. Researchers also say that obesity could be one of the risk factors of having Non- Hodgkin’s lymphoma and those whose occupation involves chemicals and herbicides.   Prognosis varies greatly  among the various types of NHL. Long term survival more than 10 years is commonly achieved in low- grade, localized lymphomas. Even with aggressive disease forms, cure is possible in at least one third of patients who receive aggressive treatments. Symptoms are highly variable, reflecting the diverse nature of these diseases. With early- stage disease, or with the types that are considered more indolent, symptoms may be virtually absent or very minor, and the illness typically is not diagnosed until it progresses to a later stage, when the patient is more symptomatic. At these stages III or IV, lymphadenopathy is noticeable. One third of patients have â€Å"B† symptoms like recurrent fever, drenching night sweats, and unintentional weight loss of 10% or more. Non- Hodgkin’s lymphoma usually begins with the presence of one or more swollen lymph nodes on the side of the neck, collarbone, and under the arms. The most common sites for lymphadenopathy are the cervical, supraclavicular, and mediastinal nodes, involvement of the iliac or inguinal nodes or spleen is much less common. A mediastinal mass maybe seen on the chest x- ray; occasionally, the mass is large enough to compress the trachea and cause dyspnea.   Pruritus is common; it can be extremely distressing, and the cause is unknown. Approximately 20% of patients experience brief but severe pain after drinking alcohol. All organs are vulnerable to invasion of NHL. The symptoms result from compression of organs by the tumor, such as cough and pulmonary effusion, jaundice from hepatic involvement or bile duct obstruction, abdominal pain from  Splenomegaly or retroperitoneal adenopathy, or bone pain which is from skeletal involvement. Herpes zoster infections are common. A cluster of constitutional symptoms has important prognostic implications. A mild anemia is the most common hematologic finding. The WBC count may be elevated or decreased. The platelet count is suppressing hematopoiesis. The erythrocyte sedimentation rate or ESR and the serum copper level are used by some clinicians to assess disease activity. The actual diagnosis of NHL is categorized into a highly complex classification system based on histopathology, immunophenotyping, and cytogenetic analyses of the malignant cells. The specific histopathologic type of the disease has important prognostic implications. Treatment also varies and is based on these features. Indolent or less aggressive types tend to have small cells and are distributed in a follicular pattern. Aggressive types tend to have large or immature cells distributed through the nodes in a diffuse pattern. Staging, also an important factor is typically based on data obtained from CT scans, bone marrow biopsies, and occasionally cerebrospinal fluid analysis. The stage is based on the site of disease and its spread to other sites. For example, in stage 1 disease is highly localized and may respond well to localize therapy like radiation therapy. In contrast, stage IV disease is detected in at least one extra nodal site. Although low- grade lymphomas may not require treatment until the disease progresses to a later stage, historically they have also been relatively unresponsive to treatment in that most therapeutic modalities did not improve overall survival. More aggressive types of NHL like Lymphoblastic lymphoma and Burkitt’s lymphoma require prompt initiation of chemotherapy; however, these types tend to be more responsive to treatments. Treatment is based on the actual classification of disease, the stage of disease, prior treatment, and the patient’s ability to tolerate therapy. If the disease is not an aggressive form and is truly localized, radiation alone may be the treatment of choice. With aggressive types of NHL, aggressive combinations of chemotherapeutic agents are given even in early stages. More intermediate radiation therapy for stage 1 and II disease. The biologic agent interferon has been approved for the treatment of follicular low- grade lymphomas, and an antibody to CD20, rituximab (Rituxan), has been effective in achieving partial responses in patients with recurrent low- grade lymphoma. Studies of this agent in combination with conventional chemotherapy have demonstrated an improvement in survival as well. Central nervous system involvement is also common with some aggressive forms of NHL; in this situation, cranial radiation or intrathecal chemotherapy is used in addition to systemic chemotherapy. Treatment after relapse is controversial. Much is known about the long term effects of chemotherapy and radiation therapy, primarily from the large numbers of people who were cured of by these treatments. The various complications are immune dysfunction, herpes infections, pneumococcal sepsis, acute myeloid leukemia or AML, Myelodysplastic syndrome or MDS, solid tumors, thyroid cancer, thymic hyperplasia, hypothyroidism, Pericarditis, cardiomyopathy, pneumonotis, avascular necrosis, growth retardation, infertility, impotence and dental caries. Aside from radiation therapy and chemotherapy, there are also stem cell transplantation, biologic therapy and radio immunotherapy. To diagnose Non- Hodgkin’s lymphoma with a patient, a nurse or a health care professional should do physical examination and anamnesis or a family history of the patient which could present the possibilities that he or she could have NHL. Most of the care for patients with Non- Hodgkin’s disease is performed in the outpatient setting, unless complications occur like infection, respiratory compromise due to mediastinal mass. For patients who require treatment, chemotherapy and radiation therapy are most commonly used. Chemotherapy cause systemic side effects like myelosuppression, nausea, hair loss, risk for infection, whereas the side effects from radiation therapy are specific to the area being irradiated. For example, patients receiving abdominal radiation therapy may experience nausea and diarrhea but not hair loss. Regardless of the type of treatment, all patients may experience fatigue. The risk of infection is significant in patients, not only from treatment related myelosuppression but also from the defective immune response that results from the disease itself. Patients need to be taught to minimize the risk for infection, to recognize signs of possible infection, and to contact the health care professional should such signs develops. Many lymphomas can be cured with current treatments. However, as survival rates increase, the incidence of second malignancies, particularly AML or MDs, also increases. Therefore, survivors should be screened regularly for the development of second malignancies. The nurse should instruct the patient to stay away from strenuous activities. He should always have the time to get adequate rest. And the nurse should encourage the patient to take medications religiously, increase fluid intake. The patient should be instructed to keep himself from any injuries and falls. The nurse should raise side rails if the patient it admitted in a hospital. The family should also be instructed to just keep on showing some support towards the patient. Hhould always rie and falls. he patient to take medications religiously, increase fluid intake. the   uld always have the time to get adequate rest. an trenous . g NOn- could have NHL. amination and anamnesis or a family histor Having Non-Hodgkin’s lymphoma is not that good. Patients are sometimes emotionally disturbed especially if they are working and they are the ones supporting their respective families. They would also think of the payments in the electricity, hospital bills and medication. Whenever patients asked something about his/ her condition, the health care professional should be able to answer it to help the patient alleviate worrying. The patient and his/ her family should be given support groups for counseling and for them to be able to express their emotions towards the current situation they are in.h care professional should be able to answer it to ent. ng whenever swollen lymphnodes are References: 1 Cavalli, F. (1998). Rare syndromes in Hodgkin’s and Non- Hodgkin’s. Annals of Oncology. 9 (Suppl. 5), S109- S113. 2. Coiffer, B. (2002). Rituximab in the treatment of diffuse large B- cell lymphomas. Seminars in Oncology, 29 (1, Suppl. 2), 30- 35. 3. Porth, C. M. (2002). Pathophysiology: Concepts of altered health states (6th Ed.).  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Philadelphia: Lippincott Williams & Wilkins. 4. Skeel, R. (Ed.). (1999). Handbook of Cancer Chemotherapy (5th Ed.). Philadelphia: Lippincott Williams & Wilkins 5. Smeltzer, Suzanne, and Brenda G. Bare. Medical- Surgical Nursing. Lippincott Williams & Wilkins, 2004.