American Military history Essay

American Military history is filled with examples of complex operations executed with varying degrees of success. (McGeorge & Wegner, 1983) The most complicated of these missions typically involve multi-phase implementation. The success of multi-phased missions is typically contingent on the actions of multiple agencies, which as a matter of course must interact throughout the duration of the mission. (McGeorge & Wegner, 1983) Historically, the nature of the interaction between various agencies with vested interest in the success of given operations has been varied. (McGeorge & Wegner, 1983) The overall success of such operations is contingent upon many factors, not the least of which is a high level of cooperation between agencies. (McGeorge & Wegner, 1983) The reasons for operational failures in complex missions are many and varied, but the lack of cooperation between agencies is one reason that is inexcusable and preventable through proper training. (McGeorge & Wegner, 1983) Background: The Iran Hostage Rescue Mission of 1980 is one of numerous examples of American attempts to rescue hostages that ended in complete or partial failure. (McGeorge & Wegner, 1983) Up to that point, the record of American military and paramilitary forces in executing successful missions against relatively soft targets had been poor. A facile explanation of this trend would be a lack of proper training and poor execution by the soldiers, sailors and airmen on the ground, but the facts do not support this hypothesis. (McGeorge & Wegner, 1983) In all cases, the failures of hostage rescue missions lay in the planning and command-chain difficulties that compromised the discretion of the assets on the ground. (McGeorge & Wegner, 1983) Task Force Baum in 1945 was a POW rescue mission commanded by General George S. Patton. (McGeorge & Wegner, 1983) Their mission was to rescue 200-300 POW’s being held by the Germans behind enemy lines. As a result of poor intelligence, the Task force encountered no fewer than 1500 POWs, whom they rescued. The larger number of rescuees compromised Task Force Baum’s exit strategy. As a result, all the POWs and nearly 300 of the rescuers were killed. (McGeorge & Wegner, 1983) The failure in this case was not on the ground, but with faulty intelligence, a problem that would become thematic in accounts of mission failures as time went on. (McGeorge & Wegner, 1983) Another example of bad intelligence compromising a mission took place in 1970. A rescue team led by Col. Bull Simmons and consisting of fifty-six Special Forces units was dispatched into north Vietnam for the purpose of liberating a POW camp at Son Tay. (McGeorge & Wegner, 1983) The assault force ended up attacking a camp that had been emptied of prisoners for at least one month. (McGeorge & Wegner, 1983) In yet another example of intelligence failure, the U. S. Marines attempted to rescue the crew of a captured cargo ship in 1975. (McGeorge & Wegner, 1983) The opposing force in this case was the Cambodians, and the operation centered on Koh Tang Island, where the hostages were thought to be held. (McGeorge & Wegner, 1983) After a coordinated assault on the island cost nearly seventy casualties (eighteen dead or missing), it was discovered that the hostages had already been released and were, at the time of the assault, returning to their own ship on a Thai fishing boat. (McGeorge & Wegner, 1983) This poor track record of agency conduct of intelligence continued in 1980, when a joint multi-service force attempted to rescue fifty three Americans who were being held hostage in the embassy in the capital of Iran. (McGeorge & Wegner, 1983) A close examination of this mission yields insights into failures that resulted from inter-agency and inter-service communications breakdowns, intelligence problems, and command issues. From the planning stage on, this mission suffered from the lack of interagency cooperation. (McGeorge & Wegner, 1983) Analysis: In the planning stage of any operation, it is vital that a number of elements be present. (Schnaubelt, 2005) The plan must articulate the organizational objective, accurately describe the current strategic and tactical situation, set forth the intended flow of events, and a definition of the expected contribution of all individuals and groups involved. (Schnaubelt, 2005) In order to have the maximum odds of success, such a plan must contain a clear indication of chain of command, robust and accurate intelligence, and sufficient secrecy to ensure the integrity of the mission. (Schnaubelt, 2005) The Iran Hostage Rescue attempt failed on many of these criteria. Of particular issue was the chain of command. (Sick, 1987) During the execution of the task, pilots in the operation later told investigators that they had no clear understanding of who had authority to be issuing orders. (Sick, 1987) This determination is an element that should have been made abundantly clear to participating personnel well before the execution phase of the operation. (Sick, 1987) In another critical example of failure of the articulation of the chain of command, the Task Force commander and his inferior officers were unclear on who held the responsibility for mission training of the helicopter crews. This state of affairs was allowed to persist for months before the execution phase of the operation. (Sick, 1987) The result of this confusion was a situation that resulted in a collision of helicopters during the aborted mission, which cost several lives. (Sick, 1987) These failure pale in comparison with relation to scope compared to the issues of intelligence that were brought about by multi-agency participation in information control. The numerous intelligence liaisons were encumbered by a specific and inflexible OPSEC (operational security) protocol, which hampered attempts to make information known to the necessary portions of the task force. (Halloway, 1980) This resulted in an unnecessary delay in intelligence compilation and analysis. It is important to note that this deficiency does not point to a shortcoming in intelligence gathering mechanisms, but rather in the inter-agency handling of gathered intelligence. (Halloway, 1980) The resulting delays in formulating intelligence estimates could have been avoided with a centralized intelligence conduit within the task force to which all relevant agencies would be required to contribute. (Halloway, 1980) This failure was justified by the decision-makers in the name of operational security, yet the fragmented gathering of relevant data made the intelligence much more vulnerable to compromise than would have been the case with a centralized intelligence mechanism. (Halloway, 1980) In the preparation phase of the Iran Task Force Operation, failures again occurred predicated on multiple agencies withholding cooperation on the basis of OPSEC issues. (Halloway, 1980) The result was a lack of a full-scale rehearsal for the operation, an element vital to anticipating contingencies, training personnel and refining operational plans. Across the board, there seemed to be more of an interest in rapid execution than in sufficient preparation. (Halloway, 1980) It is clear that a number of involved agencies would have had an issue with lack of preparation, but their objections were not given sufficient attention as the organizational decisions were out of their hands. The Joint Chiefs of Staff commissioned an analysis of the Task force operation (called Operation Eagleclaw) that was completed and presented to the Department of Defense in 1980. The analysis indicated twenty-three issues that contributed to the mission failure, and in many cases, lack of inter-agency organization and coordination were at the heart of the issues. (Halloway, 1980) The first issue addressed in the analysis was that of OPSEC. Since this was acknowledged to be a mission-critical priority, it was this element that was stressed the most during planning and preparation. (Halloway, 1980) The lack of inter-agency communication was said to have negatively effected the planning of and preparation for the operation. It was concluded that the OPSEC plan ought to have had more flexibility at least within the Joint Task Force. (Halloway, 1980) A clear delineation of who was â€Å"in† and who was â€Å"out† that transcended agency affiliation would have been a far more effective method of OPSEC, but interagency mistrust of the integrity of various agencies compelled coordinators to adopt inflexible OPSEC protocols. (Halloway, 1980) Despite the conclusion that OPSEC of the mission was adequate, it is clear that other issues could have been resolved in the preparation phase with better cooperation with regard to OPSEC. A second issue addressed in this mission was the fact that the planning did not include all necessary agencies at all stages. (Halloway, 1980) The planning team began with a limited number, and was expanded as the contingency became more of a definite probability. The haphazard organization of the Joint Task Force created gaps in planning and contingency that might have (but did not, in this case) compromised the success of this mission. (Halloway, 1980) In the absence of a standing task force consisting of multi-agency input, the necessary agencies should have been determined in advanced and all agencies should have been privy to all elements of planning. Again, the justification for the â€Å"need-to-know† contribution to the plan was OPSEC. (Halloway, 1980) The report also noted that intelligence coordination for the mission was executed in the same ad hoc manner, and reporting mechanisms were inconsistent, as task force command got direct reports from some agencies while others reported to component commanders. (Halloway, 1980) As cohesive, accurate and timely intelligence is vital to mission success, this qualified as a major concern in the execution of Eagleclaw. (Halloway, 1980) The fact that intelligence failure did not play a role in the ultimate failure of Eagleclaw should not be construed as an endorsement of the interagency disorganization inherent in early intelligence coordination efforts. (Halloway, 1980) The fact that as planning progressed, the intelligence conduits gained efficiency is also ancillary to the critique of the earlier efforts. (Halloway, 1980) The next major issue identified in the operation was the lack of independent overview of the plan-in-chief. (Halloway, 1980) While reviewed at several phases by the Joint Chiefs, Eagleclaw was never subjected to the robust evaluation by an independent panel of qualified experts. Once again, the blame for this oversight could be laid at the feet of OPSEC. (Halloway, 1980) This deficiency may have been mission-critical, because had such an independent review board contained an expert on local climate conditions and their effect on operational equipment, he or she might have informed the Task Force leadership about the necessity of specialty equipment, repair and spare parts that could have prevented the reduction in force from eight to five helicopters, which fact resulted in the abortion of the mission. (Halloway, 1980) Perhaps the most important deficiency of the Joint Task Force efforts was the lack of comprehensive, multi-agency rehearsal of all elements of the plan. (Halloway, 1980) The execution of such rehearsal is of vital importance at all levels of the operation. At the personnel level, rehearsal gives the actors a sense of the mission circumstances in a safe manner that reflects real-time environment. (Halloway, 1980) The rehearsal is equally beneficial to planning personnel in that a run-through can highlight unforeseen practical or logistical problems in the plan, which can be corrected in subsequent planning. Again, the specter of OPSEC, along with the logistical difficulties of planning a rehearsal of a joint exercise prevented the execution of this vital step. (Halloway, 1980) An issue that also undermined the success of the mission was the constant change in the political circumstances of the hostage situation during the planning phase of the operation created a constant flow of changes in the composition and organization of the task force, which, in turn, created confusion within the command structure regarding chain of command. (Halloway, 1980) Ultimately, the operatives went into mission without a clear sense (in the case of the pilots) of the authority of those giving orders to be giving those orders. While this circumstance did not prove to be a vital flaw in this particular mission, it is a flaw that could easily resulted in a disastrous mission marred by conflicting orders, causing confusion, and, very likely, casualties and mission failure. (Halloway, 1980) The implementation of Signal Integrity contingencies was another area of major failure within the Joint Task Force. While all the agencies involved has a robust understanding and solid implementation of signal protocol during the mission, the agencies did not coordinate these protocols. (Halloway, 1980) As a result, assets entered the area without a uniform protocol with respect to signals integrity. In the case of the helicopter pilots, the maintenance of strict radio silence prevented them from getting vital updates on the weather conditions in the area, leading to some of the mechanical issues that contributed significantly to mission failure. (Halloway, 1980) It is likely that the agencies with the best understanding of the importance of the weather would have implemented an signal integrity protocol that allowed for frequent conditions updates without the need for requests from the pilots, but such a plan was not implemented because it would have combined signal integrity protocols from multiple agencies. (Halloway, 1980) The origin of the circumstances that led to the abortion of the mission was the lack of helicopters necessary to complete the task in the face of mechanical failure of three of the helicopter units. (Halloway, 1980) An independent review of the equipment parameters would likely have called for at least ten helicopters to account for the possibility of mechanical failures. Such a provision would have prevented the abortion of the mission, which was precipitated by the disabling of three of the available helicopters. (Halloway, 1980) Again, proper review and oversight of the mission by independent auditors would likely have recommended ten helicopters be mission-ready at the time of the launch of the operation. These assets were readily available and could easily been incorporated into the Joint Task Force’s equipment requirements without compromising other endeavors. (Halloway, 1980) The mission training protocol for the helicopter pilots also presented problems that were in part caused by the interagency coordination of efforts. (Halloway, 1980) The Navy pilots tasked to drive the helicopters lacked operational experience in the conditions for which the mission called. The Joint Task Force Command addressed this deficiency by supplementing the number of pilots with those from the Marine Corps who had more experience flying in the expected conditions. (Halloway, 1980) Problems developed as pilots were rotated in and out of the training protocols on the basis of ability. In addition, the need to be mission-ready on short notice necessitated several two-three week sessions for training, rather than a preferred five-month long continuous program. (Halloway, 1980) The end result was a group of flying personnel who were not optimally trained, and did not have the necessary experience to deal with conditions in which they found themselves. (Halloway, 1980) The deficiency here mainly lies in the exclusion of Air Force pilots from the docket of potential pilots. It had been established after the fact that the Air Force had several pilots with operational experience in rescue missions, mid-air refueling, and other elements of the flight portion of the mission. (Halloway, 1980) It stands to reason that these pilots would have been likely to accomplish the mission training in a faster, more efficient manner than pilots without this background. When the mission commanders elected to use RH-53D helicopters for this mission, they were institutionally bound to use the pilots checked out on these machines, even though their flight experience did not match the particular mission parameters. (Halloway, 1980) Obviously, the primary factor in the operational failure of the mission was the unexpected dust storms encountered by the pilots en route to the mission. As previously noted, communication liaisons with local weather reporting services may have compromised the security of the operation, however, in retrospect, it seems that such a risk was worth the potential problem given two factors. First, this communication would necessarily be short-term, as any other weather information would be unreliable. (Halloway, 1980) This would relieve security concerns because even if the mission parameters were compromised at that point (and there is no particular reason to assume it would have been) the opposing force would not have sufficient time between the breach of security and the execution of the mission to mount sufficient contingency plans. Second, the ability to successfully navigate to the target area was a critical element in the mission, and a â€Å"sine que non† requisite of success. (Halloway, 1980) Again, in retrospect, it would appear that marginal security concerns outweighed common sense in making the determination to fly without up-to-the minute weather condition updates. Another related option rejected by the Joint Task Force was the use of C-130s in a pathfinder role. (Halloway, 1980) The employment of such equipment in such a manner would have gone further to guarantee rendezvous times and protocols despite adverse weather conditions. Crew of the mission copters lacked confidence in the navigation equipment and their own ability to use it. (Halloway, 1980) This sort of arrangement is the type of non-typical application that would raise alarms between agencies, some of whom would deem off-book applications of material as an unnecessary risk for their own assets. (Halloway, 1980) The decision of the pilot of helicopter #5 to abort mission given the particular damage to his vehicle reflected a lack of knowledge of the capabilities of the vehicle in question. Given the nature of the damage as indicated by on-board diagnostic equipment, the craft would have been able to continue at minimal risk for several hours given the speed and other operation conditions. (Halloway, 1980) The pilot’s decision to abort mission on the basis of this particular damage reflected both a lack of understanding of the nature of the damage, and a gross underestimation of the criticality of the vehicle’s participation. (Halloway, 1980) It was Helicopter #5’s decision to abort that triggered a mission-wide abort, as the number of operable craft had dropped below that which was determined to be mission-critical. (Halloway, 1980) The pilot’s possibly mistaken decision to abort was a function of his lack of training on the vehicle, and understanding of the criticality of his component of the mission. (Halloway, 1980) The fault for these deficiencies lay not with the pilot, but with the afore-mentioned training deficiencies, and a lack of mission-brief emphasis on the lack of discretionary aircraft available to the mission. Lack of information control in the area of intelligence resulted in the pilots acting upon inaccurate intelligence with respect to the capability of the opposing forces’ radar. After the fact, it became apparent that a number of pilots relied on inaccurate intelligence regarding this factor in making tactical determinations regarding flight altitude. The use of the bad information resulted in high-risk, unnecessary flight protocols. (Halloway, 1980) Despite the lack of immediate functional consequence resulting from this breach, it bears mentioning that intelligence need always be reported to the appropriate agencies for confirmation or denial before being acted upon. (Halloway, 1980) The culture within the Joint Task Force regarding intelligence flow encouraged the informal passing of vital intelligence. A lack of an interagency focal point of intelligence analysis made the confirmation and even identification of raw data difficult. It remains a possibility that the pilots placed an inordinate amount of trust in intelligence, believing it to have been confirmed by the responsibly agents, when in fact it had not. (Halloway, 1980) Such considerations are beyond the scope of responsibly of assets in action or support of action. These assets have to be able to assume that any intelligence that makes it way to them is either accurate, or that they have been informed of the probability of inaccuracy, and counseled as to the weight the information should receive in the operations. (Halloway, 1980) When the helicopters began to stray from mission parameters in location and timetable, the radio silence protocol prevented each unit from having vital information about the conditions and locations of other units in the operation. (Halloway, 1980) The USS Nimitz had the capability of conveying such information with minimal risk to OPSEC. Again, the rigidity of OPSEC protocols, brought about by inflexibly inter-agency protocols led to a critical information gap at a vital time in the mission. (Halloway, 1980) Thus, the lead helicopter had no way of knowing that #8 had recovered the crew of #6 and that #6 had been abandoned in the desert. (Halloway, 1980) Lead also could not determine whether the other elements followed him when he turned back in the dust storm, and where and when the unit had fallen apart. Most significantly, if Helicopter #5 had known that his termination would cause an entire mission abort, he might have more carefully weighed the risks of continuing. Essentially, between the weather and the radio silence, the pilots were flying blind and deaf in enemy territory. (Halloway, 1980) Yet another factor at issue was the decision to limit landing options to a single site near a road in the desert near the Iranian capital. The abandonment of the mission after the landing at Desert One guaranteed OPSEC compromise. (Halloway, 1980) The addition of a secondary landing place for refueling and the on loading of combat personnel would have opened many alternatives for the flyers and other mission decision-makers in determining whether to abort, or accounting to course and destination changes prompted by weather contingencies. (Halloway, 1980) The culmination of these factors was the abortion of the rescue mission, which in turn led to a fatal accident as the pilots attempted to withdraw back to base. The operation was a strategic, tactical and political failure. Counterargument: The conclusion that the deficiencies noted above can solely be laid at the feet of the interagency coordination (or lack thereof) is facile and inaccurate. Indeed, even given the modern day organization of counter-terrorism mission task-forces, this mission was fraught with potential for failure. (Houghton, 2001) Operational security became the end-all consideration for the mission’s success, which determination caused many other factors creating risk to be finessed or ignored. Contingencies such as poor weather and mechanical failure cannot be laid at the feet of poor planning. (Houghton, 2001) The clarity of hindsight makes the deficiencies in operation EagleClaw obvious, but it takes a rather torturous analysis to reach the conclusion that the deficiencies can all be blamed on lack of inter-agency coordination. There are several factors that contributed to the failure of EagleClaw that had little to do with the planning and execution difficulties endemic of multi-agency involvement. (Houghton, 2001) First the fluidity of the political situation called for necessary plan adjustments throughout the preparation phase. Second, the unpredictability of weather played a significant role in the mission failure. Such a factor cannot reasonably be blamed on the planning or practice phases of the operation. Decisions that were based on OPSEC considerations were not necessarily a product of interagency confusion. (Houghton, 2001) While it is true that multiple OPSEC protocols were combined to create a stifling procedure on information, the need for secrecy in this mission was considered of paramount importance to its success. (Houghton, 2001) Conclusion: While several unrelated factors contributed to the failure of Operation EagleClaw, it is indisputable that the compartamentalization of information and the ineffective standardization of protocols contributed to the failure of the mission. (Taillion, 2001) Owing to a faulty intelligence analysis protocol, actors proceeded on faulty intelligence. Operation Security concerns ended up compromising reasonable safely contingencies as well. (Taillion, 2001) A determination of Operation Security parameters would have been much more easily concluded by an inter-agency organization that specializes in anti-terrorist operations and is willing to subordinate specific agency protocols for the sake of mission-specific parameters. (Taillion, 2001) The organization of assets in anti-terrorism operations have since been consolidated in agencies such as Homeland Security, yet operations continue to be hampered by reluctance to share assets, particularly intelligence, between agencies. It is recommended that the culture of competition between agencies be undermined by institutional policies that encourage cross-agency cooperation efforts. (Taillion, 2001) It is further recommended that operation planners for future endeavors be encourgaged to ignore inter-agency discrepancies in favor of protocols most able to facilitate the duccess of the missions.

Bloodsucking Fiends: A Love Story Chapter 1

This is a work of fiction. Names, characters, places, and incidents either are products of the author's imagination or are used fictitiously. Any resemblance to actual events or locales or persons, living or dead, is entirely coincidental. Acknowledgements The author gratefully acknowledges those people who helped in the research and writing of Bloodsucking Fiends: Mark Joseph and Mark Anderson for help with research in the Bay Area. Rachelle Stambal, Jean Brody, Liz Ziemska, and Dee Dee Leichtfuss for their careful reads and thoughtful suggestions. My editors, Michael Korda and Chuck Adams, for their clean hands and composure. And my agent, Nick Ellison, for his patience, guidance, friendship, and hard work. In memory of my father: Jack Davis Moore Part I Fledgling Chapter 1 Death Sundown painted purple across the great Pyramid while the Emperor enjoyed a steaming whiz against a dumpster in the alley below. A low fog worked its way up from the bay, snaked around columns and over concrete lions to wash against the towers where the West's money was moved. The financial district: an hour ago it ran with rivers of men in gray wool and women in heels; now the streets, built on sunken ships and gold-rush garbage, were deserted – quiet except for a foghorn that lowed across the bay like a lonesome cow. The Emperor shook his scepter to clear the last few drops, shivered, then zipped up and turned to the royal hounds who waited at his heels. â€Å"The foghorn sounds especially sad this evening, don't you think?† The smaller of the dogs, a Boston terrier, dipped his head and licked his chops. â€Å"Bummer, you are so simple. My city is decaying before your eyes. The air is thick with poison, the children are shooting each other in the street, and now this plague, this horrible plague is killing my people by the thousands, and all you think about is food.† The Emperor nodded to the larger dog, a golden retriever. â€Å"Lazarus knows the weight of our responsibility. Does one have to die to find dignity? I wonder.† Lazarus lowered his ears and growled. â€Å"Have I offended you, my friend?† Bummer began growling and backing away from the dumpster. The Emperor turned to see the lid of the dumpster being slowly lifted by a pale hand. Bummer barked a warning. A figure stood up in the dumpster, his hair dark and wild and speckled with trash, skin white as bone. He vaulted out of the dumpster and hissed at the little dog, showing long white fangs. Bummer yelped and cowered behind the Emperor's leg. â€Å"That will be quite enough of that,† the Emperor commanded, puffing himself up and tucking his thumbs under the lapels of his worn overcoat. The vampire brushed a bit of rotted lettuce from his black shirt and grinned. â€Å"I'll let you live,† he said, his voice like a file on ancient rusted metal. â€Å"That's your punishment.† The Emperor's eyes went wide with terror, but he held his ground. The vampire laughed, then turned and walked away. The Emperor felt a chill run up his neck as the vampire disappeared into the fog. He hung his head and thought, Not this. My city is dying of poison and plague and now this – this creature – stalks the streets. The responsibility is suffocating. Emperor or not, I am only a man. I am weak as water: an entire empire to save and right now I would sell my soul for a bucket of the Colonel's crispy-fried chicken. Ah, but I must be strong for the troops. It could be worse, I suppose. I could be the Emperor of Oakland. â€Å"Chins up, boys,† the Emperor said to his hounds. â€Å"If we are to battle this monster, we will need our strength. There is a bakery in North Beach that will presently be dumping the day-old. Let's be off.† He shuffled away thinking, Nero fiddled while his empire went to ashes; I shall eat leathery pastries. As the Emperor trudged up California Street, trying to balance the impotence of power with the promise of a powdered-sugar doughnut, Jody was leaving the Pyramid. She was twenty-six and pretty in a way that made men want to tuck her into flannel sheets and kiss her on the forehead before leaving the room; cute but not beautiful. As she passed under the Pyramid's massive concrete buttresses she caught herself limping from a panty-hose injury. It didn't hurt, exactly, the run that striped the back of her leg from heel to knee, the result of a surly metal file drawer (Claims, X-Y-Z) that had leaped out and snagged her ankle; but she was limping nonetheless, from the psychological damage. She thought, My closet is starting to look like an ostrich hatchery. I've either got to start throwing out L'eggs eggs or get a tan on my legs and quit wearing nylons. She'd never had a tan, couldn't get one, really. She was a milk-white, green-eyed redhead who burned and freckled with sun. When she was half a block from her bus stop, the wind-driven fog won and Jody experienced total hair-spray failure. Neat waist-length waves frizzed to a wild red cape of curl and tangle. Great, she thought, once again I'll get home looking like Death eating a cracker. Kurt will be so pleased. She pulled her jacket closer around her shoulders against the chill, tucked her briefcase under her breasts like a schoolgirl carrying books, and limped on. Ahead of her on the sidewalk she saw someone standing by the glass door of a brokerage office. Green light from the CRTs inside silhouetted him in the fog. She thought about crossing the street to avoid him, but she'd have to cross back again in a few feet to catch her bus. She thought, I'm done working late. It's not worth it. No eye contact, that's the plan. As she passed the man, she looked down at her running shoes (her heels were in her briefcase). That's it. Just a couple more steps†¦ A hand caught in her hair and jerked her off her feet, her briefcase went skittering across the sidewalk and she started to scream. Another hand clamped over her mouth and she was dragged off the street into an alley. She kicked and flailed, but he was too strong, immovable. The smell of rotten meat filled her nostrils and she gagged even while trying to scream. Her attacker spun her around and yanked on her hair, pulling her head back until she thought her neck would snap. Then she felt a sharp pain on the side of her throat and the strength to fight seemed to evaporate. Across the alley she could see a soda can and an old Wall Street Journal, a wad of bubble gum stuck to the bricks, a â€Å"No Parking† sign: details, strangely slowed down and significant. Her vision began to tunnel dark, like an iris closing, and she thought, These will be the last things I see. The voice in her head was calm, resolved. As everything went dark, her attacker slapped her across the face and she opened her eyes and saw the thin white face before her. He was speaking to her. â€Å"Drink,† he said. Something warm and wet was shoved into her mouth. She tasted warm iron and salt and gagged again. It's his arm. He's shoved his arm in my mouth and my teeth have broken. I'm tasting blood. â€Å"Drink!† A hand clamped over her nose. She struggled, tried to breathe, tried to pull his arm out of her mouth to get air, sucked for air and nearly choked on blood. Suddenly she found herself sucking, drinking hungrily. When he tried to pull his arm away she clutched at it. He tore it from her mouth, twisted her around and bit her throat again. After a moment, she felt herself fall. The attacker was tearing at her clothes, but she had nothing left to fight with. She felt a roughness against the skin of her breasts and belly, then he was off her. â€Å"You'll need that,† he said, and his voice echoed in her head as if he had shouted down a canyon. â€Å"Now you can die.† Jody felt a remote sense of gratitude. With his permission, she gave up. Her heart slowed, lugged, and stopped.

Sustainablity Marketing Plan -- 3M Corporation Speech or Presentation

Sustainablity Marketing Plan -- 3M Corporation - Speech or Presentation Example Currently, it is one of the premier manufacturing corporations. The corporation manufactures diversified products including more than 60000 different products which are observed to dominate in their respective markets. The corporation operates with 81 manufacturing sites in 28 states in the United States of America. 3M operates in more than 133 manufacturing and converting facilities in over 60 nations globally (3M Company, â€Å"Inspired innovation†). The corporation is engaged in various technology oriented segments. It manufactures products for wide-range of industries such as transportation, healthcare, safety, security and protection services, consumer and office, displays and graphics as well as electro and communication businesses. In addition to this, the corporation sells its products through various channels such as through the involvements of distributors, wholesalers, retailers, dealers, as well as directly to the costumers nationally and internationally across the world (Reuters, â€Å"Profile: 3M Co (MMM)†). Thesis Statement The discussion intends to critically identify the initiatives of 3M Corporation for ensuring sustainable growth and economic progress. It also intends to provide sustainable marketing plan for the corporation keeping in consideration the integral aspects such as promotion. Marketing Mission and Corporate Sustainability 3M Corporation is a global manufacturer and technology innovator successfully operating across the world primarily in six different operation segments. The corporation’s prime mission is to earn customer loyalty and respect by effectively differentiating it from its competitors. Moreover, the company is determined to operate with uncompromising authenticity and integrity in its all operational activities. It also aims at satisfy diverse customers with innovative technologies and superior quality products and services. Furthermore, it intends to place deep respects for its investors and provi de them high and attractive returns through sustainable and global growth. The corporation in relation to its mission concentrates on continuous development of social, physical and economic environment around the world. Least but not last, the company intends to develop employees skills and leadership qualities through its continuous initiatives (3M Company, â€Å"Sustaining Future†). The corporation’s sustainability strategies are primarily focused on customers’ satisfaction and its overall commercial success within social, economic and environmental values and frameworks. Its strategies are directed towards promoting healthy environment and safety measures at its different locations worldwide. The corporation’s sustainability strategies also emphasize on pollution prevention endeavors through continuous development of new and efficient technologies and products to be offered to its wide range of customers. As a part of its sustainability strategies its focuses on acquiring and retaining a pool of competent and skilled workforce as

Annotated Bibliography Example | Topics and Well Written Essays - 750 words - 16

Annotated Bibliography Example The author is an associate professor of history at Hamilton College with a vast of experience on the experiences of black-American soldiers at the hand of the white majority, despite their efforts in the war. Being well-researched for from a wide scope of scholarly materials, the book deeply covers financial and racial discrimination visited upon the black soldiers. It is a good historical on racial discrimination against black soldiers during the civil war. The author is a senior partner in the Washington, D.C., law firm Covington & Burling, and has published carefully documented articles on the experiences of black American soldiers during the Civil War for more than thirty years.  These articles cover a broad spectrum of discriminatory nature of white soldiers and white societies against black veterans during the civil war. A profile of the author of this book reveals that he has authored many books on civil war and has a deep sense of knowledge about the experiences of black soldiers during the civil war. The book also helps us understand the various discriminatory practices that the black soldiers had to endure like substandard medical care. The book is well written and the author has extensively researched for the book. It is recommendable to history students and I expect to learn more about the predicaments of African-American soldiers during the civil war. The author is an expert in history and is a professor of History at Princeton University, and a leading historian on civil war. The book also clearly presents the humiliating experiences the black soldiers went through in the hands of white colleagues and from their white superiors. The author has drawn his references from contemporary journalism, books, speeches and letters. The book contains reputable information that helps the reader to vividly understand the discriminatory environment the Black-American soldiers lived in. The author is an amateur scholar

Tedlow's Three Stage Model Essay Example | Topics and Well Written Essays - 1000 words

Tedlow's Three Stage Model - Essay Example It was a sore neck that introduced Janine Charles to the world of Wal-medicine.Her search for a local doctor's office gave her an address that turned out to be a Super Wal-Mart in Orlando, Florida.She thought about giving up and trying another address, but she instead went inside the store and wandered around.Inside, she found that space formerly used to house a small video arcade had been transformed into a medical clinic. She ended up paying $90 for an examination and a shot of muscle relaxants. Had she gone to a traditional doctor's office, the same treatment would have cost her $200. In most emergency rooms, the treatment would have cost over $500. Even better, this clinic accepted Ms. Charles' insurance. If you also factor in the fact that Ms. Charles could do her grocery shopping in that store while she waited for the pharmacy to fill a prescription for her, you suddenly have a very convenient trip (Rowland).While Ms. Charles visited a clinic that was staffed by a doctor, most of the clinics inside Wal-Mart, Target, and other big-box retailers feature nurse practitioners, who can write prescriptions in most states. The retailers do not enter the world of medical care as part of their own corporate activities, but simply lease the space to clinics. It's not just the big-box retailers who are looking into clinics, either. Because of the losses due to mail-order pharmacies and big-box retail sales, drugstore chains are also opening clinics. Rite Aid Corp., Brooks Eckerd Pharmacy, and Osco Drugs are all entering partnerships to open clinics, and Walgreen Co., the pharmacy chain with the most sales volume in the United States, is also negotiating a deal to have Take Care Health Systems LLC operate clinics in some of their retail locations. The retailers who are leasing space to these clinics hope to make profit not just from the leases themselves, but from the ancillary shopping that will go on while people wait for their prescriptions to be filled, or wait fo r their appointment to be called. It is similar logic to those grocery stores and big-box retailers who have leased space to banks, hair salons, postal service kiosks, and fast-food restaurants (Moewe). Doctors' associations, as one might expect, have raised objections about the possible problems with this type of medical care. While nurse practitioners can treat a number of simple illnesses, the American Medical Association notes that simple symptoms can be indicative of any number of serious illnesses. The primary concern of many customers, however, is a combination of convenience and cost. Doctors' offices are often seen as insensitive when it comes to a patient's time, often making customers wait significant amounts of time past their scheduled appointments. Also, the simple cost, especially for the uninsured, of an ordinary visit to the doctor's office can easily exceed $200 - and since these clinics charge rates starting at $25, depending on what the customer needs, it is easy to see that these clinics will draw many customers away from their physicians (Spencer). What factors should companies use when considering whether or not to enter the doc-in-a-box game Tedlow's three-stage model of marketing, whereby marketers move from fragmentation to mass marketing to segmentation, can be instructive here (Ellickson). Market fragmentation can be defined as "the emergence of new market segments with distinct needs and requirements out of previously homogenous segments. These new segments limit the usefulness of mass marketing and erode brand loyalty" (Dictionary of Marketing Terms). The doc-in-a-box concept still seems to be either in the latter stages of this fragmentation stage or the initial stages of the mass marketing stage. Traditionally, the relationship between patient and doctor has given the doctor a considerable

BUSINESS ECONOMICS Essay Example | Topics and Well Written Essays - 1250 words

BUSINESS ECONOMICS - Essay Example This paper will discuss the concept of elasticity and how a government tax on a product -- in this instance, cigarettes -- can affect the business firm in terms of how much a specific tax on cigarette can be shifted to the buyer and how much has to be absorbed. Price elasticity (Ep) of demand is the ratio of the percentage change in quantity to the percentage change in the price of a product or service, all other things remaining unchanged. Algebraically, this is expressed as follows: where P and Q are the price and quantity, respectively. This formula assumes point elasticity instead of an arc price elasticity for simplicity sake, as our objective of understanding the concept of elasticity can be sufficiently served by this simple assumption. Price elasticity measures how responsive the sales would be in relation to changes in price. Products and services inherently have different price elasticities, so that managerial decisions on expansion or reduction of output would depend to an important degree on how accurate are the determination of such elasticities. At the outset, we may consider the benchmark elasticity = 1 as indicating that a percentage change in price is just equaled by the same percentage change in quantity demanded. Where demand is somewhat less responsive to changes in price, we can say that demand is relatively inelastic -- that is to say, a percentage increase in price triggers a lower percentage change in quantity demanded. Demand is relatively elastic when a change in price causes a larger percentage change in quantity demanded. A vertical demand curve denotes perfectly inelastic demand with an Ep of 0, whereas a perfectly elastic demand would be a horizontal demand curve with an Ep of infinity ( ∠ž). An important elasticity criterion is whether a good is a necessity or a luxury. A necessity has an inelastic or relatively inelastic demand curve. A good that is inessential (or a luxury) has a relatively elastic demand curve;

Critically discuss the effectiveness of parliamentary and judicial Essay

Critically discuss the effectiveness of parliamentary and judicial cantrols over delegated legislation in the english legal system - Essay Example Legislation made by delegated legislation should be created in harmony with the purposes stipulated in the Act. The role of delegated legislation is to enables the UK Government to amend laws without waiting for new Acts of Parliament to be passed in the house. It`s worth noting that delegated legislation can also be used to create technical changes to a law, for instance altering sanctions in a given statute. Local Authority also has power confer to them under some statutes to enables them to create delegated legislation and also to make law that suits their area (Jayakumar, 2005, pg. 89). The delegated legislation offers a very important function in the making of laws in UK legal system as there exists more delegated legislation enacted every year than there exist Acts of Parliament. Moreover, delegated legislation has similar legal standing as the Act of Parliament which it was made. These are clear justifications that the question of effectiveness of judicial and parliamentary control over the delegated legislation is a weighty issue to examine in the UK legal system. It would be inappropriate to assume that parliamentary control over delegated legislation is actually a burning issue in a country where most voters would probably be acquainted with what delegated legislation is about. It`s because of this that it is hard to come across members of any of UK parliaments ready to take much interest regarding the matter. Nonetheless it is of great significance, since unregulated delegated legislation provides a fertile field for UK government despotism as well as bossy interference by the bureaucrats. Therefore, it not wrong for one to say parliamentary control over delegated legislation is somehow ineffective. Delegated laws at times create much more effects on the lives of common citizens compared to most acts of parliament. In the UK, most delegated legislation

What Are The Implications For Social Workers In Combating Re-Offending Dissertation

What Are The Implications For Social Workers In Combating Re-Offending Among Children And Young People - Dissertation Example The view is holistic in approach which excavates the theories and situations and how social workers are working on curtailing re-offending among that section of the society. It is understood that the report is meant to analyze these details and intends to continue the work of social workers in the field of re-offending among delinquents and young people. The report mainly relies on the handbook of Social Exclusion in U.K brought out by the Government of U.K. And the journal article of the National Association of social Workers. Many books have been referred to which deals with abnormal psychology and portrays criminal behavior as a clinical problem. The report intends to problem-atize every bit of the topic and proposes to find a solid solution to it. Introduction: To begin with re-offending among children and the youth, one must thoroughly study crime in the first place. Every man born into the society is always penetrated with societal norms through rigorous socialization. Norms are the set of ideas and rules which members of the society must abide by. The next concept is of sanctions. Social norms are mostly accompanied by sanctions to foster conformity and more than that, protect against non-conformity to facilitate social binding.norms are mostly accompanied by sanctions to foster conformity and more than that, protect against non-conformity to facilitate social binding. Positive and negative sanctions have different forms. Punishment is a big form of negative sanction. Sociology has time and again come up with newer theories to explain crime and deviance and mostly juvenile delinquency. As mentioned earlier, socialization helps to make every human being settle in the society with ease and comfort, by abiding the social rules and norms. But many despite being socialized to follow these rules and norms decide to not follow them or rather deviate from them. These elements are usually known as sociopaths – impulsive, judgmental and usually lack insight unlike criminals whose deeds have a planned character. Most children on their path to socialization often take up deviant methods. Anything that is unusual, queer or abnormal is termed as deviant. And the character to deviance differs from each other (Quinn, 2004). Offending is a social term more than legal. But our topic clearly deals with re-offending or repetition of crime may be of the same or different character. Crime and delinquency is the subject we are dealing with. Now both these terms have a strong legal tinge to it. The concept of delinquency differs with the Penal code of different states and countries. Criminal tendency or the inclination to commit a crime is seen not only in adults but also in children. There is entire genre in literatu re dealing with sibling rivalry, dealing with infinite instances of juvenile delinquency. Young offenders are therefore criminal minors. These young people deviate from the cultural norms and commit grievous offences extending from murders to thefts, drinking to brutal sexual activities and so on. The foremost social reason for offending among children and the youth is due to a lack of proper socialization. Socialization happens both from home and peer group. Children often commit crimes under the influence of peer groups; impulsively just to try out something for fun. Or mostly as many social workers have pointed out, it happens due to

What Is Critical Literacy Essay Example | Topics and Well Written Essays - 1000 words

What Is Critical Literacy - Essay Example Critical literacy is important as it moves readers beyond traditional view point about reading literature for the sake of reading the words but also to read the world. Coming up with questions about people whose voices have been represented or missing in the text, who gains or losses because of reading the text, assists the reader comprehend the text’s objectives and protect readers from being manipulated by the text itself (Joseph, 1985). Critical literacy support readers to analyze texts actively and offer strategies for uncovering underlying information. There are many different perspectives about critical literacy which have produced various pedagogical approaches about learning and teaching. All these approaches have a common basic ground that literacy needs literate users of texts to implement a critical questioning approach (Edward, 2006). Proponents of critical literacy suggest that the practice is not just a way of achieving literacy by improving one’s ability to decode texts but is the ability to have a dialogue with others about the various meanings information might have and taking through a potentially critical learner how to think flexibly. Literacy development has encouraged students to interrogate issues of power, for example the disparities in a social context for instance socio-economic status, gender, sexual orientation, class, race etc. Students have become critically literate because they have the ability to critique messages that are in the texts that they read. Fundamentally, instructors who use critical pedagogy show how to examine the language and how it plays a role in the social construction. This therefore implies that critically literate students evaluate ongoing development, the role they play on the earth and how experiences make sense to them. There are many ways of involving students t o become critical members

Smart phones effect teenagers Essay Example | Topics and Well Written Essays - 1000 words

Smart phones effect teenagers - Essay Example These phones provide ideal environment to those young people who want to stay connected to their friends all the time. The public transport that is commonly used and ride provided by the parents to their children has provided good time for children to get connected to social cite by use of Smartphone’s. Some of the effects include teens not sleeping at night due to phone vibration due to text messages, these activates the mind distracting the sleep hence bringing issues of sleep during the day. These have forced many parents to forbid phones during bedtime and homework time. Many school has burned the use of Smartphone’s in class because student will be tempted to open the social sites and sometimes the phone will ring hence causing distraction teaching. The phones has both negative and positive impacts on the teens, this research explains how Smartphone’s have gotten into teens live, their effects, both positive and negative impacts. The article explains that smarthphones has grown from business work tools into addictive devices. Before, the phones was used to check mail and serf the web but right now it has developed into a powerful tool for accessing social websites such as twiteeter and facebook and it has end up having several effects on the children. The article further explains if teenagers requires smarthphones and whether this constant connection and accessibility to these devices are necessary. The book explains how Americans teens use internet as a source of normal socialization through Smartphone’s. It shows and explains the statistics conducted by pew internet in 2000. The survey shows that 91% use internet and social networking sites to stay in touch with friends and 72% use to make plan with friends, all these is done through the Smartphone. The article explains that the use of smarthphones among the teens

Macbeth Coursework Essay Example for Free

Macbeth Coursework Essay Refer ring to the three main scenes that the witches appear in, write about the effect they give to the play as a whole and also how they influence Macbeth to behave as he does. Macbeth, a tragic story of how greed can corrupt the mind. Written in 1606 for King James the first, people did actually believe in witches. I my-self believe that William Shakespeare used the witches as the fuel for his play, I think this led to the massive success of Macbeth. When people thought of King James the first they may have also thought of witches. After all James did publicise his beliefs and thought in witches. He believed that they had an effect on his life. The people of his countries (England and Scotland) would have thought it was completely normal. Now a day, if someone accused someone of being a witch, the accuser would be looked upon in society as insane. The idea of witches over the years has simply dried out. In class we have watched and studied two different films based on Macbeth. One was Macbeth on the Estate. This was extremely different to what I expected. Produced in 1996 its quite a modern film. I thought it was incredible how they managed to use every word from Macbeth, (the play its-self) and fit it into a modern set. The film was filmed on an estate on Birmingham and the main characters were young street yobs! Personally I think it must have been a hard job for the film producers to re-film Macbeth into a modern time. Another film was just called Macbeth produced in 1971 its quite an old film. It was though exactly what I expected. It was a brilliant film and only a few features let it down. Music which I think plays a big role in films and plays because it allows us to understand the mood and feeling of the play/film. I think technology was to blame for this though! Did the witches have an effect on the audience? Yes of course did. Why? Simply because witchcraft played an big part in the lives of the people who lived during the period of the 1500s to the 1600s. I mean, going out to town, bowling is all normal but what about going to see the local witch been executed publicly? 300 years ago this would as normal as any of the activities above. Back then I think people were fascinated with witches. Witches held so much mystery and had a force of fear surrounding them. Of course this is what people thought, if people went to see Macbeth at the theatre in Leeds, obviously I dont think people would have as much interest as people 300 years ago. There would be interest in the witches Im not saying the opposite, but not as much as back then. I think it would make the audience wonder how and why the people of the 1600s lived like they did. The witches appear in three main scenes in Macbeth: Act 1 scene 1 Act 1 scene 3 Act 4 scene 1 In act 1 scene 1 they, to me, introduce the play. Although we often forget that the play is all about witchcraft, thinking about it, the witches do play an important part in Macbeth. I think when Shakespeare wrote act 1 scene 1 his intentions were to grip the audience at the very beginning. The witches do not appear to do anything in this scene it seems as if theyre there to introduce them-selves, they dont really appear for a reason. I think its just to hype the audience up for the rest of the play. In act 1 scene 3 the witches tell us basically what Macbeth is about. Shakespeare grips the audience even tighter when they say: FIRST WITCH: All hail Macbeth, hail to thee Thane of Glamis. SECOND WITCH: All hail Macbeth, hail to thee Thane of Cawdor. THIRD WITCH: All hail Macbeth, that shalt be King hereafter. I think Shakespeare here uses repetition really well. It adds mystery and feeling to the play. A Victorian audience at this moment must be really into the play. The mystery deepens even more when less than a few scenes away a messenger arrives to tell Macbeth that he is now Thane of Cawdor. A modern audience at this point must shiver with excitement. A Victorian audience may have done the same, after all these people did fear witches in their day. In act 4 scene 1 I dont really feel that this scene does much for the play. Some people may disagree and I can see why. I mean people sat their reading the book must be thinking, how the hell can a tree move? This is because Macbeth says: MACBETH: Who can impress the forest, bid the tree Unfix its earth-bound root? This will keep the reader wondering, I wonder when this prophesy will come true? I think they would think this because they want to see how the tree ends up moving this was clever on Shakespeares part this would have helped keep the audience interested. There are three prophesies all which tell Macbeth when to start worrying. The language the witches use is strange even for Shakespeares time! Another thing is that the lines are shorter than the lines in other parts of the play. I dont think this is a coincidence, I personally think Shakespeare did this to keep the witches rhymes simple. I think he did this to keep the audience interested and not put them off. The use of rhyme people often forget that poetic writing doesnt have to rhyme, in fact in the play there isnt really much rhyming going on, but when the witches speak in Macbeth therere speeches do rhyme unlike most parts of the play. To add even more mystery to the witches they use strange ingredients in their potions! I mean we all expect strange items but not that strange. Cats tongues, guts, eyes what more do we want? I think this would have helped Shakespeare with his audience. I think they would have loved the idea of witches around a cauldron especially James! Going back and looking at these two scenes: Act 1 scene 3 Act 4 scene 1 We see that Macbeth is involved in both scenes. In act 1 scene 3 we see Macbeth as a worrier for his country, a gentleman. In this scene he bumps into the witches with Banquo his best friend. From what I can tell Macbeth is a bit shocked I think this because he basically asks them what they are, I think he doubts that they are human. I think this because Macbeth says: MACBETH: Speak if you can: what are you? The witches then tell Macbeth that he shall be Thane of Cawdor then King. Banquo interrupting seems more enthusiastic about talking to the witches who then tell Banquo his children shall be Kings. Maybe Macbeth is trying to take in what hes just been told. I think Macbeth wants to believe the witches but he doesnt want to get his hopes up. Thats why hes looking for a reason, he asks: MACBETH: By Sinells death I know I am Thane of Glamis, But how, of Cawdor? The Thane of Cawdor lives A prosperous gentleman; The witches then vanish and Macbeth is left talking to Banquo. I think Macbeth is still avoiding taking about him been King, he says: MACBETH: Your children shall be Kings. In Act 4 Scene 1 we see Macbeth as a murderer and a evil man or should I say King. He barges onto the scene and demands answers from the witches I know this because he says: MACBETH: Howeer you come to know it, answer me: Three apparitions then go on to tell Macbeth three things: One that he should be aware of Macduff, Two that he should he should be aware of anyone not born from a womens womb and Three that he should we weary when the woods begin to move. I think at this point in the play Macbeth is worried about Banquos children and what the witches told Macbeth at the beginning of the play. I think this because he says: MACBETH: Can tell so much-will Banquos issue ever Reign in this Kingdom? The witches do not give Macbeth his answer. I think the reason for this is because if the audience know the answer to this question then they can figure out the end of the play. As Ive already said, I do think the witches played an enormous part in Macbeth. I also think that they play a rather big part in Macbeths life after all arent they really the ones responsible for King Duncans death? I think they are. I think this because at the end of the day the witches gave Macbeth the idea of killing the witch. I think as soon as the third witch says: THIRD WITCH: All hail Macbeth, that shalt be King hereafter. I think this is, in a way the poison been injected into Macbeths blood. Its only a matter of time before it begins to kick in, and when it does Macbeth will think up his plans to murder King Duncan. Another reason I think the witches are to blame is because Macbeth wouldnt have done it with out them I think this because Macbeth says to his wife when she pushes him into murdering Duncan: MACBETH: We will proceed no further in this business He also says: MACBETH: So foul and fair a day I have not seen. I think the above proves he wouldnt have murdered Duncan if he had not met the witches. I dont think the witches are all to blame though, I dont think Lady Macbeth helps either shes always trying to push Macbeth into committing murder. Some people in the audience may wonder if Lady Macbeth is a witch or perhaps the witches have put a spell on her? I have seen two different versions of the witches on screen and both were extremely different. Obviously the two versions were Polanskis version and Macbeth on the Estate. In Polanskis version the witches were what you would expect, old ugly women who lived in a dirty smelling cave but in Macbeth on the estates version the witches were played by three children who lived in an old abandoned flat. I thought this was a rather interesting (and clever) concept. Both films were very good but if I had to choose one which I thought was the most effective (concerning the witches only) I would choose Polanskis version. This is because the witches were exactly what I expect and want. You dont want sweet little children playing the part of horrible witches. It just isnt Macbeth. It rips the whole idea of witches into shreds or to be more precise it doesnt follow the stereotype. Some people may think this is a bad thing but I would have to disagree with them. However in Polanskis version the witches are brilliant theyre ugly, theyre old, theyre dirty and theyre naked. I also think Polanskis version was better because we saw the witches using magic. For example when they faded out into thin air. It was what I expected and the reasons above are the reasons I choose Macbeth over Macbeth on the Estate.

Inborn errors of metabolism

Inborn errors of metabolism 1.0 Abstract Inborn errors of metabolism occurs 1 in 5000 births collectively. They can be treated if the inborn error is diagnosed properly and early. They are manly caused by a gene defect that blocks vital metabolic pathways. The can be server, which is mainly due to amount of enzymes that is causing the block or deficiency of the reaction product. This can affect the organs and also have local effect such as lysosomal storage disease. The symptoms can vary, from mild to severe. They affect any organs and occur at any time. To recognise the Inborn Errors of Metabolism, the doctor must be suspicious; for example a baby that show signs of antecedent maternal fever should undergo a blood culture and also undergo simple tests such as Amino acids, Organic acids, Glucose, Electrolytes, Lactate, and Ammonia; which is done in the laboratory. 2.0 Abstract Inborn errors of metabolism (IEM) are a group of genetic disorders that are rare. These disorders are genetic diseases that are involved in metabolism disorders. A large section of these disorders arise from single genes that encodes for enzymes; that have been defective. These enzymes are important that they catalyses chemical reactions converting substrates to products essential for everyday living. Inborn errors of metabolism disorders can arise from a number of conditions such as prolong exposure and accumulation of substances which are toxic, and the interference of normal functions and the inability to produce and synthesize essential compounds. Inborn errors of metabolism has related to defects in or damage to a developing foetus that may have been caused to genetic changes, that is why Inborn errors of metabolism is sometimes referred as congenital metabolic diseases. Inborn errors of metabolism have also been linked to heritable disorders within biochemistry, for example phe nylketonuria (PKU). That is why some times it is referred as inherited metabolic diseases as well. In the perspective of changes of normal mechanical, physical, and biochemical functions, IEM can divided into three useful groups that can be analysed diagnostically. Group 1: Disorders which causes intoxication. Group 2: Disorders involving energy metabolism. And Group 3: Disorders involving complex molecules. 1.0 Introduction 1.1 Inborn Errors of Metabolism In the early 1900s, a researcher called Sir Archibald Garrods based his studies on genetic metabolic disorders and discovered IEM [1, 2]. He was known for his work on the one gene, one enzyme hypothesis, based on his studies on the nature and inheritance of alkaptonuria. And gave the name and wrote a book on IEM (The Incidence of Alkaptonuria: a Study in Chemical Individuality.) [1, 2]. IEM can arise from a number of causes, but the major cause is alteration of a specific metabolic reaction [1, 2]. IEM has been shown to develop at a very young age, where epidemiology findings indicated that hundreds of IEM affects about 1 in every 5000 born babies [2]. But as technology advances and improved techniques such as metabolomics, has been easy to develop newborn screening that improves early diagnosis and treatment in a number of IEM disorders [2]. But as these new techniques cost a lot to run and time increases, proving to be unreliable [2]. The study and the knowledge about inborn errors of metabolism (IEM) have improved due to the latest advancement in technology and techniques [2, 3]. These improvement have led us to the conclusion, for example urea cycle disorders and organic acidemias may and will lead to the accumulation of ammonia, which is a toxic product of amino acid metabolism [2, 3]. Also the latest findings are that inborn errors of metabolism (IEM) may impair brain function due to defects in the mitochondrial respiratory chain and disorders in gluconeogenesis [4]. There are 10 facts that need to take inconsideration when people with IEM undergo clinical diagnosis [5]. Common condition such as, intoxication, encephalitis and brain tumours in older patients and also sepsis have to be analysed properly and always consider IEM in the same field [5]. Symptom that persists and that are unexplained even before, during and after initial treatment and usual investigations has been performed, have to be taken to consideration that it could be IEM [5]. Newborn babies that have organ dysfunction, hypo-perfusion, or hypotension can develop sepsis, which can be caused by IEM. So any babies in neonatal intensive care unit that die, the first cause that has to be taken to account is IEM [5]. Have to take extra care in reviewing all autopsy findings [5]. The examiner must not confuse a symptom for example peripheral neuropathy; or syndrome such as sudden infant death with etiology [5]. IEM can develop and present at any age, for example from foetal life to old age [5]. The examiner must take to account that not all genetic metabolic errors causes are due to hereditary and transmitted recessive disorders, but a large section of individual cases are sporadic [5]. Always consider inborn errors of metabolism are open to treatment for example with patients that have inborn errors of metabolism due to intoxication [5]. In server situations, the examiner will need to take a few patients with IEM that are able to diagnose and treat the patient with IEM [5]. The examiner must be open to obtain help from specialised centres that specialise with IEM [5]. The metabolic disorders can be set into three useful groups that can easily be distinguished from each other [5, 6, 7]. These three groups are sorted from a pathophysiological point of view [5, 6, 7]. The groups are; Group 1: Disorders which is caused by intoxication [5, 6, 7]. Group 2: Disorders involving energy metabolism [5, 6, 7]. And Group 3: Disorders involving complex molecules [5, 6, 7]. 1.2 Group 1- Disorders which is caused by intoxication In this group, it describes inborn errors of intermediary metabolism. These inborn errors cause acute of progressive intoxication from long exposure and increase of toxic compounds, forming a metabolic block [5, 6, 7]. In group 1 the inborn errors are manly amino acid catabolism [5, 6, 7]. These include phenylketonuria, where there is a deficiency in the enzyme phenylalanine hydroxylase (PAH); which is needed to metabolise the amino acid phenylalanine to the amino acid tyrosine [5, 6, 7]. Homocystinuria is an inherited disorder of the metabolism of methionine [5, 6, 7]. Tyrosinemia is where body cannot break down the amino acid tyrosine [5, 6, 7]. Also organic acidurias such as methylmalonic acidemia, and propionic acidemia [5, 6, 7]. Sugar intolerances are also classified in group 1 [5, 6, 7]. These include hereditary fructose intolerance caused by a deficiency of liver enzymes that metabolise fructose. Metal toxication also falls under group 1; such as hemochromatosis, where the patient has accumulated a lot of iron [5, 6, 7]. All these metabolic disorders have something in common, in that they do not affect the embryo development, and also show similar symptoms of clinical intoxication [5, 6, 7]. A patient with group 1 disorders may show an acute signs of vomiting, coma and liver failure; or chronic signs which are cardiomyopathy, developmental delay and failure to thrive. Acute symptoms that can worsen are catabolism, fever, and food intake [5, 6, 7]. The analysis in group 1 is easy, and without any complications [5, 6, 7]. It needs the use of chromatography in which the plasma and urine amino acid. Most of group 1 disorders are treatable. Treatment is usually involves special diets and cleansing drugs such as sodium benzoate and penicillamine, to remove the toxins [5, 6, 7]. The inborn error of amino acid synthesis is also included to this group, as they have the same or similar features [7, 8]. They are inborn errors of intermediary metabolism; the analysis requires the plasma and urine where disorders are able to be treated even when the disorder starts with in the uterus, for example 3-phosphoglycerate dehydrogenase deficiency [5, 6, 7, 8]. 1.3 Group 2- Disorders involving energy metabolism In this group inborn errors are errors of intermediary metabolism as well. The symptoms are mainly caused by a lack of energy production or utilization. This will involve the liver, myocardium, muscle, and brain [5, 6, 7]. There are two types of disorders involving energy metabolism. 1. involves mitochondrial energy defects. 2. involves cytoplasmic energy defects [5, 6, 7]. Mitochondrial energy defects are more aggressive and are not fully treatable [5, 6, 7]. Mitochondrial energy defects cause lactic acidemias where there is dextrorotatory lactic acid in the circulating blood, resulting to defects of the pyruvate transporter resulting to PKU, pyruvate carboxylase this causes lactic acid to accumulate in the blood, pyruvate dehydrogenase where the patient can show symptoms of severe lethargy, and defects in the Krebs cycle [5, 6, 7]. But some defects such as fatty acid oxidation and ketone body defects are partly treatable [5, 6, 7]. Cytoplasmic energy defects are not as much aggressive then mitochondrial energy defects. A cytoplasmic energy defect causes disorders of glycolysis, glycogen metabolism and gluconeogenesis [5, 6, 7]. And recent study showed it causes disorders of creatine metabolism which it is partly treatable by oral creatine supplementation [5, 6, 7]. Cytoplasmic energy defects can cause disorders that are untreatable, such as errors of the pentose phosphate pathway which will be described in further details [5, 6, 7]. In group 2, the common symptoms are heart muscle disease, hypoglycaemia, myopathy which is a muscular disease, cardiac failure, specific failure of the circulation, sudden death especially in infancy [5, 6, 7]. Mitochondrial disorders and as well as the pentose phosphate pathway defects can obstruct embryo-foetal development and give rise to dysmorphism, dysplasia causing an abnormality in maturation of cells within a tissue and congenital disorder [5, 6, 7, 9]. The analysis and the diagnosis are hard to put through as it requires 4 different tests [5, 6, 7]. 1. Function tests [5, 6, 7]. 2. Enzymatic analyses needing biopsies [5, 6, 7]. 3. Cell culture [5, 6, 7]. 4. Molecular analyses [5, 6, 7]. 1.4 Group 3- Disorders involving complex molecules. Group 3 involves cellular organelles [5, 6, 7]. The diseases that fall under group 3 modify the synthesis or the catabolism of complex molecules [5, 6, 7]. There are symptoms that are permanent and progressive, and some symptoms free from intercurrent events [5, 6, 7]. In this group there are disorders such as lysosomal storage disorders, peroxisomal disorders and inborn errors of cholesterol synthesis etc. In this group treatment is difficult would need enzyme replacement therapy, especially for lysosomal disorders [5, 6, 7, 10]. 2.0 General Symptoms and Signs There is a way for testing newborn babies for inborn errors [11]. This process is called Newborn screening. This tests babies at a very early age for four types of diseases that are treatable: genetic, endocrinologic, metabolic and hematologic diseases [11]. Dr Robert Guthrie was a microbiologist who designed a dried blood spot testing, and used it to screen for phenylketonuria [12]. To this present day that spotting test is still being used. As techniques have improved so have the screening [12]. A physician who is screening a newborn baby for a metabolic disorder has follow four groups of clinical circumstances: The physician must find early symptoms, especially in the antenatal and neonatal period of development. In the later stages the physician must find symptoms that are server and recurring. Symptoms such as coma and vomiting. If the physician finds any symptoms that are chronic and aggressive, they could be due to three things: 1) Gastrointestinal. 2) Muscular. 3) Neurological. These will be described in more detail below The physician must find any signs of cardiomyopathy, hepatomegaly etc. This could lead to organ failures. The three groups have symptoms that are chronic and aggressive that can be easily ignored or misinterpreted. 2.1 Gastrointestinal Symptoms. If a patient has inborn errors of metabolism (IEM), the person might have symptoms that fall under the Gastrointestinal Symptoms (GI) group [13]. These symptoms include Anorexia, which is an eating disorder [5, 13]. Osteoporosis which untreated could lead to bones fracturing. Chronic vomiting, feeding difficulties, and failure to thrive are also symptoms of (GI). But they are also associated with chronic diarrhoea [5, 13]. This could lead to false and the wrong diagnosis [5, 13]. There are two groups that have been described to have caused chronic diarrhoea and failure to thrive within inborn errors of metabolism: These disorders include errors of the intestinal mucosa or the exocrine function of the pancreas, for example congenital chloride diarrhoea, glucose- galactose malabsorption a condition in which the cells lining the intestine cannot take in the sugars. Lactase and sucrose-isomaltase deficiencies where the person is unable to metabolise lactose or sucrose. Abetalipoproteinemia type II disorder that interferes with the normal absorption of fat and fat-soluble vitamins from food [5, 13]. Enterokinase deficiency; Enterokinase is an enzyme involved in human digestion. Acrodermatitis enteropathica, a condition that affects that absorption of Zinc. Etc [5, 13]. Systemic disorders such as diabetes mellitus, diabetes, sickle cell disease, sarcoidosis, etc can also give rise to GI abnormalities. A problem has risen in distinguishing systemic abnormalities and inborn error of metabolism and vice versa [5, 13]. 2.2 Muscle Symptoms. There are a number of symptoms that fall under this group. For example: Hypotonia, where there is a disorder that causes low muscle tone and strength [5, 14]. Muscular weakness and poor muscle mass [5, 14]. These symptoms are common with many inborn errors of metabolism. These symptoms can be caused by urea cycle defects and many amino acid metabolism disorders [5, 14]. Recent studies have shown that the cause of muscle symptoms can be due to mutations in the monocarboxylate transporter 8 gene, which can develop Allan-Herndon-Dudley syndrome [14]. Allan-Herndon-Dudley syndrome falls under the muscle symptoms group as it causes hypotonia, general weakness of the muscle, reduced muscle mass and delayed development [14]. Further studies showed that this X-linked mental retardation syndrome is involved in the transport of triiodothyronine into neurones and disrupts the blood levels of thyroid hormone [14]. 2.3 Neurological Symptoms. Patients with inborn errors often have neurological symptoms. These include of neurological abnormalities, in the central and peripheral system. Studies have shown that these neurological symptoms are very frequent with inborn errors [5, 15]. These symptoms include poor feeding, hypotonia, ataxia, and even autistic features [5, 15]. The analysis of inborn errors, due to the screening of neurological symptoms is very difficult due to symptoms that are non specific signs; sings that include for example developmental delay, and hypotonia [15]. 3.0 Screening Newborns for Inborn Error of Metabolism 3.1 Newborn screening Newborn screening is a technique, used to detect inborn errors [17, 12]. It was first used to detect phenylketonuria (PKU) by a bacterial inhibition assay, developed in the 1961 by Dr Robert Guthrie as already stated. His technique in using dried blood sample was further developed in the mid 1975, where a scientist called Dussault used a method to screening for congenital hypothyroidism [16]. A lot of time and money has been invested into the screening programme, and now they have uncovered new disorders that are related to inborn errors [17, 12]. Disorders such as cystic fibrosis, congenital adrenal hyperplasia, which is a form mutation of genes that produces enzymes that mediating production of cortisol from cholesterol by the adrenal glands. Glucose-6-phosphate dehydrogenase deficiency and many more [5]. To this present day, for screening newborns, tandem mass spectrometry is used [18]. It is a lot easier for screening and diagnosis. The application of tandem mass spectrometry to newborn screening was first described in 1990 [18]. The primary aim of newborn screening is to identify patients, manly infants with serious disorders that are treatable [18]. This will make it easy to prevent or improve clinical symptoms of the disease [18]. Tandem mass-spectrometry is very useful in detecting more than one disorder at one time [18]. This can be used to detect early untreatable disorders and also can be beneficial if the screening was not limited to just individual babies, but the whole family as well [18]. The screening process uses MSMS [18]. MSMS is the method used to measure analytes by both mass and structure [18]. First the compounds are ionised, where the first mass spectrometer selects the ion of interest, where it is sorted by weight [18]. Then the compounds travel through a collision cell, are dissociated to signature fragments, and then pass into a second mass spectrometer where ions are selected for detection. [18]. 3.2 Method for screening Research have been done where most newborn screening programmes use simplifying sample preparation, instead derivatisation of the sample which is the old method [18]. When investigating, the sample might show more than one disorder. But the use of ratio of analytes improves sensitivity and specificity [19]. Specialised biochemical genetic testing is always done to verify which type of disorder the patient has [18]. Theses genetic tests include amino acid analysis, organic acid analysis by gas chromatography/mass spectrometry, and plasma acylcarnitine profile by MSMS [18]. 4.0 Screening for Individual Inborn Errors of Metabolism Well over 40 inborn errors of metabolism can now be detected by newborn screening [20]. This section will look at three inborn errors. 4.1 Pentose Phosphate Pathway The pentose phosphate pathway (PPP) is an anabolic pathway where is uses a 6 carbon glucose to generate a 5 carbon sugars and reducing equivalents, as shown in Fig. 1. There are three primary functions of this pathway [21]: To generate reducing equivalents, such as NADP forming NADPH. NADPH allows reduction biosynthesis reactions to occur within cells [21]. To produce ribose-5-phosphate (R5P) for the cell, for the synthesis of the nucleotides and nucleic acids [21]. Can metabolise dietary pentose sugars that are derived from digestion of nucleic acids [21]. These also rearrange the carbon skeletons of dietary carbohydrates into glycolytic/gluconeogenic intermediates [21]. 4.1.1 Disorders of the Pentose Phosphate Pathway There are three inborn error in the pentose phosphate pathway that have been identified [21]. 4.1.2 Glucose-6-phosphate dehydrogenase deficiency The enzyme glucose-6-phosphate dehydrogenase (G6PDH), catalyses the reaction that converts glucose-6-phosphate to 6-phosphogluconate. This creates one mole of NADPH each for every mole of glucose-6-phosphate (G6P) that enters the PPP [21]. A deficiency would lead to an error to the first irreversible step of the pathway [21]. This would lead further to a lower production in NADPH, making the cell more acceptable to oxidative stress [21]. G6PDH is very important for Erythrocytes metabolism [21]. A deficiency could lead Individuals to nonimmune hemolytic anaemia which can be caused by, infection or exposure to certain medications or chemicals [21]. G6PDH deficiency is also linked to favism [21]. It is thought to be an X-linked recessive hereditary disease [21]. 4.1.3 Ribose-5-Phosphate Isomerase Deficiency A recent study have shown that a patient with of ribose-5-phosphate isomerise deficiency, had developed progressive leucoencephalopathy and, developmental and speech delay [21]. They did further studies using NMR and found that polyols ribitol and D-arabitol concentration was abnormal in body fluids [21, 22]. They did their studies on fibroblasts and found that the enzyme gene-sequence analysis showed a frame-shift and a missense mutation [22]. 4.1.31 Metabolic Derangement Ribose-5-phosphate isomerase deficiency would mean that the reversible reaction converting ribose-5-phosphate to ribulose-5-phosphate and vice versa will halt [22]. If there was no deficiency ribulose-5-phosphate would be converted to xylulose 5-phosphate, which will provide the substrates for transketolase and further conversion into glycolytic intermediates [22]. Studies have found that there are two mutant allele one from each parents that results in ribose-5-phosphate isomerise gene that causes the deficiency [22]. So it could be an autosomal recessive inheritance disorder [22]. The best way to do a diagnostic test for Ribose-5-phosphate isomerase deficiency would be to take a urine sample [22]. Polyols ribitol and D-arabitol would be analysed [22]. Also enzyme assay can be used to sequence the ribose-5-phosphate isomerise gene [22]. 4.1.4 Transaldolase Deficiency Some studies have been done where three unrelated families had Transaldolase deficiency [23]. One patient had aortic coarctation where the aorta narrows [23]. During the patients life they found that ammonia was rising. But neurological and intellectual development has been normal. Another patient had HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count) [23, 24]. Children with transaldolase deficiency have been diagnosed have found that the development of intellectual and neurological showed no abnormalities [23, 24]. But there is a strong link to liver cirrhosis which results from increased cell death of hepatocytes and biliary epithelial cells [23, 24]. 4.1.41 Metabolic Derangement Transaldolase catalyses the reaction: Sedoheptulose 7-phosphate + glyceraldehyde 3-phosphate erythrose 4-phosphate + fructose 6-phosphate [59]. It is a reversible reaction in the pentose phosphate pathway. The deficiency lead to the accumulation of polyols derived from the pathway intermediates: erythritol, arabitol and ribitol [59]. Studies have shown that all patients were homozygous for these specific mutations, suggesting autosomal recessive inheritance [23, 24]. A simple urine test can be done to diagnose of transaldolase deficiency, mainly because there is a high concentration of arabitol and ribitol in urine. Also enzyme assay can be used to sequence the gene [23, 24]. Liver transplant would be the only option with patients that have severe liver cirrhosis [23, 24]. 4.2.0 Insulin secretion by the pancreatic ß-cell In the production of insulin glucose enters the ß-cell through a GLUT2 transporter where it is phosphorylated to glucose-6-phosphate by the enzyme glucokinase [58]. The enzyme is used as a control, where it monitors the level of glucose [58]. As blood glucose raises the rate of glucose metabolism also increases, where the cell will undergo glycolysis generating ATP [58]. This increase of ATP concentration causes K+ channels to close, making the membrane depolarised [58]. This depolarisation causes the voltage sensitive Ca2+ channels to open and Ca ions flood in, stimulating insulin secretion by exocytosis from storage granules; this is shown in Fig. 2. 4.2.1Persistent Hyperinsulinemic Hypoglycaemia Hyperinsulinism has been diagnoses in all ages but it is very common in childhood [25]. Persistent hyperinsulinemic hypoglycaemia (PHHI) is the one of the main cause of hypoglycaemia especially in young children. Patients who are older, that develop PHHI are due to pancreatic adenoma [25]. Hypoglycaemia when there is an overproduction of insulin by the ß-cells in the pancreas [25]. Hypoglycaemia can produce a variety of symptoms the most dangerous is brain damage which can lead to death, and that is why treatment is vital [25]. PHHI has two histopathological lesions that can be easily distinguished, making PHHI a heterogeneous disorder [25]. Focal hyperinsulinemic hypoglycaemia (FoPHHI) is caused by loss of heterozygosity which is a somatic event [25]. This causes focal adenomatous hyperplasia, which is a pancreatic lesion [25]. They are treated with pancreatectomy, where they surgically remove part of the pancreas. Diffuse hyperinsulinemic hypoglycaemia (DiPHHI) is also a heterogeneous disorder, in that fact that it is unable to encode for proteins needed for insulin secretion [25]. This can also be caused autosomal recessive and dominant genes which are rare [25]. Positron emission tomography (PET) is used to distinguish between focal and diffuse PHHI [25]. This gives a 3D image or picture of functional processes in the body [25]. Once a patient is diagnosed with PHHI, they are on treatment straight away with glucose and glucagon [25]. 4.2.12Metabolic Derangement Hyperinsulinemic hypoglycaemia is due to insulin hypersecretion by the pancreas [25]. The Action insulin causes a decrease in plasma glucose by inhibiting hepatic glucose release from glycogen and gluconeogenesis, and by increasing glucose uptake in muscle and fat [25]. PHHI is a disorder that is caused by a variety of defects, either in regulation of insulin secretion, unable to transcribe the enzymes needed of even a modified receptor [26]. For example diseases that can affect the ion channels like seizures [27, 28, 29]. Also lack of enzyme production of glucokinase (GK), and glutamate dehydrogenase (GDH) [30, 31]. Epidemiology has found that 1/50,000 patients are born with PHHI [32, 33]. Focal hyperinsulinemic hypoglycaemia is strongly linked to mutation of the sulfonylurea-receptor and the K+ channels, both used to depolarise the cell [32, 33]. Both are found to be located on the chromosome 11p15 [32, 33]. To identify these mutations they would need to be tested in a foetus or embryo before it is born. Sulfonylurea-receptor gene (SUR1) will not respond to diazoxide, which is used as a K+ channels activator [34]. Studies have found that a high activity of the enzyme glutamate dehydrogenase (GDH) has resulted to hyperinsulism/hyperammonemia syndrome. This would make sense as GDH is needed to produce insulin and this would impair detoxification of ammonia in the liver [31]. The enzyme glucokinase (GK) is also expressed highly, where the affinity is increased for glucose, causing high levels of insulin secretion [30]. 4.2.13 Diagnostic Tests Diagnostic of HI is easy, in the fact that, it can be indicated by the levels of glucose in the blood. Treatment varies from age [35]. Hyperammonemia should be treated as another disease, when a patient has PHHI, when treating hyperinsulism/hyperammonemia syndrome. This can be done by analysis of urine organic acids and plasma acylcarnitines [36]. Patients who show the FoPHHI can have lesion ranging from 2.5 to 7.5 mm in diameter [37, 38]. People who have DiPHHI found that there was ß-cells that were abnormal [39]. Pancreatic venous catheterization (PVS) and pancreatic arteriography have proven very useful in locating the site of insulin secretion [40, 41]. PVS procedure will have to able to maintain blood glucose level, which is between 2 and 3 mmol/l. Blood sample would then be taken from the pancreas to measure 3 things 1.plasma glucose, 2.insulin and 3.C-peptide levels [40, 41]. Studies have shown that people with FoPHHI tend to have high concentration of plasma insulin and C-peptide levels in some samples and low concentration in others [40, 41]. People who have DiPHHI tend to find that all their sample have high concentration of plasma insulin and C-peptide [40, 41]. The use of [18F]-labelled fluoro-L-DOPA whole-body positron emission tomography (PET), has proved to be very useful in detecting hyperfunctional islet pancreatic tissue, where this can be used on patients with focal lesion [42]. Recent studies have shown that a new technique have been use to locate focal lesion and separate focal from diffuse forms of HI; this is the tolbutamide test [44, 45]. 4.2.14 Treatment and Prognosis Brain damage can occur if you are hypoglycaemic, so treatment needs to be quick. Glucagon would be given, where the patient would have to take 1 to 2 mg per day if blood glucose levels are unstable [35]. To treat PHHI, diazoxide would be given, usually at a dose of 15-10 mg/kg/day depending on your age [35]. Normal blood glucose levels should be between 4 and 7 mmol/l, before and after a meal [56]. This could need to be check every time once taking diazoxide [35, 56]. Octreotide treatment, can also be used as it is a hormone inhibitor [46]. But a high could lead to a more severe hypoglycaemia, as it can inhibit glucagon and growth hormone [46]. Patients will find that after treatment with octreotide, they might vomit or have diarrhoea [46]. Calcium-channel blockers could be used, such as Lercanidipine and Pranidipine [46]. These treatments that have been mentioned are very effective in controlling blood sugar [46]. If a patient is diagnosed with FoPHHI, the treatment tends to be surgical as drugs are ineffective [46]. They would undergo pancreatectomy. This procedure has its risk as the patient might develop diabetes mellitus [46]. DiPHHI patients have been found to have large nuclei in the ß-cells [35, 47]. And patients with FoPHHI showed no abnormal s-cell nuclei but did show shrunken cytoplasm [49, 50]. 4.3 Glucose Transporter Deficiency Monosaccharides such as glucose and fructose have the properties of being hydrophilic [59]. The lipid bilayer has hydrophilic heads and hydrophobic tails, prevent polar molecule such as glucose from diffusing across the membrane [59, 60]. So transport mechanisms are needed. These are hydrophilic pores allowing polar molecules to diffuse in and out of the cell [59, 60]. There are two types of glucose transporters. 1. Sodium-dependent glucose transporters (SGLT), which have been found to be located in the small intestine and the proximal tubule [59, 60]. SGLT uses the difference in concentration of sodium to transport glucose [59, 60]. From high to low concentration of sodium causes the transport of glucose against its own concentration gradient [59, 60]. 2. Facilitative glucose transporters (GLUT), which has been found throughout the body, but manly in muscle and pancreas cells [59, 60]. These transporters transport glucose from high to low concentration [59, 60]. Studies have shown that there are four defects in the transport of monosaccharides [59, 60]. These defects can depend on where the transporters are located within the body and what they transport in and out of the cell [59, 60]. As already stated there are four defects. 1. SGLT2, which is found in renal tubulus cells that can cause renal glucosuria [59, 60]. 2. SGLT1, which is found in the intestine, which can cause glucose-galactose malabsorption [59, 60]. 3. GLUT2, a transporter that carries glucose to the liver kidneys and pancreas [59, 60]. 4. GLUT1 is important, in the fact that it carries glucose to the brain cell (neuron and glia cells)

Main Barriers Sustainable Development Developing Countries Initiatives Overcome Economics Essay

Main Barriers Sustainable Development Developing Countries Initiatives Overcome Economics Essay Any country whose standard of living is at a low level is referred to as a developing country. Development level varies from country to country thus cannot be generalized in meaning. Using numerical categorization, Countries with low and middle income have been categorized as developing by the World Bank. Dividing economies with the 2008 Gross National Income per capita (GNI), developing countries were identified by GNI per capital below $11 905. Countries having progressive economies but which have not attained a particular standard to be referred to as developed country are categorized as Newly Industrialized Country (NIC). Such countries are said to have rapid growth in their economy but have still not reached the standard of the First World, these are highly developed countries (see http://en.wikipedia.org/wiki/Developed_country) Almost all countries of the third world can be categorized as developing, they including all African countries excluding South Africa, all countries in the Middle East excluding Turkey, all Asian countries excluding China, Japan, Singapore, Russia, Taiwan India, Myanmar and South Korea, some countries in Eastern Europe, Southern American countries excluding Brazil and the Caribbean excluding Jamaica and Cuba. File:World Bank income groups.svg Fig1: Countries based on World Bank income groupings for 2006 (calculated by GNI per capita, Atlas method).   Ã‚   High income   Ã‚   Upper-middle income   Ã‚   Lower-middle income   Ã‚   Low income Source: http://en.wikipedia.org/wiki/Developing_country Sustainable Development Sustainable development as defined in 1987 in a report by Brundtland is development that meets the needs of the present without compromising the ability of the future generations to meet their own needs. (Hecht, 1999) Sustainable development as an aspiration is global; as an ongoing process, it is local. A growing number of scientists and technologists share in the aspiration and experiment with the local (Mabogunje and Kates, 2004). For sustainable development to be achieved, especially in developing countries, some stages have to be undergone; it is also necessary for essential building blocks to be implemented. The economic, social and environmental factors have to be considered in a transparent and open manner. In many developing countries, the fundamental building blocks, such as a free-market economy, transparency of government operations, public access to information, public involvement in decision making, and enforcement of environmental laws, are weak or absent. Although some developing countries are strengthening domestic policies and regulations and creating economic policy incentives for attracting environmentally sound investment, progress is slow and uneven. (Hecht,1999). Barriers Developing countries have less sustainable livelihoods today than they had 25 years ago. The issue of sustainable development involves making sure that the ongoing development does not affect future generation. Some of the following issues contribute to the low sustainability level in developing countries: Extreme Poverty Poverty is the most prominent barrier to development in developing countries. Almost all population found in these countries live in rural settlements and depend on agriculture as their main source of income. Poverty and the environment have a strong connection especially in countries with economies that depend on natural resources. For people in these countries to meet their needs, they engage in local activities such as tree cutting for fuel wood, wild life hunting (leading to extinction), extensive and excessive farming system and so on. These activities are carried out to meet the needs of today but the repercussions await the future generations. Deforestation Intense farming and deforestation in South America has left some areas with only 5% of natural vegetation. If this trend continues, there might be little or nothing left to pass to the future generations. Africa had about 650 million hectares of woodlands and forests but between 1990 and year 2000, about 53 million hectares of forest was lost (Africare speech, 2008). In respect to the global forest loss, this was about 56% in that period. Deforestation has a resultant effect on protection of soils, the land is more exposed to adverse conditions like erosion and evaporation, also quality of water is affected by deforestation. All these will invariably tell on the production and economy of countries involved. Urban Development Urban areas in developing countries are expected to be more populated majorly because of migration. However this comes with a great environmental challenge. A good number of urban dwellers either inhabit slum areas or carve a slum-niche for themselves simply because they do not have legal rights to own their properties. Slum conditions lack good, portable water, electricity and other basic amenities of life. The issue of waste disposal in slum areas is usually carelessly handled, this poses as a threat to health and safety of slum dwellers. It is not a surprise to use plastic bags as mobile toilets in some large slums like Kibera, Nairobis largest slum. Also, because of the nature of these areas, there is increase in miscreants among juveniles. This has a direct negative effect on young adults who are supposed to be leaders of tomorrow. This is where the effect of the environment on the social life of individuals comes in to play. Some shanty areas in Nigeria have in recent times produced the highest number of notorious young adults. Urbanization in developing countries results in very large population inhabiting very small area, polluted water and air, poor public transport among other things. These environmental conditions lead to low standard of living in these areas. In South America, urban population is found in settlements called squatter, Brazil having favelas while Venezuela has barrios. Caracas is known to have over 50% population living in squatters. These squatters are usually made from scrap and cardboard materials in areas that are prone to flooding or steep areas. After a while, the construction is upgraded with better materials but the settlements remain in an irregular network with small paths and streets, there is usually no plan for waste management, drainage or water supply. The Asian continent among others is not left out in urbanization issues. Bangladesh, a country in Asia has had an increase in urban poverty in recent times. In Dhaka city alone, from 1974 to 2005 slum population has jumped from 250,000 to 2,840,000 during the span of little over 3 decades (Haider, 2008). During these decades, the number of slums also increased from 500 to 4,300. While slum population has increased by more than 11 times the number of slums has increased 8.6 times during this period. The causes for the increase of slum population are certainly complex. However, the major aspect is again related to the lack of well paying jobs in urban areas. There are also cases of downward mobility in urban areas of urban dwellers themselves. Although Bangladesh has been able to reduce urban poverty to some extent, there are pockets of chronic poverty in slums that seem very hard to overcome. (Haider,2008). http://www.un.org/ecosocdev/geninfo/afrec/vol18no2/2809067_slum.jpg Nairobi, Kenya: Sixty per cent of the citys people live in slum areas. Source: http://www.un.org/ecosocdev/geninfo/afrec/vol18no2/182environ.htm Impact of Industrial Waste The process of obtaining non-renewable materials from natural resources has an adverse effect on the environment. A good example is Nigeria, a developing country in West Africa. The Niger Delta environment has been polluted by oil spills and flares from gas for over half a century. A target was set forth to put a stop to flaring of gas but this seems to be unachievable with the trend of events. Mine sites which are no longer in use in some parts of Africa contribute to the nuisance that the environment is becoming. In general, mineral and oil exploration contribute to water pollution (which also causes death of organisms in water), contaminated soil, e.tc. Developing countries will continue to have great challenge in attaining sustainable development if the current approach to extraction of resources is not addressed. Effect of Climate Change on Environment Africa as a continent has so many developing countries. Studies from the IPCC (Inter-governmental Panel on Climate Change) show that this continent is more prone to the impact of climate change than any other part of the world. Some of the effects of climate change include less rainfall in areas already experiencing dryness like the southern and eastern parts, and increased drought in north central Africa. It is also predicted that by 2025 (Africare speech,2008), western African countries will experience scarcity of water, such countries like Ghana, Burkina Faso, Benin Republic, Mauritania, Nigeria e.t.c. While other issues are more pressing and getting better attention from African leaders (such issues as malaria, HIV AIDS, poverty, starvation e.t.c), to sustain the future generation, Africa has to be fully at alert and address the issue of climate change peculiar to its environment. In other areas, climate change may cause flooding in contrast to its effect in these countries. In South America for instance, climate change has an effect on their environment which in essence has a multiplier effect on planning for growth. La Plata River basin which is the fifth largest river in the world generates about 50% of South Americas Gross National Product (GNP) and five countries share boundaries with this river- Brazil, Bolivia, Argentina, Paraguay and Uruguay. The effect of climate change in this river basin has affected the economy and as a result its population. Flow in this region has been 30% greater since 1970 than in previous time. This is in contrast to the average rainfall before 1970 and below average rainfall afterwards in sub-Saharan Africa (Africare speech, 2008). Corruption Corruption is a major barrier to sustainable development in every country that it exists. It steals from todays children the resources they will need to survive tomorrow. There is a direct link between underdevelopment and corruption. The former encourages the latter. A good scenario is the public service low income in developing countries, this stimulates trivial corruption. The level of education and enlightenment in these countries also put people in ignorance of their statutory rights, thereby giving room for corrupt individuals. Initiatives to Overcome Barriers The discussion about initiatives to overcome barriers to sustainable development in developing countries will not be justified without mentioning the millennium development goals (MDGs). The MDGs were initiated in September 2000 during the United Nations Summit. These goals are eight in number and they break down into quantifiable targets that are 21 in number, they are also measured by 60 indicators. They include the following: Extreme poverty and hunger eradication Universal primary education for all Encourage women empowerment and gender equality Reduce death rate of children Improve maternal health Fight against diseases especially malaria and HIV/AIDS Implement sustainable development Develop a global partnership for development These goals were created having developing countries in mind as the issues addressed are mostly concerned with them. However, the indicators for these goals show that they have not been effectively implemented locally and globally, they also show that the time frame given to them will not be realistic. Over the years, developing countries have recognized the importance of environmental management and sustainability and there have been initiatives peculiar to each country and situation to enhance this. Some of those initiatives include establishing Non-Governmental Organizations (NGOs). NGOs have gained reputation especially internationally as they are consulted on matters of planning and implementation of policies made at national and international levels. Examples of such include Global Volunteer Network, Cross-Cultural Solutions, Conserve Africa, Africa Guide, Action for Agricultural Renewal in Maharashtra (AFARM), Conservation Council for South Australia to mention a few. NGOs offer a clearer perspective and a wealth of experience in relevant areas such as human right defense, environmental protection, grassroots development, poverty alleviation, e.t.c. To thrive in their activities, these organizations should work alongside the government by participating in development, planning policies and decision making at the various levels of administration. However, since they are voluntary, availability of funds for NGOs might pose a slight challenge and they sometimes have to depend on funds from large hearted individuals. Other initiatives include creating anticorruption agencies. Since corruption impedes development at all levels of government, countries have created such agencies to check corrupt practices, examples include Office of Anti-Corruption Commission Bhutan (Asia), Independent Authority Against Corruption- Mongolia ( Asia), Anti- Corruption Commission- Bangladesh (Asia), Kenya Anti-Corruption Commission -Kenya (Africa), Independent Corrupt Practices Commission Nigeria (Africa), War Against Indiscipline and Corruption- Nigeria (Africa), Kick Against Indiscipline- Nigeria (Africa), e.t.c These are just a few as there have been numerous organizations at different levels of government that function in this regard. However, as many as these appear to be, the issue of corrupt practices still rear their head. When caught in the act and asked, culprits sometimes blame the economy and government but those are just the ones who are brought to book, top citizens who have connections in high places are usually seen as above the law. This falls back to having good leadership in developing countries as well as citizens having the right attitude, without these, corruption will still find its way in these countries and the efforts of these organizations will not be justified. For every country, the children are the future leaders; good education for them is a very important factor for development. Some efforts have been made by countries and their governments to develop the minds of youngsters educationally, there have been schemes to sponsor students abroad to acquire various skills and knowledge so as to implement and integrate these skills once back home. Recently, the Federal Government of Nigeria awarded 1,087 undergraduate and postgraduate Nigerian students scholarship to study locally. There have also been organizations (PTF-Petroleum Trust Fund) that sponsor student abroad for studies from Nigeria. Other scholarship boards in other countries include Integrated Community Development Fund (ICDF) in Bolivia, Banque Libano Francaise in Lebanon and a host of others in other countries. This initiative has a very slow but steady growth in various developing countries. Other countries simply affiliate themselves with foreign government and bodies to get n ecessary support. Conclusion Since each developing country has its own government and ruling council, initiatives for achieving sustainable development in these countries differ, this is also because apart from the challenges listed above, some countries have challenges that are peculiar in nature to their environment, society and economy. In this regard, these countries tend to lean towards initiatives which particularly address their peculiar problems. Coming up with initiatives is one thing, implementing those initiative is another. In my belief, the latter is more important than the former. To achieve sustainable development, developing countries must make conscious efforts to implement the existing initiatives while looking to create new ones. Lastly, achieving sustainable development in developing countries takes a gradual (not magical) process; levels of achievements can only be measured with indicators periodically. It is up to every individual to contribute in little ways to achieve a nation and global sustainable environment for the future generation.