Diabetes Education: The Increase In Diabetes

Diabetes Education: The Increase In Diabetes Diabetes is becoming a worldwide epidemic. It is one of the biggest health challenges that the United Kingdom (UK) is facing today with one person being diagnosed with diabetes every 3 minutes (Diabetes UK, 2009). The latest data indicates that there are now 2.8 million of people with diabetes in UK and nine out of ten people diagnosed with diabetes are Type 2 diabetes (2.5 millions). According to health experts, UK is now facing a huge public health problem and the figure is set to rise to four million by the year 2025. (Diabetes UK, 2010). The alarming increase in diabetes prevalence is a great cause of concern and has a devastating economic effect. Recent estimate shows that 10% of National Health System (NHS) spending equivalent to 9 billion pounds a year, 1 million pounds per hour goes on diabetes (Diabetes UK, 2008). The direct and indirect cost to the NHS of caring for people with Type 2 diabetes and its complications are staggering and will continue to rise with the increasing incidence of the disease. As a result of this health crisis and significant financial burden, the NHS needs to respond to this massive strain by looking at more effective and efficient ways of providing diabetes care. It is therefore of primary importance for our local primary care diabetes services to identify ways to deliver an effective quality care for people with diabetes to counter this worrying trend. 1.1 Diabetes Education Diabetes education has been considered as one of the key components of diabetes care since the 1930s and has been increasingly recognised as an integral part of the disease (Atak Arslan, 2005). Nicolucci et al (1996) demonstrated that people who have never received diabetes education had a striking fourfold increased risks of developing major diabetes complications. Furthermore, the study done by Rickiem et al (2002), showed that diabetes education has an overall positive effect on the health and psychosocial outcome. It helps to improve patients skills and knowledge on the condition and enables beneficial change in the behaviour. Diabetes education has a profound effect on glycemic control, quality of life and treatment satisfaction (clinical governance support team, 2004). Stratton et al (2000) suggested that improving Hba1c by just 1% through diabetes education can significantly reduce risk of complications. In view of all the evidence, the importance of diabetes education has been highlighted and well advocated by the National Service Framework (NSF) and National Institute of Clinical Excellence (NICE, 2003) . The NSF emphasizes that diabetes education should be made available from the point of diagnosis onwards and proposes that education should involve a structured program for people who have been newly diagnosed. This has been encouraged by NICE which recommends that all patients received structured education at initial diagnosis and then on a regular basis according to need (NICE, 2003). However there is insufficient evidence currently available to recommend a specific type of education or provide guidance on the setting for, or frequency of, sessions. In this context, how best to provide structured education to people with diabetes is an important question. NICE acknowledge the limited evidence to suggest which approach is most appropriate and state that to achieve maximum effectiveness, some principle of good practice should be in place(NICE, 2003). According to NICE criteria, diabetes education should reflect the principle of adult learning, provided by trained educators including a DSN or practice nurse with diabetes experience, and a dietitian, use a variety of techniques to promote active learning, be accessible to the broadest range of people taking into account their ethnicity, culture and beliefs. 1.2 Aim of Diabetes Education The National Institute for Health and Clinical Excellence (NICE, 2003) states that the aim of education for people with diabetes is: To improve their knowledge and skills, enabling them to take control of their own condition and to integrate self-management into their daily lives. Diabetes education should allow people to engage in their own health to put what theyve learned into action. Traditional health education can give them the information they need but the learning experience may not engage and empower them to use what theyve learned in their daily lives. Education was focused on passive didactic format where patients do not interact with the educator and generally use a lecture or print format (Norris et al, 2001). Middleton et al (2006) found that its purpose was often unclear to both patients and health care professionals. The old model of education is outmoded and ineffective (Skinner et al, 2007). Education has now moved towards a collaborative format where patient actively participate in the learning process through small group discussion, role playing and other interactive techniques (Norris et al, 2001). 1.3 Patient Centered Approach and Empowerment The National Service Framework for diabetes (DoH, 2001) standard 3 states that all people with diabetes will: Receive a service which encourages partnership in decision-making, supports them in managing their diabetes and helps them to adopt and maintain a healthy lifestyle. The purpose of diabetes education is clear. It should empower people with diabetes to make informed choices about their condition (Funnel and Anderson, 2003). Anderson et al (1991) at the Michigan Diabetes Research and Training Center (MDRTC) introduced empowerment into patient education in diabetes at the beginning of the 1990s in the US. They implemented empowerment group education programmes in diabetes (empowerment programme) and evaluated their programme. An improvement in self-efficacy and glycaemic control was reported among the patients who had participated in the programme compared to those in the wait-listed control group. Following the valuation of patient educational interventions for people with type 2 diabetes during the 21st century, Deakin et al (2006) showed that there is a trend to actively involve patients in their care in accordance with the empowerment philosophy. The investigator compared group education programmes with routine diabetes care and found that group-based programmes involving patient empowerment has positive effect on biomedical and psychological out come. The concept of empowerment requires an initial understanding of what the treatment pathway is trying to achieve and is continual information sharing process encompassing learning and behaviour change which aims to allow the patient to take responsibility for their own condition. (Meetoo and Gopaul, 2004) For empowerment to be effective it is important for patients to have the appropriate information to enable them to make informed choices, if they have the capability and desire to do so. They need to be able to agree plans and set goals with the support of the care team. To do so, it is important for them to understand their disease.The NSF set to ensure that people with diabetes are empowered to enhance their personal control on a day to day management of the condition. Implications for service planning were highlighted detailing how NHS will need to develop, review and audit education program to empower people with diabetes, (DoH, 2001) People are more likely to make behavioural changes if they are facilitated through patient centered care rather than imposed by care based on the medical model of delivery (DoH, 2001a).The philosophy of practice which support patient centered approached for diabetes education is well documented in chapter 3 of the DoH publication structured patient education in diabetes: report from the patient education working group (DoH, 2005). Specific strategies that grew out of the patient centered model included the following: affirming that the person with diabetes is responsible for and in control of the daily self-management of diabetes; educating patients to promote informed decision making rather than adherence/compliance; learning to set behavioural goals so that patients can make changes of their own choosing; integrating clinical, psychosocial, and behavioural aspects of diabetes self-management; affirming the participants as experts on their own learning needs; affirming the ability of participants to determine an approach to diabetes self-management that will work for them; affirming the innate capacity of patients to identify and learn to solve their own problems; respecting cultural, ethnic, and religious beliefs of the target population; creating opportunities for social support; and Providing ongoing self-management support. Overall the diabetes education must provide knowledge and skills, be tailored to the needs of the individual and include skills-based approaches to education. It should support people with diabetes to adopt and maintain a healthy lifestyle, prevent and manage diabetes related complications that will result in improved quality of life and self-management. Healthcare professionals are encouraged to work in partnerships in the decision-making process to support the individual to manage his or her condition. 1.4 Effectiveness of Diabetes Group Education The manner in which education is delivered can be the subject of much debate. Education can be delivered in a one to one session or in group settings. Diabetes group education has been seen as an effective intervention since 1970 (Mensing, 2003). Traditionally, it was more of a medical model where patients handed their medical problem for the doctors to cure. They are told what to do and expecting good results (Calabretta, 2002). As the process of group education has evolved over time, diabetes education has changed from a medical didactic presentation to more of theoretical, patient centered and empowerment model. Diabetes group education is now seen as a first line approach to improve diabetes outcome. With the increase in number of people diagnosed with diabetes, more education is being delivered now in groups as compared to the past. The environment should support and reinforce self management and patients and their health care should work in collaborative way. Self management can only be successful in a well organised and coordinated diabetes service where patients are supported to make informed choices (Norris et al, 2001). Several reviews and meta- analyses provide valuable information on the effectiveness of group education. Mullen et al( 1985) found that patient knowledge about their medication significantly improved in group education, one to one counselling , written and other audiovisual material. Norris et al (2002) suggest that the literature in diabetes education is divided although there may be more positive effect on group education as compared to the individual one. Deakin et al(2006) showed that there is some evidence to support group-based diabetes self-management education as an effective way to improve knowledge and glycemic control and to reduce BP, body mass index (BMI), and the need for diabetes medication. However, a number of issues arise when reviewing the literature on the relative effectiveness of group education compared to individual ones. Some researchers make comparison difficult by focusing on different outcome rather than the delivery format whereas others compare it with usual program without considering the relative effectiveness (Mensing,2003). Wilson (1997) noted that it is not easy to figure out whether the outcome is from an educational approach based on a specific theory or from intervention applied to a specific setting and population. Given these issues and limitation, it is difficult to draw conclusion about group effectiveness. More evaluation research must be done in this field to answer these questions. NICE (2003) has highlighted the effectiveness of group education sessions .For healthcare professionals, group sessions are considered as the most cost-effective way of delivering education. In the present financial climate, and with the increase in the numbers of people with newly diagnosed diabetes, it could be argued that group education is the only way forward if healthcare professionals are to be able to provide education for the majority of people with diabetes. A group approach to patient education makes sense from what we already know about the positive effects of peer support and the inadequacies of the brief medical appointment. The potential benefit of an effective group education programme for people with type 2 diabetes is to enhance skill and knowledge, to make positive behavioural changes for better metabolic outcome, psychological outcome and improve quality of life. 1.5 The Two National Programs for people with type 2 Diabetes : XPERT AND DESMOND Most people diagnosed with diabetes are offered some sort of education, at least when they are diagnosed (NICE, 2008). However, there is still much debate over the educa ­tional approach that is most effective in delivering such crucial health information in a way that leads to measurable changes in patient behaviour and improved clinical outcomes. The two national group education programs available for adults with type 2 diabetes are (DESMOND) and X-PERT program. Both are patient centered, meet the NICE key criteria, flexible in their content and adaptable to patients educational and cultural background. However, the two structured group varies in their cost implication and duration of the program. Depending upon primary care trust funding funding, avaibility of health care professionals and what best suits patients, either DESMOND or X_PERT are chosen to be delivered by the primary care trust. 1.51 XPERT DIABETES PROGRAM The X-PERT diabetes programme is a six-week professionally-led programme based on the theories of patient empowerment and patient activation. The X-PERT course is designed to be delivered to anyone diagnosed with diabetes It aims to increase knowledge, skills and confidence leading to informed decisions regarding diabetes self-management (Deakin Whitham,2010). Participation in the X-PERT Programme by adults with type 2 diabetes has been shown at 14 months to have led to improved glycaemic control, reduced total cholesterol level, improved body mass index and waist circumference, reduced requirement for diabetes medication, increased consumption of fruit and vegetables, increased enjoyment of food, and improved knowledge of diabetes, self-empowerment, self-management skills and treatment satisfaction (Deakin et al, 2006). Contents of the X-PERT Diabetes Programme include: What is diabetes? The eatwell plate and energy balance. Carbohydrate awareness and glycaemic index. The benefits of physical activity. Supermarket tour and understanding food labels. Possible complications of diabetes and their prevention. Lifestyle experiment. Are you an X-PERT? Game. Care Planning: the lifestyle experiment. There is a one off cost to run X-PERT and this is approximated to  £1400. 1.52 DESMOND The DESMOND programme was launched in 2004, and is currently the most familiar education programme provided in the UK. It was developed as a collaborative project involving a multidisciplinary, multicentre collaborative team which agreed upon a core set of philosophical principles to the use of informed choice as the key to empowerment. They drew the program on three theoretical approaches: the common-sense model of illness, social learning theory, and use of a discovery learning process (DESMOND, 2004). DESMOND aims to educate patients about type 2 diabetes. It provides resources for them to manage their disease, and offer a group-based opportunity to meet and share experiences with others in the same situation .The DESMOND programme is facilitated by two health care professionals who have been formally trained. The course is usually delivered for 6 hours and is based on a formal curriculum. It is offered either as a 1-day or 2 half-day sessions and accommodates 6-10 patients in one group. DESMOND helps to promote the understanding of type 2 diabetes, allowing the patients to be more knowledgeable about the condition and what can benefit their long-term health. It encourages patient to work together with the health care professionals to take an active role in the management of their type 2 diabetes. It helps patients to see their illness in a well define way which drives them for positive changes. The program content includes: Thoughts and feelings of the patients around their condition. Understanding diabetes and glucose: what actually happens in the body. Understanding the risk factors and complications associated with diabetes. Understanding monitoring and medications. How to take control: Food Choices and Physical Activity. Future care plan. DESMOND was piloted in 15 English PCTs between January and May 2004 (Skinner, 2006). Initial abstracts of preliminary research findings were presented at the Diabetes UK annual conference in 2005. Pilot data indicated the DESMOND course for newly diagnosed individuals changed important illness beliefs. At three month follow-up there was a reported improvement in quality of life and metabolic control. DESMOND was revised following feedback from all involved parties. A larger randomised controlled trial was conducted involving 824 adult patients in 207 general practices in 13 primary care sites in the United Kingdom. The results showed that compared to patients who did not undergo the DESMOND programme there were greater improvements in weight loss and smoking cessation and positive improvements in beliefs about illness but there were no differences in haemoglobin A1C levels up to 12 months after diagnosis (Davies et al,2008). The author feels that it is difficult to compare DESMOND to X-PERT because of the different populations (newly diagnosed diabetes compared with established diabetes) and because the study concerned multiple sites and educators. In response to the Hba1c the author commented that it is usual for noticeable reductions to occur in levels shortly after diagnosis and in terms of showing a difference in levels between groups, patients with newly diagnosed type 2 diabetes may be the most difficult in which to demonstrate this(Davie s et al,2008). To investigate this further, a follow-up was carried out three years later. 743 participants were eligible for follow-up at 3years. Biomedical data were collected from 604 (81.3%) and questionnaire data from 536. Those followed up were older, had a higher BMI , higher waist circumference and higher depression score than those who were not. The result indicates a lack of difference in biomedical and lifestyle measure but the author reckoned that this is not unexpected as drift towards pre intervention values is commonly observed (Khunki et al, 2010) . However accumulated effects, which were not significant individually, did manifest themselves as a difference in UKPDS score. The differences in illness belief scores show that attending DESMOND results in positive changes in understanding of diabetes, which are sustained at 3 years.Therefore attending a single course at diagnosis is beneficial, but patients need to continue receiving ongoing support to help them to manage their diabetes. The study done on cost effectiveness for DESMOND found that per patient cost of providing the DESMOND Newly Diagnosed or Foundation programme compares very favourably to the provision of oral glycaemic agents(Gillet et al, 2010). The therapeutic benefit of the DESMOND structured education programme is effective as a once-off intervention to help lower biomedical markers as well as having a positive impact on peoples health beliefs and health outcomes (Gillet et al, 2010). Although it is likely that the one off DESMOND intervention is cost effective, it must be noted that the DESMOND programme was never intended as a one off intervention. Moreover, in the real world, costs of delivering the DESMOND programme are likely to vary considerably across primary care trusts. The main variables affecting the cost are the number of educators trained, the grade of healthcare professional delivering courses, venue cost, ratio of demand to head of population (including participation rate), number of patients per course, and overhead rates. It hopes to promote understanding of type 2 diabetes, allowing patients to be more knowledgeable about what will positively benefit their long-term health as they live with the condition. 1.6 Diabetes Conversation Map: Recently, healthy interaction in collaboration with Diabetes UK, sponsored by Lilly company, has introduced Diabetes Conversation Maps in UK. Diabetes Conversation Maps was created in 2005 in Canada and since then over 60% of diabetes educators has been trained for the program. It was next launched in America in 2006 and now over 20,000 health professionals have been trained. Diabetes Conversation Map serves as a facilitation tool to engage individuals in conversations around their condition and usually last for 2 hours. (Healthyi, 2005) Diabetes Conversation Map is an educational tool which has transformed healthcare education throughout the world by engaging people in meaningful conversations about their health(Healthyi, 2005). The American Diabetes Association (ADA) believes that it is one of the most important innovation in a decade. Conversation Mapà ¢Ã¢â‚¬Å¾Ã‚ ¢ education tools have been developed by Healthy Interactions. They are built on the philosophy that people respond better when they are engaged, empowered, and draws their own conclusions as to why they need to change behaviours (ADA, 2006). In this way, that will be an impact on their overall health as opposed to didactic interventions where patients are told what to do by a healthcare professional. The Diabetes Conversation Map methodology creates an experience whereby patients develop their own self-management solution that accounts for their individual challenges and situation. The patients, in turn, then own the solution because it is theirs. They are subsequently much more likely to embrace and implement the change needed to improve their condition The main philosophy is that people will act on their own conclusions by engaging themselves in an experience(Healthyi, 2005). It allows them to explore health facts through dialogue and enable decision making. Conversation map shapes the way in which people are motivated for positive behavioural change. The 6 components of the map are map visuals, facts, questions, group interaction, facilitator and action plan. The program is delivered to a small group of 3-10. It facilitates discussion, not lectures and must be delivered by trained health professionals. It benefits the patients as people are visual learners and like exploring and discovering their own answers. The map is fun and provides a process that patient use to internalise and personalise health information. For educators, it is simple to use, portable and non technology dependent. The program content includes basic facts about diabetes, healthy eating, self-monitoring of blood glucose, diabetes complications, and gestational diabetes The evaluation done in Enfield showed that Diabetes Conversation Map offers several advantages (Monk, 2009). First and foremost, it enables better use of staff time as it requires one member of the healthcare team to facilitate the session, allowing more time for direct patient contact. In terms of financial implication, to run the education program, cost is very minimal. Hand-outs are provided for free from Diabetes Uk and Lilly company which can be photocopied. Although the non-attendance rate remains high in enfield, it was observed that the number of patients attending Conversation Map is better and most patient who come to the first session the other sessions. It is reported that patient get to know each other during the program which help to break down barriers and improve group dynamics (Monk , 2009). Overall, the evaluations done in Enfield area have been positive. However, the result could have been influenced by the fact that the evaluations were completed at the end of the session and handed to the facilitator. In April 2008 a survey was done to assess the effectiveness of the Diabetes Conversation Map training sessions and initial impact on diabetes self-management education (Grenci, 2010). The survey results indicated that sixty-five percent of diabetes educators attribute improved patient self-management to the Diabetes Conversation Map tools. Eighty percent of healthcare professionals say that the tools make group facilitation more interactive and engaging. More than sixty percent say that there was an increase in patient interest in diabetes education and it boosts their willingness to learn. When asked about the most effective method in helping patients to adopt positive behaviours and achieve good outcomes, forty percent of the diabetes educators believe that Diabetes Conversation Map session is most effective. Only twelve percent report that the traditional education means as effective in this survey. Ninety percent of those who have had firsthand experience with the tools suggest that they would recommend them to their peers (Grenci,2010). In terms of metabolic outcome such as Hba1c, cholesterol, blood pressure, weight and patient satisfaction, so far there is no data available. However there will be an upcoming clinical trial called Interactive Dialogue to Educate and Activate (IDEA), which is sponsored by Merck, to identify outcomes using three separate treatment arms:, patients using the Conversation Map tools, patients using individual intervention without using the Conversation Map tools, patients using no formal diabetes education but the data will only be available in five years time. The data will be gathered on an annual basis over the duration of five years and the study will look into metabolic outcomes (A1C, blood pressure, cholesterol, weight) as well as patient and educator satisfaction, knowledge retention and several other behavioural markers of success(Merck , 2009). Nevertheless, the group-based IDEA education method using the Conversation Map approach was executed as planned and showed promise to improve diabetes self-management behaviours. Clinical and behavioural outcome data are necessary and will be forthcoming. 1.7 Current Diabetes Group Education Program in NHS Bromley To fulfil the NICE criteria and provide a quality diabetes care, the NHS Bromley chose to deliver DESMOND education program for all patients who are newly diagnosed patients. DESMOND has been ongoing for the past four years but the cost implication to deliver DESMOND is  £5000 per year plus ongoing  £5/person for the resources. With a diabetes population of 13,000 and about 10-15 referrals received on a weekly basis for DESMOND, NHS Bromley is striving towards an enhanced Diabetes Service to meet the increased demands and to curb the economic burden. In view of the strong positive feedback from diabetes educators in the US, the short duration of the program and the cost, NHS Bromley feel that Diabetes Conversation Map may be an alternative that could be used. As there is a lack of data for metabolic outcome and patient satisfaction, this study will be undertaken to evaluate which group education is more effective to be delivered at NHS Bromley. 2.0 Aim of the study: The aim of the study is to evaluate the effectiveness of DESMOND Group education program versus Diabetes Conversation Map group education program for people who are newly diagnosed with type 2 diabetes at NHS Bromley. It is a requirement of the NSF for diabetes that education is available to everybody with type 2 diabetes. At present, DESMOND is the most widely used programme available in the community setting, however this may not meet the needs of every local population. The Conversation Map tools may be an alternative or additional tool that could be used. In Enfield these have been used with success. The author is aware of work that has been ongoing to ensure that this method of education is fully compliant with the NICE criteria and is keen to implement this as soon as it is available. 2.1 Objectives: To measure patient biomedical outcome before and 3 months after the delivery of both group educations To assess patient satisfaction before and after the delivery of both group educations. 2.2 Hypothesis: DESMOND and Diabetes Conversation Group Education will have different biomedical outcome DESMOND and Diabetes Conversation Group education will have different patient satisfaction and quality of life outcome. 2.3 Study Design: Questionnaire Survey involving both quantitative and qualitative design analysis.

Film Critique: “American Gangster”

Film critique is the overall analysis and review of the cast, the performance, the direction, the acting, the overall gesture, shooting set and stage settings, production, dialogues, lyrics, music and everything which is involved in making a movie; starting right from the casting of performers to the launching of the melodrama or the movie which is presented to the public. In short, film critique is the final analysis of a movie which is written in such a good way that makes it publishable in the writing and reading commodity.It is not mandatory that a film critique should always be in the favor of the movie. It could be written against the movie or its makers because of any reason; this reason could be the platform, the story, the casting, the performance, the topic of the movie, anything! In this document, we would present the film critique and review of the movie â€Å"American Gangster† which was made in the year 2007. American Gangster: The Movie: There are several and hu ndreds of movies which are launched and then thrown into the basket without anybody’s notice.But at times, the box office and the audience are hit by a masterpiece. The American Gangster is one masterpiece on which its director, Ridley Scott should be very proud of. Ridley Scott is the ideal pioneer of the melodrama and he has succeeded in keeping his pace in this movie as well. He is the person behind the direction of the fabulous movies such as, the old Roman movie â€Å"The Gladiator†, the science fictional â€Å"Alien† and the â€Å"Blade Runner†; and makes the best of the project while keeping an eye on the whole story and background of the story and moral of the movie.The American Gangster is a melodrama by the king of melodramas and with the finest performance from the performers and actors in this movie (Mondello 2007). It is observed that the movie follows the line of the crime films such as â€Å"The Departed† and possess the variety of O scar award winning actors in the casting. Presented in the year 2007 by the Universal pictures, the usual reviews from all international media sides were very kind to this movie and the audience found it tempting and catchy enough to come and watch the movie but their overall expression is not so captivating as far as the whole impression is concerned.The whole story of the movie is based on a true story and revolves around the rise and fall scenario of 1970’s most powerful drug dealing king of the New York City. The casting consists of two major superstars Denzel Washington (playing the role of the drug lord, Frank Lucas) and Russell Crowe (a responsible cop who is on the hunt to catch the drug lord). Frank is a reliable and worker/friend of Bumpy Johnson since 15 years and decides to take charge of the drug lord position after Bumpy’s death. Frank Lucas becomes the drug lord of underground crime-world who has risen up from the Harlem.He has earned this position by de livering up uncut heroin directly from the Southeast Asian region during the Vietnam War era. His proceedings were determined by the incorruptible and honorable federal investigator Richie Roberts. The film basically focuses on Frank Locus. The script written by Steven Zailliant travels in parallel ways by focusing on two major roles of the two people belonging from entirely contrast fields; one from being the gang lord and other belonging to the law enforcement. This contrast has been set very neatly by the script writer and the director.Frank demolishes the in-way barriers and competitors and becomes the drug lord by bringing drugs from Thailand to U. S via military planes and then flooding the whole city with his uncut drug products, which ultimately makes him the king of the drug world with the huge profits of his drug sales. Previously, Frank Lucas has been a pimp-style flash who prefers to live with a normal style and maintain a low-profile by dressing himself in conventional and old-fashioned style, having breakfast alone in the morning in a local nearby bar and personally does not take interest in involving with his business around.But when he advances, he becomes bold enough to punish the accused person and shoot him in front of everyone on the streets of New York City in the day time. On the other side, detective Richie Roberts (Russell Crowe) is an honest responsible cop who has been assigned the task to administer the task force and bring down Frank Lucas to his end. The whole movie seems to confuse the viewer as how to judge Frank, because it is not really being seen whether to take him as a villain in the movie or as a main title hero character. He does something good; he is capable of doing bad things more and does so.He has a strong positive gesture towards his family and city and it shows that he loves both of them very much; but on the contrary he also makes efforts on vital basis to spread drugs in the city and play major role in the deaths, destruction and drug addiction in the entire city. His role is a mixture of villain, evil character as well as portraits himself as a loving person too. Same is the case with the character of Russell Crowe as he has been portrait as a sweaty honest cop who does brilliant job in the police department but his actual home and love life is a complete failure.He is popular to complete his tasks on time with high performance and do whatever he thinks is right; but at home, he hardly manages to give proper time to his only son and barely communicates with his ex-wife. Both the stars are brilliant characters in their own field. The whole movie shots two men in parallel and we do not manage to see both the stars together till the end, until they finally meet in the last scenes of the movie. The Review:The movie â€Å"American Gangster† doesn’t really starts with a slow pace and we do not seem to see any thrilling actions in the first thirty minutes of the movie and nothing rea lly happens in the story which could change the situation of the movie. Both characters of Denzel Washington and that of Russell Crowe busy in their own circle of life. Denzel Washington being busy in working his heads off; and Russell Crowe being busy with his studies and trying to complete his law degree from the law college. The story of the two men continues to serve as particularly individual narrative stand which later on becomes closer tightly together.As a viewer, most of the people do not find the movie very interesting especially in the beginning and also the ending. The best part is in the middle of the movie. Most of the people find the opening and ending part of the movie boring whereas they like the middle part of the movie quite interesting. (Dargis 2007) There are some flaws or long tails in the movie as well which makes it boring for the viewers. These parts raise questions in minds such as; how come a movie would portrait the life of woman who is ex-wife of a cop w ith so many details and what is the use of focusing on the life of a woman in the story of a criminal drug lord?How many crime concerned movies get the details of a dirty cop who enjoys making other people’s lives miserable? There are at times so many similarities I found with other crime based movies while watching this film that I almost forgot that this movie was actually based on a true movie. There are many shots which are similar with other crime based movies and do not play a distinctive movie as a whole. What the viewers would be interested to know how the drug dealer Denzel Washington dealt with his emotional feelings and nature after becoming the drug lord and how he took it on is psychology.People would be more interested in knowing how Denzel Washington dealt with his subordinates and become the drug lord in detail. This all could have been portrait in better form rather than portraying more on the emotional irrelevant details of Russell Crowe’s wife suffer ings and life. (Dargis 2007) Whatever the movie takes, Denzel Washington is the best actor when it comes to act seriously. He can take the movie and the viewers to their edge if he gets to act and so has he done in this movie as well.As Frank Lucas, Denzel Washington wears traditional old fashioned clothes with a gun tacked up on his belt and makes his own reliable gang by calling off his relatives and inviting them and binding them together in his gang to make a team. This is how he manages to get the title of the drug lord by eliminating his competitors and getting competitive edge to all the criminals in the city. (Gleiberman 2007) Director Ridley Scott seems to like his villain too much, that is why we did not manage to judge who is the hero or who is being the villain in this movie.Ridley Scott has showcased the character of Denzel Washington with lots of positive points along with being the bad guy. He has tried to prove his point in this movie that hope and struggle should be implemented in lives and there is no such word as being a failure or hopeless. Every man has guts to be the best if he tries to. The best shot in the movie could be the one when Denzel Washington (Frank Lucas) shots a man in head on the streets on a daytime in the new York city, the camera moves backward with long focus view; this shot tells the sensitivity of life and territory consumption detail.Nonetheless, the best scene which we have found to be most interesting is the one in which Russell Crowe (Richie Robert) with his task force decides to take over and drag down an incoming military plane and immediately comes in action by putting off all the things and coffins apart. This scene contains all the concentration and emotions which are needed to hold the audience on their seats. The movie â€Å"American Gangster† is rated R which means that it is restricted for the children coming under the age of 17 years who are accompanied by either their parents or guardians because of the drug and violence reference used in the movie.The overall reaction which was perceived by the viewers was that Russell Crowe played the role of Richie Roberts very well better than Denzel Washington being Frank Lucas because he played a different role than he usually plays in other movies; whereas Denzel Washington played the same â€Å"angry man† role which he usually does all the time. However, keeping the same image of the angry man, Denzel Washington did a very good job and no matter what business the movie brought to the team involved in making, it touched the hearts of the viewers and is a movie which we could recommend others to watch to pass time with a normal fine mood.The Team: Directed by Ridley Scott; written by Steven Zaillian, based on the New York magazine article â€Å"The Return of Superfly,† by Mark Jacobson; director of photography, Harris Savides; edited by Pietro Scalia; music by Marc Streitenfeld; production designer, Arthur Max; produced b y Brian Grazer and Mr. Scott; released by Universal Pictures. Running time: 158 minutes. The Cast: WITH: Denzel Washington (Frank Lucas), Russell Crowe (Richie Roberts), Chiwetel Ejiofor (Huey Lucas), Cuba Gooding Jr.(Nicky Barnes), Josh Brolin (Detective Trupo), Ted Levine (Lou Toback), Armand Assante (Dominic Cattano), John Ortiz (Javier J. Rivera), John Hawkes (Freddie Spearman), RZA (Moses Jones), Lymari Nadal (Eva), Yul Vazquez (Alfonse Abruzzo), Ruby Dee (Mama Lucas), Idris Elba (Tango), Carla Gugino (Laurie Roberts), Joe Morton (Charlie Williams), Ruben Santiago-Hudson (Doc), Roger Guenveur Smith (Nate), Roger Bart (United States attorney), Chuck Cooper (private doctor) and Linda Powell (social worker).Works Cited Mondello,Bob; 2007, Movie Reviews – ‘American Gangster', NPR. org, Available online at: http://www. npr. org/templates/story/story. php? storyId=15885027 Owen Gleiberman, 2007, Movie Review – American Gangster (2007), Entertainment Weekly, Availa ble online at: http://www. ew. com/ew/article/0,,20155724,00. html MANOHLA DARGIS, 2007, Sweet, Bloody Smell of Success – Movie Review of the American Gangster, the New York Times.

Invisible Man Essay Topics Reviews & Tips

Invisible Man Essay Topics Reviews & Tips It has never been simpler to get inspiration and tips for your next school assignment than at TopicsMill! Think of one school rule which you really dislike. The role of assigning an essay to middle school students is to make awareness and permit them to develop writing skills. A minumum of one parent should work at home. People in demand of case study research should rush to appreciate our assistance. To choose which subject you're likely to discuss, it's essential to see the complete collection of good persuasive speech topics from the special area of study. When it can be difficult to inspire children to compose essays, the secret is to introduce subjects or issues that they're interested in. Some programs these days are intended to teach children. Gun ownership ought to be tightly controlled. Recycling should be mandatory for everybody. Life is far better than it was 50 decades ago. Vandalism is getting to be a problem in the present society. Our life is about words. The joke, clearly, is I don't dwell in Harlem but in a border area. A number of us tried to grin. Explain the steps that you proceed through to repair your hair in the morning. Vital Pieces of Invisible Man Essay Topics Some hobbies are merely diversions. All you need to do is select the category or kind of essay that yo u're assigned to write for school. Your topic is so important because you've got to make sure it is related to the class that you're taking unless it is for English class. Cell phones should not be used while driving. The Characteristics of Invisible Man Essay Topics Opt for the period of life which you think is best and compose an essay arguing why it's the very best time of life. The issue is that everybody's interpretation of what makes a great society differs. It's essential not just to supply the evidence to strengthen your position but also to refute that of your opponents. You have to come across good evidence to strengthen your ideas in addition to examples to illustrate the evidence. Teens should be asked to take parenting classes. They should be able to choose their bedtime. Parents should speak to kids about drugs at a youthful age. Parents of bullies should need to pay a fine. Invisible Man Essay Topics Can Be Fun for Everyone Writing prompts are among the best methods to create confident writers who take pleasure in the practice. Reading example essays works precisely the same way! The reader needs to be impressed by how you defend your ideas. Don't neglect to bring a strong hook at the beginning (introduction paragraph) and wind up with an impressive conclusion to earn the reader want to go over the interesting persuasive essay topics of your selection. There are lots of things you need to live, many things you feel, and you simply don't know if a number of the situations you do are ok or not. If you've got the chance to choose, start with picking a topic that suits within the format you've been given. The truly amazing thing about our website is that you may discover a lot of interesting suggestions that will get you thinking about what essay you'd like to write. Thus, it's important to read corresponding formatting guide. Test essay questions will be contingent on the topic, naturally. SATs ought to be eliminated. For example, let's say you select the very first topic from our list. Write an essay to strengthen your view about it. When it has to do with writing an argumentative essay, the most significant point to do is to select a topic and an argument which you can really get behind. It's only normal to be anxious about hiring an on-line essay writer as you can not ever be sure whether you are employing the ideal service or not. On the opposite side, acquiring a list of good persuasive essay topics is inadequate. Take a look at how to develop an essay topic! Enable the professional academic writers help to your informative paper! Young writers may try simple on-line citation generators which are ordinarily at no cost. When you're at college or school, one of the primary tasks you need to do is write essays. A set of critical essays on Invisible Man written by an assortment of scholars.

Change Continuity in Contemporary Business - Free Essay Example

Sample details Pages: 8 Words: 2526 Downloads: 5 Date added: 2017/06/26 Category Business Essay Type Analytical essay Level High school Did you like this example? Change Continuity in Contemporary Business Executive Summary The Global Business arena is a vast area. Since of late many competitors are taking the stage. At the same time many have left the arena defeated. This arena has a landscape which keeps changing constantly. Since the beginning of the 21st century the landscape has begun to shift evermore rapidly causing competitors to fall victim. Some recover and keep fighting for markets, while others leave the arena for good. This report discusses in brief the new trends emerging in the global business arena as well as new trends in politics and economic sectors. Successfully adapting to changes are the key for an organizations success in global market competition. This report also discusses in brief the implications the new trends in Sri Lanka and how it would impact the country and what steps should be taken to ensure the nation will face global competition for investors successfully. Table of Contents Acknowledgement Executive Summary Introduction 1.The Economic and Po litical Trends Emerging as a Result of Changes in the Business Environment. Competing for Customers of Diverse Income Levels. Adapting to differing regulatory environments, practices and other laws Focusing on the emerging regions for skilled labour and growing consumer markets. The technological advantages for newly starting businesses. 2.Implications of the new trends for Sri Lanka Conclusion References Books Websites Don’t waste time! Our writers will create an original "Change Continuity in Contemporary Business" essay for you Create order Introduction The global business landscape has started to shift rapidly since the beginning of the technological revolution. The technological revolution has caused large companies to close their doors and allowed smaller companies to grow at an extremely fast rate. This phenomenon is a side effect of globalization. New trends in economies, politics and business keep surfacing daily. The task of a businessman in the current era is to keep up with the changes or face bankruptcy. The competition has become fierce, and on top of this, the consumers have become more demanding. This is due to a simple fact. At present the consumers have many other alternatives to get what they require. In other words technology has not only made business easier but has made the task of competing challenging. This report discusses some of the changes in the business landscape and some new trends which are emerging in the economic and political sectors. 1. The Economic and Political Trends Emerging as a Result of Changes in the Business Environment. The article, which is adapted from à ¢Ã¢â€š ¬Ã…“Urban World: The shifting global business landscapeà ¢Ã¢â€š ¬Ã‚  by the McKinsey Global Institute, indicates changes to the business environment. Out of the said changes a few critical changes are mentioned below. Competing for customers of diverse income levels. Adapting to differing regulatory environments, practices and other laws of the country which the business operates in. Focusing on the emerging regions for skilled labour and growing consumer markets. The technological advantages for newly starting businesses. Competing for Customers of Diverse Income Levels. New organizations which are emerging around the globe at an ever increasing rate mainly focus their attention to their local markets and similar markets. Since the new organizations start-up from emerging or developing countries such as India and Brazil, they tend to focus their marketing strengths towards similar or less developed countries. In some cases a multinational giant will have to compete with an emerging company of the developing world. For example, in the motor bicycle market segment, a well-established multinational organization such as Yamaha, has to compete with Bajaj which is a manufacturer based in India. In this case Bajaj has captured the major market share due to its low cost products. Some companies have the ability to cater to consumers who have diverse income levels. Huawei, a Chinese telecommunication giant, manufactures mobile phones for individuals who have a low monthly income to individuals who have a substantial monthly income. This ability has given organizations such as Huawei to gain a global market share in the mobile handset sector. Although it may not have a large market share or technological development such as Sony mobiles, it is posing a threat to the Japanese technological giant in terms of cost. Basically organizations established in emerging markets are becoming threats to larger multinationals. Adapting to differing regulatory environments, practices and other laws Many countries and states have regulations which are more and more focused on sustaining the earthà ¢Ã¢â€š ¬Ã¢â€ž ¢s natural resources. Most nations have environmental regulations as such the manufacturers products have to go through vigorous testing prior to selling. (E.G. Automobiles, Electronic devices, perfumes etc.) An organization which is willing to compete in the global arena should be able to adapt to a majority of regulations. In a study conducted by the McKinsey Global Institute, it has been noted that organizations which started from developing countries or emerging global markets have the tendency to adapt quickly to the majority of regulations and enter foreign markets than the more established multinational organizations. In his book, à ¢Ã¢â€š ¬Ã‹Å"The World is flatà ¢Ã¢â€š ¬Ã¢â€ž ¢ Thomas Friedman states that the worldà ¢Ã¢â€š ¬Ã¢â€ž ¢s economic playing field is à ¢Ã¢â€š ¬Ã‹Å"leveling outà ¢Ã¢â€š ¬Ã¢â€ž ¢ and a more individualistic competition is more likely i n the future. In this perspective, it is not a surprise that organizations from developing nations which are smaller in scale, tend to grow quicker than the large multinational companies. Focusing on the emerging regions for skilled labour and growing consumer markets. Emerging regions are also referred to as the developing nations. The 21st century has seen the boom in the emerging regions in business as well as skilled labour. Tata group was an automobile manufacturer in India, they mainly restricted sales to the local market and neighboring countries in South Asian region. At present they are the largest private sector industrial employer in the United Kingdom. Many IT organizations are recruiting employees or opening up R D offices in emerging regions such as India, China and Brazil. Many automobile manufacturers have decided to exploit the labour resources of India and China and built manufacturing plants which employs thousands of locals. The technological advantages for newly starting businesses. Technology has been growing in leaps and bounds since the beginning of the 21st century. In the business sector almost all processes have at least one stage which there is an involvement of a computer. It is the same in the manufacturing sector, where in the past there was a substantial involvement humans. At present the human factor has been greatly reduced, sometimes replaced by machines and robots. If an individual wishes to start a business, he or she will find the process easier than it was in the past. Businesses today do not require complicated and outdated computer installations and other software. Everything could be handled by a PC, which reduces the start-up time of a business significantly. With the technological development, it has been easier to communicate with clients and business partners across the globe. Finalizing business deals is possible regardless where the client and marketer are located. After analyzing the above mentioned trends, it is compelling evide nce to prove the theory that the business world playing field is levelling out, in which case, Thomas Friedmanà ¢Ã¢â€š ¬Ã¢â€ž ¢s theory is in action. If this theory continues, it is evident that multinationals will no longer be representing a country or region, it will be individuals that would be representing a country or region in business. In 10 years it is quite possible to see small startup businesses progressing rapidly and conducting business in a larger scale than the current multinational organizations. However if Thomas Friedmanà ¢Ã¢â€š ¬Ã¢â€ž ¢s theory prevails, multinational organizations will be an obsolete concept in business, due to the fact that individuals also have an equal opportunity in competing in the global market place. Friedmanà ¢Ã¢â€š ¬Ã¢â€ž ¢s 10 flatteners allow the more individualistic approach. He also mentions of a system in which the average employee should update their skills as updating software of an electronic device. Evermore increasingly g overnments are forming alliances with neighboring nations to improve economies. These groups are known as trade blocks. The primary objective of this is to improve the economy and create more job opportunities for the citizens. Political agreements such as using a common currency is one method to improve a regionà ¢Ã¢â€š ¬Ã¢â€ž ¢s economy. The EU is currently discussing a program which will see all of the countries in the union to be governed by a single government rather than individual governments. This will help the EU to integrate resources and skills making it a stronger global economy. 2. Implications of the new trends for Sri Lanka The observed trends in the business sector can be implemented in Sri Lanka, in order to reap the benefits from FDIà ¢Ã¢â€š ¬Ã¢â€ž ¢s. At present it is crucial for the government of Sri Lanka to take steps to improve exports to support the development of the country. The government should get in to agreements which favour the country. The regime change in India shows a positive effect for Sri Lanka and the government and economists are expecting more friendly and beneficial trade agreements from the incumbent government. The government should encourage more exports. Although it is suggested by economists the government has not brought a policy which favours exports. The government should also encourage planters to get more from their plantations. At present Sri Lanka is the largest tea exporter. Although it is clear that China is catching up gradually. If the government does not act on this issue, Sri Lanka could lose its place. Sri Lanka is the 4th largest Tea producer in the w orld, with China at the top of the list. The Sri Lankan government should also allow exports of goods which are requested by foreign countries. For example, the Sri Lanka Tea Board will not allow the export of low grade teas. The fact that the officials should know is that while Sri Lanka is not providing such teas, other nations are providing and gradually gaining the market. It is known fact that there is a market for the low grade teas as well as the high graded teas. Catering to only high grades is less profitable although the value is much higher. As mentioned above, the government should encourage private institutions to cater to consumers of various income levels. If the country does not move adapt to the changes happening globally the industry and economy could collapse. Identifying markets and penetrating the markets with local products is beneficial for the entire country. In order to compete in the new age of business, the government should amend its export policies. In terms of infrastructure Sri Lanka is heading the correct direction. Improving infrastructure is the first step to attracting foreign investors. The port city project which is currently underway is a large undertaking by 4 Chinese firms which earn the government approximately Rs. 8 million per perch from the land reclaimed from the Sea. This will also improve the business sector of the country as the port city is designed to become a business hub in the Indian Ocean. Project like the Port City is a large step towards attracting larger multinational or global business firms to invest in the Sri Lankan market. The government should also adapt a policy where importing should be regulated and a policy should be implemented that locally manufactured products should match the product quality of the imported item. This policy would help the growth of local industry as well as restrict unwanted expenses in exports. This will allow the products manufactured locally to be more competit ive in the international market since the quality is almost the same as imports to the country. The governments should provide assistance to organizations which are seeking to enter foreign markets. Diplomatic ties should be used to promote trade as well as educate the local manufacturer of the regulations and laws of the particular country. This will help the local manufacturers to adapt to regulatory bodies of all countries and will be able compete successfully against foreign competitors. The government should also utilize the population to attract foreign investors. The government should encourage the workforce to update their skills in order to successfully retain their employment and improve in their personal careers. The government should also implement a policy where youths are to be trained in the latest form of technology and enable the youth to gain knowledge of the career path of their choice. Since organizations are focusing on regions with skilled labour, it would b e appropriate to implement the policies mentioned. Technology is growing increasingly every moment. The government should use the latest technology available to provide a better service to the people. The government should implement computerized systems to all government offices in order to make these offices efficient. Providing technology at a low rate to small businesses will help the business to grow. Growing small businesses leads to a growing economy. This could result in some Sri Lankan firms entering the prestigious Forbes 500 list. Conclusion The global business field is an entity which has seen many revolutionary changes. It has been growing rapidly since the beginning of the 21st century. New business techniques, economic and political trends keep emerging. An organization which fails to keep up with these is bound to fail and drop out of the market. The article from McKinsey Global Institute states several emerging trends. The most prominent trends were discussed above and the implications of these trends in Sri Lanka were discussed in comparison with some current development project which are underway. In conclusion it could be said that the Sri Lankan government has not implemented policies which will help the country perform well globally as well as the industries in Sri Lanka. In the researches point of view Sri Lanka has the potential to grow as a nation and as a business hub in the South Asian region. References Books Thomas L. Friedman, 2007. The World Is Flat 3.0: A Brief History of the Twenty-first Century. Updated and Expanded Edition Edition. Picador. C.K. Prahalad, 2006. The Fortune at the Bottom of the Pyramid: Eradicating Poverty Through Profits. 1 Edition. Wharton School Publishing. Joseph E. Stiglitz, 2007. Making Globalization Work. Reprint Edition. W. W. Norton Company Websites Sri Lanka reclamation to expand capital city. 2014. Sri Lanka reclamation to expand capital city. [ONLINE] Available at: https://www.lankabusinessonline.com/news/sri-lanka-reclamation-to-expand-capital-city/2117308738. [Accessed 02 August 2014]. Sri Lanka: Construction of Sri Lankas port city to begin later this year. 2014. Sri Lanka : Construction of Sri Lankas port city to begin later this year. [ONLINE] Available at: https://www.colombopage.com/archive_12A/Jul30_1343633133CH.php. [Accessed 02 August 2014]. Historic artificial island project begins | Daily News Online : Sri Lankas National News. 2014. Historic artificial island project begins | Daily News Online : Sri Lankas National News. [ONLINE] Available at: https://www.dailynews.lk/business/historic-artificial-island-project-begins. [Accessed 02 August 2014]. Top 10 Tea Exporting Countries in the World Top Ten. 2014. Top 10 Tea Exporting Countries in the World Top Ten. [ONLINE] Available at: https://www.mapsofworld.com/world-top-ten/tea-exporting-countries.html. [Accessed 02 August 2014]. TED Case Study: Ceylon Tea. 2014. TED Case Study: Ceylon Tea. [ONLINE] Available at: https://www1.american.edu/ted/ceylon-tea.htm. [Accessed 03 August 2014]. BBC News | BUSINESS | Sri Lanka tops tea sales. 2014. BBC News | BUSINESS | Sri Lanka tops tea sales. [ONLINE] Available at: https://news.bbc.co.uk/2/hi/business/1796478.stm. [Accessed 02 August 2014]. BABM 08