Detox Diet

No evidence supports that harmful chemicals accumulate in the body (in fact, the liver and kidneys are pretty good at getting rid of bodily toxins). And even if toxins did accumulate in the body, there’s no reason to believe that these detox diets would get rid of them. Toxicologists A. Jay Gandolfi, an associate dean for research in the college of pharmacy at the University of Arizona, and Linda Birnbaum, director of the experimental toxicology division of the Environmental Protection Agency made the following points in a LA Times article: 1. igh volumes of liquid consumption could theoretically help remove water-soluble chemicals like arsenic, but not fat-soluble chemicals (which make up most pollutants) 2. fiber consumption may help eliminate toxic chemicals that accumulate in the liver, but not chemicals that are located in other parts of the gastrointestinal system 3. raw vegetables have no special detoxifying properties other than that their high fiber content can furthe r help bulk up stools 4. most chemicals of concern are fat-soluble and so are stored in fat. The best way to get rid of these potential toxins is not through a detox diet, but through weight loss.Slender people get rid of toxins more quickly than overweight and obese individuals. The decreased bloating is likely from eating less food; the clearer skin from increased hydration; and the decreased headaches exercise and relaxation components of the program, and psychological factors. – placebo effect Some people report feeling more focused and energetic during and after detox diets. placebo There’s simply no scientific evidence to suggest that our bodies need help to get rid of waste products if we are healthy and there’s little proof to support the claims that detox diets work.Muscular System: Muscle MetabolismQuite rightly, most nutritionists, dietitians and doctors believe that our bodies are completely capable of excreting waste without the aid of ‘detoxi ng’ – that’s what our liver, lungs, kidneys and skin are designed to do, after all. Most experts also say that strict detox diets followed in the long term, can lead to nutrient deficiencies and health problems associated with this. â€Å"It may alleviate your guilt but it is actually doing more harm than good. † McGrice. Health Kick nutrition and dieteticsHowever, studies have shown that fasting and extremely low calorie intake — common elements of detox diets — cause a slowdown of metabolism and an increase in weight after the dieter returns to normal eating. Fasting to detoxify and lose weight is not necessary, says Frank Sacks, MD, a leading epidemiologist at the Harvard School of Public Health. â€Å"There is no basis in human biology that indicates we need fasting or any other detox formula to detoxify the body because we have our own internal organs and immune system that take care of excreting toxins,† Sacks says. â€Å"Your body is designed to remove toxins efficiently with organs such as the kidneys, liver, and colon. You don’t need detox diets, pills, or potions to help your body do its job,† Sacks says. Experts agree there is no credible science to substantiate claims that detox diets work or the need for detoxification, lymphatic draining, and frequent bowel cleansing. There are no studies available to document the benefits; instead, most claims are based on testimonials. Include skin British Dietetic Association, â€Å"  Detox diets are marketing myths rather than nutritional reality. Dr John Emsley said: â€Å"There is no scientific reason for people to waste time and money on so-called detox regimes, fancy diets, or expensive remedies, none of which can compare to the detox system that is already inbuilt into our natural system. † â€Å"The concept of ‘detox’ is a marketing myth rather than a physiological entity,† Dr. Catherine Collins, Chief Dietician at St George’s Hospital Medical School, London, http://www. acefitness. org/blog/2239/do-detox-diets-work http://maddashpublishing. wordpress. com/2012/03/28/detox-diets-do-toxins-hate-purified-vegetables/ http://www. etterhealth. vic. gov. au/bhcv2/bhcarticles. nsf/pages/Placebo_effect http://socialanxietydisorder. about. com/od/glossary/g/doubleblind. htm non scienticfic evidence- http://health. ninemsn. com. au/whatsgoodforyou/factsheets/826277/does-detox-work http://www. bbc. co. uk/sn/humanbody/truthaboutfood/young/detox. shtml http://www. choice. com. au/reviews-and-tests/food-and-health/diet-and-exercise/nutrition/do-diet-detox-products-work. aspx the placebo effect A placebo is any medical treatment that is inactive.A patient can be given this ‘dummy’ treatment such as a pill, surgery or form of exercise, and begin to feel better. They begin to feel cured although the medication really did nothing for them. The placebo effect is triggered by the person's belief in the treatment and their expectation of feeling better. Around one third of people who take placebos will experience an end to their symptoms. In the case of a detox diet, the individual may feel better because they believe they are doing something beneficial for their body. They feel like they have more energy and focus, but it is only a belief.Little do they know, they are causing nutrient deficiencies to the body. Double blind experiment A double blind experiment is where neither the researcher nor the participant know which treatment each participant is receiving. For example half of a group to be tested is given a placebo, and the other half are given the real medication. The purpose of this experiment is to eliminate bias from both parties. A double blind detox diet has never been carried out, but it would be very valuable in proving whether these diets truly work. Anecdotal evidence

Race and Ethnicity Related Controversies in the News Essay

Any given society relies on newspapers as one of its major source of information and basically sets the tone for the rest of the media on how it should conduct its coverage (Jennifer, 2003). Given this fact, it important to question the way information is presented to the public by journalists. In their endeavor to provide the public with information, journalists reproduce world views that are culturally embedded in a bid to distinguish the significant and the valid (Mikal, 2010). The technique of organization used by journalist to frame their stories is the similar as the one used by everyone daily to create a conversation be it controversial or interesting. Journalists frame information either positively or negatively. They have the capability of making people question the race of the character in discussion thereby either drawing sympathy or criticism from the targeted audience for the purpose for which the journalist intended (Mia, 2006). This review will be looking at race and ethnicity and how it has been in the news as regards to racial profiling. In the news world, racial profiling has been used to mean the stopping of people in public places for the purpose of inspecting them to find out their race and ethnicity for statistical reasons. In post September 11 news, the term ‘Flying while Arabs’ has been common in journalists’ vocabulary. It is used to imply that law enforcers have been unfairly targeting Arabs without a good cause (Saud 2003). The Depart of Justice defines racial profiling as a police-initiated action relying on race or ethnicity besides the behavior of any individual who is suspected of engaging in criminal activity. Amnesty international, on the other hand, defines racial profiling as the use of race, ethnicity, and religion, to target individuals or groups by law enforcement officers because of lack of trustworthy information linking the aforementioned groups to crime or a scheme (Leonard 2002). Racial profiling was a social injustice according to many articles before the September 11 attack. However, others portrayed it as a sensible technique used by law enforcement officers (David, 2013). Those who defended the practice argued that it was a case of police officers using scarce resources in fighting crime by using the law of probability (Nadra ,2011). An interesting dichotomy came up after the September 11 attack with journalist adding victims of racial profiling to their coverage and the shift of transformation in belief by the public. In 2004, Michelle Makin wrote an article in the USA today stating that it justifiable to do racial profiling based on race, religion or even nationality in a scenario where by the security of the United States is threatened. She went on to state that in situation whereby the USA and Islamic extremist are at war, it makes sense to target local Muslim communities for intelligence gathering. A similar view was supported by Charles Krauthammer who in 2001 wrote in ‘Times’ magazine that to prevent terrorists from travelling in the US, then racial profiling at the airport was a better option. On October 17 2001, a renowned African American columnist expressed relief in his column Omaha world-Herald stating that his ethnic group was no longer in the spotlight as there was now a new public enemy number one namely Muhammad and Osama. In conclusion it can be said that while news remains to be the number source of information, it is also true that the way it is presented remains to be a vital as it can be used to create or demystify sociological theories in a society. Reference Mia N. (2006). Racial Profiling in the Black and Mainstream Media Before and After September 11 . The University of Texas at Austin. Available online < http://www. academia. edu/1535675/Racial_Profiling_in_the_Black_and_Mainstream_Media_Pre_and_Post_September_11_Doctoral_Dissertation> Nadra K. (2011). Improving Media Coverage of Racial profiling. Available online Mikal M. (2010). Media black face â€Å"racial Profiling† in news reporting. Available online < http://www. peopleofcolororganize. com/analysis/opinion/media-blackface-racial-profiling-news-reporting/> Jennifer D. (2003). The perils of profiling for the media. Available online < http://www. apa. org/monitor/jan03/perils. aspx> Saud (2003). Racial profiling of Arab, Muslim Americans in US media.

The Constraints and Opportunities for an E-Commerce Strategy Assignment - 1

The Constraints and Opportunities for an E-Commerce Strategy - Assignment Example It should also allow the customers to give feedback and share their business experience with others. This helps to attract more customers to your business. The second element is the layout. The layout should help to ease navigation around the website. A simple layout facilitates the navigation process, therefore, allowing customers to easily locate the products and services that they need. It also facilitates the payment process. The third element is the ordering process, which can also be referred to as the shopping cart. This is part of the purchasing process and it should be designed to suit the needs of the customers and the employees. It should be designed in a way that facilitates understanding between the employees and the customer. The business should provide a shopping cart that meets the customers’ needs. The fourth element is the payment process. The website should facilitate the exchange of funds from the employee to the business. One should consider how the custom ers will pay for the products and services by establishing a mode of payment that can easily be transacted by the customer. The payments should also appear real time to eliminate misunderstandings that could arise from delays. The fifth element to consider is the order fulfillment. All transactions that have been paid off should be completed through the delivery of the relevant products and services. This helps to build trust and attract new customers through positive ratings (Clark, 2012). Â  There are several opportunities that a business can receive from engaging in e-commerce. Firstly, the business is able to target a wide range of customers. The internet has very many users from different backgrounds; therefore, one can easily locate many potential clients using a single interface. Secondly, it is a form of marketing.

Private Detectives & Present Legal System Essay Example | Topics and Well Written Essays - 750 words

Private Detectives & Present Legal System - Essay Example Considering the roles of Sherlock Holmes and Sam Spade in ‘A Study of Scarlet’ and ‘A Maltese Falcon’ respectively, here arises a question if not being a government representative has any impact on their ability to work as investigators. In these literary works, Sherlock Holmes and Sam Spade are portrayed as characters that are detectives having exceptional intellectual abilities and despite the fact that they are not part of legal system, they successfully manage to operate as a single entity who does not need support of government or any authority delegated by it. In order to identify if there is a connection between the position of the private detectives like Sherlock Holmes and Sam Spade outside the formal legal system and the ability to solve their cases, it is important to identify if the law recognizes private detectives and investigators as a legal entity. According to the law of many states such as UK, Indonesia etc, private investigators are individuals who are not provided with any authority delegated to them from any government agency (Private Investigators). Although there have been legislations about licensing of private investigators but there is nothing concrete in legal system which can support the independent operations of private investigators. Despite their inability to act as a legal entity, they are used by law firms, corporate officials, industry representatives, civilians and government for their own purposes. Proofs provided by these detectives are presented in the court of law with testimonies. However, concerns like in fringement of privacy and unauthorized access to sophisticated information always remain valid. In the light of this argument, it is clear that where private detectives are shown as the lead characters in the work of Dashiell Hammett and Sir Arthur Conan Doyle who cannot be replaced by any government official due to their indispensable ability to investigate critical cases; these characters have no jurisdiction or legal authority in the court of law. However, lack of legal authorization does not seem to hamper their ability to work as a private investigator; in fact, they appear to operate with more sovereignty due to no liability and accountability for their work. Characters like Sherlock Holmes, Doctor Watson and Sam Spade are imaginary characters which are personified as daring, intelligent, cunning and disconnected to emotional bonds. These traits govern their ability to operate as a private detective and also allow them to work without being hold back by other social factors. A s far as their ability to operate is concerned, it’s their personal traits, attention to details and extensive knowledge which allows them to have a command on the subject matter, identify hidden leads and pick up the clues. These detectives are often seen as being recruited by the law enforcement agencies for assistance and apparently they have the ability to work as singular force in themselves, as portrayed by their authors. Sam Spade was often suspected by the Police for murders and other crimes but somehow he managed to mislead them and carry out his own private investigations while pairing with criminals. Sherlock Holmes is perceived as an ultimate clutch used by law enforcing agencies of that time. He is often found investigating personal matters and interfering in the lives of civilians which only falls under the jurisdiction of law enforcement agencies. Where modern era has no room for private investigators as a legal entity despite their extensive use by law firms, Police, civilians and even government, these two literary works have managed to portray private investiga

New Zealand Tourism Essay Example | Topics and Well Written Essays - 1250 words

New Zealand Tourism - Essay Example This is because people falling in the above age limit are known to make frequent visit to places and destinations. Some of the social marketing elements which could be sued for the purpose are promotional campaigns like public announcements, billboards, media events and community outreaches. The importance of video marketing and blog marketing and social networking sites could also be used for the purpose. This would allow a two way communication process between the authorities and the general public. The advantage of social marketing is that the viewers would be able to provide their views and suggestions regarding their needs and requirements based on which the authorities would be able to provide the facilities. Target market segments and stakeholders Natural disaster has great impact on the tourism and also on the economic condition of the country. Thus effective marketing strategy is very essential to communicate with people over the globe that the country is ready for business. For successfully implementing the strategies proper evaluation of the target market and the stakeholders analysis is very important for NZ Tourism. ... Figure 1: Visitor arrival trend rise with income (Source: Local Government New Zealand, 2011, p. 9) The top two markets which has great trend of tourism attraction for New Zealand are China and Australia which are needed to be focused for marketing of the Tourism activity. Figure 2: China and Australia are the Key market (Source: Local Government New Zealand, 2011, p. 10) The interactive segments who are involved in the process of engagement and interaction with respect towards the social, cultural, environmental of these potential markets are the main target segment for the tourism industry. The primary stakeholders for the tourism of New Zealand may be divided into three major categories- 1. Industry groups like Hotel Council of the country, TIANZ and Inbound Tour Operators Council of the country. 2. Tourism businesses like Air New Zealand and Tourism Holdings Limited and 3. Public organizations like Department of Conservation and Tourism Research Councils. International stakeholde rs of the country include industries like hotel, transport and travel companies who are supplying tourists for New Zealand (Inter brand, 2005, p. 57-58). With time better relationship of the country with the global market and effective communication system will increase the number of stakeholders if the marketing communication strategy can be effectively developed and marketed. Role played by social marketing elements The field of tourism has been changing rapidly over the years. This holds true for the country of New Zealand which has been struck by natural disasters like earthquakes, volcanic eruptions and landslides etc. On account of the above aspects the tourism sector of the nation has suffered a setback and has been demonstrating

Total Quality Management Essay Example | Topics and Well Written Essays - 750 words - 1

Total Quality Management - Essay Example TQM has been designed for companies that are operating in various disciplines and for this reason, each company has different uses and implementation technique of TQM. However, there are organizations that fail to implement TQM at an operational level. Some of the reasons for the failure are as follows:Â   Rigid Organizational CultureOne of the key reasons for failure of TQM is that the implementation of this process requires patience and agility and it requires flexibility in organizational culture. Organizations are required to change their paradigm from a functional to customer focus approach. Organizations that are unable to cope up with this approach can face detrimental consequences because implementation of TQM is not easy and it requires mobility to changing customer needs and business trends. Not every organization can cope up to such changes and this is certainly one of the reasons of failed implementation of TQM.Resistance to ChangeIf a company wants to implement TQM, it should first communicate to its employees the importance of TQM. Every single employee, from the lowest to the highest hierarchical level, should be accepting and willing to adopt this organizational change (Donaldson & Munir, 2013). However, such changes are not successful at times because some employees do not want to come out of their comfort zone and resist to any sort of change. Employees fail to understand the importance of this activity and do not understand that this will improve the productivity and profitability of the company.

Peak Experiences and Strategic IT Alignment At Vermont Teddy Bear Case Study

Peak Experiences and Strategic IT Alignment At Vermont Teddy Bear - Case Study Example This research will begin with the description of VTB’s business model. Founded in 1981 by John Sortino, VTB has undergone several challenges including a bankruptcy threat in 1990, but still survived to provide gift delivery services. The company’s product line is composed of three major products: Calyx Flowers categorized under gifts, Bears (posh dolls), and PajamaGrams in the apparel class. With these products, the company has been striving to obtain a share of a market often dominated by rivals. The company’s customers make gift orders through web, mail, retail store, and phone as the predominant channels. Each of the aforementioned channels is supported by its unique software. However, the company is considering using a single multifaceted software that will enable it to manage all orders from its clients and monitor the demand as a way of reducing redundancies in production or running out of stock during peak seasons. As the company is committed towards meeti ng the divergent tastes and preferences of its customers, it allows its customers to select ensigns and outfits from a list of alternatives. Their choices are incorporated into the process of designing the bears. To uphold its value proposition, VTB produces purchases raw materials and fabrics from vendors from different locations. According to Austin, Nolan, and O'Donnell (2012), the purchasing of raw materials from different vendors allows the manufacturer to use the best accessible quality and circumvent snags resulting from suppliers’ failures to uphold integrity.

Rhetoric-in-Practice (RIP) Assignment (Movie review of The Hunger Essay

Rhetoric-in-Practice (RIP) Assignment (Movie review of The Hunger Games) - Essay Example Within District 12, the heroine in the film Katniss Everdeen (Jennifer Lawrence) volunteers to take part in the Games in place of her younger sister. Katniss’ special way of changing the world may appear small scale and accidental; however, towards the end Katniss appears to have changed her own world. In the event that Katniss is to return home to District 12, she confronts impossible choices (Egan 2). She should weigh her survival against the wellbeing of humanity and her life against love. PHOTO VIA HUNGERGAMES.COM The Hunger Games is a satirical sci-fi film that manages to confront and rail against the pitfalls of materialism, greed, and economic inequality via its world building and costuming. The narrative intentionally rejects to employ a subtle approach to political criticism, as it utilizes traditional satirical techniques such as visual exaggeration, hyperbole, and contrast to deliver its message. The world of Panem, representing a futuristic America, is introduced p leasingly in about 90 seconds. First, the film introduces two men in discussion about an event called â€Å"The Hunger Games† in front of an audience; the region of Panem is categorized into haves and have-nots, where the haves live within the Capitol (categorized by wealth and power) while the poor reside in a collection of impoverished districts suffering under the oppressive rule after an unsuccessful uprising (Seife 5). Possibly, the biggest achievement of The Hunger Games is the fact that it succeeds in adapting a successful teen novel to a film. This is done spectacularly to the extent that one does not need to read the novel prior to entering the cinema so as to â€Å"get it.† When a serious novel has sold millions of copies as is the case of Suzanne Collins’ trilogy, the default position would be producing something that will resemble what the readers imagined; however, The Hunger Games has been dissected, enlarged, and retooled into a piece that is inte lligent, powerful, and immersive. This world is filled with cruelty and the film director does not shy away from confronting it. The violence and cruelty are most apparent within the Hunger Games arena, an extensive synthetic forest where 24 children hunt one another, and the degree of brutality is well articulated. Ross successfully cuts around the violence in the film to get an appropriate rating for a teenage audience. The heroine in the film, Katniss Everdeen (Jennifer Lawrence), has little time for being wistful since she has to survive. Katniss is a teenage survivalist within a post-apocalyptic representation of a familiar American myth. This runs throughout the film based on the premise of what survival is worth (Gresh 4). There is no doubt that Lawrence is as ideal as Katniss given her melancholic determination. The production values in the film are ample, if not generous. The soundtrack represents a blend of regional and atmospheric flavors, although enhanced musical propul sion might have aided to juice up the film. Throughout the film, it is apparent that Mr. Ross, the director of this unnerving story, has mastered the heart-skipping pulse of the story and turned it into a thrilling and smart film through a ravishing technique with propulsive energy. The utilization of CGI technology superbly complements design to generate space of the film, and visually represents a variety of the themes in the film. There is an air of credibility owing to an

The law and special education ( Discipline ) Essay

The law and special education ( Discipline ) - Essay Example Whether or not the students are disabled, disciplinary action is necessary in learning institutions. Prescribed procedures however need to be adopted during discipline. The 4th and 14th amendments of the US Constitution state these regulations. Correct procedure includes fairness of the disciplinary actions, while substantive process ensures protection student rights from being violated by school officials and ensures that the discipline is reasonable, regardless of the physical condition of the student. Disabled students are cushioned from discriminatory disciplinary action by Section 504 of the Rehabilitation Act (1973). Procedure ought to be followed to avoid such discrimination. First, there has to be same procedure for discipline, regardless of the child’s condition. Second, school officials have to conduct the manifestation determination in order to assess any relations between student disabilities and their misconduct, before applying any actions such as long-term suspension, expulsion or placement changes. Third, school officials have to ensure the teachers are conversant with the provisions under section 504. The law categorically emphasizes on the adoption of positive behavioral interventions, support programs and provision of specialized services for students with disabilities. School officials and teachers are expected to discipline students in a non-discriminatory manner. The other underlying point is that discipline has to be addressed with the IEP process in mind. The student’s IEP team shall consider the strategies such as support programs and positive behavioral interventions to address the problem of the student. If the problem is historical, has been persistent or is anticipated, then the student’s IEP has to address the behavior. Student problem behaviors be addressed by conducting a functional

Policy Paper Essay Example | Topics and Well Written Essays - 1750 words

Policy Paper - Essay Example Russiahas a long-standing history with the Syrian rulers, which prospered during the authoritarian reign of Hafez Al Assad, the father of the current Syrian president Bashar Al Assad. There is need for the Russian government to support the Syrian Army and government and a plan is needed for this to happen as quickly as possible. The elder Assad’s relationship with the Russian leadership saw him being invited to Russia by Leonid Brezhnev and firmly installed Syria’s position as a defender of the USSR during the Cold War, a tradition that continued with the Russian republic after the breakup of the Soviet Republics. Russia is Syria’s largest supplier of arms, with annual arms sales between the two countries topping more than US$1.5 billion. The countries also have a lot of trade links and have over the years established very strong bonds, based especially on the supply of arms and cold war and post-cold war anti-American stance. This stance saw the Russian Republic - together with China - veto allUN resolutions calling for military intervention in Syria by the international community (Carpenter 3). Russia has also been very vocal in defending the Syrian administration of Bashar Al Assad and taken their side in the conflict with what they refer to as Islamic terrorist rebels. It is on the basis of the longstanding history of the relationship between the two countries that the first reason why Russia should arm the government of Syria. This ongoing relationship has been between the governments that rule the two countries and therefore remain in place no matter which government is in place in Syria. There is need for Russia to arm Syrian and provide a decisive winner in this battle in order to stop the humanitarian and political tragedy that has taken place and continues to take place in Syria today. Russia has to support Syrian in this conflict in order to stem the growth and spread of radical Islamist revolution that has continued under the gu ise of an America-supported Arab Spring (Tenin 6). Russia also needs to arm Syria in order to stop this spread of Islamist radicalism that Russia had to deal with in Chechnya and to prevent Islamist terrorists using Syria as another from to attack Russia. This plan presented herein is a plan to arm the Syrian government forces by Russia in order to provide a decisive completion to the civil strife in Syria once and for all and to protect the sanctity of the Syrian regime. The first part of this plan is the identification of the kinds and range of weapons that the Russian Republic can supply to Syria to ensure that the tide of the war in that country turns in favor of the Syrian government and to ensure that the region is stabilized and that the Syrian country does not disintegrate into tribal or ethnic enclaves, as has happened in all the other countries where international intervention usually in the form of American and American-aided invasion has taken place. One only has to look at the effect of American intervention in Iraq, Afghanistan, Libya and most recently Egypt to see how their intervention only results in more complex internal conflict and deterioration of law and order. In Syria, the situation is further compounded

The Enthalpies of Combustion Essay Example for Free

The Enthalpies of Combustion Essay Standard enthalpy change of combustion is the energy change that occurs when 1 mol of fuel is completely burnt in oxygen under standard conditions. However, it is impossible for substances to be burnt under standard conditions. The enthalpies of combustion are different depending on the number of carbons and hydrogens in each substance. For example, the enthalpy combustion for methane is -890 kJ mol-1, however the enthalpy change of combustion for ethane or propane will be greater because more bonds are involved and therefore more bonds are broken and made. All combustion reactions are exothermic because energy is given out to make bonds. Figure 1: Exothermic reaction Before you start doing calculations for enthalpy change of combustion you firstly need to balance the equation. For example: Methane CH4 (g) + 2O2 (g) 2H2O (g) + CO2 (g) Also it is important to note when making a combustion reaction balanced equation that the state symbols for all the substances are gaseous even water. Moreover, it is only in a combustion reaction that you use halves in an oxygen molecule. An example for octane is: C8H12 (g) + 12.5O2 (g) 8CO2 (g) + 9H2O (g) Method for the enthalpy of combustion for various alcohols 1. Set up a tri pod and place tiles around it. 2. Fill up a metal calorimeter with 200 cm3 of water and place on the tri pod. Also, place a thermometer on the container. 3. Record the reading on the thermometer of the temperature of the water. 4. Weigh the spirit burner containing the alcohol you are going to use and again record the reading. 5. Place the spirit burner containing the alcohol under the tri pod and quickly as possible take the lid off and light a match on it. 6. Wait till you will see a 15 degree increase on the thermometer. 7. When you see a 15 degrees increase, place the lid back on the alcohol and stir the water well with the thermometer until you see there is no change in temperature. 8. Weigh the alcohol and record the reading. Also record the reading of the temperature after it has increased. 9. Repeat steps 1-8 for all different alcohols. Results obtained from experiment Methanol Ethanol propan-1-ol Butan-1-ol Pentan-1-ol Enthalpy change of combustion (kJmol-1) 379.80 1071.23 1332.62 1715.82 2110.04 Enthalpy change of combustion = (1/moles of alcohol burned) x enthalpy released during the ex. True results of alcohols that should be obtained Methanol Ethanol propan-1-ol Butan-1-ol Pentan-1-ol Enthalpy change of combustion (kJmol-1) -890.30 1559.70 2219.70 2876.50 3509.10 From the results I obtained I can make a conclusion that the results were not very close to the true, this is because the experiment could not done under standard conditions like the other and therefore because of that some heat was lost to the surrounding. While I was carrying the experiment I realised that a black substance began to form underneath the colorimeter (container where the water was put in and heated up) which was carbon, meaning there was incomplete combustion. This therefore effected the results I obtained because the combustion experiment was not complete. Evaluation Experimental errors In any experiment, errors are made which are unavoidable. We can work out the errors of the equipments that were used in the experiment to find out which has the most effect. It is then best to convert these errors in to percentages because it is easier to see which has the most effect on your results and which has the least percentage error. Percentage error = error / reading x 100. A balance has a precision error of 0.005. Next I will turn it to a percentage error. The balance was used to weigh the spirit burners of the 5 alcohols before using it in the experiment and after it was used to heat the water up. Methanol Ethanol propan-1-ol Butan-1-ol Pentan-1-ol Initial mass of spirit burner / g 198.56 188.80 180.66 212.75 189.62 Percentage error/ % 0.003 0.003 0.003 0.002 0.003 Methanol Ethanol propan-1-ol Butan-1-ol Pentan-1-ol Final mass of spirit burner / g 197.41 188.16 180.09 212.08 189.08 Percentage error / % 0.003 0.003 0.003 0.002 0.003 Looking at the results above for the percentage errors, I can conclude that the balance did not effect the results I obtained as it gave me a small percentage error that was less than 1%. This ensures me that the measurements of the spirit burners that I obtained using the weighing balance where very accurate. Procedural errors * A thermometer was placed on the colorimeter and when reached to 500c and recorded the highest temperature by siring until there was no increase in temperature. * Keep lid on spirit burner to endure the alcohol did not evaporate to obtain a accurate measurement of the mass of alcohol combusted. * Draft exclusion made using insulating tiles. This is so less heat and temperate near the spirit burner that is lighted is relatively kept constant and not effected by air coming from window or heat from radiator.

Of Mice and Men - Character study of Curlys wife Essay Example for Free

Of Mice and Men Character study of Curlys wife Essay The novel Of Mice and Men is set in America and is about two travelling workers who have been chased off one ranch because Lennie, one of the men did not know how to behave himself. Lennie is large, heavy and ponderous and George is small quick, dark, sharp and restless. Another tragedy happens on the ranch like in weed because Lennie used his strength to kill Curleys wife. I can sympathise with Curleys wife although she was a flirt with the other men she was not expecting to be killed by Lennie. We first meet Curleys wife in chapter two. She is described as heavily made up and wears tarty red shoes. She poses her figure outlined in the doorway of the bunkhouse and is always aware that men are looking at her. This makes me think that she is just looking for attention from the men. George shows the reader that he does not like Curleys wife because George tells Lennie that she is jailbait and for Lennie to stay away from her. Lennie sees her as an attractive young lady but she is really just a threat to the men on the ranch. In chapter three there is a big fight involving Curly and Lennie. Curley has not liked Lennie since he was looking at Curleys wife so Curley just lost his rag and started punching Lennie but then Lennie just reached for Curley and just grabbed his hand and started squeezing his hand and his hand crumbled in Lennies hand, George told Curley to tell everybody that he got his hand caught in the machine and that is what he told everyone. This just shows how Curleys wife is acting like a tart and a flirt to get all the men in trouble with Curley.Curley feels insecure because of his wifes behaviour. In chapter 4 Curleys wife was heavily made. I can sympathise with her because all she is trying to do is make some friends on the ranch but every time she tries to talk to someone they all think she is trying to flirt because she is desperate for attention because she has got an unhappy marriage with Curley and that the men think that she is trying to get them in trouble with Curley.I fell sorry for Curleys wife because on the ranch she was all alone. In chapter 5 we learn that Curleys wife had a dream to be in the movies. I do feel sorry for Curleys wife because she could have been in the movies but that was just a pipe dream because now she is stuck on the ranch married to Curley with no friends. Curley and his wife have only been married for two weeks and already they both hate it being together on the ranch. I think Steinbeck is trying to get across to the readers that she has no one in the whole world that cares for her. Her death was brutal and quick, at first lennie was just playing with the pup then he broke its neck and that is what he done to Curleys wife. My final thoughts on Curleys wife is all she was trying to do is make friends on the ranch but she just got pushed out everyone. In chapter six it is hard to feel sympathy for her because she was flirting with the men but she did not deserve to be killed by Lennie. I feel sympathy for Curleys wife although she was a big flirt and she got treated badly by Curley, she did not deserve to be killed. I think Steinbeck included Curleys wife in the story because I think that she makes the story interesting because she is the story.

Chronic Pain Management: An Insight Into Neuropathic Pain

Chronic Pain Management: An Insight Into Neuropathic Pain Many people suffer from chronic pain. In these patients, the most common wish is to be pain free. Even though modern Medicine has advanced at an unprecedented rate over the past century, approaches to chronic pain management is still not completely satisfactory. I have recently seen a patient who has been living with neuropathic pain for many years. Neuropathic pain is a type of chronic pain that is considered to be the most difficult to treat and manage, due to its complex nature in etiology and clinical manifestations. Despite the improvement in scientific understanding of pathogenesis of neuropathic pain, and utilization of newer pharmacological, surgical and cognitive approaches, diagnosing and treating neuropathic pain still poses a challenge clinically. This essay will be presenting a case history of a patient with neuropathic pain being treated at the Kent and Canterbury Hospital and this case will form the basis of discussion on the current understanding of neuropathic pain m echanisms and its management. Patient case Mrs L is a 58 years old medically retired office worker who has a 25-year history of multiple sclerosis. She has been coping well until 8yrs ago when her left foot suddenly experienced a shooting pain on weight bearing. At first, she was maintained on paracetamol and nurofen by her GP with limited pain relief and then referred to the podiatrist, where an ultrasound scan revealed the presence of Mortons neuroma (a benign swelling of the intermetatarsal plantar nerve causing neuropathic pain), which was causing intense pain with a severity 10/10 across her left forefoot. To help alleviate the pain, it was initially decided that surgically removing the neuroma could achieve adequate pain relief, but this was proven to be an unrealistic goal. During the surgical intervention period, she had altogether three neuromas removed on separate occasions, with additional shaving off the bones to reduce compression on the nerve and resultant inflammation. She was then referred to be managed at the pain clinic. While Mrs L has been under the care of the pain physicians, she was given local anaesthetics steroid infiltration into her forefoot, cryotherapy (ice cold packs applied to tibial nerve), guanethedine block, lumbar chemical sympathectomy (with midazolam fentanyl), acupuncture, lidocaine patches, capsaicin cream, duloxetine and co-codamol. Despite temporary pain relief provided by these therapies, there was not a long-lasting effect that allowed Mrs L to stay pain-free. Understandably, living with an excruciating pain chronically can severely damage an individuals psychological as well as physical health. She could no longer enjoy her hobbies, such as dancing and going to antic fairs; even daily activities such as shower would make her scream in pain. As a result, she became extremely depressed and suicidal. Currently, she is receiving a multidisciplinary input from her GP, the specialist pain physician, specialist pain nurse, clinical psychologist, and physiotherapists and is maintained on gabapentin and diclofenac for her neuropathic pain, citalopram for her slowly recovering depression and baclofen for controlling her ongoing multiple sclerosis symptoms. She is also regularly attending chronic pain management programs, through which she believes that she gains better appreciation for her condition and is in a better position to be in charge of her own symptoms. This case nicely demonstrates the difficulties encountered in clinical practice in treating chronic pain. First of all, neuropathic pain is exceptionally difficult to treat, with unpredictable outcomes; secondly, most methods of pain management can only provide symptomatic relieve of pain temporarily, rather than offering a permanent cure; thirdly, chronic pain is an extremely debilitating condition to live with and its psychological impact should not be underestimated; and finally, to enable the best pain management a multidisciplinary approach is evidently the most successful and gives the patient most control over their symptoms. What is pain? We are all familiar with the term pain. The International Association for the Study of Pain (IASP) defines pain as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. (IASP 2007). It is important to note that pain is a very subjective experience, which varies enormously from one individual to the next. To emphasize on the subjectivity of pain perception and the need for individualized approach to pain management, Margo McCaffery who specialized in pain management nursing in 1968 described pain as whatever the experiencing person says it is, existing whenever the experiencing person says it does (Rosdahl Kowalski, 2007). It is undeniable that psychology and physiology are interwoven in the perception of pain. To understand pain, it is helpful to know what causes pain; as mentioned above, normally our perception of pain is triggered by a specific stimulus, such as hot, cold, or sharp objects, which could cause potential tissue irritation or injury. It is obviously advantageous in evolutionary terms to be able to sense the potential cause of injury and act via spinal reflexes to achieve self-protection, e.g. withdrawal of fingers from hot pan. This form of pain is called nociceptive pain, where the stimulus is known to be harmful in nature. This type of pain warns us of impending damage; therefore, it is regarded as the good type of pain. Of course, most of the long-term pains are certainly not good or friendly. What distinguishes between friend and foe in the field of pain is determined by the time-course, the intensity, the cause of and the social and economic consequences of the pain. An excellent example of a bad pain is neuropathic pain (Figure 1): Figure 1. Diagram showing the mechanisms behind the processing and perception of three different types of pain. Phase 1= nociceptive pain; Phase 2= inflammatory pain; Phase 3= neuropathic pain. (Cervero F, 2009) Neuropathic pains are resulted from disease or trauma to the central or peripheral nervous system; common causes include stroke, spinal cord injury, multiple sclerosis, surgery, diabetic neuropathy, and herpes zoster virus (Jensen et al., 2007). The Neuropathic Pain Special Interest Group (NeuPSIG) of the IASP has recently redefined neuropathic pain as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system (Treede et al., 2008). As a result, neuropathic pain produces very unusual pain sensations beyond the range produced by the normal nociceptive system; these include spontaneous pain, reduced pain thresholds, and mechanical allodynia (Cervero F, 2009). As illustrated in figure 1, abnormal sensory processing is one of the landmarks for diagnosing neuropathic pains; patients often experience pain in the absence of any noxious stimuli (allodynia) and additionally produces an abnormally heightened sensory input, changing a non-noxious stimulus int o a painful stimulus, producing a state called hyperalgesia. Therefore, the main characteristic is the nearly complete lack of correlation between peripheral noxious stimuli and pain sensations perceived. There are many types of neuropathic pain (Table 1), which can be broadly classified into four groups based on their aetiology and anatomy: peripheral nervous system focal and multifocal lesions, peripheral nervous system generalized polyneuropathies, central nervous system lesions, and complex neuropathic disorders (Freynhagen Bennett, 2009). It is outside the scope of this essay to discuss these different types of neuropathic pain in further detail; rather, neuropathic pain as a distinct group of pain will be explored. Table 1. Examples of neuropathic pain syndromes (Freynhagen Bennett, 2009). How is neuropathic pain diagnosed? Despite its frequent occurrence, neuropathic pain still constitutes as a major diagnostic problem in clinical practice because it can present with a variety of signs and symptoms, which vary greatly even within one particular disease entity (e.g. in postherpetic neuralgia) (Geber et al, 2009). Clinical examination and expert judgment is still the best way to make a clinical diagnosis of neuropathic pain, despite the recent development of various screening tools, such as the LANSS questionnaire (Bennette, 2001) and the Neuropathic Pain Scale (Galer and Jensen, 1997) that assist in making a diagnosis. Bedside examinations for hyperalgesia and dysthesia include assessing the effect of the same stimuli on painful areas compared to the contralateral side or an unaffected site. Allodynia is demonstrated by the experience of pain when performing light touch with cotton wool; exaggerated painful response to pin prick suggests hyperalgesia, therefore lowered pin-prick threshold. These are the typical components that define a pain as neuropathic type. Patients are most likely to present with a mixture of pain types with a neuropathic component to it. It is important to identify the presence of such a component as the treatment recommendations are different for these. With the introduction of the new grading system for neuropathic pain by NeuPSIG group (Treede et al 2008), it is becoming increasingly recognized that chronic pain is often presented as a combination of different types of pains, rather than a clear-cut nociceptive or neuropathic type of pain. In Treede and colleagues new recommendation for the diagnosis of neuropathic pain, options of definite, probable or possible are available for the diagnosis of a component of neuropathic pain in the disease presentations in the clinical setting, which aims to aid more accurate diagnosis of neuropathic pain (Figure 2). Figure 2. Flow chart of grading system for neuropathic pain. The grading system is based on four criteria: pain distribution (criterion 1), the link between pain distribution and the patients history (criterion 2), confirmatory tests of neurologic status demonstrating positive or negative sensory signs confined to the innervation territory of the lesioned nervous structure (criterion 3), and further confirmatory diagnostic tests to identify the lesion or disease entity underlying the neuropathic pain (criterion 4). Criteria 1 and 2 must be met to initiate the working hypothesis of possible neuropathic pain. *Patient requires follow-up and/or additional confirmatory tests. à ¢Ã¢â€š ¬Ã‚  The point at which the diagnosis of possible neuropathic pain should be abandoned has not been defined (Treede et al 2008). Mechanisms of neuropathic pain Broadly speaking, neuropathic pain arises from the peripheral nervous system (ectopic impulse generation due to abnormal sodium channel expression), or from the central nervous system (central sensitization, disinhibition and plasticity) (Scadding, 2003). The key behind the generation of neuropathic pain is the abnormal neurological changes to the sensory system resulting in an abnormal hyperalgesic state, achieved through three processes: 1) the activation and sensitization of peripheral nociceptors, which are responsible for sensing peripheral noxious stimuli; 2) the abnormal amplification, rather than the suppression as in the normal states, of the central nervous system, known as central sensitization, caused by the strengthening of the synaptic connections between the peripheral and central nervous systems, producing a persistent pain state; 3) the change in the central actions of the undamaged afferents, so that a non-noxious tactile stimulus sensed by these receptors are converted into nociceptive information and processed as pain, rather than a light touch (Cervero F, 2009). This also further leads to secondary hyperalgesia, which means that instead of relieving the nociceptive pain by rubbing on the painful area (tactile stim ulus), the tactile movement of rubbing will actually produce the opposite effect of enhancing the existing pain. Figure 3. The pain signaling and modulation pathways. F Cx: frontal cortex; SS Cx: somatosensory cortex; Hyo: hypothalamus. (Ro Chang, 2005) As shown in Figure 3, the physiological pain mechanisms include the pain signaling pathway from nociceptors to peripheral nervous system to spinal dorsal horn cells to thalamus and finally to the cortex, and the pain control system from the cortext to periaqueductal grey to raphe nucleus to spinal dorsal horn (Ro Chang, 2005). In normal circumstances, there is a balance between signal transduction and pain modulation, therefore the individual recovers from that episode of pain. However, when this balance is disturbed, i.e. when there is a lesion within the primary somatosensory system, then the individual experiences neuropathic pain. The lesion may occur anywhere along the pathways of the somatosensory system, and it could be as a result of compression, inflammation, ischaemia, trauma, tumour invasion, nutritional deficits, or degenerative processes to the neurons (Ro Chang, 2005). Some of these important mechanisms will be discussed individually below. Local nerve injuries After the occurance of local nerve damage, in an attempt to repair, a neuroma forms at the proximal stump of the damaged nerve. A neuroma is a tangled mass of regenerating axons embedded in connective tissues. The axons within a neuroma not only fail to regenerate properly, but also develop abnormal electrical activities (England et al, 1996). This neuroma sprout then begins to fire abnormal signals with a heightened excitability, which stimulates regenerating C-fibers. After a period in the growth of these fibers, erratic impulse generator will develop, which sends abnormal signals into the central nervous system, perceived as dysthesia, parasthesia, itching or electrifying sensations (Liu et al, 2002). Sodium channel accumulation Sodium channel density is increased in areas of axons proximal to the injury site, as shown by England et al (1996) when the excised neuromas were studied from patients who suffered from painful traumatic neuromas (Figure 4). This specific type of sodium channel accumulated have a faster recovery time after inactivation, therefore, they are able to conduct ectopic impulses in neuropathic states. The ectopic activity then maintains the central sensitization process, resulting in great amplification of peripheral afferent signals. In neuropathic pain, there is a change in ionic channels composition and functions, such an accumulation of sodium channels which leads to hyperexcitability of these nerve terminals. These are found to be accumulating in neuropathic damaged areas of the nerve, such as in neuromas and demyelinated areas (Devor, 2006). In a normal axon, the transportation of sodium ion channels is preprogrammed via endoplasmic vesicles along the axons to be distributed in the n odes of Ranvier and peripheral sensory endings; there is a low density of sodium channels on the myelinated axonlemma. However, as a consequence to neuropathic damage, the set program of ionic channel settlement is disturbed, and these ion channels end up being located at a high concentration at the areas of neuromas, demyelination and sprouting (Aurilio et al, 2008). Such important roles played by sodium channels means that by blocking these channels, neuropathic pains could be reduced. Indeed, sodium channel blockers open up a major therapeutic channel for neuropathic pain treatment. Figure 4. Sodium channel immunocytochemistry of neuromas. (a, b, c) Sodium channel-specific immunoreactivity is present throughout the axons of th these neuromas. (d) Control showing the nonspecific immunofluorescence. Scale bar = 10 micrometer (England et al, 1996). Calcium channels and signaling in injury Calcium channels are also involved in contributing to neuropathic pains, as intracellular calcium determines the phosphorylation of the membrane proteins (Aurilio et al, 2008). The inflammatory neuropeptides, calcitonin gene-related peptides (CGRP), are released from injured nerve endings. They have a role in acting as co-transmitters in the spinal cord, therefore are involved in the central sensitization and hyperalgesic states found in neuropathic pain. An in vitro study identified that the release of CGRP entirely depended on the presence of extracellular calcium ions; this process involves particularly the N- and L-type calcium channels (Kress et al, 2001). Selective calcium channel blockers, such as gabapentin and lamotrigine may have significant potential in treating neuropathic pain. Cytokines in neuropathic pain Cytokines such as interleukins and tumour necrosis factors are well known mediators of inflammatory responses. Additionally, they are involved in neurogenic inflammations and are thought to play a role in the generation of neuropathic pains. In an established experimental model of neurogenic hyperalgesia and allodynia, mice with chronic constrictive injury to one sciatic nerve, the usage of interleukin-1 antagonist has been found to significantly yield in a reduction in the pain responses (Sommer et al, 1999) (Figure 5). Since TNF- Ã‚ ¡ immunoreactivitiy is found to be higher in nerve biopsies from patients with neuropathic pain, directing treatments to reducing the level of cytokines in the nervous system may also be helpful in relieving neuropathic pains (Empl et al, 2001). Indeed, combined neutralizing therapies against IL-1 and TNF- Ã‚ ¡ produced additive effects in experimental models (Schafers et al, 2001). Figure 5. Hyperalgesia to thermal stimuli following unilateral sciatic nerve injury in six groups of mice. a negative difference score is an indicator of hyperalgesia in the experimental/treatment limb. Hyperalgesia is present throughout the experimental period in the sham-treated group of mice. Treatment with anti-IL1 reduces hyperalgesia in a dose dependent manner (Sommer et al, 1999). Central inhibition inefficiency and sensitization The pain transmission system is under continuous inhibitory control from the brainstem centers, such as periaqueductal grey and locus coeruleus. Many studies have been conducted in laboratory animals for studying the pain mechanisms in neuropathic pain. It is found that in animals with neuropathic pain their central descending inhibition is nearly 50% lower than normal (Zimmermann 2001). Additionally, there is a hypersensitized central nervous system in neuropathic pain. Normally central sensitisation process would return back to baseline level when the tissue heals and inflammation subsides (Dworkin et al, 2003), but in neuropathic pain states this is not the case. The plasticity and sensitisation following peripheral nerve injury was thought to be caused by the long-term potentiation mechanism (Liu Sandkuhler, 1995). It is thought that after local nerve damage peripherally, growth factors such as nerve growth factors (NGF) can no longer be taken up into the dorsal ganglion neurons; this alters the nervous system at the transcription and protein synthesis level. NGF is a trophic molecule essential in the development maturation of the nervous system, and it is found to be elevated in conditions which pain is a predominant feature. This change to the composition to the nervous system also results in changes in the activities of aspartate and NMDA, which leads to an i nflux of calcium ions that indirectly contributes to the sensitisation and hyperalgesia of the spinal cord dorsal ganglion cells (Ro Chang, 2005). Peripheral inhibition inefficiency In addition, there also is a reduction in the response to endorphin molecules in patients with neuropathic pain than other pain mechanisms (Terenius 1979); therefore, there is a reduction in the sensation of pain relief centrally. Peripheral nerve lesion was simulated in rats by rhizotomy, a technique which severs the spinal roots, and this has demonstrated a decreased opioid receptor binding in the spinal cord (Zajac et al, 1989). Living with neuropathic pain From a patents perspective, pain is something they have to learn to live with, however bad it is. Patients who suffer from chronic pain not only have to go through the physical anguish exerted by the pain, but being in pain also hinders them from normal day to day functioning; from not being able to stay independent or taking care of themselves, to losing jobs, family and friends, lack of support and results in social isolation. A patient has once told me that: because what Im going through (pain) is not readily recognized by others, the way other people acted towards me put me under lots of frustration and made me socially unaccepted. It is crucial to bear in mind the wider impact of living with neuropathic pain when formulating a management plan for that individual. Not surprisingly, neuropathic pain is linked to significant reduction in the patients health-related quality of life (HRQoL) as well as creating substantial costs to the health service. It is reported that generally, patients with neuropathic pain have higher pain rating scores and lower HRQoL (Jenson et al, 2007). In a cross-sectional evaluation of the impact of neuropathic pain on patients and their quality of life conducted in the Spanish population, it was found that pain substantially interfered with work and family life in these patients. Over 95% of the 1519 patients recruited for this study had either neuropathic pain or a mixed neuropathic and nociceptive pain. Younger patients tend to report a lower quality of life than that of the elderly population in both the physical and mental components of life (Figures 6a 6b); possibly due to having fewer comorbidities in younger patients helps to exaggerate the perceived deleterious effects of neuropathic pain on their daily functioning. Using the Sheehans disability scale, the younger patients are also shown to have generally a higher perceived stress compared to the older patients (Galvez et al, 2007). It is important to analyse the effects that neuropathic pain exerts upon its sufferer, not only because we start to appreciate the level of impairment on the quality of life this chronic illness can cause to the patients, but also to further explore areas that could be perhaps better dealt with in terms of treatment (Jenson et al, 2007). As was reflected by the outcome of the Spanish study, 43% of patient had extreme disability; these included disability for work (51%), 47% for social life, 42% for family life. 38% of the patients also reported extreme stress and 19% perceived that they received little or no social support (Galvez et al, 2007). This shows that living with neuropathic pain is not just leading to physical disability, but also psychological and social dysfunctioning. Having known this nature of neuropathic pain, it important to consider both a pharmacological and psychosocial approach when prescribing treatment and formulating management plans. Figure 6. Scatter graph showing the linear relationship between age (years) and quality of life of the patient; physical (6a) and mental (6b) components, given as a standardised score relative to the reference Spanish population (SDS). SDS score is shown for each patient adjusted for type of neuropathic pain, center, and present pain intensity, age, and sex. SD, standard deviation; 95% CI, 95% confidence interval. (Galvez et al, 2007) b. a. Management of neuropathic pain The management of neuropathic pain involves a number of well-established pharmacological therapies, as well as utilizing the psychosocial aspects of the neuropathic pain nature fully to best control the patients pain symptoms. Non-Pharmacological approaches As the symptoms of pain are not just derived purely from a physical entity, psychotherapy should be considered as part of the management program for neuropathic pain. At an early stage, patients should be educated on the nature of the condition and to have realistic expectations with regards to treatment options; especially the current management for neuropathic pain is still mainly palliative in nature, with main aims to reduce symptomatic complaints of pain, but not a curative fix. To be able to alleviate the pain and achieve symptomatic relieve, even if only temporarily, may be the only attainable goal (CREST, 2008). Since non-pharmacological treatments have the lowest risks of adverse side effects these must be offered early. These include a combination of physiotherapy, occupational therapy, psychotherapy and pain management programs that are adjusted to the individuals psychological and physical needs. The main aims for physiotherapy is to provide pain relieve wherever possible, but also focuses on the restoration of normal functioning and helping the patient to return to normal physical activities, such as going back employment (Serpell et al, 2008). The low risk physiotherapy modalities include TENS (transcutaneous electrical nerve stimulation) and acupuncture are offered, along with appropriate education, advice and exercise. Functional difficulties in areas of personal care, work and leisure could be managed best by the input of occupational therapists, who may work around the needs of the individual in adjusting the arrangements at home/work to best allow the patient to function despite t he pain. In Mrs Ls case, she had shower rails and hand-held tools to pick up distant objects without exerting strain on her back/affected limbs; these were extremely helpful to her. Of course, to maximize the outcome of pharmacological treatment, psychological therapy is essential in addressing the disability, emotional impacts and general life interruptions that are consequences of neuropathic pain. Apart from pharmacotherapy, psychotherapy is the best evidence-based therapy for the treatment of chronic pains like neuropathic pain (Morley et al, 2000). Additionally, patients living with chronic pain often suffer from other comorbidities. Frequently these are not treated alongside the treatment for the chronic pain, therefore, a limited effect of the pain treatment may be observed. Behavioral and psychiatric conditions are especially common in patients with neuropathic pain; recognizing and treating these will aid in improved quality of life and better pain relief overall (Fishbain, 1999). An recent eight-week study of the effects of cognitive behavioural therapy (CBT) on chronic pain-induced insomnia has found that patients who received CBT exhibited significant reductions in sleep latency, number of awakenings during sleep and overall quality of sleep (Jungquist et al, 2010). This offers further hope for patients who suffer from pain-related insomnias. Finally, the Pain Management Program is a multi-disciplinary approach to pain control that is tailored to each patients individual needs. Patients are typically referred to this program if they have been living with chronic pain for a number of years and suffer from significant physical, social and psychological functional difficulties. Many have become dependent on medications and acquired a number of side effects from these medications which are slowly eroding the quality of their lives. In the pain management programs, the goals are to reduce the subjective experience of pain, learning new coping strategies to control pain and improve physical and emotional functioning. Indeed, the pain management programs have been found to achieve a reduction in medication and enhanced rates of returning to work (CREST 2008 NRH 2009). Pharmacological therapies for neuropathic pain In most cases, patients with neuropathic pain will need to be started on analgesic medication after failure to respond to non-pharmacological treatments. Although opioid and non-opioid analgesics, such as codeine and diclofenac respectively, have a role in dampening pain transmission in within the CNS in neuropathic pain states, it is far more effective to target the sodium, calcium and NMDA receptors, which are altered during nerve injury. Generally speaking, the clinical effectiveness of these drugs is limited by their narrow therapeutic indexes, i.e. the difference between the number needed to treat (NNT) and the number needed to harm (NNH) is very small (Rice Hill, 2006). Neuropathic pain is appreciably a very complex condition and treatment for this can be a real challenge, as most patients do not respond to conventional analgesics. The main problems lie within the inadequate diagnosis, lack of understanding of the pain mechanisms, inappropriate selection of therapies, and insufficient management of comorbidities that could delay the response to neuropathic pain therapies (Ro Chang, 2005). Recently a review of the guidelines by OConnior Dworkin has resulted in the formulation of a stepwise approach to neuropathic pain management in primary care (Table 2). It is important to highlight that the first step of the management plan includes the identification of comorbidities, and relevant patient education as discussed above in the non-pharmacological managements of neuropathic pain to fully prepare the patient for adequate treatment. Table 2. Stepwise pharmacologic management of neuropathic pain (OConnor Dworkin, 2009) According to a recent review and recommendation by Dworkin et al, three lines of pharmacological treatment have been advised for neuropathic pain treatment. The first line treatments include tricyclic antidepressants (TCA), selective serotonin noradrenaline reuptake inhibitors (SSNRI), Ca2+ channel ligands (e.g. gabapentin pregabalin) and topically applied 5% lidocaine; second line treatments including opioid analgesics tramadol; and third line treatments are the other antiepileptics (e.g. Carbamazepine, lamortigine), other antidepressants (e.g. citalopram), N-methyl-D-aspartate (NMDA) antagonists and topically applied capsaicin (Dworkin et al, 2007 and OConnor Dworkin, 2009). TCAs The administration of TCAs such as amytriptyline and nortriptyline will benefit patients with neuropathic pain as TCAs have been shown consistently to be more efficacious than placebos in a number of randomized controlled trials (Saarto Wiffen 2007), and especially beneficial for patients who have a comorbidity of depression. They act via histaminic, muscarinic and serotoninergic receptors both peripherally and centrally. However, one should note that the possibility of cardiac toxicity hinders its administration in patients with pre-existing cardiac conditions, especially arrhythmias; they should also be avoided in patients who have suicide risk or poor impulse control (Serpell et al, 2008). A large, retrospective cohort study reported that there was an increased risk to sudden cardiac death at dosages higher than 100mg/day (Ray et al, 2004). Because the recommended dose of TCA can range from 25mg at the starting dose to 150mg/day as the maximum dose (Dworkin et al, 2007), administ ering TCA should be a cautious exercise. In general, TCAs should be started at low dosages, administered at night to minimize sedative effects, and titrated up slowly to be continued for 6-8 weeks to allow analgesic effects (OConnor Dworkin, 2009). SSRNIs SSNRIs such as duloxetine and venlafaxin are less effective than TCAs, but have a better safety profile. Duloxetine has consistently demonstrated efficiency in treating painful diabetic peripheral neuropathy (Dworkin et al, 2007), although its effects in other types of neuropathic pain have not been studies extensively, therefore its efficacy in those types of pain are still uncertain. Calcium channel ligands Calcium channel ligands, e.g. gabapentin and pregabalin, bind to the voltage-gated calcium channels at the ÃŽÂ ±2- Ã‚ ¤ subunit to modulate neurotransmitter release from presynaptic nerve terminals (Figure 7). Both drugs have been shown to be efficacious South Africa: Language and Culture South Africa: Language and Culture What is South African Culture? South Africa is known as the rainbow nation as it has complex and diverse cultures. (South African Languages and Cultures. It is a melting pot of culture; here are a few cultural aspects to admire about South Africa: Mapungubwe, Limpopo Province, is one of the richest archaeological sites in Africa. Two globally important battles namely, The Anglo Boer War and the Anglo Zulu War were both fought on South African soil. Since the freedom from Apartheid, dance has become a prime means of artistic expression. The Magaliesberg mountain range is said to be the oldest mountain range on earth. The Drakensberg mountain range runs the length of the country and is a Unesco World Heritage site. The Vredefort Dome is the oldest and largest visible meteorite impact site in the world. South Africa has a celebration for every event, place, art form, food, drink and agricultural commodity. South Africa has a wide variety of arts and crafts, as well as a wide range of craftwork styles; tribal designs, Afro-French wirework, wood carvings, world-class pottery and bronze casting, stained glass, basket weaving, clay and stone sculpting, dung paper and waste ornaments. The Drakensberg mountain range is the worlds largest art gallery and is a monument to the San Bushmen. Jukskei, a game which involves a player throwing a wooden pin at a peg in the ground. It has been identified as one of the seven indigenous games that should be encouraged and developed. After the Apartheid era, the youth of South Africa started to find their own voice in a style of music called Kwaito. Nguni cattle, they are indigenous to South Africa and might possibly be the most beautiful cattle in the world with their variously patterned and multicoloured hides. The Owl House, Nieu Bethesda, is a fascinating world of sculptures made from concrete and glass. The Cradle of Humankind has one of the worlds richest concentrations of hominid fossils. The Quagga, was extinct but has been rebred. It is a zebra-like animal but only has stripes on the front half of its body. Mark Shuttleworth was the first African in space. South Africa is home to seven Unesco World Heritage sites. South African cultural villages allow visitor to experience firsthand the cultures and traditions of our country, including food, drink and accommodation. South Africa produces 3.1% of the worlds wine and ranks number nine in overall volume production. The above text was referenced from: The A to Z of South African Culture 2010:1 During the Apartheid era, the government divided this diverse country into four population groups, namely white, black, coloured and Asian. (South African culture is impossible to capture in a nutshell, as the country is home to a rich variety of cultural groups of diverse ethnic and national origins. [sa]) These population groups were grouped as follows: White: English, Afrikaans, Jewish, Portuguese, Greek and Lebanese. Black: tribal groups, namely Xhosa, Zulu, Ndebele, Swazi, Tswana and Sotho. Coloured: people of mixed origin, mainly Afrikaans speaking and also a lot closer to the white cultural trends. Asian: people of Indian decent. The above text was referenced from: South African culture is impossible to capture in a nutshell, as the country is home to a rich variety of cultural groups of diverse ethnic and national origins. [sa] South Africa has eleven official languages, namely English, Afrikaans, Tsonga, Zulu, Tswana, Xhosa, Venda, Swazi, Southern Sotho, Ndebele and Sepedi. (South African Languages and Cultures [sa]) South Africas language distribution is as follows: Figure: Language distribution chart (South Africa Info) Xhosa Language: The word Xhosa is derived from the Khoisan language, which means angry men. South African Languages and Cultures [sa] There are about eighteen percent of Xhosa speaking people in South Africa, and are mainly found in the Eastern Cape. (South African Languages and Cultures [sa]) This makes Xhosa the second most spoken language in South Africa. (Languages of South Africa 2010:1) There are nine Xhosa speaking groups, some chiefdoms are larger than others, but there is conformity among them, the conformity can be seen in the homestead layouts. (Magubane 1998:10) Culture: The Xhosa speaking people were one of the first chiefdoms to be exposed to European explorers, hunters, traders, missionaries, soldiers and colonial administrators. (Magubane 1998:12) This exposure therefore altered the culture of the Xhosa people. Xhosa marriage is a polygynous affair as the chiefs and wealthy men, who had lots of cattle married more than one woman and in some instanced has as many as four wives. (Magubane 1998:20) These wives were distinguished in rank according to different houses. (Magubane 1998:20) The Great Wife was responsible in bearing a son, and of course heir who would eventually take over his fathers possessions, i.e. cattle. (Magubane 1998:24) Labola is a big part of the Xhosa culture, labola also meant that different groups could forge alliances as marriage within a clan is prohibited. (Magubane 1998:28) In a modern day Xhosa marriage negotiation it is common that money instead of cattle will be accepted. (Magubane 1998:25) Traditional rituals are performed throughout the life-cycle of the Xhosa people, from birth to puberty, marriage to menopause and filly to death. (Magubane 1998:32) One of these rituals is that of male initiation through circumcision. This ritual came about as men had to be circumcised to become a warrior, and had to be a warrior before he could marry. (Magubane 1998:33) Architecture: Dwellings consisted of a circular frame of poles and saplings, which were bent and bound in the shape of a beehive and thatched from top to bottom with grass. (Magubane 1998:18) this structure was then plastered with a mixture of mud and dug to provide adequate insulation. (Magubane 1998:18) screened off cooking areas, had an earthen oven for baking. (Magubane 1998:18) Zulu Language: Zulu people form the largest ethnic group in South Africa (Languages of South Africa 2010:1) and therefore Zulu is one of the most spoken languages in South Africa and is also understood by half of the South African inhabitants. (South African Languages and Cultures [sa]) South African English has adapted and was also inspired by many of the Zulu words, and therefore incorporate it into the English language. (South African Languages and Cultures [sa]) Culture: The Zulu nation arose in the 16th century; the Zulu warrior Shaka raised the nation to prominence in the 19th century. (Languages of South Africa 2010:1) The classic novel Chaka, by Thomas Mofolo, reinvents king Shaka into a heroic figure. (Languages of South Africa 2010:1) The current monarch is King Goodwill Zwelithini. (Languages of South Africa 2010:1) the present kings powers are essentially symboliche carries a sacred axe on important state occasions and he presides over key rituals, (Magubane 1998:37) Zulu children are exposed to nature at an early age which encompasses a deep understanding and empathy for the environment they live in. (Magubane 1998:45) Traditional foods include amasi (curds of milk) which is eaten either with maize meal or vegetables. Maize meal is either boiled into a thick porridge or eaten with vegetables. Meat was only eaten on special occasions, such as a wedding. (Magubane 1998:47) The Zulus are very crafty. The women are responsible for mat-making, beadwork and pottery. The men do woodwork and specialise in spoons, meat trays and milk pails which are crafted out of one piece of wood. (Magubane 1998:47) Traditional medicines in the Zulu culture are ancient, these medicines are divided into two parts, the Traditional Herbalist who administers medicine made from plants and animals, and the Diviner who smells out the complaints using bones, shells, seeds or other artefacts. (Magubane 1998:61) A category in the Diviners is the isangoma, who is a medium that makes contact with the ancestral spirits and prescribes medicine according to their dictates. (Magubane 1998:62) Music, song and dance have always been important in Zulu culture as it helps maintain a sense of group solidity especially in times of strees, joy and change. (Magubane 1998:62) The Zulu society had many stringed instruments, such as the uGubu which stringed bow with a calabash attached to the end. (Magubane 1998:62) Architecture: The extended homestead was roughly circular in form and was build on sloping ground facing east wherever possible, with the slope falling away to the main entrance, so that the chief dwelling would be on the highest ground. (Magubane 1998:40) In the centre of this homestead would be the cattle byre which is also linked to the temple, which is where traditional rituals would take place. (Magubane 1998:40) The building of these dwellings were the mens job and would often be a social event where the women would brew beer and neighbours, even passers-by, would come and lend a hand in erecting these dwellings. (Magubane 1998:43) The dwellings were either beehive or dome shaped. Saplings would be embedded into a circular dug trench; the saplings were then bent over and tied down to create framework which would then be tightly thatched. (Magubane 1998:43) There were no windows but the door was very low, people had to entre on their hands and knees. This door was then closed at night by means of a wicker door that was fastened with a cross-stick. (Magubane 1998:43) Afrikaans Language: Afrikaans is spoken by a majority of South Africans, either as a first or second language. Afrikaans is a rich cultural languages with much heritage from the Dutch, Afrikaans even means Africa in Dutch. (South African Languages and Cultures [sa]) Afrikaans is mainly spoken by white Afrikaners, coloured South Africans and a section of the black population. (Languages of South Africa 2010:1) Venda Language: Venda is also known as Luvenda or Tshivenda and is mostly spoken in the Northern parts of South Africa. (South African Languages and Cultures [sa]) The people who speak Venda have a Royal Family and show women great respect, therefore women are allowed to become Queens and Chiefs of their own tribes (South African Languages and Cultures [sa]) Culture: For a Venda person, music is one of the most important aspects to their culture, especially drum beats. (South African Languages and Cultures [sa]) They are hard working people but after working all day on a field, there is always music, a few drinks and dancing. (South African Languages and Cultures [sa]) A drum, named Ngoma Lungundu, is the centural feature in Venda culture. (Magubane 1998:82) Status and power are expressed through music, dance, and song. (Magubane 1998:87) Venda people use many musical instruments, even instruments that have vanished from other cultures in Africa; they use xylophones, thumb pianos, reed flutes, and three different types of drums. (Magubane 1998:87) The Venda pottery style was established in the 14th and 15th Century. (Magubane 1998:82) The young Venda men and old Venda men were highly regarded, as the Venda people believe that the young men are still close to the ancestors, while the old men are about to rejoin the ancestors. (Magubane 1998:84) Initiation played a big role in Venda culture, as with most South African cultures. (Magubane 1998:84) Initiation ceremonies were held for the many stages in life and would be made possible through external forces such as the ancestors, good and bad spirits, as well as witches. (Magubane 1998:84) A python, in Venda culture, is associated with fertility and the movements of a baby in the womb. (Magubane 1998:87) Venda women were held in much regard, unlike most African women. (Magubane 1998:89) venda women were in absolute control if in her courtyard, and elderly women played an important role in Venda society by telling the children traditional stories. (Magubane 1998:89) Venda women are able to own property and can become ruler of a clan if there was no male heir. (Magubane 1998:89) Architecture: Traditional Venda villages are surrounded by stone walls, which can still be seen near/under cliffs. (Magubane 1998:84) These villages are laid out so that the King is on the highest part of the land, with his wives and children around him, who are then surrounded by the rest of the inhabitants, who will protect the King and his family if there were to be a threat. (Magubane 1998:84) Ndebele Language: Ndebele language is split into two chief dialects namely, Southern Ndebele and Northern Ndebele, but the more common spoken dialect is Southern Ndebele. (South African Languages and Cultures [sa]) Ndebele is only spoken at home, and therefore only moves through generations, therefore it is thought to be a vanishing language. (South African Languages and Cultures [sa]) Culture: To tourists, the Ndebele culture is best known for their vibrant geometric patterns which decorate their houses, clothes and can also be seen in their beadwork. (Languages of South Africa 2010:1) These vibrant patterns embrace a variety of forms and symbols, such as natural objects, geometric forms and now days letters of the alphabet, numbers, representations of urban buildins, windmills and aeroplanes. (Magubane 1998:76) Ndebele life is characterized, life many other African groups, by the spirit world. (Magubane 1998:67) The spirit world is made up of the Ndebele ancestors who require constant sacrificing to keep them placid. (Magubane 1998:67) The Ndebele society is patriarchal; this was intensified by the white farmers who looked to Ndebele family labour where the men had to work for the white farmer. (Magubane 1998:70) The Ndebele man then moved away from the white farms and started their own businesses as taxi drivers or builders. (Magubane 1998:70) The Ndebele women would work as domestic servants in Pretoria but always returned home to look after the children and set up the homestead. (Magubane 1998:70) While the women were at the homestead, they would be supported by their husbands as well as making and selling beadwork, mats and dolls. (Magubane 1998:70) There is much deliberation on if the adornments worn by the Ndebele women are strictly for their own sensuality or whether their husbands want their wealth to be shown on their wives. (Magubane 1998:76) The most popular adornemnts worn by Ndebele women are the beaded wire hoops and/or copper or brass rings that they wear around their necks, arms, legs and stomach. (Magubane 1998:77) Sepedi Language: Sepedi is also known as Sesotho or Northern Sotho. (South African Languages and Cultures [sa]) But this language is best known for their wedding ceremonies. (South African Languages and Cultures [sa]) Culture: In the Sepedi culture, it is well known that the brides father ask the groom for lebola. Lebola is item/s exchanged for their daughter, for example money or livestock. (South African Languages and Cultures [sa]) The wedding is held at the brides or grooms home, but before the ceremony, the bride (dressed in a cows hide dress) has to go down to the river and collect water and wood for the ceremony. (South African Languages and Cultures [sa]) Once the ceremony is done, a sheep is then slaughtered in the back yard and the meat is equally divided between both families. (South African Languages and Cultures [sa]) Setswana Language: Setswana is commonly known as Tswana, which is related to the other Sotho languages. (South African Languages and Cultures [sa]) Setswana was mostly spoken in Botswana, but migrated into North Western South Africa. (Languages of South Africa 2010:1) Dr. Robert Moffat built the first school in Botswana and realised that he needed to use and write Setswana in his teachings, therefore Setswana was the first Sotho language to be in a written format. (Languages of South Africa 2010:1) Culture: Setswana is part of the Sotho-Tswana division, which use totems to contact their ancestors and these totems symbolise the sacred creature which is not to be hunted, the Setswana totem is a fish. (Magubane 1998:11) In the Setswana culture, wealth is measured by how many cattle they have in their possession; this is then ranked and put into a document called the Setswana Forbes, which lists all the names of the wealthy Setswana people. (South African Languages and Cultures [sa]) Setswana culture is also widely known for their Traditional healers, or sangomas, which play an important role in their culture. (South African Languages and Cultures [sa]) Southern Sesotho Language: Southern Sotho is spoken by more than five million South African inhabitants. (South African Languages and Cultures [sa]) It is a very complicated language, but once you get to understand it, it is a beautiful language. (South African Languages and Cultures [sa]) Sesotho originally was spoken in Lesotho, but moved into South Africa. It was also one of the first African languages, along with Setswana and Zulu, to be put into a written form as well as into literature. (Languages of South Africa 2010:1) Culture: Southern Sotho is part of the Sotho-Tswana division, which use totems to contact their ancestors and these totems symbolise the sacred creature which is not to be hunted, the Southern Sotho totem is a crocodile. (Magubane 1998:10-11) The Southern Sotho culture is one that believes strongly that Children benefit from serving their elders. (South African Languages and Cultures [sa]) Marriages are more often than not pre-arranged but in todays day and age, this has become less of normality as they are now able to pick their life partners. (South African Languages and Cultures [sa]) Swati Language: The Swati language is also known as the Swazi language. (South African Languages and Cultures [sa]) It is a very similar language to the Ndebele, Xhosa and Zulu language, and often gets confused with these languages. (South African Languages and Cultures [sa]) The language and culture of the Swati was highly influenced by the Zulus. (South African Languages and Cultures [sa]) Culture: The Swatis have many traditional events and the culture is one of colourful outfits with red feathers, carrying shields and wearing multicoloured necklaces. (South African Languages and Cultures [sa]) The Reed dance festival is one of their great festivals. (South African Languages and Cultures [sa]) The ceremony is held for eight days which runs through the end of August till the beginning of September. (South African Languages and Cultures [sa]) This ceremony is for all unmarried women and is to protect the womens chastity (South African Languages and Cultures [sa]) Tsonga Language: The Tsonga language is spoken throughout southern Africa. (South African Languages and Cultures [sa]) Tsonga is a language that does not use the English alphabet, but instead the Latin alphabet. (South African Languages and Cultures [sa]) Therefore it is a difficult language to learn or understand. Culture: The first Tsonga speaking people were traders of cloth and beads for ivory, copper and salt that was eventually joined by co-linguists pushed from the coast by Nguni raiders. Magubane 1998:90 The birth of a child is a great time for all Tsonga speaking people. (Magubane 1998:95) Babies are doctored with medicines and decorated with charms and beaded bangles. Magubane 1998:95 A Tsonga marriage is not just a relationship of two individuals, but an agreement and new relationship between the two families. (Magubane 1998:96) There is a sacrifice before the bride leaves her family and her ancestors to join her new family, her new family will now take her in as one of them and she will have to learn their etiquette and rules of behaviour. (Magubane 1998:96) Most of the agricultural work was done by women, but the harvesting was done in collaboration with the surrounding communities, with the owner/host of the land providing beer and refreshments therefore making it a festive occasion. (Magubane 1998:98) Venison was a vital part in Tsonga diet, so was fish as fishing was an important community activity. (Magubane 1998:98) Tsonga men have through the ages started working in the South African mines and send money home to their families. (Magubane 1998:99) They have to spend copious amounts of time on busses and trains, and have to live in hostels near to the mining towns. (Magubane 1998:99) The Tsonga people are able to play wind, stringed and percussion instruments, the string instruments being the most important. (Magubane 1998:99) The two other instruments they are able to play, but fall out of the mentioned catagories is the hand piano and the xylophone. (Magubane 1998:99) The stringed instruments they are able to play: Vibrating Bow Stringed bow attached to a calabash Hollow reed bow Wire stringed bow with a thickened handle plucked with a flat piece of wire The above text was reference from: (Magubane 1998:99) The wind instruments they are able to play: Cross flute Shepherds pipe Antelope horn trumpet The above text was reference from: (Magubane 1998:99) The percussion instruments they are able to play: Tambourines Drums The above text was referenced from: (Magubane 1998:99) Architecture: A Tsonga homestead comprises of the man, his wife/wives, their children and their sons families. (Magubane 1998:94) The houses are cylindrical with earthen walls and conical thatched or reed roofs. Magubane 1998:94 The homestead is generally circular with a central cattle byre and a main entrance on the eastern side, there may also be sub-entrances on the side of the water and fields. (Magubane 1998:94) English Language: South African English is rich and peculiar as it is influenced by most of the other ten languages. (Languages of South Africa 2010:1) For example: ..cars stop at robots, not traffic lights. A pickup truck is a bakkie, sneakers are takkies, a hangover is a babbelas, (Languages of South Africa 2010:1) English is understood across South Africa and is generally the chosen language in business, politics and media. (Languages of South Africa 2010:1) English is only spoken by 10% of South Africans, but is the primary language tought at primary, secondary and tertiary educational centres. (Languages of South Africa 2010:1) What artefacts are unique to each culture? Archaeology is important as it is able to tell us when and where people settled and how they lived. Archaeology is also able to link different cultural groups through the artefacts they leave behind. (Magubane 1998:8) Archaeological time periods and artefacts found from each period: Early Stone Age stone artefacts such as hand axes and cleavers. Middle Stone Age stone artefacts such as points and scrapers, as well as grindstones. Later Stone Age new technologies made way for the bow and arrow, and traps and snares. Early Iron Age new technology made way for hoes, axes, decorative pots and bowls, ornate metal work and complex terracotta sculptures. The above text was referenced from: Magubane 1998:8 The Bantu-speaking people have been thought to emerge from the Iron Age communities; the bantu-speaking people are divided into two groups, the Nguni speaking and the Sotho-Tswana speaking people. (Magubane 1998:10) These two groups are linguistically and culturally distinct (Magubane 1998:10) What is a Boutique Hotel? There are a number of characteristics and attributes that constitute a Boutique Hotel. Firstly a Boutique hotel is much smaller than a chain-hotel as the maximum amount of rooms a Boutique Hotel has is one-hundred. (Nobles Thompson 2001:1) Atmosphere is very important in a Boutique Hotel as it creates a memorable experience. (Nobles Thompson 2001:1) Management and staff need to anticipate guests needs and wants, knowing what a guest wants, when they want it and how they want it. (Nobles Thompson 2001:1) Unique and interesting themes, design and architecture. (What is a Boutique Hotel? 2003 2010) Stylish appearance (What is a Boutique Hotel? 2003 2010) Equally appropriate for business, honeymoon or vacation. (What is a Boutique Hotel? 2003 2010) Target market for Boutique Hotels is 25 55 age range and middle to upper income level. (What is a Boutique Hotel? 2003 2010) Boutique hotels offer a completely unique experience. Boutique Hotels can be hip and happening or historic in theme. (What is a Boutique Hotel? 2003 2010) Boutique Hotels offer comforts, such as bathrobes and fireplaces; spa-like services, such as healthy food choices, mind and body cleansing; the latest technology, as well as on-site dining, bar and lounge areas that are open to the public. (What is a Boutique Hotel? 2003 2010) How do you reuse an old building to create a new exciting interior? By preserving historic buildings and by updating the building and its interior for a new use (Bijelic 2006:1), the population and generations to come will be able to understand and appreciate South African heritage and culture. (The WBDG Historic Preservation Subcommittee 2010:1) By reusing existing buildings and transforming them into a new purpose, the architects and designers are in essence being environmentally responsible. (The WBDG Historic Preservation Subcommittee 2010:1) Existing buildings are in essence energy efficient as they already exist and therefore there is no need to create new building materials, which leave a carbon footprint behind. (The WBDG Historic Preservation Subcommittee 2010:1) Minor modification to the exterior or interior of these historical/existing buildings are possible and plausible as this will then create a new use for these buildings as well as upgrade these buildings in order to meet the modern building requirements and codes. (The WBDG Historic Preservation Subcommittee 2010:1) Converting historical buildings to meet modern demands might be a challenge, but there are advantages as clients will eventually realise the potential financial, cultural and marketing advantages of preserving architectural history. (Bijelic 2006:1) Practical benefits of preserving existing/historical buildings: Preservation of the history and authenticity. Increases the commercial value of the building and its ornaments/material which are more often than not high quality and not affordable. Sustainable building practice as there is less construction and demolition, and less need for new building materials as the existing infrastructure will be used. Energy efficient as there will be no energy waste on demolition and new construction. The above text was referenced from: The WBDG Historic Preservation Subcommittee 2010:1 Identify, Investigate, Develop, Execute and Educate are the five basic steps of preserving a historical building. (The WBDG Historic Preservation Subcommittee 2010:1) The four treatment approaches for historic buildings are: Preservation maintenance, stabilisation and repair of existing historic materials. Rehabilitation to alter or add to historic property. Restoration depicting the property at a particular period of time while erasing the evidence of other eras. Reconstruction re-creates non-surviving parts of the property. The above text was referenced from: The WBDG Historic Preservation Subcommittee 2010:1 Before preserving or reusing an existing building, the architect and/or designer needs to make sure that the original function of the building and the proposed new function of the building coincide and/or are compatible in order to reduce the deconstruction of the historic materials and ornaments. (The WBDG Historic Preservation Subcommittee 2010:1) In order to maintain the integrity of the historical building, the following preservation design goals need to be implemented: Update building systems this requires striking a balance between original building features and accommodating the new technologies and equipment. Life safety and security needs accommodate new functions, changes in technology and improved standards of protection. Comply with accessibility requirements provide access for persons with disabilities while meeting preservation goals. The above text was referenced from: The WBDG Historic Preservation Subcommittee 2010:1 Relevant Codes and Standards Previous research that has been done on the topic Field Research Data capturing I have sent out questionnaires to a number of architectural firms and travel agencies, as well as the Department of Tourism, Department of Home Affairs, The City Council of Johannesburg and the City Council of Tshwane. Explain in detail who, what, where, how and why The above mentioned parties will be able to advise me on (1) if there is a need for Boutique hotels in South Africa and (2) how to go about reusing/renovating existing buildings in order to preserve the environment as well as create a new, fresh Boutique hotel with the correct regulations.