Indian Consumer Behavior

CONSUMER LIFESTYLES IN INDIA (NOVEMBER 2004) 1. INTRODUCTION This report analyses consumer lifestyles in India and forms part of a 52-country series that complements the Euro monitor Consumer Lifestyles Database. Each country profile is structured under the following sub-headings: †¢ Population †¢ Consumer segmentation †¢ Regional development †¢ Home ownership †¢ Household profiles †¢ Labour †¢ Income †¢ Consumer and family expenditure †¢ Health †¢ Education †¢ Eating habits †¢ Drinking habits †¢ Shopping †¢ Personal grooming †¢ Fashion †¢ Leisure †¢ Savings †¢ Media †¢ Communications Transport †¢ Tourism The information in this report was gathered from a wide range of sources, starting with the national statistical agencies. This information was cross-checked for consistency, probability and mathematical accuracy. Secondly, we sought to fill in the gaps in the official National statis tical offices by using private sector surveys and official pan-regional and global sources. Furthermore, Euromonitor has carried out an extensive amount of modelling in order to come up with interesting data sets to complement the national standards available. The wide range of sources used in the compilation of this report means that there are occasionally discrepancies in the data which we were not able to reconcile in every instance. Even when the data is produced by the same national statistical office on a specific parameter, like the total population in a particular year, discrepancies can occur depending on whether it was derived from a survey, a national census or a projection and whether the data are mid-year or January. For slow trends, data are presented for 1990, 1995 and 2000-2003. Where it is interesting to look at projections, the data encompasses 1990, 1995, 2000, 2005, 2010 and 2015. Fast-moving trends such as communications are illustrated with data sets relating to 1990, 1995, 2000-2005, 2010 and 2015. Consumer goods data cover the period 1998-2003. 2. POPULATION 2. 1 Population by Age 700 million Indians are under the age of 35, making India one of the youngest nations in the world. The population of youth is almost equally divided between men and women, and in terms of numbers is more than the population of Latin America and the Caribbean put together. The changing demographics can be attributed to a slowdown in birth rate during the 1990s as well as rising levels of diseases amongst the 30+ age group. The biggest attraction for international players is perhaps the sheer numbers that provide them turnovers that corporates dream of. The 5-9 year-age group was the largest in 2004 though growth rates have been dropping over the review period. By the end of the forecast period though, the 15-19 year-age group is expected to be the largest in a digression from the historical trend indicating that the country will age slowly. In absolute terms, 10-14 year olds, 15-19 year olds and 20-24 year olds grew by approximately 25% since 1990. The changing demographics has been due to the high levels of birth rate in the last decade resulting in a population that attained these age levels post 2000. The population above 70 years of age will more than have doubled over the 1990-2015 period. 97% growth is expected amongst the 80+ group over the 2000-2015 period. Migration to other countries, better healthcare and a slowdown in birth rate are expected to contribute to some of these trends. The median age of the population is rising, albeit extremely slowly. Death rates are dropping gradually with improved access to healthcare but it is also accompanied by rather high levels of birth rate. According to an Oxford University Press publication by Tim Dyson, Robert Cassen and Leela Visaria by 2015, shifts are expected. The median age would rise to 31 from the current 24, and the proportion of 60+ would rise from 7% to 11%. Table 1 Population by Age: 1990-2015 ‘000 1990 1995 2000 2005 2010 2015 0-4 yrs 114,799 119,235 120,974 117,342 116,462 116,324 5-9 yrs 102,289 110,845 115,921 118,296 115,260 114,758 10-14 yrs 89,781 100,560 109,302 114,583 117,137 114,226 15-19 yrs 85,268 88,870 99,696 08,541 113,937 116,575 20-24 yrs 77,264 84,180 87,878 98,790 107,722 113,188 25-29 yrs 68,307 76,098 83,001 86,771 97,607 106,430 30-34 yrs 59,422 67,262 74,926 81,753 85,361 95,802 35-39 yrs 49,661 58,435 66,152 73,656 80,244 83,504 40-44 yrs 41,157 48,632 57,281 64,854 72,146 78,395 45-49 yrs 35,384 39,977 47,346 55,842 63,253 70,294 50-54 yrs 31,1 25 33,892 38,442 45,667 53,980 61,191 55-59 yrs 26,547 29,144 31,917 36,391 43,422 51,469 60-64 yrs 21,023 23,942 26,496 29,242 33,590 40,300 65-69 yrs 15,507 17,879 20,598 23,047 25,711 29,807 70-74 yrs 10,547 12,112 14,196 16,614 18,870 21,331 75-79 yrs 6,274 7,213 8,471 10,146 12,127 4,023 80+ yrs 3,678 4,497 5,951 7,536 9,431 11,708 TOTAL 838,033 922,775 1,008,549 1,089,072 1,166,258 1,239,325 Median age of 21. 68 22. 45 23. 28 24. 31 25. 62 27. 05 population (Years) Death rates (per ‘000 10. 63 9. 49 8. 67 8. 07 7. 66 7. 49 inhabitants) Source: UN, Euromonitor Note: As at 1 January Table 2 Population by Age (% Analysis): 1990-2015 % of total population 1990 1995 2000 2005 2010 2015 0-4 yrs 13. 70 12. 92 11. 99 10. 77 9. 99 9. 39 5-9 yrs 12. 21 12. 01 11. 49 10. 86 9. 88 9. 26 10-14 yrs 10. 71 10. 90 10. 84 10. 52 10. 04 9. 22 15-19 yrs 10. 17 9. 63 9. 89 9. 97 9. 77 9. 41 20-24 yrs 9. 22 9. 12 8. 71 9. 07 9. 4 9. 13 25-29 yrs 8. 15 8. 25 8. 23 7. 97 8. 37 8. 59 30-34 yrs 7. 09 7. 29 7. 43 7. 51 7. 32 7. 73 35-39 yrs 5. 93 6. 33 6. 56 6. 76 6. 88 6. 74 40-44 yrs 4. 91 5. 27 5. 68 5. 95 6. 19 6. 33 45-49 yrs 4. 22 4. 33 4. 69 5. 13 5. 42 5. 67 50-54 yrs 3. 71 3. 67 3. 81 4. 19 4. 63 4. 94 55-59 yrs 3. 17 3. 16 3. 16 3. 34 3. 72 4. 15 60-64 yrs 2. 51 2. 59 2. 63 2. 69 2. 88 3. 25 65-69 yrs 1. 85 1. 94 2. 04 2. 12 2. 20 2. 41 70-74 yrs 1. 26 1. 31 1. 41 1. 53 1. 62 1. 72 75-79 yrs 0. 75 0. 78 0. 84 0. 93 1. 04 1. 13 80+ yrs 0. 44 0. 49 0. 59 0. 69 0. 81 0. 94 TOTAL 100. 00 100. 00 100. 00 100. 00 100. 00 100. 00 Source: UN, Euromonitor Note: As at 1 January Table 3 Population by Age (Growth): 1990/2015, 2000/2015 % growth 1990/2015 2000/2015 0-4 yrs 1. 33 -3. 84 5-9 yrs 12. 19 -1. 00 10-14 yrs 27. 23 4. 51 15-19 yrs 36. 72 16. 93 20-24 yrs 46. 50 28. 80 25-29 yrs 55. 81 28. 23 30-34 yrs 61. 22 27. 86 35-39 yrs 68. 15 26. 23 40-44 yrs 90. 48 36. 86 45-49 yrs 98. 66 48. 47 50-54 yrs 96. 60 59. 18 55-59 yrs 93. 88 61. 26 60-64 yrs 91. 69 52. 10 65-69 yrs 92. 21 44. 71 70-74 yrs 102. 24 50. 26 75-79 yrs 123. 51 65. 54 80+ yrs 218. 34 96. 76 TOTAL 47. 89 22. 88 Median age of population 24. 76 16. 19 Death rates -29. 52 -13. 55 Source: UN, Euromonitor Note: As at 1 January 2. Male Population by Age Males constitute 52% of the population. Half are under the age of 29 and are looking for earning opportunities. Though liberalisation and the recent NDA (National Democratic Alliance) government headed by ex-prime minister Shri Vajpayee did much to invest in infrastructure and create jobs, much of this has apparently not perco lated down to the lowest income classes if election results in mid-2004 (when the incumbent government was unceremoniously and unexpectedly voted out) are anything to go by. Not surprisingly, the 5-9 year-age group is again the largest segment, representing almost 11% of the total population. In relative terms, this segment has been stagnant since 1990 and has declined marginally since 2000. Due to a larger base, 15-19 year olds will constitute the largest segment by 2015 despite higher growth by other groups. In keeping with general demographic trends, the population below the age of 20 years grew the maximum over the review period. Dropping mortality rates and better healthcare has increased this population group. The median age of the male population in India is approximately the same as the overall median age of the population. It was 22 in 2000 and stands at a little more than 24 years in 2003. Much of India is a male dominated society, and even in urban areas, women are shouldering more and more household running responsibilities. On a lighter note, urban men are more conscious of their looks be it clothing or even actual physical features. One would find many highlighting their hair or even exploring a manicure or a facial massage in big metro cities such as Mumbai or Delhi. The latest corporate entrant to the beauty services business under the name of Kaya Skin Clinics caters to both men and women with clinics even in Dubai. This is a Marico India Limited promoted venture. There is an entire new category of urban men – â€Å"the meterosexual male† that is as demanding about clothes, footwear, music and even grooming aids or beauty treatments as women. In burgeoning malls, men are spending as much or even more as women due to greater financial independence in relative terms and the freedom to spend money on items of desire or personal use. The youth desire items such as cell phones, PDAs and other electronic gizmos. Footwear is another item high in purchase priority. Whether it is body piercing or permanent tattoos, it is all about making a statement. Fitness and sports-related equipment also catches their fancy. The coming decade from 2004 to 2013 will see growth in the 30-55 age bracket by 2%. This will translate into significantly increased demand for items such as travel and leisure, home and household items, lifestyle accessories and even alcoholic drinks. Table 4 Male Population by Age: 1990-2015 ‘000 1990 1995 2000 2005 2010 2015 0-4 yrs 59,160 61,431 62,314 60,391 59,897 59,773 5-9 yrs 53,002 57,354 59,926 61,095 59,437 59,106 10-14 yrs 46,682 52,240 56,672 59,329 60,571 58,960 15-19 yrs 44,611 46,274 51,849 56,325 59,034 60,314 20-24 yrs 40,457 44,130 45,829 51,433 55,942 58,675 25-29 yrs 35,848 39,901 43,545 45,268 50,814 55,247 0-34 yrs 31,216 35,289 39,246 42,842 44,475 49,798 35-39 yrs 25,991 30,655 34,636 38,494 41,955 43,397 40-44 yrs 21,137 25,386 29,959 33,846 37,579 40,840 45-49 yrs 17,895 20,428 24,595 29,063 32,849 36,427 50-54 yrs 15,631 17,003 19,497 23,552 27,898 31,550 55-59 yrs 13,346 14,462 15,831 18,258 22,165 26,325 60-64 yrs 10,533 11,826 12,925 14,266 16,58 8 20,254 65-69 yrs 7,660 8,753 9,948 10,992 12,271 14,405 70-74 yrs 5,127 5,833 6,779 7,820 8,771 9,917 75-79 yrs 3,008 3,398 3,956 4,692 5,527 6,303 80+ yrs 1,756 2,094 2,684 3,338 4,129 5,050 TOTAL 433,062 476,458 520,192 561,005 599,902 636,341 Males as % of total 51. 68 51. 63 51. 8 51. 51 51. 44 51. 35 population Source: UN, Euromonitor Note: As at 1 January Table 5 Male Population by Age (% Analysis): 1990-2015 % of male population 1990 1995 2000 2005 2010 2015 0-4 yrs 13. 66 12. 89 11. 98 10. 76 9. 98 9. 39 5-9 yrs 12. 24 12. 04 11. 52 10. 89 9. 91 9. 29 10-14 yrs 10. 78 10. 96 10. 89 10. 58 10. 10 9. 27 15-19 yrs 10. 30 9. 71 9. 97 10. 04 9. 84 9. 48 20-24 yrs 9. 34 9. 26 8. 81 9. 17 9. 33 9. 22 25-29 yrs 8. 28 8. 37 8. 37 8. 07 8. 47 8. 68 30-34 yrs 7. 21 7. 41 7. 54 7. 64 7. 41 7. 83 35-39 yrs 6. 00 6. 43 6. 66 6. 86 6. 99 6. 82 40-44 yrs 4. 88 5. 33 5. 76 6. 03 6. 26 6. 42 45-49 yrs 4. 13 4. 29 4. 73 5. 8 5. 48 5. 72 50-54 yrs 3. 61 3. 57 3. 75 4. 20 4. 65 4. 96 55-59 yrs 3. 08 3. 04 3. 04 3. 25 3. 69 4. 14 60-64 yrs 2. 43 2. 48 2. 48 2. 54 2. 77 3. 18 65-69 yrs 1. 77 1. 84 1. 91 1. 96 2. 05 2. 26 70-74 yrs 1. 18 1. 22 1. 30 1. 39 1. 46 1. 56 75-79 yrs 0. 69 0. 71 0. 76 0. 84 0. 92 0. 99 80+ yrs 0. 41 0. 44 0. 52 0. 60 0. 69 0. 79 TOTAL 100. 00 100. 00 100. 00 100. 00 100. 00 100. 00 Source: UN, Euromonitor Note: As at 1 January Table 6 Male Population by Age (Growth): 1990/2015, 2000/2015 % growth 1990/2015 2000/2015 0-4 yrs 1. 04 -4. 08 5-9 yrs 11. 52 -1. 37 10-14 yrs 26. 30 4. 04 15-19 yrs 35. 20 16. 33 20-24 yrs 45. 03 28. 03 5-29 yrs 54. 12 26. 87 30-34 yrs 59. 53 26. 89 35-39 yrs 66. 97 25. 29 40-44 yrs 93. 22 36. 32 45-49 yrs 103. 56 48. 11 50-54 yrs 101. 84 61. 82 55-59 yrs 97. 25 66. 28 60-64 yrs 92. 29 56. 70 65-69 yrs 88. 04 44. 81 70-74 yrs 93. 41 46. 28 75-79 yrs 109. 53 59. 33 80+ yrs 187. 55 88. 16 TOTAL 46. 94 22. 33 Source: UN, Euromonitor Note: As at 1 January 2. 3 Female Population by Age 58% of the Indian female population is bel ow the age of 29. Of this 45% are over the age of 15 years. Female population proportion is likely to go up in the next decade following stringent official norms for sex determination and abortion of the female foetus. The current sex ratio stands at 933 females per 1,000 males as per the last census. Considering the decline in sex ratio from the previous census in 1991, female infanticide is still rampant not only in certain backward rural areas but also in a new form using modern technology in urban areas. Women in urban India have come a long way since the expectations their mothers or probably grandmothers had to live up to. In the 1960s and 1970s, it was a rarity to see working women. It went without saying that female members of the household handled household running responsibilities. Few would be seen dressed in anything but a sari, the national dress. Smoking and drinking were strict no-nos. Even going to the beauty parlour was considered highly emancipated! Cooking was always at home and done by women. Sacrificing personal wants and compromise were desirable attributes. The scenario dramatically changed in the 1990s with India’s entry onto the world beauty scene. Suddenly, every woman wanted to look good or do something that made a difference to her or to someone else. The salwar-kameez is almost a universal dress code. Originally, a North Indian attire, it caught the imagination of women from every region for its convenience and comfort. Young women are much surer of what they want and how to get it. Domestic duties such as cooking are minimised or taken care of in other ways. They would much rather work or do something that they would much rather be doing. Western-style dressing consisting of pants and a shirt is much more common even in workplaces. Social drinking is largely acceptable though still not desirable. On the other hand smoking is still a no-no notwithstanding the rise in number of working women who smoke in public. More and more women today have access to some means of income be it small or large amounts and even take investment decisions or play a significant role in the decision making. Today, one can see a mix of all kinds of women ranging from the traditional conservative to the ultra modern sophisticate. Even the traditional conservative is surprisingly quite progressive in emotional matters pertaining to education or even careers. While women are now increasingly comfortable with their bodies and do not mind even flaunting it, they still would prefer striking a balance between home and work. With more and more women earning their own money, they are now almost equally positioned as bread earners in families. Most men find it difficult to deal with this situation since money and the way it must be spent (larger sums that probably go beyond household expenses) is still considered a male domain. But there is an increasing segment that is now taking investment decisions as well. The stock market boom in 2003 attracted large numbers of housewives who got into the act of trading shares, earning just that little bit extra irrespective of their socioeconomic status or educational background. The attitude towards motherhood is changing. It is now more a matter of choice than chance. Young urban educated women are taking parenting much more seriously. Previously, the first child was born at an average age of 25, today in some parts it is 32 years. Women-on-vacation is another phenomenon slowly becoming visible at railway platforms, airport lounges and even gravelled roads. Single, married, divorced or bereaved and aged anywhere from 16-70 years, women are on the move. As the population ages and more working women constitute the Indian population, there will be a demand for items of personal use and anti-ageing products and services. The number of women smoking or drinking is also on the rise. Earlier considered taboo, rising pressures professionally and personally have only contributed to this changing paradigm. Table 7 Female Population by Age: 1990-2015 ‘000 1990 1995 2000 2005 2010 2015 0-4 yrs 55,639 57,805 58,660 56,951 56,565 56,552 5-9 yrs 49,287 53,491 55,994 57,201 55,823 55,652 10-14 yrs 43,098 48,320 52,630 55,254 56,565 55,266 15-19 yrs 40,657 42,596 47,848 52,217 54,903 56,261 20-24 yrs 36,806 40,050 42,049 47,357 51,781 54,513 25-29 yrs 32,460 36,197 39,456 41,504 46,793 51,183 30-34 yrs 28,206 31,972 35,680 38,912 0,886 46,004 35-39 yrs 23,671 27,780 31,516 35,163 38,289 40,106 40-44 yrs 20,020 23,247 27,322 31,008 34,567 37,555 45-49 yrs 17,489 19,549 22,752 26,779 30,404 33,867 50-54 yrs 15,493 16,890 18,945 22,115 26,082 29,640 55-59 yrs 13,200 14,683 16,086 18,133 21,257 25,144 60-64 yrs 10,490 12,116 13,571 14,976 17,001 20,046 65-69 yrs 7,847 9,126 10,651 12,054 13,439 15,402 70-74 yrs 5,420 6,278 7,417 8,794 10,099 11,414 75-79 yrs 3,266 3,815 4,515 5,453 6,600 7,720 80+ yrs 1,922 2,403 3,267 4,198 5,302 6,658 TOTAL 404,970 446,317 488,357 528,067 566,356 602,984 Females as % of total 48. 32 48. 37 48. 42 8. 49 48. 56 48. 65 population Source: UN, Euromonitor Note: As at 1 January Table 8 Female Population by Age (% Analysis): 1990-2015 % of female population 1990 1995 2000 2005 2010 2015 0-4 yrs 13. 74 12. 95 12. 01 10. 78 9. 99 9. 38 5-9 yrs 12. 17 11. 99 11. 47 10. 83 9. 86 9. 23 10-14 yrs 10. 64 10. 83 10. 78 10. 46 9. 99 9. 17 15-19 yrs 10. 04 9. 54 9. 80 9. 89 9. 69 9. 33 20-24 yrs 9. 09 8. 97 8. 61 8. 97 9. 14 9. 04 25-29 yrs 8. 02 8. 11 8. 08 7. 86 8. 26 8. 49 30-34 yrs 6. 96 7. 16 7. 31 7. 37 7. 22 7. 63 35-39 yrs 5. 85 6. 22 6. 45 6. 66 6. 76 6. 65 40-44 yrs 4. 94 5. 21 5. 59 5. 87 6. 10 6. 23 5-49 yrs 4. 32 4. 38 4. 66 5. 07 5. 37 5. 62 50-54 yrs 3. 83 3. 78 3. 88 4. 19 4. 61 4. 92 55-59 yrs 3. 26 3. 29 3. 29 3. 43 3. 75 4. 17 60-64 yrs 2. 59 2. 71 2. 78 2. 84 3. 00 3. 32 65-69 yrs 1. 94 2. 04 2. 18 2. 28 2. 37 2. 55 70-74 yrs 1. 34 1. 41 1. 52 1. 67 1. 78 1. 89 75-79 yrs 0. 81 0. 85 0. 92 1. 03 1. 17 1. 28 80+ yrs 0. 47 0. 54 0. 67 0. 80 0. 94 1. 10 TOTAL 100. 00 100. 00 100. 00 100. 00 100. 00 100. 00 Source: UN, Euromonitor Note: As at 1 January Table 9 Female Population by Age (Growth): 1990/2015, 2000/2015 % growth 1990/2015 2000/2015 0-4 yrs 1. 64 -3. 59 5-9 yrs 12. 91 -0. 61 10-14 yrs 8. 23 5. 01 15-19 yrs 38. 38 17. 58 20-24 yrs 48. 11 29. 64 25-29 yrs 57. 68 29. 72 30-34 yrs 63. 10 28. 94 35-39 yrs 69. 43 27. 26 40-44 yrs 87. 59 37. 45 45-49 yrs 93. 65 48. 86 50-54 yrs 91. 31 56. 45 55-59 yrs 90. 48 56. 32 60-64 yrs 91. 10 47. 72 65-69 yrs 96. 28 44. 61 70-74 yrs 110. 60 53. 89 75-79 yrs 136. 38 70. 98 80+ yrs 246. 49 103. 82 TOTAL 48. 90 23. 47 Source: UN, Euromonitor Note: As at 1 January 2. 4 Fertility and Birth Fertility rates in India fell to 2. 9 in 2003. The decline can be attributed to the rise in mean age at ma rriage and the postponement of the child-bearing decision. The average age of Indian women at child birth rose to 28 years in 2003. In some urban areas and metro cities it could well be early 30s. As women seek higher educational and professional achievements, urban families are postponing having children. In many cases, one of the reasons cited is that they would like to know their spouses better before giving rise to a social responsibility. Amongst celebrities such as personalities from the film industry as well as fashion, adoption is being increasingly accepted. These are usually highly successful, financially independent women who cannot or do not find the need for a spouse to raise children. Men still take a back seat where adoption is concerned. A complete change in the way earning opportunities present themselves in an increasingly open economy and the transient nature of jobs, values and money have made Indians seek personal confidence and stability before committing themselves further. Birth control has received total government support irrespective of the political party in power. However, a large number of women may not be able to afford birth control even if they wish to do so. Large numbers of couples want to space or limit births but they are not using any method of contraception. According to official sources, a nationwide survey it undertook showed that approximately 16% of couples or about 30 million couples have an unmet need for contraception. High fertility is one important factor affecting the reproductive health of women. One out of every 75 women of reproductive age dies from child birth-related causes. Other reproductive health indicators also reflect a generally poor health status. Only 15% of mothers receive complete antenatal care, and only 58% receive any iron/folate tablets or syrup. Only 34% of deliveries take place in facilities, and, at best, 42% are assisted by a health professional. Though there are official government norms for promoting two children families, there are many holding public positions that have three or four or even more children. It is therefore difficult for lawmakers who themselves go against government policies to implement them with complete resolution. There is a wide disparity in the population growth rates amongst various states. Southern states have achieved a greater measure of success in almost stabilising their birth rate growth due to a higher level of education and literacy in general. On the other hand, Northern states such as Uttar Pradesh, Rajasthan and Bihar represent a dismal picture. There is an unmet need for family planning in these states and about 25% of it is in Uttar Pradesh (UP) state. Is it a boy or a girl? The legacy of a declining sex ratio in the history of the Census of India took a new turn with the widespread use of new reproductive technologies (NRTs) in urban areas. NRTs are based on the principles of selection of the desirable and rejection of the unwanted. In India, the desirable is the baby boy and the unwanted is the baby girl. The result is obvious; the Census of 2001 revealed that with a sex ratio of 933 women for every 1,000 men, India had a deficit of 3. million women when it entered the new millennium. To stop the abuse of advanced scientific techniques for selective elimination of female foetuses through sex -determination, the government of India passed the Pre-natal Diagnostic Techniques (PNDT) Act in 1994. But techno-docs based in the metropolises and other urban centres, and parents desirous of begetting only sons, have subverted it. Outreach to the most vulnerable elements of the population is very limited, and the quality of services, in general, is poor. Additional constraints exist in the delivery of services. For family planning, the choice of methods is often limited and sterilisation remains the method of choice. Other approaches, including delaying the age of marriage and first pregnancies, and encouraging longer birth intervals, present major social and policy challenges. Religious and medical barriers exist in some areas, as do cultural issues associated with the preference for boys and denial of opportunities for girls and women. However, both the private and the public sector are taking substantial initiatives in the area of healthcare and there have been some improvements. Fertility rates fell by 23% over the 1990-2003 period though there was a slight increase in 2002. Some studies have shown that the increase was due to natural calamities in 2001 and 2002 accompanied by civil disturbances when citizens were mostly confined to their homes and had limited entertainment options. The fertility rate fell the following year by nearly 4% in 2003 over 2002 in keeping with the trend over the last decade. Table 10 Fertility and Birth: 1990/1995, 2000-2003 1990 1995 2000 2001 2002 2003 Average age of women at 20. 40 24. 20 26. 70 27. 20 27. 80 28. 33 hildbirth (years) Birth rates (per ‘000 30. 07 27. 45 24. 90 24. 37 23. 78 23. 40 inhabitants) Fertility rates 3. 80 3. 48 3. 06 2. 99 3. 02 2. 91 (children born per female) Source: National statistical offices, Council of Europe, UN, CIA World Factbook, Euromonitor Table 11 Fertility and Birth (Growth): 1990/2003, 2002/2003 % growth 1990/2003 2002/2003 Average age of women at childbirth 38. 87 1. 91 Birth rat es -22. 18 -1. 60 Fertility rates -23. 42 -3. 64 Source: National statistical offices, Council of Europe, UN, CIA World Factbook, Euromonitor 2. 5 Population by Marital Status There are only two dominant types of population by marital status in India – married or single. Married Married couples form more than half the population in India. Marriage is a sacred institution accompanied and governed by numerous social and religious customs and sanctions. Elders in the family normally arrange marriages in most of India and even with changing social fabric, parental acceptance and blessings are important. The result is a blend of the old and the new where brides/bridegrooms-to-be actually meet or see each other before the marriage and are allowed to exercise their choices. Marriage and child rearing is an accepted way of life and youngsters between the ages of 18 and 30 do look forward to settling down and getting married. An unmarried individual would stand out in the predominantly middle-class Indian society. However, acceptance of this is also increasing. There are a number of young adults, usually successful in their own lives, who choose not to get married or are unable to get married. Cracks and strains have started showing in a number of marriages due to postponement of the marriage decision, new income earning opportunities, changing lifestyles, new technologies and a sea change in attitudes and spirations in urban India. Hence, married families in 2003 grew at a slower rate than divorced or single families at only 1. 4%. Divorce Divorce is a little uncommon but is growing in incidence with young couples not willing to compromise or spend time on making a relationship successful. Interestingly, it is couples who knew each other before marriage that are seeing a rise in divorce rather than â€Å"arranged† family affairs that are part of Indian convention. There are instances of certain communities that are using technology (SMSs – Short Messaging System) to divorce their spouses by sending the message â€Å"divorce† thrice! The number of divorce cases filed in some cities reaches as high as 17,000 cases in Kolkata city with Pune having the least at 2,000. Some 9,000 cases are filed each year in Mumbai city alone. Widowers Widowers form a small 5% of Indian society that predominantly consists of youth. Rising longevity, increasing age at marriage and even social reform with respect to â€Å"child widows†, â€Å"child marriages† and â€Å"widow remarriage† have contained the growth of this category of the population. There are not too many widows/widowers in urban areas and even these generally stay with their families as in their sons or daughters. In certain rural areas, with lack of healthcare and awareness of a number of health conditions, widowers could form a slightly larger population segment. Co-habitation Co-habitation is still not viewed with much respect in a society steeped in tradition. In the Western state of Gujarat there is actually a quasi-legal arrangement called â€Å"Maitri Karar† that stipulates the responsibilities of a contract â€Å"friendship†. However, there are a growing number of homosexuals –both men and women, who have come out of the closet and are finding some acceptance. There are at least five lesbian groups in the country which are striving to provide dignity to this section of the populace. There is a large number who is probably not even aware of their preferences and go through much turmoil in the process. Yet, permissiveness is at an all-time high. 27% of the population in Bangalore; Chennai 28%; Delhi 22%t; Hyderabad 20%; Kolkata 32%; Mumbai 24% feel that both partners should be free to have extramarital sex with the spouse's consent. Delhiites are most likely to have done it at a younger age than their counterparts in other cities. Hyderabadis and Mumbaikars show the maximum inclination to infidelity. Adultery is going middle-class, to small-town India, going commonplace, even going boring. Dangerous liaisons used to be for the aristos and the plebs. Those in between, the middle classes, were tethered by moral chastity belts – only their fantasies could roam freely. Or it was all within the family, the extramarital dalliances, that is. The scarlet letter is now fading fast: stigma is getting passe and guilt for an increasing number is no more than a twitch. New technology is an important factor encouraging the phenomenon. Internet and mushrooming cyber cafes have helped, as have mobile phones and SMS facilities. Middle-class India is having a great time and most Westerners are shocked at the change. Table 12 Population by Marital Status: 1990/1995, 2000-2003 ‘000 1990 1995 2000 2001 2002 2003 Married 471,829 494,405 516,978 524,708 532,254 539,637 Divorced 3,093 5,010 8,059 8,214 8,365 8,510 Widowed 52,532 56,663 53,373 54,144 54,895 55,629 Single & other/unknown 310,578 366,696 430,138 438,100 445,958 453,729 TOTAL 838,033 922,775 1,008,549 1,025,166 1,041,471 1,057,505 Average age of women at 19. 00 22. 90 25. 50 25. 90 26. 50 26. 97 first marriage (years) Source: National statistical offices, Council of Europe, UN, Euromonitor Note: As at 1 January Table 13 Population by Marital Status (% Analysis): 1990/1995, 2000-2003 % of total population 1990 1995 2000 2001 2002 2003 Married 56. 30 53. 58 51. 26 51. 18 51. 11 51. 03 Divorced 0. 37 0. 54 0. 80 0. 80 0. 80 0. 80 Widowed 6. 27 6. 14 5. 29 5. 28 5. 27 5. 26 Single & other/unknown 37. 06 39. 74 42. 65 42. 73 42. 82 42. 91 TOTAL 100. 00 100. 00 100. 00 100. 00 100. 00 100. 00 Source: National statistical offices, Council of Europe, UN, Euromonitor Note: As at 1 January Table 14 Population by Marital Status (Growth): 1990/2003, 2000/2003 growth 1990/2003 2000/2003 Married 14. 37 4. 38 Divorced 175. 1 5. 59 Widowed 5. 9 4. 23 Single & other/unknown 46. 09 5. 48 TOTAL 26. 19 4. 85 Average age of women at first marriage 41. 93 5. 75 Source: National statistical offices, Council of Europe, UN, Euromonitor Note: As at 1 January 2. 6 Population by Educational Attainment Indians place a lot of importance on higher education as is evident from the number of graduates as well as the number of Indians doing extremely well in other parts of the world. Despite huge odds, the literacy rate now stands at more than 65% for the country as a whole. In terms of numbers, most of the population has some form of primary education. Kerala is the only state that has 100% literacy. Public expenditure on education now stands at 4% of GDP, well below the Kothari Commission recommendation of 6% way back in 1968. The private sector is now taking increasing initiatives in primary level education after having participated in a mixed fashion in the form of self-financed colleges and institutions of higher learning. This is one of the factors for higher growth in the level of education attainment at higher levels as compared to primary education. There are about 888,000 educational institutions in the country with an enrolment of about 179 million. Elementary Education System in India is the second largest in the World with 149 million children of 6-14 years enrolled and almost three million teachers. This is about 82% of the children in the age group. Compulsory education has been enforced in four States and Union Territories (UTs) at the primary stage of education while in eight States/UTs there is compulsory education covering the entire elementary stage of education. As many as 20 States/UTs have not introduced any measure of compulsion. Though education is in the concurrent list (ie both the Central and State governments are responsible for this social sector) of the Constitution, the State Governments play a very major role in the development of education particularly in the primary and the secondary education sectors. In order to facilitate donations including smaller amounts from India and abroad for implementing projects/programmes connected with the education sector, the Government constituted the â€Å"Bharat Shiksha Kosh† as a Society registered under the Society Registration Act, 1860. The Kosh was officially launched on 9 January 2003 during the celebration of Pravasi Bharatiya Diwas. The Kosh will receive donations/contributions/endowments, from individuals and corporate, Central and State Governments, non-resident Indians and people of Indian origin for various activities across all sectors of education. Table 15 Population by Educational Attainment: 1990/1995, 2000-2003 ‘000 1990 1995 2000 2001 2002 2003 Primary & no education 372,583 378,124 391,590 400,014 408,770 417,596 Secondary 79,103 121,874 163,622 167,434 171,221 175,064 Higher 79,478 92,137 107,140 109,858 112,464 115,123 TOTAL 531,164 592,134 662,352

Gloria Jeans Essay

Gloria Jeans’ is well known due to it is made by 100% natural ingredients which include home-made cookies, muffins, and any other sweet desserts. 1) Economy The point here is that Gloria Jeans’ can not set a price that is too high because competitors will be attracted by potential profits and will follow by a lower price. After having taken all the important factors into consideration, there are five-price fixing approaches seem appropriate. 1.Cost Based pricing One of the centred objectives of this project being to become the market leader in functional drinks, Gloria Jeans’ is willing to stay among the top competitors if not becoming the greater by achieving a certain target profit this could be obtained by establish a price that will largely cover variable and fixed costs while bringing tremendous profits 2.Value Added Pricing Competitors and potential substitutes prices can also be part of the strategy. Having a higher price could make customers aware of the additional benefits and the higher quality of coffee. 3.Value based pricing The company sets its target price based on customer perceptions of the product value. The targeted value and price then drive decision about product design and what cost can be incurred. As a result of pricing begin with analysing consumer needs and value perceptions and price is set to match consumer perceived value. 4.Market Penetration Pricing The company can set a low price for a new product in order to attractive a large number of buyers and a large market share. 5.Break-even Pricing The company has to make some strategies for break-even prices, setting prices to break even on the cost of making and marketing a product or setting prices to make a target profit. According to the report of Su, Chiou and Chang (2006), the case study of Starbucks coffee displayed that Western culture adoration can influence the coffee consumption of Taiwan. Kim (2002),point at consumer behavior have significant influenced by the  product-of-origin and brand image. Hao(1998), states that superior brand has become the most important element to enhance value-added products and it also is a strategy. The brand image and product-of-origin would important factors, they would provide insights on cross-culture marketing. 4ï ¼â€° Demographics According to the survey, women more desire to drink coffee than men (Jones, 2006).There is no significant difference between two groups of people. Coffees are all thousands of years ranging from adults or even older. It’s hard to resist the appeal of Coffee, and there is great opportunity to tea growing up. In addition, the social behaviour are one of the factors segmented coffee products in the market Because of different group has different demand for their need and wants. The high salary people may more focus on their healthy or willing to pay higher prices. 3ï ¼â€° Political and legal Doing coffee business there is no risky for the company because of it does not related any political and legal

Newly diagnosed with Multiply Myeloma, information on your planned Essay

Newly diagnosed with Multiply Myeloma, information on your planned treatment with Lenalidomide 2 - Essay Example There is also elevated levels of antibodies and also other plasma proteins. In vitro, effects of lenalidomide 2 include direct anti-tumor action. It inhibits the microenvironment support for the thriving of the tumor cells. It plays an immunomudulary role. In vivo, it leads to the apoptosis of tumor cells both directly and indirectly. It does this by inhibition of support for bone marrow stromal cells. It also has anti-osteocaltrogenic, anti-angiogenic, and immunomodulary activities. The choice of chemotherapy would depend on factors such as the health of the patients, future ability to undergo stem cell transplantation, age and also disease characteristics that indicate a high risk to MM. Treatment options for patients with high risk of multiple myeloma is indistinct. It is recommended that patients of that nature enrol in clinical trials. Patients who are unwilling to participate in clinical trials would have a regimen that should include a combination that has bortezomib. After initial chemotherapy, stem cell transplanataton is recommended. For standard risk MM, the treatment options include a drug without melphalan, such as lenalidomide 2 and dexamethasone (RD), or cyclophosphamide , dexamethasone and bortezomib (VCD). In case the patient would not undergo stem cell transplantation, treatment should include thalidomide, melphalan and prednisone (MPT) or prednisone, bortezomib and melphalan (VMP). Another suitable combination is lenalidomide 2, with dexamethasone in low doses (RD). Lenalidomide 2, an immunomudalting agent, is usually effective in the treatment of MM. It is most often used in combination with dexamethasone. The combination is taken in the form of pills for between 3 to 4 weeks, dexamethasone being taken weekly. Due to the tendency to lead to formation of clots, warfarin or aspirin is given to reduce the risk. Kumar, S., Flinn, I.W., Hari, P.N. et al (2009). Novel three- and four-drug combinations of bortezomib, dexamethasone,

T & M wk5 Essay Example | Topics and Well Written Essays - 7250 words

T & M wk5 - Essay Example Many of these children that I have seen are actually gifted, but they do not have a way to express their way of learning. Sometimes these placement tests are accurate but other times they are not. Part of our job is to discern what learning disabilities a child has and look for ways to assist them. An ethical issue is that sometimes we are asked to do testing that no one is qualified to do. We do send children out to be tested in these cases but it is difficult when other agencies expect that we can do everything. The role of testing and assessment in small business is important because it is important that all people within a business understand how to work together. It is also important for individuals to take charge of their careers inside a company so that when openings happen they are able to take advantage of them. One of the tests that I would use in business would be the Values Scale. This test gives an understanding of 21 values that are relevant to work and an individuals life roles. I would use this instrument to help the employee understand their own values and to help the employer understand how this individuals values may fit into the organization. I would ask that employees take this test within the first year of their employment in order to help them understand how to shape their values with those of the company. The second test that I would use is the Myers Briggs Type Indicator. I would use this to start a dialogue between employees to help them understand each other better. This is very good with management but it would also be used with other employees. T One challenge to testing and assessment in business is the fact that testing of any kind is controversial because the perception of testing is that it is used to keep certain types of people out of an

Ben Hou Lodge And Characteristics Of Market Segment Case Study

Ben Hou Lodge And Characteristics Of Market Segment - Case Study Example This is due to the fact that in business while selling a product the nationality of that specific country from where the product is created does not matter, and the product is always sold to the global market for maximum profits. The target customers would have extremely high expectations regarding the quality of the product. They would want to have the highest quality of the product which they have been promised from the Lodge and therefore it is important that the Lodge contains the best luxuries money can buy for these rich people to have a laidback leisure time away from work. It should have high-quality furniture at the resort and there should be a good amount of people to look after the guest. There should be great artwork in the rooms of the resort and the food should be made by the best of the chefs from all over the world. The entire ambiance of the place should be conducive for the retreat of the elite few from the rest of the world, and therefore the resort has to make sure that all their needs and demands should be met according to the highest standards possible. The implications for the Lodge are really promising. The Lodge has developed a safari ride for its high flying customer’s horse trekking, photography and other outdoor related activities. The resort has been converted into a game reserve and the response to this place has been very positive. The managers of the retreat think that the best way of marketing is to spread the word about the place through those people who have visited the place and have appreciated the beauty of the place. Publicity and public relations have been the main way through which marketing has been done for the retreat and it has been working out perfectly well for now. The implications for the place are bright and the future looks solid for a good business. It is not difficult for the Lodge to conduct marketing research since the segment for the  market has already been defined as the filthy rich people.  

Choose a consumer product or service that is on the market today, but Assignment

Choose a consumer product or service that is on the market today, but is declining in appeal to consumers. This product should b - Assignment Example Another explanation would be that competitors have been offering a slightly different product from the existing one with the same functions and latest features. This paper presents the current position and performance of desktop computers in the market and recommends possible ways to save the products from becoming more obsolete. Furthermore, this paper examines some market issues that greatly affect the desktop PC market. Desktop Computer and its Current Market Desktop personal computers came into existence before the latest computer tablets and netbooks were introduced to the market. Traditional personal computer has central processing units (CPU) unlike the current handy laptops and tablets. Basically, the target markets of desktop computers were businesses like internet cafes, hotels, and families with household internet access. Businesses often get desktop computers for their employees and executives for business related transactions because desktops run faster than laptops. Hou seholds also get at least one desktop computer at home despite the fact that family members may already have laptops and smartphones. According to the 2010 US Census, 63% of households with income of less than $50,000 have personal computers (desktop and/or laptops); 91% of the households having income of $50,000-$99,999; 96% of households with $100,000-$149,999; 97% of the households with income of $150,000 and more own personal computers; and, 68% of the households with income not reported have computers. Having children is also a factor to getting personal computers by households. In the same US Census, 84.1% of the households with children 6-17 years old have PCs; 79.3% of households with children not within the 6-17 range own home computers; and, 70.9% of the households with no children have personal computers. Another important demographic that also affects the decision of getting computers is the educational attainment of the households. The 2010 US Census showed that only 41 .8% of those who did not graduate from high school have home computers; 64.8% owns PCs from households with high school graduates or General Education Attainment (GED); 81.6% of those who have some college or associate degrees; and, 90.9% of the households with bachelor’s degrees and higher have personal computers. Reasons for Declining in Popularity â€Å"The decline of desktop isn’t surprising,† says Arthur (2012). According to Wilcox (2012), US sales of personal computers had reached its lowest peak on the fourth quarter of 2011, which was said to be the worst since 2001. Apple’s iPad tablets have been hurting the PC industry and affecting the current sales (Randewich, 2012). In spite of the weak sales of personal computers, Apple products have continued to flourish. Although the declining sales was partly caused by the floods in Thailand, one cannot deny the fact that consumer behaviors have also changed. Consumers are more concern on buying something that is not bulky or huge and offers multiple applications. Nowadays, most tech savvy individuals prefer to get the latest gadget. They are not anymore into desktop computers since they find it hard to update some windows applications. Smartphones, computer tablets, and netbooks have up to date applications and features. Most students already own smartphones and laptops; there would be no use of getting a desktop computer. Majority of the smartphone and laptop features have grown to be impressive over the years of

Increasing Education of ADHD Therapies for Pediatric Nurses Research Paper

Increasing Education of ADHD Therapies for Pediatric Nurses - Research Paper Example The treatment methods largely adopted are based on medication which has been found to have mild to extreme effects on the users. These side effects have endangered the life of the users even though they have had a somewhat commendable effect on the individual in regard to the condition. Personally, I have had a chance of attending to an ADHD patient, a 12 year old child who had been placed with me for adoption. The child was diagnosed with ADHD four years ago and has since been on medication and no other complimentary interventions have been initiated to treat the disorder. Being in this situation has prompted me to delve deeper into finding an alternate solution in the treatment of ADHD. Through sufficient and quality research a workable and efficient means of treating ADHD can be arrived at, one that has minimal effect on the individual. In a bid to accomplish this task, this paper will start with an in depth review of ADHD including existent statistics, medication, effects of medi cation, non-medication therapies and their effectiveness in treating ADHD. This will be followed by a look at a viable solution to the ADHD problem and an evaluation of the present obstacles to implementing this solution. In conclusion, it is expected that this study will have availed a new way through which ADHD can effectively be handled with minimal effects to the individual. Literature review The Centre for Disease Control and Prevention (CDC) estimates that there are 5.2 million children aged 3-17 that have already been diagnosed with ADHD in United States. This means that 8.4% of all children have been diagnosed with ADHD (Centre for Disease Control and Prevention 2012). This points to increased diagnoses as a decade earlier lower rates had been reported with the overall diagnoses at the time being 6.9%. Based on gender, reported diagnoses indicate that boys are much more affected than girls, boys ADHD prevalence increased from 9.9% in 2000 to the current level of 12.3%, for g irls the rate in 2000 was 3.6% and this has also increased, though in a lesser magnitude to 5.5% (Centre for Disease Control and Prevention 2012). Another notable variable in the prevalence of ADHD is income levels, in 2000 the prevalence rates were the same across all income groups, but presently the prevalence has increased among children in low income families (100%-199%) as compared to families with income greater or equal to 200%. Lastly, ethnicity also seems to be a notable variable, in 2000 the prevalence rate among non-Hispanic white children ranged from 8.2%-10.6% while that of non-Hispanic black children ranged from 5.1%-9.5% indicating a higher prevalence among non-Hispanic white children (Centre for Disease Control and Prevention 2012). These variations seem to have presently leveled out within non-Hispanic white, and non-Hispanic black groups. Treatment for ADHD has proceeded on two fronts; biological and psychosocial interventions. Typically, the goal of biological tre atments is to reduce the children’s impulsivity and hyperactivity and to improve their attention skills (Barlow & Durand, 2009). Psychosocial treatments generally focus on broader issues such as improving academic prowess, decreasing troublesome activities, and improving social skills. Although these

The religious factors that led to the clash between Native Americans Essay

The religious factors that led to the clash between Native Americans and early Euro-American settlers - Essay Example However, not everything in the Native American/White relations was entirely gruesome. Oppression and conflicts with white people turned Native Americans into a nation with remarkable adaptation potential. The development and change touched all the areas including culture and religion. As a result, while European colonialism was pushing Native American populations westwards, the latter were developing the degree of flexibility, adaptability and cohesion that had been unknown to native populations before 1607. The difference between the frontier line of America and the frontier line of other countries is the following: the other countries knew their boundaries and they knew which countries were beyond these boundaries. The North America frontier underlined the unknown land beyond it. In accordance with Calloway: â€Å"†¦fertile valleys, meeting friendly people bedecked in turquoise, and hearing wondrous accounts of the towns to be found in the north† (p. 133). As far as we can see, the diversity of the North frontier is evident. The nature of the diversity can be found in the first settlers’ necessity to deal with natural challenges and remain self-sufficient. Indian cultures are really unique and peculiar in America. Some Indian tribes have survived, although other tribes have been vanished and completely destroyed. Many of them continued their traditional cultures, while others fully lost their cultures and communities. The history of American Indians in their relationship with Americans is full of brutality and intent destruction and discrimination. (Erchack 1992) Some scientists mention that the history of American Indians is something similar to labyrinth of different opinions and ideas. Indians resides from the cold regions of the Intuit in northern Alaska to the Yahgan. Many Americans consider Indian Americans as noble savages. It became an

Earth ans Space Sciences (Meterology) Essay Example | Topics and Well Written Essays - 1500 words

Earth ans Space Sciences (Meterology) - Essay Example The Joplin Tornado is considered to be the most severe tornado in history of United States since 1953 (Storm Prediction Center, 2011) as the optimum wind velocity was about 200 mile per hour that created an enormous damage in Missouri. The death toll was 162 which topped the number of causalities produced by a tornado of 1953 in Flint, Michigan in which 115 people were died; however, death toll remained less than a tornado of 1947 in Woodland, Okalahoma, when 181 people were killed. A well advanced tornado warning was issued by the local meteorological office as well as special updated were released by National Weather Service. A great coordination between meteorological and administrative agencies enabled the general public in advance to take necessary safety measures and thus saved many lives. However, despite of taking all the measures, tornado was strengthened enough that it not only produced tremendous loss of infrastructure but also caused 162 human fatalities and moderate to s evere injuries to more than 1000 people (Reuters, 14 Sep, 2011). This paper explains several aspects of Joplin Tornado which include the synopsis of the incident with the help of real-time dealing with of the event, loss of human life and damage to businesses and properties, and some statistics as well. At the end, few points are suggested for forecasters to improve their forecast related to any such occurrence in future. 2. Joplin Tornado Synopsis A tornado is defined as â€Å"a rotating column of air ranging in width from a few yards to more than a mile and whirling at destructively high speeds, usually accompanied by a funnel-shaped downward extension of a cumulonimbus cloud† (http://www.the freedictionary.com). Tornadoes appear in a number of sizes and shapes; however they are often in the style of an observable condensation funnel, as their thin end meets the ground and are oftentimes surrounded by clouds containing waste and dust particles. The majority of tornadoes pos sess violent winds having speed not less than 110 miles per hour, however, a lot of severe tornadoes can gain the wind velocities greater than 300 miles per hour with an extension of width well over two miles around, and remain to the earth for a great deal of about more than 100 miles in length (Edwards, 2006). The strength of a tornado is ranked by Enhanced Fujita Scale which consists of six categories depending upon the wind speed. The key statistics that Joplin tornado produced are shown in tabular form below. Maximum EF-Scale   EF- 5 Maximum Wind Speed (Estimated)   In Excess of  200 mph Path Length   22.1  Ã‚  Miles Path Width   3/4 to 1 Mile Fatalities   162 Injuries 1000+ Start Time   1734 PM End Time   1812 PM Approximate Beginning Pt. 1/2 mile SW of the intersection of JJ HWY   & and west 32nd street (Newton Road) Approximate Ending Pt. 4.8 mi. NNE of Granby, Missouri (Source: http://www.crh.noaa.gov/sgf/?n=event_2011may22_survey) Joplin, Missouri exper ienced one of the most deadly tornados of the history of United States on 22nd May, 2011. The first three weeks of May, 2011 were significantly quiet as only few and isolated tornados took place, however, by the combined effect of an intensified low pressure area and dry line changed the pressure

Country Selection and Initial Analysis Essay Example | Topics and Well Written Essays - 500 words

Country Selection and Initial Analysis - Essay Example The services sector has the largest contribution of 51% approximately (estimated 2010). The population growth rate is just over 1%, which should be viewed as reasonably well for a Muslim majority emerging nation. The currency is known as Moroccan Dirham (MAD) that fluctuates against US dollar because of changes in global economy. However, the exchange rate prevails between 8 – 9 Dirham / US dollar at present. The GDP per capita was around $4,900 according to 2010 statistics (CIA Fact Book, 2010) It should also be highlighted that the recent floods in Morocco damaged its agricultural crops as the area under cultivation reduced by significant 25 – 30%. As a result, the production of wheat, barley, vegetables and other grains reduced considerably whereas the demand increased due to rise in population. Nonetheless, the government authorities were left with no other option but to increase imports from self-sufficient nations so that they could stabilize wheat prices across M orocco (Reuters Africa, 2010). It should be noted that domestic wheat consumption in Morocco has been estimated to be nearly 8.3 million tons and the shortages resulted in 47% hike in wheat prices (Weisenthal, 2011). The price surge was mainly the outcome of shortage amid price inelastic demand of food products as they are necessities.

Languages in Cyberspace Essay Example for Free

Languages in Cyberspace Essay Governments have encourage industrial farming and non-organic meat production to improve the crop yield and revenues. However, studies have shown the side effects and health hazards of industrial farming and meat processing. A distinct cultivation of a health-conscious culture became apparent as time goes by which resulted to an increase in sales of organic vegetables and meat in the world. Hence, the sales and marketing of organic products is influenced by the culture or trend that exist in the market. Muslims are known for faithfully abiding with their religious beliefs and practices. When it comes in meat, Muslims only consume meat from slaughtered animals through the Halal way. Three times more blood is pumped out of Halal-slaughtered animals than those butchered in non-Halal way. Hence, lesser toxins are consumed by Muslims since most toxins are stored in the blood. With the introduction of organic aspect, an animal is not pumped with antibiotics and hormones or additives that would increase the toxicity its blood. Hence, Muslims are drawn to organic meat because of its inclination towards their religious belief in meat intake thereby creating an outward effect to the sales and marketing of organic meat. Language is a way of communication of thoughts, messages and feelings. In the global market, one barrier that must crossed by companies to reach out to their market is language. Without the right tools and strategies to cross this barrier, marketing a product will be difficult. A Firm must find a way to communicate and introduce a product in a language known by its market, otherwise, awareness and recognition of the product will not be achieved. This does not apply in the organic meat industry alone but to all industries and businesses. Marketing have evolved with technology through the years and e-commerce was introduced and adopted by most businesses. The worldwide web has a broader scope and the interaction with the customer is direct. In marketing organic meat products, e-commerce is the best way to reach out to its customers directly. It is also the cheapest way to market and promote a product. Longcloud should develop its website in languages other than English to cross the communication barrier that language created. If Longcloud develops a website with different languages, the scope of its accessibility and comprehension will be broader and more comprehensive. It will open the gates for the development of new markets in different countries. Moreover, with this strategic undertaking, the company will be globally competitive and accessible. The power of information technology can promote and increase the sales and distribution of organic meat worldwide. In choosing the languages to translate and include in the website, there are several aspects to consider and these are the opportunities, scope and target market definition. The companys website must be available in Arabic, Chinese (Mandarin), French and Spanish languages. Most Muslims speak Arabic and it was clearly identified that Muslims are one Longclouds target markets and about 150 million people speak this language. Chinese, specifically, Mandarin language should also be available to reach 1365 million people who have developed a fondness for organic meat products. Moreover, the growth of the organic meat industry in French-speaking countries like France, Canada, North Africa and Switzerland should also be considered. 23% of the current Internet users are from Europe which include some of these countries. Although only 2% can be accounted for the Spanish-speaking Internet users, a considerable target market was defined and identified in the Latin America. There several threats and disadvantages that must also be considered in making the website available in different languages like the uneven percentages of the target market with Internet access. However, with the growth of technology, many countries have relied in the use of Internet and it has become a household need. Moreover, although some people are accustomed to using English for conducting business, it must also be noted that, English literacy only accounts for about 50% share globally. Software complexities must also be considered, however, software upgrades and development are done continuously to address these problems.

Every Child Matters: Green Paper

Every Child Matters: Green Paper In 2003 the Government released the original Every Child Matters: Green paper, it was a response to the Joint Chief Inspectors report on the findings of Lord Lamings (Victoria Climbies death) public enquiry. It highlighted many failings from services to communicate and intervene. It set out proposals on how to address the issues of concern that had been identified and suggested measures that were needed to improve and reform childcare The Green Paper identified four areas of action: Support for parents and carers Effective protection and early intervention Accountability and poor integration Reform of the workforce The aim was to not only protect children but also to enable children to improve and fulfil their lives. The Green Paper built upon the foundations of Sure Start, aiming to eradicate child poverty and raising school standards. The success of the Green Paper led to the paper being transformed in to Every Child Matters: The Next Steps. Alongside this and with the support of the Houses of Parliament, the 1998 Childrens Act was reformed and adapted into The Childrens Act 2004. This Act aimed to encourage. It also aimed to ensure that LAs (Local Authorities) were given more flexibility when implementing their provision. One result of this act was the development of Local Safeguarding Childrens Boards. These boards aimed to co-ordinate between all LAs in a local area in order to safeguard children. The Act also resulted in the formation of the Every Child Matters Framework Every Child Matters: Change for Children, became a national framework. The title Every Child Matters was used to amalgamate all of the documents, that aimed to organise and deliver services that ensured every child and young person became an active member of society. There was also the aim of preventions as opposed to just dealing with the consequences. For this to work the framework suggested multi-agency collaboration from all those working with children and young people. Through this collaboration of services it would hopefully allow children and young people to achieve the five outcomes of the The Children Act 2004 (Section 10). Section 10 requires public services to ensure all children and young people are: Protected from neglect and harm Have the right to education, training and recreation Physical and mental health and emotional well-being Contributing to society Achieve social and economic well-being These are summarised as enabling children or young people to: Stay Safe, Be Healthy, Make a Positive Contribution, Enjoy and Achieve, and Achieve Economic Well-Being. These five outcomes are referenced to throughout Every Child Matters. To ensure all children and young people progress against these outcomes, policies and practices needed to be developed and implemented. The framework also focused on trying to ensure every child had provision regardless of their background or circumstances, and to enable children and young people to have a greater say about the issues and problems that affect them collectively and as individuals. This was evident in 2005, when the first Childrens Commissioner for England was elected; this gave a voice for children. This was one action aimed to prevent problems rather than dealing with consequences. As well as this the framework was seen as an inescapable moral imperative that it intended to assist a radical reform of services In 2007 The Childrens Plan was published, this aimed to build upon the Every Child Matters framework. The Childrens Plan: Building Brighter Future was a ten year plan that aimed to centralise children and young people, and increasing the focus on parental roles and the wider communities. The Plan focused on the Childrens Trusts, and believed that this was central to delivering quality, and set high expectations of them to deliver. The Childrens Trusts had similar aims to those of the Local Safeguarding Children Boards, they both aimed to collaborate. The Trusts take the child centred approach and use an integrated strategy of joint planning and commissioning, and pooled budgets. This inter agency co-operation aims to be sustainable by using a shared language and similar processes. Working in this manner means that the trust will hopefully be able to deliver a service that is very child centred, and has no restrictions from professional boundaries or any other existing agencies. Other frameworks, initiatives, acts and policies that have been a result of, or linked to, the Every Child Matters policy include Working Together to Safeguard Children (2006) and The Equality Act (2006). My Local Authority has made many changes and developed many policies. The LA has developed a policy on e-safety, explaining the risks and what can be done to stay safe. They have also developed an Assessment and Response to Children System (ARCS). This explains the Common Assessment Framework (CAF) and how it aims to assess The LA are also currently undertaking a consultation of the Thurrocks Draft Children and Young Peoples Plan 2010-2013 (CYPP). This is the revised plan is signed up to by many organisations that provide key services for children and young people in Thurrock (including the Council, the NHS, the Police, schools and colleges and the voluntary sector). It sets out the priorities for the Childrens Trust, based on the analysis of the needs of children and young people, and what has been learnt through various consultations and interactions with children, young people, their parents, carers and professionals. These plans have to be prepared by every area in the country and the Department of Children Schools and Families (DFSF) provide guidance to help them do this. These plans will form the main planning document of all Childrens Trust agencies, and partner agencies, meaning that whatever is done with children and young people in Thurrock it will contribute to achieving the collective ambiti ons everybody has for them. Thurrock Children Young Peoples Plan 2007-10, developed many policies such as Each Child, Every Young Person, All Agencies Our Plan 2007 2010. This identified the priorities that were needed and the goals to be set in order for all children and young people in Thurrock to be able to achieve the five outcomes of ECM. It aimed to improve services in Thurrock over the past three years. The plan was delivered through the Children and Young Peoples Strategic Partnership (CYPSP), which aims to meet the need of children and young people in Thurrock. It sets out 12 goals that they aimed to achieve to be able to meet the ultimate five goals of ECM. In January of this year A Review of School Improvement was also conducted by Peter Wylie for Thurrock Council. It was a review of how effective school improvement services in Thurrock were, and it went on to propose options for the future whilst keeping in mind the local and national policy priorities. One such policy: Your child, your schools, our future: building a 21st century schools system aims to create a school system. It is a system that aims to respond to changes in economy and society and enable every child to enjoy growing up, and develop their potential and talent. It also gives them the broad skills they will need for the future. There are many guidelines, policies and legislation in place to ensure children are protected and achieve wellbeing, and each covers various areas and ensures multiagency collaboration. As a trainee teacher and a qualified teacher I will need to be aware of these because they underpin everything that I do. Within school and within my teaching and planning, the five key principles of the ECM framework must be at the forefront of my mind, they need to be at the heart of every aspect of the school, including. Within Every Child Matters, at the heart of the curriculum it states that ECM requires teachers to be committed and passionate, and offer. It also states that teaching should include activities that are beyond the school, that involve parents and relate to real life experience. It also suggests. The curriculum is designed with ECM at the centre; the design features address all 5 aspects, such as ensuring children are given the opportunity to learn in many subjects, and in a variety of settings and environments. ECM is at the centre when considering and ensuring opportunities for events such as productions and sports days, and when considering the schools routines. Also when considering any extended hours, offering opportunities before, during and after school, and links with health and social agencies. Young peoples lives are centred around school, and they clearly have an important part to play in supporting children to achieve the five aspects of ECM. Schools need to take into account the needs of all learners when planning. I will now consider how each aspect is/can be promoted in the curriculum. Schools can promote being healthy and staying safe by having a positive school ethos, which promotes inclusion. It should also follow many policies and procedures, to ensure children stay safe. When working as a Trainee Teacher and a qualified teacher I will need to be aware of all the policies that the school follows and ensure I am kept up to date with these. For example: safeguarding and health and safety policies. Some procedures for this might be: questioning any adults in the school without a name badge; and safety hinges on doors. I will also need to ensure I promote inclusion by methods such as personalisation. The school in which I am training tries very hard to ensure that children stay healthy. They have gained the Healthy School Award and have recently been given The Sports Unlimited Award. The school now offers a range of after school and lunchtime clubs, and provides healthy snacks for Foundation Stage and KS1 children. The school also brings in coaches to take P.E. lessons, to motivate learners and teach them the sport that they are experts in. Drinking water is provided throughout the day and each child has their own water bottle for them to drink from when in lessons. The school also actively promotes walking or cycling to school, and conducts cycling proficiency for pupils. Over the past year lunchtimes have become more structured with MDA and LSAs taking structured activities. Another good initiative that the school has adopted is the use of peer buddying and mentoring, with each adult in the school mentoring at least one child that is in need. The school also provides opportunit ies for learners to grow vegetables. As well as having regular assemblies taken by police officers and visits from health workers. The school makes many links between the community with visits to sing at old peoples homes and links with reading schemes through the library. When I am planning and teaching I will need to ensure that I use circle time to explore health and personal issues as well as encourage debate and peer decisions. I could also provide a quiet area within my classroom where children are able to take time out. Opportunities should be given to promote and encourage and to learn to be healthy in many subjects. I will need to be aware of this and apply them in my teaching. A few examples include: allowing for leaners to be empowered through making their own decisions, encouraging diversity, respecting difference and teaching them about their own identity, and using mathematics to investigate data on diet and health. History could also be used to explore community history and individual identity. Schools have the responsibility to ensure children are able to enjoy and achieve whilst staying safe when they are at school, through a wide range of policies and procedures. For example rules for how to use equipment safely, safeguarding, carrying out risk assessments, and bullying policies. However the staying safe element of ECM goes much further than the school and it is about. The school in which I am training provides many opportunities to ensure children are able to stay safe. They provide day and residential trips and set rules around the school based upon the schools Core values. With the increase in the use of the internet, the LA have also developed a policy for E-safety. The school provides mentoring and home work clubs to ensure the learners dont fall behind with work and also provide pupils with the opportunities to discuss any issues they may have. The school also has a council that acts as the student voice and gets learners more involved in the school. The school also encourages confidence for children to speak out, and uses role play, performances and presentations to promote this. The school uses visits from outside professionals, such as community police officers, and before any school trips, a safety check has to be conducted. There are also many opportunities to promote staying safe in the subjects that are being taught in my school. For example art, and design and technology could be used to promote safe practice and managing risks that may occur. ICT could be used to develop safety, such as questioning information and how to sit correctly at computer, i.e. .posture. When Teaching I need to be aware of how I can incorporate staying safe in my planning and in my classroom. I would also need to use the schools Core Values to assist safety and set class rules with the children. I will also need to take some responsibility in ensuring the school is safe, because it is everybodys responsibility not just the head teachers or senior managers. I could use stories in my class to deal with behaviours such as bullying and challenging stereotypes, resolving conflict and consequences. Schools need to ensure every child is making a positive contribution by ensuring the environment is created to encourage all to participate. They also give learners a voice, and vary in teaching strategies. The school where I am training has a school council that provides the children with a voice to speak out. In the Every Child Matters, at the heart of the curriculum booklet it states that if the children are aware that they have the opportunity to enrich the lives of others and support and care for them, and ultimately change things for the better, then they are much more likely to be more sociable beyond the school gates. The school I will be training at provides opportunities across the curriculum to ensure children give a positive contribution. The school council gives the opportunity to make decisions such as what equipment shall be built in the playground. It is important that children are able to make choices that have a true impact. Learners are also given various responsibilities around the school such as being responsible for the library, putting books away or giving them out, watering and looking after the garden, and collecting the register. They also encourage learners to participate in clubs and projects around the school. The school offers various clubs and everybody participates in the Christmas plays, as well as using buddying and mentoring schemes. They make links with the community through projects such as Christmas singing and also use such projects to raise money for charities. I will need to be aware of these points to ensure that I incorporate them into my classroom, for example by giving children responsibilities. I will also need to be aware of the ways the children can offer a positive contribution in certain subjects, such as promoting group work in English, including listening, speaking and responding to others, or encouraging children to contribute to a performance in music. When I am teaching I will need to ensure I enable and provide children with an opportunity to speak out and tell me the support they need, and provide an environment which is created for all to be able to participate in. I could use various methods to promote positive contribution such as using talk partners, incentives and mentors. Enjoying and Achieving is promoted in schools by lessons always taking account for different learning styles and abilities, thus ensuring that learners enjoy their learning. To ensure they enjoy and achieve, I may need to refer a child that may need more specialist help, research any needs they may have, differentiate and personalise my lessons, and celebrate achievements. If children are enjoying learning and have good supportive relationships, they are more likely to achieve. Every child has a talent, and it is the responsibility of the school to uncover these talents and ensure that all young people view themselves as a success and can live a fulfilling life. This means that the curriculum needs to be full of challenges and surprises. Children need to be able to build upon their own aptitudes as well as being able to enjoy what they are learning, and should be given opportunities to take on responsibility, whilst always considering each childs individual needs. The school that I am training at offers the pupils many opportunities to achieve and enjoy across the curriculum. The school gives each year group a topic every term, this allows children to see links between subjects, and provides them with opportunities to deeply explore issues. The school provides many trips from adventurous activities to historical sites, and provides opportunities for children to participate in the community through activities and projects. The school also provides many opportunities for children to demonstrate their skills through concerts, plays, and sports, and uses an achievement wall to praise children that achieve and/or participate, as well as having ac hievement assemblies once a week. In the achievement assemblies many awards are given: sporting awards; awards for effort; knowledge and reading; or anything else that is considered an achievement. The school also provides catch-up lessons and additional support through lunchtime and afterschool. I need to ensure that I see the school as a learning community and that I see myself as a lead learner. I will need to ensure that I provide opportunities for children to explore deeply and widely. When I am planning I will try and ensure to incorporate the childrens interest into lessons, and I will also need to ensure I arrange trips to help them to enjoy and achieve. I will need to try and use experts and organisations when teaching, and reach out and use parents where possible. I will also need to fully participate throughout the school to ensure I assist in allowing children to enjoy and achieve. There are many opportunities in lessons where I can plan to ensure children enjoy and achieve. In PSHE I could provide practical learning activities that relate to real life. I could also use real life situations in mathematics or use investigation games and strategies. I will need to be able to incorporate and ensure the children enjoying and achieving is at the heart of my teaching and planning. I must understand that it isnt about just teaching the lesson; it is about them understanding, enjoying and learning from the lesson. Economic wellbeing is about contextualising learning by relating it to the real world, and learners see the value of their learning. It also helps learners to create a. This means that children can achieve a great sense of satisfaction from being responsible for their own future. The school where I will be training uses many opportunities in the curriculum to help children to achieve economic wellbeing. The school provides learning opportunities for children to fundraise, in school or in an outside school setting. The school also encourages children to take on jobs in school such as taking responsibility for the school library or collecting the register. The school also provides leadership opportunities for pupils, such as becoming mentors or part of the school council. The school also actively promotes and embraces cultural difference and diversity. I could help children to achieve economic wellbeing by making them responsible for their dinner money and make it their responsibility to work out any change. I must ensure I encourage children to take on responsibilities in the school and in the class. There are many opportunities for learners to achieve economic wellbeing in subjects. For example I could use English to develop communication skills, and expressing views and ideas effectively. Learners could also develop their skills in obtaining information, analysing it, and evaluating it in science. P.E. could be used to teach children to work both as an individual and as part of team. When considering my personal development, my priority is to learn how to plan correctly, ensuring I use various learning environments and take into account the different childrens contexts. I will need to sit down with my School Based Trainer and maybe the classs last teacher, and consider each childs context. I will then be able to use this to personalise and differentiate planning. It will also inform me of the childrens interests, this will help me to plan for their interests and ensure they enjoy the lessons. ECM has greatly affected education and the way teachers teach. It has impacted many areas from, planning, safety, and dealing with behaviour. It has played a major part in radically reforming many children and young peoples services and lives. It is important however to not only praise the policy but also to criticise the policy in order for it to be developed and improved. This can be seen in the development from the Green Paper. At every stage the original policy aims were evaluated and then reset. For ECM to fully achieve its aims it is important that there needs to be multi-disciplinary work, and that teams and colleagues need to continuously reflect and evaluate. The overall effect of Every Child Matters and been massive, and Im sure that the results will continue to be seen for many years to come. Why Doesnt the UK Have a Constitution? Why Doesnt the UK Have a Constitution? Does the UK need a Republican Constitution? ANSWER There is a long and a short answer to this question. The short answer is â€Å"No†. The long answer is â€Å"Definitely not.† This may seem a flippant response, but this commentator predicts that it is precisely the kind of reaction that this question would engender in the majority of United Kingdom lawyers, commentators and politicians. Moreover, justification of this negative response is likely to be equally pithy: If it ’aint broke, don’t fix it. The United Kingdom is a stable, peaceful and wealthy constitutional monarchy. It is very far indeed from â€Å"broke†. Human rights are protected, the power of the state and its agencies are subject to the rule of law, corruption is relatively minimal and our legal system, welfare state and national health service are envied the world over. Democracy functions well, or at least relatively well in comparison with examples overseas. The Queen is generally respected and in many quarters cherished as a national figurehead. UK armed forces police the world and we have a seat at the highest global tables exercising far more influence over world affairs than our size and population merit. There is little in the way of civil strife or serious unrest no state of emergency or sense of impending doom. Our system, with all its typically British foibles and idiosyncrasies, undeniably works, and has done for the greater part of one thousand years.[1] It may seem like a prosaic claim but it is a blunt fact that almost no other country in the world can lay claim to a history the like of which graces these islands. The question as to whether the United Kingdom needs a Republican constitution is therefore unarguably flawed. Of course it doesn’t need a Republican constitution. The Status Quo The United Kingdom operates as a constitutional monarchy with a bicameral (two house) parliament comprised of the House of Commons and the House of Lords. Supreme executive power is technically invested in the Crown, but in practice this power is discharged in the name of the Crown by ministers of state led by the Prime Minister. The House of Lords acts as essentially as a consulting chamber and while it can delay the enactment of legislation even the fact that it is comprised of appointed rather than elected members has proved advantageous, because it leaves the authority of the House of Commons unchallenged. The system works and there is no sign of imminent frailty or jeopardy to the status quo. There is no formal separation of powers between the executive and the legislature and while the Sovereign in Parliament stands as the supreme legislative authority, ministers carry out the agenda and work of the government. In the House of Lords, Law Lords sit as judges in the Appellate Committee and they also play a full part in the legislative work of the House. All that said it must be conceded that the United Kingdom does not actually possess a formal constitution at all.[2] The United Kingdom is one of a tiny minority of countries that lack a single comprehensive document laying down the legal system of the state, the roles and functions of the apparatus of government and the procedural rules by which it should operate. It is submitted that such documents have proved useful in other countries as the ultimate statement of a nation’s supreme law with the sovereign legal authority to empower a nominated constitutional court to rule acts of the legislature illegal if they are found to contravene the rights entailed within. However, that revelation aside, it does not appear to matter that the United Kingdom lacks a single constitutional document. Our constitutional basis is found in piecemeal form shot through our entire system of government. Aspects of the United Kingdom’s constitutional system can be found in a multiplicity of rules that establish and govern the very practice of governance. It is a time-honoured system founded on a combination of Acts of Parliament conventions, judicial decisions and political practice. Perhaps it could not work in every state, but it appears to work here. A New Republican Horizon? Need it be said, a Republican Constitution would demand the abolition of the monarchy or more realistically a dramatic reduction in the power of the monarchy and a transfer of authority to, for example a Presidential executive. None of the mainstream political parties subscribe to such an ambition and one must descend to the third tier of political activity before the issue attracts even a modicum of fringe support. This commentator could identify only one Republican pressure group with a significant presence on the Internet, and even this group professes to have no political ambitions of its own.[3] This suggests that the issue of a new Republican Constitution for the United Kingdom, while titillating for students of politics and law, is simply not on the agenda. One could easily infer that the reason it is not on the agenda is that there is no perception of current need or even of current advantage, inherent in such a move. This view, which is as stated is held by the overwhelming majority of political actors and commentators, speaks for itself. It is a view that may well change over time as future events are unpredictable, and the succession to the throne of Charles may weaken the prestige of the Crown. However, with the popular Prince William waiting in the wings that may only be a temporary blip in the history of the British monarchy. Concluding Comments It is submitted that there can be only one reasonable response to this question and that is, as stated in the introduction to this paper â€Å"No†. The fault lies in the question itself and in particular with the use of the word need. The United Kingdom has developed into one of the most successful countries in the world. This commentator can see no imperative demanding immediate constitutional reform.[4] It would have made for a more interesting intellectual exercise if the question had asked if the United Kingdom would benefit from a Republican constitution? Does it need a Republican constitution? From the perspective of 2006, the answer is manifestly and unequivocally No. Indeed, this commentator would go further: it is argued that the United Kingdom seems to operate quite satisfactorily without any formal constitution at all. BIBLIOGRAPHY Brazier, R., Constitutional Reform: Re-Shaping the British Political System. (1998) Oxford University Press Dicey, A.V., Introduction to the study of the law of the constitution. (1959) London, Macmillan Republic: The Campaign for an Elected Head of State: http://www.republic.org.uk/faqs.htm Oliver, D., Constitutional Reform in the UK, (2003) Oxford University Press Footnotes [1] For comment see: Brazier, R., Constitutional Reform: Re-Shaping the British Political System. (1998) Oxford University Press. [2] For insightful comment see: Dicey, A.V., Introduction to the study of the law of the constitution. (1959) London, Macmillan. [3] See: http://www.republic.org.uk/faqs.htm. [4] Contrast the views of: Oliver, D., Constitutional Reform in the UK, (2003) Oxford University Press.

Orthopaedic Management Of Cerebral Palsy Health And Social Care Essay

Orthopaedic Management Of Cerebral Palsy Health And Social Care Essay The condition of cerebral palsy refers to a varied group of permanent disorders of movement and posture caused by injury to the immature brain in utero, at birth or in the first years of life. These lesions are static not progressive and can be caused by a wide variety of factors such as intrauterine infections, trauma, neonatal stroke and genes, often in combination. Reflecting the varied aetiology and sites of injury cerebral palsy is often accompanied by neurological disturbances in cognition, behaviour, sensation and epilepsy. Most significantly from the orthopaedic perspective is that it leads to a progressive musculoskeletal pathology and abnormalities of muscle strength, tone and joint movement. These tend to be hidden at birth and are only revealed during the rapid growth of childhood as spasticity leads to abnormal posturing and thus secondary contractures and impaired torsional bone remodelling. Eventually this process leads to problems such as scoliosis, hip dislocation an d the development of fixed contractures.1 It is here that orthopaedic surgery can intervene by correcting fixed deformities leading to improved function and appearance. Cerebral palsy is the most common cause of referral to elective paediatric orthopaedic units.2 This essay will discuss the various surgical techniques that can be employed to tackle the musculoskeletal problems caused by cerebral palsy. Classification Cerebral palsy is classified based on the type of movement disorder present. The spastic form is the predominant type and can be divided into the subcategories of hemiplegic, diplegic or quadriplegic depending on topography. Appropriate management varies between these forms based on the level of functional outcome that can be expected; the most significant factor being whether the child is ambulant or not. It was the advent of gait analysis in the 1990s that revolutionised treatment of ambulatory cerebral palsy. Prior to this surgical intervention to improve gait was a matter of opinion, and often led to unexpected new problems which were even more intractable. The systematic empirical approach of gait analysis, however, enabled both more targeted and precise interventions and also critical evaluation of the outcomes of surgery.3 http://www.cpl.org.au/images/default-source/research/cp-body-map-graphics.jpg?sfvrsn=2 [Image 1: Distribution of symptoms in subtypes of cerebral palsy. Source: Cerebral Palsy League4] Modern gait analysis takes place in a specialised laboratory and includes a standardised physical exam, video recording, kinematic and kinetic measurements, electromyography, pedobarography and estimation of the energy consumption of walking.5 Age Generally speaking surgery for ambulant CP is not attempted until after the age of 7 by which time a mature gait pattern has developed. Between this age and the onset of the growth spurt in adolescence bone surgery is sometimes required in order to stabilise the bony levers of progression in the leg. These include femoral or tibial derotation osteotomies, intertrochanteric derotation of the femur and stabilisation of the subtalar complex.6 It is between the ages of 8 and the main adolescent growth spurt (12-13 in girls, 13-14 in boys) that soft tissue surgery is undertaken, the ideal timing remaining contentious.7 Increasing maturity and awareness allow for more complex surgeries that require strict compliance with rehabilitation programmes to succeed. Yet this must be balanced against the effects of the rapid growth of bone and muscle that may exacerbate and complicate deformity. Surgery for spastic diplegia Despite advances in the usage of botulinum toxin A, intrathecal baclofen and selective dorsal rhizotomy to reduce spasticity most children with cerebral palsy still develop progressive musculoskeletal deformities as they grow. These include fixed joint contractures and bony deformities collectively referred to as lever arm disease and which can only be treated effectively surgically.8 In the past a child with spastic CP typically presented with toe-walking and was managed by lengthening of the tendo Achillis. Although this procedure successfully levelled the foot it often led to a crouch gait as contractures of the knee and hip developed progressively in late childhood. Nowadays there is a strong consensus that the best approach is to gait correction is to address all deformities simultaneously in what is known as single-event multi-level surgery.9 Correcting fixed contractures is achieved by either fractional lengthening or muscle-tendon recession. Established procedures include tenotomy (lengthening) of the psoas muscle at the pelvic brim, rectus femoris transfer to semitendinosus or sartorius and fractional lengthening of the medial hamstrings. To correct bony torsional abnormalities necessitates rotational osteotomies. For femoral anteversion and concomitant hip internal rotation, femoral derotation osteotomy has proven to produce very effective and durable results.10 In order to correct a valgus foot deformity there are two options; a lengthening osteotomy of the os calcis or more commonly an extra-articular subtalar joint fusion utilizing an autogenous graft of bone from the iliac crest combined with a screw fixation .11 Spastic hemiplegia The most common joint deformities in the upper limb include internal rotation of the shoulder, elbow flexion, forearm pronation, wrist flexion and ulnar deviation, and swan-neck and thumb-in-palm deformities in the digits .12 Muscular injection with BTX-A can be useful in managing stiffness and increasing range of movement but is not effective at improving function.13 As with gait correction deformities in the upper limb are treated in a one-stage multilevel operation combining muscle releases and tendon transfers. The most common procedures are biceps aponeurosis and pronator teres release for pronation of the forearm, tendon transfers to extensor carpi radialis longus or brevis for ulnar deviation/wrist flexion (with first web z-plasty) and first dorsal interosseous and adductor muscle release with tendon transfer for thumb-in-palm.12 Patterns of gait in spastic hemiplegia have been classified comprehensively by Winters et al. and can be used to plan surgical management. In groups I and II the primary abnormality is drop foot due to equinus contracture which can be treated by lengthening of the gastrocsoleus muscle and appropriate orthosis. The situation is more complex, however in groups III and IV which require multilevel surgical intervention and gait analysis due to the involvement of proximal muscles leading to jump knee gait and in the case of group IV fixed hip flexion on top of equinovarus. These can be managed in the same way as soft tissue deformities in spastic diplegia by fractional lengthening or muscle-tendon recession.14 [Image 2: Saggital gait patterns in hemiplegia: classification and management. For each group: contractures shown in orange text, orthoses in green, surgical correction in red. Adapted from Winter et al.14] Tendon transfers to correct muscle imbalances are also employed in hemiplegia. This is most useful for equinovarus deformity, which is treated with split tendon transfer of the tibialis posterior (useful in the younger patient with more flexible deformity) or anterior combined with lengthening of the gastrocsoleus and tibialis posterior (better for older children with stiffer deformity).15, 16 Another possible problem in hemiplegia is limb shortening, presenting most commonly in the tibia and ranging from 1-3 cm. If necessary operative correction can be achieved by epiphysiodesis at the end of growth plates proximal to the knee at the appropriate age.7 Spastic Quadriplegia Surgical management of a child with spastic quadriplegia is particularly challenging owing to the presence of multiple co-morbidities such as epilepsy, osteopenia, respiratory disease and nutritional deficiencies. As such it requires the close co-operation of a multi-disciplinary team to manage possible complications as well as follow-up in terms of pain and intensive care. A variety of tests are important to help assess suitability for surgery. Lung function tests are used to evaluate the likely necessity of protracted assisted ventilation after the operation. Testing serum total protein and albumin levels is used to spot malnutrition associated with poor wound healing and infection. Detection of osteomalcia due to anti-epileptic medication is important and must be treated, and improving general nutritional state through supplementation is often desirable. Finally, identification of the degree of osteoporosis due to disuse is relevant in assessing the stability of any surgical fixat ion desired.7 Hip Management Hip displacement is rarest in spastic hemiplegia at 1%, uncommon in spastic hemiplegia at 5%, but much more common in spastic quadriplegia with an estimated incidence of 35-55%.17 If left untreated it may lead kyphotic sitting posture and pelvic obliquity increasing the risk of spinal deformity as well as chronic hip pain and increased difficulties in activities of daily living. In hemiplegia and diplegia the gait is so severely impacted that subluxation is identified early due to rapid orthopaedic referral. In quadriplegia, however, due to the higher visibility of issues such as seizures and feeding difficulties and the fact hip displacement is hidden in the early stages, it often can go undetected. Thus systematic radiographic screening is vital to detect it early with one study recommending commencing at 30 months and following up every 6 months thereafter.18 When abnormality is detected it is best to intervene early to try to prevent dislocation. The favoured soft tissue surgical approach is adductor and psoas tenotomies.19 If dislocation has already been established more drastic intervention is required with a single-stage open reduction of the hip, combined with a varus shortening derotation osteotomy of the proximal femur, which relieves pressure from the rim of the acetabulum stimulating growth and balancing the soft tissues by re-tensioning the hip abductors and relaxing the adductors, and a pelvic osteotomy to improve the shape and coverage of the acetabulum.20 Although this procedure offers the best long-term prognosis in terms of stability, further dislocations are not infrequent.21 Scoliosis Scoliosis in cerebral palsy can be non-structural secondary to femoral and pelvic muscular spasticity or structural secondary to contractures of the intrinsic spinal muscles. In non-ambulant patients it often extends to the sacrum and is associated with poor sitting posture, pelvic obliquity and hip dislocation. Prevention of these is thus vital to reducing the risk of distortion of the spine. Surgically the established management of severe scoliosis is instrumented posterior fusion along the length of the spine to the pelvis.6 Conclusion As surgical techniques for correcting deformities have proliferated and been refined in recent decades so the orthopaedic management of cerebral palsy has progressed from art to science. We are now in the pleasing position of having a tried and tested toolbox of procedures to deploy in the common musculoskeletal pathologies induced by diplegia, hemiplegia or quadriplegia. Yet a tool is only useful if it is used in the right place and so it is arguably the standardised assessment provided by gait analysis as well as improved understanding of the development of gait that has made the most difference by allowing clinicians to target interventions precisely temporally and anatomically to ensure the best outcomes. Although validated evaluations exist for the upper arm they have yet to reach the same level of reliability and universality as gait analysis, a desirable goal for future research. It is also important to remember that orthopaedic interventions can only ever ameliorate rather than solve the lifelong disabilities caused by cerebral palsy. For this reason it is vital that management first and foremost takes into account the desired outcomes of patients and carers including concerns such as cosmesis and independence. Likewise it is important to emphasise functional outcomes rather than abstract measures of deformity as these are in the end more important to patients.