Precambrian - The Timeline of Biological History

The Precambrian (4500 to 543 million years ago) is a vast period of time, nearly 4,000 million years long, that began with the formation of the Earth and culminated with the Cambrian Explosion. The Precambrian accounts for seven-eighths of our planets history. Numerous important milestones in the development of our planet and the evolution of life occurred during the Precambrian. The first life arose during the Precambrian. The tectonic plates formed and began shifting across the surface of the Earth. Eukaryotic cells evolved and the oxygen these eary organisms exhaled collected in the atmosphere. The Precambrian drew to a close just as the first multicellular organisms evolved. For the most part, considering the immense length of time encompassed by the Precambrian, the fossil record is sparse for that time period. The oldest evidence of life is encased in rocks from islands off of western Greenland. Theses fossils are 3.8 billion years old. Bacteria that is more than 3.46 billion years old was discovered in Western Australia. Stromatolite fossils have been discovered that date back 2,700 million years. The most detailed fossils from the Precambrian are known as the Ediacara biota, an assortment of tubular and frond-shaped creatures that lived between 635 and 543 million years ago. The Ediacara fossils represent the earliest known evidence of multicellular life and most of these ancient organisms appear to have vanished at the end of the Precambrian. Although the term Precambrian is somewhat outdated, it is still widely used. Modern terminology disposes of the term Precambrian and instead divides the time before the Cambrian Period into three units, the Hadean (4,500 - 3,800 million years ago), the Archean (3,800 - 2,500 million years ago), and the Proterozoic (2,500 - 543 million years ago).

When Children Are Young They Often Want To Run Away From

When children are young they often want to run away from their parents. It might be because they do not like their rules or it be because they are being treated unfairly. In 1776, this is how the people of the thirteen colonies felt under British rule. King George the Third neglected the natural rights of the colonists. These rights include life, liberty, and the pursuit of happiness. It was because of this abuse that Thomas Jefferson wrote â€Å"The Declaration of Independence.† Inside the document, Jefferson listed many instances of abuse that lead to this formal declaration. The most significant instances include, cutting off trade with other countries, heavy taxing, and trial without jury. In the United States of America, we are taught†¦show more content†¦Ã¢â‚¬Å"WE hold these Truths to be self-evident that all Men are created equal, that they are endowed by their creator with certain unalienable Rights, that among these are Life, Liberty, and the Pursuit of Happi ness.† (Cardozo, pp.80-85) This quote was mainly influenced by the Treatise of government from John Locke that declares that all men should be treated equally and should not be deprived of their rights to life, property and liberty. The quote mainly touches on the natural rights that were given by God and those that the government does not have the authority to take from the citizens. The declaration of independence has long been a sigh of pride for Americans; it is the single most important part of American history because of the influence it has had through history. The tyranny of King George III was what made it necessary for the thirteen English colonies of American to come together, declare their independence and sever their ties to Great Britain. King George the Third also took away many opportunities from American trading. He cut off trading with other countries other than his own. He blockaded the east coasts and forced the colonists to trade with the British. This cam e about due to the over taxed and underrepresented people of America needed a strong, unwavering statement to showing the colonists resolve to be free from English rule. Vastly known as being written by Tomas Jefferson. As known based on â€Å"The AmericanShow MoreRelated Single Mothers in America Essays1059 Words   |  5 PagesIn today’s society it is not unusual to have a one-parent family with a young mother in charge. Teen mothers having children has increased so much over the years that it’s now a common occurance. Being a young single mother in today’s society is challenging but with the help of government assistance single mothers are finding their way. The government provides help for single mothers through a variety of welfare programs. Welfare programs provide benefits to single mothers with low income - incomeRead MoreSports Are Good For Children1654 Words   |  7 PagesAs a parent of young children, I am faced with the problem of extracurricular activities and what ones are best for my child. At what age is the best time to put them in? Which sports with help them develop the most? Once they start with if they decide they do not like it do I force them to keep going? As a parent, we are always looking to do the best for our children but, are there times when we are pushing them to hard and not helping them in the way we feel we should be? Organized sports areRead MoreLiterary Love Essay968 Words   |  4 Pagesman. A feeling and emotion so strong that it makes it nearly impossible to put its meaning into words. However, it is also one of the most explored subjects in the world of literature. Whether in a comedy or a tra gedy, the theme of love is very often expressed. This theme can be expressed in many different ways, for example, positively causing everyone to live happily ever after in a fairytale type of world, negatively being the cause of death and anywhere in between. In Aristophanes LysistrataRead MoreHow Children Are Raised And The Environment1453 Words   |  6 Pages How children are raised and the environment they are in from the time they are born until they are on their own plays a huge part in how their personality is shaped and what their morals are. One thing that affects personality and morals is the religion that they associate themselves with, or what they believe in; many times the rituals that go along with their beliefs has a large effect on the children, usually more so than the belief itself. The second thing that plays a part in the shaping ofRead MoreChild Exploitation During The Victorian Era1583 Words   |  7 Pages(Dutta 1). It can be deduced because of Dickens’s formative years, one much like Oliver’s from Oliver Twist, Dickens felt the need to criticize the conditions of his time period (Diniejko). The novel is well known for being about an orphaned child who starts his life in an orphanage workhouse, gets involved in a gang along with criminal activity, and is finally adopted into a middle class family. Ch ildren throughout the novel experience abandonment, abuse, and criminal activity, which are majorRead MoreThe Effects Of Parents And Family Communication On Teenage Sexual Activities1130 Words   |  5 Pagesthat come together to teach their child or children right and wrong in life. Parents play a big role in their children lifestyle and honestly it can affect the child’s future. As the child matures into a teenager they develop physically and mentally changes. One big fact a teenager faces is sex. Sex can be a very beautiful thing if taught correctly, but can also be very terrifying, especially if you do not know consequences about it. Parents often run away from the sex talk or just figure if the childRead MoreSnow White Role Models Essay1271 Words   |  6 Pagesperson looked to by others as an example to be imitated. Snow White and the Seven Dwarfs is a movie about a young girl whose stepmother, the queen, fears Snow White will be more beautiful than she is. The Queen tries to get rid of Snow White by having her killed. When this fails the queen goes after Snow White herself. Many people view Disney princesses as good role models for young children. Disney princesses are not good role models. Disney princesses make it seem like it is okay to disobey yourRead MoreLanding the Helicopter of Hovering Moms Essay1401 Words   |  6 Pagesprotecting their children from lifes hardships and preparing them for adulthood. However as with many other aspects of parenting, the results do not always match the intentions. Overprotective parents generally want to protect their children from harm, hurt, pain, failure, unhappiness, bad experiences, rejection, and disappointment (Lindsey 1). However, parents must realize that overprotective parenting has certain side effects. Parents believe that they are doing a favor for their children by keepingRead MoreAnalysis Of The Movie Stranger Things 1094 Words   |  5 Pagesstrangely affected by a series of people gon e missing. Will Byers is the first, that is shown to go missing. His friends Dustin, Mike and Lucas are set out to find their best friend. While out searching for Will, they stumble upon a young mysterious androgynous child running from something. Later on in the show we will find out that this person is biologically a girl and will name herself Eleven. Eleven is a character that the viewer can easily dissect her gender conflicts throughout the entirety of theRead MoreEssay on The Influence of Violence in Sports1553 Words   |  7 Pageshave great influence in our culture. Because sports news and sports figures are constantly in the news, sports reflect our values. We are living in a society that is filled with violence. Many adults choose to solve their problems in violent ways. When the stress of life becomes too much, or events at work or home are not going their way, they turn to violence to help them feel better. We hear the stories all the time on the news: the unhappy postal worker who lashes out at co-workers with a gun;

The Evolution of Personal Selling - Free Essay Example

Sample details Pages: 7 Words: 1974 Downloads: 6 Date added: 2017/06/26 Category Marketing Essay Type Analytical essay Did you like this example? The Evolution of Personal Selling Definition of Personal Selling Person-to-person communication with a prospect for building personal relationships with another party which salesperson attempts to persuade a buyer to make a purchase, that results in both parties obtaining value. Personal selling is also a part of the Consultative Selling Model (Manning 2014). Personal selling is a process of: Developing relationships Discovering needs Matching products with needs Communicating benefits Involves three prescriptions: Don’t waste time! Our writers will create an original "The Evolution of Personal Selling" essay for you Create order Adopt the marketing concept Value personal selling Assume the role of problem solver or partner Marketing concept It refers to the business decision-making, organization and management of marketing activities, which is a corporate business philosophy. It is an idea, an attitude, or a corporate way of thinking. The key to achieving organizational goals is to correctly determine the target market needs and wants, and more effectively than the competition. by study how to adapt and stimulate consumer demand, and then to meet this needs and wants by transferring goods or services to consumers, and finally achieve the sale. Reason of Personal Selling Evolved Increased competition Increased customer demand Selling has moved from peddling to long-term relationships, consultative selling, and value-added partnering (Manning 2014). These changes have been prompted by the emergence of a marketing concept. Modern marketing concept is showing a trend of diversification objectives, not only the pursuit of quantity of goods sold, but also the pursuit of more high-quality targets, such as identifying prospects, positioning your product, handling objections, establishing commitment and building relationships that lead to future sales. Production Orientation (early 19thcentury). During this period, those companies organize and make use of all resources, focus on everything in its power to increase productivity and expand distribution reach, and reduce costs. Production-oriented organization will focus primarily on increased production and lower costs through mass production and in order to create economies of scale. Characteristics à ¢Ã¢â€š ¬Ã‚ ¢ The basic strategy is reducing prod uct costs and increase profit purposes. à ¢Ã¢â€š ¬Ã‚ ¢ Marketing myopia: Short sighted and inward looking approach to marketing that focuses on the needs of the firm instead of defining the firm and its products in terms of the customers needs and wants (Levitt 1960). à ¢Ã¢â€š ¬Ã‹Å"If You Built It, They Will Comeà ¢Ã¢â€š ¬Ã¢â€ž ¢ The line in the movie was If you build it, he will come (Field of Dreams, 1989). And it was said by a voice telling a corn farmer. He then interprets this as an instruction to builds a baseball field in the middle of his cornfield. When the field is done, Thousands of people come from miles away to see the games. This business philosophy showing that if you believe the impossible, the incredible can come true. Obviously, the typical production concept is what we produce, we sell what. which guiding the marketing activities. Consumers are forced to accept goods on the market, thus forming a sellers market. In a sellers market conditions, produ cers do not have to worry about product sales do not go out. Therefore, the main concern to the operators are not sales but production. Although the production-oriented concept formed in the early development of commodity economy, but lack of overall marketing awareness. Selling Orientation (mid 19thcentury) At this stage the total commodity production has exceeded market demand. Objective is to sell as many products as they could, often ignore a clear margin. Products are sold rather than bought. Salesperson are committed to the promotion of products and advertising campaigns, in order to persuade, and even force the consumer to buy. Characteristics à ¢Ã¢â€š ¬Ã‚ ¢ The specific performance: I will sell anything, just trying to get people to buy anything. à ¢Ã¢â€š ¬Ã‚ ¢ Actively selling and heavy promotion to induce consumers to buy products. Commoditization emerged The product life cycle shows that, as product categories mature, they reaches a commodity status . Some customers get used to the great quality and service provided and begin to view the product as a commodity. Once this happens, the salespersonà ¢Ã¢â€š ¬Ã¢â€ž ¢s perceived value is diminished and price became the distinguishing competitive advantage. Value-added services is used to keep customers focused on value rather than price. Limited opportunity for salespeople of competing products to persuade consumers that they should switch model or brand by providing relevant comparative information and, perhaps, by providing risk-reducing guarantees. Salespeople are requires to demonstrate a differential advantage of one of their products over the competition. Effect of Competition Competition has greatly increased in most product areas, and demand for quality, value and service by customers has risen sharply. In fast moving consumer goods (FMCG) markets, it tends to be driven by competitive or retailer pressures. Pricing decision, particularly short-term tactical price ch anges, are often made as a direct response to the actions of competitors To gain further market share, salesperson must use other pricing tactics such as economy or penetration. This method can have some setbacks as it could leave the product at a high price against the competition (Kent 2004). In todayà ¢Ã¢â€š ¬Ã¢â€ž ¢s competitive world, it is more important than ever to implement a market orientated strategy. In this digital age customers are able to research the products available on the market fairly quickly. If an organization does not offer customers what they are looking for (product and customer service), they will buy from a competitor that does. The customer defined the business (Drucker 1964). Marketing Orientation (late 19thcentury present) Formed in the 1950s. The concept that the key to achieving business goals is to discovering and understanding the target markets needs and desires, and more effective than its competitors, and salesperson do everything possible to satisfy the needs and desires of target market. Characteristics à ¢Ã¢â€š ¬Ã‚ ¢ Marketing orientation refers to a business or organization based on market demand to develop a operational plans. à ¢Ã¢â€š ¬Ã‚ ¢ The corporationà ¢Ã¢â€š ¬Ã¢â€ž ¢s goal should be to meet the customers needs and desires Difference between Production orientation and marketing orientation Marketing orientation is the history of enterprise marketing management thinking, a huge breakthrough, compared with the traditional concept of operations, with the following differences: The production orientation places the production and sales center, marketing orientation places customer demand for the center; The production orientation strengthening sales functions, sell products to achieve profits, but marketing orientation marketing by fully meet customer demand; The production orientation is a short-term stimulus, to obtained large number of sales profits in short-term, marketing orientation meets customer needs through a comprehensive, long-term stability of the profits earned. Sales marketing Interface Scholars have pointed to many problem areas that may af ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡ict this interface. For example, researchers point to interfunctional con ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡icts, differences in goal orientation, tension regarding standardization and adaptation, and marketersà ¢Ã¢â€š ¬Ã¢â€ž ¢ disconnectedness from market conditions as problem areas. Similarly, scholars indicate that turf barriers and differences in culture or thought worlds pose challenges within this interface and strain the relationships between sales and marketing (Dewsnap and Jobber 2000; Homburg and Jensen 2007). Scholars also emphasize that better collaboration between sales and marketing can enhance a  ¬Ãƒâ€šÃ‚ rms ability to provide better customer value (Guenzi and Troilo 2007) The relationship between sales and marketing The sales efforts influence, and are influenced by, decisions taken on the ingredients of a companyà ¢Ã¢â€š ¬Ã¢â€ž ¢s marketing mix, which i n turn affect its overall marketing efforts. It is essential, therefore, that sales and marketing be fully integrated. In addition to changes in organizational structure, the influence of the marketing function and the increased professional approach taken to sales has meant that the nature and role of this activity has changed. Selling and sales management are now concerned with the analysis of customers needs and wants, with the provision of benefits, to satisfy these needs and wants (Kotler, Philip and Keller, L. Kevin 2012). As with all parts of the marketing mix, the personal selling function is not a stand-alone element, but one that must be considered in the light of overall marketing strategy. At the product level, two major marketing considerations are the choice of target market and the creation of a differential advantage. Both of these decisions impact on personal selling. Marketing Concept Yields Marketing Mix The marketing mix is a set of controllable, tact ical marketing tools that consists of everything the firm can do to influence the demand for its product (Don E. Schultz 2005). These possibilities can be organized into four groups: PRODUCT: Branding and brand image in particular are important as these provide reassurance for a customer and facilitate relatively easy brand choice. Many products are standard building materials but adding value to the product is important to personal selling. Methods: price levels, credit terms, price changes, discounts PRICE: Adjusting the price has a profound impact on the marketing strategy, and depending on theprice elasticityof the product, often it will affect thedemandand sales as well. Salesperson has to set the appropriate price which is the amount of money the customer willing to pay for the products and services. Methods: features, packaging, quality, range PROMOTION: To allow the customer aware of the presence in market to enhance popularity of the company. Provide informat ion to the customer such as function and feature of the product and how to get the product. To encourage the purchase or sale of a product. Methods: advertising, publicity, sales promotion, personal selling, sponsorship PLACE: Involve all those activities required to move goods and materials into the factory, through the factory and to the final consumer. It often take place through intermediaries. The channel can be used as a sales strategy that will be focusing on the high quality products offered and the ability to offer customer satisfaction. Methods: inventory, channels of distribution, number of intermediaries Important Role of Personal Selling Every salesperson must decide how much time and money to invest in each of the four areas of the marketing mix. Since the beginning of the marketing concept, personal selling has evolved (Manning 2014). Evolution of personal selling Sales and Marketing Emphasis Selling Emphasis Marketing Era Begins (1950s) Organizations determine needs and wants of target markets and adapt themselves to delivering desired satisfaction; product orientation is replaced by a customer orientation More organizations recognize salesperson is in a position to collect product, market, service information concerning the buyerà ¢Ã¢â€š ¬Ã¢â€ž ¢s needs Consultative Selling Era Emerges (Late 1960s to early 1970s) Salespeople are becoming diagnosticians of customersà ¢Ã¢â€š ¬Ã¢â€ž ¢ needs as well as consultants offering well-considered recommendations; mass markets are breaking into target markets Buyer needs identified thru two-way communication Information giving negotiation tactics replace manipulation Consultative Selling In, the late 1960s and early 1970s, is an extension of the marketing concept (Manning 2014). The sales person assumes the role of consultant and offers well-considered recommendations. Negotiation replaces manipulation as the salesperson sets the stage for a long-term partnership. The salespeople who have adopted consultative selling possess a keen ability to listen, define the customerà ¢Ã¢â€š ¬Ã¢â€ž ¢s problems, and offer one or more solutions. Service, retail, manufacturing, and wholesale firms that embrace the marketing concept already have adopted or are currently adopting consultative-selling practices. Features of consultative selling are as follows: Customer is a person to be served, not a prospect to be sold. Two-way communication identifies customerà ¢Ã¢â€š ¬Ã¢â€ž ¢s needs; no high-pressure sales presentation. Emphasis on need identification, problem solving, and negotiation instead of manipulation. Emphasis on service at every phase of the personal-selling process. Conclusions The evolution of personal selling have been outlined and discussed as an extension of the marketing concept. As selling and sales management face increasing competition and shorter deadlines, salesperson must discover more effective ways to meet the needs and wants of the customer. Sales efforts influence and are influenced by, the marketing orientation of an organization. The implications of consultative selling has emerged as a form of personal selling within the marketing orientated organization for sales activities and the role of selling in the marketing program have been demonstrated. One of the most significant developments in modern business thinking and practice has been the development of the marketing concept. Companies have moved from being production orientated, through being sales orientated to being market orientated. (Jobber and Lancaster, 2012)

The Keys For A Career - 2210 Words

The Keys to Having a Successful Career in Nursing According to Christine Belle, â€Å"Our job as nurses is to cushion the sorrow and celebrate the job, every day, while we are â€Å"just doing our jobs.† A Registered Nurse is in great demand. To be a Registered Nurse, one has to earn either an Associates or a Bachelor’s Degree in Nursing. When an employer is looking to hire a nurse in 2016, they’re starting to look for more than just where the person went to school at. Being a nurse can sometimes be challenging. Some of the responsibilities of a nurse are to monitor vital signs, perform procedures such as inserting IVs, drawing blood, and, distributing medications. A nurse has more contact with the patient than the doctor does therefore a nurse is typically the first to note problems or raise concerns about certain conditions or progression. Also, a nurse takes care of day-to-day operations like discharging patients and explaining their condition to them until the doctor is available to come. There is really no way to teach someone how to be compassionate, it just comes naturally. Though anyone can go to nursing school and become a nurse, it takes a lot to be a successful nurse. Some good qualities to have as a nurse are a caring heart, reasonable, detail-oriented, and selfless. Despite the physical and emotional demand that is placed on nurses, to have a successful career in nursing, one must be sensitive to diversity, must know how to cope with stress properly, and must have greatShow MoreRelatedKey Objectives For School And Career Readiness Essay2236 Words   |  9 PagesKey Strategic Objectives This information was gathered in an interview with Andrea Williams, Principal of Theresa Bunker Elementary School. The key objectives for this school are defined in the yearly district strategic plan. The district strategic plan states three key objective that all schools should achieve over the course of the school year. There is a key objective for literacy, numeracy, as well as college and career readiness. The literacy objective is for students to be proficient inRead MoreEducation is the key to a successful career there are many differences and opportunities between600 Words   |  3 PagesEducation is the key to a successful career; there are many differences and opportunities between an Associate degree in Nursing and a Baccalaureate degree in Nursing. The difference between an Associate degree in nursing and Baccalaureate degree is that, an Associate degree is two-three years, while a Baccalaureate degree is four years. According to Methodist College of nursing â€Å"Th e numbers of Nurses graduates from Associate-degree programs are 59%, followed by Baccalaureate programs 37% and thenRead MoreKey Roles Of One Professional Career Pathway Within Applied Psychology Essay1875 Words   |  8 PagesOutline the key roles of one professional career pathway within applied psychology and critically discuss two research areas addressed within the chosen career pathway. There are many professional pathways within psychology that an individual may apply themselves to for their career. These include: clinical, forensic, health, and educational psychology. The professional career pathway within applied psychology which will be discussed in this essay is the field of clinical psychology. Clinical psychologyRead MoreThe Key Career Academies Focus At Risk Men And Women With The Goal Of Impacting Families2063 Words   |  9 Pages Career Academies is implemented within the high school setting and strives to provide instruction in small learning communities. Additionally, the program offers youth both academics and exposure to a particular occupation or sector. The important key Career Academies focus is on partnering with local employers to provide concrete work-based learning opportunities (Wilmer and Bloom, 2014). This program is open to both at-risk men and women with the goal of impacting families that may have beganRead MoreThe Key Importance Of Education By Integrating Each Students Chosen Career Field As A Base Value970 Words   |  4 PagesMath project in November of 2015. This project included an Excel file assignment, this time focusing on finance and mortgages. The purpose of this project was to demonstrate the monetary importance of education by incorporating each students’ chosen career field as a base value, as well as to point out the advantages of investing in an IRA or 401K plan for retirement. The students were expected to make use â€Å"payment,† â€Å"present value,† and â€Å"future value† functions in Microsoft Excel to demonstrate efficiencyRead MoreThe Key Attributes of the Diversity Competency757 Words   |  4 PagesThe Key Attributes of the diversity competency It is necessary first of all to understand what is meant by diversity competency and the key attributes of the diversity competency. The diversity competency includes knowledge, skills, and abilities to value unique individual, group, and organizational characteristics, embrace such characteristics as potential sources of strength, and appreciate the uniqueness of each. The key attributes of the diversity competency include the knowledge, skillsRead MoreAnalysis On Different Employability Skills Covered Within This My First Year At University962 Words   |  4 Pagesuniversity and, evidence of how they are incorporated in my own development as a Business Leadership and Corporate Management student to successfully hold a placement for the next two years of my degree. 2. Why Employability Matters? Employability is a key determination around the way the world works. It ‘is about being capable of getting and keeping fulfilling work’ where people can move through jobs in different markets maintaining employment. (Hillage Pollard, 1998, p. 2) In 2009 a survey completedRead MoreGender Differences Between Work And Life1026 Words   |  5 Pagesviewed. There were some similarities and obvious gender differences in answers. On another note the article by Stewart Friedman, Work + home + community + self, the main focus is on three key principles to focus on to be better at integration between work and life. Each article’s content can be a guide in career planning and to help with one’s professional development. The article Manage your work, manage your life discusses the popular topic of work and life balance. Interviews were conducted andRead MoreA Career as a Computer Programmer Essay1093 Words   |  5 Pages Becoming a computer programmer would be great because there are many options in this career by having the ability to produce an operating system, or a game for the world. Computer programmers have many opportunities in life to find a job they would love. Programmers can work independently, or in a big company. Programmers have and are creating the future for computers. Computer programmers have a wide range on what they can do. Computer programmers write the detailed list of instructionsRead MoreDeveloping A Plan For Career Success1369 Words   |  6 PagesCreating Your Career Plan Developing a plan for career success can be described as journey of self-discovery. Many leaders have taken time to understand in depth their leadership skills by consistently refining skill sets but also always looking to better one self. To achieve our goals in leadership, one must develop one’s skills and construct a career plan to guide them to their goals. In the class Applying Leadership Principles, we have taken time to learn about what defines a leader and how that

Norovirus and gastrointestinal disease Free Essays

string(103) " after onset of symptoms, and studies have shown that the viral antigen may be shed for up to 56 days\." Introduction Norovirus is currently recognized as the most important non-bacterial pathogen causing gastroenteritis. It is believed that majority of gastroenteritis that occur throughout the globe is attributed to Norovirus. Norovirus was first recognised through immunoelectron microscopy (IEM) in 1972. We will write a custom essay sample on Norovirus and gastrointestinal disease or any similar topic only for you Order Now However, it is only over the past decade that Norovirus has been of great interest to the basic scientists, virologists, epidemiologists and public health experts. There is no doubt that outbreaks or epidemics of Norovirus in the coming years will challenge the medical community to the limit. Globalisation has created a single, very mobile mega-population of people on earth in which more viruses can thrive, and, a highly infectious illness caused by Norovirus can spread rapidly, thus creating epidemics or even pandemics. The potential breakthrough in the development of Norovirus vaccine with the development of effective antigenic viral-like particles (VLP), and the recognition that Norovirus evolves with antigenic drift will pose exciting challenges to all stakeholders. The other challenges or obstacles which we face include understanding the pathogenesis of the Norovirus in the gastrointestinal tract and identifying the site in the gastrointestinal tract which the virus replicates. This knowledge will hopefully allow the development of targeted antiviral therapy and thus prevent manifestation of severe clinical symptoms. This is a review of this very exciting, virus and I have chosen to amalgamate the current literatures into the following topics: Virology- Classification and structure Biology- Replication and infectivity Epidemiology- Geographic and temporal distribution Transmission Clinical features Pathogenesis Immunity Prevention and control Recent knowledge on contamination/sanitation and personal hygiene Vaccine development Treatments- Current and future Health impact of Norovirus outbreaks in the coming era Virology Classification Although Norovirus was first viewed in 1972, it was not until 1990 when it was classified. Classification of Norovirus could finally be performed due to the successful cloning of the viral genome (1). Molecular cloning and characterisation of Norovirus genome allowed this virus to be classified as a member of Caliciviridae family and it is known as a Group B Biodefense Pathogen. Caliciviruses are small (27-40nm), non-enveloped, icosahedral particles with single-stranded RNA of positive polarity. The name calicivirus comes from the Latin word calyx, meaning â€Å"cup† or â€Å"goblet†, which describes the cup-shaped depression, as observed under electron microscopy. Although they share similar features to that of the picornaviruses, caliciviruses are distinguished from their counterpart by having a larger genome and having distinctive spikes on the surface. Another example of calicivirus is the Hepatitis E virus (2). Currently, there are a few serotypes of Norovirus whic h were successfully identified through immunoelectron microscopy (IEM) and enzyme-linked immunosorbent essay (ELISA), which are represented by Norwalk virus (NV), Hawaii virus (HV), Snow Mountain agent (SMA), Desert Shield virus (DSV) and Southampton virus. (1). Currently, there are five main genogroups of Norovirus being identified (GI, GII, GIII, GIV and GV). Noroviruses, which can be found in humans, are from three genogroups (GI, GII and GIV). However, those that are commonly isolated in cases of acute gastroenteritis in humans belong only to two genogroups (GI and GII), which can then be further divided into genetic cluster or genotypes (i.e GI.1, GII.15, GIV.2 etc). There are now, at least 25 genotypes of Norovirus which were successfully identified, with the prototype Norwalk virus being labelled as GI.1 (Genogroup I, genotype 1) (3) and present within this genotype are numerous subtypes. The presence of this diversity of Norovirus strains are mainly due to both the accumulation of point mutations associated with error-prone RNA replication and to recombination between two related viruses (4, 5). Genogroup I (GI) includes76 Norwalk virus, Desert Shield virus and Southampton virus and Genogroup II (GII), includes Bristol virus, Lordsd ale virus, Toronto virus, Mexico virus, Hawaii virus and Snow Mountain virus. Norwalk virus (NV), Snow Mountain virus (SMV), and Hawaii virus (HV) are the prototype strains of genotypes GI.1, GII.2, and GII.1 and are the causative agents of an estimated 5%, 8%, and 7% of Norovirus outbreaks, respectively (6). Genogroups III and V (GIII and GV) have only been identified in animals. Structure Through structural studies and visualisation of Norovirus by electron microscopy, it is now proven that the Norovirus is composed of 90 dimers of the major capsid protein VP1 and one or two copies of the minor structural protein VP2 (7) which recognizes the histo-blood group antigens, which are regarded as receptors and host-susceptibility factors for infection (3). Figure 1. Structure of Norwalk Virus and Genome Non-enveloped, T=3 icosahedral symmetry, about 23-40 nm in diameter. Each virus particle is composed of 180 molecules of VP1 proteins which form 90-arch-like capsomers at all the local and strict twofold axes surrounding the hollows. The proteins in the capsid then folds into two main domains which are, the shell (S) domain and the protruding (P) domain, which contains two further subdomains, P1 and P2. The protruding, P domain functions to increase the stability of the capsid by increasing the intermolecular contacts between the dimeric subunits, thus, leading to speculation that it may control the size of the capsid. However, the S domain contains all the necessary protein requirements to initiate the assembly of the capsid (8). Norovirus has single stranded RNA genome and is predicted to contain three open reading frames (ORF) (9). The Norovirus genome is linear and contains approximately 7600 nucleotides (nt) (Southampton virus-7708nt, Lordsdale virus- 7555nt) (10). The ORF1 (a polyprotein that contains sequence of amino acid which shows much similarity to that of Picornaviruses) is predicted to encode the capsid protein. ORF1 may be cleaved by 3CL proteases into 6 proteins (11). ORF2 and ORF3 are not shown in the diagram. However, until now, it is not known whether these ORF would be translated or what the function of its translated protein would be. In a recent study, Norovirus- like particles was viewed under atomic force microscopy. Scientist exposed the Norovirus-like particles in environments with PH ranging from 2 to 10. This range of pH values represents the pH of the natural environment in which Norovirus thrives. The study revealed that the Norovirus-like particles were resistant to indentation of measure of 300 bar at acidic and neutral pH. However, when the Norovirus-like particles were subjected to same indentation at a pH of 10, the capsid failed to regenerate and was irreversibly destroyed (12). All these studies which are still at an early stage will pave the way for further understanding of Norovirus. Biology Norovirus Replication Strategy Progress on understanding the basic mechanisms of virus replication has been far slower due to the inability to cultivate virus in the laboratory. Therefore, the replication strategy of this virus remains speculative and is presumed that its replication cycle is of a similar manner to that of picornaviruses (2). As in the picornaviruses, the viral particle will bind to the cell surface receptors. This will result in a conformational change in the viral capsid proteins, and thus, releasing myristic acid (a common saturated fatty acid). This acid then helps in forming a pore in the cell membrane of the host cell and through this tiny hole; the RNA of the virus is injected (101). Once inside the cell, the RNA unwinds and the positive strand RNA genome is replicated through a double-stranded RNA intermediate which is formed using viral RDRP (RNA-Dependent RNA polymerase). Translation by host cell ribosomes is not initiated by the usual 5? G cap; instead it is initiated by IRES (Internal Ribosome Entry Site). The viral replication cycle is short and it takes approximately 8 hours to complete one cycle of replication. Within 30 minutes after initial infection, cell protein synthesis – essentially the macromolecular synthesis of cell is â€Å"shut off†. Over the next one to two hours there is a loss of margination of chromatin and homogeneity in the nucleus. This is followed by synthesis of the viral proteins. Subsequently, a vacuole appears in the cytoplasm close to the nucleus and this vacuole gradually starts to coalace covering the whole cell. After 3 hour time, the cell plasma membrane becomes permeable and at 4–6 hours the virus particles assemble, and occasionally could be seen in the cytoplasm. At about 8 hours, the dead cell lyses and releases the viral particles (101). Infectivity of Norovirus Studies of the stability and hardiness of Norovirus have been done by experimental infection on humans. As Norovirus is the most important cause of food and waterborne disease, it is not unexpected that it is resistant to inactivation by treatment with chlorine concentrations which is usually used in drinking water (1). Norovirus can retain its infectivity even after:- i) exposure to pH2.7 for 3 hours at room temperature, ii) treatment with 20% ether at 4 °C for 24 hours, or iii) incubation at 60 °C for 30 min (13). Norovirus can also retain infectivity after freezing (14). Recent reports have shown that through current sensitive antigen detection methods, Norovirus excretion was detected in 90% of ill volunteers. Viral shedding peaks 1-3 days after onset of symptoms, and studies have shown that the viral antigen may be shed for up to 56 days. You read "Norovirus and gastrointestinal disease" in category "Essay examples" Shedding of virus can occur in asymptomatic individuals and it can be prolonged in immunocompromised people. Also, antigen shedding can precede illness (15hr after infection and before symptomatic illness) (15). Epidemiology The successful cloning and expression of the Norovirus genome has led to the development of new assays which has allowed various epidemiological studies to be performed. Recent epidemiological studies have indicated that the infection with Norovirus is much more widespread than previously recognised (16). Geographic and Temporal Distribution Norovirus is highly infectious and can be spread easily from one person to another and is the leading cause of epidemic gastroenteritis in both the developed and developing countries. However, this epidemic gastroenteritis is usually mild, thus, differentiating it from infantile gastroenteritis (which is mainly caused by Rotavirus), which is a much more severe, and often life threatening diarrheal illness in infants and young children. Incidence of infection by Norovirus has been detected in all continents, and therefore, it has a global distribution. It has been quoted that in the United States, more than 90% of the outbreaks of gastroenteritis in the community, for which the cause was previously unknown, can now be attributed to Norovirus (2). Infection by Norovirus do occur all year round, however, its incidence is markedly increased during cold weather months (17). Outbreaks typically occur in group settings such as cruise ships, schools, camps hospitals and nursing home where p eople gather in confined areas (2) and target a number of high risk populations, particularly young children and the elderly, travellers, soldiers and immunocompromised patients or those who are recipient of organ transplant. Every year, up to 1 million people in the UK are thought to be infected by Norovirus (18). If the Norovirus is brought into the hospital environment by someone incubating the infection, then it can easily spread to vulnerable hospital patients and also to staff. It is known to cause large outbreaks of infection in hospital which results in a lot of patients and staff being affected leading to closure of wards in order to prevent further spread. This has posed a huge problem on care provision. Hospitals, therefore, have very strict policies in place to control the spread of Norovirus which will be discussed later. Transmission Humans are believed to be the only host of the human Norovirus. Norovirus is transmitted mainly by the fecal-oral route. However, it can also be transmitted through infected vomitus (3) and there is currently increasing evidence that it can be transmitted through airbourne or fomite transmission (19 20). The infection of Norovirus is enhanced by several features which facilitate their spread. First, it has a low infection dose (approximately 18 to 1000 viral particles) (21) which allow the virus to spread through droplets, person-to-person contact and through environmental contamination. Secondly, excretion of virus in stools continued for several weeks even after recovery, thus, increases the risk of secondary spread which is a particular concern among food handlers and family members (22). Thirdly, the virus is resistant to a wide range of temperatures, chemicals and pH. The virus is able to persist on environmental surfaces and contaminated objects eg in swimming pools, contamin ated drinking water, ice, bakery products and also in raw oysters, fruits and vegetables which are eaten uncooked and cold foods (celery, melon, vermicelli, sandwiches and cold cooked ham) (3). Fourthly, due to the fact that there is a great diversity of Norovirus strains and the lack of long term immunity, it can result in occurrence of repeated infection throughout life. Finally, the Norovirus genome can also undergo mutations, which causes antigenic shift and recombination, which result in evolution of new strains of Norovirus which are capable of infecting hosts. Asymptomatic infections do occur, and such person may be the carriers of some outbreaks. In recent time, there is an increased in outbreaks in military camps and with the elderly who are staying in nursing or shelter homes, and also in hospital settings (19 20). These infections can be catastrophic because of high secondary attack rates, and such outbreaks can last for several months (18). Clinical features An unresolved problem related to transmission of Norovirus is how long an affected individual can stay infectious. Firstly, the incubation period of the virus is 10-51 hours. The main symptoms are sudden onset of vomiting (more common in children) and abdominal cramps (in 37-45% of the cases) followed by watery diarrhoea (more common in adults). The stools usually do not contain any blood or mucus and asymptomatic infection do occur in approximately 1/3 of the population. The duration of symptomatic illness lasts between 1-3 days (28-60 hr) but can last longer (4-6 days) in nosocomial outbreaks (3) and among children younger than 11 years of age (22). In 15% of patients, it lasts longer than 3 days. The illness also lasts longer in immunocompromised patients and in people with chronic illnesses (3). In immunocompetent adults, the course of Norovirus infection is rapid, with an incubation period of 24–48 hours and resolution of symptoms within 12–72 hours (23). The infec tion is usually less severe compared to other diarrheal infection. However, it can lead to dehydration and requires hospitalization, especially among children with an age of 5 yrs and adults, 65 yrs. Fatalities have been reported in relation to outbreaks of gastroenteritis among the elderly in nursing homes (24) and in the United Kingdom, there is an estimate of about 80 deaths from Norovirus every year among people who are older than 64 years of age (25). However, there are usually no long term effects of Norovirus infection and majority of patients recovers fully. Pathogenesis Because of the failure to cultivate the Norovirus in laboratory properly, our knowledge regarding the pathogenesis of Norovirus come mainly from physical, histological and biochemical studies on infected volunteers who took part in surveys. Proximal intestinal biopsy specimens were taken from ill volunteers and histological changes were compared to healthy individuals. Ill volunteers showed broadening and blunting of intestinal villi, crypt cell hyperplasia, cytoplasmic vacuolization and infiltration of polymorphonuclear and mononuclear cells into the lamina propria but the mucosa itself remaining intact. No histological changes were seen in the gastric fundus or in antrum or colonic mucosa (26). The extent of small intestine involvement remains unknown because studies have only examined the proximal small intestine, and the site of replication of the virus has yet to be identified. Studies have shown that small intestinal brush border enzymatic activity (alkaline phosphatase, sucras e and trehalase) were reduced, resulting to steatorrhea (lipids in stools) and transient carbohydrate malabsorption (27). Jejunal adenylate cyclase activity was not elevated (28) and changes in gastric secretion of hydrochloric acid (HCL), pepsin and intrinsic factor have been linked to these histological changes. In addition, gastric emptying was delayed and the reduced gastric motility may result in nausea and vomiting associated with this gastroenteritis. The binding specificity of Norovirus is based on the histo-blood group antigens. These histo-blood group antigens are complex carbohydrates (oligosaccharides) linked to proteins or lipids and are located on the mucosal epithelial of the digestive tracts and are present as free oligosaccharides in saliva and milk (29). The three major families of histo-blood group antigens- ABO, Lewis and secretor families- are involved in the binding of Norovirus (29). Different Norovirus genotypes have different affinity for ABO antigens. For example, GI Norovirus has a higher affinity for blood group antigens A and O whereas GII Norovirus has a higher affinity for blood group antigens A and B (30). The P2 domain on the viral capsid plays a key role in the binding of these Norovirus to the histo-blood group antigens (31). Prevention and control Outbreaks of Norovirus can result in loss of income and significant morbidity because of frequent secondary transmission of the disease. Places which are more prone to Norovirus outbreaks and are of particular concern are normally places with a closed environment such as hospitals, nursing homes, ships and planes. Because Norovirus is highly infectious and spreads easily, and can be spread via asymptomatic individuals, the prevention of Norovirus outbreaks has become a major obstacle and poses a challenge for us. Norovirus can begin with a single common source of contaminated food (i.e. raw oysters, fruits and vegetables) and can rapidly spread like wildfire through person-to-person contact. Stopping an outbreak of Norovirus requires herculean efforts to sterilise and clean the environment (eg. on cruise ships, camp sites, nursing home, hospital wards or disaster sites), and even then, the epidemics will only subside once the viral pool have been totally eradicated (32,33). No specific methods are available for complete prevention of Norovirus infection or illness due the agent being extremely contagious. Therefore, control efforts are targeted and focused on identifying the source and the subsequent removal of that source (eg, an infected food handler, contaminated water supply or even contaminated food supply, which is often the case with fruits and shellfish- in particular, oysters) which will then reduce the chance of the virus spreading (34). It is advised that ill food handlers should not be able to retain to their job and that strict personal hygiene be enforced among food handlers as they are one of the main causes of outbreaks. However, even under these strict regulations, both measures have shown limited success. The key to stopping the continuous spread of outbreaks is by preventing the secondary spread of the virus which spread through person-to person contact and from contaminated environmental surfaces which normally occur in cruise ships and other institutions. The fact that asymptomatic infection can occur and that the antigen can still be shed 2-3 weeks after exposure need to be kept in mind to facilitate the managing of outbreaks. Methods to manage the outbreak of Norovirus infection will probably improve in the near future as new tests are being carried out in epidemiological research of virus transmission. Recent knowledge on contamination, sanitation and personal hygiene In an outbreak, whether in a hospital or other environment, various methods can be enforced to reduce the spread of Norovirus infection. It is also important to note that Norovirus gastroenteritis, which is highly contagious tend to spread in crowded areas and may be difficult to control, therefore, below, are just a few techniques which can help in controlling this spread. Proper hand washing techniques and washing hands with soap and water is the key to preventing Norovirus from spreading. Note that, alcohol hand gel does not kill the virus entirely, but it may still be useful in areas where water is inaccessible. Also, the efficacy of the alcohol based sanitizers depends on the alcohol type and concentrations as well as the amount of viral particles present (35). * Medical staff and aid workers should clean their hands prior to and after touching any patient but it is particularly important that staffs wash their hands with soap and water after attending to a Norovirus patient to prevent the infection from spreading from one patient to another patient via their hands. Staffs should also be educated about the importance of personal hygiene and about the importance of washing hands. * Visiting relatives of patients in hospitals should also wash their hands with soap and water after visiting a ward which has Norovirus and they should not interact with other patients other than the person they have come to visit. * Staff and visitors should wash their hands before handling food and after visiting the toilet. Hand washing facilities should also be provided especially in high risk areas which are prone to Norovirus infection, such as bathrooms, eating areas, diaper-changing areas and even day care centres. * Proper hand washing techniques (eg. Rub palm to palm with fingers interlaced and rub back of each hand with palm of the other hand with fingers interlaced) should also be advised and encouraged. * Strict personal hygiene among food handlers and aid workers should be enforced to prevent outbreaks of Norovirus. 2. Isolating patients with the virus. *Patients with Norovirus must immediately be isolated from non-infected patient until their symptoms subside. The infected patient should be placed in a single room, but if there are a few cases of infection on the ward, infected patients should then be nursed in a dedicated bay. If there are a large number of cases, the ward should be close to new admissions. Visiting should also be restricted to prevent visitors getting the infection and thus, preventing the subsequent secondary infection of the disease. 3. Cleaning. *Enhanced cleaning using bleach-containing products are needed to eradicate Norovirus from the environment. Vomit and diarrhoea must be cleaned up immediately and general ward cleaning must be increased. Alcohol based surface disinfectants are usually insufficient. Waste should also be dumped properly in the allocated bins. *Aggressive environmental sanitization by cleaning with proper surface disinfectants and sterilisation of bathroom surfaces, bedding and lines are also essential to decrease secondary spread (32). * Studies have shown that when bleaching agent is used on feline caliciviruses, it can inactivate the activity of the virus. Also, the effect of the bleaching agent is superior compared to that of ammonium compounds or phenols (36). 4. Symptomatic people must stay away from hospital. *Staff and visitors who develop symptoms must not come into the hospital and they must remain away from the hospital until they have been free of symptoms for 48-72 hours. Staff must be cleared by occupational health before returning to work. Immunity and Vaccine Developed To develop future vaccines for the prevention of Norovirus infection, the nature of the immunity to Norovirus is of particular importance. In an early study of immunity of the human response system to Norovirus illness, some volunteers who became ill after being exposed to the virus had partial immunity to the disease upon exposure 6 to 14 weeks later, but lost the immunity 27 to 42 months later (37). However, recent studies have shown that these early finding may be inaccurate, since the dose required to infect 50% of volunteers is as low as 18 infectious particles, whereas the dose used in the early study was more than 105 time higher (21). Immunity developed from exposure to a lower dose of Norovirus might be greater and more cross-reactive than immunity against a much higher dose. Therefore, studies on this possibility are still on going. The high incidence of illness caused by Norovirus infections especially among both the young and the elderly have led to some investigations to consider the potential role of vaccines in helping to regulate this infection. The vaccine should be designated towards specific target groups, such as infants (as part of their routine schedule for childhood immunization), the elderly, food handlers, military personnel, travellers, health care workers and nurses in day-care centres (3). The development of vaccines could also play a role in helping to reduce the number of childhood mortality and controlling diarrheal disease in infants. In a recent study, it is noted that 15% of hospitalization of children for diarrhoea in India and 31% in Peru were associated with Norovirus infection (38) and these percentages may be contributing greatly towards the estimated 1.6 million children who die each year from diarrhoea. Nevertheless, recent breakthrough in research has successfully produced Norovir us-like particles (NVLP). These particles have almost identical characteristics to the original Norovirus as it has resistant properties towards acidic pH and is also heat-stable. When these particles are given orally or intranasally to human, it can produce an antigenic effect, stimulating the production of anti-Norovirus antibodies (B and T cell responses) within the human body (39). Therefore, these particles are now being studied, hoping that it could be used as a platform and lead us to discovering a cure one day. However, there are many obstacles towards the development of a vaccine for Norovirus. Firstly, there is certainly a lack of understanding of the physiology of the virus due to the failure to cultivate them in laboratories. Thirdly, there is limited understanding on why individuals cannot develop long term immunity towards the virus. Furthermore, the virus can also withstand a wide range of temperatures and pH thus increasing their survivability. Also, the virus has multiple routes of transmission, and finally, the Norovirus strain is rapidly evolving and mutating, thus, posing a major challenge for us in developing a vaccine, which is much similar to the situation to that of the influenza viruses. Similar to that of the influenza virus, the Norovirus can accumulate point mutation in the outer capsid wall which may result in unique immunoglobulin binding sites (18). Therefore, this antigenic drift will result in the formation of new strains of Norovirus and will require the reformatio n of the vaccines annually (39). Epidemic surveillance using recent updated epidemiological data will allow the identification of predominant strains and identifying a reference vaccine strain each year, similar to the situation of that of the influenza virus (38). Studies on the testing of vaccines are still at an early stage and much work still has to be done. Treatment As discussed above, the symptoms caused by Norovirus are generally mild and self-limited and resolves itself. Currently, there is still no specific treatment for a Norovirus infection apart from letting the infection run its course. Individuals who come down with Norovirus illness do not necessarily need to visit a doctor. Instead, the individual should stay home, to prevent the illness from passing to other people in a community, take paracetamol when necessary to relieve any symptoms or fever and most importantly, oral rehydration, by drinking plenty of water to replace the fluid lost through diarrhoea and vomiting. If an individual is having problems to retain fluids, he/she should try to take in small sips more frequently to ensure one is rehydrated. Rehydration solution can also be consumed to restore all the salts and minerals which were lost during diarrhoea and vomiting. This rehydration solution normally comes in powder form which can then be added with water for drinking. F or individuals who are suffering from severe dehydration, immediate hospitalization is necessary. Fluids should then be given directly into the body by a naso-gastric tube or intravenously. Antimotility agents such as Loperamide may be useful in helping to regulate diarrhoea in individuals with severe symptoms. Opioids are also useful in regulation of diarrhoea by reducing peristalsis. Anti-emetics such as Chlorpromazine, Acepromazine and Metoclopramide may be useful in helping to control vomiting by inhibiting the D2, Dopamine receptors which are found on the chemical trigger zone of the brain. Individuals suffering from Norovirus illness are advised to consume a light diet of foods that are easily digested, such as soup, rice, pasta and bread, but babies should be given their normal feed throughout (102). It has been shown that interferon and ribavirin can effectively inhibit the replication of Norovirus in replicon-bearing cells (40), but their potential therapeutic value needs t o be further investigated. Currently, there are still no anti-viral medications to treat Norovirus. Future research to locate the site of the gastrointestinal tract where the virus replicates may result in development of more specific antiviral therapies targeting the viral replication process. The drugs stated above are only used to control symptoms of Norovirus infection. However, due to the continuous advancement of the field of medicine, all these may change, and once the virus can successfully be propagated in laboratories, studies on them can be conducted which may finally lead us to a cure for Norovirus. Health impact of Norovirus outbreaks in the coming era Norovirus would be with mankind for years to come and even though a vaccine is in the process of being developed, it will require a few more years for it to be perfected. In this era of globalisation, travelling has become a norm in our lives. Every year, it is estimated that approximately 1 billion people travel around the globe for various purposes. Travellers may include tourists, business people, soldiers, refugees, migrants etc. Therefore, from a virus perspective, there will be a linkage of people all around the world with plenty of susceptible individuals which can be infected. For example, through air travel, the virus can be passed on from one continent to another, within a couple of days, and this can result in a pandemic. Currently, travel industry has increased by leaps and bounds. Planned vacations are almost the norm for everyone. Travellers especially vacationers inflicted with Norovirus will almost certainly ruined their travelling plans. On cruise ships or other confined environments, outbreaks of Norovirus can literally bring all leisure activities to a standstill. As global warming continues to be abated, natural disasters like hurricanes, typhoon, and floods appear to be common events. Congregation of people in crowded relief centres, like what happened during the Katrina Hurricane disaster, will form fertile ground for Norovirus to spread. Failure to control the outbreaks will compound the calamites (disasters) and disrupt relief effort. Lastly, as the world is rapidly greying especially in the developed countries, many old aged people will be housed in nursing homes. These confined homes are again sitting duck for Norovirus to strike. As the morbidity and mortality of old people are much worse in Norovirus infection, outbreaks could prove disastrous to these cohorts of greying population. References Richman D D, Whitley RJ Hayden FG Clinical Virology. 2nd ed. Washington: ASM Press; 2002. Levinson W Medical Microbiology Immunology. 8th ed. United States: Lange; 2004. Roger, I. Glass, Umesh, D. Parashar and Mary, K. Estes. Norovirus Gastroenteritis. N Engl J Med 2009;361:1776-85. Nayak MK, Balasubramanian G, Sahoo GC, et al. Detection of a novel intergenogroup recombinant Norovirus from Kolkata, India. Virology 2008;377:117-23. Bull RA, Tanaka MM, White PA. Norovirus recombination. J Gen Virol. 2007;88:3347-59. Fankhauser RL, J. S. Noel, S. S. Monroe, T. Ando, and R. I. Glass. Molecular epidemiology of â€Å"Norwalk-like viruses† in outbreaks of gastroenteritis in the United States. J. Infect. Dis. 1998;178:1571-1578. Michele E. Hardy Norovirus protein structure and function. DOI 2006;10.1016. Bertolotti-Ciarlet A, White LJ, Chen R, Venkataram P and Estes MK. Structural Requirements for the assembly of Norwalk virus-like particles. J. Virol 2002;76:4044-55. Zheng D, Ando T, Frankhauser RL, Beard RS, Glass RI, Monroe SS. Norovirus classification and proposed strain nomenclature. J. Virol 2006;346:312-23. Dingle KE, Lambden PR, Caul EO, Clarke IN. Human enteric Calicivirdae: the complete genome sequence and expression of virus-like particles from a genetic group II small round structured virus. J. Gen. Virol. 1995;76:2349-55. Belliot G, Sosnovtsev SV, Mitra T, Hammer C, Garfield M, Green KY. In vitro proteolytic processing of the MD145 Norovirus ORF1 nonstructural polyprotein yields stable precursors and products similar to those detected in Calcivirus-infected cells. J. Virol. 2003; 77:10957-74. Cuellar JL, Meinhoevel F, Hoehne M, Donath E. Size and mechanical stability of norovirus capsids depend on pH: a nanoindentation study. J Gen Virol. 2010; 91:2499-56. Dolin, R., N. R. Blacklow, H. DuPont, R. F. Buscho, R. G. Wyatt, J. A. Kasel, R. Hornick, and R. M. Chanock. Biological properties of Norwalk agent of acute infectious nonbacterial Cannon RO, Poliner JR, Hirschhorn RB, Rodeheaver DC, Silverman PR, Brown EA, Talbot GH, Stine SE, Monroe SS, Dennis DT and Glass RI. A multistate outbreak of Norwalk virus gastroenteritis associated with consumption of commercial ice. J. Infect Dis. 1991; 164:860-863. Graham DY, Jiang X, Tanaka T, Opekun AR, Madore HP, Estes MK. Norwalk virus infection of volunteers: new insights based on improves assays. J. Infect. Dis 1994; 170:34-43. Inouye SK, Yamashita SY, Yoshikawa M, Kato N, Okabe N. Surveillance of viral gastroenteritis in Japan: paediatric cases and outbreak incidents. J. Infect. Dis 2000;181:S270-74. Adler JL, and Zickl R. Winter vomiting disease. J. Infect. Dis. 1969;119:668-73. Nilsson M, Hedlund KO, Thorhagen M, et al. Evolution of human caliciviruses RNA in vivo: accumulation of mutations in the protruding P2 domain of the capsid leads to structural changes and possibly a new phenotype. J. VIrol 2003;77(24):13117-24. [PubMed:14645568] Caul EO. Small round structured viruses: airbourne transmission and hospital control. Lancet 1994; 343:1240-41. Chadwick PR, McCann R. Transmission of a small round structured virus by vomiting during a hospital outbreak of gastroenteritis. J. Hosp. Infect. 1994; 26:251-59. Teunis PF, Moe CL, Liu P, et al. Norwalk virus: how infectious is itJ Med Virol 2008;80:1468-76. Rockx B, De Wit M, Vennema H, et al. Natural History of human calicivirus infection: a prospective cohort study. Clinical Infect Dis 2002;35:246-53 Estes MK, Prasad BV, Atmar RL. Noroviruses everywhere: has something changedCurr. Opin. Infect. Dis. 2006;19:467-474. Mattner F, Sohr D, Heim A, Gastmeier P, Vennema H, Koopmamns M. Risk groups for clinical complications of Norovirus infections: an outbreak investigation. Clin Microbiol Infect 2006;12:69-74. Harris JP, Edmunds WJ, Pebody R, Brown DW, Lopman BA. Deaths from Norovirus among the elderly, England and Wales. Emerg Infect Dis 2008; 14:1546-52. Levy AG, Widerlite L, Schwartz CJ, et al. Jejunal adenylate cyclase activity in human subjects during viral gastroenteritis. Gastroenterology 1976;70:321-5 Agus SG, Dolin R, Wyatt RG, Tousimis AJ, Northrup RS. Acute infectious nonbacterial gastroenteritis: intestinal histopathology: histologic and enzymatic alterations during illness produced by Norwalk agent in man. Ann Intern Med 1973;79:18-25. Meeroff JC, Schreiber DS, Trier JS, Blacklow NR. Abnormal gastric motor function in viral gastroenteritis. Ann Intern Med 1980;92:370-3. Marionneau S, Ruvoen N, Le MoullacVaidye B, et al. Norwalk virus binds to histo-blood group antigens present on the gastroduodenal epithelial cells of secretor individuals. Gastroenterology 2002;122:1967-77. Tan M, Huang P, Meller J. Mutations within the P2 domain of Norovirus capsid affect binding to human histo-blood group antigens evendence for a binding pocket. J. Virol. 2003;23:12562-71. Harrington PR, Lindesmith L, Yount B, Moe CL and Baric RS. Binding of Norwalk virus-like particles to ABH histo-blood group antigens is blocked by antisera from infected human volunteers or experimentally vaccinated mice. J. Virol 2002;76(23):12335-43. Yee EL, Palacio H, Atmar RL, Shah U, Kilborn C, Faul M, Gavagan TE, Feigin RD, Versalovic J, Neil, FH, Panlilio AL, Miller M, Spahr J and Glass RI. Widespread outbreak of Norovirus Gastroenteritis among evacuees of Hurricane Katrina residing in a Large â€Å"Megalshelter† in Houston, Texas: lessons learned for prevention. C Dis Cont. 2007;44:1032-39. Widdowson MA, Cramer EH, Hadley L, et al. Outbreaks of acute gastroenteritis on cruise ships and on land: identification of a predominating circulating strain of Norovirus- United States, 2002. J Infect Dis 2004;190:27-36. [Erratum, J Infect Dis 2004;190:2198.] Baert L, Uyttendaele M, Stals A, et al. Reported foodbourne outbreaks due to Noroviruses in Belgium: the link between food and patient investigations in an international context. Epidemiol Infect 2009;137:316-25. Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol 2002;23:S3-40. Duizer E, Bijkerk P, Rockx B, De Groot A, Twisk F, Koopmans M. Inactivation of caliciviruses. Appl Environ Microbiol. 2004;70:4538-43. Parrino TA, Schreiber DS, Trier JS, Kapikian AZ, Blacklow NR. Clinical immunity in acute gastroenteritis caused by Norwalk agent. N Eng J Med 1977;297:86-9. Patel MM, Widdowson M-A, Glass RI, Akazawa K, Vinje J, Parashar UD. Systematic literature review of role of Noroviruses in sporadic gastroenteritis. Emerg Infect Dis 2008;14:1224-31 Kralovetz MH, Mason HS, Chen Q. Norwalk virus-like particles as vaccines. Expert Rev Vaccines. 2010;9(3):299-307. Chang KO, Geroge DW. Interferons and ribavirin effectively inhibit Norwalk virus replication in replicon-bearing cells. J Virol 2007;81:12111-8. Websites Richard H.Replication of Polio, Rhino and other Picornaviruses [Internet]. Available from: http://www.pathmicro.med.sc.edu/virol/polio.htm Treating norovirus infection [Internet]. Available from: http://www.nhs.uk/Conditions/Norovirus/Pages/Treatment.aspx How to cite Norovirus and gastrointestinal disease, Essay examples

Mental Health and Intellectual Disabilities Adult Social Care in Engl

Question: Discuss about a Essay on Mental Health and Intellectual Disabilities for Adult Social Care in England? Answer: Introduction Schizophrenia is a state of mental disorder where individual persist unusual social behaviour, reduced realistic expression, development of false beliefs and confused thought process. This disease is common in young adults and can last till mortality. Similarly, Intellectual or learning disabilities are another category of mental disabilities known as Intellectual Development Disorder (IDD) occurring due to reduced IQ below 70 with additional behavioral and cognitive defects (Johnstone, 2012). In this essay, the learner will analyse the care needs of schizophrenia and intellectual disabilities sufferers along with the study of the best possible care provisions to overcome these care needs. The services discussed in this study are Advocacy, community support services, standards for clinical care improvements and psychological interventions. According to Glasby (2012), these care provisions are appropriate to develop better care services, education, support system, cognitive improvements and behavioral modifications. These services are analysed to be the best care delivery mechanism for mental disabilities like schizophrenia and intellectual disabilities as per cultural and ethical sensitivity. Evaluating the needs of people with specific mental health problems and disabilities In this section, the most specific and common needs of people suffering from Schizophrenia and intellectual disabilities are described: - Psychological care requirements It is been identified that the people with developmental or learning disorder develop psychological issues like lack of communication, personality disturbance, cognitive disabilities, the disorder in though process and many more, leading to the development of certain specific psychological care needs. The general intelligence diagnosis process involving in the identification of patients IQ score indicated that patient with Schizophrenia and learning disabilities have cognitive dysfunctions that involve speech handicaps, lack of quality standards in life, defects in memory, delays in oral language development and many other psychological defects that even lead to increasing mortality rate of patient (Jones et al. 2012). Another most important psychological care requirement is the emotional and psychological support that is generally lacking in the life of these patients due to isolation from family. They develop factors like low self-esteem, lack of confidence, lack of relationship desire, incapability to practice pleasure and lack of enthusiasm (Care Quality Commission, 2012). Need of Standards in Hospital community care The community care and health care standards play a very important role in care provision of schizophrenia, intellectual disability or any other mental disorder. Lawrence Kisely (2010) studied the survey where 101 Schizophrenia patients were interviewed to understand their care needs out of which 58 people stated that they need care improvements in the clinical domain related to more liaison health care professionals, improved quality of treatment and the maintenance of more hygienic environment in hospitals. Some other handicaps that occur in care standards for people suffering from these learning disabilities are the lack of consultants in community care, adult psychiatry throughout the UK and lack of clinical management practices (Emerson, 2012). Need of Advocacy, Education, Social care support People with learning disabilities and Schizophrenia often suffer from issues like social isolation, struggle to be attended, lack of proper education, personal support, bullying, unemployment, financial crisis and lacking professional support. These are the most basic and practical issues that are faced by the person having a cognitive imbalance (Kisner and Colby, 2012). Chadwick et al (2012) opines that as per British Institute of Learning Disabilities (BILD) the advocacy is a primary need for people with intellectual disability to achieve social standards. The fulfilment of advocacy will deliver supportive role in social care services. Stylianos and Kehyayan (2012) stated that the patients of Schizophrenia require proper education about their disease because this is a very complex state of mind where people generally do not understand the symptoms of their disease. The Education, Health and Care (EHC) plan helps to identify the education, health and care needs of people suffering from the intellectual disability and schizophrenia, that is further communicated to professional, family, consultant and supports to understand the needs of sufferers. The social care and support needs involve employment, action against isolation, removal of bullying from public spaces and defending their rights and responsibilities. Promoting mental health care that is culturally and ethnically sensitive The social, political, cultural and demographic factors may either leave of positive or a negative impact on sufferers of mental disorder and development of their care provisions. In general understanding, the Social Drift Hypothesis stated that the people suffering from mental disorder are not considered as the complete citizen of society, especially sufferers of intellectual disabilities. The Schizophrenia people were analysed in studies of Tsang et al. (2010) to be socially isolated with the lack of social network, adverse life events, deprivation and social harassment activities like bullying, violence, underestimation, family isolation and lack of housing. For control over such social isolations of schizophrenia and learning disabilities sufferers and developing self-determination, self-confidence the care provision of advocacy practices, community support and care homes are considered most ethical care practices for these patients. Until late 20th century, the children with intellectual disabilities were not allowed for routine public education and were isolated from normally developing children. Their education needs were not met leading to issues like unemployment, lack of communication skills, psychic life experiences and low rate of motivation with low living standards. Wiese et al. (2012) studied a survey where the high rate of unemployment was identified in Caribbean origin people that first presented schizophrenia in the UK. However, in the present situation there are special schools been developed for mental disorder sufferers, which were identified to develop similar levels of stigma as normal children along with great ambitions in career development prospect. Apart from this, there are special schools (SEN schools) for sufferers of intellectual disabilities to let them overcome their learning disabilities and handicaps. These schools properly follow the legal and ethical standards established by legis lation of particular country to deliver education. The cultural and demographic of patients suffering from Schizophrenia and Intellectual disabilities affects the individuals communication methods, mental illness, coping potential, support system and willpower to overcome the disorder. It is been analysed that intellectual disorder patients coming from Urban cities have better coping capacity as compared to patients of rural areas due to their lack of care facilities, special schools, employment options, advocacy and many more measures that help to cure disorders. The care provisions of EHC plan, community care services and cognitive remediation helps to overcome this cultural difference in patients (Shaw et al. 2010). There also exist the impact of gender difference on patients of schizophrenia and intellectual disorder. It is been estimated that mens age of Schizophrenia development is 15 to 25 years and that of women is 25 to 35 years. Similarly, Intellectual disorder is more common in men than women population of UK as well as other countries (Tandon et al. 2010). Heslop et al. (2014) studied that there is more concentration paid to cure the youth sufferers of mental disorder when compared to elder patients because they have the scope for improvement. The care standards provided to the elder crowd are very low in health care system. However, to overcome these issues, there are Proper standards for hospital and community care been developed that also involves training of professionals to meet the care requirements of the patient. Demonstrating knowledge and understanding of effective care provision for disabled people with mental health problems The below described are some of the most successful care provision established in the United Kingdom as well as international level to meet the care needs of patients suffering from schizophrenia and intellectual disability. Advocacy The advocacy care services are support services to vulnerable of society helping them to access knowledge, gather education, explore options, make decisions, communicate effectively, develop self-esteem and protect their rights responsibilities. The person enrolled in advocacy should not be a family member, friend, social workers or NHS professional (Heyman et al. 2010). The BILD is British Institute of Learning Disabilities provides advocacy services to sufferers of learning disabilities as well as their families to understand the disease. They empower the patient to explore choices and make self-decisions. Similarly, the BCSS is British Columbia Schizophrenia Society provides various care services along with advocacy on different regions of United Kingdom as well as Canada for sufferers of schizophrenia. Advocacy service development protocols have to follow the guidelines of Mental Health Act, Care Act 2014 and Community Treatment Order developed for patients with the mental disorder (Highland, N.H.S., 2010). Community Support Services and Standards for clinical care One of the most important care provision developed by Dual Diagnosis of Mental Health learning Disability Policy by NHS is community care services that involve social care for people with learning disabilities and Schizophrenia. These social care services are developed for adult and elder suffering from this mental disorder to deliver support practices that help patient to communicate properly, develop a social network, build relations and overcome their cognitive dysfunctions (Kreyenbuhl et al. 2010). As per Health and Social Care Act 2012, the NHS establishes community care service standards along with procedures for the regular monitoring of these protocols been followed in the care centre. These standard services involve improvement in funding arrangements for local community services, the better law supporting rights of schizophrenia people and better quality standards in the care centre. Some of the most effective community support services are the vision to individual care, family encouragement, personal budgets for patients, trained professionally as service providers, the establishment of social care criteria and better quality of clinical services (Werner and Stawski, 2012). There are various transformations made in Standards of Clinical Care by NHS to improve the care services of patients suffering for learning disabilities and other mental disorder. The inpatient treatment services are improved by standards like admitting special mental health care staff, raising funds for special cases, clinical psychologist, the psychiatrist in hospitals, update personal care plan, formal review collection and transforming care quality services. Psychological Interventions Psychological interventions for treatment of intellectual disabilities The psychological interventions are innovative changes in treatment practices for improving the treatment of the patient. The most effective psychological interventions in the treatment of intellectual disabilities is engaging professionals having skills to deliver behavioural interventions involved in Cognitive Behavioural Therapy (CBT) and Psychodynamic Therapy. The CBT involves interventions in talking and communication process to improve the treatment of intellectual disability patients. However, the CBT has certain limitations while working with patients having communication difficulties. Another behavioural intervention is the Psychodynamic therapy that helps to resolve the inner unconscious content of patient that helps to improve the low self-esteem of the patient. Psychological interventions for treatment of Schizophrenia The psychological intervention for schizophrenia involves Individual and Group Psychotherapies along with Psychological Skill Training to professionals. The individual psychotherapy involves the one-to-one interaction of patient and therapist. In contrast, the group psychotherapy is gathering of therapist for some therapeutic objectives. The psychological skill training involves the development of professionalism on the basis of Social learning Theories to analyse the complex behaviour schizophrenia. The training is provided for skill specification, modelling, leadership, didactic, verbal reinforcement and generalization (Pharoah et al. 2010). Reviewing care provision for disabled people with mental health problems The above-described care provision are advocacy, community support services, improvement in clinical care standards and psychological interventions that are working in different manners to meet the necessities of people suffering from intellectual disabilities and schizophrenia. These care provision are the most successful once providing better health care services specifically to these communities. The community care practice of providing adult social care to people with learning disabilities is highly appreciated in England. Jones et al. (2012) opine that according to NHS Information Centre, out of 16.8 fund send by English council in 2010 for social care services, a minimum of 24% was spend in social care of adults with intellectual disabilities. Heyman et al. (2010) indicated that for quality standard improvements the NHS funded 557 to improve the care of people suffering from intellectual disabilities for 58 NHS hospitals and 49 solo hospitals. The implementations of care standards have delivered high-quality care and support services, better hospital facilities, improved personal care plans and better-developed treatment options. The acute liaison nurses and professional in care standards providing exceptional advice and support to intellectually disabled people, families and other staff are considered as best practice in the improvement of health care standards by NHS (Care Quality Commission, 2012). As per Public Health England Department now the practices of establishing advisory groups in health care system is been forwarded due to the successful practice of advocacy. This advisory group in the organization are self-advocates and carers that work for a particular organization to provide advocacy services for patients ( Emerson, 2012). The psychological interventions show effectiveness, however, Pharoah et al. (2010) studied that these interventions have certain limitations like cognitive behavioural therapy for schizophrenia patients suffering from speech defect gets limited because communication cant be processed in therapy due to these speech defects of the patient. The psychodynamic therapy is effective but lacks trust building because they are innovative intervention procedures that require analysis. Chadwick et al (2012) indicated that psychodynamic interventions for disability patients have certain methodological faults that are require revising for better service delivery. Lawrence Kisely (2010) studied that cognitive behavioural therapy is a common intervention used to cure many mental disorder. Therefore, taking it as a solo intervention for intellectual disabilities can create the development of confusion in care specialist to perform and follow protocol. These were the particular pros and cons of these care provisions to cure schizophrenia and intellectual disabilities. Conclusion The mental care services of advocacy, community services and standards of clinical care delivery provides justification to health care needs of schizophrenia and intellectual patients practically by improving hospital care services, better education to patients, family engagement in treatment, social care development and mental support services. However, the psychological interventions of cognitive behavioural therapy fulfill the theoretical criteria established by Cognitive theory of mental status but is not considered as individual service for schizophrenia and intellectual disabilities. Along with this the psychodynamic therapy lacks the practical application outcomes, as this is the most innovative treatment process till date. This study helped the learner to understand the specific care requirements of people suffering from schizophrenia and intellectual disability. There is very less knowledge about the care needs required by people suffering from these mental disorder because these needs are bit complex to understand by manual diagnosis measures. But this study helped to elaborate these specific care needs and the care provision developed till today to overcome these care requirements. However, the lags of care provision indicate that still there is the requirement to revise these processes and implement better care options for schizophrenia and intellectual disabilities. References Books Care Quality Commission, (2012).The state of health care and adult social care in England in 2011/12(Vol. 763). London: The Stationery Office. Emerson, E., (2012).Clinical psychology and people with intellectual disabilities(Vol. 97). New Jersey: John Wiley Sons. Glasby, J., (2012).Understanding health and social care. Bristol: Policy Press. Heyman, B., Alaszewski, A. and Shaw, M., (2010).Risk, safety and clinical practice: health care through the lens of risk. Cambridge: Oxford University Press. Johnstone, D., (2012).An introduction to disability studies. London: Routledge. Kisner, C. and Colby, L.A., (2012).Therapeutic exercise: foundations and techniques. Philadelphia: Fa Davis. Journals Chadwick, A., Street, C., McAndrew, S., and Deacon, M. (2012). Minding our own bodies: Reviewing the literature regarding the perceptions of service users diagnosed with serious mental illness on barriers to accessing physical health care.International Journal of Mental Health Nursing,21(3), pp. 211-219. Heslop, P., Blair, P.S., Fleming, P., Hoghton, M., Marriott, A. and Russ, L., (2014). The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study.The Lancet, 383 (9920), pp.889-895. Highland, N.H.S., (2010). Clinical Governance Risk Management: Achieving safe, effective, patient-focused care and services. Jones, L., Bellis, M.A., Wood, S., Hughes, K., McCoy, E., Eckley, L., Bates, G., Mikton, C., Shakespeare, T. and Officer, A., (2012). Prevalence and risk of violence against children with disabilities: a systematic review and meta-analysis of observational studies.The Lancet,380(9845), pp.899-907. Kreyenbuhl, J., Buchanan, R.W., Dickerson, F.B. and Dixon, L.B., (2010) The schizophrenia patient outcomes research team (PORT): updated treatment recommendations 2009.Schizophrenia bulletin,36(1), pp.94-103. Lawrence, D., Kisely, S. (2010). Review: Inequalities in healthcare provision for people with severe mental illness.Journal of psychopharmacology,24(4), pp. 61-68. Pharoah, F., Mari, J., Rathbone, J., and Wong, W. (2010). Family intervention for schizophrenia.Cochrane Database Syst Rev,2 (9), pp. 12. Shaw, K.L., Clifford, C., Thomas, K. and Meehan, H., (2010) Improving end-of-life care: a critical review of the Gold Standards Framework in primary care.Palliative Medicine, 3(5), pp.45. Stylianos, S. and Kehyayan, V. (2012). Advocacy: critical component in a comprehensive mental health system.American Journal of Orthopsychiatry, 82(1), pp. 115-120. Tandon, R., Nasrallah, H.A. and Keshavan, M.S., (2010). Schizophrenia Just the Facts 5- Treatment and prevention Past, present, and future. Schizophrenia research,122(1), pp.1-23. Tsang, H. W. H., Fung, K. M. T., and Chung, R. C. K. (2010). Self-stigma and stages of change as predictors of treatment adherence of individuals with schizophrenia.Psychiatry Research,180(1), pp.10-15. Werner, S. and Stawski, M., (2012). Mental health: knowledge, attitudes and training of professionals on dual diagnosis of intellectual disability and psychiatric disorder.Journal of Intellectual Disability Research,56(3), pp.291-304. Wiese, M., Stancliffe, R.J., Balandin, S., Howarth, G. and Dew, A., (2012). Endà ¢Ã¢â€š ¬Ã‚ ofà ¢Ã¢â€š ¬Ã‚ life care and dying: issues raised by staff supporting older people with intellectual disability in community living services.Journal of Applied Research in Intellectual Disabilities,25(6), pp.571-583.

Mean Creek Movie Essay Example For Students

Mean Creek Movie Essay Describe an important idea in the text. Explain how visual and/or verbal features showed you that this idea was important An important idea in the film Mena Creek, directed by Jacob Aaron Estes in the Loss of innocence/Coming of age because when within the film almost every character where they don’t change a lot and think about it up until George’s death they’re changed a lot and they think about like a mature and adult person of how to treat this new situation in front of them. We can see this in the Aftermath Scene. The verbal and visual features that helped me understand is which is an important idea in the used are tracking, close-up, dialogue and low/high angle. Firstly, the director has used the dialogue technique in this film to show that how the characters are feeling about it. For example we can see that when Rocky tell Sam that â€Å"What are you trying to say, Sam? You have to trust me on this Sam. I’m your brother. † Then Sam tell his brother that â€Å"But I don’t trust you. We can see this that now Sam has loosen the trust on Rocky and they now don’t trust each other which is the huge loss of innocence/coming of age between Sam and Rocky. This was important because it tell us that how people lose trust of each other when they are in this situation in their real life so that characters in the film has also loosen their trust with each other. Secondly, the director has used close-up technique to show us that emotions or feeling of the characters. There are a lot of examples for this but the main two examples for this are first the George’s watch and second Millie stabbing the snail. First example was important because this symbolises us that the time is gonna change and we can also say that the time has stopped. Second example was important because this reflects us that something has been snapped inside herself. This close-up technique was important in the film because this show us that George has died and she thinks that she is a killer and she will be reminded of this in her whole life which was the loss of innocence/coming of age to her. Thirdly, the director has used the low/high angle technique used in this to tell us how scary, powerful or weaker, nicer, horror the person is. We can see this by an example from the film which is a fight between Clyde and Marty with Rocky intervening which show us the moment that how the relationship has been changed between Rocky, Clyde and Marty but mostly about Clyde and Marty. This is a key moment because Clyde was always good with Marty now he is very bad. They are also close together. This was important to the film because it tells us that Clyde is a nice person and he thinks good for other people when coming into the worst situation so like him there are also people in the world who are good but they become bad when coming into this situation. Overall the director has used these three important techniques to tell us about each character feelings and who is the mature person of all. He has also used lots of things which symbolises to us in our day – to – day life’s for example in close – up he has used George’s watch which symbolises us that the time is gonna change or the time has stopped for a minute.