Type II Diabetes in African Americans Essay Example for Free

Type II Diabetes in African Americans Essay Introduction                                                    The 1986 report of the Secretarys Task Force on Black and Minority Health called notice to the upsetting excess morbidity as well as mortality from chronic illnesses for instance non-insulin-dependent diabetes mellitus (NIDDM), cancer, and heart disease that exists in minorities in the United States. Besides the added disease burden, restricted research in the area of minority health has exacerbated the problem in the African-American population by reducing the knowledge essential for understanding the contributing factors plus planning effective intervention strategies. Diabetes mellitus, one of the diseases targeted for augmented investigate focus among minorities, carries on to have overwhelming consequences on the African American population. It is anticipated that about 1.8 million African Americans are affected with the disease (Report of the Secretarys Task Force on Black and Minority Health, 1985). Furthermore, the occurrence and mortality from diabetes are almost double as high among African Americans as in the U.S. White population (CDC, 1990). Consequently, there remains a critical need for research intended to explain the aspects contributing to the augmented diabetes-related morbidity as well as mortality in this ethnic group. Biomedical definition and Epidemiology of Diabetes Mellitus Diabetes mellitus is a heterogenous group of disorders that are typified by an abnormal augment in the level of blood glucose. It is a chronic disorder of carbohydrate metabolism ensuing from inadequate production of insulin or from insufficient utilization of this hormone by the bodys cells (Professional Guide to Diseases 1998:849). Diabetes mellitus takes place in 4 forms classified by etiology: Type I (insulin-dependent), Type II (noninsulin-dependent), other special types (genetic disorder or exposure to certain drugs in chemicals), as well as gestational diabetes (occurs during pregnancy). http://etd.fcla.edu/SF/SFE0000527/AfricanAmericanWomen.pdf When studies are performed to evaluate the epidemiology and public health impact of diabetes mellitus on the African-American population, non-insulin-dependent diabetes mellitus (NIDDM) plus insulin-dependent diabetes mellitus (IDDM) are most frequently considered. Though, further forms of glucose intolerance have as well been studied, together with impaired glucose tolerance (IGT), gestational diabetes (GDM), and other atypical diabetes syndromes. Categorization of these diabetes subtypes is usually footed on standards published by the National Diabetes Data Group (NDDG) (1979) and the World Health Organization (WHO) (1980). The analysis of diabetes is recognized by a finding of fasting plasma glucose (FBS) value greater than 140 mg/dl or a value of 200 mg/dl 2 hours after a 75-gram glucose challenge on the oral glucose tolerance test (OGGT). Non-Insulin-Dependent Diabetes Mellitus The initial estimates, footed on national samples, of the incidence of diabetes in African Americans came from data collected on male World War II registrants age eighteen to forty-five, which recommended that the occurrence of diabetes was greater in White than Black males (Marble, 1949). Since these data were collected over age ranges with a prevalence of distribution toward younger age, where diabetes rates may mainly reveal insulin-dependent diabetes mellitus, they may not offer a factual picture of the occurrence of NIDDM in the races at that time. More current and dependable data from the National Center for Health Statistics point out that, in the United States, the occurrence of known diabetes is higher among African Americans than White Americans mainly among individuals age forty-five to sixty-four, when the rate for Blacks is 50.6 percent higher (Harris, 1990). The occurrence of diabetes augments with age for U.S. Black adults and is about 1.2 times higher for females (Harris, 1990). Among African Americans, the occurrence of diabetes is inversely associated to educational achievement and is highest among individuals in the low income group. Insulin-Dependent Diabetes Mellitus The occurrence of insulin-dependent diabetes mellitus pursues a different racial prototype from that of NIDDM: White children have approximately twice the rate of Black children. (Lipman, 1991). Across the United States, there is much greater inconsistency in the occurrence of IDDM for African-American children than White children. It is probable the variability in IDDM incidence among African-American children might consequence from variations in degree of White admixture in the different registry locations. There is proof that White admixture differs by geographic region in the United States with greater admixture in northern areas than in the south. This is reliable with the drift for more European-American genetic admixture in Allegheny County, Pennsylvania, where the occurrence of IDDM in African Americans is higher, than in Jefferson County, Alabama (Reitnauer et al., 1982) and the incidence of IDDM is lower. Atypical Diabetes Atypical diabetic syndromes, typified by normoglycemic reduction with ensuing periods of hyperglycemic deterioration, generally needing insulin for glycemic control, have been explained in African-American and further Black populations. Winter et al. (1987), accounted an atypical diabetes in young African Americans that shows with features typical of IDDM however lacks the HLA association’s trait of the disease. The insulin dependence in this syndrome was irregular or steadily declined all through the course of the illness. Diabetic syndromes presenting in adulthood with alike phasic insulin dependence have as well been reported. Whereas further forms of diabetes together with protein deficient pancreatic diabetes and fibrocalculus pancreatic diabetes take place in some Black African populations, so far they have not been revealed to be important for African Americans. Type I diabetes reports for three percent of all new cases of diabetes diagnosed every year in the United States. Type I can build up at any age, thus far the majority cases are diagnosed when the individual is under thirty. Type II, the more widespread form of the disease, normally has a steady start, generally appearing in adults over the age of forty (Managing Your Diabetes 1991). It has an effect on an estimated ninety percent of the six million Americans diagnosed with diabetes yearly. The probability of developing Type II is about the same by sex however is greater in African Americans, Hispanics, and Native Americans. Main risk factors comprise a family history of diabetes, obesity, being age forty or over, hypertension, gestational diabetes, or having one or more infants weighing more than 9 pounds at birth (Professional Guide to Diseases 1998). Diabetes mellitus is a main clinical as well as public health problem in the African American community. African American men have an occurrence of diabetes that is eighty percent higher than that for European American men, whereas African American women have occurrence ninety percent higher than that for European American women (Herman et al. 1998:147). These diabetes statistics point out that not merely are there characteristic differences between African Americans and European Americans in the occurrence and hospitalization rates related with diabetes however as well that research is required to find out if any other factors, for instance social and cultural, may be causative to the large difference of diabetes-related problems (Bailey 2000). Cultural Perceptions of Diabetes Mellitus In a study to find out differences in self-reported adherence to a dietary routine, Fitzgerald et al. (1997) analyzed one hundred and seventy-eight African American and European American patients at a Michigan suburban endocrinology clinic from 1993 to 1994. They establish that the 2 groups of patients with non insulin-dependent diabetes (NIDDM) reported similar adherence to dietary recommendations; similar on the whole adherence, beliefs, plus attitudes as calculated by their diabetes care profile scale; and a similar percentage of ideal body weight (Fitzgerald et al. 1997:46). Further analyses, though, exposed that African Americans and European Americans differed in the opinion of diabetes and the view of adherence to the dietary routine for diabetes. Fitzgerald et al. (1997) speculated that among African American women the inspiration to lose weight frequently is not for health reasons however for improved look. The significance of weight loss to ones diabetic condition is de-emphasized, and more significance is placed upon losing weight for better look. If weight loss does not take place, then unconstructive beliefs and attitudes may reduce the individuals inspiration and endorse a â€Å"why bother† attitude, in that way causing nonadherence to the dietary regimen for diabetes (Fitzgerald et al. 1997:46). To work against this â€Å"why bother† attitude as it affects weight loss and dietary adherence, Fitzgerald et al. (1997) recommended that health educators require to assist patients distinguish their feelings regarding diabetes, recognize the habits that their feelings influence their behaviors, and build up tactics for managing with their feelings. The cultural/social functions of food and what food â€Å"means† plus â€Å"represents† to the individual must be measured when developing meal plans and educational interventions for the African American diabetic patient. So as to study more of the fundamental cultural health beliefs related with diabetes mellitus, Maillet et al. (1996) carried out a focus group of African American women with NIDDM and those endangered for this disease. Six African American women susceptible for noninsulin-dependent diabetes mellitus contributed in the northeastern urban medical university in a tranquil and relaxed classroom. The main themes that appeared from the focus groups were the significance of family and social support, a tendency to binge or overindulge when food limitations were placed by family members, difficulties with dietary changes, incapability to build up an exercise program due to multiple barriers, lack of clarity regarding diabetes complications, value for however lack of knowledge regarding prevention of complications, as well as a need for future programs that are ethnically responsive to African American women (Maillet et al. 1996:44). Additionally, a constant theme of this focus group was that family support or a lack of support had an impact on ones stated capability to make dietary alterations. Particularly, Maillet et al. recommended that older African American women discover it hard to make dietary changes for the reason that altering their diet disturbs a lifetime of culture within the context of family. Culture may directly manipulate diabetes education and have to be understood and included into intervention programs to persuade success (Maillet et al. 1996:45). Consequently, when providing care to African American women of all ages, Maillet et al. recommended that the primary health care providers have to be sensitive to the role that culture plays in diet, weight loss, plus diabetes self-management. By means of qualitative and quantitative data collection techniques to examine health beliefs and health care-seeking outlines of African American and Euro-American diabetics, the fieldwork project was performed in 2 phases at the diabetes clinic in the Regenstrief Health Center at Indiana University, Indianapolis. The qualitative phase 1 occurred from June to August 1991, and the quantitative phase 2 from June to December 1992 (Bailey 2000:178). From 9 total site visits over the 5 months, the following noteworthy themes come into view regarding the African American diabetic patient: Appraise the source of the patients diabetes; Effort to dispel any delusions of diabetes; Make active the patient for self-care of diabetes; Carry on to reeducate the patient on blood glucose monitoring as well as insulin injection; and Hearten social and familial support for devotion to diabetic regimen.   Besides, other qualitative results pointed out that physicians required to (1) recognize the sociocultural restraints of a patients keeping appointments; (2) regulate the dietary alteration of the patient to his or her lifestyle and cultural dietary pattern; (3) build up more permanence of care; (4) find out new skills to build up understanding and trust with patients; and (5) give emphasis to the significance of the diabetic condition to the patient (Bailey 2000:182).   Phase 2 (Bailey 2000) consisted of performing qualitative and quantitative observations and interviews of African American and Euro-American diabetic patients. For instance, during the six-month period of phase 2, African American patients shared the following comments:   Patient Informant #1 (African American female): Im not sure what caused my diabetes. I know that there is a family connection to diabetes and my weight has something to do with it, but I dont take all of it too seriously. www.ecu.edu/cs-dhs/ah/upload/Bailey.ppt When asked to assess her capability to pursue the doctors set diabetic dietary regimen, patient informant #1 stated:   My sons and husband want their meals the way they normally have it. They dont want no unseasoned meals, so what am I supposed to do? www.ecu.edu/cs-dhs/ah/upload/Bailey.ppt Patient Informant #2 (African American female): I was on those diabetic pills, but I had to be placed on insulin injections. I hate taking these injections, but I have to do it. www.ecu.edu/cs-dhs/ah/upload/Bailey.ppt   Fascinatingly, patient informant #2 was placed on diabetic pills and told to watch her diet years ago. Though, she stopped taking the pills on a regular basis and did not stick to the diabetic diet routine. Now that she is on insulin injections and closely adhering to the diabetes dietary routine, her insulin injections have slowly been reduced.   Patient Informant #3 (African American male): I was really not shocked when I was diagnosed with diabetes simply because my father and aunt have diabetes and I knew it was a matter of time before I would develop it. www.ecu.edu/cs-dhs/ah/upload/Bailey.ppt   Diabetes is widespread among African Americans and this is because of dietary eating pattern—fried foods and not sufficient vegetables.   Even though patient informant #3 thought that it was a matter of time before he would build up diabetes, he is still unsure of the procedure and the reasons why he developed Type II diabetes. He came to the clinic merely to discover what was wrong with his stomach. To his shock, he was diagnosed with Type II diabetes. The qualitative findings that tend to be more related with the African American diabetic patients than with the Euro-American diabetic patients were as follows: The doubt of the real source of ones diabetes; The lack of perceived importance of ones diabetic condition; The perceived incapability to stick to the diabetic routine; The lower ranking of ones health as compared to other social and family obligations. These qualitative outcomes pointed out that numerous sociocultural issues still require to be further examined in the African American diabetic population (Bailey 2000:184).   Lastly, the former president of the National Medical Association, Yvonnecris Smith Veal (1996), utters that there are three fundamental causes why diabetes carries on to plague the African American community. First, there is the way of life and behavioral patterns related with African Americans for example poor eating habits, obesity, restricted access to enough medical care, and restricted funds. African Americans generally tend to eat foods high in calories and loaded with saturated fats and sugar and to have an inactive lifestyle—all of which are causative factors to being overweight. Second, African Americans have a history of making foods with lard and other heavy oils. This sort of food preparation, together with the incapability to get a balanced diet, contributes to the risk factors related with diabetes. Third, African Americans require more choices to decide dietary diabetic routines that fit the preferences for certain foods plus eating practices among all segments of the African American population (Bailey 2000).   Factors Influencing the Occurrence of Diabetes in African Americans Significant factors influencing the incidence of diabetes mellitus in African Americans comprise personal characteristics for instance genetics, age, sex, plus history of glucose intolerance (IGT, GDM). Further routine factors for instance physical activity plus obesity, which are related with altering socioeconomic as well as cultural climates within countries, to a great extent have an effect on the risk of developing the disease. Even though the exact etiological interactions remain arguable, it is definite that a mixture of most of these factors is accountable for precipitating the disease. Genetics An individuals risk of developing diabetes mellitus is significantly influenced by his/her hereditary background. Individuals who are first-degree relatives of diabetes patients are at noticeable augmented risk of developing the disease compared to unrelated individuals in the general population. (W.H.O. Multinational, 1991). Proof from studies of identical twins specifies a concordance rate of about ninety percent for NIDDM and fifty percent for IDDM, representing that the influence of genetics is greater in the former than in the latter (Barnett, Eff, Leslie Pyke, 1981). The investigation for the hereditary reasons that rates of diabetes fluctuate in different ethnic groups has caused hypotheses that try to report for the observed frequencies of NIDDM and IDDM in African Americans. (Tuomilehto, Tuomilehto- Wolf , Zimmet, Alberti Keen, 1992) Thrifty Gene Hypothesis Neel (1962) recommended that populations exposed to intermittent food shortage would through natural selection augment the incidence of genetic traits, thrifty genes, that incline to energy conservation. These genes would augment survival during times of famine by permitting for adept storage of fat in times of abundance. In the absence of feast and famine cycles, in times of continued profusion, these genes would turn out to be detrimental, predisposing to the growth of obesity and an augmented frequency of NIDDM. This hypothesis would be constant with the observation of much higher rates of diabetes and obesity among African Americans and urban Africans compared to Black Africans residing in conventional environments. Age and Sex In the majority populations the occurrence of diabetes differs with age and sex. For African Americans, the peak age range for diagnosis of IDDM is about fifteen to nineteen years of age, whereas NIDDM occurs more often after age fifty-six, when it is 3 times more common than in the White population (Roseman, 1985). African-American females are more probable to build up IDDM compared to Black men are more probable to develop NIDDM than Black men, White women, and White men, correspondingly (Harris, 1990). The sex discrepancy for IDDM may be because of differences in vulnerability or experience to etiologic agents (Dahlquist et al., 1985). Differences in NIDDM by gender may be because of differences in the levels of related risk factors such as obesity plus physical activity.   Socioeconomic Status (SES) Racial differences in disease rates may reveal socioeconomic differences. In the United States socioeconomic status and the frequency of NIDDM have a converse relationship. The impact of SES on NIDDM rates among African Americans may be particularly strong. Studies concerning socioeconomic status to the development of IDDM have been contradictory. Some studies establish a positive relationship. Others have found a negative (Colle et al., 1984) or no relationship at all. It appears improbable that socioeconomic status contributes considerably to racial differences in the frequency of IDDM in the United States. Obesity Obesity, usually measured as body-mass index (BMI)), is the most important risk factor for NIDDM. Overweight is a severe problem for the African-American female, with the level of obesity (that is BMI 27.3) being greater than fifty percent among women older than age forty-five (Van Itallie, 1985). Compared to White women, African-American women are more overweight. African-American men demonstrate a similar prototype of obesity when compared to White men (Van Italie, 1985).   The development of NIDDM is not merely influenced by the presence of obesity however as well by where the body fat is distributed. The danger of developing NIDDM is greater for individuals with central or android obesity. African Americans have been accounted to have a greater propensity to store more fat in the trunk than Whites, which could clarify part of the excess occurrence of NIDDM in the Black population (Kumanyika, 1988). Physical Activity There is proof that physical inactivity is an independent danger factor for developing NIDDM (Taylor et al., 1984). On the other hand, exercise perhaps a strong defensive factor against the development of the disease. On the whole there is a converse association between levels of obesity and physical activity. Consequently, higher levels of obesity among U.S. Blacks compared to Whites propose that reduced levels of physical activity among African Americans may donate to their higher rate of diabetes. Insulin Resistance The danger of developing NIDDM is absolutely related with fasting levels of circulating insulin. It has been revealed that insulin resistance, typified by hyperinsulinemia, can predate the development of NIDDM for years. besides diabetes, insulin resistance causes numerous interrelated disorders together with hypertension, body fat mass and distribution, as well as serum lipid abnormalities (Ferrannini , Haffner, Mitchell Stern, 1991). This has encouraged speculation that hyperinsulinemia and/or insulin resistance may be the phenotypic expression of the thrifty genotype anticipated by Neel (1962). Impaired Glucose Tolerance (IGT) and Gestational Diabetes Impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM) are 2 types of glucose intolerance that are strong risk factors for developing NIDDM and IDDM. Gestational diabetes denotes the development of diabetes during pregnancy and a subsequent return to normal tolerance following parturition, whereas IGT is the class of glucose tolerance where fasting glucose values are between normal and diabetic. (OSullivan Mahan, 1968). The risk of developing obvious diabetes among individuals with IGT is associated to the severity of impaired tolerance plus presence of further risk factors, together with a positive family history of diabetes and obesity (Harris, 1989). Numerous risk factors for GDM have been recognized among African-American women, including age, gravidity, hypertension, obesity, plus family history of diabetes (Roseman et al., 1991).   Diabetes Mortality At present, diabetes mellitus is the 3rd most recurrent cause of death from disease among African Americans. Higher rates of diabetes mortality in African Americans compared to the White population may partly be because of their higher occurrence of diabetes. When mortality among individuals who have developed diabetes is measured, though, it emerges that African Americans have a lower mortality rate than Whites with the disease (Harris, 1990). In recent years, there has been a leveling off in the rate of mortality from diabetes for both races.   Diabetic Complications Chronic diabetes mellitus is related with numerous overwhelming complications that reduce the quality of life and cause early mortality. These comprise hypertension, diabetic retinopathy, neuropathy, nephropathy, as well as macrovascular complications.   In the United States, African Americans with diabetes have higher rates of hypertension than Whites. The constancy of high rates of hypertension among African Americans and Afro-Caribbean populations (Grell, 1983) has caused the proposition that Western Hemisphere Blacks are offspring of a highly selected group of Africans who were efficient at retaining salt, which permitted them to uphold sodium homeostasis and survive the long sea voyages from Africa (Grim, 1988). Recent proof proposes that high rates of hypertension among African Americans might be associated to hyperinsulinemia plus abnormal renal sodium transport (Douglas, 1990). Information on the incidence and impact of other diabetes-associated complications are limited. Though, retinopathy, neuropathy, and stroke emerge to be more recurrent in African Americans than Whites with diabetes (Roseman, 1985). The rate of lower limit amputations ensuing from diabetes has been reported to be considerably greater among U.S. Blacks than Whites. Occurrence rates of diabetic end-stage renal disease (ESRD) have been revealed to be greater for African Americans than for Whites. After developing ESRD though, U.S. Blacks emerge to survive longer than Whites. There is as well some implication that certain cardiovascular complications including angina and heart attack may take place less often among African Americans than among Whites with diabetes (Harris, 1990).   It has been recommended that the on the whole higher rates of diabetes complications among African Americans might be associated to poorer metabolic control. Additionally, the high rate of hypertension among African Americans with diabetes may make worse or make haste the start of other complications for example retinopathy and nephropathy. Other significant risk factors for diabetes complications comprise age of onset, education, cigarette smoking, socioeconomic status, plus access to medical care (Roseman, 1985).   Prevention and Intervention Strategies The main metabolic defect of type 2 diabetes is insulin resistance in association with a relative and progressive deficiency in insulin secretion. This insulin resistance, present in many tissues, makes its primary contribution to hyperglycemia by reducing peripheral glucose uptake in muscle and failing to suppress hepatic glucose output. Additionally, resistance in adipose tissue to insulin-mediated suppression of lipolysis results in an elevation of free fatty acids (FFAs) and a further aggravation of hyper-glycemia. The degree of insulin resistance observed in diabetic subjects may vary according to a subjects ethnic background, body mass index (BMI), and physical activity. Pharmacologic intervention with either metformin, a biguanide, or a thiazolidinedione (TZD) has been successful in reducing insulin resistance in subjects with type 2 diabetes. In the management of the majority forms of diabetes, there is a need to be concerned concerning the acute complications of hypoglycemia and ketoacidosis and/or development of acute hyperosmolar crises. Hypoglycemia, a major treatment concern in type 1 diabetes, is much less frequent with type 2 diabetes and is discussed later in association with specific therapies. Although DKA and hyperosmolar crises have been reported in children with type 2 diabetes, they are uncommon, in our experience after initial presentation, but such crises have been reported. About 10-15% of children and adolescents with type 2 diabetes present at diagnosis with DKA, hyperosmolar crisis, or a combination of these states. The long-term goals in the management of type 2 diabetes are twofold: first, the prevention of microvascular complications, including retinopathy, nephropathy, and neuropathy; secondly, the prevention of macrovascular complications such as atherosclerosis of the coronary, cerebral, and large arteries of the lower extremities. These lead to myocardial infarction, stroke, and amputation, and are the major causes of morbidity and mortality with type 2 diabetes. The development of these complications is multifactorial, but is influenced by associated hypertension, dyslipidemia, and hyperinsulinemia in addition to the effects of hyperglycemia. The aim of therapy in type 2 diabetes is to specifically target the underlying metabolic defects of this disorder, which are obesity, abnormal insulin secretory function, and the insulin resistance present in the three primary insulin responsive tissues skeletal muscle, fat, and liver. The first approach is to reduce obesity through lifestyle interventions in diet and exercise. In addition, the introduction of an ÃŽ ±-glucosidase inhibitor may be considered to delay carbohydrate digestion and absorption, reducing peak postprandial hyperglycemia. A second therapeutic approach is to address insulin secretory dysfunction with insulin secretagogues such as sulfonylureas or meglitinides. Alternatively, or if these secretagogues are ineffective, exogenous insulin can be initiated. A third approach is to address tissue-specific insulin resistance. Metformin can decrease hepatic glucose output and improve peripheral insulin sensitivity. Thiazolidinediones have been successful in improving peripheral insulin resistance in type 2 diabetes in adults; however, experience with these therapeutic agents is limited in children. At present, diabetes mellitus remains a serious problem tackling the African Americans population. High diabetes mortality rates reflect merely part of the problem. The viewpoint of increasing diabetes occurrence rates casts a threatening shadow over the future for the African Americans community. The morbidity related with diabetic complications places a great financial burden on individuals and communities least able to bear the cost of such an illness. Evidently, the challenge of addressing the problem of diabetes mellitus in the African Americans population is great and will need a multidisciplinary approach involving government, researchers, educators, as well as members of the African Americans community. Health Promotion Of main importance is the requirement for distribution of information regarding diabetes and its consequences into the African-American community. An uneducated African-American community may be inclined to undervalue the diabetes problem or to pay less attention to the signs and symptoms of its commencement. This may outcome in late diagnosis or care, thus raising the probability of rapid start of complications. Consequently, ethnically sensitive strategies intended to get involved and educate African Americans on the subject of the behavioral and environmental risk factors for diabetes plus its complications are necessary. Undoubtedly, in order for African Americans to take steps to lessen the diabetes linked morbidity and mortality in their communities they have to have the capability to make informed decisions regarding the disease. Cooperative Efforts for Provision of Health Services Rates of diabetes mortality and complications may depend on the accessibility and permanence of care. There is some sign that African Americans with diabetes may be underserved regarding medical care (Harris, 1990). Cautious study of this problem is needed, and innovative solutions have to be developed. The African-American community must as well become empowered to expect and demand the essential care they deserve. To have an effect on such change, community based institutions, for instance the church, can build up programs for using the health professionals within their congregations to offer care or therapy to diabetics and their families. Organizations concerned with minorities, for instance the UrbanLeague, can comprise diabetes and further health problems in their national agendas to generate concern and act at the community and national levels.   Governmental agencies and institutions engaged in training health professionals, for example medical schools and schools of public health, must institute action to augment the pool of African Americans in the professions concerned with the care of individuals with diabetes. Federal agencies, for instance the National Institutes of Health, may as well offer special grant programs to hearten submission of research grants to study diabetes in African Americans and to improve the growth of minority researchers in the area.   Research The inadequate data presently accessible on diabetes among African Americans raise numerous questions however deliver few answers regarding the etiology and natural history of diabetes plus its complications in this racial group. Up to now, a small number of studies of diabetes in the United States have included representative samples of African Americans. This inadequacy has to be addressed if future studies are to give way valid conclusions concerning the factors accountable for the incidence of the disease in the African-American population. In the Report of the Secretarys Task Force on Black and Minority Health (1985), numerous research priority areas for addressing the health disparity between Black and White Americans were recognized. These areas are mainly pertinent to diabetes mellitus and comprise the following: (1) investigation into risk-factor recognition, (2) investigation into risk-factor occurrence, (3) investigate into health education intrusions, (4) investigation into prevention services interventions, (5) investigation into treatment services, as well as (6) investigation into sociocultural factors and health outcomes. The recognition of these target areas for investigation and other recent efforts by the Department of Health and Human Services to endorse the study of diabetes in the African-American population (Sullivan, 1990) are significant steps toward addressing the gap in awareness of how diabetes have an effect on African Americans. In the future we have to translate the knowledge achieved from new and continuing studies into efficient preventive action.    References:   Bailey, Eric (2000). Medical Anthropology and Africans American Health. Westport, CT: Bergin Garvey. Centers for Disease Control (CDC). (1990). Diabetes surveillance: Annual 1990 report. U.S. Department of Health and Human Services, Centers for Disease Control, Division of Diabetes Translation, Atlanta GA Colle E., Siemiatycki J., West R., Belmonte M. M., Crepeau M. P., Poirier R., Wilkins J. (1984). Incidence of juvenile onset diabetes in Montrealdemonstration of ethnic differences and socioeconomic class differences. Journal of Chronic Disease, 34, 611-616. Dahlquist G., Blom L., Holgren G., Hogglof B., Larsson Y., Sterky G., Wall S . (1985). The epidemiology of diabetes in Swedish children 0-14 years: A six year prospective study. Diabetologia, 28, 802-808. Douglas J. G. (1990). Hypertension and diabetes in blacks. Diabetes Care, 13 (Supp. 4), 1191-1195. Ferrannini E., Haffner S. M., Mitchell B. D., Stern M. P. (1991). Hyperinsulinemia: The key feature of a cardiovascular and metabolic syndrome. Diabetologia, 34, 416-422. Fitzgerald, James, R. Anderson, M. Funnell, M. Arnold, W. Davis, L. Aman, S. Jacober, and Grunberger (1997). â€Å"Differences in the Impact of Dietary Restrictions on Africans and Caucasians with NIDDM.† The Diabetes Educator 23: 41-47. Grim C. E. (1988). On slavery, salt and the greater prevalence of hypertension in black Americans. Clinical Research, 36, 426A. Harris M. I. (1990). Noninsulin-dependent diabetes mellitus in black and white Americans. Diabetes Metabolism Review, 6, 71-90. Herman, William, T. Thompson, W. Visscher, R. Aubert, M. Engelgau, L. Liburd, D. Watson, and T. Hartwell (1998). â€Å"Diabetes Mellitus and Its Complement in an Africans American Community: Project DIRECT.† Journal of National Medical Association 90: 147-156. Kumanyika S. (1988). Obesity in black women. Epidemiology Review, 9, 31-50. Lipman T. H. (1991). The epidemiology of Type I diabetes in children 0-14 years of age in Philadelphia. Doctoral dissertation, University of Pennsylvania, Pennsylvania. Report of the Secretarys Task Force on Black and Minority Health. ( 1985). Volume 1: Executive Summary. DHHS Publication No. 017-090-00078. Washington, DC: Government Printing Office. Maillet, Nancy, G. Melkus, and G. Spollett (1996). â€Å"Using Focus Groups to Characterize the Health Beliefs and Practices of Black Women with Non-Insulin Dependent Diabetes.† The Diabetes Educator 22: 39-46. Marble A. (1949). Diabetes mellitus in the U.S. Army in World War II. The Military Surgeon, 105, 357-363. National Diabetes Data Group (NDDG). (1979). Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes, 26, 1039-1057. Neel J. V. (1962). Diabetes mellitusA thrifty genotype rendered detrimental by progress? American Journal of Human Genetics, 14, 353-362.   OSullivan J. B., Mahan C. M. (1968). Prospective study of 352 young patients with chemical diabetes. New England Journal of Medicine, 278, 1038-1041. Professional Guide to Diseases (1998). Springhouse, PA: Springhouse. Reitnauer P. J., Go R. C. P., Acton R. T., Murphy C. C., Budowle B., Barger B. O. , Roseman J. M. ( 1982). Evidence of genetic admixture as a determinant in the occurrence of insulin-dependent diabetes mellitus. Diabetes, 31, 532-537. Roseman J. M., Go R. C. P., Perkins L. L., Barger B. D., Beel D. A., Goldenberg R. L. , DuBard M. B., Huddlestone J. F., Sedacek C. M., Acton R. T. ( 1991). Gestational diabetes among Africans American women. Diabetes and Metabolism Review, 7, 93-104. Sullivan L. (1990). Opening remarks. Diabetes Care, 13 (Supp. 4), 1143. Taylor R., Ram P., Zimmet P., Raper R., Ringrose H. ( 1984). Physical activity and the prevalence of diabetes in Melanesian and Indian men in Fiji. Diabetologia, 27, 578-582. Tull E. S., LaPorte R. E., Vergona R. E., Gower I., Makame M. H. ( 1992). A two-fold excess mortality among Africans American IDDM cases compared withWhites: The Diabetes Epidemiology Research International experience Van T. B. Itallie (1985). Health implications of overweight and obesity in the United States. Annals of Internal Medicine, 103, 983-988. Veal, Yvonnecris (1996). â€Å"Africans Americans and Diabetes: Reasons, Rationale, and Research.† Journal of the National Medical Association 88: 203-204. WHO Multinational Project for Childhood Diabetes. (1991). Familial insulin-dependent diabetes mellitus (IDDM) epidemiology: Standardization of data for the DIAMOND Project. World Health Organization Bulletin OMS, 69, 767-777. Winter W. E., Maclaren N. K., Riley W. J., Clarke D. W., Kappy S., Spillar R. P . (1987). Maturity-onset diabetes of youth in black Americans. New England Journal of Medicine, 316, 285-291. World Health Organization. (1980). Report of expert committee on diabetes mellitus. Technical Report, Series no. 646. Geneva: World Health Organization. http://etd.fcla.edu/SF/SFE0000527/AfricanAmericanWomen.pdf www.ecu.edu/cs-dhs/ah/upload/Bailey.ppt

Creating Sympathy for the Johnston Family in Blood Brothers :: Blood Brothers Willy Russell Essays

Creating Sympathy for the Johnston Family in Blood Brothers Blood brother is a tragic tale about two twins who were parted at birth and as a result, led very different lives. The playwright, Willy Russell portrays the circumstances in which the twins were conceived, born and parted and also gives us an insight into how society has the influence of shaping individuals according to the classes they are in. We, the audience are made to sympathize with Mrs. Johnston on many occasions varying from the beginning of the play, even before the twins are born to the end of the play, when we learn about their unfortunate death. In the play Blood Brothers we see the upbringing of two so called blood brothers, Eddie and Mickey who are bought up in two different lifestyles. Mrs. Johnston is the mother of seven children and is already on the way of expecting twins that were to be parted soon after. This is told to us via the narrator, who states, that the mother â€Å"stood and watched brother parted from brother†. Willy Russell uses various techniques to create sympathy for the Johnston family. We also need to take into account the language barrier between the two brothers because they have been brought up in two different back grounds and have been taught different principles. Eddie seems to behave in a more socially acceptable manner whilst Mickey is louder. The play starts of by describing Mrs. Johnston’s life and her marriage. The author quotes â€Å"that I was six weeks overdue† which makes us the audience feel sorry for her. It also describes the place of marriage which was at the registry office. â€Å"We got married at the registry and had a do†. This suggests to us the audience that the wedding was nothing too fancy, not too expensive and that the marriage was sudden and unexpectant. She got married because she was expecting a baby, in difficult, circumstances to get married in. we soon learn that Mrs. Johnson is trapped in her life. Soon after the wedding she still wanted to enjoy herself as she did before but her husband became very conscious of her appearance and felt embarrassed to be seen with her. This is evident due to the fact that she gained weight and now perceived herself to be â€Å"twice the size of Marillyn Monroe†. Russell also uses a lot of ironic devices in the play. It’s ironic due to the idea that her husband left her â€Å"for a girl, they say who looks a bit like Marillyn Monroe†. The audience feels sympathetic towards her because she has seven children and low self esteem. Creating Sympathy for the Johnston Family in Blood Brothers :: Blood Brothers Willy Russell Essays Creating Sympathy for the Johnston Family in Blood Brothers Blood brother is a tragic tale about two twins who were parted at birth and as a result, led very different lives. The playwright, Willy Russell portrays the circumstances in which the twins were conceived, born and parted and also gives us an insight into how society has the influence of shaping individuals according to the classes they are in. We, the audience are made to sympathize with Mrs. Johnston on many occasions varying from the beginning of the play, even before the twins are born to the end of the play, when we learn about their unfortunate death. In the play Blood Brothers we see the upbringing of two so called blood brothers, Eddie and Mickey who are bought up in two different lifestyles. Mrs. Johnston is the mother of seven children and is already on the way of expecting twins that were to be parted soon after. This is told to us via the narrator, who states, that the mother â€Å"stood and watched brother parted from brother†. Willy Russell uses various techniques to create sympathy for the Johnston family. We also need to take into account the language barrier between the two brothers because they have been brought up in two different back grounds and have been taught different principles. Eddie seems to behave in a more socially acceptable manner whilst Mickey is louder. The play starts of by describing Mrs. Johnston’s life and her marriage. The author quotes â€Å"that I was six weeks overdue† which makes us the audience feel sorry for her. It also describes the place of marriage which was at the registry office. â€Å"We got married at the registry and had a do†. This suggests to us the audience that the wedding was nothing too fancy, not too expensive and that the marriage was sudden and unexpectant. She got married because she was expecting a baby, in difficult, circumstances to get married in. we soon learn that Mrs. Johnson is trapped in her life. Soon after the wedding she still wanted to enjoy herself as she did before but her husband became very conscious of her appearance and felt embarrassed to be seen with her. This is evident due to the fact that she gained weight and now perceived herself to be â€Å"twice the size of Marillyn Monroe†. Russell also uses a lot of ironic devices in the play. It’s ironic due to the idea that her husband left her â€Å"for a girl, they say who looks a bit like Marillyn Monroe†. The audience feels sympathetic towards her because she has seven children and low self esteem.

Coffee Cafe Business Plan Essay

Cafà © Vancouver is a new coffee shop at Granville and Robson Street in Vancouver Downtown. The hustle and bustle of downtown need a quiet, fast-paced life make people feel tired, we want our customers to relax while enjoying a coffee. Cafà © Vancouver’s team will make the best effort to create a unique place where customers can get together with each other in a comfortable and relaxing environment while enjoying the best-brewed coffee or espresso and breakfast style treats in town. We will be in the business of helping our customers to relieve their daily stresses by providing peace of mind through great ambience, convenient place, friendly customer service, and products of consistently high quality. We welcome guests of all ages; we can guarantee each guest to enjoy high-quality coffee. Vancouver Downtown has many companies, offices and shopping centers, with a strong customer base and revenue opportunities. Meanwhile, 365 days a year we will have no holiday leave, to make sure that we have opportunity to serve guests at any time. We also have a pragmatic management team. Head is the General Manager; he has a degree in Economics from the Russian Far Eastern University, and has more than six years of experience in business operations. He is the general manager, and a cafe investor. Team1 supervisor is Supervisor1 with four years of broad experience working at coffee shops and restaurant industry. Team2 supervisor is Supervisor2; he has 2 years of experience in the restaurant industry. We provide training for up to three months, including company culture, coffee brewing, food safety, and so on. All employees of our company will be well-trained and enthusiastic moderator. The financial position of the company is essential to develop the company’s financial data, including investment, net profit and so on. After the financial position and profitability assessment, in three years of operation, we expect to have profit of about 818,700 dollars (net profit after tax), with average annual net profit of 272,900 dollars will give adequate funding for our company. Compared with other coffee brands in the industry, we expect to grow faster. In the long-term, we will consider opening new cafes in different locations throughout Canada. The Company and Industry Business goals Coffee is more than a beverage; however, it is a memory, anticipation, and a lifetime of consoling moments of modest pleasure woven into our lives. Coffee’s success as a beverage undoubtedly owes both to the caffeine it harbors and to its sensory pleasure. Coffee lovers come to associate the energizing lift of the caffeine with the richness and aroma of the beverage that delivers it. Our Business goal is â€Å"to make our customers return to the simple concept of coffee, quietly enjoying every cup of coffee.† We are planning to open two stores in the Vancouver area within three years. The company Mission statement â€Å"We want our customers to return to the simple concept of coffee, quietly enjoying every cup of coffee.† Vision Statement â€Å"To grow the business and protect the rapid development of the enterprise.† The Industry Although Canada does not have the proper climate for growing coffee, Canadian-based firms do import raw materials for processing and resale into domestic and export markets. Coffee manufactured for retail and Food service markets has been an important part of food and beverage processing in the country for many years. Coffee is the most popular hot beverage in Canada with a total of 14 billion cups consumed annually. An estimated 64% of Canadians drink coffee each day, which is equal to 6.8 kilograms of green coffee or 12.7 pounds of roasted coffee per head, with 86% of adult coffee drinkers consuming the beverage in the morning or for breakfast. In-home continues to be the dominant place for consumption with just over half of Canadian consumers (51%) drinking coffee at home. Among adult coffee drinkers, the share of cups (80%) of traditional coffee made at home is eight times higher than the share of cups purchased from the market (11%).  57% of coffee purchased at coffee shops. The coffee is also the top beverage in the Canadian Foodservice category. Canada has a highly developed away-from-home coffee market and is second only to Italy in highest percentage of total cups of coffee consumed outside the home. Other consumer demands include information on the origin/source, and locally grown, fair-trade, organic, and green coffee products. The coffee industry has been quick to respond to this lucrative market, worth about $650 million a year in Canada. Products and Services The Cafà © Vancouver will proudly offer its customers the best tasting coffee and tea beverages with breakfast style treats in the area. Our highly trained staff with a passion and talent combined will provide the best customer service in competition. The friendly and polite staff will also provide a cozy environment for customers to make them feel home, and every staff member will be required to give million dollar smile to our customers. In future, we will be looking forward to train our employees in further customer and coffee-making services. The products we offer will taste better than anything in the competition. This will be achieved with the high quality ingredients and products, by strictly believing in providing quality. The menu will cover coffee, steeped specialty teas, espresso latte and beverages, classic hot beverages, cold beverages, espresso on ice, sweet baked goods, yogurt, and grilled sandwiches and wraps. The Cafà © will be offering free books; magazine, daily newspaper and WI-FI for eating in clients to make them feel entertained and relaxed. By keeping in mind the importance of internet, we will provide speed WI-FI for our customers. There will also be four televisions at display in the cafà ©, which will be playing channels on popular demand. During the normal working hours of our cafà © there will always be entertaining music playing for our customers. In future, we will be updating our product and services with the popular demand. With the business plan there is a menu given below which will provide further details about the products we will offer. MARKET ANALYSIS Coffee business in recent years has been a bright spot for those who want to start-up their own business. While there are a number of other businesses out there many categories facing poor sales, negative balance sheets but coffee cafes are continuing to show strong growth. It’s very clear that Canadians love coffee continues throughout the year. Target market The place for our Cafà © Vancouver business is located at the intersection of Robson Street and Granville Street, which is in the downtown and one of the best locations for our coffee-house for opening up our cafe. Downtown is the main part of Vancouver and remains busy all throughout the year. According to our research we found that there is year round tourist activity all across Vancouver plus there are lots of businesses nearby our place. Robson Street is famous for its shopping stores all over Canada. In target market, we will target people from young to senior citizens. At the intersection, there are excellent auto and pedestrian traffic by the place which will give some customers each day. There are busiest areas and Sky train stations near to our place so we can attract local people or travelers passing through Downtown. Market size and trends: According to the census 2009 The Robson Street is regarded as a 3rd BIA (business improvement area) in Vancouver. The retail and service business is really higher on Robson street because of its popularity and there are 29% eating and drinking places on the Robson street. The retail business is 69% on Robson and 24% in the rest of Great Vancouver. It is one of the biggest shopping destinations in Vancouver. As the target market for our product and service is mainly tourists, local residents, business people, and students. There are 79,140 residents and 145,000 daytime employee bases; population density is triple than Vancouver average. The growth for the market had increased from last year because of the innovation; lots of people emigrated there because of business opportunities. According to the census there are 39 commercial properties and 222 businesses on the Robson Street. By targeting all market segments, Cafà © Vancouver will not focus on one segment  of market like for ma ny other coffee shops. Cafà © Vancouver will avoid these barriers in business with a customer mix of all segments and in coming years we expect to increase our market share in coffee business. Competition Cafà © Vancouver will uniquely place itself in the most competitive area of Vancouver downtown. The place chosen for a cafe has competitors such as Blenz coffee, Starbucks, cafe crepe, Tim Horton’s, Waves coffee, 7 eleven and David’s tea. It will be challenging to compete with well-established business, but cafe will give most delicious products at very reasonable prices. Our prime competitors (see Appendix # 1): Blenz coffee (www.blenz.com): Blenz opened their first coffee shop in February 1992 on Robson and Bute Street. They are famous for handmade coffee. They have 61 stores in British Columbia. They also are doing business internationally like in Japan and Philippines. Their store cost range from $225,000 to $400,000. Tim Horton’s (www.timhortons.com): The Tim Horton’s chain was found in 1964 in Hamilton, Ontario. The chain’s focus on top quality, always fresh product, value, great service and community leadership have allowed it to grow into the largest quick service restaurant chain in Canada specializing in always fresh coffee, baked goods and home-style lunches. Wave’s coffee (www.wavescoffee.com): The Waves Coffee House franchise was founded in 2005 at Hastings and Richards Street in downtown Vancouver British Columbia. In 2008, Waves coffee was recognized by the Brand Coaches as the â€Å"Hottest Brand in Canada†. They have also been recognized as the â€Å"Best of Brands† by over 1,500 coffee retailers. Today there are 31 Waves across British Columbia and Alberta – with more to come. Starbucks (www.starbucks.ca): Starbucks is one of our prime competitors located near intersection of Robson and Granville. Starbucks is one of biggest coffee companies in North America with headquarters in Seattle, Washington. Starbucks has 20891 stores in 62 countries and 1324 of them are in Canada with generating revenue around $13+billion. Cafà © crepe (www.cafecrepe.com): Established in 1999; cafe crepe imports tradition of the classic European cafà © to North America, Cafà © Crà ªpe specializes in Parisian sweet & savory crà ªpes, French baguette sandwiches, and grilled Italian Panini. As an  international cafà ©, Cafà © Crà ªpe also offers world classics like a half pound certified Angus burgers, pommes frites (French fries), thin crust pizza, and a full traditional breakfast menu that includes Eggs Benedict and an exciting variety of omelets, among other specialties. In addition to serving exceptional Italian roasted Lavazza coffee, Cafà © Crà ªpe is fully licensed, offering a vast choice of alcoholic beverages and cocktails, along with select beers and wines. 7-eleven (www.7-eleven.com): Since 1927, 7 Eleven has grown and evolved into the world’s largest operator, franchisers and licensor of convenience stores. The company operates franchises and licenses more than 8,600 stores in the U.S. and Canada. Of the more than 7,800 stores the company operates and franchises in the United States, more than 6,200 are franchises. Estimated sales and market share: With the targeting mix that we are focusing on, we expect the average of 400 to 600 persons per day during the first year. We have estimated our customer expenditure about $3.5 due to premium pricing on some of the items. We presume that the total cost of sales would be about 14%. We expect the growing of our sales to 700+ customers per day for the second year of operations. And when the business will be stable and well-known we can reach the level of 800+ customers per day. The Marketing Plan Pricing There are various aims of pricing that we will focus on Survival Profit maximization Market share goals. Pricing Depends on various factors: Internal Factors- Marketing mix strategy Costs External Factors- Nature of the market Competition Competition Based Pricing- We will also be using this strategy at some stage when we get a stable number of customers in the market and then we can look at a prices level among our direct competitors, so we can adjust our prices according to that. Marketing Penetration strategy- We can charge slightly less what our direct competitors are charging for the same product. The Penetration strategy is usually used for quickly achieving a high volume of sales and to attract customers. Under this strategy product is widely promoted and price is kept comparatively low. As we will be new in the market, we will definitely go for a penetrating, this way we can have a bond with regular customers and can attract new customers. We created a detailed list of prices which we are going to start-up the cafà © with (see Appendix # 2). Advertising and Promotions Newspaper and Magazines- This will also be a good way of advertising of our product to market. We can promote our latest product in daily or weekly newspaper to give our customers as an offer for the first day of new product. We will be giving ads in local newspaper 45 days before the opening of our Cafà ©. The newspaper charges about $6 per column inch, so an ad that is two columns wide and two inches tall would be $24 for each day. Putting up Signs in Neighborhood- This is also a unique way to attract customers. The signature of our coffee shop will be placed in different locations, so people can see the ad of new coffee shops and they might come to try something new. For 100 boards it will cost around $900. Hand out values cheque- We will attract customers by giving value cheque worth $10 to first 100 customers. They will be eligible to redeem the money at any giving point of time. When we open the store, it will create a big attraction to customers. Hand out flyer discount offer - We will distribute flyers by dropping it to mail boxes, attaching any discount offer on their first coffee, sandwich or any snack. We will make our flyers on Closest to DL (95mm x 210mm) so it will be inexpensive to make 50 flyers will cost $9.74+ tax. So 1000 flyers will cost $194.80+tax. Social Media- We will also  promote our cafà © through social media like Facebook, Twitter and YouTube. We will tweet the promotional offer on twitter, so customers can have an access to discount coupons online. Website- We will create our website and advertise all our products there, so people can know about our products. There will be some discount coupons on the website, the customer could print it and redeem at any point in the store. It will cost us for a basic website $2500 to $3000 and to manage the website and to develop it $75 to $100 per hour. So this will be less expensive than social media and own company website can give people better option to have a look at our menu and daily or weekly promotions. Development plan: Development status: Our business plan is on developing stage. We have a very good plan to start our business, having the past experience of some partners will help us managing the coffee-house. We are going to lease the place in Vancouver Downtown on the intersection of Robson and Granville. We are planning to start the construction work first, after that we will give priority to the interior work. Next, we will arrange and fit the machines and dishwashers according to our layout. Along with the customer service we are providing customers with free WI-FI hotspot, cable TV and comfortable chairs and couches. So our customers can enjoy their coffee while sitting and watching TV or surfing the Internet. Proprietary issues: This is the trademark for our cafà ©. It is going to distinguish our service from those who are doing the same business in the market place. The registration of trademark is not mandatory but we are going to register it before the opening, because it gives us obvious proof of ownership. Furthermore, we are going to test our products like coffee and other eatable items through the CISPR EMC testing laboratory under the Canadian standard association plus we will test our cafà © under UL testing laboratories for safety. After getting the approval, we will give some free samples to potential customers for promotion and feedback. Operations plan Location The coffee shop will be at Granville and Robson Street in Vancouver Downtown (see Appendix # 3). It would be an excellent place with constant shoppers during the week plus business people and people who work in Downtown during weekdays. The coffee shop will be conveniently in the heart of the most popular shopping area in Vancouver and close to the Vancouver City Centre Sky Train station, which would allow attracting more transit people. Due to the enormous market size, the growth at this area rate would be considerable. The Vancouver Cafà © will give highly comfortable seats for 24 customers with hours of operation from 6AM to 8PM. Facilities The total space available for the cafà © of 600 sq. feet will offer the space for a lounge seating area, fireplace, bookshelf, back room, handicap-accessible washroom, and kitchen (See Appendix # 4). The premises are available for lease at an asking rate of $30 per square foot, net. The total annual rent would be equal to $180,000, which equates to $15,000 per month, as the listing agent informed us that the lessor is willing to reduce the monthly payment from $18,000 to $15,000. We will be eligible for the discount in case of a lease contract for at least three years term. The lessee will be expected to give a personal guarantee together with a security deposit of $10,000. Equipment To start-up our business, a variety of equipment are required. As mentioned in the â€Å"Development† section, we will need to buy a list of equipment costing in total of $ 28,344 (see Appendix # 5). All the equipment will be brand new and prices listed include delivery and setting in place. All the items will be purchased from Stealth Coffee Systems Inc. As we already negotiated, we would be eligible for an additional discount of 5%, if the amount will be paid within 90 days after the purchase. So, the estimated amount with discount will be paid for the equipment equals to $26,927. The installation of the equipment will cost us additional $ 25,000. Lead time for the delivery of the equipment is three to four weeks. The equipment will be amortized by using the straight-line method with an estimated useful life of 15 years. Supply Chain Pacific Coffee Roasters has been chosen to be the primary supplier for the best specialty coffee. The company is conveniently located in Downtown, close to our coffee shop. Pacific Coffee Roasters is a broad line coffee distributor which will satisfy all our supply needs. The inventory will be checked twice a week to make sure that we have enough in back stock. The entire inventory will be placed by dates of receiving to follow the â€Å"first in first out† system. We are expecting to place orders and receive new inventory on a weekly basis. Human Resources To operate the coffee shop we will need to hire six cashiers to split them up in two teams (see Appendix # 6). The previous restaurant experience will be required, but exceptions can be made. All the hired employees will receive an extensive training. Later, for new employees we will use on-the-job training technique to increase their performance and decrease the time of the training. A starting wage for a cashier will be $10.25 per hour; also we will use a bonus system based on the employee’s performance. Management team Is the Manager of the Vancouver Cafà © and will be responsible for overall operation of the business. Head received a degree in Economics from the Russian Far Eastern University in 2006. In addition, he is currently pursuing a Business Management Diploma at Douglas College and he will graduate from the program in December 2014. Head has an extensive experience in strategic planning, as he had been working for a production company in Russia from 2006 to 2012 as a Planning Manager. †¦Ã¢â‚¬ ¦. is the Vancouver Cafà ©Ã¢â‚¬â„¢s Supervisor of Team 1 and will be in charge of running day-to-day operations. During peak hours, he will be helping to his staff. Supervisor1 currently studies at Douglas College on Business Management program and will graduate  in December 2014. He has 4 years’ experience in the restaurant industry, as he worked at coffee shops in Vancouver. His experience varies from a cashier to a supervisor of the coffee shop. Through the work experience he recei ved a sufficient amount of expertise to run the cafà ©Ã¢â‚¬â„¢s operations. He will be responsible for the hiring and training all the cafà © employees. At this position, Supervisor1 will report to the Cafe Manager. †¦Ã¢â‚¬ ¦. is the Vancouver Cafà ©Ã¢â‚¬â„¢s Supervisor of Team 2 and will be in charge of running day-to-day operations. Supervisor2 currently studies at Douglas College on Business Administration program and will graduate in August 2014. He has 2 years’ experience in the restaurant industry. He will be supervising his staff and helping out during peak hours. He will be responsible for the purchase of supplies and management of the supply base. At this position, Supervisor2 will report to the Cafe Manager. SWOT Analysis Opening a coffee cafà © is not about knowing the difference between mocha, latte, and cappuccino but much more than this little part. Creating a SWOT analysis — identifying the good, bad and potential ugly, our customers, overcoming the competing coffee shops and strengthening our marketing plan — for our business is essential before moving forward. Strengths Easy to get financing. Easy to start up business. New talents from partners. Extensive beverage menu. Cost leadership. Value based customer service. Location. Weaknesses Lack of experience. Unknown company history and background. Divided authority. Number of competitors in the market. Too many products to start with. Opportunities Continuously expanding. Bring in different types of drinks from different parts of world. Expand into franchisee based business. Joint venture with different business organizations (e.g.: Gas stations, grocery stores, cinemas and many more that can allow our coffee shop in their business ). Involve keen investors into the business to expand. International markets. Online market. Threats High risk of failure. Conflicts might occur between partners in the future. Status as an independent coffee shop. Change in coffee trends. Recession. Rises in the price of raw materials. Shortage of specific coffee beans from suppliers as demanded by the market. Change in technology in operating coffee making equipment’s. Change in government policies. Implementation schedule An implementation schedule ensures the accomplishment of each stage of the business plan. The development plan was divided into four phases: the initial phase, commencement phase, semi completion, and final phase. The team was successful in creating a business plan after a month’s collective effort. The commencement phase will begin after the initial stage. During this phase the business will be registered and thus the company becomes eligible to take financial help from a financial organization. Semi completion stage will begin after two weeks. During this phase, the process of staff recruitment, menu preparation, marketing and advertising strategies will be carried out under the guidance of experts. This phase takes a month and a half. The final phase will begin immediately after the semi completion phase. This phase consists of deciding the interior theme, furniture, appliances and other facilities to be provided at the cafà ©. Financial plan Funding Requested In order to start our business, the capital cost would be covered under the fixtures and equipment, installation of the fixtures and equipment and decorating which are 26,927, 25,000, and 10,000, respectively, for a total of 61,927. Basically, we are doing our financing from debt and equity investment which The Canadian Imperial Bank of Commerce (CIBC) has agreed to finance a large portion of this expenditure. Our 90 % of the Capital cost is covered by CIBC by using the government-granted Canada Small Business Financing Act (CSBFA) program. Interest rate would be prime plus 4.25 per cent, which includes a 1.25 per cent administration fee paid to the federal government. We will do monthly payment up to seven years in order to pay all the debt. CIBC has agreed to a loan for $ 178,090 which covers renovation expenses, personal guarantee from the owner for 25 % of the loan amount. The owner is planning that the balance of the funding will come via a $ 19,787 remaining balance, allowing him a 100 % of the common shares in the corporation. Financial Projection Cafà © Vancouver is expected to make a profit of $ 168,200 in its first year of operations, which is a good indication for the company. The $657,000 is estimated for the first year sales figures falls way above the breakeven point by $186,787(where as B-even is $470,213). Not only this, as indicated  in the cash flow projection, the initial CIBC loan and $19,787 equity investment give the operation more than adequate cash flow. This gives an opportunity to our business to repay the loan faster. Risk Factors In order to start a new business venture, there are many risks that must be taking into consideration. Below are the some of the risks associated with cafà © business: 1. Fire Safety: Cafà © Vancouver will limit the impact of a fire by ensuring the business has compensation, insurance protection, including adequate business premises insurance as well as business interruption insurance. 2. Inadequate Capital: Despite of a solid business plan many Cafe fails because they lack adequate funding and planning. So to decrease these risk Cafe Vancouver is planning to have several months of funding to cover the costs of salaries, food and bills. 3. Food Safety Concerns: If any customer becomes injured on the premises or where an illness is attributed to product the $ 1,000,000 compressive general liability insurance coverage will insure the business has adequate liability. 4. Shortage of supply: This risk is considered as not important because there are wide variety of suppliers in downtown might be chosen in case of shortages with supply. Divestiture/Harvest Strategy In case of any quarrel, any partner wants to exit the business or if sales cannot be made then the assets of the business will be sold off individually. Firstly, company will try to sell this commercial coffee making equipment locally but if the quenched arranged cannot be made locally then the equipment will be sold over the internet. The money from selling this equipment will be used to pay off the debt obligation of the business and remaining money will be paid to the owner. However, this is not supposed to happen because the concept has significant upside latent, builds good market share. If everything goes according to the plan, it is expected to attract the attention of large national. The owner would sell the business only and only if a healthy profit is given by a buyer.   

Swan Lake - Romantic Ballet - 2817 Words

SWAN LAKE ‘Swan Lake was re-choreographed by Marius Petipa and Lev Ivanov in1895, after initially being choreographed by Julius Reisinger in 1877. The musical score was composed by Pytor Tchaikovsky. ‘Swan Lake was created towards the end of the romantic period, so the culture and style of romanticism was prominent, with glimpses of the beginning of the classical era. Because of this, it contains elements of both eras. Some of the romantic characteristics include the pursuit of the unattainable, romance, fantasy, focus on the female role, gas lighting and simple sets, pointe work, soft and feminine technique for females and the bell tutu. Some of the classical features include the length of the ballet, the classical tutu and more†¦show more content†¦Prince Siegfried has to choose between keeping his word and his love for Odette, and as a result he takes Odette and they jump into the lake and drown, the other swans also drive Odile and von Rothbart into the lake, and are left to their deserved fate. Some of the themes of a romantic ballet are shown in the plot of ‘Swan Lake, along with a few from the classical Ballets. A theme of romance between Odette and Prince Seigfried, is evident with their oath of undying love for each other. Romance was very important in a classical ballet, as the romantic era affected peoples emotions, and Although the plots may be fictional, the themes were always real and universal Also the pursuit of the unattainable is also evident, with prince Siegfried not wanting any of the princesses available, but instead wanting to be with someone living a cursed life. For the working class in Russia, the ballet was an escape, and seeing someone pursue for something they want was a source of motivation for the audience. Also themes of the supernatural are shown, with the sorcerer, von Rothbart, enchanting beautiful maidens. The supernatural themes helped the audience mentally escape from real life, so was popular for the working cla ss. ‘Swan Lake is a four act ballet, which is a common element amongst the classical era of ballets. During the romantic era they were usually only two acts, where as they were upShow MoreRelatedJean De Medici And King Louis Xiv1175 Words   |  5 PagesBallet has always been important throughout history. It was and is still a thrilling way to celebrate special events and ballet is also a form of expression. Ballet was originated during the 15th century in the Italian Renaissance Courts. Two very passionate dancers began to fund and help popularize ballet. Their names were Catherine de Medici and King Louis XIV. 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This school was controlled by an aristocrat named Czar. The most well known 19th century choreographer, Marius Petipa, became the ballet master of the entire school, shaping imperial and classi cal ballet. Ideas such as increased focus on technique, formulaic choreographyRead More History of Ballet Essay1083 Words   |  5 Pages The History of Ballet The first experience of watching a ballet, for me or any little girl, can be fascinating and exhilarating. Wondering how a dancer can be so steady on her toes as she spins in circles and leaps through the air. Watching a ballet, there is a feeling of wanting to be graceful, as well as the warm sensation felt by a little girl as she slips into dream land. My mom had taken me to my first ballet when I was 11 years old. When we returned home home, she signed me up for classesRead MoreWestern Classical And Classical Music1051 Words   |  5 PagesThe six categories are the Middle Ages, the Renaissance, the Baroque Age, the Classical Period, the Romantic Era, and the Twentieth Century. The earliest form of Western music originates from the Medieval time period of c.1150-c.1400, and the most recent time period is the music post from the Great War, which spans from 1920c.- Present. It was during the Baroque Age, the Classical Period, the Romantic Era, and the Twentieth Century that many of the famous composers, whose songs are still recognizedRead More Analysis of Tchaikovskys Swan Lake Essay1491 Words   |  6 Pagescreated some of the most beautiful of all romantic melodies. With his rich gifts for melody and special flair for writing memorable dance tunes, with his ready response to the atmosphere of a theatrical situation and his masterly orchestration, Tchaikovsky was ideally equipped as a ballet composer. His delightful fairy-tale ballets, Swan Lake, The Sleeping Beauty and The Nutcracker are performed more than any other ballets. Swan Lake, Tchaikovskys first ballet, was commissioned by the Imperial TheatresRead MoreCompare and Contrast of Classical Ballet and Modern Dance Essay1848 Words   |  8 PagesCompare and Contrast of Classical Ballet and Modern Dance Dance is one of the most beautiful, expressive forms of art known to mankind. It expresses joy, love, sorrow, anger, and the list truly goes on for all the possible emotions that it can convey. Dance not only can express how one feels, but it can tell a story or even be used to praise a higher power. Dance has intricately played an important role to every culture over the course of time. Two forms of dance that have not only stood againstRead MoreMats Ek2349 Words   |  10 Pagesï » ¿Mats Ek Allegra Vianello English National Ballet School 2nd year Words Count: 2304 23/04/2013 Contents Page Introduction Life and career Re-making of the ballet classics Stylistic elements of his choreography: clarity and irony Themes Movement Vocabulary References Influences and Muses Bibliography Introduction In this essay I will present one of the greatestRead MoreHow Ballet Has Changed Over Time970 Words   |  4 PagesToday’s ballets are nothing like what they were at first. Ballet has changed over time. A great deal of Ballet dances, at Ballet’s beginning were based off of court dances. Court dances were social dances performed in court, usually between a man and woman. They are also known as ballroom dances. Ballet has grown from being a court dance for the nobles to a sophisticated complex art many can enjoy watching or dancing it. It is often believed that the beginnings of ballet started with Queen CatherineRead MoreTerm Dance1063 Words   |  5 Pages_______________ are important elements in the Energy category. (select two) Selected Answers: Dynamics Tempo Question 10 2 out of 2 points __________________________ ballets came to the forefront in the nineteenth century, and were characterized by their use of mythical characters and places. Selected Answer: Romantic Question 11 2 out of 2 points Seeing dance on a video or DVD provides the same experience as seeing a dance live. Selected Answer: False Question 12 2 out of