Components Of Obsessive Compulsive Disorder

Components Of Obsessive Compulsive Disorder Obsessive-compulsive disorder (OCD) occurs in children, adolescents, and adults. OCD is an anxiety disorder characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviors (American Psychiatric Association [DSM-IV-TR], 2000). The two main component of OCD are obsession and compulsion. Individuals with obsessions often attempt to ease the stress that the obsessions cause through compulsions (Shih, Belmonte, Zandi, 2004). Types of OCD Obsessions Aggressive/ catastrophic Religious Sexual Contamination Somatic Compulsions Hoarding Counting Confessing/ asking Ordering/arranging Washing In a developmental study conducted by Geller and his colleagues (2001), OCD in childhood and adolescence was male preponderant and associated with a higher frequency of aggression/catastrophe obsessions, hoarding and saving compulsions, multiple obsessions and compulsions, and poor insight compared with adult OCD. Sexual and religious obsessions were selectively more prevalent in adolescents compared with either children or adults. Children with OCD had higher rates of Tourettes disorder and separation anxiety disorder than older age groups, but mood disorders were similarly high in both adolescents and adults with OCD. Adults with OCD also had higher rates of substance use and eating disorders than either children or adolescents. This study indicated that age specific correlates with different types of OCD. DSM Diagnosis Criteria of OCD (DSM-IV-TR, 2000) A. The Person Exhibits Either Obsessions or Compulsions Obsessions are indicated by the following: The person has recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress The thoughts, impulses, or images are not simply excessive worries about real-life problems The person attempts to ignore or suppress such thoughts, impulses, or images or to neutralize them with some other thought or action The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion) Compulsions are indicated by the following: The person has repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly The behaviors or mental acts are aimed at preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive. B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. (Note: this does not apply to children.) C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the persons normal routine, occupational/academic functioning, or usual social activities or relationships. D. If another axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with drugs in the presence of a substance abuse disorder). E. The disturbance is not due to the direct physiologic effects of a substance (e.g., drug abuse, a medication) or a general medical condition. Sign and Symptoms of OCD Most people with obsessive-compulsive disorder (OCD) have both obsessions and compulsions, but some people experience just one or the other (Help Guide, 2010). Common obsessive thoughts in OCD include (Help Guide, 2010): Fear of being contaminated by germs or dirt or contaminating others. Fear of causing harm to yourself or others. Intrusive sexually explicit or violent thoughts and images. Excessive focus on religious or moral ideas. Fear of losing or not having things you might need. Order and symmetry: the idea that everything must line up just right. Superstitions; excessive attention to something considered lucky or unlucky. Common compulsive behaviors in OCD include (Help Guide, 2010): Excessive double-checking of things, such as locks, appliances, and switches. Repeatedly checking in on loved ones to make sure theyre safe. Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety. Spending a lot of time washing or cleaning. Ordering, evening out, or arranging things just so. Praying excessively or engaging in rituals triggered by religious fear. Accumulating junk such as old newspapers, magazines, and empty food containers, or other things you dont have a use for. ETIOLOGY Biological Aspects of OCD Family and twin studies Family studies have demonstrated an increased prevalence of obsessive-compulsive disorder in the first degree relatives of patients as compared to controls (Hettema, Neale, Kendler, as cited inTaberner et al., 2009). Studies of OCD patients and their families have established a 10% prevalence of OCD in first degree relatives (Brynes, 2009). One American study (as cited in Anxiety Care, 2011) suggested that up to 30% of teenagers with OCD had a member of the immediate family with the problem or with obsessive symptoms. However, a two years study carried out by Black (2003, as cited in Waite Williams, 2009) demonstrated that although the children of parents with OCD were likely to go on to develop an emotional disorder, it was not particularly likely to be OCD. In studies of twins, there is a 63% concordance rate for OCD in identical twins (Brynes, 2009). Twin studies suggested a higher concordance rate in monozygotic as compared to dizygotic twins (Samuels Nestadt, 1997; Eley, Bolto n, OConnor, Perrin, Smith, Plomin, 2003). Because MZ twins share 100% of their genes and DZ twins share 50% of their genes on average, the concordance rate for a genetically influenced disorder is expected to be higher for MZ twins than for DZ twins (Shih, Belmonte, Zandi, 2004). Brain structure and chemistry Positron emission tomography (PET) studies measuring resting glucose metabolism have reported hyperactivity in the inferior frontal and anterior cingulate cortices, striatum, and thalamus in patients with OCD (Saxena et al., as cited in Busatto et al., 2001).Researcher believed that OCD may be developed by the abnormal metabolic activity in the orbitofrontal cortes, the anterior cingulate, and the caudate nucleus (Dejdar, 2002). The interaction between these different parts is called a cortico-basal ganglia network (Dejdar, 2002). Dejdar described that these cortico-basal ganglia interactions make up a neural system that is crucial in the acquisition of habits and also establishing a fixed routine of performing those habits, which in turn connected to the typical behaviors of OCD where people maintain certain obsessive habits and continue to perform those habits. Study by Lewin, Storch, Adkins, Murphy, Geffken (2005) supported the neurochemical etiology involving a functional disturbance in the frontal-limbic-basal ganglia system as well as thalamic and cortical neurostructural abnormalities. It is hypothesized that if cortical regions are dysfunctional in patients with OCD, then conscious mechanisms must be used to accomplish what would occur automatically in an unimpaired brain (Sturm, 2008). As a result, inappropriate or obsessive thoughts repeatedly intrude and conscious thought processes suppress them, facilitated by accompanying ritualistic behaviors (Neel, Stevens, Stewart, as cited in Sturm, 2008). There is a strong connection between basal ganglia and OCD. Several studies have implicated that basal ganglia is active during the learning or execution of sequential behavior (Brown, 1997; Graybiel, 1998). Graybiel (1998) explained that the chunking functions of the basal ganglia helps people to focus. Chunking refers to the organization of information into specific associated groups (Dolan DNA learning center, n.d.). This happened when the dopamine released in the basal ganglia system communicates with the brain areas in the prefrontal cortex to allow people to pay attention to critical tasks, ignoring distracting information (Dolan DNA learning center, n.d.). In an experiment by Graybiel, she hypothesized that the basal ganglia system helps the cortex to chunk learning into habits and routines to help the brain quickly access stored information. The experiment of Graybiel was done on training the rats on maze tasks and records the firing groups of neurons in the striatum as the r ats learn, forget, and then relearn the task. When the rats get used to the maze, lots of cells in motor striatum tend to fire at the beginning and the end of the run instead of the whole thing. This happened because the basal ganglia has chunked the behavior. The symptoms of OCD included repetitive, intrusive thoughts and compulsions which lead to ritualistic behaviors such as washing, counting and checking. These behaviors according to Graybiel involved sequential acts and they are performed as chunks, unitized and driven by the extraordinary imperative of urges and compulsions that the patient recognizes as abnormal and out of the persons control. As the result, OCD patients showed over focused attention to irrelevant stimuli. In OCD patients, an abnormal activation of the striatum has been observed. A clearer view is illustrated by a charity organization, Anxiety Care (2011). The organization explained that the thalamus is involved in sensory perception processes and caudate nucleus, a component within basal ganglia work to sort sensory information and filter thoughts. When these messages are being misinterpreted or misfiring, which mean that the normal electrical activity in the brain is being disrupted by the overactive electrical dischargers, it will causes the problem of communication between nerve cells. This will affect and confused the thinking part of the brain to respond chemically to a threat perceived by the primitive part of the brain as if the danger is real. In effect, the caudate nucleus is letting unnecessary thoughts and impulses through to the cortex where the thoughts and emotions combine; and an over active cingulate nucleus at the brains centre, which helps shift attention from one th ought or behavior to another, becomes over active and gets stuck on certain behaviors, thoughts or ideas. The cingulate is that part of the brain which tells the OCD sufferer that something terrible will happen if the compulsions are not carried out (Anxiety Care, 2011). Besides that, some researchers have suggested that OCD results from the imbalance of the neurotransmitter in the brain which is known as serotonin (Pauls, Mundo, Kennedy, 2002). A study by Stengler-Wenzke, Muller, Angermeyer, Sabri and Hesse (2004) revealed that there is a significant reduction of serotonin transporter availability in the midbrain and upper brainstem in OCD patients. The reduction of serotonin transporter availability may reflect a reduced number of serotonergic neurons that may result in low level of serotonin. Serotonin is responsible for transporting impulses to and away from the nerves (Dejdar, 2006). The physiological activity of serotonin starts from the brainstem in groups of brain cells called raphe nucleus (Function of Serotonin, 2009). Serotonin brain cells then spread to various regions of the central nervous system by branching out throughout the brain(Function of Serotonin, 2009). In a case reported by Cohen, Angladette, Benoit, and Pierrot-Deseilligny (1999), a 59-year-old man developed obsessive-compulsive disorder symptoms after his head injury. The magnetic resonance imaging (MRI) brain scans showed a small contusion in the right orbitofrontal region. In the similar case, the single-photon emission CT (SPECT) showed greatly reduced blood flow in the orbitofrontal region of the 59-year-old man with OCD (Cohen et al., 1999). A study by Busatto et al. (2001) supported the findings as their research found reduced right cerebral blood flow in the right orbitofrontal cortex in OCD patients as compared with the healthy control group. Paulmann, Seifert, and Kotz (2009) explained that the orbitofrontal cortex is linked to a variety of cognitive and emotional functions. Gray, Braver, and Raichle (as cited in Bracha Brown, 2009) mentioned that emotion and cognition conjointly and equally contribute to the control of thought and behavior. Additionally, Pessoa (as cit ed in Bracha Brown, 2009) added that emotions and cognition not only strongly interact in the brain, but they are often integrated so that they jointly contribute to behavior. Hence, impairment of orbitofrontal cortex contributed to the intrusive thoughts and bizarre behavior of OCD patients (Swinson, Antony, Rachman, Richter, 1998).In particular, lesions of the human orbitofrontal cortex lead to large-scale changes in social and emotional behavior (Paulmann, Seifert, and Kotz, 2009). For example, patients with orbitofrontal lesions are reported to suffer from deficits in affective decision-making (Hornak, as cited in Paulmann, Seifert, and Kotz, 2009). Consistently, Swinson and his colleagues (1998) stated that OCD patients have difficulties in decision making. Psychological Aspects of OCD According to Salkovskis, Shafran, Rachman, and Freeston (1999), there are five mechanisms for the development of inflated responsibility which are critical for the development of OCD. Inflated responsibility refers to an excessive sense of personal responsibility related to unwanted or upsetting thoughts (Abramowitz, Deacon, Woods, Tolin, 2004). The first mechanism is being given too much of responsibility. A child or adolescent, who assumed responsibility during early age due to incompetent parenting, might believe that they are responsible for the negative consequences over which they have little or no control. This is related to the parental communications, where the child is scapegoated for negative occurrences whether or not they are in fact responsible. Through this type of upbringing, Salkovskis et al. stated that the child will develop and accept a wide sense of responsibility and are inclined to translate it into a high degree of conscientiousness, marked by a dedication to work and an acute sense of social obligations. The second mechanism in influencing a person to be OCD is the exposure to rigid or extreme codes of conduct. Strict behavioral codes being instilled by schools, authorities or religion will lead to the development and the reinforcement of attitudes about responsibility. In the study by Abramowitz et al., they found evidence that religion and other cultural influences affect the presentation of OCD symptoms. Rasmussin and Tsuang (as cited in Abramowitz et al., 2004) observed that strictly religious patients often had religious themes to their obsessional thoughts and compulsive rituals. An early study by Khanna and Channabasavanna (as cited in Abramowitz et al., 2004) noted a large portion of symptoms related to contamination and washing among Hindus with OCD, and commented that Indian culture emphasizes on the issues of purity and cleanliness. The third mechanism for the development of inflated responsibility is being given too little responsibility. The responsibility is withheld from the child by the parents. Worries are prominent in the family system and the parents are likely to be excessively anxious and fearful themselves, they will be overprotected toward their child. This will thus convey a sense that danger is around the corner to the child. When growing up, the child will have difficulty in leaving home and being independent; he or she is unprepared to cope with the dangers that the child believe to have in the world outside. Salkovskis et al. further mentioned that leaving home is usually marked by the emergence of OCD symptoms in the child. The lack of preparation to deal with the world outside will frighten the child and leads to the development of anxiousness in the child. The fourth route to the development of an inflated sense of responsibility is the sudden critical incidents that happened where a persons action or inaction contributed to serious misfortune. An example illustrated by Salkocskis et al. on a young doctor who gave the wrong prescription to the patients. Although it did not have any adverse effects on the patient, the young doctor was reprimanded intensely by his senior supervisor. Since then, he developed repetitive checking on the prescription and spent an inordinate amount of time in checking the details of each prescription. Another factor that contributed to the exaggerated sense of responsibility occurred from an incident that is in fact coincidental but the person erroneously assumed that their thoughts, actions or inactions contributed to a serious misfortune. This happened though the learning experiences, for example, when a child angrily wishes an adult dead; soon afterwards the adult, by unfortunate coincidence, actually dies (Salkocskis et al., 1999). The child will think that it is his fault and he has caused the death but actually it was just a coincidence. Salkocskis et al. described that people who are prone to the cognitive bias of thought-action fusion are the ones who are most likely to experience inflations of responsibility and thus contribute to the origins of OCD. PHYSIOLOGICAL TREATMENT Medication Selective serotonin reuptake inhibitor The pathogenesis of OCD has been linked to abnormal serotonin levels. Drugs which increase levels of serotonin in the brain have been shown to improve symptoms of OCD. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants to deal with OCD (Taylor, 2009). SSRIs included citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline (Taylor, 2009). Taylor in his study discussed that SSRIs ease the anxious feeling of OCD patients by affecting the neurotransmitters of the brain that used to communicate between brain cells. SSRIs block the reuptake or re-absorption of the neurotransmitter serotonin in the brain. Changing the balance of serotonin seems to help brain cells send and receive chemical messages, which in turn boosts patients mood. Taylor explained that SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmitters. Side effects of SSRIs included nausea, headaches and insomnia (Taylor, 2009). In evaluating the safety and effectiveness of sertraline in children and adolescents, Cook et al. (2001) ran a study in United States. Their research indicated that long-term sertraline treatment was well tolerated and effective in the treatment of childhood and adolescent OCD. In consistent with the result of sertraline, studies has showed that fluoxetine, citalopram and fluvoxamine were well tolerate and effective in treating children and adolescent with OCD (Liebowitz et al., 2002; Riddle et al., 2001). Nonetheless, six adverse events occurred significantly more frequently in fluoxetine patients who experienced palpitations, weight loss, drowsiness, tremors, nightmares, and muscle aches (Riddle et al., 2001). Escitalopram, another type of SSRI has been examined by researchers in Malaysia in treating OCD patients (Hatim et al., 2008). The research reviewed that the risk of relapse for those treated with placebo appeared to be four times that of those treated with escitalopram. Moreover, the study suggested that escitalopram is well tolerated in Malaysian patients with OCD. No serious adverse event was reported throughout the study. A few milder side effects have been reported by the patients, such as dizziness, hypertension, delayed ejaculation, and throat tightness. The sample of the study, however, may be too small to yield broad generalizations. Serotonin norepinephrine reuptake inhibitor Serotonin norepinephrine reuptake inhibitor (SNRI) such as venlafaxine has been used to manage OCD. Researchers found that venlafaxine may be beneficial to individuals with OCD, including those who have not responded to prior SSRI trials (Hollander, Friedberg, Wasserman, Allen, Birnbaum, Koran, 2003SNRI works by inhibiting the reuptake of the neurotransmitters serotonin and norepinephrine (Donaldson, 2010). As low serotonin is associated with OCD, SNRI function to increase the amount of two neurotransmitters, serotonin and norepinephrine, and thus enhance the neuronal activity of the brain. The side effects of SNRI included nausea, restlessness, sexual dysfunctions, insomnia, and increased blood pressure (Bandelow, 2008). Tricyclic antidepressants One of the effective tricyclic antidepressants (TCAs) that have been using to treat OCD is clomipramine. It was one of the first anti-obsession drugs prescribed in the 1960s, but is less prescribed now due to their unpleasant side effects (Goodman, 2011). The side effects of this drug included dry mouth, constipation, urinary retention, sexual dysfunction, weight gain, seizures, and cardiac side effects (Bandelow, 2008). Bandelow added that TCAs should be avoided in patients who are considered to be at risk of suicide, due to their potential cardiac and central nervous system toxicity after overdose. In general, the side effects of TCAs are more adverse than SSRIs. Therefore, it is usually recommended when the treatment with SSRIs have failed (Taylor, 2009). Neurosurgical treatment More than 10% of OCD patients remain incapacitated despite rigorously involving in medication trials and intensive behavior therapy (Kim et al., 2003). Several neurosurgical procedures have been used in OCD for treating such refractory patients. Cingulotomy is among the neurosurgical methods to deal with OCD. Cingulotomy defined by Carlson (2008) as the surgical destruction of the cingulum bundle, which connects the prefrontal cortex with the limbic system; helps to reduce intense anxiety and the symptoms of obsessive-compulsive disorder (p. 489). Anterior cingulotomy targets the anterior cingulate cortex and the fibers of the cingulum has been recently reported as being effective and safe (Dougherty, as cited in Kim et al., 2003). Study by Kim et al. (2003) aimed to to investigate OCD symptom improvements and to evaluate any cognitive changes and adverse effects after cingulotomy. Their study found no evidence of cognitive dysfunction including intelligence, memory and executive fun ction after cingulotomy compared with preoperative performances. In addition, seizure, urinary problems, chronic pain and suicide were not reported and other adverse effects, such as headache, insomnia and weight changes did not continue for more than 3 months. Taken together, they suggested that cingulotomy could be safe in terms of cognitive and other side-effects. Furthermore, deep brain stimulation (DBS), a procedure in which surgically implanted electrodes stimulate localized brain structures, has also been reported to be effective in patients with OCD when the anterior limb of internal capsule was targeted (Nuttin et al., as cited in Cannistraro et al., 2007). Deep brain stimulation surgery involves the placement of tiny implantable electrodes into abnormally functioning areas of the brain through burr holes in the skull; then a neurostimulator, which is commonly implanted near the collarbone; an insulated wire that connects the electrode to the neurostimulator (Brown University, 2003). The electrodes emit pulses of electrical stimulation to block abnormal brain activity that can cause obsessions, moods, and anxieties associated with psychiatric disorders (Brown University, 2003). A study conducted by Gabriels, Cosyns, Nuttin, Demeulemeester, Gybels (2003) concluded that deep brain stimulation may have important therapeutic benefits on psy chopathology in OCD and no harmful side-effects were detected during follow-up up to 33 months (see Appendix A, for case study). However, Greenberg, Rauch, and Haber (2010) stated that hemorrhages on device insertion may have long-lasting or permanent consequences, although relatively rare. Infection represents another significant risk (Greenberg et al., 2010). On the other hand, Greenberg and his colleagues added that the great appeal of DBS in comparison with lesions is that it permits focal, adjustable, and reversible modulation of the brain. Specifically, various combinations of electrodes can be activated, at adjustable polarity, intensity, and frequency; DBS thus permits flexible neuromodulation. The great clinical advantage of this is that parameters can be optimized for individual patients. In cases in which no beneficial settings can be identified despite extensive efforts, the electrodes can be inactivated, and the devices may be removed (Greenberg et al., 2010). DISCUSSION CONCLUSION Overdose TCAs have been revealed to be lethal in overdose (Bandelow, 2008). These drugs should be avoided in patients who are considered to be at risk of suicide, due to their potential cardiac and central nervous system toxicity after overdose (Bandelow, 2008). Although the benefit of SSRI and SNRI is that they are relatively safe in overdose (Bandelow, 2008), the issues of associating SNRI with other substances need to be highlighted. During 2010, Donaldson revealed that overdose with SNRIs has commonly occurred in combination with alcohol and/or other drugs. The adverse event of combining alcohol with SNRI medication include electrocardiogram changes, sinus and ventricular tachycardia, bradycardia, hypotension (low blood pressure), altered level of consciousness (from somnolence to coma), rhabdomyolysis, seizures, vertigo, liver necrosis, and death have been reported. Besides that, Donaldson emphasized that SNRI medications should not be taken by patients also taking monoamine oxidase inhi bitors (MAOIs). This can lead to increased serotonin levels and cause serotonin syndrome which is a rare, but serious and potentially life-threatening condition unfortunately often mistaken for a viral illness, anxiety, neurological disorder or worsening psychiatric condition). Therefore, it is vital to address the adverse events of drug overdose and the combination with other substances. Relapse Relapse and remission is common in OCD and many patients will never be free of the disease (Taylor, 2009). Earlier study in 1973 by Capstick (as cited in Ravizza, 1998) stated that if the SSRI is withdrawn or reduced too quickly, the patient is able to relate the time of onset of the recurrence of the obsessions, usually 36 to 48 hours after the former dose. In a follow-up study of 15 patients with OCD who responded to clomipramine, Thoren et al. (as cited in Ravizza, 1998) reported that 6 patients who had stopped taking the drug had a recurrence of their symptoms within a few weeks of discontinuation. A research group by Ravizza et al., 1996, the group completed a 2-year, open-label follow-up study of 130 patients with OCD who had previously responded to 6 months treatment with clomipramine, fluoxetine or fluvoxamine. At the end of the 2 years of follow-up, the relapse rate was 77 to 85% among those patients who discontinued pharmacotherapy. Implication Most research related to the physiological treatment has been studied for not more than five years. Therefore, the effects of long term treatment have yet to be observed. However, when the discontinuation of treatment is discussed, researchers indicated several relapse problems and adverse events. A study stated that response to selective serotonin reuptake inhibitors (SSRIs) may be influenced by body weight, age, sex, and genetic makeup, and therefore can vary between individuals of different ethnic populations (Hatim et al., 2008). Malaysia as a multi-cultural and multi-ethnic country, the use of treatment in patient with OCD should be wise and well considered. The lack of physiological treatment in Malaysia is the major limitation for the implication of treatment toward Malaysian. On the issue of unresponsive to treatment, researcher found the benefits of switching between venlafaxine and paroxetine for OCD. In 2004, the Brown University reported that 56% of patients who were not responding to venlafaxine benefited from a switch to paroxetine; 19% of patients who were not responding to paroxetine benefited from a switch to venlafaxine.Despite the evidence that clomipramine and selective serotonin reuptake inhibitors (SSRIs) are effective in the pharmacology management of obsessive-compulsive disorder (OCD), between 40% and 60% of the patients suffering from it show only a partial or no symptom improvement (Marazziti et al., 2008). Therefore, Marazziti and his group conducted a research to examine the effectiveness of combined treatment by associating clomipramine and citalopram in the treatment of OCD. The study found that combination treatment is effective and well-tolerated for OCD patients, and much more effective than treating patients with single drug, su ch as SSRI or TCA. In prescribing medication for the OCD patients in Malaysia, the doctor should inform the possible side effects of the medication to the patients. The adverse events that would occur in combination of substances should be stressed and patients should be education on the appropriate dosage and time to consume the medication. Limitations on the use of medications include unwillingness of approximately 25% of OCD patients to take medications which they view, globally, as a form of contamination (Greist, 1998); side effects that interfere with comfortable use of medications; and continuing costs of medications that are necessary to prevent relapse associated with discontinuation. Besides physiological treatment, psychotherapy has been recommended to deal with OCD. The consensus guidelines produced by the American Psychiatric Association (2000) suggested that cognitive, behavioral therapy (CBT) was the first choice treatment for children and young people. Waite and Williams (2009) mentioned that CBT alone or in combination with medication appears to be more effective and less likely to lead to relapse. More recently, National Institute for Health and Clinical Excellence (2011) described a stepped care model beginning with self-help materials for mild cases through CBT, medication and finally combined treatments. The Malaysian Psychiatric Association reviewed a research being done by Saxena et al. (2009) indicated the effectiveness of CBT on brain glucose metabolism in OCD. They discovered significant changes in brain activity solely as the result of four weeks of intensive cognitive-behavioral therapy in ten OCD patients. Reduction of thalamic activity, decrea ses in glucose metabolism has been observed after the intervention. However, the study also showed a significant increase in activity in an area of the brain called the right dorsal anterior cingulate cortex, a region involved in reappraisal and suppression of negative emotions. The major constraints on the use of CBT include patient unwillingness to invest the time and energy. This may be due to patients fear that their anxiety will be too great when they expose themselves to their triggers. As the conclusion, there are several causes of OCD which involved both biological and psychological aspects. In introduc

Technology Use in the Mathematics Classroom Essay -- Education School

Technology Use in the Mathematics Classroom Technology is a growing field that affects every aspect of our everyday lives. When I look at centuries past, I am amazed at the technological advances this country has made. Just during my lifetime, computers, cell phones, digital cameras, and many other devices have become a huge part of everyday life. Not only is technology affecting every day life, but it is also making a huge impact on education, especially within the mathematic field. Computer programs are being created everyday to aid in the understanding of mathematical concepts. Calculators are replacing the pen and paper method of tabulating answers. The question that remains is, â€Å"Are the uses of technology helping or harming the classroom environment?† I do not have the answer to this question but from reading the National Council of Teachers of Mathematics (NCTM) Technology Principle and viewing the Mathematics Association of America website I can offer personal opinions on this issue. I agree with the Technology Principle when it states, â€Å"Technology should be used to enhance the classroom experience but should not be a replacement for basic understandings.† I believe that basic concepts (addition, subtraction, multiplication, etc.) should be taught by hand first, and then when these concepts are used to solve higherlevel math problems, a calculator may be used to speed the process along. If we, as a society, become too dependent on technological devices to solve math problems, we will be in trouble when computers crash or electricity. The basic mathematical concepts are so important for many life activities (paying bills, balancing check books, time management, etc.) and they should be learned without ... .... Each student has a different path in life. Some will continue their education with college and others will go straight to work, but either way they will need to be familiar with technology programs. In conclusion, I agree that technology needs to be used in the math classroom, but I strongly believe that it should not take the place of the pen and paper method. The basic concepts should be taught by hand and then calculators and computer programs should be brought into the classroom. The challenge as an educator is to balance the use of technology and the use of lecture. It is also a challenge to realize that each child is different and they all have different learning patterns, so each child deserves a fair chance to receive the kind of learning environment they need. I think these are the challenges that school systems and teachers will have to evaluate.

Comparing Barnes of The Sun Also Rises and Caraway of The Great Gatsby

Similarities Between Barnes of The Sun Also Rises and Caraway of The Great Gatsby   Ã‚  Ã‚  Ã‚  Supported by Ten Quotes from   Sun Also Rises, No quotes from Gatsby  Ã‚  Ã‚  Ã‚   Jacob Barnes shares a personality quirk with Nick Caraway; both want to give the impression of being decent, honest men forced to endure the corruption and pettiness of those around them. â€Å"What's not clear through most of The Sun Also Rises is whether or not Jake believes his own press†(Trilling, 34). Nick Caraway speaks openly of his integrity and then contradicts himself with his actions. Hemingway uses the contrast between Jake's descriptions of others and what is left unsaid to establish his superior morals. This leaves room to wonder about Jake's sincerity, but it's not until the last page of the story that his complicity is fully revealed.    Like Nick, Jake is the narrator of the story, yet the first two chapters of The Sun Also Rises focus on the character of Robert Cohn; a man that Jake says that he likes, but describes with subtle condescension. When Jake recounts the wealth and position of Cohn's family, it's inferred that his own background is modest and somehow more honest. He tells of the women who have controlled Cohn, mother, ex-wife and the forceful Frances, implying that he himself has never been so weak-willed. Even Cohn's accomplishments as a boxer at Princeton are called into question and that detail is like a loaded gun introduced in the first act of a play and bound to go off in the third. Cohn is painted as spoiled and immature to Jake's own self-sufficient manliness.    As the stage is set and the characters introduced, Jake seems detached from the events. His descriptions are clever and can be cruel, as when he notes that he "saw... ...de the conflict out of which comes Brett's plea to Jake for help. Did he plan this all along? Perhaps not, but he certainly did nudge things along in the direction that would bring him to Brett's rescue. He may not be able to enjoy her as other men make fools of themselves to, but she'll always return to the safety of him and he'll never look the fool.    Works Cited and Consulted: Bloom, Harold. Ernest Hemingway. New York: Chelsea House Publishers, 1985. Fitzgerald, F. Scott. The Great Gatsby. 1925. New York: Scribner Classic, 1986. Hemingway, Ernest. The Sun Also Rises. New York: Simon and Schuster Inc., 1993. Raleigh, John Henry. "F. Scott Fitzgerald's The Great Gatsby." Mizener 99-103. Trilling, Lionel. "F. Scott Fitzgerald." Critical Essays on Scott Fitzgerald's "Great Gatsby." Ed. Scott Donaldson. Boston: Hall, 1984. 13-52.   

Oedipus Rex as a Religious Drama

Titans who devoured Dionysus. [3] Only his heart remained, which Zeus ate and Dionysus was born a second time. [4] Zeus destroyed the Titans with lightening, and from their remains sprang human life, consequently humans are both divine and evil. [5] Sophocles embodied this aspect of God given human nature, mutual opposites, In the character of Oedipus. His actions are driven by the mother. 6] He is not consciously guilty of the crimes of incest, but the reality and irony of the play states that he is endorsing them. He takes the role of husband and son, brother and father; he is mutually guilty and innocent, despite the Juxtaposed nature of these conditions, a reflection of the conditions from which humanity sprang. There is a definite tone of reverence in the dark subject matter, and a subsequent lesson that Gods that their prophecies demand respect. Nevertheless, the setting of the festival and tribute to the Gods make it a fundamentally religious lay.Central to religious drama is the concept that ‘man must conform to divine order- even at the cost of himself. 17] In Oedipus Rexes, this divine order Is predetermined by the prophecies of the Oracle which is the driving force for the entire plot. Oedipus' parents receive the prophecy at his birth; later, when called a ‘bastard', Oedipus goes to the Oracle and receives the same Information; and when a plague attacks Thebes, Croon Is sent to consult It again, which reveals Its fulfillment. [8] The oracle's presence Is highly active, and In this sense, fulfils the role of an antagonist.Its also enforces Aristotle notion that a character is only a result of plot, as the characters action are solely dictated by the information provided by the Oracle. [9] The role is further enforced by the fact that it is not a mere invention; it was a very real part of Greek culture, where spirituality and politics are intricately linked. Despite the characters best efforts (Accost and Alias leaving their son for dead, and Oedipus fleeing who he believed to be his parents. ) Its fulfillment was seemingly inevitable, perhaps even caused by their knowledge of the prophecy. 10] It s in the avoidance of circumstance in which the prophecy could be fulfilled, that is proximity to the dangerous other, that Oedipus and Alias were able to meet. [11] As afore mentioned the prediction is the force behind the plot, but it is the characters resistance that cause the conflict and therefore the drama. Not to taint a religious discussion with a Freudian psychoanalytical perspective, but, as this conflict shows, opuses Is perhaps ten least Kelly person to nave an opuses complex; en allocates his life to its avoidance. 12] When he discovers his predicament, his costs are encashment, the loss of his children and his eyes, â€Å"Now I will do what must be done to the source of This is a highly symbolic action as in Greek the words for ‘know and ‘see' are correspondent. [14] He is literally removing the à ¢â‚¬Ëœknowledge' of his sins, knowledge he sought with such dynamism from the oracle, an image drenched with irony. The eventual acceptance that Apollo will have been fulfilled is, perhaps, the religious moral of the play; the Gods are omniscient, therefore their laws will always be up held.Aristotle states, within its six elements (plot, character, diction, spectacle, thought ND song)[1 5], that ‘Tragedy is an imitation†¦ Of events inspiring fear or pity[16] and that the Tragic hero is ‘above the common man', but not definitively good, he must have a flaw. [17] In relevance to Oedipus Rexes, and the sense in which it is a religious play, these elements highlight the enforced influence the presence of the Gods have on the actions of the characters, and the concept of free will. The event ‘inspiring fear and pity is most likely the act of incest.Although a taboo subject regardless of culture and period, its interpretation changes across time. A modern view is o ne that inherently links incest to child abuse, as we are greatly influenced by feminist theory. [18] Such theory states that incest is an abuse of the power dynamics in the family unit, usually from father to daughter. [19] However the incest portrayed in the play is unwittingly performed, by consenting adults, but, nevertheless, provokes a disgusted reaction. The cross-contamination of ‘blood' is universally considered tainted and unnatural'. 20] The circumstances surrounding Oedipus and Costar's union could be the fear provoking element. The magnitude of the tragic universe created requires he reader to question whether or not Oedipus would really have killed a stranger over ‘right of way, if the riddle of the ‘Sphinx' was honestly that difficult- which allowed his passage to Thebes, or if the drunken mans accusation of ‘bastard' were mere coincidence. The enormity of the irony suggests some foul play on the part of the Gods.

Fashion Film

Rules and Regulations As fashion film is a new addition to the fashion installment, there aren't any specific rules and regulations that the filmmakers have to follow because fashion is all about expressing opinions, feelings etc. However there are a few ethics that they should be aware of, with any film such as violence, drug abuse, discrimination etc. The filmmakers need to be aware of these ethics because the last thing you want the film to do is offend anyone because then the company, or in this case designer, could get a bad reputation and not become successful.Other things that should be considered when putting together a fashion show is the location because you want the show to be memorable to the audience and a unique location will help make it more memorable. The set is another important thing to think about because if there is a theme such as ‘nature' being carried out though the fashion then you'll want to back that up with a nature themed set; this will also make it more memorable to the audience.Seating should be considered because you want the audience to have a perfect view of the fashion and the film hat they will be seeing though out the show so that they can fully take in what they will be seeing. Lights are an important part of a fashion show because you want the catwalk to be lit up perfectly so the audience can see the clothes perfectly especially if there is any fine detail in the clothes.Music is something to consider because this can really add on to the theme of the show and create the sense of escapism that some audiences crave for; for example if there is a nature theme in your show then it could be a good idea to add some slow classic music with some wildlife sounds. The air and make up of the models is key to a fashion show because this can complete the look of the whole fashion show and really enhance the theme of the fashion show. One fashion show that really has been thought out to every detail is the Alexander Macaque show Homeowners SIS 10 in Paris.The title of the show was ‘Plat's Atlantis' and was inspired by concepts of environmental destruction, stem-cell technology, ‘mutation of the fittest' and the underwater kingdom of Atlantis. The location of this fashion show is unknown but it was performed in Paris during Fashion Week at the end of October 2010. I would hold my fashion show in Paris because it is considered the fashion capital of the world. Paris is a great place to hold a fashion show because the fashion history is so strong compared to other cities like London or Tokyo.The set of the fashion show consists of a very long, white, wide catwalk to represent a laboratory to expand the theme of Stem Cell Technology; there was also a 60 foot LED screen at the back to display the fashion film and two twenty foot robotic cameras along side of the catwalk where one of the cameras displayed the footage it was getting onto the giant screen. I really liked this set because it enhanced th e theme of a laboratory really well from the Petri dish like catwalk, the fashion on the models making them appear to be the experiments in the lab and the cameras acting like the scientists observing what was going on.The lighting used for this show was simple and even, this allowed the audience in the fashion show to see each outfit perfectly. This is a great way to install lights and I would defiantly use it in a fashion show because it doesn't take the attention of the viewers away from the fashion. The music for this fashion show sounds like it would e played in an opening scene for a blockbuster movie set underwater; it contains a lot of heavy synchs and long slow drums.I like this music and would use it in a fashion show because it adds to the theme of the show ‘Atlantis' and gives the audience a sense of escapism. To be able to broadcast my fashion film with music, I need to follow the rules set by The I-J Copyright Service. The law set by them states 1. Using the work of others If you use samples of music by other authors in your work, ensure that you get permission to use the work before you attempt to publish or sell your work. Similarly, f you use loops or samples available via sample collections etc. Ensure that these are licensed as free to use, or obtain permission first. 2. Obtaining permission If you need to get permission to use a piece of music, normally the best place to start is with the last know publisher for the work. They will certainly know how to get permission to use the work, (as they must have permission themselves), so they will certainly know who you would need to contact. If the work is by an U. S. Artist, you could contact the American Society of Composers, Authors and Publishers, IBM (Broadcast Music, IncBand members agreements Where music is written as a group effort, we recommend that you draw up an agreement to clarify issues, such as which rights belong to which member, and how royalties would be distributed in the event that members of your group leave. For successful commercial bands, incorporation is also an option. As with a normal incorporated company, the band members would own shares in the band/company. In this situation, a band member would typically sell his shares to the other members if he decided to leave. This states that I need to obtain permission by the DC/Producer that produced this song.

E-Retail Industry – The Uk Internet Grocery Market

This study aims to understand the competitive environment of some of the main retailers within the UK market and to demonstrate the different elements of the e-environment that impact on the retailer's business and marketing strategy. Furthermore this study will assess the impact of many factors and constraints surrounding the e-retail industry and specifically the grocery sector of the retail industry. It is known globally that the UK has the most developed grocery e-tailing sector in the world and that is increasingly appearing specially after the failure of many business models which have adopted the internet for distributing and selling there products This study will exclude B2B sector and will focus on B2C sector in the retail market I will be focusing on the online grocery market and the main British players leading this market. I have selected this industry because recently, it has caused a noise globally, and many interested people are wondering whether this industry has reached the mature level or it is still growing or it is only a noise which will lose its importance later. The UK Grocery Market it is estimated that à ¯Ã‚ ¿Ã‚ ½105 billion of groceries are sold in Britain each year, (MINTEL Nov, 2002) , that shows a noticeable increase in sales over the period since 1999 until the end of 2002. The Total retail sales through specialist and non-specialist food retailers were worth some à ¯Ã‚ ¿Ã‚ ½90 billion in 1999 and many specialists predict this market to continue growing to reach 120 billion by 2005 (MINTEL, Nov. 2000) Within the food market itself, fruit and vegetables represent the largest market, with high demand within the sector for fresh produce. Convenience foods – fresh and frozen ready meals – are also highly demanded, as are products which generally fit well with the needs of the much maligned ‘cash rich and time poor' consumer. Key debates within the market surround the use of genetically modified (GM) produce, and this has helped to create niches in the retail market for suppliers of GM-free or organic ranges. The major supermarkets have been moving quickly into the organic sector, in which higher margins can be found. (Key Note) The UK grocery market is driven by economic factors, population structures, household size employment pattern and lifestyle patterns whose impact is shown below as macroeconomic factors: Economic factors – Although consumer expenditure is predicted to continue to grow by 12.6% to 2004, with personal disposable income expected to also grow steadily, it is unlikely that this will impact strongly on spending on food for in-home expenditure; As personal wealth has grown, spending on food has decreased as a proportion of total expenditure, with leisure activities, including eating out, taking most of the surplus. Some premium categories of food, such as organic produce, will benefit. As a result the focus of promotional strategy is moving away from price competitiveness towards other aspects of the retail offer. The population structure – Food expenditure and the overall market size is directly related to the size of the population but the long-term outlook for the British population is for very low growth, implying that the food retailing sector is likely to find domestic profits hard to grow. Household structure – Over the period 1999-2004, an increase of 830,000 (3.4%) (MINTEL, Nov 2000) household is anticipated. This is due to factors other than an increase in population; the growth is coming from one- and two-person households, due to rising divorce and separation rates, getting married later or not at all and the elderly living longer These trends disrupt the economic logic of the superstore model which is designed to offer large families convenient means to buy large volumes of food in one place, relatively infrequently, during the daytime, and to transport that shopping home by private car. Yet only 20% of adults have children under 16 living at home with them. All the major grocery retailers are competing to grow their share of this crucial segment of the population. Smaller households equate to more frequent shops for a few items at a time, often at unsociable hours, a considerably more expensive retailing proposition. Changing employment patterns and practices, with increasing frequency of part-time working, mean there are fewer families in which one partner has the time to shop at relative leisure during the day, and more for whom shopping is a shared duty, carried out whenever busy schedules will allow. In turn, time-pressured shoppers will often want to use a variety of shopping patterns according to circumstance, with retailers being required to offer more channels to market in order to compete. This cannot be done without cost implications. Changes in consumer tastes and lifestyles have an influence on grocery demand patterns. Healthy-food fashions and food-safety scares cause people to change what they eat, while there is a strong trend towards snacking and convenience eating – which involves an increasing proportion of food being bought through channels other than grocery retailers.(MINTEL) Internet adoption in the UK retail Sector Retailers generally begin on-line activities by providing information and interactive communication. Their site may develop into an electronic shop almost mirroring their offline activities A study by the department of trade and industry (DTI) called, ‘E-Commerce Impact Study: Retail Overview' (www.dti.gov.uk 29 July 2002) shows that: More than 75% of retailers are adopting e-business technologies, Nearly a quarter of retailers surveyed, and more than 56% of micro firms in the convenience store sector, have not thought about the benefits of the e-commerce. This report provides a detailed look at a number of key retail sector, and shows how UK retailers are getting to grip with e-commerce and that modern technologies are helping to change the way they do business. The report mentioned that: – 77% of companies are adopting e-commerce technologies – 71% of businesses use external e-mail – 53% of firms have a website More British food shoppers have converted to online grocery shopping than in any other country. However, Internet sales still represent a tiny, although growing, percentage of the overall UK grocery market. Most people use the Internet as a way of gathering information on products and making price comparisons before visiting their local store.(Key Note) Despite these statistics are showing quite positive numbers, some experts and specialists state that this field needs further research to determine the extent to which the web is likely to promote long term changes in the retail sector . Table 1 A classification of online retail activit 1 Food and consumables: Grocery, including supermarkets and hyper-markets 2 Convenience stores 3 Specialists food retailers, e.g. bakers and confectioners 4 Alcohol retailers, including off-licences 5 Clothing and accessories: Clothing retailers, including female, male and children 6 Footwear retailers, including fashion and work wear 7 Jewellery retailers, including accessories 8 Home: Furnishings retailers, including hard and soft furnishings and Textiles 9 Electrical goods, including brown and white goods and Computers 10 DIY, including gardening 11 Leisure and entertainment: Sports retailers, including sportswear and equipment 12 Toys retailers, including games, hobbies and crafts 13 Books, music, stationery and video retailers 14 News, including newsagents and CTNs 15 Health and beauty: Health and beauty, including chemists and opticians 16 Home shopping: Home shopping, including catalogues and mail order Directories 17 Mixed stores: Mixed stores, including department stores and variety retailers Source N.F. Doherty, F. Ellis-Chadwick and C.A. Hart. 1999 .Cyber retailing in the UK: the potential of the Internet as a retail channel Online Grocery UK Market In the UK online market there are four main grocery retailers dominating the market those are (Tesco, J Sainsbury, Asda, and Iceland.co.uk) According to the researchers the UK leads the world in online grocery shopping. â€Å"Chains like Tesco and Iceland have been much faster than their US counterparts in exploiting the immense potential of new virtual shopping markets.† They estimate that the online grocery market is already worth à ¯Ã‚ ¿Ã‚ ½200m a year and will reach à ¯Ã‚ ¿Ã‚ ½1bn within two years.(Guardian Friday February 4, 2000 ) The online grocery market is characterised by many of the features of the traditional grocery market. Big supermarkets have woken up to the Internet as a distribution channel and are gearing up to dominate the market. Smaller suppliers, using the Web as another side of their portfolio, are sure to lose out in this area. Smaller niche suppliers make up a large element of the market in terms of numbers of firms. In fact, there are so many companies, many of which operate on a very local delivery basis, that it is almost impossible to calculate their actual number. MARKET SIZE Online shopping grew 19 times faster than traditional brick-and-mortar retailing in December 2002, and increased a further five percent in January 2003 to represent six percent of all UK retail .(www.nua.com) Various reported predictions suggest the online grocery market will be worth around up to 10 % of 120 billion which is the predicted grocery market size by 2005 (MINTEL Nov, 2000) The current size of the UK online grocery market has been estimated to be worth à ¯Ã‚ ¿Ã‚ ½1.2bn. (Key Note 2001), while Tesco reported 446 million sales during 2003. Sainsbury's the second market leader announced annual sales of à ¯Ã‚ ¿Ã‚ ½110 million during 2002 (MINTEL Mar 2003) More than half the UK population will have bought something online by the end of 2003. Online shopping will represent 7% of all retail sales in the UK, accounting for à ¯Ã‚ ¿Ã‚ ½2 billion a month.(MINTEL Apr 2003) The total size of the UK grocery market has been estimated at à ¯Ã‚ ¿Ã‚ ½100bn per year. To support the market, the UK has 5.9 million online shoppers, growing to a predicted 8.5 million over the next 5 years à ¯Ã‚ ¿Ã‚ ½500m of turnover, that suggests that average spending per user in 2000 was in the region of à ¯Ã‚ ¿Ã‚ ½83 per head, suggesting that the Majority of users are not regular consumers of online services.(Key Note) Market size is difficult to determine, as figures for turnover from Internet sales are often included in total sales figures. Companies that are struggling to perform in the market may be taking a rather flexible view in how they present figures that may disappoint shareholders. However, Key Note's assessment is that the size of the true online market is currently à ¯Ã‚ ¿Ã‚ ½465m (lower than many estimates suggest). Within this, Tesco claims 64.5% of the market, Sainsbury's 9%, ASDA 7.5%, Iceland 4.7%, , with the balance held by a range of independents, small suppliers and niche companies. Table:2 The UK Online Grocery Market by Online Sales by Supermarket (à ¯Ã‚ ¿Ã‚ ½m and %), 2000 Online Sales (à ¯Ã‚ ¿Ã‚ ½m) % of Total Tesco 300 64.5 J Sainsbury 42 9.0 ASDA Wal-Mart 35 7.5 Iceland.co.uk 22 4.7 Others 66 14.2 Total 465 100.0 Source: Key Note Macro Environment To understand the macro-environment a technique called a PEST (Political, Economical, Socio-cultural, and Technological) analysis is usually undertaken. The PEST analysis identifies all external factors that affect the way a business can operate. What follows is a PEST for the E-grocery industry PEST ANALYSIS POLITICAL FACTORS The UK government sets itself as the target of making the UK the world's best place for e-commerce by developing public internet access and e-commerce awareness among UK businesses To trade in the UK there are 40 different laws that a company may be subject to (chaffey) Stephen Timms, e-commerce Minister, said: â€Å"The UK's retailers are making progress in adopting e-commerce and developing e-business solutions. But there clearly is room for improvement, and we cannot afford to be complacent. â€Å"E-business technologies offer a wealth of benefits. In order to exploit these we must help create the right culture throughout the business community so that UK firms of all sizes can seize the competitive advantage. â€Å"UK online for business is leading the way in getting business online, and the Government's aim to make the UK the best place in the world for e-commerce.†( http://www.gnn.gov.uk) The first Annual Report on the strategy was launched in September 2000. The UK strategy for online development is laid down in the UK Online Action Plan, which details 94 recommendations for action in 25 areas of priority. One specific goal is to develop the UK as the world's best environment for electronic trading by 2002. This, it is stated, will be achieved in four specific ways: * Encouraging competition in Internet access markets * Establishing a new regulatory framework for converging telecommunications and broadcasting markets * removing regulatory obstacles to electronic ways of working * Co-operating with international partners to develop a ‘global framework for e-commerce'. Oftel (Office of Telecommunications) is one of the tools for achieving this strategy, and, as such, has been charged with driving competition in the areas of dial-up access and delivering high-speed access routes to the Internet , specifically the encouragement of adoption of Broadband technology, and NPD (new product development) in the mobile-phone and fixed-wireless markets. Government strategy is to put as many UK consumers as possible online. Those responsible for driving this strategy are aware of consumer concerns about the Internet that must be addressed if the Government's objective is to be secured.(Key Note) ECONOMICAL FACTORS The innovation in information technology (IT) and new business practices facilitated by IT are forming a â€Å"new† economy, Electronic commerce and the IT innovations fuelling it are supposed to be fundamentally changing the logics of business practice, forming new social realities, and new business models. Traditional â€Å"old economy† firms and organizations are busy building bridges to the new economy. A stable rate of economic growth is one way in which the Government hopes to guarantee macro-economic stability, which can assist firms when assessing the risks associated with innovative practices. This, combined with the factors outlined below, has an influential effect on the rate of growth of the online grocery market. Low Cost of Internet Access One of the main drivers encouraging the use of Internet access and e-grocery in the UK is the relatively low cost of time spent online. The UK is the cheapest off-peak location in the world from which to surf the Internet, peak rates have has been dropped. This advantageous position benefits consumers, and the state of competition within the market is strong, with a large number of good quality Internet service providers (ISPs) available and eager to serve the public demand. Levels of Disposable Income The greater the levels of PDI consumers have, the more likely they are to be tempted towards higher margin products. Such high-margin products can make the difference between a profitable online transaction and a loss-making one. Table: 3 Index of Personal Disposable Income (1995=100 and %), 1995-2001 1995 1996 1997 1998 1999 2000 2001 Disposable Income index 100 106 113 116 122 127 132 % change Year-on-year – 6.0 6.6 2.7 5.2 4.1 3.9 Source:National Statistics Table 3 shows that levels of disposable income are rising, and have risen by 32% since 1995. The indications are that the upward trend will continue to apply, suggesting that this economic indicator will contribute to growth within the market in the short term. Rate of Change of Prices The change of prices gives a good sign of the stability of the economy. The UK has a low rate of inflation, and this is confirmed by an assessment of the RPI in Table 4 Table 4: Retail Price Index for All Items and Food(1995 =100 and %), 1995-2000 1995 1996 1997 1998 1999 2000 RPI (all items) 149.1 152.7 157.7 162.9 165.4 170.0 % change Year-on-year _ 2.4 3.3 3.3 1.5 2.8 RPI (food) 151.4 154.9 160.5 166.5 169.4 175.2 % change Year-on-year – 2.3 3.6 3.7 1.7 3.4 RPI – retail price index Source: National Statistics It can be seen from Table: 4 that the rate of change in the price of food between 1995 and 2000 has been roughly in line with the general rate of change in the RPI. Similarly European Currency and Simplification O European Trading Laws The advance of the European currency and the simplification of European trading laws will mean that Consumers will find it increasingly easy to trade with European retailers. The Internet offers International retailers a great opportunity to attack the UK marketplace. British shoppers are already prepared to go Euro to get what they want online. â€Å"Big brand names are in the best position to immediately exploit e-commerce but if they don't start moving soon the threat from foreign competition is real.† (Jolanta Pilecka, E-commerce Marketing Manager, Hewlett-Packard). In future a number of important factors might affect the economic state of the UK and inevitably supermarkets. The first is the possible introduction of the Euro. The Euro has been introduced in various European countries, but most notably France. The introduction of the Euro in France has pushed up weekly shopping bills for the average French household by 10 per cent. Could the same be expected to happen in Britain should the Euro SOCIAL FACTORS To know the barriers to consumer online purchasing adoption it is useful to understand the different factors that affect the level of internet access. Value proposition ease, Security and fear of unknown are the main factors affecting the internet adoption (Chaffey) Over the period July to September 2002 an estimated 11.4 million households in the UK could access the internet from home, that amount 46 percent of all households. This is over twice the number three years earlier and is an increase of 7 percent from 39 percent reported in the third quarter of 2001. (www.nua.com ) Evidence suggests that household formation will continue to grow, but that the profile of home size as mentioned at the first of this paper will stay strongly biased towards homes with one or two people. Table 5: Changing Household Numbers in the UK (million and %), 2000 and 2005 2000 2005 Million % of Total Million % of Total One person 7.3 29.1 8.0 31.1 Two persons 8.9 35.5 9.0 35.0 Three persons 3.7 14.7 3.5 13.6 Four persons 3.5 13.9 3.5 13.6 Five or more persons 1.7 6.8 1.7 6.6 All households 25.1 100.0 25.7 100.0 Source:National Statistics An estimated 62 %of adult in the Great Britain have accessed the internet some time according to figures from the October 2002 national omnibus survey. This is equivalent to approximately 28.6 million adults in Britain having accessed the internet. In the month prior to the survey 52 per cent of adults had accessed the internet. Differences between the countries and regions of the UK Levels of access vary greatly between different parts of the UK. In October 2001 to September 2002 the proportion of households with access was lowest in Northern Ireland (30%), Wales (31%) and the West midlands (34%). It is noticeable that the proportions were highest in the East of England (52%), London (50%) and the South East (50%) were around half of households had access to the internet. Table:6 Households with home access to the Internet by Government Office Region & UK country: October 2000 to September 2001 and October 2001 to September 2002 Oct 2000 Oct 2001 to to Sep 2001 Sep 2002 Per cent North East 26 36 North West 35 41 Yorkshire and the Humber 32 39 East Midlands 40 46 West Midlands 35 34 East 40 52 London 46 50 South East 46 50 South West 38 41 England 39 44 Wales 27 31 Scotland 30 40 Northern Ireland 26 30 United Kingdom 37 43 Source: national statistics According to International Telecommunication Union (ITU) (www.itu.int ) it is shown that in the UK 36.62 per 100 own a PC Table 7: Internet Estimated PCs Hosts total 2002 Hosts per 10`000 inhab. 2002 Users (k) 2002 Users per 10`000 inhab. 2002 Total (k) 2002 Per100 Inhab. 2002 2`865`930 485.03 24`000.0 4`061.74 22,00 36.62 table 7 , shows that a large proportion of the UK population own a PC that makes accessing the internet easer than going to the work place or other places Legal and ethical concerns It is argued that people do not change as quickly as may be believed. They still do not like parting with personal details, especially to those that they do not trust. Firms that request data from consumers need to make supplying information optional and allow users to change and delete the information provided. Crucially, they need to convince consumers that they will treat all information confidentially. Firms that are recognised as ‘good citizens' and with a high reputation in this regard are well placed to ease the anxieties of consumers scared of fraudulent use of details. Smaller companies with an Internet-only presence will find it hard to build up this trust. TECHNOLOGICAL FACTORS E-retailing can be seen as an innovation in retailing that in turn is built around a technological innovation Many reports have summarized technological problems as: The complexity of the user interface bandwidth restrictions and access connection speeds and security concerns A wide range of new technologies have enabled companies to create better and more efficient relationships with consumers as e-retailers: – provide more information in the pre-shop experience; – increase the number of access points to meet customers needs; – offer a wider choice of products than can be held in-store; and, – improve the overall service provision, for example through better stock management. www.gnn.gov.uk Technological breakthroughs are some of the key drivers in building the right conditions for online grocery to thrive. The main technological factors influencing the market include: à ¯Ã‚ ¿Ã‚ ½ The expansion of broadband Internet à ¯Ã‚ ¿Ã‚ ½ The introduction and growth of DTV (digital television) à ¯Ã‚ ¿Ã‚ ½ M-commerce (mobile-commerce) and WAP (wireless application protocol) phones à ¯Ã‚ ¿Ã‚ ½ Automated reordering systems à ¯Ã‚ ¿Ã‚ ½ Systems offering defence against fraud à ¯Ã‚ ¿Ã‚ ½ Automated customer service. (Key Note 2001) Broadband Internet One of the problems many consumers have when dealing with the Internet is the speed of access. Many consumers connect using 56K modems, although the majority never achieve this speed, perhaps because they live a great distance from the central phone-exchange routes or because their phone lines are too old. Broadband connections can alleviate this problem. Broadband connections come in two basic types: digital subscriber line connections (DSL) and cable modem connections In the first quarter of 2001, the number of DSL lines grew by 90% in the UK This market is likely to experience high growth in the coming years.(www.itu.int) Digital Television Advancements in television are running parallel to other Internet-enabled technologies 4.4 million households had DTV in 2000, and the figure is now probably in excess of 5 million. Not all DTV services are fully Internet-enabled, but there are plans to achieve this. The growth rate in subscription to DTV services is believed to be higher than the rate of new subscribers to ISPs. It has been suggested that more than 45% of homes will have digital satellite TV by 2008 (generating revenues for the communications companies of à ¯Ã‚ ¿Ã‚ ½2.4bn per year). One of the major barriers to e-grocers is the high costs charged to the suppliers by the DTV companies. Tesco reported to have found Open Digital's charges too expensive to make a venture worthwhile, however, the majority of the large supermarkets are signing up to the service may have very severe consequences in the long term. M-Commerce and WAP Phones M-commerce for all markets in Europe is forecast to reach levels of around $38bn by 2004.(Key Note) with over half of European companies planning to offer some form of service via mobile phones (particularly in the banking and service sectors). Major multiples are increasingly active in the service sector, and their online successes in other areas could well spill over into m-commerce activities, Mobile communications company Ericsson has estimated that, by 2004, there will be more than 600 million people using mobile Internet services in Europe. In 2000, the market for subscriptions to mobile-phone services grew by 67% and by 84% in 2002 .(www.itu.int ) However, WAP phones, currently the only method of accessing Internet via a mobile, have been relatively slow to catch on in Europe and make up only 15% of overall handset sales globally. Automated Re-ordering Systems All the technologies so far discussed require a conscious effort on the behalf of the consumer. In the future, it is possible that automated re-ordering systems will mean that the retailer is automatically notified when products are being used up within the home and need replenishing. There are two enabling technologies currently under development that may make this less fictional and more everyday. Vendor managed inventory (VMI) is one of these technologies. Another enabling technology in the same area is radio frequency identification technology, also known as RFID. This improves on VMI by using radio waves to scan all products in the fridge at any one time. Those kinds of technologies build and grow up the relationship between the consumer and the supplier learns more about the consumer behaviour to satisfy his demand Also they can create a competitive advantage for the business Systems Offering Defence Against Fraud Concern over fraud continues to scare many consumers away from using the Internet as a route for purchasing items and services. Credit-card companies are already making changes to their services to ease these concerns, but longer-term solutions may be found in encryption technology. Technology is being developed that adds digital signatures to a purchaser's Web browser which may help fight fraud. Such services can only be developed and provided by strategic partnerships between online retailers and Web security corporations such as Inktomi, Ariba, Broadvision, Vignette and Verisign (all leaders in secure-payment processing solutions). INDUSTRY ENVIRONMENT Porter's 5 forces analysis Michael Porter's five forces is The model that widely used for competition analysis in business strategy formulation, states that an organisation exists within an industry. To succeed it must deal with the competitive forces that exist within that industry: (1) Entry of new competition. (2) Threat of substitute products. (3) Bargaining power of buyers. (4) Bargaining power of suppliers. (5) Rivalry amongst existing competitors. THE GROCERY E-TAILING MARRET As an industry in the early stages of its life cycle, the online grocery market is currently very fragmented, with a growing number of competitors. The reasons for this fragmentation lie in several factors: relatively low entry barriers, high transportation costs, the perish ability of grocery items, nontradable goods and services industry, and the ability to specialize in geographic regions and reap the benefits of economies of scale. Much like traditional bricks-and-mortar supermarkets, online grocers are highly localized except for a few that operate nationally or internationally by delivering only non-perishable goods. (Success factors) Barrier to entry Compared to building traditional supermarkets, the barriers to entry in the online grocery market are relatively low, since most online grocers are localized. Set-up costs include establishing the computer system, creating logistics and warehousing capabilities, building brand awareness, and having the necessary alliances with local grocers in place. Many online grocers have already established partnerships or alliances. Entry into the industry is currently relatively easy, because no one has inherent advantages. Innovation and competitive moves, which can be easily replicated, have not prevented new firms or substitutes from entering the market. However, entry barriers may rise in the future as consolidation likely occurs. Market such as groceries, barriers must be built on differentiation through brand recognition by achieving superior customer service and responsiveness. One attraction for the recent surge of Internet startups in the grocery business is that online grocers require less capital and have lower variable costs than bricks-and-mortar stores. Fixed costs are high, but the potential for big returns is great if a large sales volume can be generated. Exit barriers can be moderate to high, depending on the amount invested in logistics and warehousing, the Web site, computer systems, and marketing. PPOWER OF SUPPLIERS Retailers have high bargaining power when they purchase a large volume of goods from their suppliers. Unlike huge supermarket chains, the smaller online grocers typically possess a lower level of bargaining power than their suppliers. But traditional grocers that decide to branch out onto the Net have the advantage in this regard, buying in bulk and enjoying established relationships with suppliers and customers. This allows them to price their goods competitively, deterring new entrants or forcing inefficient incumbents out. POWER OF BUYERS The bargaining power of buyers or consumers is very high in this industry. With many substitutes and competitors to choose from, dissatisfied customers can simply switch to a competitor. Groceries are commodities, so consumers can be sure to purchase the exact same products elsewhere. THREAT OF SUBSTITUTE PRODUCTS The threat of substitutes is undoubtedly high for two reasons: Firstly, the products and services offered online to customers are extremely similar. So similar in fact that supermarket' often have to lower their prices to give them more appeal. Secondly although there is a certain degree of brand loyalty, it can't be relied on, as customer loyalties tend to change when they find they can obtain better value for money elsewhere. E-grocers understand that the threat of substitutes is high, and this then is the main reason for supermarkets branching out and pursuing a broader product line, as a means of calming the intense competition with their competitors. However, in pursuing broader product line grocers open themselves up for further competition from experienced players in other non food retail markets. RIVALRY AMONGST EXISTING COMPETITORS Competitors will do everything in their power to increase their market share. Supermarkets also have high fixed costs due to the sheer number of stores they have open. They must make a sufficient amount of sales to cover their costs and generate profit. As discussed earlier there are a variety of substitute products and services that are becoming increasingly difficult to differentiate thus custom is very much determined by price. This situation is further aggravated because switching costs are difficult to impose, as food is an everyday necessity, many customers will happily forget any loyalties if they really need to obtain it. Conclusion The environment in the online grocery industry is growing more and more competitive as new firms continue to enter. Grocers which established its online purchasing site first is gaining the benefits of the first-mover advantages such as Tesco.com E-grocery has become a considerable industry sector each main player in this industry is trying to create a competitive advantage to attract more numbers of spoiled customers trying to satisfy there demands. The UK e-environment is one of the best e-environments globally that ease the entrance to this industry and generate the potential for more and more customers to buy grocery on line. This industry sector is a quite new industry that makes the flow of information about its success and pitfall factors relatively not enough to know every factor influences this industry We can't say that e-grocery sector has reached the mature level since there are more and more numbers of customers and rivals are entering this sector.

Eat Local Assignment Example | Topics and Well Written Essays - 1250 words

Eat Local - Assignment Example The mere appearance of the burger was enticing. On consumption, I articulated its tasty nature to the regular and fast deliveries covered from the farm to the restaurant. Further, the organic farming practices and sustainable strategies used by the farm in outsourcing other products contributed to the food’s value. I ate mashed potatoes served with beef stew on the second day, whose ingredients emanated from Buckleberry Farm. It was realistic from the cost analysis that the farm stipulated reduced prices for its products prices citing to the reduced costs of the meals (Miller, 2014). For instance, the burger sold at $7 compared to the other burgers that cost $7.9 in the competing restaurants. The perception held following the meal’s consumption was that â€Å"local† food represented any supplies bred under sustainable and socio friendly methods within the US (Schindler, 2014). I concluded that eating local food was a healthy and an economical practice worth embra cing. In the contemporary global community, the majority human population prefers organic to inorganic foods. The perception is that organic agricultural foods are healthy compared to those grown under inorganic practices. It is arguable that the former practices include toxic elements that harm flora and fauna. The highlighted aspect prevails amongst other benefits accrued from the solution to consume locally grown and processed foods. The production and processing of the food at Buckleberry Farm is subject to strategic measures that guarantee hygiene and fast delivery thereafter. Arguably, the locally produced food will cost less compared to similar foreign or distant products in Eugene, Oregon. The freshness of local foods is evident from the practices embraced by the stakeholders (Miller, 2014). Foreign foods are subject to costly processes from production to marketing. In the end, outsourcing of the foreign foods incurs