HRM and Business Process Outsourcing - Free Essay Example

One of the major challenges facing Human Resource Management is the introduction and management of Business Process Outsourcing (BPO). In dyads or tryads produce a group briefing paper for either; Directors of a company or a specific trade union, of your choice, regarding the changes taking place in the UK labourmarket and economy regarding the impact of outsourcing and/or offshoring. INTRODUCTION The current economic climate is forcing organizations to explore tactics to remain competitive. According to the traditional make or buy decision framework, the fundamental value proposition behind BPO is cost reduction. The recent economic downturn forced HR departments to do more with less. Many HR organisations were asked to increase the scope of their capabilities without increasing overall headcount. As a result, some organisations viewed outsourcing as a way of combating current economic situation and achieving competitive advantage. In spite of the recent economic slowdown, Gartner Group stated that, the worldwide business process outsourcing (BPO) market, is continuing to grow by approximately 9.5. Organisations are increasingly seeking standardization as part of a re-emphasis on strategic business initiatives. They realise that they need to standardize HR processes and policies as a first step in their HR transformation. Business process outsourcing of certain functions is becoming an increasingly popular way to improve basic services while allowing HR professionals time to focus on issues vital to the businesss strategic initiatives, instead of being burdened with HR administration. Chaffey (2003) defines BPO as the contracting out of specified services to a third party with a controlled, flexible relationship. Lee (2002) refers to BPO as the outsourcing of different managerial and operational functions. Specifically in HR, BPO is designed to ensure that a companys HR system is supported by the latest management information systems, with self-access and HR data warehousing options. The Business Issues (1995) further views BPO as the delegation of one or more business processes to an external provider, who then owns, manages and administers the selected processes based on defined and measurable performance metric. The CIPD defines off-shore as the process of outsourcing business activities or services overseas, as a direct or indirect employer. Off-shore does not always involve the services of an external provider . According to the Oxford Dictionary it means: made, registered or situated abroad. The concept of outsourcing centres on David Ricardos theory of Comparative Advantage (cited in Mullins 2001) which states that even if a country could produce everything more efficiently than another country, it would still reap gains from specialising in what it was best at producing and trading with other nations. AIM OF BRIEFING The aim of this briefing is to brief the Directors of Name of our company the effect of outsourcing the HRM function and will encompass its influence on organisational performance and culture; and concurrently its impact on the UK Labour market and economy. The team will carry out a case-study on BT and will critically evaluate, analyse and highlight the advantages and disadvantages of HR outsourcing with the intention of reviewing the outcomes and where necessary suggest solutions where likely problems can be encountered. An analytical review will be carried out of the major HRM problems which can arise from organizational change and where required recommendations made. The team will use British Telecommunications as a case study to establish the impact of BPO. This briefing aims to provide a reasoned critique of existing literature based on surveys, textbooks, journals and official trade data. BACKGROUND British Telecommunications (BT) is a wholly owned subsidiary of BT Group Plc, a public limited company registered in England and Wales and listed on the London and New York Stock Exchanges . BT is one of the worlds leading providers of communications solutions and services operating in 170 countries. It principal activities include networked IT services, local, national and international telecommunications services, and higher-value broadband and internet products and services.Its main activities are web hosting, IT solutions, Internet services, telecommunications and broadband networks. In the fiscal year ended 31 March 2007 BT had a net turnover of 9,499 billion. In the UK alone it has pool of 87,000 employees and 180,000 pensioners, whilst on a global scale it has 10,000 employees spread over the countries it operates within. For years, British Telecom ruled the UK market as a monopoly. It was the British Telecommunications Act of 1981 that brought this to an end and put in its place a duopoly, where BT competed with Mercury. The company was formed in 1981 as a subsidiary of Cable Wireless, mainly to challenge the monopoly of British Telecom. The privatisation of British Telecom in 1984 opened the industry to full competition and in 1991, this effectively brought the duopoly share by BT and Mercury to an end. With the liberalisation and opening up of the phone market to global competition came renewed pressure on BT from the telecoms watchdog Oftel to open up more of its network to competitors and cut its prices. The pressures on BT became greater than ever. The stiff competition in the telecoms market, the huge cost of paying for third-generation (3G) mobile phone licences, pressure from the industry regulator Oftel to lower its prices and informed, discerning customers meant BT had to deliver even higher levels of quality and service, at competitive prices in order to stay afloat. All these pressures necessitated mindset change and BT was forced to review its business processes. In order to meet up with the arrival of new competitors and the quickening pace of technological change in the industry, speed of action and reaction became critical success factors. With the competition that flooded the UK market in the 1990s, BT started considering cost reduction that will maximise efficiency without compromising quality. One of the major steps taken was to outsource the transactional side of its human resources operation to Accenture HR Services, which in turn off-shored to its India branch. BT believed that the competitive edge for any global communications provider is human capital and to survive and thrive, it requires world-class human resource (HR) competencies and the processes for managing them. Youndt et al. (1996) highlights that a HR system focused on human capabilities is directly related to multiple dimensions of operational performance. Huselid and Becker (1997) describe that a firms effectiveness is associated with HR capabilities and its attributes. ADVANTAGES OF OUTSOURCING / OFFSHORING Outsourcing enables an organisation to improve its focus on its core values allowing it to remain competitive on the market (Morello, 2003) . Prahalad and Hamel 1990 state that firms must concentrate on core competencies to gain competitive advantage. Through outsourcing specialist skills can be drawn out from a pool of expertise when and where needed whilst opportunities for enriched career development exist for the remaining staff. Organisations are able to turn over certain classes of risks to their suppliers, such as demand variability and capital investments. Unlike the buyer, the outsourcing buyer can spread these risks over multiple clients. Profitability can be achieved as outsourcing increases a businesss cashflow by creating cost reductions through cheap labour and reduced operational expenses i.e. office space, utility. Funds which would have been used for large capital investments can be released for other uses. Contracting out operational functions reduces the competition on capital as the outsourcing company provides the capital investment as part of its overheads. Companies can create an integrated market as it is a cost effective way of globalisation particularly when it selects the best available resources and labour. Figure [rumbi insert appendix] reflects the changes to operational costs which BT experienced when it outsourced. According to Som Mittal, former Managing Director of Compaq India has claimed that payroll processing to countries like India companies can achieve a 20-25% gain in productivity. Outsourcing can increase the service level given to clients. With offshoring an organisation has the ability to have a 24-hour a day workforce resulting in a more timely service which would not be possible if the organisation operated in once country. BT gained flexibility through outsourcing to Accenture as agility or quick response to business demands was made. Competitive advantage can be attained through cheaper prices. When the product prices cannot come down further operating in a highly skilled, low-wage labour area will be advantageous. (Frubel, Heinrichs and Kreye 1980) . As the product price falls consumers are willing to demand a larger amount of goods. The off-shored countries receive economical benefits. Nasscom Chairman Som Mittal remarked Its a win win situation for countries which allow outsourcing and the countries which receive outsourcing (Ahmed 2004) . DISADVANTAGES OF OUTSOURCING/OFFSHORING: When outsourcing to a third party resentment can occur between permanent and contracted staff. Contract/temporary staff may fail to have a sense of belonging whilst permanent staff can remain aloof in order to protect their works hindering teamwork. Offshoring particularly on the outsourcing of work to India as the UK labour force believes that they are losing out on career opportunities. However the McKinsey Global Institute Report states that there are actually too many jobs and not enough people in the UK to fulfil them. Therefore fears of a widespread unemployment are unlikely and thus this resentment could be seen as unnecessary (Lander 2006) . The lack of direct communication between the organisation and the client can hinder the development of solid relationships and can result in the main organisation lacking control of the outsourced project. One of the key aspects of motivation is social interaction and self actualisation (Maslow cited in Mullins, 2001). Another perceived drawback of off-shoring is the decrease in levels of communication. When English is not the native language of the source area, poor command of the English Language leads to prominent resentment of offshored services (Ahmed,2004). Results of a survey carried out by the Nationwide building in 2005 reflected that 91% of UK adults would prefer their calls to be handled by UK-based call centres (Lander (2006). A major drawback is the expense of regaining a customer once lost, because it could cost up to 6 times more in marketing costs to gain a replacement. Cultural differences can be a disadvantage of offshoring i.e. Ryan Kinzy of K3 Group a large outsourcing company states that there are 3 months which are viewed as the most auspicious time for weddings in India, for example half the staff are out of the office. Ryan highlights that building up teamwork is a difficult challenge as employees may lack intuition due to their culture, Indian workers require a lot of direction. Their relationships are hierarchal, family and caste dependent and they have an educational system that emphasises routine learning over independent research. Outsourcing can prove expensive as payment of redundancy packages for the laid off staff can be a major drawback. As the number of companies offshoring to India rises, employee retention becomes a challenge due to the fact that as market competition increases, salaries are required to be competitive. Organisations will have to decide whether the cost-savings outweigh the revenue generated. Risks can be encountered due to the socio-economic conditions which can hinder the progression of operations i.e. maintaining trade risks. The chance of off-shore fraud also exist as the use of funds can be diverted. There is also the risk or data loss. BT faces the risk of fraud emanating from HR outsourcing as off-shore workers have full access to personnel details ranging from bank account numbers, home addresses and other personal details. Non-automated transactions and processing responsibilities enable off-shore workers to have access to highly confidential information. There is an increase in foreign organised crime groups who have targeted foreign off-shore enterprises to gain access data which they process. Organisiations can face compliance risks and their reputation being damaged due to negative publicity resulting from the third party being inconsistent in meeting ethical standards and internal policies. The organisation needs to carryout thorough audits to ensure control . Expertise levels need to be measured to ensure that required service levels of service are met. {Figure xxRumbi to appendix 2} reflects results of problems faced by several companies which have off-shored. The main problem met appears to be low control of performance and data. Offshoring has the limited disadvantage in that the core function of an organisation cannot be accomplished if passed onto an external source . A business which outsources a department still requires in-house technical experts to monitor activities (Greco 1997) Political infrastructure such as changes in government can affect can impact the outsourcing company. Shortly after the election of Sonia Ghandi stock markets plummeted on fears that her leftist allies would roll back fundamental economic reforms. Erratic power grids inexperienced officials and unmotivated employees can also prove to be a disadvantage. ORGANISATIONAL CULTURE BTs management believes organisational culture is innovative with teams that are strategically aligned to BTs operations. Advances in technologies have been applied to benefit BT and its customers to improve processes. Culture can be an object which is manipulated to achieve productivity and organisational improvements, and change over time (Tran, 2008) . In this context, culture is the character of an organisation. However if culture is accepted as being .the basic, taken- for- granted assumptions and deep patterns of meaning shared by organisational participation and manifestations of these assumptions ( Johnson, 2007) then in this respect culture can be difficult to change. In order to explain the content of cultural context in BT after HR outsourcing, the cultural web will be used. The table below shows the content of the organisational culture with HR outsourcing. Rumbi to appendix 1] According to the above table the organisational culture hinders collective learning in the organisation. Individuals see each other as rivals, rather than a partners. This paradigm creates various obstacles for learning within the organisation, that usually arise due to rivalry, power conflicts and absence of network communication channels (Mullins, 2001). The disadvantage of this power structure is explained by Mullins (2001) who claims that such approach decrease the effectiveness and efficiency of operations management, as participants are detached from the decision-making. BTs new organisational structure is bureaucratic, with the emphasis on standard procedures and operational routines. It might slow down the communication process, with the absence of feedback channels and unnecessary layers that might increase obstructions and cause various distortions in the communication process( Graham Bennet, 1998) . BT has placed its employees after revenues. The management has failed to take into account individual needs of each employee hence developing a coercive rather than participative approach. Within this approach people are being treated as liabilities rather than the core elements of the operations management process, where people become the primary determinant of the outcome quality (Armstrong, 2003) . The organisational culture implies for traditional type of performance appraisal system, which utilises various types of monetary techniques. Wright (2007) argued that the utilisation of monetary tools does not provide the development of a higher level of effective commitment or higher degree of intrinsic motivation and provides a blurred understanding of the relationship between their performance and corresponding appraisal. The communication component forms an important of the above mentioned changes. According to McGregor (1960, cited in Mullins, 2001) in order to get people to direct their efforts towards organisational objectives, management must tell them what to do, judge how well they are doing and reward or punish accordingly. There is also an informative and a motivational purpose. He claims that a clear and thorough description of individual duties and rights within the framework of the organisation may prevent the rise of unmet expectations. As it shows on the table, the communication in the company is of a top-down nature, without proper feedback. This type of communication scheme is good for conveyer-type organisations and not ideal for innovative market-led companies. CHANGE MANAGEMENT The new requirements for adaptation made it necessary for the company to undertake the reengineering of the whole business process, including both hard and soft elements. According to Senior (1997) hard system change implies an attempt to use the benefits of a scientific method whilst recognising that in the real world of business where thing are happening fast, there may not be time to be as scientific as one would like. In BTs case, hard system change referred to the introduction of new operations management systems, equipment and business facilities, designed to speed up existing operations and reduce the cost per a single transaction. It was designed to maximise the efficiency of every single operation within the business process. Senior (1997) indicates that Soft System changes imply for the change of the organisational culture. The main idea of this approach is listening to the organisation, good communication, developing a shared, vision, gaining real commitment to the change and the vision, education and training, and understanding the tools and techniques for the process. William et al.(1993) indicates that to facilitate effective adaptation of the employees to new working conditions, managers shall reduce restraining forces and reinforces driving forces. However, it shall be considered, that not all measures are equally effective. As Hetzbergs maintainance theory ( cited in Mullins, 2001) shows , the presence of certain factors may act as a powerful motivating factors, while the absence of other elements may produce slight dissatisfaction. At the same time strategic priorities shall reflect the current organisational aims. Under such conditions in order to improve the situation and meet objectives (create a better customer focus) the high involvement of senior managers, who acts as a link between operational and business levels of the organisation, is required. Senior managers shall act as major change agents. Taking the role of change agents, it is important for senior managers not to ignore employees natural resistance to new systems, but to create appropriate incentives to fasten the transactional process from resistance to commitment (Graham and Bennet, 1998). The ignorance of or resistance to changes will introduce different open conflicts, which will significantly worsen the organisation environment affecting its performance level and flexibility. This could result to failure to raise performance and attract or retain customers, which may lead to significant costs and even reduce the companys chances to survive and succeed in changing market conditions. According to Mintzberg Quinn and Ghoshall (1995) the overall rationale for any outsourcing activity is that outsourcing provides, greater economies of scale, flexibility, increase in levels of expertise, cost effectiveness, reduced costs and added value to any organisation. The rationale of BT outsourcing its HRM functions were to increase shareholder value, sustain progress and cope with the pace of change. Outsourcing of parts of the HR function has become more common. Lonsdale and Cox (1998) argue that outsourcing decisions can be classified under the following three headings: 1 outsourcing for short-term cost and headcount reductions; 2 core-competence-based outsourcing, where peripheral activities are passed to third parties and core activities are retained in-house; 3 iterative and entrepreneurial outsourcing, where periodic reviews of critical market activities are undertaken, with subsequent decision to retain or outsource. IMPACT ON UK LABOUR FORCE Human capital is emphasized as the most valuable asset of the 21st century business. The primary effects of outsourcing/offshoring on HR and Labour Relations are related to managing transition in HRM such as personnel changes, managing layoff, downsizing issues, and the costs/dynamics of actually managing an off-shore contract. The laying off of UK employees as a result of restructuring to effect the outsourcing contracts can have a negative impact on employees. Layoffs cause major morale problems among in-house survivors and may lead to dissatisfaction and reduced delivery speed. Some UK companies experienced productivity dips and potential legal action from laid off employees resulting in costs of severance, retention bonuses and retraining being encountered. According to a survey by Deloitte and YouGov (2006) revealed that fear of job losses was prevalent in the UK with 82% of public perceiving offshoring as a threat . 1 in 3 people stated that UK companies should be forced to bring back jobs to the UK. Chief economist of the Work Foundation, Ian Brinkley commented Fears have been stoked by claims that the Chinese and Indians are coming to get your lunch to describe the insecurity that offshoring has caused. With regards to knowledge transfer there is concern that some of the job experience is being exported. If low-level skill tasks are sent off-shore then so is the experience gained from performing those tasks. When the time comes to perform higher-level tasks where previous experience is mandatory, there is no alternative than to go off-shore because that is where the experience will available. In some instances company plans imply that higher-level tasks will remain performed on-shore, the lower-level tasks are performed miles away. The knowledge and experience of those low-level jobs will be gone forever, and may impact the proper development of the higher-level jobs. Forrester a US research group released a study that by 2015 Europe will have lost a collective number of 1.2 million jobs to off-shore locations increasing its reliance. Alan Blinder a US economist and former advisor to Bill Clinton has supported this thesis by stating that offshoring will lead to a third Industrial Revolution. He views that off-shore is now a man-made comparative advantage and that workers will be forced to seek employment in personal services which remain non-tradable. There is a long-term impact on the types of jobs that people are training for, as well as the transfer of knowledge relating to many job structures in the workplace such that there is a domino effect. Steve Loy feels that these outgoing tide of jobs could threaten fundamental technology research as well as jobs. The astute students will recognise the rapidly dwindling job opportunities in HRM and will choose other programs of study thus loss will be encountered in HR leading to a labour-force that has inadequate HRM knowledge to compete in a high knowledge based economy. The evaluation of the impact of off-shore is mainly based on estimations of collective data. Jobs most at risk are non-client facing and low knowledge content jobs those which use a lot of Information technology, creating outputs that can be transmitted via IT. An analysis by the CPRP concluded that 20% of non-client facing jobs are likely to be moved abroad. The potential is apportioned as a function of international trade and investment, the industrial structure of the economy, human capital, employment indicator, product market regulations indicator. Not all jobs created off-shore by UK companies automatically translates to job losses in the UK labour market. Employees are increasingly demanding services hence time difference plays a role in off-shore, offering them extended services. The lower price makes it possible for instance to offer services which would not be available otherwise i.e. 24 hr call centres. The information collated by the European Restructuring Monitor (ERM) s hows that job loss due to offshoring is in fact very small. During the first quarter of 2007 ERM recorded 420 restructuring cases in Europe. They announced 137,762 job losses and 184,511 job gains. Only 5.5% of all jobs lost were due to offshoring activities. For the year 2005 the percentage of job losses due to offshoring was only 3.4% of the total job losses. To measure the extent of job loss due to restructuring we can use redundancy notification, the effects of offshoring does however vary with the country. In France, national Institute for Statistics and Economic Studies estimates in its 2007 report on the French economy that offshoring has been responsible for the destruction of 15,000 jobs per year between 2000 and 2003. This is to contrast with a job creation in the private sector of 200,000 per year . In the UK there is no significant decline as per the results of the LFS Redundancy Tables Employment growth in the occupations considered susceptible to offshoring has been very strong. The redundancy levels for these occupations, although high relative to the whole economy, have been falling in the last four years. The overall employment rate for these occupations has also shown an increase showing the cost of moving low-skilled jobs abroad is either falling or positive job creation is highly prevalent in the IT enabled occupations. This does not mean that jobs are not being off-shored, and it is entirely possible that in the absence of offshoring, employment in these areas might have been higher. The adverse impact is entirely triggered by much larger changes in domestic demand for such services, the UK in particular has been extremely successful in developing as a world leader in knowledge based international trade. Jobs created through the expansion of exports of services are likely to outweigh the contraction of jobs caused by import of services. According to a report by Amiti and Jin Wei (2005) job growth at divisional levels has not been negatively related to service outsourcing but has had a negative impact on the demand for unskilled labour. In the UK outsourcing has had no reflected effect on the labourforce. The Deloitte and Recruitment Employment Confederation Report states that both permanent and temporary staff billings continue to rise. National press recruitment advertising in the UK went down by 11.3% in July 2005 in both public and private sectors reflecting a positive direction in the labour market and no relevant changes in the economy. Outsourcing is increasing consultancy work in the United Kingdom hence is beneficial as it offers flexible working hours / days for UK employees. This is particularly favorable for women who are raising children as is allows them to earn a salary whilst at the same time having adequate time with their children. There is also the flexibility of home-working. Structural changes can occur in the economies of both the outsourced/sourcing companies and due to the debate on who is benefiting/losing racism can be allowed to rear its head. A report prepared for the Department of Trade Industry by Ovum (2006) concludes that even though the actual impacts of an increase in trade and the expansion of global sourcing have been quite modest to date, offshoring can change the skills structure of labour demand, increasing the vulnerability of low-skilled workers in particular. ECONOMIC IMPACT Concern over off-shoring has become a surrogate for wider issues about economic insecurity, said Work Foundation chief economist Ian Brinkley. An interesting corollary benefit of outsourcing is the benefit to the economy. Indias National Association of Software and Services Companies commissioned a report by Evaluserve that stated that for every $100 worth of work sent abroad by US companies, $130 to $145 will be reinvested in the US economy. Cost savings are said to create value in the UK economy. Ahead of monetary capital, knowledge economy has become a focal point in the policy of outsourcing and off-shore. Strategies have been devised i.e. the Lisbon Strategy centres to promote, research, innovation in the development of human capital. In the future, human capital is the only way that Europe can remain prosperous. The main beneficiaries in the UK are the educated high skilled workers and the losers will be semi/low skilled workers. The UK government needs to investment more in education to continue pushing towards a leading knowledge based economy to avoid vulnerability. It needs to investment in human capital and focus on domestic policy choices for the losers of rapid structural changes within the UK. As a result of off-shoring the UK government is losing funds which could possibly be raised by corporate and income tax. However, it has stated that it does not have plans in place as yet to prevent outsourcing. The Department of Trade Industry has stated it is a commercial decision for companies to decide where to locate their business operations such as call centres. The absence of official statistics on off-shore outsourcing leads to speculation and there is also misinterpretation of indirect measures/evidence. The experience of an individual company may or may not select a trend in a specific sector but does not allow conclusions to be made on the economy as a whole. It is possible that the rise in rice prices caused by lower production could be a result of a shift by the working population in India from working in the agriculture moving to the services sector. A great deal of knowledge is tacit and therefore difficult to transfer. Its reproduction can be extremely costly and requires an environment in which it can be harnessed effectively. According to a recent World Bank publication India is at the bottom end ranking 98 out of 128 countries of an index that measures the ability to create, absorb and diffuse knowledge therefore its threat is minimal to the UK economy. The economy-wide measures such as a countrys balance of payments can assist us in understanding the patterns of cross border trade and establish the impact of offshoring. If the outsourcing of tasks by UK based companies to off-shore locations i.e. India is soaring then the UK should be importing more of these services from India. The CBI has stated that the UK companies have benefited from off-shore as they are now receiving improved work-force skills at a low rate making their enterprises more profitable. According to results obtained from the Office for National Statistics the redundancy rate for the three months to January 2008 was 4.4 per 1,000 employees, down 0.9 over the quarter and down 1.1 over the year. These figures on the redundancy rate reflect that though a large number of organizational services have been off-shored services this has not had a significant impact on the UK economy. The UK has emerged as a world leader in knowledge services and between 1995 2005 exports of its services grew by over 100% compared to its exports of traditional service exports such as transport. India is ranked 6th for global insourcing behind the US, UK, German France and the Netherlands who appear to be the top recipients of off-shore outsourcing . Indian business insiders see future off-shore outsourcing as an advantage for Europe enabling it to focus on the thinking part of the job, providing opportunities for better jobs and knowledge work in Europe . Increase in knowledge base will benefit the UK economy. The scale of the off-shore phenomenon has been exaggerated and future pattern of off-shore will need to be different if it is going to be different from the one today. The UK economy reflects that is able to cope with all sorts of change when combining competitive markets with social networks in order to manager transitions. CONCLUSION Business process outsourcing allows organizations to gain competitive advantage whilst reducing costs and allows the organisation to concentrate on its core functions and engage experts in that particular field. Although the advantages seem tempting to any organization that is aiming to make profits, its is crucial to realize that there are also numerous disadvantages which accompany it such and major costs involved in relocating operations which could far outweigh the income generated. In order to ensure a high level standard service is being supplied stringent measures, risk assessments and audits need to be carried out. In order to gain competitive advantage organisations have to outsource and off-shore. Distance and lack of control may harm the flexibility and speed of delivery due to practical implications of language, time, cultural difference and the lack of face to face interaction often needed to resolve problems. Some services can be done in anywhere in the world in theory, but even multinationals rely in practice on local delivery of services with a global brand image supported by global expertise. Initially the costs for BT went up and the transferred workforce took time to adjust to their role as a service provider. By outsourcing, BT reduced its training by 50% and cut the waiting lists of people requiring training by 26%. In 2007 the organization managed to save an amount worth US$2.2 million relative to time savings and adequate coverage for sick absences. BT employees satisfaction increased and a tremendous enhancement of Information Systems to provide self HR services took place, offering the employee flexibility in terms of obtaining their personnel data and self-service. Value has been added, BT now has one HR specialist to every 200 employees, which is well ahead of the benchmarks in the telecommunications set by companies on the FTSE 100. The analysis of the BT case study reflects that when BT outsourced its HR function its operational co sts were reduced costs and it gained competitive advantage through organisational performance. The HR outsourcing created a change in BTs organisational structure and created cultural change that is reflected in the low priority on employee motivation, trust and overall commitment. Rewards based on performance reflect that BT was transformed to become a profit led organization with a top to down bureaucratic line of communication posing the risk of limited knowledge sharing between permanent and contract staff who view each other as rivals hence defining the cultural change. RECOMMENDATION It is important to be brutally honest when communicating with staff on intentions to retrench or move work off-shore in order to facilitate smooth transitions. To improve its environment, BT needs to maximize the effectiveness of its human capital throughout the organisation and look into ways of motivating its workforce so that they are motivated and enthused to contribute more towards the companys goal. Increasing motivation is likely to result in innovation and a willingness to contribute to the organisations success. To facilitate effective adaptation of the employees to new working conditions, managers should reduce restraining forces and reinforces driving forces. The UK government needs to supporting companies skills shortages through bespoke and generic training of school or college leavers. Organisations need to developing and assisting people by giving them the necessary transferable skills they need in order to remain in or enter into the engineering sector. Offering secon dments, mentoring and coaching opportunities to support the sectors HR and operational needs. 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(1959), The Theory of the Growth of the Firm, Wiley, New York, NY, . Peteraf, M. (1993), The cornerstone of the competitive advantage: a resource-based view, Strategic Management Journal, Vol. 14 pp.179-91. Prahalad, C. and Hamel, G (1990) The Core Competence of the Corporation Harvard Business review May-June Report on the Department of Trade and Industry by Ovum (2006) Ryan Kinzy, K3, CEO Saunders and Gebelt and Hu 1997 xxx Source: Office for National Statistics Published on 19 March 2008 at 9:30 am Steve Loy, Lecturer Eastern Kentucky University Tran, V., (2008), The role of the emotional climate in learning organisations, The Learning Organisation, 3, issue. 5, pp. 99-103. Ulrich, D., (1996), Human Resources Champions, Boston, Harvard University Press. Wernerfelt, B. (1984), A resource-based view of the firm, Strategic Management Journal, Vol. 5 pp.171-80. William M. Mercer and Cranfield School of Management (2000), European Trends in HR Outsourcing, William M. Mercer and Cranfield School of Management, research report. Wright, P., McMahan, G., McCormick, B., Sherman, S. (1998), Strategy, core competence, and Human Resource involvement as determinants of HR effectiveness and refinery performance, Human Resource Management, Vol. 36 pp.17-29. Wright, S., (2007), Management of Innovation and Change, 3rd edition., London, Distant Learning Centre, South Bank University. William, R.L., Bukowitz, W.R., (2002), The yin and yang of intellectual capital management: the impact of ownership on realising value from intellectual capital, Journal of Intellectual Capital, 2, issue. 2, pp. 96-110. Youndt, M., Snell, S., Dean, J., Lapak, D. (1996), Human resource management manufacturing strategy and firm performance, Academy of Management Journal, Vol. 39 No.4, pp.836-66. INTERNET/ WEBSITES: Accenture, (2004), Accenture HR Services: Client success story : BT, https:// www.accentureHRservices.com,, accessed 17/03/08. Online Government Labour Statistics https://www.statistics.gov.uk/cci/nugget.asp?id=12 Daily Telegraph, (2008), Outsource Your HR, Entrepreneur.com, 23/12, https://www.entrepreneur.com,, accessed 18/03/08. Lee, M. (2002) https://www.entrepreneur.com site visited 17.03.08 The Guardian, (2004), BT announces print and despatch contract with Edotech,, https://www.btplc.com,, accessed 20/03/08. BBC News Thursday, 26 April 2001, The rise and Fall of BT https://news.bbc.co.uk/1/hi/business/1014978.stm

SAT Essay Sample - How Do I Use Science to Address the Space Issue?

<h1>SAT Essay Sample - How Do I Use Science to Address the Space Issue?</h1><p>A question that is often asked by understudies composing a SAT paper: How would I use science to address the space issue? By utilizing a sat exposition test to survey, you will increase extra data that can assist with tending to a portion of the science issues. Here, you will discover data on the most proficient method to compose a science question.</p><p></p><p>A space innovation paper can be an intriguing theme for a SAT exposition. A few understudies may ask 'How would I use science to address the space issue?'</p><p></p><p>An paper that tends to the space issue should be as exact as could reasonably be expected. In spite of the fact that the inquiry doesn't indicate the kind of science, it makes notice of explicit logical instruments or advancements. Utilizing such logical instruments or advances requires reliable discernment about how t o assess and decipher the information. This is the place SAT science exposition test questions can help you.</p><p></p><p>First, likewise with all article subjects, set aside the effort to survey all the speculations that science offers. Clarify your thinking in the most brief way conceivable. This will assist perusers with knowing precisely why you are tending to the space issue.</p><p></p><p>Second, while tending to the space issue, you ought to consistently utilize the data that is offered in the SAT exposition test and rundown your reasons. In the event that you don't give instances of what you mean, at that point the peruser will have no clue what you are talking about.</p><p></p><p>Last, likewise with all the SAT paper tests, you should include references where vital. For instance, if the exposition is tending to whether space investigation prompted the advancement of new, inventive space innovation, refer to the diary article or course book that discussions about the relationship between's space investigation and the improvement of new space innovation. Also, refer to your sources at whatever point possible.</p><p></p><p>The key to composing a SAT science paper that tends to the space issue is first deciding the kinds of science that would be utilized. At that point, applying these techniques will permit you to respond to the first inquiry, 'How would I use science to address the space issue?'</p><p></p><p>When it comes to SAT article subjects, there are scarcely any more convoluted than the space question. Nonetheless, this theme is one that has some extremely exact and significant issues. Understudies taking the SAT will be very much served by realizing how to address the inquiry utilizing a SAT article sample.</p>

Anaemia overview and treatment - Free Essay Example

Sample details Pages: 26 Words: 7802 Downloads: 6 Date added: 2017/06/26 Category Statistics Essay Did you like this example? 1. Introduction Anaemia is a syndrome characterised by a lack of healthy red blood cells or haemoglobin deficiency in the red blood cells, resulting in inadequate oxygen supply to the tissues. The condition can be temporary, long-term or chronic, and of mild to severe intensity. Don’t waste time! Our writers will create an original "Anaemia overview and treatment" essay for you Create order There are many forms and causes of anaemia. Normal blood consists of three types of blood cells: white blood cells (leucocytes), platelets and red blood cells (erythrocytes). The first generation of erythrocyte precursors in the developing foetus are produced in the yolk sac. They are carried to the developing liver by the blood where they form mature red blood cells that are required to meet the metabolic needs of the foetus. Until the 18th week of gestation, erythrocytes are produced only by liver after which the production shifts to the spleen and the bone marrow. The life of a red blood cell is about 127 days or 4 months (Shemin and Rittenberg, 1946; Kohgo et al., 2008). The main causes of anaemia are blood loss, production of too few red blood cells by the bone marrow or a rapid destruction of cells. Haemoglobin, a protein, present in the red blood cells is involved in the transport of oxygen from the lungs to all the other organs and tissues of the body. Iron is an important constituent of the haemoglobin protein structure which is intimately involved in the transport of oxygen. Anaemia is generally defined as a lower than normal haemoglobin concentration. The normal blood haemoglobin concentration is dependent on age and sex, and, according to the World Health Organisation (WHO) Expert Committee Report, anaemia results when the blood concentration of haemoglobin falls below 130 g/L in men or 120 g/L in non-pregnant women (WHO, 1968). However, the reference range of haemoglobin concentration in blood could vary depending on the ethnicity, age, sex, environmental conditions and food habits of the population analysed. According to Beutler and Warren (2006), more reasonable benchmarks for anaemia are 137 g/L for white men aged between 20 and 60 years and 132 g/L for older men. The value for women of all ages would be 122 g/L. Also, the lower limit of normal of haemoglobin concentrations of African Americans are appreciably lower than that of Caucasians (Beutler and Warren, 2006). Besides the well recognised iron deficiency anaemia, several inherited anaemias are also known. These are mostly haemoglobinopathies. Adult haemoglobin is a tetrameric haeme-protein. Abnormalities of beta-chain or alpha-chain produce the various medically significant haemoglobinopathies. The variations in amino acid composition induced genetically impart marked differences in the oxygen carrying properties of haemoglobin. Mutations in the haemoglobin genes cause disorders that are qualitative abnormalities in the synthesis of haemoglobin (e.g., sickle cell disease) and some that are quantitative abnormalities that pertain to the rate of haemoglobin synthesis (e.g., the thalassemias) (Weatherall., 1969). In SCD, the missense mutation in the ÃŽÂ ²-globin gene causes the disorder. The mutation causing sickle cell anemia is a single nucleotide substitution (A to T) in the codon for amino acid 6. The substitution converts a glutamic acid codon (GAG) to a valine codon (GTG). The form of haemoglobin in persons with sickle cell anemia is referred to as HbS. Also, the valine for glutamic acid replacement causes the haemoglobin tetramers to aggregate into arrays upon deoxygenation in the tissues. This aggregation leads to deformation of the red blood cell making it relatively inflexible and restrict its movement in the capillary beds. Repeated cycles of oxygenation and deoxygenation lead to irreversible sickling and clogging of the fine capillaries. Incessant clogging of the capillary beds damages the kidneys, heart and lungs while the constant destruction of the sickled red blood cells triggers chronic anaemia and episodes of hyperbilirubinaemia. Fanconi anaemia (FA) is an autosomal recessive condition, and the most common type of inherited bone marrow failure syndrome. The clinical features of FA are haematological with aplastic anaemia, myelodysplastic syndrome (MDS), and acute myeloid leukaemia (AML) being increasingly present in homozygotes (Tischkowitz and Hodgson, 2003). Cooleys anaemia is yet another disorder caused by a defect in haemoglobin synthesis. Autoimmune haemolytic anaemia is a syndrome in which individuals produce antibodies directed against one of their own erythrocyte membrane antigens. The condition results in diminished haemoglobin concentrations on account of shortened red blood cell lifespan (Sokol et al., 1992). Megaloblastic anaemia is a blood disorder in which anaemia occurs with erythrocytes which are larger in size than normal. The disorder is usually associated with a deficiency of vitamin B12 or folic acid . It can also be caused by alcohol abuse, drugs that impact DNA such as anti-cancer drugs, leukaemia, and certain inherited disorders among others (Dugdale, 2008). Malaria causes increased deformability of vivax-infected red blood cells (Anstey et al., 2009). Malarial anaemia occurs due to lysis of parasite-infected and non-parasitised erythroblasts as also by the effect of parasite products on erythropoiesis (Ru et al., 2009). Large amounts of iron are needed for haemoglobin synthesis by erythroblasts in the bone marrow. Transferrin receptor 1 (TfR1) expressed highly in erythroblasts plays an important role in extracellular iron uptake (Kohgo et al., 2008). Inside the erythroblasts, iron transported into the mitochondria gets incorporated into the haeme ring in a multistep pathway. Genetic abnormalities in this pathway cause the phenotype of ringed sideroblastic anemias (Fleming, 2002). The sideroblastic anemias are a heterogeneous group of acquired and inherited bone marrow disorders, characterised by mitochondrial iron overload in developing red blood cells. These conditions are diagnosed by the presence of pathologic iron deposits in erythroblast mitochondria (Bottomley, 2006).    2. Classification of anaemia Anaemia can be generally classified based on the morphology of the red blood cells, the pathogenic spectra or clinical presentation (Chulilla et al., 2009). The morphological classification is based on mean corpuscular volume (MCV) and comprises of microcytic, macrocytic and normocytic anaemia. (a) Microcytic anaemia refers to the presence of RBCs smaller than normal volume, the reduced MCV ( 82 fL) reflecting decreased haemoglobin synthesis.   Thus, it is usually associated with hypochromic anaemia. Microcytic anaemia can result from defects either in iron acquisition or availability (Iolascon et al., 2009), or disorders of haeme metabolism or globin synthesis (Richardson, 2007). The differential diagnosis for microcytic anaemia includes iron deficiency anaemia (IDA), thalassaemia, anaemia of chronic disorders (ACD), and rarely sideroblastic anaemia (Chulilla et al., 2009). Microcytosis without anaemia is characteristic of thalassaemia trait. The red blood cell distribution width (RDW) obtained with haematological analysers provides the index of dispersion in the erythrocyte distribution curve and complements MCV values. RDW is helpful to differentiate between thalassaemia and IDA. RDW is normal in thalassemia; on the contrary, microcytic anemia with RDW 15 would p robably indicate IDA (Chulilla et al., 2009). In macrocytic anaemia, erythrocytes are larger (MCV 98 fL) than their normal volume (MCV = 82-98 fL). Vitamin B12 deficiency leads to delayed DNA synthesis in rapidly growing hematopoietic cells, and can result in macrocytic anemia. Drugs that interfere with nucleic acid metabolism, such as.hydroxyurea increases MCV ( 110 fL) while alcohol induces a moderate macrocytosis (100-110 fL). In the initial stage, most anaemias are normocytic. The causes of normocytic anaemia are nutritional deficiency, renal failure and haemolytic anemia (Tefferi, 2003). The most common normocytic anaemia in adults is anaemia of chronic disease (ACD) (Krantz, 1994). Common childhood normocytic anaemias are, besides iron deficiency anaemia, those due to acute bleeding, sickle cell anemia, red blood cell membrane disorders and current or recent infections especially in the very young (Bessman et al., 1983). Homozygous sickle cell disease is the most common cause of haemolytic normocytic anemias in children ( Weatherall DJ, 1997a). In practice, the morphological classification is quicker and therefore, more useful as a diagnostic tool. Besides, MCV is also closely linked to mean corpuscular haemoglobin (MCH), which denotes mean haemoglobin per erythrocyte expressed in picograms (Chulilla et al., 2009). Thus, MCV and MCH decrease simultaneously in microcytic, hypochromic anemia and increase together in macrocytic, hyperchromic anemia. Pathogenic classification of anaemia is based on the production pattern of RBC: whether anaemia is due to inadequate production or loss of erythrocytes caused by bleeding or haemolysis. This approach is useful in those cases where MCV is normal. Pathogenic classification is also essential for proper recognition of the mechanisms involved in the genesis of anaemia. Based on the pathogenic mechanisms, anaemia is further divided into two types namely, (i) hypo-regenerative in which the bone marrow production of erythrocytes is decreased because of impaired function, decreased number of precursor cells, reduced bone marrow infiltration, or lack of nutrients; and (ii) regenerative: when bone marrow upregulates the production of erythrocytes in response to the low erythrocyte mass (Chulilla et al., 2009). This is typified by increased generation of erythropoietin in response to lowered haemoglobin concentration, and also reflects a loss of erythrocytes, due to bleeding or haemolysis. The r eticulocyte count is typically higher. Sickle cell disease is characterised by sickled red cells.   The first report of SCD was published a century ago noting the presence of peculiar elongated cells in blood by James Herrick, an American physician (1910). Pauling et al. (1949) described it as a molecular disease. The molecular nature of sickle haemoglobin (Hb S) in which valine is substituted for glutamic acid at the sixth amino acid position in the beta globin gene reduces the solubility of Hb, causing red cells to sickle (Fig. 1). Sickling of cells occurs at first reversibly, then finally as a state of permanent distortion, when cells containing HbS and inadequate amounts of other haemoglobins including foetal haemoglobin, which retards sickling, become deoxygenated (Bunn, 1997). The abnormal red cells break down, leading to anaemia, and clog blood vessels with aggregates, leading to recurrent episodes of severe pain and multiorgan ischaemic damage (Creary et al., 2007). The high levels of inflammatory cytokines in SCD may promote retention of iron by macrophage/reticuloendothelial cells and/or renal cells. SCD care commonly depends on transfusion that results in iron overload (Walter et al., 2009). 3. Pathogenesis of anaemia Anaemia is a symptom , or a syndrome, and not a disease (Chulilla et al., 2009). Several types of anaemia have been recognised, the pathogenesis of each being unique. Iron deficiency anaemia (IDA) is the most common type of anaemia due to nutritional causes encountered worldwide (Killip et al., 2008). Iron is one of the essential micronutrients required for normal erythropoietic function While the causes of iron deficiency vary significantly depending on chronological age and gender, IDA can reduce work capacity in adults (Haas Brownlie, 2001) and affect motor and mental development in children (Halterman et al., 2001). The metabolism of iron is uniquely controlled by absorption rather than excretion (Siah et al., 2006). Iron absorption typically occurring in the duodenum accounts for only 5 to 10 per cent of the amount ingested in homoeostatis. The value decreases further under conditions of iron overload, and increases up to fivefold under conditions of iron depletion (Killip et al., 2008). Iron is ingested as haem iron (10%) present in meat, and as non-haem ionic form iron (90%) found in plant and dairy products. In the absence of a regulated excretion of iron through the liver or kidneys, the only way iron is lost from the body is through bleeding and sloughing of cells. Thus, men and non-menstruating women lose about 1 mg of iron per day while menstruating women could normally lose up to 1.025 mg of iron per day (Killip et al., 2008). The requirements for erythropoiesis   which are typically 20-30 mg/day   are dependent on the internal turnover of iron (Munoz et al., 2009) For example, the amount of iron required for daily production of 300 billion RBCs (20-30 mg) is provided mostly by recycling iron by macrophages (Andrews, 1999). Iron deficiency occurs when the metabolic demand for iron exceeds the amount available for absorption through consumption. Deficiency of nutritional intake of iron is important, while abnormal iron absorption due to hereditary or acquired iron-refractory iron deficiency anemia (IRIDA) is another important cause of unexplained iron deficiency. However, IDA is commonly attributed to blood loss e.g., physiological losses in women of reproductive age. It might also represent occult bleeding from the gastrointestinal (GI) tract generally indicative of malignancy (Hershko and Skikne, 2009). Iron absorption and loss play an important role in the pathogenesis and management of IDA. Human iron disorders are necessarily disorders of iron balance or iron distribution. Iron homeostasis involves accurate control of intestinal iron absorption, efficient utilisation of iron for erythropoiesis, proper recycling of iron from senescent erythrocytes, and regulated storage of iron by hepatocytes and macrophages (Andrews, 2008). Iron deficiency is largely acquired, resulting from blood loss (e.g., from intestinal parasitosis), from inadequate dietary iron intake, or both. Infections, for example, with H pylori, can lead to profound iron deficiency anemia without significant bleeding. Genetic defects can cause iron deficiency anaemia. Mutations in the genes encoding DMT1 (SLC11A2) and glutaredoxin 5 (GLRX5) lead to autosomal recessive hypochromic, microcytic anaemia (Mims et al., 2005). Transferrin is a protein that keeps iron nonreactive in the circulation, and delivers iron to cells possessing specific transferrin receptors such as TFR1 which is found in largest amounts on erythroid precursors. Mutations in the TF gene leading to deficiency of serum transferrin causes disruption in the transfer of iron to erythroid precursors thereby producing an enormous increase in intestinal iron absorption and consequent tissue iron deposition (Beutler et al., 2000). Quigley et al. (2004) found a haem exporter, FLVCR, which appears to be necessary for normal erythroid development. Inactivation of FLVCR gene after birth in mice led to severe macrocytic anaemia, indicating haem export to be important for normal erythropoiesis. The anaemia of chronic disease (ACD) found in patients with chronic infectious, inflammatory, and neoplastic disorders is the second most frequently encountered anaemia after iron-deficiency anaemia. It is most often a normochromic, normocytic anaemia that is primarily caused by an inadequate production of red cells, with low reticulocyte production (Krantz, 1994). The pathogenesis of ACD is unequivocally linked to increased production of the cytokines including tumour necrosis factor, interleukin-1, and the interferons that mediate the immune or inflammatory response. The various processes leading to the development of ACD such as reduced life span of red cells, diminished erythropoietin effect on anaemia, insufficient erythroid colony formation in response to erythropoietin, and impaired bioavailability of reticuloendothelial iron stores appear to be caused by inflammatory cytokines (Means, 1996;2003). Although iron metabolism is characteristically impaired in ACD, it may not play a key role in the pathogenesis of ACD (Spivak, 2002). Neither is the lack of available iron central to the pathogenesis of the syndrome, according to Spivak (2002), who found reduced iron absorption and decreased erythroblast transferrin-receptor expression to be the result of impaired erythropoietin production and inhibition of its activity by cytokines. However, reduced erythropoietin activity, mostly from reduced production, plays a pivotal role in the pathogenesis of ACD observed in systemic autoimmune diseases (Bertero and Caligaris-Cappio, 1997). Indeed, iron metabolism as well as nitric oxide (NO), which contributes to the regulation of iron cellular metabolism are involved in the pathogenesis of ACD in systemic autoimmune disorders. Inflammatory mediators, particularly the cytokines, are important factors involved in the pathogenesis of the anaemia of chronic disease, as seen in rheumatoid arthritis anaemia (Baer et al., 1990), the cytokines causing impairment of erythroid p rogenitor growth and haemoglobin production in developing erythrocytes.   Anaemia is also commonly found in cases of congestive heart failure (CHF), again caused by excessive cytokine production leading to reduced erythropoietin secretion, interference with erythropoietin activity in the bone marrow and reduced iron supply to the bone marrow (Silverberg et al., 2004). However, in the presence of chronic kidney insufficiency, abnormal erythropoietin production in the kidney plays a role in the pathogenesis of anaemia in CHF. The myelodysplastic syndromes (MDS) are common haematological malignancies affecting mostly the elderly as age-related telomere shortening enhances genomic instability (Rosenfeld and List, 2000). Radiation, smoking and exposure to toxic compounds e.g., pesticides, organic chemicals and heavy metals, are factors promoting the onset of MDS via damage caused to progenitor cells, and, thereby, inducing immune suppression of progenitor cell growth and maturation. TNF- and other pro-apoptotic cytokines could play a central role in the impaired haematopoiesis of MDS (Rosenfeld and List, 2000). Premature intramedullary cell death brought about by excessive apoptosis is another important pathogenetic mechanism in MDS (Aul et al., 1998).   Sickle cell disease (SCD) arising from a point mutation in the ÃŽÂ ²-globin gene and leading to the expression of haemoglobin S (HbS) is the most common monogenetic disorder worldwide. Chronic intravascular haemolysis and anaemia are some important characteristics of SCD. Intravascular haemolysis causes endothelial dysfunction marked by reduced nitric oxide (NO) bioavailability and NO resistance, leading to acute vasoconstriction and, subsequently, pulmonary hypertension (Gladwin and Kato, 2005).    However, a feature that differentiates SCD from other chronic haemolytic syndromes is the persistent and intense inflammatory condition present in SCD. The primary pathogenetic event in SCD is the intracellular polymerisation or gelation of deoxygenated HbS leading to rigidity in erythrocytes (Wun, 2001). The deformation of erythrocytes containing HbS is dependent on the concentration of haemoglobin in the deoxy conformation (Rodgers et al., 1985). It has been demonstrated that sickle monocytes are activated which, in turn, activate endothelial cells and cause vascular inflammation. The vaso-occlusive processes in SCD involve inflammatory and adhesion molecules such as the cell adhesion molecules (CAM family), which play a role in the firm adhesion of reticulocytes and leukocytes to endothelial cells, and the selectins, which play a role in leukocyte and platelet rolling on the vascular wall (Connes et al., 2008). Thus, inflammation, leucocyte adhesion to vascular endothelium, and subsequent endothelial injury are other crucial factors contributing to the pathogenesis of SCD (Jison et al., 2004). 4. Current therapies for clinical management of sickle cell diseaseincludingacritical appraisal of transfusion Between 1973 and 2003, the average life expectancy of a patient with SCD increased dramatically from a mere 14 years to 50 years thanks to the development of comprehensive care models and painstaking research efforts in both basic sciences especially molecular and genetic studies, and clinical aspects of SCD (Claster and Vichinsky, 2003). The clinical manifestations of SCD are highly variable. Both the phenotypic expression and intensity of the syndrome are vastly different among patients and also vary longitudinally within the same patient (Ballas, 1998). New pathophysiological insights available have enabled treatments to be developed for the recognised haematologic and nonhaematologic abnormalities in SCD (Claster and Vichinsky, 2003). The main goals of SCD treatment are symptom alleviation, crises avoidance and effective management of disease complications. The strategy adopted is primarily palliative in nature, and consists of supportive, symptomatic and preventative approaches to therapy. Symptomatic management includes pain mitigation, management of vasoocclusive crisis, improving chronic haemolytic anaemia, treatment of organ failure associated with the disease, and detection and treatment of pulmonary hypertension (Distenfeld and Woermann, 2009). The preventative strategies include use of prophylactic antibiotics (e.g., penicillin) in children, prophylactic blood transfusion for prevention of stroke in patients especially young children who are at a very high risk of stroke, and treatment with hydroxyurea of patients experiencing frequent acute painful episodes (Ballas, 2002). Currently, curative therapy for sickle cell anaemia is only available through bone marrow and stem cell transplantation. Hematopoietic cell transplantation using stem cells from a matched sibling donor has yielded excellent results in paediatric patients (Krishnamurti, 2007). Curative gene therapy is still at the exploratory stage (Ballas, 2002). Current and potential therapies The potential treatment strategies basically target cellular dehydration, sickle haemoglobin concentrations, endothelial dysfunction, and abnormal coagulation regulation (Claster and Vichinsky, 2003). HbS concentrations are essentially tackled through transfusions while approaches to reduce HbS polymerisation which is the main mechanism for the development of vaso-occlusion include (a) increasing foetal haemoglobin (HbF) concentration using hydroxyurea (Fig. 2), butyrate, or erythropoietin, and (b) preventing sickle cell dehydration using Clotrimazole (Fig. 3) or Mg2+pidolate. Hydroxyurea therapy increases the production of HbF in patients with sickle cell anaemia, and, thereby, inhibits the polymerisation of HbS and alleviates both the haemolytic and vaso-occlusive manifestations of the disease (Goldberg et al., 1990). Recombinant erythropoietin also increases the number of reticulocytes with HbF. Additionally, it has been observed that administration of intravenous recombinant eryt hropoietin with iron supplementation alternating with hydroxyurea enhances HbF levels more than hydroxyurea alone (Rodgers et al., 1993). As SCD is essentially characterized by an abnormal state of endothelial cell activation   that is, a state of inflammation, a pharmacologic approach to inhibit endothelial cell activation has proved clinically beneficial (Hebbel and Vercellotti, 1997). Thus, administration of sulfasalazine which is a powerful inhibitor of activation of nuclear factor (NF)-B, the transcription factor promoting expression of genes for a number of pro-adhesive and procoagulant molecules on endothelium to humans has been found to provide transcriptional regulation of SCD at the endothelium level (Solovey et al., 2001). Red blood cell transfusion : a critical appraisal A key therapy that is applied regularly in the clinical management of patients with SCD is packed red blood cell transfusion. RBC transfusion improves the oxygen-carrying capacity which is achieved by enhancing the haemoglobin levels, causes dilution of HbS concentration thereby, reducing blood viscosity and boosting oxygen saturation. Furthermore, RBC transfusion is helpful in suppressing endogenous production of sickle RBCs by augmenting tissue oxygenation ( Josephson et al., 2007). There are two major types of RBC transfusion therapy: intermittent and chronic which are further classified as prophylactic or therapeutic. Intermittent transfusions are generally therapeutic in nature and administered to control acute manifestations of SCD whereas chronic transfusions are performed as general preventative measures to check complications of SCD. RBC transfusion given as a single dose is termed as simple transfusion. Exchange transfusion involves administration of a larger volume of RBCs replacing the patients RBCs that are simultaneously removed. Details of the various types of RBC transfusion and the major clinical indications for the same in SCD patients are listed in Table 1. SCD (Source: Josephson et al., 2007) Indications for Intermittent transfusions Indications for intermittent transfusions include acute manifestations of SCD, as indicated in Table 1, that require redressal through therapeutic transfusions. However, under certain circumstances intermittent transfusions could be prophylactic such as for instance, when SCD patients are transfused before specific surgeries viz., those related to pregnancy complications or renal failure (Table 1). Acute Chest Syndrome (ACS) describes a manifestation of SCD in which, due to sickling, infectious and noninfectious pulmonary events are complicated, resulting in a more severe clinical course. The diagnosis is the presence of a new infiltrate on chest radiography that is accompanied by acute respiratory symptoms. ACD accounts for nearly 25% of all deaths from SCD (Vichinsky, 2002). Repeated episodes of ACS are associated with an increased risk of chronic lung disease and pulmonary hypertension (Castro, 1996). The severe pulmonary events occurring in SCD may be precipitated by any trigger of hypoxia (Vichinsky, 2002). Transfusions are very efficacious and provide immediate benefit by reversing hypoxia in ACS. Transfusion of leucocyte-poor packed red cells matched for Rh, C, E, and Kell antigens can curtail antibody formation to below 1% (Vichinsky, 2002). Simple transfusions suffice for less severe cases; however, exchange transfusion is recommended to minimise the risk of increased viscosity. Also, chronic transfusion appears promising for prevention of recurrence in selected patients (Styles and Vichinsky, 1994). In a multicentre ACS trial, prophylactic transfusion was found to almost completely eliminate the risk of pulmonary complications (Vichinsky, 2002). Acute Symptomatic Anaemia arises in SCD as a result of blood loss, increased RBC destruction, suppression of erythropoiesis etc. and is effectively treated with intermittent transfusion of RBCs to relieve symptoms of cardiac and respiratory distress (Josephson et al., 2007). Aplastic Anaemia is commonly caused in SCD on account of infection of haematopoietic precursors in the bone marrow by Parvovirus B19 leading to a steep fall in RBCs. According to Josephson et al. (2007), therapeutic intermittent transfusion of RBCs is again the recommended first-line of treatment to improve total haemoglobin count and prevent cardiac decompensation. However, in those patients who are prone to fluid overload on account of cardiac or renal dysfunction an alternative transfusion strategy is to remove the whole blood and replace it with packed cells while avoiding the addition of excess volume (Josephson et al., 2007). Acute Stroke is a high risk especially in paediatric SCD cases because of elevated cerebral flow. Enormous decline in stroke rate have occurred in children receiving intermittent simple transfusion (Adams et al., 1998). However, the identification of the stroke type would be necessary in all SCD patients in order to determine the appropriate treatment approach since the occurrence of infarctive strokes is higher in children as opposed to a higher incidence of haemorrhagic strokes in adults (Adams, 2003). Indications for Chronic Transfusions Prophylactic chronic RBC transfusion every 3 to 4 weeks to maintain HbS levels lower than 30% is crucial for preventing first as well as recurrent strokes in children (Johnson et al., 2007). The transfusions could either be chronic simple transfusion or prophylactic chronic RBC exchange transfusion. Prophylactic chronic transfusions are recommended for patients with chronic renal failure so as to avoid severe symptomatic anaemia and for those patients with SCD undergoing pregnancy with complications. However, prophylactic transfusion is not indicated for SCD patients with normal pregnancy (Tuck et al., 1987). Controversial and indeterminate indications for intermittent or chronic transfusion According to Hankins et al. (2005), chronic transfusion therapy is helpful in reducing the incidence of strokes in children but not the severity of strokes. In the case of acute priapism, improvement in patients has been observed after exchange or simple transfusion (Rifikind   et al., 1979). Yet, due to the ASPEN syndrome, transfusion currently is only a second-line therapy in the management of priapism ( Miller et al., 1995). RBC transfusion is a vital component in the management of symptoms and complications of SCD. It has drastically reduced the morbidity and mortality of SCD. Yet, immune-related effects such as FNHTRs and alloimmunisation to HLAs,   and nonimmune-related effects e.g., iron overload and transfusion-transmitted infections are serious adverse effects of the transfusion therapy that need to be attended to in SCD patients receiving transfusion (Johnson et al., 2007). Chronic transfusions could result in an inexorable accumulation of tissue iron that could become fatal if not treated (Cohen, 1987). Excess iron damages the liver, endocrine organs, and heart and may be fatal by adolescence (Engle, 1964). 5. Critical review of thalassemias : (i) Molecular pathogenesis The large number of inherited haemoglobin disorders known today include (a) those related to anomalies in the haemoglobin structure e.g., sickle cell disease, and (b) the thalassemias whose hallmark is globin-chain deficiency of one or other of the globin chains of adult haemoglobin in erythroid cells. ÃŽÂ ²-Thalassaemias These are a set of genetic disorders inherited as simple codominant traits affecting haemoglobin synthesis. Depending on the haemoglobin chain affected, 2 types of thalassemia are recognised: ÃŽÂ ±-thalassaemia and ÃŽÂ ²-thalassaemia. Homozygous ÃŽÂ ²-thalassaemia is marked by a quantitative deficiency of the ÃŽÂ ²-globin chains in the erythroid cells. A complete absence of the ÃŽÂ ²-globin chains occurs in homozygous ÃŽÂ ²o-thalassaemia whereas in homozygous ÃŽÂ ²+-thalassaemia the ÃŽÂ ²-globin chains are present at less than 30% of normal. Accounting for nearly 90% of the cases, ÃŽÂ ²+-thalassaemia is the most commonly observed form of ÃŽÂ ²-thalassaemia. The condition is termed thalassaemia major when there is microcytic hypochromic anaemia with severe haemolysis, hepatosplenomegaly, skeletal deformities and iron overload. ÃŽÂ ²-thalassaemia homozygotes exhibit severe transfusion-dependent anaemia in the very first year of life. Homozygotic individ uals having a relatively benign clinical phenotype and surviving with or without transfusion are described as thalassaemia intermedia (Weatherall, 1969). The thalassaemias, thus, encompass a wide gamut of clinical disability from intrauterine death to a mild anaemia with no overt symptoms (Weatherall, 1997b). The coexistence of   ÃŽÂ ± -thalassaemia leading to reduction in the synthesis of ÃŽÂ ±-globin chains, and a genetic predisposition to produce high levels of HbF, could be important factors for the extensive phenotypic variability described above (Weatherall, 1996). The milder form of thalassaemia intermedia is the result of a lesser imbalance in globin chain synthesis probably the result of residual ÃŽÂ ² -globin chain synthesis due to mild mutation or due to reduced synthesis of ÃŽÂ ±-globin chains due to co-inheritance of ÃŽÂ ±-thalassaemia (Nadkarni et al., 2001). Persons having the heterozygous form of the disorder are usually asymptomatic but can be recognised by typical abnormalities of red cell morphology (shown in Fig.4) and indices (Spritz and Forget, 1983). Compared to the heterozygous form of ÃŽÂ ²-thalassaemia, a larger imbalance exists in the ÃŽÂ ±- to ÃŽÂ ²-globin chain synthesis in the homozygous ÃŽÂ ²-thalassemia or Cooley anaemia. The excess ÃŽÂ ±-globin chains are liable to precipitate, causing damage to the ÃŽÂ ²-thalassemic red cell membrane and affecting erythropoiesis. Important manifestations of homozygous ÃŽÂ ²-thalassemia are severe chronic microcytic haemolytic anaemia and hepatosplenomegaly due to extramedullary haematopoiesis (Spritz and Forget, 1983). (Source: Weatherall, 1997b) As many as 175-200 molecular mutations affecting the ÃŽÂ ²-globin gene complex are involved in creating the ÃŽÂ ²-thalassaemia syndromes with the resultant altered synthetic ratios of ÃŽÂ ±- to ÃŽÂ ²-globin chains, precipitation of excess unbalanced ÃŽÂ ±-globin chains, and programmed cell death of erythroid precursors (Steinberg and Rodgers, 2001; Gambari, 2010). Hence, the pathogenetic basis of the clinical diversity of the ÃŽÂ ²-thalassaemia syndromes essentially rests with the striking heterogeneity of mutations in the ÃŽÂ ²-globin gene (Thein, 1993). The -158 (C ÃÆ'   T) substitution in the GÃŽÂ ³ gene has been found to be linked to the increase in HbF synthesis leading to less severe disease in thalassaemia intermedia (Gilman and Huisman, 1985; Ragusa et al., 1992). Red blood cell transfusion and iron overload Regular RBC transfusions have proved to be efficacious in the treatment of ÃŽÂ ²-thalassemia by nullifying the complications of anaemia and compensatory bone marrow (BM) expansion. However, thalassaemias are also complicated by physiological iron overload which gets exacerbated by blood transfusion and causes various endocrine diseases, liver cirrhosis, cardiac failure and also death (Engle, 1964). Complemented with iron-chelating therapy (e.g., deferoxamine) for iron overload, the prognosis of thalassemia major has become dramatic (Olivieri and Brittenham, 1997).  Ãƒâ€šÃ‚   Recently, the mechanism of iron overload in the absence of transfusion in thalassaemia has been unraveled by Tanno et al. (2007) who observed that the overproduction of the protein GDF15 suppresses the production of the liver protein, hepcidin in thalassaemia patients which eventually leads to an increase in the uptake of dietary iron in the gut. This information could translate into new diagnostic and therapeutic tools in the future. 6. Critical review of thalassemias : (ii) Clinical management therapies ÃŽÂ ²-thalassaemia syndromes are the most common genetic diseases worldwide. Improvements in treatment strategies have resulted in good prognosis. Yet, disease- and treatment-related complications get exacerbated over time, increasing morbidity and curtailing life expectancy of the patients. Currently, the only curative treatment available for thalassaemia is stem cell transplantation (SCT) (Gaziev et al., 2008) which is a gold standard in treating the disease. Many challenges exist for transplantation therapy including graft versus host disease (GVHD), rejection of the donated stem cells, and infections while a major limitation for SCT is finding HLA-matched blood-related donors viz., siblings. Currently available high-resolution HLA-typing could minimise rejection and GVHD by matching major as well as minor HLA antigens (Gaziev et al., 2008). The advanced techniques of HLA-typing can also identify unrelated but suitable voluntary donors. Intermittent red blood cell transfusion is the recommended mode of treatment for people who have moderate or severe thalassaemias. ÃŽÂ ²-thalassemia major, or Cooleys anaemia require regular blood transfusions. Emerging Gene Therapies Gene therapy for treatment of thalassaemia is still evolving. Research is focussed on finding a potential treatment of ÃŽÂ ² -thalassemia based on globin gene transfer. One of the aims of the genetic research is to trigger the production of HbF in adults to make up for the lack of healthy adult haemoglobin. The molecular mechanisms that initiate the change in gene expression during the switch from foetal (HbF) to adult (HbA) have been partially elucidated. Several chemical compounds able to reactivate HbF synthesis in vitro and in vivo in adult bone marrow have been identified (Testa, 2009). Induction of HbF to treat thalassaemia is a novel therapeutic strategy especially for those patients who are resistant to conventional therapy that is, regular blood transfusions and chelation therapy (Gambari, 2010). Chemical inducers of foetal haemoglobin In view of the fact that gene therapy could be inaccessible to many because of biological/genetic as well as economic constraints (Gambari, 2010), chemical inducers are being extensively studied. Hydroxyurea has already been used as HbF inducer in both moderate and severe forms of ÃŽÂ ²-thalassaemia (Testa, 2009). Some of the potential inducers of HbF are histone deacetylase (HDAC) inhibitors, DNA-binding drugs and inhibitors of the mTOR pathway (Gambari and Fibach, 2007). Also, according to Gambari and Fibach (2007) chemical inducers need to be used with caution since many of those used so far were potentially cytotoxic. Erythropoietin suppression of apoptosis Accelerated apoptosis has been observed in the erythroid progenitors of patients with ÃŽÂ ²-thalassaemia major (Silva et al., 1996). The hormone erythropoietin (Epo), which is the principal regulator of red blood cell production, is known to interact with high-affinity receptors on the surface of erythroid progenitor cells and promote cell viability. Epo has been shown to repress apoptosis via Bcl-XL and Bcl-2 during proliferation and differentiation of erythroid progenitors (Silva et al., 1996). Hence, recombinant human erythropoietin (rHuEpo) could have potential application in the treatment of transfusion-dependent thalassaemia patients as it promotes the differentiation and proliferation of erythroid cells, and stimulates the production of HbF (Makis et al., 2001). 7. Conclusion Inherited haemoglobinopathies including sickle cell disease and thalassaemias result from genetic abnormalities in the synthesis of globin protein chains. SCD is caused by structural defects in the haemoglobin molecule while thalassaemias occur due to reduced or absent globin chain. Only bone marrow or haematopoietic stem cell transplantation can cure patients with either disease. Clinical management of SCD generally involves supportive therapy consisting of pain relief, fluids and antibiotics, and folic acid supplements. Cases with severe complications such as stroke, acute chest syndrome or frequent painful sickling crises are treated with hydroxyurea. Intermittent red cell transfusion is administered to most patients, pre-surgery and in specific cases of severe complications. The only cure available currently for ÃŽÂ ²-thalassaemia major is afforded by haematopoietic stem cell transplantation from a compatible donor. 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Scholarship Essay Examples - What Do You Know About Writing A Scholarship Essay?

Scholarship Essay Examples - What Do You Know About Writing A Scholarship Essay?Need help writing a scholarship essay? Then you're in luck. If you need help with this, a number of scholarship essay examples are available online. Read on to learn about some samples.There are various kinds of scholarships and there are scholarships for different purposes. Scholarships for minority students, for example, may be different from scholarships for women in technical fields. The same is true for scholarships for first-generation college students. These scholarships are awarded to specific groups or they may be non-competitive and awarded to those who have some sort of special skills. Sometimes, the types of scholarships are restricted by the competition - there is a limit on the number of scholarships available each year.A lot of scholarship essay examples come from popular magazines and newspapers. The writers can benefit from these sources. Of course, the writing is not as good as having yo ur scholarship money and having your time and resources free. But, it's a great way to get ideas for essays and information that are related to the purpose of the scholarship.Obviously, the majority of people are looking for assistance for certain types of scholarship that are available for different people. The words you use and the topics you are researching may influence the focus of your essay. The words you use and the topics you're researching should reflect what the author is trying to accomplish in writing the essay.Scholarship essay examples for scholarships for minority students may be about inclusiveness, family, politics, and the nature of college. The writer needs to be able to talk about the main ideas without seeming like an outsider or without sounding like they're trying to come off as a jerk. The information needed should relate to the situation, not necessarily to the author themselves. It should reflect the author's personality and capabilities and should present their perspective.Scholarship examples for women in technology may be different than scholarships for technical or science fields. They may have to do with the types of things women in technology do. For example, there may be gender-related issues, such as raising children or working in the home. In addition, there may be something about how technology has affected society. There are a lot of ways that a scholarship essay for women in technology may have to do with politics, family and being in a certain industry.The essay doesn't have to be just about you. You can use the information that's written about you as a resource. Maybe you have a specific skill that can be applied to an industry or can show the purpose of your specialty. Or, maybe you have a story that needs to be told, or you're a part of a group or a company that the writer wants to illustrate. In any case, scholarship essay examples have the advantage of not making you sound like you're bragging about yourself.There i s no substitute for your own experiences or knowledge when getting help. Use your own experiences, education and resources to write your scholarship essay. The writer who makes sense of the materials and gets it all together will win the attention of the school or college. Scholarship essay examples are valuable resources for help writing a well-written scholarship essay.