Stuart W. Jamieson, MB, FRCS

• Endowed Chair and Distinguished Professor of Surgery
• Chief, Division of Cardiovascular and Thoracic Surgery
• Chair, Department of Cardiothoracic Surgery
• University of California, San Diego
• La Jolla, California

In this context anxiety symptoms 8dp5dt 75mg doxepin, the chapter will interrogate representations of the Gulf by influential American policy makers (specifically the national security advisor to the Carter administration anxiety uti order doxepin 25mg visa, Zbigniew Brzezinski) and how these were taken up and disseminated by aspects of the print media anxiety symptoms 3 year old 10mg doxepin mastercard. Soon after its establishment in 1923 anxiety symptoms in 2 year old buy generic doxepin 25 mg on line, Time came to be seen as the authoritative American news magazine anxiety symptoms in cats cheap doxepin 25 mg mastercard. As the nation struggled out of the depression and then went along the road to war anxiety therapist discount 75 mg doxepin with visa, the uncertainties and tensions, the complexities of the times perhaps made Americans more needful than ever of publications that tried to sift the news and explain its significance. Its status reinforced in the Cold War,5 Time in particular became an important signifier of American (global) culture. The rise of television only served to reinforce the authority of the more measured analysis of the news magazine, and docu mentaries began to show real covers of Time to underscore the importance of the topic they covered. The first point to note here is that in earlier imperial scripts, notably those of Britain, the Gulf emerges as of vital interest and deep concern (see Adelson 1995; Rich 1991). For the focus of the First Cold War was distinctly Europe, and, in the second instance, the Far East; while the focus of the Second Cold War is South-west Asia, and in particular the Persian Gulf. It is here that the West is now said to have its major strategic interests, and it is here that the full blast of the Soviet threat is alleged to be most evident. Ethiopia was the site of a large-scale and successful Cuban intervention, in support of the Ethiopian government. The events of Iran showed, moreover, that apparently secure regimes could be rapidly overthrown once a popular movement started to grow. Certain places were deemed vital to the supply and open uninterrupted flow of the raw materials (particularly oil) on which Western societies depended. The resulting political chaos could well be filled by elements hostile to our values and sympathetic to our adversaries. In the Time graphic, the Soviet bear was pictured looming over a crescent (rather like the ones on the top of mosques and on the flags of Pakistan, Turkey and Algeria). Regardless of what kind of regime comes to power in this immensely strategic land, the politics of the region, and indeed the geopolitics of the entire world will be affected. Nonetheless, it is also apparent that what happens next in Iran could have an impact on the whole region. The collapse of the Portuguese colonial empire gave the Russians new opportunities in southern Africa. An interview with Kissinger followed, in which he deployed his characteristic objectifying language of `geopolitics. The Soviet Union must be taught that it cannot pursue `a systematic attempt to overturn the geopolitical equilibrium. In Time, they were put forward to reinforce and confirm the diagnosis and analysis of danger in the arc. The family fled to Canada in 1938 and, like Kissinger, Brzezinski first made a career in an academic environment. By the standards of the Carter administration, Brzezinski was at first something of an unreconstructed cold warrior. However, his real moment came after the Soviet invasion of Afghanistan in early January 1980. Therefore: `By the time Carter returned to Washington on Monday, he had a new speech. Beginning with an invocation of America as the world and of the world: `As we meet tonight, it has never been more clear that the state of our union depends on the state of the world. The Soviet effort to dominate Afghanistan has brought Soviet military forces within 300 miles of the Indian Ocean and close to the Strait of Hormuz [i. Meeting this challenge will take national will, diplomatic and political wisdom, economic sacrifice and, of course, military capability. We must call on the best that is in us to preserve the security of this crucial region. Let our position be absolutely clear: Any attempt by any outside force to gain control of the Persian Gulf region will be regarded as an assault on the vital interests of the United States. In this context, the cruise missile, which had been a floundering Cold War project, found a new rationale (see Hayes et al. This was much to the delight of the Boeing Corporation, which was selected to manufacture it. What this chapter has set out to show is how a set of representations and commitments made in hysterical Cold War times have had unforseen but profound (post-Cold War) consequences. But the network of bases, the weapons systems and the commitment to and capacity for fighting in the Gulf were over a decade in the making. Ironically, Brzezinski (1991) himself, in testimony before the Senate Foreign Relations Committee in December 1990, called for diplomatic means to force Iraqi compliance. In this respect, what is striking is how easily the Gulf was re-inscripted and represented as a place of vital interest and/or danger when the notion of Soviet threat (of which Brzezinski had made so much) was no longer relevant. Does America really want to let the Saddams of the world shape the new global power structure In the months that followed only rare examples of anything other than a more-or-less official view turned up in the pages of the magazine. Equally important, the magazine blithely noted that if people did not like the way that some described the policy (imperialism), then another more congenial description (containment) should be adopted. See Enloe (1993) for an analysis of the militarization of gender difference during the war. Indeed, such claims seem farcical or irresponsible when the unnumbered dead Iraqi troops and civilians are taken into account. Other readings claim Baudrillard as a morality story and radical denunciation of (televised) high-technology violence (Merrin 1994); as a genre of science fiction response to the evident fiction of a new world order and of clean smart weapons (as Baudrillard 1993a, 1993b, has claimed for himself); or part of a French intellectual response to or dis-orientation in a late capitalist dystopia (Mathy 1993); and as a parody of orientalist tales of savage Arabia. Critical Perspectives on the Pacific Region Idea in Dirlik (1993), whose tide I have drawn upon for this chapter. The report goes on to contrast the fate of the Ilois with those of a roughly equal number of Falkland Islanders. Soviet Policy from Afghanistan and Iran to the Horn of Africa, Harmondsworth: Penguin. Kessings Record of World Events (previously Kessings Contemporary Archives), various issues. Virtual Geography: Living with Global Media Events, Bloomington: Indiana University Press. As the drama unfolded, it became apparent that this was not simply another Latin American foco1 movement, in the tradition of previous revolutionary uprisings. Rather, it demanded the democratic revitalization of Mexican civil and political society, and autonomy for, and recognition of, indigenous culture. As a result, the Zapatistas have received enormous national and international media attention. In order to do so, let me first consider the importance of social movement practices for critical geopolitics. Critical geopolitics and social movements An important area of investigation within critical geopolitics is the role of social movements3 in challenging the power of both the state and international institutions to enact particular economic and political programmes. Social movements are usually located within the political boundaries of a state, and affected by the actions and policies of the state (as in the effects of the development project). However, it is important to note that, increasingly, certain resistances are becoming regional and international in focus and organization, such as the recent protests against the 50th anniversary of the World Bank (see Brecher and Costello 1994). Also, within states, social movements may address their actions to groupings or institutions other than the state, for example ethnic groups, or the media. Hence, while social movements are frequently in perpetual interaction with states. They tend to pose political, cultural, discursive, and economic alternatives to the state and state policies. Attention to the actions of social movements such as the Zapatistas contributes to a critical geopolitics in at least two ways. First, it (de)centers analytical focus away from an exclusive concern with the machinations of the state. The consequences of such an approach may include the broadening of political geography to encompass more radical understandings of the political; an understanding of how place is central to particular terrains of resistance and the creation and articulation of alternative knowledges; and how local contexts of resistance may interplay with global processes (Routledge 1993; Dodds and Sidaway 1994). Strategic mobility within social movement practice allows for myriad perspectives to be explored, which may reveal possibilities of action unimagined from other positions and collectivities. Perhaps nowhere is this potential for mobility more apparent than in the use of contemporary media within resistance, and it is to a discussion of these themes within social movement practices in general, and the Zapatista rebellion in particular, that I will now turn. This is in part effected by the refusal of social movements to accept the boundaries of communication taken for granted by established systems of domination. Through their use of media vectors, social movements can escape the social confines of territorial space upon which much of the legitimacy of the state is predicated. Indeed, the globalization of communications provides new opportunities for decentralized political practices, as many social movements increasingly locate their strategies within local and translocal spaces as well as national and transnational spaces (Adams 1996: 419). Moreover, political conflicts frequently involve struggles over the representation of events and whether the conflict should be bounded in particular spaces, or publicized and traverse those spaces. It is usually in the interests of governments to restrict the bounds of a conflict in order to effect containment (if not total control) of events, whereas social movements frequently wish to publicize their struggles in order attract the attention of as wide an audience as possible to their aims and grievances. The former constitutes broadcast areas, satellite and telephone networks, and the signs and images that accumulate through the interactions in this space of media vector fields. The latter constitutes the physical space of interactions, social relations of production and reproduction, and the places of work and habitation. He argues that the occupation of time in the information network is an important aspect of contemporary struggle, the occupation of space in the symbolic landscape being a means to that end. Referring specifically to practices of resistance, Melucci (1989) argues that, since collective action frequently focuses on cultural codes, the forms of contemporary social movements are themselves messages, operating as signs, representing a symbolic challenge to dominant codes. By confronting power, contemporary social movements aim to challenge the symbolic order of what constitutes permissible thinking and action on specific issues. They aim to force power to take differences into account by articulating alternative ideas and practices in space. Indeed, Baumann (1992: 33) has argued that the contemporary media present the real world as a drama, a staged spectacle. Just as authority located in the street was once met by demonstrations and barricades, the authority that locates itself in the electronic field must be met with electronic resistance. Spatial strategies may not be key in this endeavour, but they are necessary for support, at least in the case of broad spectrum disturbance. Indeed, it is tempting to consider the Zapatistas primarily as a media event, since for the many onlookers, the experience of the Zapatistas has been entirely a media-ted one. Such a process is deeply entangled with the increasing importance of multivariate media in the lifeworlds of business, news, politics, and culture.

These `What is new in the current discussion is the willingness of people to reflect upon the positive and negative aspects of their own actions and legacies as well as those of other cultures anxiety symptoms women discount 75mg doxepin with visa. As much as any other business sector physical anxiety symptoms 24 7 purchase doxepin 75 mg with visa, the commercial media has shifted away from a pure emphasis on profit towards establishing a broader role in society anxiety symptoms eye twitching cheap doxepin 75 mg with amex. There are also fundamental shifts in terms of how the data used to track development are measured anxiety 30 minute therapy buy 10mg doxepin visa, analysed and presented anxiety symptoms in 12 year old boy cheap doxepin 75mg mastercard. Aggregate figures that hide discrepancies between anxiety symptoms 89 best 25mg doxepin, for example, genders and social groups, or between urban and rural areas, give way to more disaggregated data collection and reporting. The changes are highlighted by the continuing evolution of the United Nations System of National Accounts, especially the shift away from Gross Domestic Product as the major indicator of development. Environmental, economic and social indicators track real progress at all scales - business, national, regional and global - giving the public a more informed basis for seeking change. New technologies also play a big role, both as catalysts for, and in response to , many of these changes. Developments in information and communication technologies enable groups to connect to and learn from each other, by sharing success stories, but also by exposing behaviour, whether legal or illegal, existing or planned, that gives cause for disquiet. These technologies also become more instrumental in coordinating social, political and economic activities. They are the natural medium for a new consciousness, providing a sense of immediacy and unity to a diverse and pluralistic movement. Among such advances are improvements in energy and water use efficiency, desalination and medical technologies and treatment. These breakthroughs are closely linked to general developments in the areas of nano-technology and biotechnology. Governments, businesses and other private organizations stimulate much of the technological development, not only by direct investment in research and development, but also by offering worthwhile prizes for new developments. In the areas of biotechnology and genetic engineering, there is strong awareness of potential issues related to biosafety, bioterrorism and moral concerns. Biotechnology also becomes increasingly linked to biodiversity research within regions. Concerns over genetic engineering continue to run high, but they are eased somewhat as developments in this area take on a more regional profile, both in terms of who is undertaking and benefiting from the research and the raw materials used in the processes. Carefully controlled studies in many regions, including Asia and the Pacific, West Asia, Latin America and the Caribbean and Africa, highlight the use of endemic resources. They also take greater responsibility for the whole life cycle of projects and products. By the year 2032, some shifts are already well on the way to a new, more stable level of functional completion, while others are only beginning to take off. The reason for this smooth passage lies in the nature of the process which, while somewhat chaotic and unplanned at times has been driven from the grass roots up with strong support at higher levels. The degree of participation between governments and society, and the ongoing evolution of basic beliefs have been instrumental in allowing governments to pursue policies that would not otherwise have been possible. Examples are the establishment of land and marine sanctuaries and major shifts in the constructive use of tax breaks and penalties. The evidence of these accrued benefits helps governments in taking action, as they make it very difficult for those who are opposed to `New technologies play a big role, both as catalysts for, and in response to , many of these changes. And as formal actions are taken, they act as a ratchet, keeping the advances from slipping back. The interlinked sets of changes that have occurred during the first three decades of the new millennium are clearly part of a broad societal transformation. Although no one would argue that sustainability has been achieved, there is a clear sense that the world is moving in the right direction and there is no turning back. Which scenario - or which mixture of scenarios - prevails in reality is a matter partly of contingency and partly of choice. This section illustrates what the four scenarios can tell us about the consequences of policy and management for the environment over the next three decades. The pressures exerted on the environment, the changes in its state and the impacts on people differ from one scenario to the next. When interpreting the results it should be remembered that not all natural and human systems operate on the same time scale: both feature fast, medium and slow processes. Hence some of the effects of our actions emerge only slowly and much of what will happen in the next 30 years has already been determined. Decisions made over the next 30 years will have significant impacts and implications that reach far beyond this period. Quantitative material is included to help illustrate the trends that would be expected under each scenario. The quantitative results presented here as charts and diagrams have been derived, in consultation with regional experts, using a range of analytical tools. The results underline the magnitude of the challenges we face in developing environmentally relevant policies for the future. The emphasis is on general trends and the proportional differences under different scenarios, rather than on the precise levels of impacts. More details of the analytical tools used and the variables presented are provided in the technical annex to this chapter. Certain environmental implications only make sense when viewed at the global scale. It is important to remember, however, that the origins of these global effects are often local, national or regional. The initial global perspective of environmental implications presented below also provides a backdrop for the more detailed examination of the environmental outlook that follows for each region. Also summarized is the impact that different policy approaches have on the possible outcomes of the event. The effects of the economic troubles in a Security First world push down per capita energy consumption and lead to the slower emission growth seen at the end of this period. The policy actions taken under a Policy First scenario, notably carbon taxes and investments in non-fossil-fuel energy sources, effectively curb growth in global emissions. The dramatic behavioural shifts implied under Sustainability First, in conjunction with significantly improved production and conversion efficiencies, result in a very rapid levelling off of emissions followed by a decline by the middle of the 2020s. Even by the year 2050, some 20 to 25 years after the start of the decline in emissions in the Policy First and Sustainability First scenarios, the atmospheric concentrations are only beginning to level off in Sustainability First and have yet to do so in Policy First (see chart). Carbon dioxide trajectories in Markets First and Security First continue to climb rapidly, reflecting the weak policies and lack of behavioural changes in these scenarios. The rate at which climate is changing is indicated by the rate of change in average global temperature (see chart, overleaf). The relatively long delay in the response of the climate system shows up in the relatively small differences between the scenarios in their early stages. There are strong links between climate change and other environmental issues, specifically local and regional air pollution. For all four scenarios, it is assumed that stabilization of primary energy use is first reached at the end of the 21st century. In the longer term, however, the dynamics in a world resembling Markets First or Security First imply much faster and greater overall temperature rises, whilst the rate of temperature increase slows down in Sustainability First. For instance, by 2032, there is very little difference between the scenarios in terms of sea level rise. The total increase since the beginning of the century is approximately 10 cm, yet this level and rate of rise has serious implications for 20 20 the build-up of greenhouse gases follows trends in emissions but the stock has a long life span once in the atmosphere. Only the Sustainability First scenario is on a trajectory to stabilize at 450 ppm (parts per million) carbon dioxide equivalent. Together with the growing impacts of climate change, these developments severely deplete biodiversity in most regions in all scenarios (see maps on page 355). One particularly troublesome result related to climate change is that significant areas are at risk because the natural vegetation cannot adapt to the rates of change in temperature and precipitation. Some change for the worse appears unavoidable in almost any scenario that can be considered for the next 30 years. Nevertheless, reductions in the emission of greenhouse gases, coupled with bold conservation initiatives, including the following, can have a significant limiting effect on the impacts: q 30 00 20 Ecosystems under pressure Biodiversity preservation represents another major environmental challenge at the global level. Without strenuous policy action, humans continue to develop more of the planet, reducing and fragmenting natural ecosystems. The built-up area increases in nearly all regions and scenarios, the only exceptions being North America and Europe where the area declines slightly in Sustainability First (see chart opposite). Lack of effective controls, including realistic price hurdles to urban land expansion, is most evident in the Security First scenario. The percentage of built-up land may seem small, but the infrastructure network (roads, power lines, airports, harbours and dams) that supports these sites affects much larger areas and also sees dramatic expansion over the next 30 years (see chart opposite and maps on page 354). The introduction of such infrastructure can lead to uncontrolled resource exploitation often linked to hunting and poaching, deforestation, land and water degradation, growing of illegal crops, tourism and land conflicts. In both Markets First and Security First, these resource-driven processes accelerate, with rapid losses of remaining wilderness areas and severe impacts on biodiversity and indigenous peoples. A Policy First world continues to protect additional areas and introduce mitigation measures. It does so, however, at rates far below that of development, as in the previous century. Even under Sustainability First a sharp reduction in further expansion of infrastructure into remaining wilderness areas; curbs on further fragmentation of already impacted areas; implementation of mitigation measures to reduce impacts on biodiversity from existing networks; introduction of potentially costly restoration measures; and demarcation of wide buffer areas around nature reserves. In addition to pressures from the direct exploitation of resources in these areas, there are also impacts from coastal infrastructure and land-based sources of pollution (see chart on page 355). These pressures are especially large in Asia and the Pacific, where they stem from various sources, dominated by agricultural activity. West Asia also faces rising pressures under Security First and Markets First conditions, but generally sound water management practices in the region have a very positive effect, especially in Sustainability First. Asia and the Pacific, Africa and West Asia see big increases to 2032, irrespective of scenario. Latin America and the Caribbean currently features minor pressure from land-based sources of pollution along much of its coastline, compared to other regions, but this rises sharply over the coming years. North America and Africa also start from a relatively low base, but certain areas, such as the mouths of large river systems like the Mississippi and the Nile are of key concern. Pressure on people the scenarios carry important implications for the provision of basic human needs that are related to broader environmental impacts. In the longer term, global climate change can have a strong impact on the local availability of freshwater. Meanwhile, growing populations and increased economic activity, particularly in agriculture, lead to increased demand for freshwater in most scenarios. Permutations of these pressures determine those areas and populations that face the greatest challenges in meeting needs. Outside North America and Europe, these challenges increase in all scenarios, along with a trend toward more extreme water stress (see charts on page 356). Differences in policy actions, such as reforms in the pricing of water and shifts in subsidies, and technological improvements can have a strong effect on the size of these challenges. The ability to meet these challenges reflects broader social and economic policies. Under the Markets First and Security First scenarios, the number of people living in areas with severe water stress increases in both absolute and Key to charts Markets First Policy First Security First Sustainability First Land area impacted by infrastructure (% of total land area) 100 90 80 70 20 60 02 02 20 20 02 20 40 30 20 0 20 02 10 20 02 20 50 Human demands for resources and transportation continue to impact on biodiversity and ecosystem function up to 2032. In a Markets First scenario, biodiversity comes under threat in nearly 72 per cent of the land area by 2032. The situation is particularly critical in Southeast Asia, the Congo Basin and also parts of the Amazon. As much as 48 per cent is directly converted to agricultural land, plantations and built-up areas, compared to 22 per cent today, suggesting widespread depletion of biodiversity. Even the Sustainability First scenario suggests continued biodiversity loss across nearly 56 per cent of the land area by 2032. By 2032, this conversion is in full motion, especially in the Southern Hemisphere. The Markets First scenario sees a strong decrease of the quality of nature in most regions. In some regions agricultural land is taken out of production and presumed to be reconverted into natural area. However, in biodiversity terms this reconverted land is of low quality during the first decades or longer. Policy First and Sustainability First show roughly comparable results in the scenario period. But their trends by 2032 are different, with Sustainability First moving towards a sharp decrease in pressures. The development of the biodiversity situation in absolute terms is shown in the regional bar charts. For example, the increases in pressures in Australia and New Zealand are large in relative terms because the pressures in 2002 are small. Potential increase in nitrogen loading on coastal ecosystems North America Markets First Policy First Security First Sustainability First qq q q q Latin America and the Caribbean qqq qqq qq q q q large Africa qq qq q q q q q very large Europe and along the Mediterranean coast of West Asia and Northern Africa. Europe and Central Asia (without Turkey) qq q q q West Asia (with Iran and Turkey) qqq q qq q Asia and the Pacific (without Iran) qqq qqq qq qq Expected increase by 2032 q small Nitrogen loading can be taken as a proxy for a wider range of land-based pollution on coastal ecosystems. These increases are partly due to continuing population growth in water-stressed areas and partly due to new areas experiencing severe water stress (namely large parts of Africa, North and Latin America and Europe). The situation is different under the Policy First and Sustainability First scenarios. In most regions the actual area under severe water stress remains more or less constant or even decreases, due to stable or decreasing water withdrawals, particularly for irrigation. This results in little change in the overall proportion of people living in water-stressed areas by 2032. Nevertheless, the absolute number of people living in water-stressed regions increases significantly across the developing world.

For every products internal factors like motivation anxiety symptoms leg pain buy doxepin 75 mg visa, learning anxiety nursing diagnosis discount doxepin 10 mg otc, perception anxiety symptoms fear doxepin 75mg generic, beliefs and attitudes in association with external factors like culture anxiety symptoms treated with xanax cheap doxepin 25 mg fast delivery, environment anxiety 5 things you can see buy doxepin 10 mg on-line, social class anxiety symptoms 8 months purchase doxepin 25 mg with visa, religious, national economic condition and 4p directly or indirectly affect the consumer behavior (Kotler et al. Income must be considered as it indicates the social status or hierarchy of a person in the society. In addition to income and motivation, perception defined as how consumers select, organize, and interpret the physical sensory elements such as sight, sounds, and smells also influence the consumer behavior (Solomon, 2004). Solomon (2004) also noted that as the people belong to a society or group, group influence becomes an important external factor to influence the purchase behavior of the consumers because consumers ask suggestions or information regarding the products. Normally products can be measured through feature, quality and quantity; and the right balance between these 4P can either make or break a product. For instance, correct pricing strategy; placing the product in the right location to make it available or accessible to customers and right type of promotion to increase awareness can enhance the chance of the product being purchased. Gold creates an emotional attachment to the female consumers because they consider gold as a precious metal or as a symbol of purity, luxury, wealth, status, prestige, beauty and affection. Moreover the historical events reveal that ancient women would wear gold ornaments as a symbol of status and dignity (Nia and Judith, 2000). Gold buying is ritualistic to the Bangladeshis because gold is worn in many religious festivals and occasion such as eid, puja or wedding ceremony (Dempster 2006). According to Ramaswamy and Namakumari (1983) factors like culture, education, economic status, and level of exposure or degree of sophistication induce consumers to purchase and wear gold ornaments whereas khadekar, et al. In their study it was also observed that around 80% respondents preferred the branded jewellery items over the non-branded jewellery items. Gomathy & Devi (2015) also concluded in their study that maximum number of consumers are aware of the branded jewellary. And the main attraction towards the branded jewellery items is its unique style (Ramachandran & Karthick, 2014). According to Kearney, (2013) the rise of the usage of the gold ornaments among the women is also driven by the rising income levels and the exposure of western concepts such as solitaire engagement rings. And In many situation the purchase decision of the women is influenced by their family, friends and needs. Data were collected from 200 female consumers living in Khulna city of Bangladesh using convenient sampling method. They were from different religions and from different professions like students, service holders, housewives and others. A total of 200 consumers were selected because in factor analysis we need 5 times or more of the number of variables used in the questionnaire. To collect data the consumers were provided with a self-administered questionnaire in which there were two parts; one part was designed with the demographic variables such as age, religion, marital status etc. Later data were analyzed by some descriptive statistics (mean, standard deviation and frequency). Factor Analysis, a data reduction tool was applied to group the 19 variables on some significant factors. Varimax rotation, a principal component of the factor analysis was used to identify the factors. Table 1(Appendix) illustrates when the female consumers feel the necessity to purchase the gold jewelries. It is found that around 38% consumers purchase gold ornaments during a special occasion like Eid, Puja or wedding ceremony. Table 2 (Appendix) illustrates how the female consumers take the decision of buying gold jewelries. Table 3 (Appendix) describes from where the female consumers purchase the gold ornaments. Table 4 (Appendix) illustrates the descriptive statistics (Mean & Standard Deviation) of the variables used in the study. Reliability test score of the variables used in the study is presented in the Table 5 (Appendix). As shown in the table 7(Appendix) the cumulative percentage of variance explained in the current study is 53. Table 8 (Appendix) shows that 19 variables are loaded on 5 specific factors using varimax procedure, most commonly used orthogonal rotation method which minimizes the number of variables with high loading values on a factor. And the factors have been titled and interpreted according to the variables of highest loading value. The study examined 19 variables developed from the previous studies related with consumer behavior towards jewelry products in different countries. Finally the factor analysis grouped the 19 variables into 5 specific factors titled as Social Status, Financial Security, Unique Design & Price, Occasion and Trust. Most of the female consumers in Bangladesh feel proud to wear gold ornaments in any type of program. They would like to show off themselves or to increase their social status or self-esteem by wearing gold ornaments. Consumers view the purchase of gold ornaments as one kind of investment or financial security. They believe that the gold might provide them financial support in case of any necessity like wedding of their daughter or opening of any business. The third factor of the findings is explained as Unique Design & Price responsible for 7. Sometimes the female consumers become motivated to make or purchase gold ornaments when a new design comes in the market. Most of the consumers in Bangladesh prefer to wear gold ornaments during any festive occasion like puja, eid or wedding ceremony. Trust towards the familiar jewelry shops or branded shops is another influencing factor which explains 6. Female consumers feel secured to buy gold jewelry from trusted and branded shop because this is very hard to judge the quality of gold even after using it. After the factor analysis we found five important factors that influence the female consumer in the Khulna city in purchasing gold ornaments. It has been also found that around 38% female consumers in Khulna coity purchase gold ornaments during a special occasion like Eid, Puja or wedding ceremony, around 48. The result may not be generalized reflection of all the customers of the country as the study was conducted only based on the opinions of Khulna city customers. The study might have failed to find out many other factors that also affect the customers to purchase gold jewelry. The study has focused only on the behavioral pattern of female consumers and the factors that affect or influence their gold ornaments purchase decision. His research interest includes consumer behavior, Fast Moving Consumer Goods, Human Resources. He is currently serving as an Associate Professor, Business Administration Discipline, Khulna University. His research interest includes service marketing, consumer behavior, culture, ritual products. Materials & Method: A cross-sectional questionnaire based study was carried out among the intern doctors of Assam Medical College & Hospital, Dibrugarh. The Intern doctors working in Assam Medical College during the study period were included in the study. Results: 150 pretested questionnaire were distributed among the intern doctors and out of which 110 responded with completely filled up questionnaire. Among the intern doctors, 76% of them have experienced adverse drug reaction in patients but only 13. Since the intern doctors would be the future health care professionals and would influence the society in many ways, hence this study was undertaken. With the passage of time, there is a tremendous increase in the usage of drugs leading to several adverse drug reactions6. The total number of intern doctors who participated in the study were hundred and ten. A prior written informed consent was obtained from the intern doctors before conducting the study. The aims and objectives of the study was explained to them before distributing the questionnaire. Our study showed that despite of having an adequate knowledge and attitude among the intern doctors, only 13. Knowledge, Attitude, and Practicesregarding Pharmacovigilance and Adverse Drug Reaction reporting among Dental Studentsin a Teaching Hospital, Jodhpur, India: A Cross-sectional Study. An evaluation of knowledge,attitude and practice of Indian pharmacists towards adverse drug reaction reporting: A pilot study. Knowledge,attitude and practice of adverse drug reaction reporting among docrors in a tertiary care centre in South India. Knowledge, attitude and practice of adverse drug reaction reporting among teaching and nonteaching hospital physicians. Knowledge, attitude and practice of community pharmacists of Gujarat towards adverse drug reaction. An Educational Intervention to assess Knowledge Attitude Practice of Pharmacovigilance among Health care professionals in a Indian tertiary care teaching hospital. O2 2 Department of Environmental Health Science, Kwara State University, Malete, Kwara State, Nigeria. Department of Pure and Applied Biology, Ladoke Akintola University, Ogbomosho, Oyo State. The use of strain-specific microbial fermentation in the production of organic acids towards the removal of heavy metals has been extensively studied. However, the use of indigenous micro flora toward the bioleaching of heavy metals has not been well researched. This study assessed the bioleaching of heavy metals from hospital sewage sludge using cassava peels fermentation extracts. Sewage sludge sample was collected from the University College Hospital sewage treatment plant, Ibadan, Oyo State, Nigeria and analysed for selected heavy metal concentrations such as Copper (Cu), Zinc (Zn), Chromium (Cr), Nickel (Ni), Cadmium (Cd) and Lead (Pb) by Atomic Absorption Spectrophotometry using standard methods. The mixture was centrifuged after a leaching time of 1-12 days at 1000 rpm for 1hour. The filtrate was analysed for heavy metals concentrations and compared with the standards. Crude fermentation extract of cassava peel was found to be effective in removing the heavy metals from sewage sludge. Therefore, its use could be embraced and promoted for removing heavy metals from sewage sludge, thus safe disposal could be achieved. Keywords: Aspergillus tereus Fermentation Extract, Crude Fermentation Extract, Hospital sewage sludge, Cassava peels. This is due to industrialization, increasing population density and high urbanized societies [1,2]. Sewage sludge is the solid, semi-solid or liquid residue generated during the treatment of sewage in a treatment works. Sludge generated at these plants contains heavy metals at relatively high concentrations, which may vary considerably with time and mostly depend on industrial activities. Heavy metals such as Lead (Pb), Chromium (Cr), Nickel (Ni) and Cadmium (Cd) constitute toxic pollutants found in sewage sludge [3-5]. Heavy metals accumulate in soil and in plants when sludge is applied as fertilizer and eventually produce harmful effects in animals and humans. Due to the high level of awareness of the negative impacts of high concentration of heavy metals to the environment, stringent guidelines and verifications have been designed to limit the application of sewage sludge to agricultural soils [6]. In order to use sewage sludge as soil conditioner, it is necessary to remove or minimise the amount of heavy metals in sludge to prevent biomagnification and bioaccumulation. Inorganic chelating agents which are the most popular extracting reagents for heavy metal removal have been proved to be very efficient as they form stable complexes with most heavy metals over a broad pH range. Although, the use of inorganic and synthetic chelating agents for heavy metal removal tends to decrease soil productivity and impaired the chemical and physical structure of soils due to mineral dissolution. These compounds are very stable and could remain adsorbed in the soil after extraction, thus making the soil unfit for further use [3,7]. In bioleaching of metals from sewage sludge, organic acids are more promising than inorganic chelating agents, since extraction can be at mildly acidic condition and are biodegradable, hence low environmental impact. Also, the use of organic acids as a better option for heavy metal solubilisation from sewage sludge have been explored by several authors to have low effectiveness compared to the synthetic chelates [8]. The use of strain-specific microbial fermentation in the production of organic acids has been studied [9,10]. However, the use of indigenous microflora towards the removal of heavy metals has not well been researched. Therefore, this study assessed the bioleaching of heavy metals from hospital sewage sludge using cassava peels fermentation extracts. The Sewage Treatment Plant involved the conversion of the organic matter into inorganic matter before discharging the treated effluent into the recipient environment while the sludge is processed into organic manure for agricultural purposes. Production of fermentation extracts (extractants) Itaconic acid producing strain of Aspergillus tereus was isolated from the soil using the pour plate method and screened using Czepak-Dox Agar. Therefore, the substrate (cassava peels) still retains its indigenous microflora which is needed for crude fermentation [12,13]. Extraction studies Extraction of heavy metal was carried out to determine the efficacy of extractants using varied optimum conditions (pH, temperature and contact time) as modified by Okareh and Enesi [14]. The extraction was carried out at contact time of 1, 3, 6, 9 and 12 days at ambient/room temperature (28oC) and the elevated temperature (45oC) for each extractant using 10ml for each extractant. Each tube containing 3 g of sieved sewage sludge in 25ml centrifuge tubes was filled with varied doses (ml) of the extractants. The concentrations of heavy metals in the final solutions (filtrate) were determined by an Atomic Absorption Spectrometer. Adsorption/leaching model was used to calculate the amount of metal ion leached and percentage removal of heavy metals from the sewage sludge. Removal efficiency: Efficiency (%) Where Qe is the metal uptake (mg/g); C1 and Cs are the concentrations of the metal in supernatant (in mg/L) and sludge (mg/kg) respectively, M is the mass of the sewage sludge (kg) and V is the volume of the extractant (l).

Goods traded at this inter-regional service scale are accommodation or lodging services as well as fashion stores whose customers are not only the people of Yogyakarta City but also foreign parties anxiety symptoms of flu cheap 75mg doxepin with mastercard. With tourists as their customer target anxiety symptoms after quitting smoking doxepin 25 mg otc, Sosrowijayan becomes increasingly dense and crowded because of many customers passing by anxiety symptoms one side of body buy doxepin 75 mg without prescription. Then for the regional service scale of goods traded in the form of building materials and supplies anxiety 6 things you can touch with your hands 25mg doxepin amex, cake shop anxiety jury duty 10mg doxepin overnight delivery, optical shop and also a cosmetics store anxiety 1st trimester buy discount doxepin 25mg on-line. Most of these commercial activities have customers who are not only domiciled in Sosrowijayan but also from the outer region. The mix then saw the chance of developing Ownership of 71% commercial functions include homestay, business activities as many tourists activities is mostly personal property grocery store, laundry. Before the establishment of place of business is 64% personal In addition, commercial activity in the commercial activities, property and 31% lease/contract. In Sosrowijayan Region has been Sosrowijayan was dominated addition, many businessmen who set established for more than 10 years, by buildings with residential up businesses here mainly because of it is known that the commercial it close to the city centre, many tourist functionalities. The questionnaire consists of 14 questions used for the analysis of each suitability criteria. Evaluation indicators on accessibility are seen from accessibility characteristics of strategic location, transportation, road condition, distance from city centre and travel time as follows: Table 3. Amongst them is accommodation, food and beverage business, infrastructure and tourist information. Accommodation is a part of an industry which means a component of the tour itself, accommodation can be a place or room where people or visitors or tourists can rest or stay to sleep, bathe, eat and drink and enjoy the available services and entertainment. Whereas, tourism information needs to be provided to support tourism activities so it is necessary to create as much information as possible. Convenient surrounding will trigger a comfortable sense in using the facility and doing particular activities. A clean tourism area will provide a sense of comfort for visitors and make the aesthetic value of a region remains high. In addition, hygiene is also one of the health aspects for visitors which should be prioritized. Based on observation results, there are no scattering piles of trash around the perimeter. Affordability of prices affects the number of coming tourists as the affordable costs will attract more tourists to come over. Price compatibility with whatever is offered by a place affects its promotional campaigns. These indicators include the strategic location, distance from the city centre, travel time, accommodation, facilities and incurred costs. Here the calculation as follows: % Conformity Levels = Fulfilled Indicators X 100% Total Indicators = 6 X 100% 14 dx. This suggests that Sosrowijayan is not yet functionally suitable as a tourism-supporting area. Commercial activities found in the Sosrowijayan are accommodation or lodging, food and beverage business, grocery store, bookstore and other tourism support such as vehicle rental, tours and travel, money changer and others. The building functions of Sosrowijayan is highly dominated by commercial activities, ownership status is either own or personal. Then, reasons for establishing the venture are dominated by tourism effects of Malioboro, or merely as their side business. Furthermore, as it seen from the shape of the buildings, it indicates that many commercial activities there violate the building permits of residential. Sosrowijayan area is located in a very strategic location so that the price of land in the area is high and available buildings are not sold but rented out. There are eight indicators that are not met for the calculation of the suitability level of commercial space utilization function as supporting tourism in Sosrowijayan area. The eight indicators are road, transportation, restaurant or restaurant, infrastructure, tourist information, security, comfort and hygiene area. Based on the Detailed Spatial Plan of Yogyakarta 20152035, Sosrowijayan has its main function as trade and services zone. Looking at the zonal development wise, Sosrowijayan has a specialized area pattern where commercial activities with certain commodities are interconnected as tourism-supporting activities. This is because almost all commercial activities are reachable by tourists coming from outside the Sosrowijayan and even dominated by foreign tourists. Most of the commercial activities have the function of space as a place of business along with the status of private properties, also, the commercial bustles are preceded by residential functions. Many businessmen who set up businesses here mainly because of it close to the city centre, many tourist attractions, or it has been long established there. Rapid tourism development in Yogyakarta as well as placing Sosrowijayan as one of the tourism centres has been attracting many tourists to come around so that the initial use for residential later being shifted into commercial to meet the needs of tourists. From these six indicators, the conformity level result is 43% suggesting that Sosrowijayan is not yet functionally suitable as a tourism-supporting area because the level of conformity is less than 50% of the fulfilled variables. Thanks to Diponegoro University, especially the Department of Urban and Regional Planning which has provided the best educational approach as well as Ragil Haryanto who always provides guidance and supportive gestures in every possible way. Evaluasi Keberhasilan Taman Lingkungan di Perumahan Padat sebagai Ruang Terbuka Publik Studi Kasus: Taman Lingkungan di Kelurahan Galur, Jakarta Pusat. A Phenomenon of Spatial Economic Democracy: Emerging Small-Medium Enterprises along the Street Corridors of Yogyakarta, Indonesia. Pengaruh Kegiatan Komersial Terhadap Fungsi Bangunan Bersejarah di Koridor Jalan Malioboro Yogyakarta. Penerapan Hospitality Tourism di Desa Wisata Penglipuran (Ditinjau dari Attractions, Accesibilities, Amenities, Ancillaries and Community Involvement). Kajian Keterkaitan Usaha Pendukung Akomodasi Dengan Penginapan di Prawirotaman dalam Perkembangan Pariwisata Kota Yogyakarta. The Turgo impulse turbine is known for its reliability and strength, and it can perform efficiently with the range of flows. In this research the power and torque are compared between theoretical and numerical at various jet speeds for Turgo impulse turbine. Therefore the flow rate is not limited by the discharged fluid interfering with the incoming jet (as is the case with Pelton turbines). As a consequence, a Turgo turbine can have a smaller diameter runner and it can rotate faster than a Pelton for an equivalent flow rate. The Turgo turbines are used in medium head and high head of water between the head of 15 m to 300 m. Turgo turbine transforms kinetic energy of water jet to rotational energy with the help of a nozzle. The high speed of water jet directed on to the turbine blades and the turbine is rotated at high speed after striking the water to the turbine blades. For the same power output the Turgo turbine runner is one half the diameters of the Pelton runner, and the specific speed is twice the Pelton runner. If the number of jets are increased the specific speed of the turbine is also increased. This is widely used in pico hydro power plant because the cost of the turbine is low and it can easily manufacture in minimum cost. Turgo turbines are mostly used in rural areas electrification in pico hydro power plants. The simulation is important before the actual operation of turbine as it helps to optimize the design according to the obtained values of flow velocities, pressure distribution and efficiency. The research was performed to calculate the power and torque by the computational method. The jet diameter dj can be calculated using (2) Therefore, the diameter of runner is D = m dj (3) the jet diameter plays an important role in the designing of the buckets of the Turgo turbine. Buckets and runner of Turgo turbine the jet velocity is determined from the net head as: (4) Where cv is the efficiency of the nozzle and generally 0. At optimum efficiency, the circumference or tangential velocity of the runner is connected with the jet velocity as: (5) dx. To achieve this, the design of buckets and runner were initially designated according to the hydrodynamic theory. This study consists of the buckets, nozzle, casing, fluid part and rotating bodies. The flow domain consists of the fluid, the nozzle, the bucket, the casing and rotating region. The domains are separated into two parts such as the stationary components and rotating component respectively. In the meshing, the size function is taken as curvature and the relevance center is considered as the medium. Figure 5 shows the meshed on buckets and nozzle and the numbers of nodes are 1045788 and the numbers of elements are 5393410. Figure 3 shows the geometry for rotating part and figure 4 describes the geometry for rotating and stationary part of the Turgo turbine. Meshed on Meshing on buckets and nozzle can be seen from figure 5 and figure 6 shows the detail mesh on buckets. Domain motion was set to stationary for the nozzle and casing while rotating for runner and bucket with appropriate speed. The motion of the rotating domain was set in clockwise direction along positive x-axis direction. In the input boundary parts, the water stream from the nozzle is injected into the rotating region. The faces at the stationary domain except nozzle are taken as the opening with relative pressure 1atm. But the back surface set as the outlet whereas the pressure outlet show 1 atm respectively. Boundary Conditions (d) Outlet Figure 7 (b) illustrates the rotating part of Turgo turbine. The places around the stationary part such as front surface, top and bottom surface and the sides surface are taken as opening. Simulation Domain the pressure distribution, the velocity distribution and torque variation in the turbine bucket were analyzed after the simulation. The liquid flow in the rotating runner of an impulse turbine is complex and unsteady. Streamline of water flow on the bucket (i) Pressure distribution the pressure distribution in the bucket was due to impact of high jet. The pressure is maximum at the place where the jet strike on the bucket with the value of 0. Pressure distribution on the buckets (a) front side (b) back side (b) Figure 9 (a) illustrates the pressure distribution on the buckets from the front side and figure 9 (b) also shows the pressure distribution on the back side of the buckets. Pressure distribution on one bucket length Figure 10 shows the pressure distribution along the bucket length where the jet strike. Since the inclination of the jet angle is 20, the pressure decrease at the tip of the bucket length and then it increase gradually. From the simulation results, the pressure is maximum at the spot where the jet strikes the bucket, and then decreases towards the edges of the bucket. The velocity is maximum when the water emerge from the nozzle and then it will decrease when it strike the bucket. If the pressure increases, the force will increase proportionally and the bucket can be more failure. The results show that the value of torque of the turbine varies when the jet velocity changes. And then the power also varies accordingly because the power is directly proportional the torque of the turbine. From figure 14, it can be seen clearly that the power will increase when the jet velocity increases. Therefore the jet velocity is the important point in the designing of Turgo turbine. The results obtained from the simulations were dependent on the accuracy in domain set up, quality of mesh, turbulence model and boundary conditions. Therefore, the results can be improved by increasing the mesh quality and the number of mesh nodes. Moreover, in the designing of the Turgo turbine, the jet ratio and jet velocity play an important role. The theoretical power that is developed from the analytical calculation is 520 watts and the jet velocity is 13. Moreover, the simulation shows that the power is 145 watt when the jet velocity is decreased to 3. Acknowledgement the author wishes to express the deepest gratitude to her parents, for their moral support and encouragement.

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