Effect of Washington Consensus Upon Emerging Market

Washington Consensus implemented by emerging markets refers to economic policies created by John Williamson (Hooper, 2002; Rodrik, 2006). It is based on financial liberalization theory of McKinnon and Shaw, which emphasis on freeing financial markets from government intervention. Financial liberalization theory assumed perfect financial markets with perfect information, perfect competition and depends on institution-free analysis (Demetriades, 1999). These assumptions are irrelevant in the sense that market, as a whole is imperfect. Despite these deficiencies, emerging countries agree to implement Washington Consensus requested by International Monetary Policy (IMF) and World Bank as part of their loan contracts. According to Washington Consensus, emerging economies facing similar problems with developed markets should be treated with the same tools. Washington Consensus aims to encourage privatization with high level of economic openness. There are many criticisms regarding the policies content of Washington Consensus. Some critics argue that the policies are not being devised in a sequentially correct manner and did not consider emerging markets’ development stage (Hooper, 2002). There are several impacts of the implementation of Washington Consensus upon the emerging capital markets namely worsen economic growth and increase stock market’s volatility. Implementation of the Washington Consensus through financial liberalization has affected economic growth of emerging capital markets. Financial liberalization is developed in the objective of improving economic growth by encouraging saving, investment and capital productivity. Before financial liberalization is introduced, many developing countries encounter financial repression, which is the process where government intervenes in the economy (Demetriades, 1999). In 1960s and 1970s, government intervention was needed to control pegged exchange rates under Bretton-Wood regime. Government controlled the markets by allocating high reserve requirement, interest rates ceiling, and controlling capital, credit as well as exchange rate. These interventions led to disequilibrium in interest rate, for example, interest rates were below equilibrium level (Hooper, 2002). In order to curb the problem, financial liberalization is introduced, for instance, by setting higher interest rates. High interest rates were aimed to encourage savings, which will attract investment through borrowing and thus improved economic growth. Unfortunately, financial liberalization did not result in greater savings instead high interest rate can destroy reformation in real sector (Hooper, 2002). In addition, financial liberalization exacerbates economic growth in the sense that ratio of reserves to foreign denominated short-term indebtedness had declined substantially (Stiglitz, 2000). Washington Consensus suggests emerging capital markets to deregulate their economies in order to achieve economic growth. However, lack of comprehensive regulation has led to Asian Financial Crisis in 1997. Moreover, dampen economic growth during Asian Financial Crisis came from maturity and currency mismatch. For example, long-term investment in local currency financed short-term liabilities in dollars. Besides, Washington Consensus did not emphasis on capital flow structure in liberalizing capital flows. Many emerging capital markets destabilized due to high level of capital flows. In Latin America (1980), economic crisis was a result of cash flow structuring problem with the increase in portfolio equity to replace portfolio debt. Asian Financial Crisis 1997 has been deteriorated due to regular flows of money between financial markets. This term hot money will flow from countries with low return to countries with the highest interest rates as banks attempt to get highest return as possible. These flows can affect balance of payments if exchange rates in the total is high (Hooper, 2002). Thus, Washington Consensus worsens economic growth of emerging capital markets. Volatility of stock markets is also affected by the implementation of Washington Consensus. Financial liberalization lead emerging capital markets to more volatility. This is because financial liberalization encourages deregulation, and liquidity, which are the components enhancing volatility. It also goes for taxation as lower taxes lead to volatility. Since liberalize markets usually have lower market concentration, volatility will also increase (Hooper, 1998). Moreover, increasing portfolio equity flows increasing volatility of stock markets (Hooper, 2002). These situations reduce the attractiveness of investing in emerging stock markets (Stiglitz, 2000). Besides, stock markets’ volatility will be exasperated when there is no sufficient accounting disclosure since investors are not able to make informed judgment about the firm. However, financial liberalization did not improve accounting disclosure and structure of governance (Hooper, 2002). There is negative relationship between quality of accounting system and volatility of stock market. Poor accounting system lead to higher market volatility. Moreover, Washington Consensus policy of deregulation has also intensified volatility of stock market (Hooper, 1998; Hooper, 1998). In addition, financial liberalization increased volatility of stock markets with changes in outside country. Since, emerging markets seemed risky, investors are discouraged to invest in the markets. Thus, results in large capital outflows (Stiqlitz, 2000). However, in the long run, volatility of emerging stock markets is improving as they liberalize. International investors find investing in emerging markets are profitable since their risk-return of overall portfolio improved. Investing in emerging stock market lead to diversification of risk, as there is low correlation with other markets (Hooper, 1998). Despite that, implementation of Washington Consensus in emerging capital markets lead to volatile stock market especially in the short-term cycle. There are several ways for IMF and World Bank to conduct policy in developing countries. One of the ways is IMF and World Bank have to make sure that Washington Consensus policies are implemented in correct sequencing manner (Hooper, 2002). For example, financial sector should be reformed after regulatory and bank supervision are restructured and after real sector has been reformed. IMF and World Bank should also encourage developing countries to review and comprehend their regulation system since deregulation can harm economic growth (Hopper, 2002). Furthermore, fortifying securities and accounting regulation help reduce volatility (Hooper, 1998) by implementing framework and policies like fiscal policy, which represent the countries stock markets’ volatility. Besides, IMF and World Bank should bequest emerging countries to be more transparent in accounting disclosure and adopt good governance structure. For example, companies with poor governance are required to pay high return to investors. To reduce the premium, corporation should lessen information asymmetry by increasing accounting disclosure. Thus, cost of equity is lowered since investors are more aware about the firms’ cash flow. Moreover, accounting disclosure overcomes capital flows problem while clear securities framework helps lower volatility. Accounting disclosure should improve so that firms are abled to be monitored and controlled by government (Hooper, 2002). In addition, higher interest rates in emerging capital markets leads to adverse selection and moral hazard problem. Adverse selection normally occurs when interest rates are high as borrowers invest in extremely risky investment without lenders’ knowledge. While moral hazard arises when borrowers invest in projects they had not agreed to. This can lead to increase in cost of borrowing for other borrowers. Thus, encouraging accounting disclosure helps to reduce adverse selection and moral hazard. For example, Thailand and South-East Asian faced moral hazard due to deficient accounting disclosure and comprehensive regulation (Hooper, 2002). Besides, transparent information helps heal economic growth through effective resource allocation (Stiglitz, 2000). IMF and World Bank should also emphasis on binding constraints on economic growth by finding ways to correct the constraints. It is important for an economy to use the appropriate tools in reducing the constraints. For instance, reforming financial intermediaries will not improve investment with poor property rights. Thus, binding constraints have to be evaluated (Stiglitz, 1998). In conclusion, implementing Washington Consensus in emerging capital markets is not efficient. It deteriorated economic growth of many developing countries; for instance, East Asian and Latin America were in bad financial crisis. Moreover, the liberalization process also affects stock market of emerging countries by exacerbating stock markets’ volatility. Thus, International Monetary Fund and World Bank have to play their role by setting up efficient policies in order to curb problems arise from the implementation of Washington Consensus as well as improving the economy of emerging countries. REFERENCE LISTS * Demetriades, P 1999, ‘Financial liberalization: the experience of developing countries’, Eastern Economic Journal, vol. 25, no. 4, pp. 441-457. Hooper, V 1998, ‘Volatility and openness of emerging stock markets: some empirical evidence’, Emerging Capital Markets: Financial and Investment Issues, pp. 35-45. * Hooper, V 2002, ‘The Washington Consensus and Emerging Economies’, pp. 1-14. * Rodrik, D 2006, ‘Goodbye Washington Consensus, hello Washington Confusion’, pp. 1-28. * Stiglitz, J 1998, ‘More instruments and broader goals: moving toward the Post–Washington Consensus’, pp. 1-46. * Stiglitz, JE 2000, ‘Capital market liberalization, economic growth, and instability’, World Development, vol. 28, no. 6, pp. 1075-1086.

Bmw and Peugeot

[pic] MBA 503: Managerial Decision Making: Financial Analysis Professor: Sameer Mustafa [pic] [pic] INVESTMENT IN AUTOMOBILE INDUSTRY: BMW OR PEUGEOT Section F12N72 Team members: Ranjan Saha Sam Khassawneh Elena Dugarova Executive Summary This report provides a financial analysis and assessment of two automobile companies Bayerische Motoren Werke (BMW Group) and PSA Peugeot Citroen. Methods of analysis include comparison and evaluation of financial ratios, financial SWOT, R&D and cash flow analyses. All calculations can be found in the appendices.Results of data analyzed show that both companies have strengths, weaknesses, threats and opportunities, but Peugeot has more strengths and opportunities in terms of long-run prospective, than in BMW. After analyzing both companies we recommend to invest in Peugeot. Table of Content 1. Introduction †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. â⠂¬ ¦Ã¢â‚¬ ¦.. 2. SOWT Analysis †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦ 1. BMW Strengths †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 2. BMW Weaknesses †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 3. BMW Opportunities †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 4. BMW Threats †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5. Peugeot Strengths †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚ ¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 6. Peugeot Weaknesses †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7.Peugeot Opportunities †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 8. Peugeot Threats †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3. Comparison of two companies †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 4. Recommendations †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 5. Conclusion †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 6. Appendices †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 7. References †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 1. Introduction This report provides data on the financial situation of two well-known automobile brands, BMW Group and PSA Peugeot Citroen, over 2009 and 2011. The purpose of the report is to evaluate the financial situation of these companies in order to make an investment decision in any of these companies.First part of the report provides brief description about the companies followed by the situation analysis of both companies. Third part of the report illustrates the comparison followed by recommendation and conclusion. The recommendation will be made based on the result of the situation analysis. BMW Group was founded in Germany in 1917. This is one of the most prospering automobile, motorcycle, and engine manufacturing companies. BMW Group has three one of the finest brands in this industry: BMW, MINI and Rolls-Royce (Annual report, 2011, p. 3).The other company PSA Peugeot Citroen was founded in Paris in 1976. PSA Peugeot Citroen offers automobiles and motorcycles worldwide (PSA Peugeot Citroen, 2012). Nowadays this automobile company is supplying its products to China, Latin America, Russia and Europe (Annual report, 2011, p. 4). 2. Situation analysis for BMW and Peugeot The following section will discuss the financial strengths, weaknesses, threats and opportunities of both companies. 2. 1 Strengths of BMW 2. 1. 1 Sustainability of the company Maintaining the profitability is vital for any firm in order to be remaining sustainable.From the profitability test, it is apparent that the company improved it’s profitability over the year 2009 to 2011. Gross profitability increased significantly from 13. 96% in 2009 to 24. 38% in 2010 and continued to climb up to 27. 79 by the end of 2011. 2. 1. 2 Excellent creditworthiness BMW has been assigned credit rating status as â€Å"stable† by both Moody’s (rating A2) and Standard & Poor (rating A) which indicates the firm’s sound solvency position to debt (www. bmwgroup. com). In addition, their interest cover ratio provides very positive indication as it increased from 3. 36 in 2009 to 9. 54 in 2011.By utilizing this status company will be able to attract potential creditor with lower interest rate. Therefore, their profitability will increase due to the lower interest expenditure. 2. 1. 3 Increase investment in research and development Investment in research and development (R&D) is significantly important in order to take competitive advantage and mai ntain sustainable growth. BMW is committed to in R&D to meet current and future demand. Their expenditure rose up by 13. 3%? to â‚ ¬2,773 million from 2010 to 2011. One of the most advantages of BMW is creative production (Annual report BMW, 2011).They invested extensively in the past 3 years towards improving the environment and reduction of the CO2 emissions by 30 %. They also introduced fuel efficient product line such as BMW i models in order to meet the current demand. Moreover, BMW is searching for alternative energy solution by electrification and utilizing solar energy in their future product range. By introducing new product line BMW could take competitive advantage over it competitors by attracting environmental friendly customers which would maximize their profit as well as their image as innovative company. 2. 1. Commitment to Employees training The company values its human resources and invests in attracting and training skilled workforce to boost the quality of its products by reducing error rate, waste in production. It will also help BMW to strengthen customer relation as trained employees would able to communicate with confident by utilizing their knowledge and skills which will increase customer satisfaction. Moreover, due to the training employees will gain confidence to communicate more clearly with management which will improve the relationship between employee and management.As a result disputes between labour union and BMW will be reduced (Bloom & Lafleur, n. d. pp 5 – 9) In 2011 expenditure on basic and further training rose sharply by 37. 4% to â‚ ¬246 million (Annual report BMW, 2011). 2. 1. 5 Social responsibility BMW signed the UN Global Compact and issued a â€Å"Joint Declaration on Human Rights and Working Conditions which demonstrates that BMW complies with the fundamental working standards of the International Labor Organization (Annual Report BMW, 2011). It also indicates that BMW is a socially responsible firm w hich will have a positive impact on the image of the company (Murillo & Martinek, 2009).BMW’s image as a good citizen would help to attract potential investors, creditors and customers who care about social responsibility of any company. 2. 2 Weaknesses BMW 2. 2. 1Operating efficiency Receivable turnover has sharply declined from 55. 04 in 2009 to 15. 93 in 2011. Inventory turnover has also declined from 14. 50 in 2010 to 5. 43 in 2011. Both ratios are below the industry norm, which indicates that management was not efficient enough to collect its receivables. This also indicates that sales and marketing department didn’t perform well compare to the competitors to increase the sales. . 2. 2 Sharp decline in sales: In 2011 BMW’s sales dropped by 37 % in the US which is the largest market outside Europe. If it continues to decline, BMW may lose market share significantly which would have a very negative impact on the profitability as well as it would be a threat t o the sustainability of the company. 2. 2. 3 Liquidity BMW’s ability to meet the short-term financial obligation is low comparing to the industry norm. If BMW don’t pay attention to increase the liquidity, it could turn into a threat from weakness. 2. 2. 4Market shareDecreasing global market share for BMW. It goes down from 2. 89% in 2005 to 2. 45% in 2010. (www. statista. com). This shows that demand BMW’s cars are decreasing which is a bad sign for company. 2. 3 Opportunities BMW 2. 3. 1 Utilizing the exist technology to produce more environmental friendly products: As this issue became an important for the society. (BMW Annual report, 2011, p. 19) states, â€Å" In September 2011, SGL Automotive Carbon Fibers – a joint venture of the BMW Group and the SGL Group – opened a new state-of-the-art carbon fiber manufacturing plant in Moses Lake, USA.The facility plays a major strategic role in the manufacture of ultra-lightweight carbon-fiber reinfor ced plastics (CFRP), which will be used extensively in the BMW i vehicles to be launched by the BMW Group from 2013 onwards†. BMW group is already having this idea, but they could get more profit if they increase the art carbon fiber plants. 2. 3. 2 Growth in Asia: Asian countries are encouraging the foreign investment and they have a cheap labor. In addition, the cost of capital is cheaper than Europe. These factors lead to less cost of production and higher revenue.In order to gain this benefit BMW adopted â€Å"Completely Knocked Down† (CKD) assembly to manufacture automobiles with partners in six locations such as Thailand, Malaysia, Russia, Egypt, Indonesia and India (www. bmwgroup. com ). This would help BMW to attract the large Asian market as well as increase market share in the region. 2. 3. 3 Increasing demand on sports car BMW is already produced a few sport cars and they have to increase the number of sport cars and promote them to championships and customer s who like this type of cars. In July 2011,  BMW  pulled the covers off of the  BMW M3 DTM Concept Car, a vehicle that was to be the basis of the actual racer that will compete in the 2012 DTM season† (www. topspeed. com). 2. 3 Threats BMW 2. 3. 1 Euro zone crisis: Current economic slowdown along with sovereign euro zone crisis may tremendously hurt the company as sales are declining in Europe. It might pose even greater threat if bigger economies like Italy and Spain has to default like Greece which will lead Europe into a recession (World Economic Forum, 2012).It would not only affect BMW’s sales in Europe but also rest of the world because recession in the EU will have adverse effect in the world’s economy (International Monetary Fund, 2012). 2. 3. 2 Changes in Trend: Recent trend in the usage of car, where wealthy people prefer cheaper/affordable cars instead of luxurious car (24/7 Wall Street, 2012). Due to this trend, BMW as a luxurious car manufactur er might lose sales revenue and market share. Ultimately, it would have negative impact on the sustainability of the company. 2. . 3 Disputes with labour union: Labour union in Germany is very strong where firing employee is very costly (Global Competitiveness Index, 2012). Any dispute with the labour union could have significantly negative impact on the business operation as union could go for strike which will break the whole supply chain. 2. 4 PSA Peugeot Citroen 2. 4. 1 Strengths Peugeot 2. 4. 2 Sustainability of the company Company’s overall profitability significantly increased from very negative profitability in 2009(gross profit on sale -3. 0% and return on sale -5%) to a positive profitability in 2011 (gross profit on sale 17. 10% and return on sales 1. 50%), which demonstrates management’s extraordinary performance to bring the company back into a sustainable position. 2. 4. 3 Operating Efficiency Over the years from 2009 to 2011 Peugeot demonstrated continuo us improvement of its operating efficiency as management was improved efficiency to collect receivables (receivable turnover 20. 63 in 2009 and 26. 98) as well as increased inventory turnover (7. 14 in 2009 and 9. 06 in 2011) which is higher than industry norm (6. 4).Though receivables turnover is lower than industry norm (34), Peugeot’s continuous improvement indicates that management is paying attention to improve in order to maintain the capacity of operating assets. 2. 4. 4 Diversified business segments Diversification in the business segment reduces the risk of failure as it reduces company’s dependency on one single segment (The Economics Times, 2012) The Group's operations are organized in five main business segments: the Automotive Division, the Automotive Equipment Division, the Transportation & Logistics Division, the Finance Division and other businesses. These segments increased revenue by 6. % from â‚ ¬56061million in 2010 till â‚ ¬59912 million in 2 011 (Annual report BMW, 2011). Due to the diversified business segments Peugeot will be able to offset of one segment’s loss from other segment’s profit. 2. 4. 5 Investment in research and development To meet the current and future demand Peugeot invest heavily in research and development. This French auto manufacturer has maintained its R budget at â‚ ¬2152 million in 2011, or 3. 6% of revenue in order to secure sustainability in the future (www. peugeot. com). In 2011, PSA Peugeot Citroen was the most active patent filer in France with 1,237 patents in all.This performance demonstrates the positive outcome of its exceptional investment in R. New patents would enhance the innovative product line which would differentiate Peugeot’s product from its competitors in order to gain competitive advantage. This indicates better future for Peugeot. 2. 4. 6 Affordable price with good quality PSA Peugeot Citroen offers high quality distinctive cars for affordable price and specifically targets middle class (annual presentation 2010 PSA Peugeot Citroen). It would help Peugeot to gain market share faster in the emerging market such as China, Brazil and India where the number of middle class is very large.Higher market share in the emerging markets would strengthen Peugeot’s position in the global automotive industry. 2. 5 Weaknesses Peugeot 2. 5. 1 Creditworthiness Recently, Peugeot’s credit rating has been downgraded from â€Å"stable† to â€Å"negative† by both international credit rating agency Standard & Poor and Moody’s which would negative impact on creditors confidence. As a result, their interest rate will increase as creditors might feel risky to invest (Mustafa, 2012, Class lecture). However, French government’s â‚ ¬7b credit guarantee for Peugeot might help to maintain creditor’s confidence which will keep the interest expense stable. . 5. 2 Declining sales in Europe: Peugeot’s s ales declined by 5. 75% in 2010 in Europe, it’s largest market and it remained stable in 2011. Moreover, sales dropped further by 10. 8% by the end of September 2012 (European Automobile Manufacturers’ Association, 2012) It indicates a potential threat for Peugeot to losing market share in Europe, if it continues further. However, increasing sales outside Europe 39% in 2011 compare to 32% in 2010 (Annual Report Peugeot, 2011) could help Peugeot to maintain market share in the global automotive industry. 2. 5. 3 Liquidity Since 2009 to 2011 Peugeot’s liquidity has declined from 1. 07 to 1. 4 which even lower than the industry norm. Decrease in liquidity could have negative impact on the operating activities as firm might run out of cash to meet short term obligations. 2. 6 Threats Peugeot 2. 6. 1 Unionized labour market: French labour market is strongly unionized which give labour union a very strong bargaining power. The recent announcement by Peugeot to cut 800 0 jobs in their French plant (BBC News, 2012) might create disputes with the union. Therefore, there is a huge risk that union could go for strike due to the dispute with Peugeot which might disrupt their supply chain and cost a considerable amount for the company.However, French government’s announcement to provide credit guarantee in exchange to keep these jobs (The New York Times, 2012) would help Peugeot to avoid dispute with the union. 2. 6. 2 Euro zone crisis: Economic downturn and euro zone crisis had a very negative impact on Peugeot’s sales in Europe as the market demand declined sharply which resulted a decline in sales by 5% in 2010 and. If it continues may be the sales will drop further. 2. 6. 3 Competition from other producers: Increasing market share gained by other affordable car producers such as Hyundai could hurt Peugeot. There is a risk that French firm could lose market share. . 7 Opportunities Peugeot 2. 7. 1 New Trend Peugeot would be able to attr act customers with high income people due to the new trend as more rich people buy affordable price car (24/7 Wall Street, 2012) This is a very positive indicator for Peugeot to increase market share by attracting this large segments. 2. 7. 2 Market shift to globalization Peugeot is focusing on specific markets in the world. Since globalization is facilitating world trade, Peugeot would benefit significantly from it’s expansion to the emerging markets in Asia, Latin America and Middle East (The New York Times, 2012). . 7. 3 Increase the demand of hybrid electric cars PSA Peugeot has a joint venter with GM to produce hybrid cars. The joint arrangement agreement was signed on 25 October 2011. The Group is committed to providing total capital of â‚ ¬63 million, of which â‚ ¬13 million had been paid as of 31 December 2011. Registered in the Netherlands. (Peugeot annual report 2011) 3. Comparison of BMW and Peugeot This section compares and contrasts of both company in order to identify the better option for investment. 3. 1 Sustainability Both BMW and Peugeot improved their gross profit.BMW is around 10% more profitable in terms of gross profit ratio compare to Peugeot. However, Peugeot had higher return on sales which indicates that management of Peugeot was more capable to control it’s variable cost. Peugeot was also able to generate higher return from its asset compare to BMW as well as industry norm this demonstrates the management’s ability to utilize its asset in order maintain sustainable profit. 3. 2 Management efficiency Management efficiency is lower than the industry norm for both companies. However, Peugeot’s management is more efficient than BMW in collecting receivables.It is also more efficient in inventory turnover, which indicates that Peugeot’s sales, and marketing department is performing better than BMW. 3. 3 Diversified business segments Peugeot’s business segments is more diversified that BMW th is would help Peugeot to reduce the risk because it can cover the loss of one segment from another segments profit. 3. 4 Market share Even though BMW has higher market share in certain market. However, it has declined gradually over the past several years while Peugeot has increased market share in the emerging markets such as China, Russia, India and Latin America. This indicates better future for Peugeot. . 5 Credit ratings BMW’s credit ratings are better than Peugeot because BMW’s credit ratings have been improved from negative to stable. On the other hand, Peugeot’s credit ratings have been downgraded in 2012 (Moody’s 2012) As a result Peugeot’s borrowing cost might increase while BMW will benefit from the lower interest rates. 3. 6 Interest coverage ratio BMW’s interest cover ability is considerably better than Peugeot, which is 9. 54 and 1. 68 respectively. Due to higher interest coverage ratio it will create more confidence in BMW, wh ich will reduce interest expense. 3. 7 Liquidity Liquidity for both companies is below industry average.However, Peugeot has higher liquidity than BMW. This indicates that Peugeot has better ability to cover the short-term obligations. 3. 8 New trend Demand for Peugeot cars would be higher than BMW due to the changes in trend and customer’s preferences as wealthy people are buying cheaper cars. However, increasing demand for sports car would provide benefit to BMW. 3. 9 Euro zone crisis Euro zone crisis has significantly affected on both companies. However, Peugeot has increased sales outside Europe from 32% in 2010 to 39% in 2011 while BMW lost 37% sales in 2011 in the US which is their biggest market.Due to the increasing sales outside Europe, Peugeot will be able to maintain overall sales revenue though there is decline in sales revenue in the European market. 3. 10 Political risk Political risk could negatively effect on both companies. However, BMW is more vulnerable in the Middle Eastern countries which are one of their biggest market due to Arab spring. 3. 11 R Both companies invested heavily in R but Peugeot was able to generate more patents than BMW. In 2011 Peugeot had in total 1237 patents (Annual Report 2011 Peugeot).Higher capability of invention would provide competitive advantage to Peugeot as it will be able to meet the consumers demand. 4. Recommendation The above analysis illustrates that both companies has strengths and weaknesses. However, Peugeot has more strength and opportunities than BMW. Peugeot’s strengths and opportunities are better sustainability, higher management efficiency, diversified business segments, better match with new trend and increasing market share in the emerging market. These strengths demonstrate that investment in Peugeot would be a better choice as the company’s future seems to be stronger and more sustainable than BMW.These also indicate that investment in Peugeot would be less risky. Theref ore, we recommend investing in Peugeot. 5. Conclusion In conclusion, different factors were investigated in order to come up with right decision regarding the investment in BMW or Peugeot. Some of these factors are related to profitability, efficiency, debt, R & D and market position. Some other factors are related to their products’ quality and customer satisfaction. All of these factors were analyzed for three years starting from 2009 to 2011. In addition, the SWOT analysis played an important role in our decision-making.However, after analyzing both companies’ situation and looking at their strengths and opportunities, Peugeot was the best choice to invest in. References BBC News (2012) Peugeot Citroen plans 8000 job cuts. Available at http://www. bbc. co. uk/news/business-18808662 [accessed 11 November 2012] Bloom, M. R. & Lafleur, B. (n. d. ) Turning Skills into Profit: Economic Benefit of Workplace Education Program. The Conference Board. Available at http://www. conferenceboard. ca/Libraries/EDUC_PUBLIC/Skills_Profits. sflb [accessed 10 November 2012] Murillo, R. H. & Martinek,C. J. (2009) Corporate Social Responsibility Can Be Profitable.The Regional Economist. Available at http://research. stlouisfed. org/publications/regional/09/04/socialresponsibility. pdf [accessed 8 November 2012] The Economics Times (2012) Nine Diversified Companies: Are these firm attractive investment proposition. Available at http://economictimes. indiatimes. com/features/slideshows/et-slideshows-made-here/nine-diversified-companies-are-these-firms-attractive-investment-propositions/nine-diversified-companies-are-these-firms-attractive-investment-propositions/quickiearticleshow/7390833. cms [accessed 5November 2012] The New York Times (2012) France to back Peugeot With 7 billion euro in credit.Available at http://www. nytimes. com/2012/10/24/business/global/france-to-back-peugeot-with-7-billion-euros-in-credit-guarantees. html? _r=0 [accessed 11 November 2012] Wo rld Economic Forum (2012) Global Competitiveness Report. Available at http://www3. weforum. org/docs/WEF_GCR_Report_2011-12. pdf [accessed 25 October 2012] International Monetary Fund (2012) Debt Crisis, as it happened. Available at http://www. telegraph. co. uk/finance/debt-crisis-live/9681567/Debt-crisis-as-it-happened-November-16-2012. html [accessed 16 November 2012] Appendices [pic] Figure 1: Source: [pic] Figure 2: Source: PSA Peugeot Citroen 2011 [pic]

Behavioral Change: Rubbing Snuff

Rubbing snuff, like other forms of tobacco use, is an addictive behavior that poses a serious challenge to individuals who want to change their habits. Perhaps an even greater challenge looms for those whose partners would like to change their behaviors! Paul’s habit of rubbing snuff is the ideal opportunity to enact a well-planned behavior plan intended to motivate lasting change. The specific targeted overt behavior is the act of swallowing tobacco juice. To understand this behavior, it’s important to consider the dimensions of the broader act of rubbing snuff.The frequency of Paul’s dipping is estimated around 5-8 times per day with the frequency of swallows much greater. Dipping is described as replacing or adding additional tobacco to the mouth. Intensity increases with the progression of the day, starting with smaller amounts in the upper lip and ending with larger quantities in the lower lip by nighttime. The intensity of swallowing also rises with this in crease in use. The duration of Paul’s tobacco use holds the greatest possibility for change.At baseline, he dips constantly from the moment of waking to seconds before retiring to bed. The latency of Paul’s dipping of additional interest in the development of an intervention. At baseline, he began dipping approximately 2. 5 seconds after opening his eyes in the morning. The latency of Paul’s first swallow of tobacco averages approximately 2 minutes after waking. The action of concern, swallowing of tobacco juice, is a behavior excess. Any swallowing greater than 0 times per day qualifies as the presence of this behavior in excess.The intervention selected to extinguish Paul’s swallowing behavior was the use of a pop bottle for spitting. Paul established a reasonable goal of less than 3 swallows per day for one week followed by less than 2 the next week. This decreasing trend would continue for several weeks until complete extinction is achieved. With the decrease in swallowing, it will be important to document the increase in spitting behavior. Paul will document the number of times he spits for two 30 minute intervals throughout the day.As he begins changing his behavior, it is hoped that increased spitting will aid the decrease in swallowing. A few ground rules will also be established to enforce the intervention. Paul should have his spit bottle, spittoon, and/or other spitting place on hand wherever he goes throughout the day. Along with targeting the decrease of swallowing tobacco juice, this intervention should also serve to increase the behavior of spitting. The reaction of poor Paul’s wife to this change is yet to be determined! The effectiveness of this intervention was assessed on a daily and then weekly basis.By the third week, Paul experienced complete swallowing cessation and had increased his frequency of spitting from relatively nothing to dozens of times a day. The result was the elimination of vomiting behavi or, a perceived increase in energy, and self-reported decreases in fatigue. According to subjective and objective reports, Paul accomplished significant behavioral change. To improve the likelihood Paul would maintain his behavioral change, one final reporting and documentation measure was used two months after the start of the intervention.Hidden cameras were placed in Paul’s home and place of work to record each and every time he demonstrated the primary target behavior (swallowing tobacco juice) and the secondary desired replacement behavior (spitting in the bottle). The results were encouraging. Paul had completely stopped swallowing, but had also decreased the frequency of his need to spit throughout the day. With careful review, this was related to a decrease in duration of Paul’s dipping habit during the day. Paul was on his way to rubbing snuff out of his life! Behavioral Change: Rubbing Snuff Rubbing snuff, like other forms of tobacco use, is an addictive behavior that poses a serious challenge to individuals who want to change their habits. Perhaps an even greater challenge looms for those whose partners would like to change their behaviors! Paul’s habit of rubbing snuff is the ideal opportunity to enact a well-planned behavior plan intended to motivate lasting change. The specific targeted overt behavior is the act of swallowing tobacco juice. To understand this behavior, it’s important to consider the dimensions of the broader act of rubbing snuff.The frequency of Paul’s dipping is estimated around 5-8 times per day with the frequency of swallows much greater. Dipping is described as replacing or adding additional tobacco to the mouth. Intensity increases with the progression of the day, starting with smaller amounts in the upper lip and ending with larger quantities in the lower lip by nighttime. The intensity of swallowing also rises with this in crease in use. The duration of Paul’s tobacco use holds the greatest possibility for change.At baseline, he dips constantly from the moment of waking to seconds before retiring to bed. The latency of Paul’s dipping of additional interest in the development of an intervention. At baseline, he began dipping approximately 2. 5 seconds after opening his eyes in the morning. The latency of Paul’s first swallow of tobacco averages approximately 2 minutes after waking. The action of concern, swallowing of tobacco juice, is a behavior excess. Any swallowing greater than 0 times per day qualifies as the presence of this behavior in excess.The intervention selected to extinguish Paul’s swallowing behavior was the use of a pop bottle for spitting. Paul established a reasonable goal of less than 3 swallows per day for one week followed by less than 2 the next week. This decreasing trend would continue for several weeks until complete extinction is achieved. With the decrease in swallowing, it will be important to document the increase in spitting behavior. Paul will document the number of times he spits for two 30 minute intervals throughout the day.As he begins changing his behavior, it is hoped that increased spitting will aid the decrease in swallowing. A few ground rules will also be established to enforce the intervention. Paul should have his spit bottle, spittoon, and/or other spitting place on hand wherever he goes throughout the day. Along with targeting the decrease of swallowing tobacco juice, this intervention should also serve to increase the behavior of spitting. The reaction of poor Paul’s wife to this change is yet to be determined! The effectiveness of this intervention was assessed on a daily and then weekly basis.By the third week, Paul experienced complete swallowing cessation and had increased his frequency of spitting from relatively nothing to dozens of times a day. The result was the elimination of vomiting behavi or, a perceived increase in energy, and self-reported decreases in fatigue. According to subjective and objective reports, Paul accomplished significant behavioral change. To improve the likelihood Paul would maintain his behavioral change, one final reporting and documentation measure was used two months after the start of the intervention.Hidden cameras were placed in Paul’s home and place of work to record each and every time he demonstrated the primary target behavior (swallowing tobacco juice) and the secondary desired replacement behavior (spitting in the bottle). The results were encouraging. Paul had completely stopped swallowing, but had also decreased the frequency of his need to spit throughout the day. With careful review, this was related to a decrease in duration of Paul’s dipping habit during the day. Paul was on his way to rubbing snuff out of his life!

Organization Essay Example | Topics and Well Written Essays - 250 words - 2

Organization - Essay Example This paper will look at advantages of a collaborative role among organizations. A collaborative role benefits both clients and the services given to them. Through collaboration, the organizations become more responsive to customers’ needs. On the other hand, a collaborative role within the organization seals the gaps in services being offered and also provides for a provision of services that are more comprehensive. Apart from the advantages to clients and service provision, the collaborative role has advantages to the organization. It enables the organization to introduce new practices, expectation, and ideas. Moreover, collaboration among organizations facilitates enhanced access to available resources. Additionally, Game Theory has been used by organizations to improve quality or maximize profits (Shuman, Twombly & Rottenberg, 2001). Collaboration by nature combines several and different initiatives. The advantage of having many individuals in a group, where the pool of ability is bigger, produces a beneficial resource in units that cannot be found where people work individually. People with different academic and personal background should be merged so as to achieve the best out of an organization. Conversely, it is essential to lessen connectivity in places where collaboration is not of

Scotch Whisky Industry in the UK and in particular, William Grant & Essay

Scotch Whisky Industry in the UK and in particular, William Grant & Sons - Essay Example Homogeneity in the needs of the market therefore is the unifying factor in creating better international markets. This argument is contended by others that believe an international market is impossible to exist since there are several dynamic differences in the trends of various nations. The growth of trading agreements in certain regions has constantly developed and become a source of interaction in business and marketing strategies creating trading relationships between countries (Stalk et al 1980). 2.0 Balvenie in the UK. Such bodies as the North American Free Trade Arrangement, the European Union and others are forms of regional trade agreements that have been formed over the years of international marketing development. These bodies work on eliminating region trade barriers to allow other organizations without those regions trade freely within each other’s borders. These relationships are advantageous in allowing the companies engaged in international trade to obtain econ omies of scale while consumers of their goods enjoy low prices and access to a variety of products. These trading regions create free movement of labor and resources among other advantages. Engagement in international trade is therefore more of an advantageous venture for greater success in companies and have more advantages to disadvantages. Organizations like Grant and Sons are among the firms involved in the free international trade operations that are an expansion to the business in the long run. The firms gain in advantage from free movement and labor. The firms as well engage themselves in further customization of the products that creates better quality in the products sold such as the whisky distilled by Grant and Sons organization in the various outlets of the company’s distilling plants (Zuckerman et al 1998). The extensions of the Grant company into the international market is a cause for the exciting entrepreneurial environment created by interactions in joint ven tures with companies such as Remy Cointreau and third party agreements in UK Portugal. This kind of ventures have also given motivation and confidence to the organization from acceptance by the market outside their own country. 2.1 The Scotch whisky industry in the UK. Scotch whisky has over the years only been matured and distilled in one country which is Scotland. This brand has grown from a simple cottage industry to being the sole global supplier in over 210 countries. Changes created in bid to make international ventures include complete changes or adjustments in the administration and organizational structure. The management approach incorporated involves the geocentric approach suggested by Permulter (1969) that brings about a more globally integrated management system. Despite the successes of Scotch whisky, the industry requires methods that grow every day to maintain the position of top quality as an unchallenged player. This will involve customization of the brands by see king customer response to quality. It is important that the industry carries out an area study of the people it supplies with whisky in order to realize options of expansion. 2.2 William Grant and Sons in the UK. William Grant and Sons is a great contributor to the whisky industry in the UK. It is characterized by authenticity in its production. William Grant and Sons utilizes its own water from springs in production process and its own grown barley

What were the causes and effects of the global financial crisis in Essay

What were the causes and effects of the global financial crisis in 2007 and three clear leasons for portfolio risk management that have emerged from this experience - Essay Example The financial crisis of 2007-2009 caused disastrous effects in the US economy as well as numerous other countries of the world. The effects have been so severe that the world still struggles to return to normalcy. The crisis is considered to have planted its roots since as early as 2001. This is the time when United States of America recovered from a minor recession due to the terrorist attacks and the dotcom bubble. Dotcom bubble was a stock market recession that took place due to the heavy investments in the dotcom companies. Many investments were made in the technological companies with the expectancy of gaining even greater profits. The US economy survived this setback in their economy but their minds feared the probability of an actual recession. Singh (2007) stated that the Federal Reserve decided to decrease the interest rate to 1.75% from a rate of 6.5% to avoid any occurrence of a recession. This lowering of the rate proved to be an attractive package for the people as many more individuals could finally make their dreams come true and make desired investments. What the concerned authorities did not predict were the consequences of such an increase of loans and mortgages. Due to the decrease in the interest rates, the people became restless buyers and started applying for more mortgages and loans. The demand for houses appreciated the property prices to a great extent and lowered rate for rented properties. A greater element of encouragement was introduced in the market when Federal Reserve lowered the interest rate even lower to only 1% in the mid of 2003. This was done with the aim of keeping the economy strong. Singh (2007) stated that this rate was the lowest one that was witnessed in the past 45 years. This gave an even bigger push for the people to invest as much as they possible could. Then, another factor was introduced in

Journal article Essay Example | Topics and Well Written Essays - 2000 words

Journal article - Essay Example reasing workloads and time constraints, many of the functions solely performed by radiologists are now being performed by radiographers, leading to increased medical malpractice claims. Hence the specific objectives associated with this study are as follows: Since the introduction of the new NHS Plan in 2000, based upon reforms in the way the staff of the NHS worked, nurses and staff members were allowed to extend their roles beyond their traditional boundaries, in the expectation that it would make care more patient centred. Greater workforce flexibility and a team approach have contributed towards the provision of a high quality patient service (Woodford, 2006). The availability of skilled radiologists is limited, but financial constraints, increases in workloads and financial imperatives in the NHS have mandated a transfer of some of the functions of the radiologist to radiographers (Price, 2007). To specifically address the needs of radiographers, the proposed method was to introduce a four tiered service delivery model, wherein advanced practitioners, i.e., radiographers, were to play a key role.(Buttress and Marangon, 2008). In a recent editorial (2010), it has been argued that there is a need for a wider service perspective that can be provided by radiographers, but there is little evidence available to suggest that individual radiographers have grasped the full implications of the nature of leadership and vision that is required to perform these roles successfully. The distinction between an â€Å"advanced† versus â€Å"extended† role for radiographers has been clarified by  ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Hardy and Snaith (2006), who point out that role extension is the acquisition of additional skills, duties and responsibilities beyond those expected of the post while â€Å"advancement† assumes the attainment of a higher level of professional knowledge and ability. Radiographers fall under the category of extended practitioners while radiologists conform to the advanced

Conservation and Management of the Environment Case Study - 5

Conservation and Management of the Environment - Case Study Example On the other hand, her employer Carl Damon is not strongly into environmentalism. He gets excited and hopes that Jacquie would create awareness about the entire thing across the organization’s employees. Jacquie Lipscomb’s interest was in the prevention of pollution which dated back to her school days. She used to track everything that happened to all the papers and came up with a recycling program that was implemented in the entire school. Thus, Jacquie was really encouraged by the company’s interest in conserving the environment. She got accustomed to all the operations at KTI and educated herself of all the outputs from the manufacturing procedures and designed ways through which the firm could reduce the release of harmful substances into the atmosphere. Her work at KTI was remarkable and Carl, her boss, was really impressed with her performance at work. After about a year, Jacquie realized that the company has been selling its wastes to another company which never disposed of the wastes properly. This made her approach her boss for clarification. To her surprise, Carl disclosed how the implementation of environmental approaches made the firm’s interest to diminish. In addition, his response was clear that the strategies Jacquie had put in place were never supported. Jacquie felt deceived and wondered if the management is transparent with every operation in the company. Jacquie has all the reasons to feel or rather conclude that Carl deceived her. Deceit has been a problem in companies for years. Thus, to cope with such situations in organizations, there are a number of actions that one should take. These actions are meant to make a person deal with the management which has lost its sight of vision and reality and failed to implement the strategies that are worth to the company, employees, environment and the entire society. To start with, pinpointing the reason why managers sometimes lie is extremely crucial.  

Phenomenology and Philosophy Essay Example | Topics and Well Written Essays - 2000 words

Phenomenology and Philosophy - Essay Example We may use our senses to make up our minds and pass judgment on certain issues but not to arrive at knowledge as such. Accordingly, and as stated, it is quite safe to say that the primary difficulty that a student faces when reading through Husserl's Phenomenology is that it forwards a different process of knowledge acquisition and the formulation of ideas than we have been conditioned to operate by. Despite the fact that Husserl's philosophy is quite different from the way in which we have been normally trained to think, leading to difficulty in fully understanding him, once we open our minds to his argument and his thoughts and consider them carefully, we are hit by the dawning realization that not only is Husserl's phenomenology directly relevant to the contemporary world but, in a way expressed ideas and conceptualizations of knowledge that exist in most cultures and in many schools of philosophy. This is especially evident in his discussion on "transcendental idealism" (40) and "phenomenological reduction" (41). As defined by G. As defined by G. Boland in "Phenomenology and Philosophy," phenomenology refers to a "20th-century philosophical movement dedicated to describing the structures of experiences as they present themselves to consciousness, without recourse to theory, deduction, or assumption from other disciplines such as the natural sciences." In other words, phenomenology is a school of philosophy which states that knowledge may be, and is, obtained from the senses and by experiences, and not only by the methods of science. Although such a statement on cognitive knowledge appears so obviously true that it requires no philosophical theories to argue on its behalf, the fact is that the growing reliance on scientific knowledge as compared to the decreasing dependence on, and trust in, the types of knowledge sources argued by this philosophy determine its importance and necessity. Not only that, but phenomenology, like other schools of philosophy, does not only state theories as such bu t precisely defines the intent of those theories and the scope which they cover. It is within the context of attempting to define precisely what phenomenology embraces and determine the types of knowledge that it can be cognitively produced, that Husserl undertook his philosophical inquiry and theorization. Husserl, a German philosopher, is considered one of the founders of the phenomenology school of philosophy and, in fact was the first to use the term, "phenomenology" (Bogland). As stated by Bogland, the main aim of Husserl's philosophical writings and studies was to the examination of "the structures of consciousness that enable consciousness to refer to objects outside itself." Doing so determined a complete focus on the human mind itself and the process of idea formation that occur within its limits. This process in which the mind itself, and nothing beyond it is studied, is referred to as "transcendental reduction" (Husserl, 12) and as "phenomenological reduction" (41). One of the interesting aspects of the human mind that Husserl called attention to is the fact that the mind is not only limited in thought and consideration to objects and things that actually do exist, but has

The development of travel and tourism industry Dissertation

The development of travel and tourism industry - Dissertation Example This paper outlines also the current developments of tourism. Low cost airlines â€Å"Evidence in the Europe and the U.S. indicates that the leading LFAs [low-fare airlines] fared significantly better than their full-fare rivals in the wake of the terrorist attacks on the U.S.,† wrote Thomas Lawton, author of Cleared for Take-Off: Structure and Strategy in the Low-Fare Airline Business, in the November 2003 Irish Journal of Management. â€Å"While established rivals cut staff, grounded aircraft and even collapsed into bankruptcy, the LFAs continue to open new routes and order new aircraft. LFAs are more resilient than traditional airlines to market downturns.† Europe deregulated its skies in 1997 and there has been no looking back as far as the travel and tourism boom is concerned. The low cost airline like Ryan Air, Excel Jet and Budget Air have offered the passengers no frill airlines and this has fuelled a lot of travel. This has exceedingly lowered the prices making holiday travels very affordable. For this reason these airlines have steadily gained market share. An old adage about cruises painted the typical passenger as "newlywed, overfed or nearly dead," but demographics for cruises are changing. A million children took cruises in 2002, double the number from 1998, according to the Cruise Lines International Association (CLIA), which represents 21 cruise lines. A five-day, $500 (or less) trip to a warm place (meals included), available in many markets; prices being affordable even for middle-class families.

Importance of Computer Essay Example for Free

Importance of Computer Essay Computer is an electronic device used in almost every field even where it is most unexpected. That is why this age is called as the era of IT. And now we cannot imagine a world without computers. It is made up of two things one is the hardware and other is software. All physical components of computer like keyboard, mouse, monitor etc comes under the hardware whereas all the programs and languages used by the computer are called software. These days computers are the tools for not only engineers and scientists but also they are being used by millions of people around the world. Computers have become an integral part of our lives. Be it the desktop computers or laptop computers, both have various advantages in our daily life. The landscape of global communication has changed since computers have been introduced in our society. Importance of computers can be attributed to the fact that almost every sphere of our life is affected by computers. Information technology (IT) is a whole new industry that has developed after the introduction of computers. Presenting before you is an article with an abridged summary of importance in computers in various fields. Importance of Using Computer Among several advantages of computers, access to the Internet is hailed to be an advantage that has shaped the way we communicate. Importance of information technology has been such that besides creating millions of IT jobs, it has become an integral part of every other industry. Features and operations of IT are indirectly required in every other sector. Role of Computers in Education Right from elementary school students to PhD researchers, every educational system has been influenced by computers. Some of the uses of computers in education are as follows: †¢Students can be better prepared for the future technologies and its easier to explain them several topics that are hard to be understood without 3-D images. †¢Online education has made learning easier and convenient for a large section of population. †¢Easy access to encyclopedia on the Internet certainly makes us ponder over textbooks versus computer teaching. Online encyclopedia have made researching and preparing documents simpler. †¢Students aware of computer uses have better chances of job opportunities as computers literacy is a need now. Importance of  computer education was never so important as it is in the present scenario. †¢Using computer aided facilities like PowerPoint presentation eases understanding of complex topics. BANKS Almost every bank is using computers to keep the record of all the money transaction and other calculations. Moreover it provides speed, convenience and security. COMMUNICATION Communication is another important aspect of computer and has become very easy through internet and email. Computer communicates using telephone lines and modems. Through email we can send messages to anybody in any part of the world in just a second while if we write letter then it will reach in some days. So the internet has made the earth a global village and above all saves time. This would not be possible without computers. Internet helps to find information on every topic. It is the easiest and fastest way of research. Computer network makes the user capable of accessing remote programs and databases of same or different organizations. MEDIA Almost every type of editing and audio- visual compositions can be made by using special software especially made for this purpose. Some software can even make three dimensional figures which are mostly used in the cartoon films. Special effects for action and science fiction movies are also created on computer. TRAVEL AND TICKETING Computers do all the work of plane and train reservation. It shows the data for vacant and reserved seats and also saves the record for reservation. WEATHER PREDICTIONS Weather predictions are also possible by the experts using supercomputers. SPORTS It is also used for umpiring decisions. Many times the umpire has to go for the decision of third umpire in which the recording is seen again on the computer and finally reaches to the accurate and fair decision. Simulation software allows the sportsman to practice and improve his skills. DAILY LIFE We operate washing machines, microwave oven and many other products using software. Moreover we can store all the information about our important  work, appointments schedules and list of contacts. Crucial Role of Computers in Medicine The health care field has gone through a revolution after computers have been introduced in our society. Uses of computer in the medical field has been immense. Computers have been integrated with almost all medical technologies to improve accuracy in results. †¢Big hospitals require computer systems to maintain database of patient records. This has lessened the burden of paper management. †¢Some uses of computers in hospitals include maintaining staff attendance records, medical records recording of incoming and outgoing timings of staff, computerized accounting and managing records of patient and associated doctors. †¢The use of computers in medicine has gained more significance as heartbeat rate, pulse rates all can be checked on special graphs on monitor screen. †¢Internet technology has made it easier to exchange information, news and reports about latest medical development all across the globe. †¢Medical imaging has grown to become an extremely important aspect of medical diagnosis. By using techniques to create body images of even the most complex structures in the body, scientists have made it easier to treat ailments. †¢Web conferencing has made it easier for expert doctors sitting in some distant country to guide and instruct junior surgeons. More so, even while operation, many senior doctors can guide junior doctors. These are some of the amazing uses of computers in hospital set ups. †¢All surgical procedures are recorded in small cameras (some even installed in the medical equipment) so that the process of surgery can be learned better and improved. †¢Nowadays, even computer counseling is possible owing to extensive use of computers. Benefits of Computers in Business The use of computers in business has grown by leaps and bound since the last few decades. Here are some of the benefits of computers in business field. †¢Using Internet technologies, computer networking and several types of software, businesses are able to communicate all across the globe crossing geographical boundaries. †¢Communication has taken a new role among partners, suppliers, consumers and theyre able to keep a track of each other that facilitates the business process. †¢Development of software like  Enterprise Resource Planning (ERP) software solutions and Management Information Systems (MIS) have made it possible to centralize administrative features of a firm. †¢Project management and other planning activities are easily designed by integrating latest software with computers. This decreases time on planning and figuring out certain complex issues. †¢Seminars, conferences and meetings can be scheduled with bosses and big corporate giants through web conferencing that can be heard by all the employees simultaneously. While the debate on advantages and disadvantages of Internet or computers will always exist, its certainly a truth that computers have made our life totally different, progressive and better. So we can say that today computer is playing very important role in our lives. Now is the time when we cannot imagine the world without computers. And this technology is advancing both in industry and home. It has become necessary for everyone to have the basic knowledge about computer. Otherwise he cannot get a job as computers have invaded almost all the fields.

Strategies for Selecting a Topic Essay Example for Free

Strategies for Selecting a Topic Essay Question-Answer What two objects, people, subjects, or concepts are you going to compare and contrast?The subjects I am going to use is Bipolar 1 and Bipolar 2 What are the similarities between the two objects, people, subjects, or concepts? List as many similarities that you can think of. One type of bipolar acts out unexpectedly and has similar adhd acts. The other type of bipolar acts out uncontrollable, and has similar, mood disorders and adhd. What are the differences between the two objects, people, subjects, or concepts? List as many differences that you can think of.The differences are one bipolar is uncontrollably and the other bipolar is more timid Are you going to focus on similarities, differences, or both? Explain your rationale. I want to explain the differences and similarities and hope to let people know that there are others out there with the same problems. What do you want your readers to learn and understand after reading your essay? What is the purpose of your essay?The differences between the two, and I want to know that just because kids look normal they may not be. What three parallel points of comparison or contrast will you address in your essay? For example, if you were going to compare and contrast two teachers, your three parallel points might be these: †¢Each teacher’s homework policy †¢Each teacher’s classroom conduct policy †¢Each teacher’s demeanor 1.The differences between bipolar 1 and bipolar 2.What types of other mental disorder usually comes with the two types of bipolar and different ways to try to handle the situations and medications. 3.Some of the ways to know how each child is and how to go about it from the morning through school and at home. Explain why this is an appropriate and workable topic selection for the final assignment.This  is an appropriate workable topic because people need to be aware of different kids of kids and not to judge. The most important is to let people know that they are not alone because there are not many blogs, groups out there for these families.

Aetiology of Gestational Diabetes Mellitus

Aetiology of Gestational Diabetes Mellitus Abstract Gestational Diabetes is a condition present in the later stages of pregnancy where the mother has insulin resistance leading to glucose intolerance. The aetiology of Gestational Diabetes Mellitus is largely unknown but several theories include autoimmune destruction of the beta cells, monogenic mutations and insulin resistance. In pregnancy it is normal for there to be some levels of insulin resistance and it is thought that the products of the placenta contribute to the state of insulin resistance as GDM usually subsides after pregnancy. GDM in pregnancy can lead to an increased risk of cardiovascular disease in the offspring such as hypertension and atherosclerosis. This is due to the increased levels of oxidative stress and inflammatory mediators present during pregnancy. The placenta is very important as it is able to control and buffer the amount of glucose that is delivered to the fetus but if this level is too high then it is out of the placentas control and the fetus may have increased rate of growth due to this extra glucose. The current focus of research in this area seems to be into finding ways to diagnosis GDM earlier in the pregnancy and to try and reduce the amounts of oxidative stress. Gestational diabetes: consequences for fetal programming of vascular disease in adulthood Introduction Gestational Diabetes Mellitus (GDM) occurs when there is a glucose intolerance that is first detected during pregnancy. It is a form of hyperglycaemia (Buchanan and Xiang 2005). The aetiology of the condition is unknown but there have been many suggestions as to the cause of it, including autoimmune destruction of the ß pancreatic cells and the possibility of a genetic predisposition to the condition. Hormones that are produced in pregnancy help contribute to the insulin resistant state which characterises diabetes. In recent years, there has been an increase in the cases of Obesity and this is a risk factor for both Diabetes Mellitus and Cardiovascular Disease. The intrauterine environment can affect fetal programming and development. This essay will look into how the placenta and its products can affect the insulin resistant state and how this resistance effects programming as well as the role of oxidative stress and inflammation in making the offspring more susceptible to cardi ovascular disease. Gestational Diabetes Mellitus (GDM) GDM is a state of insulin resistance which disturbs the intrauterine environment and can lead to accelerated fetal growth (Radaelli et al 2003).It effects approximately 7% of pregnant women with approximately 200,000 cases seen each year (Schillan-Koliopoulos and Guadagno 2006). The term GDM is applicable when the onset is during the second and third terms of the pregnancy, but it does not exclude the possibility that the insulin resistance was undiagnosed before the pregnancy. If this is the case and is found to occur in the earlier stages of pregnancy then the mother should be treated the same as mothers who are known to have diabetes before pregnancy (Metzger, Coustan 1998). There is a degree of insulin resistance in normal pregnancy which begins towards the middle of the pregnancy but during the later part of the second and the final trimester these can increase to levels of insulin resistance that are associated with type 2 diabetes (Yogev et al 2008 Chapter 10). Insulin resista nce is when the tissues do not produce a response to insulin due to problems with the secretion of insulin or where the tissues are desensitised to insulin and therefore lack the ability to produce a response (Catalano et al 2003). In a normal pregnancy, the mother changes her metabolism to allow a constant supply of nutrients to reach the fetus to support its rapid growth. Among these nutrients is glucose, which is the main energy source used by the fetus. During the later stages of pregnancy the mother becomes hypoglycaemic and although there is increased gluconeogenesis, the hypoglycaemia still occurs because there is a high rate of transport of glucose to the fetus (Herrera 2000 cited in Herrera and Ortega 2008). GDM can have effects that impact the development of the fetus such as hypoglycaemia and macrosomia, which is an increase in body weight and has the possibility of leading to problems when giving birth, such as shoulder dystocia (Schillan-Koliopoulos and Guadagno 2006). During the second trimester of pregnancy there is peripheral insulin resistance but there is also the possibility that hepatic insulin sensitivity is altered in pregnancy, although few studies confirm this. By the end of the pregnancy the levels of insulin that are circulating are thought to be double those at the start (Redman 2001). Insulin Resistance Insulin resistance in GDM can occur in two forms. The first is where it develops in late pregnancy and it has been postulated that there is a post-receptor mechanism that may influence the insulin signalling pathway which leads to a reduced glucose uptake. The second form is where there is already a degree of resistance before the pregnancy but the changes that occur in normal pregnancy aggravate this (Metznger et al 2007). The insulin resistance that develops in pregnancy is much needed to allow the flow of nutrients, from the mother, directly to the fetus to allow for growth (Radaelli 2003). Increased insulin resistance leads to an increase in insulin secretion by the ß pancreatic cells (Buchanan and Xiang 2005). The insulin resistance is thought to be caused by increased adiposity and as the insulin resistance usually stops after pregnancy this suggests that there is a possibility that the products of the placenta are a potential cause of the resistance. During the course of th e pregnancy the actual changes in glucose levels are very small. It would be assumed that the glucose levels would rise due to the increased insulin resistance but the pancreatic ß cells increase their secretion of insulin to maintain homeostatic glucose levels (Yogev et al 2008 Chapter 10). GDM occurs because there is an increased demand for insulin which under normal circumstances can be met unless there are problems with the secretion of insulin leading to the development of hyperglycaemia. The majority of mothers who develop GDM have been discovered to have a degree of insulin resistance before they became pregnant. Therefore, with the insulin resistance that occurs in normal pregnancy it can be said that GDM occurs with a greater insulin resistance than normally present in gestation (Yogev et al 2008 Chapter 10). Insulin resistance causes a decreased uptake of glucose into skeletal muscle, adipose tissue and liver as well as a decreased production of hepatic glucose. (Catala no et al 2003). One suggestion for insulin resistance looks into the possible role of the mitochondria. Studies using Magnetic Resonance Spectroscopy (MRS) have shown that in normal offspring of parents with type 2 diabetes, there is an increased amount of intramyocellular lipid. This has been shown to cause a reduced function in mitochondria which suggests that mitochondrial dysfunction may play a part in insulin resistance (Petersen et al 2004 cited in Morino et al 2005). It has been suggested that this increase in intramyocellular lipid activates a serine kinase cascade which causes an increase in the Insulin Substrate Receptor 1 (IRS-1), which inhibits insulin receptor phosphorylation on tyrosine sites. This can cause a decrease in the effects and utilisation of glucose. One study showed that in the insulin resistant offspring the mitochondrial density was reduced by just over a third to that of a normal offspring. This suggests that offspring who are insulin resistant may inher it a condition that causes a reduction in rate oxidative phosphorylation in mitochondria (Griffin et al 2009 cited in Morino et al 2005). Detection of GDM Diagnosis of GDM helps to identify pregnancies that are at risk of fetal morbidity as well as obesity and glucose intolerance in the offspring (Buchanan and Xiang 2005). GDM is hard to diagnose as it is asymptomatic. Normal diabetes could be diagnosed by glycosuria but in pregnancy the renal threshold to glucose is lowered so that glycosuria doesnt give a true representation of hyperglycaemia (Redman 2001). There are several risk factors of GDM which can be classified into three groups and help in the screening process. Low risk factors include women who are younger than 25, normal weight at conception, no known family members with diabetes and no history of glucose intolerance. High risk factors include obesity of the mother, diabetes in close relatives, a history of glucose intolerance, current glycosuria and previous pregnancies with GDM (Metzger and Coustan 1998 Chapter 25). Causes of Diabetes There are several theories as to why diabetes occurs and this has been thought to be similar to the underlying mechanisms that cause gestational diabetes. Diabetes is a result of pancreatic beta-cell dysfunction which can present in three main ways: autoimmune, a genetic cause and on top of already present insulin resistance (Buchanan and Xiang 2005). Autoimmune diabetes accounts for approximately 5-10% of all diabetic cases (American Diabetes Association 2010). There are circulating antibodies to the ß cells of the Islet of Langerhans. In GDM, there are a small number of women who have with these antibodies present in their circulation. It is thought that these cases present with GDM due to problems with insulin secretion caused by destruction of the Islets by the autoantibodies (Buchanan and Xiang 2005). This form is similar to type 1 diabetes. The Islet Cell Autoantibodies (ICA) have been shown to have four major molecular targets: Insulin, Glutamic acid decarboxylase (GAD 65), Insulinoma-associated antigen-2 (IA-2) and Zinc Transporter 8 (ZnT8) (Tree 2010). Monogenic diabetes has 2 general forms, one where there are mutations in autosomes and the other where there are mutations in the DNA of mitochondria. The first form is commonly referred to as Maturity Onset Diabetes of the Young (MODY). In both cases onset tends to be at a young age and the patient doesnt present with insulin resistance or obesity (Buchanan and Xiang 2005). Mutations that cause MODY have been found in some women with GDM and commonly occur in genes coding for glucokinase, hepatocyte nuclear factor and insulin promoter factor, MODY is associated with beta cell dysfunction (Weng et al 2002). Chronic insulin resistance with beta-cell dysfunction seems to be the most common cause of GDM. As mentioned before there is an increase in insulin resistance in normal pregnancy but if this develops with background insulin resistance then there is an even greater insulin resistance which can lead to GDM. An established suggestion is that women who are unable to increase their secretion of insulin to cope with the insulin resistance developed in late pregnancy are more susceptible to developing GDM (Buchanan and Xiang 2005). However there could be various environmental processes that are involved in the underlying pathophysiology of GDM. The products of the placenta may also have a role in increasing or decreasing insulin resistance and these will be discussed later. Placental Function The placenta is an organ that has many roles during the development of the fetus. One of these functions is that it acts as a barrier to separate the maternal and fetal surfaces such that the syncytiotrophoblast surface exposes the placenta to the maternal circulation and the endothelium is exposed to the fetal circulation. This position between the two circulations means that the placenta is influenced by molecules from both circulatory systems, including cytokines, hormones and growth factors. The placenta produces molecules which can separately affect the maternal and fetal circulation and it expresses a large number of cytokines including leptin, resistin and tumour necrosis factor. However it has been discovered that these molecules are also produced by adipocytes. All molecules that are going from the mother to the fetus have to cross the placenta. Here they are either modified, for example lipids or like glucose, they are metabolised for placental purposes (Desoye et al 2008). The placenta plays an important role in fetal growth and the regulation of pregnancy (Giachini 2008). The placenta acts to sustain normal homeostatic levels and to carry out the functions of the vital organs. It also provides an immunological defence to the fetus and allows the exchange of molecules vital to its development (Jansson and Taylor 2007). Placental Development Approximately 4-5 days after conception, the process of cleavage causes rapid cell divisions and one of the groups of cells to form are called trophoblast cells. Further developmental processes form the blastocyte which is surrounded by an outer layer of the trophoblast cells. As the pregnancy progresses, the trophoblast cells develop into the placenta while the inner parts of the blastocyte form the embryo and umbilical cord (Huppertz 2008). The blastocyte implants itself onto the epithelium of the uterus where it differentiates into a syncitiotrophoblast which is able to implant itself in the epithelium leading to it being embedded into the decidual part of the uterus (Huppertz 2008). After the attachment of the blastocyte, the trophoblast layer divides very quickly and changes into 2 layers; the inner cytotrophoblastic layer and the outer syncytiotrophoblastic mass (Gude et al 2004).The whole implantation process takes 12 days to complete and after this the fetus is fully embedded into the endometrial layer (Huppertz 2008). The chorionic plate is the surface of the placenta that faces the fetus and this is where the umbilical cord inserts. The basal plate is the surface that faces the mother which contains many types of cells including immune cells such as macrophages and killer cells to carry out the placentas immunological function. The maternal basal plate and the fetal chorionic plate converge to form the smooth chorion which is composed of three layers (Huppertz 2008). When the trophopblast invades the endothelium there is a remodelling of the uterine spinal arteries which is necessary to ensure that the fetus and the placenta receive an adequate blood and nutrient supply and is able to remove any waste materials. This direct supply of blood and nutrients to the placenta can define it as being haemochorial villous organ (Gude et al 2004). After the rapid divisions of the trophoblast and development into 2 layers there are two pathways that can occur, th e villous and extravillious pathways. The extravillious pathway results in the trophoblast being able to invade into the decidua and cause the remodelling of the uterine arteries to increase blood supply to the placento-fetal unit. The villious pathway has a transportation function as well as having endocrine and protective functions (Gude et al 2004). Normal Placentation Placentation involves the structure and function of the placenta. The process of placentation is helped by the composition and arrangement of the extracellular matrix (ECM) of the endometrium. Studies on rats induced with diabetes provided results that showed that diabetes has an effect on the distribution of the ECM molecules. This study by Giachini et al illustrates that Types I and III collagen as well as other molecules, such as proteoglycan molecules decorin and biglycan were distributed throughout normal and diabetic placentas. It was shown that diabetes affects the expression of fibronectin and an increase in deposition of fibronectin may cause changes to the ECM structure which could affect the transfer of molecules from the mother to the fetus. One way in which changes in the ECM can be overcome is to test blood glucose levels frequently during the pregnancy and if kept in normal ranges this can dramatically decrease the prevalence of diseases and disorders present in the fe tus (Giachini et al 2008). As the pregnancy progresses the size of the placenta increases which also means an increase in the amount of products that the placenta produces therefore increasing in the insulin resistance (Schillan-Koliopoulos and Guadagno 2006). This is because the net effect of the products of the placenta is to increase insulin resistance. The increase in size of the placenta means that it needs an increased blood supply. Failure of the mother to increase its blood supply to the placenta can lead to placental insuffiency which if exacerbated can be attributed to be a cause of intrauterine growth restriction (IUGR). This growth restriction is more related to poor maternal nutrition rather than to a cause of GDM. GDM have been associated with an increased fetal and placental weight (Jansson and Taylor 2007). One of the reasons why GDM and increased insulin resistance affects the fetus is that while glucose can cross the placenta, insulin is unable to. This means that the fetal pancreas has to compensate by producing more insulin to prevent high blood glucose levels. The fetal pancreas is capable of doing this and the liver responds to the higher levels of insulin by increasing its production of glucose (Schillan-Koliopoulos and Guadagno 2006). Offspring who have an increase in birth weight have been shown to be at risk of developing cardiovascular disease and diabetes later in life. The main risk factor for this is poor transfer of nutrients via the placenta (Jansson and Taylor 2007). How dramatic these changes are depends on how good the control of blood glucose levels have been during the development of the placenta, if any treatment has been received and if there were any periods of away from normal glucose levels (Desoye 2006). How does diabetes affect Placentation? Diabetic insults at the beginning of the pregnancy can have long last effects of the placenta. One of the roles of the placenta is that it is able to buffer excess maternal glucose which can help to keep the fetal glucose levels within range However if the insult lasts longer than the placenta is able to compensate for then excessive fetal growth may occur (Desoye Mouzon 2007). In diabetes there is endothelial dysfunction which can lead to vascular disease. The endothelial cells help to control the vascular tone of the smooth muscle lining the vasculature. They do this by producing substances that help to vasodilate the smooth muscle including Nitric Oxide, Prostacyclin and Endothelium-Derived Hyperpolarising Factor (EDHF). There have been several studies to suggest different mechanisms of how diabetes affects the endothelium including impaired release of these vasodilating molecules, faults with signal transduction and increased release of constricting mediators of the endothelium. The dysfunction of the endothelium in diabetes is thought to be caused by activation of protein kinase C (PKC) as well as increased oxidative stress, non-enzymatic glycation and an increased activation of the polyol pathway (De Vries et al 2000).The main reason why these effects occur is thought to be due the activation of the protein kinase C pathway and the increased oxidative stress. This can cause early damage to the development of vascular vessels (Roberts and Raspollini 2008). These mechanisms will be discussed later. The effect of hormones produced in pregnancy Pregnancy causes changes in the circulating hormones and cytokines which can all have different effects on insulin resistance and this may help explain the mechanism underlying the resistance that is found in pregnancy and in GDM. Cytokines produced in pregnancy, such as TNF-a, Adiponectin and Leptin have been found to cause an increase in the insulin resistance (Gao et al 2008). In early pregnancy, the levels of oestrogen and progesterone rise but no net effect is seen as the two have antagonistic effects. Oestrogen increases the binding of insulin to its receptor whereas progesterone reduces the ability of insulin to bind (Ryan and Enns 1988). Cortisol levels in pregnancy increase so that by the end of the pregnancy the levels are three times that of what they were at the beginning (Gibson and Tulchinski 1980 cited in Yogev et al Chapter 10). Studies have shown that with increased amounts of cortisol there was a decrease in insulin sensitivity causing insulin resistance (Rizza et a l 1982 cited in Yogev et al 2008 chapter 10). During pregnancy the levels of prolactin increase up to ten times the normal amount (Yogev et al 2008 chapter 10). Studies have shown that in a culture of pancreatic beta cells, prolactin can cause an increase in levels of secreted insulin (Sorenson et al 1993 cited in Yogev et al 2008 Chapter 10). However, high levels of prolactin are not seen to be a pathological cause of GDM (Yogev et al 2008 chapter 10). Human placental lactogen (HPL) is a hormone, and its levels rise during the second trimester of pregnancy. This causes a decrease in the phosphorylation of insulin receptor substrate (IRS1) which can lead to significant insulin resistance (Ryan and Enns 2008 cited Yogev et al 2008 ch 10). Leptin is associated with obesity and concentrations of leptin have been shown to be related to the concentration of insulin in the plasma. In pregnancy the leptin levels increase dramatically. During pregnancy the mother uses her fat stores to supp ort fetal growth and it is thought that the leptin levels increase with the mobilisation of these fat stores. Leptin levels relate to the body mass of the individual (Sattar et al 1998). Placental Leptin is the same in structure and charge to the one produced by adipose tissue (Ashworth et al 2000). One study showed that high leptin concentrations in the umbilical cord increased the likelihood of developing fetal macrosomia (Wiznitzer et al 2000). It is also thought that leptin effects insulin sensitivity by effecting glucose metabolism in both skeletal muscle and in hepatocytes. Rats that received an external source of leptin were found to have an increase in gluconeogenesis which accounted for the majority of hepatic glucose production (Rossetti et al 1997). In GDM there is a greater secretion of TNF-alpha in response to glucose. TNF-alpha functions to regulate metabolism of glucose and lipids as well as being involved in insulin resistance. Many studies suggest that TNF-alpha is involved in the progression to GDM. They found that an increase in glucose cause the placenta and adipose tissue to increase production of TNF-alpha in some cases up to 4 times more than non-diabetic pregnant(Coughlan et al 2001). One study showed that the increases in the levels of TNF-alpha during pregnancy increased consistently with increases in body weight (Catalano et al cited in Yogev et al 2008). Adiponectin is a protein derived from adipose tissue and its function is to regulate insulin resistance and maintains levels of glucose. During pregnancy it has been found that its levels drop and could therefore lead to the increase insulin resistance found in GDM (Gao, Yang, Zao 2008). Adiponectin has also been found to decrease the secretion of TNF-alpha which as stated above can lead to insulin resistance (Hotamisligil 1999 cited in Yogev et al Chapter 10 2008). Adiponectin may cause increased insulin sensitivity as its concentration decreases throughout the gestational period ( Desoye and Mouzon 2007). Resistin is a protein that is produced by adipose tissue and is thought to be involved in insulin resistance in diabetes and is associated with obesity (Steppan and Lazar 2002) In pregnancy, resistin is secreted by the placenta and this secretion reaches its peak by the last trimester (Yura et al cited in Megia et al 2008). Studies show that TNF-alpha is an important factor in insulin resistance during pregnancy and with inputs from leptin and cortisol there is altered glucose metabolism whereas inputs from oestrogen, progesterone and prolactin had little significant effects (Kirwan and Mouzon 2002). There are many hormones produced during pregnancy, mainly by the placenta and adipose tissue that have varying affects but with the overall impact being insulin resistance. Inflammation in Diabetes There are genes in the placenta which regulate reorganisation of the endothelium and inflammatory responses and in GDM these were found to be altered. The increase in leptin receptors suggests that in the placenta this can cause proinflammatory responses (Radaelli 2003). One of the current theories is that the abnormal metabolic environment in GDM can lead to increased production of cytokines and inflammatory mediators. Molecules such as TNF-alpha, Resistin and Leptin increase during pregnancy and these increases in these inflammatory mediators produce metabolic changes by increasing insulin resistance (Desoye and Mouzon 2007). Leptin and TNF-alpha activate phospholipase A2 which are a family of eicosanoid precursors that go on to produce essential fatty acids such as w3 polyunsaturated fatty acids (Desoye Mouzon 2007). There has been a recent investigation which found that with increased adiposity at birth there has been an increase in w3 fatty acids in the placenta (Verastehpour et al 2005 cited Desoye and Mouzon 2007). As stated before, the placenta produces cytokines but it is also a site of action of the cytokines. It is the location of the receptors for these cytokines will influence if the cytokines act on the mother, the placenta or the fetus. With cytokines there is very little transfer across the placenta from mother to fetus and the origin of the cytokines in the fetus can be from either the placenta or from the fetus itself (Desoye and Mouzon 2007). Fetal Programming Many studies have highlighted the fact that events that occur while the fetus is developing can alter its developmental pathway and have adverse outcomes in later life. Fetal programming describes how the environment can affect certain developmental events of which the effects are permanent and can affect processes such as metabolism and the organisms physiology. Women with GDM have an increased risk of the fetus developing macrosomia (Catalano 2008 Chapter 11). The main factor that effects the growth of the fetus is the maternal environment and there is a strong association with the weight and height of the mother and the growth of the fetus such that mothers who are heavier and taller will produce heavy babies. (Love and Kinch 1965 cited in Catalano 2008 Chapter 11). The placenta and fetal programming The placenta is very important to the developmental processes of the fetus as it is able to change the quantity of signals and nutrients that the fetus receives. Deviation from normal would alter the fetal programming, thus making it more susceptible to disease in later life. Pregnancies that are complicated by GDM have excessive oxidative and nitrate stress which has been found to change the activity of certain proteins. Oxidative and nitrate stress alter the placentas function and may cause changes in the fetal programming. Nutrient transfer depends largely on the normal development of the vasculature to allow blood flow and this can be affected by GDM which can cause a decrease in the flow of substrates and is a mechanism in which fetal programming can be affected (Myatt 2006). Fetal programming involves a large amount of development plasticity and interruptions to this development may cause abnormalities in the development of certain cells which may progress to structural differe nces in organ development (Gluckman and Hanson 2004 cited in Jansson and Powell 2008 ref 16). Effects to the fetus exposed to GDM If a fetus is exposed to a diabetic environment during pregnancy then there can be certain long term effects. These effects can be classified into three groups; Anthropometric, Metabolic or Vascular and Neurological or Psychological. Anthropometric changes are concerned with the rates of growth for both height and weight and in a diabetic environment these can be excessive leading to macrosomia and obesity in later life. Metabolic and vascular changes that occur are abnormal glucose tolerance which can eventually lead to diabetes mellitus. Finally the neurological and psychological changes that can occur are usually minor but development of psychological and intellect can sometimes be deficient (Dabelea and Pettitt 2008). Potential problems that may arise with the fetus from an exposure to maternal diabetes include abnormal organ mass, altered angiogenesis and increased levels of fetal insulin (Fetita 2006). It has also been found that if there is an increase in weight during pregnan cy then there is usually a higher birth weight of the fetus (Humphreys 1954 cited in Catalano 2008 Chapter 11). The developing fetus cannot synthesise glucose and is dependent on the mother to produce it where it is transported to the fetus via facilitated diffusion through the placenta (Aerts et al 1996 cited in Mello, Parretti and Hod 2008). The result of decreased insulin sensitivity is that there is more glucose available to the developing fetus which can lead to a greater birth weight (Mello, Parretti and Hod 2008). Using animal models, it has been shown that exposure to high levels of glucose in utero can lead a diminished number of nephrons in the offspring (Amri et al 1999 cited in Fetita 2006 ref 68). This is important as nephrogenesis only occurs in the fetus and stops after birth (Gomez, Norwood 1999). It has been shown that a reduction in the numbers of nephron may affect the rate of progression of renal disease in adults due to an inability to secrete sodium. This may l ater develop into salt-sensitive hypertension (Brenner et al 1988). The mechanisms of reduced organ mass, high levels of fetal insulin and defects in angiogenesis may help explain how the fetus programs abnormal glucose tolerance in adulthood as a result of exposure to GDM (Fetita 2006). Transmission of diabetes from mother to offspring Exposure to gestational diabetes mellitus increases the risk of the fetus developing abnormal glucose tolerance which may develop into type 2 diabetes. (Fetita et al 2006). The association between greater incidences of the offspring having diabetes with a mother with GDM is greater than what would be predicted that could be passed on by maternal genetics (McLean et al 2006). One study showed that the phenotype for GDM/T2D was more common in daughters of mothers who were diabetic rather than daughters of fathers who were diabetic suggesting that the transmission is from mothers with GDM to their daughters. However there were limitations of the McLean study. Patients may not be aware of their fathers diabetes status due to men having lower inclinations to report symptoms and share illnesses with the family. One study showed that the mass of the pancreatic beta cells is relatively fixed by the end of fetal growth and this can be influenced by an intrauterine environment of hyperglycaema (McLean et al 2006). Congenital defects are more common in babies born to diabetic mothers (Farrel et al 2002 cited in Fetita et al 2006). There are many factors that can influence the prevalence of these malformations including the duration, severity and age of onset of GDM (Kousseff 1999). If the onset of GDM is at the beginning of development then development of some organs may be affected. However as said before, the majority of GDM develops during the second trimester. This can then lead to embryopathy which includes defects such as failure of neural tube closure and malformations in the Renal, Cardiac and Gastrointestinal systems which present in childhood (Fetita 2006). In diabetes the hexosamine pathway is activated and inhibits the pentose shunt pathway which decreases the production of antioxidants and therefore leads to an increase in oxidative stress. This oxidative stress has been found to disrupt gene expression and may contribute to congenital defects. One example is that oxidative stress inhibits a gene called pax-3 which is needed for neural tube closure and in diabetes there is an increased risk of neural tube defects (Horal et al 20 Aetiology of Gestational Diabetes Mellitus Aetiology of Gestational Diabetes Mellitus Abstract Gestational Diabetes is a condition present in the later stages of pregnancy where the mother has insulin resistance leading to glucose intolerance. The aetiology of Gestational Diabetes Mellitus is largely unknown but several theories include autoimmune destruction of the beta cells, monogenic mutations and insulin resistance. In pregnancy it is normal for there to be some levels of insulin resistance and it is thought that the products of the placenta contribute to the state of insulin resistance as GDM usually subsides after pregnancy. GDM in pregnancy can lead to an increased risk of cardiovascular disease in the offspring such as hypertension and atherosclerosis. This is due to the increased levels of oxidative stress and inflammatory mediators present during pregnancy. The placenta is very important as it is able to control and buffer the amount of glucose that is delivered to the fetus but if this level is too high then it is out of the placentas control and the fetus may have increased rate of growth due to this extra glucose. The current focus of research in this area seems to be into finding ways to diagnosis GDM earlier in the pregnancy and to try and reduce the amounts of oxidative stress. Gestational diabetes: consequences for fetal programming of vascular disease in adulthood Introduction Gestational Diabetes Mellitus (GDM) occurs when there is a glucose intolerance that is first detected during pregnancy. It is a form of hyperglycaemia (Buchanan and Xiang 2005). The aetiology of the condition is unknown but there have been many suggestions as to the cause of it, including autoimmune destruction of the ß pancreatic cells and the possibility of a genetic predisposition to the condition. Hormones that are produced in pregnancy help contribute to the insulin resistant state which characterises diabetes. In recent years, there has been an increase in the cases of Obesity and this is a risk factor for both Diabetes Mellitus and Cardiovascular Disease. The intrauterine environment can affect fetal programming and development. This essay will look into how the placenta and its products can affect the insulin resistant state and how this resistance effects programming as well as the role of oxidative stress and inflammation in making the offspring more susceptible to cardi ovascular disease. Gestational Diabetes Mellitus (GDM) GDM is a state of insulin resistance which disturbs the intrauterine environment and can lead to accelerated fetal growth (Radaelli et al 2003).It effects approximately 7% of pregnant women with approximately 200,000 cases seen each year (Schillan-Koliopoulos and Guadagno 2006). The term GDM is applicable when the onset is during the second and third terms of the pregnancy, but it does not exclude the possibility that the insulin resistance was undiagnosed before the pregnancy. If this is the case and is found to occur in the earlier stages of pregnancy then the mother should be treated the same as mothers who are known to have diabetes before pregnancy (Metzger, Coustan 1998). There is a degree of insulin resistance in normal pregnancy which begins towards the middle of the pregnancy but during the later part of the second and the final trimester these can increase to levels of insulin resistance that are associated with type 2 diabetes (Yogev et al 2008 Chapter 10). Insulin resista nce is when the tissues do not produce a response to insulin due to problems with the secretion of insulin or where the tissues are desensitised to insulin and therefore lack the ability to produce a response (Catalano et al 2003). In a normal pregnancy, the mother changes her metabolism to allow a constant supply of nutrients to reach the fetus to support its rapid growth. Among these nutrients is glucose, which is the main energy source used by the fetus. During the later stages of pregnancy the mother becomes hypoglycaemic and although there is increased gluconeogenesis, the hypoglycaemia still occurs because there is a high rate of transport of glucose to the fetus (Herrera 2000 cited in Herrera and Ortega 2008). GDM can have effects that impact the development of the fetus such as hypoglycaemia and macrosomia, which is an increase in body weight and has the possibility of leading to problems when giving birth, such as shoulder dystocia (Schillan-Koliopoulos and Guadagno 2006). During the second trimester of pregnancy there is peripheral insulin resistance but there is also the possibility that hepatic insulin sensitivity is altered in pregnancy, although few studies confirm this. By the end of the pregnancy the levels of insulin that are circulating are thought to be double those at the start (Redman 2001). Insulin Resistance Insulin resistance in GDM can occur in two forms. The first is where it develops in late pregnancy and it has been postulated that there is a post-receptor mechanism that may influence the insulin signalling pathway which leads to a reduced glucose uptake. The second form is where there is already a degree of resistance before the pregnancy but the changes that occur in normal pregnancy aggravate this (Metznger et al 2007). The insulin resistance that develops in pregnancy is much needed to allow the flow of nutrients, from the mother, directly to the fetus to allow for growth (Radaelli 2003). Increased insulin resistance leads to an increase in insulin secretion by the ß pancreatic cells (Buchanan and Xiang 2005). The insulin resistance is thought to be caused by increased adiposity and as the insulin resistance usually stops after pregnancy this suggests that there is a possibility that the products of the placenta are a potential cause of the resistance. During the course of th e pregnancy the actual changes in glucose levels are very small. It would be assumed that the glucose levels would rise due to the increased insulin resistance but the pancreatic ß cells increase their secretion of insulin to maintain homeostatic glucose levels (Yogev et al 2008 Chapter 10). GDM occurs because there is an increased demand for insulin which under normal circumstances can be met unless there are problems with the secretion of insulin leading to the development of hyperglycaemia. The majority of mothers who develop GDM have been discovered to have a degree of insulin resistance before they became pregnant. Therefore, with the insulin resistance that occurs in normal pregnancy it can be said that GDM occurs with a greater insulin resistance than normally present in gestation (Yogev et al 2008 Chapter 10). Insulin resistance causes a decreased uptake of glucose into skeletal muscle, adipose tissue and liver as well as a decreased production of hepatic glucose. (Catala no et al 2003). One suggestion for insulin resistance looks into the possible role of the mitochondria. Studies using Magnetic Resonance Spectroscopy (MRS) have shown that in normal offspring of parents with type 2 diabetes, there is an increased amount of intramyocellular lipid. This has been shown to cause a reduced function in mitochondria which suggests that mitochondrial dysfunction may play a part in insulin resistance (Petersen et al 2004 cited in Morino et al 2005). It has been suggested that this increase in intramyocellular lipid activates a serine kinase cascade which causes an increase in the Insulin Substrate Receptor 1 (IRS-1), which inhibits insulin receptor phosphorylation on tyrosine sites. This can cause a decrease in the effects and utilisation of glucose. One study showed that in the insulin resistant offspring the mitochondrial density was reduced by just over a third to that of a normal offspring. This suggests that offspring who are insulin resistant may inher it a condition that causes a reduction in rate oxidative phosphorylation in mitochondria (Griffin et al 2009 cited in Morino et al 2005). Detection of GDM Diagnosis of GDM helps to identify pregnancies that are at risk of fetal morbidity as well as obesity and glucose intolerance in the offspring (Buchanan and Xiang 2005). GDM is hard to diagnose as it is asymptomatic. Normal diabetes could be diagnosed by glycosuria but in pregnancy the renal threshold to glucose is lowered so that glycosuria doesnt give a true representation of hyperglycaemia (Redman 2001). There are several risk factors of GDM which can be classified into three groups and help in the screening process. Low risk factors include women who are younger than 25, normal weight at conception, no known family members with diabetes and no history of glucose intolerance. High risk factors include obesity of the mother, diabetes in close relatives, a history of glucose intolerance, current glycosuria and previous pregnancies with GDM (Metzger and Coustan 1998 Chapter 25). Causes of Diabetes There are several theories as to why diabetes occurs and this has been thought to be similar to the underlying mechanisms that cause gestational diabetes. Diabetes is a result of pancreatic beta-cell dysfunction which can present in three main ways: autoimmune, a genetic cause and on top of already present insulin resistance (Buchanan and Xiang 2005). Autoimmune diabetes accounts for approximately 5-10% of all diabetic cases (American Diabetes Association 2010). There are circulating antibodies to the ß cells of the Islet of Langerhans. In GDM, there are a small number of women who have with these antibodies present in their circulation. It is thought that these cases present with GDM due to problems with insulin secretion caused by destruction of the Islets by the autoantibodies (Buchanan and Xiang 2005). This form is similar to type 1 diabetes. The Islet Cell Autoantibodies (ICA) have been shown to have four major molecular targets: Insulin, Glutamic acid decarboxylase (GAD 65), Insulinoma-associated antigen-2 (IA-2) and Zinc Transporter 8 (ZnT8) (Tree 2010). Monogenic diabetes has 2 general forms, one where there are mutations in autosomes and the other where there are mutations in the DNA of mitochondria. The first form is commonly referred to as Maturity Onset Diabetes of the Young (MODY). In both cases onset tends to be at a young age and the patient doesnt present with insulin resistance or obesity (Buchanan and Xiang 2005). Mutations that cause MODY have been found in some women with GDM and commonly occur in genes coding for glucokinase, hepatocyte nuclear factor and insulin promoter factor, MODY is associated with beta cell dysfunction (Weng et al 2002). Chronic insulin resistance with beta-cell dysfunction seems to be the most common cause of GDM. As mentioned before there is an increase in insulin resistance in normal pregnancy but if this develops with background insulin resistance then there is an even greater insulin resistance which can lead to GDM. An established suggestion is that women who are unable to increase their secretion of insulin to cope with the insulin resistance developed in late pregnancy are more susceptible to developing GDM (Buchanan and Xiang 2005). However there could be various environmental processes that are involved in the underlying pathophysiology of GDM. The products of the placenta may also have a role in increasing or decreasing insulin resistance and these will be discussed later. Placental Function The placenta is an organ that has many roles during the development of the fetus. One of these functions is that it acts as a barrier to separate the maternal and fetal surfaces such that the syncytiotrophoblast surface exposes the placenta to the maternal circulation and the endothelium is exposed to the fetal circulation. This position between the two circulations means that the placenta is influenced by molecules from both circulatory systems, including cytokines, hormones and growth factors. The placenta produces molecules which can separately affect the maternal and fetal circulation and it expresses a large number of cytokines including leptin, resistin and tumour necrosis factor. However it has been discovered that these molecules are also produced by adipocytes. All molecules that are going from the mother to the fetus have to cross the placenta. Here they are either modified, for example lipids or like glucose, they are metabolised for placental purposes (Desoye et al 2008). The placenta plays an important role in fetal growth and the regulation of pregnancy (Giachini 2008). The placenta acts to sustain normal homeostatic levels and to carry out the functions of the vital organs. It also provides an immunological defence to the fetus and allows the exchange of molecules vital to its development (Jansson and Taylor 2007). Placental Development Approximately 4-5 days after conception, the process of cleavage causes rapid cell divisions and one of the groups of cells to form are called trophoblast cells. Further developmental processes form the blastocyte which is surrounded by an outer layer of the trophoblast cells. As the pregnancy progresses, the trophoblast cells develop into the placenta while the inner parts of the blastocyte form the embryo and umbilical cord (Huppertz 2008). The blastocyte implants itself onto the epithelium of the uterus where it differentiates into a syncitiotrophoblast which is able to implant itself in the epithelium leading to it being embedded into the decidual part of the uterus (Huppertz 2008). After the attachment of the blastocyte, the trophoblast layer divides very quickly and changes into 2 layers; the inner cytotrophoblastic layer and the outer syncytiotrophoblastic mass (Gude et al 2004).The whole implantation process takes 12 days to complete and after this the fetus is fully embedded into the endometrial layer (Huppertz 2008). The chorionic plate is the surface of the placenta that faces the fetus and this is where the umbilical cord inserts. The basal plate is the surface that faces the mother which contains many types of cells including immune cells such as macrophages and killer cells to carry out the placentas immunological function. The maternal basal plate and the fetal chorionic plate converge to form the smooth chorion which is composed of three layers (Huppertz 2008). When the trophopblast invades the endothelium there is a remodelling of the uterine spinal arteries which is necessary to ensure that the fetus and the placenta receive an adequate blood and nutrient supply and is able to remove any waste materials. This direct supply of blood and nutrients to the placenta can define it as being haemochorial villous organ (Gude et al 2004). After the rapid divisions of the trophoblast and development into 2 layers there are two pathways that can occur, th e villous and extravillious pathways. The extravillious pathway results in the trophoblast being able to invade into the decidua and cause the remodelling of the uterine arteries to increase blood supply to the placento-fetal unit. The villious pathway has a transportation function as well as having endocrine and protective functions (Gude et al 2004). Normal Placentation Placentation involves the structure and function of the placenta. The process of placentation is helped by the composition and arrangement of the extracellular matrix (ECM) of the endometrium. Studies on rats induced with diabetes provided results that showed that diabetes has an effect on the distribution of the ECM molecules. This study by Giachini et al illustrates that Types I and III collagen as well as other molecules, such as proteoglycan molecules decorin and biglycan were distributed throughout normal and diabetic placentas. It was shown that diabetes affects the expression of fibronectin and an increase in deposition of fibronectin may cause changes to the ECM structure which could affect the transfer of molecules from the mother to the fetus. One way in which changes in the ECM can be overcome is to test blood glucose levels frequently during the pregnancy and if kept in normal ranges this can dramatically decrease the prevalence of diseases and disorders present in the fe tus (Giachini et al 2008). As the pregnancy progresses the size of the placenta increases which also means an increase in the amount of products that the placenta produces therefore increasing in the insulin resistance (Schillan-Koliopoulos and Guadagno 2006). This is because the net effect of the products of the placenta is to increase insulin resistance. The increase in size of the placenta means that it needs an increased blood supply. Failure of the mother to increase its blood supply to the placenta can lead to placental insuffiency which if exacerbated can be attributed to be a cause of intrauterine growth restriction (IUGR). This growth restriction is more related to poor maternal nutrition rather than to a cause of GDM. GDM have been associated with an increased fetal and placental weight (Jansson and Taylor 2007). One of the reasons why GDM and increased insulin resistance affects the fetus is that while glucose can cross the placenta, insulin is unable to. This means that the fetal pancreas has to compensate by producing more insulin to prevent high blood glucose levels. The fetal pancreas is capable of doing this and the liver responds to the higher levels of insulin by increasing its production of glucose (Schillan-Koliopoulos and Guadagno 2006). Offspring who have an increase in birth weight have been shown to be at risk of developing cardiovascular disease and diabetes later in life. The main risk factor for this is poor transfer of nutrients via the placenta (Jansson and Taylor 2007). How dramatic these changes are depends on how good the control of blood glucose levels have been during the development of the placenta, if any treatment has been received and if there were any periods of away from normal glucose levels (Desoye 2006). How does diabetes affect Placentation? Diabetic insults at the beginning of the pregnancy can have long last effects of the placenta. One of the roles of the placenta is that it is able to buffer excess maternal glucose which can help to keep the fetal glucose levels within range However if the insult lasts longer than the placenta is able to compensate for then excessive fetal growth may occur (Desoye Mouzon 2007). In diabetes there is endothelial dysfunction which can lead to vascular disease. The endothelial cells help to control the vascular tone of the smooth muscle lining the vasculature. They do this by producing substances that help to vasodilate the smooth muscle including Nitric Oxide, Prostacyclin and Endothelium-Derived Hyperpolarising Factor (EDHF). There have been several studies to suggest different mechanisms of how diabetes affects the endothelium including impaired release of these vasodilating molecules, faults with signal transduction and increased release of constricting mediators of the endothelium. The dysfunction of the endothelium in diabetes is thought to be caused by activation of protein kinase C (PKC) as well as increased oxidative stress, non-enzymatic glycation and an increased activation of the polyol pathway (De Vries et al 2000).The main reason why these effects occur is thought to be due the activation of the protein kinase C pathway and the increased oxidative stress. This can cause early damage to the development of vascular vessels (Roberts and Raspollini 2008). These mechanisms will be discussed later. The effect of hormones produced in pregnancy Pregnancy causes changes in the circulating hormones and cytokines which can all have different effects on insulin resistance and this may help explain the mechanism underlying the resistance that is found in pregnancy and in GDM. Cytokines produced in pregnancy, such as TNF-a, Adiponectin and Leptin have been found to cause an increase in the insulin resistance (Gao et al 2008). In early pregnancy, the levels of oestrogen and progesterone rise but no net effect is seen as the two have antagonistic effects. Oestrogen increases the binding of insulin to its receptor whereas progesterone reduces the ability of insulin to bind (Ryan and Enns 1988). Cortisol levels in pregnancy increase so that by the end of the pregnancy the levels are three times that of what they were at the beginning (Gibson and Tulchinski 1980 cited in Yogev et al Chapter 10). Studies have shown that with increased amounts of cortisol there was a decrease in insulin sensitivity causing insulin resistance (Rizza et a l 1982 cited in Yogev et al 2008 chapter 10). During pregnancy the levels of prolactin increase up to ten times the normal amount (Yogev et al 2008 chapter 10). Studies have shown that in a culture of pancreatic beta cells, prolactin can cause an increase in levels of secreted insulin (Sorenson et al 1993 cited in Yogev et al 2008 Chapter 10). However, high levels of prolactin are not seen to be a pathological cause of GDM (Yogev et al 2008 chapter 10). Human placental lactogen (HPL) is a hormone, and its levels rise during the second trimester of pregnancy. This causes a decrease in the phosphorylation of insulin receptor substrate (IRS1) which can lead to significant insulin resistance (Ryan and Enns 2008 cited Yogev et al 2008 ch 10). Leptin is associated with obesity and concentrations of leptin have been shown to be related to the concentration of insulin in the plasma. In pregnancy the leptin levels increase dramatically. During pregnancy the mother uses her fat stores to supp ort fetal growth and it is thought that the leptin levels increase with the mobilisation of these fat stores. Leptin levels relate to the body mass of the individual (Sattar et al 1998). Placental Leptin is the same in structure and charge to the one produced by adipose tissue (Ashworth et al 2000). One study showed that high leptin concentrations in the umbilical cord increased the likelihood of developing fetal macrosomia (Wiznitzer et al 2000). It is also thought that leptin effects insulin sensitivity by effecting glucose metabolism in both skeletal muscle and in hepatocytes. Rats that received an external source of leptin were found to have an increase in gluconeogenesis which accounted for the majority of hepatic glucose production (Rossetti et al 1997). In GDM there is a greater secretion of TNF-alpha in response to glucose. TNF-alpha functions to regulate metabolism of glucose and lipids as well as being involved in insulin resistance. Many studies suggest that TNF-alpha is involved in the progression to GDM. They found that an increase in glucose cause the placenta and adipose tissue to increase production of TNF-alpha in some cases up to 4 times more than non-diabetic pregnant(Coughlan et al 2001). One study showed that the increases in the levels of TNF-alpha during pregnancy increased consistently with increases in body weight (Catalano et al cited in Yogev et al 2008). Adiponectin is a protein derived from adipose tissue and its function is to regulate insulin resistance and maintains levels of glucose. During pregnancy it has been found that its levels drop and could therefore lead to the increase insulin resistance found in GDM (Gao, Yang, Zao 2008). Adiponectin has also been found to decrease the secretion of TNF-alpha which as stated above can lead to insulin resistance (Hotamisligil 1999 cited in Yogev et al Chapter 10 2008). Adiponectin may cause increased insulin sensitivity as its concentration decreases throughout the gestational period ( Desoye and Mouzon 2007). Resistin is a protein that is produced by adipose tissue and is thought to be involved in insulin resistance in diabetes and is associated with obesity (Steppan and Lazar 2002) In pregnancy, resistin is secreted by the placenta and this secretion reaches its peak by the last trimester (Yura et al cited in Megia et al 2008). Studies show that TNF-alpha is an important factor in insulin resistance during pregnancy and with inputs from leptin and cortisol there is altered glucose metabolism whereas inputs from oestrogen, progesterone and prolactin had little significant effects (Kirwan and Mouzon 2002). There are many hormones produced during pregnancy, mainly by the placenta and adipose tissue that have varying affects but with the overall impact being insulin resistance. Inflammation in Diabetes There are genes in the placenta which regulate reorganisation of the endothelium and inflammatory responses and in GDM these were found to be altered. The increase in leptin receptors suggests that in the placenta this can cause proinflammatory responses (Radaelli 2003). One of the current theories is that the abnormal metabolic environment in GDM can lead to increased production of cytokines and inflammatory mediators. Molecules such as TNF-alpha, Resistin and Leptin increase during pregnancy and these increases in these inflammatory mediators produce metabolic changes by increasing insulin resistance (Desoye and Mouzon 2007). Leptin and TNF-alpha activate phospholipase A2 which are a family of eicosanoid precursors that go on to produce essential fatty acids such as w3 polyunsaturated fatty acids (Desoye Mouzon 2007). There has been a recent investigation which found that with increased adiposity at birth there has been an increase in w3 fatty acids in the placenta (Verastehpour et al 2005 cited Desoye and Mouzon 2007). As stated before, the placenta produces cytokines but it is also a site of action of the cytokines. It is the location of the receptors for these cytokines will influence if the cytokines act on the mother, the placenta or the fetus. With cytokines there is very little transfer across the placenta from mother to fetus and the origin of the cytokines in the fetus can be from either the placenta or from the fetus itself (Desoye and Mouzon 2007). Fetal Programming Many studies have highlighted the fact that events that occur while the fetus is developing can alter its developmental pathway and have adverse outcomes in later life. Fetal programming describes how the environment can affect certain developmental events of which the effects are permanent and can affect processes such as metabolism and the organisms physiology. Women with GDM have an increased risk of the fetus developing macrosomia (Catalano 2008 Chapter 11). The main factor that effects the growth of the fetus is the maternal environment and there is a strong association with the weight and height of the mother and the growth of the fetus such that mothers who are heavier and taller will produce heavy babies. (Love and Kinch 1965 cited in Catalano 2008 Chapter 11). The placenta and fetal programming The placenta is very important to the developmental processes of the fetus as it is able to change the quantity of signals and nutrients that the fetus receives. Deviation from normal would alter the fetal programming, thus making it more susceptible to disease in later life. Pregnancies that are complicated by GDM have excessive oxidative and nitrate stress which has been found to change the activity of certain proteins. Oxidative and nitrate stress alter the placentas function and may cause changes in the fetal programming. Nutrient transfer depends largely on the normal development of the vasculature to allow blood flow and this can be affected by GDM which can cause a decrease in the flow of substrates and is a mechanism in which fetal programming can be affected (Myatt 2006). Fetal programming involves a large amount of development plasticity and interruptions to this development may cause abnormalities in the development of certain cells which may progress to structural differe nces in organ development (Gluckman and Hanson 2004 cited in Jansson and Powell 2008 ref 16). Effects to the fetus exposed to GDM If a fetus is exposed to a diabetic environment during pregnancy then there can be certain long term effects. These effects can be classified into three groups; Anthropometric, Metabolic or Vascular and Neurological or Psychological. Anthropometric changes are concerned with the rates of growth for both height and weight and in a diabetic environment these can be excessive leading to macrosomia and obesity in later life. Metabolic and vascular changes that occur are abnormal glucose tolerance which can eventually lead to diabetes mellitus. Finally the neurological and psychological changes that can occur are usually minor but development of psychological and intellect can sometimes be deficient (Dabelea and Pettitt 2008). Potential problems that may arise with the fetus from an exposure to maternal diabetes include abnormal organ mass, altered angiogenesis and increased levels of fetal insulin (Fetita 2006). It has also been found that if there is an increase in weight during pregnan cy then there is usually a higher birth weight of the fetus (Humphreys 1954 cited in Catalano 2008 Chapter 11). The developing fetus cannot synthesise glucose and is dependent on the mother to produce it where it is transported to the fetus via facilitated diffusion through the placenta (Aerts et al 1996 cited in Mello, Parretti and Hod 2008). The result of decreased insulin sensitivity is that there is more glucose available to the developing fetus which can lead to a greater birth weight (Mello, Parretti and Hod 2008). Using animal models, it has been shown that exposure to high levels of glucose in utero can lead a diminished number of nephrons in the offspring (Amri et al 1999 cited in Fetita 2006 ref 68). This is important as nephrogenesis only occurs in the fetus and stops after birth (Gomez, Norwood 1999). It has been shown that a reduction in the numbers of nephron may affect the rate of progression of renal disease in adults due to an inability to secrete sodium. This may l ater develop into salt-sensitive hypertension (Brenner et al 1988). The mechanisms of reduced organ mass, high levels of fetal insulin and defects in angiogenesis may help explain how the fetus programs abnormal glucose tolerance in adulthood as a result of exposure to GDM (Fetita 2006). Transmission of diabetes from mother to offspring Exposure to gestational diabetes mellitus increases the risk of the fetus developing abnormal glucose tolerance which may develop into type 2 diabetes. (Fetita et al 2006). The association between greater incidences of the offspring having diabetes with a mother with GDM is greater than what would be predicted that could be passed on by maternal genetics (McLean et al 2006). One study showed that the phenotype for GDM/T2D was more common in daughters of mothers who were diabetic rather than daughters of fathers who were diabetic suggesting that the transmission is from mothers with GDM to their daughters. However there were limitations of the McLean study. Patients may not be aware of their fathers diabetes status due to men having lower inclinations to report symptoms and share illnesses with the family. One study showed that the mass of the pancreatic beta cells is relatively fixed by the end of fetal growth and this can be influenced by an intrauterine environment of hyperglycaema (McLean et al 2006). Congenital defects are more common in babies born to diabetic mothers (Farrel et al 2002 cited in Fetita et al 2006). There are many factors that can influence the prevalence of these malformations including the duration, severity and age of onset of GDM (Kousseff 1999). If the onset of GDM is at the beginning of development then development of some organs may be affected. However as said before, the majority of GDM develops during the second trimester. This can then lead to embryopathy which includes defects such as failure of neural tube closure and malformations in the Renal, Cardiac and Gastrointestinal systems which present in childhood (Fetita 2006). In diabetes the hexosamine pathway is activated and inhibits the pentose shunt pathway which decreases the production of antioxidants and therefore leads to an increase in oxidative stress. This oxidative stress has been found to disrupt gene expression and may contribute to congenital defects. One example is that oxidative stress inhibits a gene called pax-3 which is needed for neural tube closure and in diabetes there is an increased risk of neural tube defects (Horal et al 20