Sunday, February 23, 2020
And Research Proposal - That extra intervention of a dietician and occupational therapist will maintain a he - Literature review Example To date there is no known cure for the disease even though there are various methods which slow down its advance and thus assists the patients in relieving some of the signs. It is a terminal disease which incurable and leads to death (Innes, Kelly and McCabe, 2012, p. 104). Extra intervention of a dietician and an occupational therapist will ultimately maintain a healthy body mass index and improve quality of life, depression and dyskinesia in the patient with AlzheimerÃ¢â¬â¢s disease. This literature review and research paper will take a deep comprehensive study on the vital important role that the dieticians and the occupational therapist play in the slowing down on the effects and symptoms of patients with AlzheimerÃ¢â¬â¢s disease (Small and Vorgan, 2011, p. 124). This paper summarizes the specific approaches to the maintenance of a healthy body mass index in the patient whereas taking into consideration the other aspects of good health which include improvement of the qualit y of life, significant reduction of depression and dyskinesia (McDonald, 2010, p. 32). This paper will take into account the world-class recommendations that a dietician will highly recommend regarding certain foods which the AlzheimerÃ¢â¬â¢s patient will eat so that the symptoms of the disease are significantly reduced (Pulsford and Thompson, 2012, p. 129). Notable recommendations will also be highlighted regarding the advice that an occupational therapist would outmost recommend to the patient. A detailed overview on what the patient should do to reduce these symptoms are noted whereas providing very valuable advice on how the patients health will improve taking in to consideration the patientÃ¢â¬â¢s body mass index, superior life quality and an overall reduction in depression and dyskinesia (Downs and Bowers, 2008, p. 58). Literature Review AlzheimerÃ¢â¬â¢s disease has in the recent past turned out to be a widespread dementia complication among old people in the society. As defined, AlzheimerÃ¢â¬â¢s disease is the general loss of cognitive functioning which includes reduced reasoning, remembering, and thinking ability. AlzheimerÃ¢â¬â¢s disease is also presumed to be an irreversible and a progressive brain disorder which minimises thinking and memory skills. Moreover, recent researches have also confirmed that, long term existence of AlzheimerÃ¢â¬â¢s disease may as well reduce individualsÃ¢â¬â¢ ability to carry out some of the simplest jobs (Basak, Boot, Kraemer and Voss 2008, p. 777). Based on the available statistics, AlzheimerÃ¢â¬â¢s disease is in most cases apparent among people who are above 60 years of age. Compared to traditional society, contemporary societies have witnessed significant increased in cases of AlzheimerÃ¢â¬â¢s disease (Vance, McNees and Meneses, 2009, p. 51). In the extreme cases, AlzheimerÃ¢â¬â¢s disease is as well affecting young people. The side effects and magnitude of AlzheimerÃ¢â¬â¢s disease is with time tur ning out to be very severe and in some cases AlzheimerÃ¢â¬â¢s disease has reported to cause deaths. The contemporary nature and side effects of AlzheimerÃ¢â¬â¢s disease have forced health researchers and thinkers to undertake intensive researches to identify the main cause of the disease as well as the most cost effective and efficiency means of dealing with the problem (Ziere, Dieleman, Hofman, Pols, Cammen and Stricker, 2007, p. 223). The subsequent literature review is intended at examining how the extra intervention of a dietician and occupational ther
Thursday, February 6, 2020
Multinational Company and Its Organizational Goals - Case Study Example Organization structure should be chosen based on its strategy (Bartol and Martin, 1998, p. 251 - 278). For example, suppose an organization is making or delivering large volumes of only a few products or services in the same geographical area, and these are very similar to each other. All the organization needs to do is coordinate the various departments, then departmentalized or functional structure works best. Departmentalization allows people to specialize in a function, and achieve economies of scale. Suppose the organization is producing or delivering several products or services in the same geographical area, and these products are very dissimilar from each other. Then, it is better to organize along product lines. This is because one product does not have anything to do with the other, there are no economies in the functional structure for this case. On the other hand, giving each product its independent departments lets the product managers serve their customers more efficien tly. Suppose the organization is producing or delivering several products or services to several different customers whose demands are very different. Then it is better to organize along customer lines so that the managers can work towards satisfying each customer according to his or her needs. The same logic goes for organizing on the basis of country or region. If the organization is making products in several places with different tastes and demands, the organization should organize along geographical lines.
Wednesday, January 29, 2020
Understanding Spesific Needs in Health and Social Care Essay The aim of this essay is to analyse the concepts of health, disability, illness and behaviour and also investigate how health and social care services and systems support individuals with specific needs and look at different approaches and intervention strategies available to support individuals with specific needs, lastly will explain what challenging behaviour is and explain strategies available for those working with people with specific needs LO1. 1 Health is defined as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity (WHO, 1974). During the Ottawa Charter for Health Promotion in 1986, the World Health Organisation said that health is Ã¢â¬Å"a source for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacitiesÃ¢â¬ . Health is traditionally equated to the absence of disease. A lack of fundamental pathology was thought to define ones health as good, whereas biological driven pathogens and conditions would render an individual with poor health and labelled diseased. However, Aggleton amp; Homans (1897), Ewles amp; Simnett (1999) argue that health is holistic and includes different dimensions and all needs to be considered. Bilingham (2010) explains health in two models which are the biomedical model and the socio-medical model. She said biomedical model is an approach to health and illness that identifies healthy as the Ã¢â¬Ëabsence of diseaseÃ¢â¬â¢ and focuses on diagnosing and curing individuals with specific illnesses , the socio medial model is an approach to health and illness that focuses on the social and environmental factors that influence our health, including the impact of poverty and poor housing. The Disability Discrimination Act 1995 defines a disabled person as anyone with a physical or mental impairment which has a substantial and long term adverse effect upon his or her ability to carry out normal day to day activities. Disability can affect someoneÃ¢â¬â¢s mobility, learning or understanding, and lack of understanding when it comes to danger. Disability covers a lot of impairments which include physical impairments, sensory impairments and communication difficulties. There are three models of disability which are the personal tragedy model, the medical model and the social model. In the past people with disabilities were discriminated by the families and the society. The language and terminology used were words such as imbeciles, handicapped and mental retarded. People with disabilities were called dangerous and scary and they were seen as not equal citizens, in need of special care. They were not seen as normal people. Behaviour is anything that a person does or does not do which has a negative effect on their lives or the lives of others. The negative effects can be emotional, physical and social. Also, oneÃ¢â¬â¢s behaviour pleases and otherÃ¢â¬â¢s infuriates. Some behaviour are socially acceptable here in the western world but not socially acceptable in African communities, for example kissing in public is not totally acceptable where I come from nevertheless, here in London (Europe) people can kiss in the public without any problem, people accept such behaviours in Europe . Illness is the partial experience of loss of health (Naidoo and Wills, 2000 p7). Illness is having poor health and is considered a synonym for disease; some have described it as a perception by a patient to define a disease. Illness indicates a condition causing harm and pain. Social constructionists argue that the following concepts illness, health, disease and behaviour are all relative concepts not universal but particular. Social concepts are learned and shared. Concepts often tell us more about the societies out of which they came than about the thing they are actually describing. LO1. 2 PeopleÃ¢â¬â¢s perceptions on specific needs vary from cultures and societies. PeopleÃ¢â¬â¢s perceptions Are also culturally and historically specific. Epilepsy in the Middle Ages was viewed as a violent possession by malevolent or even divine forces. Early part of the 20th century epilepsy was linked with insanity; people believed that the Holy Spirit was working them. In Third World cultures epilepsy continue to be defined in super natural terms. Recently a community study in Nigeria found that after heredity, witch craft was the cause of epilepsy amongst the lay populace (Awaritefe et al, 1985). Danesi (1984) has revealed that most Nigerians with epilepsy experience it as highly stigmatizing and something to be hidden from others but through medical discoveries and medical advances we know that epilepsy is caused by abnormal neurological activity that occurs as a result of damage or result to the brain. Epilepsy is now controlled by carbamazepine tablets and sodium valproate which controls the seizures however, what we all know is subject to reinterpretation. At any time new technological advances, new medical discoveries, new ways of looking at the structure and functioning of the body or brain could replace the current orthodoxy and epilepsy could come to be seen in a completely different light. Department of Health (1999) launched a strategy to ensure that doctors and nurses have the skills they need to use to make the best use of new technology introduced into the NHS. The right to freedom from discriminations for people with a range of disabilities, including those with a learning disability, has been enshrined in the 1995 Disability Discrimination Act which says employers should make reasonable adjustments to allow an individual with disability to gain employment and ramps to be provided so that wheel chair users can access t facilities in the facilities in the community. Also there is the Valuing People 2001 which state that support should be given to people with learning disabilities and their families and that people with disabilities should have control over their lives as much as possible (Department of Health, 2009). I have also done a small scale research and investigated the perceptions of people with specific needs which I carried at Shining Star Residential Care Home . LO1. 3 Social policy is the only one way of encouraging and promoting ethical practice. The functions of a regulatory body go much further than disseminating policies and code of ethics. Legislation acts have helped to set and enforce educational standards, which meet the needs of people, e. g. the Disability Discrimination Act 1995, which protect individuals with disabilities from discrimination (Rogers and Pilgrim, 1991). Legislation plays an important role in ways that services are made available for individuals with specific needs. Legislation modifies attitudes and practices. From the mid 1980Ã¢â¬â¢s some western countries e. g. Australia have enacted legislation which embraces a right based discourse rather than a custodial discourse and which seeks to address issue s of social justice and discrimination. The legislation also embraces the conceptual shift form disability being seen as individualised medical problem to rather being about community membership and participation and access to regular societal activities such as employment, education and recreation. Where access is inappropriate, inadequate, difficult or ignored, advocacy processes have been initiated to address situations and promote the people rights. Under the Disability Discrimination Act 1995 an individual has the right to get the information about health services in a format that is accessible to them where it is reasonable for the service provider to provide in the format, a hospital will have to provide forms and any literature in braille or large print to assist any blind person or anyone who have a visual impairment. Most of The Disability Discrimination Act 1995 has been replaced by the Equality act, this was changed on the 1st of October 2010 and is aimed to protect disabled people and prevent disability discrimination. Disabled people are protected in areas of employment, education, access to goods, service and facilities including larger private clubs and land based transport services buying and renting land. The Data Protection Act 1998 is the key legislation that governs the protection of data , when records for service users are kept for the purpose of sharing information to provide a well informed care service the details are kept in the individual service user file , they will have access to it but the information will not be shared with others The Valuing People 2001 was designed to improve support for people with learning disabilities and their families; to make sure people with disabilities are in control of their lives and that they have the job they want. The Mental Capacity Act aims to protect people with learning disabilities and metal health conditions. It provides clear guidelines for carers and professional about who can take decisions in which situations. The Health and Social Care Act 2008 established the Care Quality Commission as the regulator of all health and adult social care services. It is a single Act of Parliament that contains the commissionÃ¢â¬â¢s powers and duties, and represents the modernisation and integration of health and social care. It contains some new powers of enforcement that were not held by any of the predecessor organisations. LO2. 1 A Care plan is a document that articulates a plan of care for and individual with specific need or disability. It helps individuals achieve valued fulfilling lifestyles, because it is build around the needs of the person rather than expecting them to fit into existing provision (Ritchel et al, 2003). The care plan is for Mr RN , who has autism and has learning disabilities. He is Jewish and is non verbal and he understands little English and uses makaton, sign language and pictures as a mode of communication. To analyse his care needs I will use the MaslowÃ¢â¬â¢s hierarchy of needs. See figure 1 for Maslow hierarchy of needs Figure 1 : Maslow hierarchy of needs Mr. RN had stroke and is unable to walk properly. He uses a walking stick to move around in the house and a wheel chair when out in the community. He does not hear properly and uses hearings aids. At the care home staff always checks if it is working properly, by changing the butteries and cleaning it for him. He also uses glasses to improve his vision. Mr RNÃ¢â¬â¢s care plan is person-centred to meet all his care needs at the same time he makes his own choices. His holistic needs are met according to his choice through assessment. He is from a Jewish background and sticks to his religious beliefs and culture seriously. RN is always supported to the synagogue every Friday to attend to his spiritual wellbeing. I respect his beliefs to avoid abuse, discrimination, oppression or prejudice. He is also provided with kosher meals. The organisation I work for has a Jewish calendar that recognises all the facts and festivals to highlight his religious rights. I relate this to Abraham MaslowÃ¢â¬â¢s (1908-1980) hierarchy of needs, Ã¢â¬Ëa theory of human MotivationÃ¢â¬â¢. It has five levels to it with the most basic needs at the bottom of the pyramid. I prepare meals for RN according to his cultural and religious needs. I ask him what he would like to eat from the variety of his kosher meal. I make sure RNÃ¢â¬â¢s safety and security or protection from harm and abuse according to Health and Safety Act 1974. I have to ensure that the environment around the care home is safe and welcoming for family members visiting. Socially, I support RN to visit family and friends. This gives him sense of belonging, love, friendship and trust. During the key working I encourage RN by reassuring him everything is fine. This builds his confidence thus leading to self actualisation growth. When these needs are successfully met chances are the service users feels more valued and respected, it also promotes independence. LO2. 2 At my workplace we have a set of policies and procedures that we use when we work with clients with specific needs. Looking at Mr RNÃ¢â¬â¢s care plan I follow the Data Protection Act 1998 in maintaining his confidentiality and that only necessary people access his care plan. He has little awareness when it comes to safety and I follow the Health and Safety at Work 1974 to meet his safety needs, Mr RN cannot walk for long distance, he uses a wheelchair when out in the community and the wheel chair is checked every day before use to see if itÃ¢â¬â¢s not damaged. We have the dial a ride that comes to pick him up and take him to the day centre and he has the blue badge scheme that allows him to have free parking he goes to shopping malls. We use the visual communication systems such as Picture Exchange Communication to help him plan for activities; he is able to choose what he wants to eat with no problems. By doing this we are promoting independence as he is able to do things on his own. LO2. 3 The organisation I work for is located in the Redbridge Borough. The borough offers the Community Toilet Scheme which provides clean, safe and accessible public toilets in more convenient locations for residents. Disabled people can use the toilet free of charge during normal working hours. There is a Redbridge Institute of Adult Education that provides a range of courses for people with specific needs and offers pottery lesson, arts and crafts, music and dance lesson for people with learning disabilities . he college provides a range of specialised equipment or learning resources to meet specific needs for people with disability, this includes hearing loops and large print keyboards. Day care services provideÃ supportÃ forÃ people living in the community, social inclusion and respite careÃ for carers. It offersÃ practical and emotional support by providingÃ a range of activities and facilities toÃ helpÃ stay as independent as possible and improve and maintainÃ quality of life. Dial a ride provides offers door-to-door service for disabled people who cant use buses, trains or the London underground. It can be used for all sorts of journeys, making it easier to go shopping, visit friends and attend doctors appointments. Furthermore, there is London Taxi card, which provides subsidised door-to-door transport in taxis and private-hire vehicles for people who have serious mobility or visual impairment doo The Borough provides ambulances in case of emergencies. There is also Occupational Therapy Service which works with rehabilitation care workers to ensure carers practice safe manual handling. They carry our risk assessments and provide carers with specialised training to use a range of equipment. STAAR (supporting those with autism and Aspergers Redbridge) offers swimming for people with special needs. They organise activities to raise awareness and highlight the needs of children and adults with specific needs. LO3. 1 Autism has no cure and therefore there are a number of approaches and interventions available to help people with various difficulties they may have. Approaches vary in costs and availability in different areas. It also depends what suits an individual, the family, the multi Ã¢â¬âdisciplinary team will decide what best intervention or approach is suitable for an individual. There are ten approaches /interventions for people to choose from, these are: the behavioural intervention, complementary therapies, diet and supplements, medical interventions, physiological intervention, relationship based intervention, service based intervention, and skills based intervention, standard therapies and technology. I will explain the two service based interventions and one standard therapy intervention because we use these at my workplace. TEACCH is a service based intervention/programme and stands for Treatment and Education of Autistic and Related Communications Handicapped Children/Adults. TEACCH is not a technique or a method. It is a complete programme based on the principle that the person with autism is the priority. It provides services for children and adults with autism and related developmental disorders. TEACCH works with people from all parts of the autistic spectrum and offers continuing support with the primary aim of enabling them to live as members of the community. TEACCH programme helps alleviate some possible frustrations associated with challenging behaviour for people who are non verbal or verbal and also assist in communication (Clements and Zarkowska 2000, Cumine at al 2000, Jordan and Jones 1999, Jordan and Powell 1998, Powell and Jordan 1997) SPELL approach is also a service based intervention and stands for : Structure: people with autism find change very frightening and they struggle to cope in new or unfamiliar situations. This safe, predictable and reassuring environments and activities give people with autism the opportunity to increase their independence, develop their communication skills and reduce their anxiety. Positive expectations and approaches: barriers of each person are identified and in this approach people work tom overcome these and achieve their goal and potential Empathy: people see and understand the world in the same way that a person with autism experiences it. They focus on individual interests and preferences, understanding what motivate distresses or preoccupies each person . sing these insights to help people deliver the best possible care and support. Low arousal: in this approach people respond to peopleÃ¢â¬â¢s sensory needs by providing surroundings and activities that are calm, focused and free from clutter and distraction. This approach helps to increase independence in all aspects of life Links: this is linking the family and the wider community and other support services and reducing the difficulties faced by people with autism, it is aimed to help them move together towards a world where they have the same opportunities Lastly the speech and language therapy is a standard intervention. It is aimed to understand the nature and extent of child/adults difficulties and facilitate better communication where possible. Through the speech and language therapy the service users I work with are able to have a say in the things they like to do. LO3. 2 The TEACCH approach has been very effective to the service users I work with. It has enhanced their lives and we have seen an increased improvement in self help skills, social skills and there is reduction in appropriate behaviour. Through skill enhancement one of the TEACCH seven key principles, CA one of the service users can make tea on his own and all staff encourage him to keep on doing that on a daily basis, the risk assessment also highlighted the risk associated with him making the tea and the benefit of him making the tea, the benefit are increased independency. Also a research conducted by Ulster University has shown that communication, concentration and independence has improved by 80% for people with autism. TEACCH has helped our service users to introduce routine and stability in cases where they are hyper sensitive and confused (Cumine et al 2000). The SPELL approach is also effective. , we have a sensory room (it is a quite simple room, for a person with special needs, it is a pleasant environment where the distractions of the outside world are completely absent, present them with, music and attention grabbing moving colours and shapes and then add the ability for the person to actually make things happen that are so dramatic that they cannot be missed and you have the building blocks of real progress. This is a low arousal technique and it really works as the service users have gained a lot of independence. The Speech and Language Therapy is the key part of the autism treatment. This therapy has been effective to the service users I work with because the speech therapist has assisted us in working with the service users through the speech therapy technique. We use makaton, signs, and pictures boards with words to communicate with the service users. This approach is effective because now we are able to communicate with them both verbally and non verbal. Service users are able to make choices and preferences about their day to day lives. JW is able to ask who is sleeping over by showing us this sign (it means sleep). Without the intervention of the speech therapist JW was only saying few words and never learned any news words, this was also said by (Koegel and Koegel 1998) However, some of the approaches cost a lot of money and there has been many service dilemmas and polices. It a service userÃ¢â¬â¢s right that they get support to meet their communication needs and we had to wait a long time before a speech language therapist was assigned to our home. Our priority is to make sure service users get the right support they need at all times. In addition, it is costly for Social Services because they have to pay professionals who support families with autistic members. To support residential and day care cost extremely high, for adults who require ongoing support. There is cost of education for individuals with autism who require more level of support. More hours and attention is need for carers who have to go through national training strategy for Autism, to meet the needs of service users. LO3. 3 There are a lot of developments emerging in todayÃ¢â¬â¢s world to support people with specific needs. As I work with people with autism, there is an Autism Awareness Card and this card is used to educate the general public in challenging moments while in the community. One side of the card contains information specific to the individual and strategies that are helpful to use. The other side of the card is the general information about autism, the card are developed using the person centred approach so that specific information about the individual is used. There are approaches available to help treat autism and organisations that offer advice to parents and organisations. There are services offered to organisations and people working with, or supporting someone who has an autistic spectrum disorder there organisation provide autism specific expertise to advise/help with future service planning and people on mailing list so that they are kept informed of developments or training in the area, they help key people access to resources for people with autism . There are training available for staff to enable them to work with people with specific needs. LO4. 1 Emerson (1995) defines challenging behaviour as Ã¢â¬Å"culturally abnormal behaviour(s) of such intensity , frequency or duration that the physical safety of that person or others is likely to be placed in serious jeopardy , or behaviour which is likely to seriously limit use of, or result in the person being denied access to , ordinary community facilities. Challenging behaviour is a social label and a person is not a challenge, the behaviour may challenge us in terms of our understanding and response Challenging behaviour can Ã¢â¬Ëresult in the person being denied to access, to ordinary community facilitiesÃ¢â¬â¢ (Emerson, 1995). At my workplace service user TB has been banned from five pubs because he was spitting on other customers and urinating on the floor. Customers complained about his behaviour and pub managers had to ban him. Research has shown that males are more likely to display challenging behaviour than females and their behaviours tend to be more aggressive. Challenging behaviour tends to reach a peak between the ages of 15 and 34 years of age and is particularly over represented in the 14-24 year old age group. The service users I work with have autism and present a lot of challenging behaviour. They present a lot of challenging behaviour as an act of communication, environmental factors sometimes causes challenging behaviour for example JW exhibits challenging behaviour when we go to crowded noisy places. Also JW cry when he listens to certain music this is contributed by historical / emotional factors. Some service users self harm by lip and hand biting. Furthermore, challenging behaviour is caused by mental health factors for example a service user with dual diagnosis (Down syndrome and Autism Spectrum Disorder); they develop repetitive behaviour and donÃ¢â¬â¢t like to be touched and loud noises. 4. 2. When dealing with challenging behaviour health care organisations need intervention plans, policies and procedures to follow as this is best practice. At my workplace we follow the BILD (British Institute of Learning Disabilities) policy framework for physical interventions which sets out three broad categories of physical intervention and the DoH Dfes guidance on restrictive physical intervention. My manager makes sure staff get proper induction when they start their employment and clear guidelines are written in the employees handbook, all staff attend training to deal with challenging behaviour and this include training challenging behaviour, managing violence and aggression, self harm and Caring for People on the Autistic Spectrum. Also the manager makes sure that policies and procedures are written and all times followed under the BILD policy framework. As professionals in the health care sector we have a duty of care towards the vulnerable people we look after, we need to avoid action that will or may harm others and we should always work in the best interest of the service user. At my workplace we follow the General Social Care Council, Codes of Practice for Social Care Workers (Code 4) which states that as a social worker you must respect the rights of service users while seeking to ensure that their behaviour does not harm themselves or other people. This includes: * Recognising that service users have the right to take risks and helping them to identify and manage potential and actual risks to themselves and others * Following risks assessments , policies and procedures to access whether the behaviour of service users presents a risk of harm to themselves or others * Taking necessary steps to minimise the risks of service user from doing actual or potential harm to themselves or others and * Ensuring that relevant colleagues and agencies are informed about the outcomes and implications of risk assessment. My organisationÃ¢â¬â¢s policy is to make sure all staffs are trained in managing challenging behaviours without causing any harm to individuals. This is done in accordance with the Mental Capacity Act 2005, which states that: someone is using restraint if they: use force Ã¢â¬â or threaten to use force Ã¢â¬â to make someone do something they are resisting, or restrict a personÃ¢â¬â¢s freedom of movement, whether they are resisting or notÃ¢â¬â¢. At my care home we use safe practices like the team teach training. LO4. 3 Ã¢â¬Å"Each person is different and each behaviour needs to be considered in its own right. In addition the reasons behind oneÃ¢â¬â¢s behaviour may not be the same as the reasons behind another behaviour which the person shows. A person may shout because this makes others do as he asks. He may hit because this makes others leave him alone. There is therefore a need to build a detailed understanding of why a particular person is engaging in a particular behaviour and why he is likely to engage in that behaviour more under some circumstances than under others. Ã¢â¬ (Clement and Zarkowska 2000) p. 38 The NICE (2006) states that non-phamalogical interventions should be used first before medication in cases of challenging behaviours. Some of the challenging behaviours are caused when service users are expressing their unmet needs . At my workplace all staff have been trained in communication as effective communication plays important role managing behaviours. We use body language, signs and pictures to communicate with service users who are non verbal. At my workplace we use different strategies to deal with challenging behaviour for service users. We try to use positive, preventative, calming, defusing and problems solving skills instead of holding, restraining and breakaway when dealing with challenging behaviour and in most cases it works well. For example service user JW likes to know who is sleeping over at the end of the shift, when he is presenting challenging behaviour staff calm him down by saying Ã¢â¬ËJW do you want me to do sleep over tonight,Ã¢â¬â¢ he answers yes and staff will tell him that what he is doing in not nice and because of that no one is sleeping over ,we encourage him to do something like emptying the dishwasher , and remind him that someone will sleep over if he continues to be good, JW calms downs apologises to staff and the other service user for his behaviour . He continues to sign sleep in makaton to show that he is happy. Also we always try to remind JW of his behaviour at calm moments of the day (Attwood 1998, Clements and Zarkowska 2000, Gray 1995). Also we have a change in setting strategy to manage DCÃ¢â¬â¢s challenging behaviour. DC has Autistic Spectrum Disorder and finds any change difficult to tolerate. We support DC to the day centre every Monday we do group activities and DC is disruptive at all times. An assessment was done and it showed that DC did not like crowds and noisy environment. He is encouraged to work in a small quiet room with few other people and once she is settled we give her a small task which means she only visits the larger room for a short time and return. After sometime we reintroduced her to the larger group but we seated her at a table near the door with only two people near her. To manage her behaviour she is asked to deliver things to different rooms. This strategy has worked well and it means DC does not have to spend the whole day in the larger room and the gradual reintroduction resulted in significant reduction of disruptive behaviour.
Monday, January 20, 2020
Growing up in an affluent New Jersey neighborhood, Peter BalakianÃ¢â¬â¢s house can tell us a lot about his up bringing. Tenafly, New Jersey seems to be a common topic in BalakianÃ¢â¬â¢s memoir Ã¢â¬ËBlack Dog of Fate.Ã¢â¬â¢ Not only must we study the house, but also the relationships that are formed within BalakianÃ¢â¬â¢s household. His extended family is made up of physicians, merchants, and well-known literary authors. Arguably the biggest presence in PeterÃ¢â¬â¢s life was his Grandmother, along with his Mother and Father. One of PeterÃ¢â¬â¢s most vivid memories is of his Grandmother. He starts off his memoir with a lengthy description of her and her apartment, as if she were still alive when he wrote it. He describes her apartment as Ã¢â¬Å"mysterious and exotic after the suburban houses of TeaneckÃ¢â¬ (6). He seems to view her apartment as old fashioned (Ã¢â¬Å"it was a 1940s kitchen with long white cabinets, a white enamel sink, red-speckled linoleum cracking at the seams, and a coiled buzzing fluorescent light on the ceilingÃ¢â¬ (7)) and different then the houses he is used to in suburbia. Her apartment seems to be laced with Armenian culture compared to his Americanized home back in Teaneck. A tradition or at least custom that seems important to Peter and his life at home is his love for and following of the Yankees. The Yankees were a type of family bonding for Peter, and he even followed them with his Grandmother. Ã¢â¬Å"My grandmother and I followed the Yankees together, and by the time I was ten it had become an ongoing conversation between us. Box scores, averages, pitching rotations, prenogis for the World Series Ã¢â¬â because there was almost never a series without the YankeesÃ¢â¬ (12). The Yankees were a symbol of American pride for Peter, Ã¢â¬Å"they were more than a team... ...e. Ã¢â¬ ¦ On either side of our new development were grand nineteenth-century houses and manors set back behind high hedges. Ã¢â¬ ¦ Seventeenth- and eighteenth-century stone Dutch houses still spotted the town and some quite fabulous nineteenth-century estates surrounded our new streetÃ¢â¬ (50). This description of BalkiansÃ¢â¬â¢s house, as he remembers it, might tell him that his family is becoming more accustomed to the American culture, yet still keeping with their Armenian roots. The move from Teaneck to Tenafly just shows that his family is living the American Dream by finding a city that fits them best and a house that is custom built to their liking. All of a sudden Peter is living in a community where families are larger and dinner is just a race to get done with. It seems as though the move to Tenafly is an immersion into the American lifestyle, even more than Teaneck.
Sunday, January 12, 2020
Britannia -the Ã¢â¬ËbiscuitÃ¢â¬â¢ leader with a history-has withstood the tests of time. Part of the reason for its success has been its ability to resonate with the changes in consumer needs-needs that have varied significantly across its 100+ year epoch. With consumer democracy reaching new levels, the one common thread to emerge in recent times has been the shift in lifestyles and a corresponding awareness of health. People are increasingly becoming conscious of dietary care and its correlation to wellness and matching the new pace to their lives with improved nutritional and dietary habits. This new awareness has seen consumers seeking foods that complement their lifestyles while offering convenience, variety and economy, over and above health and nutrition. Britannia saw the writing on the wall. Its Ã¢â¬Å"Swasth Khao Tan Man JagaoÃ¢â¬ (Eat Healthy, Think Better) re-position directly addressed this new trend by promising the new generation a healthy and nutritious alternative Ã¢â¬â that was also delightful and tasty. Thus, the new logo was born, encapsulating the core essence of Britannia Ã¢â¬â healthy, nutritious, and optimistic and combining it with a delightful product range to offer variety and choice to consumers. INTRODUCTION TO THE INDUSTRY BISCUIT INDUSTRY IN INDIA Ã¢â¬â AN OVERVIEW Ã¢Å¾ ¢ Biscuit industry in India in the organized sector produces around 60% of the total production, the balance 40% being contributed by the unorganized bakeries. The industry consists of two large scale manufacturers, around 50 medium scale brands and small scale units ranging up to 2500 units in the country, as at 2000-01. The unorganized sector is estimated to have approximately 30,000 small & tiny bakeries across the country. Ã¢Å¾ ¢ The annual turnover of the organized sector of the biscuit manufacturers (as at 2001-02) is Rs. 4,350 crores. Ã¢Å¾ ¢ In terms of volume biscuit production by the organized segment in 2001-02 is estimated at 1.30 million tonnes. The major Brands of biscuits are Ã¢â¬â Britannia, Parle Bakeman, Priya Gold,Elite,Cremica, Dukes, Anupam, Horlicks, Craze, Nezone, besides various regional/State brands. Ã¢Å¾ ¢ Biscuit industry which was till then reserved in the SSI Sector, was unreserved in 1997-98, in accordance with the Govt. Policy, based on the recommendations of the Abid Hussain Committee. Ã¢Å¾ ¢ The annual production of biscuit in the organized sector, continues to be predominantly in the small and medium sale sector before and after de-reservation. The annual production was around 7.4 Lakh tonnes in 1997-98 in the next five years, biscuit production witnessed an annual growth of 10% to 12%, up to 1999-00. Ã¢Å¾ ¢ The annual Growth showed a decline of 3.5% in 2000-01, mainly due to 100% hike in Central Excise Duty (from 9% to 16%). Production in the year 2001-02 increased very marginally by 2.75% where in 2002-03 the growth is around 3%. Ã¢Å¾ ¢ The Union Budget for 2003-04 granted 50% reduction in the rate of Excise Duty on Biscuit i.e. from 16% to 8%. The FederationÃ¢â¬â¢s estimate for the current year indicates a growth of approximately 8% to 9%. Ã¢Å¾ ¢ However the average utilization of installed capacity by biscuit manufacturers in the country has been a dismal 60% over the last decade up to 2001-02. Ã¢Å¾ ¢ Though dereservation resulted in a few MNCs, i.e. Sara Lee, Kellogs SmithKline Beecham, Heinz etc entering the biscuit industry in India, most of them, with the exception of SmithKline Beecham (Horlicks Biscuits), have ceased production in the country. Ã¢Å¾ ¢ On the other hand, import of biscuits, especially in the high price segment has started from 1998-99, but however, the quantum of imports has not so far increased alarmingly and has remained at around 3.75% of the consumption of biscuits in the country in the year 2001-02. However, recent imports from china industries cheaper verities of biscuit, needs to be examined with cautions, especially in the context of the price as the low margin based domestic industry, which is operating at 60 % of the total installed capital. Exports of biscuits from India have been to the extent of 5.5% of the total production. Exports are expected to grow only in the year 2003-04 and beyond. Ã¢Å¾ ¢ Biscuit is a hygienically packaged nutritious snack food available at very competitive prices, volumes and different tastes. According to the NCAER Study, biscuit is predominantly consumed by people from the lower strata of society, particularly children in both rural and urban areas with an average monthly income of Rs. 750.00. Ã¢Å¾ ¢ Biscuit can he broadly categorized into the following segments: (Based on productions of 2000-01) Glucose 44% Marie 13% Cream 10% Crackers 13% Milk 12% Others 8%. Ã¢Å¾ ¢ . FBMI ( Federation of Biscuit ManufacturerÃ¢â¬â¢s of India ) is an association of all the biscuit manufacturers of India. Major players include Britannia, Parle, ITC, Priyagold, Windsor etc. Ã¢Å¾ ¢ In recognition of industryÃ¢â¬â¢s obligations towards the community, being a part of it, biscuit manufacturers supply biscuits to the social welfare agencies in all States for the benefit of school children, senior citizens and other needy sections of the society. FBMI ( Federation of Biscuit ManufacturerÃ¢â¬â¢s of India ) Members have always responded positively to our appeal as also by the Government, to rush truck loads of biscuits to the people affected by earthquakes, floods, famine etc. These members have also participated in supplying biscuits to the people of war ravaged Afghanistan and presently to the Iraqi people, under the aegis of the UN. Ã¢Å¾ ¢ As regards the consumption pattern is concerned. surveys and estimates by industry from time to time indicate the avera ge consumption scenario in the four Zones have been more or less close to each other, as below: 1. Northern States: 28% 2. Southern States: 24% 3. Western States: 25% 4. Eastern States: 23% [pic] Ã¢Å¾ ¢ Though India is considered as the third largest producer of Biscuits after USA and China, the per capita consumption of biscuits in our country is only 2.1 Kg., compared to more than 10 kg in the USA, UK and West European countries and above 4.25 kg in south cast Asian countries, Le. Singapore, Hong Kong, Thailand, Indonesia etc. China has a per capita consumption of 1.90 kg, while in the case of Japan it is estimated at 7.5 kg. Ã¢Å¾ ¢ In view of the meager per capita consumption even as penetration of biscuits manufactured by the organised sector, into rural areas in India, has been very good during the last 10 years, as also in the metro and other cities, small towns etc. However, in spite of this, the industry has not been able to utilize about half of their installed capacities. Ã¢Å¾ ¢ Biscuit is a comparatively low margin food product in the PMCG (Packaged Mass Consumption Goods) sector. The commodity is also price sensitive, as a consequence of which, even when the Excise Duty was doubled on biscuits in 2000-01 biscuit manufacturers, including the major brands, were not able hike MRPs to the extend of the steep increase in the Duty. Taxation, both Central Excise Duty as also State Sales Tax, other miscellaneous levies i.e. turnover tax, local area tax, mandi taxes, purchase tax, Octroi etc., has been a major deterrent in the growth of the biscuit industry. The CII Study Report has identified Biscuit as one of the products that should treated as Ã¢â¬Å"Merit Good for the purpose of liberal tax policy both by the Centre and States. Ã¢Å¾ ¢ Besides lack of technology upgradation in manufacturing, packaging etc has also been a factor affecting our industry, along with inadequate financial credit and support particularly for the medium and small scale biscuit un its. Ã¢Å¾ ¢ On the other hand, the Government of India has identified food processing industries as a priority area to be encouraged for growth and development and created the Ministry of Food Processing Industries (which was till then a Dept in the Ministry of Agriculture), headed by an Ministry of State with Independent charge. Ã¢Å¾ ¢ Biscuit manufacturing as well as other bakery products like Bread etc are agro based industries, with the major inputs Ã¢â¬â wheat flour/atta sugar, milk vanaspati/vegetable oil etc all being agriculture produces. Ã¢Å¾ ¢ Industries such as Biscuit are also languishing as they are not able to achieve their potentials for higher production, in the absence of the concrete food Processing Industry Policy. FBMI in close coordination with other organizations and apex Chambers, initiated to urge the Govt of India to formulate a comprehensive Policy Document, for smooth growth and harmonious development of the industry. The Food Processing Industry Policy, which has been evolved as a result of various workshops, deliberations and representations by a large cross section of food processing industries, is yet to be finalized. It is hoped that the Ministry of Food Processing Industries, GOI would initiate action for implementation of the Policy expeditiously. Ã¢Å¾ ¢ According to the production figures of members available upto the calendar year 2003, the total production was 625000 tonnes as against 475000 tonnes in the previous year. The production of biscuit for the last 11 years is as under: Ã¢Å¾ ¢ 1993 Ã¢â¬â 167750 1994 Ã¢â¬â 180526 1995 Ã¢â¬â 202567 1996 Ã¢â¬â 222371 1997 Ã¢â¬â 362000 1998 Ã¢â¬â 400000 1999 Ã¢â¬â 425000 2000 Ã¢â¬â 450000 2001 Ã¢â¬â 465000 2002 Ã¢â¬â 475000 2003 Ã¢â¬â 625000 Note: the production of members of FBMI consist of 50% (approx.) of the total production of biscuit in the organized sector. INTRODUCTION TO THE COMPANY HISTORY The story of one of IndiaÃ¢â¬â¢s favourite brands reads almost like a fairy tale. Once upon a time, in 1892 to be precise, a biscuit company was started in a nondescript house in Calcutta (now Kolkata) with an initial investment of Rs. 295. The company we all know as Britannia today. The beginnings might have been humble-the dreams were anything but. By 1910, with the advent of electricity, Britannia mechanized its operations, and in 1921, it became the first company east of the Suez Canal to use imported gas ovens. BritanniaÃ¢â¬â¢s business was flourishing. But, more importantly, Britannia was acquiring a reputation for quality and value. As a result, during the tragic World War II, the Government reposed its trust in Britannia by contracting it to supply large quantities of Ã¢â¬Å"service biscuitsÃ¢â¬ to the armed forces. As time moved on, the biscuit market continued to growÃ¢â¬ ¦ and Britannia grew along with it. In 1975, the Britannia Biscuit Company took over the distribution of biscuits from ParryÃ¢â¬â¢s who till now distributed Britannia biscuits in India. In the subsequent public issue of 1978, Indian shareholding crossed 60%, firmly establishing the Indianness of the firm. The following year, Britannia Biscuit Company was re-christened Britannia Industries Limited (BIL). Four years later in 1983, it crossed the Rs. 100 crores revenue mark. On the operations front, the company was making equally dynamic strides. In 1992, it celebrated its Platinum Jubilee. In 1997, the company unveiled its new corporate identity Ã¢â¬â Ã¢â¬Å"Eat Healthy, Think BetterÃ¢â¬ Ã¢â¬â and made its first foray into the dairy products market. In 1999, the Ã¢â¬Å"Britannia Khao, World Cup JaoÃ¢â¬ promotion further fortified the affinity consumers had with Ã¢â¬ËBrand BritanniaÃ¢â¬â¢. Britannia strode into the 21st Century as one of IndiaÃ¢â¬â¢s biggest brands and the pre-eminent food brand of the country. It was equally recognised for its innovative approach to products and marketing: the Lagaan Match was voted IndiaÃ¢â¬â¢s most successful promotional activity of the year 2001 while the delicious Britannia 50-50 Maska-Chaska became IndiaÃ¢â¬â¢s most successful product launch. In 2002, BritanniaÃ¢â¬â¢s New Business Division formed a joint venture with Fonterra, the worldÃ¢â¬â¢s second largest Dairy Company, and Britannia New Zealand Foods Pvt. Ltd. was born. In recognition of its vision and accelerating graph, Forbes Global rated Britannia Ã¢â¬ËOne amongst the Top 200 Small Companies of the WorldÃ¢â¬â¢, and The Economic Times pegged Britannia IndiaÃ¢â¬â¢s 2nd Most Trusted Brand. Today, more than a century after those tentative first steps, BritanniaÃ¢â¬â¢s fairy tale is not only going strong but blazing new standards, and that miniscule initial Investment has grown by leaps and bounds to crores of rupees in wealth for BritanniaÃ¢â¬â¢s shareholders. The companyÃ¢â¬â¢s offerings are spread across the spectrum with products ranging from the healthy and economical Tiger biscuits to the more lifestyle-oriented Milkman Cheese. Having succeeded in garnering the trust of almost one-third of IndiaÃ¢â¬â¢s one billion populations and a strong management at the helm means Britannia will continue to dream big on its path of innovation and quality. And millions of consumers will savour the results, happily ever after. HISTORY OF BISCUITS Sweet or salty. Soft or crunchy. Simple or exotic. Everybody loves munching on biscuits, but do they know how biscuits began? The history of biscuits can be traced back to a recipe created by the Roman chef Apicius, in which Ã¢â¬Å"a thick paste of fine wheat flour was boiled and spread out on a plate. When it had dried and hardened it was cut up and then fried until crisp, then served with honey and pepper.Ã¢â¬ The word Ã¢â¬ËBiscuitÃ¢â¬â¢ is derived from the Latin words Ã¢â¬ËBisÃ¢â¬â¢ (meaning Ã¢â¬ËtwiceÃ¢â¬â¢) and Ã¢â¬ËCoctusÃ¢â¬â¢ (meaning cooked or baked). The word Ã¢â¬ËBiscottiÃ¢â¬â¢ is also the generic term for cookies in Italian. Back then, biscuits were unleavened, hard and thin wafers which, because of their low water content, were ideal food to store. As people started to explore the globe, biscuits became the ideal traveling food since they stayed fresh for long periods. The seafaring age, thus, witnessed the boom of biscuits when these were sealed in airtight containers to last for months at a time. Hard track biscuits (earliest version of the biscotti and present-day crackers) were part of the staple diet of English and American sailors for many centuries. In fact, the countries which led this seafaring charge, such as those in Western Europe, are the ones where biscuits are most popular even today. Biscotti is said to have been a favorite of Christopher Columbus who discovered America! Making good biscuits is quite an art, and history bears testimony to that. During the 17th and 18th Centuries in Europe, baking was a carefully controlled profession, managed through a series of Ã¢â¬ËguildsÃ¢â¬â¢ or professional associations. To become a baker, one had to complete years of apprenticeship Ã¢â¬â working through the ranks of apprentice, journeyman, and finally master baker. Not only this, the amount and quality of biscuits baked were also carefully monitored. The English, Scotch and Dutch immigrants originally brought the first cookies to the United States and they were called teacakes. They were often flavoured with nothing more than the finest butter, sometimes with the addition of a few drops of rose water. Cookies in America were also called by such names as Ã¢â¬Å"jumblesÃ¢â¬ , Ã¢â¬Å"plunketsÃ¢â¬ and Ã¢â¬Å"cry babiesÃ¢â¬ . As technology improved during the Industrial Revolution in the 19th century, the price of sugar and flour dropped. Chemical leavening agents, such as baking soda, became available and a profusion of cookie recipes occurred. This led to the development of manufactured cookies. Interestingly, as time has passed and despite more varieties becoming available, the essential ingredients of biscuits havenÃ¢â¬â¢t changed Ã¢â¬â like Ã¢â¬ËsoftÃ¢â¬â¢ wheat flour (which contains less protein than the flour used to bake bread) sugar, and fats, such as butter and oil. Today, though they are known by different names the world over, people agree on one thing Ã¢â¬â nothing beats the biscuit! Some interesting facts on the origin of other forms of biscuits: The recipe for oval shaped cookies (that are also known as boudoir biscuits, sponge biscuits, sponge fingers, Naples biscuits and Savoy biscuits) has changed little in 900 years and dates back to the house of Savoy in the 11th century France. Peter the Great of Russia seems to have enjoyed an oval-shaped cookie called Ã¢â¬Å"lady fingersÃ¢â¬ when visiting Louis XV of France. The macaroon Ã¢â¬â a small round cookie with crisp crust and a soft interior Ã¢â¬â seems to have originated in an Italian monastery in 1792 during the French Revolution. SPRING-uhr-lee, have been traditional Christmas cookies in Austria and Bavaria for centuries. They are made from a simple egg, flour and sugar dough and are usually rectangular in shape. These cookies are made with a leavening agent called ammonium carbonate and baking ammonia. The inspiration for fortune cookies dates back to the 12th & 13th Centuries, when Chinese soldiers slipped rice paper messages into moon cakes to help co-ordinate their defense against, Mongolian invaders. .
Saturday, January 4, 2020
War, War Never Changes (A discussion on reinstating the draft) Ã¢â¬Å"War is delightful to those that have no experience of it.Ã¢â¬ A quote by Desiderius Erasmus, a Dutch humanist and social critic, shows tells that war isnÃ¢â¬â¢t always as epic and awesome that most Americans make it out to be. Reinstating the draft might sound like a great way to impose our power on the world furthering the American agenda, as well as enforcing the American ideal of extreme pride in nationalism. The problem is however, that most Americans that want the draft reinstated have no clue about the mountain of problems that it would create. America would be in very dire straits if the draft were necessary. The last time America used the draft was during the Vietnam War and that draft did indeed fit those three requirements. The draft should only be used under three crucial prerequisites. If it does not meet these requirements then the draft should not be reinstated. Those three pretenses are: America is in an extreme confl ict, every U.S citizen able would be entered in the draft and it would need to be a lottery type system. The most important rule, without question, is America would need to be in a major conflict. This conflict would have to be on the global scale. It would involve numerous countries, millions of soldiers, possible nuclear war and endless violent death. With a conflict on this scale there would be no doubt that America would need more soldiers than they currently have. The U.S military mayShow MoreRelatedA Separate Peace By John Knowles1529 Words Ã |Ã 7 PagesWar is a destructive force whose nature is to destroy all things and change lives forever. It is a whirlpool that sucks everything in and is fueled by hatred and violence. Whether one is directly involved in the battlefield or waiting to see the outcome, war has the capacity to affect all people. 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Friday, December 27, 2019
Its easy to see why someone who lives in New York State is called a New Yorker. And why a resident of California is a Californian. But what do people in Massachusetts call themselves? And where do Huskies and Nutmeggers live? In the first column of the table below, youll find the official names for residents of the 50 states according to The United States Government Printing Office Style Manual. The right-hand column contains alternative names and nicknames. Origins of Some Nicknames Its probably self-explanatory to think of why Colorado folks unofficially call themselves Highlanders or Alabama residents Bamers. But the name Hoosiers, in Indiana, didnt come from the basketball movie but actually a poem by John Finley about the state called The Hoosiers Nest, from 1830, where the term was originally spelled Hoosher. Nebraskans arent Huskers just because of the state university nickname of Cornhuskers for its sports teams but actually for the people who husked corn there by hand before the advent of machinery to automate the task.Ã Empire Staters, in New York, derive that nickname from the name of the state being the Empire State, a place of great wealth and resources, or an empire. Bay Staters of Massachusetts are proud of their definitive water inlets. Ohios Buckeye name is in reference to trees that once dominated the landscape there. Down Easters arent a serious type of winter storm; the termÃ was actually a maritime reference to a specific area of Maine coastline, begun in the late 1700s. Ships going from Boston to Maine in warmer months had a strong wind at their back while traveling east, so they were traveling downwindÃ and east, which became combined into the shortcutÃ down east. The term also became associated in general with New England, but Mainers are the ones who kept it for their own. Insults You dont actually want to call an Iowan an Iowegian to his or her face, though; its a pejorative term for the people from there (often used on the two-lane highways in Minnesota when drivers cant pass an Iowa car going less than the speed limit, for example). Whether the term Cheesehead is an insult to a Wisconsinite or not, though, depends on whos originating it (and possibly if its being said inside a football stadium). Wisconsin is particularly proud of its dairy industry, so people from there proudly wear the foam cheese wedge hats on their heads to their sports arenasÃ¢â¬âand quite conspicuously to other ballparks and fields when following their teamsÃ¢â¬âturning a former insult into a badge of honor. Those hats have even saved people from injury a time or two. (Really!) For more information about the origins of more of these names, along with the terms for residents of other countries and of major cities around the world, check out Paul Dicksons entertaining book Labels for Locals: What to Call People from Abilene to Zimbabwe (Collins, 2006). State-Based Nicknames Official Names Nicknames Alternative Names Alabamian Alabaman, Alabamer, Bamer Alaskan Arizonan Arizonian Arkansan Arkansasian, Arkansawyer Californian Californiac Coloradan Coloradoan, Highlander Connecticuter Nutmegger Delawarean Delawearer Floridian Floridan Georgian Hawaiian malihini (newcomer) Idahoan Idahoer Illinoisan Illini, Illinoyer Indianian Hoosier, Indianan, Indianer Iowan Iowegian Kansan Kanser Kentuckian Kentucker, Kentuckeyite Louisianian Louisianan Mainer Down Easter Marylander Marylandian Massachusettsan Bay Stater Michiganite Michiganian, Michigander Minnesotan Mississippian Mississippier, Mississipper Missourian Montanan Nebraskan Husker Nevadan Nevadian New Hampshirite Granite Stater New Jerseyite New Jerseyan New Mexican New Yorker Empire Stater North Carolinian North Dakotan Ohioan Buckeye Oklahoman Okie Oregonian Oregonner Pennsylvanian Rhode Islander Rhodian South Carolinian South Dakotan Tennessean Texan Texian Utahn Utahan Vermonter Virginian Washingtonian Toner West Virginian Wisconsinite Cheesehead Wyomingite