Rate of Treatment Failure among Tuberculosis Patients

Rate of Treatment Failure among Tuberculosis Patients ABSTRACT Treatment failure in patients with pulmonary tuberculosis (PTB) poses a great danger to the global effort in control of tuberculosis. This study evaluated prevalence of treatment failure among PTB patients at a tertiary care teaching hospital in Pakistan. Consecutive patients of smear positive PTB patients managed between February 2011 to October 2013 at the directly observed therapy (Tuberculosis) unit of our hospital were enrolled for the study. Sputum specimens were collected from each patient at entry for Acid Fast Bacilli microscopic examination and repeated at the end of 2nd (in category I cases only), 3rd (in category II cases only), 5th and 7th month of treatment. Of the 144 patients recruited, 124 patients consisting of 53 (42.74%) males and 71 (57.26%) females aged 14-85 years completed the study. Ninety three (75 %) of the patients were New (category I) at entry while 31 (25%) were Retreatment cases (category II). Among 124 smear positive patients at baseline, 22 (17.74%), 6(4.84%) and 6(4.84%) patients remained positive after 2nd (in category I patients only) and 3rd (in category II cases only), 5th and 7th month of treatment respectively. In conclusion, there is considerable treatment failure rate (4.84%) among our smear positive TB patients; and this poses a great danger to healthcare personnel and close contacts in the community. Key words: Pulmonary tuberculosis, prevalence, treatment failure. INTRODUCTION: About two billion or nearly a third of the world’s population is infected with Mycobacterium tuberculosis.(1) The global prevalence of TB was an estimated 14 million, with 9.4 million incident cases and 1.3 million deaths among HIV-negative cases for the year 2009. (2) Eighty-five percent of the 9 million people infected with TB each year live in the developing countries. (2) Whereas more women of child bearing age die of Tuberculosis than from all causes of maternal mortality combined.(3) TB incidence has tripled in high HIV prevalence countries in the last two decades with a slight decline in 2009. Globally, in people living with AIDS, one out of every four deaths is due to TB; globally 380,000 people died of HIV associated TB in 2009. Persons co-infected with TB and HIV are 20-30 times more likely to develop active TB disease than persons without HIV. Globally, 440,000 MDR TB cases were estimated in 2009 (8). There are 27 high MDR TB burden countries contributing 86% of the MDR TB case burden. Pakistan falls on number 4 among these high MDR TB burden countries.(2) Currently Pakistan stands 5th amongst the 22 high TB burden countries which account for about 81 % of all estimated TB cases around the globe. (4) Pakistan contributes about 63% of tuberculosis burden in the Eastern Mediterranean Region. According to WHO, the incidence of sputum positive TB cases in Pakistan is 97/100,000 per year and for all types it is 231/100,000 or around 420,000 new cases each year. The prevalence of the disease is much higher and is estimated at 373/100,000 population or 670,000 cases.(5) TB is responsible for 5.1 percent of the total national disease burden in Pakistan. The impact of TB on socio economic status is substantial.(6) Sputum smear-positive patients are the most potent sources of infection and, without chemotherapy, have poor outcomes, as about two-thirds of them die within 2-3 years of developing disease. (Ten years case fatality rate of HIV negative untre ated smear positive pulmonary tuberculosis is 70%, while that for smear negative cases is 20%). (7) Non-completion of treatment has serious consequences, including ongoing infectiousness and development of drug-resistant Mycobacterium tuberculosis. The problem of resistance results from treatment that is inadequate, often because of an irregular drug supply, inappropriate regimens, or poor compliance. Drug resistance is a potential threat to tuberculosis-control programs throughout the world. (8) Materials and methods The study was carried out in a tertiary care teaching hospital in  Pakistan. The research proposal was approved by the Ethics and Review Committee of the hospital. Informed consent was obtained from the patients. The hospital has a TB clinic which is supported by the National Tuberculosis Control Programme Pakistan. Laboratory services for sputum microscopy and the drug regimens are provided according to National Tuberculosis Control Programme protocol. Consecutive patients who presented at the TB clinic of the hospital with smear positive pulmonary tuberculosis were enrolled. Sociodemographic data such as age, sex, marital status and occupation were recorded. Patients of age less than 5 years were excluded. Before enrolling into the study, the patients were well informed about the consequences and potential predictors of treatment failure such as treatment compliance. Pretreatment sputum specimens were collected from each patient for acid fast bacilli (AFB) examination. Patients were categorized as New cases (category I) and Retreatment cases (category II) on the basis of history of previous anti TB treatment. All patients were followed up to completion of eight months TB treatment. Sputum examinations were repeated at 2nd month (in case of category I only), 3rd month (in case of category II only), 5th month and 7th month of treatment. Data were entered and analyzed using SPSS 16.0 version. Results A total of 144 patients were recruited during the study period (between February 2011 and October 2013). Twenty patients were either transferred out or lost to follow up. One hundred and twenty four patients who completed their treatment at the centre were evaluated. There were 93(75%) New cases (category I) and 31(25%) Retreatment cases (category II). There were 71 (57.26%) females and 53(42.74%) males aged between 14 and 85 years. Majority of the patients (47.58%) were aged above 45 years with 6 patients above 80 years. Table 2 shows the age group distribution of sputum positive pulmonary TB patients on entry. Repeat sputum AFB results in study participants are presented in figure 1. Of the 124 patients who were sputum positive at baseline, 6 (4.84%) patients were AFB smear positive after 5 months therapy revealing the prevalence of treatment failure in these patients. Our study showed that TB affects mainly the middle and elderly age in our environment (47.58% of the patients managed were above age 45 years). This finding is also observed in some studies from the developed countries (9), While in developing countries it affects mainly the young age group. (10) One reason may be the changing circumstances in the less developed countries and further large scale studies may highlight the issue. Greater percentage of our study population was females which again is different from studies in our region. (10,11) Treatment failure rate among our patients was 4.84%. Though this is lower tthan reported in many studies we still need to further improve it (The cure rate of tuberculosis among Category I patients in our study was more than the cure rate reported by studies from Bangalore (65.7%) and Tamil Nadu (75%). (12,13) The World Health Organization guidelines have recommended achieving cure rate of 85%. The smear positive TB patients pose a significant risk to members of the public, close relatives, and health care staff who treat these patients. They are the focus for infection control measures, and contact investigations. This type of patient must be isolated because of risk of transmitting microbes. Treatment failure increases the risk further. These are the cases where there are much chances of drug resistance including multidrug resistance and extended drug resistance. ((((All 3 failure patients who underwent DST testing had MDR-TB, while 3 of 22 of relapse patients and 0 of 5 default patients tested did. While these DST results were only available for three failure patients and, therefore, not representative, these data and those from other studies suggest that MDR ri sk is not uniform among retreatment subgroups, with increased prevalence of MDR among patients with initial treatment failure. (14-16) Drug resistance is a global health concern and effective programmatic therapy of the smear positive cases is one of the cornerstones in its prevention. Facilities for rapid detection of rifampicin resistance are being made available throughout the country which can help in early detection of drug resistant cases. Physicians involved in TB management need to be involved in its programmatic management and timely referrals for testing resistance in appropriate cases. Taken together, these findings support use of DST in all retreatment patients, earlier DST testing in those with clinical and microbiological indications of impending treatment failure, and use of second-line drugs for retreatment of patients with initial treatment failure until DST results are known.(17) Recently, total drug-resistant tuberculosis has been described in which some patients with TB infection were completely unresponsive to all TB drugs. This is a big blow to the global effect in control of TB. On the other hand, additional burdens of isolation and stigmatization on the patients are enormous. (18) Noncompliance to treatment, deficient patient knowledge/health education, drug quality, and other comorbidities like diabetes mellitus and HIV infection had been identified as major predictors of treatment failure in patients with TB. These factors were not considered in our study participants. According to observations made in many countries, only directly observed therapy is capable of improving treatment outcomes. (19-22) The effectiveness of the DOTS strategy is also confirmed by our own studies. In conclusion, there is still considerable treatment failure rate among TB patients managed in our tuberculosis clinic. There is need for provision of facility for sputum culture for detection of patients with drug resistant TB cases. Policies on the management of tuberculosis need to be reviewed and strengthened in order to reduce open TB cases in the community.

Parle Project Essay

Parle Products Pvt. Ltd.: A cream colored yellow stripped paper with a cute baby photo containing 10-12 biscuits with the company’s name printed with in Red. Times changed, variety of biscuits did come and go but nothing has changed with these biscuits. Yes, the size of their packing has definitely changed but for the consumer good as these are money saver pack. The Parle name conjures up fond memories across the length and breadth of the country. After all, since 1929, the people of India have been growing up on Parle biscuits and sweets. Initially a small company was set up in the suburbs of Mumbai city to manufacture sweets and toffees. The year was 1929 and the market was dominated by famous international brands that were imported freely. Despite the odds and unequal competition, this company called Parle Products, survived and succeeded by adhering to high quality and improvising from time to time A decade later, in 1939, .Parle products began manufacturing biscuits, in a ddition to sweets and toffees. Having already established a reputation for quality, the Parle brand name grew in strength with this diversification. Parle Glucose and Parle Monaco were the first brands of biscuits to be introduced, which later went on to become leading names for great taste and quality. For around 75 years, Parle have been manufacturing quality biscuits and confectionary products. Over the years Parle has grown to become a multimillion dollar company with many of the products as market leaders in their category. The recent introduction of Hide & Seek chocolate chip biscuits is a product of innovation and caters to a new taste, being India’s first ever chocolate chip biscuits. Apart from the factories in Mumbai and Bangalore Parle also has factories in Bahadurgarh in Haryana and Neemrana in Rajasthan, which are the largest biscuit and confectionery plants in the country. Additionally, Parle Products also has 7 manufacturing units and 51 manufacturing units on contract. All these factories are located at strategic locations, so as to ensure a constant output and easy distribution. Brands An in-depth understanding of the Indian consumer psyche has helped Parle evolve a marketing philosophy that reflects the needs of the Indian masses. With products designed keeping both health and taste in mind, Parle appeals to both health conscious mothers and fun loving kids. The great tradition of taste and nutrition is consistent in every pack on the store shelves, even today. The value-for-money positioning allows people from all classes and age groups to enjoy Parle products to the fullest. Biscuit goodies:| Confectionary:| Parle-G| GolGappa| Krackjack| Classic Mint| Monaco| Lite Mint| Monaco Funion| Kismi| Kreams| Orange Candy| Hide and Seek| Mango Bite| Hide and Seek Milano| Melody| | Poppins| | Eclairs- 50 p| Bourbon| Melody Softe- 1Rs.| | Kismi Bar| Parle Marie| Chox| | Kacha Mango| Milk Shakti| Mazelo| | Imli Bite| | Kismi Gold| Parle 20-20 Cookies| Munch on snacks:| Nimkin| Musst Bites| Parle biscuits: Parle biscuits are linked with factors of power and wisdom providing nutrition and strength. Parle biscuits are indeed much more than a tea- time snack, they are considered by many to be an important part of their daily food. Parle can treat you with a basket of biscuits which are not only satisfying but are also of good and reliable quality. Parle biscuits cater to all tastes from kids to senior citizens. They have found their way into the Indian hearts and homes. Parle G For over 65 years, Parle G has been a part of the lives of every Indian. From the snow capped mountains in the north to the sultry towns in the south, from frenetic cities to laid back villages, Parle G has nourished strengthened and delighted millions. Filled with the goodness of milk and wheat, Parle G is not just a treat for the taste buds, but a source of strength for both body and mind. Tear over a packet of Parle G to experience what has nourished Generations of Indians since last sixty five years, making it truly Hindustan Ki Taakat. Pack Sizes available: 16.5G, 38.5G, 60.5G, 82.5G, 99G, 209G, 313.5G, 418G, 825G 20-20 Rich butter and tempting cashews. An irresistible combination. Parle Twenty-20 cookies. Baked to perfection to deliver the perfect experience of taste and aroma, they melt in your mouth to give you a cookie eating experience unlike one you have ever had before enjoy a feast of crunchy, crispy scrumptious cookies. Pack Sizes available: 75 G, 110 G, 225 G Monaco Share the company of great taste anytime, anywhere with Monaco. A light crispy biscuit sprinkled with salt, Monaco adds a namkeen twist to life’s ordinary moments. Pack Sizes available: 75 G, 120 G, 240 G Hide and Seek The ingredients that go into making this prized cookie are a well-guarded secret. What is is the effect it has on those who eat it. A cookie with a reputation for romance. Indulge in the sinful taste of Milano and everything that follows it. Pack Sizes available: 25 G, 62 G, 100 G, and 200 G Krackjack The original sweet and salty biscuit is one of the most loved biscuits in the country. It’s not just a biscuit, it’s the taste of relationships captured in a biscuit. A little sweet and a little salty crafted in such a delicate and delicious balance, you can never get enough of it. Have it anytime you like with anything you like. Pack Sizes available: 75G, 170G, 240G Parle Confectionaries: Right from candies to toffees, the sweet ‘n’ treat category of the Parle product range is a genuine treat for every snack lover. This category can satisfy one’s taste and at the same time create a desire for more. These confectioneries are a sheer delight to the taste buds and have a universal appeal. Parle Biscuits and confectioneries, continue to spread happiness & joy among people of all ages. Melody Mango Bite Orange Candy Kachcha Mango BiteKismi ToffeeGolgappa Many of the Parle products – biscuits or confectioneries, are market leaders in their category and have won acclaim at the Monde Selection, since 1971. With a 40% share of the total biscuit market and a 15% share of the total confectionary market in India, Parle has grown to become a multi-million dollar company. While to consumers it’s a beacon of faith and trust, competitors look upon Parle as an example of marketing brilliance. Parle G, a premium glucose biscuit is the world’s largest selling biscuit. A factory of these glucose biscuits is situated in Neemrana is producing 7000 metric tonnes every month. A list of premium quality biscuits and confectioneries is produced and distributed across nations. 2. RESEARCH DONE- â€Å"Brand representation of Parle product With Compare to Britannia, ITC in Amravati city† INTRODUCTION The report is an earnest endeavor made to understand the present market scenario in biscuits captured by the Parle and the other competitor brands viz., Britannia, ITC & Other. The researchers were required to see the coverage by Parle Products Pvt. Ltd., and bring out the potential and loyal retailers so that the company could maintain the market leadership in the existing business scenario in the biscuits and the confectionaries. During the course of study the researchers visited around 450 unorganized retail stores and 30 organized retail stores and analyzed all major brands of biscuits available as well as studied the brands, which are most preferred among the retailers. The study encompasses the penetration of the existing Parle products (biscuits and confectionaries). Their motive was to study the working of the distributors in Amravati City market. They have mentioned the problems and the loop holes in the Parle’s distribution system and the promotional tools, which they have found during the course of the study and recommended various corrective measures for it. Their study also comprises the comparative analysis between organized and unorganized retail stores in terms of brand availability with the help of hypothesis testing, Depth of Parle with other competitor, Space sharing by Parle and other competitors, and distributors services given to a retailers with the help of questionnaire. Statement of the Problem: * To analyze the brands of Parle Products in unorganized retail stores: 1. As compared to competitors (ITC, Britannia& other). 2. As compared to organized retail stores. * To analyze Market Depth of Parle Products as compared to competitors (ITC, Britannia& other). * To analyze Space Share of Parle Products as compared to competitors (ITC, Britannia& other). * To analyze Distribution Services of Parle as compared to competitors (ITC, Britannia& other). Objectives of the Study: 1. To find out Parle Coverage in various areas of Amravati City. 2. To check the Brand availability of the company products at different stores. 3. To compare the Brand with its competitive Brands like ITC, Britannia, other in terms of coverage, number of brands available, Market Depth and Space Share. 4. To analyze that which type of biscuits and Confessionary are most preferred in what category of store. It was done by analyzing questioner data. 5. To compare the organized retail stores with unorganized retail stores in terms of brand availability. 6. To analyze Distributor Services with competitors like ITC, Britannia & other. Reference Period: This study is conducted for the period of 45 days starting from 15th of JUNE 2011 to 30th of JULY 2011. PROJECT METHODOLGY: Research Type: EXPLORATORY RESEARCH EXPLANTION: The study was conducted by Parle Products Pvt. Ltd in 6-7 areas of Amravati City mentioned below (source list) for the first time regarding market review and comparative analysis between unorganized and organized retail stores.. Thus it is an exploratory type of research. Sample Design: A sample design is a definite plan for obtaining a sample for a given population. It refers to a techniques or procedure adopted in selecting items for the sample. Sampling: Further, the design that has been adopted for the study of the given topic is CONVENIENT SAMPLING. EXPLANATION: During the course of the study we visited a no. of stores that were scattered all over Amravati City (source list mentioned below). Apart from this we had no written record of the number and names of the stores in the city. It was very difficult to tabulate a record of all the retailers and wholesalers present in the city and then carry out our study, in the short span of time that was allotted. As a result we had to select the retailers according to our convenience. We went to the areas and surveyed all shops that could possibly be approached. The following is the sample design that has been adopted for the study. 1. Population:- Finite(Amravati City) 2. Sampling Unit:- Areas of Amravati City 3. Source list:- Unorganized retail stores (Areas): a. Gadge Nagar b. Yashoda Nagar c. Kour Nagar d. Sai Nagar (Badnera Road, Saturna MIDC Road) e. Raja Peth f. Ram Nagar g. Camp, Chaprasi Pura h. Irwin Chouk Organized retail stores: a. D Mart b. Big Bazar c. Super shopee d. Small mals 4. Sample size:- A total of 470 unorganized retail stores with 10 organized retail stores and 4 Distributors. Tools and techniques for Data Collection: Tools and techniques for: 1. Primary Data: – The researchers collected primary data during the course of research period with the help of the questionnaire that was designed for the storekeepers to collect the information that was required to carry out the research. 2. Secondary Data: – Secondary data was collected from books, articles, Internet and previous research papers that had been conducted by the company representatives and officials. Tools and techniques of Analysis: Simple statistical tools and techniques like average, ratios, pie charts, tables and graphs in addition to hypothesis testing (z-test, for difference between proportions) & factor analysis method are used to analyze the data. Limitations of the Study: 1) The study was conducted in 45 days that is not enough for such a vast topic. 2) It was difficult for the storekeepers to pinpoint the sales of a particular brand in both organized and unorganized retail stores. 3) No proper data was available about the stores in the city. 4) There were not a big number of organized retail stores in Amravati to carry out the research more efficiently. 5) As the nature of research was exploratory so it was difficult to cover each and every retailer. 6) Many retailers don’t express their original perception and views because of biasness. ANALYSIS After Doing the PARLE Products Survey as the researchers analyzed that the best selling branded biscuit company offers its customers with large variety of biscuits (parle-g, krack-jack, 20-20, Monaco, hide and seek etc.), confectionaries (mangobite, melody, poppins). It aims â€Å"TO SERVE PEOPLE AND NATION† The privately owned self financed company provides motivation and confidence to its staff and other related members by providing various facilities and organizing certain events. It has a very open work culture. The atmosphere is so comfortable and relaxed that helps in increasing productivity and efficiency. It lunches and outstation team-building exercises that augment inter-personal relations and mutual understanding. Parle has found its way into the Indian hearts and home. It spreads happiness and joy among the people of all ages. SWOT ANALYSIS OF PARLE PRODUCTS STRENGTH 1. Low price as compared to competitors 2. Sizeable market share in the country. 3. Offers variety of products under its brand. 4. Different sizes of packets are available. 5. An experienced team of sales and marketing executives. 6. Deep and effective coverage 7. Largest distribution system.| WEAKNESS 1. Breakage of biscuits while delivering to retailers 2. No proper replacement system for broken biscuits to retailers 3. Improper and irregular supply. 4. Less share in Premium biscuit market. 5. Dependent on its flagship brand, Parle-G 6. Poor packaging in family pack of glucose biscuits. 7. Lack of schemes for retailers and distributors.| OPPORTUNITY 1. Rising demand for innovative packaging in packaged foods. 2. Retaining loyal retailers or wholesalers. 3. Improving supply system for established brands. 4. Huge scope for some Parle products in medical shops. 5. Information revolution brought about by the television. 6. Good scope for snacks and namkeens, if launched and properly promoted by Parle.| THREAT 1. Highly advertised brands such as Britannia. 2. Ever increasing competition from multinationals and local companies. 3. Increase in sale of cheap local bakery products. 4. Emerging substitutes like wafers, snacks and toast. 5. Margin war among th e major Brands| FINDINGS: After close study of the present market situation prevailing in the areas assigned the researchers, following are the observations. 1. Breakage problem in the Family packs of glucose biscuits is leading to the decline in sales in this category. 2. Schemes, Discounts, offers, coupons etc. are not reaching to the retailers and customers whereas Britannia and ITC on the other hand are doing that. 3. Retailers and even wholesalers is satisfied with the supply system of Parle. 4. It was found that Parle (especially Parle- glucose) is most favored brand and is sold most. Parle biscuits are the retailers and consumers prime choice. 5. Very little range of Parle biscuits were visible in organized retail outlets. 6. Britannia is emerging as Major Competitor in the organized & unorganized retail outlets. RECOMMENDATIONS & SUGGESTIONS: 1. Company should start a program for the loyal retailers and wholesalers to reduce their complaints by providing timely supply and replacement. This will help in increasing their sales. 2. The packaging of Parle Glucose biscuits (1/2 and 1 kilogram packs) must be improved for its better sales. The company should come up with double packaging as people refuse to buy family pack biscuits with loose packaging. 3. Salesmen should be properly dressed and should have good communication skills to effectively promote the new products recently launched, by making sure that the product reaches each and every retailer and also increase the visibility of the products by arranging the product clearly on the shelf or rack and show its prominence. 4. To increase the number of stock keeping units {SKU} available in the retailers store. Each salesman should stress the retailers to keep the maximum SKUs and to maintain these SKUs throughout. With this, the replacement of the damaged and expired biscuits should be prompt and without any hassles, so that retailer can be save d from the loss of the expired and damaged goods. 5. The company should take proper measures that the schemes and offers are not gulped by the middlemen, and that it benefits the retailers and customers. CONCLUSION: After conducting the survey on 470 unorganized retailers, 10 organized retailers and 4 Distributors, the researchers found that there is a bigger market for biscuits and Confessionary in unorganized retail stores if proper supply of goods without breakage is there. It was also concluded that Parle is the first preference of both the customers and retailers (Organized and unorganized both) because of its price and brand image. Brand Parle G dominates the volume-dominated biscuit market. Even in today’s times when multinationals are beefing up their operations and trying to change the dynamics of the market, Parle G’s numbers & Quality position is unchallenged. Its competitors have roped in superstars like King Khan and Sachin Tendulkar, but Parle G has only gone from strength to strength. Brand Parle G is iconic and has evolved over the years. Trust, relevance, affordability are its hallmarks, which have withstood pressures from the hyper-competitive marketplace. The Parle Biscuit brands, such as, Parle-G, Monaco, Krackjack, 20-20, Marie Choice, Hide & Seek and confectionery brands, such as, Melody, Poppins, Mangobite enjoy a strong imagery and appeal amongst consumers across the world. Which has resulted into Parle-G being the â€Å"world’s largest selling biscuit†. The Parle name symbolizes quality, health and great taste. Constantly innovating and catering to new tastes PARLE-G has built its reputation. This can be seen from the success of its new brands such as 20-20, Imli Bite etc. Parle Products Pvt Ltd., is now lagging in services to retailers because of improper supply and distribution in some areas and competitors taking advantage of these points. Appendix: QUESTIONNAIRE Name of the shop: †¦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‚¬ ¦.. Name of the shop owner: †¦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‚¬ ¦.. Address: †¦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‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. Contact No. : †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. Shop Category: †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 1. Weather the retailer keeping Biscuit of any company. Parle Britannia ITC Other 2. If not keeping, weather they are interested to keep? Yes No 3. How much Biscuits brand the retailers have? Parle Britannia ITC Other 4. Space share by Biscuits? Parle Britannia ITC Other 5. Glucose Biscuit Depth. Parle-G Tiger Sun fest other 6. Salted Biscuit Depth. Monaco 50-50 Snacky 7. Cookies Biscuit Depth. 20-20 Good Day Sunfest butter cookies 8. Marie Biscuit Depth. Marie Marie Gold Marie Light 9. Cream Biscuit Depth. Hide-n-Seek Bourbun Spacial 10. Chocolate Brand in Shops? i)Perfeti ii)Parle iii)ITC iv)Nastle v)Cadbary vi)Nutrien vii)Others 11. Space share by chocolates. Perfeti Parle ITC Nastle Cadbary 12. Are you satisfied with distributor services? Parle Britannia ITC Other Remark: ________________________________________________ BIBLIOGRAPHY: I. KOTHARI .C.R. Research Methodology, New Delhi New Age International Publishers II. KOTLER PHILIP & KELLER KEVIN LANE ,Marketing Management ,Practice Hall ,New Delhi III. Websites: wikipedia search: (www.wikipedia.com) www.parleproducts.com www.tradeindia.com

A Brief History of the Young Lords

The Young Lords was  a Puerto Rican political and social action organization that began on the streets of Chicago and New York City in the late 1960s.  The organization disbanded by the mid-1970s, but their radical grassroots campaigns had long-lasting impacts. Historical Context In 1917, the U.S. Congress passed the Jones-Shafroth Act, which granted U.S. citizenship to citizens of Puerto Rico. That same year, Congress also passed the Selective Service Act of 1917, which required all male U.S. citizens between the ages of 21 and 30 to register and potentially be selected for military service. As a result of their newfound citizenship and the extension of the Selective Service Act, approximately 18,000 Puerto Rican men fought for the U.S. in World War I.   At the same time, the U.S. government encouraged and recruited Puerto Rican men to migrate to the U.S. mainland to work in factories and shipyards.  Puerto Rican communities in urban areas like Brooklyn and in Harlem grew, and continued to grow after World War I and during World War II. By the late 1960s, 9.3 million Puerto Ricans lived in New York City. Many other Puerto Ricans migrated to Boston, Philadelphia, and Chicago. Origins and Early Social Activism As Puerto Rican communities grew, dwindling economic resources like proper housing, education, employment, and healthcare became increasingly problematic. Despite their involvement in the wartime labor force and  participation in the front lines of both world wars, Puerto Ricans faced racism, lower social status, and limited employment opportunities. In the 1960s, young Puerto Rican social activists gathered in the Puerto Rican neighborhood of Chicago to form the Young Lord Organization. They were influenced by the Black Panther Partys rejection of a white-only society, and they focused on practical activism such as cleaning up neighborhood garbage, testing for disease, and providing social services. The Chicago organizers provided a charter to their peers in New York, and the New York Young Lords was formed in 1969. In 1969, the Young Lords were described as a ‘’street gang with a social and political conscience.’’ As an organization, the Young Lords were considered militant, but they opposed violence. Their tactics often made news: one action, called the â€Å"Garbage Offensive,† involved lighting garbage on fire to protest the lack of garbage pickup in Puerto Rican neighborhoods. On another occasion, in 1970, they barricaded the Bronxs decrepit Lincoln Hospital, collaborating with likeminded doctors and nurses to provide proper medical treatment to community members. The extreme takeover action ultimately led to the reformation and expansion of Lincoln Hospitals health care and emergency services. Birth of a Political Party As membership grew in New York City, so did their strength as a political party. In the early 1970s, the New York group wanted to disconnect with a perceived street gang held by the Chicago branch, so they broke ties and  opened offices in East Harlem, the South Bronx, Brooklyn, and the Lower East Side.   After the split,  the New York City Young Lords evolved into a political action party, becoming known as the  Young Lords Party. They developed multiple social programs and established branches across the Northeast. The Young Lords Party developed a political structure that resembled a complex hierarchy of parties, within the organization aligned with top-down goals. They used an established set of unified goals and principles that guided multiple organizations within the party called the 13 Point Program. The 13 Point Program The Young Lords Partys 13 Point Program established an ideological foundation that guided all organizations and people within the party. The points represented a mission statement and a declaration of purpose: We want self-determination for Puerto Ricans--Liberation of the Island and inside the United States.We want self-determination for all Latinos.We want liberation of all third world people.We are revolutionary nationalists and oppose racism.We want community control of our institutions and land.We want a true education of our Creole culture and Spanish language.We oppose capitalists and alliances with traitors.We oppose the Amerikkkan military.We want freedom for all political prisoners.We want equality for women. Machismo must be revolutionary... not oppressive.We believe armed self-defense and armed struggle are the only means to liberation.We fight anti-communism with international unity.We want a socialist society. With the 13 Points as a manifesto, sub-groups within the Young Lords Party formed. These groups shared a broad mission, but they had distinct goals, acted separately, and often used  different tactics and methods.   For example, the Womens Union sought to aid women in their social struggle for gender equality. The Puerto Rican Student Union focused on recruiting and educating high school and college students. The Committee for the Defense of the Community focused on social change, establishing nutrition programs for community members and taking on big issues like access to health care. Controversy and Decline As the Young Lords Party grew and expanded  their operations, one branch of the organization became known as the Puerto Rican Revolutionary Workers Organization. The PPRWO was explicitly anti-capitalist, pro-union, and pro-communist. As a result of these stances, the PPRWO came under scrutiny by the U.S. government and was infiltrated by the FBI. The extremism of certain factions of the party led to increased member infighting. The Young Lords Partys membership declined, and the organization was essentially disbanded by 1976.   Legacy The Young Lords Party had a brief existence, but its impact has been long-lasting. Some of the radical organizations grassroots social action campaigns resulted in concrete legislation, and many former members went on to careers in media, politics, and public service.   Young Lords Key Takeaways The Young Lords Organization was an activist group (and, later, a political party)  aimed at improving social conditions for Puerto Ricans in the United States.Grassroots social campaigns like the Garbage Offensive and the takeover of a Bronx hospital were controversial and sometimes extreme, but they made an impact. Many of the Young Lords activist campaigns resulted in concrete reforms.  The Young Lords Party began to decline  in the 1970s as increasingly extremist factions broke off from the group and faced scrutiny from the U.S. government. The organization had essentially disbanded by 1976. Sources â€Å"13 Point Program and Platform of the Young Lords Party.†Institute of Advanced Technology in the Humanities  , Viet Nam Generation, Inc., 1993, www2.iath.virginia.edu/sixties/HTML_docs/Resources/Primary/Manifestos/Young_Lords_platform.html.Enck-Wanzer, Darrel.  The Young Lords: a Reader. New York University Press, 2010.Lee, Jennifer. â€Å"The Young Lords Legacy of Puerto Rican Activism.†Ã‚  The New York Times, 24 Aug. 2009, cityroom.blogs.nytimes.com/2009/08/24/the-young-lords-legacy-of-puerto-rican-activism/.â€Å"New York Young Lords History.†Ã‚  Palante, Latino Education Network Service, palante.org/AboutYoungLords.htm.â€Å" ¡Presente! The Young Lords in New York - Press Release.†Ã‚  Bronx Museum, July 2015, www.bronxmuseum.org/exhibitions/presente-the-young-lords-in-new-york.

Political Issues of Same-Sex Marriage Essay - 3061 Words

Political Issues of Same-Sex Marriage The political aspects of whether same-sex couples should be allowed to federal and government recognized marriages are a very complex issue. There are basically two sides to the political argument of whether same-sex couples should be allowed to marry. On one side are the liberals who feel that marriage is a civil right that should be denied based on the basis of a persons sexual orientation. On the other side you have conservatives who feel that marriage is an institution in which should only constitute one man and one woman. In this report we are going to examine how the issue of same-sex marriages are affecting our current political environment, how politics is affecting the movement for†¦show more content†¦In order to get a better hold of how the issue of same-sex marriage would affect politics, we will take a look at the current and proposed legislature that is shaping the political atmosphere of this issue. 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