Cigar Bar free essay sample

Investigates foundation of imaginary stogie bar. Items, area, advancement, value, rivalry, financing and dangers. Presentation Stogie bars have started showing up in unordinary settings as of late; notwithstanding upscale cafés and clubs, stogie bars have been found in retail chains, lodgings, and as independent organizations. Now and again, the stogie bars are just added to a current foundations tasks; in different cases, the stogie bars fill in as the point of convergence of the activity. This comes when cigarette smoking is getting progressively disagreeable and when endeavors are being made to boycott smoking in numerous bars and cafés. Situated as unwinding for the well off, stogies don't have the disgrace appended to them that cigarettes do, and stogie bar proprietors are anxious to catch a market, including a lot of ladies, which has seen solid development during the 1990s. Given that the stogie bar is at present in the development phase of the lifecycle, there would appear to be . We will compose a custom paper test on Stogie Bar or on the other hand any comparable theme explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page .

Financial Management for Cash Outflows - MyAssignmenthelp.com

Question: Examine about theFinancial Management for Cash Outflows. Answer: Ed Analysis isn't right. Ed has not effectively expected NPV of the item. The likelihood of occurring and non-occurring of any occasion can never be equivalent that is 98% every it must be equivalent to 100%. Ed thinking of increasing of two probabilities for example (98x98)%= 96% and afterward lessening the money inflows by 4% is absolutely erroneous. The item NPV is the right method of assessing the undertaking yet not in the manner Ed has determined. CFO chance appraisal is right and is to be effectively determined. $ 20 million is an extremely considerable sum for an organization like Airway to contribute. In the event that the item isn't acknowledged, the organization may confront chapter 11 or conclusion of business. Money related reasonability is significant for venture acknowledgment. It is plainly observed that if ED item isn't acknowledged, Airway Company will lose all that they have put resources into the item advancement. The right technique for ascertaining NPV is Presen t estimation of Cash inflows Present estimation of money outpourings (Correia et. al, 2005). NPV: PVCI-PVCO Where PVCI is Present estimation of Cash inflows PVCO is Present estimation of Cash surges Money surges are done at zero period that is an underlying period while money inflows are spread over no. of years (model: 5 years) contingent on item anticipated deal life. A reasonable limiting rate is utilized to limit the money inflows and outpourings. On the off chance that NPV is sure, the item or the task ought to be acknowledged in any case on the off chance that NPV is negative, the item or the venture ought to be dismissed (Albrecht et. al, 2011). So the item presented by ED ought to be decided on NPV rules and not on ED computations. We might want to clarify this with a model: Beginning Investment of a venture: 130000 $ Anticipated existence of item: 4 years Rebate Rate: 12% PV factors at 12% YEAR Outpouring INFLOW in $ PV FACTOR @ 12% * PVCI in $ 0 - 130000 $ 1 1 25000 0.8928 22320 2 35000 0.7971 27898 3 55000 0.7117 35585 4 75000 0.6355 47662 All out - 130000 $ 133465 $ *1/1.12= 0.8928, 0.7971, 0.7117, 0.6355. We can find in the model that Present estimation of money outpourings PVCO is 130000 in negative which implies this is a money surge is made at zero periods while the current estimation of money inflows PVCI is + 133465. This shows in the event that this venture is acknowledged, the Net present estimation of this has taken care of its expense outpouring and it is in positive. Here we can say that NPV is 3465 (133465-130000), the venture might be acknowledged. Essentially, Ed is therefore exhorted that he ought not utilize his fanciful figurings for venture examination and acknowledgment of his item. CFO of the organization is right that the NPV computation isn't right (Healy Palepu, 2012). CFO conflict is correct and it is seen plainly. The CFO has accurately implied an inappropriate estimation and consequently, Ed should drop the way fo calculation. So we may infer that Ed technique for computing NPV isn't right and his measurable figurings are unclear. He should update his count of NPV and IRR and utilize right NPV estimations. There are a few lacks in the calculation and subsequently, a right choice won't be conceivable by thinking about this. The fanciful counts whenever utilized can prompt serious issues and numerous difficulties may emerge on the task examination (Henderson et. al, 2015). No doubt, the calculation ought to be done according to the acknowledged strategy and there be a bad situation for nonexistent estimations. References Correia, C, Mayall, P, O'Grady, B Pang, J. 2005. Corporate Financial Management, second ed. Perth: Skystone Investments Pty Ltd. Henderson, S, Peirson, G, Herbohn, K, Howieson, B. (2015). Issues in budgetary bookkeeping. Pearson Higher Education AU. Healy, P. M, Palepu, K. G. (2012). Business Analysis Valuation: Using Financial Statements. Cengage Learning. Albrecht, W, Stice, E Stice, J. (2011). Budgetary bookkeeping. Bricklayer, OH: Thomson/South-Western.

Hospital State of Mind

Hospital State of Mind I hate going to the hospital. Yes, hospitals help people. Most nurses and doctors are nice and have your best interest in mind. But hospitals can also drive you cRaZy. Im in the hospital, and have been since Wednesday. It is driving me crazy. I started talking to my squishible monster and cat socks yesterday. Here are some more terrible things about being in a hospital while also managing being a student at MIT: 1. You constantly worry about missed work Thankfully, Student Support Services is super great about sending emails to professors and letting them know that you are stressed out and medically decapitated. Yes, I did mean the word decapitated. It feels like doctors have chopped off my head. I just want to sit quietly and finish all my homework. 2. There are restrictions that are unnecessary for you (I want to crotchet!!) and are stupid 3. Sleep just doesnt happen in a hospital 4. The food is terrible 5. So bored. Bring art to play with. I decorated my crutches with stickers. I like stickers. I also water color pictures of dolphins. 6. Miscommunications between doctors make everything terrible 7. You have to wear gross-colored unfitted hospital scrubs 8. Home/cat sickness is awful. I miss my kitty!! My boyfriend is watching her and sends me pictures every day. Basically, I want to go home. And I never plan on going to a hospital ever again, or at least for a very very very long time. Also, now Im terrified of doctors and nurses and I am afraid to talk to them. But theres a cat waiting for me. I want my cat!!! And thats it. Im here, and Im stuck until I get better. Hopefully Im better soon, because this sucks.

Essay on The Power of Guiding Children - 1500 Words

The Power of Guiding Children Over the course of an individual’s life span, one is seen forming relationships with several people in whom they find their presence an important aspect to their life. However, among these relationships, parent-child relationships are the most valuable, but also very complex. These relationships are built from a foundation of interaction starting from the birth of the child to their adulthood. Unfortunately, if this involvement is not present within a child’s life, it can ultimately cause them to feel neglected causing outrageous conflicts, behavior issues and emotional disputes. Parental involvement within a child’s life allows them to gain a sense of security ultimately increasing new learning of the child†¦show more content†¦Descriptive praise also comments on what the child has done wrong. Although this may appear to decrease a child’s self-esteem and confidence, in reality it allows them to reflect upon their mistakes, pushing themselves fur ther in order to be appreciated. Without recognition a child feels the need to work towards the incomplete task in order to receive praise, encouraging themselves eventually increasing self-confidence after being praised. Gradually children will become aware of the expectations that are expected of them, comprehending that they have the ability to achieve great heights when they are determined. This motivation allows children to approach situations in the future with a positive attitude as they will take on any task with the mindset to complete it to the best of their ability allowing for success. Certain words of encouragement such as â€Å"youre not complaining about the food† or â€Å"you tasted the peas. That was brave† can influence a child’s behavior positively. This form of communication is not only a way for parents to motivate them, but also a way for them to realize on their own the various expectations parents have for children; thus better understand ing their view on situations. As children are constantly praised for the same things they feel the need to go above and beyond what is expected of them portraying to both themselves and parents that they are aware of expectations. Once children are aware ofShow MoreRelatedPersonal Philosophy Of Guidance For Young Children Essay927 Words   |  4 Pagesindividuality in the classroom. While young children are in our care I believe that teachers need to focus on guiding young children in the right direction. Therefore, three long-term goals that are critical for young children to develop are independence, self-discipline, and initiative. All of the aforementioned goals are pertinent for young children to develop. These goals will influence how they learn and live their lives. Therefore, young children should be guided through multiple techniquesRead MoreSocial Learning and Child Development878 Words   |  4 PagesPlay helps equip children for what life may throw at them. Children are born to be actively engaged and explore the world with their own eyes. Through play children learn what it means to fail in life as well as what it means to accomplish a goal. Play is not only a strategy to keep children entertained in early childhood, but also allows children to learn how to create and work together at an early stage. Children at play has been undervalued by society without realizing that â€Å"playfulness is thatRead MoreThe Principles Of The Early Childhood Education Program972 Words   |  4 Pagesteach is to engage in lifelong intellectual work through the merging of academic theories and research, classroom research and practice, living in the social and political world, and studying the intellectual work of children to produce practices and knowl edge in the best interest of children in a socially just, democratic society. †¢ To teach is to be persistent in learning through inquiry into something or someone; such inquiry is richer and more generative when done collaboratively. †¢ To teach isRead MoreGuiding Childrens Behavior965 Words   |  4 PagesI have rated the fourteen steps to guiding childrens behavior based on personal belief and experience. 1. Model Appropriate Behavior: Show, demonstrate, model and supervise. Children are watching you therefore you need to be the best role model you can be. As a positive role model you need to make good choices and encourage children to do their best too. It has been proven that children with positive role models have higher self-esteem, do better in school and social settings, and are more likelyRead MoreUsing Handheld Breath Guiding Device1291 Words   |  6 PagesWe, Geoff Shellady, Abby Magner, and Kelly Norfleet, engineering students at the University of Virginia in Charlottesville, VA, have invented a handheld breath-guiding device. It is an electronic tool that displays visual animations with which users sync their breathing patterns in order to ease stress and anxiety. Its digital, handheld format provides users with easy access to the device whenever it is needed. Many people are negatively impacted by anxiety and stress on a daily basis. AccordingRead MoreHow Principals Can Establish School-Wide Success870 Words   |  4 Pageswhile having the guiding coalition role model the behavior expected of employees. Creating a climate hospitable to education Effective principals’ ensure that their schools allow both adults and children to put learning at the center of their daily activities. Such â€Å"a healthy school environment,† as Vanderbilt researchers call it, are characterized by basics like safety and orderliness, as well as fewer tangible qualities such as a â€Å"supportive, responsive† attitude toward the children and a sense byRead MoreErik Erikson963 Words   |  4 Pagesenough about language to communicate with other people. Children in the â€Å" terrible twos† no longer want to depend totally on others. Instead, they strive toward autonomy, the ability to do things for themselves. The child’s desires for power and independence often clash with the wishes of the parent. Erikson believes that children at this stage have the dual desire to hold on and to let go. Parents who are flexible enough to permit their children to explore freely and do things for themselves, whileRead MoreOur Prog ram s Philosophy On Positive Child Guidance1063 Words   |  5 Pagespunishing children for accidents or mistakes they make. With the help of our committed staff, we can provide a positive atmosphere that will allow the children to feel loved and accepted to help build their self-esteem. Our program will offer the children with choices, but there will also be reasonable, and developmentally appropriate limits. The educators will model positive behaviours that will teach the children to problem solve and build self-control in a healthy, and safe way. Children are goingRead MorePeru S Tourism History1644 Words   |  7 Pages(O’Hare, 1997). PERU’S INCA HERITAGE The INCA heritage like Machu Picchu and the Inca Trail where TOURISTS IN THE LAKE TITICACA REGION MANAGING GUIDING IN PERU To ensure tourists have pleasing experience while travel in Peru, there are some difficulties that the tourism industry has to face in managing tour guiding (McGrath, 2004). According to the article from a research by University College London , there are different kinds of guides that tourists can find in Peru which includedRead MoreEthical Dilemmas Of Healthcare Professionals1211 Words   |  5 Pagesdefined by Miracle (2011) â€Å"mechanism by which individuals make known how they want medical treatment decisions made when they can no longer make them for themselves† (p.229). Without an advanced directive, medical decisions will fall to Mrs. Smith’s children, Sara and Frank. Each of which have different views regarding their mother’s plan of care. The decision that needs to be made is whether to prolong Mrs. Smith’s life with continued medical intervention, as Sara would like to do, or stop all treatments

According to Arlov Grammatically Free Essays

Many instructors urge their students not to start their sentences with the word â€Å"but†, or any other coordination conjunction for that matter. This can be disheartening for students because we commonly speak with our sentences beginning with a conjunction. However, writing is not like speaking. We will write a custom essay sample on According to Arlov Grammatically or any similar topic only for you Order Now There are two schools of thought on beginning a sentence with the word, â€Å"but†. According to Arlov, â€Å"Grammatically, it is correct to start a sentence with but or any other FANBOYS conjunction. However, your instructors may discourage the practice for two good reasons† (343). She goes on to list the reasons. One good reason not to begin a sentence with the word but is because it is informal and casual. Academic writing is not usually casual or informal, and using â€Å"but† at the beginning of a sentence may make a more formal paper appear less than well thought out. While it is OK for some sorts of writing such as narrative or dialog, a professional paper is seldom written with coordination conjunctions at the beginning of sentences. Also, using words like â€Å"but† is addictive! It is easy to use and overuse. Arlov advises using conjunctions to begin sentences sparingly so as not to make it a hard habit to break. The other side of the issue says using but is just like using any other word to begin a sentence, and therefore, there is nothing wrong with it. How to cite According to Arlov Grammatically, Papers

My Explanation free essay sample

I want to explain to you that I’m average, but I’m one of a kind. I’m a typical teenager, but I’m unique. I want to explain my life to you, but it is impossible to explain one’s life in a few pages. I’m an average 17 year-old white girl living in an average upper-middle class suburb with both of my average parents on Long Island. I’ve never met the President, I’ve never traveled to Africa, and I’ve never cured cancer. I’ve never rescued a cat from a tree, I’ve never helped birth a baby, and I’ve never been on an exotic journey. In 17 years I’ve done a lot, but nothing extraordinary. I wish I could explain all that I’ve done. All of the times I’ve laughed and cried. All of the times I’ve lost people who were important to me, and met new friends that have filled gaps in my heart. We will write a custom essay sample on My Explanation or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page All of the times I’ve read books for hours straight, and watched TV for endless amounts of time. All of the times I’ve been afraid, and I’ve helped others conquer their fears. All of the times I’ve felt alone and felt overwhelmed. All of the times I’ve listened to the same song on repeat for hours, and sat in silence. All of the times I’ve been to funerals, and been to baptisms. All of the times I’ve made others laugh, and made others cry. I wish I could explain it all to you because all of these small ordinary pieces of my life are important. In 17 years I’ve experienced many emotions. I wish I could explain to you all that I’ve felt. All of the emotions that have shaped the person that I am today. How I felt when my Grandpa died. How I felt when people made fun of my acne. How I felt when I came in second place in a poetry contest. How I felt on my 17th birthday. How I felt on September 11th, 2001. How I felt when I s cored three goals in my lacrosse game. How I felt while riding Kingda Ka at Six Flags. How I felt on my first day of sleep away camp in 4th grade. How I felt on my first day of work. How I felt on the first day of high school. But it is simply impossible to explain it all. How can anyone explain all of the emotions that they have felt in their life? In 17 years I’ve learned a lot about myself. I wish I could explain to you everything that I’ve learned. Everything that makes me the person that I am. The person who is allergic to peanut butter. The person who can’t sing. The person who sometimes eats when she’s bored. The person who is shy. The person who is creeped out by bugs. The person who is naturally nervous. The person who gets sunburnt easily. The person who is a perfectionist. The person who hates when people make racist jokes. The person who is a pacifist. The person who is sarcastic. But I can’t tell you everything about myself because I d on’t know everything about myself yet. In 17 years I’ve met a lot of people. I wish I could explain to you the impact that each person has had on my life. The impact of my babysitter that watched me from the time I was a few months old up until I was in fifth grade. The impact of my third grade teacher that let me help grade papers. The impact of my first friend that I met in kindergarten. The impact of my first crush that I played tag with on the playground. The impact of the third graders that I spent an entire summer with. The impact of my seventh grade social studies teacher who I could talk to like a friend. The impact of all of my family members. The impact of all my friends. The impact of my parents. Too many people have touched my life to just choose one to write about. In 17 years I’ve learned important life lessons too. We all have. I wish I could explain to you how and when I learned them all. But I can’t pinpoint when I learned all of these lessons because it happened over a matter of time. I can tell you that I learned the world is a cruel place. I learned that people change. I learned that people say things that they don’t mean. I learned that everything happens for a reason, even if it doesn’t make sense at the time. I learned to cherish the time that I have with people because they can be gone in an instant. I learned to be grateful for all that I have. I’ve learned that change can be a good thing. And I continue to learn new lessons each day. Lessons that will make me understand life. In 17 years I’ve lived an ordinary life. A life that cannot be explained in a couple of pages. A life that cannot be summarized by one experience, one person, one feeling or one lesson. I’ve lived a life that I’m proud of.

A case study diffuse non-scarring alopecia in an adult female patient and an approach to diagonossis and management female-pattern hair loss in primary care setting The WritePass Journal

A case study diffuse non-scarring alopecia in an adult female patient and an approach to diagonossis and management female-pattern hair loss in primary care setting Introduction A case study diffuse non-scarring alopecia in an adult female patient and an approach to diagonossis and management female-pattern hair loss in primary care setting IntroductionCASE STUDYDISCUSSIONHair AnatomyLifecycle of the hair Factors influencing hair growthGrowth FactorsHormonesMineralsOther factorsTypes Of Non-Scarring AlopeciaDiffuse hair lossFemale Pattern Hair LossAcute telogen EffluviumChronic telogen EffluviumTreatment of FPHLMinoxidilThe Hair ConsultationHistoryExaminationScalpHairPull testNon-scalp hair and skinLab testsCASE DISCUSSION AND CONCLUSIONREFERENCESRelated Introduction CASE STUDY Mrs   KJ, a 29 year old manager at a busy law firm, presented to her GP complaining of recent sudden onset of hair loss over a period of a few weeks. What prompted her visit to the GP, was noticing large amounts of hair on the bathroom floor whilst on honeymoon, and subsequently that her scalp hair was suddenly thinner than usual, especially around the temporal areas. She had wondered whether she should be changed back to Cilest (from the Dianette she was currently taking), her original contraception, the cessation of which had appeared to trigger the same symptoms two years before. On that occasion, after stopping Cilest, she had experienced amenorrhoea with facial hirsutism and similar hair loss, leading to investigations and a diagnosis of polycystic ovarian syndrome (PCOS). She then used Dianette oral contraception and for a short time, oral cyproterone acetate, which improved the hair loss. Mrs KJ, who was also a vegetarian, denied use of hair dye or chemicals on her hair, and on the day of her consultation her hair was not styled in a manner promoting traction. Questions regarding family history revealed that her father had died of a heart attack in his fifties. The GP agreed with Mrs KJ that the hair around the temporal and crown areas appeared less than elsewhere on her scalp. The scalp was found to be otherwise normal, with no evidence of scarring alopecia or alopecia areata. The pull test was negative (however, her hair had been washed that morning), blood results (biochemistry and haematology) were deemed normal by the GP and because of the hair shedding, a diagnosis of telogen effluvium (secondary to stress – work and wedding planning) was made. She was advised to stay on Dianette. Because of the previous history and treatment she was referred to a dermatologist with an interest in alopecia, who described a mixed picture of telogen effluvium secondary to low ferritin, and mild androgenetic alopecia. He also asked for the bloods to be repeated, and these showed a decreased ferritin level, high SHBG, and all the rest normal, including zinc, antibody screen, and thyroid tests. He too advised that Mrs KJ remain on the Dianette, and that she start taking an iron supplement. Of interest is that the initial ferritin level done by the GP was 37ng/l, and this fell to 28ng/l over a period of about a month. Haemoglobin was normal. Both these figures were within the normal range provided by the lab (normal range 13-150ug/l, with optimum ferritin for females advised at 27ug/l)1. A few weeks after starting the iron supplements, Mrs KJ came back to see her GP to discuss work related stress which had spiked. In particular she was concerned that she would not be able to manage a very important presentation to the senior partners at the firm. She was so distressed that she found the only thing that calmed her was drinking alcohol, which she was understandably not keen on using regularly! So after some discussion about stress, the GP suggested that she try low dose propranolol for performance anxiety, for only the few days leading up to the presentation, including the actual day of, then to discontinue. Hair loss was not discussed at this consultation. A month later she was back to see the GP, complaining that there had been an even bigger spike in hair loss, and on contacting the dermatologist she had been advised to continue the iron supplementation. She requested a second dermatology opinion, and was then diagnosed with androgenetic alopecia secondary to PCOS, unmasked by telogen effluvium secondary to low ferritin, and a degree of scalp seborrhoea. She was advised to continue taking Dianette, iron supplementation, Ketoconazole shampoo a few times a week, topical minoxidil and topical cyproterone. She was also put on Metformin by her gynaecologist as part of the treatment for PCOS. A number of months later there was a marked improvement in hair growth. As she was keen on starting a family, she was advised to stop oral contraception and to continue the topical treatments, but to stop both minoxidil and cyproterone once she conceived. DISCUSSION In order to understand abnormalities associated with hair loss, it is important to understand the normal hair physiology and anatomy. Having personally spoken with a group of 12 GP’s, about how they would approach a patient complaining of hair loss, all admitted that they felt underprepared to do so. They also admitted to a poor understanding of hair anatomy and physiology. Hair Anatomy Figure 1.   Structure of a hair follicle2 Types of hair There are three types of hair – terminal hairs are thick hairs found on the scalp, axilla and pubic areas; vellus hairs are finer, shorter hairs on the rest of the body; and lanugo hairs develop in utero and are shed in the first few months of life. Anatomy The hair starts to develop within the hair follicle, which is a stocking-like structure made up of an inner and an outer layer.   The hair is divided into the part that protrudes above the skin, called the shaft, and the root, which is within the follicle. The dermal papilla is a finger-like projection into the base of the follicle. It contains capillaries to allow for a rich blood supply to the hair bulb, forming the base of the hair root, the only living part of the hair, and therefore requires nutrients. The hair bulb is the enlarged lower end of the hair into which the dermal papilla projects. It is made up of living cells with a high potential for division and differentiation which divide every 23-72 hours, the fastest rate of any cells in the body3. These cells are called the hair matrix. They divide and move up the follicle to become either hair cells or cells of the inner sheath of the follicle. Among the matrix cells are melanocytes which produce dark (melanin) or red/blonde (phaeomelanin) hair pigment. Pigment is taken up by the differentiating cells of the matrix by phagocytosis. The matrix gives rise to the layers which form the hair shaft – the medulla is the inner layer(not always present in non-terminal hair), the cortex makes up the main bulk of the hair shaft and contains dead keratinocytes, and the cuticle is the layer of tightly packed overlapping cells surrounding and sealing the shaft. The matrix is fed by the dermal papilla, which plays a significant role in hair growth. The dermal papilla produces a number of substances which have an effect on matrix cell growth and differentiation. The dermal papilla is itself under the influence of hormones and regulating substances, which include growth factors. These can increase proliferation of dermal papilla cells, which release cytokines which can act as inhibitors or stimulators of matrix cell growth. The hair follicle is a component of the pilosebaceous unit – one of the other components being the sebaceous gland (as well as apocrine glands in specific areas such as the groin and axilla). The inner layer of the follicle extends up the shaft and ends below the opening of the gland into the follicle, while the outer sheath extends to the gland itself. The outer sheath has a fibrous membrane to which is attached the erector pili muscle, contraction of which causes the hair to stand upright (giving the effect of ‘goosebumps’ when someone is nervous or cold). The sebaceous gland secretes sebum, an oily substance that helps to moisturise the skin and hair, while the apocrine gland is a sweat and scent gland, and mostly becomes activated at puberty under the influence of hormones. Lifecycle of the hair There are three phases of hair growth. Anagen – is the active phase when the cells of the hair bulb are constantly dividing and causing the hair shaft to elongate. This growth phase can last between 3-4 years. Catagen – is the transitional or involutional phase which follows anagen. The hair stops growing, the follicle shrinks slightly and the root is diminished and breaks away from the dermal papilla. This phase lasts 2-3 weeks. Telogen – is the resting phase when the hair is no longer growing and the dermal papilla is not attached to the follicle. This phase lasts 6-12 weeks. When anagen phase restarts and the follicle and dermal papilla reconnect, a new hair forms and starts growing, and can push the old hair out. About 10-15% of scalp hairs are thought to be in telogen phase at any given time.3,4 There is no synchronicity in the hair cycle and so small amounts, about 100 hairs per day, are lost every day, unnoticeably for the most part.   Very occasionally, cycles can be synchronised, for example toward the latter part of pregnancy, thought to be under the influence of hormones, so that larger amounts at a time are shed a few months postpartum; this hair loss is by and large seen as physiological and not pathological, and normal hair growth pattern is usually soon re-established.5 Factors influencing hair growth Progress has been made toward understanding the processes which influence hair growth, but there is still much work to be done in this regard.3,6 Growth Factors Insulin-like growth factor (IGF) accelerates hair growth depending on its concentration at the dermal papilla. This is regulated by IGF binding protein (IGFBP) which reduces the amount of free IGF available for action, and therefore has an inhibitory effect on hair growth. There are also a number of other growth factors which play in a role in hair growth regulation.3,6,8 Hormones Androgens were proven to play a role in androgenic alopecia by Hamilton who noticed that men who were castrated before puberty never grew beards or developed baldness, unless they were treated with testosterone, and that balding men who were castrated showed no progression of balding.6 Androgens stimulate hair growth in some areas such as the beard and groin. In genetically predisposed individuals the presence of circulating androgens can also cause hair loss in areas such as the temporal and vertex areas of the scalp; the occipital area is usually spared. The reason for this is not well understood, and is thought to be related to specific receptors.6,8 The main androgens are testosterone and its metabolite dihydrotestosterone (DHT), the conversion occurring under the action of the enzyme 5 a-reductase at the site of the end organ, in the case of hair, the skin. DHT is more potent than testosterone in this area as it has a higher affinity for the receptors. Sex hormone binding globul in (SHBG) binds to free testosterone, preventing its breakdown to its more active metabolite DHT. Therefore, SHBG has an inhibitory effect on testosterone function. SHBG is in turn inhibited by IGF and insulin – these therefore help to increase the level of active testosterone and DHT.3 Testosterone reduces the anagen phase of the terminal hair, with the result that the hair is shorter and has a smaller diameter, called miniaturisation of the hair, and conversion of the terminal pigmented hair into a vellus (often) non-pigmented hair.3,6,8 The result is that with time, the areas where this occurs appears to have thinner hair growth or appear balding. In females, androgens are manufactured in the ovaries and the adrenal glands. The ovaries produce both male and female hormones, and under the influence of insulin there is increased conversion to testosterone. 3,9 In women with higher levels of circulating insulin, such as those with polycystic ovarian syndrome (PCOS), metabolic syndrome (MS) and insulin resistance, there can be higher levels of androgens due to increased conversion, and the suppressant effect on SHBG. 9 The net result would be a hyperandrogenic state, which could result in AGA, hirsutism, acne, voice changes, among other signs of virilisation. 7 The role of oestrogens appears to be more complicated. 15 The enzyme aromatase is found in oestrogen producing cells in the adrenals, ovaries, testes, fat cells, as well as a few other organs. Aromatase helps to convert testosterone into oestradiol, thereby decreasing the amount of free testosterone. Women who took aromatase inhibitors as part of treatment for other conditions, were found to develop androgenetic male pattern hair loss, indicating that aromatase has a role to play in the pathogenesis of alopecia. The exact nature of this role is unclear. 10 According to Yip et al. oestrogens are at least of equal importance to androgens in scalp hair growth.15 Minerals While iron deficiency anaemia has been widely accepted to be a cause of hair loss17, it is less clear to what extent ferritin levels without the presence of anaemia, has on hair loss. When comparing women of child-bearing age with diffuse telogen hair loss, to those without, in the presence of no nutritional supplementation or underlying medical conditions, women with the hair loss were found to have a mean ferritin level that was significantly lower than those without hair loss. The odds that someone would have ratio   TE was higher when the ferritin level was at 30ng/ml or lower. The authors concluded that serum levels at 30ng/ml or lower therefore increased the chances of TE. 14 However Olsen et al. compared   iron deficiency in women with female pattern hair loss (FPHL or AGA – difference discussed later), CTE and a control group with no hair loss, and found that while iron deficiency was common in all the women, there was no significant difference in levels between the three groups. This study cited as a limiting factor that the outcome of treating the women, who had been discovered to have iron deficiency, was unknown. 12 Theoretically then, those who had hair loss and iron defiency, could have experienced a degree of hair regrowth after the iron deficiency had been treated. While a number of studies have supported the theory that ferritin levels affect hair loss, such as the study by Kantor et al 11 a number have also. Disputed. 12 Although the effects of ferritin on hair loss is still being studied and debated, Rushton suggests it would be advisable to treat even a low normal ferritin, if it was under the level of about 30-70 ng/ml; Trost et al . also advocate that ferritin above 70ng/ml should be aimed at to optimise treatment for AGA, and that the reason for the presence of anaemia or low iron stores should be sought if appropriate, while iron overload should be avoided. 13,16 Zinc deficiency is known to play a role in alopecia, but the mechanism is unclear. 17,18,19 Lack of essential fatty acids can help cause a diffuse alopecia with some lightening in colour of the remaining hair. Selenium deficiency can cause a hair loss similar to zince deficiency. Biotin deficiency can be genetic or acquired (medications like valproic acid, adult excessive consumption of raw eggs) and is also thought to play a part in causing hair loss, but there have been no clinical trials to support biotin supplementation to improve this. 19 Other factors Hair loss is also a well known side effect of thyroid problems, inflammatory illnesses such as lupus, malnutrition, anorexia nervosa, among other conditions, all of which can be picked up as part of the differential diagnosis when evaluating someone with hair loss. 17,20 Stress has also been known to cause hair loss, such as following major surgery or emotional trauma. 17,20 A long list of medications also affects the hair. Heparin, Warfarin, Ace inhibitors, Beta Blockers, Allopurinol, and levodopa, among many other drugs, have been found to cause hair loss 20 Age is also an important determinant, as balding increases with age 21, as is genetics – baldness appears to run in families. There is a marked difference between races in manifestation of androgenic hair loss, with Caucasians exhibiting this the most. 8,15 Types Of Non-Scarring Alopecia Hair loss can be broadly classified as scarring (or cicatricial) alopecia and non-scarring alopecia. There are some occurrences when there is some overlap between these two. Non-scarring alopecia can be further divided into a diffuse hair loss, or localised/patchy hair loss (alopecia areata, not discussed further). Diffuse hair loss This problem is not an uncommon presenting complaint to a GP. It can be noticed by the patient as either decreased hair density/thickness, or as increased hair shedding. The main causes for this would be acute telogen effluvium (ATE), chronic telogen effluvium (CTE) and female pattern hair loss (FPHL). 17 FPHL, together with male pattern hair loss (MPHL) is also known as androgenetic alopecia (AGA), but more authors are now referring to separate nomenclature for the sexes. 8,15,17,20 Although MPHL and FPHL are histologically identical the age of onset in females is later than in males. Also the patterns of hair loss between the sexes differ. The progression of the problem is not as rapid with women or as severe and there is not as good a response to anti-androgen therapy with women, as there is with men.15, 20 Many authors have therefore suggested that in women there is therefore a very complex, multifactorial aetiology. Female Pattern Hair Loss This is the most common type of hair loss affecting women, with prevalence increasing with age. It affects about 12% of women aged 20-29, to about 50% of women over 40, and over 50% by the age of 80. 20, 28 FPHL is an under-recognised entity.20 Androgenetic alopecia has been defined as progressive hair loss in genetically susceptible people in the presence of circulating androgens. Histologically, there is miniaturisation of the terminal hair follicle with progressive transformation of the terminal hair follicle (with central medulla) into a vellus hair follicle (no medulla). 15,17, 20 The role of androgens and androgen receptors is much more established in MPHL, and therefore finasteride and minoxidil are established treatments for MPHL. Androgens definitely have their role to play in FPHL, but there are other factors which influence the disorder as well, which are not clearly understood, such as oestrogens and iron. Many women with FPHL do not have demonstrable elevated androgen levels or other features of hyperandrogenism. 17 Women with hyperandrogenism respond better to anti-androgen treatment. 20 MPHL commonly follows the pattern described by Hamilton, with temporal recession initially, followed by vertex balding, with eventual fusion of the temporal and vertex balding areas and sparing of the occipital area).23 In women, only a small number present with this pattern of hair loss and the degree of balding is not usually as severe as in men. 20 The pattern in FPHL follows three main distributions: Diffuse central-frontal hair loss with sparing of the frontal hairline. In 1977 Ludwig described this in three scales – mild, moderate and severe (almost completely bald at vertex, this is very rare). 17, 20, 24 Diffuse, mainly frontal hair loss (frontal accentuation) with breach of the frontal hairline. The Olsen scale or Christmas tree pattern – this is demonstrated by parting the hair in the midline and noting the part widening, with the narrowest part at the vertex and the widest part toward the frontal hairline. 17, 20, 24 Fronto-temporal and vertex hair thinning, in other words a male pattern of hair loss or Hamilton-Norwood- type. 17, 20, 24 Hamilton-Norwood  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ludwig  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Olsen  Ã‚  Ã‚  Ã‚   (male pattern)  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  (diffuse central)  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   (frontal accentuation)drawing, courtesy ref.24 More recently the Sinclair 5 point scale has been adapted and introduced, and may become more widely used as it allows more subtle description; this may become more necessary as women start to present more early with their hair loss. 20, 24 Sinclair 5-point scale for FPHL drawing courtesy ref. 24 (drawing by L. Tosti) Because it is a progressive problem, without effective treatment the condition will worsen. However the rate of the progression is variable and unpredictable. Diagnosis is usually clinical, based on history and examination. Correct diagnosis is imperative so that the correct treatment can be commenced to try to at least slow down/halt the progression of hair loss, or at best bring about some degree of hair regrowth.17, 20 Progression tends to be slow, with hair loss quite diffuse. It mainly occurs in the distributions mentioned above. Miniaturised hairs are seen in the affected areas, hair shaft diversity is noted more easily on dermoscopic examination. Very occasionally peripilar halos/atrophy is seen as well.   If shedding is present it is not as significant as in ATE or CTE, and the hair pull test is usually negative. Biopsy shows the abovementioned miniaturisation and a decreased terminal:vellus hair ratio, with a lower anagen:telogen ratio. The biopsy, which is not necessary unless doubt exists as to the diagnosis, should be taken from three sites, as a horizontal section and be about 4mm in diameter.17,20,24 By the time a biopsy is contemplated a patient would probably be seen by a dermatologist. While the diagnosis of FPHL is usually clinical, a biopsy should be performed when the diagnosis is uncertain.17,24The main differential diagnosis is CTE.17,20,23 The main difference is that CTE occurs as a rapid hair loss (FPHL is slower), lots of shedding is noted (as opposed to the presenting complaint being thinning hair). With CTE there is a positive pull test (patient should not shampoo their hair for 24 hours prior to test), when the effluvium is in an active shedding phase. Examination of the scalp in CTE does not show widening of the part, or miniaturisation, and biopsy is normal in CTE (apart from showing an increase in telogen hairs).17, 20 Acute telogen Effluvium ATE is also a diffuse type of hair loss which has an abrupt onset, usually seen 2-3 months after a trigger event, and usually does not last for longer than 6 months. About 15% of adult scalp hairs are in telogen phase – when telogen hairs are shed the bulb or club-shaped tip can usually be seen. Anagen hairs have a more tapered tip – there is no bulb because it is attached to the dermal papilla as the hair is still growing. 25 At the time of the precipitating event or trigger for the effluvium, as many as 75% of anagen hairs can be pushed into telogen. 20 A few months later the new anagen hairs starting to grow in the follicle push the old hairs out, and the hair shedding is noticed by the person as hair loss. In actual fact, this shedding is really a sign that new hair is growing. 25 Shedding reaches a peak and hair thickness gradually returns to normal over months in the majority of cases things are largely back to normal by about 1 year. 17 Sometimes the precipitati ng event causes a corresponding Beau’s line in the nail. 25 Potential causes of ATE would include: (febrile) illness, surgery, trauma/accident, childbirth, emotional trauma. Severe and sudden weight loss can also precipitate this. A number of drugs, including beta blockers, can cause an effluvium. Discontinuing the oral contraceptive can also cause hair to fall out, as can jetlag and excessive sun exposure.25 Chronic telogen Effluvium In CTE, the cause tends not be a single event that acts as a one-off trigger, but something that allows the hair loss to be perpetuated for longer than 6 months. 17 Many cases of CTE are idiopathic, but iron deficiency anaemia, hyper/hypothyroidism, zinc deficiency and malnutrition have been implicated as causative/contributory factors by a number of studies. 17,20 In CTE the hair shedding can fluctuate in severity, for example as an animal might moult. 25 Both acute and chronic telogen effluvium does not cause baldness as there is no miniaturisation or conversion of terminal hairs to vellus hairs, only decreased anagen hair growth. However, it can unmask an individual’s genetic tendency to bald. 20    Treatment of Diffuse hair loss Treatment of telogen Effluvium Treatment of acute and chronic telogen effluvium involves treating the underlying causes, if found. Removing the trigger factor for acute telogen effluvium should allow for an improvement in hair growth in most cases by about one year; most people will see an improvement after a few months already. 17,20 If no cause for CTE is found, a biopsy to rule out FPHL should be considered. 20 The course for CTE is that shedding occurs in phases, but never leads to balding. 20 It is thought to potentially take up to 3-10 years to resolve, but there are insufficient studies that have looked properly at this condition over time. 17 Empiric use of minoxidil 2% has been suggested, in the hope of decreasing telogen and increasing anagen. 20 Treatment of FPHL While a general practitioner may not be expected to able to offer all of the therapies available for the treatment of FPHL, it is very helpful to have a good understanding of the therapeutic processes so that patient questions can be dealt with a knowledgeable manner; this improves the therapeutic relationship. The primary care doctor should be able to initiate medical treatment in an uncomplicated case of FPHL. Minoxidil Minoxidil was first discovered to improve AGA while undergoing development as an oral antihypertensive drug, when it was seen to cause hypertrichosis, and hair growth in balding men. 8, 22, 26 It is now used as a topical treatment for AGA in a 2% and 5% strength. The exact mechanism of action is unclear. It is converted into its active metabolite by an enzyme present in the outer follicle of the hair sheath. In its activated form the drug opens potassium channels to bring about a vasodilatory effect, but studies looking at this effect after topical application of minoxidil, have been inconclusive. 22, 27 Other potential mechanisms of action could include induction of new blood vessel formation by increasing vascular endothelial growth factor gene expression at the site of the dermal papilla. Another theory is that it could stimulate activity of an enzyme (cytoprotective prostaglandin synthase I) which stimulates hair growth. 22, 27 It could also increase expression of the gene for he patocyte growth factor, which stimulates hair growth. Messenger and Rundegren 2004 have proposed that the mechanism of action is to cause premature end to telogen and prolong anagen.20, 27 Ongoing studies are needed into the mechanism of action of minoxidil, as this could help with development of better treatments. Although not enough is known about the mechanism of action to improve alopecia, it has been proven to be efficacious for both men and women. 17, 20, 22, 23, 26, 27 The European Dermatology Forum (EDF) performed an extensive literature review (of specific databases) with the aim of formulating evidence-based treatment guidelines for the treatment of AGA (it differentiates between male and female treatments but calls the conditions AGA). Based on the studies reviewed, it recommends topical application of minoxidil 2% or 5% applied twice daily for mild to moderate AGA, with the 5% strength favoured if greater efficacy required. A foam application (as opposed to the solution) is also available, but further studies comparing efficacy to the solution, are needed. 20 For women, the recommendation is also to use the 2% solution twice daily, but there is no evidence currently available to support the use of 5% strength in females.20, 22, 28 In a study by Lucky et al. female patients were foun d to show psychosocial improvement after using 2% and5% minoxidil respectively, compared with placebo. More pruritis, local irritation and hypertrichosis were reported by women using the 5% solution.28 Patients should always be counselled thoroughly before starting medication. This is vital for compliance, as the progression of the hair loss is only halted/reversed for the duration of compliance. Counselling should include how to apply the medication (1ml in   a dropper, applied to dry scalp morning and night and not washed for at least 4 hours – if hair/scalp get wet within an hour the medication should be reapplied), the importance of compliance for results,   when to expect an improvement, as well as potential side effects. 20 There are three main side effects. One is an apparently paradoxical shedding of hairs – if minoxidil does indeed shorten telogen and stimulate anagen then any new hairs forming would ‘push out’ the old. It is very important that the patient is informed to continue with the treatment, and they could be reassured that this is a sign of the medication working; this effect usually occurs in the first 2-8 weeks of treatment.17, 20 , 22, 23 The other main side effects are related to contact, so it is important to warn the patient to wash their hands immediately after application. Hypertrichosis can occur, mainly because of incorrect application (usually disappears about 4 months after cessation of the treatment). 17, 20, 22, 28 The patient should be advised to apply the medication 2 hours before going to bed at night so that there is less risk of transfer to the pillow, and subsequently to the face. 22Contact dermatitis, either allergic or irritant, has also been reported. 17, 20, 22, 28The main causative agent is the vehicle for the drug, called propyleneglycol, in higher concentration in the 5% solution. 20,22, 28 If contact irritant dermatitis is confirmed then the vehicle should be changed (for example to the foam application – positive results have been produced by Lucky et all with regards to equal efficacy to the solution, and better tolerability from subjects). 20 However if an allergy to minoxi dil is confirmed then the treatment needs to be abandoned/changed completely. 20, 22 The EDF has advised that efficacy should be assessed at 6 months for cessation of shedding and 12 months for regrowth.   22 The treatment should be continued for as long as the therapeutic benefit is required. This is lost with cessation of treatment, with hair loss recommencing about 3 months after cessation. Pregnant and lactating women are advised not use minoxidil, even though no adverse outcomes were noted after a large study.17, 20, 22, 23 5 a-reductase inhibitors These drugs were initially aimed at treating men with prostatic hypertrophy, and both licensed 5 a-reductase inhibitors, finasteride and dutasteride, are currently used to treat this condition. Of the two, finasteride is also registered to treat AGA in men.22 The mechanism of action of finasteride is to act as on 5 a-reductase II, the receptors of which are mainly found in the scalp, skin and liver. Dutasteride acts on both types I (gut and prostate) and II 5 a-reductase. Finasteride reduces serum DHT by about 58-60% 17, 22 while dutasteride reduces serum DHT by about 90% 22 In all the clinical trials assessed by the European Dermatology Forum, 1mg of finasteride taken daily showed a significant improvement by 6 months, compared to placebo, and the same was true at 12 months, and up to a 60 months follow-up. Dutasteride was also looked at by a number of authors and showed an improvement in hair loss but at a much higher dose than that needed to treat benign prostatic hypertrophy. 22 Further studies comparing its efficacy to 1mg finasteride are needed. There are not many studies assessing the efficacy of finasteride in females – in a study of post menopausal women taking finasteride, further hair loss was noted.22, 23 Finasteride is therefore not indicated in women, although one study has shown positive results in women with FPHL and hyperandrogenism. 17, 20 There have also been sporadic reports of finasteride improving hair loss in individual female patients.20, 23More studies into finasteride for use in FPHL, are needed. If finasteride is used off licence in a female of reproductive age, adequate contraception needs to be taken to avoid feminisation of a male foetus. 17, 20, 22, 23   For this reason it is completely contraindicated in pregnancy. Finasteride also lowers PSA levels, so a baseline PSA blood test should be done on men aged 45 years or older, who are starting finasteride.20, 22, 23, 26 Finasteride also has a number of side effects which have potential psychosocial impact – it can cause erectile dysfunction in men and decreased libido. As with minoxidil, counselling is therefore indicated as compliance is important for outcome. For those who do not tolerate the 1mg dosage, a 0.2mg dosage can also be effective. 22 Studies looking at combining the above therapies were done. Khandpur et al showed that 2% minoxidil applied twice daily, and 1mg of oral finasteride daily, taken together, was superior to each therapy used by itself. Taking finasteride with Ketoconazole shampoo was also reported to be superior to the abovementioned monotherapies.20, 29 Combination therapies can therefore be considered if monotherapies are insufficient. Compliance is of course important. Hormone Treatment According to the European Dermatology Forum, evidence for the efficacy of hormonal treatment is limited. Anti-androgens act by blockading androgen receptors (AR) – these are therefore contraindicated in men as they cause feminisation. There is no evidence to support the use of oestrogens in men. (ref. 22) The Forum also decided that, based on their literature review, there was insufficient evidence to support the use of oestrogens, progesterones or anti-androgens in FPHL , although there was a place for anti-androgens in the treatment of some women with hyperandrogenism.22 Use of Spironolactone to treat hirsutism and FPHL is common, especially in the US.20 Spironolactone acts by binding to AR and also acts at the site of the ovary to reduce manufacture of androgens. In a study spironolactone was shown to be as effective as cyproterone acetate in FPHL, but only a small percentage of women showed improvement; the majority of women in the study showed no response. 20 Spironolacto ne   is taken at a dosage of 100mg 200mg per day, with concurrent use of contraception. Cyproterone acetate is taken at a dosage of 25-100mg per day for 10 days of every menstrual cycle, also with concurrent use of contraception.17, 20 Cyproterone inhibits gonadotrophin-releasing hormone (GnRH) and blocks AR; it is also used for treatment of acne, prostate cancer and hirsutism. Vexiau compared minoxidil 2%   and cyproterone – the former was more effective in women who had no hyperandrogenism, and the latter was more effective for those who had, 20, 30 suggesting some role for anti-androgens. Flutamide is another anti-androgen; it compared favourably against finasteride and cyproterone for treatment of FPHL, and also compared favourably against Spironolactone for treatment of acne, seborrhoea, FPHL and hirsutism. 20 However, this drug has a significant side effect profile in that it can potentially cause hepatotoxicity – ongoing monitoring is therefore required and the medication should be stopped or not commenced in the face of significant abnormality.20 Anti-androgen therapy can cause disturbances of the menstrual cycle, breast tenderness, and are contraindicated in pregnancy due to feminisation of male foetus. Spironolactone increases potassium levels, so monitoring of electrolytes is required, as well as hypotension. Adequate counselling prior to commencement of treatment is paramount.20 Surgery There are two types of surgical procedures used to treat alopecia – these are hair transplantation and scalp reduction surgery; they can also be used in conjunction with each other. Because AGA is pattern hair loss, as mentioned earlier, there will be certain areas on the scalp that have a greater tendency to balding than others, for example the occipital area does not have a tendency to bald in pattern hair loss. It makes sense therefore, that for hair transplantation to be effective, the donor site needs to be from an area that is less androgen sensitive or prone to shedding, such as the occipital scalp. The process involves microsurgical techniques of implanting harvested terminal hair follicles under local anaesthetic, into areas of scalp needing more hair. Donor sites must be carefully chosen, the grafts harvested, prepared and implanted without any damage, in order to obtain optimal results. Certain techniques show superiority of efficacy 22.   One study showed a combi nation of hair transplantation surgery with 1mg of oral finasteride had superior results at one year compared with surgery alone. 22 In women the ideal candidate has thick occipital hair and decreased hair density over the frontal scalp. 20 Between one and three sessions are usually required 6 months apart to allow adequate assessment of each surgery. 20 Occasionally there is an effluvium a few weeks after the procedure, but this can often be avoided with concurrent use of 2% minoxidil 20. The best results are achieved in controlled/stabilized AGA and when there is optimal, sufficient donor site. Women with concurrent diffuse effluvium are not good candidates as there is not an optimal donor site. In a good candidate, surgery can result in as good a result as in men. 20 Scalp reduction surgery is not as widely practiced as hair transplant surgery. In scalp reduction surgery the area of scalp with alopecia is surgically removed and two areas of scalp with hair growth are surgically approximated. Scarring and the need for revision surgery, are disadvantages. 20,22 Supplementation A number of trials looking at amino acid supplementation, trace element supplementation (zinc, copper, iron), vitamins like biotin and niacin, antioxidants and millet seed, were assessed by the EDF who found the most of the studies flawed in some way and therefore inconclusive. 22 An improvement in hair growth with use of a herbal treatment containing hibiscus, polygonum, fennel chamomile, thiya and menthe was reported by one author 22Another study also showed some improvement in hair growth after application of a Chinese herbal treatment for six months. 22Retinoids were not proven to show a significant improvement. 22 Saw Palmetto was also looked at by some studies and showed improvements that were significant when compared with placebo.22 Cosmetic Aids While treatments for FPHL are ongoing, or if the patient may for some reason choose not to pursue treatment, or if these were perhaps contraindicated in someone, discussing ways of coping cosmetically may be useful. One study 22 noted that both males and females suffer psychologically when afflicted with hair loss, but for men it was more socially acceptable to be balding than for women, and so the psychological impact can be higher for women who face more pressure to have a ‘normal’ physical appearance. Another study looked at the difference between a woman’s perception of the severity of her hair loss, compared with the clinician’s assessment of this 31.   It found that women consistently rated the severity of their hair loss as higher than the clinician. The study also found that the decrease in quality of life was disproportionate to the degree of hair loss. 31 It is therefore important to consider the patient’s psychological and mental health as well when approaching the issue of hair loss. For this reason it is important to address cosmetic aids and discuss practical issues which may help camouflage the problem in a way that makes the patient feel less conspicuous. Sinclair makes the point that a good hairstylist can be invaluable 20; styling hair in a way to create volume and hide the problem, and learning washing, drying and styling techniques that discourage damage to remaining hair is important. Camouflaging products to create the illusion of thickness include hair building fibres, spray hair thickeners, masking lotion, and topical shading. Fibres can be shaken onto the affected scalp and works in about 30 seconds to create the illusion of thickness. Spray thickeners also create the illusion of increased thickness but can be messy to apply. Tinted lotion and topical shading are less messy and help to create thicker looking hair. Another option, especially if the hair loss is very   advanced or if the application of products is unacceptable for whatever reason, is to use hair extensions, hair weaves/integration pieces or wigs. These depend on choice, and on the quality and amount of remaining hair 20. Hair accessories such as hats, scarves and other fashion accessories can also be useful. The Hair Consultation History After noting gender and age, it is important to determine the nature of the complaint. Has the hair been falling out, breaking off, appearing thinner without noticeable hair loss, or does the quality of the hair appear different.   23 Conditions like monilethrix can result in short fragile hair that breaks easily; in some protein energy malnutritional states such as kwashiorkor hair also breaks easily; with thyroid disorders hair can appear dry and course. Has the problem occurred in the past, or is this the first episode? Has it appeared to improve before? In other words, what is the course of the problem? In CTE, the problem can occur for short periods of time, intermittently for a number of years.   Spontaneous regrowth occurs in TE postpartum. Is there a seasonal variation? Also determine the age at which the problem was first noted. 23,24 Have there been associated symptoms related to the hair problem, such as dandruff, itching of the scalp, burning or painful sensation of the scalp, any rashes occurring simultaneously on the body, any systemic features such as tiredness (anaemia, thyroid problems). Initial signs of AGA can be itching or trichodynia. 24 Any inflammatory condition of the scalp can cause hair loss which can be precluded by itching, scaling or flaking of the scalp. An oily skin can indicate increased activity of the seborrhoeic glands which could indicate increased androgen sensitivity/levels. 24 What is the patient’s past medical history (including any change in health in the year before noticing the hair loss)– severe infections, chronic disease which can cause anaemia of chronic disorder, thyroid problems, medications taken, eczema, any autoimmune disorders, and any chemotherapy or radiation therapy in the past. 23,24 Treatment for breast cancer involving anti-oestrogen therapy can be associated with male pattern hair loss. 10 Gynaecological history for women is also important – menorrhagia, PCOS, amenorrhoea, hormonal contraception, whether post-menopausal and if so has/is hormone replacement therapy used. Discuss past pregnancies – was there difficulty in conceiving, miscarriages, was delivery particularly stressful/complicated. Discuss future family planning. Is there a tendency toward acne, hirsutism, and scalp/skin seborrhoea/oiliness?   23,24 Mental health – issues such as trichillomania, anorexia, and taking antipsycholtic or antidepressant medication. Medications can affect hair growth – beta blockers, anti-epileptics, chemotherapy, thyroid medication, oral contraceptions.   20, 23, 24 Social history is also important – some studies have pointed at smoking exacerbating hair loss. 24 Diet can affect nutritional status, which can affect hair. Sudden weight loss can trigger hair loss. 24Being overweight has been connected with hyperinsulinaemia and metabolic syndrome. The use of anabolic steroids can be significant. 24Enquire about hair products and styling methods – traction can cause problems. Family medical history can indicate an autoimmune problem, family history of male or female pattern balding, skin disorders such as atopy or psoriasis, PCOS, hirsutism. 23,24 It is also important to note from the history how the condition has affected the patient. In the study by Reid et al. mentioned earlier, 31 the clinician’s assessment of severity of hair loss did not predict the patient’s perception of severity of the problem, or their quality of life. While mental health may not always be present as a causative factor, hair loss can cause psychosocial problems such as depression, loss of self esteem and social isolation. 26 It is also important to find out what the patient’s expectations, and hopes, for treatment are. 23 Examination The clinician’s initial impressions are important – is the patient wearing a hairstyle with lots of traction on the scalp, is the person over/underweight, is there obvious hirsutism or acne, is the face looking a bit shiny? Does the person appear emotionally distressed/shy and recalcitrant? It is important to clinically evaluate the whole scalp, including skin and actual hair, facial skin and hair growth (are eyelashes present, is there hirsutism, is there appropriate beard growth), body skin and hair growth, and nails (in alopecia areata the nails can appear pitted). 23,24 Scalp With non-scarring alopecia the scalp should appear normal. Sometimes increased seborrhoea can aggravate AGA. (ref. 26) Scaling, erythema and crusting can indicate inflammation.   With scarring alopecia there is loss of the follicular os. 24 Sun damage in longstanding baldness can be significant. 24 Yellow dots are seen in alopecia areata on dermoscopy, which is thought to represent follicular openings plugged with a keratinous and sebum debris mixture. This can help to distinguish FPHL and TE, from alopecia areata incognita. 32 Hair Note the hairstyle, and whether the hair shafts appear damaged/ dry/ brittle/ broken. 23,24 Part the hair and compare width of the parting at the vertex, frontal, temporal and occipital areas – this is important when describing pattern of hair loss. Use a sheet of white paper for dark hair, and black paper for light/grey hair, over a parting in the hair, to look for miniaturised hair, broken hairs or variations among the hairs. 33 Exclamation hairs (tapering broken hairs) indicate alopecia areata. 32 Miniaturisation indicates AGA. 32 Note the pattern of hair loss – in MPHL, there is thinning and recession bitemporally initially, then in the vertex. In FPHL the pattern can demonstrate the Ludwig, Olsen (Christmas tree pattern) or the Sinclair description, or the Hamilton distribution. 20, 23, 24 Diffuse thinning of the hair can also be caused by diffuse alopecia areata or diffuse telogen effluvium. 20, 26, 24, 32 Pull test This is an important test to help differentiate at the initial consultation between the types of non-scarring alopecia, when not clinically obvious. It is important to determine when hair was washed, as a head washed more recently would be more likely to have lost telogen hairs and have fewer to yield. 17, 20 About 50-60 hairs are pulled between the thumb, forefinger and middle finger. A positive test occurs when more than 10% of the hairs can be pulled out.17, 20, 23, 24 Performing the test on different areas of the scalp is useful in excluding diffuse telogen effluvium; often this can co-exist with a pattern hair loss. 17 The test is usually negative for pattern hair loss, except when performed during a telogen phase in the affected area, when there would be more hairs than usual in the telogen phase. If the pull test is positive, a diagnosis other than pattern hair loss should at least be considered. 24 Non-scalp hair and skin Abnormal distribution of body hair is important to note as can indicate a hormonal problem which may need further investigations. An increased amount of body hair can be hormonal or genetic or related to medication. 24 Absent sexual hair can indicate a hormonal problem, and absent or scanty eyebrows or eyelashes can be associated with alopecia areata or frontal fibrosing alopecia. 24 Acne and seborrhoea can be hormonal. 26 Nails are affected by a number of dermatoses, but of the non-scarring alopecias, only alopecia areata has been known to cause nail changes. 24 Mentioned above is that the trigger causing ATE can sometimes cause Beau’s lines in the nails. 25 Lab tests The history and clinical examination should allow a diagnosis of non-scarring alopecia to be made, and for the problem to be classified as either pattern hair loss, telogen effluvium, or alopecia areata (or a combination). Because confounding factors may also be present which can exacerbate hair loss or prevent treatment, it is reasonable to do some laboratory tests, if suggested by the findings of the history and examination.17, 20, 23, 24 Serum ferritin and thyroid hormone levels should be done. 17, 20, 23, 24 In men it has been advised that after the age of 45, a PSA level should performed prior to treatment with finasteride, as this drug can lower PSA. The patient should be made aware of this side effect.23, 26 If on history and examination there is a suspicion of a virilising tumour, PCOS, or hyperandrogenism in women, then additional tests such as a free androgen index (FAI) (total testosterone x 100 / SHBG) test, and prolactin level as screening tests for hyperandrogenaemia – for example levels of FAI of 5 and above indicate that someone may have PCOS (reference). Depending on findings, FSH, or cortisol levels may also be needed, and the patient referred to either a gynaecologist or endocrinologist (or both if needed). 17, 20, 23, 24 Hormone levels are affected by ingestion of exogenous hormones so should be tested if no hormones taken for 2 months at least, and the time of the menstrual cycle noted for adequate interpretation of hormone results. 23 Oestrogens can increase the level of SHBG, and therefore improve FAI. 23 Other investigative tools available to dermatologists are  ·Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   dermoscopy    in FPHL it shows increased hair diameter diversity and an increased number of vellus hairs. 32 Global photography – helps to evaluate the course of hair changes in clinical studies in an objective fashion – set regions of the scalp are photographed using standardised procedure and equipment 23,24 Trichoscan – for diagnostic and follow-up purposes, it measures hair density and anagen/telogen ratios. For reproducibility tattoos of the sample areas in frontal and occipital regions are needed. 23,24 Trichogram – to be used by a dermatologist experienced in its use. 24 Biopsy – not usually required for diagnosis of non-scarring alopecia, but may be helpful if there is doubt about the diagnosis. Much more relevant for cases of scarring alopecia. 17, 20, 23, 24 CASE DISCUSSION AND CONCLUSION The case of Mrs KJ is interesting because of the complexities involved. Her initial hair loss had occurred on cessation of Cilest. She therefore believed that stopping this had caused the problem, and helped maintain hair thickness, hence her request to be put back on Cilest when she saw her GP. As mentioned above, cessation of the combined oral contraceptive has been noted to cause transitory hair loss. However, at the time of the initial presentation she was put on Dianette and cyproterone as she was found to have PCOS. This is one of the potential causes of hyperandrogenism. Although her blood results did not show any hormonal imbalances, she mentioned that she had had facial hirsutism at the time, so was clinically hyperandrogenous without being biochemically hyperandrogenous. It may be that in the presence of normal hormone levels, she was more responsive to existing hormones, possibly with increased receptor sensitivity. The blood results could also not accurately be relied on as she was not taken off the oral contraception. The fact that there was hair growth with cyproterone suggests that androgens had their role to play in her case. When she presented to the GP for the second time, there were a number of issues to note. She had a very stressful and demanding job. It must be noted that Mrs KJ’s personality was that of a perfectionist, and it could be argued that people like this, who are driven to succeed might be more susceptible to stress. She had also planned her wedding and honey moon in the months leading up to the dramatic hair shedding which occurred whilst on honey moon. Added to this was her vegetarian diet, and although she was not anaemic, her ferritin level was below ‘the optimum’ levels discussed above, even though normal according to the lab reference range. The plot thickens. Based on the above the GP had correctly made the diagnosis of a telogen effluvium. However Mrs KJ had the compounding problem of PCOS. The underlying problem for Mrs KJ was the PCOS, a syndrome affecting about 5-10% of women. 34 PCOS symptoms are related to abnormal levels of sex hormones – high/high-normal Luteinising Hormone (LH) and androgens (including testosterone), and low Follicle Stimulating Hormone (FSH) and progesterone. The cause for PCOS is not known but there is an association with insulin resistance. 35 Insulin resistance causes the body to increase the amount of insulin produced. Higher insulin levels increase ovarian production of androgens, which inhibit ovarian follicular maturation, hence the menstrual abnormalities. 35 Higher androgen production also has an effect on hair growth, specifically, thinning of scalp hair in a pattern of hair loss. Although there was no history of baldness in the family, male or female, she presented with a typical male pattern of baldness with bilateral thinning of the temporal areas (Hamilton I). The second dermatologist noted increased seborrhoea, which can indicate clinical hyperandrogenism, and treated with Ketoconazole. This bitemporal thinning could have been occurring unnoticed as FPHL tends to be slowly progressive. Her hair loss shot to her attention with the abrupt onset of the telogen effluvium. One more interesting point to note is that when she saw her GP to discuss stress, neither considered the impact of the propranolol on her hair loss. She did present a few weeks after the short period of having used the propranolol, with a sudden increase in her hair loss, which may well have contributed to by the beta blocker. Whether a few days at a low dose would have made such an impact, is uncertain. The interesting case of Mrs KJ serves as a perfect example of why primary care physicians need to have a good approach to dealing with the rather complex problem of diffuse hair loss. Once each of the (potential) contributory factors had been treated, Mrs KJ started to grow a thicker, more dense, head of hair. Lastly, there is a small subset of patients in whom non-scarring hair loss serves to uncover more serious medical problems such as thyroid disease, hyperinsulinaemia, PCOS, Metabolic Syndrome and potential for heart disease.   This link has been the subject of numerous studies. Matilainen et al. investigated whether early AGA could serve as a marker for insulin resistance, and concluded that further research was needed, but suggested that people with early AGA could benefit from cardiovascular screening.   36 This was supported by Arias-Santiago et al. who investigated lipid levels in women with AGA, and found that women with AGA were shown to have significantly higher levels than women with no AGA. 37   Abdel Fattah and Darwish found that people with metabolic syndrome, regardless of the presence of AGA, were more likely to be have insulin resistance, compared with people with AGA and normal controls. 38 This serves to highlight the point that while much work is still needed t o clarify the above, the vigilant GP, presented with the problem of FPHL, should also be on the lookout for comorbid disease or potential for these.   Mrs KJ’s father had died of a heart attack in his early fifties, but she maintained a healthy lifestyle, normal lipid and glucose profile, and low-normal blood pressure and so had a low risk for cardiovascular disease. There is much on hair loss that was not discussed in this paper, such as cicatricial or scarring alopecia, localised hair loss (alopecia areata) and hair loss in children and adolescents. If the latter occurs, and appears to be non-scarring, it is best discussed with a paediatric endocrinologist and dermatologist. Dr Yumnah Ras MBChB, June 2011 REFERENCES 1. The Doctors Laboratory reference range for normal ferritin levels,2010. tdlpathology.com 2. Gray, Henry. Anatomy of the Human Body. Philadelphia: Lea Febiger, 1918; Bartleby.com, 2000   www.bartleby.com/107/.June 2011 3. Slobodan M.Jankovic and Snezana V.Jankovic. The control of hair growth. Dermatology Online Journal 4(1):2 http://dermatology.cdlib.org/DOJvol4num1/original/jankovi.html 4. http://emedicine.medscape.com/article/835470 Author Samer Alaiti 5. http://emedicine.medscape.com/article/259724 Author Suzanne R Trupin, 6. Messenger, A. The control of Hair Growth: An overview.Journal of Investigative Dermatology Vol.101 No.1supplement,July 1993 7. http://emedicine.medscape.com/article/273153   Author Mohamed Yahya Abdel-Rahman, 8. Trueb, R. Molecular mechanisms of androgenic Alopecia. Experimental Gerontology 37 (2002) 981-990 9. Apridonidze et al.Prevalence and Characteristics of the Metabolic Syndrome in Women with Polycystic Ovary Syndrome. The Journal of Clinical   Endocrinology Metabolism April 1, 2005 vol. 90 no. 4 1929-1935 10. Carlini, et al. Alopecia in a premenopausal breast cancer woman treated with letrozole and triptorelin. Ann Oncol (2003) 14 (11): 1689-1690. doi: 10.1093/annonc/mdg444 11. Kantor et al. Decreased Serum Ferritin is Associated with Alopecia in Women. Journal of Investigative Dermatology (2003) 121, 985–988; oi:10.1046/j.1523-1747.2003.12540.x 12. Olsen et al. Iron deficiency in female pattern hair loss, chronic telogen effluvium, and control groups. Journal Am. Acad. Derm 2010 Dec 63 (6):991-9 Epub 2010 Oct 13. Rushton, D. Decreased Serum ferritin and Alopecia in Women. Journal of Investigative Dermatology (2003) 121, xvii–xviii; doi:10.1046/j.1523-1747.2003.12581.x 14. Moeinvaziri et al.   Iron status in diffuse telogen hair loss among women. Acta Dermatovenerol Croat. 2009;17 (4):279-84. 15. Yip et al. Role of genetics and sex steroid hormones in male androgenetic alopecia and female pattern hair loss: An update of what we now know. Australian Journ derm (2011) 52, 81-88 16. Trost et al. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. Journ. Am. Acad. Dermatol. Vol (54) No.5 824-844 17. Shrivastava et al. Diffuse Hair loss in an adult Female: Approach to diagnosis and management. 18. Prasad, A. Clinical, endocrinological and biochemical effects of zinc deficiency. Clinics in Endocrinology and Metabolism Volume 14, Issue 3, August 1985, Pages 567-589 19. Goldberg et al. Nutrition and Hair. Clinics in Dermatology, Volume 28, Issue 4, July-August 2010, Pages 412-419 20. Dinh, Q and Sinclair, R. Female pattern hair loss: current treatment concepts. Clin Interv Aging. 2007 June; 2(2): 189-199. Published online 2007 June. 21. Gan, D and Sinclair, R. Prevalence of male and female pattern hair loss in Maryborough. J Investig Dermatol Symp Proc. 2005 Dec;10(3):184-9. 22.European Dermatology Forum, S3-Guideline on Androgenetic Alopecia. euroderm.org/edf/images/stories/guidelines/S3_guideline_androgenetic_alopecia.pdf 23. Blume-Peytavi, U and Vogt, A. Current Standards in the diagnostics and therapy of hair diseases. JDDG; 2011 9:394-412 24. Blume-Peytavi et al. S1 guideline for diagnosic evaluation in androgeentic alopecia in men, women and adolescents. Br J Dermatol. 2011 Jan;164(1):5-15. doi: 10.1111/j.1365-2133.2010.10011.x. Epub 2010 Dec 8. 25. http://dermnetnz.org/hair-nails-sweat/telogen-effluvium.html June 2011 26. Hordinsky, M. Medical Treatment of Noncicatricial Alopecia. Seminars in Cutaneous Medicine and Surgery Volume 25, Issue 1, March 2006, Pages 51-55 27. Messenger, A and Rundegren, J. Minoxidil: Mechanisms of Action on Hair Growth. British Journal of Dermatology Vol 150 (2):186–194, Feb 2004 28. Lucky et al. A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss. J Am Acad Dermatol Vol 50 (4) p 541-553 29. Khandpur et al. Comparative efficacy of various treatment regimens for androgenetic alopecia in men.J Dermatol. 2002 Aug;29(8):489-98. 30. Vixiau et al. Effects of minoxidil 2% vs. cyproterone acetate treatment on female androgenetic alopecia: a controlled, 12-month randomized trial. British Journal of Dermatology Volume 146, Issue 6, pages 992–999, June 2002 31. Reid et al. Clinical Severity does not reliably predict quality of life in women with alopecia areatam telogen effluvium, or androgenenic alopecia. Journal of the American Academy of Dermatology, In Press, Corrected Proof, Available online 24 May 2011. 32. Tosti, A and Duque-Estrada, B. Dermoscopy in Hair Disorders. J Egypt Women Dermatol Soc. Vol. 7, No. 1, 2010 33. Course Notes on Hair, QMUL post.grad. Dip.Derm 2010/2011. 34. verity-pcos.org.uk/guidetopcos/whatispcos 35. Kovacs,P. Metabolic Syndrome amd PCOS. Medscape Ob/Gyn 2003; 8(2) medscape.com/viewarticle/456221 36. Matileinen et al. Early Androgenetic Alopecia as a marker of Insulin Resistance. The Lancet Vol(356) p1165-1166 Sept 30, 2000. 37. Arias-Santiago et al. Lipid levels in women with angrogenetic alopecia. International Journal of Dermatology 2010, 49, 1340-1342 38. Abdel Fattah, N and Darwish Y. Androgenetic alopecia and insulin reistance: are they truly associated? International Journal of Dermatology 2011, 50, 417-421

Eight Great Gift Ideas for Your Francophile Friends

Eight Great Gift Ideas for Your Francophile Friends What gifts could you give to your Francophile or France loving friends? Nowadays, with e-commerce, sending the right gift to the right person is so much easier. Yet, there are so many choices out there. Here is my top eight list: 1 – A Book about France Check out your local Amazon store, there are plenty of beautiful books about France.  First, select the â€Å"book† category. Then, you have a lot of choices. To narrow down the searches, look at the options on your left (you may need to press â€Å"see more†). Select: - â€Å"Art and photography† for beautiful books. I love The Louvre - all the paintings, The Best loved villages of France, and Spectacular Paris.- â€Å"Travel guides† to prepare a trip.  - â€Å"Cookbook, food and wine also make a great idea. My husband is a great cook, and his favorite is Mastering the Art of French Cooking - You cannot go wrong with Julia Child! And My Paris Kitchen - Olivier often picks up David Lebovitzs book for inspiration, and all his recipes always turn out perfect - we highly recommend it.- â€Å"Comic book† – what about a French edition of the world-famous â€Å"Tintin† or â€Å"Astà ©rix†?   Then, you can have your book shipped wherever you like, and even have it gift-wrapped. How practical! 2 – A French CD/MP3 or DVD French music is so readily available, both in stores and on the web. Of course you have the classics: Brel, Aznavour, Piaf... but there are many young talents out there: you may have heard of â€Å"Stromae† but he is not the only one (check out â€Å"Zaz†, â€Å"M Pocora† â€Å"Tal†, â€Å"Bà ©nabar†Ã¢â‚¬ ¦) : Check out my Pinterest board â€Å"Les VIP du PAF (Screen and Audio French VIPs) for inspiration, pictures, and videos of who’s hot in France right now. For movies in French, check out Amazon Canada – you’ll pay a bit more for shipping but will have a much larger selection and you are still in the appropriate DVD zone for the US.​ Note: Unfortunately, DVDs are ‘region locked’ and so a DVD meant for the European market will not play on a standard US/CAN DVD player. If this is a DVD for a US/Canadian based friend, make sure it’s â€Å"Region 1† (or that they have a hacked and unlocked DVD player). 3 – A French Audiobook What about learning some French? There are a ton of resources out there, including pricey French learning software (If you are going this way, I recommend Fluenz) and old-fashion dictionaries. You will, of course, find plenty of textbooks on Amazon, but if you ask me, students of French absolutely need an audio support. Audiobooks are convenient; your friend can download them to their smart phone and use them on the go, during workouts or commuting time. If your friends are French or speak French fluently, check out Audible for their selection of audio novels in French. And if your friends are still learning French, then pick a  level appropriate French audio novel or French learning method  on my site, FrenchToday.com. 4 – French Gourmet Food Still on Amazon, check the category â€Å"grocery and gourmet food† and type â€Å"France† or anything special you would be looking for. There is a gift there for any budget. You can also go to your local fine grocery store, and once you look carefully, you’ll be surprised at the number of French food items.   â€Å"Fleur de sel de Guà ©rande† makes a great gift for foodies (this is actually the one Olivier loves), but there are also many French mustards (I love the brand â€Å"Maille†) and spices, cookies, and chocolate. 5 – French Wine Tasting You don’t need to be in France to taste French wines. If you live in a large city, chances are that your local wine store organizes wine tastings. Pay them a visit and ask them if and when they plan on having a French wine tasting. You could even ask them if they could organize one for you and your Francophile friends. Stores are usually very happy to do so and it would be a fun moment, and a personalized gift for your friend. 6– French Perfume and Make-Up Chanel, Dior, Lancà ´me... We dream about these brands but only few people can treat themselves to this kind of luxury. However, many of these brands do have a cosmetic department, and a Dior Lipstick for example is a gift that will most likely impress any lady. You can find them online or in any large department store. 7 – Coupon for a French Restaurant Ok, this one may be a bit on the expensive side. But it’s fun. And if your friends often go to their favorite French restaurant, you can call that restaurant and ask to buy a bottle of wine for the next time your friends go there.   8– French Magazine Subscription There are many French magazines out there, and with Amazon.com, you can get a subscription to a magazine in French right to your door: Vogue, Cuisine et vins de France, Marie-Claire Maison, Photo, Voici or Gala,  they make wonderful gifts because every month, your friend will be reminded of your thoughtful gift. Je mets tous les jours des mini-leà §ons gratuites sur Facebook, Twitter et Pinterest - venez m’y rejoindre! I also wrote many articles about Christmas in France:- 7 Must Know Noà «l Traditions- Christmas in France Dialogue - French English Bilingual Easy Story- Meet the French Santa - French English Bilingual Easy Story-8 Gift Ideas for Your Francophile Friends- Petit Papa Noà «l - The Most Famous French Christmas Song (with a link to a video of my daughter singing it!)-  My enunciated recording of the Catholic mass prayers in French Joyeuses fà ªtes de fin dannà ©e! Happy Holidays!

Buometric ID system in Europ Essay Example | Topics and Well Written Essays - 2000 words

Buometric ID system in Europ - Essay Example (Jain, 2004) The privacy issues related to biometrics are primarily concerned with the civil rights of individuals and the way that the security apparatus of government uses biometric information in law enforcement. The issues of individual privacy vs. the legitimate technological use of biometric information will be discussed in this essay in order to analyze the EU policy that would implement biometric information as a basic part of passports and identity cards. Where the social utility of biometric data is furthered by the expansion of technological developments, the civil rights issues of their use must be clearly determined by a review of institutional practice in order for a fair and sustainable policy to be developed. This essay will review the current efforts to implement biometric identification on a universal basis in the EU in the context of human rights and civil liberties to determine if the current application of policy is threatening to the privacy concerns of individu als. The current proposal for biometric use in the EU includes the complete integration of the technology with existing passport controls and personal identification cards in society. (Heath, 2006) This system will be used in the management of immigration, travel, and related security services in the EU. (Jain, 2004) What the debate over biometrics in this context suggests is that the implementation for security is the main concern, with the risk of terrorism in airports and train stations a major risk to public safety. However, the security use may also â€Å"demonize† this technology by painting it in a negative light socially, whereas the technology itself may be given a wider and more beneficial use in easing transactions and identity verification for other purposes. The biometric technology is a product of human invention and its use is contingent on the motivations of the architects of the system. Rather than being inherently invasive or a threat to civil

Movie Safe 1995 Essay Example | Topics and Well Written Essays - 1250 words

Movie Safe 1995 - Essay Example It is looks like that traditional medical science is not capable of healing those people, who cannot accept the environment. In the movie 'Safe', to my view, Carol White doesn't receive appropriate and adequate treatment, yet she seeks aid in a high-tech medical center. The main problem is that she is alone in her family who has not emotional relationship with her husband and her stepson. Also, using soft and dark colors and sounds cause her to go to inner darkness of illness. The nature of Carol's illness and to compare treatment methods, applies by two different directions of medicine In the movie 'Safe', Carol White (Julianne Moore) lives with her husband and stepson in a comfortable suburban home in California. Her life is completely predictable, and in spite of the fact that she has 'relationship' with her husband, she begins feeling isolated and then - drained and depressed. Mysteriously, she falls ill with weird symptoms: she experiences nose bleedings, dizziness and allergies, and doctor attributes it to stress. Having passed different tests, she understand that there is nothing physically wrong with her, but nevertheless she takes medication and changes her diet, getting of the all-fruit diet and cutting back diary products. When her condition doesn't go away, she gets a recommendation to visit psychiatrist. The problem with her mind is a reason for the illness. Carol finally understands the necessity, which requires of her to go to a place, where people who suffer from toxic allergies and those with AIDS can 'clean' themselves, and, probably, the only pla ce where she can feel safe. To my view, treatment, received at hospital, is improper and probably, only worsened the situation. Haynes's idea was to show the powerlessness of traditional medical science against new illnesses, which are called by external irritants, but destroy humans from inside. In the films, Carol combats a real ten-headed hydra, which responds to the new treatment courses with new painful fits of allergy. Carol drives her car - and endures a coughing fir; she breathes in her new perfumes -and feels lightheadedness. Aerobic classes, which pursued a goal of helping her relax, initially doomed to be unsuccessful: she has never had tension in her life, she has never had close relations, so there was no ground for either extremely positive or extremely negative emotions in her life. Thus, she cannot relax, because she never experiences stresses in pure medical meaning. Moreover, the medicaments Carol receives are irritants, as they also consist of toxins or other synthetic substances. On the cont rary, Dunning chooses a different direction and creates some kind of cult, or community with certain beliefs, values and philosophy. People living there find there attachment and new system of coordinates, in which it is possible to consider their illness and cope with related inner problems. It is possible to notice that by the end of the movie, she becomes increasingly more shattered, and probably her sickness breaks her and makes her re-evaluate the relationships which had existed in her life before she fell ill. She has a husband, bad hasn't given birth to children, because Carol 'endures' the existence of domestic plant, which should be carefully watered and supplied with the necessary nourishment, but whose opinion weighs like any plant's opinion. It is possible to

Introduction To Social Media Analysis Marketing Essay

Introduction To Social Media Analysis Marketing Essay Introduction to Social Media Analysis People are talking about you-your company, your products, your people. With modern, digital communications tools, theyre publishing their thoughts to a worldwide audience. They write on blogs and in online communities, and they share pictures and videos on popular sites, such as MySpace and YouTube. Sometimes, the issues they raise show up on the front page of major newspapers. Paying attention to these online conversations is a new imperative for anyone who cares about their companys reputation. Social media analysis is the broad term for the services and tools you will use to pay attention. It incorporates monitoring, measuring and analyzing Internet-based social media, usually combining automated systems and human insight to turn raw data into useful information. Its most often used in marketing and communications/PR functions, which is why some people call it brand monitoring. But theres more to it than monitoring, and its not used only in marketing. Customer service, product groups, competitive intelligence, and investor relations-or any other relations function-will find useful information. Specialized applications for institutional investors, lenders and supply-chain managers are also available. If you use information, social media analysis opens vast new sources. Idea behind This Study: In Pakistan very few people are encouraging their businesses through social media marketing, mostly our internet usage went under the heading of ENTERTAINEMENT, so I want to study that where the actually person drive to while using Internet in Pakistan. How social media marketing can help us? How it is used, what are its advantages and disadvantages, how to build interest in it and those who are using and making money through it, how they are doing this? ABSTRACTS SAP A Company Transforms Itself Through Social Media This case study was written to demonstrate how a company can create a social networking platform that not only achieves its tactical goals of pushing company content to its target audience, but also broader, strategic purposes aligned with the companys corporate profile and brand. The study will look at technologies used to develop the SDN and the BPX networks, the quality of the user experience, and metrics achieved, as well as issues related to maintaining and growing the network. SAP, faced a new challenge. No longer was it content simply to be a developer of much of the worlds most successful business software. Instead, it wished to become a platform company, on its own Web-based platform solution: NetWeaver. That meant it had to open its platform to developers outside its own walls, who would drive innovative ways for businesses to use this platform to solve their business problems. It meant it had to talk to a huge, new audience that had not been part of its prior focus: developers across the globe that may or may not be SAP employees. Additional objectives included a desire to increase adoption of SAP products and to provide a platform of innovation for SAP and its partners. To obtain the main goal, SAP launches two new softwares for this called as SDN and BPX. Both networks are transparent, anyone can sign up, and both are searchable. Users can subscribe and obtain RSS feeds from the most popular bloggers, and all the content is accessible to social book-marking sites, as well as from Google and other search sites. SAP was formerly viewed as rigid, monolithic, and overly process-oriented but after adoption of Social Media it is now viewed as open and collaborative Methodology: Discussion Forums were opened up in Web page format where a rate of about 4,000 posts Per day was recorded. These were followed by blogs, initially contributed by employees, and quickly opened to outsiders. Active contributors include customers, consultants, and other opinion leaders, and the blogs feature everything from long-form essays on relevant topics to shorter bursts about future trends or interesting innovations. Conclusion Finally, the author speculates on how the success of the combined networks could lead to further revenue growth and enhancement of current corporate communications. How People Perceive Online Behavioral Advertising They performed a series of in-depth qualitative interviews with 14 subjects who answered advertisements to participate in a university study about Internet advertising. Subjects were not informed this study had to do with behavioral advertising privacy, but raised privacy concerns on their own unprompted. They asked, What are the best and worst things about Internet advertising? and what do you think about Internet advertising? Participants held a wide range of views ranging from enthusiasm about ads that inform them of new products and discounts they would not otherwise know about, to resignation that ads are a fact of life, to resentment of ads that they find insulting. Many participants raised privacy issues in the first few minutes of discussion without any prompting about privacy. They discovered that many participants have a poor understanding of how Internet advertising works, do not understand the use of first-party cookies, let alone third-party cookies, did not realize that behavioral advertising already takes place, believe that their actions online are completely anonymous unless they are logged into a website, and believe that there are legal protections that prohibit companies from sharing information they collect online. They found that participants have substantial confusion about the results of the actions they take within their browsers, do not understand the technology they work with now, and clear cookies as much out of a notion of hygiene as for privacy. They also found divergent views on what constitutes advertising. Industry self-regulation guidelines assume consumers can distinguish third-party widgets from first-party content, and further assume that consumers understand data flows to third-party advertisers. Instead, we find some people are not even aware of when they are being advertised to, let alone aware of what data is collected or how it is used. Methodology: A series of in-depth qualitative interviews with 14 subjects were conducted. A modified mental models protocol of semi-structured interviews were followed using standard preliminary questions for all participants while also following up individually to gather participants understanding of and reaction to behavioral advertising in particular. Conclusion Consumers have a very clear understanding of when and where Google search displays advertisements. However, consumers do not understand which parts of the New York Times website are advertisements. They lack the knowledge to distinguish widgets from first party content. Consequently, it is overly optimistic to believe consumers know their data flows to widget providers as a first party. THE VALUE OF A FACEBOOK FAN: AN EMPIRICAL REVIEW As Facebook matures as a viable marketing and customer service channel, many organizations are looking to quantify and understand the impact of their overall marketing investment on their business. Quantifying the Return on investment (ROI) of Facebook marketing efforts includes multiple variables and companies often fail to understand and to properly value their efforts in terms of the potential long-term business benefits of the Facebook channel. Many brands overcomplicate their measurement requirements by tracking dozens of independent variables. Many oversimplify by trying to apply a single number concept of value, and far too many fail to quantify ROI in such a way as to convince a CFO of the merit of increasing or shifting investment towards Facebook marketing. Syncapse has adopted a unique approach to understanding the financial returns that social members on Facebook provide to a business. Facebook fan ROI can be understood though a knowledge of key performance indicators that have traditionally led to increased sales and profit in business and the key differences between Facebook users who have opted to fan a brand and those who have not. This study will examine the five leading contributors to Facebook fan value. (1) Product Spending (2) Brand Loyalty, (3) Propensity to Recommend, (4) Brand Affinity and (5) Earned Media Value. Methodology The quantitative research for this Syncapse undertaking was conducted in conjunction with Hotspex Market Research and consisted of a 25-minute survey using their online panel. Data was collected from over 4,000 panelists across North America in June 2010. Conclusion As growing audiences migrate to social networks like Facebook, a brands ability to connect and influence these customers must shift from traditional marketing strategies. Facebook fans represent a significant opportunity to drive revenue enhancement, brand, and loyalty without incurring the considerable cost-per-person of conventional marketing. More importantly, such Facebook strategies allow for a discernable ROI that is not allowed by most other approaches. Fans are an extremely valuable segment of the Internet audience and should be addressed with specific strategies to nurture their ongoing participation and influence. Unlike traditional campaign-based marketing, Facebook-based marketing through well crafted fan utilization has no defined shelf life and can be more readily integrated into the day-to-day operation of the enterprise. Social Media Use in the United States: Implications for Health Communication Given the rapid changes in the communication landscape brought about by participative Internet use and social media, it is important to develop a better understanding of these technologies and their impact on health communication. The first step in this effort is to identify the characteristics of current social media users. Up-to-date reporting of current social media use will help monitor the growth of social media and inform health promotion/communication efforts aiming to effectively utilize social media. The purpose of the study is to identify the sociodemographic and health-related factors associated with current adult social media users in the United States. Methods: Data came from the 2007 iteration of the Health Information National Trends Study (HINTS, N = 7674). HINTS is a nationally representative cross-sectional survey on health-related communication trends and practices. Survey respondents who reported having accessed the Internet (N = 5078) were asked whether, over the past year, they had (1) participated in an online support group, (2) written in a blog, (3) visited a social networking site. Bivariate and multivariate logistic regression analyses were conducted to identify predictors of each type of social media use. Conclusions: Recent growth of social media is not uniformly distributed across age groups; therefore, health communication programs utilizing social media must first consider the age of the targeted population to help ensure that messages reach the intended audience. While racial/ethnic and health status-related disparities exist in Internet access, among those with Internet access, these characteristics do not affect social media use. This finding suggests that the new technologies, represented by social media, may be changing the communication pattern throughout the United States. DELIVRABLE II Introduction Billions of people create trillions of connections through social media each day, but few of us consider how each click and key press builds relationships that, in aggregate, form a vast social network. Passionate users of social media tools such as email, blogs, microblogs, and wikis eagerly send personal or public messages, post strongly felt opinions, or contribute to community knowledge to develop partnerships, promote cultural heritage, and advance development. Devoted social networkers create and share digital media and rate or recommend resources to pool their experiences, provide help for neighbors and colleagues, and express their creativity. The results are vast, complex networks of connections that link people to other people, documents, locations, concepts, and other objects. New tools are now available to collect, analyze, visualize, and generate insights from the collections of connections formed from billions of messages, links, posts, edits, uploaded photos and videos , reviews, and recommendations. As social media have emerged as a widespread platform for human interaction, the invisible ties that link each of us to others have become more visible and machine readable. The result is a new opportunity to map social networks in detail and scale never before seen. The complex structures that emerge from webs of social relationships can now be studied with computer programs and graphical maps that leverage the science of social network analysis to capture the shape and key locations within a landscape of ties and links. These maps can guide new journeys through social landscapes that were previously uncharted. Social network analysis is the application of the broader field of network science to the study of human relationships and connections. Social networks are primordial; they have a history that long predates systems like Facebook and Friendster, and even the first email message. Ever since anyone exchanged help with anyone else, social networks have existed, even if they were mostly invisible. Social networks are created from any collection of connections among a group of people and things. In the twenty-first century, network science has blossomed alongside a new global culture of commonplace networked communications. With widespread network connectivity, within just the past few decades, billions of people have changed their lives by creatively using social media. We use social media to bring our families and friends closer together, reach out to neighbors and colleagues, and invigorate markets for products and services. Social media are used to create connections that can bind local regions and span continents. These connections range from the trivial to the most valued, potent collaborations, relationships, and communities. Social media tools have been used successfully to create large-scale successful collaborative public projects like Wikipedia, open source software used by millions, new forms of political participation, and scientific collaboratories that accelerate research. Unheard of just a few years ago, today systems such as blogs, wikis, Twitter, and Facebook are now headline news with social and political implications that stretch around the globe. Despite the very different shapes, sizes, and goals of the institutions involved in social media, the common structure that unifies all social media spaces is a social network. All of these systems create connections that leave traces and collectively create networks. The rise of social media Social media are visible in the form of consumer applications such as Facebook and Twitter, but significant use of social media tools takes place behind the firewalls that surround most corporations, institutions, and organizations. Inside these enterprises employees share documents, post messages and engage in extensive discussions, document annotation, and create extensive patterns of connections with other employees and other resources. Social media tools cultivate the internal discussions that improve quality, lower costs, and enable the creation of customer and partner communities that offer new opportunities for coordination, marketing, advertising, and customer support. As enterprises adopt tools like email, message boards, blogs, wikis, document sharing, and activity streams, they generate a number of social network data structures. These networks contain information that has significant business value by exposing participants in the business network who play critical and unique roles. Some employees act as bridges or brokers between otherwise separated segments of the company. Others have patterns of connection that indicate that they serve as sources of information for many others. Social network analysis of organizations offers a form of MRI or x-ray image of the organizational structure of the company. These images illuminate the ways the members of the organization are actually structured in contrast to the formal hierarchies. Individual Contributions Generate Public Wealth Collections of individual social media contributions can create vast, often beneficial, yet complex social institutions. Seeing the social media forest, and not just the trees, branches, and leaves, requires tools that can assemble, organize, and present an integrated view of large volumes of records of interactions. Building a better view of the social media landscape of connection can lead to improved user interfaces and policies that increase individual contributions and their quality. It can lead to better management tools and strategies that help individuals, organizations, and governments to more effectively apply social media to their priorities. However, dangerous criminals, malicious vandals, promoters of racial hatred, and oppressive governments can also use social media tools to enable destructive activities. Critics of social media warn of the dangers of lost responsibility and respect for creative contributions, when vital resources are assembled from many small pieces [1]. These dangers heighten interest in understanding how social media phenomena can be studied, improved, and protected. Why do some groups of people succeed in using these tools while many others fail? Community managers and participants can learn to use social network maps of their social media spaces to cultivate their best features and limit negative outcomes. Social network measures and maps can be used to gain insights into collective activity and guide optimization of their productive capacity while limiting the destructive forces that plague most efforts at computer-mediated communications. People interested in cultivating these communities can m easure and map social media activity in order to compare and contrast social media efforts to one another. Around the world, community stakeholders, managers, leaders, and members have found that they can all benefit from learning how to apply social network analysis methods to study, track, and compare the dynamics of their communities and the influence of individual contributions. Business leaders and analysts can study enterprise social networks to improve the performance of organizations by identifying key contributors, locating gaps or disconnections across the organization, and discovering important documents and other digital objects. Marketing and service directors can use social media network analysis to guide the promotion of their products and services, track compliments and complaints, and respond to priority customer requests. Community managers can apply these techniques to public-facing systems that gather people around a common interest and ensure that socially productive relationships are established. Social media tools have become central to national priorities requiring government agency leaders to become skillful in building and managing their communities and connections. Governments at all levels must learn to optimize and sustain social media tools for public health information dissemination, disaster response, energy conservation, environmental protection, community safety, and more. Background to the Problem Billions of people now weave a complex collection of email, Twitter, mobile short text messages, shared photos, podcasts, audio and video streams, blogs, wikis, discussion groups, virtual reality game environments, and social networking sites like Facebook and MySpace to connect them to the world and the people they care about. Twitter enable short exchanges ideal for efficiently pointing out resources or knowing what conferences people are attending, while discouraging in-depth discussion and analysis on the platform itself. In contrast, traditional blogs without length limitations and with their support for sharing multimedia content and comments are better suited for more in-depth presentations and conversations. Other media including books, newspapers, wikis, email, social networking sites, and so forth each have a set of properties that create a unique terrain of interaction. Learning to effectively meet your objectives using social media requires an understanding of that terrain and the social practices that have grown up around its use. One of the most exciting aspects of online social media tools is that they produce an enormous amount of social data that can be used to better understand the people, organizations, and communities that inhabit them. More specifically, they create relational data: information about who knows or is friends with whom, who talks to whom, who hangs out in the same places, and who enjoys the same things. Social Media Design Framework Social media systems come in a variety of forms and support numerous genres of interaction. Although they all connect individuals, they do so in dramatically different ways depending in part on the technical design choices that determine questions like these: Who can see what? Who can reply to whom? How long is content visible? What can link to what? Who can link to whom? Social media services vary in terms of their intended number of producers and consumers. An email is usually authored by just one person, whereas a wiki document is likely to be authored by several or even hundreds of people. An individually authored email might be sent to just one other person or be broadcasted to thousands. More generally, social media tools support different scales of production and consumption of digital objects. Many social media tools help individuals or small groups interact. Instant messaging (IM), video chat, and personal messaging within general-purpose social networking sites provide intimate communication channels comparable to phone calls and face-to-face office meetings. Social media can help individuals reach out to medium-sized groups of friends or acquaintances by broadcasting a personal message (e.g., a tweet sent to a users followers on Twitter; a post sent to a departmental email list) or allowing others to overhear a comment (a post to someones Facebook wall). They can also allow individuals to reach large groups through popular blog posts, podcasts, videos posted on sites like YouTube, or updates on Twitter by companies or celebrities with numerous followers. Purpose of the Research Thousands of people are earning huge amount of money through Social Media, This research will help to understand that when one person enters into social media, what is his path and where does he go? This Research will also help to understand that how can a person earn from a particular social network website. Research Questions To understand the pattern of browsing of individuals using social media network. To check the awareness among the people of earning through social media. How an individual can earn through Social Media in Pakistan? How this pattern can be used to gain maximum output in online advertising. DELIVERABLE III Medium of Research Social Network Theory Social network analysis is the application of the broader field of network science to the study of human relationships and connections. Social networks are primordial; they have a history that long predates systems like Facebook and Friendster, and even the first email message. Ever since anyone exchanged help with anyone else, social networks have existed, even if they were mostly invisible. Social networks are created from any collection of connections among a group of people and things. Social network analysis helps you explore and visualize patterns found within collections of linked entities that include people. From the perspective of social network analysis, the treelike org-chart that commonly represents the hierarchical structure of an organization or enterprise is too simple and lacks important information about the cross connections that exist between and across departments and divisions. In contrast with the simplified tree structure of an org-chart, a social network view of an organization or population leads to the creation of visualizations that resemble maps of highway systems, airline routes, or rail networks Network analysts see the world as a collection of interconnected pieces. Those studying social networks see relationships as the building blocks of the social world, each set of relationships combining to create emergent patterns of connections among people, groups, and things. The focus of social network analysis is between, not within people. Whereas traditional social science research methods such as surveys focus on individuals and their attributes (e.g., gender, age, income), network scientists focus on the connections that bind individuals together, not exclusively on their internal qualities or abilities. This change in focus from attribute data to relational data dramatically affects how data are collected, represented, and analyzed. Social network analysis complements methods that focus more narrowly on individuals, adding a critical dimension that captures the connective tissue of societies and other complex interdependencies. Once a set of social media networks has been constructed and social network measurements have been calculated, the resulting data set can be used for many applications. For example, network data sets can be used to create reports about community health, comparisons of subgroups, and identification of important individuals, as well as in applications that rank, sort, compare, and search for content and experts. The value of a social network approach is the ability to ask and answer questions that are not available to other methods. This means focusing on relationships. Although analysts, marketers, and administrators often track social media participation statistics, they rarely consider relationships. Traditional participation statistics can provide important insights about the engagement of a community, but can say little about the connections between community members. Network analysis can help explain important social phenomena such as group formation, group cohesion, social roles , personal influence, and overall community health. Significance of Research Social media marketing is the process of promoting your site or business through social media channels and it is a powerful strategy that will get you links, attention and massive amounts of traffic. There is no other low-cost promotional method out there that will easily give you large numbers of visitors, some of whom may come back to your website again and again. If you are selling products/services or just publishing content for ad revenue, social media marketing is a potent method that will make your site profitable over time. (Maki, 2007) Limitations Following are the issues which could be faced during the research: Lack of awareness of utilizing social media among people in Pakistan. No prior research available. DELIVERABLE IV LITERATURE REVIEW Social Media Marketing Social media marketing is the way of promoting your business or sites through different social media channels and it is an effective plan that will surge traffic to your sites, get more links and grasp the attention of people. It is one of the low cost website or product publicity method. It grasps more number of visitors, some of whom may repeatedly visit the website. If you are in a business which deals with selling products or services, then social media marketing is one of the effective ways that will make your site profitable over a period of time. Those who do not know the worth of social media sites fall into three different categories (1) the one who do not anything about social media marketing (2) one who are interested and do not know to use the social media (3)the one who do not have confidence in the worth that a social media marketing can bring in. Why Social Media? Nowadays Blogs are even ranked higher than the static websites because of their relevant content and their fresh thoughts which meet the searches criteria to come on top positions. The more links you have the better your site will be ranked by search engines. When your website receives more natural permanent links, it builds more authenticity of your site and builds search engine trust on your website. This helps to get ranked even with competitive keywords. social media is a essential tool for promoting your site and its really a worthy method to get into fame. (1)Social media marketing helps you to get more natural links to your site and your website is exposed in front of more people which helps yo to drive more traffic on your website. (2)Its a dependable method, if you utilize it properly and successfully, social communities help you to drive traffic more than the previous amount traffic you received from the search engine. (3) Social media marketing is a community based marketing method, and this doesnt harm several other methods that drive traffic to the websites regularly Social media marketing helps to get famous all around the globe. Social media sites includes online communities, social networks, blogs, wikis and another type of media for marketing, sales and customer support.. The different types of social media marketing tools include facebook, orkut, hi5, twitter, Linkedin, blogs, YouTube and Flickr. The social media marketing acts as a cheapeest method of advertising. It is seen that social media marketing acts as one of the leading business venue to use. Nowadays business technology buyers participate more socially to promote their business. Building a attractive website may take more amount of time and efforts. Getting ranked in search engine can take years, in order to build a competitive position. Social media marketing helps you to get huge amount of traffic in a single day. Once you become aware of social media tools the it would be easy for you to grab audience and to satisfy their needs. The fast growth of Social Media Marketing shows the future of internet in social media marketing. The major players in the social media market may revolutionize themselves in course off time and online business peoples also have to change their trends according to it. With social media marketing you can easily compete with the counterparts and attain the end in concern. The Value of Marketing through Social News Websites For those who dont understand or see the value of social media websites, lets take a look at the benefits of creating viral content and effectively promoting them through social media channels. Developing link baits and successfully getting it popular on various social media websites like Digg and StumbleUpon will lead to multiple benefits for any website: Primary and Secondary Traffic. Primary traffic is the large amount of visitors who come directly from social media websites. Secondary traffic is referral traffic from websites which link to and send you visitors, after they come across your content through the social sites. High Quality Links. Becoming popular on social news websites like Digg or Reddit will get you a large number of links, some of which