THE NEUROMUSCULAR COMPLICATIONS OF HIV INFECTIONS Essay

THE NEUROMUSCULAR COMPLICATIONS OF HIV INFECTIONS - Essay Example Distal symmetric, often painful sensorimotor polyneuropathy and CMV infection are more common in the late stages of AIDS. 6. AIDP and CIDP may be the initial manifestation of disease, related to autoimmune dysfunction. CSF shows pleocytosis and increased protein. Nerve conduction studies (NCSs) and biopsy are compatible with demyelination. 7. Mononeuropathy multiplex is an inflammatory response in the early stages of disease. Late MM is typically associated with CMV infection. May appear as IDP or PP. EMG and NCS show axonal degeneration and asymmetric involvement. SDF shows pleocytosis and elevated protein level. 8. Progressive polyradiculopathy (PP) is typically associated with CMV and herpes infections. Highly active antiretroviral therapy (HAART) has reduced the incidence of PP. CSF shows pleocytosis and elevated protein level. It typically presents with a cauda equina–like picture, and EMG shows denervation of the lower extremities. NCSs are mildly slow. 10. Myopathy shows proximal weakness and is confirmed with EMG. Elevated CK may also be seen, and muscle biopsy can be helpful, demonstrating necrosis and inflammation. HIV-related myopathy must be differentiated from toxin (AZT) related myopathies. (1) Peripheral neuropathy is the commonest neurological disorder associated with HIV infection. Though symptomatic peripheral neuropathy is observed in 10% to 15% of HIV infected patients, pathologic evidence of involvement of peripheral nerve is seen almost all cases of end-stage AIDS patients. Although the pathogenesis of distal sensory polyneuropathy is unclear, the condition is associated with deterioration of the patients immune system. A primary viral etiology is unlikely, since Human Immunodeficiency Virus does not infect peripheral nerve Schwann cells or axons. The similarities in clinical and pathologic findings of HIV-associated distal sensory polyneuropathy (DSP) and vitamin B12 deficiency-related

Destination Management - Japan Essay Example | Topics and Well Written Essays - 2500 words

Destination Management - Japan - Essay Example Also, international tourism receipts reached a record of US$1.030 trillion, up from US$928 billion in 2010. Tourism growth worldwide will be at a more moderate rate of 3.3% per year as compared to the average of 4.2% witnessed over the last six decades. The presence of emerging economies will add an average of 30 million arrivals per year, compared to 14 million from advanced economies. As a result, there will be a shift in the global market share by 2030. Japan Tourism is relatively a new attraction in Japan. In 2003, the first initiative was established to attract 10 million international visitors to Japan by 2010. This was later updated in 2007 to grasp a better understanding of foreign visitors and to increase satisfaction with the hope of creating repeat visits. As the country continued with efforts to make the shift from being a â€Å"Trade Nation† to â€Å"Tourism Nation,† the central government enacted its first tourism policy, making tourism a priority. As a re sult, the Japan Tourism Agency was created in order to promote the country abroad. The Japanese economy is facing many challenges, most notably a lower birth rate and aging population. Tourism brought US$608 billion (4.9% of GDP), while creating employment for 4.06 million people, and 6.3% of total employment during 2009. Okinawa Tourism has traditionally flourished in Okinawa. Regarded as the â€Å"Hawaii of Japan†, it has been a popular destination for domestic visitors, accounting for 95% of total domestic arrivals. The contribution of tourism to GDP in 2009 was 4.6%, which is quite significant when compared to other â€Å"big destinations† in the world (USA - 3.4%, Australia - 4.3%, France - 3.7%, and Japan - 3.4%. Okinawa is uniquely situated within a 1,500 kilometer radius from most major cities in Southeast Asia; however, the percentage of international tourist arrivals from this area is low. The advantages compared to other beach destinations like Bali, Phuket, and Cebu are accessibility, safety, and cleanliness. For the last few years, the share of the international markets, especially from Mainland China, Hong Kong, Shanghai, and Korea, grew steadily with a visa relaxation scheme and additional flights. In order to develop an untapped market, analysis and research on a destination competitive environment is evaluated. Destination Management Tourism is no longer about changing cultures and history; the industry has evolved into a brand. The results of the Travel and Tourism Competitive Index and Country Brand Index are used to evaluate countries’ progress over time in each category. This is necessary to improve a country’s competitiveness, growth, and prosperity. Although Japan has a strong country brand, it scored poorly in its affinity of the country and must strengthen the country’s creative and innovative industries. Okinawa can benefit from Japan’s strong country brand to develop its competitive identity. The second part of the section studies the structure and role of the government in tourism development. The transparency of tourism organizations in Okinawa is questionable. For an industry that is economically significant, tourism is weak politically. The government needs to be inclusive and engage participative decision makers and influencers in destination management. In the event of a crisis, it is the government’s role to provide ample opportunities for the media to gain access full and accurate information in