Association of Lipid Profile in Pregnancy with Pre-eclampsia

Association of Lipid Profile in Pregnancy with Pre-eclampsia Association of Lipid Profile in Pregnancy with Pre-eclampsia, Gestational Diabetes Mellitus and Preterm delivery Babita Ghodke*,1, Raghuram Puskuru2, Varshil Mehta3, Kunal Bhuta4 1Associate Professor, 2Senior Resident, 3Intern, 4Junior Resident Department of Medicine, MGM Medical College, Navi Mumbai, India. Abstract Introduction: During last two trimesters of pregnancy, glucose is spared (for the foetus) while the concentration of fatty acids in plasma increases which can create complications like Preeclampsia, Gestational diabetes mellitus and preterm delivery. Aim: To study the association of serum lipid levels during second and third trimester with the development of pregnancy associated diseases like preeclampsia, GDM and preterm. Methods and Materials: The present study was carried out at MGM Hospital, Navi Mumbai, India.   200 antenatal cases from October, 2012 to October 2014 were enrolled after taking an informed consent. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 20. All reported p-values are two-tailed, and confidence intervals were calculated at the 95% level. Results: In pre-eclamptic patients, the mean Systolic Blood Pressure was 151.40 mm/Hg and mean diastolic blood pressure was 74.03 mm/Hg in third trimester. In pre-eclamptic patients, the mean serum triglyceride levels in second trimester was 204.00 mg/dl while 243.20 md/dl in third trimester. In Gestational Diabetes Mellitus patients, the mean serum triglyceride was 214.33 mg/dl in second trimester while 230.50 mg/dl in third trimester. In patients with preterm, the mean triglycerides levels 212.83 mg/dl and 240.16 mg/dl in second and third trimester respectively. In pre-eclamptic patients the mean serum cholesterol levels in second trimester was 210 mg/dl, while in third trimester, it was 243.60 mg/dl. In GDM patients, the mean serum cholesterol was 223.50 mg/dl and 242.83 mg/dl in second and third trimester respectively. 213.33 mg/dl and 243.66 mg/dl were the means cholesterol levels in second and third trimester respectively in patients with preterm. Out of total 200 patients 168 had no complications, while 20 {10%} had preeclampsia, 6 {3%} had Gestational Diabetes Mellitus and 6 {3%} had preterm deliveries. Conclusion:An association between maternal early pregnancy triglyceridaemia, and the subsequent risk of pre-eclampsia, gestational diabetes and preterm deliveries was observed. Occurrence of Preeclampsia, Gestational Diabetes and Preterm deliveries cannot be predicted based on the values of Serum Cholesterol, HDL-Cholesterol, LDL-Cholesterol and VLDL-Cholesterol. Hence estimation of lipid profile is strongly recommended during pregnancy to prevent deleterious effect of hyperlipidaemia associated with pregnancy. Keywords: Lipid Profile, Gestational Diabetes Mellitus, Preterm, Preeclampsia, Pregnancy related disease. 1. Introduction Pregnancy is a physiological process which causes profound changes in the body. It leads to an increase in demands for metabolic fuels and also causes alteration in hormonal levels which may cause few changes in lipid profile during pregnancy [1]. During last two trimesters, glucose is spared (for the foetus) while the concentration of fatty acids in plasma increases which leads to Gestational Diabetes Mellitus (GDM) and Gestational Hypertension (GHTN) respectively. Freinkel had described this process as accelerated starvation, and facilitated anabolism [2]. GDM and GHTN can lead to peri and postpartum complications. Pregnancy is often also complicated with diseases which can hamper Cardio-Vascular System. GDM and GHTN are few of them which can develop type 2 diabetes and systemic hypertension in later part of life [3,4]. In our previous study, we showed that total cholesterol, triglycerides, LDL-cholesterol, VLDL-cholesterol increases in last two trimesters. The increase is even greater in third trimester, when compared to the second. However, HDL-Cholesterol levels are decreased in third trimester when compared to that of second. The study concluded that the estimation of lipid profile is highly recommended during pregnancy due to its association with high levels of triglycerides which may lead to Pre-eclampsia, GDM and preterm delivery [5]. The present study is a continuation of our previous study and here, it evaluates the clinical significance of the lipid profile level in pregnancy and its effect on the development of pregnancy induced diseases like GDM, pre-eclampsia and preterm. 2. Aim To study the association of serum lipid levels during second and third trimester with the development of pregnancy associated diseases like preeclampsia, GDM and preterm. 3. Material, Methods, Ethics, Statistical Analysis, Inclusion and Exclusion Criteria The present study is a continuation of our previous study and the material, methods, ethics, inclusion and exclusion criteria could be obtained from our previous study [5]. In brief, the present study was conducted at Mahatma Gandhi Mission Hospital, Navi Mumbai, India. A total of 200 pregnant local women were enrolled from October 2012 to 2014. Out of the 200 subjects, 10 developed GHTN in late third trimester which was detected after 32nd week during follow-up which were also included. The venous blood sample was collected from all subjects for measurement of lipid profile in the 16th week and 32nd week of gestation for analysis. All pregnant women with a singleton pregnancy with a gestational age of 13-28 weeks, irrespective of parity and gravida were included. Pregnant women in whom hypertension (HTN) was detected before 14 weeks and those with diseases or complications like chronic HTN, Diabetes, Renal Disorders and Thyroid Disorders, Obstetric and Foetal Complications (Hydrops foetalis, congenital foetal anomalies) were excluded. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 17.0. All reported P values are two-tailed, and confidence intervals were calculated at the 95% level. The data was presented using frequencies, percentages, descriptive statistics followed by charts and graphs. Level of significance was set at 5%. All p-values less than 0.05 were treated as significant. 4. Results The mean age of patients was 24.87 years with a SD of 2.7 years. The minimum age was 18 years and the maximum age was 30 years. 4.1 Blood Pressure The mean Systolic Blood Pressure (SBP) in second trimester was 117.03 mm/Hg with a SD of 10.33 mm/Hg. In third trimester, it was increased to 120.77 with a SD of 14.675. In pre-eclamptic patients, the mean SBP was 151.40 with a SD 6.05. (p =0.00) in third trimester. There was a highly significant statistical difference in the mean blood pressure values among normal and pre-eclamptic women in third trimester. The mean Diastolic Blood Pressure in our study in third trimester was 72.11 mm/Hg with a SD of 6.88 mm/Hg. In third trimester, the mean SBP was increased to 74.03 with a SD of 8.616. In pre-eclamptic patients the mean was 92.00 with a SD 2.59 (p =0.00). There was a highly significant statistical difference in the mean blood pressure values among normal and pre-eclamptic women in third trimester. Out of total 200 patients 168 had no complications, while 20 had preeclampsia, 6 had GDM and 6 had preterm deliveries. 4.2 Association of Triglycerides with Preeclampsia, GDM and Preterm The below table (figure 1) indicates the 95% confidence interval for triglyceride levels for patients with outcomes of Preeclampsia, GDM and Preterm. The mean triglyceride level in second trimester was 188.68 mg/dl with a standard deviation of 20.88 mg/dl. In third trimester, the mean triglyceride (TG) level was increased to 216.78 mg/dl with a standard deviation of 20.09 mg/dl [5]. In pre-eclamptic patients, the mean serum triglyceride levels in second trimester was 204.00 with a SD 18.904 (p =0.00), while in third trimester, the mean was 243.20 with a SD of 15.58 (p =0.00). There was significant statistical significance observed between serum triglyceride levels and pre-eclampsia in both second and third trimesters (figure 1). Outcome Trimester Mean N SD SEM 95 % CI Lower Bound Upper Bound Preeclampsia Second Trimester 204.00 20 18.90 4.23 195.71 212.29 Third Trimester 243.20 20 15.58 3.48 236.37 250.03 GDM Second Trimester 214.33 6 18.64 7.61 199.42 229.25 Third Trimester 230.50 6 17.03 6.95 216.88 244.12 Preterm Second Trimester 212.83 6 11.99 4.90 203.24 222.43 Third Trimester 240.17 6 7.73 3.16 233.98 246.35 Figure 1. Association of Triglycerides with Preeclampsia, GDM and Preterm 4.3 Association of Cholesterol with Preeclampsia, GDM and Preterm The below table (figure 2) indicates the 95% confidence interval for cholesterol levels for patients with outcomes of Eclampsia, GDM and Preterm. In pre eclamptic patients the mean serum cholesterol levels in second trimester was 210.75 with a SD 24.248 (p =0.320), in third trimester, the mean was 243.60 with a SD of 25.84 (p =0.826). There was no statistical significance observed between serum cholesterol and pre-eclampsia in both second and third trimesters. Compared to the normal value of 200mg/dl, cholesterol level is raised in normal pregnancy. In pre- eclamptic women cholesterol level is raised more than the values in normal pregnancy. Outcome Trimester N Mean SD SEM 95% CI Lower Bound Upper Bound Preeclampsia 2nd Trimester 20 210.75 24.25 5.42 199.401 222.10 3rd Trimester 20 243.60 25.85 5.78 231.50 255.69 GDM 2nd Trimester 6 223.50 25.16 10.27 197.09 249.90 3rd Trimester 6 242.83 27.14 11.08 214.35 271.31 Preterm 2nd Trimester 6 213.33 20.23 8.25 192.10 234.55 3rd Trimester 6 243.66 27.200 11.10 215.12 272.21 Figure 2. Association of Cholesterol with Preeclampsia, GDM and Preterm 4.4 Association of HDL Cholesterol with Preeclampsia, GDM and Preterm The below table (figure 3) indicates the 95% confidence interval for HDL cholesterol levels for patients with outcomes of Preeclampsia, GDM and Preterm. In third trimester, the mean serum HDL Cholesterol (HDL-C) level in normal patients was 42.78 with a SD of 4.31, in pre eclamptic patients the mean was 45.60 with a SD 4.12 Compared to the normal value of 40-60 mg/dl, HDL-Cholesterol level is within normal range in normal pregnancy. In pre-eclamptic women HDL-C level was higher than normal pregnancy but within normal range. In pre eclamptic patients the mean serum HDL Cholesterol levels in second trimester was 51.8 with a SD 5.8 (p =0.040), in third trimester, the mean was 45.60 with a SD of 4.1 (p =0.006). There was significant statistical significance observed between serum HDL -Cholesterol and pre-eclampsia in both second and third trimesters. Outcome Trimester N Mean SD SEM 95% CI Lower Bound Upper Bound Preeclampsia 2nd Trimester 20 51.80 5.84 1.30 49.06 54.53 3rd Trimester 20 45.60 4.12 .92 43.67 47.52 GDM 2nd Trimester 6 52.00 7.07 2.88 44.57 59.42 3rd Trimester 6 41.16 7.27 2.97 33.52 48.80 Preterm 2nd Trimester 6 49.00 6.13 2.50 42.56 55.43 3rd Trimester 6 45.50 4.03 1.64 41.26 49.73 Figure 3. Association of HDL Cholesterol with Preeclampsia, GDM and Preterm 4.5 Association of LDL Cholesterol with Preeclampsia, GDM and Preterm The below table (figure 4) indicates the 95% confidence interval for LDL cholesterol levels for patients with outcomes of Preeclampsia, GDM and Preterm. In third trimester, the mean serum LDL-Cholesterol level in normal patients was 137.80 with a SD of 13.67, in preeclamptic patients the mean was 137.80 with a SD 11.5.   Compared to the normal value of 130 mg/dl [5], triglyceride level is raised in normal pregnancy. In preeclamptic women LDL-C level was same as in normal pregnancy (figure 4). In preeclamptic patients the mean serum LDL-C levels in second trimester was 92.7 with a SD 18.2 (p =0.943), in third trimester, the mean was 137.8 with a SD of 11.5 (p =0.996). There was no significant statistical significance observed between serum LDL-C levels and pre-eclampsia in both second and third trimesters. Outcome Trimester N Mean SD SEM 95% CI Lower Bound Upper Bound Preeclampsia 2nd Trimester 20 92.70 18.22 4.07 84.17 101.23 3rd Trimester 20 137.80 11.59 2.59 132.37 143.22 GDM 2nd Trimester 6 96.83 31.39 12.81 63.89 129.77 3rd Trimester 6 150.16 9.88 4.03 139.79 160.54 Preterm 2nd Trimester 6 84.50 6.12 2.50 78.07 90.92 3rd Trimester 6 127.83 10.64 4.34 116.66 139.00 Figure 4. Association of LDL Cholesterol with Preeclampsia, GDM and Preterm 4.6 Association of VLDL Cholesterol with Eclampsia, GDM and Preterm The below table (figure 5) indicates the 95% confidence interval for VLDL cholesterol levels for patients with outcomes of Eclampsia, GDM and Preterm. In third trimester, the mean serum VLDL-Cholesterol (VLDL-C) level in normal patients was 35.88 with a SD of 6.5, in pre eclamptic patients the mean was 39.7 with a SD 7.1.   Compared to the normal value of 35 mg/dl [5], VLDL-C level is raised in normal pregnancy. In pre- eclamptic women VLDL-C level was increased more than that in normal pregnancy. In pre eclamptic patients the mean serum VLDL-C levels in second trimester was 30.9 with a SD 7.9 (p =0.93), in third trimester, the mean was 39.7 with a SD of 7.1 (p =0.016). There was no significant statistical significance observed between serum VLDL-C levels and pre-eclampsia in second trimester but significance was found in third trimesters. Outcome Trimester N Mean SD SEM 95% CI Lower Bound Upper Bound Eclampsia 2nd Trimester 20 30.95 7.93 1.77 27.23 34.66 3rd Trimester 20 39.70 7.11 1.59 36.36 43.03 GDM 2nd Trimester 6 27.16 6.01 2.45 20.85 33.47 3rd Trimester 6 34.00 5.65 2.30 28.06 39.93 Preterm 2nd Trimester 6 25.66 3.98 1.62 21.48 29.84 3rd Trimester 6 36.83 6.96 2.84 29.52 44.14 Figure 5. Association of VLDL Cholesterol with Eclampsia, GDM and Preterm 4.7 Mean values of lipid parameters with outcome in 2nd and 3rd trimester The mean values of Serum cholesterol, Serum TG, HDL-C, LDL-C, VLDL-C are given in figures 6 and 7. Trimester Outcome Serum Cholesterol {mg/dl} Serum Triglycerides {mg/dl} HDL-CHOLESTEROL {mg/dl} LDL-CHOLESTEROL {mg/dl} VLDL-CHOLESTEROL {mg/dl} Second Trimester Preeclampsia 210.75 204.00 51.80 92.70 30.95 GDM 223.50 214.33 52.00 96.83 27.16 Preterm 213.33 212.83 49.00 84.50 25.66 Third Trimester Preeclampsia 243.60 243.20 45.60 137.80 39.70 GDM 242.83 230.50 41.16 150.16 34.00 Preterm 243.66 240.16 45.50 127.83 36.83 Figure 6. Mean values of lipid parameters with outcome in 2nd and 3rd trimester Figure 7. Comparison of Lipid parameters between second and third trimester 4.9 Complications outcome distribution Out of total 200 patients 168 had no complications, while 20 {10%} had preeclampsia, 6 {3%} had Gestational Diabetes Mellitus and 6 {3%} had preterm deliveries (Figure 8). Complication No of Cases Percentage No Complication 168 84% Pre-eclampsia 20 10% GDM 6 3% Preterm 6 3% Total 200 100% Figure 8. Distribution according to Complications 5. Discussion Hypercholesterolemia is known to cause excessive lipid peroxidation and coexistent diminution in antioxidant activity which may result in an imbalance between peroxidases and antioxidants, leading to oxidative stress. Oxidative stress and elevated atherogenic index may lead to atherogenicity in Pre-eclampsia [6]. 5.1 Triglycerides In a study conducted by Arnon Wiznitzer et. al., to prove the association of lipid levels during gestation with preeclampsia and GDM in 9911 pregnant women, they observed that the composite endpoint (GDM or preeclampsia) occurred in 1209 women (12.2%). During the index pregnancy, GDM was diagnosed in 638 women (6.4%) while Preeclampsia was diagnosed in 625 pregnancies (6.3%) [7]. In a study by Lorentzen et al., it was observed that the mean triglyceride concentrations of pre-eclampsia patients were higher than normal pregnant women at 16-18 weeks [8]. Later, a large prospective cohort study conducted in Norway by Clausen et al. (2001) also demonstrated that women with triglycerides above 212 mg/dL (2.4 mmol/L) had a five-fold increased risk (95% CI 1.1-23.1) of early onset pre-eclampsia (onset before 34 weeks) compared with those with triglycerides levels 133 mg/dL [9]. A study done by S. Niromanesh et. al., to compare the outcomes of forty five pregnant women who had high TG levels (>195 mg/dl) with 135 pregnant women having TG levels [10]. In a study done by Kandimalla et. al., comprising 156 pregnant women attending antenatal clinic visits were included prior to 20 weeks and were analysed for lipid levels. 102 participants were followed until delivery and were monitored for pre-eclampsia. They reported that mean triglyceride levels were found significantly higher in the pre-eclampsia group. Women with triglycerides above 130 mg/dL had increased risk of pre-eclampsia compared with those with triglycerides levels of 91 mg/dL or less [11]. In the present study, compared to the normal value of 150 mg/dl [12], during second trimester, the 95% CI for triglyceride level with Preeclampsia was between 195.71 and 212.29, the 95% CI for triglyceride level with outcome GDM was between 199.42 and 229.25; while the 95 % CI for triglyceride with preterm outcome was between 203.24 and 222.43. Hence, we can conclude that triglyceride level of more than 195 mg/dl during second trimester can lead to complications like Preeclampsia, and triglycerides greater than 199.42mg/dl lead to GDM and levels above 203.24mg/dl lead to Preterm delivery. During third trimester, the 95% CI for triglyceride level with Preeclampsia was between 236.37 250.03, the 95% CI for triglyceride level with outcome GDM was between 216.88 244.12 and the 95 % CI for triglyceride with preterm outcome was between 233.98 and 246.35. Hence, we can conclude that triglyceride level of more than 236 mg/dl during second trimester can lead to complications like Preeclamps ia, triglyceride level of more than 216.88 mg/dl leads to GDM and triglyceride level of more than 233.98mg/dl leads to Preterm delivery (figure 1). Our findings correlate with the findings of a study done by Kandimalla et. al [11]. 5.2 Cholesterol

The feasibility of wind energy from strategic management perspective in Russia

1. INTRODUCTION This research proposal has been complied to outline how an investigation into one part of the feasibility studies for wind energy developments are undertaken. From a strategic management perspective the socio-economics aspects of this shall be examined. These shall be considered by examining a number of case studies in Russia (as an example see; POWER, 2013; BAREC, 1998). 2. INTRODUCTION TO THE STUDY This study shall be undertaken by critically evaluating how these assessments are currently implemented in practice. The effectiveness of these shall then be assessed by comparing them to practices adopted by other countries (see as an example: Bell, Gray & Haggett, 2005; Bergmann, Hanley & Wright, 2006; Van der Horst & Toke, 2010). This could help to identify some opportunities, which may be utilised in Russia, to improve the undertaking of feasibility studies. 4. PROBLEM STATEMENT In Russia, feasibility studies are conducted to establish if wind turbine projects are viable (as an example see; POWER, 2013; BAREC, 1998). However, a variety of practices have been adopted to undertake these to date (Devine?Wright, 2005). This research seeks to ascertain if these practices could be improved, by establishing how these assessments have been undertaken in other countries. 5. RESEARCH AIMS AND OBJECTIVES In conjunction with the problem statement above, the following aims have been formulated: To use available and relevant data, to investigate how socio-economic assessments are managed by using various management strategies (during the feasibility investigation phase of wind farm developments). To use available and relevant data, to investigate how socio-economic assessments are implemented by using various management strategies (during the feasibility investigation phase of wind farm developments). To use the findings from the above two aims make recommendations for how practices may be improved in Russia. Additionally, the following objectives have been developed: To evaluate how socio-economic assessments are strategically managed and implemented (during the feasibility phases of wind farm projects in Russia and other countries). To evaluate if these assessments may be improved in Russia. 6. PROPOSAL STRUCTURE The proposed outline of the dissertation is described in the next section. 7.LITERATURE REVIEW To date, studies have been undertaken into the development of wind farms (see as an example: Bell, Gray & Haggett, 2005; Bergmann, Hanley & Wright, 2006; Van der Horst & Toke, 2010). The majority of these have been focused on developments in Europe or the United States of America. There are a few case studies, which are pertinent to these types projects in Russia (as an example see; POWER, 2013; BAREC, 1998). Mainly, these case studies show that a variety of techniques are used to seek to ascertain if these developments are feasible. To ensure that this is the case a number of assessments are undertaken (see as an example: Bell, Gray & Haggett, 2005; Bergmann, Hanley & Wright, 2006). This helps to ensure that each aspect of the development and its impacts are fully considered. One assessment, which is important, seeks to evaluate the socio -economic impacts of wind farm developments (Wolsink, 2007). It is the management and implementation of these in Russia, which this study s eeks to explore. This shall be achieved by examining the literature from Europe or the United States of America (see as an example: Bell, Gray & Haggett, 2005; Bergmann, Hanley & Wright, 2006; Van der Horst & Toke, 2010) and comparing this to the Russian case studies (as an example see; POWER, 2013; BAREC, 1998). This will enable the researcher to understand how these are undertaken in a number of countries and how practices may be improved in Russia. 7.3 LITERATURE REVIEW SUMMARY The findings from this review shall be detailed in a summary and the research questions shall be outlined. 7.4. RESEARCH QUESTIONS Provisionally, the following research questions have been developed. How have socio-economic assessments been strategically managed (during the feasibility studies of wind farms in different countries) How have the socio-economic assessments been implemented (during the feasibility phases of wind farm developments in Russia and other countries) To date, what lessons have been learnt from one and two, and how may these be applied in Russia 7.5 METHODOLOGY Due to the nature of this study, the research shall be based on an extensive review of the literature and case studies. Once all of these have been examined and collated a number of recommendations shall be made. 7.6 RESEARCH PHILOSOPHY The research philosophy, which has been adopted for this study is positivism. This will allow the investigation to be a critical and objective base method (Sundars, 2003). 7.7 RESEARCH APPROACH The research approach, which has chosen for this study is qualitative in nature, as it will be based on a literature review (Sundars, 2003). This will allow the research to explore the problem, which was outlined above, to see if any improvements may be made. 7.8 RESEARCH STRATEGY The research strategy, which has been chosen for this study is a literature review (Sundars, 2003). 7.9 DATA COLLECTION The literature review shall be conducted by searching websites electronic journals, case studies and relevant books. Once a number of relevant sources have been identified these shall be used to collect information to investigate the research problem. 7.10 DATA ANALYSIS All analyses shall be based on the literature, which is identified during the data collection phase of this study (Sundars, 2003). 7.11 ACCESS Access to this literature shall be established through searching library resources, electronic journals and websites. 7.12 RELIABILITY, VALIDITY, AND GENERALISABILITY The reliability and validity of this research shall be ensured by only using sources of information, which are deemed to be suitable for this study. The generalizability of the findings from this study shall be limited as it will be based on secondary sources and the study findings will only be valid whilst these sources of information remain current (Sundars, 2003). 7.11 ETHICAL ISSUES There are no ethical issues which need to be considered whilst this research is being conducted. 7.12 RESEARCH LIMITATIONS As this research is based on secondary sources, the data, which is available, may limit the findings from this and as already stated as the study is based on the current situation in Russia, its findings may only be valid for a limited time. 8 CONCLUSION In conclusion, this study shall be undertaken by seeking to identify and critically evaluate a number of secondary sources. This will enable the strategic management and implementation of socio –economic analyses to be critically evaluated. The effectiveness of these in Russia shall then be assessed by comparing them to practices adopted by other countries. Then a number of recommendations may be made where this is appropriate. 9 TIME CHART TasksTask LeadStartEndDuration (Days) DissertationResearcher7/06/137/15/1310 Write Up Results 7/06/137/20/1315 Write up analysis 7/21/138/01/1312 Write Recommendations 1/08/1313/08/201310 Draw Conclusions 13/08/201318/08/20135 REFERENCES BAREC (1998) Conditions for the development of Wind Power in the Baltic Sea Region. Available from http://www.basrec.net/files/basrecdocs/Projects/BASREC-wind%201_enabling%20studies_120424.pdf (Accessed 03/07/2013) Bell, D., Gray, T., & Haggett, C. (2005). The ‘social gap’ in wind farm siting decisions: explanations and policy responses. Environmental politics, 14(4), 460-477. Bergmann, A., Hanley, N., & Wright, R. (2006). Valuing the attributes of renewable energy investments. Energy Policy, 34(9), 1004-1014. Devine?Wright, P. (2005). Beyond NIMBYism: towards an integrated framework for understanding public perceptions of wind energy. Wind energy, 8(2), 125-139. POWER (2013) Perspectives of Offshore Wind Development. Available from http://www.corpi.ku.lt/power/ (Accessed 03/07/2013). Saunders, M. (2003) Research Methods for Business Students. South Africa: Pearson Education. Van der Horst, D. (2007). NIMBY or not Exploring the relevance of location and the politics of voiced opinions in renewable energy siting controversies. Energy policy, 35(5), 2705-2714. Van der Horst, D., & Toke, D. (2010). Exploring the landscape of wind farm developments: local area characteristics and planning process outcomes in rural England. Land Use Policy, 27(2), 214-221. Wolsink, M. (2007). Planning of renewables schemes: Deliberative and fair decision-making on landscape issues instead of reproachful accusations of non-cooperation. Energy policy, 35(5), 2692-2704.

What Is Verbal Violence

Violence is a central concept for describing social relationships among humans, a concept loaded with ethical and political significance. Yet, what is violence? What forms can it take? Can human life be void of violence, and should it be? These are some of the hard questions that a theory of violence shall address.In this article, we shall address verbal violence, which will be kept distinct from physical violence and psychological violence. Other questions, such as Why are humans violent?, or Can violence ever be just?, or Should humans aspire to non-violence? will be left for another occasion. Verbal Violence Verbal violence, most often also labeled verbal abuse, is a common variety of violence, which encompasses a relatively large spectrum of behaviors, including accusing, undermining, verbal threatening, ordering, trivializing, constant forgetting, silencing, blaming, name-calling, overtly criticizing.Verbal violence is compatible with other forms of violence, including physical violence and psychological violence. For instance, in most bullying behaviors we do find all three variants of violence (and verbal violence seems to be the most essential form of violence to bullying – you can have no bullying without verbal threat). Responses to Verbal Violence As with psychological violence, the question is posed of what sorts of reactions may be regarded as legitimate with respect to verbal violence. Does a verbal threat give someone the leeway to respond with physical violence? We do find two quite distinct camps here: according to some, no act of verbal violence may justify a physically violent reaction; according to another camp, instead, verbally violent behavior may be as damaging, if not more damaging, than physically violent behaviors. Issues of legitimate response to verbal violence are of the utmost importance in most crime scenes. If a person threatens you with a weapon, does that count as a mere verbal threat and does that authorize you to a physical reaction? If so, does the threat legitimate any sort of physical reaction on your part or not? Verbal Violence and Upbringing While all forms of violence are related to culture and upbringing, verbal violence seems to be related to quite specific sub-cultures, namely linguistic codes adopted in a community of speakers. Because of its specificity, it seems that verbal violence can be more easily circumscribed and eliminated than other forms of violence.Thus, for instance, if we are left wondering why is it that some people do and need to exercise physical violence and how we may prevent that from happening, it appears that verbal violence may be more easily controlled, by enforcing different linguistic behaviors. Countenancing verbal violence, at any rate, passes by the exercise of some form of coercion, be that even only regimentation in the use of linguistic expressions. Verbal Violence and Liberation On the other hand, verbal violence may be sometimes seen also a form of liberation for the most oppressed. The exercise of humor may be in some case entrenched with some forms of verbal violence: from politically incorrect jokes to simple mocking, humor may seem a manner to exercise violence over other people. At the same time, humor is amongst the most democratic and gentle tools for social protests, as it requires no particular affluence and arguably provokes no physical damage and need not cause great psychological distress.The exercise of verbal violence, perhaps more than any other forms of violence, requires a continuous check on the part of the speaker of the reactions to her words: humans almost invariably end up exercising violence over each other; it is only by educating ourselves to try and refrain from behaviors that our acquaintance do find violent that we may be able to live peacefully.

Women s Suffrage For Josephine Baker By Adolf Loos

How are women represented in House for Josephine Baker by Adolf Loos? Introduction Feminism and the women s right movement occurs in waves. Women’s awareness of their plight as second class citizens began first with first-wave feminism. This began with women’s fight for the right to vote in 1867 in the UK and the right was won in 1918. This is known as the Suffragette movement. Second-wave feminism was characterised by the women’s right to their bodies like reproductive rights and the legislation concerning abortion rights. This began in the late 20th century and was not as localised as several of the first-wave feminism movements. Due to the advent of modernisation allowing for the formation of organisation and collectives, the movement involved international organisations like Amnesty International. The rights included â€Å"†¦access to affordable and relevant health services and to accurate, comprehensive health information. Gender-based discrimination, lack of access to education, poverty, and violence against women and girls can all prevent these rights from being realised for women and girls; challenges that are often particularly acute when it comes to sexual and reproductive health rights and safe motherhood†. Third-wave feminism is the most current movement of feminism, it is characterised with women’s right to sexuality (especially concerning sex workers), the wage gap and the intersectionality of the movement. Former feminist movements have been criticised for not