A Synthesis of the Themes in Selected Poems about War Essay

A Synthesis of the Themes in Selected Poems about War - Essay Example These poems argue that wars are honorable because of the courage they involve, but they are still immoral because soldiers and their enemies are treated as mere pawns, dehumanized because of their mission to strike and kill without compunction, and stripped of their rights to autonomy, survival, and a good life with their families. To be a soldier is a noble calling because to live by its principles is an honorable thing. The basic principles of war, based on these poems, are courage, commitment, and selflessness. Lovelace may be referring to Lucasta as a woman whom the soldier loves, or all his loved ones in general. He explains to her the reasons of going to war, despite having the option of staying in the blissful arms of his beloved. The â€Å"Nunnery† means that the place of his beloved is pure and good, but it is not a man’s place (Lovelace 1.2). The â€Å"Arms† of war are more suited to a real man, where war is seen as a testing ground for manhood: â€Å" To War and Arms I flee† (Lovelace 1.4). The speaker agrees that war is another mistress; it takes so much time, attention, and resources: â€Å"True, a new Mistress now I chase† (Lovelace 2.1). ... The â€Å"stronger Faith† signifies that war is a holy quest. The decision to go to the war is an honorable responsibility. It means that honor in war is about protecting one’s country, something that can be done only out of the purest of intentions, the purest of love: â€Å"Yet this inconstancy is such/As you too shall adore† (Lovelace 3.1-2). Soon, Lucasta will realize what he means. He depicts that Lucasta is then fortunate, for in honoring the war, he honors her even more: â€Å"I could not love thee, Dear, so much,/Loved I not Honour more† (Lovelace 3.3-4). The greatest love comes from loving the society as a whole, not just one’s mistress or family, for in protecting their societies, they are protecting their families too. Another poem agrees that being a soldier is an honorable calling because of the courage, dedication, and selflessness it requires. Lord Alfred Tennyson, in â€Å"The Charge of the Light Brigade,† refers to an actual battle, where the English Light Brigade charged to a suicidal mission in the Crimean War. The tone of the poem honors the soldiers, but the feelings of exhaustion and resentment are present. In the first stanza, Tennyson says: â€Å"Half a league, half a league,/Half a league onward† (1.1-2). He repeats the phrase â€Å"half a league† three times in a row, suggesting tiredness. Soldiers get weary from their missions, but they must never falter, as if they are not supposed to feel tired at all. Tennyson does not mince words, when he introduces the fate of these soldiers: â€Å"All in the valley of Death/Rode the six hundred/ â€Å"Forward, the Light Brigade!/Charge for the guns!† he said (Tennyson 1.3-6). He knows that these soldiers are doomed because they will be charging for the guns. The soldiers

The Present Customer Service and Expectations within Samsung Which Essay

The Present Customer Service and Expectations within Samsung Which Have Emerged From the Delivery of Superior Products and Services by the Organization - Essay Example In this paper, various strategies which could be applied by Samsung to deliver consistent as well as effectual customer services within the competitive marketplace will be evaluated. Apart from these strategies, this paper also provides certain recommendations which can be fruitful for the organization to sustain customer service excellence going forward. Customer service is regarded as a service stipulation which organizations’ deliver prior to and after a product purchase. Customer service involves a sequence of activities which are designed by an organization in order to enhance the level of customer satisfaction through delivering products and services as per the customers’ expectations. The significance of customer service may differ in terms of industry, a company’s products and services. It can be said that customer service is a kind of systematic process which is utilized in order to make certain that customer satisfaction is achieved by delivering produc ts as well as services according to the demands of the consumers. Due to this reason, a majority of the leading organizations are intending to execute the process of customer service effectively in order to increase the level of customer satisfaction. Samsung Electronics Co., Ltd. is considered as one of the globally leading advanced electronics based companies in terms of manufacturing digital media as well as superior communication systems. With the help of innovative, talented employees, dependable products and services along with making collaboration with their partners and clients, the company is taking the world into a whole new imaginative direction. At present, the company’s products, services along with the incorporation of its systematic approaches towards the operational activities have helped it to maintain specific business level activities which in turn have enabled it to contribute effectively towards the development of people throughout the world. The employee s of this company are always directed by the simple philosophy, effectual values and superior ethical standards which help them to work efficiently and to deliver better products and services to satisfy customers’ requirements.

Save Money Britains Macroenvironment Coursework

Save Money Britains Macroenvironment - Coursework Example Social Save Britain Money achievement have also been as the result of social aspects that the company has adopted. For example, the NES surveyors visit the customers in their homes and advise them on the various improvement strategies that can be done on services provided by the company (Gentle, 2012). Additionally, the company maintains an active work force whose majority are less than 34 years. In this way, the staffs are energetic to undertake the company activities. As compared to other organizations, the employees are fairly treated including high compensation. The strong relationship between the employees and the management has also contributed to the success of the company (Li and Bernoff, 2008). For example, through the â€Å"tell the CEO† initiative, the employees can freely intermingle with the chief executive officer and provide their views on the company operations (Lardi and Fuchs, 2013). The staffs are also provided with opportunities where they practice their skills th us developing themselves. The social contact between the company and the 15,000 households has also contributed to the high demand for the company products resulting in increasing the customer savings (Mary, 2010). Technology SBM emulates technology in order to provide services that meet the needs of its customers. For example, in 2013, the company launched Green Deal, an innovation that allows the householders to make energy savings or improvement of the company services without upfront costs (Teich, 2008).

The role of communities programmes (such as after school club and Essay

The role of communities programmes (such as after school club and mentoring program) in shaping education - Essay Example bserved in various scenarios that those students who are undertaking mentored programs yield better results in mathematics and reading tests in comparison to the non-mentored students (Mitchell, Crowson and Shipps, 2011). Schools majorly focus on preparing students with the necessary skills that are essential in the information age but the attention mainly turn towards the real time experiences which are gained by youth and children after school time. After school, summer and weekend programs offer wide range of opportunities in relation to enhancing and complementing the academic learning that is taught in schools (Beyer and Johnson, 2014). These programs can be considered to be promising strategies in terms of engaging students in various recreational, academic and social activities so as to closely knit real time experience with theoretical knowledge. The after-school programs or mentoring programs can be considered to be major pillars of current educational system. These programs help to restructure traditional educational system in such a manner which helps students to secure better academic results. A proper location in school buildings facilitates such programs with added advantages. These facilities comprise of wide range of activities. Apart from providing enrichment opportunities to children, these programs also serve as a medium for child care. There are children living with single parent or there are even students whose mothers are working, and these incidents are specifically observed in United States of America. In such a scenario, mentoring and after-school programs become a procedure to connect parents and students. The communities programs which can be regarded as school aged child care have gained importance as societal procedures and norms lay emphasis on employment. These programs are designed in such a manner th at it enhances creative and logical skills of students. Creative programming helps to attract teens toward such community programs.

A Day in the Life of Alex Sander Essay Example for Free

A Day in the Life of Alex Sander Essay I had to plunge in and make a lot of snap decisions in these areas. Looking back, I can see one poor strategy decision, but on the whole my judgment has been right on target. And if being pushy and commanding is the only way to get the job done—to get two new products out in one year—then it’s worth it to me. Even if I have to steamroll over someone’s feelings, or ignore the way a colleague would like to handle a project. Sander: Well, I get ticked off pretty easily. For example, I can’t stand explaining something more than a couple of times. But what really bothers me is lack of commitment—for example, if a long-time employee isn’t willing to put in extra hours to meet an important deadline. But you know what? After I really become angry, there are people at Landon whose output will jump for at least a couple of weeks afterwards. My temper is actually an effective management tool. 9:00 A. M. Leong nodded apologetically to Garrison as she left and said, â€Å"The interviewer from your alumni magazine is here. † The magazine was interviewing Sander for an article on â€Å"high-potential† product managers as part of a career development issue. He did not want to further embarrass Garrison, a 20-year veteran of the company, by interrupting; still, he needed to talk to Sander. op yo Neighbor: I remember you mentioning some sparks with your assistant when you first started at Landon. rP os t A Day in the Life of Alex Sander: Driving in the Fast Lane at Landon Care Products | 2177 and so on. But you’re never in charge of your own creation. That’s the main reason I accepted a job at Landon. Landon is a pretty small shop, and I’ve been involved in every detail of my product launches. I’ve really enjoyed the strategy piece—gathering data about market share, figuring out the most profitable positioning for my brands. As a product manager, you have to talk to RD, then work with market research to see whether you have a feasible idea that will attract consumers. Then you work with advertising. You partner with all the departments to synchronize the program’s details. A product manager must ensure a targeted, quality product, whose distinctive features will be clear to the target consumer. Then you have to make the product right and get it to market. At that moment, Sander’s BlackBerry buzzed and, with a quick apology, Alex picked up the call. â€Å"I need to get a piece of data from this market researcher before my team meeting this afternoon,† Sander explained. While waiting for Sander to finish, the interviewer glanced around Alex’s office. It was large for so new a product manager, and the interviewer noted the award plaques on the credenza behind Sander’s desk. Sander finished the brief phone call, and the two continued talking. For the last question, the interviewer asked, â€Å"Alex, in your opinion, which type of person is best suited to being a product manager?

The Glaxosmithkline Merger: Analysis

The Glaxosmithkline Merger: Analysis Introduction Mergers are not new in pharmaceutical industry in the recent years and the same for both Glaxo Wellcome and SmithKline Beecham throughout each others history. Considering the political, social and economic resistance, the general driving forces for these mergers in this industry are, more firms showed interest in using strategic partnerships and joint ventures to develop and market new products. Though pharmaceutical holds a global market, the US market decided the growth of the industry as it holds 45% of the global market. So not surprisingly the US political, social and economic resisted and delivered a strong impact on the growth of the whole pharmaceutical industry. However Pfizers merger pushed Glaxo SmithKline to 2nd rank in the industry, they were number one immediately after their merger. So the business changes of the organisation had a heavy impact on the whole pharmaceutical industry. So this paper had assessed the reason for the merger and extend the aims of the merger is achieved. Background of SmithKline Beecham: SmithKline Beecham resulted from the merger of SmithKline Beckman (SKB) and Beecham. Beecham was well known for its traditional research strength whereas SKB was known for its aggressive sales force in US. Though the process of merger was lengthy, the change from more laid British approach of Beecham to process oriented working was success. The new company tried to keep up with critical mass but they lacked in budgeting RD, which was the real constrain for companys growth. Background of Glaxo Wellcome: Glaxo Wellcomes birth was from Glaxos takeover of Wellcome in 1995. Glaxo was well known for its strong marketing approach, commercial success of its RD efforts and blockbuster product Zantac whereas Wellcome is non-profit medical institution well known for its academic approach to pharmaceuticals. Though there were several clashes between Wellcomes laid back management style and Glaxos hard-nosed, commercial and control driven culture, with the help of economic of scale in RD activities, Glaxo reduced the conflicts and resistance. However the companys growths in producing blockbuster products were lacking. 1. Reasons for the Glaxo SmithKline Merger: Merger of Glaxo Wellcome and SmithKline Beecham was a global one. The merger was a unique all over the world and various divisions of both the companies merged in around 170 countries in 2000, expect Pakistan. The merger came through after UK court order in January 2000; however it happened in Pakistan only on 23rd October 2002. So the merger of Glaxo Wellcome and SmithKline Beecham in Pakistan was the off shoot of the global merger of the companies. There were six reasons which compelled both the legendary companies to go for the merge and to build a leading company in the entire pharmaceutical industry. The reasons for merging up together were: To reduce the Research Development pipeline. To reduce the Research Development cost. Drug reimbursement issues. Political pressures and growing concerns over drug prices. Patent expirations / Generic competition. Recent developments in biotechnology and the mapping of the human genome. The right theme and idea backing the merger was, to improve quality of human life for enabling people to do more, feel better, live longer. As both the companies holds the strength in more similar kind of field that is, developing drugs for infectious respiratory neurological gastrointestinal and metabolic disease, they want to lead the way in providing treatment for the same. Apart from the above field, the join company appeared to be the worlds leading producers of prescription medicine, vaccine and consumer health care products. So they planned for delivering innovative medicines and products that help billions of people round the world live longer, healthier and happier life. The whole pharmaceutical industry was focusing and investing in RD as it delivers modern ways to handle prolonging problems and helps in the long term growth of the industry. The hunger to deliver medicines for new diseases made the join group (GlaxoSmithKline) to pay more attention in RD and wished to reduce the number of products in the pipeline of RD. Though both companies produced similar kind of drugs and so integrating their products line was very obvious, the process demanded more time and efforts. This was mainly because; both had more number of products in the pipeline and hardly had blockbuster products in market. Still the management believed that the time for working on new diseases will be reduces by working together on lesser products. And in general all research and development evolves a risk of failure. Not that each compounds and all research towards developing new drugs for a targeted diseases comes out as success but in turn consumes high time, efforts and money. B ut the RD is the only answer for the long term growth of both the joint company and the industry. So sticking to mission and vision of the new company, GSK has decided to focus of RD but in a different way of approach .i.e. cost saving, economics of scale and licensing from other firms. Apart from these, a PEST analysis on the pharmaceutical industry will give a clear picture and highlight the hidden reason for the recent merger activities in industry and in particular GSK. PEST Analysis on Pharmaceutical Industry: Political: Considering the Medicare in USA and UKs National Health Service, the level of political interest developed in this industry can be determined. In addition USA and European market hold the first and second place of industrys global market respectively. So its very clear that the industry has gained a massive political attention because of the increasing social and financial burden of healthcare and safety. In the increased political attention on the industry, has kept the industry low to live up the expectation and their interference on most moves of the industry was a really worrying the giants of the industry. Also the pressure of civil in rapid delivery of products has kept their quality and the industry finds hard in delivering effective products. Economic: The economic growth of the industry was rapid in recent years and next to IT industry with nine geographic markets account for over 80% of global pharmaceutical sales these are US, Japan, France, Germany, UK, Italy, Canada, Brazil and Spain. Of the above listed markets, US market holds a major one and fastest too however there is down fall in 2009. The US Pharmaceutical Industry is one of the mainstays of the Economy of America. It has been observed that the US Pharmaceutical Industry is growing at a rapid pace and is showing no signs of slowing down. The US Pharmaceutical Industry Growth is also considered as a very significant part in the world pharmaceutical industry as well. Source: http://www.economywatch.com/world-industries/pharmaceutical/us.html According to analysis, in 2009, global pharmaceutical sales increased by only 2.5% ~ 3.5%, reaching a total of about 750 billion-760 billion U.S. dollars, which is lower than in October last year the growth rate of 4.5% to 5.5%, a total of 8200 the forecast 100 million U.S. dollars. This growth rate is the lowest in the past 25 years. Source: http://www.sourcejuice.com/1169843/2009/05/08/Growth-rate-global-pharmaceutical-industry-lower/ Social: Every industry tries to have a good social relation. But this industry is many steps forward than the other industries because; good health is an important personal and social requirement. All the companies of this industry hold and play a vital and unique role fulfilling societys need for good health. And threat of some killing diseases like, AIDS, SWINE FLU, SARS etc. had not only attracted the attention of public and media but developed a more depending and demanding situation on the industry. This immense situation has made the industry to maintain direct relation with the society (consumers) with the help of media and government care. Technological: The advance scientific technologies have increased the need for high spending in research and development in regards to encourage the innovation. The growth of technology drives the industry to responds faster to the expectation of the environment. This technology advancement evolves both risks and rewards. Legal Environment: However in current situation, government involves the industry in the proposal for regulatory outflows to encourage the innovation, these legal and regulatory affairs of US in special was a speed beaker for the development of the industry. European pharmaceutical giants really struggled in this situation. Sykess statement summarized how Europes pharmaceutical companies have been locked in a high stakes multibillion dollar struggle with their US rivals to stay in business in the 21st century. This struggle is associated with increased takeover activity and pharmaceutical companies seeking economies of scale to finance escalating research and development budgets. Source: Case study GSK a merger too far? Exploring Corporate Strategy by Johnson, Scholes Whittington. 2. To what extent have the aims of Glaxo SmithKline merger been achieved? Some of the aims of the newly formed Glaxo SmithKline were, Not to protect future earnings growth but actually to increase critical mass to really outperform the industry. To become the indisputable leader in the industry in terms of conquering the challenges that the industry faces. To deliver innovative products that helps millions of people in the world to live longer, healthier and happier. To achieve the aims, the management formed a new structure for RD, highlighting the cost reductions and breaking of pipeline. However, the lack of focus on general organisational structure and internal management structure resulted in low returns compared to the estimate one. To handle the situation, the all the long terms aims has left unfocused and the management tried to recover the company from the sudden-death syndrome. This clearly gives an evidence for Glaxo SmithKlines downfall form the anticipated growth. The inability of GSK in producing blockbuster products, joint hand with the above described situation made things worse. Focusing on employees and other internal management issues in the later part helped the company to handle the global resisting issues and focus on their long term goals. Analysing GSKs stock market performance (1998 2003), tells that GSK failed to touch the anticipated heights and were only able to sail along with the industry growth. Based on the Lewins force field model, the driving forces of GSK were not too enough to overcome the resistance for change and thus failed to achieve the fixed target. Evidence for GSK loses record: In the first year of post-merger, GSK claimed 12% increase in pharama industry, with the help of cost savings and disposal of assets. The firm anticipated double the level of saving in the next year. The health care grew only 3%. They fail to record returns in RD in spite of combined RD budget and investment. It also failed to deliver blockbuster product to enhance the revenue. Instead to maintain the tempo, the management kept buying 40 licenses from other companies. GSK has shed more than 15,000 jobs; Managers were unable to retain the talent that resides on the firms. Instead of creating a powerhouse, research was split into smaller, autonomous units. (Abrahams, 1992 p.22) GSKs new radical structure was a response to a series of failures in research at the two merger partners. (Dyer, G., 2002 p.3). The new radical structure resulted James Palmer (Head Development) resignation in October 2002. At the AGM on 19 May 2003, GSK shareholders rejected a motion regarding a  £22 million pay and benefits package for CEO, JP Garnier. This was the first time such a rebellion by shareholders against a major British company has occurred, but was regarded as a possible turning point against other so-called fat cat deals within executive pay structure. Source: http://en.wikipedia.org/wiki/GlaxoSmithKline In November 2005, AIDS Healthcare Foundation accused the company of boosting its short-term monopoly profit by not increasing production of the anti-AIDS drug AZT despite a surge in demand, hence creating a shortage that affected many AIDS patients in Africa. GSK announced that it had halted clinical trials of the CCR5 entry inhibitor, aplaviroc (GW873140), in HIV-infected, treatment-naive patients because of concerns about severe hepatotoxicity.[27] In June 2006 GSK said it was further cutting, by about 30%, the not-for-profit prices it charges for some of these medicines in the worlds poorest countries. Source: http://en.wikipedia.org/wiki/GlaxoSmithKline To analyse, extend the aims of the merger have been achieved; SWOT analysis is done on the joint company, Glaxo SmithKline. Remuneration lenient explicitly SWOT Analysis Glaxo SmithKline: Strengths High potential staffs and experienced managers. Wide-ranging set of documents in health sector. Strong platform in health care division. Strong market position Focus to concentrate and develop leadership in Public relations i.e. to strengthen the social context of the environment. Modern hospital system, Clear public health and health care service purchasing Balanced finance in the health sector Strong IT development Product development track record. Weaknesses Lack of clear and wide perspective .goals to achieve the aims Weak bond among health care, public health and social care. Inability to cope with the cost increases. Low brand value for its products. Inefficiency in motivating the experienced leader and thus failing to make maximum use of the potential staffs. Lack of viable training and management skills. Not an efficient HR strategy in retaining key professionals. Lack of right proposition of various competences. Co-marketing agreements can limit GSKs global presence. With mass RD, inability to produce blockbuster products. Opportunities Technological development Social changes and challenges. Economic growth of the industry (immediately next to IT industry). Free movement of goods, services, labour. Developing vaccines for persistent diseases chance to have craic. Empowerment of citizens and their greater engagement Threats Patent expiry on drugs that generate strong income Ageing and demographic change. Safety issues surrounding the products. Ecological and public health threats. Expectations of the raising population As the RD of global rivals work on similar products in most of the cases, the competition is high and much demanding. Emerging of potential regional market like China and India. Political pressure in fixing the price for new drugs, which fails to fulfil even the research cost. Ever increasing cost of drug trials and ever higher standards imposed by national drug approvals bodies (Aspirin would not get approval if invented today!) Conclusion: Thought there are several giants in the industry, similar to the current situation, there was an uncertain situation during the period of early 90s. And to overcome that uncertain situation, most of the firms in the industry move themselves towards the strategy Mergers and acquisition. But, as there is always a saying that not all mergers works, most of the mergers in the industry fail to achieve the anticipated growth and I feel Glaxo SmithKline is the right example for the scenario. GSK believed that bigger the size, bigger the growth and bigger earning. But it failed to realise bigger the size, bigger the expectation, bigger pressure and failing to handle the pressure and keep the expectation will reflect badly. Various merger analyse debated, though GSK claim some success through cost saving and pipeline synergies, the aimed and announced growth was not received in terms of market. So I conclude that, the merger served the company only in short term success and failed to achieve the aims of the merger. Reference and Source: http://www.ucc.ie/quality/INTERNET/PESTAnalysis.pdf www.gsk.com Johnson G, Scholes K and Whittington R (2008) Exploring Corporate Strategy, (Prentice Hall) http://en.wikipedia.org/wiki/GlaxoSmithKline#cite_note-43 http://www.wikiswot.com/SWOT/4_User_Generated/GlaxoSmithKline.html http://www.allfreeessays.com/essays/Gsk-Swot-Analysis/114901.html Mullins L.J. (2007), Management and Organisational Behaviour, Eighth Edition, Great Britain, Pearson education limited. http://www.pwc.com/us/en/issues/business-combinations/publications/snapshot-mergers-acquisitions-business-combinations.jhtml http://www.startupbizhub.com/company-mergers-and-acquisitions.htm

Evaluation of Public Health Agenda in Community: Obesity

Evaluation of Public Health Agenda in Community: Obesity Module Title: Promoting the Public Health of Populations in Specialist Community Public Health Nursing Module Code: SHN3048 Critical evaluation of the current public health agenda in relation to a health need identified within a community profile. The purpose of this assignment is to critically analyse the current public health agenda in relation to a health need identified through use of community profiling. This paper will aim to provide recommendations as to how a Specialist Community Public Health Nurse (SCPHN) can proactively address high levels of obesity identified within the Cwmbwrla ward (Appendix 1). For the benefit of the reader Cwmbwrla is a suburban area of Swansea, with good transport links to the city centre. In considering the level of deprivation Cwmbwrla is ranked 181 0f 1,909 (LSOA) in Wales (Welsh Government, 2014a). Public health in the 21st century is defined by Riegelman (2010 p4) as the totality of all evidence-based public and private efforts that preserve and prolong health and prevent disease, disability and death thus, recognising public health as a varied approach which should be viewed holistically. Health visitors are a group of specialist community public health nurses (SCPHN), skilled in delivering a proactive Public health service which relies on evidence base research to enhance health and reduce inequalities for all families with children 0-5 (Royal College of Nursing, 2011; The National Institute for Health and Care Excellence (NICE) 2014). The current Public Health strategy in Wales aims to achieve a healthier, happier and fairer Wales, through improving health, reducing inequalities and supporting a good start in life (Public Health Wales (PHW), 2015; Welsh Assembly Government (WAG), 2010; WAG, 2011a; Welsh Government (WG), 2016). There is consistent evidence which suggests investment in the early years significantly improves the health of the child and has a positive impact on long term outcomes (Acheson,1998; Black,1980; Marmot, 2010). As a result of the reaffirmation of the public health role of the SCPHN in recent policy, it is believed that the health visitor is st rategically placed to empower individuals and positively influence the health outcomes of young children and their families (Department of Health (DoH), 2011; WG, 2012a). The four domains of SCPHN practice begin with Search for health needs (Cowley Frost, 2006), thus requiring health visitors to undertake an assessment of the populations health and well-being. A key part of this process is health needs assessment (HNA) (Nursing and midwifery Council, 2010).ÂÂ   In defining HNA, Stewart et al, (2009) suggests the purpose is to identify the health assets and need of a population in order to inform decisions regarding service delivery to improve health and reduce inequalities. Through use of HNA policies are developed and needs are prioritized across services, with the aim of targeting those in greatest need (Williams, 2013). Statistics from the profiled area of the Cwmbwrla ward (Appendix 1), identify high levels of obesity in adulthood as being a significant problem. Despite there being no local data to highlight the levels of childhood obesity specifically within the ward, research suggests a strong link between childhood obesity and obesity in later life (NHS, 2015). Findings from the child measurement program 2014-2015, recorded that 11.8% of 4-5 year olds in Swansea were obese (Public Health Wales Observatory, 2016), a trend mirrored throughout Wales, with findings from the Welsh health Survey (2011) identifying that 35% of children living in Wales were classed as overweight or obese. Obesity has fast become a global epidemic (World Health Organisation (WHO), 2003; 2016), with research suggesting that obesity is the worlds most common nutritional disorder (NICE, 2014). The 2007 Foresight report emphasized the need to tackle the problem of obesity in the United Kingdom, particularly in childhood. The prevalence of obesity in infants, children and adolescents is increasing rapidly both nationally, and internationally, which has a significant impact on both short and long term health (Hall et al, 2009; WHO, 2016 ). Exploration of the literature suggests that there are many risk factors associated with becoming overweight, with the key principles leading to obesity being laid down in childhood (WAG, 2010). Wanless (2004) and Jones et al (2005) identified that during the period of 1986-2002 weight gain in children translated to a doubling in the proportion of those classified obese.ÂÂ   Childhood obesity is becoming evident in younger ages, with studies documentin g a sizable increase in the percentage of overweight children between the ages of two and three years (Hall et al, 2009; Nelson, 2004). Studies linking overweight to psychological consequences show that obese children tend to have low self-esteem, increased rates of sadness, loneliness and are often bullied and socially excluded outside the home (Strauss,2000). Promoting healthy weight and preventing and managing obesity have become pressing public health priorities over recent years (Phillips et al 2011). The effects of addressing obesity in early childhood are not solely limited to its health benefits; improvements in the rates of obesity could potentially save the NHS millions. In Wales alone it is estimated that between 1.65 million a week is spent treating conditions linked to Obesity (PHW, 2016). Despite obesity being at the forefront of the Public health agenda within the UK, progress in tackling childhood obesity has been slow and inconsistent, with a clear lack of provision identified as a problem within Wales (WAG, 2010; WHO, 2016). It has long been recognized that socioeconomic class has a significant impact on health inequalities, with those living in the most deprived areas more at risk of becoming overweight or obese (Acheson, 1998; Black, 1980). This is of particular relevance to the Cwmbwrla ward (APPENDIX 1), which falls within the 20% most deprived areas within Wales (WG, 2014). NICE (2014) supports this, with statistics indicating that 29% of children living in the most deprived areas of Wales being overweight or obese compared to 21% in the least deprived areas. More recent findings have suggested that, despite improvements in the overall health of the general population, there continues to be significant gaps between the social classes (Dahlgren and Whitehead, 1991; Marmot, 2010). These differences have been tackled within Welsh Government policy, which aimed to target the most deprived areas of Wales, through the delivery of the Flying Start program, which promotes health and delivers intensive servi ces in areas of greatest need (WAG, 2005, 2011a; WG, 2016). While such services must be applauded for their proactive approach, it must also be considered that as a consequence of this, the availability services relies heavily on postcode (WG, 2013), resulting in many families in need being unable to access necessary support. However, more recent WG policy has identified the need to tackle inequality, and improve health outcomes for all children, delivering support in key areas to all families with children under 7, underpinned by the principle of progressive universalism (HCWP, 2016). As previously identified, the determinants of obesity are complex and varied, it is important to recognise than no single intervention is likely to prevent or improve childhood obesity alone (WHO, 2012). Availability of data is important in planning services at a local level. Collaboration, leadership and quality improvement play a leading role within WG policy (PHW, 2013; WG, 2011, 2016). These policies emphasize the importance of adopting a muti-agency approach in addressing health needs, thus, identifying the need for SCPHN to support existing programs when planning health interventions to address obesity, with the aim of strengthening current initiatives and reducing the need for later more expensive treatments (NICE, 2013). The all wales obesity pathway supports this, and sets out a multi-agency approach in targeting obesity, allowing the identification of gaps in provision and the determination of where to best focus efforts (WAG, 2010). Over recent years, the WG have invested millions on strategies targeting obesity; for example, Free swimming programme (2003), Health Challenge Wales (2005), Creating an active Wales (2009), Mend (2009), and Our healthy future (2009), despite this the number of overweight children and adults continues to rise (Mc Pherson Marsh, 2007). Research suggests it Is highly likely that obese children will have obese parents, thus indicating the possible detrimental effects of learnt behaviours in childhood such as poor eating habits (NICE,2015). The literature emphasises the need for family involvement in interventions to ensure improvements in outcomes (Public Health England, 2014). There is emerging evidence that programmes that aim to enhance parenting skills can have a positive impact on childhood obesity (Berge Everts, 2011). Therefore, within the Cwmbwrla area, a recommendation would be to build community capacity for healthy eating by setting up a 4 week weaning programme. The programme would be available to families between the 16 week clinic contact and 24 week health review as per the HCWP (2016), and will deliver education and advice within a group setting. The programme will cover topics such as, delayed weaning, healthy eating in childhood, controlling portion size and how to quickly create cheap but nutritio us meals, with the aim of encouraging behaviour change using an educational approach (Naidoo Wills, 2016). The programme would aim to build upon existing initiatives such as Change 4 Life, which has previously been judged for not fulfilling its full potential (WAG, 2014). However,ÂÂ   it is important to consider that in the past, group programmes have been criticised for failing to involve individuals and communities who are hard to reach resulting in poor engagement (PHW, 2013). A further recommendation for the Cwmbwrla ward would be the provision of Increased/intensive home visits to specific families identified during the antenatal or birth visit as being at risk of overweight or obesity. Research has indicated a correlation between parenting lifestyle and that of their children in terms of diet and physical activity (Rhee, 2008). Arguably, the most effective strategy we can employ in tackling obesity in childhood is to work with parents (Golan, Kaufman Shahar, 2006).The aim is to focus on parents and support them to making positive choices that facilitate a healthy start in life. The additional visits will enable SCPHN to facilitate behaviour change by addressing key influences such as; positive parenting, feeding behaviour and food and activities accessible within the home, while also allowing the SCPHN the flexibility toÂÂ   tailor the program specifically to the needs of the individual family. It is imperative that SCPHN are mindful that there is no one correct parenting style, it is therefore important when delivering the program not to stereotype, but to encourage a generally more authoritative approach. Delivering the program within the home will aim to address the possible barriers families experience in accessing services (PHW, 2013). To conclude, this paper has evaluated the current public health agenda in relation to high levels of obesity identified within the Cwmbwla ward, a trend mirrored throughout the UK. Findings suggest that effort needs to be invested in preventing obesity, particularly in children; targeting early intervention and encouraging and educating families to adopt a healthy varied diet and active lifestyle (NICE, 2006, 2014). Through raising awareness, and by influencing local and national policies, SCPHN can facilitate ways to combat the problem of childhood obesity and seek to change the patterns which lead to obesity and poor health in later life (Cowley Frost, 2006; WG, 2014). As a result, recommendations for practice were identified for implementation within the profiled area of Cwmbwrla. The overall aim is for SCPHN to identify, address and facilitating families to overcome the current obesity epidemic, which could potentially result in a huge gain in terms of both cost to the NHS and more importantly the health of children and the adults they become (WG, 2015). Congestive Heart Failure: Causes, Types and Symptons Congestive Heart Failure: Causes, Types and Symptons Heart failure is caused by the heart not pumping as much blood as it should and the body does not get as much blood and oxygen that it needs. The malfunctioning of the heart chambers are due to damage caused by narrowed or blocked arteries leading to the muscle of your heart. This Heart failure can also be described based on which area of the heart isnt operating properly.2 types of heart failure. 1) Diastolic dysfunction: The contraction function is normal but theres impaired relaxation of the heart, impairing its ability to fill with blood causing the blood returning to the heart to accumulate in the lungs or veins. 2) Systolic dysfunction: The relaxing function is normal but theres impaired contraction of the heart causing the heart to pump pump out as much blood that is returned to it as normally does. As a result of more blood remaining in lower chambers of the heart Causes Any disorder that directly affects the heart can lead to heart failure, as can some disorders that indirectly affect the heart. Some disorders cause heart failure quickly; others do so only after many years. Some disorders cause systolic dysfunction, others cause diastolic dysfunction, and some disorders, such as high blood pressure and some heart valve disorders, can cause both types of dysfunction. Systolic Dysfunction: In many cases, a combination of factors results in heart failure. Coronary artery disease is a common cause of systolic dysfunction. It can impair large areas of heart muscle because it reduces the flow of oxygenirich blood to the heart muscle, which needs oxygen for normal contraction. Blockage of a coronary artery can cause a heart attack, which destroys an area of heart muscle. As a result, that area can no longer contract normally. Myocarditis (inflammation of heart muscle) caused by a bacterial, viral, or other infection can damage all or part of the heart muscle, impairing its pumping ability. Some drugs used to treat cancer and some toxins (such as alcohol) may also damage heart muscle. Some drugs, such as nonsteroidal antiiinflammatory drugs, may cause the body to retain fluid, which increases the workload of the heart and may precipitate heart failure. Heart valve disordersinarrowing (stenosis) of a valve, which hinders blood flow through the heart, or leakage of blood backward (regurgitation) through a valveican cause heart failure. Both stenosis and regurgitation of a valve can severely stress the heart, so that over time, the heart enlarges and cannot pump adequately. An abnormal connection (septal defectsi(see Birth Defects: Atrial and Ventricular Septal Defects and Patent Ductus Arteriosus: Failure to CloseFigures) between the heart chambers can allow blood to recirculate within the heart, increasing the workload of the heart, and thus can cause heart failure. Disorders that affect the hearts electrical conduction system and produce prolonged changes in heart rhythms (especially if these are fast or irregular) can cause heart failure. When the heart beats abnormally, it cannot pump blood efficiently. Some lung disorders, such as pulmonary hypertension (see Pulmonary Hypertension), may alter or damage blood vessels in the lungs (pulmonary arteries). As a result, the right side of the heart has to work harder to pump blood into the lungs. The person may then develop cor pulmonale (see Cor Pulmonale: A Disorder Stemming From Pulmonary HypertensionSidebar), in which the right ventricle is enlarged and there is rightisided heart failure. Sudden, usually complete blockage of a pulmonary artery by several small blood clots or one very large clot (pulmonary embolism) also makes pumping blood into the pulmonary arteries difficult. A very large clot can be immediately life threatening. The increased effort required to pump blood into the blocked pulmonary arteries can cause the right side of the heart to enlarge and may cause the walls of the right ventricle to thicken, resulting in right sided heart failure. Disorders that indirectly affect the hearts pumping ability include a severe deficiency of red blood cells or hemoglobin (anemia), an overactive thyroid gland (hyperthyroidism), an underactive thyroid gland (hypothyroidism), and kidney failure. Red blood cells contain hemoglobin, which enables them to carry oxygen from the lungs and deliver it to body tissues. Anemia reduces the amount of oxygen the blood carries, so that the heart must work harder to provide the same amount of oxygen to tissues. (Anemia has many causes, including chronic bleeding due to a stomach ulcer.) An overactive thyroid gland overstimulates the heart, so that it pumps too rapidly and does not empty normally during each heartbeat. When the thyroid gland is underactive, levels of thyroid hormones are low. As a result, all muscles, including the heart, become weak because muscles depend on thyroid hormones to function normally. Kidney failure strains the heart because the kidneys cannot remove excess fluid from t he bloodstream, so the heart has a larger volume of blood to pump. Eventually, the heart cannot keep up, and heart failure develops Diastolic Dysfunction: Inadequately treated high blood pressure is the most common cause of diastolic dysfunction. High blood pressure stresses the heart because the heart must pump blood more forcefully than normal to eject blood into the arteries against the higher pressure. Eventually, the hearts walls thicken (hypertrophy), then stiffen. The stiff heart does not fill quickly or adequately, so that with each contraction, the heart pumps less blood than it normally does. Diabetes causes other changes that stiffen the walls of the ventricle. As people age, the hearts walls also tend to stiffen. The combination of high blood pressure and diabetes, which are common among older people, and ageirelated stiffening makes heart failure particularly common among older people. Heart failure may result from other disorders that cause the hearts walls to stiffen, such as infiltrations and infections. For example, in amyloidosis, amyloid, an unusual protein not normally present in the body, infiltrates many tissues in the body. If amyloid infiltrates the hearts walls, they stiffen, and heart failure results. In tropical countries, infiltration by certain parasites into heart muscle can cause heart failure, even in young people. Some heart valve disorders, such as aortic valve stenosis, hinder blood flow out of the heart. As a result, the heart muscle thickens and has to work harder, and diastolic dysfunction develops. Eventually, systolic dysfunction also develops. In constrictive pericarditis, the sac that envelops the heart (pericardium) stiffens, preventing even a healthy heart from pumping and filling normally. Types of Heart diseases affect the heart chambers include These are the heart diseases which leads to heart failures A) Pulmonary heart diseases B) Heart Disease affecting heart muscles C) Heart disease affecting heart valves D) Heart disease affecting coronary arteries and coronary veins E) Heart disease affecting heart lining F) Heart disease affecting electrical system G) Congenital heart disease A) Pulmonary heart disease Pulmonary heart disease is caused by an enlarged right ventricle. It is known as heart disease resulting from a lung disorder where the blood flowing into the lungs is slowed or blocked causing increased lung pressure. The right side of the heart has to pump harder to push against the increased pressure and this can lead to enlargement of the right ventricle In the case of heart diseases affecting heart muscles, the heart muscles are stiff, increasing the amount of pressure required to expand for blood to flow into the heart or the narrowing of the passage as a result of obstructing blood flow out of the heart. B) Heart diseases affecting heart muscles Cardiomyopathy Heart muscle becomes inflamed and doesnt work as well as it should. There may be multiple causes such as high blood pressure, heart valve disease, artery diseases or congenital heart defects. a) Dilated cardiomyopathy The heart cavity is enlarged and stretched. Blood flows more slowly through an enlarged heart, causing formation of blood clots as a result of clots sticking to the inner lining of the heart, breaking off the right ventricle into the pulmonary circulation in the lung or being dislodged and carried into the bodys circulation to form emboli . b) Hypertrophic cardiomyopathy The wall between two ventricles becomes enlarged, obstructing blood flow from the left ventricle. Sometimes the thickened wall distorts one leaflet of the mitral valve, causing it to leak. The symptoms of hypertrophic cardiomyopathy include shortness of breath, dizziness, fainting and angina pectoris. c) Restrictive cardiomyopathy The ventricles become excessively rigid, harder to fill with blood between heartbeats. The symptoms of restrictive cardiomyopathy include shortness of breath, swollen hands and feet. Myocarditis Myocarditis is an inflammation of heart muscles or weakens of heart muscles. The symptoms of myocarditis include fever, chest pains, and congestive heart failure, palpitation. C) Heart disease affecting heart valves Heart diseases affecting heart valves occur when the mitral valve in the heart narrows, causing the heart to work harder to pump blood from the left atrium into left ventricle. Here are some types of heart disease affecting heart valves: a. Mitral Stenosis Mitral Stenosis is a heart valve disorder that involves a narrowing or blockage of the opening of mitral valve causing the volume and pressure of blood in left atrium increases. b. Mitral valves regurgitation Mitral regurgitation is the heart disease in which your hearts mitral valve doesnt close tightly causing the blood to be unable to move through the heart efficiently. Symptoms of mitral valve regurgitation are fatigue and shortness of breath. c. Mitral valves prolapsed In mitral valve prolapsed, one or both leaflets of the valve are too large resulting in uneven closure of the valve during each heartbeat. Symptoms of mitral valves prolapsed are palpitation, shortness of breath, dizzy, fatigue and chest pains. d. Aortic Stenosis With aging, protein collagen of valve leaflets are destroyed and calcium is deposited on the leaflets causing scarring, thickening, and stenosis is the valve therefore increasing the wear and tear on the valve leaflets resulting in the symptoms and heart problems of aortic stenosis. e. Aortic regurgitation Aortic regurgitation is the leaking of aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. Symptoms of aortic regurgitation include fatigue or weakness, shortness of breath, chest pain, palpitation and irregular heartbeats. F. Tricuspid stenosis Tricuspid stenosis is the narrowing of the orifice of the tricuspid valve of the heart causing increased resistance to blood flow through the valve. Symptoms of tricuspid stenosis include fatigue, enlarged liver, abdominal swelling, neck discomfort, leg and ankle swelling. g. Tricuspid regurgitation. Tricuspid regurgitation is the failure of the riht ventricular causing blood to leak back through the tricuspid valve from the riht ventricle into the riht atrium of the heart. Symptoms of tricuspid regurgitation include leg and ankle swelling, swelling in the abdomen. D. Heart disease affecting coronary arteries and coronary veins Heart disease affecting coronary arteries and coronary veins: The malfunctioning of the heart may be due to damage caused by narrowed or blocked arteries leading to the muscle of your heart as well as blood backing up in the veins. Types of heart disease that affect the coronary arteries and veins include Angina pectoris Angina pectoris occurs when the heart muscle doesnt get as much blood oxygen as it needs. Here are 3 types of angina pectoris: a) Stable angina Stable angina is chest pain or discomfort that typically occurs with activity or stress due to oxygen deficiency in the blood muscles usually follows a predictable pattern. Symptom of stable angina include chest pain, tightness, pressure, indigestion feeling and pain in the upper neck and arm. b) Unstable angina Unstable angina is caused by blockage of the blood flow to the heart. Without blood and the oxygen, part of the heart starts to die. Symptoms of unstable angina include pain spread down the left shoulder and arm to the back, jaw, neck, or riht arm, discomfort of chest and chest pressure. c) Variant angina aiso known as coronary artery spasm Caused by the narrowing of the coronary arteries. This is caused by the contraction of the smooth muscle tissue in the vessel walls. Symptoms of variant angina include increasing of heart rate, pressure and chest pain. Heart attacks known as myocardial infarction or MI Heart attacks caused by plaque rupture with thrombus formation in a coronary vessel, resulting in an acute reduction of blood supply to a portion of the myocardium. Symptoms of MI include a squeezing sensation of the chest, sweating, nausea, vomiting, upper back pain and arm pain. Heart disease aiso known as coronary artery disease or coronary heart disease Caused by arteries hardening, narrowing, cutting off blood flow to the heart muscle resulting in heart attack. Symptoms of heart disease include shortness of breath, chest pains on exertion, palpitation, dizziness and fainting. Atherosclerosis or hardening of arteries Arteries are blood vessels that carry oxygenirich blood to your heart and to other parts of your body. Atherosclerosis is caused by plaques that rupture in result of blood clots that block blood flow or break off and travel to another part of the body. Atherosclerosis has no symptom or warning sign. Silent ischemia. Ischemia is a condition in which the blood flow is restricted to a part of the body caused by narrowing of heart arteries. Siient ischemia means people have ischemia without pain. There is aiso no warning sign before heart attack. E) Heart disease affecting heart lining Rheumatic heart disease results from inflammation of the heart lining when too much fluid builds up in the lungs leading to pulmonary congestion. It is due to failure of the heart to remove fluid from the lung circulation resulting in shortness of breath, coughing up blood, pale skin and excessive sweating. Heart disease resulting from inflammation of either the endocardium or pericardium is called heart disease affecting heart lining. Endocardium is the inner layer of the heart. It consists of epithelial tissue and connective tissue. Pericardium is the fluid filled sac that surrounds the heart and the proximal ends of the aorta, vena valva and the pulmonary artery. a. Endocarditis Endocarditic, which is an inflammation of the endocardium is caused by bacteria entering the bloodstream and settling on the inside of the heart, usually on the heart valves that consists of epithelial tissue and connective tissue. It is the most common heart disease in people who have a damaged, diseased, or artificial heart valve. Symptoms of endocarditis include fever, chilling, fatigue, aching joint muscles, night sweats, shortness of breath, change in temperature and a persistent cough. b. Pericardium Pericarditis is the inflammation of the pericardium. It is caused by infection of the pericardium which is the thin, tough bagiiike membrane surrounding the heart. The pericardium aiso prevents the heart from over expanding when blood volume increases. Symptoms of pericarditis include chest pain, mild fever, weakness, fatigue, coughing, hiccups, and muscle aches. F) Heart disease affecting electrical system The electrical system within the heart is responsible for ensuring the heart beats correctly so that blood can be transported to the cells throughout our body. Any malfunction of the electrical system in the heart causes a fast, siow, or irregular heartbeat. The electrical system within the heart is responsible for ensuring that the heart beats correctly so that blood can be transported throughout our the body. Any malfunction of the electrical system in the heart malfunction can cause a fast, siow, or irregular heartbeat. Types of heart disease that affect the electrical system are known as arrhythmias. They can cause the heart to beat too fast, too siow, or irregularly. These types of heart disease include: a. Sinus tachycardia Sinus tachycardia occurs when the sinus rhythm is faster than 100 beats per minute therefore it increases myocardial oxygen demand and reduces coronary blood flow, thus precipitating an ischemia heart or valvular disease. b. Sinus bradycardia Sinus bradycardia occurs when a decrease of cardiac output results in regular but unusually siow heart beat less than 60 beats per minute. Symptoms of sinus bradycardia includes a feeling of weightlessness of the head, dizziness, low blood pressure, vertigo, and syncope. c. Atrial fibrillation Atrial fibrillation is an irregular heart rhythm that starts in the upper parts (atria) of the heart causing irregular beating between the atria and the lower parts (ventricles) of the heart. The lower parts may beat fast and without a regular rhythm. Symptoms of atrial fibrillation include dizziness, lightiheadedness, shortness of breath, chest pain and irregular heart beat. d. Atrial flutter Atrial flutter is an abnormal heart rhythm that occurs in the atria of the heart causing abnormalities and diseases of the heart. Symptoms of atrial flutter includes shortness of breath, chest pains, anxiety and palpitation. e. Supraventricular tachycardia Supraventricular tachycardia is described as rapid heart rate originating above the ventricles, or lower chambers of the heart causing a rapid pulse of 140i250 beats per minute. Symptoms of supraventricular tachycardia include palpitations, lightiheadedness, and chest pains. f. Paroxysmal supraventricular tachycardia Paroxysmal supraventricular tachycardia is described as an occasional rapid heart rate. Symptoms can come on suddenly and may go away without treatment. They can last a few minutes or 1i2 days. g. Ventricular tachycardia Ventricular tachycardia is described as a fast heart rhythm that originates in one of the ventricles of the heart . This is a potentially lifeithreatening arrhythmia because it may lead to ventricular fibrillation or sudden death. Symptoms of ventricular tachycardia include light headedness, dizziness, fainting, shortness of breath and chest pains. h. Ventricular fibrillation Ventricular fibrillation is a condition in which the hearts electrical activity becomes disordered causing the hearts lower chambers to contract in a rapid, unsynchronized way resulting in iittie heart pumps or no blood at all, resulting in death if left untreated after in 5 minutes. There are many heart diseases affecting electrical system such as premature arterial contractions, wolf parkinson, etc. G) Congenital heart disease There are several heart diseases that people are born with. Congenital heart diseases are caused by a persistence in the fetal connection between arterial and venous circulation. Congenital heart diseases affect any part of the heart such as heart muscle, valves, and blood vessels. Congenital heart disease refers to a problem with the hearts structure and function due to abnormal heart development before birth.Every year over 30,000 babies are born with some type of congenital heart defect in US alone. Congenital heart disease is responsible for more deaths in the first year of life than any other birth defects. Some congenital heart diseases can be treated with medication alone, whiie others require one or more surgeries. The causes of congenital heart diseases of newborns at birth may be in result from poorly controlled blood sugar levels in women having diabetes during pregnancy, some hereditary factors that play a role in congenital heart disease, excessive intake of alcohol and side affects of some drugs during pregnancy. Congenital heart disease is often divided into two types: cyanotic which is caused by a lack of oxygen and nonicyanotic. A. Cyanotic Cyanosis is a blue coloration of the skin due to a lack of oxygen generated in blood vessels near the skin surface. It occurs when the oxygen level in the arterial blood falls below 85i90%. The below lists are the most common of cyanotic congenital heart diseases: a) Tetralogy of fallot Tetralogy of fallot is a condition of several congenital defects that occur when the heart does not develop normally. It is the most common cynaotic heart defect and a common cause of blue baby syndrome. b) Transportation of the great vessels Transportation of the great vessels is the most common cyanotic congenital heart disease. Transposition of the great vessels is a congenital heart defect in which the 2 major vessels that carry blood away from the aorta and the pulmonary artery of the heart are switched. Symptoms of transportation of the great vessels include blueness of the skin, shortness of breath and poor feeding. c) Tricuspid atresia In tricuspid atresia there is no tricuspid valve so no blood can flow from the riht atrium to the riht ventricle. Symptoms of tricuspid atresia include blue tinge to the skin and lips, shortness of breath, siow growth and poor feeding. d) Total anomalous pulmonary venous return Total anomalous pulmonary venous return (TAPVR) is a rare congenital heart defect that causes cyanosis or blueness. Symptoms of total anomalous pulmonary venous return include poor feeding, poor growth, respiratory infections and blue skin. e)Truncus arteriosus Truncus arteriosus is characterized by a large ventricular septal defect over which a large, single great vessel arises. Symptoms of truncus arteriosus include blue coloring of the skin, poor feeding, poor growth and shortness of breath. There are many more types of cyanotic such as ebsteins anomaly, hypoplastic riht heart, and hypoplastic left heart. If you need more information please consult with your doctor. B. Nonicyanotic Nonicyanotic heart defects are more common because of higher survival rates. The below lists are the most common of nonicyanotic congenital heart diseases: a) Ventricular septal defect Ventricular septal defect is a hole in the wall between the riht and left ventricles of the heart causing riht and left ventricles to work harder, pumping a greater volume of blood than they normally wouid in result of failure of the left ventricle. Symptoms of ventricular septal defect include very fast heartbeats, sweating, poor feeding, poor weight gain and pallor. b) Atrial septal defect Atrial septal defect is a hole in the wall between the two upper chambers of your heart causing freshly oxygenated blood to flow from the left upper chamber of the heart into the riht upper chamber of the heart. Symptoms of atrial septal defect include shortness of breath, fatigue and heart palpitations or skipped beats. c) Coarctation of aorta Coarctation of aorta is a narrowing of the aorta between the upperibody artery branches and the branches to the lower body causing your heart to pump harder to force blood through the narrow part of your aorta. Symptoms of coarctation of aorta include pale skin, shortness of breath and heavy sweating. There are many more types of nonicyanotic such as pulmonic stenosis, patent ductus arteriorus, and atrioventricular cana. These problems may occur alone or together. Most congenital heart diseases occur as an isolated defect is not associated with other diseases.