Individual Case Analysis Colgate vs. PG - 796 Words

Game Theory And Strategic Marketing Individual Case Analysis [pic] Brighter Smiles for the Masses----Colgate vs. PG [pic] [pic] BY: ZHUANG Lingzhi ( Erin ) 52373176 Individual Case Analysis The Procter Gamble Company (PG) was the first one to launch the over-the-counter tooth-whitening product, Crest Whitestrips, which is able to be used at home to the market. After two years, Colgate followed to launch the rival product, Simply White, and snatched big part of the market share from PG. The market share of Whitestrips dropped from 80% to 37% while Simply White achieved almost 50%. Apparently, Colgate has won this teeth-whitening competiton. Usually, a new product would have†¦show more content†¦What PG can do is to find a third party which is authoritative to do the test again and announce the results to the public. The effectiveness of Whitestrips is doultless cause it have won the challenge before the NAD. Once the consumers notice that Simply White is not as effective as it claimed, their trust towards Simply White wouled be lowerd and veryShow MoreRelatedPG Swot Analysis10435 Words   |  42 Pagesincluding cosmetics, fragrances and over the counter medications; and diapers and feminine hygiene products. Other items range from cat litter to automotive additives. The top worldwide producers include Procter and Gamble, Kimberly Clark, Unilever, Colgate-Palmolive, Church and Dwight, Clorox, and Ecolab. Industry Trends and How It Operates Given the low growth rates of population and household formations in the developed nations, it has become more difficult for consumer product manufacturersRead MoreColgate Max Fresh Case4915 Words   |  20 Pagesfactors leading to Colgate Max Freshs success in the US market†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..4 Question 2. Critically evaluate CMFs adaptation strategies in China and Mexico. From a global CMF perspective, what are the short-term and long-term impacts of these adaptations?.............................................................................................................................6 Question 3. Suggest guidelines for optimizing new product introductions for Colgate Palmolive worldwideRead MoreColgate Max Fresh Case4902 Words   |  20 Pagesleading to Colgate Max Freshs success in the US market†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..4 Question 2. Critically evaluate CMFs adaptation strategies in China and Mexico. From a global CMF perspective, what are the short-term and long-term impacts of these adaptations?.............................................................................................................................6 Question 3. Suggest guidelines for optimizing new product introductions for Colgate Palmolive worldwideRead MoreColgate-Palmolive Keeps the World Smiling6844 Words   |  28 PagesSummary The objective of this RFI is to determine whether or not Colgate-Palmolive (CP) should remain with SAP for their technology infrastructure, or if they should seek out other or new IT opportunities. CP needs to determine what is important and whether or not IT supports it. We evaluate the current problem CP is facing and the future trend of the technology. We reviewed SAP and its competitor, Oracle, to determine whether CP should stay with their current provider and what advantages wouldRead MoreSamsung and Financial Crisis Case Study11108 Words   |  45 Pagesand brand prominence. Brand-self connection. First, the idea that attachment involves a bond (with the brand included as part of the self) suggests that a critical aspect of attachment involves the cognitive and emotional connection between the individual and the self, defined here and elsewhere as brand-self connection (Chaplin and Roedder John 2005; Escalas and Bettman 2003; Escalas 2004). By categorizing the brand as part of the self, a consumer develops a sense of oneness with the brand, establishingRead MoreInternational Management67196 Words   |  269 PagesThis page intentionally left blank International Management Culture, Strategy, and Behavior Eighth Edition Fred Luthans University of Nebraska–Lincoln Jonathan P. Doh Villanova University INTERNATIONAL MANAGEMENT: CULTURE, STRATEGY, AND BEHAVIOR, EIGHTH EDITION Published by McGraw-Hill, a business unit of The McGraw-Hill Companies, Inc., 1221 Avenue of the Americas, New York, NY 10020. Copyright  © 2012 by The McGraw-Hill Companies, Inc. All rights reserved. Previous editions  © 2009Read MoreCelebrity Endorsements19810 Words   |  80 Pagesspecial skills that are not commonly observed. Thus, it can be said that within a society, celebrities generally differ from the common people and enjoy a high degree of public awareness. According to Friedman and Friedman, a â€Å"celebrity endorser is an individual who is known by the public for his or her achievements in areas other than that of the product class endorsed†. Compared to other endorser types, famous people always attach a greater degree of attention, recall and loyalty. In this age of intenseRead MoreEffect of Experiential Value on Customer Satisfaction with Service Encounters in Luxury-Hotel Restaura nts7250 Words   |  29 Pagesloudly (Baker and Cameron, 1996). Fiore and Kim (2007) presented a conceptual framework for the inï ¬â€šuences on the consumption experience exerted by environmental variable inputs (i.e., the physical elements of the service environment), individual variables (namely, individual attributes such as intelligence), and person-environment interaction variables or situations (e.g., shopping with friends). Overall, this work posits that environmental factors, including interactions with service employees or otherRead MoreGlobal Marketing Summary Chapter 5-106416 Words   |  26 Pagesthat nation-states consider binding among themselves †¢ Disputes between nations are issues of public international law †¢ World Court or International Court of Justice (ICJ) †¢ Judicial arm of the United Nations Common Law vs. Civil Law †¢ The Napoleonic Code of 1804 drew on the Roman legal system and is the basis for continental European law today. Code law is also known as civil law. †¢ U.S. law is rooted in English common law. Common law country Read MoreManagement and Teaching Note19520 Words   |  79 Pagesecch the case for learning case collections update 2007 Quarter 4 Visit the case search section of the ecch website at www.ecch.com to identify relevant cases from the ecch collection and view over 31,000 full text inspection copies. ecch provides a free monthly e-mail update service giving details of new cases from all sources. Visit www.ecch.com to subscribe. Economics, Politics and Business Environment 9-407-049 ALLIANZ AG: BECOMING A EUROPEAN COMPANY Lorsch, JW; Chernak, A Harvard

Stitch and Mrs. Wright - 868 Words

TAlejandro E. Martinez Pena 4/6/2012 801-11-3929 Questions : Trifles 1. What attitude towards woman do the sherriff and the County Attorney express? How do Mrs.peters and Mrs. Hale react to these sentiments? -The reaction of the sherriff was one that showed that he really believed that the weren’t going to be very usefull in any way and the County’s attitude was more of a flirtatious manner. - They both do not pay much attention to their sentiments. 2. Why does the County Attorney care so much about discovering a motive for the killing ? -Not only is it because is his job to find the reason to the murder and understand what happen so he can present it in court to a†¦show more content†¦- Because it shows that Mrs. Wright knows how to knot a rope its ironic that she uses that term as mrs. Wright used a knot to kill her husband . 11. Point out some moments in the play when the playwright conveys much to the audience without dialogue -when they show how the parchment she was stitching and the way the canary was taken care of 12.How would you sum the plays major theme? - You don’t never get to truly know what a person is capable of doing 13.How does this play , produced in 1916 show its age ? in what ways does this play seem remarkably new - the horrid archaic grammar -in the themes which a reader can relate to. 14. Discuss this view I agree in one point Trifles is a very lousy and boring and obvious mystery it’s full of clichà ©s which bored me to tears But I disagree with the rest of the argument just because the action already took place doesn’t mean it’s boring in some occasions its invigorating to the reader to find out what happened but in this case it wasn’tShow MoreRelatedGender Differences In Susan Glaspells Trifles885 Words   |  4 Pagesthe effect of gender differences on perceptions of duty, law, and justice. The early 1900’s is the setting, arriving at the Wright farmhouse on a crisp, cold morning. Mr. Hale, a neighbor, found John Wright murdered the morning before. Hale has brought his wife, the county attorney, the sheriff and his wife to the home so the men can investigate Wright’s death. With Mrs. Wright as the primary suspect, Henderson, the county attorney, is looking for her motive. While the sheriff and the county attorneyRead More The Importance o f Mrs. Hale and Mrs. Peters in Susan Glaspells Trifles1112 Words   |  5 Pagesstormy night, a shadowy figure, a sinister butler, and a mysterious phone call. Susan Glaspells Trifles does not fit this mold. Glaspells mysterious inquiry into the murder of John Wright presents the reader with only one suspect, Mrs. Wright. Even though the court examiner and sheriff cannot find evidence against Mrs. Wright, the reader can plausibly argue the case against the neglected wife. Glaspells use of descriptive language and subtle hints established the mood, presents the motive, and uncoversRead MoreTheme Of Trifles1093 Words   |  5 Pageshuman. In the play, Mrs. Wright works tirelessly in her lonely home with no one but an ungrateful and cold husband to The dead Canary symbolizes Mrs Wrights imprisonment Mrs Wright has been imprisoned in all aspects of her life. When Mrs wright married her husband, her life became one of a prisoner. She is constantly doing work and never has a moment of peace for herself. She has been expected to do not only household chores but also has to take care of the farm while Mr. Wright is out on the townRead MoreTrifles Essay1410 Words   |  6 Pagessheriff and the county attorney begin questioning Mr. Hale about events that occurred on the previous day. Mr. Hale told them he was on his way into town and decided to stop and ask John Wright to go together with him for the cost of a party telephone line. He had asked him in the past but he said no, so Mr. Hale wanted to talk to him about it in front of his wife with the hope that she might have some influence. When Mr. Hale knocked on the Wrights door, there was no answer. It was after eightRead MoreGender Differences In Trifles1499 Words   |  6 Pagesthe effect of gender differences on perceptions of duty, law, and justice. The early 1900’s is the setting, arriving at the Wright farmhouse on a crisp, cold morning. Mr. Hale, a neighbor, found John Wright murdered the morning before. Hale has brought his wife, the county attorney, the sheriff and his wife to the home so the men can investigate Wright’s death. With Mrs. Wright as the primary suspect, Henderson, the county attorney, is looking for her motive. While the sheriff and the county attorneyRead MoreAn Analysis Of Susan Glaspell s Trifles 1293 Words   |  6 Pagesrelieving comments on the characters of the play and the themes of the story. One of the first symbols introduced in the work, Mrs. Wright’s apron is deeply symbolic of her personal struggle in her home and marriage. Physically, the apron is a feminine piece of apparel, especially as women in the twentieth century were solely viewed as wives and homemakers. For Mrs. Wright, her assigned purpose in life was to be a woman, which solely meant that she was responsible for satisfying the needs of her husbandRead MoreSusan Glaspells Play Trifles Essay1325 Words   |  6 Pagesanother and begin to look for a way out of marriage. In Susan Glaspell’s play Trifles, there is evidence to believe Mrs. Wright took her vows of, death do us part to extremes, ending the marriage by killing her husband. The law states, â€Å"That any man or woman who means to harm another, either on purpose or by accident, shall be guilty of murder left up to a jury of what degree.† Mrs. Wright had the means, motive, and opportunity to kill her husband, there is logical, e thical and emotional proof to convictRead MoreSusan Glaspell s A Jury Of Her Peers Essay1789 Words   |  8 Pagesseen differently, depending upon the viewer. In Susan Glaspell’s, A Jury of Her Peers, the idea of who is capable to fairly judge a person, and therefore serve justice, is examined through the arrest of Mrs. Minnie Wright for the murder of her husband. As the sheriff and others go to the Wrights’ house, the suggestion is made that those empowered by law to cast judgement and those with an understanding of fairness are not always the same, and thus justice may not be served. Using symbolism, alongRead More Susan Glaspells Trifles and A Jury of Her Peers Essay1754 Words   |  8 Pagesthe short story A Jury of Her Peers a woman named Minnie Wright is accused of the murder of her husband. Minnie Wright is a farmers wife and is also isolated from the out side world. There is an investigation that takes place in the home of the murder. There are three men t hat are involved on the case and two women accompany, but are not there to really help solve the murder. These two women will solve the murder and protect Mrs. Wright of any wrongdoing. The women will justify to themselves, thatRead MoreA Story Of Gender Differences2295 Words   |  10 Pagesof plot and character. The drama â€Å"Trifles,† starts off by introducing the scene as Mr. and Mrs. Wright’s kitchen. It also introduces the main characters of the drama: the County Attorney named George Henderson, Henry Peters the sheriff, his wife, Mrs. Peters, and the neighbors Mr. and Mrs. Hale who are all investigating the murder of John Wright (Glaspell 630). The group is inside the kitchen of John and Minnie Wright, the men are looking around for any signs of motive and the women are huddled together

Victory Dance of the Lotha Nagas Free Essays

VICTORY DANCE Rhanthungo Kikon INTRODUCTION: LOTHAS of TSUNGIKI village performed this dance in the days of old when young warriors from a CHUMPO (popularly known as MORUNG) visited other CHUMPOS in the different KHELS of the village. For the young warriors, this Victory Dance acted both as a fit reminder of the great victories their forefathers had over their enemies and also as an inspiration for them to replicate in the future. It was a time to take pride from their past achievements and to encourage and dare each other for the days to come. We will write a custom essay sample on Victory Dance of the Lotha Nagas or any similar topic only for you Order Now It prepared them for the future. Those were the days†¦ THE DANCE: Now, the present generation performs the Victory Dance on all occasions. But the spirit and zeal of the warriors performing this dance remain as spirited and as full of fervour since times immemorial. Behold! All the young warriors are out of the CHUMPOS bedecked in all their ornamental fineries. Among them include the round black head-wigs made of the long hair from the neck and shoulders of the Himalayan black bear, or of the fur of the arms of the male gibbon. On the head-wigs, as warriors of proven valours, are stuck in the feathers of the great bird, the Hornbill. On their arms, they have wristlets, bracelets and elbow armlets made of parts of sawn-off tubes of elephants’ tusks. Across their shoulders are thrown over colourful baldric-like woven strips of cloths. Joined to the end of the baldrics at the waist are the spikes’ holders – the spikes were used during raids over enemy camps. Kneecaps, the LENGTA and the colourfully decorated daos and spears complete their attire. Now the young warriors will go around dancing in two rows to finally make a circle. Singing along and shouting loud cries as they stamp their feet, twirl their daos and spears, they make the circle – an indication of having surrounded their enemies. When they have their enemies surrounded, they thrust up their spears and dare each other not to let any enemy warrior escape from their individual posts or positions. THE SHANTHA: An exciting, and perhaps the most important, part of the Victory dance is the SHANTHA. The name ‘Victory Dance’ rightly belongs to this part-dance within the dance. The SHANTHA is performed by four of the most-abled warriors. This group acts as the Escort of the warriors. It also is the rearguard and flanks protection of the warriors. The SHANTHA warriors are also wont to perform many skills and antics. Among them is the biting and holding of their daos on the blunt sides as they hop along – it is actually an oath-taking pledge not to die in enemies’ hands. They will also take a stance and hop forwards and backwards challenging their enemies making it clear what they will do to them with their daos and spears. How to cite Victory Dance of the Lotha Nagas, Papers

Computer Literacy free essay sample

March 8, 2010 JOSEPH JACKSON INF103: Computer Literacy INSTRUCTOR: BASHAR ELKHATIB WEB-BASED TRAINING In the following research paper I will be discussing Web-Based training. I will be going into the details of what this type of training consist of, who uses this training, the different types of web-based training, the efficiency of the training, and also my experience with this training. Once you have read this paper I feel you will obtain a better understanding on Web-Based training and be able to not only feel confident with this topic but also talk to others on this topic. In the following paragraph I will be explaining to you what web-based training is and consists of. Web-based training (WBT) is an innovative approach to distance learning in which computer-based training (CBT) is transformed by the technologies and methodologies of the World Wide Web, the Internet, and intranets. Web-based training presents live content, as fresh as the moment and modified at will, in a structure allowing self-directed, self-paced instruction in any topic. Notebook computers are personal computers that are portable and designed to fit on our lap. On a regular notebook computer, the keyboard is on top of the sytem unit, and the display is attached to the system unit with hinges. They have all the same qualities of a desktop computer Just compact into a thin lightweight size. Mobile devices are also a types of computers. Different types are smartphones, PDAs, E-book Readers, MP3 and digital cameras. They often use memory cards to store programs and data permanently. These mobile devices are Internet-enabled, connecting them to the world. Because of the size difference, mobile device screens are small. Smartphones hold different personal information management functions such as, address book, calculator, and notepad. These phones also allows you to send text, instant, picture, and video messages. All these types of computers are small sized and easy to carry around. Most are usually pocket sized and internet accessible. Servers, mainframes, super and embedded computers are not pocket sized and able to carry around. These types of computers are usually stationary and cannot be moved. Servers, control access to hardware and software. Personal are needed to access information off of a server. Unlike servers, mainframes do not need personal computers to access data. Mainframes has so much space that it stores huge amounts of data and information. Most big business and corporations use mainframes for many things. Mainframes carry out functions such as preparing payroll for employees and manage inventory. You can aslo access programs on a mainframe using a personal computer. Supercomputers are the fastest, most powerful and most expensive. These computers are needed for sophisticated athematical calculations. Calculations for things such as automotive design, weather forecasting, and aerospace use supercomputers. Embedded computers are used for functions in a larger product. They are located in things such as automobiles, consumer electronics and office machines. As we all know computers come in many shapes and sizes. They can be used for many different things and can be located anywhere. Technology has increased so much that the most unheard compact thing can be a computer.

Marylen Moss Initial Psychological Evaluation

Good health is what many people wish as long as they live. Any problems with health normally complicate the situation in families. Marylen Moss is thirty-eight years of age. She has a reliable husband whose name is George. It is her second marriage. She bore two children in her previous marriage. But now they have grown up.Advertising We will write a custom case study sample on Marylen Moss Initial Psychological Evaluation specifically for you for only $16.05 $11/page Learn More The chief complaint is that Marylen has a mood disorder. Her psychological problem has caused her to feel ecstatic and have erratic behaviors. She needs medication and or treatment to help her come back to normal again (Coaley, 2010). The history of this present illness started few months after she got pregnant. Four months into her pregnancy, her moods changed (Boyle, Matthews, Saklofske, 2012). She grew very tired. She could sleep until after midday. She started having problem s with her appetite. It caused her to lose weight. She gave birth when she had lost so much weight that she was several pounds lighter (Coaley, 2010). It affected her entire work at home and the workplace. She could not continue keeping both records correctly (Langwith, 2009). It caused her to stop dealing with the family and business finances. She could not focus long enough to come up with the right records (Goodwin Sachs, 2010). All this time George had been thinking that it was the pregnancy that was causing her to have changes in her moods. Towards the end of her pregnancy term, she confessed her feelings to her husband (Coaley, 2010). She thought she could not survive the childbirth. So she wished her husband well with her baby after birth (Goodwin Sachs, 2010). She thought that her condition was not going to improve. Immediately after giving birth to the first child in her second marriage, her moods changed abruptly. She was no longer getting tired. The long night sleeping hours till afternoon also disappeared (Langwith, 2009). All these disappeared instantly after birth, and she seemed to have a lot of energy (Coaley, 2010). She had never had such symptoms in her life. The new personality traits have been with her for the past one month. It is a medical condition that the husband does not understand. She had not sought any medical help (Krawitz Jackson, 2008). Her mood swings indicated bipolar symptoms (Langwith, 2009).Advertising Looking for case study on psychology? Let's see if we can help you! Get your first paper with 15% OFF Learn More The pregnancy, therefore, triggered a major depression. She has some neurovegetative symptoms (Echevarria, 2012). She has middle and terminal insomnia. She cannot sleep ordinarily. Her sleep lasts two to three hours. On the day before the visit to the hospital, she had woken up at five in the morning. It means she had slept at around two or three in the morning. She wakes up feeling restless, but r eady to go. She does not take any medication for sleep and does not have nightmares. Her condition only causes her to become a lot more active than normal. But she does not go about destroying everything. She is not a threat. When she was pregnant, she lost most of her weight because of lack of appetite (Goodwin Sachs, 2010). But after pregnancy, Marylen has not had problems with her appetite. She has also not taken measurements for her weight, even though she has been eating a lot lately (Langwith, 2009). She has a lot of energy during the day until she surprises her husband. It is not normal for her to behave that way (Echevarria, 2012). Moss used to enjoy opening her bakery shop and doing business. Lately, she has been doing badly with the finances (Langwith, 2009). At some point, she tried charging their Visa card for the kitchen supplies. Her sexual drive has also increased. She cannot concentrate on one thing. She keeps changing from one activity to another. The maniac phase started after her few moments of normalcy (Boyle, Matthews, Saklofske, 2012). She thinks of opening her bakery, but it is just in her minds. In the real sense, she is not up to the task. She is only fantasizing. She develops the grandiose illusion. On a scale of one to ten, her mood can be eight. She feels very happy about herself (Goodwin Sachs, 2010). She likes going out with her girlfriends to have fun on weekends. She does not have bad thoughts about other people. She only thought of dying when she was pregnant (Langwith, 2009). But afterward she feels full of life and would go out of her way to always feel happy (Krawitz Jackson, 2008). The manic symptoms include her sexual urge and the desire for instant gratification (Echevarria, 2012). Her spending sprees are also out of control. She also has racing thoughts. She starts things and leaves them unfinished. She could not concentrate in the shop; she could also not do and finish baking (Boyle, Matthews, Saklofske, 2012).Adve rtising We will write a custom case study sample on Marylen Moss Initial Psychological Evaluation specifically for you for only $16.05 $11/page Learn More She has not had any psychiatric disorders. During all this time, there had been no doctor who had diagnosed Marylen because she had not visited any hospital. There is no history of her taking alcohol or drug abuse prescription (Boyle, Matthews, Saklofske, 2012). The only drug that she has been taking is Marijuana. She used to take it before pregnancy. She also continued using it after pregnancy (Langwith, 2009). George and Marylen have a family business. When her condition was poor, her husband used to continue with the business. During the examination, she seemed restless and guarded. She was anxious and told of how she felt better than at any time in her life. Marylen has had no physical injuries. She does not show any signs of allergies. She has also not been exercising. She has been using her ene rgy move around and do things that she feels make her happy. There are also no visible signs of any accident. It is not possible to tell if there has been a family history of the disorder. Since her response to questions is still not very clear, there is some information that would remain unclear perhaps until after medication. She still has a good and working relationship with her husband. Despite discovering her condition, husband still understands her and would like to help. He is the one who decides to take her for the medical examination. The family does not have financial problems for now. They can still maintain their family with that they have (Langwith, 2009). The husband continues to work so that he can provide for the family. Marylen is one of the few people who are struggling with mood disorders in the world. Sometimes it is not easy to recognize the condition when it starts. For instance, Marylen’s husband had thought that she was just sad because of her third pr egnancy after a long time. But the pregnancy had triggered depression that was slowly wearing her down. References Boyle, G., Matthews, G., Saklofske, D. (2012). Psychological assessment. London: SAGE.Advertising Looking for case study on psychology? Let's see if we can help you! Get your first paper with 15% OFF Learn More Coaley, K. (2010). An introduction to psychological assessment and psychometrics. London: SAGE. Echevarria, K. (2012). Mood disorder. Delhi: Research World. Goodwin, G., Sachs, G. (2010). Bipolar disorder. Abingdon: HEALTH Press. Krawitz, R., Jackson, W. (2008). Borderline personality disorder. Oxford: Oxford University Press. Langwith, J. (2009). Mood disorders. Detroit: Greenhaven Press. This case study on Marylen Moss Initial Psychological Evaluation was written and submitted by user Jazmin Lott to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

grrek essays

grrek essays The basis of Greek drama was a religious festival, which paid homage to Dyonicis, god of wine and fertility. Greek drama consisted of a protagonist, the main character, of noble birth whose life is full of happiness in the beginning, but ends up in agony in the end due to their tragic flaw or weakness. To provide all the background information about the characters and the play the chorus was also an important part in a Greek drama. Even now, these elements can still be found in a play or a television sitcom. A good example of a Greek drama is the Pilot episode of the HBO show Six Feet Under. The episode begins with a commercial about a glamorous hearse. The commercial divides the acts of the episode. Before a new act begins, the commercial provides the audience with the information about a product, which will be used in the act. The commercials are a part of the episode, but at the same time, it provides the audience with background information like the chorus did in the Greek dramas. After the hearse commercial Nathaniel Fisher, the owner of the Fisher and Sons Funeral Home, is introduced. It is Christmas Eve in Los Angeles and Nathaniel is on his way to pick up his oldest son Nate in his new hearse from the airport. Then his cell phone rings and the audience are introduced to his wife Ruth. She nags at him for not taking his vitamins and for smoking in the new hearse. She tells Nathaniel if he keeps on smoking he will end up dying a slow and horrible death which foreshadows the accident Nathaniel is about to get into. At the same time, she is serving her second son, Dave, breakfast. Dave is telling his mom it was a mistake to let his father take the new hearse. She then reminds Nathaniel about the time when Nate got a new motorcycle and how he still has a pin in his foot which is foreshadowing the accident again. The ironic thing is Nathaniel is listening and singing along to the song Ill Be Home for C...

Critique the literature on Intercultural (Business) Communication Essay - 1

Critique the literature on Intercultural (Business) Communication - Essay Example In business, there has to be a common language. Thus, English has emerged as the basic official language for businesses in the corporate world. This may seem as a step towards intercultural communication, but Charles (2007, p. 278) differs. He says that the choice of languages is a tricky issue. He highlights the complex nature of it and argues that that English is more present in multinational regions thus creating its own operational culture. In a sense, it merges the culture of a region with the required operational necessities of the business under question. One has to fully consider the regions and their cultures before venturing into that market. Without proper analysis of these factors, one will not fully grasp the market that is available. This makes entrepreneurs have to do quite a lot of research before venturing. According to Johnson (2006, p. 539), scholars and researchers have only looked at cultural competence as a collection of attributes that are measurable in terms of knowledge, skill and technical know-how of cross-cultural communication instead of paying more attention on the effectiveness the attributes if and when applied correctly. That is to say, rather than just talk/teach about it, those that are informed should practice these attributes in order to achieve maximum prowess as business people. Thus, now people should be educated in ways of making effective uses of these attributes rather than just being taught about them. This will help bridge the gap that occurs between the two cultures. Holmes (2012, p. 708) looks at the concept of cultural competence in another light. Though many scholars have come up with different ways looking at cultural competence, they have failed to take into consideration of the methodology used. He uses the PEER – Prepare, Engage, Evaluate, Reflect – model

Global Healthcare Exchange Case Study Assignment

Global Healthcare Exchange Case Study - Assignment Example Secondly, the founders made it clear that their aim was not the registration of an Initial Public Offering (IPO). They had a commitment to increase â€Å"customer value†, which was about the improvement of services to customers, and not â€Å"market value†, which would have been about increasing profits for investors. On one hand, GHX founding companies are all buyers or sellers in the medical supplies industry. Therefore, to this extent, the figure is true. However, on the other hand, GHz is a separate entity with its own management, vision, and direction. This makes it a third party since it considers the collective interests of all the players in the medical supplies industry. GHX software capabilities for the primary benefit of suppliers before the merger with Medibuy included the GHX AllSourceâ„ ¢ Catalog. Suppliers maintained their catalogs, which in turn formed the database that buyers queried. Software for the benefit of the buyers included GHX Connectâ„ ¢ that allowed buyers to utilize their existing ERP systems to connect to GMX’s exchange platform. The GHX Advantageâ„ ¢ let buyers use an intermediary platform hosted by a GMX partner to access the exchange platform (Applegate 23). GMX developed an ERP, the GHX Axiomâ„ ¢, used by buyers with no ERP (Applegate 23). The software discussed above-handled connectivity. On the value-added services, there was the Report Source, which provided buyers with real-time information about their transaction on the Exchange platform. The second one was the GHX Content Intelligenceâ„ ¢ that identified any errors in the transaction process such as discrepancies in catalogs and alerted the parties involved (Applegate 23).

Funeral Service Thanatology Research Paper Example | Topics and Well Written Essays - 2000 words

Funeral Service Thanatology - Research Paper Example †¢ Whether or not the person was expected to die at that point or not, i.e. how much notice the bereaved person had in order to prepare themselves, to say their goodbyes, to make arrangements. The circumstances will also affect this , for example if a person commits suicide or is murdered this is obviously more traumatic than if someone very elderly just fades away peacefully. †¢ Their religious faith or lack of it. This may depends not so much on belief as whether or not they regularly attend a place of worship as to the fact that if they do so they will have a strong social support system in place. †¢ The amount of support available to them. Restricted social support tends to produce more problems, as Clute points out with regard to those who have underdeveloped systems of support. ( Clute, 2007) . The loss of someone close can be devastating. People deal with this in many different ways. Anxiety is a natural response - part of humanity’s ‘fight or flight’ response to difficulties. As described by Worden, the biological response to loss is aggression. (2002, page 9) It is a heightening of senses as described by Mind 2012. This reflex results in high levels of adrenaline being released which causes several physical results – an increase in oxygen levels as the heart rate rises in an attempt to get oxygen where the body feels it is needed in order to flee danger. There is a corresponding reduction in appetite as blood is moved away from the digestive system into the muscles. The person can become twitchy, making nervous movements and refusing even necessary food, perhaps even becoming nauseated. They cannot concentrate or relax, so this physical difference makes an emotional impact. Death, even if it was expected, means a loss of control. This will be particularly profound in someone who already has little control over the situation and its implications upon their future. This is

Distribution of Power within the Political Community

Distribution of Power within the Political Community In Max Webers Distribution of Power within the Political Community, he discusses three concepts: class, status and parties. Weber begins by arguing power is the fate of men that try to grasp their will, even against that of others within the same society. He discusses two types of power: economic and social. Economic being the ability to determine what is to be done with materials and commodities, regarding production, consumption, etc. Social power overlaps with economic power, but also includes legal and political power. This concept, however according to Max Weber means, the way in which social honor is distributed in a community between typical groups participating in this distribution.(247). Therefore, the distribution of power within a community is based on three important aspects: class, status, and parties. This paper will summarize Webers main points; include a comparison of ideas with an author previously discussed in lecture, and my interpretation of what Max Weber is argu ing in his 1914 excerpt. Sociologist Max Weber first begins his article by discussing class. When identifying class there are three points Weber outlines. These points consist of 1) a specific casual ingredient of peoples fate (in terms of living conditions, materialistic possessions to see the level of power and wealth one has) among various actors, 2)is based on economic interests and wealth, and 3) is represented under the conditions of the labour market. Therefore, class situation ultimately signifies a situation where people are found with the same characteristics in regards to class. According to Weber, in society, there are two types of people, property owners and property-less. Quite apparent would be the fact that property owners are of course privileged, while the property-less live day-to-day trying to sell their services in the market. Wages and skill level are dependent on the service being provided. This depends on communal action (oriented on basis of shared belief or affiliation). In oppositi on, societal action deals with adjusting ones interests-not to sense a shared purpose, but to recognize shared interests. In order for either action to occur, everyone has to be familiar with the differences between wealth and opportunity, but must be seen as a result of property distribution and economic power. In the excerpt it says something along the lines of class antagonism is a simple state of affairs that has frequently been decisive for the role of class situation has played in formation of political parties. The second aspect Weber argues is status. Status, according to him means communities, unlike class. Status is defined as the likelihood that your fate is determined by social honor, also known as prestige. The common link of status group is a similar life style which is established based on wealth and income. According to Weber, there are social restrictions that are reflected in prestige-marriage patterns and residence. Rituals are a big deal within a caste. Members are prohibited from having any contact with any other group that is considered lower than that of their own-especially when the differences are ethnic. In caste structure, ethnic distinctions have become functional distinctions within the political association.(253) Weber also touches upon social stratification, which according to him, goes hand in hand with a monopolization of ideal and material goods or opportunities (253) Of course those stratified above others are more privileged and oppose the distribution of power that is regulated through the labour market and based on wealth. When economic stratification barely changes, changes regarding status tend to increase. Thirdly, Max Weber discusses parties. Parties as said by him are organized power. They are a mixture of both class (economic order) and status (social order). Parties aim to influence social action and aim to enforce their goals within both a legal and political realm. A party is never just associated with a class situation or status. A party puts in a great effort in order to achieve political control, and it all depends on how a community is classified-by status or class. Though this paper is about Max Weber, it is important to compare sociologists to one another based on their concepts and ideas. One author discussed in lecture was Karl Marx. Marx and Webers theories are not quite different from one another. Marx also believed that classes refer to economy but in a different sense. Marx saw class as being connected with means of production, in contrast Weber linked class to the factors previously discussed: prestige, wealth, and most importantly power. Both men had agreed that the more skills one has, the higher there wage is. Weber however, supposed that the differences in peoples wages suggested ones material conditions, hence why there are different types of social action. Also, Marx saw the divisions of class as an important source in society in regards to social conflict unlike Weber. In his article, Distribution of Power within a Political Community, one may accept as true what Max Weber had to say. In order for a political party to be formed, one must be wealthy, therefore prestigious, and ultimately have the power to dominate. Though one may face obstacles due to the fact that there are others competing for the same position who share the same status, or class, also known as communal action. Weber does an excellent job in distinguishing the differences among class and status, though when mixed may influence the formation of a political party. Unlike other authors discussed in lecture, Max Weber, I have found to be the easiest to comprehend and definitely agree with.

An Analysis Of Why Jimmy Doyle Will Never Succeed In Life Due To His F :: essays research papers

An Analysis of Why Jimmy Doyle Will Never Succeed in Life Due to His Father In "After The Race", by James Joyce in the book "Dubliners", the main character, Jimmy Doyle will be an unproductive citizen, fooling around with his friends and living off of his father's money for the rest of his life. In this short story he demonstrated that he doesn't realize the value of money, because he has never had to work for it, hence he is too frivolous with it at times. Jimmy also likes to be with his friends and to not work hard at what he does. Jimmy has no work ethic because his father had a lot of money, in fact he is referred to as a "merchant prince" in Dublin due to his success as a butcher, and his father did not want Jimmy to work for what he has, but would rather see his son become popular and make a lot of connections. Jimmy's father is the reason he will never succeed in life on his own. Jimmy Doyle grew in a family that was quite well off financially due to the hard work of his father. Mr. Doyle made a lot of money through hard work and sacrifice as butcher, and he wanted nothing but the best for his son. He did not want his son to work as hard as he did growing up. When Jimmy went away to college, he spent more time socializing than he did studying. "Jimmy did not study very earnestly and took to bad courses for awhile. He had money and he was popular; ..."(p.25). Jimmy liked better to be in the company of peers rather than study, and his father condoned it. When Jimmy was not doing well at Dublin University, his father let him go off to Cambridge where he could "see life a little". While there he seemed to run the bills a little high, and his father took care of all the expenses because he wanted to show off the money that he had acquired. The way Jimmy's dad just gave him money and only wanted Jimmy to meet people who were "worth knowing" corrupted Jimmy's work ethic and his behavior in the book clearly demonstrates this. Jimmy Doyle has no work ethic and is just happy to be with his friends accomplishing nothing. Jimmy loves having acquaintances and meeting people. He was very proud coming through his home town after the big race and being seen in the car with such people that he was with; Charles, an heir to a hotel empire

Aristotle the Great Philosopher Essay

Aristotle was one of the most profound philosophers of all time. He was a pupil of Plato; he adapted many of Plato’s concepts into his own. Aristotle follows in the footsteps of Plato and Socrates idea of taking the virtues to be vital in a well-lived life. Based on the precise nature, true happiness can be found. In this paper, I will discuss Aristotle’s beliefs of human good and human flourishing. Aristotle’s most influential work was Nichomachean Ethics. No one is quite sure where Nichomachean Ethics originated from; they assume it is either, a combination of lecture notes from Aristotle or his students. He believes that every human activity aims at some good; every human activity aims at some end. He believes that good equals end. Aristotle refers to good as being the object of an action. He believes people should be goal oriented no matter if the goal is morally good or bad. Aristotle thought that human actions are not haphazard, random, gratuitous, and purposeless. Otherwise, they’re relevance is the distinguishing mark of human rationality, as opposed to the instinctive ness of animal conduct or an unintentional sequence of natural events. He believes that humans seek rational means to attain their goals. (Zunjic, Books 1 & 2) Aristotle was born in 384 BCE and later died in 322 BCE. He grew up in Stagirus, which was a small Greek colony. His father was a physician to King Amyntas of Macedonia. The Macedonia Court would influence Aristotle’s life, greatly. Aristotle’s father died while he was still a child. His guardian, Proxenus, sent him to Athens. While in Athens, he became a pupil of Plato; he attended Plato’s lectures for twenty years. He then began to lecture himself, particularly about rhetoric. (Aristotle’s Biography) After Plato had died, Aristotle may have become the leader of the Academy, except his differences in teaching. They gave the leadership role to Plato’s nephew, Seusippus. Aristotle then left Athens and went to a different court. He married Pythias and then a short while after he moved to the island of Lesbos. Some years later, Aristotle was invited back to Macedonia by the King to tutor the young Alexander. Their ideas differed, which lead to an interesting relationship. (Aristotle’s biography) Aristotle taught and managed the Lyceum for twelve years, producing, during this time, his lecture notes. Only a small amount of Aristotle’s works had survived over the years. Aristotle’s works included all the major areas of thought: logic, science, metaphysics, ethics, and politics. He developed a new theory of form that differed from Plato, created a system of deductive reasoning for universal and existential statements, and produced a theory of the universe, matter, life, and mind. (Aristotle’s Biography) Aristotle expanded his knowledge significantly when he studied under Plato, if his guardian had not sent him to Athens he probably would have never studied under Plato. Though Aristotle learned a lot from Plato, his ideas also differed greatly, and he was a great thinker all on his own. Aristotle might not have been the great philosopher that he is without the guidance of Plato. â€Å"Aristotle’s style of lecturing involved walking around in in covered walkways, for which reason Aristotle was called ‘Peripatetic’ meaning walking around. † (www. about. com) Greek influences helped shape what Aristotle believed. His education under Plato was also a huge influencing factor. He believed that there were only two causes in the universe: form and matter; form and matter leads to intelligence. Aristotle was a firm believer that education and morality went hand in hand with each other. He thought it was the duty of the state to produce well rounded citizens who would lead good lives. The realization of oneself is the main way to reach goodness. Aristotle has been recognized as one of the greatest philosophers of all time. He has had essential time working with other top philosophers of his time. Years after his death, people still learn and adapt his beliefs. Aristotle was a teleologist, meaning, he believed that all existing things have a purpose. Aristotle was way ahead of his time, in his thinking. Many of the ideas he had were completely baffling to others around him. They still take a great deal of thought to grasp what he means but it is worth examining. Aristotle believes in instrumental goods and self-sufficient goods. Multiple instrumental goods are needed to achieve ourselves; they include health, friendship, wealth, knowledge, and virtue. The ancient Greek word for virtue is, ‘Arete’ meaning excellence. The excellence a person demonstrates when acting towards virtue. Virtue, when practice, begins to make us who we are. Aristotle believes that virtue must be practice habitually, so that everyone has the capacity to perfect their own character. (Aristotle Ethics Podcast 1) He believed that every idea can be traced back to the very beginning. This is known as finite regress: finite, meaning an end, and regress, meaning to trace back. Objects of thought can be traced back to the very beginning; many consequences lead to the knowledge of the object of thought. He thought that the idea in your head can be traced back, because the idea in your head is a product of everything else, even what people earlier had in their head. Once the thought reaches the corner stone, you cannot go any farther, showing it has one clear beginning. He does not believe in infinite regress that would mean there would be no defined order. (Aristotle Ethics Podcast 2) Aristotle was not concerned with his own good but, rather, the good for all humans. He called this good, eudaimonia, meaning happiness. Eudaimonia serves as the one, final self-sufficient good. He did not believe happiness was just a feeling; he believed it was also a way of living. Many have adapted this idea as human flourishing. Human flourishing involves achievement of excellence. He believes that everyone aims at some good, but different people have different ideas of what good is. The product of the activity should be better than the activity, says Aristotle. The end is the achievable good. (Kessler, 80-87) Aristotle’s beliefs can be used to view life today. His ideas of what a good is and how to reach human flourishing influence life today. When examining any thought, it is almost possible to try and trace it back to where it originated. Aristotle showed that everything has a clear beginning and end, and that everyone should try to have a life full of virtues. Aristotle’s ideas influenced many other philosophers for years after his time. He was a great influence on medieval scholasticism: much of the Roman Catholic theology shows his ideas of teleology. It was also a big influence to biology; but it was banished from physics by the scientific revolution. Aristotle is a firm believer that happiness is the most important thing in life. Ethics was the main topic Aristotle focused on, the difference between what is a right or wrong, good and evil, rule and virtues, character and vice, success and happiness. Works Cited â€Å"Aristotle – Greek Philosopher Aristotle. † About. com Ancient / Classical History. N. p. , n. d. Web. 02 Dec. 2012. . â€Å"Aristotle of Stagirus – Biography. † Aristotle. N. p. , n. d. Web. 29 Nov. 2012. . Flip4Learning. â€Å"Aristotle’s Ethics (Part One). † YouTube. YouTube, 04 Mar. 2012. Web. 03 Dec. 2012. . Flip4Learning. â€Å"Aristotle’s Ethics (Part Two). † YouTube. YouTube, 04 Mar. 2012. Web. 03 Dec. 2012. . â€Å"Nicomachean Ethics. † Nicomachean Ethics. N. p. , n. d. Web. 29 Nov. 2012. . Kessler, Gary E. Voices of Wisdom: A Multicultural Philosophy Reader. Belmont, CA: Wadsworth, 2010. Print.

Characteristics of Successful Online Students Essay

â€Å"In this age of learner-centered learning, online instruction provides a unique opportunity for learning materials, tasks, and activities to fit individual learning styles and preferences (Bonk, Wisher & Lee, 2003).† Learning styles along with other factors have an impact on the characteristics of successful online students. Each student is different, how he or she obtain information and apply it to their online learning will determine their success. Successful online students must be well rounded, having characteristics to regulate, self-motivate, and manage their time wisely; thus, successful online students must be responsible and have the ability to adapt. Web-based learning has become increasingly popular, as technologies have advanced. Time-management as well as different learning styles has the ability to affect the success of online learners. Online learners must have the ability to manage their time effectively, use visual and non-visual tools; also, they must be able to manage their resources. Student backgrounds also affect the success of online learners. â€Å"Learning styles refer to the different ways learners use to perceive, process and conceptualize information. (Zacharis, N. Z. 2011)† Students should determine their learning style and have the ability to apply it to their online learning to better use their time and to obtain the most information out of their learning. In reading this article I have learned it is best for a student to first identify their learning style in order to determine their potential successes and failures in becoming an online learner. Online learning is not for everybody. The content of this article was not surprising; I find online learning to be a challenge every day. Each semester you have to become familiar with different teaching styles of professors and their expectations with the inability to personally meet the professor. I found this article to go hand in hand with the course material read this far. It is important to determine learning styles and to determine what works best for you, s uch as flashcards, highlighting, reading and re-reading. Each individual is different, it is important to determine a  plan of action in order for an online learner to succeed to his or her full potential. â€Å"Instruct the wise and they will be wiser still; teach the righteous and they will add to their learning. (Proverb 9:9)† This proverb relates to the article and course material in that online courses only provide a sense of direction for a student and what the student does with that direction will determine their success. In my own path of obtaining my online degree I will begin to better so determine what works best for me, what learning style best fits to my courses and myself. First, I will determine my main learning style. Second, I will apply it to this course and my other courses to determine a plan of action to complete the rest of my assignments. Lastly, I will use what I have learned throughout the rest of my degree to achieve the highest level of success and understanding. I believe this information can also be applied to everyday life, to manage relationships, money, and time effectively. In conclusion, effective online learning is not for everybody. The success of online learning is determined by the success and abilities of the individual person to comprehend, and manage their time and resources effectively. Characteristics of successful online learners include patience, motivation, and also self-discipline. In proverbs 1:5 â€Å"let the wise listen and add to their learning, and let the discerning get guidance†. Works Cited: Bonk, C. J., Wisher, R. A. & Lee, J. (2003). Moderating learner-centered e-learning: problems and solutions, benefits and implications. In T. S. Roberts (Ed.), Online collaborative learning: theory and practice (pp. 54–85). Hershey, PA: Idea Group Publishing. Zacharis, N. Z. (2011), The effect of learning style on preference for web-based courses and learning outcomes. British Journal of Educational Technology, 42: 790–800. doi: 10.1111/j.1467-8535.2010.01104.x

Essay on SurrealismEssay Writing Service

Essay on SurrealismEssay Writing Service Essay on Surrealism Essay on SurrealismSurrealism has had a considerable impact on the development of the contemporary art. At the same time, traces of surrealism can be found not only in art but also in advertising. At this point, it is possible to refer to Dali and Magritte inspired VW Polo Blue Motion Campaign (See App. Image 1).The ad bears elements of surrealism since it brings a strong sense of surprise, unexpected shapes and figures which may puzzle the audience and influence the perception of the ad as a whole. The ad uses the surrealistic juxtaposition, when the man symbolizing the autonomous personality rejects the conventional fuel. He wears blue clothing and cap and grows up from the water with the lower part of his body covered by water. In such a way, he represents the autonomous personality that rejects conventional fuel and technologies that have a negative impact on the environment. In this regard, the cloud in the shape of the fuel pump symbolizes the â€Å"other†, which is actu ally the alternative fuel and energy efficient technology, Blue Motion which is actually promoted by VW Polo ad. In such a way, the ad creates the feeling of surprise and bewilderment and conveys the message of the ad clearly, while the surprise of the audience attracts viewers to the ad.Thus, Dali and Magritte inspired VW Polo Blue Motion Campaign is the sample of the surrealistic advertising that has a strong impact on the audience, although evokes some puzzlement in the audience.

International logistics Level 2 Essay Example | Topics and Well Written Essays - 2500 words

International logistics Level 2 - Essay Example It also entails the efficiency of in-process account, complete products, as well as information that relates to the final consumption by the consumers from the point of production of the consumable goods. The operations of the company in the attainment of vision and mission rely heavily on the environmental location. For instance, special considerations are made for the silver town Refinery’s upstream supplies chain and the next tier downstream in regards to the reinstated logistical processes. The completion of logistical processes in production and delivery of the products is more successful when the company is able to address a range of challenges that are commonly faced. There is also a need for change adoption to enhance the survival values of the Tate and Lyle organization in Britain. However, constraints for transformation have been rampantly experienced and are an ample factor for address. The recent developments in the organization entail the utilization of supply-cha in management strategies with an intention of countering every form of organizational negativity. The best models of supply chain need be utilized in the logistical processes management to ensure organization compatibility with the input strategies (Plunkett, 2007). The discussion in this paper establishes the key factors that influence the logistical processes at Tate and Lyle. The comprehension of these factors will be boosted by conducting a special survey on the Silver town Refinery’s upstream supplies chain and the next tier downstream. Identification of the range of challenges that Tate and Lyle must address is also considered vital at this juncture and the different logistical activities within the supply chain. It is also crucial to investigate into the extent of change of activities at Tate and Lyle could change and constrains for change that are majorly experienced. Key factors that influence the logistical processes at Tate and Lyle Logistical processes at Tate and Lyle are massively influenced by overwhelming factors that are deemed crucial as success or failure drivers. The most crucial and long term factor is the organizational equipment that is utilized in the execution of the required processes. The plant is well established in ample sites that follow each other to accomplish a sequential process. The location of a main plant at Silver town is considered as an upstream domain for the main production of the needed end products, while the downstream tiers are considered as sequential plants that enhance the produced goods delivery to the final customer. Every organization upstream settings determine the success of the downstream tiers and the final product deliveries. Thus, the Tate and lyre logistical processes execution are highly determined by the operational equipment in the set up plant. Secondly, the operational compatibility is a long term factor that influences logistical processes. The Tate and Lyle being a food company has operat ional

Kenya Airways Assignment Example | Topics and Well Written Essays - 500 words

Kenya Airways - Assignment Example The airline was initially owned by the Government of Kenya until the year 1995, and it was privatized in 1996 and since then it has become the first African flag carrier in successfully doing so. Today Kenya Airways is a public-private partnership. In this regard, the shareholding of this partnership is as follows Government of Kenya (29.8%), followed by KLM, which has a 26.73% stake in the company. The rest is held by private owners. (Kenya airways.ac.ke) Â  Being first flag carrier in Kenya its stocks are traded in different exchange markets this includes Nairobi Stock exchange, the Dar-es-salaam Stock Exchange, and the Uganda Stock exchange. Kenya Airways has become widely considered as one of the leading Sub-Saharan operators and became a full member of sky team in June 2010 and a member of African Airlines Association since 1977 and it has had quite a tremendous growth with 4,834 employees as per June 2012. Â  The airline has been using web sale service and this has shown some tremendous growth of USD 28.6 million in ticket sales compared to USD 24.2 million in the previous year showing a growth rate of 17.9%, with total revenue of USD 95.2 billion which is an increase of 26.3% above prior year. Â  The management of Kenya Airways has given a report that the profitability of the company has been affected by some factors this includes high fuel prices, the euro crisis and a generally weak economy in the West. Despite this, the management has announced a high turnover of USD 107.9 billion which represent a 26% increase on prior year turnover of USD 85.8 billion, profit after tax realized was USD 1.66 billion compared to the prior year of USD 3.5 billion. Â  

Passive euthanasia is unethical Essay Example | Topics and Well Written Essays - 250 words

Passive euthanasia is unethical - Essay Example Especially due to this second form being in existence, passive euthanasia is unethical. Ethical behavior is defined as following behavioral standards and values of the community and of society in general. In medicine, ethics involve applying values and judgements to the practice of medicine, in order to find a balance between the wishes of an individual and the impact of those actions on the community at large. Primarily, ethical behavior for physicians involves respecting the principles of patient autonomy, promoting the well-being of others, avoidance of harm, justice, protecting the dignity of the patient, and honesty. Passive euthanasia is unethical because it fails to meet several of the criteria for ethical behavior in physicians. In the case where a guardian decides that the best thing to do is euthanasia and the physician complies, the physician is failing to meet the ethical standard for patient autonomy. Even when the patient decides for themselves that they wish to have tr eatment withdrawn, obliging with those wishes could be considered failing to avoid harm to the patient, and possibly even a violation of the ethical principle of justice.

The Lottery by Shirley Jackson Essay Example for Free

The Lottery by Shirley Jackson Essay The Lottery written by Shirley Jackson tells such a story: There is an ancient traditional annual event held in a small town in America. Anyone who wins the â€Å"lottery† will be stoned to death for harvest. Tessie is the new unluckier this time, who has to suffer this cruel and inhumane punishment. Seen deeply, females’ inferior position is showed elaborately in this novel. First, the appellation to females shows that they are in subordination to males. â€Å"Mrs. Hutchinson came hurriedly along the path to the square† (Jackson, 2), â€Å"she said to Mrs.   Delacroix† (Jackson, 2), â€Å"Mrs. Dunbar said regretfully† (Jackson, 3). Here â€Å"Mrs. Delacroix†, â€Å"Mrs. Hutchinson† and â€Å"Mrs. Dunbar† all suggest that one female cannot be an individual being after her marriage, since she has to be a part of her husband by calling her â€Å"Mrs†. When Tessie comes lately, the villager’s addresses that â€Å"Here comes your Missus, Hutchinson† (Jackson, 2) instead of calling her own name also shows that she has become a subordinate object for her husband. Just like Lakoff says in his book Language and Womans Place, â€Å"It is with Mrs, Miss, and Mr.  Since a significant part of the opinion one normally forms about a womans character and social station depends on her marital status as is not the case with men† (Lakoff, 73). This phenomenon is common all over the world. Why don’t males change their appellations like female do? Actually, the marriage cannot change anything but the couple’s new relationship and family lifestyle. So does a female have to compromise to become her husband’s stooge? Perhaps only when she makes accomplishment can she be introduced as an independent individual. Those who are satisfied with their status quo are likely to accept the new subsidiary address. Thus, females’ subordinated appellations gradually become accustomed. Second, the role of being a housewife unconsciously influences a female’s equal right to fulfill her own accomplishment. In the novel, â€Å"Mrs. Hutchinson came hurriedly along the path to the square, her sweater thrown over her shoulders†¦ â€Å"Clean forgot what day it was,† she said to Mrs. Delacroix†¦She dried her hands on her apron†¦Wouldnt have me leave mdishes in the sink, now, would you, Joe? † (Jackson, 3) Tessie’s words and the act of â€Å"drying her hands on her apron† suggest the female’s low social position at that time. Obviously, if she does not â€Å"win the lottery†, her next work is to rush home and serve meals for the family, since the traditional allocation of family roles has subsided into an established social norm: once a woman is married, she will give up her career and play the role of a housewife, heart and soul. So how can a female have more time to do something more prominent fulfillment since she has been limited into such situation? It’s no wonder that females do not share the equal position to do something more meaningful to some extent. Just like Journalist Ruth Franklin subtitled her 2010 piece in The New Republic: â€Å"On Shirley Jackson and the challenge of being both a mother and a writer† (p. 1). She says, â€Å"In the 1950s, just as much as now, women can only write when the baby naps, or while the children are at school, or after the dishes are done and the lunches are packed and the house is, at last, quiet. This sort of logistics has always worked with efficiency, once the woman understands that no matter how smoothly the thoughts are flowing, they will have to stop when the school bus comes. It works as a resignation to frustration† (FRANKLIN, 2010). It’s easy to perceive that Shirley Jackson’s writing career is somewhat influenced demonstrably because of her female identity. Being both as a mother and a wife, she has to regard her career—writing as the secondary mission to the family. The embarrassing situation she faced is linked with any females at that time. Thus, the role of being a housewife unconsciously influences a female’s equal right to fulfill her own accomplishment. Third, females don’t have the power to make decisions. As it is showed in the novel, males govern all the affairs, â€Å"The lottery was conducted by Mr. Summers; The postmaster, Mr. Graves carried a three- legged stool; Mr. Martin†¦ came forward to hold the box steady on the stool† (Jackson, 1). Three most powerful men dominate the whole village politically and financially. â€Å"There were the lists to make up of heads of families, heads of households in each family† (Jackson 2), which suggests the male’s dominant position in a family. Moreover, â€Å"Dunbar’s wife substituted him to draw the lottery because he had broken his leg, but Mr.  Summers asked whether she had a grown boy to do it† (Jackson, 2) also shows that the unusuality of a female to do such an essencial and decisive thing. In the end, Tessie’s death is another evidence to show that female is not only inferior, but a victim in that lamentable social circumstance. Having no rights to make decisions, females doom to be decided instead of deciding. Thus, the female’s inferior position has formed. In a world, females’ inferior position is shown elaborately in The Lottery. Their appellations, their family division of the labor and their no power to make decisions all display the inferior position of females.

Problems with UK Glaucoma (POAG) Treatment

Problems with UK Glaucoma (POAG) Treatment CHAPTER 1: INTRODUCTION Glaucomas are a group of diseases which have the potential of causing damage to the eye and are distinguished from other eye related diseases by the fact that they can cause an increase in intraocular pressure inside which in turn causes damage to the optic nerve and to the retina. Primary Open Angle glaucoma (POAG) is the second commonest cause of registerable blindness and partial sight registrations in the UK (Bougard et al 2000). It is particularly dangerous because of its progressive nature and ability to go unnoticed for years thereby preventing treatment of the disease until, in some cases it can be too late to rescue the vision completely. Therefore the only way to detect the disease before it becomes a serious problem is with a thorough screening program. Optometrists usually are the first in line to examine a patients ocular health and refer patients onto the hospital based on several risk factors. The prevalence of POAG increases with age. This was shown in the Framingham Eye Study which estimated prevalence to be 1.2% between 50 and 64 years, 2.3% from 65 to 74 years and 3.5% in 75 years and over (Leibowitz et al, 1980). Another study has shown that POAG is positively related to the levels of intraocular pressure. The Baltimore Eye Survey concluded that the prevalence of the disease was 1.18% in patients with IOPs less than 22mmHg and 10.32% above this IOP level (Tielsch, 1991). Hereditary links have also been associated with POAG especially African-Americans who are at higher risk of developing the condition than Caucasians and, if there is a family history of glaucoma, the risk is up to six times higher than for the general population. Also, patients who are highly myopic, have diabetes mellitus or cardiovascular problems are at high risk of developing glaucoma and so these are the individuals who need to be monitored and checked regularly. Thus, in the first instance it may seem appropriate to test all individuals who present as being at a (low) threshold risk of developing the disease at regular intervals for disease progression; however the numbers of patients who are referred for suspect chronic open angle glaucoma and then found to have no glaucoma is around 40%. These false positive referrals are thought to cause unnecessary anxiety to the patient, alongside adding to the volume of paperwork that is needed to be completed by the practitioner and also thought to be a waste of local hospital resources (Parkins, 2006). Hence, these matters alongside the increasing requirements for patient centered care and reducing the costs occurred by the NHS have led to the development of certain criteria which enables optometrists to refine their own referrals for glaucoma prior to deciding whether or not a patient should be referred. This can be made easier by carrying out simple procedures or following specific protocols, for e xample, repeating suspicious IOP measurements preferably at a different time of day by using a contact method (Perkins or Goldmann) and repeating visual field tests on a separate occasion. (Parkins, 2006). More importantly, further schemes have been introduced where referrals are directed to specially trained optometrists who then decide on whether to refer the patient to the hospital eye service (HES) or return the patient for management under primary care. This appears to have ultimately increased the role played by optometrists in diagnosing and referring patients thought to be suffering from POAG, increasing their abilities to reach and treat individuals within the community more effectively. This in turn reduces the number of cases of POAG observed within the population as individuals are able to gain access to primary or more conventional methods of health care, i.e. hospitals. By reviewing the literature which has been published regarding the treatment and management of patients with POAG by optometrists, this paper aims to look at the way new schemes and interventions will affect the treatment and management of the disease within the UK. In addition, the ability of optometrists to prescribe certain drugs and the potential benefits will be discussed. CHAPTER 2: GLAUCOMA IN THE UK. (EPIDEMIOLOGY) This chapter will focus on the distribution, occurrence and control of the disease within the UK population. Glaucoma, as described above is one of the most frequent causes of blindness, predominantly in the industrialized world and therefore accounts for a high proportion of blindness observed within the UK. (Coyle and Drummond, 1995) The disease accounts for 14% of blind registrations in the UK and many cases around the country present at an advanced symptomatic stage (Aclimandos Galloway, 1988). With the potential to cause blindness in both eyes glaucoma has a dramatic effect on the individuals who are suffering from it but it also has a severe economic burden upon the nation, including direct and indirect costs. Within the UK alone these were estimated to be  £132 million in 1990. (Zhang et al, 2001) The most frequently prescribed drug for treatment of glaucoma is timolol which is a non-selective beta-adrenergic receptor blocker. The drug is used to treat open-angle glaucoma due to its ability to reduce the aqueous humour production by blocking the beta receptors on the ciliary epithelium. However, beta-adrenergic receptors blockers are thought to have serious side effects on patients who are suffering from cardiovascular or pulmonary disorders. For this reason an additional drug, 2-4 Pilocarpine, which is a cholinergic agonist may be used. This acts on a specific type of muscarinic receptor (M3) found on the iris sphincter muscle which causes contraction of the muscle and therefore miosis. This widens the trabecular meshwork through increased pressure on the scleral spur which aids the aqueous humor to leave the eye and reduce intraocular pressure. However this drug also has its limitations which are primarily associated with the requirement for it to be administrated four times per day and its ability to cause miosis, myopia and occasionally in some patients, retinal detachment and progressive closure of the anterior chamber angle. Thus, new drugs which will be more effective and safer methods of treating open-angle glaucoma are required. There have been many agents suggested for use for the treatment of the disease, however they often fail on several counts, including their failure to control intraocular pressure. (Schwab et al, 2003) This problem is observed within the three non-beta blocker drugs: latanoprost (a prostaglandin F2à ¡ analogue), dorzolamide (a topical carbonic anhydrase inhibitor), and brimonidine (a Selective à ¡2 agonist). However, out of these three drugs, Latanoprost seems to be the most highly promising because of its comparable or, in some cases, better efficacy when compared with timolol. (Zhang et al, 2001) Risk factors, which are associated with the development of the disease, include individuals who are members of a family pedigree, which have suffered from glaucoma in the past. (OMIM, 2006) It is thought that a family history of the disease increases ones likelihood of developing the disease by 6%. This is suggestive of a genetic link or predisposing factor which may be associated with the development of the disease. Diabetes and being of African descent are also factors which are thought to increase the likelihood of developing the disease, and individuals with either of these factors, are three times more likely to develop the disease than the average individual. Asian populations have a dramatically higher risk of developing glaucoma than Caucasians, increasing their chances of disease development by a staggering twenty to forty percent. Men are also three times more likely to develop open-angle glaucoma than women due to the presence of wider anterior chambers in the eye. (Paron and Craig, 1976) Evidence is becoming increasingly available to suggest that the levels of ocular blood flow are involved within the pathogenesis of glaucoma. Fluctuations in blood flow are more harmful in those with glaucomatous optic neuropathy than those who experience a steady reduction in the blood flow to their eye through the optic nerve head. This also correlates with the damage observed to the optic nerve head and to the deterioration in the visual field acuity. (National Institute of Health, web Reference) There are also a number of studies which suggest that there is a correlation between glaucoma and systemic hypertension. This is linked with the fluctuations in blood flow mentioned above, as varying blood pressure can affect blood flow. There is however, no evidence that vitamin deficiencies play any role in the development of glaucoma. A survey carried out (Rhee et al, 2002) revealed that it is highly unlikely that vitamin supplements provide a useful treatment method for any individual suffering from the disease. CHAPTER 3: SCREENING FOR GLAUCOOMA IN THE UK. As we are now aware of the epidemiology of glaucoma within the population in the UK, it is clear that screening of individuals, particularly of those individuals at high risk of disease development is required. Many factors influence whether or not screening is considered a necessary precaution by ophthalmologists. However, it is perhaps first, most useful to provide an overview of what screening is and why it is a procedure invested in for treatment of open angle glaucoma. 3.1 Definition of screening Screening may be defined as the examination of a group of usually asymptomatic individuals to allow the early diagnosis or detection of those individuals with a high probability of having a given disease, (Collegeboard, 2008) and it is often carried out on individuals who are considered to theoretically have a high chance of inheriting or suffering from the disease, due to either genetic or environmental factors or even a combination of these issues. It is thought that screening is useful when it enables the diagnosis of a disease earlier than it would usually have been detected giving the ability to improve the patients outcome. However, there are several ethical issues surrounding screening processes as some individuals are of the opinion that it is only right to screen for some diseases when an individual is at an age to consent to such a procedure. This raises issues surrounding the onset of screening procedures, and whether siblings and offspring of individuals with a family history of open angle glaucoma should be screened for the disease because of certain opinions that suggest the patient themselves should decide whether or not to be screened. This is debatable because of the implications on the individuals life and the worry which is associated with the knowledge of perhaps developing such a disease which could eventually lead to blindness. However, due to the fact that the screening procedure gives the potential for treatment of the disease symptoms, it is likely that many ethical issues which surround some screening processes are not relevant to the screening of individuals at high risk of open angle glaucoma, particularly due to the fact that the genetic risk is minimal in comparison to the environmental risk factors and thus, genetic screening of parents and their offspring is not yet (and is unlikely to become) an issue. 3.2 Tests for glaucoma There are several tests that are used to identify those patients with glaucoma, however, there is no single test that can determine whether a patient has the disease or not. To start with a thorough eye examination is a prerequisite prior to undergoing the specific tests for glaucoma. Following this examination, the management of glaucoma involves serial tests which are carried out at regular intervals over several years allowing the practitioner to determine whether the pressure in the eye has become stable and hence further damage will be avoided. Good record keeping is vital as it is only possible to determine whether the pressure has worsened by using previous values and measurements as a comparison. The ‘Gold Standard tests for glaucoma are determination of eye pressure with an application tonometer, assessment of optic nerve head and visual field screening. In optometric practice these tests are carried out once every year under NHS regulation, however, a patient under hospital management will usually be seen at least 3 or 4 times to monitor their intraocular pressure. The established ‘Gold Standard for intraocular pressure measurement is the Goldman applanation tonometer. To carry out this procedure, the Goldman head is mounted on a slit lamp and a drop of anesthetic a dye (fluorescein) is placed in the eye. Then a gonioprism is placed in contact with the cornea through which practitioner is able to see green rings and make adjustments to arrive at the end point where the half rings overlap. The eye pressure reading (in mmHg) is recorded at this position. There are several other means of recording intraocular pressure using different types of tonometers, which include the air puff tonometer, Perkins tonometer, Pneumotonometer and Schiotz tonometer. In addition, there are tonometers, which allow the estimation of eye pressure at home. One such example is the ‘proview eye pressure monitor (Bausch and Lomb, 2001). The visual field is usually the first to be affected in glaucoma and by the time the central vision is affected, the disease is already far advanced with almost all of the vision in the periphery permanently lost (Parks, 2006). Perimetric threshold-measuring techniques are sensitive to the early progression of such glaucomatous field loss and full threshold screening programs are seen as the ‘Gold Standard. However, threshold tests can be lengthy and can induce fatigue within a patient causing them to lose fixation and overall lead to unreliable results. This lead to the development of SITA testing which reduced the testing time while maintaining the same quality of results as full threshold testing (Bengtsson, et al 1998). The computers, which are used to compute the visual field, are those such as the Humphrey or the Octopus perimeters. These machines use a light point that is presented in a predetermined fashion (location sequence) in a lighted bowl and the patient is asked to press a button when they see the light point. The patients responses are analyzed statistically and compared with a database of ‘normal responses. From this information, any deviations from normal are marked on a printout as black squares which represent visual field-defect areas. à ¢Ã¢â€š ¬Ã‚ ¨ Optic nerve head assessment is mandatory in all eye examinations performed and the ‘Gold Standard method is the use of a Volk lens with the patient dilated. The preliminary signs of the disease occur at the optic nerve head where nerve fibre loss is apparent. However, it only until the loss of fibres exceeds a certain threshold that visual field impairment is noticed. Evidence from histological studies and glaucoma modelling has shown that up to 40% of optic fibres can be damaged before a loss of visual function takes place (Quigley, et al 1982). Diffused thinning and localised notching of the neuroretinal rim (NRR) indicate early signs of the disease. The cup is affected due to the loss of fibres and it widens and deepens as a result. Also, the optic disc of a glaucomatous patient will not follow Jonas ISNT rule where the NRR is thickest at the inferotemporal sector, then at superotemporal, followed by nasal and temporal. Clinical examination using a Volk lens is, however, affected by inter-observer variability amongst optometrists. Another useful technique is stereoscopic optic nerve photography which is a cost-effective method for the detection of glaucoma and its progression. With the benefit of 3-dimensional and permanent data, practitioners can study the optic nerve features (disc cupping, vessel baring) over time (Tielsch et al, 1988). Under hospital management, comparison of these photos which have been taken over the course of the year is a highly effective method of following glaucoma progression. CHAPTER 4:HOW SUCCESSFUL ARE OPTOMETRISTS AT SCREENING FOR GLAUCOMA? A number of studies and clinical trials have been carries out on the effects of treatment on newly discovered primary open-angle glaucoma patients, and it has been noted on several occasions that immediate treatment leads to a slower rate of disease progression. (Bullimore, 2002) As one must first identify that a patient has the disease before the individual can be treated, this ultimately implies that effective screening procedures would be beneficial in the treatment of glaucoma. However, one question which this leads to is: how successful are optometrists at screening for glaucoma and are all patients who should be screened, being checked for disease progression or any clinical symptoms. 4.1 The Baltimore eye Survey The Baltimore eye survey (Tielsch, 1991) was carried out to evaluate the efficacy of population level screening procedures and evaluate the performance of the screening methods used to test for glaucoma. The research team noted that â€Å"†¦screening for glaucoma has a long history and is a well-established activity† (Tielsch, 1991). However, they also were aware that most screening organizations used tonometry as the screening technique even though it is known to have several limitations associated with its use. The efficacy of the other known screening processes were thought, by the research team, to have not received deep enough investigations into their effectiveness, and this was considered to be a reason why these methods were not being utilized in the screening processes. In research studies which had been carried out prior to this study, only small research groups had been used or the studies had proved to being biased towards individuals who have a family history of the disease and therefore highly likely to developing glaucoma themselves. (Leibowitz et al, 1980) Hence the studies were thought to provide false information about the usefulness of the analyzed screening methods. The Baltimore Eye survey looked at a total of 5,308 individuals who were forty years of age or older, including both black and white individuals and analyzed the success of screening each individual for glaucoma using â€Å"†¦tomometry, visual fields, stereoscopic fundus photography and a detailed medical and ophthalmic history.† (Tielsch et al, 1991) The survey was not limited to looking at individuals who were known to be at a high risk of developing glaucoma as this would influence the analysis of the success of certain screening methods. After the examination was complete, a diagnosis of glaucoma was made for any participant found to have indicative symptoms. Out of the 5,308 individuals participating in the study, 196 were diagnosed with glaucoma. (Tielsch et al, 1991) The research team then evaluated tonometry, cup to disc ratio, and narrowest neuroretinal rim width for their ability to correctly classify subjects into diseased or non-diseased states. There was no defined cutoff values at which these variables provided a reasonable balance of sensitivity and specificity, (separately or in combination) as this made the test more robust and thus allowed the screening method to only gain positive results if it was able to identify an individual who did indeed have glaucoma. The statistical analytical methods used to analyze the data obtained from the study included making logistic regression models of the results, which were then fit to the data. These models included demographic and other risk factors, to ensure that the analysis of the data was as accurate as possible. Sensitivities and specificities were then calculated for varying cutoff levels on the distribution of predicted probabilities. The research team came to the conclusion that there was no cut off for reasonable sensitivity and specificity and that the effectiveness of current techniques for glaucoma screening was limited. (Tielsch et al, 1991) The research said that although â€Å"at first glance, glaucoma fits the model of a disease for which screening could make a significant impact on the burden of disability in the population†¦unfortunately, objective assessments of the most commonly used technique for screening†¦demonstrate its ineffectiveness.† (Tielsch et al, 1991) The study identified that tonometry was a poor technique when it came to correctly classifying subjects as diseased or non-diseased. It also mentioned that despite intraocular pressure remaining as one of the strongest known risk factors for open angle glaucoma; measurements of this were not used as a criterion for referral in order to maximize the sensitivity of the screening examination. Tielsch et al (1991) identified only Only 215 subjects out of 1770 who were referred for further tests simply because of their intraocular pressure measurements and only four of these individuals actually had definite or probable glaucoma. This was a detection rate of 1.86 percent which is very low. Thus, the use of the intraocular pressure as a guide added little additional sensitivity beyond what was contributed by the other referral criteria. Other methods of screening for the development of glaucoma were also considered to be ineffective and cumbersome. Despite this study being carried out forty years after the initiation of screening programmes for glaucoma, the program still appeared to require extra work in order to develop a more successful screening programme. 4.2 Frequency-doubling technology study In contrast to the study carried out by Tielsh et al (1991) a study was carried out by Yamada et al (1999) with the aim to assess glaucoma screening using frequency-doubling technology (FDT) and Damato campimetry. The research group carried out a two day public glaucoma screening programme which was implicated at two different institutions. Each participant underwent the following visual field tests: Damato campimetry, FDT perimetry in screeningmode and Humphrey perimetry(24-2 FASTPAC). A full ophthalmologic examination, for each eye was also carried out. The data collected from this study was then divided into four categories, including normal, ocular hypertensive, glaucoma suspect and definite glaucoma. The sensitivity and specificity level of each test was then estimated with â€Å"receiver operating characteristic curves† (Yamada et al, 1999). The results of the eye examinations revealed that out of the 240 individuals who underwent testing, 151 were identified as being no rmal, 28 were classified as ocular hypertensive, 35 were described as having suspect glaucoma and 26 were classified as being definite glaucoma individuals when using the FDT perimetry screening mode. Out of the one hundred and seventy five subjects who underwent Damato campimetry, the numbers for the same groups were 118, 19, 19 and 19 respectively. The specificities for each test were 92-93% for the FDF perimetry and 53-90% for the Damato campimetry tests respectively, hence leading to the conclusion that FDT perimetry was superior to Damato campimetry in the screening for glaucoma within the study. (Yamada et al, 1999) However, these methods for screening are rarer than the usual tonometer and visual field analysis methods described within this paper. Despite the fact that they appear to be useful and effective methods for glaucoma screening in this case, the tests are rarely used in conventional practice and therefore the results of this study should be regarded with caution. 4.3 Burton Hospital screening study The aim of this study was to investigate the â€Å"referral practices to the outpatient clinic of a consultant ophthalmologist† and also to identify the current screening routines of optometrists and general practitioners in regards to glaucoma and diabetic retinopathy diagnosis. (Harrison, et al 1988) A total of 1437 patients were referred to Burton District Hospital, from 1 November 1986 to 31 December 1987, to be viewed by a consultant ophthalmologist. The patients were grouped into urgent, semi-urgent or non-urgent depending on their referral letters. Only 1113 patients were ultimately reviewed as the remaining 324 could not be seen by the end of the study. (Harrison, et al 1988) Selected biographical data was recorded from the case notes such as age, sex and more importantly the source of referral. Any symptoms as well as the reasons for referral were looked for in the referral letters. A classification system was used for the reason for referral; this was based on symptoms and bodily location. Furthermore, there was an analysis on the referral data for the procedures used by the referring source, in this case assessment of visual acuity, visual fields, binocular vision and the optic nerve head. Also, intraocular pressure readings as well as any fluorescein checks for corneal staining. (Harrison, et al 1988) The results showed that optometrists were responsible for 39% of the referrals (439 patients) in comparison to the 49% (546 patients) of general practitioners. The most important reason for referral was visual field loss which account for 31% (345) of cases, followed by suspected glaucoma which accounted for 13% (145). The reasons for referral were also different when comparing the two referrers. GPs referred 107 (84%) patients due to eyelid disorders and 66 (77%) patients with conditions on the outer adnexa. On the other hand optometrists were responsible for referring 118 (81%) of the patients on suspicion of glaucoma. (Harrison, et al 1988) In total there were 70 referrals for possible asymptomatic glaucoma and another 77 for symptomatic disease. In 33 cases glaucoma was confirmed (20 asymptomatic) and borderline glaucoma was found in 73 cases (48 asymptomatic). â€Å"The diagnosis was confirmed in 96 (80%) of the referrals from ophthalmic opticians but in only 10 (37%) cases referred by general practitioners.† (Harrison, et al 1988) This showed that optometrists were far more accurate in referring suspect glaucoma patients, i.e. a greater number of true positives. Using information from the referral letters, the diagnostic procedures undertaken by both referral sources was explored. Optometrists relied on intraocular pressure readings in 52 of the 96 referrals (54%). The rest of the patients were referred because of suspicious cup-disc ratios, visual field loss or other clinical aspects. However, GPs would refer mainly on the grounds of symptoms that are present. Also, the ophthalmologist did not confirm suspect glaucoma in 24 patients from the optometrists referrals and 17 from the referrals by GPs. The main conclusions from the report show that optometrist were far more likely to refer retinal or optic disc disorders. There was insufficient evidence to show that GPs screened for glaucoma â€Å"whereas ophthalmic opticians screened for glaucoma with considerable skill.† (Harrison, et al 1988). Several factors contribute to these differences between the referral abilities of both professional groups. Patients will normally visit an optometrist when they are experiencing visual loss because they are usually under the impression that they require new glasses. However, when patients have external symptoms they normally go to their GP. Due to the equipment available to optometrists they are also more likely to pick up on pathologies within the eye especially those affecting the retina and optic nerve head, hence â€Å"maintaining a high degree of vigilance for asymptomatic conditions such as glaucoma.† (Harrison, et al 1988) The suggested diagnostic accuracy, however, u ndermined the actual accuracy of the opticians examination. Any difference was due to the importance given to the findings of the ophthalmologist. The quality of referrals to the hospital is vital for maintaining an effective service, especially in Britain where many outpatients departments are overstretched. Improvement in the accuracy of referrals eventually leads to less false positive referrals, therefore enhancing the value of true positive referrals. One of the protruding reasons for false positive referrals in this study was suspected glaucoma but with â€Å"greater utilisation or development of community based screening programmes† the false positive referral rate could be reduced. Harrison, et al (1988) states that currently the closest approach to a screening programme is offered by optometrists. Harrison et al (1988) is also of the opinion that by establishing a planned screening service where ophthalmologists and optometrists work in conjunction on the basis of a fixed referral criteria, the progression of the disease in patients will reduce and so will the burden on HES. There is evidence from the data within the study to show that such glaucoma screening programme would have an influence. The 41 false positive glaucoma referrals would have been prevented and so would most of the 73 referrals for borderline glaucoma. A potential 100 outpatient appointments could have been saved with a community based screening strategy and this in turn would free up follow-up appointments. The study does show the benefit of current screening procedures and how optometrists are successful at accurately referring suspect glaucoma patients. Harrison, et al (1998) highlights that this is an invaluable skill which would prove more beneficial if used within a community based screening scheme. 4.4 England and Wales survey The objective of this survey was to investigate â€Å"the efficiency of referral for suspected glaucoma to general practitioners and consultants by optometrists.† (Tuck Crick, 1991) This survey involved 241 optometrists who represented areas clustered in England and Wales. Majority were enrolled through an interview procedure, but some responded to an advert in optometric publications. The scheme ran from November 1988 to February 1989 and each time a referral took place the optometrist would fill out a questionnaire on the individual patient. In total the respondents completed 275600 sight tests, which accounted for â€Å"about five per cent of the national total†. The actual number of referrals was 1505 for those suspected of glaucoma. For people over the age of 40 an estimated 0.9% referral rate was found. The end result of the referral was established for 1228 individuals. There were 125 patients were not examined at all and the remaining 1103 were examined by a consultant ophthalmologist. (Tuck Crick, 1991) An analysis was done on 704 cases to assess the accuracy of the referrals. Glaucoma was confirmed in 40.19% (283) of patients and 31.53% (222) of patients were further monitored. The data showed that in nearly all the confirmed patients the disease was at a chronic stage. Optometrists were further questioned to specify the key reasons for referral in each of the cases. There were 171 patients referred due to intraocular pressure in at least one eye being greater than 30mmHg. From these, 112 (65%) were positively diagnosed with glaucoma and only 20 were discharged as false positives. It was noted, however, that accuracy of referral in patients with lower IOPs (20-25mmHg) was much less. Only 7 individuals out of the 87 with lower IOPs were found to have glaucoma. Amongst them 50 patients who were released with no glaucoma. (Tuck Crick, 1991) When the optometrist recorded optic nerve head changes and visual field plots, the IOP referral accuracy was greater. However, when the referral was based on optic disc appearance and visual fields alone the accuracy was low. This category of referral accounted for 28 (10%) of confirmed cases. Furthermore, only 331 of the 704 patients had undergone a visual field test. This explained those cases in which visual field loss was not described as a reason for referral because the screening test had not been carried out in the first place. Even so, the analysis stressed â€Å"that field screening generally enables a case to be more precisely described and the risk of glaucoma thereby better assessed at the primary level.† (Tuck Crick, 1991) Gathering the evidence from th