Short Story fiction Essay Example | Topics and Well Written Essays - 1000 words

Short Story fiction - Essay Example After leaving Red Sammy’s place, Grandmother throws a tantrum in order to be taken to a plantation nearby that she had known long ago. Bailey agrees to divert into the way in which his mother shows him. The grandmother realizes she has lost all recollection of the plantation. They drive back when they fail to trace the plantation. Grandmother’s cat jumps out of its box and lands on Bailey’s shoulder. Bailey loses control of the car and off the road. The car flips and plunges into a ditch. Just then, another car approaches them, and three men climb out. These men are The Misfit, Hiram, and Bobby Lee. The grandmother recognizes the Misfit, and he is unhappy with the fact that somebody recognizes him (Kilcourse 73). Grandmother tries to flatter the Misfit, but as it turns out, he is the hard-to-please kind. He orders Bobby Lee and Hiram to take John Wesley and Bailey into the forest. A moment later, Bobby Lee and Hiram shoots and kills them in cold blood. Grandmothe r fears for her life and she resorts to her Christian faith for the hope to live through the moment. The Misfit puts on Bailey’s shirt that Bobby Lee and Hiram have brought to him after killing Wesley and Bailey. Grandmother pleads with the Misfit not to kill her and advises him to pray to Jesus. In a matter of seconds, the Misfit shoots the grandmother thrice in the chest. Hiram and Bobby Lee come back from killing The Mother, June Star and the baby. The Misfit remarks that there is no pleasure in life (Kirk 39). Analysis of A Good Man is Hard to Find The title of the book, A Good Man is Hard to Find, points to Red Sammy Butts in the moment he conversed with grandmother while at The Tower. Mistrust of others is a theme that is consistently evident in O’connor’s book. In their conversation, Red Sammy Butts and grandmother confirm this. They reckon that it is hard to trust anybody in the world. Red Sammy recounts how he allowed two men to take gas on credit, and he laments ever having to be good to people (Robillard 52). Grandmother believes that there is not even a single soul on earth that can be trusted. This contradicts the Christian faith to which the grandmother is a strong believer. In this book, O’connor presents the reader with two clashing moral codes. Both grandmother and the Misfit have beliefs and perceptions that guide their conduct. A moral code is a collectivity of people’s behaviors, and beliefs thought of as reasonable and acceptable. The rightness of a person’s moral code is subjective. At a glance though, one would not help but notice how the Misfit’s code is erroneous. Grandmother’s code is also contradictory and unconvincing (Hardy 48). It is clear that grandmother’s moral code derives from what she thinks is good. For example, she emphasizes the importance of looking like a lady, depicting that she is more interested in appearance than in substance. She subtly deceives Bailey and the whole family without remorse. Despite her claim of Christian piety, she cannot even remember to pray when in a crisis. She even dares to question the divinity and power of Jesus. On the other hand, the misfit is consistent and apt in following his moral code. The Misfit believes that punishment is always bigger than the wrong done, and in the end, the wrong done does not receive the emphasis it deserves. It is clear that religion baffles the Misfit. Whilst the grandmother took faith blindly

Air traffic essay Essay Example for Free

Air traffic essay Essay Today many people state that the authorities have to lighten air traffic by introducing new charges, because airports generate a lot of noise and damage environment. The reason is huge demand for cheap flights, so there are too many people to use airline services. In my opinion, this idea is completely wrong, because of several reasons. To begin with, if there be less people, who can afford themselves to travel by air, then they will choose cars and other ground transport, what will cause a lot more pollution and traffic jams on the roads. Just compare 100 people on one plane and 100 people on 100 cars. It goes without saying that second option is much more damaging for environment. Moreover, such soluton will cause dramatical fall in business activity, because people will not be able to control production performance, visit important meetings and so on. Some people will say that these are just minor set-backs, but in fact, we will face the catalyst of new world economic recession. Finally, I see reducing air traffic as a slow-down of progress. If airlines and airports have less financial resources then they will not be able to maintain their development teams. As a result, world will be one-step further from creating new ways of air travel. Following topic’s logic, we should start living in lairs and eat with the stick. In conclusion I want to say that services that enjoys great demand are essential for people and they became natural part of society’s infrastructure. Today many people state that the authorities have to lighten air traffic by introducing new charges, because airports generate a lot of noise and damage environment. The reason is huge demand for cheap flights, so there are too many people to use airline services. In my opinion, this idea is completely wrong, because of several reasons. To begin with, if there be less people, who can afford themselves to travel by air, then they will choose cars and other ground transport, what will cause a lot more pollution and traffic jams on the roads. Just compare 100 people on one plane and 100 people on 100 cars. It goes without saying that second option is much more damaging for environment. Moreover, such soluton will cause dramatical fall in business activity, because people will not be able to control production performance, visit important meetings and so on. Some people will say that these are just minor set-backs, but in fact, we will face the catalyst of new world economic recession. Finally, I see reducing air traffic as a slow-down of progress. If airlines and airports have less financial resources then they will not be able to maintain their development teams. As a result, world will be one-step further from creating new ways of air travel. Following topic’s logic, we should start living in lairs and eat with the stick. In conclusion I want to say that services that enjoys great demand are essential for people and they became natural part of society’s infrastructure.

Character of Walter Mitty in The Secret Life Of Walter Mitty :: The Secret Life Of Walter Mitty

The Secret Life Of Walter Mitty - Character Study of Walter Mitty   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In the short story, "The secret life of Walter Mitty," a man by the name of Walter Mitty goes into town with his wife to get some things done. Throughout this story Walter Mitty shows that he is very forgetful and a really stubborn man with a vivid imagination.   He is constantly being distracted, and starts to day dream often.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There are a few hints in this story that show Walter Mitty is very forgetful.   Most of this is probably caused by his constant day dreaming throughout this trip into town and not concentrating too hard on what he's doing.   Once Walter Mitty had dropped off his wife for her hair appointment, he began to do his shopping.   Walter picks up his overshoes and then "Walter Mitty began to wonder what the other thing was his wife had told him to get. She had told him, twice before they left."(90)   Also, a little later on, Walter Mitty "was always getting something wrong"(90) This last quote shows that Walter Mitty must forget things quite often.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The story also shows that Walter Mitty is a really stubborn person. When he was dropping off Mrs. Mitty, Mrs. Mitty told Walter Mitty not to forget the overshoes he was sopposed to buy while in he was town. Walter Mitty's reaction was "I don't need overshoes,"(88) but he did give in to his wife in the end, and bought the overshoes.   Another incident that shows Walter Mitty is stubborn occurs when his wife told him to put his gloves on, then Walter Mitty puts them on, but when his wife is out of site he took them off immediately.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The most obvious trait of Walter Mitty is his constant day dreaming. Throughout the whole story, Walter Mitty is being distracted easily by everyday events.   His dreams turn these simple events into wild fantasies such as being a surgeon, bomber pilot and a captain of a sea vessel.   An example of how he changes something from everyday life into a dream occurs when Walter Mitty is trying to remember what it was his wife had told him Character of Walter Mitty in The Secret Life Of Walter Mitty :: The Secret Life Of Walter Mitty The Secret Life Of Walter Mitty - Character Study of Walter Mitty   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In the short story, "The secret life of Walter Mitty," a man by the name of Walter Mitty goes into town with his wife to get some things done. Throughout this story Walter Mitty shows that he is very forgetful and a really stubborn man with a vivid imagination.   He is constantly being distracted, and starts to day dream often.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There are a few hints in this story that show Walter Mitty is very forgetful.   Most of this is probably caused by his constant day dreaming throughout this trip into town and not concentrating too hard on what he's doing.   Once Walter Mitty had dropped off his wife for her hair appointment, he began to do his shopping.   Walter picks up his overshoes and then "Walter Mitty began to wonder what the other thing was his wife had told him to get. She had told him, twice before they left."(90)   Also, a little later on, Walter Mitty "was always getting something wrong"(90) This last quote shows that Walter Mitty must forget things quite often.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The story also shows that Walter Mitty is a really stubborn person. When he was dropping off Mrs. Mitty, Mrs. Mitty told Walter Mitty not to forget the overshoes he was sopposed to buy while in he was town. Walter Mitty's reaction was "I don't need overshoes,"(88) but he did give in to his wife in the end, and bought the overshoes.   Another incident that shows Walter Mitty is stubborn occurs when his wife told him to put his gloves on, then Walter Mitty puts them on, but when his wife is out of site he took them off immediately.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The most obvious trait of Walter Mitty is his constant day dreaming. Throughout the whole story, Walter Mitty is being distracted easily by everyday events.   His dreams turn these simple events into wild fantasies such as being a surgeon, bomber pilot and a captain of a sea vessel.   An example of how he changes something from everyday life into a dream occurs when Walter Mitty is trying to remember what it was his wife had told him

Struggle between Good and Evil in The Scarlet Letter and Macbeth Essay

Struggle between Good and Evil in The Scarlet Letter and Macbeth It is said that â€Å"all conflict in literature is, in its simplest form, a struggle between good and evil.† Indeed, the fundamental conflict of human nature is that of darkness and light; and as a mirror to life, the conflicts in literature is not different from those in human nature. The struggle of good and evil is shown in Nathaniel Hawthorne’s The Scarlet Letter, which portrays the spiritual battle between and evil man and a sinned minister, as well as the minister’s internal turmoil. William Shakespeare’s Macbeth, similarly describes a man’s moral decay and the vengeance of the wronged good people. Both authors use various literary elements and techniques such as symbolism, metaphor, theme, and characterization to illustrate the struggle between good and evil in their works. The Scarlet Letter, written by Nathaniel Hawthorne, is a story of damnation and redemption. Roger Chillingsworth, finding out his wife’s adultery with Arthur Dimmesdale upon his returning from Indian captivity vows to take revenge on the minister. In the process, however, he transforms himself into the minion of devil on earth. Through the mouth of Pearl (the fruit if the illegitimate union), the author metaphorically calls Chillingsworth â€Å"the Black Man.† Comparing Chillingsworth to the Devil, Pearl warns Dimmesdale â€Å"the Black man wants thy soul.† Indeed, Chillingsworth sets out to poison his rival – both physically and mentally. Dimmesdale, on the other hand, is waging a war within himself. His good nature craves to confess his secret affair with Hester Prynne, yet his darker side – cowardice perhaps- stubbornly refuses. In ... ...ts stem from this eternal struggle. Nathaniel Hawthorne writes The Scarlet Letter to question sin, and Shakespeare’s Macbeth gives an alarming example of moral decay. The moods of both masterpieces are gloomy, dissecting and examining the powerful darkness of human psyche. In the end, however, goodness endures and shines through the dark clouds, offering hope and testimonies for the complexity and ambivalence of humankind. Works Cited and Consulted: Brooks, Cleanth. Blame in Macbeth. London: Reynal & Hitchcock, 1987. Chase, Richard (1996). "The Lessons of the Scarlet Letter." Readings on Nathaniel Hawthorne (pp. 145-152). San Diego: Greenhaven. Hawthorne, Nathaniel. The Scarlet Letter. New York: St. Martins, 1991. Shakespeare, William. Tragedy of Macbeth . Ed. Barbara Mowat and Paul Warstine. New York: Washington Press, 1992.

Advanced Paramedical Science

Nausea and vomiting is a commonly encountered problem in the emergency department as it accompanies a multitude of conditions ranging from seemingly benign conditions such as migraine and gastroenteritis to potentially lethal conditions such pancreatitis and the acute abdomen.Studies from the U.S have shown that each year, almost 8 million individuals present to the emergency department with complain of nausea and vomiting, either as a principal complain or as a part of another disease etiology (Braude, Soliz, Crandall, Hendey, Andrews, & Weichenthal, 2006, p. 77).Nausea and vomiting are not distinct disease entities. Rather, they are symptoms which can be present in a wide range of disease conditions and are considered to be the ‘end-points’ of several pathological processes (Klosterhalfen and Enck cited in Kowalski, Rapps, & Enck, 2006 p.28). The term nausea refers to the subjective feeling or the urge to regurgitate gastric contents (Kuver, Sheffield, & McDonald, n.d. ).From a physiological point of view, this is associated with reduced gastric motility and increased smooth muscle tone of the small intestine. Moreover, there might also be the presence of reverse peristalsis in the small intestine, which can cause the feeling of imminent regurgitation (Bowen, n.d.).On the other hand, vomiting refers to ‘the forceful discharge of gastric contents’ (Kuver, Sheffield, & McDonald, n.d.) which is meant to serve the purpose of protecting the gastrointestinal tract from potentially harmful substances by preventing their entry and transit through the gastrointestinal tract (Kuver, Sheffield, & McDonald, n.d.).Vomiting, if persistent can have several potentially hazardous consequences such as dehydration, electrolyte imbalances, metabolic derangements, manifesting as alkalosis and even bleeding and esophageal perforation (Kuver, Sheffield, & McDonald, n.d.). Moreover, from the patient’s perspective, nausea and vomiting can be distressfu l and thus appropriate and timely management of these two conditions is imperative.The Physiology of Nausea and Vomiting – an overview of the stimuli and pathway involvedFor several decades now, it has been established that the chemoreceptor trigger zone in the brain which is responsible for emesis is the area posterema. This is a region located at the dorsal surface of the medulla oblongata near the caudal end of the fourth ventricle. It is one of the ‘circumventricular organs’ and by the virtue of possessing a relatively permeable blood-brain barrier, is sensitive to a variety of stimuli (Sanger & Andrews, 2006, p. 5).Thus, it plays an important role in emesis. Studies have shown that there are five main kinds of stimuli which can trigger nausea and vomiting via different pathways viz. the presence of toxic materials within the gut lumen, presence of toxins in the blood, a pathology within the gut, a central nervous system (CNS) stimulus or disturbances in the vestibular system (Sanger & Andrews, 2006, p. 5). The mechanism whereby each of these stimuli brings about nausea and vomiting is discussed below.The presence of toxic materials within the gut lumen:The presence of toxins, such as drugs has been shown to stimulate the enteroendocrine cells, such as the enterochromaffin cells, located in the gut mucosa and result in the release of several mediators such as 5HT3, Substance P and CCK.This results in the stimulation of vagal afferent neurons which are located in the abdomen. These neurons traverse through the nucleus tractus solitarius (NTS) and are projected to the dorsal brainstem, with some projection in to the area posterema (Sanger & Andrews, 2006, p. 5).Presence of toxins in the bloodToxins which have been absorbed and are circulating in the bloodstream can directly stimulate the area posterema and cause induction of emesis (Sanger & Andrews, 2006, p. 5). This is the most common mechanism whereby ingested or parenterally administe red drugs, such as chemotherapeutic agents and other toxins such as drugs of abuse, invoke the emetic response.Gastrointestinal tract pathologiesCertain pathologies of the gastrointestinal tract, such as gastritis or hypertrophic pyloric stenosis can stimulate the vagal afferents or directly activate the pathways leading to emesis (Sanger & Andrews, 2006, p. 6).Central nervous system (CNS) stimuliCertain stimuli such as intense fear, anticipatory anxiety, injury to the brain or a sudden increase in the intracranial pressure can induce emesis (Sanger & Andrews, 2006, p. 6). The mechanism involved in such a response has not yet been elucidated clearly.Disturbances in the vestibular systemAmongst other manifestations of disturbances in the vestibular system, such as dizziness, nausea and vomiting is also an important symptom. The vestibular system has been shown to directly stimulate the pathways involved in the emetic response and hence produce nausea and vomiting (Sanger & Andrews, 2 006, p. 6).All these stimuli have been shown to stimulate various pathways which have one common outcome viz. the stimulation of the emetic center in the area posterema. (Kuver, Sheffield, & McDonald, n.d.). Several receptors, both central and peripheral, have been implicated in bringing about emesis.Amongst these the most pertinent ones are Dopaminergic receptors (particularly D2), Histaminergic receptors (especially H1), Muscuranic receptors (including M3/M5), 5-hydroxytryptamine receptors, in particular, 5-HT3 and the neurokinnin receptor, NK1 (Sanger & Andrews, 2006, p. 8)Once any of the above mentioned stimuli are encountered, an afferent response as discussed above is generated. This results in the activation of the chemoreceptor trigger zone in the area posterema. Subsequently, a motor response is generated, whereby efferent pathways involving the cranial nerves V, VII, IX and X are activated. Moreover, autonomic responses are also generated (Kuver, Sheffield, & McDonald, n.d .).The vagal efferents to various muscle groups such as those located in the esophagus, stomach and the intestine are activated bringing about stimulation of these muscles (Sanger & Andrews, 2006, p. 6). Moreover, abdominal muscles, phrenic muscles and the diaphragm are also stimulated to bring about the required increase in the intra-abdominal pressure. The combination of both these effects leads to the regurgitation of the gastric contents.Moreover, this is also accompanied by various other manifestations such as an increase in salivation, brought about by the stimulation of the chorda tympani branch of the facial nerve, autonomic stimulation of the cardiovascular and respiratory systems and vasoconstriction of skin vessels (Sanger & Andrews, 2006, p. 6).Antiemetic drugs used in pre-hospital careNausea and vomiting are commonly encountered clinical problems. Over the years, several anti-emetic medications have been discovered to effectively alleviate the symptoms of nausea and vom iting.These drugs work by blocking the pathways involved in the initiation and production of emesis. Various drugs have been developed which block the different receptors, both central and peripheral, involved in producing emesis.The anti-emetic medications which are used in common clinical practice can be grouped in to seven major categories according to their mode of action. These include anti-cholinergics, antiserotonins, antihistamines, Benzamides, Butyrophenones, Phenothiazines and steroids (Scuderi, 2003, p. 43).The mechanism of action and the dosages of the four main anti-emetics used in Ambulance Services in Australia are discussed below:1.  Ã‚  Ã‚  Ã‚  Ã‚   Metoclopramide (Maxolon):Metoclopramide has been used in clinical practice for several decades now as an antiemetic and a prokinetic agent (Walkembach, Bruss, Urban, & Barann, 2005, p. 50). These antiemetic functions are thought to be brought about by the antagonistic actions of Metoclopramide on the dopamine (D2) rece ptors, both central and peripheral, and also on the 5HT3 receptors (Walkembach, Bruss, Urban, & Barann, 2005, p. 50).On the other hand, the prokinetic action of Metoclopramide are brought about by the relaxation of the pyloric sphincter, the increase in the strength and frequency of peristalsis and an increase in the tone of the lower esophageal sphincter (Australasia, 2008).This drug is available in both tablet (white, round, 7mm in diameter) and injection (colorless, aqueous solution) forms (Australasia, 2008). The maximum dose of Metoclopramide commonly used in all age groups is up to 0.5 mg/kg body weight.The recommended dosage regimen for adults is 10mg three times daily while for children it varies between 2.5mg-5mg   three times daily (Australasia, 2008). The metabolism of Metoclopramide takes place in the liver and it is eliminated from the body predominantly via the kidney. (Australasia, 2008)2.  Ã‚  Ã‚  Ã‚  Ã‚   Prochlorperazine (Stemetil)Prochlorperazine is a phenothi azine which has been shown to block the dopamine receptors (D2) in the chemoreceptor trigger zone located near the area posterema. By blockage of these receptors, Prochlorperazine exerts its antiemetic actions. The recommended dosage of Prochlorperazine in is 10 mg intravenously (Goodman and Gilman’s: The Pharmacologic Basis of Therapeutic cited in Ernst, Weiss, Park, Takakuwa, & Diercks, 2000, p. 92).In emergency practice, IV administration of 2.5-10 mg of Prochlorperazine at a rate of up to 5mg/min is recommended for adults. The maximum dose should not exceed 40mg per day. Moreover, IM injections of this drug are also available. They are administered at a dose of 5-10 mg every 3-4 hours (Bartlett, 2009, p. 861).3.  Ã‚  Ã‚  Ã‚  Ã‚   Ondansetron (Zofran)Ondansetron is a carbazole derivative and is a potent antiemetic drug which is widely used in alleviating the symptoms of nausea and vomiting associated with chemo- and radio- therapies and also in the management of post-ope rative nausea and vomiting (Scuderi, 2003, p. 59). Its proposed mechanism of action is via selective antagonism at the level of the 5 HT3 receptors (Scuderi, 2003, p. 59).Chemotherapeutic agents are thought to bring about nausea and vomiting via the stimulation of enterochromaffin cells in the gut mucosa leading to 5HT3 production and subsequent vagal stimulation. This pathway is blocked by 5HT3 antagonists such as Ondansetron.Ondansetron has been shown to have a short half life of approximately 3 to 5 h (Ho & Gan, 2006, p. 607). The recommended dosage of Ondansetron varies between 8-16 mg twice daily (Bartlett, 2009).4. Promethazine (Phenergan)Promethazine is also a phenothiazine but is shown to have dual modes of action. It not only blocks the dopamine receptors (D2) but has also been shown to have anti-H1 histamine receptor effects. It is used for a wide range of purposes including in the treatment of motion sickness, vertigo and even allergies (Bartlett, 2009, p. 869).The recomm ended oral dose of Promethazine is 25 mg twice daily. It can also be administered intravenously at a dose of 12.5-25 mg every four hours. The maximum dose is 150 mg/day (Bartlett, 2009, p. 869).PART IIThere are several clinical conditions which can present with the symptoms of nausea and vomiting. Amongst these the most common condition is gastroenteritis, migraines and pancreatic amongst others.The adequate and timely management of patients with nausea and vomiting has posed a challenge for the clinicians for several decades and although several effective anti-emetics have been discovered, there has been a quest for a single anti-emetic which is efficient, fast acting and relatively safe.In the practice of ambulance services and emergency situations, different anti-emetics are commonly used including Metoclopramide, Chlorpromazine, Ondansetron and Promethazine. Amongst these, in my opinion, the most suitable drug for use in the ambulance service and emergency departments is Metoclo pramide.This is because on comparing the onset of action, clinical efficacy and side effect profiles of the most common anti-emetic agents, it is apparent that Prochlorperazine is superior to all other agents used. Moreover, its cost, availability and easy administration make it suitable for use in the emergency practice. Following is a comparison of the four most commonly used anti-emetic drugs.A common concern with the use of any drug is its safety and side effect profile. Safety becomes more important while dealing with patients in the emergency or ambulance care since limited resources, time and personnel are available in such settings, and the prime concern is the stabilization of the patient and alleviation of his symptoms.Drugs which have potentially unsafe need to be administered with caution and the patients need to be monitored for the occurrence of adverse effects. This is not feasible in emergency and ambulance practice and thus the ideal drugs for use in such settings a re those which have no or minimal side effects.With Metoclopramide, there is a 10-20% incidence of side effects and these side effects are mild. The most common side effects observed with this drug are CNS effects such as anxiety, restlessness and insomnia which can vary in severity (Australasia, 2008).Moreover, it has also been shown to cause fatigue and occasionally can cause extrapyramidal side effects. Another relatively common side effect of Metoclopramide is gynecomastia which occurs as a result of enhanced prolactin secretion (Kuver, Sheffield, & McDonald, n.d.).A rare complication associated with the use of Metoclopramide is Neuroleptic Malignant Syndrome which is a medical emergency and can lead to death. However, it is observed in only less than 1 in 10,000 cases (Australasia, 2008) .On the other hand, the phenothiazines including Prochlorperazine and Promethazine have been shown to have a greater number of side effects. Amongst these the ones which arouse the most concern are extrapyramidal symptoms.Extrapyramidal symptoms can range from tremor to akathisia and the potentially hazardous tardive dyskinesias (Australia, 2009). Moreover, they can also manifest as dystonic reactions are similar to the manifestations of Parkinson's disease. Less commonly, Neuroleptic Malignant Syndrome, which is a medical emergency, can also result from the use of these drugs.These effects are thought to be caused due to the central antidopaminergic properties of the phenothiazines on the dopamine receptors. The occurrence of these symptoms is noticed most commonly within 36 hours of initiation of treatment. However, these symptoms are reversible and once the drug is discontinued, they disappear within 24 hrs (Australasia, 2008).It is important to note that with Metoclopramide, the occurrence of extrapyramidal side effects is not very common. On the other hand, the phenothiozones such as Prochlorperazine and Promethazine have a much greater incidence of these side effect s.Drotts and Vinson (1999) in their study showed that with the use of Prochlorperazine, incidence of akathisia was 44% within 1 hour and 5% within 48 hours. (Braude, Soliz, Crandall, Hendey, Andrews, & Weichenthal, 2006, p. 181). Other studies, such as those of Ernst et. al., have supported these findings.These extrapyramidal symptoms, if severe, have to be treated with intravenous infusions of an anti-cholinergic agent such as diphenhydramine (Ernst, Weiss, Park, Takakuwa, & Diercks, 2000, p. 92).Other common side effects of phenothiazines include constipation, blurred vision, mild elevation of the hepatic enzymes (if the patient develops cholestatic jaundice), ECG changes, arrhythmias and hypotension (Australia, 2009).Hypotension in patients who are already dehydrated due to vomiting can lead to significant patient distress and is also important from the point of view of health care professionals, as it poses difficulties in patient management in emergency and ambulance settings. Moreover, most phenothiazines, in particular Promethazine are known to cause sedation due to histamine blockade.Promethazine has also been shown to reduce the seizure threshold. Due to the multitude of serious adverse effects of Promethazine the Food and Drug Administration (FDA) has restricted its use in children under two years of age (DeCamp, Byerley, Doshi, & Steiner, 2008, p. 859).As compared to Metoclopramide, Ondansetron has relatively lesser side effects. The most commonly encountered adverse effects of this agent include headaches, constipation and mild elevation of serum transaminases (Kuver, Sheffield, & McDonald, n.d.).But this drug is not preferred over other anti-emetic agents due to its cost and availability issues (Ernst, Weiss, Park, Takakuwa, & Diercks, 2000, p. 92). Moreover, it is used more commonly to prevent post-operative nausea and vomiting and in patients receiving chemotherapy and its role in acute settings has not been extensively studied.Pregnancy is one of the most common conditions which present with nausea and vomiting.   Amongst the commonly available anti-emetics only a few are safe to use in pregnancy.Studies have shown Metoclopramide to be safe for use during pregnancy and this drug has not been shown to cause any long term complications in children of mothers using it during pregnancy (Sà ¸rensen, Nielsen, Christensen, Tage-jensen, Ekbom, & Baron, 2000). Similarly the safety of Ondansetron has also been proven by several studies conducted recently (Einarson, Maltepe, Navioz, Kennedy, Kennedy, & Koren, 2004, p. 940).However, both Promethazine and Prochlorperazine belong to Category C and thus   have limited use in pregnancy (Australia, 2009).Another advantage of Metoclopramide is its ability to provide faster relief from the symptoms of nausea and vomiting. Metoclopramide has been shown to have a rapid onset of action. Following IV administration, its effects start manifesting in around 1 to 3 minutes, whereas following intramuscular administration, 10 to 15 minutes is required (Australasia, 2008). This rapid action makes it suitable for use in emergency practice,Although there is a paucity of studies comparing the cost effectiveness of Metoclopramide with other antiemetics, studies comparing the cost-effectives in patients undergoing chemotherapy have shown that Metoclopramide to be more cost effective than Ondansetron (Ballatori, et al., 1994).Thus, in conclusion, keeping the side effect profiles, the availability and cost effectiveness of all the anti-emetics in view, in my point of view Metoclopramide is best suited for use in ambulatory settings. Metoclopramide has several benefits over other anti-emetics.It has a fast onset of action which makes its practical for use in emergency settings. Moreover, it has lesser and milder adverse effects as compared to other anti-emetics. In addition, it can be used in all age groups and is safe in pregnancy. Thus, all these properties make Metoclopramide i deal for use in ambulatory care settings.ReferencesAustralasia, V. P. (2008, October 22). Metoclopramide hydrochloride-Data sheet. Retrieved May 1, 2009, from Medsafe-INFORMATION FOR HEALTH PROFESSIONALS: http://www.medsafe.govt.nz/Profs/datasheet/m/Maxolontabsyrinjsupp.htmAustralia, S.-A. (2009). Sanofi-Aventis Australia. Retrieved May 1, 2009, from Product Information: http://www.sanofi-aventis.com.au/products/aus_pi_phenergan.pdfBallatori, E., Roila, F., Berto, P., De Angelis, V., Neri, C., Olivieri, A., et al. (1994). Cost and cost-effectiveness analysis of ondansetron versus metoclopramide regimens: a hospital perspective from Italy. Pharmacoeconomics , 227-37.Bartlett, J. &. (2009). 2009 Nurse's Drug Handbook . Jones & Bartlett .Bowen, R. (n.d.). Physiology of Vomiting. Retrieved May 1, 2009, from The Stomach: http://www.vivo.colostate.edu/hbooks/pathphys/digestion/stomach/vomiting.htmlBraude, D., Soliz, T., Crandall, C., Hendey, G., Andrews, J., & Weichenthal, L. (2006). Anti emetics in the ED: a randomized controlled trial comparing 3 common agents. American Journal of Emergency Medicine , 177–182.DeCamp, L. R., Byerley, J. S., Doshi, N., & Steiner, M. J. (2008). Use of Antiemetic Agents in Acute Gastroenteritis:A Systematic Review and Meta-analysis. Archives of pediatric and adolescnet medicine , 858-865.Drotts, D. L., & Vinson, D. R. (1999). Prochlorperazine Induces Akathisia in Emergency Patients. Annals of Emergency Medicine .Einarson, A., Maltepe, C., Navioz, Y., Kennedy, D., Kennedy, D., & Koren, G. (2004). The safety of ondansetron for nausea and vomiting of pregnancy:a prospective comparative study. BJOG: an International Journal of Obstetrics and Gynaecology , 940–943.Ernst, A. A., Weiss, S. J., Park, S., Takakuwa, K. M., & Diercks, D. B. (2000). Prochlorperazine Versus Promethazine for Uncomplicated Nausea and Vomiting in the Emergency Department: A Randomized,Double-Blind Clinical Trial. Annals ofEmergency Medicine , 89-94.Ho, K .-Y., & Gan, T. J. (2006). Pharmacology, pharmacogenetics, and clinical efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting. Current Opinion in Anaesthesiology , 606–611.

The Official Instructions to Start a Super PAC

The Official Instructions to Start a Super PAC So you want to start a super PAC. Maybe youre worried that your vote doesnt really matter. Maybe youre tired of other super PACs raising and spending unlimited amounts of cash from corporations and unions to sway elections and youre asking yourself If you cant beat em, why not join em? Not a problem. Thanks to the U.S. Supreme Court and Citizens United, anyone can start a super PAC. And the best part: It doesnt cost a dime. Never mind the Steven Colbert super PACs Super Fun Pack, which hilariously offers prospective activists, All you need is a burning desire for civic engagement and $99. Heres how to start a super PAC. For free. Just by signing your John Hancock on a couple pieces of paper. Step 1: Pick a Cause or Candidate First things first. Your super PAC doesnt have to target a politician, though it certainly can. Restore Our Future Inc., for example, is the pro-Mitt Romney super PAC that spent considerable sums of cash in Election 2012 going after the former Massachusetts governors Republican opponents, including Rick Santorum. Your super PAC can raise awareness about a particular cause or issue such as hydraulic fracking, abortion, or taxes. Yours can be a liberal super PAC or a conservative super PAC. Got a burning desire for civic engagement, as Colbert would put it, on a particular topic? Go for it. Step 2: Pick a Clever Name for Your Super PAC Youll want to name your super PAC something catchy. Something people will be able to easily remember when they break out their checkbooks. Already taken are Joe Six PAC, a super PAC that proclaims it is for the average Joe; the Sick and Tired of Washington super PAC, whose goals seem pretty obvious; and DogPAC, a super PAC representing Dogs Against Romney. Step 3: Other Essentials for Starting Your Own Super PAC All you need to create and run your official super PAC now are a bank account, a charming personality to raise all that money from corporations and unions, and a friend to serve as treasurer to keep track of your super PACs fundraising and spending. Pick someone who is trustworthy and responsible. Theyll need to file spending reports with the government. Step 4: File the Paperwork To officially launch your super PAC you will need to file whats called a Statement of Organization, or Form 1, with the Federal Election Commission. Check box 5(f) under Type of Committee. Also, write a short cover letter to the Federal Election Commission. Youll want to be sure you make it clear your new committee will be functioning as a super PAC. You can do that by including the following paragraph verbatim: This committee intends to make unlimited independent expenditures, and consistent with the U.S. Court of Appeals for the District of Columbia Circuit decision in SpeechNow v. FEC, it therefore intends to raise funds in unlimited amounts. This committee will not use those funds to make contributions, whether direct, in-kind, or via coordinated communications, to federal candidates or committees. Make sure to include your Statement of Organization your name, address, contact information, and the name of your super PAC and its treasurer. Mail your form to: Federal Election Commission 999 E. St., NW Washington, D.C. 20463 Step 5: What To Do With Your Super PAC As the proud new owner of a super PAC, you are permitted to raise unlimited amounts of money from people including your friends, neighbors, and families. But you can also solicit money from political action committees, corporations, and labor organizations. You can turn around and use all that money to produce and air TV commercials or take out a massive billboard along a busy highway to roundly criticizes a politician you dont like. Have fun and be creative! A Note of Caution: What You Cant Do With Your Super PAC This is pretty simple. You are not allowed to use all that money youve raised from corporations and unions to make direct contributions to candidates or their political action committees. You also cant take out TV ads or billboards in coordination with any of those candidates or their PACs. This is a fairly gray area, so play it safe and steer clear of planning your attacks with any candidate or elected official.

Free Essays on Bantu Steve Biko

Bantu Steve Biko was a strong leader and showed his courage during the fight against apartheid. The confidence he had in changing the black treatment in South Africa, his philosophy of civil disobedience, and the effectiveness in his writing style made him a strong and efficient leader. He matches with the definition of a strong leader: a person who is determined and ready to fight for their objective until and after their death. Perhaps the best description of him would be â€Å"Unconquered and Unconquerable,† as stated in the title of Lewis Latimer’s poem. Leaders such as Martin Luther King, Jr. and Henry David Thoreau did not face the violence Biko faced where the government prevented his voice from being heard, however, Biko made sure the people of South Africa knew who he was and the objectives he was striving for. Biko was a South African political leader of the late 1960s; he wanted to end the restrictive racial policies in the white government of South Africa known as apartheid. He was born on 1946 in King William’s Town and was always active during political activities; he died in the hands of the ones he fought against on 1977 while in prison, but left his name and beliefs fighting for justice. Biko was president of two associations fighting for the end of apartheid, South African Students' Organization in 1968 and Black People's Convention in 1972; he was continuously arrested for the â€Å"violence† he was creating during the meetings of these associations and he ended up banned. Biko sought to liberate the minds of Africans, arguing that liberation grows out of â€Å"the realization by the Blacks that the most potent weapon in the hands of the oppressor is the mind of the oppressed † (â€Å"Biko, Stephen†). This idea was the â€Å"Black Consciousness† he tried to explain to the Black people so they would not be used and instead fight back for their rights. Civil disobedience is a word that the government, and they... Free Essays on Bantu Steve Biko Free Essays on Bantu Steve Biko Bantu Steve Biko was a strong leader and showed his courage during the fight against apartheid. The confidence he had in changing the black treatment in South Africa, his philosophy of civil disobedience, and the effectiveness in his writing style made him a strong and efficient leader. He matches with the definition of a strong leader: a person who is determined and ready to fight for their objective until and after their death. Perhaps the best description of him would be â€Å"Unconquered and Unconquerable,† as stated in the title of Lewis Latimer’s poem. Leaders such as Martin Luther King, Jr. and Henry David Thoreau did not face the violence Biko faced where the government prevented his voice from being heard, however, Biko made sure the people of South Africa knew who he was and the objectives he was striving for. Biko was a South African political leader of the late 1960s; he wanted to end the restrictive racial policies in the white government of South Africa known as apartheid. He was born on 1946 in King William’s Town and was always active during political activities; he died in the hands of the ones he fought against on 1977 while in prison, but left his name and beliefs fighting for justice. Biko was president of two associations fighting for the end of apartheid, South African Students' Organization in 1968 and Black People's Convention in 1972; he was continuously arrested for the â€Å"violence† he was creating during the meetings of these associations and he ended up banned. Biko sought to liberate the minds of Africans, arguing that liberation grows out of â€Å"the realization by the Blacks that the most potent weapon in the hands of the oppressor is the mind of the oppressed † (â€Å"Biko, Stephen†). This idea was the â€Å"Black Consciousness† he tried to explain to the Black people so they would not be used and instead fight back for their rights. Civil disobedience is a word that the government, and they...

Poring over Pore and Pour

Poring over Pore and Pour Poring over Pore and Pour Poring over Pore and Pour By Maeve Maddox Some confusion appears to exist regarding the use of pour and pore. Charlie complains that he has to pour through stacks of badly-written letters to the editor every day. In this context the word should be pore. The usual idiom is to pore over. Apparently the preposition through has entered into use, as in the above quotation, and as in this headline in the New York Times: Teachers Pore Through Stacks Of Possibilities The verb pore, with the meaning examine closely, may derive from two Old English words, a verb, spyrian, meaning to investigate, examine, and a noun, spor, meaning a trace, vestige. The noun pore, meaning an opening in the skin, is not related to the verb in the expression to pore over. The noun comes from a Greek word meaning a passageway. The verb pour, meaning to transfer water or some other substance from a container, came into English by way of Old French from a Latin verb, purare, to purify. In ritual practice, objects are purified by pouring water over them. The English word pure comes from Latin purus, pure. The Latin verb came from the Latin noun. Memory device: Lore is learning, knowledge, doctrine. To become well-versed in computer lore or the lore of magic, or the lore of religion, one must pore over learned tomes. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:Congratulations on or for?How to spell "in lieu of"8 Great Podcasts for Writers and Book Authors

The miracle video Assignment Example | Topics and Well Written Essays - 250 words

The miracle video - Assignment Example Since Helen is unable to speak, see and hear, i would have similarly used the simple objects like water, spoon and signs to enable her learn. I would also be persistant in teaching Helen just the same way teacher Annie Suvillian did. Helens story has immensely taught me on how to make appropriate choices and on how to manage time, for example, if it were that the teacher didnt make an apprpriate solid choice to separate Helen from her parents, she would have not learnt in an appropriate environment. The teacher was also able to manage her time. The shortest period she had to teach Helen was succssful hence impresing Helens parents. I learnt that hardwork pays. Helen as a teacher was so hardworking thus making her teaching progress succssful. Obedience, Helen became obedient thus enhancing her studies. Understanding also enables someone a teacher to provide the required teaching skills. Do you think teacher Annie was right to have taken Helen away from her

Pros and Cons of a Person With a Mental Illness as a US President Essay

Pros and Cons of a Person With a Mental Illness as a US President - Essay Example Some mental disorders have symptoms which may negatively affect not only the patient him or herself but also the other people around which is classified as a violation of one’s freedom and certain right in every individual case. Delusions of the President would negatively affect his decisions making: the decision made in a condition of delusion would be characterized by nonsense, for example, to close all the universities or increase the taxes by 1000 times. Obviously, these ideas are not realistic, but the person with a mental illness would not react to such statements and would go on reckoning that only he or she is right. Hallucinations are also negative things for the person acting as a US President: for example, some decision may be taken properly, but it may turn out to be that the patient with a mental disorder has taken advice from a phantom, not from a real person, and revealing this fact would create concern among the public. Disorganized behavior is also a symptom which makes a person unpredictable: for example, today the President feels excited and makes good presents and treats the people around good, but tomorrow he or she may become very aggressive and apply the behavior model which is not proper for a country leader. Taking the above said into consideration, it is possible to state that there are more cons than pros in the possibility of a mentally ill person becoming the US President, and they all concern the way the other people may be affected by a person subjected to a certain mental illness.

Alcohol Related Violence Essay Example | Topics and Well Written Essays - 500 words

Alcohol Related Violence - Essay Example Most of the violence take place when the venues close or when the known figureheads move out of the bar. According to the research, lighting and security staff, taxi ranks and availability of public means of transport are a precursor to liquor related violence. The study recommends frequent revision of licensing terms for setting up liquor venues to reduce the possibility of injury and potential harm. The environment within which the bar needs special consideration since they contribute largely to liquor related violence. Proven evidence shows that change in alcohol price directly affects alcohol consumption. Increased taxation can effectively reduce liquor related violence through reduction of access to alcohol. High taxation of alcohol encourages consumers to turn to drinks with low alcoholic levels of or avoid alcohol. The reduction in alcohol uptake translates to a decrease in alcohol-related violence. The tax earned from increased alcohol taxation can in turn be used to educate the public on the dangers of alcohol as well as treat alcohol-related problems. An increase in alcohol tax will reduce alcohol related violence. Evidence shows that the best way to reduce alcohol related violence involves the local community in addressing the liquor related violence. The community in conjunction with the government and the businessmen can work together towards changing the drinking habits of the people. The empowered community can set code of conducts at the beer dens and agree on violence minimization practices. The community can also come up with measures such as frequent identification at liquor places to know the clients and also spearhead responsible drinking. Research suggests that the government should fund and provide them with the necessary support. Evidence shows that short-term interventions from the community are effective in reducing alcohol-related violence and should be supported. Local

Complete a project based on your choice of an investment portfolio Essay

Complete a project based on your choice of an investment portfolio - Essay Example In addition to this, it helps to identify the risk associated with each of the financial assets. Risk involved in portfolio investment is directly linked with the value. The willingness of an individual make investment or avoid risk is the most important factor for portfolio investment (Reilly & Brown, 2011). The investment portfolio has to be made in such a manner that maximum return can be earned from financial assets. The investment portfolio has been based from Monday 2nd March 2015 to Monday 6th April 2015. The major aim of investment in financial assets is to earn return and maximise profitability. Moreover, portfolio investment is considered to be the safest mean of earning income. The total amount fixed for portfolio investment is  £100,000 (Reilly & Brown, 2011). The paper analyses current market trend and the risk involved with each of the financial assets that has the potential to prevent investments. Apart from risk other factors that have the potential to affect investment in financial assets include the amount invested and the expected length for which an individual holds different financial assets. The time horizon defines the time period between the investment in financial assets and receiving the return from it. The time length is considered to be the crucial factor in portfolio investment, because it directly affects the ability of investors to minimise the overall risk involved. The paper analyses the financial market according to the data of London stock exchange and identifies the assets from which the borrower can achieve maximum return with respect to the risk involved. Investment theory focuses on the process of decision making associated with selecting the appropriate financial assets for investment that in turn has the potential to maximise the overall return earned. Investment theory defines the relation between the risk involved in investment and overall return from the financial assets. Investment in financial

The fundamental Premise is that business performance will be better Essay

The fundamental Premise is that business performance will be better when there is an alignment between competitive stragegy and the managment of core operating workers inside the business - Essay Example cceptable quality levels and prices; enter into agreements with unions in order to stabilize labour market conditions and be informed about the activities of competitors" (Putti, 1987). Aiming to enable the organization to achieve its strategic goals by attracting, retaining and developing employees, Human Resource Management functions as the link between the organization and the employees. A company should first become aware of the needs of its employees, and at a later stage, understand and evaluate these needs in order to make its employees perceive their job as a part of their personal life, and not as a routine obligation. The Human Resources (HR) function provides significant support and advice to line management. The attraction, preservation and development of high calibre people are a source of competitive advantage for our business, and are the responsibility of Human Resource Management Department. Human resource management is very crucial for the whole function of an organization because it assists the organization to create loyal employees, who are ready to offer their best. The concept of Human Resource Management developed with a more strategic level of thinking about the nature and role of people (as total 24hr per day human beings) working in organizations which are ‘cultures’ in their own right (Lundy O, 1994). While the recent thinking has moved from the control-based model to the compliance model, the soft edge of the latter involves eliciting employee commitment and expecting effectiveness and efficiency to follow. The hard edge of the latter involves ridding the organization of unnecessary layers of middle management which, when stripped of control functions, have very little by way of value added. "The HRM planning should be based on the organisations strategic planning processes with relation to analysis of the labour market, forecasting of the external supply and internal demand for labour, job analysis and plan implementation" (BPP,

Complete a project based on your choice of an investment portfolio Essay

Complete a project based on your choice of an investment portfolio - Essay Example In addition to this, it helps to identify the risk associated with each of the financial assets. Risk involved in portfolio investment is directly linked with the value. The willingness of an individual make investment or avoid risk is the most important factor for portfolio investment (Reilly & Brown, 2011). The investment portfolio has to be made in such a manner that maximum return can be earned from financial assets. The investment portfolio has been based from Monday 2nd March 2015 to Monday 6th April 2015. The major aim of investment in financial assets is to earn return and maximise profitability. Moreover, portfolio investment is considered to be the safest mean of earning income. The total amount fixed for portfolio investment is  £100,000 (Reilly & Brown, 2011). The paper analyses current market trend and the risk involved with each of the financial assets that has the potential to prevent investments. Apart from risk other factors that have the potential to affect investment in financial assets include the amount invested and the expected length for which an individual holds different financial assets. The time horizon defines the time period between the investment in financial assets and receiving the return from it. The time length is considered to be the crucial factor in portfolio investment, because it directly affects the ability of investors to minimise the overall risk involved. The paper analyses the financial market according to the data of London stock exchange and identifies the assets from which the borrower can achieve maximum return with respect to the risk involved. Investment theory focuses on the process of decision making associated with selecting the appropriate financial assets for investment that in turn has the potential to maximise the overall return earned. Investment theory defines the relation between the risk involved in investment and overall return from the financial assets. Investment in financial

Discuss and assess the parallels between cold war anti-communism and Essay

Discuss and assess the parallels between cold war anti-communism and contemporary debates about terrorism and border protection - Essay Example apparently aimed at protecting human rights by inculcating political sovereignty in the so-called ‘failed states.’ Apart from a few isolated murmurings in the West, these experiments in state-building, humanitarian intervention and policing of wayward nations were neither openly associated to an American empire nor were they labelled as imperialist. The arrival of George Bush at the White House and the terrorist atrocities of September 11, 2001 reveal the role of the U.S. in the global economy. Furthermore, the war on terror that ensued shortly after September 11 seem to have reversed the world order and ignited a debate on the role of the U.S in fostering international peace. The debate presented in this paper argues that the U.S. role seems to have accorded itself the role of maintaining a check on communism (Bamford, 2004: pp 18-47). The paper aims at exploring the analytical and historical value of the connection between terrorism, war, efforts at border protection a nd the efforts at taming communism and fostering the extension of the American empire. Some of the historical questions that the paper aims to solve include the role that the Cold War played in shaping a domineering American empire. There is also an attempt to analyze how the nature of this empire was affected by the end of the Cold War. Therefore, the paper aims at presenting a comparison between the prevailing conjecture of border protection measures and the war on terror with the origins of the rivalry between capitalism and communism. Researchers have done a critical analysis of several theoretical perspectives that shed more light on the underlying dynamics in the aggravated efforts to fight terrorism in the world.. These perspectives also highlight how these dynamics serve to entrench border protection measures, especially after the end of the Cold War. The first perspective regards to the theory of realism which emphasizes several motives that are connected to the power, national

Construction of a runway Essay Example for Free

Construction of a runway Essay A runway is a defined as a paved or clear land or strip prepared for landing and take-off of a plane. Majority of the runways are built but some are natural surfaces. Reckless construction can lead to a number of losses, putting human lives at stake and even damage of property. The construction of a runway is important and steps and procedures should be followed to ensure successful construction. Some of the important steps include; the length of a runway and the marking and lightings. The length of a runway is manly affected by the types of plane that use the runway and the altitude. Larger aircrafts such as passenger planes require longer runways and smaller ones such as private jets can be accommodated by shorter runways. At a higher altitude these runways are designed to be longer due to the reduced density of air which decreases the engine power. If it’s a fully operational and international airport it would require a longer runway that would accommodate the number of planes that would be constantly streaming in and out. CITATION Jef l 1033 (Jeffrey Price) The markings and lightings of a runway are important since they enable operations at night or when there’s low visibility. The lighting systems such as strobe bars or light bars are installed at the far end of the runway or synchronized flashing lights installed at each side of the runway path. These would aid the pilot in landing and help him not to sway from the main landing path. CITATION Je f l 1033 (Jeffrey Price) After full consideration and implementation of some of these procedures, one can be able to successfully construct a functional, efficient and manageable runway Reference 1033 Jeffrey Price, Jeffrey Forrest. Practical Aviation Security: Predicting and Preventing Future Threats. n.d. www.bomag.com//construction-equipment-dictionary-airport-construct Source document

Interprofessional Working As Central To Healthcare Management Nursing Essay

Interprofessional Working As Central To Healthcare Management Nursing Essay Fast-Track Discharge is a service available to in-patients who wish to leave hospital at the end of their lives and to die in a place of their choosing (REF). In practice, this requires the use of Fast-Track Pathway Tool for NHS Continuing Healthcare (July 2009) which aids healthcare practioners in ensuring support for individuals with a rapidly deteriorating condition entering the terminal phase in their preferred place of care (REF). This process is designed to bypass potential delays associated with the completion of the full NHS continuing healthcare eligibility process; meaning responsibility for care packages lies with the PCT in order to move the individual to their preferred place in a timely fashion (REF). This innovation has been introduced to combat the issue that the majority of people who would choose to die at home ultimately end their lives in hospital (Gomes Higginson, 2006) despite the UK having one of the worlds most developed palliative care systems (Economist Intelligence Unit, 2010). The Fast-Track Discharge aims to reduce the incidence of hospital deaths by speeding up the discharge process, facilitated by the Department of Health (DoH) End-of-Life strategy that includes ten markers to measure implementation and effectiveness (REF); for example, ensuring that individuals end-of-life care preferences and choices are well documented, communicated and where possible, achieved (DoH 2010). Furthermore, the strategy makes recommendations to better meet patient needs by improving community services, improved cross-agency communication, and improved communication skills of the healthcare worker to better enable delivery of end-of-life through collaborative efforts by PCTs and spe cialist NHS providers (RCN/Royal College of General Practitioners 2011). Partnership working and quality of care has become a central focus for the NHS following the NHS Next Stage Review High Quality Care for All (Darzi, Date?), that has identified the need to personalise services for individuals through the provisions of information and choice. However, the current economic climate of austerity has seen the NHS identify  £15-20bn of efficiency savings that must be achieved by year end 2013/2014 as a result of increased pressure on the NHS budget from the growing healthcare demands of an ageing population with higher patient expectations (DoH, 2010). This is being achieved through four themes shaping healthcare policy in an environment of austerity; quality, innovation, productivity, and prevention QIPP; a regional and national programme supporting clinical teams and NHS organisations to improve quality care whilst making efficiency savings that can be reinvested into NHS services (REF). QIPP is engaging large numbers of NHS staff to help address qua lity and productivity challenges at local and regional levels through tools and programmes developed by national QIPP workstreams, to ensure success implementation (REF). The dynamic nature of the healthcare environment and the need to successfully deliver efficiency savings whilst enhancing patient care, particularly in relation to the Fast-Track Discharge, has highlighted the importance of effective communication and successful motivation by those in management and leadership roles to achieving this (REF). Leadership and management are by no means two distinct and separate roles, and in fact the level of overlap between the two means they often form part of the same role, with many leadership or management roles involving a combination of both i.e. there is continual adjustment of the direction (leadership) and controlling resources that pursue that direction (management) (REF). Essentially, leadership articulates a new vision or direction for a group whilst management facilitates the realisation of this vision through effective control of people/resources according to established values or principles (REF). Scouller (2011) quantifies this by suggesting that management involves the effective utilisation of resources to achieve goals that have been formulated by the change, inspiration and enthusiasm necessary for leadership. However Marquis and Huston (2012) warn against viewing these as two separate functions performed in two distinct roles, asserting instead that leadership is a function of management. Nonetheless Finkleman (2006) contends in healthcare settings it is possible to observe many nurses who fill roles of leadership without being in formal management positions, and arguably there exists managers who are not effective leaders; suggesting then that the harmonisation of management and leadership falls to individuals to be able to successfully integrate the need for change and inspiration with the ability to control and utilise. The qualities and abilities required for managers/leaders to effectively implement the necessary vision and drive with organisations have been the focus of models and styles of leadership that have their foundation in theoretical approaches to leadership and have impacted the management and delivery of healthcare (Finkleman, 2006). Perhaps the most prescriptive of theories pertaining to management/leadership is the trait-based leadership model that emerged from Carlyles (DATE) Great Man Theory; it is based on the integrated patterns of personal characteristics, following the assumption that individuals possessing certain qualities and traits are better disposed to leadership roles (Zaccaro, Kemp Bader, 2004). There is a strong emphasis on values and beliefs, personality, confidence, the need for acceptance or achievement and emotional, mental and physical attributes and the theory contends that people are born with specific traits, some of which are strongly aligned with good leader ship (Eysenck, 1992). However Tulsian Pandey (2006) have reiterated the argument raised by Spencer (1680) regarding this assumption; that the belief that people demonstrate successful leadership abilities independently of their environmental situations and influences is flawed. However this approach to identifying what makes a good leader is inherently appealing in so much as it fits with the notion that leaders are gifted individuals that can do extraordinary things; which individuals can use as a measure of their own personal leadership attributes (Jung Sosik, 2006). That notwithstanding critiques of the theory express concern about the over-simplified approach to leadership (Conger Kanugo, 1998), contending that traits are a poor predictor of behaviour, primarily because a high score on an assessment of a particular trait does not necessarily equate to consistent displays of that trait in varying situations (Boeree, 2006). This contention is particularly applicable when considering leadership in nursing environments; the dynamic nature of said environment is largely unpredictable, potentially leading to individuals integral to these environments to react to this capriciousness and behave in ways that are strongly indicative of consistent traits (REF). However from these traits, it may be possible to patterns of behaviour in individual leaders. The behavioural view of leadership, whilst acknowledging the traits of leaders, places emphasis on the learned patterns behaviour that leaders acquire (REF); Weber (1905) identified two types of leaders bureaucratic and charismatic. The highly structured and procedural approach of the bureaucratic leader contrasts with the energy-enthusing enthusiasm of the charismatic leader approach. From this developed the democratic leadership style, which assumes that individuals are motivated by internal drives and impulses with a proactive desire to undertake and complete tasks (Sullivan Garland, 2010). Arguably, such an approach to leadership is suited to the automony and individual management required for extended periods of group working (Marquis Huston, 2009). However, critiques of theory propound that without clearly defined roles or in a time-constrained environment this approach to leadership has the potential to lead to communication failures and incompletion of projects (REF), high lighting the integral role that communication and motivation play in the context of the effectively delivery of the Fast-Track Discharge innovation. Communication, defined by Boddy (2008) as the reaching of a common understanding through the exchange of information in the form of written or spoken words, symbols or actions, impacts all levels of management activities and incorporates all key stakeholders including; clients, colleagues, superiors and subordinates (Marquis and Huston, 2012). The process of communication is a complex two-way complementary process used to convey a message between two or more individuals, with sender and receiver roles that should be used in such a way that benefits patient care and reaches identified outcomes (Finkleman, 2006). Considering the potential implications of ineffective or inadequate communication on patient care and the implementation of initiatives, an understanding of the communication process for healthcare providers is of paramount importance (Marquis and Huston, 2012). This process, at its most basic level, involves the initiation of communication from the sender by trying to transfer ideas, facts or information to the party who receives the message, the receiver; the message is coded by the sender using words, actions or expressions which represent a tangible expression of the senders ideas through a chosen communication channel (face-to-face, electronic communication, written words). This message is then decoded by the receiver and reconstructed to resemble the original message (Boddy, 2008). However, Finkleman (2006) asserts that perception of a message is fundamental to the communication process and effective communication dictates that the receiver must be capable of perceiving the senders message correctly; failure to do so will result in ineffectual communication or messages being misconstrued (University of Rhode Island, 2010). Furthermore, Marquis Huston (2012) have suggested that directions of communication (upwards, downwards, diagonal, lateral) also impacts of the way the message is decoded by the receiver; contributing to directives, facilitation of tasks, negotiation, problem-solving and discussion according to which direction of communication is used (Sullivan Garland, 2010). In the context of the Fast-Track Discharge initiative, downward and diagonal communication are likely to be most salient, owing to the need for senior management to effectively impart the initiative throughout the organisation and the requirement for nursing practictioners to communicate with external agencies in order to effectively deliver said policy (Nursing Midwifery Council, 2010). However, these are not the only consideration for the effective implementation of the Fast-Track Discharge initiative; the choice of communication model has the potential to impact on the sending and receiving, and integrity of information. Models of communication are visual, simplified representations of complex relationships in the communication process (West Turner, 2010). The earliest of these models, the linear model developed by Shannon and Weaver (1949), frames communication as a one-way process of transmitting a message to a destination, from the sender to the receiver through a channel (see appendix 1) and gives consideration to the potential for message distortion in the process communication noise (University of Rhode Island, 2010). Critics of this model suggest that the definable beginning and end of communication presumed by the theory is incorrect and does not take account of interuptions (Anderson Ross, 2002). Furthermore, there is an assumption of the passivity of listeners and that communication can only occur when speaking that has not been borne out in reality (West Turner, 2010). These issues are addressed in the interactional model (Schramm, 1954), that highlights the bi-directional nature of communication; from sender to receiver and receiver to sender; suggesting an ongoing rather than linear process that is characterised primarily by feedback or response to the message in the form of assessment of the communication. However although this model addresses some of the shortcoming of the linear approach, critics have suggested that the interactional model still neglects to consider the impact of non-verbal messages sent with verbal messages and maintains the one-dimensional view of senders and receivers propounded by the linear model (West Turner). Conversely, the transactional model highlights the notion that sending and receiving messages is simultaneous and mutual and both senders and receivers are responsible for the effect of and effectiveness of communication, building a shared perception of the message being communicated and acknowledging the necessity of both verbal and non-verbal behaviours as an inherent element in the communication process (West Turner, 2010) Clearly then, effective communication is of paramount importance in the conveying, delivering and receiving of messages and is therefore central to the effective implementation of the Fast-Track Discharge initiative. The most appropriate model of communication to ensure the successful delivery of the initiative is the transactional model, allowing for the building of shared perceptions regarding the initiative that have the potential to converge to form a shared vision (Torrington et al, 2005). Such a model does not fall prey to the overly-simplified approaches to communication propounded by the linear and interactional models such as neglecting to consider the symbiotic nature of human communication and the issues caused by not giving due to consideration to the influence of external distortions; whilst giving appropriate weight to the impact of non-verbal communication on sender/receiver perception of the message and how noise levels alter this message (West Turner, 2010). Semantic noise is a particularly pertinent issue; the highly technical nature of frontline healthcare, in this case delivered by nurses to terminally ill patients, invariably results in the use of jargon and technical language to communicate with colleagues (Devlin, 2009). The British Medical Association contends that the use of jargon and technical language when dealing with wider stakeholders, as is central to this initiative, has the potential to cause confusion for both staff and patients and feedback collated from patients surveys by the BMA has revealed a significant negative emotional impact on patients and their families as a result of ineffectual communication methods (Triggle, 2009). The interdependent, cross-agency relationships that are necessary for the effective delivery of the initiative means that frontline care providers have to communicate information to individuals in a diverse range of agencies that are not familiar with the use of department or speciality-specifi c language (REF). The use of unfamiliar or technical language has the potential to alter the receivers perception of the message, which may lead to mistakes or delays in the delivery of the initiative for a particular patient (Triggle, 2009) Whilst styles of leadership and the qualities and skills of leaders is of paramount importance in the effective implenatation of the fast-track discharge programme, the issue of interproffessional working and team building needs to be considered in conjunction with these skills (sounds clumsy!). It is crucial that intergrated models of health and social care are effectively implemented in a timely manner that is cost efficient, innovative whilst using resources wisely (CIPW DATE). Team working enables the professions to solve complex health problems that cannot be adequately dealt with by one profession alone. (WHO 1999: 135). A team can be described as a group of people with complementary skills who are committed to a common purpose, performance goals, and approach, for which they hold themselves mutually accountable. (Carrier Kendall 1995), implying a willingness to share ideas and knowledge for a common goal. Various models of team working exist to allow recognition of basic concepts. Identifying team roles may be useful in identify peoples strengths and weaknesses in the workplace. This information can be used to: Build productive working relationships Select and develop high-performing teams Raise self-awareness and personal effectivenessBuild mutual trust and understanding(REF). Belbin identifies 9 roles (Appendix) within a team and suggests that balance is the key to an effective team that requires at least one of each role to ensure a strong team. Allowable weaknesses of each role are also recognised allowing for management of these perceived weaknesses (Belbin 1981). However it can be argued that not all teams will be made of 9 people each carrying an identified role and that some people may have one or more strength in a preferred role (Brooks, 2009). B. Tuckman (1965) proposed an alternative view to addressing group dynamics, suggesting that groups move through 5 stages of development. Firstly, leader-led information and resource gathering (Forming). Conflicts may develop with tasks being resisted (Storming), and then conflicts settled with a developing team group cooperation with new standards set (Norming). At this point teamwork is achieved and solutions are found and implemented (Performing). On completion of task the group disperses (Adjourning) (Cole, 2004). This suggests then that effectiveness as an outcome is achieved over a period of time as the group develops an understanding of the task, what is required to complete the task and an awareness of the skills and knowledge of the individuals making up the group (REF). These models focus on the behaviour within groups, however inter-professional working requires intergroup working and collaboration between these groups is vital in the delivery of good quality healthcare. Following a three year study of multi-professional working Miller et al (2001) suggested three main types of interprofessional working; Integrated team working whereby the teams served the same population of patients leading to a joint approach to care planning and evaluation of care. However it was noted that this approach worked most well when caring for a group of patients who were medically stable (Hewison 2004). Fragmented working describes a group of professionals making decisions within their own profession groups but with sharing of information often resulting in a superficial understanding of roles and boundaries and a lack of consensus around decision making. A type of interproffessional working incorporating both of these models has been described as core and periphery w orking whereby a predominantly integrated core group works alongside a more peripheral fragmented group. Glendinning et al (2002) argue that whilst integrated style of working has benefitis for the patient the circumstances to achieve this in its purest form are not often in place and as a result this disclocation of the core group from the periphery can result in a lack of communication and a poor understanding of the role of others. These various approaches to interprofessional working can enable practitioners to plan and design the best type of care and to clarify how they are organised. The fast-track discharge programme involves health care professionals from both health and social care sectors and is supported by a Fast-track Discharge End of Life Pathway (DoH 2008). An integrated style of interprofessional working is required to co-ordinate all elements of the care pathway. With nurses being the key provider and co-ordinator for patients in hospital reaching the end of theirs the responsibility falls to them to link and communicate across the health and social care teams (RCN 2011) whilst working in partnership with and as an advocate for the patient and their family/carers. This requires the nurse to ensure that all team members contribute to the care planning process and, with consent (NMC 2008), circulate relevant information to key co-ordinators. A MDT meeting with the key nurse, consultant/Registrar, O Ts/Pts, Discharge Liaison Nurse, Palliative Care Nurse, Pharmacist, and Social Services representative is appropriate to share information, ensure that all team members are aware of the patients wishes and the plan to discharge. It may be most appropriate for the Palliative Care Nurse to liaise with the patients GP and this needs to be decided upon. All decisions need to be clearly documented and regularly updated and shared with relevant professionals. Poor communicaton and fragmented working across professions is the main barrier to this innovation being successful. Organisational cultures refers to the values and behaviours that contribute to the social and psychological environment of an organsition, including the expectations, experiences and philosphosies and is based on shared attitudes and beliefs. (Schein 210).

City Boy versus Country Girl :: Mama Day Gloria Naylor Essays

City Boy versus Country Girl Gloria Naylor’s novel, Mama Day, shows how two loving people can unite in marriage, while being from two separate worlds. The way that Naylor creates the anxiety between these two characters is by the differences in their backgrounds--including their families, traditions and their geographical origins. Cocoa and George are extremely different; however, this is what makes their marriage so strong. Raised by the two most respected women in the town, Cocoa grew up on a small southern island with a loving family, while George grew up in a boys’ home without a family in urban New York. These differences in background bring George and Cocoa together, while helping to instill traditions and values in George. In the end, George has changed his point of view of the island and the way Cocoa acts in her home so dramatically that he sacrifices his life for her. Mama Day illustrates differences that are all around us through one couple’s marriage and the two places they call home. Willow Springs, the island on which Cocoa spent her childhood, lies between Georgia and South Carolina. Set apart from the rest of the world because it belongs to neither state, Willow Springs has many traditions unlike the world around it. Candle Walk, for instance, the tradition that created Willow Springs, goes back to the legend of Sapphira Wade, Cocoa’s great-great-great-grandmother. Saphira Wade had walked to the ocean in hopes of returning to her mainland with only the light of a candle showing the way. Thus, each year since that time, the island celebrates the memory of Saphira Wade during Candle Walk, takes place at night and encourages every neighbor to give homemade gifts to others in the community. Coming from the city, George has personality issues because of his non-existent family background. As a young child, his prostitute mother abandoned him to be raised by the state in the Wallace P. Andrews Shelter for Boys. George explains to Cocoa how the shelter treated him as though there were nothing out of the ordinary about a home without love in it. â€Å"They may not have been loving people, [Mrs. Jackson] and Chip–or when you think about it, even lovable. But they were devoted to their job if not to us individually† (Naylor 23).

Light and Dark Imagery Depicted in Shakespeares Macbeth Essay

The natural order of the world is disrupted; this is made obvious from the start of the play. Even though they generally speak in riddle, the three witches are significant characters because of their foresight and knowledge of future atmosphere. ‘Fair is foul and foul is fair.’ ~Act 1, Scene 1~ Because this chant is towards the beginning of the play, the audience immediately see the supernatural control over things. Throughout the play of Macbeth the audience is made aware of the differences in dark and light. This could be seen as being metaphorical for many other binary oppositions one of which being good and evil. This example supports the power of the witches, representing evil and the dark. Another scene that shows Macbeth is a play of light and dark is act 1 scene 4 Macbeth whispers to himself. ‘Stars; hide your fires / let not light see my black and deep desires’ ~Act 1, Scene 4~ The dark is seen as a mask that can disguise and hide, this is foreshadowed when King Duncan at the announcement of his successor says; ‘but signs of nobleness, like stars, shall s...

Coffee Bean Essay

ST. GREGORY’S UNIVERSITY Coffee Bean, Inc. Managerial Accounting, BU2123, Research Project, Spring 2007 Coffee Bean, Inc. (CBI) is a processor and distributor of a variety of blends of coffee. The company buys coffee beans from around the world and roasts, blends and packages them for resale. CBI currently has 40 different coffees that it offers to gourmet shops in one-pound bags. The major cost of the coffee is the raw coffee beans. However, there is a substantial amount of manufacturing overhead in the company’s predominantly automated roasting, blending and packing process. The company uses relatively little direct labor. Some of the coffees are very popular and sell in large volumes, while a few of the newer blends have very low volumes. CBI prices its coffee at manufacturing cost plus a markup of 30%. If CBI’s coffee prices are significantly higher than the market, adjustments are made to bring CBI’s prices more into alignment with the market. The company competes primarily on the quality of its products, but customers are price conscious as well. For the coming year, CBI’s budget includes estimated manufacturing overhead cost of $3,000,000. CBI assigns manufacturing overhead to products based on direct labor-hours. The expected direct labor cost totals $600,000, which represents 50,000 hours of direct labor time. Based on the sales budget and expected raw materials costs, the company will purchase and use $6,000,000 of raw materials (mostly coffee beans) during the year. The expected costs for direct materials and direct labor for one-pound bags of two of the company’s many coffee products appear below: Mona Loa $4. 20 0. 30 Malaysian $3. 20 0. 30 Direct Materials Direct Labor (0.025 hours per bag) CBI’s president is very concerned about lowering profit margins. Several prices have had to be reduced to meet market pressures and other products are selling at good volumes without price adjustments. The president talked with CBI’s controller who believes that the company’s traditional costing system, which uses direct labor costs to allocate manufacturing overhead, may be providing misleading cost information. To determine whether or not this is correct, the controller has prepared an analysis of the year’s expected manufacturing overhead costs, as shown in the following table. Activity Center Cost Driver Purchasing Purchase Orders Materials handling Number of Setups Quality control Number of Batches Roasting Roasting Hours Blending Blending Hours Packaging Packaging Hours Total manufacturing overhead cost: Expected Activity 1,710 orders 1,800 setups 600 batches 96,100 hours 33,500 hours 26,000 hours Expected Cost $ 513,000 720,000 144,000 961,000 402,000 260,000 $3,000,000 Data regarding the expected production of two representative products, Mona Loa and  . Coffee Bean Malaysian coffee, are presented below. There will be no raw materials inventory for either of these coffees at the beginning of the year. Mona Loa Malaysian 100,000 2,000 Pounds 10,000 500 Pounds 3 3 Per batch 20,000 500 Pounds 1. 0 / 100 1. 0 /100 Hours per pound 0. 5 / 100 0. 5 /100 Hours per pound 0. 1 / 100 0. 1 /100 Hours per pound Expected sales Batch size Setups Purchase order size Roasting time Blending time Packaging time Step into the shoes of the controller and prepare a complete report for the president explaining the results of your research. Compare the two product-costing methods: (1) the currently-used, volume-based method, and (2) an activity-based method. The supporting tables should determine full costs and prices of both products using the two different cost allocation methods. Continue your detailed report to the president by justifying why the company should remain using their present overhead allocation method or to go activity-based costing. Go beyond the accounting issues in your report, mentioning the impact on pricing, volume, and marketing decisions. Support your recommendation with current articles (Use the online resources of the SGU James J. Kelly Library to locate articles within the last year that deal with cost allocation issues). Three to five supporting articles should be sufficient to support your findings. Since this is a formal report, it will require a transmittal memo summarizing your findings. This memo/summary should be supported by a detailed report including tables and references to business/accounting literature. Include a bibliography in APA format. Also, since presidents rarely have time to read the entire article, but are interested in their content, provide an abstract of each citation. Remember: appearance, spelling, grammar count. Adapted from Managerial Accounting, Eight Edition, Garrison & Noreen, Irwin, 1997. 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Decrease in Supply of Dalda Ghee

OLPER`S MILK EXPIRES BEFORE EXPIRY DATE PREPARED FOR THE REGIONAL MANAGER,ENGRO FOODS, COL. AKHTAR KHALILI PREPARED BY ASST. QUALITY CONTROL MANAGER DECEMBER 29, 2012 TABLE OF CONTENTS EXECUTIVE SUMMARY†¦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‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 03 INTRODUCTION†¦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‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 04 CONCLUSION AND RECOMMENDATIONS†¦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‚¬ ¦ 04 FACTS AND FINDINGS†¦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‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 05 1. Testing Expired Milk Before Expiry Date†¦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‚¬ ¦.. 05 2. Survey Of Plant In Sukkur†¦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‚¬ ¦O6 3.Chain Of Distributors†¦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‚¬ ¦07 DISCUSSION/ANALYSIS†¦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¢ € ¦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‚¬ ¦08 EXECUTIVE SUMMARY:- This report comprises of the cause of decline in the sale of Olper`s Milk as many complaints were received quoting that milk was expired before the expiry date. This report analyses the causes and recommend certain solutions that Engro Foods should take to correct this situation. The report also clarifies that Olper`s Milk is 100% full of nutrition and have no harmful chemicals or bacteria which could cause diseases. INTRODUCTION:-Engro foods launched its most famous product Olper`s milk in the year 2006. Since then this product is highly demanded all over Pakistan. Recently many complaints have been made from our most valuable customers that milk was expired before the expiry date. This report comprises of facts and findings about this cause of failure of Olper`s milk due to which our bar of good will is decreasing. After study of this report you will be able to answer the following questions: * Who was responsible was this failure of Olper`s milk? * What are the reasons behind this problem? What initiative should be taken to solve this problem? CONCLUSION AND RECOMMENDATIONS:- After completing all my research work and findings on this problem I came to a conclusion that the distributors of Olper`s milk were at fault, they played with our trust and good will. They removed the original expiry date form the tetra pack container of Olpers milk and printed a new expiry date just to avoid the consequences of over stocking of inventory. Olper`s milk is full of nutrition than any other tetra pack milk. It consists of some good nutritional fats that give it a rich flavor and taste.According to my survey of plant and dairy farm no harmful chemical of bleaching agent is added in our milk it’s pure and healthy. Following are the recommendations I conclude on the basis of my finding: * Engro foods should immediately break it s contract with JAVED BROS. chain of distributors as they misused our product for their benefit and directly blamed our brand for providing expired milk. * Promotional deals should be launched for Olper`s milk for increasing its demand. * New advertisements should be on aired to promoting Olper`s milk and for gaining back the trust of our customers * JAVED BROS. hould be sued and compensation should be demanded. FACTS AND FINDINGS:- For finding the real causes behind our customers complains I made certain surveys and researches to come to a conclusion. The research findings presented here falls in to four categories: 1. Testing Expired Milk Before Expiry Date 2. Survey Of Plant In Sukkur 3. Chain Of Distributors 1) TESTING OF EXPIRED MILK BEFORE EXPIRY DATE:- I started my work by testing the expired milk before expiry date to know about the actual damage of the milk. The results showed that milk was actually expired and had been curdled and a bit smelly.The expired milk contained a few percentage of urea in it which revealed that it was harmful and expired. Due to this reason our sales declined by a heavy margin in last month as compared to our competitors: Size (ml)|   |   | PERCENTAGE OF SALES IN NOVEMBER 2012|   |   |   | OLPER`S| HALEEB| MILKPACK | MILLAC| NIDO| 1000| 46| 45| 70| 45| 39| 500| 50| 65| 85| 57| 49| 250| 13| 12| 19| 10| 20| This rapid decrease of sales came with no of complaints as well and I compared the complaints of last three months and found out that that in November complaints were increased by 90%. ) SURVEY OF SUKKUR PLANT:- After testing the expired milk I visited our milk processing plant in Sukkur and there I came to know that Olper`s milk is being processed in the correct way and no harmful chemicals are being added in it to make the expiry process earlier. The nutritional values of our milk are in accordance with those suggest by World`s Health Organization Here we can also see that expired milk did not contain any amount of iron in it as it was turned in to urea after expiring. 3) CHAIN OF DISTRIBUTORS:- My final survey was of the chain of distributors we use to distribute our roduct in market we recently changed our distributors an 2012 and had signed a deal with JAVED BROS. chain of distributors. I disguised myself as a new trainee over there and spend a week analyzing the situation over there. I came to know that from past few months they are having a problem of overstocking of Olper`s Milk and as it’s a perishable good it has to be used otherwise the distributor will face loss | | | | (Packets )| | S. No| Month| Order| Demand| 1| September| 30000| 28000| 2| October| 31000| 22810| 2| November| 37000| 29000|The above chat is the ending inventory chart of distributors of Olper`s Milk. This shows that the Distributors are at fault and for their own profit are selling the expired milk by changing its expiry date. 3) DISCUSSION/ANALYSIS:- Olper`s Milk is the sign of good taste. Never in past s ix years such problem has occurred as Engro Foods works with honesty and show complete dedication towards their work. They have even created employment for women in their Sukkur plant and also give employment to women in Punjab to collect milk form dairy farms and deposit in Olper containers.The Facts and Findings of my research also mention the fact that Engro Foods were not at fault. Distributors played a deadly game with us and tried to destroy our good will just off the sake of their own profit. * UHT OLPERS MILK:- Olper`s Milk can never get expired before its expiry date as Engro foods uses UHT(ultra heat treatment)method to pasteurize the milk for 3-4 seconds under 275?. It uses a special new technology LACTOSTAR from China to make sure milk is 100% suitable for health.