Health care system in usa Essays

Health care system in usa Essays Health care system in usa Paper Health care system in usa Paper The health of a nation is the strength of the nation: indeed health is wealth. A healthy nation is a productive nation. The fortress of such a super power as our country, whether in a stable economy or vibrant military and police force, is hinged on the health status of the Public. This is why it is imperative that the government I would lead would make it a point of duty to provide safe affordable and accessible health care service for the populace we serve. This task is not without contemporary challenges. Current health policy agenda does not provide a cogent cohesive approach to resolving the health problems facing the nation. Many people complain daily about the poor nature of services they get, and its inaccessibility. They complain also that when such services are available, they are poor resulting in countless number of deaths. Â  These complaints are justified and welcome in this government. The challenge is explained by the iron triangle of health which includes access, cost, and quality. People fail to visit the hospital or attend to health care because of the exorbitant cost of treatment, as compared to other industrialized countries. These services are only accessible to those who are insured. In comparison to other industrialized nations like Japan, Britain, Sweden, France, Canada, US is rated poorly by a number of local and international health agencies including the WHO in its health care delivery service. Indicators used include life expectancy, low-birth-weight averages and infant mortality. Some people blame poor health on poor health habits: the perception that the American public’s poor health status compared to other industrialized countries is a result of their negative unhealthy health habits is false. Facts confirm this [Starfield, 2000]. According to many researches carried by different agencies, third leading cause is iatrogenic, that is, arising from medical treatment, and errors of medical investigations and diagnoses. It is because the services are poor, inaccessible, and costly that health indicators show poor performance in the US. Past governments have tried at different stages of America’s health care development to find lasting solutions to the challenge that militate against our health care services. Six times in the last century [during the First World War, the Depression, the Truman, government, Johnson Administration, the Senate in the 1970s, and during Clinton’s tenure], efforts were made to introduce some kind of universal health insurance, and each time the efforts have been rejected.. Indeed for a lasting change to the problem of health care: we need to begin with changing our orientation about the system. No doubt there are challenges; the question should be: what can we do to help assuage them? Our policies in the last few decades focus primarily on methods of financing instead of health outcomes: we need a change here. We need to rise up with a fresh fulfilling perspective on health care: the focus is not funding but directed funding. Cost and Quality The plan is to make sure that people and the government contribute to the health system that subserves. Insurance has created more problems than solve them: the safe way is to create a consensus mechanism which is economy-based. People pay some money in advance for the services they would enjoy according to their economic capacity. Government continues its system of funding the system, by providing competent health policies and sophistication of the health system. If we people complain of poor service, then we must equip the system, train the practitioners well and create systems for checks through structured medico-legal systems. Doctors guilty of offenses would be duly prosecuted.

Ripe vs. Rife

Ripe vs. Rife Ripe vs. Rife Ripe vs. Rife By Maeve Maddox Researching banking in the Roman Empire, I read the following in a scholarly discussion of Roman tax collecting: The process was ripe with corruption and scheming. The context calls for the word rife, not ripe. The process was not â€Å"ripe with corruption,† but â€Å"rife with corruption,† that is, the process was riddled with corruption. In simplest terms, ripe conveys readiness, whereas rife conveys abundance. Ripe is related to reap. When something is ripe, it is ready to be harvested or eaten. Ripe may be used literally or figuratively: You can tell if a peach is ripe or not by a gentle, yet firm squeeze with your fingers. When the time is ripe, I myself will deal out justice in strict fairness. Rife means abundant, prevalent, or widespread. When something is rife, there’s a lot of it: In the tiny community of Peyton Place, immorality was rife. Jones made his money when manufacturing opportunities were rife. Ripe is often followed by a prepositional phrase beginning with for: The field is ripe for harvest. The World’s largest Net Lease Is Ripe for A Takeover Why Commercial Real Estate Is Ripe For Disruption in 2015 Rife is often followed by a phrase that begins with the preposition with: Judicial Races Now Rife With Politics Nursing Profession Rife with Occupational Hazards Congress Rife With Gridlock and Partisanship Rife is frequently used in a negative context, but it can also be used to denote the abundance of something positive, like opportunities. Here are some examples of the misuse of ripe and rife on the Web, with corrections: Incorrect: Men’s health industry ripe with content marketing opportunities Correct : Men’s health industry rife with content marketing opportunities Correct : Men’s health industry ripe for content marketing opportunities Incorrect: Myanmar is ripe with Economic Opportunities Correct : Myanmar is rife with Economic Opportunities Correct : Myanmar is ripe for Economic Opportunities Incorrect: The commission uncovered an industry ripe with corruption and unjustifiable rates. Correct : The commission uncovered an industry rife with corruption and unjustifiable rates. Incorrect: The industry is ripe with challenges, but it is also ripe with opportunity. Correct : The industry is rife with challenges, but it is also ripe for opportunity. 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 Misused Words category, check our popular posts, or choose a related post below:Awoken or Awakened?Adverbs and Hyphens

Brief Justification for Selecting Cantonese Cuisine Assignment

Brief Justification for Selecting Cantonese Cuisine - Assignment Example First, Cantonese cuisine dishes include a stilled whole fish, roast suckling pig. Additionally, crispy-skinned chicken and shark’s fin soup form part of Cantonese cuisine dishes. The hotel considers these ingredients special because of their indigenous nature and quality. As a result, these meals are popular in China and neighboring countries. The dishes are also unique given the Cantonese cuisine. This cuisine is applicable in this region because of the abundance of the ingredients of the dishes. In this respect, Canton is abundant of diverse animal and plant food sources. This port city has been a prime attraction of many foreign techniques of cooking and cooking materials. Second, the major focus of Cantonese cuisine is on the heating temperature applied in the course of cooking the dishes. Other cooking techniques originated from Europe in order to supplement the Cantonese cuisine. The foreign techniques improved the Cantonese cuisine. This is because the dishes prepared could fit all kinds’ races. The fact that even the hotel incorporates western cooking techniques into the Cantonese cuisine is proof that this dish accommodates preferences from multiple regions across the globe. This is why restaurants serve this cuisine across the world. Gillespie (2010) says customers associate Cantonese cuisine dishes with an intensive selection of materials. The Cantonese cuisine involves stir-frying, frying, stewing, and braising. Third, the hotel also considers food color, taste, and fragrance. This is because these qualities are the ones, which make any food appealing to clients. According to Ninemeier (2009), Cantonese cuisine focuses on a variety of food preparation methods in order to satisfy the desires of customers. One achieves diversity in this aspect because Ninemeier considers all races.  

Marketing Essay Example | Topics and Well Written Essays - 500 words - 26

Marketing - Essay Example In the cut throat business of electronic goods, Sonic mission would be to capture the market segment that caters to the upcoming young executives who are looking for gizmos which are small enough to hold in their pockets but powerful enough to be used as computer, or phone or even as an entertainment device, as and when the need arises. Globalization has changed the dynamic of the business and today the professionals need to have all the information at their tip while following a hectic schedule. So the smaller the device which can pack such features, better are its chances of capturing this target group. PDAs from big companies like Hewlett Packard, Sony etc. have been in the market for the few years. Palm One, Blackberry etc. are PDAs that are well known. Over the years, these PDAs have evolved and new features have been incorporated. So Sonic 1000, would be competing with the companies whose PDAs, already have a market. Since the growing world economy has opened opportunities where new technology would be playing a very important role. Sonic, needs to come out with something which would be unique while having all the features of the currently popular PDAs, at no extra cost. After thorough analysis of the present market, the company proposes to give several value added services to its customers. The new Sonic 1000 would be a small hand held compact computer serving as a 3G camera phone with wi-fi features like Bluetooth, infra red technology thus facilitating easy internet connection. Sonic 1000 PDA would be equipped with a micro mini hard drive of 40 GB and USB connection that would make data handling easy, fast and efficient. 3G facility would enable video conferencing and the executives would be able to interact with their office and clients, while on the move. Looking at the vast potential for this type of gizmos, in the first year, the company proposes to sell 240,000

To Kill A Mockingbird Reader Response Essay Example for Free

To Kill A Mockingbird Reader Response Essay Harper Lee’s book, â€Å"To Kill a Mockingbird,† is, in my opinion, a book with a diverse collection of messages, skillfully woven into an interesting and engaging story. It seems to me, though, that the book is very focused on symbolism. The symbol of mockingbirds is reoccurring in the book. It appears in the title, it is suggested in various characters and situations, and in parts of the book it is stated explicitly. For example, on page 90, Atticus told Scout and Jem, â€Å"Remember it’s a sin to kill a mockingbird. † Scout didn’t understand this, and so she asked Miss Maudie about it. She responded, â€Å"Mockingbirds don’t do one thing but make music for us to enjoy. They don’t eat up people’s gardens, they don’t nest in corncribs, they don’t do one thing but sing their hearts out for us.† From these parts of the book, we learn that mockingbirds are innocent; it is a sin to hurt or injure them. I think that the symbolism of mockingbirds extends to humans also. They represent the innocent ones who are injured by evil. For example, I think that Tom Robinson is a prime example of a mockingbird that was killed. He was innocent; he was a good guy who didn’t hurt anybody. However, because of prejudice, he was accused of a capital offence. He was convicted by a prejudiced jury and sentenced to death. With all his hope gone, he made a crazed attempt to escape his prison, but was shot dead. Clearly, the author is telling us here that Tom shouldn’t have died. It was a sin to kill him. He shouldn’t have been convicted because he didn’t do anything. Boo Radley, however, is an example of Mimidà ¦n symbolism that was not killed, but nearly was. He led a reclusive life, but he was a kind person. He gave gifts to Scout and Jem, and even patched up Jem’s pants. However, his greatest moment in the book was when he saved Scout and Jem from Bob Ewell. Without Boo, Scout and Jem would have ended up dead. However, even though Scout and Jem were saved, Mr. Ewell was not so lucky. When Atticus heard about all this, he was presented with a serious moral situation. He didn’t really know what to do about Boo. Boo had almost definitely murdered Mr. Ewell, but Mr. Ewell had nearly murdered two children. At first Atticus was convinced that Boo should go to court. In Atticus’s mind, not sending Boo to  court would be hypocrisy. As he stated on page 274, â€Å"I can’t live one way in town and another in my home.† The choice boiled down to this: if Boo went to court, justice would be carried out, but an innocent life might be destroyed. If Boo didn’t go to court, Atticus would be a hypocrite. Atticus was confronted with this problem, but Heck Tate and Scout convinced him that it a greater sin to kill a mockingbird. As Scout said on page 276, â€Å"[sending Boo to court would] be sort of like shootin’ a mockingbird.† Eventually, Atticus decided that it would be better to save Boo. Here, the author is telling us that killing a mockingbird, or hurting an innocent person, is wrong, more so than most things that a person can do. â€Å"I wanted you to see what real courage is†¦ It’s when you know you’re licked before you begin but you begin anyway and you see it through no matter what. You rarely win, but sometimes you do. Ms. Dubose won†¦ She was the bravest person I ever knew.† Atticus told this to Scout and Jem to help them understand what real courage was. According to Atticus, real courage is when you keep on trying to do what you think is right, even if you’re almost certain to lose. When I was reading about courage and Ms. Dubose, I was reminded of Homer’s â€Å"The Iliad.† The main character of the Iliad, Achilles, was a nearly invincible Achaean hero who possessed the same refusal to change his views as Ms. Dubose. In Homer’s book, the king of the Achaeans had wronged Achilles, and so he decided not to fight in the war. He kept this totally fixed resolve for most of the book. In the Iliad, Homer even compared Achilles’ total refusal to change his opinions, based on what others thought, to how the Greek gods behaved. In the book, for example, Athena, Hera, and Aphrodite each believed that they were the most beautiful goddess. Rather than make a compromise, they eventually started the Trojan war because of this dispute, and fought each other over something so seemingly insignificant. For example, in one part of the Iliad, Athena and Aphrodite were each helping opposing sides in the war. Athena was helping the Achaean hero Diomedes, and so she had him throw a spear at Aphrodite. The spear went right through Aphrodite’s wrist, injuring her, and gave the Achaeans a small victory in the battle. Ironically, thousands of Achaean and Trojan lives were lost because of a dispute between three goddesses. The goddesses did not care how many mortals were killed because of their  dispute, just as Achilles didn’t care that the Achaeans might lose the war because of his decisions. Similarly, Ms. Dubose would not change her views for anything. This is what Atticus described as real courage. According to the Merriam-Webster’s Collegiate Dictionary, prejudice is, â€Å"preconceived judgment or opinion.† Prejudice is also a major theme in â€Å"To Kill a Mockingbird.† For example, while in court Atticus referred to, â€Å"the evil assumption that all Negroes lie, that all Negroes are immoral, that all Negroes are not to be trusted around women.† According to Atticus, people with minds like Mr. Ewell had these assumptions, and Mr. Ewell was counting on the jury being the same. For most of the trial though, Mr. Ewell’s attempts to win over the jury with such an extreme assumption were a total failure. Atticus had solid evidence and Mr. Ewell had nothing. As Atticus put it, â€Å"[The state] has relied instead upon the testimony of two witnesses whose evidence has not only been called into serious question on cross-examination, but has been flatly contradicted by the defendant.† However, Tom Robinson didn’t win the trial. Somet hing happened that caused the jury to turn against him. This event happened on page 197, when Tom said, â€Å"I felt right sorry for her.† The people in the jury were uncomfortable with this answer, as alluded to on the same page. I think that this was because they believed black people to be subhuman. They thought that black people, such as Tom Robinson, had a limited capacity to feel human emotions, especially for someone who was supposedly higher than them in society. Atticus though, a firm believer in equality, called Tom’s feelings for Miss Ewell, â€Å"unmitigated temerity† (page 204). The jury was not prejudiced enough to assume that all black people were born criminals, but they did feel that a black person could not feel sorry for a white person. Somehow, Tom’s one statement of temerity jeopardized all of Atticus’s evidence. To the jury, Tom was guilty. Of course, prejudice in â€Å"To Kill a Mockingbird,† also occurred on a less dramatic level. Maycomb itself was divided into different social groups. For example, in chapter 23, Scout thought that it would be nice to invite Walter Cunningham over for dinner. However, Aunt Alexandra forbade this, on the grounds that Walter was somehow not as good as the Finches. Jem summed up  Maycomb’s social hierarchy on page 226 when he stated, â€Å"Our kind of folks don’t like the Cunninghams, the Cunninghams don’t like the Ewells, and the Ewells hate and despise the colored folk.† Scout, however, didn’t quite agree with this system. She believed that all folks were equal. I think that by showing us the prejudice in â€Å"To Kill a Mockingbird,† the author is telling us that all labels are wrong. For example, Scout thought that Walter was a nice person, but society disagreed. Tom Robinson was a respectable man, but because he was black and admitted to being capable of feeling sorry for someone who was white, society condemned him. I personally think that giving a person a label is wrong, because each person is an individual, not a clone of some stereotype. Today, I think prejudice and stereotypes are a not only a big problem for the entire world, but they also affect teenagers such as D’Arcy students. It seems that all too often students categorize each other into stereotyped groups, much like how the citizens of Maycomb divided themselves. For example, if someone was walking down the hall at a school wearing old 70’s style glasses, corduroy pants, a plaid vest, suspenders, an ugly bow tie, and a shirt with a pocket protector and several pens plus a calculator in the pocket, many students would immediately associate this person with a stereotype. However, this student might be a great skateboarder who enjoys cooking and football. Obviously, labels are wrong. They can never be accurate because a person is not a stereotype. People are individuals. If everyone understood this, then maybe the world would have less problems, because many of the artificial barriers that we create because of prejudice would be broken down, and we would all get along much better. Of course, what starts off as a barely conscious stereotyping at school could develop into racism, just as Maycomb’s subtle prejudice escalated in enough racism to kill an innocent black man. Racism is a major problem around the world, and I think that its foundation is based on small acts of prejudice, and hypocrisy or ignorance. For example, one major connection to racism in the book occurred in chapter 26 when Scout was discussing current events in her class. What she wanted to know was, â€Å"How can you hate Hitler so bad an’ then turn around and be ugly about folks right at home?† I think that what the author was trying to tell us here was that many people are hypocrites.  Atticus was very careful to avoid this, almost to the point of killing a mockingbird, but others, such as Ms. Gates (Scout’s teacher), were total hypocrites when it came to racism. As Scout said, how could a person accept the social hierarchy of Maycomb, convict Tom Robinson, and then turn around and say that prejudice is wrong? I think that the author is not only telling us that racism is completely wrong, but she is also telling us that we should not be hypocrites. We should make up our minds about what is right. â€Å"Folks don’t like to have somebody around knowin’ more than they do. It aggravates em’.† Calpurnia said this on page 126, in response to a question from Scout. When I read this, I realized that it was very true. Generally, people don’t like to have people around who know more than they do. For example, a few weeks ago I was talking to someone at school who had gotten an excellent mark on an important assignment. When they told me their mark, they asked me not to tell their friends, because they might be angry. I think that it’s too bad that people, especially students such as those at D’Arcy, can’t always share their achievements with others without running the risk of â€Å"aggravating em’.† While I was reading, â€Å"To Kill a Mockingbird,† I noticed that one of the most effective tools that was used was point of view. The story was told in first person perspective, with Scout speaking. I think that this mainly allowed us to follow Scout’s personal development; it allowed us to see Scout’s thoughts and emotions. For example, in the beginning of the book, Scout enjoyed terrorizing Boo Radley in an attempt to make him get out of his house. Later on, though, she realized that doing this was really just hurting an innocent person. On page 279, Scout finally understood Boo well, and she felt that she had developed so much that â€Å"there wasn’t much else left [for her] to learn, except possibly algebra.† This sort of progress in Scout’s character made the story much more interesting for me, and helped me to better recognize the messages that the author was trying to convey. I also thought that the author used point of view to alter the mood in certain parts of the book. For example, on page 211, when the jury was convicting Tom, Scout said that it â€Å"had a dreamlike quality†. This sort of dazed confusion from Scout helped me understand what she thought of the  conviction. I think that Scout knew that Tom would be found guilty, but she didn’t want to accept it. This sort of tension and confusion seemed to convey similar feelings to the reader. When I first read this part of the book, I had to read it again to make sure that Tom really was being convicted, just like how Scout seemed to have some trouble accepting what happened to Tom. One of the characters in the book that I found particularly interesting was Atticus. Atticus was a person who knew what the world was like. He knew that countless mockingbirds were being killed every day around the world. He knew that there were many people who were selfish and unwilling to help others. However, even when he knew all this, he was one of the few characters in the book that continued to believe that there was good in the world. For example, after Jem had seen prejudice in a jarring way at the trial, he decided that everyone was not really equal. As he stated on page 227, â€Å"If there’s just one kind of folks, why can’t they get along with each other?† Jem didn’t understand that even though many people fight each other and divide themselves into social groups, they really are equal. Because what Jem thought was right wasn’t reflected in society, he changed his values. Atticus, though, understood that prejudice and racism were common in the world, but he always tried to see the best in people. On page 281, the story was ending when Atticus was putting Scout to bed. Scout was talking about a book that Atticus had been reading, and she said, â€Å"When they finally saw him he hadn’t done any of those things. Atticus, he was real nice†¦Ã¢â‚¬  Atticus responded, â€Å"Most people are, Scout, when you finally see them.† From this quote we can see that Atticus kept his own values, and his faith in humanity, despite what others did. I think that Atticus was able to do this because he didn’t think of a person as a ‘good’ person or a ‘bad’ person, instead he saw people as individuals with good and bad qualities. I think that the author is trying to tell us that people should be like Atticus, and not change their values to suit society’s values. We need to see people for who they really are, though, or it would be almost impossible to do this. Also, the way that Jem changed his own values to represent what society thought reminded me of John Wyndham’s book, â€Å"The Chrysalids.† In the book,  the people of Waknuk were obsessed with ‘the norm’. They believed that any deviation from ‘the norm’ was totally wrong, and they exiled offenders for (a very short) life. All of the people strived for their concept of normality, sort of an exaggerated example of how Jem changed his values to reflect what the majority of Maycomb thought. One last theme that I noticed in the book was the importance of education. The novel seemed to contrast two different types of education. One type was Atticus’ teachings to his children. Atticus enjoyed reading, and he passed this on to Scout by reading to her every night. Atticus also helped Scout and Jem to understand courage by sending them to Ms. Dubose. When Atticus taught something to Scout and Jem, he was always sympathetic and he usually succeeded in teaching whatever he was trying to. This contrasts strongly to the way that Scout’s schoolteachers tried to teach children. They ignored, or perhaps were oblivious to, the needs of their students, and tried to force them to follow the educational system they had been hired to teach. For example, on Scout’s first day of grade one, her teacher, Miss Caroline, found out that Scout could read. You would think that any reasonable grade one teacher would be very impressed by this, and maybe send Scout up a few grades, but instead Miss Caroline said (on page 16), â€Å"You tell [Atticus] I’ll take over from here and try to undo the damage†¦ Your father does not know how to teach.† Actually, Atticus was a much better teacher than Miss Caroline, because he understood Scout and Jem, his students. I think that the author is trying to tell us that while it is important to educate children, it is important to do it right. The key to teaching children, or, for that matter, anyone else, is to understand those who you are trying to teach. In conclusion, I think that, â€Å"To Kill a Mockingbird,† is a book that talks about innocence and understanding. It encourages us all to not hurt the innocent ones, the mockingbirds.

The Effects Of Violence In Media On Society Today Essay -- essays rese

Is societies violence the media’s fault? This is the question that has been asked since before television was in every American’s house. Of course there are the different types of media today ranging from newspapers, to on-line reports and stories. There have been arguments upon arguments about this issue, and over 3,000 studies conducted. Unfortunately there isn’t one single result, there is only an array of supposed answers to this undying question. CBS president, Howard Stringer is pointing to a different scapegoat for society’s violence. â€Å"I come from a country †¦ that puts a lot of American movies on and has more graphic violence within it’s live drama on the BBC than anywhere else, and there is a lot less violence in the United Kingdom than there is here. There are 200 million guns in America, and that has a lot to do with violence.† He feels it has to do with gun control, which others have suggested. But there are so many violent acts, that one can’t focus on the guns, just like one can’t focus on the media. David Phillips, one of the men we discuss later put it perfectly, â€Å"It’s like watching rain fall on a pond and trying to figure out which drop causes which ripple.†There have been many studies conducted on the effects of violence on children, and on the effects on society as a whole. There have been about 3,000 studies performed on this topic. Two of the most prolific studies were the UCLA Television Violence Monitoring Report, and the Mediascope, Inc. test sponsored by the National Cable Television Association. Of course there were many other studies done, but these made headlines because of their results. The UCLA study focused on all of the television media, and discovered some interesting facts from their study. Prime Time Series raised the least concern. Theatrical films raised more concern and had a lot more violence. The Saturday morning cartoons had mixed reviews. 23% of the cartoons raised concern, but that was only rating the most popular cartoons: Mighty Morphin Power Rangers, X-Men, etc. They termed the action in cartoons as â€Å"Sinister Combat Violence† which basically means the whole story line leads to violence.Mediascope, Inc. focused on the amount and context on cable, effectiveness of rating systems and parental advisories, and the success of anti-violent messages. They found that perpetrators go unpunished in 73% of all viole... ...ciety. And when we read about violence, it only reinforces what we know.† People have become used to seeing violence on television, but this has become somewhat surreal to them. They don’t think of it as reality until it happens to them. â€Å"When violence happens to people or their family, they become eyewitnesses to this violence. They have personal experiences – compassion sensitivity, fear. People haven’t lost that.†We have covered a huge amount of information about the effect of violence in media on society. Did we answer the question though? I don’t think we did, but I do think that the answer is making progress. We are also a lot more informed now of what exactly is in the media right now, and what studies have shown to be happening. There has always been an issue of something effecting society, and there will always be a plentitude of scapegoats. What is the actual answer though? No one seems to have it. There is a lot of gray area, but society seems to be making this more of a black and white issue. Will the government ever really take action? Does action need to be taken? Hopefully after reading this, one is more educated on the difficulty in answering these questions.

Flow Oriented Incentive Spirometry Health And Social Care Essay

Tracheostomy is among the most often performed process in critically sick patients, being done in approximately 24 % of patients in ICUs. The usage of tracheotomy increased over recent old ages. The most common indicant for tracheotomy in the ICU is need for drawn-out mechanical airing. However after some yearss or hebdomads of endotracheal cannulation, ability to cough is compromised because the glottis mechanism is bypassed. The lowest acceptable critical capacity that determines adequateness of cough is 15ml/kg of organic structure weight ( Shapiro el al 1985 ) Patients unable to exhibit a strong effectual cough are at hazard for maintained secernments ; this makes trouble in re-expansion of air sac in that section. So decreased lung volumes from decreased tidal take a breathing non merely can impair oxygenation and predispose to Hypercarbia. It besides can take to atelectasis. Normal self-generated take a breathing form have periodic hyperinflations that prevent alveolar prostration. But the shallow tidal airing take a breathing pattern cause atelectasis, retained secernments and respiratory infections. Atelectasis is a common job in postoperative patients and those with neuromuscular disease. Because atelectasis in some patients appears to be due to reiterate little inspirations. The intervention of atelectasis based on two rules. The lungs must be expanded with a transpulmonary force per unit area sufficient to open the collapsed lung tissues and dead secernments must be cleared. Deeper breaths may be helpful to successfully change by reversal the atelectasis in the first 24-48 hours. Incentive spirometer encourages enlargement of the lungs every bit much as possible above self-generated external respiration ; these have proved to be good in controlled surveies. They used to advance maximum inspiratory attempts, improved cough mechanism due to improved inspiratory capacity and therefore keep normal lung volume. In the inducement spirometry ocular provender back system is incorporated into the device such as raising a ball that the patient attempt controls.Physiological rule:Physiological rule of sustained maximum inspiration is to bring forth a maximum transpulmonary force per unit area gradient bring forthing a more negative intrapleural force per unit area. This force per unit area gradient produces alveolar hyperinflation with minimum air flow during inspiratory stage.1.1NEED FOR THE Survey:Most surveies investigated the usage of incentive spirometry to better the station operative pneumonic map. But merely a few surveies investigate the effectivity of incentive spirometry in tracheostomized patients. Hence the demand arise to look into the effects of incentive spirometry on tracheostomized patients.1.2 OBJECTIVE OF STUDY:1. The aim of this survey was to measure the effects of flow-oriented incentive spirometry on, atelectasis, Pao2, and PaCO2 in tracheostomized patients. 2. To measure the effects of diaphragmatic external respiration exercising on atelectasis, PaO2, and PaCO2. 3. To compare the effects of flow-oriented incentive spirometry with diaphragmatic external respiration exercisings on tracheotomy patients.1.3 Hypothesis:1. There is a important difference following flow-oriented incentive spirometry on thorax radiogram mark, PaO2, and PaCO2 in tracheostomy patients. 2. There is a important difference following diaphragmatic external respiration exercisings on chest radiogram mark, PaO2, and PaCO2 in tracheostomy patients. 3. There is a important difference following flow oriented incentive spirometry on thorax radiogram mark, PaO2, and PaCO2 when compared to diaphragmatic external respiration exercisings.1.4 Operational Definition:Tracheostomy: surgical opening up of windpipe to set an air passage to ease respiration in laryngeal obstructor or a status necessitating drawn-out respiratory aid Flow oriented incentive spirometry: Incentive spirometry is a method of voluntary deep external respiration by supplying ocular provender back about inspiratory volume utilizing a specially designed spirometer, the patient inhales until a preset volume is reached so sustains the inspiratory volume by keeping the breath for 3-5 sec. Incentive spirometry reduces the hazard of atelectasis Atelectasis: atelectasis is a prostration of lung tissue impacting portion of all of one lung. This status prevents normal O2 soaking up to healthy tissues Inspiratory capacity: The maximal volume of gas that can be inhaled from the terminal of a resting halitus. This is equal to the amount of the tidal volume and the inspiratory modesty volume. Arterial blood gas: The O2 and CO2 content of the arterial blood measured by assorted methods to measure the adequateness of airing and oxygenation and acid-base position of the organic structure. Oxygen impregnation of Hb is usually 95 % or higher. The partial force per unit area of arterial o2 usually 80-100mmhg and Pco2 is usually 35-45mmHgPartial force per unit area of O in arterial blood ( PaO2 ) :The portion of entire blood gas force per unit area exerted by O gas. It is lower than normal in patients with asthma, clogging lung disease. The normal PaO2 in arterial blood is 95 to 100 millimeter Hg.Partial force per unit area of C dioxide in arterial blood ( PaCO2 ) ,The portion of entire blood gas force per unit area exerted by C dioxide. It decreases during rapid external respiration and it increases with respiratory upsets. The normal force per unit areas of C dioxide in arterial blood are 35 to 45 millimeters Hg1.5 PROJECTED Result:Based on the literature reappraisal available ; the jutting result of this survey will be, the tracheotomy patients who undergo incentive spirometry preparation will hold betterment in lung enlargement, PaO2and PaCO2 degree in arterial blood than the patients who underwent diaphragmatic external respiration exercisings.Chapter IILITERATURE REVIEWTan AK conducted a prospective clinical survey on patients with major caput and cervix surgery was conducted to measure the usage of incentive spirometry to better station operative lung map. An arranger was foremost designed to let patients with tracheostomy tubings to utilize the spirometer. Parameters studied include critical marks, arterial blood gases and pneumonic map trial. Significant betterment of lung map and deficiency of complication warrant the usage of incentive spirometry in station operative caput and cervix surgery patients. ( 2 ) Naveen Malhotra, parveen Malhotra, and Deepak Varma successfully used the modified inducement spirometer in tracheostomized patients admitted in ICU as a lung enlargement technique. The equipments used are an incentive spirometer, an arranger and a Y Connector. The arranger used is merely an anaesthesia tubing connection. In their survey they have besides mentioned that inducement spirometry besides helps to measure lung maps particularly the critical capacity and inspiratory volume. They have concluded that the combination of incentive spirometry, chest physical therapy and early mobilisation improves the efficiency of incentive spirometry. ( 1 ) Mirza S, Hopkinson L, malik TH, Willat DJ were reported that respiratory map proving in patients with tracheal pore or tracheotomy tubings is hard due to the job of neglecting to accomplish a good seal between the tracheotomy tubing or pore. Standard pneumonic map devices connected to a tracheostomy tubing via the same adapter and underwent the respiratory map trial. ( 3 ) Basoglu OK, Atasever A, Bacakoglu F. , Compared a incentive spirometry group to groups having merely medical intervention. A sum of 27 back-to-back patients admitted for COPD aggravations were recruited. 15 ( IS intervention group ) used IS for 2 months, together with medical intervention. The staying 12 ( medical intervention group ) were given merely medical intervention. Pneumonic map and blood gases were measured. PaCO2 values decreased ( P = 0.02 ) , PaO2and PaCO2 values increased ( P = 0.02 and P = 0.01, severally ) in the IS intervention group. However, there were no important differences between the measurings made pretreatment and after 2 months of medical therapy in the medical intervention group, with respects to pneumonic map, blood gases, they concluded that the usage of IS appears to better arterial blood gases in patients with COPD aggravations, although it does non change pneumonic map parametric quantities. ( 4 ) . Celli et al. , compared a no-treatment control group to groups having 15 proceedingss of IS, intermittent positive force per unit area external respiration ( IPPB ) or deep external respiration exercising ( DBE ) in patients who had undergone both upper and lower abdominal surgery. Compared to no intervention, the three intervention techniques were every bit more effectual in forestalling pneumonic complications. The writer suggested that IS may be preferred following upper abdominal surgery, because it appeared to shorten the patient ‘s length of stay. ( 5 ) Ricksten et al. , compared the consequence of 3 yearss of hourly ( 30 breaths ) IS, uninterrupted positive air passage force per unit area ( CPAP ) , and positive terminal expiratory force per unit area ( PEEP ) on gas exchange, lung volumes, and development of atelectasis. The patients who received both CPAP and PEEP were superior to Be for alveolar-arterial O force per unit area difference, FVC, and the incidence of atelectasis. ( 6 ) Stephen et al. , studied the consequence of incentive spirometry versus deep external respiration exercising on cut downing the diminution in critical capacity in patients undergoing abdominal surgery and found that incentive spirometry is more effectual than deep external respiration exercisings in reconstructing critical capacity to preoperative degrees ( 7 ) Thomas JA, McIntosh JM. , Conducted a meta-analysis was to quantitatively measure the conflicting organic structure of literature refering the efficaciousness of incentive spirometry ( IS ) , intermittent positive force per unit area external respiration ( IPPB ) , and deep external respiration exercisings ( DBEX ) in the bar of postoperative pneumonic complications in patients undergoing upper abdominal surgery. He concluded that Incentive spirometry and deep external respiration exercisings appear to be more effectual than no physical therapy intercession in the bar of postoperative pneumonic complications. ( 8 )Chapter IIIMATERIALS AND METHODOLOGY3.1 STUDY DESIGN:Pretest station trial design with a comparing group. It is a quasi experimental design. Two groups were taken: one is experimental group and another one is comparison group. Group A- Experimental group Group B- comparing group3.2 SAMPLE SIZE:Twenty patients were selected and were assigned into two groups ; comparing group and experimental group.3.3POPULATION AND Sampling:An norm, approximately 5 % of patients undergone tracheotomy in ICU for every month. Among these patients, 20 patients were selected and were assigned into two groups by simple random trying method for the survey after obtaining informed consent. One is experimental group who received incentive spirometry preparation and another group is comparison group who received diaphragmatic external respiration exercisings.3.4 STUDY Setting:The survey was conducted at the medical Incentive attention unit ( MICU ) , PSG infirmary, Coimbatore. PSG infirmary is 810 stratified multi forte systems.3.5 TREATMENT DURATION:5-10 breaths per session ; every one hr while awake for 48 hours.3.6 STUDY DURATION:6 months ( from June 1st 2010 to 30th November 2010 )3.5 CRITERIA FOR SAMPLE SELECTION:3.5.1. INCLUSION CRITERIA:1. Conscious and concerted patients 2. Aged above 18 year 3. Gender: both males and females 4. Patients who are weaned from ventilator and execute self-generated take a breathing with tracheotomy 5. Post operative patients who are at hazard of developing atelectasis 6. Patients with neuromuscular upsets, and post operative patients with thoracic surgery3.5.2EXCLUSION Standards:1. Patients with reduced degree of consciousness 2. Patients who are unable to understand or collaborate with the intervention 3. Patients with respiratory infective diseases3.6 INSTRUMENT AND TOOL FOR DATA COLLECTION:1. Chest X beam class for atelectasis 2. Arterial blood gas analysis- PaO2 and Paco2 degree3.7 Technique OF DATA COLLECTION:In this survey baseline appraisal was taken for both the experimental group and comparing group ab initio. Then the patients in experimental group underwent incentive spirometry preparation via modified flow oriented incentive spirometer with the healer supervising so post trial appraisals were taken at the terminal of 48hrs after incentive spirometry preparation. In the comparing group, they received diaphragmatic external respiration exercisings and station trial appraisal was taken after 48 hour of baseline appraisal. Any alterations in each group ‘s PaO2, PaCO2, and chest radiogram mark for atelectasis are compared.3.8 Technique OF DATA ANALYSIS AND INTERPRETATION:Datas collected from both group participants were analyzed utilizing paired't ‘ trial to mensurate the alterations between the pre and station trial values with in the group and Independent ‘t ‘ trial to mensurate the alterations between the groups. Paired't ‘ trial: Where, n = Number of samples S = Standard divergence vitamin D = Mean divergence Independent't ‘ trial: X1 = Mean Differece of Group A X 2 = Mean Difference of Group B SD- combined standard divergence of group A and B n1 = Number of patients in Group A n2 = Number of patients in Group B SD1 = Standard Deviation of Group A SD2 = Standard Deviation of Group BChapter 1VDATA ANALYSIS AND INTERPRETATIONData analysis is the systematic organisation and synthesis of research informations and testing of research hypothesis utilizing those informations. Interpretation is the procedure of doing sense of the consequences of a survey and analyzing their reading ( Polit and Beck, 2004 ) . Pre trial and Post trial value collected utilizing Radiographic Grades to mensurate the degree of atelectasis for patients in Group A and Group B were presented in Table 1 and 2 ( Annexure-VI ) and they expressed as a saloon diagram chart 1 and 2. The Pre trial and Post trial values of Group A and Group B for PaO2 in arterial blood of patients from selected population were presented in Table 3 and 4 ( Annexure-VI ) and besides expressed in chart 3 and 4. Similarly the pre trial and station trial values of Group A and Group B for PaCO2 in arterial blood from selected population were presented in Table 5 and 6 ( Annexure- VI ) and besides presented in chart 5 and 6.Table-7 Difference in average values and Standard Deviation of pre trial and station trial values based on Radiographic Grades for both Group A and BS. NoGroupsDifference in meanStandard Deviation1.Group A0.704832.Group B0.20.4211. Comparison of pre and station trial values of 10 topics in Group A based on Radiographic Grades. ( Graph-1 ) Hypothesis: There is important difference on thorax radiogram mark for atelectasis following flow oriented incentive spirometry preparation. ‘t ‘ value = = 4.582 df = n – 1 = 9 The t-value 4.582 gives P & lt ; 0.01 that agencies there is a important difference between the agencies of pre trial and station trial values.COMPARISON OF PRETEST AND POST TEST MEAN VALUES FOR GROUP A- CHEST RADIOGRAPH SIGN2. Comparison of pre and station trial values of 10 topics in Group B based on Radiographic Grades.Hypothesiss: There is important difference on thorax radiogram mark for atelectasis following deep external respiration exercisings. ‘t ‘ value = = 1.5 df = n – 1 =9 The t-value 1.5 gives P & gt ; 0.05 that agencies there is a no important difference between the agencies of pretest and station trial. The values are besides represented in a chart 2COMPARISON OF PRETEST AND POST TEST MEAN VALUES FOR GROUP B – Thorax RADIOGRAPH SIGNTable-8 Difference in average values and standard Deviation of pre trial and station trial values based on PaO2 for both Group A and B ( n=10 ) .S. No Groups Difference in Mean Standard Deviation 1. Group A -6.6 6.744 2. Group B 0.91 6.314 In order to happen out the important difference between the pre trial and station trial PaO2 degree in arterial blood paired â€Å" T † trial was used. 1. Comparison of pre and station trial values of 10 Subjects in Group A based on PaO2 values. ( Chart-3 ) Hypothesis: There is important difference on PaO2 value following flow oriented incentive spirometry preparation. ‘t ‘ value = =-3.094 df = n – 1 =9 The gathered information is tabulated ( ref Table: 2 ) and the mated t trial is conducted. The t-value -3.094 gives P & lt ; 0.01 that agencies there is a important difference between the agencies of pre trial and station trial values. The pretest and station trial values are besides represented in a chart ( Ref Chart: 3 ) COMPARISON OF PRETEST AND POST TEST MEAN VALUES FOR GROUP A- PaO2 VALUE 2. Comparison of pre and station trial values of 10 topics in Group B based on PaO2 values. ( Chart-4 ) Hypothesis: There is important difference on PaO2 following deep external respiration exercisings. ‘t ‘ value = =0.455 df = n – 1 = 9 The t-value 0.455gives P & gt ; 0.05 that agencies there is a no important difference between the agencies of pretest and station trial. The values are besides represented in a chart ( Ref Chart: 4 )COMPARISON OF PRE TEST AND POST TEST MEAN VALUES FOR GROUP B- PaO2 VALUE.Table-9 Difference in average values and standard Deviation of pre trial and station trial values based on PaCO2 in arterial blood for both Group A and B ( n=10 ) .S. No Groups Difference in Mean Standard Deviation 1. Group A 7.04 7.58 2. Group B 0.41 5.51 In order to happen out the important difference between the pre trial and station trial for PaCO2 paired â€Å" T † trial was used. 1. Comparison of pre and station trial values of 10 Subjects in Group A based on PaCO2 value. ( Graph-5 ) Hypothesis: There is important difference on PaCO2 value following flow oriented incentive spirometry preparation. ‘t ‘ value = = 2.93 df = n – 1 = 9 The t-value 2.93 gives P & lt ; 0.01 that agencies there is a important difference between the agencies of pre trial and station trial values.COMPARISON OF PRE TEST AND POST TEST MEAN VALUES FOR GROUP A- PaCO2 VALUE2. Comparison of pre and station trial values of 10 topics in Group B based onPaCO2. ( Graph -6 ) Hypothesis: There is a important difference on PaCO2 value following external respiration exercisings. ‘t ‘ value = = 0.23 df = n – 1 = 9 The t-value 0.23 gives P & gt ; 0.05 that agencies there is a no important difference between the agencies of pretest and station trial.COMPARISON OF PRE TEST AND POST TEST MEAN VALUES FOR GROUP B- PaCO2 VALUETable-10.Difference in average values and standard divergence of Pre trial and station trial values based on Radiographic Grades, PaO2 and PaCO2 values for both Group A and B ( n =20 ) .S.No Variable Difference in mean Standard Deviation 1. Chest Radiographic Grade 0.5 0.453 2. PaO2 5.69 6.533 3. PaCO2 6.63 6.63 In order to happen out the important difference between station trial values of both Group A and B based on Radiographic Grades, PaO2 and PaCO2 Independent't ‘ trial was used.1. Comparison of average values of 20 topics in Group A and B based on chest Radiographic Grade.Comparison of Mean Values of 20 topics in Group A and Group B Based on chest Radiographic Class Hypothesis: There is important difference following flow oriented incentive spirometry preparation on thorax Radiographic Grade, when compared to diaphragmatic external respiration exercisings. Independent't ‘ trial SD = ( n1-1 ) SD12+ ( n2-1 ) SD22 ( n1+n2 – 2 ) = 0.453 T = ( x1- x2 ) n1 n2 SD n1 + n2 = 2.46 df = n1+n2 – 2 = 18 The deliberate value is greater than the table value of 2.46 ( P & lt ; 0.05 ) . This shows that there is important betterment between the Mean values of chest Radiographic Grade in Group A and B. Hence Hypothesis accepted.COMPARISON OF MEAN VALUES BETWEEN GROUP A AND GROUP B BASED ON CHEST RADIOGRAPHIC GRADE2. Comparison of station trial values of 20 topics in Group A and B based on PaO2 valueHypothesis: There is important difference on PaO2 following flow oriented incentive spirometry preparation, when compared to diaphragmatic external respiration exercisings Independent't ‘ trial SD = ( n1-1 ) SD12 + ( n2-1 ) SD22 ( n1+n2 – 2 ) = 6.533 T = ( x1- x2 ) n1 n2 SD n1 + n2 = -2.57 df = n1+n2 – 2 = 18 The deliberate value is greater than the table value of -2.57 ( P & lt ; 0.05 ) . This shows that there is important betterment between the station values of paO2 in Group A and B. Hence Hypothesis accepted.COMPARISON OF MEAN VALUES BETWEEN GROUP A AND GROUP B BASED ON PaO23. Comparison of Mean values of 20 topics in Group A and B based on PaCO2 value.Comparison of Mean Values of 20 topics in Group A And Group B Based on PaCO2 value Hypothesis: There is important difference on PaCO2 following flow oriented incentive spirometry preparation, when compared to take a breathing exercisings. Independent't ‘ trial SD = ( n1-1 ) SD12+ ( n2-1 ) SD22 ( n1+n2 – 2 ) = 6.63 T = ( x1- x2 ) n1 n2 SD n1 + n2 = 2.236 df = n1+n2 – 2 = 18 The deliberate value is greater than the table value of 2.236 ( P & lt ; 0.05 ) . This shows that there is important betterment between the Mean values of PaCO2 in Group A and B. Hence Hypothesis accepted.COMPARISON OF MEAN VALUES BETWEEN GROUP A AND GROUP B BASED ON PaCO2Chapter VRESULTS AND DISCUSSIONThe purpose of the survey was to compare the efficaciousness of flow-oriented incentive spirometry preparation with diaphragmatic external respiration exercising in tracheostomized patients. Wholly 20 participants were participated in this survey. They are assigned into comparing group and experimental group. The selected result steps were, Chest radiographic scaling for atelectasis, PaO2 value, PaCO2 valueChest radiographic Grading for Atelectasis:In Experimental group, Based on chest radiographic class for Atelectasis, there is an betterment in the thorax radiogram mark after incentive spirometer preparation. The deliberate T value is 4.58, which gives P & lt ; 0.01. Hence, statistically important betterment was found between pre and station trial means. It shows that the flow oriented incentive spirometry has important consequence on bettering the atelectatic country for the patients with tracheotomy. But in Comparison group, the deliberate T value is 1.5, which gives P & gt ; 0.05. This implies that there is no important difference in the agencies. So, this shows the diaphragmatic external respiration exercising has less important consequence on bettering atelectasis.PaO2 value:In Experimental group, Based on PaO2 value, the deliberate T value is 3.09, which gives P & lt ; 0.01. Hence, there is a statistically important betterment in the station trial values of PaO2. It shows that that the sustained maximum inspiration improves arterial blood O degree. But in Comparison group besides, some little differences between the pretest and station trial mean values. But the deliberate T value is 0.45, which gives P & gt ; 0.05. This implies that there is no important difference in the agencies. Hence, the diaphragmatic external respiration exercising has less consequence on bettering PaO2.PaCO2 value:In Experimental Based PaCO2 value, the deliberate T value is 2.93, which gives P & lt ; 0.01. Hence, there is an betterment station trial and the difference is extremely important. It shows a important decrease in carbon dioxide degree after incentive spirometry preparation. But in Comparison group, the deliberate T value is 0.235, which gives P & gt ; 0.05. This implies that there is no important difference in the agencies. Hence, this shows that the patients who treated with diaphragmatic external respiration exercisings had no decrease in PaCO2 degree. The p-value ( & lt ; 0.05 ) obtained from independent't ‘ trial showed that the agencies of two group are significantly different. So the patients who received incentive spirometry preparation got more betterment than patients who received diaphragmatic external respiration exercising.RestrictionThere were some restrictions in this survey are given below: This survey was done in a shorter period. The smaller Sample size is a strong modification factor in our survey The entire work of external respiration of the patients during incentive spirometry was non measured. Lung volumes and capacities are non measured Inspiratory musculus strength was non assessed.5.4 RECOMMEDATIONSBased on the result of statistical analysis, it is suggested that the farther surveies should be modified to suit the undermentioned alterations, Effectss can be proved by utilizing pneumonic map trial. Different populations can be analyzed to formalize the consequence. Measure the impact of the extra imposed work of take a breathing ( WBimp ) generated by two different spirometers.Chapter VIDecisionWith the mention to the statistical analysis done from the informations collected by Radiographic Grades, PaO2 and PaCO2 values, concluded that the flow oriented incentive spirometry preparation has important consequence in bettering the degree of atelectasis, PaO2 and PaCO2 degree in arterial blood than diaphragmatic external respiration exercising entirely in tracheostomy patients..‘So, the modified inducement spirometer has been successfully used in tracheostomized patients who were admitted in intensive attention unit as a lung enlargement technique.CHAPTER-VII

Philip Morris Essay

1.How would you describe Marlboro’s competitive position in early 1993? Marlboro, the leading cigarette brand for Philip Morris, was the dominant player in the premium priced market. While RJR was the second largest player in the market, RJR’s cigarette brands were fragmented. At the end of 1992, Marlboro had 24.4% unit market share, while each of the RJR brand cigarettes had less than 7% market share. Philip Morris, at 53% operating contribution margin, was significantly more profitable than RJR, at 34% operating contribution margin. Marlboro was essentially backed by the biggest, most profitable player – Philip Morris. Philip Morris was also the consistent market share leader, at least since 1988, over RJR and other much smaller companies. The industry had sustained profitability over time. There we can conclude that there are significant barriers to entry in the cigarette market. Additionally, the need for a strong distribution network with retailers and wholesalers added to the barriers to entry into the market. Threat Discussed on more detail later, Marlboro was facing stuff competition in the 90s from discount brands, particularly RJR brands. While Marlboro, a premium brand, suffered a steadily declining market share since 1989, discount brands were quickly gaining market share. 2.What is Marlboro’s marketing strategy at this time? Marlboro positioned itself as a premium brand cigarette. While it played in the discount segment as well, it was second to RJR brands in the discount segment. Marlboro spent a significant amount of money in advertising and promotions to command its premium pricing. Marlboro became synonymous with Iconic imagery such as the â€Å"Marlboro man† and wild western country images. This led to Marlboro’s strong hold amongst young men. Marlboro outspent its competitors in advertising – spending $3.5 million per percent market share in 1992, compared to $2.1 million spend per percent market share by RJR. (RJR was focused on the discount segment by 1992) Marlboro also used its market power to engage in â€Å"Trade loading†, essentially forcing retailers to forward buy and to stock up on Marlboros just before a price increase. This probably encouraged retailers to allocate more shelf space to Marlboro to get their inventories moving from their warehouses. 3.How does this compare to R.J. Reynolds? RJR focused on its discount brand. RJR had built it self to the discount segment market share leader with 33% discount segment share by 1992. RJR carried about 200 brands under its umbrella. While they had national brands, they also created individual brands for each retailer, resulting in a string distribution system. This was probably well received by the retailers since a cigarette was one of the most profitable products sold in stores. RJR not only cut price to increase discount market share, but also invested in price promotions. Their growth in the 90s had come by taking market share from premium brands during a recessionary period. 4.What accounts for Philip Morris’ dramatic shift in strategy in April 1993? What are its goals? 6. What kind of industry future does Philip Morris anticipate? Market shift (Consumer behavior and regulation) The 1990’s was a recessionary period in the US. While cigarette smokers were believed to be loyal to their brands (and are generally very sticky consumers), there was a marked shift in the emergence of discount brands. In a span of 11 years (1981- 1992), the market share for discount brands in the US went from 0 to 30%. Meanwhile, Marlboro was steadily loosing market share, loosing 2 market share percentage points from 1989 to 1992. Additionally, the regulatory climate was putting an upward pressure on price. While government taxes were on the rise, restrictions on advertising of cigarettes were emerging, both of which made selling cigarettes more expensive. It can be argued that with the rising awareness amongst consumer on the hazards of smoking this upward pressure on price from a regulatory perspective would persist in the medium term. RJR Phillp Morris was also presumably worried about the aggressive price cuts and promotions by RJR to increase its market share. Goals of Philip Morris Strategy Philip Morris needed a aggressive competitive response to tacklethe threats of: declining market share, increasing share of discount brands, regulation, and RJR’s promotions and price cuts. They decided to aggressively attack the existing discount brands and make the Philip Morris brand significantly more price competitive. Philip Morris effectively cut price by 20%, creating 2 tiers of cigarette pricing (from 3 tiers before). Their premium products were now significantly more competitive, compared with the discount brands due to their reduced price and existing strong brand image. Philip Morris were betting that a large portion of consumers would compare their premium product as price competitive with the discount brands, and would chose Marlboro due to its superior brand image and comparable prices. They essentially wanted to win the pricing game and lead with their brand. Surprisingly, they slightly increased the price of their discount brand by a mere 6 cents. This was probably to restrict the range in which the pricing war could be played by other players. Industry Outlook for Philip Morris Surely with the consumer behavior shift and the increasingly hostile regulatory climate described above, Philip Morris views the industry margins becoming thinner and realizes it will get progressively harder to get new consumers. Therefore attracting heavy smokers becomes key for growth and long term profitability. Additionally, Marlboro views the market as price sensitive, especially for heavy smokers. Attracting and retaining this segment is not only a branding game but also a pricing game as well since there is a high frequency of repeat purchases. 5.How should R.J. Reynolds respond? In my opinion, RJR needs to â€Å"make good† (option 3 below) with Philip Morris. The three options for RJR are: Fight with a further price cut or increase in advertising: not only will this option further erode industry margins, but also RJR will probably get crushed in a price/advertising war against the much larger and more efficient Philip Morris. Do nothing: and risk loss of its discount market share dominance to Philip Morris. Price increase (â€Å"make good†): Philip Morris is clearly signaling that it will play aggressively in the discount segment, and in the war for consumers moving or likely to move to the discount segment. With a slight price increase, RJR can signal to Philip Morris that it does not want to engage in a further price war, and it will maintain industry profitability. Such collaborative behavior is probably best for both players in the industry. Additionally, since RJR has a strong distribution with personalized brands for retail outlets, it should focus on building its capability in such brands. The localized brands are arguably a slightly different turf than only fighting the game as big national brands (where Marlboro is very strong with its dominant brand imagery), and local retail branding is RJRs stronghold.

Biography of Georges Seurat, Father of Pointillism

Biography of Georges Seurat, Father of Pointillism Georges Seurat (December 2, 1859 – March 29, 1891) was a French painter of the post-impressionist era. He’s best known for developing the techniques of pointillism and chromoluminarism, and one of his iconic paintings was instrumental in ushering in the era of Neo-Impressionism. Fast Facts: Georges Seurat Full Name:  Georges-Pierre SeuratOccupation: ArtistKnown For: Creating the techniques of pointillism and chromoluminarism, with scenes emphasizing smooth lines and colors blended by visual observation, not mixed pigmentsBorn: December 2, 1859 in Paris, FranceDied: March 29, 1891 in Paris, FrancePartner: Madeleine Knobloch (1868-1903)Children: Pierre-Georges (1890-1891), unnamed child (died at birth, 1891)Notable Works:  Bathers at Asnià ¨res, A Sunday Afternoon on the Island of La Grande Jatte, The Channel of Gravelines, Petit Fort Philippe Early Life Georges Seurat was the third and youngest child of Antoine Chrysostome Seurat and Ernestine Seurat (nà ©e Faivre). The couple already had a son, Émile Augustin, and a daughter, Marie-Berthe. Thanks to Antoine’s success in property speculation, the family enjoyed considerable wealth. Antoine lived separately from his family, visiting them weekly rather than living under the same roof. Georges Seurat began studying art early; his first studies occurred at the École Municipale de Sculpture et Dessin, an art academy run by the sculptor Justin Lequien near the Seurat family’s home in Paris. In 1878, he moved to the École des Beaux-Arts, where his studies followed the typical courses of the time, focusing on copying and drawing from existing works. He finished his artistic training in 1879 and left for a year of military service. Early Career and Innovation When he returned from his military service, Seurat shared a studio with his friend and fellow artist Edmond Aman-Jean, where he worked to master the art of monochrome drawing. In 1883, he had his first work exhibited: a crayon drawing of Aman-Jean. The same year, he spent most of his time working on his first major painting, Bathers at Asnià ¨res. Final Study for Bathers at Asnieres by Georges Seurat. Francis G. Mayer / Getty Images Although Bathers at Asnià ¨res had some impressionistic influences, specifically in its use of light and color, it broke from that tradition with its textures and outlined figures. His process also departed from impressionism, as he sketched out several drafts of the piece before actually starting to work on the final canvas itself. The painting was rejected by the Paris Salon; instead, Seurat showed it in May 1884 at the Groupe des Artistes Indà ©pendants. Among that society, he met and befriended several other artists. However, the society’s disorganization soon frustrated Seurat and some of his friends, and together, they split from the Indà ©pendants to create a new artists’ society of their own, called the Socià ©tà © des Artistes Indà ©pendants. Georges Seurat was heavily influenced by contemporary ideas about color theory, which he tried to apply to his own works. He subscribed to the idea of a scientific approach to painting with color: that there was a natural law to the way colors worked together to evoke emotion in art, similar to how musical tones worked together in harmony or dissonance. Seurat believed that he could create a new artistic â€Å"language† using perception, color, and lines. He called this theoretical visual language â€Å"chromoluminarism;† today, it’s included under the term divisionism, referring to how the technique requires the eye to combine adjacent colors, rather than the artist mixing pigments before painting. Family Life and Famous Work Right on the heels of the debut of Bathers at Asnià ¨res, Seurat began work on his next piece, which would come to be his most famous and enduring legacy. A Sunday Afternoon on the Island of La Grande Jatte depicts members of different social classes all spending a leisure afternoon at a park on the waterfront of the Seine in Paris. Sunday on the Island of la Grande Jatte by Georges Seurat. To create the painting, Seurat used his color and pointillism techniques, using tiny dots of individual colors overlapping and adjacent to each other so that they would be â€Å"blended† by viewers’ eyes, rather than mixing the paints themselves. He also prepared for the painting by spending significant time at the park he depicted, sketching his surroundings. The resulting painting measures 10 feet wide and currently is displayed at the Art Institute of Chicago. A smaller, related study, Study for A Sunday Afternoon on the Island of La Grande Jatte, resides in New York City in the Metropolitan Museum of Art. Although Seurat never married, he had a significant romantic relationship with Madeleine Knobloch, an artist’s model. She was the model for his 1889/1890 painting Jeune femme se poudrant, but they took pains to conceal their relationship for some time. In 1889, she moved into Seurats apartment, and she became pregnant sometime in 1889. The couple moved to a new apartment to accommodate their family, and Knobloch gave birth to their son, Pierre-Georges, on February 16, 1890. Final Years and Legacy During the summer of 1890, Seurat spent most of his time at the commune of Graveline, along the coast. He was incredibly prolific that summer, producing four canvas paintings, eight oil panels, and several drawings. Out of his works from that time period, the most notable was his painting The Channel of Gravelines, Petit Fort Philippe. The Channel at Gravelines, in the Direction of the Sea by Georges Seurat. Francis G. Mayer / Getty Images Georges Seurat began working on another painting, The Circus, but he did not live to continue innovating and working. In March 1891 he fell ill, and on March 29, he died at his parents’ home in Paris. The nature of the illness that caused his death is unknown; theories include meningitis, diptheria, and pneumonia. Whatever the illness was, he passed it on to his son Pierre-Georges, who died weeks later. Madeleine Knobloch was pregnant at the time, but their second child did not survive long after birth. Seurat was buried on March 31, 1891 at Cimetià ¨re du Pà ¨re-Lachaise, the largest cemetery in Paris. He left behind a legacy of significant artistic innovation, despite dying at the very young age of 31. Seurat’s use of color and his work with pointillism have been his most enduring artistic legacies. In 1984, nearly a century after his death, Seurat’s most famous painting became the inspiration for a Broadway musical by Stephen Sondheim and James Lapine. Sunday in the Park with George is inspired by the painting, and the first act of the musical depicts Seurat himself in a highly fictionalized way, imagining his creative process. The musical focuses more on his artistic pursuits but also does depict a fictionalized version of his personal life, notably in the character of his mistress â€Å"Dot,† who seems to be an avatar for Madeleine Knobloch. Art students still study Georges Seurat today, and his influence on other artists began not long after his death. The cubist movement looked at his linear structures and form, which then influenced their ongoing artistic developments. And of course, even young children in the modern world learn about pointillism, usually through A Sunday Afternoon. Despite his short life, Georges Seurat established himself as a key and permanent player in the art world. Sources Courthion, Pierre. â€Å"Georges Seurat: French Painter.† Encyclopaedia Britannica, https://www.britannica.com/biography/Georges-Seurat.Georges Seurat, 1859–1891. New York: Metropolitan Museum of Art. 1991Jooren, Marieke; Veldink, Suzanne; Berger, Helewise.  Seurat. Krà ¶ller-Mà ¼ller Museum, 2014.

Gerrymandering - Congressional Districts on Census Data

Gerrymandering - Congressional Districts on Census Data Every decade, following the decennial census, the state legislatures of the United States are told how many representatives their state will send to the United States House of Representatives. Representation in the House is based on state population and there are a total of 435 representatives, so some states may gain representatives while others lose them. It is the responsibility of each state legislature to redistrict their state into the appropriate numbers of congressional districts. Since a single party usually controls each state legislature, it is in the best interest of the party in power to redistrict their state so that their party will have more seats in the House than the opposition party. This manipulation of electoral districts is known as gerrymandering. Although illegal, gerrymandering is the process of modifying congressional districts to benefit the party in power. A Little History The term gerrymandering is derived from Elbridge Gerry (1744-1814), the governor of Massachusetts from 1810 to 1812. In 1812, Governor Gerry signed a bill into law that redistricted his state to overwhelmingly benefit his party, the Democratic-Republican Party. The opposition party, the Federalists, were quite upset. One of the congressional districts was shaped very strangely and, as the story goes, one Federalist remarked that the district looked like a salamander. No, said another Federalist, its a gerrymander. The Boston Weekly Messenger brought the term gerrymander into common usage, when it subsequently printed an editorial cartoon that showed the district in question with a monsters head, arms, and tail, and named the creature a gerrymander. Governor Gerry went on to become vice president under James Madison from 1813 until his death a year later. Gerry was the second vice president to die in office. Gerrymandering, which had taken place prior to the coinage of the name and continued for many decades thereafter, has been challenged many times in federal courts and has been legislated against. In 1842, the Reapportionment Act required that congressional districts be contiguous and compact. In 1962, the Supreme Court ruled that districts must follow the principle of one man, one vote and have fair borders and an appropriate population mixture. Most recently, the Supreme Court ruled in 1985 that manipulating district borders to give an advantage to one political party was unconstitutional. Three Methods There are three techniques used to gerrymander districts. All involve creating districts that have a goal of encompassing a certain percentage of voters from one political party. The first method is called the excess vote. It is an attempt to concentrate the voting power of the opposition into just a few districts, to dilute the power of the opposition party outside of those districts that contain an overwhelming majority of the oppositions voters.The second method is known as the wasted vote. This method of gerrymandering involves diluting the voting power of the opposition across many districts, preventing the opposition from having a majority vote in as many districts as possible.Finally, the stacked method involves drawing bizarre boundaries to concentrate the power of the majority party by linking distant areas into specific, party-in-power districts. When Its Done The process of reapportionment (to divide the 435 seats in the House of Representatives into the fifty states) takes place soon after every decennial census (the next will be 2020). Since the primary purpose of the census is to count the number of residents of the United States for purposes of representation, the Census Bureaus highest priority is to provide data for redistricting. Basic data must be provided to the states within one year of the Census - April 1, 2021. Computers and GIS were utilized in the 1990, 2000, and 2010 Census by the states to make redistricting as fair as possible. Despite the use of computers, politics does get in the way and many redistricting plans are challenged in the courts, with accusations of racial gerrymandering tossed about. We certainly wont expect accusations of gerrymandering to vanish anytime soon. The U.S. Census Bureaus Redistricting site provides additional information about their program.

Governance Essay Example | Topics and Well Written Essays - 750 words - 1

Governance - Essay Example Most people in European society mainly prefer the bureaucracy mode of role which they actually relate it as the process of good governance. According to the Rome treaty all the states were required to practice and implement various strategic means that will ensure there is good governance, if a state failed to recognize the changes there were going to be tough measures that would be taken against its heads. Therefore the states were required to observe and put into consideration the following changes. All the citizens were required to participate in the nation building regardless of their gender background. This meant that there was the freedom of expression; therefore all ordinary citizens were required to engage themselves in the nation building programs. As a result of the communal wok the nations started developing both socially as there was the inter mixture of both the genders and economically as all citizens participated in the nation building programs. Therefore these participation changes brought in good governance in the entire whole region. The other change that was put in place was the need of transparency; this is where the decision making was to be done in a process where the rules are being put in place and followed. The common citizens were to contribute some ideas of how the country was to be governed by may be deciding on how the rules and regulations were to be observed. Also transparency changes were to ensure that there is the effective flow and direct feed back without some barriers. These transformation changes also contributed greatly to the aspect of good governance in the whole continent. Moreover, the European society was required to put in laws that were to be followed and respected by everybody in the region without considering their positions. These law changes made the countries free of illegal deeds including the 'crime' of corruption, as the seniors and the juniors' feared prosecution from the law. By the end of that year the public resources were run out commendably and therefore the countries could start enjoying their good fruits which were brought in by the good governance processes. Finally there was the need for the top officials to put into consideration efficiency and effective measures, whereby all the outcomes meet the common citizen demand. This could well be catalysed by the government ensuring that those people who may have been assigned or given a tender are highly qualified and recognized by the society. Now the region was in a directive way and shape for good governance with all these 'disciplines' brought in by transformation changes. In some situations not all transformation changes bring in good governance but some of them bear bad governance especially when a given region is mainly used to changes. Continuous process of transformation will end up bringing in some unwanted changes to the institution therefore scaring away the investors. Continuing Tradition To some extent continued tradition has also some positive impacts and negative impacts on the governance system. The positive impacts are brought in by strongly believing in your customs since an individual will like to observe and follow his or her own discoveries without having to just keep on relying on the 'donors'. In European Union culture is highly recognised