Blood Money Essay

The ethical issue concerning the title of this paper Blood Money is that there is illegal kidney sales going on in the world and it has reached the USA. The most unethical procedure of all of this is that the kidneys are coming from incarcerated men in China. Without permission or disclosing to those on the death role in China, they are prepped beforehand and then they are shot and killed and immediately after their death they extract the kidney and the transplant occurs with the buyer or for whom it was intended for. Who can think this type of behavior is acceptable let alone ethical and morally right, unfortunately many do. Morally everyone is different, but when it comes down to all that are involved in this illegal business, from what it seems they have no morals. Their responsibility and the least they can do is let these human beings know the truth; let them know where their organs are going, let them decide. The person or groups with direct interest in this illegal activity have many moral failings, the simple fact that it is all about the money, they do not care if the prisoners deserved to die or not, all they want to do is make money. What many may think is not alarming to them; they do not care about the trauma they put the Chinese military through, because I am sure there was at least one that had morals. They had no respect for these human beings and no respect for their lives. The ideals in this operation are to make money and stay out of the spotlight, their obligations are to maintain a steady supply of kidneys, where do they conflict, and it is very simple. They need to keep convicting prisoners to the death sentence in order for them to execute them and get more kidneys, so they are convicting left and right, I am sure they are purposely doing this to keep up with the demand of illegal kidney sales. The only good outcome to all of this is that a lives are†¦

How Do You Think the Asian Passenger Air Transport

The Asian passenger air transport marketplace will stable and growing rapidly. The latest Airbus Global Market Forecast (GMF), released in December 2010, shows that key drivers for the marketplace are the replacement of aircraft for newer more eco-efficient models in mature markets, dynamic growth in new emerging markets, the further growth of low-cost carriers – particularly in Asia-Pacific and Europe, further market liberalisation and capacity growth on existing routes. In 2010, views on whether low-fare airlines would continue to flourish in Asia varied. Three factors regulation, population demographics, and socioeconomic trends -drove this calculus. Although the target consumer base for AirAsia was enormous -more than 500 million people lived within three hours of AirAsia's hubs in Kuala Lumpur and Bangkok, more than Western Europe's entire population -the failure of Asia's regulatory environment to keep pace and the uncertain demand for low-fare services created uncertainty. Those who sold airplanes, airports or advice tended to be of the opinion that low-fare carriers would redraw Asia's socioeconomic map, offering affordable international travel to millions and thereby fostering the integration of a region divided by water, politics, and poor infrastructure. Analysts who saw a large and growing market predicted that budget airlines would tap pent-up demand among less affluent Asians, who typically travelled by bus and hardly expected attentive service. Since the global economy peaked in the second half of 2006 and even during the recession of 2008-2009, Asian carriers had seen increased success. â€Å"We're seeing that people in Asia travel as soon as they have some extra money in their pocket,† said Don Birth, president and chief executive officer of Abacus, a distribution services provider†) Although average incomes were lower in Asia than in Europe, Timothy Ross, an analyst for UBS, said that the region's lower average incomes should boost rather than constrain demand for cheap fares. Other analysts argued that there had traditionally been too few bilateral agreements that allowed new low-fare carriers to fly between countries and too few of the satellite airports that the airlines needed to keep costs low. In that vein, budget airlines such as AirAsia were hoping for increased cross-border travel in the wake of the December 2008 Asean open skies agreement. The agreement allowed carriers based in the region to make unlimited flights between all 10 Asean member states. Although it would be 2015 before the agreement was fully implemented, it was a positive step forward. For instance, in January 2010, the Indonesian Transportation Ministry announced it was gearing up for the country's full participation in the Asean air transport liberalization plan and intended to inc1ude five of Indonesia's twenty-seven international airports in the implementation. † Although this was only a small proportion, it was a symbolic start. â€Å"Liberalization tends to be infectious, and the germs of change are in the air,† concluded Peter Harbison, the executive chairman of the Centre for Asia Pacific Aviation. ‘ As more and more countries opened their skies, AirAsia was quick to start cross-border joint ventures, most notably in Thailand and Indonesia. AirAsia prompted increased passenger travel with its 2007-2008 â€Å"To Malaysia with Love† campaign. The campaign celebrated 50 years of nationhood for Malaysia, and offered travelers affordable fares â€Å"starting from MYR0. 50 (about 15 cents), available for all destinations to/from its Malaysian hubs. ,,36 Cheaper airfares were also made possible by the low-cost carrier terminal at Kuala Lampur Airport, with a throughput of about 10 million passengers annually. Even though, external, industry-wide challenges -particularly the escalating cost of fuel -also posed a threat to AirAsia. As the lowest cost carrier in the world, the company suffered more from high fuel prices, as they were a higher percentage of total costs, than any other airline (assuming similar equipment and seat density). Surcharges and baggage fees covered some of this but the airline was conscious that if it loaded on the full charge, it might find no demand on some flights due to a high base price (e. g. inimum or zero fare plus taxes, fees and surcharges). To offset this eventuality, AirAsia did a lot to improve operations and efficiency and also saw the benefits of the fuel efficient Airbus 320 help to maintain its low-fares brand position. To retain its cost advantage in the wake of the global recession, AirAsia entered into an alliance in January 2010 with Jetstar, the low-fare subsidiary of Australia's flag carrier, Qantas. This was the first time two leading budget airlines had collaborated in this fashion. The alliance allowed the companies to explore joint aircraft purchasing, passenger and ground handling services cooperation and the transportation of each other's passengers in the event of a disruption. Assuming the focus of the alliance was on cost sharing for services and aircraft procurement, it might prove effective. AirAsia had played the game very well and had ambitious growth plans to keep ahead of the pack. Time would tell if Fernandes and his team could maintain the company's position as Asia's -or perhaps the globe's -most successful budget airline. But what were the business implications for AirAsia if oil prices remained above $100 a barrel for the foreseeable future? Little possibility. Between slim and none The pattern in other regions suggested that once rules start to relax, growth follows. In the United States, the upsurge of budget carriers saw passenger numbers rise nearly 50 per cent in the five years following deregulation, compared with four per cent for traditional airlines. In 2010, low-fare carriers now had more than a third of the market. In Australia, Virgin Blue took only three years to win a 30 per cent market share. The growth of low-fare carriers had great potential to spill over into the broader tourist and business travel economy: having more air passengers generates higher demand for hotel rooms. This connection had been seen in Australia, where Virgin Blue took nearly one-third of the domestic market from Qantas Airways (which responded in part by setting up Jetstar). This resulted in a sharp upturn in demand for economy hotels, such as Accor. â€Å"In many cases, it's entirely new business that wouldn't have happened if it weren't for cheap air tickets,† commented Peter Hook, general manager for communications at Accor Asia Pacific . In addition, low-fare carriers might offer options for Asian travelers to mix business with pleasure, as many North American and European business travelers did, by extending trips or bringing family members to accompany them. Ultimately, Fernandes pointed out, budget airlines in Asia had an advantage in that Asia had almost no interregional highways and no high-speed international rail. â€Å"There's a lot of sea in between,† he said. â€Å"Air travel is the only way to develop interconnectivity in Asia. â€Å"

Case Study: Our Perfect Wedding Essay

Claire has done a reasonably good job about target markets for her new web based business, and understands the relevant needs quite well. But for the marketing mix, she as fallen short because it’s not clear whether this business involves one strategy or several strategies. For example, a marketing mix that appeals to engaged couples would not be the same as a marketing mix that appeals to the companies that pay for web pages. Claire’s target markets are engaged couples /newlyweds (for gift registry); companies that target newlyweds with both goods and services (with the advertising of web pages); and friends and family of the couple to be married (whom the advertisers want to reach). Claire has done a reasonably good job about target markets for her new web based business, and understands the relevant needs quite well. But for the marketing mix, she has fallen short because it’s not clear whether this business involves one strategy or several strategies. For example, a marketing mix that appeals to engaged couples would not be the same as a marketing mix that appeals to the companies that pay for web pages. Claire’s target markets are engaged couples /newlyweds (for gift registry); companies that target newlyweds with both goods and services (with the advertising of web pages); and friends and family of the couple to be married (whom the advertisers want to reach). What may or may not be obvious at first is that there is little about this business that requires that it be focused only on customers or advertisers in the same city or metro area. To the contrary, gift-givers who are inclined to get on the internet to check a wedding registry might be equally willing to order gifts from distant companies (advertisers), especially if the company provides special services such as gift wrap, personalized gift cards, and delivery direct to the recipient. Even for local customers, there may be a number of mail order, catalog, and specialty retailers in distant locations who are interested in reaching this target market. Simply focusing on retailers or service providers in the local area to generate website listings and advertising revenue may not make sense. Similarly, there is little reason that the registry service should be limited to local couples-a user of the Internet usually doesn’t know or care whether the base operation for a website is nearby or far away. To the extent that there are advantages of localizing aspects of the service, Claire could potentially set up a segmented approach in which different parts of the website were designed to appeal to people from different areas. As a start, for example, she might think about retailers or advertisers who have facilities or base operations in her own area but who also are targeting customers in other places. Let’s think about the marketing mix that Claire offers for each of these target markets. For each group: What is the specific product (and what are its benefits)? What is the price of obtaining those benefits? How are the benefits promoted? And (to a lesser extent) what is Claire’s role in the place arrangements between the advertisers and their customers? How does her current geographic focus come into play? The benefits for engaged couples seem pretty clear. The $20 price to register is not a big investment if it saves time and leads to the desired gifts rather than things that are not of interest. So, it is unlikely that price sensitivity should be big concerns unless other services appear that will provide the service (and/or other superior benefits) for free. This is certainly a possibility because revenue from advertisers could pay for the services provided if enough advertisers and customers can be attracted. If the couple doesn’t know about the service and doesn’t know to look for it, they won’t sign up. There is also some evidence for this diagnosis because the main flurry of activity came after Claire finally got some attention with publicity. That attention and interest simply wasn’t forthcoming from her limited advertising. Claire should work harder to get more publicity. There also seems to be a very important role for word-of-mouth referrals here. For example, there is no explicit discussion in the case about how friends and family of the couples are supposed to learn about the website, but it would certainly make sense to develop ideas that could be shared with the registered couples about how to inform gift givers about the website, what it is supposed to do, and how it is supposed to work. Furthermore, the relationship with couples who do sign up needs to be a close one, even if for only a short time period. Most couples are not going to be repeat customers but on the other hand, couples who are about to get married often know others who are at the same life stage; especially the among the younger first time married. Claire needs to think about how to stimulate word-of-mouth referrals so that people who do sign up help to bring in additional customers. Since she doesn’t have a lot of money, one way to do this is to think in terms of marginal revenue from new customers and what it might cost her to acquire a customer. It might be better and cheaper to offer couples who recommend the service to a friend a $5 or $10 â€Å"rebate† on the $20 fee, or perhaps she could enter them in a bi-monthly drawing for some more substantial prize like a honeymoon trip. So far, Claire has not done a particularly good job of giving advertisers a reason to buy into her service. She is basically selling a professional service to them, but most of them can’t evaluate it in advance and they are unclear about its benefits. The comparison with the cost of a Yellow Pages ad is interesting because it provides a sort of reference price for the advertiser. Yet, the advertiser probably sees some sort of Yellow Pages listing as a must buy. Perhaps this sort of website advertising will become a must buy, but probably not until more of these companies target customers who think of the web as â€Å"the place† to look for this sort of information. Claire is also being a bit production-oriented in the way she is thinking about her product. She designs web pages in her other job, and so she is thinking about potential advertisers who need a web page. But companies that already have a good web page might be more interested in something else, like a banner ad or button ad at her website that would allow a net surfer to click over to get their existing message. Companies that have already invested in a website know that they face the same problem that Claire does–they want to attract people to the site. So, for them the value of banner ads (perhaps at a lower cost, or even with the fee based on the number of click-through from Claire’s website) might be easier to see. Claire also might think about the pricing arrangement for advertisers. She currently bundles the price of the on-time service of preparing the web page and the ongoing online web page. She might want to charge separately for the preparation of the web page and/or allow customers to have something more elaborate than a single page. Claire’s service in many ways operates with the same approach as a magazine attracting an audience and advertisers who want to reach that audience. Yet, most companies that sell advertising media time and space rely on personal selling and/or offer incentives to advertising agencies or others that refer business. Claire hasn’t done much personal selling to advertisers, even after her direct response mailing didn’t work. The case offers several hints why she didn’t like the job she had doing personal selling, and she is busy doing other things. It is likely that if she is going to need to get help if the personal selling parts of her promotion blend is going to be handled well. Since she doesn’t have a big budget, she might think about trying to find someone who would sell advertising space on her website on a straight commission basis. That way, she would not have much expense until she had revenues. Of course, the salesperson would still need to have a good story to tell, and that might depend on having a way to better establish the link between the advertiser’s sales and visits to the websites. For example, if Claire could convince advertisers to offer a small discount to customers who purchased because of the website she might be more successful in getting customers to tell the advertisers that â€Å"I am an OurPerfectWedding. com† customer. The case also portrays her as a doer not as a planner, which is in part true. She had an idea but doesn’t have a detailed plan for what needs to be done. Rather, she hasn’t yet really made the investment of time and money to give her idea a chance to work. She’s a doer when it comes to some things but has not really been a dedicated doer when it comes to getting this business started. She probably wouldn’t have the time to do that unless she gave up her full-time job or really cut back on her social life. While it is not hard to think about different things that Claire could do, what is perhaps more relevant is what is she willing to do.

Practice Enhancement role of the Mentor on the facilitation of Essay

Practice Enhancement role of the Mentor on the facilitation of learning in your current place of work - Essay Example An example of this case is the "Nursing" profession. Whereas in the latter case, the mentee decides to seek the mentor's guidance because the mentee wishes to take up that particular profession solely out of interest or need. The process of mentoring is in fact so vast that it is offered as a course and therefore, has got many sub-themes attached to it. But two of the topics that will be critically analyzed in the present essay are: The essay is set in the backdrop of an outpatient wing of a local hospital. Within this specified work area, the essay focuses on the role played by the mentor in applying the relevant theories connected to the two themes mentioned above, and aims to critically analyze the outcomes of the application of all such theories in the work area. As is inherent, the mentees in this essay will be trainee nurses, on whom all the proposed practices will be implemented. Everyone cannot become a successful mentor even if they aspire to become one. It turns out that many of them possess the inherent qualities that are necessary for blossoming into effective mentors, but fail to become one because of the lack of having the ability to implement the knowledge that they possess or communicate their ideas and guide the people under them in an effective manner. It has also been found that many of them consider the outlined procedures of mentoring to be a farce, which is absolutely not the case. The experiences of successful mentors have shown that most of them stuck to the basics as outline by the theories of mentoring, and went on to yield outstanding results.Mentoring is highly dependent on a one-on-one relationship between the mentor and every mentee. But this is not possible most of the time as there are irregularities in almost every case. As such, it is the duty of the mentor to instill confidence into the trainee and this can be achieved by motivati ng him/her as also encouraging and not deploring him in case the trainee has done some mistake. The implementation of this principle demands a great deal of perspiration and patience on the part of the mentor. Therefore, it is necessary to outline the various modes, which are adopted by a mentor in order to affect the basic objective of training the mentees under him (Richard Luecke, 2004): Mentors share their own experiences with the mentees. This includes successes as well as failures. This gives the trainee an insight on what must be adopted and what must be avoided. Mentors are supposed to instill a sense of professionalism into the mentee, which can be initiated by modeling the requisite professional behavior. Mentors guide the trainees under them by training them on various aspects that cannot be taught in college. Mentors provide complex cases for trainees to solve and

What role do the concepts of virtu and fortuna play in Machiavellis Essay

What role do the concepts of virtu and fortuna play in Machiavellis political thought - Essay Example The essentialness of leadership is actualized when a balanced state or jurisdiction is achieved.Leadership,perhaps,is the oldest form of responsibility bestowed upon the people.Biblically,there were Adam and Eve as â€Å"stewards† of Creation,while history speaks of ancient tribes with their respective leaders as earliest evidence of organized states. In the 1500’s, an Italian of noble ancestors rose to be in line with the rulers of his time. He is Niccolo Machiavelli, whose The Prince envisioned a leader in its perfect form in terms of success of ruling. Machiavellian thought undermines the modern political philosophy which basically governs the constitution of most powerful nations. Specifically the twin concept of Virtu and Fortuna, Machiavelli’s principle was born out of the nation’s tormented political situation. The concepts presented in his book The Prince owe much to virtu and fortuna as main foundations of Machiavelli’s political thought. I taly in the time of Niccolo Machiavelli Persistence against the Italian monarchy would describe the end of life for most Italians. Europe, during the dusk of the Middle Ages and the dawn of the Renaissance is a place of real-life nightmare. If there is one good thing about the oppression of Italians, it is the blossoming of ideologies inspired by the severity of social and political assault. . However, this was shortly after the Medici family has regained control of Florence. On May 3, 1469, Niccolo Machiavelli was born in Florence, Italy. Unlike the unfortunate Italians in his time, he was born in a family of nobility and political position, which made him unlikely to experience the uneven treatment of the poor in most Italian communities--although the Italian awakening is a better time for Italy. However when the Medici had gone out to regain power, Machiavelli’s political position consequently diminished when he was accused of tyranny and betrayal of the oligarchical gover nment. â€Å"Machiavelli was a direct victim of regime change† (â€Å"Niccolo Machiavelli,† n.d.) and that the only chance of him to survive was the steadfast opinions regarding Florentine princedom. He made several attempts of reviving his place in the government which resulted to his most notable work, II Princepe (The Prince). The book is a collection of â€Å"critiques of traditional moral norms and ideologies† (The European, 2010). It has been said that the book is a form of persuasion to prove the Medicis that he values loyalty and service to the present government. Much appreciated by Lorenzo de Medici, he gained partial reconciliation with the government. The Prince (An Overview) The highlights of Machiavelli’s thought are its complexity and looking beyond the values of norms and its role in the ruling of a kingdom. Viroli (1998) wrote that the Machiavelli contains a significant aspect of â€Å"spiritual narrowness,† that life is constantly governed by reasons, and objectivity towards any subject is the key to the strength of public governance. Politics’ austerity towards the issue of infallible loyalty during the Medici regime may one that drove Machiavelli to think the way he did in times when he realized that his status would become a sinking ship. Although written in a traditional style of â€Å"mirror of prices† genre, the book teaches a different pattern of didacticism which other critiques of his time regard as inappropriate or in the worst case, immoral. According to Kniatt and Johnson (2007), The Prince contains three aspects in which the principles are tightly knitted together. They believe that the book holds the faces of sarcasm, double entendres and Science. Sarcasm is an important element used by Machiavelli in delivering his sentiments and criticisms in the government he was in. The terms â€Å"part reconciliation with the government† may imply that Machiavelli discovered certain ir regularities in the Medici regime. Knowing not of ways on how to directly criticize, he used

Sound media Essay Example | Topics and Well Written Essays - 500 words

Sound media - Essay Example t that the radio is a critical tool in promoting different records, many people have not taken the time to understand the relationship between the labels and the radio stations. In the recent past, there are multiple radio stations, some of them streaming online. This means that, there is a higher chance of radios promoting records. This paper will consider how records are promoted highlighting the role of the radio as well as an overview of the cultural influences of both recording and radio industries. Records are promoted using different media, and the radio has been one of the influential media forms in promoting records. Record labels usually hire a promoter who ensures that the record receives air play on different radio stations. These records usually seek to exploit the available opportunity presented by the diverse audience listening to the radio. Although record labels ensure that their music is in different distribution shops before it is given popularity through the radio, it is evident that the radio plays a critical role. Statistics indicate that the radio contributes about 19-23% popularity to a certain record. When listeners get to hear of a certain record through the radio, and become interested, they go to the distribution shops and makes purchases of the specific records (Spence, 2011). In this way, the performers earn indirect revenue from radio promotion. On the other hand, radio stations ensure that there is a continuous streaming of music preferred by the audience so that they can create a favorable environment for advertisers. In this way, radio stations benefit indirectly from promoting different records. Notably, this symbiotic relationship ensures that both the record labels and the radio benefit indirectly at the end. This explains why many radio stations are willing to give free airplay to different records. Worth noting is the fact that, royalties are only paid to the composers and the publishers (p. 67). Without doubt, both the

Aberdour Coursework Example | Topics and Well Written Essays - 250 words

Aberdour - Coursework Example In the first two figures (provided that those two were from the same shore) the zonation pattern of the species varies a lot in the same species. So it is an interesting point to note as well as to research. Comparison between the Zonation Pattern of transects from Site A and B:- Transects from site A and Site B were from the same shore, although they have a lot of difference in their zonation pattern. Looking at both the figures given, Ascophyllum nodosum has totally different represented structure in the second figure as compared to first. Max scale level in the first figure is in C group, but in the second figure, it is only included in F group. Limpets also have different represented structure in the second figure as compared to first. Max scale level in the first figure is in C group, but in the second figure, it is only included in O group. Difference between Exposed Shore and Sheltered Shore Sheltered rocky shore is one where on earth the tide/waves cannot crash onto it; such as one where within a bay offering is some protection. Exposed rocky shore is a short time ago the opposite, nil to stop waves crashing onto it. Exposed can be worse for deep-sea life as the pounding of the top can damage some organisms e.g. could construct them lose their grip on the rocks. Further, organisms that can withstand the exposed shore are prone to less predatory effects and as a consequence can survive longer.

Six Sigma Essay Example | Topics and Well Written Essays - 3000 words

Six Sigma - Essay Example For example GE announced in 1998 that it had managed to save some $350 million as a result of Six Sigma initiatives. Subsequently this figure eventually reached more than $1 billion. (Dusharme, 2001) However, not all companies utilising Six Sigma have ended up saving money or making substantial gains. Fortune 500 reported that ninety one percent of fifty eight large companies that established Six Sigma regimes have been trailing the S&P 500 index ever since. (Betsy, 2006) One major reason for this phenomenon is that Six Sigma is less understood and more employed in businesses often in ways that make little or no sense. In essence, Six Sigma is a statistical technique and the lack of data, its analysis, proper presentation and follow up can all lead up to its demise. Amongst other things attempted through Six Sigma, RCA (Root Cause Analysis) is a major application. The contention behind RCA is to locate and subsequently rectify problems in a business operation. However, the applicatio n of Six Sigma to RCA in inappropriate methods often causes less than desirable outcomes. Often Six Sigma is used to â€Å"create† evidence in order to justify some kind of process or business hypothesis. This text attempts to delineate clearly defined methods to tackle Six Sigma along with RCA within a lean approach. The external customer’s perspective as well as the VOP (Voice of Process) perspective will be utilised to explain the application of lean Six Sigma to RCA. Differentiating the VoC and the VoP Approaches Any business process will always possess an external customer who receives the finished good. If the business process spectrum consists of multiple processing steps then the external customer might be a secondary processing department. On the other hand if the business is small enough or based on a single process, then the external customer will be someone who gets the final product. However, the size of an organisation is critical to the implementation of Six Sigma. Hence this text will take implementation within a large business context as small businesses can seldom afford Six Sigma initiatives. Therefore the external customer in question will be an allied business processing unit or function. Using the customer’s input as the guideline within Six Sigma is better labelled as VoC (Voice of Customer). The customer specifies their requirements using surveys, discussions, focus groups, comment cards etc. (Curious Cat, 2009) In comparison, the VoP (Voice of Process) depends on the process capability. The contention is to measure the best performance that a system could deliver. This is often described statistically using a control chart. Historical performance statistics may also be used to analyse the situation better. The most differentiated aspect of the VoP approach is its reliance on hard statistical data to take decisions. However, there is a great chance of leaving large gaps in collecting data through misreporting as wel l as omission. (Mann, 2006) VoP is also reliable in discerning the stability or instability of any given business process or operation. Statistical quality records are utilised to create control chart models and this will be discussed below. Lean Methodology for VoP The methodology for a lean Six Sigma RCA will be analysed by following it step wise. Strengths, weaknesses and vulnerabilities will be discussed in an attempt to introduce the sources of error in such systems. Data Collection and Processing Data collection is the single most important part of any RCA treatment. If data is flawed by any given definition then there is no chance that the entire analysis and its subsequent follow up will yield any favourable results at

Napoleon Crossing the Alps Essay Example | Topics and Well Written Essays - 500 words

Napoleon Crossing the Alps - Essay Example According to the paper the source of light in the painting is the sun, the universal light and illuminates the foreground even more. The background is not truly dark but the fact that Jacques-Louis David has illustrated the horse and the rider in such a way that dominates the whole painting, which is the whole point. Bright colors and dark shades help achieve this. The effect created by the color and brushstrokes indicate roundness and depth that is evident in the curves of the horse and the folding of the cloak fluttering in the wind.This discussion highlights that the use of colors highlights the leading figure glorifying Bonaparte, depicting his greatness. The oil painting truly captures his greatness. It is as if he is put under the spotlight. Especially when the background is a little blurry which creates the effect of distance, and gives brings horse rider even closer to the viewer. The lines in the painting converge towards the legs of the horse. As a result, the viewer needs to look up towards Bonaparte's face. This illusion creates dominance and power. His war victories and smart tactics have won him several accolades, and this painting is a depiction of his achievements, elegance, and his grace.  Jacques-Louis David had a strange relationship with Bonaparte but by painting such elegant portraits he helped the general in his cause.  The word ‘Hannibal’ in the painting refers to one of the greatest military minds that ever lived.

Company development Case Study Example | Topics and Well Written Essays - 1250 words

Company development - Case Study Example Even though it is legal to use television commercials for political campaigns, television advertisements in this country are heavily regulated by the Federal Communications Commission and the Federal Trade Commission (FCC, 2012; FTC, 2012). To avoid legal or technical problems, television commercial production companies should be familiar with the technical standards implemented with regards to products, claims, and contents (Cheap TV Spots, 2012). For instance, the advertising of cigarettes on television is totally restricted or banned in the United States. Therefore, television commercial production companies in the United States should observe and up-date themselves with the on-going changes with regards to television commercial restrictions. Likewise, television commercial production companies are obliged to observe the laws on IPR. The U.S. economy is still under recovery. Therefore, television commercial production companies may encounter delay in the payments for their service. Eventually, this will negatively affect the companies’ cash flow. To maintain their competency in the market, television commercial production companies should cut down their fixed monthly operating cost without sacrificing the quality of their television commercial videos. There are social implications with regards to the production of television commercials. To avoid offending the viewers, television commercial production companies should avoid producing offensive commercial programs that can adversely affect its reputation. With regards to technology, television programs in the United States is accessible through on-air broadcast, unencrypted satellite, cable services, direct broadcast satellite, or internet protocol television (FCC, 2010). On the other hand, television advertisers are using various technologies such as video software, hard ware, digital cameras, digital video cameras, etc. Since the capital requirement in putting up this kind of business is low,

Viruses & Cells Comparison Essay Example | Topics and Well Written Essays - 500 words

Viruses & Cells Comparison - Essay Example They are classified differently because of the inherent structural and functional differences. Unlike living cells which can reproduce on their own, viruses have to rely on other cells for them to reproduce. Viruses lack other cells parts like the plasma membrane, ribosomes, and the cytoplasm. They, therefore, infest a living host and use its cells to reproduce. Secondly, living cells are self-sustaining while the viruses are not. Living cells are able to survive on their own because they have all the required structures and proteins which allow them to carry out life-sustaining processes and functions. Viruses, on the other hand, have to rely on a host cell or organism. The third difference is that living cells can synthesize proteins while viruses cannot. Cells have ribosomes and can easily synthesize proteins on their own. Viruses lack these ribosomes and have to rely on the host cells to be able to translate its messenger RNA into the viral proteins. According to Grifo and Tahara , viruses do not have the ability to generate and store energy in form of adenosine triphosphate (ATP) as in the case with living cells. They derive their energy and all other metabolic functions from the host living cells. They do this by using basic building materials like Amino acids, lipids, and nucleotides from the host organism. Finally, viruses cannot respond to stimuli as it is the case of the living cells. Viruses are inert chemicals which cannot perform critical life functions or even responding to stimuli.

Joint Commission Accreditation, Certification, and Licensing Essay Example for Free

Joint Commission Accreditation, Certification, and Licensing Essay Given health record completion policies, correctly apply accreditation or licensing standards to determine the organization’s compliance. Write a 1-page paper on how you think Joint? organization’s compliance. Commission’s standards impact health record completion and organizational compliance. Be sure to discuss advantages/disadvantages of being accredited by Joint Commission. The Joint Commission on Accreditation of healthcare organizations (JCAHO) is a non-profit and independent accreditation organization that provides accreditation and certification for various healthcare organizations, health plans, health packages and hospitals in the US. It has been functioning in the US, and is recognized throughout the world. More than 15, 000 healthcare organizations in the US have been accredited and certified by the Joint Commission. An organization that subscribes to accreditation by the JCAHO would constantly have to make an effort to reach certain performance standards. JCAHO gives greater importance to maintaining patient safety standards and improving the quality of care (The Joint Commission, 2008). The Joint Commission has accredited several aspects of medical care including ambulatory care, assisted living, behavioral healthcare, critical care, laboratory services, home care, surgeries, old age clinics, staff and employees, disease-management, long-term care, etc (The Joint Commission, 2008). It is very important that the healthcare organization complies with the specifications mentioned by the JCAHO. Firstly, the healthcare organization has to understand the importance of having these specifications in place. It would benefit the organization and also the patients, insurance companies, government and the general public. The litigations against malpractice are significantly fewer when a hospital has accreditation. Flowsheets that record detailed information and observations of the patients vitals and care administered would help in precise documentation. An electronic system would act as an aid in ensuring that the specifications of the joint Commission are enforced and followed. Studies have demonstrated that the compliance levels of the JCAHO specifications are around 50 % in all healthcare organizations that subscribe to accreditation by this organization. The outcome of any case would certainly be better if the specifications laid down by the JCAHO are followed. Frequently, the Joint Commission would be conducting surveys and suggested measures to be implemented in order to improve the status of the employees and the patients. One way of ensuring that the organization complies with the JCAHO specifications is to have several monitoring devices in place. These include surprise checks, regular visits, inspection of the records, etc. The information transmitted and stored in the hospital database should be accessible to the JCAHO for the purpose of monitoring. Patient surveys are another method of ensuring compliance by the JCAHO. Another way would be to record the cases of malpractice against the healthcare organization (Massachusetts General Hospital, 2007). There are several requirements a hospital or a healthcare organization has to follow in order to get accredited to the JCAHO. These include: ? Following the recommendations launched by the AMH and the BHC ? Following the requirements of the HIPAA ? Having a system that fulfills the recommendations lay down by the JCAHO regarding flow of information (using software tools such as TIER). ? Some of the important criteria regarding the information management system includes: 1. Maintain confidentiality of the patient information 2. The internal and the external needs have to be addressed through comprehensive planning 3. Security of the information – accessibility only to the relevant staff members 4. Data, which can be collected, analyzed and decisions-made. 5. Addressing the education and training needs – Information should be presented to the staff members and the patients in an automated manner 6. Information and clinical records presented to the patients should be comprehensive and specific. The Joint Commission accreditation has several advantages and disadvantages. Advantages: †¢ The patients would be having greater confidence in the healthcare organization and health plan. †¢ In the market, there would be greater competition between the healthcare organizations. †¢ The risk management would be more efficient. †¢ The business practices and ethics would improve. †¢ The human resource management process would be better. †¢ Insurance companies and third parties would have better relationships with the healthcare organization. †¢ Compliance with the terms and conditions mentioned by the regulatory bodies would be better. Disadvantages: †¢ Information provided to the JCAHO could be potentially misused. †¢ The hospital would be spending huge sums of money for the purpose of accreditation and would actually not be involved in improving patient care. †¢ Unhealthy competition may be propagated. References: Brink, L. J. (2004). â€Å"JCAHO Information Management Standards and TIER† Retrieved on February 18, 2008, from Hospitals for a Healthy Environment Web site: http://www. sequest. net/articles/TIER%20and%20JCAHO%20IM%20Standards. pdf Hospitals for a Healthy Environment (2007). â€Å"Guide to JCAHO Environment of Care Standard 1. 10.1† Retrieved on January 29, 2008, from Hospitals for a Healthy Environment Web site: http://www. h2e-online. org/regsandstandards/jcahoEC1. 10. 1. html Masshecutes General Hospital (2007). â€Å"Massachusetts General Hospital Summary of the Joint Commission Findings. † Retrieved on January 29, 2008, from MGH Web site: http://www. massgeneral. org/findings_summary. html The Joint Commission (2008). â€Å"Joint Commission Requirements. † Retrieved on January 29, 2008, from The Joint Commission Web site: http://www. jointcommission. org/Standards/Requirements/

Emergency Departments And Effects Of Non Urgent Cases

Emergency Departments And Effects Of Non Urgent Cases Emergency Departments (EDs) are under increasing pressure and increases in numbers of patients deemed inappropriate or some which could be seen by alternative providers are all a burden on the ED and the health service in general. Over recent years there has seen an increase of attendances at EDs of more than 20% with the majority being primary care cases. Recent changes to the GP contracts in 2003 have also had an impact on increases in attendance to EDs. There is a potential saving of in excess of  £120 million if patients attended the appropriate health service provider either GPs, walk in centres or by self treating and asking a pharmacist. Patient education and good promotion of the Choose Well campaign could reduce these numbers and therefore do away with the need to have to potentially turn away non-urgent cases. Introduction EDs are under increasing pressure to deliver high quality care due to rising attendances. Over the period from 2007-2010 there has been an overall increase in attendance at EDs of England of 20.9%. There was an increase of 10.7% in attendance between the period 07/08 to 08/09 (12,318,051 attendances in 07/08 and 13,794,072 in 08/09) 11.4% increase between 08/09 and 09/10 (15,569736 attendances in the period 09/10). There have been numerous attempts to try and stem the rise in ED attendances including offering patients guidance, making them aware of the consequences and informing them of the alternative health services available. A GP ED Triage Pilot conducted by Sheffield Teaching Hospitals NHS Foundation Trust and Sheffield General Practitioner Collaborative in March 20101 which was conducted to ensure patients were seen in the most appropriate location and by the most appropriate health care professional found that cases deemed to be actual primary care cases amounted to 19%. From this study it could be said that approximately 20% of attendees could potentially have been seen by a general practitioner in primary care rather than attending the ED but this is very small sample and many more studies would need to be carried out looking at different departments to be able to draw a more definitive conclusion. Applying 20% would therefore estimate that for the year 2009/10 in England approximately 3 million attendees were candidates for primary care. The estimated cost of seeing these patient in the ED based on the cost of  £56 for treating a minor ailment and  £75 for a standard (average cost  £65.50) totals  £196.5 million. Doctors consultations in primary care settings are the most cost effective part of the medical component of the NHS at  £15- £30 (averaging  £22.50), GP consultations cost less than out-patients appointments, ED and ambulance calls (ambulance calls costing  £255 per patient). Therefore the cost of treating the 3 million potential primary care/GP patients in the GP setting would total  £67.5million which would save the NHS a potential  £129 million.2 These values are only for normal working hours. Most non-urgent cases actually occur out of hours which would actually increase this amount even further with even more potential savings. The above costings are currently being changed to new Health Care Resource (HRG) code costings which are slightly less which could reflect lower savings than those calculated.3,4 The choose well campaign North West estimated the national cost to the NHS of treating minor illnesses is  £2 billion a year.5 The new system will have 11 different HRG groups, opposed to the current three Groups. The new HRG codes mean you must code both investigations and treatments, as opposed to investigations alone6 (appendix 1). This review hopes to come to an understanding why these patients use the emergency department rather than GP surgeries, barriers to other forms of care and access to GP surgeries and therefore answering the question whether emergency departments should be able to turn away non-urgent cases. Other points which will be taken into account are the ethical dilemmas associated with potentially turning patients away and the potential repercussions of doing so. Method and literature review A search was performed using Lancaster Universitys metalib data base which searched Scopus, Springerlink, Science Direct and Ovid Medline and Pub Med data bases. After accounting for duplicates and reviewing titles and abstracts, papers were selected for review. Search criteria included the terms, non-urgent, emergency department, primary care. The date was initially limited to 1996 2010 but on further searches earlier articles were allowed in order to search for historical articles. The search was also limited to humans and English language. The Department of Health website and the Primary Care Foundation website were also used to find current legislation and data. Database Limits Results OVID Medline emergency department, non-urgent primary care year-1996-2010 humans, English 25 Pub Med 12 Springerlink 19 Science Direct 72 Why patients attend the emergency department There is no formal definition of what is deemed an appropriate attendee to the emergency department due to peoples own impressions of what they believe to be an emergency. This leads to inappropriate attenders who could have legitimately seen their own GP. The types of patient who attend inappropriately and their decisions to do so are complex and involve social, psychological and medical factors.7 Urgency is also a term which is difficult to define and to measure. Studies have been carried out which have measured urgency but there is such wide variation on what is deemed urgent the results are subjective. Due to this subjective nature when defining urgent it is important to be consistent and have appropriate and qualified medical professionals determining the urgency of a situation using set criteria. In an early study Lavenhar et al described an urgent problem as one that requires medical attention within a few hours.8 This definition is used in this review. It has also been found, what medical professionals deem as non-urgent is often not perceived the same in the patient and the urgency of the situation should be based on the presenting signs and symptoms and not the eventual final diagnosis.9 Patients have been seen to attend the ED for many reasons including, the following: They deemed their condition/illness to be appropriate for the ED They believed the GP would refer them anyway The GP surgery was too far to travel to The GP surgery was closed A friend or family member felt it appropriate For those patients who deemed their attendance to be appropriate for their illness or condition it would be very difficult to convince them otherwise and such patients generally attend the ED for reassurance that there condition is not serious and is not going to get any worse. Such patients also have high anxiety, and a sense of urgency and self diagnose yet have no formal medical knowledge.9-12 Those who believed that their GP would have referred them anyway thought they would cut out the middle man. The patients found to do this in a study carried out by Palmer et al deemed their condition to be bad enough and that their GP would refer them, and attending their GP prior to attending the ED would just be a waste of time13 this study also found that pain was a major factor patients took into consideration when deciding on where to attend. Pain itself being subjective and open to individual interpretation. Those that found the GP surgery to be too far to travel were patients who generally lived in rural areas where the distance to both GP and ED were significantly far away and patients therefore decided they may as well attend the ED rather than the GP to save time in the event that the GP would just refer them anyway. Those patients for whom the GP surgery was closed mainly attended out of hours or at weekends. These patients generally thought their condition was urgent and couldnt wait until the surgery reopened.11,12 For attendees who were advised by friends and family to attend the ED did so purely on this advice and the majority of which would not have done so without this advice. This included people advised by colleagues, first aiders and schools where responsibility for the patient was in someone elses hands and the person advising did so in order to protect themselves.12,13 Another major factor to consider when looking at why patients attend the ED is the decision making capabilities of the patients themselves. This would include social, psychosocial and medical factors. Padgett and Brodsky14 proposed a three stage model which outlined how the stages of decision making interacted between the three different stages within the model. The three factors were predisposing, enabling and need. The decision making stages being recognising the problem, deciding to seek treatment and the decision on where to get the treatment. Predisposing factors which are part of stage one included the age, sex, race, level of education, family and social support available. The enabling factors, stage 2 were the income of the patient, usual source of care, proximity of the source of care and the perceived accessibility of this care source and the factors contributing to the need, stage three, were symptom recognition, evaluation of need, level of distress and psychiatric co-morbidity. Padgett and Brodskys three stage model14 Barriers to Care The above predisposing factors are also forms of barriers to care and are dealt with by patients in many different ways. Patient education would be a major tool for breaking down such barriers.11 This is the aim of a local and national campaign called Choose Well. This is a campaign that is supported by the NHS and its staff and aims to ensure people who need advice and treatment for common complaints, get fast and expert care.5 The North West has seen an increase of 177,000 patients in the ED over the last two years and hoped the Choose Well campaign would reduce this over the winter of 2010/11. The North West NHS estimated that 1 in 4 ED attendances were due to patients who could have self treated or could have been seen by other health professionals elsewhere. Offering guidance in both GP surgeries and EDs would give patients the information for themselves to determine the urgency of their condition. This information could include what definitely should be seen at the ED and what definitely shouldnt. Where this is a good idea and has the potential to work well however it could potentially cause patients with urgent problems to believe that they are non-urgent therefore putting them at risk of harm. On the other hand it could also cause some patients to deem themselves urgent and attend the ED when they were initially happy to attend their GP practice adding to the non-urgent caseload. The Choose Well campaign briefly describes the types of conditions that should attend the ED as an emergency and gives contact numbers for patients to ring in order to get further information on where is best for them to attend. This may be difficult for some patients; particularly the elderly as navigating around a website may be difficult or impossible and at a time when you are not well or believe to be in an emergency situation this could be valuable time needed for treatment. It does however offer valuable advice for minor injuries and illnesses known not to be life or limb threatening and could possibly eliminate the need for these patients to enter the health service at all reducing overall numbers and costs. Does Choose Well make a difference? The Choose Well campaign North West sent out a survey (appendix 1) to determine the number of people who had made alternative decisions to attending the ED and whether the messages from the campaign had reached the local people. The survey results are not yet available but Merseyside NHS was successful in increasing the level of awareness amongst the people of Merseyside of the range of NHS services available to them over the winter of 2008 with 94,547 people using NHS Walk in centres in Merseyside, a rise of 18% from the year before and there was a drop in AE attendance of 6.4%, compared to the previous winter yet they still had high attendances to the ED with up to half of these potentially of the type that could have been treated by more appropriate NHS services.15   Many patients do not realise that there are cost implications and differences in cost between EDs and GPs and believe that it makes no difference whether they visit as all they want is a diagnosis regardless of who gives it to them.16 Many do not visit their GPs because of the appointment systems in place, and they are often unable to make an appointment and are therefore more willing to wait around in the ED where they are guaranteed to be seen rather than wait for an appointment at their GP practice. It has also been noted that when patients were unable to see their regular GP and were offered an appointment to see an alternative the decision was made to attend the ED rather than see the alternative.17,18 The opening hours of primary care facilities also do not satisfy the needs of some patients, those who work during the day may not be able to take time off from their daily activities to attend appointments which are set at the discretion of the GP practice rather than at the discretion of the patient such as in the evening, during the night and at weekends. Repeat attendees of the ED are found to make up a large proportion of cases. In a report by NHS Manchester19 who had registered 230,000 attendances per year at its three main sites showed that 13% of these attendances were frequent attendees (patients who attended the ED four or more times in a six month period) with the average number of times a frequent attender being 5.7 times. The report also suggested that this was inappropriate use of the ED and that patients needs were not being met by primary care providers. They decided to increase performance by putting in place best practice which was to include devising computer software that would identify the frequent attenders and allow GPs to see who they where so that they can make contact with the patients and inform them about their inappropriate use of the ED. The patients were sent letters stating key messages on the use of the ED and an information leaflet. The pro-forma letter which read An AE department is often not the best p lace to receive care for non-urgent problems or those that will need ongoing treatment. They do not have your medical records which included information about other medical problems both past and present, investigations, regular medication, and any allergies to medication. Not having this information can compromise the treatment you receive. The enclosed leaflet contains information about services other than AE departments which are available to you. à ¢Ã¢â€š ¬Ã‚ ¦.AE departments should be used when the problem is an accident or requires emergency treatment. We would request that you contact the surgery first when you have a health problem that requires some advice and/or treatment.19 This intervention was found in one GP practice to reduce the number of repeat attenders by 20%19 even though studies have shown that this would be the number of frequent attenders that would over time stop attending anyway without any form of intervention.20,21 In order to validate the results found the intervention should be compared between surgeries with some surgeries having intervention and some not having the intervention. GP services within the ED There has been an increase in the number of primary care doctors in EDs or based closely to EDs over recent years. This has been found to decrease the numbers of non-urgent cases seeking ED treatment in favour of a GP and has also reduced the number of unnecessary admissions to hospital. This sort of initiative requires team work and close working partnerships with both EDs and GPs which at times has be proven to be tricky due to differences in culture and beliefs. The primary Care Foundation has carried out research commissioned by the Department of Health, the study, which was carried out in May 2009, looked at different models of primary care across England practising within and alongside EDs. The number of patients deemed to be primary care patients were identified. It found that around half of all EDs did in actual fact have some form of primary care presence working within the ED and that between 10% and 30% of attendees were classified as primary care candidates.22 Discussion Ethical dilemma of turning patients away The four principles of ethics developed by Beauchamp and Childress23 must be taken into account when coming to a decision as to whether to turn patients away from the ED. The 4 principles approach takes into account that whatever our personal beliefs, philosophy, moral theory or life stance the care of patients is the most important factor. It could be said that turning patients away from the ED was going against the ethics of the health service in that it is considered freely accessible to all at any time. The Four Ethical Principles Autonomy Patients must be respected and must not be deceived and must be given adequate information. If patients are turned away then they are not given all the required information regarding their condition. Even though they would be advised to see their GP they may not do so. Beneficence and non-maleficence It may be seen as causing the patient harm by turning them away, they may suffer further pain or psychological trauma by not being seen. Justice Justice or fairness may be breached if patients are turned away. The health service is free at the point of entry and patients that are turned away may feel as if they are being denied care or treatment, even though they would be offered it at their GP practice for some this may not be possible or an option therefore denying them any form of care at all. Conclusion From the articles and documents reviewed it can be seen that non-urgent attendees at the ED are a drain on public funds and a time of economic instability and when there is a keen focus on service cuts and delivering value for money. In spite of the evidence and from reviewing articles I feel that it could potentially be detrimental to the health and well being of patients if they were to be turned away from the ED for non-urgent or minor conditions that could be seen in general practice. Turning them away could make them stop seeking medical treatment and could make them lose faith in the health service altogether. I believe that more patient education and greater access to GPs and primary care health professionals is what is required in order to reduce the numbers and therefore the cost of treating such patients. It is not the duty of the treating professional to determine the perceived severity of illness or injury a patient attends with but to offer them the care and support they need in order for them to continue their lives as they would like to. It is however the duty of health professionals to educate their patients and offer support on how they should deal with such illnesses and injuries so as not to have to attend or re-attend the ED. This could come in the form of information leaflets or just by talking to the patients and finding out their reasons for attending the ED rather than GPs and how things can be put in to place and organised for future patients to overcome the barriers to other forms of care. In 2003/4 there was a change in the GP contracts, following this there was an increase in ED attendances. The new contracts made changes to the after-hours access to GPs and allowed GPs to opt out of this area of care, this then resulted in the increase of after-hours presentations to the ED of GP cases.24 So in order to increase access there would need to be more GPs not opting out of the after-hours work or changing the contracts to omit the option to opt out of such. Even though there are provisions such as walk in centres and out-of-hours services people attend the ED, this could be due to the unfamiliarity of such places and lack of knowledge of the facilities available. More patient education and promotion of such centres would be required to ensure they are made aware to everyone in the event of requiring such services. Also the integration of primary and secondary care could help improve services for everyone by bringing GPs into the EDs and from a closer working partnership. Appendix 1 HRG code HRG name Band AE tariff ( £) VB01Z Any investigation with category 5 treatment 1 183 VB02Z Category 3 investigation with category 4 treatment 1 183 VB03Z Category 3 investigation with category 1-3 treatment 2 133 VB04Z Category 2 investigation with category 4 treatment 2 133 VB05Z Category 2 investigation with category 3 treatment 2 133 VB06Z Category 1 investigation with category 3-4 treatment 3 78 VB07Z Category 2 investigation with category 2 treatment 4 110 VB08Z Category 2 investigation with category 1 treatment 4 110 VB09Z Category 1 investigation with category 1-2 treatment 3 78 VB10Z Dental Care 5 52 VB11Z No investigation with no significant treatment 5 52 HRG codes and tariffs6 Appendix 2 North West Choose Well Survey If you or a family member had a minor illness or injury (for example a sore throat, backache, cough or cold), which is the first NHS service you would use for advice and treatment? (Please select one answer) Y/N Y/N Pharmacy Minor Injuries Unit GP/Doctor Look for advice on the internet Phone NHS Direct or look on their website Dial 999 NHS Walk-in Centre Go to AE Urgent Care Centre None of the above, I would look after myself Other, please state below If your first choice service was unavailable, which other NHS service would you contact next? (Please select one answer) Y/N Y/N Pharmacy Minor Injuries Unit GP/Doctor Look for advice on the internet Phone NHS Direct or look on their website Dial 999 NHS Walk-in Centre Go to AE Urgent Care Centre None of the above, I would look after myself Other, please state below If you are a parent or carer for children under 16 years of age, please complete questions 3 4. Otherwise go straight to question 5. Which age group are your children in? Y/N Y/N 0 4 years 10 13 years 5 9 years 14 16 years If your children had a minor illness or injury (for example a temperature, a sore throat, cough or cold, a small cut or a sprain), which is the first NHS service you would use for advice and treatment? (Please select one) Y/N Y/N Pharmacy Minor Injuries Unit GP/Doctor Look for advice on the internet Phone NHS Direct or look on their website Dial 999 NHS Walk-in Centre Go to AE Urgent Care Centre None of the above, I would look after myself Other, please state below 5. If you have selected AE or 999 in answer to questions 1, 2 or 4 above, please answer this question. Otherwise go straight to question 6. If you have selected AE or 999 in answer to questions 1, 2 or 4 above, can you tell us why you would make this choice? (Select as many as apply) Y/N Y/N You will receive the best quality care and advice You know that you are guaranteed to be treated You will be seen quicker than any other service The AE is closest to where you live You do not know where else to go In the past your GP sent you to your AE or told you to call 999 You would have chosen a GP, but are not registered with one In the past you were told to go to AE or to call 999 by another health service, e.g. pharmacy/NHS Direct You would have chosen a GP, but it is difficult to get an appointment Other, please state below Which of the following services do you currently use your local pharmacist store for? (Select as many as apply) Y/N Y/N Picking up a prescription Advice if your child has a high temperature Advice and treatment for a headache Advice and treatment for backache and other aches pains Advice and treatment for an upset stomach Advice and treatment for a urine infection Advice and treatment for treating coughs, colds flu Contraceptive advice Other, please state below Did you know that your local pharmacist store provides a confidential consultation area? Yes/No Did you know that your local pharmacist can offer you confidential advice and treatment without an appointment? Yes/No Would you consider using your local pharmacist for any of the following? (Select as many as apply) Y/N Y/N Contraceptive advice Advice if your child has a high temperature Advice and treatment for a headache Advice and treatment for backache and other aches pains Advice and treatment for an upset stomach Advice and treatment for a urine infection Advice and treatment for treating coughs, colds flu Other, please state below Do you know where to find information about late night and weekend opening hours for your local pharmacist? Yes/No Choose Well is an NHS campaign that aims to help people in the North West to understand which NHS service to use if they need fast and effective treatment for minor illnesses and ailments; and how to use 999 and AE services appropriately. Have you heard of the Choose Well campaign? Yes/No If yes go to Q 12; if no go to Q 13 Where have you seen or heard about the Choose Well campaign? (Select as many as apply) Y/N Y/N Local newspaper Local news websites PCT website Community radio Local radio Life Channel (GP TV) Bus advert Leaflet Signs on ambulances Other posters Word of mouth (someone mentioned it to you) Other, please state below Have you heard any of the following messages? Tick as many as appropriate. The number of people using AE and 999 services is continuing to rise One out of every four people who go to AE could have either treated themselves at home, or used another local NHS service You can get three free text messages, with details of your three nearest pharmacies by texting pharmacy to 64746 Your local pharmacy provides expert, convenient advice and treatment for minor ailments AE and 999 services are for life-threatening and serious conditions such as heart-attacks, strokes, breathing problems and serious accidents Get the right NHS treatment As a result of seeing these messages, if you or a member of your family has a minor illness or ailment are you less likely or more likely to use the following services (please select as appropriate). Less Likely More Likely Your local pharmacy Your local GP NHS Walk-in Centre or similar service Minor Injuries Unit Urgent Care Centre NHS Direct NHS Choices Website AE 999 To help us to get our campaign right, it would be really helpful if you could give us some information about yourself. Which age group do you fall in to? Y/N Y/N Y/N 16 19 40 49 70 79 20 29 50 59 80 89 30 39 60 69 90+ Gender please delete as appropriate Male Female Please could you tell us the first part of your postcode e.g. M22 or SK6 Ethnicity Please can you select the group that best describes your ethnic background White Y/N Y/N English/Welsh/Scottish/Northern Irish/British Irish Gypsy or Traveller Other, please give details Mixed/Multiple Ethnic Groups Y/N Y/N White and Black Caribbean White and Asian White and Black African Other, please give details Asian/Asian British Y/N Y/N Indian Bangladeshi Pakistani Chinese Other, please give details Black/African/Caribbean/Black British Y/N Y/N African Caribbean Other, please give details Other Ethnic Y/N Y/N Arab Other, please give details Thank you for your time we really appreciate your help. If you are willing to help us to develop this project further, please fill in your contact details below Name Address Tel. No. Email address Taken directly from the Choose Well questionnaire5

Leadership Being a Change Manager

Leadership Being a Change Manager Abstract Ronald Heifetz has done wonders in the field of leadership his approach to leadership so compelling is that he is much honest about the demands of real leadership. the role of leadership is drastically changing, as the new responsibility is helping in facing the reality and mobilizes them to make change, but making such changes has not been easy. This is due to many challenges that future and current leaders are facing. For instance, the future leaders will be facing the challenges of adapting to the world of rapid change. This is so especially in Dubai, where the preservation of what is most important from the past while moving into the future is an everyday experience. To deal with such situations, future leaders need to focus on the cultural diversity, due to an increase in the significance of globalization, the future leaders the new leaders will need to appreciate cultural diversity. They also need to look at technological savvy as it will be the main competence for the global l eader of the future. Another area that future leaders need to focus on is the construction of partnerships, this is because The process of restructuring, reengineering as well as downsizing, are resulting to a world in which outsourcing of all except core practices might become the norm. The new blueprint models depend on the availability of proven best practices in the organization planning. They also defines the technology as well as the process design choices , which allows customers to jump-to start new efforts and extends their existing planning budgeting and focusing deployments across their organizations. There are several qualities that an effective future leader has to posses. Some of them include, being Charisma, Positive Attitude, Motivation, Honesty and Assertiveness. This paper also found that, there are many lessons that we can learn from the behaviors of the past leaders. For instance, there is so much hunger for leadership in business current. Every person wants leaders who are the best leaders; hence great leaders have to face the reality. In addition, we learn that, organizations have a remarkable tendency of underestimating their external threats, while overstating d their own powers. As a reason, it is very difficult for leaders to convince indivi duals face reality in life. The paper concluded that future leaders have no alternative other than becoming good change mangers. Introduction It has proved has proved to be much hard to imagine the future leader without looking at Ronald Heifetz, who is one of the worlds leading authorities on leadership. The goodness with Heifetz is that, his approach to leadership so compelling is that he is much honest about the demands of real leadership. It has been argued that, the role of leadership is drastically changing, as the new responsibility is helping in facing the reality and mobilizes them to make change. However, making change is much painful. Most individuals have smiling faces in view of what it means by leading, but get a rude awakening when they find themselves with a leadership opportunity. (William, 1999). The process of exercising leadership generates both pain and resistance; individuals get worried that, they might end up losing something that might be worthwhile. Areas That the New Leader Need To Focus On Cultural Diversity As there has been an increase in the significance of globalization, the future leaders the new leaders will need to appreciate cultural diversity. They will have to get acquainted themselves not only with the economic and legal differences, but also the social and behavioral differences that are also part of working globally. -it has been shown that respect for differences in people is one of the most important qualities of a successful global leader. (Marshall, 2005). It has been proved that, the development of culture understanding is termed as not only an obligation, but also as an opportunity. Appreciation of culture diversity includes all things that makes up culture, may it be small or big. For instance, few Americans working in the Middle East have taken their time to read the Koran. It is much clear that, religion is considered as being one of the significant variables that influences behaviors in the religion. Smaller issues like the meaning of gifts or the significance of t imeliness will need to be understood also. It has been noted that, the capability of motivating individuals in different cultures is becoming mostly significance. The motivation strategies that tend to be effective and efficient in one culture might not be effective in the other. Effective leaders, who happen to learn, appreciate and motivate their followers across cultural diversity, will be valuable resource in future. Technological Savvy High-potential leaders globally are consistently expressing the point that technological savvy will be the main competence for the global leader of the future. On trend on this issue is much clear, the younger the participants, the higher their reiteration on the technological savvy importance. Most of the young future leaders, have been brought up in an error of technology, and view it just as part and parcel of their life. Current leaders view technological savvy as a very important thing for staff individuals, but never for the line officers that run the business. With technological, future leaders will have to learn on how the intelligent use of new technologies will help their organizations, recruitment, development as well as maintaining a network of individuals who are technically competent, they also need to know the procedure of making and managing investments in new technologies. Last but not least, they need to be positive examples in the use of new technologies. All these are based on the fact that, in future, technology will become a critical factor that will tent to impact the companys core business. Building partnerships The construction of partnership along with alliances of all forms is looked upon as being very much important for the future than as it was in the past. Organizations that formed alliances in the past like IBM are forming alliances regularly today. This trend is projected to be far much significant in future. The process of restructuring, reengineering as well as downsizing, are resulting to a world in which outsourcing of all except core practices might become the norm. The capability of negotiating complex alliances and management of complex networks will be much significant in future. The changing responsibility of suppliers, customers along with partners has deeper implication for leaders. In the past, it was much clear on who the enemies or friends are, while in future this role is becoming blurred. In diversified field like telecommunication, similar organization might be the supplier as well as the customer, competitor or partner. New and Distinctive Challenges Faced By New Leader The second challenge is that, individuals might not be willing to be lead by the leader. Sometimes, this comes as a shock, but no one might be willing to work with the leader promotions and titles may confer grudging to0lerance and even a little bit more difference, but never credibility as well as real respect. Another problem is that, everyone might be having an agenda, but they might not be willing to share it. New leaders have a tendency of believing that, every person looks at business challenges, departmental objectives, and a long with the initiatives from the similar perspective with them. They need to learn on how to pay attention to their associates, so that they can be a position of understanding their unique agendas, motivation, interests, motivation along with their ambitions. The next thing is that, personal problems of their associates to become their problems. It has been proved that both new managers as well as experienced ones in most cases attract their mates personal problems to become their personal problems. It is true that, at times, they usually find themselves in the receiving end of [other individuals challenges in their private lives, with their health, their finances, among other dilemmas that individuals encounter. There are times that such leaders follow their instincts which might be wrong. Since they do have the authority to say, Is best left for your parenting chores and checked at the door when you enter the office. (McCarthy, 2009). In most cases, success comes when individuals leading the success are not the subject. It is much important for some individuals to realize individuals never change their nature. In most cases, new leaders make their weaknesses to be their focal point. Some times leaders take the responsibility of fixing the flaws of their associates. As an effect, they need to learn to leverage individuals strength, and develop groups whose members need to have complimentary skills. This will make one succeed beyond their wildest visions. Leaders tend to start off overly nit-picky; but Im sure Art would agree that there are times when weaknesses do have to be addressed. (McCarthy, 2009). Sometime new leaders are faced with the responsibilities of being a ware of over-investing their times with the wrong individuals. At every point, the managers will at the some time get to deal with the brilliant problem child employee, with the outstanding technical withstanding skills but fatal flaws concerning other people skills. Such like employees in one way or the other lack the emotional intelligence, for them to recognize their aberrant behaviors. As an effect, they rarely ever change, (Fullan, 2001). Blueprint for Dynamic Planning The blue print operational planning systems were designed to be highly flexible, where there are a variety of operations along with incidents are managed. The common traits of blueprints are that, they do have a scale have a scale for the size of the deliverables, as well as clear indications of the dimensions of any component elements displayed in the drawing. (McCarthy, 2009). In schematics, the scales might not be exact, however, the forms of elements that needs to be used as well as the nature of such elements tent to be expressed in details. They all have legends that explain the any of the unusual symbols which might be used for the representation of features in the drawing. In most cases, blueprint spans as many pages as possible, as they usually assist in the capture rendering s of the scheme deliverables from multiple angles and at different levels or details. The new blueprint models depend on the availability of proven best practices in the organization planning. They also defines the technology as well as the process design choices , which allows customers to jump-to start new efforts and extends their existing planning budgeting and focusing deployments across their organizations. It is true that, Cognos has recognized that, the process of planting is much more than just financial practices. This is something that ought to spread across the organization and be coordinated across many departments. On the other hand, giving appreciation to the fact, and giving support to it in principle in the planning software is just considered as being one thing, while supporting it in practice is just another practice. In Cognos, blue print helps in the users to adopt such like practices relatively easily. The current initiative planning blueprint covers both capital and labor initiatives. Multiple phased project planning has been addressed in the blueprint for the undertakings that seem to be capital intensive like adding new manufacturing capacity, along with labor initiatives like the implementation of large labor intensive projects. The blueprint schemes having strategic long range planning, in most cases assists firms in assessing the influence of market growth assumptions. Major initiatives such as new IT infrastructure, (McCarthy, 2009). Can be far much essential components for the growth of revenue, as well as increasing productivity. The management of complex financial in most cases, blueprint provides Leadership Qualities Charisma There are different skills that develop leadership qualities that the current and future generation leaders ought to have. The bellow mentioned qualities are far much vital for effective leadership. One of them is being charisma. There have been charisma leaders, who are still being honored for their passionate movements towards equality. For instance, Martin Luther kings I have a dream speech still impacts current peoples. Charisma lessons impact individuals through speeches as they reiterate on the radiation of personalities due to their expressive words in their fight against inequalities. There speeches need not to have the gift of touching individuals through their word choice. Leaders who tent to be charisma tent to be alluring, charming, as well as encouraging their followers to support a grand vision, (Tuia, 2008). Positive Attitude Current and future generation leaders need to posses positive attitudes, as they have the responsibility of influencing their future and current followers. Leaders in some companies like in BMW are viewed upon as role models to their employees and to the coming generation. In one way or the other, employees become very much dependent of leaders, due to the fact that, they are their vehicles to their employment world, and provide much needed help as well as the assistance. If the manger provides a positive learning experience to employees, they will then tent to drive this encouragement, and will succeed and become contagious. In general, under any condition, the positive attitude of leaders will always have a greater impact as well as the influence on their followers. Motivation Fin most cases, motivation leaders are trainers, however, they might also be managers. Though the aims and targets of employees or even players is a good determinant of prosperity in an organization, the motivating qualities of their leader is also of much significance. The motivation of a leader involves infusing their followers with high standards, as well as setting challenging but attainable targets and goals, as they continue performing well. As a result, the motivation capabilities of a leader enhance his followers performances. In addition, motivation also correlates with possessing positive attitude. The presence of positive attitude provides positive environment for the followers, who then fill much motivated to move to the leaders direction, where ultimate success can be attained. Assertiveness Current and future leaders are charged with the responsibility of guiding the direction of his or her company. Companies need firm and assertive leaders, who have the ability to delegate the work to their subordinates, as this will make them earn respect to follow through on their assignments. Assertive leaders have the ability to convey enforcements without being too autocratic to their followers. Din addition, assertive leaders never make their followers feel they are in a hostile environment; instead, they will respect their people, and at the same time demanding proper accountability. Since, leaders assertiveness and confidence earns respect, their followers tent to follow, emulate and help their leaders to achieve success, (Leithwood, 2005). Honesty Both current and future leaders need to be honest, as this is the sign of good leaders towards their work as well as employees. They ought to be honest to themselves as well. They should never loose integrity whatsoever the circumstance, as they will never be considered reliable and worthy following. Other qualities that current and future leaders need to look at include; patience, focus, dedication consistency, as well as effective communication, (Tuia, 2008). Lessons from Past Leadership Behaviors There is hunger for leadership in the business organization The past leaders have shown that, real heroism of leadership involves having courage to face the reality, as well as helping individuals close to face reality. The term vision in business means something that is abstract, But the quality of any vision depends on its accuracy, not just on its appeal or on how imaginative it is. (William, 1999) To muster the courage to face reality and interrogate it is the main function of a leader. Leaders do not get into the act of answering the questions like what values does the organization stand for? What are the organizations talent and skills?, this is because, it forms the old definition of leadership. This teaches that, the leader needs to have vision, answers and everything else is just a sales job to urge individuals to sign up for it. It is the responsibility of leaders to provide directions. In attaining these, they ought to structure questions well, other than offering definitive answers. There are differences between behaviors of leade rs who operates under the idea that, being a leader means impacting the organization to follow leaders direction, and those who think that, leadership means influencing the organization to face its problems and to live into its opportunities. (William, 1999). The second though, enables individuals in an organization to deal with tough challenges. And the lesson is, this is the new definition of leadership job. It Is Hard To Convince Individuals to Face the Reality Organizations are allergic to conflicts, especially organizations that have been under operation for a long period of time. This is based on the fact that, conflicts are much dangerous, as they may damage the relations, threaten friendships, but they also engineer innovation and creativity. Old behaviors have taught that, individuals never learn by looking at the mirror, but when encountered with a difficult condition. With this in mind, future and current leaders need to have the power of dealing with conflicts along with uncertainties. They need to have experimental mind-set. It is true that, there are some decisions that will work, but other might not. Just as like, there will be projects that will pay, while others will not. However, every decision and every project will provide lessons don how the world is changing, and how the organization compares with its competitors. This means that, facing the reality implies, dealing with mistakes and failures, especially our own failures in the organization. For instance, in 1990s, Bill Gates made a big decision about the internet, as he decided that, the net was not going to be such important, but later changed his decision after those who advised him contradicted the decision. How We Should Help Individuals Keep Their Bearings It is true that, not everything is subject to change, if the leader is obligated to help individuals face the reality, and mobilize them to make changes, Which values and operations are so central to our core that if we lose them, we lose ourselves? (William, 1999). The leaders at the highest level are supposed to lead conversations about what is important and what is not. For instance, it was very difficult for Lew Platt, who was the Hewlett-Packed CEO, to lead conversation about breaking up of his company, and about leaving the HP name, together with computer business other than with the test-and business of measurement, where they started. How Leaders Do Listen Most leaders in the past used do die with their mouth open, this teaches us that, leaders have to know how they listen, but listening is more subtle than how most individuals think. But first, and just as important, leaders must want to listen. (William, 1999). Good listening is engineered by curiosity along with empathy. Conclusion It is now obvious that, future leaders have no alternative other than becoming good change mangers. Markets have changed, conditions have also changed, as well; the business plans have undergone some changes. It is the choice of future and current leaders to either make a change a proactive decision or reactive compulsion. These leaders are obligated to shape today and tomorrow, it is not a definite time to start feeling sorry about tough circumstances, but is is an opportunity as well as a new day.

anthoy lister :: essays research papers

Fox Galleries (103 Brunswick Street, Fortitude Valley) has opened the doors on it newest exhibition, â€Å"Anthony Lister: subtitled†. The showcase displays Anthony Lister’s unique brand of street art. His works can be described as anywhere from abstract to pop, to graffiti. The style is very free-form and none confined. Many mediums were used to create his art but he seems favor putting it all on canvas. When Lister paints he tells a story about whatever kind of environment he’s in at the moment. The layout of the exhibition itself is rather structured and organized. I think simple and neat was the aim here. I have chosen three painting to closely analyze: â€Å"Portrait of Egon Schiele†, â€Å"Discard the Retard† and â€Å"Paddington from Pratts†. When compared to his mentor, Max Gimblett the two distinctive styles would probably be as far as each other as possible. Max prefers his paintings to be on irregular canvases and his work can range from patterns to abstract, yet don’t have the slight chaos of Lister’s. Predominant throughout the three mentioned works you can see the use of repetition, restriction of colour, emphasis and line. His particular style seems free, spontaneous and sees no real confinement. The general restriction of colour make anything not in bland almost scream off the canvas and creates a very effective focal point. Anthony has said himself â€Å"I’m not trying to change the world, I’m just reacting to the world trying to change me†. That would perfectly describe Lister’s motivation to paint and create. Whether it’s a social statement or purely something for himself he has created something that people can enjoy. Again Lister stated he normally chooses his subject matter by simply finding something within his immediate environment. Any deeper meanings one might find would probably be purely speculation, but the interesting composition in â€Å"Discard the Retard† where the constant stencil of a duck pattern has been used and a single â€Å"stand-out of the crowd† duck can be seen (solid black rather than just black outlining).

Violence on Television Essay -- essays research papers

"There was murderers going around killing lots of people and stealing jewelry." This quote comes from the mouth of an eight year old girl after watching the evening news on television. The eight year old girl claims that she is afraid "when there is a murder near because you never know if he could be in town" (Cullingford, 61). A recent report from the National Institute of Mental Health (NIMH) pools evidence from over 2,500 studies within the last decade on over 100,000 subjects from several nations to show that the compiled evidence of television's influence on behavior is so "overwhelming" that there is a consensus in the research community that "violence on television does lead to aggressive behavior" (Methvin, 49). Given that the majority of scientific community agrees that "the research findings of the NIMH publication support conclusion of a causal relationship between television violence and aggressive behavior" (Wurtzel, 21), why is it that "the Saturday morning "kid vid ghetto" is the most violent time on T.V." (Methvin, 49), and that "despite slight variations over the past decade, the amount of violence on television has remained at consistently high levels" (Wurtzel, 23)? Why is it that, like the tobacco companies twenty years ago, the present day television broadcasting companies refuse to consent that violent films and programming can and do have harmful effects on their viewers (Rowland, 280) What can be done to combat the stubborn minded broadcasting companies and to reduce the amount of violent scenes that infest the current air waves? The television giants of today, such as ABC, CBS, and NBC continue to air violent shows, because they make money off of these programs. In general, society finds scenes of violence "simply exciting" (Feshbach, 12). Broadcasting companies argue that "based on the high ratings, they are giving the public what it wants, and therefore are serving the public interest" (Time, 77). Michael Howe states: "We have to remember that children and adults do enjoy and do choose to watch those programs that contain violence" (48). At the same time, however, we must also remember the undeniable truth that "there is clear evidence between television violence and later aggressive beh... ...Television and the Child. London: Oxford University Press, 1958. Howe, Michael J.A. Television and Children. London: New University Education, 1977. Lowe, Carl, ed. Television and American Culture. New York: The H.W. Wilson Company, 1981. Methvin, Eugene H. "T.V. violence: the shocking new evidence." Reader's Digest Jan. 1983: 49-54. Milavsky, Ronald J., Ronald C. Kessler, Horst. H. Stipp, and William S. Rubens. Television and Aggression. Orlando: Academic Press Inc., 1982. Palmer, Edward L. Children and the Faces of Television. New York: Academic Press Inc., 1980. Pearl, David. "Violence and Aggression" Society Sept.-Oct. 1984: 17-23. Rowland, Willard D. Jr. and Horace Newcomb. The Politics of T.V. Violence. Sage Publications Inc., 1983. Feshbach, Seymour and Robert D. Singer. Television and Aggression. San Francisco: Jossey-Bass Inc., 1971. Skornia, Harry J. Television and Society. New York: McGraw Hill Book Company, 1965. Time. "Warning from Washington: Violence on Television is Harmful to children." May 17, 1982: 77. Wurtzel, Alan, and Guy Lometti. "Researching Television Violence." Society Sept.-Oct. 1984: 22-31.

Beowulf’s Confidence Essay

Beowulf was written in the earliest age of English poetry. Back in the Anglo-Saxon times, in order to make a name for themselves, warriors had to fight in battles. They believe that you should fight until death with absolutely no retreating. Beowulf, a young Geatish warrior, comes to Hrothgar’s kingdom to return a favor to him. While Beowulf is there, he fights in two battles; the battle with Grendel and the battle with Grendel’s mother. Much later in the poem, he fights in his third battle, defeating the dragon harming his country. Beowulf’s confidence decreases as each battle occurs. In Beowulf’s battle with Grendel, Beowulf is extremely confident. This confidence is very apparent in his attitude. When he first comes to Hrothgar’s court, he tells him that he had â€Å"firm resolve when [he] set to sea† (Beowulf 22). This confidence is also apparent in Beowulf’s preparation. He chooses to abandon his armor and weapons in the fight. He very dramatically â€Å"[strips] from his shoulders the byrny of steel, / [doffs] helmet from head† (23). Beowulf has a huge advantage on Grendel because he is very strong. He is so strong that the people of his country say that his handgrip is equivalent to that of â€Å"thirty men’s strength† (15). Beowulf’s confidence is extremely evident as he prepares to fight Grendel. Beowulf prepares differently in the fight with Grendel’s mother because he is not as confident as he was in the first battle. Beowulf’s attitude while talking to Hrothgar is less confident due to the fact he is not sure of how the battle will end. He has Hrothgar pledge to â€Å"Protect [his] kinsmen, [his] trusty comrades, / If battle take [him]† (48). Beowulf also shows his confidence lessening by deciding to use armor and weapons in the battle. To prepare for the battle, he â€Å"[dons] his armor† (47) with â€Å"A gleaming helmet† (47) and â€Å"the sword the herald of Hrothgar loaned† (47). Beowulf is still somewhat strong compared to his last battle. When Grendel’s mother â€Å"[grapples] and [grasps] the warrior / With horror grip† (48, 49) and tries to â€Å"tear through the tempered mail / With her savage fingers† (49), she cannot harm him. Beowulf’s confidence is not as apparent in the second battle with Grendel’s mother. Beowulf’s confidence continues to decrease as the battle with the dragon occurs. Beowulf’s attitude was extremely negative. His heart â€Å"[is] heavy with anguish† (75). Beowulf’s confidence level is so low that he has special armor prepared for him. The king â€Å"bade work him of iron a wondrous shield, / Knowing full well that wood could not serve him / Nor linden defend him† (75) against the dragon. Beowulf’s strength has drastically changed since the beginning of the first battle. Rather than having the grip of â€Å"thirty men’s strength† (15), Beowulf â€Å"[trusts] the strength / Of his single might† (82). Beowulf shows little to no confidence in the battle with the dragon. Beowulf’s confidence lessens as each battle approaches. He goes from being a great, bold warrior with much confidence, to an old, fragile king with very little confidence. Beowulf comes to a point of weakness where he can no longer defend for himself and needs help from fellow warriors, like Wiglef. His confidence adjusted so extremely that he goes into the last battle expecting a not so good outcome. At the end of the battle with the dragon, Beowulf passes away, with his weakness and little confidence being a huge factor.