Partnership Care Nursing: A review of two Peer-reviewed Journals on Care Nursing

Introduction The concept of teamwork in health and social care has a vast literature. For instance, a policy developed by the Department of Health in 2007 mainly focused on eradicating inequalities in health service provision through partnership working between primary care providers and other social care agencies. Today’s healthcare service status demands teamwork, which is particularly true for nurses who have to deal with multiple of factors during their professional service provision. On the same breadth is the increased call for more patients’ involvement in their health, including on the right to make decision and seek legal support on the basis of their health. In other words, every patient receiving healthcare services, including nursing service is entitled to be actively involved in their own care. The philosophy behind partnership working in nursing is based on several concepts and principles: empowerment, autonomy & rights, power-sharing, information sharing, respect, mak ing informed choices, and paternalism. The aim of this paper is to analyse ideas from two different articles by different authors on the topic of nursing, particularly on the partnership working in nursing. Discussions Article I: Patient participation in nursing care: towards a concept clarification from a nurse perspective In their study, â€Å"Patient participation in nursing care: towards a concept clarification from a nurse perspective† Sahlsten et al. (2007) explored the evolution of patient participation, a concept that has not only gained significant transformation overtime, but also brought with it more challenges on definitions and dimensions of patient participation. The authors used focus group interviews to collect data, conducting open interviews on the selected seven groups. While the data gathering took five months to accomplish, the researchers were able to uncover the respondent’s perspectives in depth. While the focus group interviews may have mainly focused on the meaning and implementation of patient participation in line with the study’s aim, the results can clearly reveal what nurses value most in terms of patient participation. Respondents rated equal partners’ participation, co-operation, and shared responsibility as the most significant factors in rel ational nursing (Sahlsten et al., 2007, pp. 635-636). While the aim of the study was to explore â€Å"the meaning of patient participation in the nursing care from a nurse perspective† (Sahlsten et al., 2007, p.632), the review of other authors’ works reveals a plethora of issues in the nursing care and partnership working. The nurse-patient relationship is considered successful when both parties view each other as partners, with the nurse required to use professionalism, knowledge and positive ideas in the implementation of nursing care plan. Patient, on the other hand, is expected to have the intellectual ability to understand and make the right choices with regard to their own nursing care. The authors, however, faults the incongruence relationship between studies conducted in relation to patient participation on one side and definitions, elements and processes in literature and practice on the other side. Although there are a lot of empirical literature on nursing theories and patient participation, the authors claim t hat no empirically grounded theory has ever been established, calling for significant insight into more studies related to the concept of patient participation in their own nursing care. The authors claim that the traditional approach where patients were mere recipient of nursing care has changed, and subsequently replaced by the more active patients who are directly involved in their own care. More importantly, patients’ participation simply means the opportunity for them to participate in their own care, with regular adjustment as the situation may demand. Article II: The relational core of nursing practice as partnership Jonsdottir, Litchfield and Pharris (2004), while exploring â€Å"the relational core of nursing practice as partnership†, focused their analysis on the evolving relational core of nursing care in the backdrop of increased technology use and outcome-oriented approaches. The three authors, unlike their previously outlined counterparts, only focused on critical review of the available literature, espousing the role of evolving dialogue between nurse and patient in terms of partnership nursing and care. While technology is considered in the positive side in terms of medical breakthroughs, experts and general observers alike have associated it with distraction in health care services that need personalised attention including nursing (Jonsdottir, Litchfield and Pharris, 2004, p.241). In retrospect, the authors claim that the distracted modern nurse sees patient as a problem rather than partner to be attended to, consequently obscuring the humanness of nursing experience. To emphasise on the need to correct the deteriorating relational nursing concept in the perspective of partnership, Jonsdottir, Litchfield and Pharris (2004) outline and analyse various research studies that backs the need for nurses to be real partners through presence, care, and attentiveness in every stage of care nursing. The authors categorically state that the patients need medical treatment as priority, but emphasis should also be given to proven holistic approaches to care nursing, which studies have revealed to be equally significant in the overall healthcare. The focus on holistic care nursing should thus be based on dialogue between nurses and patients, for example, where the former should be in a position to explain to the latter why a certain procedure or activity is necessary in the process of care nursing. Conclusion While the two set of authors had different approaches to their respective work, both articles exemplifies harmony in terms of the need for partnership care nursing. One may, however, notice that the former article largely referred to partnership in the perspective of increased patient participation in own care nursing. The latter article mainly focused on partnership as a dialogue between nurse and patient. It is prudent to state that the former authors’ focus on patient elevation is largely due to historical background of healthcare service provision that pushed patients to the periphery of their own health. Nonetheless, the difference in semantics and approach notwithstanding, the two sets of authors agree that both patients and nurses need to collaborate, and view each other as partners rather than either one party feeling superior to one another. After all, it is common knowledge in the health care cycle that post-modern health and social care services requires more than t he post-war’s â€Å"one-size-fits-all† approach that dominated the universal health care service provision more than fifty decades ago. References Jonsdottir, H., Litchfield, M. and Pharris, M.D. 2004. The relational core of nursing practice as partnership. Journal of Advanced Nursing, 47(3), 241-250. Sahlsten M.J., Larson I.E., Sjostrom B., Lindencrona, C.S. and Ploskae. 2007. Patients participation in nursing care: towards a concept clarification from a nurse perspective. Journal of Clinical Nursing, 16, 630-637.

How Many Satellites Are Orbiting the Earth? Essay

Satellites are tracked by United States Space Surveillance Network (SSN), which has been tracking every object in orbit over 10 cm (3.937 inches) in diameter since it was founded in 1957. There are approximately 3,000 satellites operating in Earth orbit, according to the US National Aeronautics and Space Administration (NASA), out of roughly 8,000 man-made objects in total. In its entire history, the SSN has tracked more than 24,500 space objects orbiting Earth. The majority of these have fallen into unstable orbits and incinerated during reentry. The SSN also keeps track which piece of space junk belongs to which country. The SSN was founded in the wake of the launch of Sputnik, the first artificial satellite, by the Soviet Union in October 1957. Orbiting the planet at 20,000 mph (32,186.88 kph) while emitting a constant radio signal, Sputnik was a red flag that told America not to take its technological dominance for granted. In the following decade, the Space Race between the USSR and USA occurred, ending with Apollo landing in July 1969. As space technology matured, satellites were launched for military and commercial purposes. The price of satellite launches has dropped to as low as a few million dollars for light satellites, and a few tens of millions for heavy satellites. This put satellite technology within the reach of many nations and international companies. Satellites have an operating lifespan between five and 20 years. As of 2008, the former Soviet Union and Russia had nearly 1,400 satellites in orbit, the USA about 1,000, Japan more than 100, China about 80, France over 40, India more than 30, Germany almost 30, the UK and Canada 25, and at least ten each from Italy, Australia, Indonesia, Brazil, Sweden, Luxembourg, Argentina, Saudi Arabia, and South Korea. The company Sea Launch — a consortium of four companies from the United States, Russia, Ukraine and Norway — has launched a few satellites into orbit from international waters every year, although the company filed for bankruptcy in 2009. The largest man-made satellite currently in orbit around the Earth is the International Space Station. Some satellites, called microsats, nanosats, or picosats, can be as small as 10 cm (3.937 inches) in diameter and 0.1 kg (0.22 pounds) in mass.

Nutrition Related Diseases Essay Example | Topics and Well Written Essays - 2500 words

Nutrition Related Diseases - Essay Example The presence of these nutrients in the adequate amounts is essential for proper functioning of the body. Mudambi (2007) lists out the major nutrients as carbohydrates, fats, proteins, vitamins and minerals. Each of these nutrients performs their unique function, and various processes takes place through their unified functioning (p. 4). Each group of these nutrients altogether constitute over 40 essential nutrients which again produce over thousands of other substances that are essential for various body processes. As Ridgwell (1996) describes, among the various nutrients, carbohydrates and fats provide us with energy; proteins are used for growth and repair, vitamins and minerals help to protect our body and are also needed for maintenance. A diet can be considered as a balanced diet if it includes variety of healthy foods which supplements all the nutrients in the right proportion. Due to unhealthy eating habits world is now witnessing a rise in food borne illnesses and diet relate d disorders like obesity, diabetes, cancer, hypertension and heart diseases. Food borne illnesses are caused due to the consumption of contaminated food infected by microorganisms like bacteria, viruses or parasites or due to some chemicals in the food (NDDIC). Person suffering gets infections or irritations in gastrointestinal tract which result in symptoms like vomiting, abdominal pain, diarrhea and fever. Food borne illnesses can affect a person suddenly after eating contaminated food. If food is highly contaminated, food borne illnesses may become severe which can even lead to death. Thus if a person is severely affected with food borne illnesses, immediate medical attention should be provided. The people who are most susceptible to food borne illnesses include infants, pregnant women, elderly persons or individuals with weak immune system. Thus extra care should be given for keeping food safe for people belonging to this risky category. Nutrient

Manegerial Finance Essay Example | Topics and Well Written Essays - 1500 words

Manegerial Finance - Essay Example On the other hand management accounting is expected to provide information for analysis and use by internal uses of an organization like the senior executives and managers. Different data and financial data are required by different user groups. External users are more interested in the financial status of the company and they analyze the financial information presented with the general economic trend and the conditions of the industry in which the organization operates. Financial accounting makes information available on the financial transaction that have taken place in the past and this information is analyzed by the investors and creditors to assess overall performance of the company in which they have staked their funds. The internal users of the financial information require different types of information which they use to assess the internal performance of the company in various disciplines. The internal users also need non-financial information like the movements of competitors, levels of customer satisfaction which are assimilated and analyzed to help the growth of the company in the proper direction. As against the scope of financial accounting which deals more with historical data, management accounting deals with both past and present data. ... ation and rely on them, the financial accounting is made subject to the regulations of governing bodies like Financial Accounting Standards Board (FASB) and Public Company Accounting Oversight Board (PCAOB). In contrast the management accounting is not subject to any regulatory measures being presented by any agencies. The reason for absence of regulatory control is that management accounting prepares information only for the internal users and therefore is not subjected to any regulations. Since there is involvement of any public interest no need to protect the information has been felt. Periodicity of Reporting Financial accounting bases its reporting on the basis of historical data and therefore there is the necessity for making periodical reports. The financial reporting is done for different periodicity like monthly, quarterly, and annual reporting. Management accounting reports on the other hand are made for continuous periods so that the internal users would be able to evaluate the past and present performances of various functional divisions and departments. There may be some urgent needs of management accounting reports to evaluate a capital expenditure project or some other investment decisions. Forecasts about the future prospects and growth of business of the organization also need management accounting reports. Therefore there is the continuous need of the management accounting information by the internal users. (Edmonds et al, 2006) The differences in financial accounting and management accounting can be summarized in the following table: Criteria Financial Accounting Management Accounting Primary users External Internal Primary organization focus Whole organization Parts or subsections; specific areas Information characteristics Must be GAAP; based

Human Brain and Computer Essay Example | Topics and Well Written Essays - 1500 words

Human Brain and Computer - Essay Example Possibly, it can be said that the brain is better at doing some specific jobs and the computer is good at doing other jobs. This paper is intended to analyze the benefits and limitations of the metaphor "the brain is often compared to a computer" which is commonly used by many. Before getting into the details it is important to understand why such a comparison was made. Theoretically the brain is a machine just as the heart and kidney. It can be said that the brain is a computer (processor) with neural connections, programmed responses, and a data bank. It has sensors in the body that input information into the computer. It has an output to devices that perform actions, and the brain communicates with these devices through electrical and chemical channels. The comparison of the brain and the computer is a metaphor. In general metaphors are just used to help us better understand things. Or in other words metaphors are used to convey the idea that one thing is similar to another thing. They are useful for helping us understand things, such as mind/body interaction. Metaphors do not mean that both the things compared are one and the same neither is one thing is a substitute for the other. Since several processes in the brain are similar to the computer, it is commonly compared with each other. For instance, both brain and computers use electrical signals to transmit information. Both have a memory which tends to grow over time. With proper instructions given, both brain and computers can learn. Both work based on the energy present. Brain and computers are able to think logically and do math. There are also differences between brain and the computers. For instance, brain uses chemicals such as calcium and sodium to transmit information where as the computer uses electricity. Electrical signals generated in the brain travels much slower when compared to computers. A computer uses switches that are either on or off and works on the binary system, where as the brains do not have such a system. Memory of the brain generally grows by stronger synaptic connections but in a computer it is only possible by adding additional memory chips. The brain needs essential nutrients such as oxygen and sugar for working where as the computer only require electricity or a battery to keep working (faculty.washington.edu, N.D.). Though till date the technology had not grown to replace the brain with a computer, there have been several advantages with the development of this technology. For instance, today it is possible to use computer inputs as substitutes for other sensory inputs, and for outputs to limbs or devices to create movement of neurologically damaged limbs, control the environment by sensing the brain's electrical impulses, and even create limited forms of sight. Besides, great steps are being made in bionics, including artificial hearts that work for longer periods. In recent years study is under progress for replacements for muscle made from specialized ceramic or polymer materials that contract like muscles, which can be triggered by a computer. With this trend of advancement in technology, perhaps one day we could also replace computers with brain (Cole, 2003). A person can do many things which a computer cannot even attempt to do it. A brain beyond doubt has one thing that a computer doesn't and this is a major difference. A brain communicates with itself and the body

Moral Problems Raised by the Immoralists Essay Example | Topics and Well Written Essays - 1250 words

Moral Problems Raised by the Immoralists - Essay Example In this argumentative essay, I will focus on finding out whether Plato provide adequate solution to the moral problems raised by immoralists and whether he provides good reasons to suggest that the good life is the best life (Melchert, 45) Plato’s dialogue referred to as Euthyphro brings out a discussion that occurred between Socrates and his counterpart, Euthyphro. The dialogue concerns the meaning of piety, as brought out by Socrates asking the meaning of piety, as well as impiety. He tries to clearly find out this virtue which he mostly regards as a manner of living that brings satisfaction to one’s duty both to gods and to humanity, this he affirms by saying â€Å"that which is considered holy by God is piety† This is of concern with respect to the fate of Socrates, who as seen from the dialogue has been accused of impiety and is thus is almost to be tried before the Athenian court in order to establish his guilt or innocence of the crime accused to him. His consistent argument is based on the opinion that the Athenian societies generally did not comprehend the real nature of either devotion or wickedness (Melchert, 18). This is observed when Socrates asks Euthyphro to reply to the question â⠂¬Å"What is piety?† He has an aim in doing this, for Euthyphro, a sophist, claims to be wise concerning such issues, while in the case of Socrates is making no such claim for himself but professes to just be ignorant. Socrates tries to find out how wise Euthyphro, and if not to the given standard, he will expose the shallowness of his claim. The statement of Socrates saying, â€Å"In cannot assent to your superior wisdom†. Euthyphro is seen to have the fame of being a wise individual, a mystic, and a fortuneteller. Being a teacher, he provides instructions on moral and political matters, as Socrates states, â€Å"I have become your disciple. You Mellitus, as I shall say to him, acknowledge Euthyphro to be a great theologian, and sound in his opinions†, (Plato’s Republic, 34).

Philosophy and theory of architecture Essay Example | Topics and Well Written Essays - 3500 words

Philosophy and theory of architecture - Essay Example Common features however, are considerations such as aesthetics, proportion, and surroundings. Present changes revolve mainly around the need to cope with environmental concerns but the despising of modernism runs deeper. It is generally seen as lacking in character. Prince Charles champions the call for returning to more traditional styles of architecture. A case study of Regent’s Park Mosque in London showed the building is a blend of both Islamic and modernist architectural elements. It reflects the thinking at the time of its construction. Nonetheless, it is evident of the diversity of ideas and practices present today. Architecture, its underlying philosophies and a look at Regent’s Park Mosque This paper examines some theoretical underpinnings of architecture from a philosophical perspective. It shows how theories of design presuppose specific concepts and theories. A brief overview is made of some historical and contemporary architecture and a discussion follows o f present day changes in thinking on architecture. Attention is given to the views of Prince Charles on architecture as they represent those that are dissatisfied with modernism and who hearken back to earlier architectural thinking. The global environmental changes are also contributing to the changed approach. A case study is then made of a particular building in the UK in order to illustrate such ideas, namely the Regent’s Park Mosque in central London. Architecture is intricately related with philosophy. Architecture is after all an imposed organisation of a social space, and that space has to be designed with considerable thought. A certain intended expression is exuded, which holds associations and meanings for the people who see and use the building. Many important religious buildings for example, are designed to be imposing or soothing and evoke an appreciation and respect for the almighty being. They are designed to be experienced at a deeper level so they have stron g philosophical foundations. These and other planned buildings are typically large or otherwise of some importance. They affect the lives of people in some significant way or other. Beauty is one of the important features of the outcome of architectural planning and what we come to expect from a specially designed building. According to de Botton (2008), ideas of a meaningful life are what we consider to be beautiful in architecture. People love beautiful buildings because they represent the kind of ideas about the world we live in and ourselves that they can relate with. The theme of his book deals with the search to find the kind of dwellings in which people could stand the greatest chance of happiness. In doing so, he traces the development of various styles of architecture that have attempted to satisfy human needs and desires. However, the explanation for what makes for happiness is more psychological than philosophical. People do not only associate beauty in buildings with the ir feelings but also their thoughts, and their conception of what is ideal. Kantian philosophers link aesthetics with using logic for aesthetic judgment. They â€Å"suppose that free beauty is simply beauty, but the beauty of works in particular arts is judged beautiful in the light of some antecedent notion of artistic perfection† (Mitias, 1994: 3). That is to say, a specially planned building as opposed to an ordinary building is usually judged based on some understanding of its nature

Steel Prices on the World Market Essay Example | Topics and Well Written Essays - 2500 words

Steel Prices on the World Market - Essay Example i) Number of Steel Plants (Over supply caused reduction in plants via bankruptcies, mergers and plant concentration) Increase of Supply can only be achieved by increasing production capacity via (i) more plants (slow process as lead time is many years due to cost, market entry barriers via government regulations, environmental regulations, investment capital requirement to finance installations, complex mechanics), or (ii) increase of productivity within the plants (possible to a certain extent only until capacity is maxed out, The question of steel Prices has moved into the center of attention of the economic world since they started skyrocketing over the last 2 to 3 years. As steel is at the core of a large number of products, increases in the base product have a tremendous effect on the prices of subsequent product and thus on several price indices. In the extreme, certain business areas can be largely effected by shortages and price increases, strongly influencing their overall profitability and ultimately, in certain cases, threatening their survival. In the following I would like to investigate some of the causes, effects and remedies of this phenomenon and will attempt to make some predictions as to its future development. So while both primary and fu... As steel is at the core of a large number of products, increases in the base product have a tremendous effect on the prices of subsequent product and thus on several price indices. In the extreme, certain business areas can be largely effected by shortages and price increases, strongly influencing their overall profitability and ultimately, in certain cases, threatening their survival. In the following I would like to investigate some of the causes, effects and remedies of this phenomenon and will attempt to make some predictions as to its future development. It is being reported that steel price is one of the major contributors to the overall increase in wholesale price index. A little analysis would put the thing in right perspective. Item Weight Index on 24.7.04 (Base:1993-94=100) % Growth over last year % Contribution to price rise All Commodities 100 186.2 7.5 Primary Articles 22.02 191.0 6.3 1.4 Fuel, Power, Lubricants etc 14.23 274.4 10.0 1.4 Manufactured Products 63.75 164.9 7.1 4.53 Iron & Steel 3.64 240.9 45.0 1.6 So while both primary and fuel have contributed 1.4 percent each to 7.5 percent increase in WPI indices during the last one year, the prices of manufactured products has led to a 4.53 percent growth in prices. And out of the manufactured product prices, the prices of iron and steel items have contributed 1.6 percent to the overall price rise. This implies that around 21 percent of the general price rise in the last one year has been accounted for by prices of iron and steel. Under any counts this is substantial and unprecedented. The direct linkage of domestic steel prices with international prices is frequently being cited as the

Pre School Observation Essay Example | Topics and Well Written Essays - 1500 words

Pre School Observation - Essay Example It can be noticed that many children in the class are overweight but Edwin seems to be have a well proportioned body. Edwin is one child in the class who has good physique. 3. The three things that acknowledged his status as a preschooler was his talkative attitude, his impulsive behavior and his hyperactivity. I observed the way he talked, which was without a break. Moreover he was not able to stand in one place; he was very impulsive and acted whatever he spoke out in words. Also he was not standing in one place and was moving continuously. 4. Looking from the health perspective, Edwin was a normal child with good physique and a cheerful attitude. But it is a fact that he is bit over grown compared to his classmates. His body also showed an overgrown aspect which when compared to his aged children become odd. I can take this fact as a hereditary attribute as his parents both are tall and well built. Emotionally he seemed to be strong with good activity and physical capabilities. 1. While observing closely, the three gross motor skills that can be pinpointed are the way he walked, ran and did sit dups. I noticed that while walking, he was not placing his foot with pressure on to the ground and it seemed as if he is not touching the ground with his feet. While running, I observed that he ran with his shoulders stooped to front which was not a healthy way of running, this can hurt his shoulder with time. When I asked the class do sit –ups, he could not get up properly and had to place his hands on legs. I could see that Edwin was not enjoying the sit – up movements. 2. While comparing what I read in book and activity of Edwin it can be understood that what Edwin was doing was not exactly right. The walking part can be understood as he his hyper but to place shoulder stooping while running is not a recommended activity. Doing sit – ups he was normal as

The Scarlet Letter by Nathaniel Hawthorne Research Paper - 1

The Scarlet Letter by Nathaniel Hawthorne - Research Paper Example Her lover Reverend Dimmesdale whom she had chosen to protect later confessed at the gallows where Hester was punished earlier and dies. Chillingworth, who was Hesters husband, also dies leaving Hester and pearl alone. After several years, Hester died and buried near Dimmesdales’s grave; they shared the gravestone with writings â€Å""On a field, sable. The letter A, gules" (Hawthorne). In Chapter one, the prison door is symbolic, it is introduced in this chapter, and it is used when a crowd of people was standing outside the prison. It is built with heavy oak and is studded with iron spikes. There is a rose bush that grows near the same prison door; this shows how nature is kind despite being criminal it is said to provide â€Å"sweet moral blossom† (Hawthorne). The character Hester Prynne is introduced in chapter two. Sin, social order, and knowledge are clearly shown. The writer uses the symbol to depict sin, and that sinner must be punished in public according to puritan customs and belief. Hester’s punishment was to be an example to other people who were planning to commit adultery. However, only the woman was punished, and the man left, the women did not seek to pity, Hester instead they condemned her as a sinner, an adulterer. They saw her as a great sinner, they never imagined they being sinners. Hester fights it by accepting the condemnation for the need for love after his husband going along with the possibility of being dead. The perfect embroidery of the â€Å"A† letter on her dress was a sign of acceptance the women saw it as Hester was proud of the sin she had committed. She accepted the reality rather than resisting since her child was the fruit of the act. Resisting it was like opposing her child, Pearl. Hester from the beginning was different from other women she was said to be beautiful, tall and radiates natural dignity, unlike other women. The third Chapter introduces Hester punishment as an act against humanity; the puritan order makes

Using Bicycles as an Alternative to Automobiles Essay Example for Free

Using Bicycles as an Alternative to Automobiles Essay Abstract: This paper basically shows the reasons to use the bicycle as an alternative mode of transportation. It will points out the benefits of the use of a bicycle. It will also show what is being done to get rid of the negative aspects of using a bicycle for transportation. Bicycling is one of the fastest growing forms of recreation. People are drawn to it for many reasons, being out in the fresh air, the thrill of speed, the physical challenge, along with many other things. But there can be many more uses for the bicycle. The use that this paper will focus on is transportation. The use of bicycles can greatly improve the economy of a nation. A comparison between the efficiency of the transportation systems of the United Stated and Japan points this out. In 1990 Americans spent 17. 9 percent of the GNP on transportation, whereas the Japanese spent only 10. 79 percent on transportation. This difference of nearly 7 percent, gives the Japanese economy much more money for investing in their future. Our Economy is not the only thing we should worry about, and it is also not the only thing that can be improved by the use of bicycles. There are several major problems that could be drastically reduced by the increased use of bicycles. Traffic would be a lot lighter due to the extremely small size of bicycles. It would also greatly reduce the wear and tear on our roads and highways, and therefore reduce government expenditure. But one of the most serious problems it would reduce is that of pollution and smog in out larger cities. There are more benefits to biking, though. There are benefits that come at a more personal level. Biking greatly improves ones health. It can be a way to exercise without taking much times out of ones schedule. The time one would spend biking to work serves two important purposes. One, getting to work, but also as a great form of exercise. Improved mobility in crowded situations. In downtown areas, biking to work may actually save time. Cars crawl through congested traffic, while bicyclists ride around it. The time it takes to park a car could also be factored in. Finding a parking space takes time and may be far away, while bikes are easy to lock and can be locked close to any destination. Personal economics are also important. Cars are expensive to own and operate. On top of the high prices for new cars, one must also pay for insurance, fuel, and maintenance. Not only is the price of a new bicycle much lower, they cost almost nothing to operate. Still with all of these benefits, many people choose not to consider a bicycle as a viable form for transportation. People feel that it is to time consuming, to inconvenient, and to dangerous. But there are things that can be done to change these facts. How a city is designed will play a large part in whether or not people choose to use bicycle as a form of transportation. Many of Americas large cities are not very friendly to the bicycle commuter. City streets should be wide enough to have room for a safe sized bike path that is separate from automobiles and pedestrians. This would improve the safety of bicycling. Another method that can be used is traffic calming. Traffic calming is a term that has emerged in Europe to describe a full range of methods to slow cars, but not necessarily ban them, as they move through commercial areas and residential neighborhoods. Traffic calming exists in certain downtown areas as a natural outcome of design initiatives to accommodate sizable special populations. Some the best examples of traffic calming are not in the United States. Traffic calming was originally introduced in the Netherlands and Germany, but is now being put to use in Denmark, Sweden, and the United Kingdom. In 1981, Germany set up six traffic-calming demonstration projects in various places with varying density. The initial reports showed that there was a reduction of speed from 23 mph to 12. The traffic volume remained constant, but there was a 60 percent decrease in injuries, and a 43 to 53 percent reduction in fatalities. In a recent survey, most people showed that if conditions where improved, more people use bicycles to commute. Things are being done to make things better. Private organizations are offering incentives and promotions, and our government is also making legislation to improve things. The need for bicycle and pedestrian provisions to be fully integrated into state and local plans and transportation policy documents has assumed even greater significance due to the ISTEA and the Clean Air Act Amendments of 1990. States were not required to have long-range transportation plans until ISTEA was passed, and Metropolitan Planning Organizations have had little or no control over project selection until now. Because of this fact, in the past, State highway agencies have dominated the spending of highway and transportation dollars. Plans developed at the city level would often contain many worthy transit and non-motorized projects. ISTEA makes a number of important changes. Both levels of government are now required to produce annual transportation improvement programs and long range transportation plans. These plans shall provide for the development of transportation facilities (including pedestrian walkways and bicycle transportation facilities) which will function as an intermodal transportation system. (Section 1024 (a) and 1025 (a)) State long-range plans are required to have consider strategies for incorporating bicycle transportation facilities and pedestrian walkways in projects where appropriate throughout the state. (Section 1025 (c)(3)) State long-range plans are also required to have a long-range plan for bicycle transportation facilities and pedestrian walkways for appropriate areas of the State, which shall be incorporated into the long-range transportation plan. People need to realize what the over use of automobiles is doing to our country. Our nations wealth is probably the greatest contributor to this problem. Americans generally feel that a car is a necessity and not a luxury. We are also spoiled with some of the lowest gasoline prices in the world. Some suggest an increase in gasoline taxes to drive people towards the use of alternative modes of transportation. Surveys shows that it would influence more people to not drive as frequently. But economists feel when the government imposes an intentional price floor on a common product, it can only hurt the economy. All of these things will help influence people to use alternative modes of transportation. But when it comes down to it, everyone must make a personal choice. Bicycles will probably never be as convenient as automobiles, and in this writers opinion, they shouldnt be. Commuting on a bike is a sacrifice in some ways, but we need to set our priorities straight. No legislation will do that for us. Boulder is probably one of the best place to get into the habit of frequently using a bicycle. In this community bikes are generally a lot more convenient than cars, in pretty much every aspect. Probably more than half of the time, I can get to wherever I want to in less time on a bike than in a car. Not to mention the time saved by not having to find a parking spot. This is accomplished by the use of good bike routes, underpasses, and having the right of way over cars. I use my bike almost daily, whereas I would probably use a car about once a week. It is also a lot more economical to ride a bike than to drive a car, especially on campus. As I already mentioned cars require several expenses, whereas bikes require almost none. Also on campus, if you have a car, you must pay for a parking permit. I plan to use a bicycle whenever and where ever possible. I think that everyone should own a bicycle and a least use it occasionally. I would like to inform other people of how easy it is to use a bicycle for transportation. References 1. United States, Integrating Bicycle and Pedestrian Considerations Into State and Local Transportation Planning (Washington: The Administration, 1994). 2. United States, Transportation Research Record, Pedestrian and Bicycle Planning With Safety Considerations (Washington: Transportation Research Board, 1987) 3. United States, Actions Needed To Increase Bicycle/Moped Use In The Federal Community (Washington: U. S. General Accounting Office, 1981) 4. Mike Hudson, Bicycle Planning (The Architectural Press: London, 1982) 5. National Research Council. Transportation Research Board. Pedestrian Behavior and Bicycle Traffic (Washington: National Academy of Sciences, 1980) 6. National Research Council. Transportation Research Board. Nonmotorized Transportation Around The World (Washington: National Academy Press, 1994) 7. National Research Council. Transportation Research Board. Nonmotorized Transportation Research, Issues, and Use (Washington: National Academy Press, 1995) 8. John T. Doolittle, Integration of Bicycles and Transit (Washington: National Academy Press, 1994) 9. http://www. tnrcc. state. tx. us/air/ms/vexercis. htm 10. http://www. nd. edu/~ktrembat/www-bike/BCY/TryBikeCommute. html.

Higher education in Canada Essay Example for Free

Higher education in Canada Essay Education, if looked at beyond its conventional boundaries, forms the very essence of all our actions. What we do is what we know and have learned, either through instructions or through observation and assimilation. When we are not making an effort to learn, our mind is always processing new information or trying to analyze the similarities as well as the tiny nuances within the context which makes the topic stand out or seem different. If that is the case then the mind definitely holds the potential to learn more, however, it is us who stop ourselves from expanding the horizons of our knowledge with self-doubt or other social, emotional, or economic constraints. While most feel that education is a necessity, they tend to use it as a tool for reaching a specific target or personal mark, after which there is no further need to seek greater education. Nonetheless, the importance of education in society is indispensable and cohering, which is why society and knowledge cannot be ever separated into two distinct entities. Let us find out more about the role of education in society and how it affects our lives. Receiving a good education helps empower you, thus making you strong enough to look after yourself in any given situation. It keeps you aware of your given surrounding as well as the rules and regulations of the society youre living in. Its only through knowledge that you can be able to question authority for its negligence or discrepancies. It is only then that you can avail your rights as a citizen and seek improvement in the structural functioning of governance and economy. Its only when a citizen is aware about the policies of its government can he be able to support or protest the change. As a whole, people can bring about development only when they know where improvement is necessary for the greater good of mankind. Education helps you understand yourself better, it helps you realize your potential and qualities as a human being. It helps you to tap into latent talent, so that you may be able to sharpen your skills. Another importance of education is that it helps you gain sufficient academic qualification so that you are able to get suitable employment at a later stage. A decent employment would be combined with hard-earned remuneration or salary through which you can look after your personal expenses. While you earn for yourself, you gradually begin to realize the true worth of money and how hard it is to earn it. You realize the significance of saving for a rainy day and for unforeseeable contingencies. There also comes a phase when the amount you are earning presently will seem inadequate because your aspirations and expectations from yourself would have grown considerably. After this, you will want to change jobs so as to have a higher profile. However, here is when you need to be prepared. A promotion of this figure can occur in two given situations, which are, that either you have the necessary higher academic qualification or a college degree which allows you a safe passage, or that you have amassed enough practical experience which allows you to be a suitable candidate for the employment you seek. This is why college education is very important after high school and must not be taken for granted. When faced with the option of choosing between a highly qualified candidate and a not so educated candidate, the employers will most probably go in for the qualified person. The reason being that, a qualified candidate will not require much investment of the employers time and money. The organization need not teach him or her the tricks of the trade, or the various ways of functioning and performing the tasks of the workplace. On the contrary, a novice / amateur applicant would need to be taught everything from scratch, which many employers are usually not willing to do. The same applies for people who seek higher education and get advanced diplomas while working. These people are continuously improving their profile and their knowledge base so as to go higher up on the competitive ladder. Those who have amassed enough education, steer the path of development and progress for their country. It is these individuals who go ahead and become teachers, scientists, inventors, welfare activists, soldiers, and politicians who work together to form the very backbone of the society. Without this pool of intellect, the economic and social framework would crumple and fall, paving its way for anarchy, degradation, and violence. While this intricate balance of growth is maintained, there will be a continuous rise in progress in all quarters of life, whether that be personal growth, or development of the nation as an entity. This progress has a very important role to play for the coming generations, which will reap the benefits of our hard work, as they develop it further. At the same time, the negative impact of our actions shall have its collateral damage on the coming generation as well. Which is why we must be exceptionally prudent about the decisions we make and the actions we take in the present. This is when you will decide to become a self-employed individual, who would like to watch his / her own ideas take realistic form. You would prefer being the one offering job opportunities to others and aid in providing income to them. At this stage of entrepreneurship, you may use your own expertise as well as that of other trained and skilled associates. As a team, you will find your business or venture expanding and yielding good results. You may even gain the confidence and insight, which will help you diversify and spread your expertise into other business arenas, which were previously unknown to you, or you were unsure about. This ability, comes with experience and knowledge amassed over the years. Education and studying regularly, gives people of all age groups something substantial and challenging to do. It helps them think and use their idle hours, doing something productive and worthwhile. Education need not be purely academic and may include reading for leisure or as a passion for literature, philosophy, art, politics, economics, or even scientific research. There is no limit, to all that you can teach yourself, only if you take the interest to learn and grow as an individual. However, those who treat knowledge as trash, eventually find themselves getting absorbed with thoughts of violence, and jealously against those who are better off than themselves. It is people such as these who turn towards drug addiction, unnecessary rebellion, crime, and plain inactivity. Such people lack the self-esteem, that a good education often provides to its followers. Education is an important factor inside mankind’s existence. Youngsters who want to always be Educate will offer a greater impending for the kids or maybe their own around close relatives in addition to nations. Using improved Education, numerous other areas are generally favorably damaged. In other words, education gets the power to produce the earth a greater location. Knowledge implies you could receive a greater handing over method, that can implies you could be more in financial terms guaranteed. Advises people how to deal with liability, Will give you giving her a very means to contemplate without help as well as back-up your battles. Shows someone to extra on the acquaintances allowing you to find as well as data wide variety and different factors relating to perspective. Assists you to recognize your prospective, that can implies you could permit you to eventually carry out higher than everyone believed you could potentially carry out before. Education starts with preschool and end up receiving excellent stage may be operations, medical professional, electrical engineer, builder, attorney at law and many other. Within reasonably competitive life group of friends also to preserve common leaving its required to get these levels. Due to the fact this will make a decision the future and can assists to offer the Vision imagine anyone. Education and learning will be a sort of common competition established by culture, its obligatory for all to be able to get involved as well as gain the particular competition. Due to the fact With out having formal study as well as levels humans usually are not whole throughout today’s world. Education the only real instrument which will keep updating those on a regular basis and yes it aids to visit to your next label within lifestyle. Knowledge enables folks work better and can build opportunities with regard to maintainable as well as practical monetary progress now as well as time. Understanding inspires presence, excellent federal, equilibrium as well as enables challenge towards graft as well as offender motion. Education is essential for everyone. It is the level of education that helps people earn respect and recognition. In my opinion, it is indispensable part of life both personally and socially. However, the unequal standard of education is still a major problem that needs to be solved. The importance of education is undeniable for every single person. It goes without saying that education has a positve effect on human life. All people need to study. Only with the advent of education can people gain knowledge and enlarge their view over the world. For example, learning by watching TV or reading books gives people a huge amount of information about anything they are interested in such as mathematics, current news, exchange rates, other countries cultures and so on. Apparently, people may become more useful and civilzed if better educated. In areas where residents are not able to receive an appropriate education, life cannot be as thriving and properous as locations where there is a high standard for education. Conclusion Education is absolutely beneficial for society on the whole. It is a life-long process to each person that need to be reinforced throughout life.

Intergrated marketing communications in the retail banking sector

Intergrated marketing communications in the retail banking sector Nigeria is among the developing countries in the World today. In the 1980s, several developing countries pursued some form of financial liberalization program or other, in order to boost the development of their countries. (Ayadi and Hyman, 2006). In achieving this financial liberalization, the First Bank of Nigeria Plc played a major role since the development and maintenance of the Nigerian economy. Being the first of its kind in Nigeria. The Nigerian Banking system started its history as far back as 1892 with the establishment of the African Banking in Lagos, the Capital of Nigeria as at then; it was taken over by the Bank of British West Africa (BBWA) in 1894 and was later acquired by Standard Bank of West Africa in 1965. In 1969, Standard Bank of West Africa incorporated its Nigerian operations under the name Standard Bank of Nigeria. In 1971, Standard Bank of Nigeria listed its shares on the Nigerian Stock Exchange and placed 13% of its share capital with Nigerian investors. The bank changed its name to First Bank of Nigeria in 1979. (The journalof African society). Now, First Bank is the biggest bank in Nigeria out of the 25 banks, it has been rated as the largest RETAIL lender in the country. FBN has a subsidiary in London, UK which started its operation in year 2002 having a branch in Paris. The bank as at 2009 December had a total asset of N2,172 billion (USD14,718 million). (First Bank Financial Highlights 2009). Being the first of its kind in Nigeria, it has made a large clientele base and this has given the management so much confidence and a sense of satisfaction which has led to the neglect of customers satisfaction maximizations and feelings. There are 25 banks in Nigeria, although FBN Plc has been rated has the largest retailer bank, other banks are improving on the loop holes of their products and services and using that medium to sap their customers. The Nigerian populace has come to realise that they own the money (capital) of the bank and because of that; they should get the best products and services possible. Doole et al, (2005) says In the fast moving competitive environment it is vital for organisations to provide customer satisfaction otherwise they risk losing their customers to competitors. The penalty for not providing customer satisfaction can be a steep decline in the organisations performance, as Marks Spencer, McDonalds and British Airways (BA) have recently found. Integrated marketing communication consists of varieties of medium of communication all in the name of satisfying customers in order to get new customer and to retain existing customers. Zeithaml et al (2006) says, marketing communication is more complex today than it used to be. In the past customers received marketing information about goods and services from a limited number of sources, usually mass communication sources such as network television and news papers. With a limited number of sources, marketers could easily convey a uniform brand image and coordinate promises. However, todays consumer of both goods and services receive communications from a far richer variety of advertising vehicles- targeted magazines, websites, direct mail, movie theatre advertising, e-mail socialisation and a host of sales promotion. Consumers of services receive additional communication from services capes, customer service departments, and everyday service encounter with employees. FBN Plc is the biggest bank in Nigeria in terms of asset and clientele base but lacks a proper integrated marketing communication system. It has so much relied on the facts that it is the first bank ever in the country and the Nigerian populace believe strongly in the bank because of its strong asset base and because it has stood the test of times. Despite their strong clientele base, FBN can single handled own 90% of the customer population in the country if it adopts IMC. Chris Fill (2009) IMC has emerged partially as a reaction to this inadequacy and to the realisation by clients that their communication needs can (and should) be achieved more efficiently and effectively than previously. The FBN customers are yearning for qualitative and uniform information about their funds and interest. The Nigerian government created a monetary policy reform that was geared to stabilize the economy in short-run and to introduce a market system for effective allocation of resources. The efforts were directed at promoting financial savings, reducing distortions in investment decisions and inducing an effective intermediation between savers, investors and their financial institutions. (Ayadi and Hyman, 2006). Integrated marketing communication build a strong brand identity in the market place by tying together and reinforcing all your images and messages. IMC means that all your corporate messages, positioning and images, and identity are coordinated across all venues. It means that your PR materials say the same things as your direct mail campaign and advertising has the same look and feel as your website. (Zeithaml et al 2006). Thus this research work aims to explore the opportunities awaiting FBN Plc after adopting a well integrated marketing communications system to boost its customer satisfaction. Research Questions and Objectives: Identify the need, want and demand of the market. Identify the causes of lack of customer satisfaction Identify and evaluate the market opportunities for FBN Plc. Analyse the FBNs competitive advantage over its rivals Develop a well qualitative and quantitative integrated marketing communication system for FBN Plc. Methodology: Conceptual Framework and Design Fisher (2010) says conceptual framework is formed of patterns of concepts and their interconnections. It is usually based on cause and effect relationships which are often the basis of hypotheses that such research seeks to test. It has also been noted by Easterby- smith et al (2002) that conceptual framework helps to take a more informed decision about the research approach, decide which method(s) are appropriate for the piece of research, and also to think about constraints which may impinge on the research. FBN Plc being a bank and with diverse staff and customers spread all over the country, it is therefore advisable from the understanding of methodology (conceptual framework) to go by positivism approach which is linked to quantitative method. Yates (2004) states that other approaches (quantitative methods) within the social sciences may come from the fact that natural science methods appear to be successful in their field of use. Most research texts have categorised research into two parts; quantitative and qualitative approaches. (Knox 2004) notes that this is mostly done for ease of explanation or to reflect differences in style or marketing, (for structural reasons or for addressing alternative research disciplines) or simply differences in approach is in hindsight for the research. It is said by Yates (2004) that from research texts, the relationship between positivism and quantitative method is almost a law or truth. He then further highlights (with other authors) that quantitat ive methods can be used with other areas of examples within the social sciences. Also that one can argue clearly that positivist thinking has influenced quantitative or numeric research. This could be as a result from the justification that quantitative methods are just as appropriate within an interpretivist piece of research. Ticehurst and Veal (2000, p15) support this linkage between quantitative and positivism by stating that the quantitative approach to research is also known as management science or operations research. Therefore linking discipline with philosophy. Saunders et al (2003) sees research process as an onion. Adapted from Knox (2004, P.123) Within this onion the second layer refers to the subject of the research approach that flows from ones research philosophy. Therefore linking the philosophy of positivism with different approaches. This onion has now explained that ones research could make do with Deductive Approach: develop a theory and hypothesis or hypotheses and design a research strategy to test the hypothesis. Inductive Approach: in which data will be collected and a theory will be developed as a result of data analysis. (Saunders et al (2003). Deductive approach is a form of reasoning in which a conclusion is validly inferred from some premises and must be true if those premises are true. And Induction is a form of reasoning that usually involves the inference that an instance or repeated combination of events may be universally generalised. (Malhotra, 2003). From the above, I as a researcher in the case of FBN Plc have chosen to use from the Onion; Positivism approach which will lead me to deductive approach (quantitative method). I am expected to use this approach to identify an area of enquiry which is the customers and members of staff of FBN Plc to be able to have a good background of developed theory, which is seen as crucial for, guide me. The issues to focus an enquiry upon emerge from the established theoretical framework i.e., the customer service procedure, products and services and information given to customers about their funds. Specific variables are identified that the researchers deem should be measured, i.e., hypotheses are set. An instrument to measure specific variables is developed. Respondents give answers to set and specific questions with a consistent language and logic. The response to the set questions are analysed in terms of a prior established theoretical framework. The researcher tests theory according to whether their hypotheses are accepted or rejected. (Malhotra,2003). Knox (2004) concludes that positivist paradigm is majorly used by marketing researchers (positivism = deduction =quantitative methods); in aligning methods with philosophical stances. It also helps to form the nature of techniques that are applicable by researchers. Alternative Paradigm Names Positivist Interpretivist Quantitative Objectivist Scientific Experimentalist Traditionalist Qualitative Subjectivist Humanistic Phenomenological Revolutionist Adapted from Malhotra(2003 p.138). Easterby-Smith et al (2002 p28) argue that the key idea of positivism is that the World exists externally, and that its properties should be measured through objective methods. This infers that only knowledge, which is observable, is in fact valid. This then brings together the epistemology of positivism with quantitative methods i.e. methods which are essentially numerical evidence, following a very natural science approach to the research in hand. In reference to the Onion diagram, the third layers consists of six Research Strategies which include; Experiment, Survey, Case study, Grounded theory, Ethnography and Action result. This research is to make use of all these strategies to know the expectation of customers and what the management and staff are ready to deliver to their customers. Saunders et al (2003) further expatiated on data collection to be by the following which will be the means of my gathering of information; Case study (questionnaires, interviews, observations) and Documentary analysis. Expected data collection: Collection of primary data will be conducted majorly in Nigeria through personal interviews (observations), questionnaires for customers and staff of FBN Plc, and customers and staff of other banks. A major interview will be conducted with the Head of Department of the following units; Retail, Human Capital and Social and Welfare (customer service) at the Regional office. Secondary data will be collected through the customer and staff complaint boxes, financial news and reports and other related websites. Resources: This deals with how to find things out by research than discovering things by reading literature. Fisher et al., (2010). In gathering information for the research work, survey research will be adopted to have accurate and generalised views. In having a successful research work, one needs to make use of several resources in the survey approach which includes the following: Questionnaire: a question is a method of obtaining specific information about a defined problem so that the data, after analysis and interpretation, result in a better appreciation of the problem. In this research work, the questionnaire must have these set of information inclusive Facts and knowledge Opinions Past behaviour Future behaviour (chisnall 2005). Pilot testing questionnaire: chinall (2005) notes that, it is vitally important to make sure that questionnaire are piloted through all the stages of development. He further explains that it contains question which are specific, clearly understandable, capable of being answered by particular population sampled and free from bias. Webb (2002) confirms that piloting of questionnaire helps to evade participants biased answer. Personal interviews: helps with structured questions like rating question in self-response instruments and open-ended questions. These are orally presented, with the advantage that there is the opportunity for the interviewer to interpret questions, clear up misunderstanding, or gather data from those not fully literate from the designers language. (Black, 1999). It also helps observe and quantify the respondents attitude when interviewed. Documentary analysis: this is analysing the news originating from the financial sector of the country, news about the general views of customers and staff and complaints of staff and customers. Ethical issues: this poses as a problem in gathering information from staff and customers when there is a restriction on privacy, customers and staff that believe they should be loyal to their bank and employer and this can be done by keeping some things secret. Research bias: Saunders et al.,(2009) says to avoid research being bias, questionnaires and interviews must be designed and tested before being put to use. Time: a time frame must be set to achieve the expected result for the research. Literature Review To appreciate the importance of integrated marketing communication (IMC) it is useful to understand its origin and the major elements that have helped in its development. For many years agencies and clients believed that to deliver messages to particular audiences it was necessary to use specific tools of the communication mix. At the time it was a common belief that to achieve specific communication effects on buyers it was necessary to use particular tools. (Chris Fill,2009). Schultz et al.,(1993) says the practice of integrated marketing communication is emerging as one of the most valuable magic bullets companies can use to gain competitive advantage. Advertising, sales promotion, direct response marketing, and public relations practitioners are busy finding common ground to meet the coming challenge of selling to customers rather than market. This explains that integrated marketing is not out to increase profitability alone but also to achieve maximum customer satisfaction. IMC has now emerged as the response to this structural shortfall and the realisation by customers that their communication needs can (and should) be achieved more efficiently and effectively than the way it was in the past. IMC develops and extends the notion and value as a communications process targeting a firms external market. By directing Internal Integrated Marketing Communications (IIMC) towards their employees, firms are able to promote employee satisfaction, trust and commitment, thereby strengthening the firm-employee relationship and ultimately affecting profitability by enhancing customer satisfaction (Herington, Johnson and Scott 2006). By achieving employees satisfaction, trust and commitment, it results in employees dedication and putting in their best at their duties and this helps increase customer satisfaction. Gummenson (2002) confirms this, that previous studies have shown that employees who are familiar with and committed to an organisations market orientation and brand values play a critical role as part-time marketers. All customer oriented employees, not just those associated with marketing, help to deliver the brand promise. They can influence relations, increase customer satisfaction, customer perceived quality and ultimately revenue. Therefore, directing integrated marketing communications towards a firms internal market is itself a critical part of achieving sustainability and profitability. (Ferdous, 2006). Schultz et al., (1993) have produces a lively, no-nonsense critique of this fast moving marketing trend in integrated marketing communications. Taken alone, the early chapters documenting the shift from mass production to mass marketing are worth the price of the book. Yet the real meat of the text is revealed as the authors analyze the emerging reality of true one-on-one marketing to individuals, a reality made possible by the power of information technology to develop this ultimate consumer segmentation approach. The fundamental reasons offered for the popularity of Integrated Marketing Communications (IMC) among marketers is that it is good for the bottom line and a necessity in todays fractured market place. Nonetheless, despite the evolution and increased critical evaluation of IMC, it remains neither universally understood nor universally accepted as a useful construct. Furthermore, IMC is not consistently applied as a marketing principle and according to Hutton à ¢Ã¢â€š ¬Ã‚ ¦has resulted in superficiality, ambiguity and blurred focusà ¢Ã¢â€š ¬Ã‚ ¦ (Hutton 1997, p. 8). It is high time financial institutions realised that they all offer the same products and services and the only thing that can put a major distinctive difference to their services and product is by going extra mile to adopt IMC. Financial products are controlled by regulatory authorities in an economy. It includes administrative tinkering by governments with financial prices such as interest rates and exchange rates. McKinnon and Shaw (1973) further agrees that financial institutions are generally offering the same services and are controlled by government, and this is hindered in a repressed financial system by the low level of savings, it responds in a positive way to real rates of interest on deposits as well as the real rate of growth in output. Moreover, investment is negatively related to the effective real rate of interest on loans, but positively related to the growth rate of the economy. However, if it is proven that the basic financial practices of a bank is solely dependent of government policies, it is only a good thing for the bank(s) to look for best opportunities to improve on their services to survive and sustain their stand in the highly competitive market. This is further proven by Ferdous (2008) that the fundamental reasons offered for the popularity of Integrated Marketing Communication (IMC) among marketers is that it is good for the bottom line and a necessity in todays fractured market place. IMC has been able to achieve what other marketing processes have not been able to by breaking down corporate, geographic, and political borders to reach into customers homes and offices in a matter of weeks or days through the use of worldwide networks created by computer and communications technology that have been inculcated into the process of IMC. (Schultz et al., 1993). Integrated Marketing Communication Integrated marketing communication plan. PLACE Distribution strategy CHANNEL/MEDIUM CHOICE C OTHERS (PR, POS, etc.) Objectives Strategy ELECTRONIC Objectives Strategy PERSONAL CONTACT Objectives Strategy TELEPHONE Objectives Strategy DIRECT MAIL Objectives Strategy MASS MEDIA Objectives Message strategy Media strategy Adapted from McDonald and Dunbar (2004, p.19). Ferdous (2006) describes IMC to have been variously described in terms of a process, a marketing orientation, an organisational structure, a set of marketing tools, a basis for accountability and a philosophy. In fact it is all of these. However according to Robert Lauterborn who helped coin the IMC label, What IMC has come to mean to too many people is little more than two-from-column A, one-from-column B media selection process (Lauterborn 2003, p.14). Schultz (1997) agrees that the focus has been one of à ¢Ã¢â€š ¬Ã‚ ¦. Trying to integrate discipline rather than customer or prospects communications. In addition, focusing IMC efforts on the integration of a firms external marketing communications disciplines ignores the gains in competitive advantage to be had from a horizontal integration across a firms total communications effort including that of its internal market. The need for integration is the notion that some aspects of marketing communication should be integrated. The origin of IMC can be found in the prevailing structural conditions and the needs of particular industry participants, an understanding of what elements should be integrated in order to achieve IMC needs to be established. The elements to be integrated are; relationships, structures, brands, communication tools, messages, employees, technology, agencies and IMC strategy. (Chris Fill, 2009). The integrated elements are applicable to understanding IMC as a customer oriented process in creating a common understanding of its principles and core values. It is known that the primary aim of any business is profitability which can only be achieved when customers are satisfied. Profitability as defined by Ferdous (2006) is the function of customer behaviour, and then customer orientation is not only logical but essential. IMC integrates everything that impacts customer behaviour, not just the organisations conscious outgoing marketing messages. It begins with product development and includes packaging (branding), selection of distribution channels (communication tools), channel management (agencies), customer behaviour (relationship), customer relationship management and total quality management. It involves the multi-dimensional, interactive, continuously measured communication that connects brands or products and the customer. Lauterborn (2003 p. 15). Furthermore, Cravens et al. (2003) identifies four attributes that set IMC apart from traditional promotional strategies. They are comprehensive, drawing on all of the media, tools and technologies available to affect behaviour; unified execution of all the components of the organisation; and IMC programs em phasise productivity in reaching the designated targets when selecting communication channels and allocating resources to marketing media. Before considering the delivery of values of IMC, the communication channels will be given further attention, the channels are generally complex, and they involve various media for different communication with the same set of target market or customers. Ferdous (2006), these views about IMC values share three key attributes which are fundamental to its values as a marketing concept. They recognise that IMC is about the connection between the brand and the customer and that communication in all its forms facilitates this relationship. Implicit is the understanding that marketing is the whole business from the point of view of its final result, which is from the customers point of view, marketing today is not a function, but a way of doing business; marketing is everything and everything is marketing. (Harris 1993,p.13). Most importantly in this approach is the recognition that purposeful and coordinated management of customers and their relationship with the organisation is at the heart of building brand equity, which at a time of brand proliferation is critical to success. (Ferdous 2006). The Role of Communication. Communication is the greatest use of language. John Locke has seen the use of communication as the clue to an analysis of the notion of linguistic meaning. Customer communication completes the marketing cycle, linking customer with product, service and availability. At a societal level, in order to connect to mass production and consumption there simply must be mass communications. At its best, commercial communication engages in real dialogue, transmitting value and meaning, while responding to feedback and remaining close to the external customer. Communication has the role to announce, inform, promise, persuade and influence customers to buy in by communicating and delivering customer satisfaction. ( Doole et al.,2005). Communication is the best instrument for sustaining a good relationship between a business and its customers if well understood. In as much as communication is essential between a business and its customers, so also a communication feedback is also very crucial. This because; if a wrong interpretation has been gotten from the information passed by an organisation and a feed back is not received from the customer, the customer retains the wrong information , the organisation might be repeating the same information again at great expense. But when a feedback is in place, the organisation has an opportunity to correct the misinterpreted information and pass the right information across which makes the customer a happy one. Communication when used in the right context strengthens relationships. Doole et al.,(2005) recognising that employees deliver quality, internal communication encourages affiliation with organisational values as well as providing everyday working information. He further explains that communication to both external and internal customers is central to both marketing transactions and relationships. LEVEL OF COMMUNIVATION CORPORATE BUSINESS UNIT MARKETING DEPARTMENT Product Price Promotion Place Price packaging BRAND MANAGEMENT People Sales Advertising Public relations Merchandising Direct Adapted from Doole et al., (2005p.249) This explains the level of communication and how uniquely they have their level of importance to the whole communication process of an organisation. If one malfunctions, it invariably affects the whole system. This helps to increase the value and credibility of brand communication. At this stage, it should be clearly noted that commercial communication should be based on clear intent as noted by Doole et al., (2005), a communication campaign generally seeks to both push product on to and pull products off the shelf and position the offer competitively in the mind of the consumer. Its components parts need to hang together as a cohesive whole and remain consistent with core brand values. It is further noted that during the process of product life cycle, communications have very different roles to play; Introducing new products: the role to play at this initial stage is getting target market attention, also getting the market to test the product or service and the major task at this initial stage is acceptance of the product or service. Product maturity: at this stage, the product has been accepted and needs to proceed to the next stage, the task here includes sustaining the brand identity, maintaining the loyalty, defending the market share and adding value to the product or service is the major task at this level. In a situation where the products or services face rejection or losing market share, the need to improve on the product is essential (revitalise and reposition) or direct customers towards alternative, perhaps reducing communications to bare bones dominates. With the aid of product or service campaign, messages can be charged with differentiating, reminding, informing or persuading (DRIP) or sequentially securing attention, arousing interest, building desire and promoting action (AIDA) and moving a customer from unawareness through purchase to brand loyalty. The Communication Process. The communication process of IMC is between internal external customers. This research work is based on the evaluation of IMC between the employees (internal) of FBN Plc. and its customers (external). Groonroos (1985) explained internal marketing as an instrumental behavioural strategy for developing the state of mind that allows customer service effectiveness and building of relationship marketing. Ferdous (2006), in recent times, marketing professional and scholars have given considerable importance and attention to Internl Marketing (IM). According to Lings (2004) much of the literature on internal marketing, contains a variety of interpretations of the domain of internal marketing, it aim and focus. This means, treating employees as customers, understanding and attending to their wants and views which will help achieve a positive change in employees attitudes and on the long run affecting customer (external) satisfaction positively. Chernatony ( 2001 as cited in Ferdous 2006) suggested that in order to coherently transfer brand values to the companys stakeholders, employees must develop a shared understanding of what the brand stands for, through implementation of a unified communication approach. Today, the way organisations communicate with their internal markets, better known as internal communication (IC) (Tansuhaj et al., 1998; Thompson and Hecker 2000; Ahmed and Rafiq 2003; Kong 2007) is considered one of the most essential internal marketing considerations. Ahmed and Rafiq (2003) attempted to give a more acceptable and holistic explanation of internal marketing through the use of internal communication as a cultural framework and instrument for achieving strategic alignment while building customer service competence. This is reveals the importance attached to internal (employees) communication in operationalising internal marketing concepts/activities and achieving organisational competitive advantage and success. (Ferdous 2006). External customers are the major component of a business or an organisation. Customers determine the existence and longevity of a business. It is therefore important to understand how to carefully communicate information across such that it would not be misinterpreted. Organisations should understand how they receive, process and respond to the feedbacks gotten from customers. (Doole et al., 2005). If quality is meeting and influencing customer expectation (Doole et al., 2005) and even delighting clients, then managing expectations matters. It is very crucial that employees (internal customers) do not promise more than what they can deliver. Communicating with customers regularly is critical, keeping in touch with them, comprehending their expectations, apologising and explaining the limits of service possibilities can influence their expectations and may expand their zone of tolerance. Ferdous (2006) emphasises on viewing IMC as a process that focuses on both internal and external customers is the first step to developing a c

Emerging Technologies Essays -- Digital Gadgets, Personal Information

During the 21st century the world has witnessed massive developments in technology. Almost every person is familiar with the use of digital gadgets for communication, socialization and data storage among other services (Freedman 02). The inventions of electronic devices that can be used to store, send, receive and access any information are results of advancements in technology. These developments belong to the information and communications category. Many people in today’s world make the mistake of thinking that the technological advancements that are happening right now are the only technologic advancements evolving in the world. However when it comes down to it, people have been experiencing technological advancements as early as the Neolithic period, impacting almost every aspect of life. These ancient technologies have come to be overtaken by time, as there are new ones which seem to be more efficient in accomplishing similar tasks. Emerging technologies can be said to be innovations and advancements that can be witnessed in different sectors of technology (Zelkowitz 6). Most up-coming technologies have brought synchronization of the previous developments, making them work together in achieving a similar goal. A good example of this is how video, data and telephonic technologies have now been made to work together in achieving the same goal of effective communication (Zelkowitz 12). All of these technologies used to exist completely by them self, but not anymore. Scientists developed different social services that connect people together in a form of social media. Examples of these applications include; Twitter; Facebook, Vine, and Instagram among many others. As much as these new technologies have brought efficiency and a... ...ormation, and we cannot just do away with emerging technologies just because of critics. We need to accept that everything has its share of merits and demerits, and move on. All we need is looking for means of preserving our cultures and history as well as basic education whether there are emerging technologies or not. Works cited Freedman, C. D. The Extension of the Criminal Law to Protecting Confidential Commercial Information: Comments on the Issues and the Cyber-Context. (August 01, 2013). International Review of Law, Computers & Technology, 13, 2, 147-162. http://www.tandfonline.com/doi/abs/10.1080/13600869955116#.UdhxNezkU1I Gopnik, Adam. â€Å"The Information: A Critic at Large.† The New Yorker 14 Feb. 2011: 124+. ProQuest. Web. 31 October 2011. Zelkowitz, Marvin V..Vol.73 Advances in Technology: Emerging Technologies. Amsterdam [u.a.: Elsevier, 2013. Print.

Iraq - military campaign Essay -- essays research papers

Abstract  Ã‚  Ã‚  Ã‚  Ã‚  1 1.  Ã‚  Ã‚  Ã‚  Ã‚  Introduction  Ã‚  Ã‚  Ã‚  Ã‚  2 2.  Ã‚  Ã‚  Ã‚  Ã‚  Past experience  Ã‚  Ã‚  Ã‚  Ã‚  2 3.  Ã‚  Ã‚  Ã‚  Ã‚  Diplomatic problems  Ã‚  Ã‚  Ã‚  Ã‚  2 4.  Ã‚  Ã‚  Ã‚  Ã‚  Concept of Operation  Ã‚  Ã‚  Ã‚  Ã‚  3 5.  Ã‚  Ã‚  Ã‚  Ã‚  The campaign  Ã‚  Ã‚  Ã‚  Ã‚  3 5.1.  Ã‚  Ã‚  Ã‚  Ã‚  Air power  Ã‚  Ã‚  Ã‚  Ã‚  4 5.2.  Ã‚  Ã‚  Ã‚  Ã‚  Ground operations and special forces  Ã‚  Ã‚  Ã‚  Ã‚  5 5.3.  Ã‚  Ã‚  Ã‚  Ã‚  Iraqi strategy and tactics  Ã‚  Ã‚  Ã‚  Ã‚  5 6.  Ã‚  Ã‚  Ã‚  Ã‚  Intelligence  Ã‚  Ã‚  Ã‚  Ã‚  6 7.  Ã‚  Ã‚  Ã‚  Ã‚  Psychological operations  Ã‚  Ã‚  Ã‚  Ã‚  6 8.  Ã‚  Ã‚  Ã‚  Ã‚  Public relations  Ã‚  Ã‚  Ã‚  Ã‚  6 9.  Ã‚  Ã‚  Ã‚  Ã‚  Technology  Ã‚  Ã‚  Ã‚  Ã‚  6 10.  Ã‚  Ã‚  Ã‚  Ã‚  Casualties  Ã‚  Ã‚  Ã‚  Ã‚  7 11.  Ã‚  Ã‚  Ã‚  Ã‚  Weapons of mass destruction (WMD)  Ã‚  Ã‚  Ã‚  Ã‚  7 12.  Ã‚  Ã‚  Ã‚  Ã‚  Conclusion  Ã‚  Ã‚  Ã‚  Ã‚  7 13.  Ã‚  Ã‚  Ã‚  Ã‚  References:  Ã‚  Ã‚  Ã‚  Ã‚  8 14.  Ã‚  Ã‚  Ã‚  Ã‚  Glossary of terms  Ã‚  Ã‚  Ã‚  Ã‚  9 1.  Ã‚  Ã‚  Ã‚  Ã‚  warfare  Ã‚  Ã‚  Ã‚  Ã‚  9 2.  Ã‚  Ã‚  Ã‚  Ã‚  vanguard  Ã‚  Ã‚  Ã‚  Ã‚  10 3.  Ã‚  Ã‚  Ã‚  Ã‚  breach  Ã‚  Ã‚  Ã‚  Ã‚  11 4.  Ã‚  Ã‚  Ã‚  Ã‚  sortie  Ã‚  Ã‚  Ã‚  Ã‚  12 5.  Ã‚  Ã‚  Ã‚  Ã‚  enclave  Ã‚  Ã‚  Ã‚  Ã‚  13 6.  Ã‚  Ã‚  Ã‚  Ã‚  domain  Ã‚  Ã‚  Ã‚  Ã‚  14 7.  Ã‚  Ã‚  Ã‚  Ã‚  envisage  Ã‚  Ã‚  Ã‚  Ã‚  15 8.  Ã‚  Ã‚  Ã‚  Ã‚  resistance  Ã‚  Ã‚  Ã‚  Ã‚  16 9.  Ã‚  Ã‚  Ã‚  Ã‚  paramilitary  Ã‚  Ã‚  Ã‚  Ã‚  17 10.  Ã‚  Ã‚  Ã‚  Ã‚  campaign  Ã‚  Ã‚  Ã‚  Ã‚  18 Abstract This article draws together early military implications of a campaign where intensive operations lasted just about a month. The deeper insights will need much more time for the post operations reports to be written, detailed batt... ...#8226;  Ã‚  Ã‚  Ã‚  Ã‚  Does technology replace troops? •Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Can air power now eliminate the power of armies to defend? •Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Do logistics still constrain rates of advancement? •Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Are special forces assuming greater importance for future warfare? •Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Did the coalition get its media strategy right? •Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  How accurate was intelligence? •Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  How important are allies? •Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  What are the combat applications of the need to rebuild a nation after a conflict? Now, more than a year after the official end of the war, one thing is clear. Only the military part of the operation went approximately according to plan. Everything else went wrong. The peace still hasn’t returned to the country and it seems that occupational forces can’t provide it. The country is on the edge of religious war and it will be hard to extinguish that flame. Iraqis and democracy had to pay high price for cheap gasoline in the United States.

Unmasking Monsters of Meaning in the ‘Narrative Complexity’ of Supernat

The subjects of this study, The X-Files (Carter, 1993-2002) and Supernatural (Kripke, 2005-), can be seen as innovative pioneers of ‘Narrative Complexity’ and of the ‘monster-of-the-week’ concept. The X-Files stars FBI agents, Mulder and Scully, as they take charge in investigating the X files (cases that occur through unknown phenomena). Mulder, the believer, and Scully, the sceptic, face corrupt government officials, monstrous mutants and phenomena that cannot be explained. The episodic and formulaic series allow Mulder and Scully to face phenomena after phenomena while being spliced with a greater ‘mytharc’ concerning government corruption and of the alien colonisation of earth. Supernatural stars Dean and Sam Winchester, brothers in arms, who also, within formulaic and self-contained episodes, hunt monsters and creatures of folklore, urban legend and myth. Supernatural features arcs every season that take Dean and Sam searching for their los t father, preventing a demon apocalypse and do battle with Satan and God’s Angels. American television has, since its very first broadcast, twisted and changed to cater towards its ever-growing and ever-changing audience (Mittel, 2007, p.162-163). Narratives, structure styles, special effects, characters and themes have developed and changed, been tested and tried. Mittel identifies the three notable structures of the television: the anthology, the serial and the series (2007, p. 163). For this study, we are more interested in the serial and the series for its crossover in narrative complexity. Mittel states that ‘narrative television offers ongoing storyworlds, presenting specific opportunities and limitations for creating compelling narratives’ (2007, p.163). The ‘episodic series’ is bro... ...d Everyday Life in Buffy the Vampire Slayer. In: M. Hammond and L, Mazdon, eds. 2005. The Contemporary Television Series. Edinburgh: Edinburg University Press, pp.159-182. Hodges, L., 2008. Mainstreaming Marginality: Genre, Hybridity, and Postmodernism in The X-Files. In: J. P. Tellote, ed. 2008. The Essential Science Fiction Television Reader. Kentucky: Kentucky University Press, pp.231-246. Mittel, J., 2007. Film and Television Narrative. In: D. Herman, ed. 2007. The Cambridge Companion to Narrative. Cambridge: Cambridge University Press, pp.156-171. Mittell, J., 2006. Narrative Complexity in Contemporary American Television. The Velvet Light Trap, 58(32), pp.29-40 Nixon, N., 1998. Making Monsters, or Serializing Killers. In: R. Martin and E, Savoy, eds. 1998. American Gothic: New Interventions in a National Narrative. Iowa: Iowa University Press, pp.217-236.

The Treatment Of Eating Disorders Health And Social Care Essay

Eating upsets are characterized by forms of perturbations in eating behavior frequently accompanied by feelings of hurt and/or concern about organic structure weight or form. Anorexia Nervosa ( AN ) , Bulimia Nervosa ( BN ) , Eating Disorders-Not Otherwise Specified ( ED-NOS ) are three classs by which eating upsets identified. The American Psychiatric Association ( APA ) ( 1994 ) foremost identified Binge Eating Disorder ( BED ) as a probationary feeding upset diagnosing in the DSM-IV. BED is frequently classified under the â€Å" catch all † of the ED-NOS diagnosing. The DSM-IV-TR ( APA, 2000 ) standard for AN, BN, and BED are listed in Table 1. Eating upsets have frequently been noted as one of the most hard psychiatric conditions to handle and hold been associated with increased mortality and self-destruction rates ( Crow et al. , 2009 ) . Other physical and psychosocial wellness effects include but are non limited to limb and joint hurting, concern, GI jobs, catamenial jobs, shortness of breath, thorax hurting, anxiousness, depressive symptoms, and substance maltreatment ( Johnson, Spitzer, Williams, 2001 ) . Despite legion co-morbid conditions, effectual behavioral and pharmacological interventions for eating upsets have been established. For illustration, family-based therapy ( i.e. , Maudsley Approach ) is deriving acknowledgment as an evidenced-based intervention for striplings with AN ( Wilson, Grilo, & A ; Vitousek, 2007 ) in both joint household Sessionss ( Lock, Agras, Bryson, & A ; Kraemer, 2005 ) and in â€Å" detached † format where person with AN and her household attend separate Sessionss ( Eisler et a l. , 2000 ) . Additionally, cognitive-behavior therapy ( CBT ; Hay, Bacaltchuk, & A ; Stefano, 2009 ) , dialectical-behavior therapy ( DBT ; Chen et al. , 2008 ) , and interpersonal therapy ( IPT ; Fairburn, 1997 ) have been successful in the intervention of BN. Research tends to back up CBT as the intervention of pick for both BN and BED ( Hay, Bacaltchuk, Stefano, 2004 ) . Table 1. DSM-IV-TR diagnostic standards for AN, BN, BED.Anorexia NervosaRefusal to keep organic structure weight at or above what is normal weight for age and tallness ( i.e. , & gt ; 85 % of what is expected ) . Intense fright of deriving weight or going fat, even though scraggy. Perturbation in the manner in which 1 ‘s organic structure weight or form is experienced, undue influence of organic structure weight or form on self-evaluation, or denial of the earnestness of the current low organic structure weight. In postmenarcheal female, amenorrhoea ( i.e. , absence of 3 back-to-back catamenial rhythms ) . Specify Type: Restricting Type – During current episode of AN, person does non regularly engage in binge-eating or purging behaviour. Binge-Eating/Purging Type – During current episode of AN, the individual has on a regular basis engaged in binge-eating or purging behaviour.Bulimia NervosaPerennial orgy eating episodes. Characterized by: 1 ) feeding, in a distinct period of clip ( e.g. , within a 2-hour period ) , an sum of nutrient that is larger than most would eat in a similar period of clip under similar fortunes and 2 ) a sense of deficiency of control over eating during the episode ( e.g. , a feeling that one can non halt eating or command what or how much one is eating ) . Recurrent purging/compensatory weight loss steps in order to forestall weight addition. Binge feeding and purging/compensatory behaviours present at least 2 times a hebdomad for 3 months. Self-image inexcusably influenced by organic structure weight and form. Absence of Anorexia Nervosa. Specify Type: Purging Type – During current episode of BN, the person has engaged in self-induced emesis or the abuse of laxatives, water pills, or clyster. Nonpurging Type – During the current episode of BN, the individual has used other inappropriate compensatory behaviours, such as fasting or inordinate exercising, but has non engaged in self-induced emesis or the abuse of laxatives, water pills, or clyster.Binge Eating DisorderRecuring orgy eating episodes. Characterized by: 1 ) feeding, in a distinct period of clip ( e.g. , within a 2-hour period ) , an sum of nutrient that is larger than most would eat in a similar period of clip under similar fortunes and 2 ) a sense of deficiency of control over eating during the episode ( e.g. , a feeling that one can non halt eating or command what or how much one is eating ) . The binge-eating episodes are associated with 3 or more of the followers: 1 ) eating more quickly than normal, 2 ) feeding until experiencing uncomfortably full, 3 ) eating big sums of nutrient when non physically hungry, 4 ) eating entirely because of being embarrassed by how much one is eating, 5 ) feeling disgusted with oneself, depressed, or really guilty after gorging. Marked hurt environing orgy feeding. The orgy feeding occurs, on norm, at least 2 yearss a hebdomad for 6 months. The orgy feeding is non associated with the regular usage of inappropriate compensatory behaviours ( e.g. , purge, fasting, inordinate exercising ) and does non happen entirely during the class of ANor BN. Pharmacological interventions have been used in concurrence with behavioural intervention or entirely ( Zhu & A ; Walsh, 2002 ) in the intervention of eating upsets. Research supports pharmacological intervention for persons with BN and BED ( Bacaltchuck, 2000 ) . Specifically, antidepressants have been found to hold short-run benefit in the decrease of binging and purge behaviours ( Walsh et al, 2000 ; McElroy et Al, 2003 ) . Unfortunately, pharmacological intervention tends to hold high disobedience rates and backsliding is frequently frequent ( Becker, 2003 ) . Presently, there is no empirical support for the usage of antidepressants among persons with AN ( Wilson, Grilo, Vitousek, 2007 ) . Behavioral and pharmacological interventions are most frequently used in combination with another in handling eating upsets due to legion co-morbid conditions. Unfortunately, the aforesaid behavioural interventions have a figure of restrictions when delivered outside a forte scene ( e.g. , outpatient mental wellness clinic, inpatient eating upset centre ) . For illustration, the bringing of family-based therapy for AN requires 10-20 hour- long household Sessionss over a 6-12 month period ( Lock, le Grange, Agras, & A ; Dare, 2001 ) , and manualized CBT for BN requires 15-20 Sessionss over five months ( Fairburn, 1989 ; 1993 ) . Treatments for AN and BN are non merely drawn-out and dearly-won, but eating upset forte suppliers are limited, and persons with feeding upsets are frequently immune to specialty attention ( Fairburn & A ; Carter, 1996 ) . Additionally, merely a little part of persons with feeding upsets are treated in mental health care ( Hoek & A ; van Hoeken, 2003 ) and are more likely to show with feeding disordered symptoms in a primary attention puting ( Hoek, 2006 ) . While primary attention doctors frequently recommend forte intervention on claim signifiers, there is small follow- through with referrals ( Hach et al. , 2005 ; 2003 ) . Therefore, the primary attention scene is frequently the chief intervention installation for those with a life-time eating upset diagnosing ( Hudson, Hiripi, Pope, & A ; Kessler, 2007 ) . Due to the fast-paced nature of a primary attention scene, interventions need to be brief, cost-efficient, and executable in application for bing staff. Therefore, development and designation of brief, effectual intercessions for eating upsets are necessary. A figure of surveies have tested the efficaciousness of specific brief intercessions for AN, BN, and BED outside of primary attention environment. Fichter, Cebulla, Quadflieg, & A ; Naab ( 2008 ) implemented a self-help constituent ( i.e. , self-help CBT manual ) to the pretreatment stage of forte attention for persons with AN giving significantly shorter inpatient attention. For intervention of persons with BN and BED, a stepped-care attack has gained support ( Laessle, 1991 ; Treasure, 1996 ; Carter, 1998 ) . This attack may suit good with the construction of primary attention, since persons with BN are offered brief intercessions and so reevaluated. Brief intercessions for BN are often in the signifier of abridged CBT frequently accompanied by a self-help constituent ( Treasure, 1996 ; Cooper, Coker, & A ; Fleming, 1994 ) . A figure of self-help CBT books have been published aimed at assisting persons with binging and purge ( e.g. , Cooper, 1995 ; Fairburn, 1995 ) . Brief executio n of CBT ( Leonard et al. , 1997 ) , self-help CBT ( Sysko & A ; Walsh, 2008 ) , telephone counsel ( Palmer, Birchall, McGrain, & A ; Sullivan, 2002 ) , internet bringing ( Pretorius et al, 2009 ) , and motivational sweetening ( Schmidt, 1997 ; Vitousek, 1998 ) are all illustrations of promising brief intercessions explored for the intervention of binging and purge symptoms. While primary attention has been identified as an ideal puting for handling BN and BED, few effectivity surveies using brief intercessions for eating disordered symptoms have been conducted in the primary attention scene. A figure of eating upset intervention guidelines for primary attention suppliers have been published ( e.g. , Carter & A ; Fairburn, 1995 ; Gurney & A ; Halmi, 2001 ; Pritts & A ; Susman, 2003 ; Williams, Goodie, Motsinger, 2008 ) . However, there is limited information about the effectivity or deductions of behavioural intercessions for eating upsets delivered in the primary attention puting. Therefore, the purposes of the current survey are to 1 ) place all surveies presenting a behavioural constituent for AN, BN or BED in a primary attention scene, 2 ) examine the features and intervention results of surveies identified, and 3 ) supply intervention deductions every bit good as waies for future research. Methods Literature Review The reappraisal of the literature involved multiple computing machine hunts and reappraisal of old reappraisal documents every bit good as surveies cited within these documents. Search databases included CINAHL, EMBASE, PsycARTICLES, PsychInfo, and PubMed utilizing the hunt footings â€Å" binge-eating syndrome nervosa † OR â€Å" orgy eating upset † OR â€Å" anorexia nervosa † AND â€Å" primary attention. † Figure 1 outlines the literature hunt and shows 314 abstracts of articles reviewed for inclusion every bit good as mentions cited in five eating upset intervention reappraisal documents ( i.e. , Berkman et al. , 2006 ; Hay, Bacaltchuk, Stefano, & A ; Kashyap, 2009 ; Kondo & A ; Sokol, 2006 ; Williams, Goodie, & A ; Motsinger, 2008 ; Wilson, Grilo, & A ; Vitousek, 2007 ) . If deficient information was provided in an abstract the first writer obtained the full article for reappraisal. Inclusion and Exclusion Criteria Primary care-based intercession surveies aiming AN, BN, and BED, were identified based on the undermentioned inclusion and exclusion standards. Inclusion standards included: 1 ) the survey incorporated a behavioural constituent to the intercession for persons with AN, BN, or BED ; 2 ) the intercession was conducted in a primary attention puting ( or the intercession was implemented in a scene explicitly intended to emulate primary attention, as stated in the survey ‘s â€Å" methods subdivision † ) ; 3 ) the survey was a ) published in 2009 or earlier, B ) in English, degree Celsius ) and included empirical informations ; therefore, qualitative and instance surveies were excluded. Exclusion standards included: 1 ) intercessions in scenes other than primary attention puting ( or non explicitly saying an purpose to imitate a primary attention puting ) ; 2 ) non-intervention surveies ( e.g. , surveies conducted in primary attention with ends of obtaining epidemiological inf ormations ) ; 3 ) intercession surveies concentrating on weight loss or including an obesity-oriented attack ; 4 ) non-behavioral intercessions ( i.e. , entirely medicative intercessions ) . International and domestic surveies were included in this reappraisal. Given the limited literature, surveies were non excluded on the footing of whether or non participants were randomized to intervention, type of behavioural intercession, sample size, continuance of intervention, or participant features ( e.g. , gender ) . A sum of five surveies met standards for the current reappraisal. All surveies included were on the intervention of BN and BED. No surveies were found on AN. 314* abstracts/full-text articles reviewed: CINAHL ( 45 ) Embase ( 83 ) PsychArticles ( 0 ) PsychInfo ( 86 ) PubMed ( 100 ) Mentions cited in 5 eating upset intervention reappraisal documents: Berkman et Al. ( 2006 ) Hay et Al. ( 2009 ) Kondo & A ; Sokol ( 2006 ) Williams et Al. ( 2008 ) Wilson et Al. ( 2007 ) 3 original surveies identified 2 original surveies identified 4 primary care-based intercession ( 3 randomized, 1 non-randomized ) 1 designed-for-primary attention intercession ( randomized )Entire: 5 original surveiesFigure 1. Flow chart showing designation procedure of selected primary attention articles. *Note: Overlap nowadays among articles showing in multiple databases. Consequences Features of the Studies Reviewed Of the five surveies that met inclusion standards, four of the surveies were randomized ( i.e. , Banasiak, Paxton, Hay, 2005 ; Carter and Fairburn, 1998 ; Durand and King, 2003 ; Walsh et al. , 2004 ) . Among randomised surveies, none of the surveies fulfilled all of the standards of the Consolidated Standards of Reporting Trials ( CONSORT ) , a criterion and minimal set of guidelines for describing randomized-controlled tests. All surveies included were self-described as effectiveness surveies. Therefore, feasibleness of intercession was paramount to the survey. Merely two of the five surveies recruited participants in the primary attention puting ( Durand & A ; King, 2003 ; Waller et al. , 1996 ) . The figure of participants in the five surveies ranged from 11 to 109 ( M = 70.2, SD = 36.9 ) . Primary attention suppliers ( PCPs ) were the exclusive supplier of the behavioural intercession in two of the five surveies ( i.e. , Banasiak et al. , 2005 ; Durand & A ; King, 2003 ) , and P CPs delivered behavioural intercessions in concurrence with nurses in two other of the five surveies ( i.e. , Waller et al. , 1996 ; Walsh et al. , 2004 ) . Minimally trained facilitators ( i.e. , former concert dance terpsichorean, medical secretary, and group leader ) delivered the behavioural intercession in the 1 survey ( Carter & A ; Fairburn, 1998 ) . Three of the five surveies provided at least 2-6 hours of preparation for doctors and/or nurses transporting out the intercession ( i.e. , Banasiak, Paxton, Hay, 2005 ; Waller et al. , 1994 ; Walsh et al. , 2004 ) . Two of the surveies did non supply separate preparation for those transporting out the intercession, but instead gave facilitators the same educational stuffs distributed to the participants ( i.e. , Carter & A ; Fairburn, 1998 ; Durand & A ; King, 2003 ) . One survey incorporated both behavioural and pharmacological intervention attacks ( Walsh et al. , 2004 ) . See Table 2 for extra survey features. Table 2. Features of surveies reviewed.SurveyParticipants & A ; CriteriaRecruitmentRandomized/Non-randomizedDelivery of Intervention/TrainingInterventionDurationBanasiak et al. , 2005 N=109 ( full or sub-threshold BN â€Å" modified † DSM-IV standards ) Community Ads: Newspaper: 61.4 % Primary Care: 21.1 % Community centre: 12 % ED centre referral: 5.5 % Randomized aˆ?16 PCPs aˆ?given manual & A ; attended a half-day workshop GSH utilizing Bulimia Nervosa and Binge feeding: A usher to recovery vs. delayed intervention control 17 weeks/1 30-60 minute initial contact & A ; 9 20-30 minute intervention Sessionss. Carter & A ; Fairburn, 1998 N=72 ( full BED DSM-IV standards, but non run intoing full BN standards ) Newspaper Ads Randomized aˆ?3 facilitators: Former concert dance terpsichorean Medical secretary Group leader aˆ?given manual & A ; intervention of 2-3 pilot participants. PSH vs. GSH utilizing Overcoming Binge Eating V. Wait list control 12 weeks/ 6-8 25-minute Sessionss. Durand & A ; King, 2003 N=68 ( BN symptoms ) Primary attention physician referral Randomized aˆ?32 PCPs aˆ?given manual, guidelines, & A ; phone no. for particular concerns GSH via Bulimia Nervosa: A usher to recovery vs. forte clinic intervention Duration of intervention varied GSH: ~ 5 visits with PCP Waller et al. , 1996 N=11 ( full BN DSM-IV standards ) Back-to-back series of primary Care patients Non-randomized aˆ? 4 Health professionals 1 nurse aˆ? 2 three-hour preparation workshops Abridged CBT & lt ; 8 20-minute Sessionss in hebdomadal intervals. Walsh et al. , 2004 N= 91 ( BN symptoms ) Newspaper advertizements and referrals Randomized aˆ? 7 Health professionals 8 nurses aˆ? brief 2-hour preparation & A ; intervention of a sum of 6 pilot patients aˆ? GSH + placebo vs. GSH + Fluoxetine vs. placebo-only vs. Fluoxetine-only. aˆ? GSH used Overcoming Binge Eating. 6-8 30-minute Sessionss over 4-5 months. Note: PCP – Primary Care Physician, GSH – Guided Self-Help, PSH – Pure Self-Help, ED – Eating Disorder Interventions Overall, this current reappraisal identified two chief attacks to handling BN and BED in primary attention. The first was for practicians to supply behavioural reding themselves, with an augmentation ( i.e. , self-help manual ) . The 2nd option used a collaborative attack in which a non-physician ( e.g. , nurse ) served as the primary intervention supplier with the doctor in a encouraging function with or without an augmentation ( i.e. , self-help manual, psychopharmacological medicine ) . A PCP was the exclusive supplier of the intercession in two surveies ( Banasiak et al. , 2005 ; Durand & A ; King, 2003 ) and a non-physician ( i.e. , nurse ) in two surveies ( Waller et al. , 1996 ; Walsh et al. , 2004 ) . A fifth survey used facilitators ( i.e. , concert dance terpsichorean, medical secretary, and a group leader ) to emulate primary attention suppliers ( Carter and Fairburn, 1998 ) . Guided Self-help versus Pure Self-help Among all surveies examined, four surveies implemented cognitive behavioural self-help in the intercession and incorporated the usage of a self-help manual ( i.e. , Banasiak, Paxton, Hay, 2005 ; Carter and Fairburn, 1998 ; Durand and King, 2003 ; Walsh et al. , 2004 ) . Get the better ofing Binge Eating ( Fairburn, 1995 ) , Bulimia Nervosa and Binge-Eating: A Guide to Recovery ( Cooper, 1995 ) , and Bulimia Nervosa: A Guide to Recovery ( Cooper, 1993 ) were the three manuals used. The add-on of the self-help manual came in two signifiers: 1 ) guided self-help and 2 ) pure self-help. Guided self-help pattern included a doctor or other supplier ‘guiding ‘ and directing the participants through the manual during scheduled visits and delegating specific reading in the manual to the participant. Pure self-help involved the supplier providing a manual to the participant and the instructions to read the manual over the class of the intercession. Treatment Results Three of the four surveies utilizing self-help found self-help methods to be good in relieving orgy eating episodes ( Banasiak, Paxton, & A ; Hay, 2005 ; Carter & A ; Fairburn, 1998 ; Durand & A ; King, 2003 ) . One survey comparing guided self-help and Prozac found no benefits of guided self-help used entirely or used in concurrence with the medicine ( Walsh et al. , 2004 ) . However, medicative benefits of diminishing bulimic symptoms were important. These consequences should be interpreted with cautiousness, since this survey yielded a 69 % abrasion rate. Another survey comparing the benefits of guided self-help, pure self-help, and wait-list control found those who received guided self-help and pure-self aid to hold significantly fewer binge-eating episodes at station intervention and three month followup ( Carter & A ; Fairburn, 1998 ) . While no important differences were obtained between guided self-help and pure self-help intervention groups at the terminal of intervention, t he guided self-help group attained significance over the pure self-help group across post-treatment clip points ( i.e. , 3 months and 6 months ) ( Carter & A ; Fairburn, 1998 ) . Waller et Al. ( 1996 ) was the lone survey non using a self-help constituent, but instead an abridged CBT intervention. This intervention yielded a 55 % betterment rate in bulimic symptoms. See Table 3 for result informations on each survey. Table 3. Outcome information on examined surveies.SurveyResultEffect SizeRestrictionsAbrasionBanasiak et al. , 2005 60 % decrease in nonsubjective orgy eating in GSH vs. 6 % decrease in DTC. 61 % decrease of purging behaviour in GSH vs. 10 % decrease in DTC. GSH V DTC: Gorging – Einsteinium: 1.96 Purging – Einsteinium: 1.47 aˆ? PCPs delivering intervention had involvement in eating upsets prior to analyze aˆ? Not all participants recruited from Personal computer 33 % dropped out Carter & A ; Fairburn, 1998 Decrease in frequence of orgy eating episodes important in both PSH & A ; GSH. GSH significantly lower in dietetic restraint than PSH at posttreatment & A ; 3-month followup. GSH V PSH in dietetic restraint posttreatment: *ES: -.71 3-month followup: *ES: -.66 aˆ?34 % decrease of orgy feeding in wait list control aˆ? deficiency of weight alteration aˆ? conformity poorer in PSH vs. GSH aˆ? Participants non recruited from Personal computer aˆ? survey simulated PC office 12 % dropped out Durand & A ; King, 2003 No clinical significance between self-help and forte clinic intervention result. Both self-help and forte attention yielded important betterment in bulimic symptoms indicated by BITE. Self-help at baseline V 6 month followup on BITE: *ES: .56 Forte at 6 month followup on BITE: *ES: .67 aˆ?Small sample aˆ?Outcome informations based on self-report graduated table aˆ?lack of specificity in magnitude of difference b/w intervention attention aˆ?23 % dropped out in GSH group aˆ?17 % dropped out in forte attention Waller et al. , 1996 55 % improved well, 45 % did non profit Not able to cipher ; Insufficient informations aˆ?Small sample aˆ?long preparation aˆ?inefficient intercession 18 % dropped out Walsh et al. , 2004 GSH had no important consequence on the decrease of bulimic symptoms compared to Fluoxetine. Fluoxetine had important decrease in bulimic symptoms. GSH vs. Fluoxetine: *ES: -.06 Fluoxetine V Fluoxetine w/GSH: *ES: .02 aˆ? Disobedience aˆ? 8 participants were reassigned conditions aˆ? Recruitment non in Personal computer. aˆ? No public-service corporation for GSH detected. 69 % dropped out Note: GSH – Guided Self-Help, PSH – Pure Self-Help, DTC – Delayed Treatment Control, PCPs – Primary Care Physicians, Personal computer – Primary Care, BITE – Bulimic Investigatory Test Edinburgh *Effect sizes ( ES ) calculated by article ‘s first writer utilizing the undermentioned computation: vitamin D = M1 – M2 / i?-iˆ [ ( i1A? +iˆ iiˆ iˆ?A? ) / 2 ] . vitamin D = M1 – M2 / i whereiˆ i = i?- [ iiˆ ( X – M ) A? / N ] . Discussion Persons with eating upsets have some of the highest mortality rates of all psychiatric conditions ( Crow et al, 2008 ) coupled with high physical and psychological co-morbid conditions. Because of these co-morbid conditions, persons with feeding upsets are likely to show in primary attention puting with co-morbid ailments ( CITE ) . PCPs and staff are in a alone place to supply early sensing and intervention. Due to clip restraints, primary attention suppliers frequently lack the experience and preparation to implement intercessions for persons with feeding upsets. Therefore, brief, evidenced-based intercessions with minimum required preparation are paramount to the acceptance and airing of eating upset intervention. Consequences of this reappraisal expose the limited sum of research that has been conducted on the intervention of AN, BN, and BED in a primary attention puting. The current reappraisal identified five surveies – four on BN, one on BED, and no surveies were found on the intervention of AN in a primary attention puting. Of the five surveies that met standards for inclusion, four were randomized-controlled tests ( RCTs ) , which are often recognized as the gilded criterion in efficaciousness research. Among the RCTs, none of the surveies fulfilled all of the suggested CONSORT criterions. Four of the five surveies reviewed enforced CBT self-help in the signifier of a manual with educational constituents aiming binging and purge behaviours. Three of the four surveies utilizing self-help intervention found the intervention to be good ( i.e. , Banasiak, Paxton, & A ; Hay, 2005 ; Carter & A ; Fairburn, 1998 ; Durand & A ; King, 2003 ) . Therefore, self-help intervention may be a good intervention for some patients showing in primary attention. Among surveies describing benefits, guided self-help proved to be more good than pure self-help ; nevertheless, pure self-help was still found to hold benefit ( Carter & A ; Fairburn, 1998 ) . In a scene comparing survey, guided self-help CBT intervention was deemed every bit effectual as forte clinic intervention ( Durand & A ; King, 2003 ) . Effectiveness and Feasibility While all surveies were conducted in a primary attention puting or in a scene that explicitly simulated a primary attention scene, merely two surveies recruited participants from this scene ( Durand & A ; King, 2003 ; Waller et Al. 1996 ) . The enlisting context may restrict the effectivity of the interventions examined given studies of persons showing in primary attention exhibit higher rates of somatization, mental unwellness, and chronic conditions ( Jyvasjarvi et al. , 2001 ; Toft et al. , 2005 ) . Besides, given this survey was an international reappraisal, primary attention scenes differ across wellness attention systems ; hence, non merely may community samples differ from primary attention samples, but primary attention samples may differ from state to state ( Bailer et al. , 2004 ) . Similarly, PCPs in different states may hold changing clip restraints with respects to preparation and intervention bringing. However, minimum preparation and bringing efficiency are of import features for PCPs ( CITE ) . In this reappraisal, two surveies required less than an hr of preparation for the primary attention suppliers presenting the intercession ( Durand & A ; King, 2003 ; Carter & A ; Fairburn, 1998 ) . Given PCPs clip restraints, developing necessitating more than an hr may non be executable for the typical supplier. Another restriction to generalising intervention to the primary attention scene is the continuance of intervention in the surveies examined. Duration of intercession ranged from 5-10 visits at 20-30 proceedingss per visit. The length of intervention could explicate the high rates of abrasion ( i.e. , 12-69 % ) found in the surveies reviewed. However, Waller et Al. ( 1996 ) noted the indicated intervention may non take every bit long as the prescribed interv ention, since participants dropping out prior to completion of intervention still benefitted. The long-run effects and backsliding rates of brief intercession interventions in this scene is unknown, since the none of the surveies collected follow-up informations six months post intervention. Deductions for Practice Brief intercessions may merely be effectual for a subset of patients with bulimia nervosa and orgy feeding inclinations. Most surveies reviewed excluded participants with co-morbid upsets. Therefore, findings may non be generalizable to the typical primary attention population. Identifying the subset of persons in which brief intercessions will be most effectual remains disputing. While evidenced-based, brief intercessions are considered the first line of intervention for persons showing in primary attention ( NICE, 2004 ) , it is ill-defined how patients neglecting to react to these intercessions should be treated. PCPs electing non to supply behavioural intervention to patients with BN or orgy feeding must still play a important function in measuring and handling the physical symptomatology of eating upsets. With the outgrowth of incorporate attention, psychologists and mental wellness suppliers are going more present in the primary attention puting. Therefore, persons with BN and orgy eating inclinations may be treated holistically in the primary attention scene. Directions for Future Research Future research should concentrate on honing self-help CBT intervention in the primary attention puting and including participants with co-morbid features. Expanding bringing of intervention beyond primary attention doctors to other suppliers, such as nurses, dieticians, societal workers, and staff workers, may let for more trim intervention for the single presenting with feeding disordered behaviour.