Barriers to Effective Pain Management Essay

Nurses have a unique role in alleviating the pain experienced by their patients. With their professional knowledge and regular close contacts with patients, they are ideally placed to listen and respond to any concerns. Taking time to assess the individual will allow for the development of a thrusting relationship between the nurse and patient. Accurate assessment and documentation can help to chart the multi- dimensional nature of the pain, aiding decision making and patient care planning (Mcguie 1992). Adequate control of pain is only achieved in 50% of patients in Western societies. This emphasizes that pain control is a serious problem for a great number of patients. Health care professionals, patients and the health care system itself all contribute to this problem. Other factors that add to this undesirable situation include the following: – Poor decision making on part of health care professionals – myths and misconceptions about pain and opoids – patients non compliance with treatment and their reluctance to report pain – Problems within the organization of health care Pain assessment and management is an integral part of the daily nursing routine. Health care professionals must strive to overcome the barriers to effective pain management in practice. The tendency to under medicate older adults may be related to several factors, including misguided beliefs, fears regarding complications, and a failure to assess ant treat confused older adults. It is imperative that nurses don’t act upon false misconceptions in delivering patient care. The management of pain in the elderly represents a considerable nursing challenge. This is because the elderly are more likely to experience both acute and chronic pain than their younger counterparts. Age related factors may also complicate the assessment and management of the individual’s pain. Failing sight and hearing, cognitive impairment, confusion and dementia create communication difficulties and therefore pose significant barriers to pain assessment particularly in the use of the measurement tools. Lack of knowledge of the Doctor and nurse / poor communication: An individuals pain is complex, the management should not rely on one professional clinical judgment and action. The pain control process should be interwoven between numerous health care professionals. The nurse must strive to exercise their communication skills in discussing aspects of patient care with the MDT team. A lack of confidence and knowledge are the common reasons for poor communication and teamwork. There is ample evidence to demonstrate that both nurses and doctors have poor knowledge about pain and its management. It is also known that contemporary nursing and medical education programs do not equip health care professionals with significant information on the nature of pain, the methods of pain assessments and the principles of pain management. With a lack of knowledge and basic fundamental management skills, nurses may feel unprepared to care for patients suffering from pain, and consequently make incorrect decisions regarding the management of patient’s pain. Poor decision making on behalf of the nurse can reflect on the following: âž ¢ Underestimation of the severity of the illness âž ¢ Overestimation of the effectiveness of the interventions âž ¢ Reluctance to administer parental analgesia âž ¢ Administering a low dose of opoid rather than the required dose needed to control the severity of patient’s pain. âž ¢ Nurses rarely employing non pharmacological strategies In addition, the lack of knowledge and confidence of the nurse may interfere with his or her ability to effectively communicate aspects of patient care to other health care professionals. The under educated nurse has a tendency to underestimate the MDT and doctor’s involvement in pain assessment and management. However, it is imperative that the doctor carriers out a physical examination of the patient on admission to identify the pathological causes of the patients pain. This is an imperative part of pain management and is much needed to facilitate the planning of care. The more experienced the nurse is the more inclined they are to underestimate severe pain. The less experienced nurse is more inclined to overestimate an individuals pain. The doctor’s lack of confidence and knowledge may result in him or her avoiding discussions relating to analgesia and changing the drug or dose of the opoid, irrespective of the nurse’s belief that it for the best interest of the patient. Doctors that are lacking in knowledge have a tendency to prescribe analgesia below the therapeutic level of the pain and are often reluctant to act upon the nurse. This is a serious issue that must be addressed as the nurse is often the person who knows the most information about the patient as they provide a 24 hour round the clock care to the patient. It is clear that these poor practices arise from a number of inter- related reasons. However the lack of knowledge and effective team work seems to be the central issue. In order to assure effective communication is brought to the clinical practice, efforts to increase group learning and confidence of health care professions is much needed. Role play may improve health care professional’s knowledge and collaboration skills. Interpersonal education may be effective at allowing health care professionals understand each others roles in practice. Regular education sessions in the hospital with numerous health care professions from different specialties may be a great opportunity for nurses and other health care professionals to learn together. Communication Barriers The collection of information at assessment is dependent on the nurse’s ability to communicate effectively. However, nurses commonly lack the skills required in this area. Health care professionals often expect the patients to complain spontaneously of pain and patients often assume the nurse will enquire about their pain. This is one significant issue within communication that is commonly demonstrated in practice. Certain nurses don’t even ask the patient if they are experiencing pain. This is a serious issue as patients may be reluctant to report their pain because they don’t want to appear unpopular or don’t want to distract the health care professionals from treating their condition. The omission of verbal assessment may result in these patients suffering unnecessary pain for a prolonged period of time. This can have devastating long term consequences to an individual’s health. A quantity of nurses may employ some form of verbal communication to the patient’s pain assessment. However, they usually confine the assessment to asking one question only, such as, are you experiencing any pain at present? This can be misinterpreting as the patient may be pain free lying still in bed, yet the patient may be experiencing pain on activity. In order to improve the management of pain in practice, continuous education of improving communication skills must be enforced into the clinical setting. A number of communication barriers such as deafness, blindness, and disorientated, confused and cognitive impaired persons can further complicate the assessment process. It is important to compensate for the auditory and visual impairments that the individual may have. While assessing and monitoring the patient, the nurse must position her/his face in view of the patient, speak in a slow and normal tone of voice, use large print size, and provide written instructions and aids such as glasses or hearing aids. Pain assessment should be considered a greater challenge amongst the elderly as these patients more commonly present with communication barriers. Such barriers include deafness, blindness, and cognitive impaired, unconscious and disorientated individual. Pain assessment tools are designed to suit patients with various communication barriers. Health care professionals must choose the appropriate assessment tool that would best suit the individual in pain. For example, a visual analogue scale may be more suitable for a deaf individual. The abbey scale is specially designed for the cognitive impaired individual. The nurse must validate the pain and believe that the pain is as bad as the patient reports it to be. Nurses have a tendency not to validate the patient’s pain. They tend to overestimate lower levels of pain and underestimate more severe pain. If the nurse places him or herself in the role of the family member, they may become more sensitive to the patients needs and his or her experience of pain. Commonly the nurses distance themselves from the patient which results in the nurses failing to recognize the patient’s needs. Nurses have a tendency to block communication with patients who are terminally ill or patients who have chronic pain. This is because they believe they cannot do much for the patient. Efforts to improve professionals collaboration skills with the terminally ill patients and chronically ill is fundamental. Clearly continuing education that integrates helping nurses become more sensitive to patient pain may have an important role in facilitating nurses to develop better assessment skills. Health care professional’s poor pain assessment A good assessment is the cornerstone of good control of distressing symptoms. Yet, current pain assessment practices leave much to be desired. The underestimation of the patient’s pain seems to be problematic in current practice. Nurses have developed a tendency to interfere about a person’s pain on a basis of what they observe. This may be acceptable if they confirm the validity of the interferences with the patient, however this is not happening. Poor use of verbal cues Health care professionals frequently observe patients behaviors and activities when assessing pain and consider non verbal cues as being reliable indicators of pain intensity. However, it is easy to misinterpret non verbal cues. For example the nurse tends to only regard pain as intense or severe if the patients show real intense behavioral signs. The nurse assumes the patient is pain free if such intense behavior signals are absent. Nurses need to take into account that each patient will have a unique response to pain which will be influenced by many factors including cultural beliefs and religious morals. Such patients will exhibit expressive pain behaviors such as crying and moaning, where others may adapt a stoical approach and will not express their suffering outwardly. The presence of pain is therefore not always obvious from the patient’s facial expression and non verbal cues should not be regarded as reliable indicators of pain. If health care professionals place emphasizes on non verbal cues and make interferences on the basis of what they observe, it is not surprising that they yet tend to underestimate the intensity of patients pain and over estimate the effectiveness of interventions. The use of measurement tools which provide patients with a means of quantifying their pain experience is one way of overcoming this problem in practice. However, the under use of assessment tools is a problem that needs to be addressed. Interviewing the patient who is experiencing pain is a critical component of assessment since it provides patients with an opportunity to express not only intensity of their pain but also what it means to them and the effect it has on their lives. Constraints to developing a therapeutic relationship with the patient Pain assessment should be viewed as a unique opportunity for the nurse to use effective communication skills and spend time to build a relationship with the patient. This may encourage patients to express their fears or concerns, enhancing patient assessment and therefore improving the overall goals of care. However, staff shortages and time constraints often make it difficult for the nurse to spent time with the patient and hence it is difficult to build a thrusting relationship with the patient. The fact that there is a high turnover of patients in the hospital means that nurses have little opportunity to establish and sustain a good therapeutic relationship with the patient and family.

Leisure and recreational activities Essay

CONCLUSION Leisure and recreational activities engaged in by the majority of adults, teenagers and children were generally passive or non-active, and tended to occur in the home. There is, however, a desire for more variety, particularly for activities outside the home. Shortage of time and money limited leisure opportunities for both adults and teenagers, along with the shortage of entertainment venues and transport difficulties reported by teenagers. Choices about leisure and recreation, the type and extent of involvement, are subject to the practicalities and reality of one’s life: it is much easier to constrain or vary leisure pursuits than to cut down on work/study or family commitments. It is with home-based leisure and recreation that constraints and variations can be most easily accommodated. LEISURE AND RECREATION Violet Kolar Participating in leisure and recreational activity can foster a range of positive experiences: from simple relaxation, fun and enjoyment to personal development and fulfilment, and improved health. Choices about types of activity and extent of involvement are not unilaterally made but are influenced by the demands and practicalities of every-day life. This paper presents some of the findings from the Institute’ Australian Living Standards Study undertaken in an outer Melbourne area. Leisure and recreation constitute one of the 14 ‘spheres of life’explored in the study. Here, discussion focuses on the leisure and recreational behaviour of 1269 people, comprising 717 adults, 193 secondary school teenagers, and 359 primary school children. Adults and teenagers were asked to complete their own questionnaires, while children’ activities were reported on during interviews with parents. http://www.aifs.gov.au/institute/pubs/fm1/fm34vk.html Destinations of the World (DOTW- Qatar) performance is in keeping with the organisation’s long-term strategic plan, which focuses on continuously building and expanding its core business operations. The travel and tourism industries have suffered in current times due to poor world economic conditions and global uncertainty. Despite this downward spiral, in terms of  international visitors on a global scale, our results are more encouraging than ever. The recent inauguration of our offices in Europe (DOTW-London), (DOTW-Austria) and in the Far East (DOTW-Malaysia, DOTW-Thailand) have been largely successful and already show positive signs of proactive cost management and sound customer service. Services Offered Provide personalized touch to the trip by offering unsurpassed services such as Travel Insurance, Hotel Booking, Car Rental, . You can choose from Incentive Tours readily provided for a memorable trip ahead. Its services are majorly spread over world’s key destinations like Qatar, Australia, Uae, India, Pakistan, Austria http://www.hellotravel.com/destinationsoftheworld On the year anniversary of Qatar’s successful bid to bring the FIFA World Cupâ„ ¢ to the Middle East for the first time in 2022, the Qatar 2022 Supreme Committee has started the process of distributing all ticketing proceeds from the international friendly match (Brazil v Egypt – November 14 2011) held in Doha last month to famine victims in Somalia. The Supreme Committee has partnered with Qatar Charity to ensure that the funds – totaling $400,000 (USD) – reach the people that are most in need in Somalia. The partnership was announced by Qatar 2022 Supreme Committee Communications Director, Nasser Al Khater and Director of Public Relations for Qatar Charity, Khalid Ahmad Fakhro. Qatar 2022 Supreme Committee Secretary General, Hassan Al Thawadi said: ‘One year on from what was a historic day for our country, we are pleased to announce this initiative for those in need in Somalia with Qatar Charity as our partner. During the bidding process we always stressed the importance of football and the FIFA World Cup as catalysts for positive change. This initiative is one of many initiatives that we will undertake with the goal of harnessing the power of football to make a difference in people’s lives – in our region and beyond.’ Commenting on the international friendly, Al Thawadi said: ‘The game demonstrated yet again the appetite for top-class football in Qatar and the  Middle East. Guests and media traveling from abroad were given a taste of what 2022 will offer – a full stadium with people from many different nationalities, coming together to create a carnival atmosphere.’ The match was held at Al Rayyan stadium on the outskirts of Doha on November 14, with Brazil beating Egypt 2-0 thanks to two goals by Valencia striker Jonas. http://www.fifa.com/worldcup/qatar2022/media/newsid=1552120/index.html The FIFA World Cupâ„ ¢ will be coming to the Middle East for the first time in 2022. Even before Qatarwas announced as hosting the World Cup, the country has been keen to stress the many legacies that the tournament will create in the region for the years after 2022. That legacy element in football has taken another great stride in Qatar as top U-17 teams from around the world compete in the first ever Al Kass International Cup. Emerging junior teams from top clubs such as FC Barcelona, Paris Saint-Germain, Vasco Da Gama, Juventus, Ajax, Kashima Antlers, Al Jazira and Al Ahly and Qatar’s very own Aspire Qatar and Aspire International, will gather at Aspire in Doha to compete and display their skills for those seeking to witness the future global foo tball stars. Playing in the 2022 World Cup host nation is an exciting event for all the best young players in the world, as they dream to return in ten years to represent their national teams. In addition, the head coaches from each team have taken time out to visit the 2022 Legacy Pavilion that was visited by the FIFA Inspection Committee during the bidding process for the World Cup. Here they were provided an opportunity to see first-hand the great advances Qatar is undergoing to ensure the hosting of a truly spectacular World Cup. FIFA and the Qatar 2022 Supreme Committee have held their first working meeting on Qatari soil this week, with members from both organisations coming together to discuss a wide array of subjects relating to the 2022 FIFA World Cupâ„ ¢ Qatar. The FIFA delegation headed by its Competitions Director Mustapha Fahmy, Marketing Director Thierry Weil, TV Director Niclas Ericson and Communications and Public Affairs Director Walter De Gregorio met with Qatar 2022 Supreme Committee Secretary General Hassan Al Thawadi and his team during the visit and attended a series of presentations by various  Qatari organisations engaged in projects directly and indirectly related to the preparations for the 2022 FIFA World Cupâ„ ¢ Qatar. â€Å"It was FIFA’s first visit since the bid inspection. We are impressed by the overall vision developed by the Qataris and the first steps of the preparations taken already. It is great to see the commitment and excitement of the 2022 Supreme Committee and other key stakeholders to create amazing. We are looking forward to continuing the path started over the last few days and seeing these visionary projects coming together on the way to the first FIFA World Cup in the Middle East,† explained Mustapha Fahmy. Commenting on the visit, Hassan Al Thawadi (Qatar 2022 Supreme Committee – Secretary General) said, ‘We are pleased to have held our first working meetings this week in Qatar with our counterparts from FIFA. There is no doubt in my mind that the discussions and presentations held this week were of mutual benefit in terms of aligning our visions for the journey toward 2022. We have always insisted upon the importance of taking the time to ensure the proper foundations are in place for the next ten years. After our meetings this week with FIFA and our appointment of our delivery partner early last month, we believe we are on the right track.’ Stakeholders involved in the presentations included representatives from the New Doha International Airport project, Qatar Rail, the Gulf Organisation for Research and Development, Qatar Foundation andQatar’s Central Planning Office. FIFA’s team also toured various facilities and sites in Qatar, including the Aspire Academy For Sports Excellence and the newly established Qatar National Convention Centre, which will serve as a key non-competition venue during the 2022 FIFA World Cupâ„ ¢ Qatar.

12 Angry Men

The theme may be a life lesson that was discovered by one of the characters or it may be an evaluation that the author offers regarding an aspect of existence; in other words, a theme is a profound observation about people in general or the way the world works. Theme is primarily shown by the resolution of a conflict. Whether the conflict is between opposing forces (character vs. character, character vs. society) or is within the characters themselves (internal struggle), how a problem is solved and how the characters react sends a powerful message. As we know, the events surrounding the trial of Tom Robinson in the Pulitzer Prize winning novel To Kill a Mockingbird reveal much about the character of people. Similarly, the 1957 classic movie (adapted from the play 12 Angry Men) uses a trial to explore human nature, revealing many important themes. Because both texts explore similar issues of justice (racism, social class, etc. ), they share many of the same themes, including the 12 listed below. 1. Prejudice obstructs the truth (and justice). . True understanding requires time, study, and effort. 3. Intuition can be deceptive neither dismiss initial judgments, nor trust them blindly. 4. There are many interpretations of the facts; few things are truly black or white. 5. Patient silence and loud persistence can both be powerful, at the right times. 6. One determined individual can wield great influence. 7. Courage â€Å"†¦is when you know you’re licked before you begin but you begin anyway and you see it through no matter what. † 8. Respect and understanding are the keys to peaceful coexistence. 9. Real leadership is not derived from titles, but from leading by example. 10. â€Å"You can never really understand a person until you consider things from his point of view—until you climb into his skin and walk around in it. † A person must examine and respect who people are and where they come from if he is to truly understand them. 11. A person is often not what he or she seems to be; everyone has something inside that motivates him or her to be who they are. 2. People will go to great lengths to preserve their pride. Your task then is to select one of these themes and in a comparative essay, explain and compare how this message is revealed in 12 Angry Men and To Kill a Mockingbird, providing specific supporting examples from each text. Therefore, as you watch 12 Angry Men, you will need to take notes on the problems that the characters face, how these conflicts develop, and how they are resolved. Following the movie, you will then craft a response in which you explain how the chosen message (theme) is revealed in the book and the movie and support your conclusion with specific evidence from the film and the novel. You can draw on your own experiences and prior knowledge to judge the situations. For example, if you believed the message of the film (and the novel) is that â€Å"Prejudice obstructs truth†, you would support this conclusion with evidence from the movie and discuss how this truth is seen in life. Plan BEFORE you begin writing; use the tools provided to prepare for your essay. This assignment is worth 100 points. Your response should be well-thought out and organized, including: _ (x2) a well-crafted written introduction that funnels to your thesis (position on theme) _ (x3) organized body paragraphs supporting the thesis, showing how the theme applies to texts _ (x2) use of specific evidence and insightful interpretations of the whole stories _ (x2) a final conclusion about how the theme is revealed similarly/differently in both texts. (x1) writing free of grammatical errors that interfere with a reader’s understanding. Identifying the Characters For your writing assignment on this film you will need to identify the different jurors. We only know the names of two of them. To identify the others you can refer to them by their juror number, occupation, personality trait, or appearance. Juror #1 – foreman of the jury, an assistant coach Juror #2 – short man with the high voice who worked in a bank Juror #3 – angry man who had a son he didn’t speak to Juror #4 – wealthy stockbroker Juror #5 – demonstrated how to use the switch blade Juror #6 housepainter Juror #7 was in a hurry to leave because he had tickets to a baseball game Juror #8 – Mr. Davis, the man who persuaded the others that the boy may not be guilty Juror #9 – Mr. McArdle, the old man with the keen eyesight Juror #10 – was prejudiced against other races Juror #11 – watchmaker, a refugee from Europe Juror #12 – tall thin man with glasses who worked in advertising Funnel Method of Organization General Introduction General Conclusion Thesis about Point #1  ¶ about Point #2 Thesis Crafting Your Thesis Statement 1) What are the questions you are answering? Ex: How is the theme revealed in the text? Ex: How is this similar/different? 2) Decide what you think. Ex: Both texts use a trial to prove that everyone has something inside that motivates him or her to be who they are, but they use different people. 3) Include reasons/points with your position to show w hat you will talk about Ex: The book uses conflicts between witnesses to show people’s motives; the movie uses conflicts between jurors. ) Use transition words and phrases to make the relationship between ideas clear. Ex. Thesis: Although both the book To Kill a Mockingbird and the movie 12 Angry Men use a trial to show the theme that everyone has something inside that motivates him or her to be who they are, the book uses witnesses to show how people’s motives influence their actions while the movie uses jurors to prove this point. Introduce Texts Compare Texts

Operations Management wk1 Essay Example | Topics and Well Written Essays - 1000 words

Operations Management wk1 - Essay Example A poor operations management can always result in poor quality of the final products. Q.1 (b) Specialization in production activity is the basic strategy to be established. That is when a product like vehicles are produced every person or group must be specialized in performing certain activities. A particular group must be assigned the duty of production of Chassis, another group or individual must be specialized in electric works, etc. Similarly, after each and every activity it must be checked for perfection. That is the any component of the vehicle should be transferred to the next section only after detailed examination. Q.2 One of the major strategies that made Coca Cola to gain competitive advantage is its branding strategy. Coca Cola popularized its brand image through different advertising modes. They also opened food houses. â€Å"Some of Coca-Cola’s latest domestic marketing strategies include Coke dominating fountain sales.† (Coca Cola Marketing strategy, 2008). Excessive consumer oriented approach is what made Pepsi to be obtain competitive advantage. It even reduced prices of the product during great depression in order to make it available to the consumers. Later on it popularized the brand as a new generation drink. The strategies of both companies were good as both resulted in gaining market advantage through different methods. The three factors that have resulted in the success are better knowledge of the market, strong brand building strategy and uniqueness in the product. Similar strategy adopted by Apple and Dell would also work as consumers are always impressed by extr emely popularized and branded products. Both are retail stores that sell goods to the final consumers. Operation optimization is not possible in the case of Mom and Pop Stores. Goods are not purchased directly from the manufacturers in the case of Mom and Pop Stores. Staff motivation is very high in case of Wal-Mart but it is absolutely

Shifting Paradigms In The Automotive Industry Essay

Shifting Paradigms In The Automotive Industry - Essay Example The reduction could be due to the combination of an increase in taxes and inflation with a decrease in the income levels. The cars could become less affordable and be perceived as luxury goods (Hubbard, 2004). For the people who have the ability to afford the automobile, they could require tailor made products that meet their needs. This could lead to the reduction of skilled labor with the expertise in the automobile industry. The market share could reduce, skilled labor shortage could occur, and there could be an increase in the demand of tailor made automotive products. The second scenario could be in the manufacturing of high tech automotive products. There could be a need to fit the automotive with devices that could allow drivers to access the internet. The consumers could want the automotive to have the software installed, which could allow them to personalize the interface features of the machine during driving (Ginsberg, 2008). The younger people who form a major part of mid dle-income earners could demand internet connectivity on their automobiles. This could be a compulsory feature for all the automotive if there is a need for a strong and large market share. There could be a need for the development of new business models aimed at the production of high tech automotive products. A valuable strategy for Better Place could better work for the company, in order to gain a large market share and for the production of high tech automotive (Automotive Industrial Strategy).

Five structural differences between the farmhouse in Tales from the Assignment

Five structural differences between the farmhouse in Tales from the Green Valley and the medieval cruk house - Assignment Example The Tipi in both accounts is a conical shape; however, several material differences prevail. The animal skin and wooden poles in Green Valley presents a much difference from medieval Cruck, which takes a more nomadic pastoralist perspective. The skills, tools and technology used in both explorations presents a structural replication in thatching. The primitive dwelling pit house in Green valley has a grass roof meant to protect belonging from any environmental harm. The extreme weather in the medieval period; however, brings into light a series of materials such as wood and sticks that represent cultural beliefs. The dazzling social appearance of igloo in the contemporary world presents digital imagination. Nevertheless, in Green Valley igloo and earth lodges only shape presents a notable difference. Apparently, both have the same materials to put up the structure. Arguably, both accounts have the best proclamation of past construction features. Most importantly, the tales can form a primary step to counter faulty digital discoveries (Suggett

Aunt Jullia and the scriptwriter Essay Example | Topics and Well Written Essays - 1000 words

Aunt Jullia and the scriptwriter - Essay Example Though age has no barrier where love is concerned, yet how the couple goes about fulfilling their dreams with each other is what is going to be discussed in this essay. This comedic novel is neither an autobiography nor history but an endearing portrait painted by the artist himself that sheds light on his journey of becoming a novelist. This novel is the story of a young writer whose aspirations and dreams are put at risk due to his love for his aunt-in-law Julia. It is a story where a young boy falls in love with his own aunt, a thirty two year old divorcee. The writer’s romantic association with Julia complicates his life and puts his career as a writer at risk. His writing suffers as he is busy living life to its fullest. His laborious writing laden with symbolism is doomed from inception. Aunt Julia enters his life at a time when he is trying to establish himself as a writer and find an individual identity without the help of his family. Julia and Mario are quite in love with each other, but when the relatives come to know of the news they disapprove totally and the couple flees to a town they don’t know anything about with the intention of getting married and leading a happy and peaceful life. In the melee, Mario chances upon Pedro Camacho, a Bolivian serial author, who is a soap opera radio writer  and he befriends him. ... be fired from his job due to his inconsistency in keeping control over his characters, who seemed to die in one of the episodes and again reappear in the next, getting his audience totally confused over the happenings. Mario does not want to keep the secret of his love for Julia any longer and so confronts his family stating that he would provide Julia with a good life. Julia encourages Mario and supports him in every way possible and encourages him to pursue his dream of going to Paris and becoming a writer. It was during this time that Pedro Camacho loses his mind totally and is rushed off to the mental hospital. Becoming a man of letters was the primary aim of Mario who keeps writing a lot. However, his writing is not much appreciated by his friends who feel that he still has to gain a lot of experience in the arena of writing. Mario admires Pedro’s talent and skill for writing and tries to emulate his love for hard work. Mario meets Pedro when he gets hired by his employer s to the same radio station where Mario works to write scripts for the radio serials. The radio stations gains a lot of popularity when the serials become quite famous in the capital. Pedro comes up with shockingly different characters that keep the audience spell bound. Though he gains the height of popularity, yet as time passes he makes a hash of his work by mixing up the different characters and changing their names. He gets totally confused with his own work and also confuses the audience to a great extent. He finds it impossible to go on and tells Mario of his problems. Pedro finally loses his reality and is hospitalized. Irony plays a major role in Mario’s ‘Aunt Julia and the Scriptwriter’ but at a much deeper level, it speaks of artistic failure. On one hand, we have Mario desiring

E-Commerce Proposal Essay Example | Topics and Well Written Essays - 750 words

E-Commerce Proposal - Essay Example . It would create a market for the product and would entail various sales opportunities in Taiwan thus meeting the demands of the people and making large customer base for the same. The website â€Å"www.World-Brand-Saving.com† would list all the various luxury products from US market and make sure to list it in the website for sale to Taiwan citizens. †¢ Demand evaluation: The survey techniques with newspapers and magazine reviews would take care to fetch average demand for branded products. Once the evaluation is done the correct dimension for such products are ascertained and a purchase plan is prepared accordingly. †¢ Price sensitiveness evaluation: The price in Taiwan market for the branded products are evaluated and compared with the price at which it can be fetched from the US market. Various evaluations are taken care for the purchase of the product at US stores, delivery of the products in Taiwan, maintenance of the products in warehouse, if required, cost of traveling and wages and salaries of the people involved in making it possible. †¢ Procurement process: The branded products of US primarily namely Coach, Burberry, Gucci would be directly fetched from the stores and warehoused. Another option that can be exercised is the very purchase of the products at order and thus saving the cost of warehousing. †¢ Delivery model: The various models for supply chain require an evaluation and would be analyzed for effective and efficient delivery of the products.

A Study on Martin Luther King Essay Example | Topics and Well Written Essays - 2000 words

A Study on Martin Luther King - Essay Example Martin Luther King combined leadership, activism and clerical duties in his life time. He had a pivotal role in the civil rights progress, in United States, and globally. He advanced his civil rights crusade through nonviolence as mentored by Mohandas Gandhi. Martin Luther King is a national icon in modern American history because of his leadership style, policy and strategic thinking. In his activities, he advanced principles of strategy. His historical significance goes beyond his civil rights crusade or clerical work. He represented black leadership absent at the time in America. During this period, black leaders whether accommodative or reformists had minimum influence on power. These black leaders acted as power brokers for the white leaders or as spokesmen; they never expressed or acted on their own. However, Martin Luther King had his leadership rested on religious establishments that went beyond the church to a constituency that tagged him because of his strategy and ideology . He differed from the times, conventional leaders because of his independence from political machinery and institutional constraints. He addressed broader issues than race and the racial injustices (Barber, 2011, p. 52). Martin Luther King exemplified talented and strategic thinking, and leadership on both a national and international scale. In all his actions, he carefully advanced his strategic principles, and they all paid off. Growing Up and Early Influence Martin Luther King, born on 15th January 1929, grew up in Atlanta Georgia. The son of Martin Luther King Sr. and Alberta Williams King, he had a younger brother and an elder sister. King devoted much of his time in the church choir, where he sang with the choir during the opening of the movie Gone with the Wind. During his early age, king had intelligence and the will to question. He did not believe in things easily without getting all the information required to make a conclusion (Kavaloski, & Kavaloski, 2011, p. 25). Most striking was his skepticism of the resurrection of Jesus at the age of 13. He afterwards noted the inescapable truths in the Bible. This led him to join the seminary at a tender age. He attended Booker T Washington High School, but as a precocious student, he jumped ninth and twelfth grade. He joined the Morehouse College where he graduated with a Degree in sociology. During his seminarian years, King’s educator and theologian Howard Thurman immensely influenced his life. Thurman crucially mentored him as seen by their closeness. The success of Mahatma Gandhi nonviolent resistance inspired King to nonviolence in the movement. He had a commitment to the American civil rights struggle. The oppression that the minority faced played a significant role as well in influencing his thinking. The rich and wealthy had all the powers to do anything they wanted while oppressing the poor. King observed that using nonviolence offered him a strategy to push for the oppressed human dignity a nd justice, and also fight for their civil rights (Barber, 2011, p. 53). King’s society was plagued by racial discrimination, segregation and poverty. He disliked the society’s social state and decided to fight for their justice. The society’s inequality also pushed him to study sociology and theology because he wanted to help socially (Carson, 2005, p. 8). Achievements, Challenges and Great Moments In his lifetime, Martin Luther King had many achievements. He secured the progress of civil rights in U.S, and before his assassination the U.S Congress passed the

Developing a Medical and Fitness Standard Essay

Developing a Medical and Fitness Standard - Essay Example As the paper stresses the medical and fitness standards within every department is essential. Its necessity is to monitor and promote safety when working. The job for the firefighters is a physical one and there is need to keep the employs fit. Ways of keeping the employees fit is through physical exercises. Just imagine how it would be if an athlete went to a running competition without trainings and exercises? It would be a mess because the athlete will not be physically fit and will tire quickly and may not finish the race. If the athlete wants to win a race, then rigorous exercises must be incorporated. According to the report findings when responding to a fire, sometimes the fire fighters may be involved in a physical injury. Therefore, after every firefighting response, they should be cross-examined by a medical practitioner to ensure that they are well. Where they have been hurt, medication should begin immediately. The regular check will even motivate the employees to perform well when working because they have peace of mind and their health is being taken care of by the management. When developing the medical and fitness standards, there should be injury programs to check on the overall health of the employees and their wellbeing. Eating habits and diet should be monitored. Health can be determined by the types of foods the officers take. Also, it predicts the physical fitness of an individual. The officers should be flexible and it should be youthful.

Liberal Education Essay Example for Free

Liberal Education Essay Essay Education is the most important factor behind the progress man has achieved in this world. It has been the permanent character of human history and evolution of thought. However, in the past, it used to be prerogative of only a few privileged men and the pace of development was quite slow. Since it has been disseminated to common people, there has been rapid growth in every sphere of development: science, technology, sociology, politics, anthropology, etc. Now it is treated as basic human right of every man. Though, it encompasses a wide sphere of knowledge, it has been metamorphosed by man according to his needs. It has been mainly applied as a tool of economic development, which has limited its application. Consequently, people are deprived of the potential education offers for the overall development of personality and stability of society. The chaos in modern world is also partly due to this fault. Therefore, in order to meet the multi-dimensional challenges, man faces in the world, it is essential to impart real education i. e. liberal education. The liberal education has been defined in many ways, though emphasizing the similar essential elements. The best definition is offered by the â€Å"Association of American Colleges and Universities†. â€Å"Liberal education means to empower an individual and prepare him to deal with diversity, complexity and change†. As manifest from the definition, the purpose of education is to enable man to surpass the challenges faced in the world, to know and obtain his rights and to accommodate himself in the constantly changing environment in the present day competitive world. The importance of liberal education in this contemporary globalised world is greatest than ever before. The world has become so shaped that every economic and social activity requires modern and advanced means of communication and technology. The transformation of technological development is on a very fast track. There is a demand of more interactive and communica tive manpower to run this complex system. Moreover, despite the interdependence on each other, the diversity in different areas is in sharp contrast. Hence, the man is required to be quite sufficiently prepared to move forward. And the instrument that can enable him to face these challenges is nothing but liberal education. This is why the renowned scholar â€Å"Skarnovey† says: â€Å"Liberal education: the developing countries must adopt it as it is a necessity†. Nevertheless, it is essential for every nation but the developed countries are already ahead in this sphere. The developing countries, which are still far behind, need to forge efforts to transform their education system in order to catch up with the rest of the world. Not only because it helps in achieving economic development but also because it fulfills the need of society in every sphere of life. The sphere of liberal education is wide enough to call it real education. Basically, education is aimed to develop whole being of a person. It is necessary to educate man to learn social ethics, cultural values, religious obligations, ways and means of a stable society and skills of professional competitiveness. Liberal education, simply, fulfills all these essential needs. It emphasises the development of a citizen who is professionally capable of living in the society in civilised way the way which is not only beneficial to himself alone, but also fruitful for other members of his family, community and society. It is best elaborated in the words of Kurth Kahin; â€Å"Liberal education teaches something about everything and everything about something†. His words can be best understood by contrast to the maxim â€Å"Jack of all; master of none†. Simultaneously, there are also people who are â€Å"Jack of none but master of one†. The people, who acquire general education without proficiency in any specific subject, are explained by the first maxim. While some people who are very skilled and highly qualified in one field like an engineer, scientist or doctor but do not know any other subject or field of life; these are referred to the latter assumption. However, liberal education is a moderate way between both the polar positions. It is aimed at making a person a good professional in any one field and also to possess knowledge and skills about other important fields. More importantly, it makes constructive members of society better described as â€Å"Jack of all; master of one†. In such a way, the objectives of liberal education are multifaceted, which address the requirement of society to a considerable extent. These objectives are briefly discussed here: Firstly, it is the most important for a man to be an informed citizen. The people who are concerned only with their single professional field of occupation cannot be ideally good citizens. They would only be members and nationals of a community or nation. A good citizen is required to be participatory in the social and political building of community, which is the foundation of any society. As the actions of man are based on information and knowledge, without these none understands the obligation towards community and resultantly remains inactive member of society. However, but if the students are inculcated the knowledge of their needs and roles, they would be quite prepared to foresee occurrences and would direct their thoughts and actions towards social and political participation. This can be achieved when the system of education is made liberal which does not aspire to produce only technical robots in human shape but informed and good citizens. Secondly, the philosophy of liberal education envisages the development of creative thinking among the students. Creative thinking has acquired fundamental place in the education system of advanced countries. The students are encouraged to â€Å"think a new†. The creative experiments, creative writings and creative art lead to frame the development of thought process. Though, it is practised in western countries, it owes its origin to the most influential scholars and artists of Greek period and early Muslim era. Socrates, Plato, Aristotle, Machiavelli, Ibn-e-Khaldun, Galileo, Khuw-arzmi, Newton, to name a few, all were creative thinkers. In short, whole of the development in the world and education itself is the result of creative thinking. On the contrary, the limited application of education is insufficient to produce brilliant minds. The specific technological development devoid of human values and ethics has failed to form the basis of a viable society. Thus, it is the objective of liberal education to teach the students various subjects like history, sociology, philosophy and psychology besides their professional field, so that creative thought is encouraged to be developed among them. Therefore, we need to introduce liberal education in order to secure our future based on collective ideals. Thirdly, liberal education improves the skills and competitiveness of students, which is necessary to enable them to get foothold in the competitive market. For example a typist may have good efficiency in his field but computers have replaced typewriter. People like to get their papers typed on computer in order to save their document and to get good command. Now, the excellent typist is in trouble, he would go jobless in the market unless he learns to operate computer. Same is the case with every field of employment. The modes of technology are being transformed very rapidly. In order to meet the demands of market one should be quite prepared and skilled. Hence, the knowledge of mathematics, science, computer literacy and technological acquaintance are necessary to be imparted to the students, which can be achieved through liberal education. Fourthly, as the world has become a global village, the importance of communication skills has been increased manifold. A person must be proficient in national and at least one international language. He must know how to send e-mail, voice-mail or to carryout visual communication. The social change compels the person to change the job for better opportunities. The talented people feel an urge to move towards other countries as well in order to actualise their talent and to obtain maximum result. This is where the communication skills are mostly required. All the communication techniques, basically, listening, speaking and writing are essential ingredients. Therefore, it is necessary to improve the skills of students through methods of listening comprehension and speaking ability tests. All the examinations of foreign languages comprise these elements and even very talented students from developing countries fail to go abroad due to lack of these communication skills in international languages. The world has become so shaped that every economic and social activity requires modern and advanced means of communication and technology. The transformation of technological development is on a very fast track. These few objectives of liberal education underline its importance and need in the developing countries, including Pakistan. Unfortunately, it has not been taken seriously. The system of education in our country is obsolete. It is devoid of the contemporary methodology of teaching and the curriculum is almost from primary to university level. Computer is studied as a field of study only, not as a skill. Even in most of the universities it is taught only to the students of computer department seeking degree in that subject, let alone its use at primary and secondary level. In universities the students of other subjects like sociology, languages, arts and other sciences are not taught the computer skills. This lags them far behind from students of other countries and few quality institutes of the country. Same is true of languages. English though introduced from primary level, is not taught according to the modern techniques of comprehension. Only reading lessons and knowing meaning of words cannot enable students to master the language. The methodology of English departments in universities is also in question. The national language, Urdu, is also not focused at any level of education. Learning of both these languages is important to produce capable and competitive students at the national and international level. The fate of the students of other subjects is also not much different. On the one hand, they are deprived of computer and language skills; on the other they do not become proficient in their field of interest as the proper methodology is not applied. Faculty members are not well qualified, research is not pursued and creative thought is ignored. These defects of our education system are the main reasons of the chaos, unemployment, poverty and social instability in our society. In order to overcome these shortcomings, we must adopt the liberal education system without any further delay. However, this requires a well thought out and comprehensive policy to improve the existing education system. Primarily, we should redesign our curriculum at all levels. All the major components/subjects of liberal education: sociology humanism, citizenship, history, philosophy, languages, computer and sciences must be introduced in every tier of education from primary to university levels in accordance with the capacity of students and the needs of society. Secondarily, all the institutions should be equipped with computer and scientific laboratories and libraries. The research and creative thinking should be encouraged through modern techniques of education. In this regard the accessibility and equality of all sections of our stratified society must be ensured in order to achieve uniform development. Lastly, the faculty must be energised by providing skilled and experienced teachers. The existing teachers should be trained to equip them with modern techniques of teaching methodology. Fresh and young blood must be encouraged to join education field as a profession by enhancing the monetary incentives in the education sector. This policy will yield tremendous benefits to the future of a nation. The liberal education is hailed because it brings concrete advantages. The young generation of Pakistan makes bulk of the population of country. According to a report of the State Bank of Pakistan 65 per cent of the educated youth is unemployed due to irrelevance of their skills with market. If this portion of population is properly skilled, it will prove to be a boost to the economy as the manpower is considered a resource in all countries of the world. Another benefit would be the eradication of poverty. Once our youth are employed, they will naturally add to the income of their families and consequently eradicate their poverty. It will also help in raising the living standard of our common man as it is directly proportional to the income of a family. The liberal education would create sense of understanding and cooperation among the people. The contemporary chaos of extremism and isolationism are due to lack of approach towards collective interests and common goals among people. Once they realise their social obligations and think creatively they will initiate participating positively in the stability of society. It is quite clearly manifested from the discussion that liberal education, which is the real education, is an essential component of good governance and stable society. It not only helps an individual to progressively achieve goals but also gives impetus to economic, political and social stability to a state. In short, it forms the basis of human development in this complex global world of diversity and challenges. It offers a way towards a better change.

Revolutionary Changes in the Atlantic World Essay Example for Free

Revolutionary Changes in the Atlantic World Essay 1. List four (4) 18th century European wars. p.542 2. Define, in short, John Locke’s political philosophy. p.542- 3 3. What was Jean-Jacques Rousseau’s political argument? p.543 4. European monarchs that supported some Enlightenment ideas were called â€Å"enlightened despots†. Who were these monarchs (examples) and why did they favor some Enlightenment ideas? P.543 5. What is Nicolas-Jacques Conte famous for? P.544 6. Describe at least 3 ways in which women were instrumental in the dissemination of new ideas. P.545 7. The intellectual movement known as the Enlightenment most deeply influenced what emerging class in Europe? P. 545 8. What were folk cultures and what were some of their characteristics? P.546-7 9. What two (2) related problems did the British face after defeating the French in 1763? P.547 10. Which Amerindian chief drove the British from some western outposts and raided Virginia and Pennsylvania at the end of the Seven Years’ War? p.547 11. What was the purpose of the Proclamation of 1763? P.547 12. What sparked a political confrontation that led to rebellion in the British N. American colonies? P.548 13. What was the Stamp Act of 1765? P.548 14. Who were the Sons of Liberty? p.548 15. What violent event radicalized many colonists against the British? p.548 16. Before declaring its independence (essentially war), list at least three (3) tactics used by American colonists in response to British policies. P.548 17. Who wrote the inflammatory pamphlet Common Sense? p.549 18. Read the excerpt from the Declaration of Independence. What kind of â€Å"rights† are expressed in the excerpt and what famous British philosopher popularized it? p.549 19. What convinced the French to enter the war on the side of the U.S. in 1778? P.550 20. What were at least two negative aspects of the government under the Articles of Confederation? p.551 21. Why were slaves counted as 3/5 of a person when considering representation? P.551 22. Until what year did the U.S. Constitution permit the slave trade to continue? p.551 23. What happened to King Louis XVI as a result of the French Revolution? p.552 24. (a)Describe the makeup of the Estates General. (b) Why did Louis XVI call a meeting of the Estates General after 175 yrs of recess? P.552-3 25. Which French Estate declared itself to be the National Assembly? p.554 26. What was the Bastille and what prompted common people to attack it in 1793? pp.554-5 27. List four things that were accomplished by the new French constitution. p.555 28. What happened when rumors of counter-revolutionary plots circulated throughout working-class neighborhoods? p.555 29. With whom did Robespierre forge an alliance? p.556 30. What was the period of repression led by Robespierre called? p.556 31. Why did Robespierre remove Sunday from the new calendar? p.556 32. Why did Napoleon succeed in forming Europe’s first popular dictatorship? p.557 33. How did Napoleon achieve support of the peasantry and the middle class? p.557 34. Napoleon’s arch nemesis was Britain, which he attempted to invade in 1805. What was the name of the decisive naval battle and what was the outcome? p.557 35. Napoleon’s invasion of what country eventually led to his demise? p.557-561 36. At what famous battle was Napoleon finally defeated after only one hundred days in power? p.561 37. What was the financial worth of Saint Domingue to French trade? P. 561 38. What destabilized the colonial government of Saint Domingue (Haiti)? p.561 39. What was the main purpose of the Congress of Vienna? p.563 40. The revolutions of 1848 were widespread across Europe and were inspired by what? p.564 41. Greece gained its independence in 1830 from whom? P.564 Free Response Focus Questions: Answer these questions in a 5-7 sentence paragraph. In your own words. Do not simply copy from the book and memorize the response. Know it. Support your response with plenty of facts. Understand where events fall historically (global context, cause/effect, etc) 1. How were the revolutions of the 18th century inspired by a body of new ideas? Discuss Locke and Rousseau in your response. 2. After defeating the French in North America in 1763, the British faced the related problems of continued westward expansion by its settlers and paying for governing the colonies (taxation). What did the British government do in response to these problems and how did they contribute to colonists’ resentment of the British government and eventual war? 3. Describe the nature of the fiscal crisis that triggered the French Revolution. 4. What were some of the reasons for the failure of the French Revolution to initiate lasting representative government and for the rise of the new dictatorship? 5. What were the causes of the revolution in Saint Domingue? 6. The Enlightenment as a social and intellectual movement impacted many segments of society. How did this movement affect women in the elite classes and the common women during the revolutions? Compare/Contrast Thesis statement 7. Compare and contrast the goals and outcomes of the French and Haitian Revolutions.

Healthcare Industry: IT Systems

Healthcare Industry: IT Systems Healthcare services have seen several changes throughout the years to respond to changing demands of the population. The present key drivers and issues that stakeholders (patients, healthcare providers, vendors and government) in the healthcare sector face are ageing population, increased burden of chronic conditions, rising public demand/expectation for quality healthcare, fragmented and uncoordinated healthcare services and rapid advances in information technology. At present, information technology is considered a strategic necessity by world class organizations instead of just a supporting tool. To obtain a competitive advantage in an environment with intense competition, it is vital for organisations to use more sophisticated information technology tools to address the challenges of building and deploying system in the short term and the identification, research and design of future system. Information technology (IT) is rapidly becoming integrated with healthcare to improve processes and communications, support decision making, reduce inaccuracies, and improve patient safety. The advancement of medical science through the years has made possible the use of more expensive equipment and the latest technology. This will allow healthcare providers and patients to gain access to health information easily and thus has the potential to improve the quality, safety, and efficiency of health care. As the healthcare industry is information intensive and knowledge intensive, there is also a need to publish health care information and knowledge. Healthcare systems vary from country to country but they all have a common aim that is to meet the healthcare needs of target populations. In this report, I will be focusing on healthcare IT in Singapore context. Healthcare System in Singapore Singapore has a dual health care system where individuals can choose between public and private providers. The government through Ministry of Health (MOH) manages the public healthcare system. MOH plays a major role in formulating national health policies, coordinating the improvement and planning of the public and private healthcare sectors and regulating health standards. MOHs mission is to promote good health and reduce illness, to ensure Singaporeans have access to good and affordable healthcare and to pursue medical excellence (Ministry of Health, 2007). MOHs vision is to develop the worlds most cost-effective healthcare system to keep Singaporeans good health. Delivery Structure Healthcare services in Singapore are provided by different types of providers from primary care to tertiary care and to step-down care. Primary Care Primary care includes primary medical treatment, preventive healthcare and health education (Info-communications Development Authority of Singapore, 2009). In Singapore, primary health care is provided through outpatient polyclinics and private medical practitioners clinics. 80% of the services are provided by private practitioners while the remaining 20% by government polyclinics. Conveniently located in town centres all over the island, polyclinics are one stop health centres which offered services such as outpatient medical care, maternal and child care health. Secondary and Tertiary Care For the secondary and tertiary care, 80% of the hospital care being provided by the public sector and the remaining 20% by the private sector. This public sector is organised into two vertically integrated delivery networks, National Healthcare Group (NHG) and Singapore Health Services (SingHealth) that operate as not-for-profit private companies. Having these two groups enable more integrated and better quality healthcare services through greater cooperation and collaboration among public sector health care providers. Each cluster consists of both general hospitals that provide multi-disciplinary healthcare services and specialised hospitals in various disciplines e.g. obstetrics and gynaecology and ophthalmology. The private sector provides similar specialist disciplines and comparable facilities to the public clusters. The two main providers are Raffles Medical Group and Parkway Group Healthcare (Info-communications Development Authority of Singapore, 2009). Step-Down Care Voluntary welfare organisations (VWOs) provide most of the step-down care services. They run nursing homes, inpatient hospices, community hospitals and chronic sick hospitals. Four of the public acute hospitals also provide geriatric units (Info-communications Development Authority of Singapore, 2009). Public Healthcare Delivery Structure One of the objectives of forming the two clusters is to facilitate integration of healthcare services at the various levels. The clusters have begun introducing measures to integrate primary healthcare at the polyclinics and secondary care at the hospitals. A Vision for 21st Century Healthcare Intelligent Nation 2015 (iN2015) is a 10-year masterplan to help Singapore realise the potential of infocomm. The vision of iN2015 is An Intelligent Nation, a Global City, powered by Infocomm. The goal for the Healthcare and Biomedical Sciences sectors is To accelerate sectoral transformation through an infocomm-enabled personalised healthcare delivery system to achieve high quality clinical care, service excellence, cost-effectiveness and strong clinical research. (IDA, 2006) Refer to Figure 1 in Appendix to see how it will look like. Key drivers of change in Singapores healthcare sector were identified and a number of likely shifts and changes to the system were predicted (IDA, 2006). Key Drivers Shifts/Changes Ageing population of chronic conditions Focus on prevention, health promotion and wellness care Rising public expectations of healthcare services Integrated and patient-centred system of delivery Fragmented and relatively uncoordinated healthcare services Consistent widespread application of evidence-based medicine Very rapid advances in infocomm, medical science and technologies and biomedical research Greater role of members of the public in managing their own health Greater facilitation of data flows between healthcare sector and biomedical sciences Strategies and Programmes (IDA, 2006) The targeted outcome is a well-integrated quality healthcare, cost effective healthcare services and greater ability of public to manage their health. To bring about successful business change using IT, healthcare providers should ensure that IT works in performance with meaningful changes in organisational functions and processes (Rothenberg, 1995). How IT can be used? In the healthcare industry, one suite solution is not common because certain user departments will need to have more in-depth functionalities than others. A more common approach in the industry is best of breed where it attempts to give full equal weight in terms of functionalities and features to individual user departments. Some considerations for best of breed approach are: It deals with more than one vendor A need to connect or interface the different applications to provide a fully integrated solution Future upgrades issues. Therefore, there is a need to strike a balance between having too many application platforms and departmental requirements or functionalities (Online Consultant Software). IT Infrastructure for the Healthcare Industry Functional interoperability is needed in order for computers to be able to share clinical data with one another. Computers must have functions to be able to physically communicate, send and receive documents and data files, share data and information. Therefore, there is a need for integration, standards and interface engines to build the healthcare industry infrastructure. MediNet MediNet forms the backbone of medical system in Singapore (IDA, 2006). It is Singapores nationwide computer network for medical and health care community that focuses on five components (Lim, 1990): Central Claim Processing System(CCPS) processing of claims in hospital bills National Patient Master Index (NPMI) consists of patients risk factors, drug allergies and demographic data Procurement Electronic procurement of medical and surgical supplies Notification Transmission of notifications to government agencies Information Services Access to local and foreign databases MediNet links up computer systems of all participants (MOH, Central Provident Fund Board (CPFB), Government Bodies, restructured hospitals, private hospitals, general practice clinics) in the healthcare delivery system so that they will be able to communicate, exchange data and access common applications on the network (ANNEX C: FACTSHEET: Infocomm Milestones, 2006). Health Level 7 A group of healthcare computer systems users who founded the Health Level 7 organization in 1987 started developing the HL7 protocol to create that common language that allows healthcare applications to share clinical data with each another. Over time the HL7 interoperability protocol became a nationally, internationally and globally accredited standard (HL7 Singapore). Health Level Sevens domain is clinical and administrative data. Interface Engine Interface engine is a software program intended to simplify the creation and management of interfaces between separate applications and systems, either within the organization or with other affiliated organisation (McLeod CG, Inc., 2006). It carries out messaging between systems and usually handles any mapping, translation and data modification required to ensure the effective exchange of data. Examples of common interface engines used in the healthcare industry are Cloverleaf, Datagate and Openlink (MDI Solutions, 2009). Imagine in a hospital where there are different departments needing different functionalities and features, different applications might be running. It would be very complex and technically difficult to maintain separate interfaces between them. Healthcare Applications Enterprise Resource Planning (ERP) The public healthcare sector uses SAP industry solution for hospital (IS-H) (SAP, 2008). It supports patient management, medical and nursing documentation, and patient accounting, and integrates these with financial accounting, controlling and materials management. The information system contains evaluations of patient and hospital data that can be used both internally and externally. It also contains a communication component that enables data transfer both within the hospital and to external parties. The picture below shows the SAP footprint in Singapore Healthcare Industry. Only Parkway Health (Private Sector) and Republic Polytechnic (for educational purpose) are not under the public healthcare sector. Source: (SAP, 2008) Case Study: Hospital Information System at St Andrews Community Hospital (InfoComm Singapore Portal, 2008) St Andrews Community Hospital was relocated in April 2005 to a larger premise in Simei. The change in hospital and care processes was the drive to upgrade the Hospital Information System (HIS) at St Andrews Community Hospital from its manual administrative system and record stock which require tedious work to a more efficient way to process information by technology. The project team were focused on being user-centric rather than IT-centric in the choice of an HIS. User departments were pro-active and committed during the pre-selection brainstorming and consultancy and during the implementation stages of the new system. The VESALIUS, a complete HIS provided NovaHealth which covers front-end modules such as Appointments, Registrations, ADT and billing and ancillary support modules such as Pharmacy, Medical Records, back-end Inventory and integration to the Financial System. The benefits of the system are: Assisting management to track costs down to the minute details Increasing efficiency as manual and administrative work are being minimised Enabling links to the MOHs Elderly and Continuing Care system for online submission of information to receive government subsidies; and the CCPS for automated submission for Medisave claims Serving as a check and balance for inventory audit and reducing waste. As a result, there is no need for Pharmacy staff to spend time physically checking stock levels when transferring items from the various stores in St Andrews Community Hospital. Having a lean and efficient team complemented by the HIS, paperwork is also minimised. An Integrated Electronic Medical Database Electronic medical record (EMR) stores patients medical information through IT to enable sharing across healthcare institutions (MOH; SingHealth; NHG, 2004). It can be made more secure through appropriate IT access and security safeguards. The MOH holds the vision of One Singaporean, One Family Physician, One Medical Record to improve long term care. EMR provides medical staff involved in patient treatment with quick and accurate access to patients essential medical information (Yong, 2007). The integrated patient database system was thus vital in Singapore as there is a need to get the right information to the right people especially in an industry where a second could mean a difference between a life and death situation. EMR Adoption Model The EMR Adoption Model is devised by HIMSS Analytics to track the progress of hospitals towards creating a paperless patient record system. It is based on an eight-stage scale which starts at zero (HIMSS Analytics). The EMR Adoption Model Structure ensures all application capabilities must be operational before that stage can be achieved as it sets a foundation for subsequent stages. Refer to Figure 2 in Appendix for the EMR Adoption Model. Electronic Medical Record Exchange (EMRX) EMRX is an initiative by MOH and the two public healthcare clusters (SingHealth NHG) to share electronic medical record across all public hospitals and polyclinics in Singapore. The EMRX will have the following information (MOH; SingHealth; NHG, 2004): Discharge summary which summarises recent hospitalization records including the treatment received and clinical course; Operation reports and laboratory results, including radiology images and scanned medical records Medicines prescribed with drug allergy history It was launched in April 2004 to focus on the improvement of patient care outcomes. It is a pragmatic and incremental implementation where SingHealth and NHG first developed the key systems within selected institutions and then replicate in other institution within the cluster and eventually across clusters and where practical with the private sector. The benefits of EMRX are (MOH; SingHealth; NHG, 2004): Better coordinated care for patients moving across different providers and improved levels of healthcare delivery. Better clinical decisions, with access to complete and legible clinical histories, and updated test results at the providers fingertips. Reduce the risks of transcription errors and missing records. Save cost through the avoidance of unnecessary repeat tests and investigations Better distribution of care Facilitation and follow up of other IT based applications such electronic prescriptions and clinical decision support systems Potential for 24 hour access to real-time data for up to date results reporting Provision for data security and audit features to be built into the system. Current EMRX Implementation The aim of the clusters is to implement the EMR in all institutions within each cluster incrementally. SingHealth and NHG manage their clusters EMR independently. SingHealth started using an EMR system in SGH in year 2000. The main application SingHealth has used to develop its EMR system is iSOFTs iClinical Manager Solution (E-HEALTH-MEDIA LTD, 2004). Similarly, the National Healthcare group has also started using EMR systems in Tan Tock Seng Hospital and National University Hospital. EMRX was developed to enable secure cross-cluster exchange of patient information. This is to ensure that a patients record can be retrieved regardless where he or she seeks treatment. EMRX was later extended to healthcare partners, providing a central capability for effortless movement or records across the public healthcare clusters, community hospitals and Ministry of Defence (MINDEF), facilitating care delivery. SAF Electronic Medical Records The SAF healthcare system is centred on the SAF EMR system which is known as Patient Care Enhancement System 2 (PACES 2). It has clinical data repository, administrative function for manpower and logistics and also has the feature for research or analysis (Wong, 2009). The system connects all SAF medical centres across Singapore to allow for online and real time medical info retrieval and simultaneous viewing. Figure 3 in Appendix shows how it is connected. NHG Polyclinic Bukit Batok Polyclinic was the first to adopt the electronic medical records system. With paperless medical records, patients medical records can now be retrieved while diagnoses are entered into the system (Hoe, 2009). This move is part of MOH vision of integrating services between the healthcare providers. Benefits to Patients: Enhanced safety as there is a reduced patient risk through improved legibility of orders. Reduced waiting times due to the improved process Better care coordination and disease management through sharing of medical records Benefits to the polyclinic: Quality: Continuous improvement of quality care and patient service through error monitoring and elimination of unnecessary procedures Productivity: Saving time and effort that would otherwise be spent on correcting lost and illegible orders. Furthermore, there is no longer need to go to the records office, retrieve the physical paper records and bring it up to either the doctors or nurses room which can take up to 20 minutes or half an hour. Access: More readily available information and data of patients for healthcare professionals to make faster critical decisions Future Outlook National Electronic Health Record (NEHR) The next phase of electronic health record is moving towards creating a health record that is in fact personalised and accessible everywhere to be implemented by April 2011 (ChannelNewsAsia, 2010). With NEHR, all key information such as a patients demographics, allergies, clinical diagnoses, medication history, X-rays, laboratory investigations and discharge summaries will be fully exchangeable between various healthcare providers. Due to the costly implementation, only a number of primary and step-down care providers, including GPs, polyclinics and a community hospital will be linked up first (ChannelNewsAsia, 2010). The full implementation of NEHR will take many years as it has to cover the entire healthcare ecosystem and not just the public sector. The decision on whether to implement each phase will have to be justified on cost-benefit analysis. Refer to Appendix for an attached article on What could healthcare in Singapore look like in 2020? (Ministry of Health, 2008). Medical Information Services IT is also widely used as an information tool by both medical professional and the public. Several government and privately initiated websites provide information for health care services and databases for medical related issues. Web portals provide the following services: Searching for medical professionals within Singapore The MOH has a list of online resources to search for healthcare professionals in Singapore (MOH, 2007) Online pharmacies For example, Changi General Hospital myPharmacy is the first online hospital pharmacy in Singapore (Changi General Hospital, 2004). Medical publications One example of medical publications is PubMed (PubMed). Health related publications Some examples of health related publications from SingHealth (SingHealth Academy ). Health service reports Queue watch provide patients with timely information to arrange their visit. The number of patients waiting for registration and consultation, live webcam images showing the waiting areas for registration, consultation and pharmacy/payment and peak non-peak periods are displayed online (Government of Singapore, 2007). Medical schemes such as Medifund, Medisave MediShield Information regarding these schemes can be found in CPF Board website (Central Provident Fund Board, 2009). Competitive Advantages The growth and survival in the healthcare industry depends on how well Singapore is able to compete in this highly and competitive market. With the integration of the healthcare infrastructure, the advanced medical technology and the highly skilled professionals, Singapore has managed to establish a reputation of being a world class healthcare hub, the ability to deliver innovative healthcare solutions, a complete range of services and quality healthcare providers (EDB, 2009). There will be a strong demand from the population for quality healthcare and value added services with rising economic affluence and longer lifespan. Thus, there is a need to ensure that healthcare research and development continues to be supported so that Singapore healthcare services sector can excel and be a source of competitive advantage. To sustain the competitive advantages, Singapore should be aware of their strengths and weaknesses and also of their competitors. The approach for the future must be one that focuses on possible improvements, supporting innovations and facilitating changes. The focus will have increasingly to be on openness to new influences, a willingness to recognize different schools of thought and methods of training and a search for the best available expertise from around the world (Desker, 1991). Innovation is needed to overcome the future challenges ahead to maximise Singapores competitive advantage. Healthcare providers should enhance their medical and service offerings, develop new healthcare products, and promote a pioneering spirit that will help in dealing with evolving patients needs, and in creating holistic and flawless experiences for patients (Tan, 2009). Thomson Medical Centre The Business Times reported that Thomson Medical is leading the healthcare sector (Ramchandani, 2010). Focusing on three core areas patient expectations, perceived quality and perceived value to improve patient satisfaction, Thomson Medical Centre has been continuously innovating to provide greater value-added services to its patients. Their redesigned patient-centric workflow had helped them gain a competitive advantage over their rivals: Use of technology and raise in service and product standards has improved patient care and satisfaction Improve in-patient , out-patient and administrative processes by using touch screen billing in place of a key-in method, which has halved the time spent on billing and has resulted in cost savings of $2000 a month. Reduce waiting time for admission and discharges with express check outs, direct admissions and courtesy and in-room discharges. Act on service recovery. When there is an unhappy patient with service, they move fast to resolve the problem. Train front line staff to raise service standards which resulted in an increase in the number of compliments as compared to complaints (4.9:1 to 9.2:1). Create a positive patient experience by having a resort style ambience, offering concierge service, a welcome drink and, in the case of premier rooms, luxurious dà ©cor and relaxing spa music. Introduce value added services such as the interactive website ThomsonBaby.com to help new mothers prepare for the parenthood journey and save them time and money. The hospitals efforts in cultivating lasting relationships have also led to an increase in patient loyalty. 32.2% of its patients were repeat patients in 2009, compared to 26.8% in 2008. Besides that, there was an increase in the number of babies born. Thomson Medical Centres dedication in understanding patient needs and receiving feedback on their stay and their expectations at key hospital touch points has thus improved patient satisfaction level. Challenges The vision for an integrated and continued patient- centric healthcare system requires interoperable IT systems, active engagement of patients and suitably aligned financial framework. In the development of the Singapore healthcare system, there are some issues that hinder the implementation of healthcare integration due to unique specificities. In general, the problems faced by the players involved can be classified into five categories: Clinical and medical practices: Often built around specialization but could be better oriented towards integrated care Financing framework: GPs, Specialist Outpatient Clinics (SOCs) and patients does not see the incentive for integration of care Establishment of a new idea mindset towards integration of care for players involved Organizational processes: Enhanced by bridging communication and IT gaps, coordinating across sectors and defining workflows for the smooth move of patients between caregivers IT systems: Better connected across sectors and allow for the transferability of patient records. As shown in Figure 4 in the Appendix, these challenges have over the years led to ingrained mindsets and behavioural practices of parties at multiple levels of the system, further hindering the integration of care (Ministry of Health, 2008). The various challenges and loophole that currently exist are the result of institution-centric and tertiary-centric system of healthcare. As EMRX becomes widely accessible, there are concerns over patient confidentiality and privacy. For instance, legal implications of providing EMRs beyond cluster boundaries were considerable and attaining consent from individual patients would have been burdensome and stalled widespread accessibility of EMRs (MOH; SingHealth; NHG, 2004). This shows that there are vital ethical concerns over the privacy of personal medical records. Furthermore, the infrastructure for data standardisation needed to achieve this integrated healthcare system is getting more intricate and costly due to the vast amount of data involved from different independent systems. Despite SingHealth and NHG adoption of the HL7 v2.3, data exchange could not be easily achieved in spite of HL7 v2.3. This is because the standard was open to variations that hampered direct interoperability. Moreover, modification of systems to enable data interoperability would have been costly, without direct benefits to the clusters (Lee, Lim, Tan). Conclusion Previously, healthcare sector has lagged behind other sectors in the adoption of IT for its key process. Healthcare providers need to review the way businesses are conducted. IT can be a powerful enabler for an information intensive industry like healthcare through automation, knowledge management, business process reengineering, and even artificial intelligence. A pragmatic approach should be adopted to consider the current status and to focus on implementing immediate goals that would bring about meaningful changes in organisational functions and processes within a reasonable time frame. The use of IT to create value in a patient-centric approach to care is likely to contribute significantly to the overall level of care that patients can benefit from. Innovation can help healthcare providers to gain a competitive advantage. The success of some healthcare provider as mention above has shown that IT can help in the healthcare sector to improve healthcare quality, reduce costs and to meet some of todays trends in demographics and disease burden. This quote which is published in NHG annual review 2007-2008 shows the importance of IT, Technology is our enabler. We use technology to record and disseminate information with higher precision, accuracy and safety. More importantly, it allows healthcare to be delivered safer, faster and better. (National Healthcare Group Polyclinics, 2008) In the enthusiasm to adopt and invest in IT, it is important to note that there are some barriers in the move toward an integrated healthcare system as stated in the abovementioned section. Addressing and overcoming these challenges will involve the collaboration and cooperation of players at all levels of the system, across both the public and private sectors. Learning points / Opinions Strategy Technology should be used as a supporting tool not to steer health care reform. To transform Singapores health care system into a modern and responsive 21st-century health care system, a practical IT strategy which is consumer-focused is needed. In particular, it needs to be competitive in terms of price and quality because that is what consumers look for. A tripartite model of health care regulation, involving the active participation of empowered consumers, is Singapores best hope for containing costs and ensuring quality of care. What is done well? A committee to plan for the future development in healthcare iN2015 Healthcare and Sub-Committee came out with strategies and programmes to help address todays challenge and support the developmental opportunities. It aims to achieve high quality clinical care, service excellence, cost-effectiveness and strong clinical research. Improve business process with IT IT has played an important role in the delivery and development of healthcare services in this information age with applications ranging from finance and personnel administration to medical equipment operations. Healthcare service administrations have become more efficient and responsive, reducing patient waiting time and paper work. Medical equipments have become more accurate, laboratory results can be processed more quickly and effective communication among medical staff in Singapore and those overseas has become easier. What more can be done User Involvement IT investment decisions must serve the best interests of the key players involved. It is important to understand the users and their work flow and requirements as a one size or solution may not fit all. Flexibility is needed as each department requires different functionalities. Express clearly the benefits and value for the change Users involved need to understand the strategic goals of the organization and understand how IT, from technical and managerial perspectives, can help to achieve them. The success of IT investments is to ensure users see the benefit and value of IT so that they will be motivated to make the change. Limitations of IT Healthcare providers should be mindful of the limitations of technology and have a deep understanding of the information search behaviours of their target audience. Health care is still a hi Are Consumers Central to Marketing Activities? Are Consumers Central to Marketing Activities? In view of the dynamic nature of the marketing environment, to what extent do you consider consumers to be, in practice, central to marketing activities? Words count: 1621 words Marketing is the analyzing, organizing, planning, and controlling of the firms customer-impinging resources, policies, and activities with a view to satisfying the needs and wants of chosen customer groups at a profit. (Kotler and Keller, 1967) [1] The main purpose of any business is to make profit. To do so, their customers are necessary. The role of marketing is to anticipate and identify consumers needs and wants, in order to satisfy them efficiently and profitably.2 In view of the dynamic nature of the marketing environment, to what extent are consumers, in practice, central to marketing activities? First of all, it is necessary to define what characterizes the marketing environment, and in what way this environment is dynamic. Secondly, we will see how the consumer is central to marketing activities. Finally, we will discuss about the relative importance of the consumers in these activities and the other factors that can also influence them. The marketing environment consists of external factors that affect the companies and their ability to satisfy customers.[2] There are two aspects to this marketing environment: the macro-environment, and the micro-environment. The PESTEL factors are the factors found in the macro-environment: political, environmental, social/cultural, technological, economical and legal.[3] They are societal factors, thus not controllable; and the companies need to adapt to these factors. In the macro-environment is included the demographical factor. The study of the demographic environment can help predict the size of the market of a certain product. For example if the number of elderly people is going to rise, the potential market for retirement homes will grow. The same goes for a change in the number of children, which could impact the number of schools and teachers needed.[4] Companies need to adapt to changes in the micro-environment as well. The factors in the micro-environment are the ones close to the company, making them easier to control: customers, competitors, distributors, suppliers, and other departments within the company.For example, if a company has competitors satisfying the same needs with a similar product but at a lower price, it wont be able to sell its product and make profit out of it. Companies make use of marketing research and marketing intelligence to collect information about the marketing environment in order to adapt their marketing strategies. Marketing takes place in a dynamic environment: these external factors change constantly, and companies need to be aware of these changes taking place in the marketing environment in order to adapt themselves efficiently and effectively, and be able to keep on answering consumers needs and wants.[5] To satisfy their target consumers, marketers need to understand them. They need to study the existing and potential markets. Resources need to be efficiently managed in order to meet the identified needs in these markets.2 Marketing orientation is important because different customers have different needs. In order to meet the specific needs of each customer, firms have to adapt. Answering everyones needs is not a realistic thing, which is why segmentation is used. Segmentation is the method used to separate the population into specific segments, which contains customers with similar needs. Understanding the needs of these segments of population will allow the determination of the marketing strategy that will be used in a specific business plan.[6] The marketing strategy determines the actions that will be taken over time to achieve the objectives of the company. Marketing decisions are based on the 4Ps, also called marketing mix: Product, Price, Place and Promotion. The four components of this marketing mix are determined by the target consumers.[7] As said before, the purpose of any business is to make profit, and it needs to satisfy the consumers for that to happen. The product needs to fulfil the customers need of course, but not only. The product also has to be at an acceptable price in the eyes of the consumers for them to buy it. The price is what makes money for the company, it is determined by the production costs and the competition, as well as by how much the customers are willing to pay for the product. On the one hand, if the price is too high, consumers wont buy, which means the company wont achieve its sales target. On the other hand, if it is too low, the target will be achieved but there will be no profit made out of it. 4 Price has to be chosen accordingly as well as place. Different types of consumers will need the product to be available at specific places. A very expensive product, such as a luxury item, will not necessarily be available at the local supermarket for example, but most certainly in a specific shop or place. Consumers also prefer to buy products when they are located close to their homes and workplaces.[8] In order to answer consumers needs profitably, marketers have to use segmentation to target their market, and match their marketing strategy to their target consumers needs.4 Thus making the consumers central to the companys marketing activities. Lets take Microsoft as an evolutionary example of changes in the marketing environment with the technological factor (macro-environment) and the companys competition (micro-environment).9 Recently, Microsoft has struggled to find its place in a fast changing digital and technological environment. Microsoft was and still is in consumers mind the leader in Personal Computers. They are now lagging behind competitors like Apple or Samsung, and are trying to develop other devices like tablets, smartphones, consoles, etc. They even acquired Nokias smartphone business in order to do so. They developed a new version of their operating system that works on every platform, including their console Xbox; which provides a cloud based connectivity that consumers are looking for. Their change in strategy to provide consumers what they need in this era of technological improvements has paid off: Microsofts sales are trending upward since the past few years.[9] In order to keep his place in the market, Microsoft had to change its strategy to improve its solutions to satisfy todays consumers after being left behind by competitors and technological advances. To this point, we can affirm that consumers are indeed essential and central to marketing activities. Marketing is all about satisfying consumers profitably, and marketing research and marketing strategies are calculated around them. Despite their importance, consumers are only one of the forces in the marketing environment. Changes in the marketing landscape are so fast that it is now more and more difficult for companies to adapt. One of the most influential factors of marketing activities is technology: 40% of the worlds population now has access to the Internet, compared to 1% in 1995.[10] The vast majority owns a smartphone that also has access to the Internet. The Internet and social media are thus also used for marketing purposes as well[11]: websites, adverts, e-mails, videos, etc. Influencers on the Internet are also important for marketing research; they can be people who have blogs and websites for example, and are useful to marketers for them to better understand current trends and interests.[12] Companies can also sponsor people such as bloggers and video makers (YouTube in particular) by making them review products and/or services online.[13] Globalization is another factor that influences marketing activities. Lots of companies now face global competition. Also, when a company decides to sell its products abroad, it has to take into account the tastes and habits of the selected country. For example, for the French market, Nutella is manufactured to be more spreadable, due to the fact that French people mostly eat it on baguettes, making it more difficult to spread.[14] Nowadays, companies also need to take into account the environmental aspect for their marketing activities. They have to be environmentally responsible, to be more sustainable in their practices than in the past. These are a few other examples of factors, apart from the consumers, that can have an influence on the marketing activities of businesses. To conclude, consumers are indeed central to marketing activities, but are only one of the many factors that have an influence on them: notably changes in the marketing environments factors; the technological factor in particular, which is probably the fastest changing factor as of now. References Berthon, P., Pitt, L., Plangger, K. and Shapiro, D. (2012). Marketing meets Web 2.0, social media, and creative consumers: Implications for international marketing strategy. Business Horizons, 55(3). Ça mintà ©resse La curiosità © en continu. (2017). Pourquoi le Nutella nest pas le mà ªme en France quen Allemagne ? Ça mintà ©resse. [online] Available at: http://www.caminteresse.fr/economie-societe/pourquoi-ne-mange-t-on-pas-le-meme-nutella-en-france-quen-allemagne-1129354/ [Accessed 26 Mar. 2017]. Corcoran, C. (2017). Marketings New Rage: Brands Sponsoring Influential Bloggers. [online] WWD. Available at: http://wwd.com/business-news/marketing-promotion/marketings-new-rage-brands-sponsor-influential-bloggers-3230386/ [Accessed 26 Mar. 2017]. Goi, C. (2009). A Review of Marketing Mix: 4Ps or More?. International Journal of Marketing Studies, 1(1). Internetlivestats.com. (2017). Number of Internet Users (2016) Internet Live Stats. [online] Available at: http://www.internetlivestats.com/internet-users/ [Accessed 26 Mar. 2017]. Kotler, P. and Armstrong, G. (2016). Principles of marketing. 16th ed. Harlow: Pearson. Kotler, P. and Keller, K. (1967). Marketing management. 1st ed. Upper Saddle River, NJ: Pearson Prentice Hall. Li, Y., Lai, C. and Chen, C. (2011). Discovering influencers for marketing in the blogosphere. Information Sciences, 181(23). Palmer, A. and Worthington, I. (1992). The business and marketing environment. 1st ed. New York [etc.]: McGraw-Hill Book Co.. Richardson, M. and Evans, C. (2007). Assessing the Environment. British Journal of Administrative Management. Smallbusiness.chron.com. (2017). What Are the Four Types of Utility Marketing?. [online] Available at: http://smallbusiness.chron.com/four-types-utility-marketing-24420.html [Accessed 26 Mar. 2017]. [1] Kotler, P. and Keller, K. (1967). Marketing management. Upper Saddle River, NJ: Pearson Prentice Hall, p.12. [2] Palmer, A. and Worthington, I. (1992). The business and marketing environment. New York [etc.]: McGraw-Hill Book Co., pp.1-6. [3] Richardson, M. and Evans, C. (2007). Assessing the Environment. British Journal of Administrative Management. [4] Palmer, A. and Worthington, I. (1992). The business and marketing environment. New York [etc.]: McGraw-Hill Book Co., p.167. [5] Kotler, P. and Armstrong, G. (2016). Principles of marketing. 16th ed. Harlow: Pearson, pp.94-95. [6] Palmer, A. and Worthington, I. (1992). The business and marketing environment. New York [etc.]: McGraw-Hill Book Co., pp.10-17. [7] Goi, C. (2009). A Review of Marketing Mix: 4Ps or More?. International Journal of Marketing Studies, 1(1). [8] Smallbusiness.chron.com. (2017). What Are the Four Types of Utility Marketing?. [online] Available at: http://smallbusiness.chron.com/four-types-utility-marketing-24420.html [Accessed 26 Mar. 2017]. [9] Kotler, P. and Armstrong, G. (2016). Principles of marketing. 16th ed. Harlow: Pearson, pp.92-94. [10] Internetlivestats.com. (2017). Number of Internet Users (2016) Internet Live Stats. [online] Available at: http://www.internetlivestats.com/internet-users/ [Accessed 26 Mar. 2017]. [11] Berthon, P., Pitt, L., Plangger, K. and Shapiro, D. (2012). Marketing meets Web 2.0, social media, and creative consumers: Implications for international marketing strategy. Business Horizons, 55(3), pp.261-271. [12] Li, Y., Lai, C. and Chen, C. (2011). Discovering influencers for marketing in the blogosphere. Information Sciences, 181(23), pp.5143-5157. [13] Corcoran, C. (2017). Marketings New Rage: Brands Sponsoring Influential Bloggers. [online] WWD. Available at: http://wwd.com/business-news/marketing-promotion/marketings-new-rage-brands-sponsor-influential-bloggers-3230386/ [Accessed 26 Mar. 2017]. [14] Ça mintà ©resse La curiosità © en continu. (2017). Pourquoi le Nutella nest pas le mà ªme en France quen Allemagne ? Ça mintà ©resse. [online] Available at: http://www.caminteresse.fr/economie-societe/pourquoi-ne-mange-t-on-pas-le-meme-nutella-en-france-quen-allemagne-1129354/ [Accessed 26 Mar. 2017].