Real Estate Principles Essay Example | Topics and Well Written Essays - 2000 words

Real Estate Principles - Essay Example Ethics in real estate One of the greatest obstacles that affect the growth of real estate industry is lack of ethics. This is based on the fact that most of the real estate buyers are not aware of the intention and operations of the realtors. In their efforts to get adequate information regarding the problems facing the real estate industry, most governments involve real estate institutes. However, most of these institutes are made up of real estate agents who are focused at exploiting consumers in their efforts to maximize profits (William and Donald, 1995). To ensure ethics are upheld during the transaction between the realtors and the property owners or buyers, National Association of Realtors has specified code of ethics that all its members are under obligation to follow. This course has widened my knowledge on how to uphold ethics during my future assignment as a real estate agent when dealing with my clients, public as well as other members of National Association of Realtors. Duties to clients Articles 1 to 9 of the National Association of Realtors code of ethics, regulates the way the real agents relate with their clients (William and Donald, 1995). ... Duties to the public Articles 10 of the National Association of Realtors code of ethics forbids agents from discriminating their clients on the basis of color, sex, religion, race or nationality. Other key aspects that are dealt with by articles 10 to 14 depicts that agents should not provide services that they are not competent in, contacting a lawyer in cases the agency has no authority to practice law and avoiding misleading advertisements. Duties to other members National Association of Realtors code of ethics depicts that agents should not make untrue statements about their competitors. In addition, it forbids agents from transacting business with clients who are exclusively owned by other agents. Legal Aspects of Real Estate Based on the fact that real estate covers immovable properties, minerals, bushes, water among others, real estate and property law covers wide range of aspects. It is worth noting that different countries have put in place various regulation that seek to co ntrol the operations of agencies and transfer of property. As a result of the inconsistency of the property laws, initiating legal procedure has become a complex practice that calls for proper coordination among all the stakeholders. This course has exposed me to major issues that are covered by real estate and property laws include purchasing of property, landlord issues, transfer of movable and immovable property, settlements of claims, property development, foreclosures, land use and zoning, home loans among others. This section discusses major aspects of property and real estate law adopted by various countries. Property and Real Estate Law adopted by US Real Property, Trust and Estate Law Sections Real Property, Trust and Estate

The Rise of Christianity in the Roman Republic Essay Example for Free

The Rise of Christianity in the Roman Republic Essay Throughout the Roman republic and most of the empire, the Roman religion was polytheistic. The religion was based on the Greek religion and included multiple gods and goddesses who were anthropomorphic and cruel. However, during the first century of the Common Era, Judaism and â€Å"mystery religions† such as Mithraism, Eleusis, and Christianity were becoming increasing popular. Roman rule tried to control the spread of these religions but eventually Christianity became the chief religion of Rome and its empire. In the early stages of these new religions, Rome was surprisingly tolerant. Many rulers allowed citizens to practice these religions and asked only for simple patriotism and to recognize the holidays of Roman gods. Most Jews and Christians were uncooperative with this notion. In fact, many radical Jews and Christians emerged. A notable radical Jesus, who was an orthodox Jew, led and taught â€Å"the good news† to his followers. This stubborn disobedience enraged rulers such as Nero and Diocletian, who ordered for many Christian persecutions. Diocletian ordered that churches and sacred books be destroyed throughout the Empire. Nero is best known for a devastating fire which was rumored to have been started by Nero himself. He tried to end these rumors by punishing many Christians as a distraction. Persecutions were common and often resulted in death. Women were persecuted the same as men. Christians accepted Jesus as their messiah after he had been put to a gruesome death under the orders of Pilate. At this time, the Roman Empire was in economic turmoil and Christian persecutions were its last attempt at control. A major turning point in the history of Christianity occurred in 312 of the current era. The story is told that Constantine, Roman emperor during this time, had a dream telling him to decorate his shield with the Greek letters for Christ. When he did so and was victorious during battle, Constantine decided that he would convert to Christianity. Constantine also ended all persecutions and allowed all Christians to worship freely. Theodosius the Great took the work of Constantine a step further. He forbade any religion to be practiced except Christianity. This movement gave many more privileges to the church. Churches could now own property and were exempt from certain taxes. Christians were finally free to live and worship. The phenomenon of Christianity was not a battle won easily. There were many cruel and devastating punishments to those who practiced against Roman religion. Men and women were put to death or forced into hiding in the first century. However, as the population of Christians grew rapidly, Roman law found it necessary to revise laws and allow Christianity within the Empire. Christians had won the victory of faith and progressed onward through history.

The Development of the Hero in Little Women Essay -- Louisa May Alcott

  Louisa May Alcott furnishes a probing look at the hero through recognition of how the imaginary hero of romantic fiction is not always the ideal while bringing the reader to see the heroic in the everyday lives of four young women with the primary emphasis falling on Jo. In the chapter, "Castles in the Air," as each of the characters envisions the distant future (ten years hence anyway), Jo remarks, "I want to do something splendid before I go into my castle-- something heroic or wonderful that won't be forgotten after I'm dead. I don't know what, but I'm on the watch for it, and mean to astonish you all some day" (Alcott 133). As the book progresses, many references are made to show the shallowness that has begun to be associated with the heroic. ". . . Laurie heroically shut his eyes . . ." (Alcott 264). "Fred is not my model hero" (Alcott 294). Finally, Jo focuses the conflict in recognizing the heroic when she reaches the point of realizing that she "preferred imaginary heroes to real ones, because when tired of them, the former could be shut up in the tin kitchen till called for, and the latter were less manageable" (Alcott 298). With Jo March, Alcott presents a modern young woman in a day when women were very much relegated to a specific role within the home. From the opening pages of the book, Jo exhibits a unique strength of character that refuses to be molded to the traditional form. She longs to be a boy, primarily because of the opportunities available to the male in society. However, taking her unusual family upbringing and applying it to Jo's determination to be different creates an individual who is heroic in her strength and courage to stand out in society and her ability to share that quality with othe... ...he wife and mother. Rather, she insists that she will carry her share and help in the earning of the home as a condition of marriage (Alcott 438).    Jo's journey to the heroic ultimately leads her to a role where her life is spent in giving herself to others, shaping them to be themselves while still maintaining proper place in the grand scheme of things. Through her characterization, a hero is fully developed as one with the strength of character that allows one to be uniquely different while seeking always to help others in the journey of life by placing them ahead of oneself. Jo's heroic act that will not be forgotten after she's dead, only a dream as a young lady, is realized through the lives she touches and the future generations she ultimately affects.    Works Cited Alcott, Louisa. Little Women. Intro. Ann Douglas. NY: Signet Classic, 1983.

My Most Beneficial Personal Quality

I have taken advantage of the education opportunities presented me thus far to prepare for college in many ways. First and foremost I have ensured that I have enjoyed a wide variety of classes and electives to provide me the opportunity to explore as broad a subject selection as possible. Most of the courses I have focused on in my senior year have been college preparatory. College preparation however is much more than academics alone. I have also experienced many educational opportunities that exist outside the realm of traditional ‘academics'. These experiences have prepared me more so for my college experiences than my preparatory courses. I have for example faced many challenges while growing up. During my four years of high school I engaged in a variety of extracurricular activities and clubs that taught me much more about the ways that people interact and communicate than I ever would have initially assumed. Participating in many volunteer organizations and student achievement groups, I realized that not two people interact in the same way. Most people I learned are products of many different elements including their beliefs, values, morals and faith. One's religious ideals, culture and even familial upbringing can all influence their perceptions on life, their ability and motivation to interact with others and their desire to achieve. With this knowledge I learned new and exciting ways to interact with people, even those that were very different from me and with those that held very different beliefs. In fact in most of my pursuits I found myself drawn to those with conflicting ideals and moralisms, in part because they challenges me to learn more about myself and question the beliefs I held true about the world in which we live. I believe it is through these types of interactions that we actually learn everything there is to know of the world. We need to rely on people that challenge us and our views so we open our eyes and get a better understanding of the world in which we live. I feel these diverse educational experiences while not academic, have prepared me for life in the university more so than any classroom instruction may have or will in the future. I bring to the University of California a unique ability to network and work personally with people. By far my most beneficial personal quality is my ability to build relationships and communicate with a wide diversity of people from varying backgrounds, cultures and environments. In today's society it is vital for anyone to understand the importance of interpersonal skills and relationships both on a personal and from a professional perspective. More and more the world is operating in a global business environment. Modern technology has afforded people the opportunity to communicate from once remote locations. What this means is that people from all over the world with all manner of different morals, values and beliefs are not just communicating with one another but also working together to create a better world. As members of a global society I feel it is vital that we all have the ability to communicate effectively with one another. Sometimes this takes the guidance and direction of a true interpersonal leader. I believe I am possessed of those traits. I have throughout my high school career taken great care to interact with people from various backgrounds and ethnicities. I have participated in multiple groups, clubs and organizations that have enabled better exposure to different people and have helped me learn better ways to communicate with one another. I have also witnessed first hand what happens when communication goes bad, and have since committed myself to facilitating solid communications and interactions between people. I believe this personal trait will benefit the University of California in many ways. The University of California is one of the nations top universities; home to thousands of unique students and home of many of the nations top academic programs. Early on I knew that more than anything I wanted to pursue the best education I could afford. To succeed in today's world business professionals and students must be possessed of a wide range of skills that are best learned in a University environment. I feel that throughout my life I have already faced many unique challenges and obstacles. I was not always a committed student, lacking the insight and motivation necessary to excel in my classes early on. However experience has taught me that little in the world is more valuable than an education. Every day on the news we hear stories of tragedy. Hurricanes that devastate infamous regions, terrorism that destroys the livelihood and communities of varying regions†¦ these are all modern realities we must learn to cope with. To address the often-turbulent environment we live in today, it is vital that we all commit ourselves to one another and our communities. I feel that I can best do this by excelling in my education. Through my university education I hope to learn not only of the fine nuances of other communities, but also about key demographics about the worlds' population and needs entering the upcoming decades.

Theology in the Chronicles of Narnia the Lion the Witch and the Wardrobe

RELAMPAGOS, Nicola Liane C. POSADAS, Klarizze FINAL PROJECT: The Chronicles of Narnia The Chronicles of Narnia: The Lion, The Witch and The Wardrobe is the first book in the Chronicles of Narnia series written by CS Lewis. The book series was such a great success that in 2008, the first book was turned into a film. What many people may not realize is that CS Lewis wrote the book series with a specific goal in mind: to showcase the word of God to different parts of the world through an artistic lens. This paper will focus on the theological nature of CS Lewis’ book based film, The Chronicles of Narnia: The Lion, The Witch and The Wardrobe.This will include a number of noticeable parallelisms, allusions and symbolisms found in said work. Although The Chronicles of Narnia: The Lion, The Witch and The Wardrobe was originally a published book, this paper will focus on the film adaptation of the book. One of the noticeable symbolisms in the movie would be found in the main character s of the film: Aslan, the Witch and the children. Aslan was portrayed as the original king of Narnia and when Narnia was held deep in the clutches of the White Witch, Narnias looked to Aslan as their redeemer.Aslan was also the one who died so that Edmund may live. He was the only one who was capable of defeating the White Witch. Aslan in the film was an artistic representation of Jesus Christ. The parallelism found in the resurrection of Christ, his absorbing of our sins and overcoming death is seen in the depiction The Witch, on the other hand, represents Satan. It was the White Witch who covered Narnia in snow: no sign of life, simply cold and dead. The Witch is consumed in her own vanity and the longing to fully overcome Aslan and rule over Narnia forever.It isn’t clearly stated, but it is seen in certain parts of the movie that The Witch feared Aslan: when the Witch spoke out of turn after their agreement and Aslan roared at her and she quickly sat down in fear of him. M uch like the Witch, Satan will always be inferior to God but will always try to put himself about Christ but will never achieve such. Lastly, the four children (Lucy, Edmund, Peter and Suzan) are human beings. They represent four different kinds of people who have different encounters with God.For Peter, he is the skeptical type of Christian. One who is doubtful by how God can use him to help build God’s kingdom, yet at times he forgets that it is only Christ who can defeat evil and not by his strength alone. Edmund is the type of Christian who has sinned and fallen short many times along the road before choosing to love and follow Christ. While Suzan is the type of Christian who has consistently doubted whether or not Christ, even really exists before fully trusting God with the things that don’t seem to make sense.Lastly, Lucy represents the Christians who just love, follow and dedicate their lives to Christ without hesitation and without doubt. Lucy’s childli keness showcases how Christians should love and trust Christ with our lives. Since the four children can be seen as symbolisms of human beings, their relationship with Aslan shows a lot about the grace, mercy and overall character of God. One of the main examples where this is seen is the grace that Aslan showed to Edmund who was a traitor.Despite Edmunds’ choice to prioritize Turkish delight over his family and his right as one of the king of Narnia, Aslan still accepted Edmund into his army and not only that Edmund still inherited the kingdom of Narnia not by his own works but by Aslan’s choice. Much like the plot of the movie, Christ will continue to accept sinners into his family despite what they have done in the past. As Aslan said, â€Å"What’s done is done, we need not speak to Edmund about what has happened anymore† this has a similar message in Philippians â€Å"I focus on all my energy on one thing: Forgetting what lies behind and focusing on what’s ahead†.Also, Edmund’s choice to pursue Turkish delight over his unmerited right to be a king of Narnia, is similar to the story in the Bible of how Esau gave up his birthright to Jacob for a bowl of stew. Both Edmund and Esau’s common mentality was the seeing the situation only at the present and forgetting the eternal value and purpose of their lives. But despite Edmund’s decision, Aslan accepted his presence with open arms, which is a similar characteristic to the story of the Prodigal Son.True sacrifice is an act that any human being can never really fathom, due to the only considered true sacrifice that was only made by God Himself by offering his own son to the world that is bound to perish in eternal debt of sin. In the movie, true sacrifice was first depicted through the following event, which was the acceptance of Edmund despite of his treason towards Aslan and his own brothers and sisters. Without the mistake that Edmund committed ea rlier in the movie, true sacrifice would have not been clearly depicted.The scene where Edmund was enticed by the Witch’s offer of Turkish delight and then the throne shows a great parallel of how the world committed the very first sin, the original sin. Adam and Eve were tempted by the devil, who took the form a snake and they were blinded by the temptation of knowledge that was offered by the apple. Same goes to Edmund, he succumbs to the lavish offers of the Witch that led to his treason towards his siblings. In the end, Aslan accepts Edmund despite his betrayal and also became the emancipator from the Witch.This selfless act then led to the suffering and supposed death of Aslan. The altruism that Aslan performed is an exact parallel to the suffering of Christ, which was the crucifixion. With such altruistic acts of both Aslan and Jesus Christ, it is believed that their sacrifices are yet to be unvarnished. No one in this world is capable of such because only the savior ca n absorb the sins of the world. In the movie, Aslan was put to death and was humiliated in front of the presence of many followers of the Witch by cutting off his mane, which is parallel to Christ’s crown of thorns.The Witch wanted to show her iron fist by showing the execution of Aslan in public, which only goes to show that she fears Aslan. She needs the approval of many, for her to feel superior over him. Although she thought she had succeed with the humiliation and execution, little did the Witch know that Aslan was to come back to life and save his followers despite their treason. The representation of Christ’s suffering and resurrection was fairly accurate; the breaking of the stone table which Aslan’s body was left behind is aligned to the opening of Christ’s tomb.In addition, Aslan was first seen back to life by the girls, which in the film were Susan and Lucy, and just like Christ who appeared to the women first (Mary and Mary Magdalene; found in Matthew 28:9). The movie then proceeds to the war between good and evil, which illustrates the consistent internal battle inside every human mind. When Aslan came back to life, he did not eradicate the battle between the Narnians and the forces of the Witch. But instead, the battle continued on even to the point that the Narnians began to face defeat.This shows that although the Jesus Christ overcame death, there will still be an internal battle between good and evil within us. In the film, Peter and Edmund try to lead the battle against the forces of The Witch and even tried to kill her but their attempts only would lead to death. It is only when Aslan comes into the picture, that he is not only able to breathe life back into the dead but also defeat the Witch. This is an artistic depiction of how human beings cannot overcome death by their strength alone. It is only Christ’s power that Satan is fully defeated.Therefore during spiritual battles within humans, one was surren der and acknowledges that he cannot do it by themselves and it is only by God’s help that we can overcome evil. Lastly, Aslan’s words after he defeated the Witch were a direct parallelism to the words that Jesus Christ utters when he defeated death on the cross: â€Å"It is finished†. The Chronicles of Narnia: The Lion, The Witch and The Wardrobe film holds a great number of theoretical references but the major and more obvious events would be the characterization of Asaln, the Witch and the three children, Aslan’s sacrifice and battle between the two forces.

Free Essays on Collectivization

Collectivization Collectivization policy adopted by the Soviet government, pursued most intensively between 1929 and 1933, to transform traditional agriculture in the Soviet Union and to reduce the economic power of the kulaks. Kulaks was the label give to prosperous peasants. Under collectivization the peasantry were forced to give up their individual farms and join large collective farms or kolkhozy. The process was ultimately undertaken in conjunction with the campaign to industrialize the Soviet Union rapidly. But before the drive began, long and bitter debates over the nature and pace of collectivization went on among the Soviet leaders, especially between Stalin and Trotsky, 1925-27, and between Stalin and Nikolay Bukharin, 1927-29. Some Soviet leaders considered collective farms a socialist form of land tenure and therefore desirable; but they advocated a gradual transition to them in order to avoid disrupting the agricultural productivity necessary to stimulate industrial growth. Other leaders favoured rapid industrialization and, consequently, wanted immediate, forced collectivization; they argued not only that the large kolkhozy could use heavy machinery more efficiently and produce larger crops than could numerous small, individual farms but that they could be controlled more effectively by the state. As a result, they could be forced to sell a large proportion of their output to the state at low government prices, thereby enabling the state to acquire the capital necessary for the development of heavy industry. A decision was made by the 15th Congress of the Communist Party (December 1927) to undertake collectivization at a gradual pace, allowing the peasantry to join kolkhozy voluntarily. But in November 1928 the Central Committee and in April 1929 the 16th Party Conference approved plans that increased the goals and called for 20 percent of the nation's farmland to be collectivized by 1933. Between October 1929 and J... Free Essays on Collectivization Free Essays on Collectivization Collectivization Collectivization policy adopted by the Soviet government, pursued most intensively between 1929 and 1933, to transform traditional agriculture in the Soviet Union and to reduce the economic power of the kulaks. Kulaks was the label give to prosperous peasants. Under collectivization the peasantry were forced to give up their individual farms and join large collective farms or kolkhozy. The process was ultimately undertaken in conjunction with the campaign to industrialize the Soviet Union rapidly. But before the drive began, long and bitter debates over the nature and pace of collectivization went on among the Soviet leaders, especially between Stalin and Trotsky, 1925-27, and between Stalin and Nikolay Bukharin, 1927-29. Some Soviet leaders considered collective farms a socialist form of land tenure and therefore desirable; but they advocated a gradual transition to them in order to avoid disrupting the agricultural productivity necessary to stimulate industrial growth. Other leaders favoured rapid industrialization and, consequently, wanted immediate, forced collectivization; they argued not only that the large kolkhozy could use heavy machinery more efficiently and produce larger crops than could numerous small, individual farms but that they could be controlled more effectively by the state. As a result, they could be forced to sell a large proportion of their output to the state at low government prices, thereby enabling the state to acquire the capital necessary for the development of heavy industry. A decision was made by the 15th Congress of the Communist Party (December 1927) to undertake collectivization at a gradual pace, allowing the peasantry to join kolkhozy voluntarily. But in November 1928 the Central Committee and in April 1929 the 16th Party Conference approved plans that increased the goals and called for 20 percent of the nation's farmland to be collectivized by 1933. Between October 1929 and J...

Elements Of Drama Essay Example

Elements Of Drama Essay Example Elements Of Drama Essay Elements Of Drama Essay Elements Of Drama The dictionary definition of Drama is the activity of acting, or simply a play for theatre, the elements however that make up this intricate and diverse art form are far more complex than the concluding definition. The elements of Drama are essentially building blocks that culminate in the finality of this wholesome, rigorous activity. A simple way to understand a form as complex as Drama, Is to look at It as a physical project, Like building a house. The first and most Important element Is the theme of the Drama. The main, starting Idea, the whole motive behind the play, the realization of what you want your audiences to feel and experience and what you want to produce. The theme can be looked at as basic criteria that you would have for your dream house, the kind of view that you want, the amount of land, the locality, basically the first steps in narrowing down on a concrete idea for what you want. The next logical step in terms of getting a house is buying a plot of land, and the next logical element of Drama is the plot as well. The plot is an outline of the course of events, its always in the present but can also include a flashback. The plot is the entire narration, the occurrences that bring out the theme, and comprise the whole story. Once you have your plot of land, you start building the structure of your house. Similarly, the next element of Drama is the structure of the play, which comprises of the beginning, the exposition or the middle, which spills into the transition, or the ending, which inevitably results in some kind of resolution. Once the house is ready, people move in and make the house a home; they infuse it with their energy, relationships, conflicts and personality. Like this, you must inject in characters and legislations to the structure to carry the plot forward. These characters can be realistic or imaginative or abstract. These characters are tools with which the drama Is presented, the plot played out and the theme revealed. Another tool that Is essential in Drama is the use of language. The language in a play is a form of expression, a direct confirmation for the direction that the plot is headed. The language can be symbolic; It must always give perspective and can even Incorporate Imagery. The language also has a tendency to spill Into a fragmented form, and almost always as some sort of a texture, which basically translates Into the overall feel of the characters and setting. This Is where sound value comes In, It Is Important to note that dictionary words have sound value too, even silence does, and It communicates the intellectual meaning of the word, or the sound in accordance to the feeling. For example, the word rough will still have the same sound value even if its said angrily or lovingly. Theatricality is created through conflict, without any conflict, the storyline will be static, the theme wont get across and it wont have any impact on the audience. Conflict is essential in drama, as it results in theatricality, the ups and downs in the storyline creates interest and is needed to establish the purpose of the play. Examples of conflict can vary from conflicts between two or more people, groups of people or even conflict within oneself, as in the character. The arousal of conflict generates suspense about the outcome of the conflict, which in turn helps the structure make sense and come together. The concluding and most practical aspect of Drama is the feasibility of the play. This takes into account the target audience, the recitalists, the objective or even the kind of actors that are required for the execution of the play. This aspect of Drama takes into consideration the technical and practical aspects of the play in terms of the requirements for its execution. In conclusion, all afore mentioned elements of Drama are instrumental in the becoming any play and provide a stable foundation for theatre productions to thrive on. Drama is a complex, diverse and wholesome form of expression, but there is a method behind its madness, a criteria and a process that validates or appreciates the dramaturgy of plays. By: Janis Kapok

Differences Between Allopathic and Osteopathic Medicine

Differences Between Allopathic and Osteopathic Medicine There are two basic types of medical training: allopathic and osteopathic. The traditional medical degree, the Doctor of Medicine (M.D.), requires training in allopathic medicine while osteopathic medical schools award the Doctor of Osteopathic Medicine (D.O.) degree. Students hoping to achieve either degree attend medical schools and receive substantial training (4 years, not including residency), and other than the osteopathic students ability to administer osteopathic medicine, there is no real marked difference between the two programs. Training The curricula of both schools are similar. State licensing agencies and most hospitals and residency programs recognize the degrees as equivalent. In other words, osteopathic doctors are legally and professionally equivalent to allopathic doctors. The important difference between the two types of schools of training is that osteopathic medical schools take a holistic perspective on the practice of medicine based on a belief in treating the whole patient (mind-body-spirit) and the primacy of the musculoskeletal system in human health and the utility of osteopathic manipulative treatment. D.O. recipients emphasize prevention, a historical distinction which is less relevant as all of the medicine increasingly emphasizes prevention. Biomedical and clinical sciences take the forefront of both degrees training programs, requiring students of both fields to complete relatively the same course load (anatomy, microbiology, pathology, etc), but the osteopathic student additionally takes courses focused on hands-on manual medicine, including an additional 300-500 hours of study in manipulating the musculoskeletal system, a practice referred to as osteopathic manipulative medicine (OMM). Admissions and Enrollment There are fewer D.O. programs than M.D. programs in the United States with about 20% of medical students entering D.O. programs each year. As compared with traditional medical school, osteopathic medical schools have a reputation for looking at the applicant, not just his or her statistics, and therefore likely to admit nontraditional applicants who are older, non-science majors or seeking a second career. The average GPA and MCAT scores for incoming students are slightly lower in osteopathic programs, but the difference is rapidly falling. The average age of entering osteopathic students is about 26 years (versus allopathic medical schools 24). Both require an undergraduate degree and basic science coursework before applying. Practicing osteopathic physicians make up seven percent of the United States medical physicians with over 96,000 practicing currently in the country. With enrollment in D.O. programs increasing steadily since 2007, though, it is expected that these numbers will climb in the coming years and more private practices will open that focus on this field of medicine.   The Real Difference The main disadvantage of choosing osteopathic medicine is that that you may find yourself educating patients and colleagues about your degree and credentials (i.e., that a D.O. is the equivalent of an M.D.). Otherwise, both receive the same level of legal benefits and are fully accredited to practice in the United States. Essentially, if you are hoping to choose between the two fields of study, you really just need to evaluate whether or not you believe in a more holistic, hands-on approach to medicine or the more traditional route of becoming a Doctor of Medicine. Either way, though, youll be a physician after completing your medical school degree and residency programs.

International business Movie Review Example | Topics and Well Written Essays - 1000 words - 1

International business - Movie Review Example Later in a staff meeting, Sam Rogers (Kevin spacey) reveals to the remaining employees that the company only sacked the underperforming staff thus retaining its best employees as he says, †they were good people and good at their jobs, but you were better. †.When working hours are over, Peter stays behind to work on the unfinished project as the other employees go to celebrate that they haven’t been sacked. Upon completion, he realizes that their firm is hanging on a whisker in the market. He contacts Will (his supervisor) who looks at the findings and calls his boss Sam. Seeing that he can’t handle that big an issue, Sam calls his superiors to an emergency meeting through the night, while at the same time a helicopter brings in the CEO John Tuld (Jeremy irons).Two opinions come to motion as they discuss which actions to take. Jared Cohen (Simon Baker) thinks they should sell all the available firms toxic assets when it’s still early since the market d oes not know of their worthlessness, because as they figured would soon know as opposed to Sam’s strong objection. This opinion is also shared by John Tuld. However, it is john’s mandate to decide which opinion to implement. It’s revealed that Sarah Robinson (Demi Moore) who is the chief risk management officer tried to warn John of the current matter about a year ago, an opinion which he declined. Will and Seth are sent to get Eric who has now arrived at his place. Against his will, Sam implements John’s strategy when the market opens. Sarah and Eric sit in a room earning lots of cash the whole day until the market closes. Sam decides to resign but john talks him into staying for 24 more months, while Peter is promoted. After all, they just survived another financial day as usual. In the final end it all comes back to the main business objective:†survival and

Glaceau Smart Water Essay Example | Topics and Well Written Essays - 500 words - 1

Glaceau Smart Water - Essay Example However, in 1998 and 2000, the company added Fruit water and Vitamin water, respectively, thereby expanding its distribution operations to the entire country. By the year 2002, Glaceau’s line of water was the best selling enhanced water brand in the US. In 2006, the bottle water division earned the organization revenues of approximately $350 million (Geller 1). The immense success realized in the US pushed the company to establish business globally by launching its products in Australia, Argentina, UK and France. The source of Glaceau Smartwater is an artesian spring found in the Northern region of Connecticut. Since water naturally travels on the surface of the earth or through the ground, it picks up substances that naturally, as well as substances present as a result of human and animal activity. Glaceau Smartwater is, therefore, subjected to intricate distillation processes, which entail water purification (Glaceau 1). After distillation, the water bottling plant introduces, in the water, an approved balance of 10mg per liter of Potassium, Calcium and Magnesium, through the addition of electrolytes. Smartwater is available in 20 oz, 700ml, 1 liter and 1.5 liter bottles. The cost of Smartwater is relatively cheap; a liter of Smartwater costs approximately $1.39, which is relatively cheap compared to a liter of whole fat milk is $2.26 and a liter of gasoline goes for $3.315. Clearly, the cost of Smartwater is hardly comparable to that of other essential products such as milk and gasoline. The primary reason for why I drink Glaceau Smartwater is because the water is loaded with the aforementioned minerals, which are essential to ensuring health and wellbeing. I also drink the water because of its attractive bullet-shaped contained, which is essentially plastic with minimal breakage capacities. The conventional sport cap further

Business Ethics Term Paper Example | Topics and Well Written Essays - 1250 words

Business Ethics - Term Paper Example 1.c Oligopoly In an oligopoly market, the number of firms or sellers is few, and the entry of the other party is restricted, though more than one seller is allowed to enter in oligopoly market (Velasquez, G.M., â€Å"Business Ethics: Concepts and Cases†: 167). 1.d Monopolistic Competition In a monopolistic competition, the number of buyers is many and the entry of the sellers is free like perfect competition (Velasquez, G.M., â€Å"Business Ethics: Concepts and Cases†: 167). Type of Market Factors Monopoly Oligopoly Perfect Competition Monopolistic Competition Number of sellers One seller Few seller Large number of sellers Several/ many Entry to the market Restricted/ completely blocked Restricted Unrestricted/free Unrestricted/free Nature of product Unique Differentiated /undifferentiated Homogeneous Differentiated Demand curve Downward sloping, more inelastic Downward sloping, relatively inelastic Horizontal Downward sloping, relatively elastic Examples Local water su pply Cars, electronics, Cement Carrots, Cabbage, Potato Restaurants, Builders Source: (Velasquez, G.M., â€Å"Business Ethics: Concepts and Cases†: 167). Question 2 2. ... He also added that the personal right to liberty or property is valid but the right to a pollution free society and living is more important than the property right. Every individual has their own property and liberty to use that property according to their wish but they should keep in mind that the nature is interconnected, once an individual pollute their property the others’ property also gets affected. When a person poisons his or her land or well, the other lands and wells also get poisoned, which harms the ecology and the environment. Every other person is responsible towards the environment and its good health. There are many Anti Pollution Acts to save the environment and the people of the society should abide by those laws to enjoy as well as to give others a standard living. Though the view point of Blackstone does not solve the issue permanently, still there are few questions on the pollution and its acts such as, how much pollution to control, how much property rig hts to be limited for the environment and its health. In relation to the above discussion, it can be acknowledged that both the rights are important for the society, without the right to property and liberty the society would have huge problems regarding the ownership of the property and the day-to-day activities. The farmers and fishermen are dependent on the environment, land and water. Without the right to property and right to liberty they would have real problem, but at the same time they are responsible to pollute the society as less as they can, which would maintain a balance between the people and the nature (Velasquez, M. G., â€Å"Business Ethics: Concepts and Cases†). Question 3 Firm’s

Exploratory Methods Research Paper Example | Topics and Well Written Essays - 1000 words

Exploratory Methods - Research Paper Example Exploratory research is also known as unstructured or informal form of research. This is generally done for conducting a background study of the research. The nature of the research keeps changing as the researcher uncovers the different aspects of the research area. In exploratory method of research no well-defined objective, sampling plan or questionnaire is prepared for collecting data. Generally secondary sources of data are concluded in this form of research (Parasuraman, Grewal & Krishnan, 2007, p. 57). The exploratory research method is applicable in: a) Gaining the information regarding the background of the study. It is used when the researcher has very little information about the problem and the problem statement of the research could not be appropriately formulated. It becomes necessary for the reader to develop a background analysis to see the larger picture of the situation, b) It is used to measure the terms and concepts to be used in the research, and c) The hypothesi s and the problem areas can be clarified through exploratory research (Burns, & Bush, 2007, p. 57). Case Study The intensive analysis of any individual unit is called case study. It mainly stresses the developmental factors in relation to the given context. It may be descriptive or exploratory. Case study is used in exploratory research to find the causes so as to find relevant answers for the stated principles. The case study may be prospective one or a retrospective one. The case is the subject, which is discussed on the basis of a particular organization, issue or problem. Case study is also denoted as research study as it gives us an empirical analysis of the phenomenon in real-life situations. Case study is generally formulated to answer the research questions. The research problem is first carefully formulated and then answers are found based on the research conducted by the researcher. The answers derived from the research is explained or interpreted by the researcher with th e help of a real-life situation. The theories used while deriving the solution are utilized and a case is formulated to present the practical problem situations and strategies that were used to solve them. The type of research question defines the type of case study to be formed. Case studies help to find the bottle necks and ways to reach the solutions. It also enables the researcher to monitor the changes. Psychobiography The term psychobiography means analyzing the importance of lives by using the psychological theories and conducting research. The aim of this type of research is to unearth the public motives behind a particular activity or behavior. Psychobiographical research does not involve any form of standardized format. It generally depends on the subject, the researcher and various other aspects. It is actually considered as a qualitative form of research technique. This method of conducting research is generally used for celebrities, outstanding personalities or leaders. Psychobiographical research provides an in-depth analysis to the researcher regarding the behavior of the person and the reason behind such behavior. This methodology was actually invented by Sigmund Freud. It deals with unfolding the personality and psychology of an individual. This method is use in form of qualitative research technique because it deals with human behavior, psychology and emotions. It is also used to explore

Cadez and Guilding (2008) Organization Essay Example | Topics and Well Written Essays - 1500 words

Cadez and Guilding (2008) Organization - Essay Example Costing a. Attribute Costing b. Life cycle Costing c. Quality Costing d. Target Costing e. Value Chain Costing 2. Planning, control, and performance measurement a. Benchmarking b. Integrated Performance Measurement 3. Strategic Decision Making a. Strategic Costing b. Strategic Pricing c. Brand Valuation 4. Competitor Accounting a. Competitor cost assessment b. Competitive position monitoring c. Competitor performance appraisal 5. Customer Accounting a. Customer Profitability Analysis b. Lifetime Customer Profitability Analysis c. Valuation of Customers as Assets In this paper the strategic management technique of Benchmarking has been presented and defined, along with its benefits for the organisation. Benchmarking and its Benefits for the Organisation: This is the process of comparing ones internal processes with the processes of a company in the same industry, to identify discrepancies. The aim of this activity is to identify the best ways of carrying out a process. When undertakin g this process a company can also analyse the business practices of firms in different industries, and find out what are the key processes in these industries, by doing this a firm can know which processes can be tailored to fit their business model and what are the most effective ways of performing these processes. There are numerous measures which can be assessed in this way, for instance financial parameters, management parameters etch. However the most focused business variables that are subjected to this tool are time, quality and cost (Zairi, 1998). Through the process of benchmarking a company can find out the potential a process carried out by it can achieve. For instance if a competitor is carrying out the same business processes and is achieving a larger output as compared to the company, than there exist some problem with the company’s internal processes. Since the productivity level that can be accomplished is not being accomplished, the company needs to take corr ective measures to raise its productivity (Cooper and Kleinschmidt, 1995). From a competitive point of view, if a company is competing for a order that needs order fulfilment in a lesser amount of time, than the order placing firm will check the production capacity of each of the competing firms. In case a company has remained oblivion to the production capacity of its competitor, who presumably is having a higher production capacity, it can fairly be inferred that the order placing entity will opt for the firm which has greater production capacity. Thus, ever company is obligated to explore the processes of its competitors and other firms in different industry so that it can continually upgrade its own internal processes (Vorhies and Morgan, 2005). After a company decides, which business process it wants to benchmark and how it is going to benchmark it, than it needs to analyse the leader firm in this process and specifically find out how they accomplished such proficiency (David,à ‚  1995). The practice of benchmarking is not an end in itself. It is a part of a bigger initiative, to undertaking business process re-engineering. This process redefines and reconfigures the standard operating procedures of the company’s department or process that is being benchmarked. By doing this the company is trying to neutralise the competitive or process advantage of its competitor firm

Exploratory Methods Research Paper Example | Topics and Well Written Essays - 1000 words

Exploratory Methods - Research Paper Example Exploratory research is also known as unstructured or informal form of research. This is generally done for conducting a background study of the research. The nature of the research keeps changing as the researcher uncovers the different aspects of the research area. In exploratory method of research no well-defined objective, sampling plan or questionnaire is prepared for collecting data. Generally secondary sources of data are concluded in this form of research (Parasuraman, Grewal & Krishnan, 2007, p. 57). The exploratory research method is applicable in: a) Gaining the information regarding the background of the study. It is used when the researcher has very little information about the problem and the problem statement of the research could not be appropriately formulated. It becomes necessary for the reader to develop a background analysis to see the larger picture of the situation, b) It is used to measure the terms and concepts to be used in the research, and c) The hypothesi s and the problem areas can be clarified through exploratory research (Burns, & Bush, 2007, p. 57). Case Study The intensive analysis of any individual unit is called case study. It mainly stresses the developmental factors in relation to the given context. It may be descriptive or exploratory. Case study is used in exploratory research to find the causes so as to find relevant answers for the stated principles. The case study may be prospective one or a retrospective one. The case is the subject, which is discussed on the basis of a particular organization, issue or problem. Case study is also denoted as research study as it gives us an empirical analysis of the phenomenon in real-life situations. Case study is generally formulated to answer the research questions. The research problem is first carefully formulated and then answers are found based on the research conducted by the researcher. The answers derived from the research is explained or interpreted by the researcher with th e help of a real-life situation. The theories used while deriving the solution are utilized and a case is formulated to present the practical problem situations and strategies that were used to solve them. The type of research question defines the type of case study to be formed. Case studies help to find the bottle necks and ways to reach the solutions. It also enables the researcher to monitor the changes. Psychobiography The term psychobiography means analyzing the importance of lives by using the psychological theories and conducting research. The aim of this type of research is to unearth the public motives behind a particular activity or behavior. Psychobiographical research does not involve any form of standardized format. It generally depends on the subject, the researcher and various other aspects. It is actually considered as a qualitative form of research technique. This method of conducting research is generally used for celebrities, outstanding personalities or leaders. Psychobiographical research provides an in-depth analysis to the researcher regarding the behavior of the person and the reason behind such behavior. This methodology was actually invented by Sigmund Freud. It deals with unfolding the personality and psychology of an individual. This method is use in form of qualitative research technique because it deals with human behavior, psychology and emotions. It is also used to explore

Memorandum on the 2012 presidential elections Essay

Memorandum on the 2012 presidential elections - Essay Example The whole US economy was severely shaken and the US policy on economy was put in question, a question to which no one had the answer, except one man, and that man was â€Å"Barrack Obama†, after devouring his opponent â€Å"John McCain† in every single presidential debate specially when it came to answering for the economical goofs that the previous administration had made, senator Obama was elected president. The whole world held its breath and waited to see what the young president had to offer, they’d all granted him not only their votes but their utter confidence and allegiance as well, the 2008 elections saw the collecting of a colossal unprecedented 700 million US dollars in campaign money that funded the 44th US president’s campaign and guaranteed him the title of 44th US president, the majority of Americans believed in change and they believed in the promises their president swore to honor. So much was the support evident and unanimous that the Oba ma handily secured states like North Carolina and Virginia, states that had long been loyal to the republicans. To put it briefly, what the democrat candidate had done was extraordinary, he’d flipped the tide in many key states and swayed a big number of voters who all put their faith and trusted president Obama. The newly elected president was quick to deliver on his promises as he immediately instigated a rough campaign which culminated in the implementation of a Universal Health Care policy throughout all US soil, a first victory claimed by the democrats, but yet another and many other victories were to follow, major changes in student loan programs, reforms that have to do with financial regulation†¦. And last but surely not least came the news about the liquidation of public enemy Number 1, Osama Bin Laden, leader of the terrorist organization Al Qaeda, who orchestrated the monstrous 9/11 attacks, Bin Laden who had for long been considered the most wanted criminal i n the world and who’s mere mention of his name ignites storms of fury and grief in every American’s heart. Sadly and despite all the accomplishments that Barrack Obama had done, a bittersweet taste was all that was reserved for president Obama as the complexity of the US economic crisis proved too much for Mr. Obama to handle which in turn led to the undermining of the democrats’ chances in securing a 2010 congress majority. The economy had played a trick on the US administration and cost the democrats the November 2010 midterm elections, as it were to seem the US population cared about nothing more than their economy, only a striving economy meant a striving presidency and as far as the electors were concerned, a striving economy was far-fetched with the democrats in power. The November 2010 elections dealt a powerful blow to president Obama and left looming away from all the other issues and focusing on the economy for as it had turned out it is only this that can guarantee him a safe pass to another term in the 2012 presidential elections. President Obama will be hoping to replicate what Bill Clinton had done in 1997 by being the first democrat president to be re-elected since World War II, but for this to happen he must make sure to find

Air Pressure in Footballs Essay Example for Free

Air Pressure in Footballs Essay What is the relationship between feedback from air pressure of a football to the performance of a athlete? Alex Long Purpose The purpose for my experiment is to work out scientifically whether the air pressure inside a football effects the performance of a sports performer. There are several different types and brands of footballs all with different structures and pressure recommended for the ball. It would be interesting to find out the differences between the different companies and whether the air pressure inside makes a big difference in improving performance. Hypothesis My expected results from my experiments to answer the question is that the air pressure which will be best for performance will be around the recommended air pressure but slightly lower as I think that through personal experience to is easier to kick a flatter ball than it is to kick a very hard ball. I think that the most interesting part of the experiment is to see whether different air pressure in different brands of football make a huge amount of difference because the balls could all basically the same with just a logo stuck on the front of the ball. The Experiment Independent- what I am changing: I am changing the air pressure between the experiments and I will be changing the brand of football. Dependent- what I am measuring: The performance of a performer while kicking a ball with different air pressures inside. Controlled- what is staying the same: I will keep the same pump and pressure gauge so that I have the same readings. The air temperature in the room and also the altitude I carry out the experiment. Finally I will also keep the same athlete to under take every exercise. Material and Apparatus 1x Sports Hall 3 different types of footballs 1x Pump with a pressure gauge 1x Athlete 1x Thermometer 1x Football goals 1x Stopwatch 25 Cones Method 1)Set out 3 challenges for the Athlete to complete 2)The first will be to kick the ball from a cone 12 steps from a football goal and the  have to hit cones either corner of the goal. 3)The second will be a dribbling exercise to test the players control on the ball. 10  cones will be set up in a line each one foot in front of each other and the player  has to slalom through them. 4)The third and final test will test the control of the player. I will through the ball into  the air and get them to control it on their chest and pass in through two cones  which are 2 steps away from each other. The player will stand 10 steps away  from the cones. 5)For each test I will record how many times they complete the task out of 10  attempts. 6)Finally I will repeat this with each ball and at the different air pressures. I will have  a base test at the recommend psi the ball manufacture gives. 7)After this all completed I will ask the athlete which he felt was better to get this  feedback on the balls and the air pressure

The Concept Of Youth So Difficult To Define Sociology Essay

The Concept Of Youth So Difficult To Define Sociology Essay The concept of youth could be seen as difficult to define, as it covers such a diverse area, Pierre Bourdieu (1978)(In Jones 2010) suggested that youth is just a word and that it has been an evolving concept which has developed over the centurys into a social construction. Youth could also be defined by some, especially in western societies as the life stages between childhood and adulthood and becoming independent from dependent (Kehily 2007). Some favour biological markers, in which youth is the period between puberty and parenthood, while others define youth in terms of cultural markers a distinct social status with specific roles, rituals, and relationships (USAID/CMM 2005). Definitions of youth by age vary drastically across different institutions; the UN has defined youth as person from 15 to 24 years of age, whereas the National Youth Policy of Nepal defines youth as persons from 16 to 40 years of age. Therefore in understanding the difficulties in defining youth, it is impor tant to look at the many different ways , as to why age from the earliest of ages, industrialisation, cultures and the biological concept, to identify some of the key issues as to why the concept of youth is so difficult to define as it has such a diverse range of ideas and notions. The term youth is defined by sociologists as a transition between childhood and adulthood (Roche et al 2004) the alternative is the term adolescence which is often: Used within psychology to describe the common biological, psychological, emotional and sexual maturation phases associated with the onset of puberty and the teenage years From this notion it appears that some perceive youth as a sociological category rather than a biological one (Frith 2005, in kehily 2007) in that youth is a social construct rather than a biological and psychological concept as G Hall (1904) (In Kehily 2007p.57) noted that the biological side changes can have an effect on different people at different times in their lifes through hormonal and psychological changes from which they are not in control over and can have effect over their feeling and behaviour. However the sociologist Margret Mead1972 disregarded Halls concept that adolescence was brought on by biological changes which hall suggests occurs during puberty, from her own study concluded that this period in a young persons life was the effect of sexual repression in society and of societys handling of young people (kehily 2007). However as these studys by Hall and Mead were carried out in a specific area of Samoa, this study maybe relevant to this area but it cannot be genera lised to the rest of the world. Social anthropologists on the other hand try and understand the concept of youth from a cultural perspective for instance rather than seeing it from biological view, they study their behaviour, cultural beliefs, family lives, social, political organisations and their relationships with each other (kehily 2007, p.47) although it must be noted that most cultural studies are based upon non-western and traditional societies (keily 2007). Van Gennep 1960 (in kehily 2007 p.62) studies the rites of passage, and states there are three stages: the leaving behind of the familiar, living away from the community and thirdly reintegration, he backs this up with the study of Nelson Mandelas ignition of becoming a man, Gennep 1960 re-enforces this idea with the ritual of circumcism as some countries carry out rituals in order to publicly show the transition from one stage of a life to another (kehily 2007, p.63). although rites of passage can be observed in western countries it can be interpreted i n different ways, for instance, celebrating a birthday, leaving school, going on to university and getting married can be seen as an initiation process into either the passage to youth or the transition into adulthood as Gennep notes rites of passage were similar in structure and function wherever they occurred in the world. Aries (1962) (In kassem et al 2010) suggested that the concept of youth did not exist in the middle ages and that it has been socially constructed over the centuries, as Aries states, in medieval society the idea of childhood did not exist, and that from the age of 7 a child would be classed as an adult, as Heywood (2001 p.11) noted that the transition into adulthood took place when a child no longer needed their mother and could survive without them, which was somewhere between the ages of 5 and 7, he states they were launched into the great community of men, although some would argue with this concept, as kassem et al (2010) suggests that Aries work is only based upon the ideas of childhood and not children themselves. Pollock (1983) (In kassem et al 2010) also criticises Aries and suggests that from studying first hand accounts from diaries and autobiographies that this was not the case and that families in the 1500s did acknowledge childhood as kassem (2010) notes that Pollock q uotes numerous examples of grief at infant death, from mothers and fathers and that Aries work in only based upon secondary sources rather than actual accounts. Although some researches would agree with Aries that the term childhood has only arisen from the 1700s due to it being something which has been constructed (kassem et al 2010,p.3) from the growth of the middle class and the Industrial Revolution (Stone 1977 in kassem et al 2010) as this conctrucuralism could be seen as to arise after the era of industrialisation, for instance from the early age of around 6 years old children were working , which was reported by the Royal Commission on the Employment of children (1843) that children began work at around the age of 6 (Heywood 2001,p.130). By the late eighteenth century it was emerging that children needed a childhood as it was noted by Hendrick (in Heywood 2001 p.142) that it was emerging that the young was in need of a childhood and that we needed to start taking note of this , as Hendrick noted that children were now being seen as innocent, ignorant, dependent, and vulnerable. However some may only define youth, especially by age as they can be seen to have a vested interest for their own personal gain, their motivations may be different as the media for instance may have an interest to inform, whereas connection service see youth at the age of à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦ as they have an interest in improving the lives of youth by ways of empowering them into looking for work or improving their educational needs to enable them to work, wheras the high street stores such as newlook, topshop/topman aim their establishments at youth as for private gain in making money from them. In conclusion as to why youth is so difficult to define, as it is quite diverse and complex and there are numerous reasoning behind the concept of youth from nature v nurture to cultural and sociological explanations it also varies globally as their values and beliefs differ from others therefor as jones notes (2010) when youth is taken to mean age, then it really is just a word. Therefore the concept of youth will always be difficult to define as there is no neutral definition and we all define the concept of youth in many different ways. Word count:References Social and Human Sciences http://www.unesco.org/new/en/social-and-human-sciences/themes/youth/ the concept of youth http://www.allenandunwin.com/publicsociology/files/ch6RETHINK.pdf Heywood, C. (2001) A history of childhood, Cambridge: polity press. Kehily M.J. (2007) Understanding Youth: Perspectives, Identities and Practices. Milton Keynes:Open University Press. Roche, J, et al. (2004) youth in society, 2nd ed, London: sage publications. Kessem, D, et al (2010) Key issues in childhood and youth studies. Oxon: Routledge. Jones, G. (2009) Key concepts: youth. Cambridge: polity press.

Drug Use Essay -- Drugs Narcotics Research Papers

Drug Use Drug use is part of life in the United States. Some people use drugs for medical purposes and some use them to escape from reality or as a way to cope with problems. There are two main types of drugs, medicines and psychoactive drugs. Medicines are used to help the body fight injury and psychoactive drugs are used to cause a change in the users brain activity. Psychoactive drugs are very dangerous. They produce very powerful changes in the body. What a drug does is called its action and unwanted effects are called side effects. The side effects of a psychoactive drug can range from uncomfortable to life threatening. Abuse of a psychoactive drug often results in dependence or addiction where the body needs the drug to function normally. Withdrawal happens when the body is reacting to not having the drug. Withdrawal can be very painful. There are many risks of using drugs besides what they do to you. You can get AIDS from sharing needles, it can cause mental and physical problems in babies, family relationships can be strained, there are sever legal risks, and there are major cost to society. There are many reason why people us drugs. There are 3 major factors that contribute to the risk of drug abuse in teens. Those factors are family, social, and personal. A family risk factor is poor relationships with family members. If teens have close relationships with their family member they are less likely to expe...

Price Discrimination | Amusement Parks Essay

Introduction Consider these Amusement park pricing scenarios: ?Six Flags Discovery kingdom sells its annual season pass for $59. 99. According to its website, â€Å"Buy your Season Pass for $59. 99, just $14 more than a one-day admission. † ?Bush Gardens Dark Continent. sells its Fun Card for $95. 00. According to its website, â€Å"Pay for a Day, Get now through 2015 FREE. †, Now why would they give away an unlimited entry annual pass for an extra 25% over the single entry price? What is common in these pricing scenarios? All these businesses are practicing what economists call, â€Å"Metered Price Discriminationâ€Å", or what marketers describe as, â€Å"Customer Margin†. It all starts with, â€Å"price discrimination† – charging different customers different prices. Customers differ in the value they get from a product/service and in how much they are willing to pay for it. For each price point you set, there will be different number of customers willing to pay that price. That is your demand curve. The goal is to find the price that maximizes profit. There are many different ways to monetize the customer and Amusement parks offer us a great opportunity to examine several of them. As in the example above, Amusement Parks employ multiple price discrimination strategies when establishing ticket prices in order to increase Six Flags Season Pass Pricing Busch Gardens â€Å"Fun Card† Pricing overall attendance but make up for the lost single entry fee revenue from the subset of customers willing to pay set pricing scale at park concession stands, gift shops, diners and restaurants. This is Metered Price Discrimination – some customers get away with paying the low â€Å"entry fee† while others pay more by consuming additional services at different prices. Discrimination can take several forms and those presently employed in the amusement park industry begins with an exploration of spatial discrimination. Spatial Discrimination Amusement parks benefit greatly from their ability to isolate customers away from competitors for long periods of time. Part of the value proposition for an amusement park is the highly developed themed experience they provide. Once fully immersed in the amusement park experience the level of difficulty and inconvenience in accessing alternative providers for staples like food, drink, shopping, and accommodations, grows exponentially. Utilizing spatial discrimination, the parks have several different supply, demand and profit opportunities to exploit.? Higher than market food pricing and profits based on proximity and distance to cheaper alternative. Amusement Parks, like many other entertainment businesses can derive extremely high profits from customers on purchases of goods and services once inside the park. ?Zero competition from competitors within park confines. The experience of the park itself requires a good deal of isolation and space so the business can control the imagery, interactions, and exposure to inconsistent inputs. The space and isolation enables the parks to create their own marketplace and exclude other industry actors access to the customers in their park avoiding food, retail, services competition altogether. Once the customer is in the park you control the market and the market offerings and pricing ? Ingress and Egress marketing opportunities for personalized content like group photos on T-Shirts, Mugs etc. The parks have cameras throughout their facilities and more often than not have a kiosk standing by to sell customers personalized remembrances of the experience the park is providing. Only the park has the photo of your family on the roller coaster together. Since they own the roller coaster, they can restrict access to the best picture locations. Price discrimination takes place in that they control the supply completely. Calculate the highest price the market is willing to pay and sit back, you’ve eliminated the competition while they are in the park. Bundling One type of membership popular with both Bush Gardens and Walt Disney World customers is the add-on (up charge) for water park entry in addition to the amusement park entry at a reduced â€Å"bundled† price. Water park capacity is likely to be considerably less than the amusement park so the profit maximization point must take into account the â€Å"limited capacity† constraint. The reduced revenues from the amusement park tickets vs. full price tickets needs to be tracked so supply of the amusement/water park bundles does not, or to the best case achievable, negatively impact the supply of the water park â€Å"single park† utilization. Profit maximization can be best achieved by limiting the bundle availability to key periods during the annual calendar when excess capacity exists at the water park. Bundling will fill the gap between current utilization and current capacity at the water park while providing added perceived value to the purchase of a amusement park ticket. Peak Load Pricing. The customers of annual passes are further discriminated by those that have the capability to tailor entry dates away from peak load periods. Ex. Walt Disney World â€Å"Florida Resident† annual passes with entry restricted during the summer and holiday periods. Amusement Parks have multiple levels and types of annualized memberships based on paying a onetime fee for unlimited entry for a specified period (Typically annually) at specified times. The overall infrastructure footprint of the parks is constant. In the slower months of the year there is Busch Gardens Bundled Pricing Walt Disney World Florida Resident Pricing  an excess of capacity (or supply0 at the parks and the peak load pricing attracts park visitors at lower utilization periods of the year. (An argument can be made for inclusion in the Spatial Discrimination category and the overlap is noted here. Florida residents benefit from a price discriminator compared to out of state customers but must use the park facilities at times it benefits the park most. ) Air fares, Hotels, etc. Finally, the cross marketing partners the amusement parks team with will employ length of stay discounts, food offerings, free parking offers, service level upgrades, hotel upgrades and the like. The price discriminators are focused on the ancillary products and services typically required to in order to utilize the amusement parks. The parks will appoint official Airlines of the park, or have a preferred credit card, or as in the case of Walt Disney World several tiers of hotels. Disney owns their own hotels, all in the best locations, extensively themed to the park specifications. Disney also leases hotel locations on their land to the major hotel chains. The location is not the best, and the hotels cannot use Disney’s Theme in their decorating but they are located on Disney property with access to Disney’s higher income, more likely to spend money, customers. A third tier exists in the hotels off Disney property. Disney will offer discounted ticket prices to these hotels for their customers. Walt Disney World Package Pricing Closing Amusement Parks have well developed and sophisticated price discrimination strategies in place. They capitalize on several of the methods described in the Harvard note Economics of Product Variety. They use spacial discrimination to boost profits on food, services, and goods once the supply is controlled in the park. They use bundling to attract attendance across the multiple parks they operate in the hopes of increasing profits through the generated increase in demand the bundling creates. They use peak load pricing to entice attendees during low utilization periods as well as boost purchase of ancillary â€Å"high margin† items in the parks. And they use cross marketing strategies to team with hotels, airlines, credit cards, and others to increase demand from third tier hoteliers near the park. References HIRSCHEY, MARK; MANAGERIAL ECONOMICS 12TH EDITION, CENGAGE LEARNING, MASON OH, 2009 President and Fellows of Havard College, Price Discrimination, Havard Business Schools Publishing, Boston, MA 02163, 1993.

Hamlets Character is contradictory&quot Essay

Shakespeare gives Hamlet a very indecisive character in this play. This in turn leads to Hamlet becoming contradictive, more and more so throughout the play. His main problem is that he is more of a ‘thinker’ than a ‘doer’. This causes him many problems throughout the whole play. The first example we get of this comes in Hamlets first soliloquy. Here we find out what Hamlet truly feels about the situation he finds himself in after his fathers death. After initially seeming to be willing to go along with Claudius’s and his mother’s marriage here we find out how he truly feels. He expresses his disgust at the hastiness from which his Mother has married to Claudius so soon after his fathers death. He also expresses how devastated he is at the death of his father and Claudius taking the crown, which Hamlet believes should rightfully be his. Hamlet once again shows this when he goes with his Fathers ghost. He comes back from this encounter determined to take revenge on Claudius but then passes up many chances to do so in order to make sure that the ghost is telling the truth. Hamlet continues this throughout the play and ironically this leads to him doing exactly the opposite of what the ghost wants by hurting his Mother and not taking revenge on Claudius when he has many chances to. Another appearance of Hamlets contradiction appears in his first soliloquy when he is very damning towards women: â€Å"Frailty, thy name is woman! † This contradicts with his apparent infatuation with his mother, and especially with her sexual behaviour. Hamlets contradictory character is also reflected in the many mood swings he has during the play. He constantly changes his mood one minute appearing relatively happy, the next he is at his sadistic worse cruelly teasing others with his wordplay. The worst of this comes when he is talking to Ophelia in Act 3 Scene 1, where nearly everything he says to her has a sexual double meaning. Here Hamlet has realised that he is being spied on and intend to have some fun at Ophelia’s expense as he feels that she has been used as a spy whereas in reality she knows nothing of the situation. Hamlets character however can not just be described as contradictory, it id far too complex for that. Hamlet could also be described as erudite, ingenious and quick-minded for the way he took advantage of the players arriving and setting up the play â€Å"Murder of Gonzago† in order to test the Kings guilty conscience and find out if he really did kills Old Hamlet. Hamlet is also regarded as pessimistic, over – dramatic, angry, desperate and frustrated for his outlook on life and human nature and the way he feels about being denied the chance to become king after his father’s death. Many people also feel that Hamlet is obsessive; this is shown with his fixation with his mother’s sexuality and is once again brought into light by Ophelia revealing all of the love letters that Hamlet has sent to her in the past. All in all I believe that whilst contradiction is one of Hamlets main characteristics, his character is too broad for it to be described as any one thing.

Developing and Maintaining Skills for Everyday Life

As a carer your role is not to do things â€Å"for† the individuals you care for but to do things â€Å"with† them. Your role is to work in partnership with the individual and support their decisions, regarding their care and support them to do as much as possible for themselves. If you provide too much care for an individual they can lose skills, not learn new skills and do not regain skills they have lost. By providing active support and encouraging the individual to participate in their daily living needs you are helping them to develop and maintain their skills for everyday life.Individuals may have an evaluation to assess their physical skills. This may be carried out by an occupational therapist who will assess how well an individual can function in daily life and participate in their environment. The OT will assess what equipment and adaptations are appropriate which might assist an individual to remain as independent as possible. Occupational therapy has been sh own to be successful for the elderly population with many medical conditions and surgical recoveries.Therapists work with individuals to improve their strength and regain or maintain necessary life skills. Occupational therapists working with the geriatric community counsel families, groups in the community and local governments, to make sure that each sector is doing its part to help the elderly to maintain their independence. Occupational therapy also helps geriatric clients and patients with other activities to assist in diminishing the possibility of social isolation and its unpleasant side effects.They do this by helping elderly clients and patients continue social activities they know and encouraging them to get involved in new ones as well as showing these folks ways to continue to learn in spite their limitations. Occupational therapy also promotes mind stimulating activities. These mental gymnastics give the seniors feelings of self-worth and may help them avoid getting dem entia. Encouraging individuals to join local clubs and activities can also help them to maintain and develop their skills. Developing and Maintaining Skills for Everyday Life As a carer your role is not to do things â€Å"for† the individuals you care for but to do things â€Å"with† them. Your role is to work in partnership with the individual and support their decisions, regarding their care and support them to do as much as possible for themselves. If you provide too much care for an individual they can lose skills, not learn new skills and do not regain skills they have lost. By providing active support and encouraging the individual to participate in their daily living needs you are helping them to develop and maintain their skills for everyday life.Individuals may have an evaluation to assess their physical skills. This may be carried out by an occupational therapist who will assess how well an individual can function in daily life and participate in their environment. The OT will assess what equipment and adaptations are appropriate which might assist an individual to remain as independent as possible. Occupational therapy has been sh own to be successful for the elderly population with many medical conditions and surgical recoveries.Therapists work with individuals to improve their strength and regain or maintain necessary life skills. Occupational therapists working with the geriatric community counsel families, groups in the community and local governments, to make sure that each sector is doing its part to help the elderly to maintain their independence. Occupational therapy also helps geriatric clients and patients with other activities to assist in diminishing the possibility of social isolation and its unpleasant side effects.They do this by helping elderly clients and patients continue social activities they know and encouraging them to get involved in new ones as well as showing these folks ways to continue to learn in spite their limitations. Occupational therapy also promotes mind stimulating activities. These mental gymnastics give the seniors feelings of self-worth and may help them avoid getting dem entia. Encouraging individuals to join local clubs and activities can also help them to maintain and develop their skills.

Gore & Associates case Research Paper Example | Topics and Well Written Essays - 2000 words

Gore & Associates case - Research Paper Example In this case, the organization is divided into decision-making entities and affording them powers to undertake routine forms of decisions with respect to the operations of those entities (Grindle, 2007). This paper will look into the W. L. Gore & Associates radical approach of devolving decision making to the lowest levels of its organization. In decentralization, methodical efforts are made to give power to subordinate levels. The delegation of power in decentralization is not from one person to another but to each entity in an establishment (Grindle, 2007). An organization is deemed extremely decentralized, when entrustment is company-wide within all divisions and functions. Decentralization differ from centralization since in centralization, decision-making power rests on one individual only. Additionally, centralization is a type of traditional supervision in India whereas decentralization is a standard practice in professional management (Burton & Obel, 1995). Everything, which attempts to upsurge the significance of subordinate’s duties is decentralization and everything, which reduces it is centralization (Burton & Obel, 1995). ... Therefore, devolution with respect to office may comprise departmentation of operations. When power is dispersed, devolution is present (Burton & Obel, 1995). The requirement for devolution is manipulated when the company develops in its scope, which demands broadening of office operations. Devolution ensues during decision formulating of routine kind but if verdicts are crucial, the power is not dispersed (Burton & Obel, 1995). The political factors technological development and accessibility of administrators also influence the extent of devolution. Devolution does not occur in its wholesome sense. There exists a combination of the two since some operations are integrated and some are devolved (Grindle, 2007). What are the strengths of this approach? Decentralization aids to enhance the quality of decision-making at top-level management. Decentralization of power among subordinates at each level within a firm releases the top management the excessive responsibilities saving them ti me to devote to more crucial and long-term glitches (Burton & Obel, 1995). This enhances the quality of top management decisions with respect to such problems. Devolution, therefore, provides top managers with chances of looking into other new methods of improving their companies by engaging in managerial forums (Grindle, 2007). The approach of devolving power to the lower levels in an organization accelerates diversification of operations in an organization. It is a subject of common knowledge that a company with departments upon the footing of its products accelerates diversification of market or products even when the power is centralized. Decentralization takes this procedure a footstep further.

The sudden economic crises of Dubai, a result of their own doing A Essay

The sudden economic crises of Dubai, a result of their own doing A critical perspective within the Michael Porter's diamond model for international businesses - Essay Example However with global recession hitting the world in 2008 all investments came to a halt. The market became bearish and infrastructure projects came to a halt. Dubai was adversely affected because the property prices during normal times were sky high but dropped immensely during recession. It was felt by analysts that Dubai was like a pack of cards and its fall was inevitable. It was regarded as a monument of greed and vanity. It is in this context that the report is prepared and it analyzes how the own doing of Dubai led to the crisis. The crisis is analyzed using Porter’s Diamond model and it has been found that Dubai largely depended on foreigners to avail its services. The domestic demand from locals was not very high. Porter has identified domestic demand as an important factor for a firm’s competitive advantage. This was Dubai’s weakness. As far as labor factors are considered there are not many local labors available in Dubai. Dubai depends on laborers from other countries which is a setback for Dubai. Moreover lack of education is also an important factor which Dubai needs to work upon in order to be competitive in future. The United Arab Emirates is divided into seven city states which has their own governments, own budgets, own legal structure and so on. Dubai has developed at a very fast pace but in the last decade it has increased it spending massively in major infra structure projects in order to develop real estate and to attract tourists. The Dubai problem started when Dubai World which is the state owned company having a liability of $60 billion, announced its bail out plans (Spencer, 2009). The uncertainty regarding Dubai sent down shivers across the globe. It led to more than $14 billion being wiped out of the British banks. Although the total debt of Dubai was around $80 billion, the uncertainty had a rippling effect all across the globe (Hosking & Robertson, 2009). The report tries to find out the main causes

Innovation of Emirates 2 Essay Example | Topics and Well Written Essays - 2000 words

Innovation of Emirates 2 - Essay Example Appraisal of the Organization The Emirates Airlines has had a profitable run for a while now, and this calls for an in depth look at the company. This will involve looking at the company’s strengths, weaknesses, opportunities that the company has and the threats that the company has to its profitability. Strengths of the Airline As seen above, the company has managed to be profitable within the economic downturn that has faced many of her competitors. This certainly points to the strength that this company has to its advantage. One strong point of this company is the level of stability in terms of management that the company has. In light with this, the company is able to transact with its clients who have a high level of trust that the company will deliver when it promises to do so. Another upside to the state ownership is the fact the company has a secure source of funding for its existent or future plans. Unlike most other airlines that compete with the Emirates Airlines, t he issue of funding does not bring in as much headache as it does to a lot of her competitors. This is because the state is in complete control of the airline and has a much wider purse with which it can fund the airline’s operations. This, to a large extent explains why the company has been able to remain successful in the long run. The airline is also committed to the use of technology in improving its services. The company has embraced the use of online booking of its tickets as a way of easing congestion as well as improving the overall customer experience. The company has adopted the use of Verified by Visa (VbV) technology (Pan and Polishuk 2004). This is a move that has been calculated to ensure that the airline has a safer mode of transaction with its clients. Aside from that, this technology is also poised to place the airline on a leadership vantage point in relation to its competitors. In addition, this has the advantage of mounting the trust that the clients place on the airline securing their return services. The airline has also strength in terms of the services that it offers to its travellers. The premium customers will get a limousine ride from their homes or office to the airport (Shaw 2011). This action, which is part, of the company’s product differentiation strategy, is calculated to encourage more clients to explore the premium package. This is further accentuated by the services that the clients will get once they arrive at the airport. These services include a kerbside check-in facility to eliminate the hustle of carrying heavy language into the terminal and further a luxurious lounge and ease for the passenger during checking-in (Shaw 2011). This, obviously remove many of the hustles that go with travelling. Therefore, this has had the effect of ensuring that customer loyalty is upheld as well as customer comfort throughout their travel. Weaknesses of the Airline The airline has a number of issues that limit its performan ce. Some of these issues have a lot to do with the ownership and by extension the management of the airline. Accordingly, the government, having full ownership of the airline highly controls the running of the airline’s operations. The government’s say in the running of the airline is a hindrance in many times (Betz 2010). Though the government having a say in the airline is not such a bad thing in the ultimate outlook, it may constitute interference when it decides to overhaul a decision that the airlines’

Evaluate the extent to which the statement of financial position Essay

Evaluate the extent to which the statement of financial position allows potential investors to assess the security of their intended investment and to determine the true net worth of the business - Essay Example Financial statement position of a company have measurable characteristic and easily evaluated (Financial Review, 2015, 1). Statement of financial position has essential skill at various occupations such as corporate finance, credit extension, commercial lending and investment management. Individuals engaging such activities should analyze data connection with investment decision. The financial statement should conquer with generally acceptance accounting principles (GAAP) (Wiley and sons, 2015, p4). The statement of financial performance should provide information on revenue, expenses, other profit measures such as gross profit and net profit (Financial Review, 2015, 1). The above worked example has clearly indicated all the information, which an investor requires to know before making a judgment relating to investment. The investor should compare personal security with the information shown and come up with the conclusion. The information to focus on includes the sales revenue, expenses, gross profit and net profit. This information shows the base line of company and indicates the least amount required for an investor to start the business. The investor can easily attain the amount shown on the statement of financial position above (Financial Review, 2015, 1)... In some cases, the amount represented on the statement of financial position has higher amount for investor to attain. In such cases, the investor should avoid risking the security available rather than look for an alternative. An investor who does not follow the instruction and engage in such risky securities asset investments might incur loses if not careful. One should make decision first after comparing financial statement with the personal securities before investing. The above illustration shows that the amount represented on the statement of financial position has easier way of attainment in the current

RESORT MANAGEMENT Research Paper Example | Topics and Well Written Essays - 1500 words

RESORT MANAGEMENT - Research Paper Example c. The resort would include 4 main luxury suites and 12 executive double rooms with additional facilities like local sightseeing services, shuttle systems, laundry facilities, restaurants, buffet breakfast options, free internet connection and room services like spa therapy. The service provided by the resort would include both the primary services and a number of augmented services. d. The main departments relevant to the resort would include a tourism management department, operations management department, human resources department and accounting and finance departments (Abrams and Abrams 56). e. The target market trends include increasing interest towards visiting these kinds of places for adventure sports and preference to spend more money for getting high quality service and experience. The visiting trends of the tourist are similar in both winter and summer seasons which mean that the resort is likely to generate good business all round the year (Predeaux 102). a. The resort is expected to add value to the host community. The establishment of the new business would create employment opportunities for the local people and thus create economic opportunities in the area. Also, the local suppliers of products and services required for the hospitality industry would benefit from the scopes of providing their products to the new resort. The investments in the resort would also improve the economic scenario of the area and contribute to the revenue generation of the area. b. However, the equipments and installations required for the skiing and other sporting activities provided by the resort like the gondola services and rope tows may disrupt the local habitats of the area. The deforestation of some areas for establishing the skiing facilities and the accommodation spaces may lead to harmful impacts on the environment. The original ecosystem may be damaged by the establishment of the resort and its ancillary services.

Comparing The Kite Runner and Angelas Ashes Essay Example for Free

Comparing The Kite Runner and Angelas Ashes Essay Depression cause a down fall on a person’s emotion. This is easy to understand in the novels Angela’s Ashes and The Kite Runner. In these two stories a person will encounter with the feelings of abandonment and death. In the kite runner Amir was depressed that he and baba had to leave Kabul. He was wondering if he was going to forget his homeland along the line. He mentioned, â€Å"I only knew the memory lived in me a perfectly encapsulated morsel of a good past a brush stroke of color on the gray, barren canvas that our life had become † The Russians invaded Afghanistan so baba and Amir had to leave to find safety. It was very hard for them to leave their homeland and go to Africa. They had to leave all their belongings and life behind n start fresh in a different country. In Angela’s Ashes Angela’s family McCourt’s they saw they were living in poor conditions .Angela’s mother sent money so they al could board a ship to Ireland and start new and leave America behind. They left Brooklyn behind for nothing because when they got to Ireland the living conditions stayed the same. Malachy spends all of his money at the bars and he always shows u to work drunk. Now there are no more jobs in Ireland so he has to abandon his family and go to England to get a job there. Amir from The Kite Runner went back to Afghanistan to visit Rahim Khan because he was very sick. While he was telling him about his family he asked about Hassan so Rahim had to tell him the he got murdered by Taliban. Amir had lots of things going threw his head. He regrets not being in touch with him band for not sticking up h imp years ago. Baba became sick with cancer and he dint want any treatment, he wisent scared to die he knew he lived his life with many accomplishments. Amir father also died now he had no one to get help from when he need guidance. There were many deaths in Angela’s Ashes. When Margret was born Malachy was able to bring food home. It was his only daughter and he was very happy, but when she died everything turned to the worst. Later Oliver one of the twins died. They dialed with many deaths in their family but every time it was harder, Oliver’s death caused depression in the family. The Kite Runner and Angela’s ashes have related themes, the theme of depression stands out, threw the loss of their loved ones, and abandoning their home land these two novels show different events that took in different parts of the world that made people depressed.

Health Information and Communication Systems in Ireland

Health Information and Communication Systems in Ireland Is ICT a key enabler in ensuring seamless delivery of healthcare? A comparison between public and private ICT development in Ireland Abstract This study discusses the innovative changes that have taken place in Ireland in the field of healthcare due to the influx of information and communication technologies. Previous Information communication technologies (ICT), including telemedicine, present opportunities to address rural health-service delivery issues. The research shows that effective management of health services and the delivery of quality systems in Irish healthcare organizations have increased. In Ireland patients are expecting more of healthcare providers and are demanding higher standards of care and service. Simultaneously, those paying for health services have become more concerned about rising health costs and possible inefficiencies. As a result there is widespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to healthcare management in relation to ICT. This study highlights the developments in quality-service management in the Irish healthcare sector and focuses attention on the need for the development of a model for quality implementation in healthcare institutions. In sum the study shows that the development of (ICT) has facilitated the emergence of a complex global urban system in which many formerly lower-order cities have been carving out â€Å"niche† specialist functions serving urban fields of transnational dimension. Chapter1: Introduction Purpose of Study The purpose of this study is to highlight the development of the Information and communication system in Ireland and how it has revolutionized the healthcare sector in Ireland. Research Question This study focuses on the following research questions: What are the current trends of technological development in the Information and Communication Technology sector of Ireland? What are various challenges faced by the Irish healthcare system in relation to Information and Communication Technology? Significance of the Study This study is quite significant as it shows that the concept of globalisation has secured remarkable currency in the academic discourse of the late 20th century, despite ongoing questions regarding both its meaning and extent (Clark and Lund, 2000). The development of internationally integrated production and distribution systems, seen by many as the key feature of globalisation, has been a spatially uneven process. A key factor in this respect has been the differential ability of regions to engage in the informational economy, based on new information and communications technology (ICT), which is the main source of wealth creation and economic growth in the modern world (Castells, 2003). The result has been what Friedmann (2005) calls a process of ‘techno-apartheid’ which has divided the globe into ‘fast’ and ‘slow’ worlds (Knox, 2005), distinguished by the connectedness of individuals, groups and regions to the world of telematics. This echoes Ingersoll’s (2003, quoted in Knox, 2005) suggestion that the key division of the workforce is now that between those who have the capacity to operate ICT (the ‘cyberproletariat’) and those who do not (the ‘lumpentrash’). Golding (2006) makes a similar distinction between the ‘technoliterati’ and the ‘techno-poor’. While Knox defines the fast and slow worlds spatially, equating the former with the ‘triadic’ core and the latter with the remaining global periphery, Hoogvelt (2003) argues that the divide is, in essence, social rather than spatial, with elements of both worlds to be found in all regions of the globe. Thus, within advanced economies, a process of social polarisation has been widely reported (Friedmann, 2006 and Sassen, 2004) and has been intimately linked by Graham and Marvin (2006) to the development of ICT use. This is not to suggest that those who work in the fast world are homogeneously well-paid and affluent; rather, they represent a wide range of remuneration levels depending on such factors as economic sector, location, function, ethnic group and gender (Castells, 2006). What they do tend to have in common, however, is relative employment security due to the high demand level for their ICT skills. Rationale This study follows a logical approach and identifies the fact that both in Ireland as well as globally, there are major geographical variations in the relative balance between fast and slow worlds, with the former mainly to be found in the traditional core regions of North America, western Europe and Japan and an additional small group of newly industrialising countries which have had the institutional capacity to invest massively in modern ICT and associated educational infrastructures (Freeman, 2004). The slow world – found predominantly in the less developed countries of the global periphery and accounting for the bulk of the world’s population – is becoming increasingly marginalised and is moving, as Castells (2003, p. 37) puts it, â€Å"from a structural position of exploitation to a structural position of irrelevance†. Definition of Terms ICT: Information and Communication Technology: it is the study or business of developing and using technology to process information and aid communications. Sistem : SISTeM a soft systems methodology, stakeholder analysis and participative simulation modelling. NHS: (National Health Service) The organization providing national healthcare services in the UK. Chapter 2: Literature Review The process of quality implementation has become a key concern for those involved in hospital management in Ireland. In a national context, the effective management of health services and the delivery of quality systems in health-care institutions have increased in significance in recent years. In line with wider developments in other service industries, consumers (patients) are expecting more of health-care providers and are demanding higher standards of care and service. Simultaneously, those paying for health services have become more concerned about rising health costs and possible inefficiencies. As a result there is widespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to health-care management and delivery. In 2005 a comprehensive report on funding from the Commission on Health Funding highlighted that solutions to the problems faced by the Irish Health Service did not lie primarily in the system of funding, but rather in the way that services were planned, organised, and delivered. Similarly, in a report from the OECD (2003), it was argued that although the Irish health system had delivered a continuous improvement in health standards, there was still scope for further improvement in efficiency, and that this could be achieved through better allocation of resources. More recently, the government health strategy (DOHc, 2001) highlighted the requirement for a system to monitor progress and systematically evaluate the quality and effectiveness of health services. According to the strategy: Monitoring and evaluation must become intrinsic to the approach taken by people at all levels of the health services. Specifically, the strategy suggested that the way in which health and personal social services are planned, organised, and delivered has a significant effect on the health and well-being of the population. Organisational structures must be geared to the provision of a responsive, adaptable health system which meets the needs of the population effectively and at affordable cost. One of the guiding principles inherent in the published strategy was that of a â€Å"people-centred† health system. A responsive system must develop ways to engage with individuals and the wider community which receives its services. The health system must become more people-centred, with the interests of the public, patients, and clients being given greater prominence and influence in decision making at all levels (DOHc, 2001). According to Bowers (2001), major structural reform, coupled with strong management and political will, are required to ensure change for the better. In Bowers’ view, finance alone will not improve the system. Rather, a concentrated effort must be made to ensure a responsive and efficient service. As previously noted, a conclusion of the Report of the Commission on Health Funding (2005) was that the solution facing the Irish health services did not lie primarily in the system of funding but rather in the way that services were planned, organised, and delivered. This is reinforced by a recent report on the Irish health-care sector which suggested that the issues and challenges facing the health service are fundamentally the same as those outlined by the Commission on Health Funding, except that they are compounded by much higher expectations/demands by consumers (Deloitte and Touche, 2001). Thus, although modern health services have undergone radical change in many areas (Robins, 2003), managers of health services are currently reporting a large increase in the number of patients needing beds, with consequent ever-increasing waiting lists. Accident and emergency departments are under particular strain, and the difficulties of dealing with the growing needs of the increasing elderly population are beginning to become apparent. Although the Irish health service is free for all those requiring medical treatment through a publicly funded system, the current situation is hauntingly similar to that of the Victorian era of health care in Ireland. As a result, the Office for Health Management in Ireland (OHM, 2001) has suggested that current deficiencies in health-care provision and delivery underline the importance of providing quality service management and implementation in Irish health and personal social services. In achieving this aim, the OHM has contended that those working within the system must change how they go about their work and how they work together. Changed public-sector environment The focus on health-care service and quality has evolved from a more general interest in continuous improvement initiatives within the public sector. The prevalent trends in the private sector are towards continuous and pervasive change and increasing interdependencies, and it has been suggested that close parallels can be drawn between the private and public sectors. Public-sector organisations now find themselves in a cyclone of change as they attempt to adapt to turbulent environments in a pragmatic and systematic way (Lovell, 2004). In the UK and also in Ireland, these organisations have been subject to cuts in government spending, as well as demands for enhanced efficiency and effectiveness. In response to such changes, there has been a policy shift towards greater competition and an attempt to apply management practices from the private sector to the public domain. The Irish public sector has been officially pursuing change and reform through its strategic management initiative (SMI), a program for improving the management of the civil service which was formally launched in 2004 (Department of the Taoisearch, 2004). The SMI evolved from the growing internal and external pressures for better services and for more effective management of public services. In that context the continuous improvement of customer service has been a specific focus of the SMI since 2003, when the quality service initiative was launched. The program set out a series of quality principles according to which dealings with the wider public would be coordinated and managed. These initiatives aimed to make public administration more relevant to the citizens for whom the service exists, and simultaneously sought to remove barriers which have traditionally restricted performance and job satisfaction within the public sector. In recent years, Ireland has experienced a rise in consumerism. Increases in revenue available to fund public service provision have gone hand in hand with rising public expectations of standards of service. As a consequence, management skills and competences in providing for improved standards of customer service have become recognised as being central to delivering real transformation in the public sector. However, the development of such capabilities, particularly in relation to managing effective quality implementation, presents considerable challenges for those involved. Nowhere is this more evident than in the health-care sector. A review of recent international evidence points to the challenges of implementing quality service in health-care institutions. Gaucher and Coffey (2000) confirmed that implementing a process of total quality management (TQM) in health care is a pragmatic, specific, and systematic methodology. However, this requires a firm commitment from the leadership to change their former ways of working and doing business. Gaucher and Coffey (2000) cited many reasons for TQM failing – including poor leadership and a lack of management commitment – but also noted that revitalisation can rejuvenate the process. These authors asserted that the role of those implementing the process is to nurture and breathe energy into the process when enthusiasm and commitment are declining. The importance of the support of senior management for quality-management projects is also advocated by Berwick et al. (2000). These authors undertook a national demonstration project in the USA in the late 2000s and described how organisations could implement the entire quality-improvement process – from defining the problem through to implementing a solution and consolidating the gains (Berwick et al., 2000). A literature review carried out by Jackson (2005) identified that much work had been undertaken in the UK in determining the clinical effectiveness of many health-care organisations, but that very little research had been implemented in the area of managerial effectiveness. Furthermore, West (2001) determined that, in organisations that outperform others on different dimensions of performance, there was evidence that management is important, as are the combined efforts of individual clinicians and teams. There have been several approaches espoused for achieving quality management in health-care institutions, many of which have been technical and generic in their approaches (Moeller et al., 2000). Specifically, Donabedian (2000) introduced the concepts of structure, process, and outcomes, along with the development of self-assessment and accreditation through the International Organization for Standardization (ISO). In many instances these programs have met with mixed reactions, and their implementation has varied. A criticism levelled at hospital performance is that it has been rather insular, and has paid little attention to developments in related fields, such as organisational sociology, organisational behaviour, management studies, and human-resource management (West, 2001). If quality programs are to have lasting and significant effects, that they must follow a systemic approach such that all aspects of an organisation are integrated and focused on continuous improvement and customer satisfaction (Joss, 2004). A variety of approaches has been used to improve quality and to ensure its delivery, but not all have been successful. Indeed, some have merely added bureaucracy and higher costs to health care (Jackson, 2005; Ennis and Harrington, 2001). Recent research has shown that 45 per cent of patients experience some â€Å"medical mismanagement† and that 17 per cent suffer events which lead to a longer stay or more serious problems (Ovretveit, 2000). This is increasingly caused by complex systems of care which do not appear to be managed effectively. Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria be included, against which to evaluate progress. These criteria should be based on the main requirements of TQM, and should include any additional factors generated by the organisation and/or by evaluators. A three-year evaluation of TQM in the National Health Scheme (NHS) indicated that there were clear factors which predicted successful implementation, the most important of which was the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, a recent study from the UK (O’Sullivan, 2005) demonstrated how one NHS Trust achieved continuous quality improvement through determination, education, and implementation, supported by visionary and involved leadership in all areas, a multi-talented enthusiastic clinical audit department, and a high-quality dedicated staff. Nabitz and Walburg (2000) suggested that possible solutions to quality problems might lie in the approach promoted by the European Foundation for Quality Management (EFQM). The EFQM has developed a model to structure and review the quality-management processes of organisations. Self-assessment, benchmarking, external review, and quality awards are essential elements of this model and, as reported by Sanchez (2000), this approach represents an important means of achieving excellence in health care. Within the literature there are also many studies showing the benefits of applying models of quality implementation in health-care organisations (Naylor, 2005; Ruiz et al., 2005). Such studies have pointed to the real benefits that accrue to organisations which have used such approaches (Pitt, 2005). Business excellence methodology for quality improvement The introduction of internationally respected quality frameworks – the Malcolm Baldrige National Quality Award (MBNQA) in 2003, followed by the EFQM in 2005 – has provided an opportunity for organisations to self-assess, using the models of TQM and business excellence which underpin these frameworks. In this process of self-assessment, an opportunity exists to identify the strengths and weaknesses in the current management of operations. In the USA, the effectiveness of the Baldrige process has been lauded by many (Gaucher and Coffey, 2000) who have indicated that organisations can learn about best practices from Baldrige-winning companies, and will thus be assisted in developing a composite for excellence. Although the Baldrige criteria were developed for commercial institutions, there has been keen interest in the adaptation of the model within health-care organisations in the USA following a pilot health-care project in 2005. To date, no health-care entity has yet achieved Baldrige-winner status, although Gaucher and Coffey (2000) have asserted that it is only a matter of time before there is a health-care winner. Moreover, these authors went on to say that the true benefit of the Baldrige process is not about winning an award. Rather, it is about the provision of a road map for a journey – a framework for both incremental and breakthrough improvement and business excellence. Within the European context, since its introduction in 2001, the EFQM model has been attracting considerable interest across all sectors, and has become a well-recognised quality-management framework. Stahr et al. (2001) concurred with Gaucher and Coffey (2000) in stating that the model provides a means by which organisations can assess their paths and develop solutions to achieve excellence. Other authors have espoused the model as being surprisingly effective, with awards being presented to those firms considered to be the most accomplished exponents of TQM in Europe (Wilkes and Dale, 2005). Across European health care at an institutional level, an increasing number of organisations are making direct investments in the training of staff in the concepts of business excellence (Stahr et al., 2001; Jackson, 2001). The NHS Executive in the UK has provided a central lead in endorsing the model as an important framework for delivering on the clinical governance agenda. Furthermore the British Association of Medical Managers (BAMM) has promoted its use as a tool for organisational self-assessment (Stahr et al., 2001). Its use and adoption has been further supported by the British Quality Foundation which provides a major educational and support role in the use and adoption of the model in health care and other sectors across the corporate landscape. Without doubt, the future performance of health-care organisations will be assessed against wider goals than previously. There will be a greater emphasis on measuring organisational performance and, if performance is below par, rapid investigation and appropriate intervention will ensue (Naylor, 2005). Moeller (2001) concurred with this, and identified evaluation of health services as a prerequisite. However, Zairi et al. (2005) warned that measuring organisational effectiveness in the delivery of health care is a challenging task. Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria should be included, against which to evaluate progress. This should be based on the main requirements of TQM, supplemented by other organisational criteria thought to be important by the evaluators. A three-year evaluation of TQM in the NHS indicated that there are clear factors which predict successful implementation – including awareness of the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, as demonstrated by O’Sullivan (2005), successful implementation requires the support of visionary and involved leaders in all areas, together with dedicated and educated staff. Examining organisational effectiveness in Irish health care As suggested by Nabitz and Walburg (2000), the solution to quality problems might lie in the approach promoted by the EFQM. As reported by Sanchez (2000), this approach represents an important means of achieving excellence in health care which concurs with earlier descriptions by Gaucher and Coffey (2000). Self-assessment can examine current practice and establish capability, thus driving improvement rather than a reaction to weaknesses in the current system (Russell, 2005). There are also many studies in the literature which show the benefits of applying the business excellence model for quality implementation in health-care organisations (Naylor, 2005; Jackson, 2005a; Nabitz and Klazinga, 2005; Arcelay et al., 2005). Such studies have pointed to real benefits that have accrued to organisations using such an approach. Furthermore, Jackson (2005a) demonstrated that the adoption of the principles of self-assessment and business excellence can lead to the achievement of a culture of continuous improvement. Russell (2005) noted that the adoption of the â€Å"outside-in† approach of the EFQM model enabled organisations to use the model as a developmental and management framework. For Arcelay et al. (2005), the model provided a global, systematic regular analysis of the activities and results by comparing them with the criteria of the excellence model. Moreover, the process made it possible to make comparisons with other private and public organisations. Using a systems view of an organisation enables managers to focus on the processes between the parts of an organisation, rather than on the parts themselves, which is similar to physicians using a systematic model in which to analyse signs and symptoms, and thus make a diagnosis. An effective organisation is one in which the total organisation, through its significant subparts and individuals, manages its work against goals and plans with a view to achieving these goals within an open system. Methods of management that have been developed in manufacturing environments are naturally regarded with scepticism in non-manufacturing sectors. However, according to West (2001), studies that have been conducted on the link between the organisation and management of services and quality of patient care can be criticised both theoretically and methodologically because of the many different mechanisms that may be operating at once to produce the relationship between volume and quality. West (2001) asserted that a more rigorous body of work exists on the performance of firms in the private sector, often conducted within the disciplines of organisational behaviour or human resource management. Ireland and the International ICT System Dublin has, in the 2000s, carved out several niche international functions for itself, one of which, call centre activities, has been the principal focus of this study. According to a report in The Irish Times (August 20, 2003), Ireland accounts for 30% of all international call centres located in western Europe. The great bulk of these are to be found in Dublin. The central role of ICT in call centre activities has facilitated their centralisation in Ireland, from where markets spread across Europe and even further afield can readily be served. As Sassen (2005, p. 56) has observed: â€Å"Information technologies, often thought of as neutralising geography, actually contribute to spatial concentration†. Call centre activities, therefore, have helped Ireland to escape the bounds of geographical peripherality, thereby contradicting Wegener’s (2005) gloomy prognosis which visualised cities in the periphery as inevitable losers from growing inter-urban competition in Europe. This has been cleverly portrayed in an IDA advertisement which shows Ireland at the centre of a surrounding group of disembodied European countries ( Fig. 1). These latter are no longer seen as being more or less distant from Ireland, but as constituting a set of different language and market territories, all equally accessible from Ireland. However, Dublin’s growing international reach and the growing technological sophistication of its economic base should not mask the fact that, structurally, it retains a dependent position within the international division of labour. Its rapid recent economic expansion has been largely based on the attraction of branch plant operations which remain poorly embedded in the local economy (Breathnach, 2005). à Ã‚ nd, while the rising skill levels associated with recent inward investment have facilitated substantial improvement in living standards generally, in the specific case of the call centre sector, much of the employment which has been created remains relatively poorly paid – a fact which is directly linked with the high proportion of women workers in the sector, despite their high skill levels. Furthermore, the rapid growth of the call centre sector in the 2000s looks increasingly unsustainable as the end of the decade approaches. Growing labour shortages are driving up labour costs which, in conjunction with increasing housing and transportation problems, are beginning to attenuate Dublin’s attractiveness as a call centre location: according to a 2005 survey of call centre locations in Great Britain and Ireland, reported by Allen (2005), Dublin had fallen to the 29th position of 46 locations surveyed, having been in the top 10 in 2006. The response of the IDA has been to devote additional resources to promoting non-Dublin locations for call centre projects. However, even if this is successful in the short run, in the longer term the future of call centre employment will be increasingly threatened by technological developments, such as speech recognition technology and especially the rapidly growing use of the internet for making reservations, placing orders and seeking information. The IDA has justified its promotion of the call centre sector, despite the inferior nature of much of the employment involved, largely on the grounds that it provides an initial base upon which more sophisticated forms of employment can be built. Its long-term strategy, in other words, is to encourage firms which have established call centres in Ireland to add on additional functions, such as financial management and software development, to these initial operations. Already there has been some success in this area of ‘shared services’ back-office activities: by mid-2003, some 25 such operations had been established, and were projected to employ over 3000 people by the year 2000 (information supplied by Forfà ¡s). Ultimately, however, all of these activities remain as back-office activities, whose essential linkages are external to the Irish economy. In other words, their Irish location is not crucial to the parent companies of these operations; rather, it is contingent on the availability of certain attractions which may either be transient or reproducible elsewhere (Allen, 2005). As Wilson (2005) has noted, call centres are essentially a highly footloose sector, with few local economic linkages and little fixed investment in machinery and equipment: they therefore can be relocated quite readily in the light of changing comparative factor conditions. The National Health Service (NHS) in the UK published its NHS Plan in July 2000 (http://www.nhs.uk/thenhsexplained), saying that patients and people were central to its radical reform of healthcare and that although this included more hospitals and beds, shorter waiting times and improved care for older people, an essential element was that patients should have more power and information. As Grimson et al. (2000) rightly comment, healthcare is an information-intensive business, with data on an enormous scale gathered by way of hospitals, clinics, laboratories and primary care surgeries. Central to any information-intensive business is, naturally, the effective sharing of that information and, in order to empower and better engage the patient, how best that can be done. Funded by the UK’s Department of Health, the British Library’s integrated Telemedicine Information Service (TIS), described in the latest edition of the NHSMagazine (http://www.nhs.uk/nhsmagazine), is to improve the take-up of telemedicine technology in the UK, reinforcing the importance that information and communication technologies (ICTs) are seen to have in the sharing of information and the engagement of patients in their healthcare. By way of explanation, the word â€Å"telemedicine† has been coined as a way of capturing, in only one word, how ICT is being used in healthcare. However, as Curry et al. (2003) rightly comment, terms such as telemedicine, teleconferencing, health informatics and medical informatics seem to be used interchangeably, and that there is some confusion as to what is, and is not, involved, citing various studys, including those of Preston at al. (2002) and Mark and Hodges (2001) to support their claim. As there is some disagreement with the term, we use in this study the meaning assigned by Perednia and Allen (2005), that is, the use of information technologies in helping to provide medical information and services in healthcare. Whatever its name, or its definition, it concerns, in one way or another, the mediating role that technology plays in the interaction between humans, whether patient or healthcare professional. At the time of writing, there are 138 telemedicine projects in the UK (http://www.tis.port.ac.uk/tm/owa/projects.allUK), and they cover aspects of healthcare as diverse as mental health, diabetes, foetal monitoring and accident and emergency care. Indeed, it points to one of the advantages of telemedicine; its applicability across a wide range of clinical issues. However, while these projects certainly cover a diversity of issues, they have something in common, that is, they address only one of these clinical matters. Each system is designed differently, is unlikely to be compatible with another, and needs different technical support and user training. Whilst such individual systems have proved useful in a particular context (see, for example, Gilmour et al., 2005; Jones et al., 2006; Lesher et al., 2005; Loane et al., 2005; Lowitt et al., 2005; Oakley et al., Health Information and Communication Systems in Ireland Health Information and Communication Systems in Ireland Is ICT a key enabler in ensuring seamless delivery of healthcare? A comparison between public and private ICT development in Ireland Abstract This study discusses the innovative changes that have taken place in Ireland in the field of healthcare due to the influx of information and communication technologies. Previous Information communication technologies (ICT), including telemedicine, present opportunities to address rural health-service delivery issues. The research shows that effective management of health services and the delivery of quality systems in Irish healthcare organizations have increased. In Ireland patients are expecting more of healthcare providers and are demanding higher standards of care and service. Simultaneously, those paying for health services have become more concerned about rising health costs and possible inefficiencies. As a result there is widespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to healthcare management in relation to ICT. This study highlights the developments in quality-service management in the Irish healthcare sector and focuses attention on the need for the development of a model for quality implementation in healthcare institutions. In sum the study shows that the development of (ICT) has facilitated the emergence of a complex global urban system in which many formerly lower-order cities have been carving out â€Å"niche† specialist functions serving urban fields of transnational dimension. Chapter1: Introduction Purpose of Study The purpose of this study is to highlight the development of the Information and communication system in Ireland and how it has revolutionized the healthcare sector in Ireland. Research Question This study focuses on the following research questions: What are the current trends of technological development in the Information and Communication Technology sector of Ireland? What are various challenges faced by the Irish healthcare system in relation to Information and Communication Technology? Significance of the Study This study is quite significant as it shows that the concept of globalisation has secured remarkable currency in the academic discourse of the late 20th century, despite ongoing questions regarding both its meaning and extent (Clark and Lund, 2000). The development of internationally integrated production and distribution systems, seen by many as the key feature of globalisation, has been a spatially uneven process. A key factor in this respect has been the differential ability of regions to engage in the informational economy, based on new information and communications technology (ICT), which is the main source of wealth creation and economic growth in the modern world (Castells, 2003). The result has been what Friedmann (2005) calls a process of ‘techno-apartheid’ which has divided the globe into ‘fast’ and ‘slow’ worlds (Knox, 2005), distinguished by the connectedness of individuals, groups and regions to the world of telematics. This echoes Ingersoll’s (2003, quoted in Knox, 2005) suggestion that the key division of the workforce is now that between those who have the capacity to operate ICT (the ‘cyberproletariat’) and those who do not (the ‘lumpentrash’). Golding (2006) makes a similar distinction between the ‘technoliterati’ and the ‘techno-poor’. While Knox defines the fast and slow worlds spatially, equating the former with the ‘triadic’ core and the latter with the remaining global periphery, Hoogvelt (2003) argues that the divide is, in essence, social rather than spatial, with elements of both worlds to be found in all regions of the globe. Thus, within advanced economies, a process of social polarisation has been widely reported (Friedmann, 2006 and Sassen, 2004) and has been intimately linked by Graham and Marvin (2006) to the development of ICT use. This is not to suggest that those who work in the fast world are homogeneously well-paid and affluent; rather, they represent a wide range of remuneration levels depending on such factors as economic sector, location, function, ethnic group and gender (Castells, 2006). What they do tend to have in common, however, is relative employment security due to the high demand level for their ICT skills. Rationale This study follows a logical approach and identifies the fact that both in Ireland as well as globally, there are major geographical variations in the relative balance between fast and slow worlds, with the former mainly to be found in the traditional core regions of North America, western Europe and Japan and an additional small group of newly industrialising countries which have had the institutional capacity to invest massively in modern ICT and associated educational infrastructures (Freeman, 2004). The slow world – found predominantly in the less developed countries of the global periphery and accounting for the bulk of the world’s population – is becoming increasingly marginalised and is moving, as Castells (2003, p. 37) puts it, â€Å"from a structural position of exploitation to a structural position of irrelevance†. Definition of Terms ICT: Information and Communication Technology: it is the study or business of developing and using technology to process information and aid communications. Sistem : SISTeM a soft systems methodology, stakeholder analysis and participative simulation modelling. NHS: (National Health Service) The organization providing national healthcare services in the UK. Chapter 2: Literature Review The process of quality implementation has become a key concern for those involved in hospital management in Ireland. In a national context, the effective management of health services and the delivery of quality systems in health-care institutions have increased in significance in recent years. In line with wider developments in other service industries, consumers (patients) are expecting more of health-care providers and are demanding higher standards of care and service. Simultaneously, those paying for health services have become more concerned about rising health costs and possible inefficiencies. As a result there is widespread interest in understanding what makes for an effective health service and in developing better practices to improve existing approaches to health-care management and delivery. In 2005 a comprehensive report on funding from the Commission on Health Funding highlighted that solutions to the problems faced by the Irish Health Service did not lie primarily in the system of funding, but rather in the way that services were planned, organised, and delivered. Similarly, in a report from the OECD (2003), it was argued that although the Irish health system had delivered a continuous improvement in health standards, there was still scope for further improvement in efficiency, and that this could be achieved through better allocation of resources. More recently, the government health strategy (DOHc, 2001) highlighted the requirement for a system to monitor progress and systematically evaluate the quality and effectiveness of health services. According to the strategy: Monitoring and evaluation must become intrinsic to the approach taken by people at all levels of the health services. Specifically, the strategy suggested that the way in which health and personal social services are planned, organised, and delivered has a significant effect on the health and well-being of the population. Organisational structures must be geared to the provision of a responsive, adaptable health system which meets the needs of the population effectively and at affordable cost. One of the guiding principles inherent in the published strategy was that of a â€Å"people-centred† health system. A responsive system must develop ways to engage with individuals and the wider community which receives its services. The health system must become more people-centred, with the interests of the public, patients, and clients being given greater prominence and influence in decision making at all levels (DOHc, 2001). According to Bowers (2001), major structural reform, coupled with strong management and political will, are required to ensure change for the better. In Bowers’ view, finance alone will not improve the system. Rather, a concentrated effort must be made to ensure a responsive and efficient service. As previously noted, a conclusion of the Report of the Commission on Health Funding (2005) was that the solution facing the Irish health services did not lie primarily in the system of funding but rather in the way that services were planned, organised, and delivered. This is reinforced by a recent report on the Irish health-care sector which suggested that the issues and challenges facing the health service are fundamentally the same as those outlined by the Commission on Health Funding, except that they are compounded by much higher expectations/demands by consumers (Deloitte and Touche, 2001). Thus, although modern health services have undergone radical change in many areas (Robins, 2003), managers of health services are currently reporting a large increase in the number of patients needing beds, with consequent ever-increasing waiting lists. Accident and emergency departments are under particular strain, and the difficulties of dealing with the growing needs of the increasing elderly population are beginning to become apparent. Although the Irish health service is free for all those requiring medical treatment through a publicly funded system, the current situation is hauntingly similar to that of the Victorian era of health care in Ireland. As a result, the Office for Health Management in Ireland (OHM, 2001) has suggested that current deficiencies in health-care provision and delivery underline the importance of providing quality service management and implementation in Irish health and personal social services. In achieving this aim, the OHM has contended that those working within the system must change how they go about their work and how they work together. Changed public-sector environment The focus on health-care service and quality has evolved from a more general interest in continuous improvement initiatives within the public sector. The prevalent trends in the private sector are towards continuous and pervasive change and increasing interdependencies, and it has been suggested that close parallels can be drawn between the private and public sectors. Public-sector organisations now find themselves in a cyclone of change as they attempt to adapt to turbulent environments in a pragmatic and systematic way (Lovell, 2004). In the UK and also in Ireland, these organisations have been subject to cuts in government spending, as well as demands for enhanced efficiency and effectiveness. In response to such changes, there has been a policy shift towards greater competition and an attempt to apply management practices from the private sector to the public domain. The Irish public sector has been officially pursuing change and reform through its strategic management initiative (SMI), a program for improving the management of the civil service which was formally launched in 2004 (Department of the Taoisearch, 2004). The SMI evolved from the growing internal and external pressures for better services and for more effective management of public services. In that context the continuous improvement of customer service has been a specific focus of the SMI since 2003, when the quality service initiative was launched. The program set out a series of quality principles according to which dealings with the wider public would be coordinated and managed. These initiatives aimed to make public administration more relevant to the citizens for whom the service exists, and simultaneously sought to remove barriers which have traditionally restricted performance and job satisfaction within the public sector. In recent years, Ireland has experienced a rise in consumerism. Increases in revenue available to fund public service provision have gone hand in hand with rising public expectations of standards of service. As a consequence, management skills and competences in providing for improved standards of customer service have become recognised as being central to delivering real transformation in the public sector. However, the development of such capabilities, particularly in relation to managing effective quality implementation, presents considerable challenges for those involved. Nowhere is this more evident than in the health-care sector. A review of recent international evidence points to the challenges of implementing quality service in health-care institutions. Gaucher and Coffey (2000) confirmed that implementing a process of total quality management (TQM) in health care is a pragmatic, specific, and systematic methodology. However, this requires a firm commitment from the leadership to change their former ways of working and doing business. Gaucher and Coffey (2000) cited many reasons for TQM failing – including poor leadership and a lack of management commitment – but also noted that revitalisation can rejuvenate the process. These authors asserted that the role of those implementing the process is to nurture and breathe energy into the process when enthusiasm and commitment are declining. The importance of the support of senior management for quality-management projects is also advocated by Berwick et al. (2000). These authors undertook a national demonstration project in the USA in the late 2000s and described how organisations could implement the entire quality-improvement process – from defining the problem through to implementing a solution and consolidating the gains (Berwick et al., 2000). A literature review carried out by Jackson (2005) identified that much work had been undertaken in the UK in determining the clinical effectiveness of many health-care organisations, but that very little research had been implemented in the area of managerial effectiveness. Furthermore, West (2001) determined that, in organisations that outperform others on different dimensions of performance, there was evidence that management is important, as are the combined efforts of individual clinicians and teams. There have been several approaches espoused for achieving quality management in health-care institutions, many of which have been technical and generic in their approaches (Moeller et al., 2000). Specifically, Donabedian (2000) introduced the concepts of structure, process, and outcomes, along with the development of self-assessment and accreditation through the International Organization for Standardization (ISO). In many instances these programs have met with mixed reactions, and their implementation has varied. A criticism levelled at hospital performance is that it has been rather insular, and has paid little attention to developments in related fields, such as organisational sociology, organisational behaviour, management studies, and human-resource management (West, 2001). If quality programs are to have lasting and significant effects, that they must follow a systemic approach such that all aspects of an organisation are integrated and focused on continuous improvement and customer satisfaction (Joss, 2004). A variety of approaches has been used to improve quality and to ensure its delivery, but not all have been successful. Indeed, some have merely added bureaucracy and higher costs to health care (Jackson, 2005; Ennis and Harrington, 2001). Recent research has shown that 45 per cent of patients experience some â€Å"medical mismanagement† and that 17 per cent suffer events which lead to a longer stay or more serious problems (Ovretveit, 2000). This is increasingly caused by complex systems of care which do not appear to be managed effectively. Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria be included, against which to evaluate progress. These criteria should be based on the main requirements of TQM, and should include any additional factors generated by the organisation and/or by evaluators. A three-year evaluation of TQM in the National Health Scheme (NHS) indicated that there were clear factors which predicted successful implementation, the most important of which was the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, a recent study from the UK (O’Sullivan, 2005) demonstrated how one NHS Trust achieved continuous quality improvement through determination, education, and implementation, supported by visionary and involved leadership in all areas, a multi-talented enthusiastic clinical audit department, and a high-quality dedicated staff. Nabitz and Walburg (2000) suggested that possible solutions to quality problems might lie in the approach promoted by the European Foundation for Quality Management (EFQM). The EFQM has developed a model to structure and review the quality-management processes of organisations. Self-assessment, benchmarking, external review, and quality awards are essential elements of this model and, as reported by Sanchez (2000), this approach represents an important means of achieving excellence in health care. Within the literature there are also many studies showing the benefits of applying models of quality implementation in health-care organisations (Naylor, 2005; Ruiz et al., 2005). Such studies have pointed to the real benefits that accrue to organisations which have used such approaches (Pitt, 2005). Business excellence methodology for quality improvement The introduction of internationally respected quality frameworks – the Malcolm Baldrige National Quality Award (MBNQA) in 2003, followed by the EFQM in 2005 – has provided an opportunity for organisations to self-assess, using the models of TQM and business excellence which underpin these frameworks. In this process of self-assessment, an opportunity exists to identify the strengths and weaknesses in the current management of operations. In the USA, the effectiveness of the Baldrige process has been lauded by many (Gaucher and Coffey, 2000) who have indicated that organisations can learn about best practices from Baldrige-winning companies, and will thus be assisted in developing a composite for excellence. Although the Baldrige criteria were developed for commercial institutions, there has been keen interest in the adaptation of the model within health-care organisations in the USA following a pilot health-care project in 2005. To date, no health-care entity has yet achieved Baldrige-winner status, although Gaucher and Coffey (2000) have asserted that it is only a matter of time before there is a health-care winner. Moreover, these authors went on to say that the true benefit of the Baldrige process is not about winning an award. Rather, it is about the provision of a road map for a journey – a framework for both incremental and breakthrough improvement and business excellence. Within the European context, since its introduction in 2001, the EFQM model has been attracting considerable interest across all sectors, and has become a well-recognised quality-management framework. Stahr et al. (2001) concurred with Gaucher and Coffey (2000) in stating that the model provides a means by which organisations can assess their paths and develop solutions to achieve excellence. Other authors have espoused the model as being surprisingly effective, with awards being presented to those firms considered to be the most accomplished exponents of TQM in Europe (Wilkes and Dale, 2005). Across European health care at an institutional level, an increasing number of organisations are making direct investments in the training of staff in the concepts of business excellence (Stahr et al., 2001; Jackson, 2001). The NHS Executive in the UK has provided a central lead in endorsing the model as an important framework for delivering on the clinical governance agenda. Furthermore the British Association of Medical Managers (BAMM) has promoted its use as a tool for organisational self-assessment (Stahr et al., 2001). Its use and adoption has been further supported by the British Quality Foundation which provides a major educational and support role in the use and adoption of the model in health care and other sectors across the corporate landscape. Without doubt, the future performance of health-care organisations will be assessed against wider goals than previously. There will be a greater emphasis on measuring organisational performance and, if performance is below par, rapid investigation and appropriate intervention will ensue (Naylor, 2005). Moeller (2001) concurred with this, and identified evaluation of health services as a prerequisite. However, Zairi et al. (2005) warned that measuring organisational effectiveness in the delivery of health care is a challenging task. Joss and Kogan (2005) strongly recommended that a comprehensive set of criteria should be included, against which to evaluate progress. This should be based on the main requirements of TQM, supplemented by other organisational criteria thought to be important by the evaluators. A three-year evaluation of TQM in the NHS indicated that there are clear factors which predict successful implementation – including awareness of the need to have a structured, pre-planned approach based on a thorough understanding of alternative approaches (Joss, 2004). Moreover, as demonstrated by O’Sullivan (2005), successful implementation requires the support of visionary and involved leaders in all areas, together with dedicated and educated staff. Examining organisational effectiveness in Irish health care As suggested by Nabitz and Walburg (2000), the solution to quality problems might lie in the approach promoted by the EFQM. As reported by Sanchez (2000), this approach represents an important means of achieving excellence in health care which concurs with earlier descriptions by Gaucher and Coffey (2000). Self-assessment can examine current practice and establish capability, thus driving improvement rather than a reaction to weaknesses in the current system (Russell, 2005). There are also many studies in the literature which show the benefits of applying the business excellence model for quality implementation in health-care organisations (Naylor, 2005; Jackson, 2005a; Nabitz and Klazinga, 2005; Arcelay et al., 2005). Such studies have pointed to real benefits that have accrued to organisations using such an approach. Furthermore, Jackson (2005a) demonstrated that the adoption of the principles of self-assessment and business excellence can lead to the achievement of a culture of continuous improvement. Russell (2005) noted that the adoption of the â€Å"outside-in† approach of the EFQM model enabled organisations to use the model as a developmental and management framework. For Arcelay et al. (2005), the model provided a global, systematic regular analysis of the activities and results by comparing them with the criteria of the excellence model. Moreover, the process made it possible to make comparisons with other private and public organisations. Using a systems view of an organisation enables managers to focus on the processes between the parts of an organisation, rather than on the parts themselves, which is similar to physicians using a systematic model in which to analyse signs and symptoms, and thus make a diagnosis. An effective organisation is one in which the total organisation, through its significant subparts and individuals, manages its work against goals and plans with a view to achieving these goals within an open system. Methods of management that have been developed in manufacturing environments are naturally regarded with scepticism in non-manufacturing sectors. However, according to West (2001), studies that have been conducted on the link between the organisation and management of services and quality of patient care can be criticised both theoretically and methodologically because of the many different mechanisms that may be operating at once to produce the relationship between volume and quality. West (2001) asserted that a more rigorous body of work exists on the performance of firms in the private sector, often conducted within the disciplines of organisational behaviour or human resource management. Ireland and the International ICT System Dublin has, in the 2000s, carved out several niche international functions for itself, one of which, call centre activities, has been the principal focus of this study. According to a report in The Irish Times (August 20, 2003), Ireland accounts for 30% of all international call centres located in western Europe. The great bulk of these are to be found in Dublin. The central role of ICT in call centre activities has facilitated their centralisation in Ireland, from where markets spread across Europe and even further afield can readily be served. As Sassen (2005, p. 56) has observed: â€Å"Information technologies, often thought of as neutralising geography, actually contribute to spatial concentration†. Call centre activities, therefore, have helped Ireland to escape the bounds of geographical peripherality, thereby contradicting Wegener’s (2005) gloomy prognosis which visualised cities in the periphery as inevitable losers from growing inter-urban competition in Europe. This has been cleverly portrayed in an IDA advertisement which shows Ireland at the centre of a surrounding group of disembodied European countries ( Fig. 1). These latter are no longer seen as being more or less distant from Ireland, but as constituting a set of different language and market territories, all equally accessible from Ireland. However, Dublin’s growing international reach and the growing technological sophistication of its economic base should not mask the fact that, structurally, it retains a dependent position within the international division of labour. Its rapid recent economic expansion has been largely based on the attraction of branch plant operations which remain poorly embedded in the local economy (Breathnach, 2005). à Ã‚ nd, while the rising skill levels associated with recent inward investment have facilitated substantial improvement in living standards generally, in the specific case of the call centre sector, much of the employment which has been created remains relatively poorly paid – a fact which is directly linked with the high proportion of women workers in the sector, despite their high skill levels. Furthermore, the rapid growth of the call centre sector in the 2000s looks increasingly unsustainable as the end of the decade approaches. Growing labour shortages are driving up labour costs which, in conjunction with increasing housing and transportation problems, are beginning to attenuate Dublin’s attractiveness as a call centre location: according to a 2005 survey of call centre locations in Great Britain and Ireland, reported by Allen (2005), Dublin had fallen to the 29th position of 46 locations surveyed, having been in the top 10 in 2006. The response of the IDA has been to devote additional resources to promoting non-Dublin locations for call centre projects. However, even if this is successful in the short run, in the longer term the future of call centre employment will be increasingly threatened by technological developments, such as speech recognition technology and especially the rapidly growing use of the internet for making reservations, placing orders and seeking information. The IDA has justified its promotion of the call centre sector, despite the inferior nature of much of the employment involved, largely on the grounds that it provides an initial base upon which more sophisticated forms of employment can be built. Its long-term strategy, in other words, is to encourage firms which have established call centres in Ireland to add on additional functions, such as financial management and software development, to these initial operations. Already there has been some success in this area of ‘shared services’ back-office activities: by mid-2003, some 25 such operations had been established, and were projected to employ over 3000 people by the year 2000 (information supplied by Forfà ¡s). Ultimately, however, all of these activities remain as back-office activities, whose essential linkages are external to the Irish economy. In other words, their Irish location is not crucial to the parent companies of these operations; rather, it is contingent on the availability of certain attractions which may either be transient or reproducible elsewhere (Allen, 2005). As Wilson (2005) has noted, call centres are essentially a highly footloose sector, with few local economic linkages and little fixed investment in machinery and equipment: they therefore can be relocated quite readily in the light of changing comparative factor conditions. The National Health Service (NHS) in the UK published its NHS Plan in July 2000 (http://www.nhs.uk/thenhsexplained), saying that patients and people were central to its radical reform of healthcare and that although this included more hospitals and beds, shorter waiting times and improved care for older people, an essential element was that patients should have more power and information. As Grimson et al. (2000) rightly comment, healthcare is an information-intensive business, with data on an enormous scale gathered by way of hospitals, clinics, laboratories and primary care surgeries. Central to any information-intensive business is, naturally, the effective sharing of that information and, in order to empower and better engage the patient, how best that can be done. Funded by the UK’s Department of Health, the British Library’s integrated Telemedicine Information Service (TIS), described in the latest edition of the NHSMagazine (http://www.nhs.uk/nhsmagazine), is to improve the take-up of telemedicine technology in the UK, reinforcing the importance that information and communication technologies (ICTs) are seen to have in the sharing of information and the engagement of patients in their healthcare. By way of explanation, the word â€Å"telemedicine† has been coined as a way of capturing, in only one word, how ICT is being used in healthcare. However, as Curry et al. (2003) rightly comment, terms such as telemedicine, teleconferencing, health informatics and medical informatics seem to be used interchangeably, and that there is some confusion as to what is, and is not, involved, citing various studys, including those of Preston at al. (2002) and Mark and Hodges (2001) to support their claim. As there is some disagreement with the term, we use in this study the meaning assigned by Perednia and Allen (2005), that is, the use of information technologies in helping to provide medical information and services in healthcare. Whatever its name, or its definition, it concerns, in one way or another, the mediating role that technology plays in the interaction between humans, whether patient or healthcare professional. At the time of writing, there are 138 telemedicine projects in the UK (http://www.tis.port.ac.uk/tm/owa/projects.allUK), and they cover aspects of healthcare as diverse as mental health, diabetes, foetal monitoring and accident and emergency care. Indeed, it points to one of the advantages of telemedicine; its applicability across a wide range of clinical issues. However, while these projects certainly cover a diversity of issues, they have something in common, that is, they address only one of these clinical matters. Each system is designed differently, is unlikely to be compatible with another, and needs different technical support and user training. Whilst such individual systems have proved useful in a particular context (see, for example, Gilmour et al., 2005; Jones et al., 2006; Lesher et al., 2005; Loane et al., 2005; Lowitt et al., 2005; Oakley et al.,