Primark and the 5 Gaps Model Essay Example | Topics and Well Written Essays - 3000 words

Primark and the 5 Gaps Model - Essay Example Primark is famous because they sell their items of clothing at budget end prices of the market. This is the main reason of success of Primark as they supply their sources cheaply. The clothing they have is of simple fabrics and designs. Sizes of the clothes are of the standards sizes and they make it in bulks with different types of varieties (About us- Primark, 2010). These are some of the brands of Primark (About us- Primark, 2010): Atmosphere — Women wear/footwear Active - menswear Backswing - Women and men’s sportswear Butler & Webb — formal menswear Cedar wood State — casual menswear Denim Co. — women wear, casual men's and children’s wear Early Days — baby wear (newborn-23mnths) Essentials - basic cheaper items Girl 2 Girl — young girls wear (2yrs-7yrs) Limited Edition — women wear Competitors of Primark The main competitors of Primark are all the fashion retail stores such as Marks and Spencer, John and Lewis, Zara ’s and other such brand retail stores. The difference between Primark and its competitors are that Primark has adopted a low cost strategy in fashion retailing and its competitors are high priced. ... The type of services provided by the organisation is at times very difficult to measure as service is an intangible thing (Wisniewski, 2001). There have been many definitions discussed on the term service quality and the most common ones are the service quality is the meeting of the expectation of the needs of the customers (Lewis and Mitchell, 1990). It should be strongly adhered by all organisations that they should constantly work upon improving their service quality so that they can attain a large customer base. The type of services provided by the organisation has to be valued against the perceived service by the customer. In other words it is the difference between the expectations of a customer of the service and the perceived service (Asubonteng et al., 1996). All service organisations need to match up to the expectation level of the customers so that they have a good perception level of the organisation. If the customers have expected vey high and the performance is not up t o the level, then dissatisfaction is observed from the customer (Parasuraman et al., 1985). Organisations need to constantly work upon improving their standards of service delivery so that they can attain a high level of customer satisfaction from their valuable customers (Dotchin and Oakland, 1994). Reasons for Primark’s Success In the midst of high competition in the fashion retail market, Primark has successfully managed to overcome their tough competitors such as Marks & Spencer, John & Lewis and other such fashion retail stores. The reasons for Primark’s success are as follows: Primark implemented the low cost strategy in their organisation and this strategy worked perfectly for them. In the time periods of high inflation, everyone has to work upon their budgets; they cannot

Strategic Choice and Evaluation Research Proposal

Strategic Choice and Evaluation - Research Proposal Example In accordance to this, an evaluation would be made on the new objective conditions as well as the internal strengths and weaknesses of the organization. Value Discipline Every business organization must adhere to a certain value discipline in order to succeed. This is actually a principle that the organization must uphold always as it continues to operate. There are three types of basic value discipline from this business may choose from; namely, operational excellence, product leadership, and customer intimacy. While it does not necessarily disregard the both operational excellence and product leadership, this daycare facility puts heavy emphasis on customer intimacy. The organization managing this believes that it is through being in close contact always with the children and their parents could ideas arise regarding the continuous development of the services being provided. Customer intimacy is â€Å"a value discipline based on development and nurturing of customer relationships and the customized delivery of product and service solutions for those customers† (Marks 2002, p. 14). ... Apparently, by adhering to the value discipline of customer intimacy, this daycare business may also realize the operational excellence. It must be noted that in this particular kind of business, the best gauge for the effectiveness of its operation is through determining the level of satisfaction of the children and parents. Unlike other businesses that produce actual commodities, operational excellence here could not be measured by the quantity and quality of products produced at a short time and at the least cost. If the children learn and enjoy during their stay and if the parents appreciate the work that is being done then the operation of the facility may be considered as satisfactory or even outstanding. This organization does not believe that it should strive to be a leader in the daycare business. It possesses the perspective that daycare businesses should not put a premium on competition because this does not have a good effect on the training of the children in general. Ho wever, by striving to practice customer intimacy, it may also develop operational excellence, which should then result in leadership in this particular field of business. The point, however, is that is focus should be more on customer intimacy and the rest would inevitable follow. Generic Strategies Since the daycare facility to be established and operated is still a business, it must maintain its viability not just to generate the desired target profits but also to continue providing services to the community. As pointed out earlier in the mission and goal of this business, although profit is an important concern, the ability to provide service to the children and their working parents share is also a significant aspect. In order to

Strategy and its importance for competitive advantage

Strategy and its importance for competitive advantage A companys strategy is organization action plan which is running the business and conducting operations. Especially this can mention as managerial commitment to achieve their goals. Companies target on gaining sales and market share at the expense of competitors and companies which are in strong industry position are more reflect on the strategy what they use (Helfat, 2004). Through the action Plan Company can enter its competitors and can make the goals and strategies to meet their market place. A company should formulate a business strategy which incorporates cost leadership or differentiation to achieve a sustainable competitive advantage. Michael Porter introduced two basic types of competitive advantages which are cost advantage and differentiation advantage. Cost advantage exits when company can give same benefits as competitor with lower cost. And differentiation advantage exits when the company can make different benefits or the value to the customer from their products. As an Example BP is using combination of Crude oil and natural energy such as solar power to give differentiation to their customers and it is a well successful strategy. Source: http://www.bp.com/sectionbodycopy.do?categoryId=2contentId=7065607 (Access on 20th May 2011) There are several technical tools which are used to analysis situations in strategic Management. STEEPLE is one of it shortening the external environment in a business operates and concerned with the political, economic, social factors influential industry change and helps to gain a better understanding for external conditions for growth in a market. Companies or the decision makers can develop effective strategies by using GE Matrix as well (Thomas, ONeal, and Ghertman, 1997). The porters five forces investigation helps to diversity a competitive environment. For example, BP analyzes the market for Quality oil production. Five forces analysis describe five key areas exclusively the threat of entry, the power of buyers, the power of suppliers, the threat of substitutes, and competitive rivalry (Bettis, 2004) Figure1. Porters Generic Strategies (source:http://www.google.co.uk/search?q=Porter+five+forces+analysishl=enclient=opera) Competitors for BP Shell, Sharp, Kyocera, Solar, and BP are the current major players in this industry. Price differences are not big among these companies, solar energy is already expensive technology to produce, so its cost of production is very high, but it is environmental friendly. BP has mass production, so it can face to price rivalry happen. Business strategy in BP BP enter of solar market in 1973 and produced BP solar in 2000, it was one of main strategy to face current oil crisis and environment issues. BP solar becomes profitable but it is not prominently spread among the public, so government involvement is important to become popular of solar power. Evaluating BP External Environment BP is one from the world leading Multinational Corporation which produces Consumer energy, and it is UK based organization. BPs SWOT analysis can be mentioned as follows. Strengths World third largest energy company Operation spreads worldwide Strong Brand loyalty Good brand image Financial strength of the company. It has vertical integration operation system. Weaknesses Increase the petrol price in UK Has to paid criminal charges due to spread huge amount of oil in the Alaska Sea in 2006. Reduce in natural gas and crude oil production. Criticism and Controversies Opportunities Has high investment capacity Research to investigate alternative fuel such as Hydrogen, Solar, Wind and natural gas Extension of acquisition of North sea area Increase demand for natural gas in USA and Europe countries. Implement more flexible price polices to face their competitors. Gas and Oil exploration Treats Unsound policies related to Environment after oil and toxic spill in 2006. Explosion of refinery tunnels in occasionally Has big rivals such as Shell and Chevron Sold corporate owned stations. Pipeline corrosion Instability in some oil and gas producing countries and regions Table.1. SWOT analysis of BP By implementing proper marketing policies and practices company will make its market position. BP culture so distinctive because they focus on customer, and believe BP is better than all other Energy produce companies. Source: (http://www.bp.com/genericarticle.do?categoryId=2012968contentId=7059787) Effectiveness of Current Business Plans BP business plan has advantage in the Research and investigation area. The crude oil plus the solar power combinations was very successful strategy implemented in recently. Products segmentation, explorations and productions, significantly company restructuring, improve cost efficiency, centralized company departments are their current strategies to compete with rivalry and increase company profits. Task Two Strategic Options Strategic Options is an important facet and it helps to craft companys alternatives and provide safe and keep up the competitive situation. After situation analysis company can create strategic options to devise organizations external atmosphere and can scrutinize the potential. BP has a comprehensible strategy to invest to raise investigation and manufacture advantageously through a mixture of leadership positions in the worlds most productive hydrocarbon basins. BP creates value through the appliance of technology and potential to force performance and operating efficiency. The procedure and technology offers extensive chance for further expansion and improvement. The international requirements for energy for the next 20 years are such that hydrocarbons are still going to have a leading part in meeting that energy demand. BP supports emissions trading mechanisms as a means of putting a value on carbon in order to make appropriate investment decisions. BP spends on growing technology budget on potentially most competitively profitable innovations both in open and new power spaces. It is both a strategic option and an opportunity for BP when comparing with the rivals as BP is strategically positioned themselves in a highly innovative RD processes which is unmatchable by the rivals easily. While facing major challenges of dilapidated supplies and defense of supply in oil and gas, global warming and insist for pure energy in major markets, BPs percentage of expend on novel technologies is growing. BP has a decentralized en route for RD units. It also drives the strategic positioning of BP in competition among rivals. Operational excellence in acquiring right technologies from within and outer the organization and strategically as a winner of chosen new technologies, BP is keeping its innovation leadership in the industry. With an aim of being twice as good as next best competitor BPs innovation schema is far above the ground outline. Hence a low cost strategy is an ideal positioning for BP while serving to a large market segment that prefers a standard product. Corporate Mission of the BP BP mentioned that there goal for next few years to realize the latent impending of their advantage base by improving the efficiency and effectiveness of everything they do. They will dynamically drive cost and capital efficiency whilst at the same time maintaining the first main concern of safe and reliable operations. Objectives of the BP BP has some objectives for their growth in 2015. And all employees are working as a team to achieve company goals. Average 1-2% p.a. volume growth to 2015 Underpinned by upward resource base and quality through preference Key sources of growth beyond 2015 will come from: Increasing deepwater Leveraging expertise in gas Managing worlds enormous oilfields Enabled by application of technology Source-: http://www.bp.com/sectionbodycopy.do?categoryId=2contentId=7065607 Values and ethics of the BP BP is a compilation of resources and there people working together. To attain business objects they focus on sustaining and encouraging their leaders and staff. And they maintain recruitment stands and developing people skills at every level. BP is a well distinguish organization and wants to do some different in the world. BP is a performance driven company which is competitively booming. Through all this they prefer high ethical stand. Directions and methods of Strategic Options BPs direction is clear and it is the unrelenting pursuit of competitive leadership in respect of cash costs, capital efficiency and margin quality. The Strategy Clock is another suitable way to analyze a companys destructive position in comparison to the contributions of competitors. The Ansoff Growth matrix tool which is helps businesses to decide their product and market growth strategy. Figure 02.Ansoff Market mix (Source-: http://tutor2u.net/business/strategy/ansoff_matrix.htm) Steps to develop Strategic Options at BP To develop strategic options company can use following steps. Access the external context Priorities and gather Develop strategic options Rate the options Follow up Evaluating strategies at BP SOP Matrix is a tool which can use to identify the company relevant strategies through external environmental factors. As an example BP Opportunities and treats as below and by indentifying the external environmental factors can recognize the relevant strategies options. Opportunities Opportunities Strategic Option A Has high investment capacity Invest in HR development and through that develop the skills of the staff members. An same time invest in market opportunities. B RD to investigate alternative fuel such as Hydrogen, Solar, Wind and natural gas By research can find the best alternative and company can give attention to that. C Extension of acquisition of North sea area Can develop deep sea oil well. D Increasing demand for natural gas in USA and European countries. Efficient and effective resource allocation to maximize profit. Implement more flexible price polices to face their competitors. By price reducing can get more customers on their products Gas and Oil searching Will help to increase their market values and can demand them among the competitors Treats Treats Strategic Option Unsound policies related to Environment after oil and toxic spill in 2006. Understand the policies and work with less effect to environment Explosion of factory tunnels in occasionally By keeping the brand image without harm can face the problem Has big rivals such as Shell and Chevron To make company as No1. And more promotional works Sold corporate owned stations. Buy the stations Pipeline decomposition Should check the pipeline back and do the needful changers Insecurity in some oil and gas producing countries and regions Should find some more producers in case to use. BPs existing company strategies are, 1) Safe, obedient and consistent operations 2) Operational and financial force high dividends and cost diminution program Task Three SMART Objectives of BP BP Objectives are prepared according to SMART (Specific, Measurable, Achievable, Realistic, and Timed).That means it should be particular about what we are going to achieve and should calculate about the objectives. There are a several types of objectives like process objectives, outcome objectives, personal objective that all can be done in the SMART format. BPs five year plan objectives are, Increase profitability by 20% Increase production Financial gain by serving to the increasing demand Build brand value that was affected by the oil spills Five year development plan for BP Business plan is a statement about companys future goals and plans to achieve those goals. This can be externally focus or internally focus. BPs Strategies in development can position as, Upstream growth Downstream turnaround Alternative Energy: alert disciplined Corporate overview In the upstream will hub on cost and capital efficiency to distribute profitable growth. In the downstream will drive additional efficiencies and a focus on quality and incorporation. They will maintain their disciplined approach to substitute energy and will carry on unlock corporate efficiency through a culture of uninterrupted enhancement. Five year development plan for BP # Objective Strategy Actions Performance Indicators Time Period 1 Increase profitability by 20% Research and development Hire most qualified researchers Innovative ways of doing things One year 2 Increase production Acquisition of north sea area. Negotiations with governments and agreeing for a joint profit sharing. Coming into an agreement with relevant governments Two years 3 Financial gain by serving to the increasing demand Sales and Marketing approaches to increase market share Recruiting experienced sales and marketing people and objective training Acquiring new market opportunities, increase the market share One year 4 Build brand value that was affected by the oil spills Communication and promotion strategy Using new media opportunities of social media to build brand name again, invest in CSR activities in Go Green. Reduce the black mark 3 years Evaluating and implementing the plan In business strategy, Johnson, Scholes and Whittington shows a model in strategic options are evaluated next to three key success criteria such as Suitability, Feasibility, and Acceptability. Source-: http://en.wikipedia.org/wiki/Strategic_management # Objectives Time Line 1 year 2 year 3 year 4 year 1 Increase profitability by 20% X 2 Increase production X X 3 Financial gain by serving to the increasing demand X 4 Build brand value that was affected by the oil spills X X X Table.03. Five year BP strategic plan Conclusion When it is mention about the strategic management and the leadership strategic planning is a major part of it. Strategic planning can divide in to three stages as strategic Analysis, Strategic Options and Evaluation and Implementation. The British petroleum Corporation is a well established organization in petroleum industry and here it is mentioned about the strategy and competitive advantages of the BP and the technical tools which could they can use to analysis situations. The porters five forces investigation helps identify the competitive environment BP analysis their market for Quality production. There are so many competitors like Solar, sharp in the market and BP establish with mass production. By doing the SWOT analysis its helping company to identify the internal and external environment of the company. BP is focused on customers and they believe in their productions. They used the oil plus solar power combination and they used product segmentation, improve cost efficiency and some more strategies to increase their profits. They have created value through technology and this is a barrier for their competitors. Company can use strategy clock, Ansoff growth matrix tools to analysis their position in the market. To develop strategic options first it should identify the external context and priorities and clusters. Then it should develop the strategic options. SOP matrix is best tool to identify the strategies of the company.

A Circuitous Path to Dentistry :: Dentistry Admissions Essays

A Circuitous Path to Dentistry I could hardly keep myself from staring at the girl: the right side of her face was misshapen and bigger than the left. Only later did I notice that Cheryl, about nine at the time, had light brown hair, lively brown eyes, and a captivating smile. When she walked into the candy shop where I worked six years ago, Cheryl told me she was a student of my former fourth grade teacher with whom I had kept in contact. We talked then and spent time talking each time she visited. She became a very special friend of mine, one whom I admire greatly. At the time we met, I was taking honors and AP classes, working about twenty hours a week, and feeling sorry for myself. Cheryl's outgoing confidence and good cheer put my situation in perspective. Cheryl was strong, kind, and surprisingly hopeful. She never focused on her facial deformities, but always on the anticipated improvement in her appearance. Her ability to find strength within herself inspired me to become a stronger person. It motivated me to pursue a career where I could help those like Cheryl attain the strength that she possesses. At the time, my initial interest turned toward psychology. Impressed with Cheryl's outlook, I overlooked the source of her strength: she knew that treatment will improve her appearance. Focusing on the emotional aspects of her illness, I volunteered at the Neuropsychiatric Institute. There, I supervised the daily activities of pre-adolescents, played with them, and assisted them in getting dressed. I worked with crack babies, autistic children, and children who had severe behavioral problems. I enjoyed interacting with the children, but I often became frustrated that I was not able to help them. For instance, a young autistic boy frequently hit himself. No one was permitted to stop this child. We had to turn away and allow him to continually strike and hurt himself until he tired. I was increasingly disappointed with the lack of progress I saw in my volunteer work at NPI, but my job again pushed me in the right direction. During the fall quarter of my junior year in college, I left the candy shop where I had worked for nearly five and a half years, and I began working as a senior clerk in the Anesthesiology Residency Program. Ironically work, which frequently made study difficult, helped me find the right

Importance of Literature

ENG 101 7 February 2012 Importance of Literacy Literature is a creative and imaginative type of writing. It is a source of information that leads to the guiding principles of life. Having the knowledge to read literature attentively and understand it is extremely important. Literacy is not optional, it is necessary. Literature is not just reading a text but being able to reflect upon it. There are many different types and forms of literacy. Some come in forms of poems and others as dramas or films. Literacy expands towards many varieties.There are children literatures such as â€Å"Winnie the Pooh† and there are also more sacred types of literature such as the scripter’s or Holy Bible. Reading or watching literature gives a person a chance to experience different thoughts towards different situations, it opens a persons mind to imagination. Understanding literature is a sign of intelligence and knowledge. It is not always simple to understand and reflect on literacy. It is important to be open-minded when reading or watching literature.Philosopher Edmund Burke once said, â€Å"Reading without reflecting, is like eating without digesting. † For all means philosopher Burke is one hundred percent correct. The ability to reflect on what is being told shows intelligence, it shows that you have not only read word by word, but you have read the whole piece as one. There are many mistakes that are caused by illiterate people. A perfect example of this concept is the story of a man who was responsible for the death of his son.In the essay â€Å"Hunger in America†, written by Richard Mitchell, Bill Barnhart was charged for certain criminal acts towards his sons death. Barnhart used a passage from the bible for his defense in the case. He believed that in the bible God said that no one should use any medication whatsoever. His son was sick and Barnhart refused to treat his son. His misunderstanding of what was being said cost his sons life. Bei ng literate is extremely important. It can affect everyone around you. Learning literacy is a task that can take a while, but it is not impossible.Reading is extremely important; it is the basics in life. Sense everything requires reading words, the only thing that remains is the reflecting part. Reflecting what you have read shows that you have a clear understanding of what is being said. To be literate does not mean that a person has to read novels and books. It could be simply by reading the news paper, and article, or even a magazine or watching a film. As long as you take time to reflect on the information given and understand what is given, you can read whatever you wish to.Reading or watching literacy gives a person a chance to experience different thoughts towards different situations, it opens a persons mind to imagination. The understanding of literature brings many good things to us, either in science or entertainment. Everything that our world is built on has been based on literacy and continues to do so. Being literate is required to humankind, it is important that we all understand obstacles and situations in life. Literacy allows us to have an idea on how different people live their lives, and it also helps us to understand the purpose in our own life.

The Client Maintenance

AbstractThis examination is done to watch that how extraordinary factors impacts the client maintenance. In this paper the survey was utilized as the gathering instrument. The possibility of this examination was obviously advised to the respondents. The exploration was done on 300 respondents through which 170 filled polls were returned. We have utilized the co connection examination and the relapse investigation. Unwavering quality examination was likewise done. Pearson co connection examination was utilized to test the created speculation. Through the discoveries we come to realize that Customer reliability have constructive outcome on the client maintenance. With the assistance of this investigation the conclusion and the future suggestions are said. Part # 01 1.Introduction1.1 Background of themeClient maintenance in basic words is characterized as checking of the business that serves to measures how steadfast its clients are. Then again it is likewise characterized as keeping up the client towards their item (White and Yanamandram, 2004). Client maintenance is the principle objective for the organizations that aides in keeping up their business (Coviello , 2002).There are an expansive number of firms that are connected with the client maintenance . The organizations will undoubtedly anticipate the client maintenance to get the focused on result Kotler (2003). Client maintenance happens when the clients are completely happy with the administration gave by the inns (Grà ¸nhaug and Gilly,2001).On the other hand the clients are particularly faithful towards their image (lodging) and it brings about the client maintenance of that brand (Buttle, 2004). Every proprietor centers around the client maintenance to accomplish the greatest benefits and advantages (Dawkins and Reichheld, 2009). There are few examinations that clarify the impact of the diverse variables that impact the client maintenance in inns. This is especially simple for the clients to get disappointed with the offers administrations to them (Colgate and Lang, 2001; Colgate and Norris, 2001)1.2 Purpose Of The StudyThe Main and preeminent reason for this examination is to discover the impact of the diverse factors on the client maintenance.1.3 Research ObjectivesThe essential targets for this article are as per the following: †¢ To find the impacts of the distinctive factors on the client maintenance.1.4 Significance and extent of the investigationIn this examination the principle critical of this is client maintenance is the fundamental activity for any business for the most extreme yield. This examination is done to clarify the connection between benefit quality, client unwaveringness, condition, consumer loyalty and client maintenance. This examination will assist the entrepreneurs with working on these variables in light of the fact that these elements are the fundamental need of the each client. Furthermore, with the assistance of this investigation the entrepreneurs can succeed their lodging business. This examination is additionally helpful for other comparable associations who are confronting the issues in keeping up their clients.2. Writing Review2.2 Customer RetentionIn relatively every business there is a factor of client maintenance. The brands attempt their best for the client maintenance. Numerous analysts have been done to discover the elements behind the client maintenance ( Levesque and McDougall,1996, p.14). All the main organizations of the world will undoubtedly comprehend the significance of the client maintenance Omotayo l, (2008). The client maintenance centers around the conduct of the redundancy, and it is likewise considered as especially near the brand steadfastness and buy goal ((Hennig-ThurauandKlee,2007). (Jones and Farquher, 2003). In numerous investigates the consumer loyalty and the client maintenance is taken or learned in the meantime since they both have the relationship. Through Customer maintenance and the consumer loyalty we can get to the client's dependability and for this the client maintenance is contemplated profoundly. As indicated by Ennew and Binks (1996) there is a solid connection between the client maintenance and administration quality. Numerous specialists have likewise demonstrated the connection between the client maintenance and administration quality (Hennig-Thurau 1997) . Client maintenance is the fundamental factor for the key of accomplishment for any business. So every brand (inn) proprietor should center around the client maintenance.2.3 Service QualityAs indicated by Lenka et al. (2009) he characterizes the administration quality as ‘ it is the general examination of any administration gave by the organization, contrasting the execution of the firm of that administration with the general desires of the client. Who expect the administration (Ladhari, 2009) As per the examination of Jamal and Anastasiadou (2007) they guarantee that there are a few impacts of the administration quality on the client maintenance and the consumer loyalty. Administration quality is one of the primary factors that influence the client maintenance in the business. The brands ought to entirely center around the administration quality. Administration quality is particularly identified with the client maintenance. Numerous analysts demonstrated the positive effect of the administration quality on the client maintenance Cody and Hope (2009).In different words the administration quality is particularly important for any business uncommonly in lodging industry.2.4 Customer SatisfactionAs per Kotler(2000) Customer fulfillment on the opposite side it is additionally characterized as the it is the conduct of the client in the wake of buying the item . Consumer loyalty is characterized as † it is a term that is in the market that shows how items and administrations gave by the organization meets the desires of the client (Spreng, 2006). Then again consumer loyalty is likewise characterized as â€Å"the response of the clients in the wake of getting the administration as indicated by their desire and it brings about their inward fulfillment. It is additionally essential for the advertisers and the representative since it gives the way that they can use to enhance and upgrade their business. As per (Thai 2008) to the faithful clients winds up constant of their buying choice from a similar brand that outcomes in the consumer loyalty. At the point when there is the consumer loyalty subsequently additionally emerges the client maintenance that outcomes in the advantage for the lodging. The clients who buys consistently from a similar brand then they are very fulfilled from that brand (Lam , 2010).Customer fulfillment likewise brings about making the positive informal exchange for that business and it brings about the client maintenance (JonesandSuh,2000) . There are numerous specialists who center around the consumer loyalty to accomplish the consumer loyalty (Bontis 2007).2.5 Customer LoyaltyIn basic words (Lenkaet, 2009 characterized the client reliability as when the client ends up ongoing of any brand, benefit, store, item then the factor of client unwaveringness emerges. On other hand (Jacoby) additionally characterized client dedication as â€Å"it is the non arbitrary conduct or reaction of the client that has been appeared after some time for settling on any choice regarding in excess of one elective brand . But Oliver (2009) condemned this definition and he says that the client dependability is the blend of three human conduct and the conduct are comprehension ,influence and behavioral intention.When the level of rivalry emerges then the client reliability is enormously checked. In the event that other brand gives the substitute brand in great quality and less value the client will desert towards that brand ( Lenka., 2009). Client devotion is the positive consequence of the client's experience traits and the amount he is happy with the item. It might incorporate administration or an item. It is additionally characterized by the Jacoby that it is the aftereffect of regular purchasing of the client from a similar association. So client steadfastness is the principle factor of the client maintenance and it is particularly gainful for the monetary exercises of the business. Jacoby, and Chestnut, (1978)2.6 EnvironmentNature is characterized as † the area or region that comprise of living or non-living things (Morgan and Daryle, 2007).I terms of business it is additionally characterized as he territory which is particularly appropriate or agreeable for the client. Here the region is taken as far as business or association. In business terms the earth assumes the principle part for the client maintenance and for the workers also .When nature of the organization will be especially cordial and agreeable for the clients then the clients will pull in towards that business and it will brings about the clients and which is particularly useful for the organization's procuring and making the great picture in the market (Klee, 1997). So every association should center around the factor of condition to influence their clients to stay with their image.

How To Become a Straight-A Student Without Struggling Too Much

How To Become a Straight-A Student Without Struggling Too Much How to become a straight-A student? How to effectively manage time and succeed in studying without being chained to a library? A lot of students ask these questions. However, not many of them actually manage to not only find answers but also transfer knowledge from theory to practice. High grades open many doors and provide great opportunities. Getting straight As is all about hard work, discipline, and perseverance. But there are some lifehacks that will help you to improve your studying process on your way to higher grades. Check out the best tips on how to score high while studying and maintain your social life we gathered for you. Manage Your Time The most effective way to start getting higher scores is organizing your studying process. Scheduling your time may seem tough at first, but it will definitely pay off. The first thing you need to understand is that quality matters more than quantity. Thats why being focused while studying is the key to save time and get better results. Set up a rule to turn off your TV, phone and exclude any other distracting factors when studying. Seems too boring? Maybe. But you will notice, that time you spend on one assignment will be drastically reduced because of this simple but effective practice. The Pareto Principle Youve probably heard about â€Å"80/20† rule or the Pareto principle. It states that 80% of effects come from 20% of causes. How can you use this rule in your time management? Basically, keep focused and devoted while studying instead of distracting on entertainments. Studying without distractions for one hour equals 3 hours of studying with side activities. It will increase your productivity during studying time and help you reach better results while spending less time. Get Organized with Online Tools There are a bunch of online tools and applications for organizing your studying process in high school or college. For example, there are many apps which allow you to use online schedules and notes, folders, journals, and stickers. It seems like an unnecessary waste of money, but they actually help. Design your own sorting system that will be suitable and convenient to use. Keep all your lecture notes in one folder and all of your assignments in another folder. Keep track of the due dates and mark them in your calendar – digital or daily planner. This way, you will be able to see the amount of work and deadlines which will help you to manage your time. Check your planner every day and make notes if needed. Setting goals or mini tasks for a day and check daily accomplishments in the evening is also a powerful tactic. Tips from a real straight-A student: Dont forget to set reminders at your desktop for the most urgent tasks. This way, you can focus on the assignments with upcoming deadlines and effectively manage your time. Form a Group to Study Together One of the most typical study techniques is studying in a group. Facing difficulties while doing your homework is not a rare thing. Thats why its great to have someone who can explain you something you havent caught in class. Solving occurred troubles is much easier when you have someone to hold your back. Studying in a group is very helpful for unorganized students. It helps to: overcome laziness boost motivation get good grades get in the right mood for a study session Gather your classmates for doing homework together. You can meet at someones home or a cafà ©, online chat or video call. The best ideas usually reveal in discussions. Take into consideration: Studying in groups is not for anyone. You should try this method to make your own opinion about it. Some students feel their productivity decreases in a group, and its easier for them to focus when theyre alone. Find out if you are one of them. Dont Let Studying Stress You Out Many students face this common trouble – stress. It causes health problems and makes studying even harder. If you want to succeed and become the top of the class, its essential not to let stress manage your life. Coping with anxiety is not the easiest thing to do, especially during the end of semester and finals. Thats why we prepared some tips for reducing stress while studying or taking exams. Alternate Studying and Rest Common and still ignored advice is having an 8-hour sleep. Its crucial for your body and brain to have rest after a productive day and intense mental work. Many students prefer to party and sleep from 4 to 5 hours, which leads to poor productivity, reduced focus, and sleepiness. Moreover, it also leads to weakening of the immune system, and one feels sick all the time. This isnt the best way to become a top student, right? Have a good rest and let your brain rest too. The relaxation techniques you should try are: yoga and meditation massage listening to calming music aromatherapy As long as you keep your body healthy and your brain clear and sharp– you can succeed and focus on your studying. Stop Procrastinating Do you tend to postpone writing an essay or exam preparation? This makes things even it worse. Being in a rush because of upcoming deadlines causes much more stress and anxiety. Thats why keeping your assignments piling up is not the best decision. Solution: Try to complete one small task every day and break large assignments into small pieces and complete them one-by-one. You will see how profitable it is to understand that you have a lot of time ahead till your due date and half-done work already. Plan beforehand and track all of your incomplete tasks to make sure you dont miss any critical date or assignment. After you adopt these study habits, you will see that stress goes away. 3 Ps You might have heard about Cal Newport and his blog with brilliant tips for better studying. He successfully wrote book series about his career and student life, which you can deservedly add to your motivational books list. One of his brilliant tips is the 3 P approach which you should use when feeling like your brain took a vacation during quizzes and exams. It helps to keep away from anxiety and includes three steps: Planning Proceeding Proofreading Planning The first thing you do when you receive your tasks is flipping through them. Make a quick plan of answering order, starting with easier questions. Plan your time and make quick notes of the key points of your answers. Proceeding The next step is proceeding answering questions starting with the easiest ones. This way, you will reduce the pressure and manage your time wisely, leaving enough time to think on other subjects. It also helps to clear your head and find the right answer. Proofreading The last step is proofreading, and it takes about ten minutes. Correct any mistakes and attentively reread your answers. Wrapping Up Sleep well, manage your time and keep your head up. Dont forget that high grades are not the main thing in your life. Keeping a balance in your life is essential. Consider that knowledge you get is much more important than your grades. Dont sacrifice your social communication and health in order to get straight As.

Teaching Conversational Skills Tips and Strategies

Teaching Conversational Skills Tips and Strategies Teaching conversational skills can be challenging as not only English skills are required. English students who excel in conversation tend to be those with self-motivated, outgoing personalities. However, students who feel they lack this skill are often shy when it comes to conversation. In other words, personality traits that dominate in everyday life tend to appear in the classroom as well. As English teachers, its our job to help students improve their conversational skills, but often teaching is not really the answer. The Challenge Generally speaking, most English learners feel that they need more conversation practice. Grammar, writing and other skills are all very important, but, for most students, conversation is the most important. Unfortunately, teaching conversational skills is much more challenging than teaching grammar  as the focus is not on accuracy, but on production. When employing role-plays, debates, topic discussions, etc., some students are often timid in expressing their viewpoints. This seems due to a number of reasons: Students dont have an opinion on the subject.Students have an opinion but are worried about what the other students might say or think.Students have an opinion but dont feel they can say exactly what they mean.Students begin giving their opinion but want to state it in the same eloquent manner that they are capable of in their native language.Other, more actively participating students, feel confident in their opinions and express them eloquently making the less confident students more timid. Pragmatically, conversation lessons and exercises should first focus on building skills by eliminating some of the barriers that might be in the way of production. Here are some suggestions to help free up students in conversation. Point out that its not necessary to always speak the truth in class. In fact, not worrying about exactly what happened can help free up students.Create lesson plans that focus on functional skills such as asking for permission, disagreeing, etc. rather than open-ended lessons that students might find vague.Set micro-tasks such as the use of specific verbs, idioms, etc. within overall speaking tasks.  Use tasks such as information gathering or problem-solving activities that encourage students to communicate in English in order to complete the tasks. Here is a closer look at some of these ideas: Focus on Function   Its important to help students become familiar with language functions rather than focusing on a grammar-based approach when developing lessons to help with conversational skills. Start off simple with functions such as: Asking permission, stating an opinion, ordering food in a restaurant, etc.   Explore grammar issues by asking what linguistic formulas should be used to achieve the desired results. For example, if you are comparing two sides of an argument which forms might be helpful (comparative, superlative, would rather, etc). Use formulas to encourage correct usage such as: How / What about Verb Ing for making suggestions - How about taking a trip to San Diego?Would you mind Verb Ing for making requests -  Would you mind giving me a hand?Would you rather Verb or Verb  for asking for preferences -  Would you rather take the train or drive? Expand this approach slowly by asking students to create short role plays using cue cards. Once students become comfortable with target structures and representing differing points of view, classes can move onto more elaborated exercises such as debates and group decision-making activities.   Assign Points of View Ask students to take on a specific viewpoint. Sometimes, its a good idea to ask students to try to state opinions that they dont necessarily share. Having been assigned roles, opinions, and points of view that they do not necessarily share, students are freed from having to express their own opinions. Therefore, they can focus on expressing themselves well in English. In this way, students tend to concentrate more on production skills, and less on factual content. They also are less likely to insist on literal translations from their mother tongue. This approach bears fruit especially when debating opposing points of view. By representing opposing points of view, students imaginations are activated by trying to focus on all the various points that an  opposing  stand on any given issue may take. As students inherently do not agree with the view they represent, they are freed from having to invest emotionally in the statements  they make. More importantly, from a pragmatic point of view, students tend to focus more on correct function and structure when they do not become too emotionally involved in what they are saying. Of course, this is not to say that students should not express their own opinions. After all, when students go out into the real world they will want to say what they mean. However, taking out the personal investment factor can help students first become more confident in using English. Once this confidence is gained, students - especially timid students - will be more self-assured when expressing their own points of view. Focus on Tasks Focusing on tasks is quite similar to focusing on function. In this case, students are given specific tasks they must complete in order to do well. Here are some suggestions on tasks that can help students practice their conversational skills: Create student surveys to gather information.Teamwork activities such as treasure hunts.Board games.Build something - group activities such as a science project or presentations allow everyone to join in the fun. Quick Review Decide whether the following statements are true or false. Its a good idea to have students report their experiences truthfully and in great detail.General conversational activities are best for more advanced students while beginner should focus on functions.Assigning a point of view helps students focus on linguistic accuracy rather than stating exactly what they believe.Problem-solving teamwork  tasks should be avoided as they are not realistic.Outgoing students tend to be better at conversational skills. Answers False - Students shouldnt have to worry about telling the exact truth because they might not have the vocabulary.True - Advanced students have the linguistic skills to deal with broader issues.True - Assigning a point of view can help free up students to focus on form rather than on content.  False - Problem solving requires teamwork and conversational ability.True - Motivated outgoing students tend to allow themselves to make mistakes and thus speak more freely.

WRITING FOR THE WEDDING MARKET

WRITING FOR THE WEDDING MARKET The wedding industry is big business – with the average US wedding costing more than $25,000. Most couples turn to wedding magazines to help them navigate the taffeta and lace, seating plans and relatives. If you love everything wedding – the clothes, the flowers, and the romance – you could make money as a wedding writer. Breaking In to the Wedding Market The wedding market is extremely popular among freelancers, and the larger glossy magazines only come out a few times a year.   A great way to begin as a wedding writer is to pitch wedding articles to magazines outside the wedding industry. Regional magazines produce wedding content focusing on local suppliers, and service industry trade magazines are interested in wedding related articles. Some wedding and business blogs even pay for articles. Once youve built up a selection of clips, youll have more success pitching the glossy magazines. Another way to break in is to pitch an article focusing on a topic you already specialize in. For example, if youre a financial writer, you could write about wedding budgets. If you write in the technology niche you could review wedding planning Apps. Travel writers can submit pitches on honeymoon destinations. Because wedding magazines are all about visual inspiration, if you can demonstrate photo sources in your pitch, the editor will be more likely to consider your submission. Expertise in the wedding industry – such as being a cake designer or a wedding planner – will make your pitch stand out. Read the different magazines carefully, and pitch articles aimed at their specific bridal market. Some magazines dont want articles on budget or gay weddings, while others only want weddings and vendors from a certain region. Wedding Article Topics Since wedding magazines have a new set of readers every year (women start reading magazines once theyre engaged and tend to move on after theyve been married) theres a certain amount of repetition among topics. But the editors are always looking for new concepts and trendy ideas. For example, an article on wedding cakes might focus on choosing wedding cupcakes, since these are extremely popular right now. You can become a specialist in certain wedding topics – such as beach weddings, wedding dà ©cor or eco-friendly weddings, and tailor your pitches to suit. Im a certified wedding celebrant, with a specialty in weird, alternative weddings, and theres certainly not many other writers covering that! Your Wedding File One of my tricks is to keep a folder of contact details for interesting wedding-related businesses and experts I can approach for sources.   I also keep an eye on wedding blogs, as trends appear on blogs before they reach the magazines. Adding a few of your favorite wedding blogs to your RSS Reader is a great way of keeping up-to-date with the industry. My favorite wedding blogs are: Offbeat Bride http://offbeatbride.com A Practical Wedding http://apracticalwedding.com Rock n Roll Bride http://rocknrollbride.com Alice in Weddingland aliceinweddingland.co.uk Weddings are beautiful, fun-filled events, and writing about them injects a little sparkle and romance into the solitary writing life. Wedding magazines can be a tough market to crack, but a little creative pitching and a lot of enthusiasm for the industry will soon land you assignments. Wedding Markets Flower MagA trade magazine for floral designers, including an extensive wedding section. Pays professional rates. flowermag.com/contact/ Bride and GroomRegional wedding magazines accepting features, service articles and honeymoon profiles. Pays between .50 and $1 per word. http://originalweddingexpo.com/writeforus.html BustFun, contemporary womens magazine that often runs wedding material. Pays between $50-500 depending on department. http://bust.com/info/submit-to-bust.html Somerset WeddingSimple and elegant wedding craft ideas. Pays professional rates. stampington.com/submissions/index.html

The Leadership Role in Management Research Paper

The Leadership Role in Management - Research Paper Example Managers are those individuals who are in charge of the company. Their responsibility is to be the individual that monitors the progress of people who work under them and who take care of payroll and budgeting matters. Leaders are those individuals who are hired into the company to make change (57). Leaders are the change agents who are hired to see an organizations big picture. "Management is a function that must be exercised in any business, leadership is a relationship between leader and led that can energize an organization" (57). Another way of comparing leaders and managers is portrayed in this chart: A great leader has certain qualities that are apparent and that managers may not have available to them. Marcus Buckingham and Coffman suggest that focus is what makes a difference between the manager and the leader. The managers focus is on the inside of the company and how each part of the company works together. A good manager will notice the differences in style, goals and needs of their individual employers. Leaders look at outward and they are most concerned with the competition, the big picture for the company, broader patterns and see where and when they can get the advantage over their competition (63). The challenge for most companies is that they cannot understand the differences in these roles so they expect managers to be leaders and leaders to be managers. Instead, they need both types of people to move their companies forward. Marcus Buckingham states that "leadership requires certain natural talents" (33). He said that because of this a manager cannot be a leader unless they have these natural talents. When a manager is a leader the company must understand their intense focus. There are hundreds of websites that will tell the qualities that make great leaders. The challenge is that everyone has a different idea as to what qualities an individual should have to lead their team. Today it is imperative to know

Effects of Alcohol on the Body Essay Example | Topics and Well Written Essays - 250 words

Effects of Alcohol on the Body - Essay Example ut the adverse effects of alcohol, my desire to speak to you about your alcohol consumption has risen, especially so that I am very much aware of your symptoms. I have learned that alcohol is an irritant which explains the burning sensation as it goes down (Kinney, 2011). However, that is not the only thing that happens as you consume more and more alcohol. Imagine what happens to your skin if you scratch it a number of times. It gets irritated and turns red. If you continue scratching it, it could either inflame or bleed. Similarly, alcohol destroys the lining of the stomach and small intestines, making patients suffer stomach pains which I know you have been complaining about for months now. However, what makes me more concerned is not only your symptom but also my suspicion that what you are suffering from is not simply inflammation but perhaps an open sore in your stomach’s lining. I strongly suggest that you see your doctor very soon before your condition gets

Annotated Bibliography (fashion) Example | Topics and Well Written Essays - 500 words

(fashion) - Annotated Bibliography Example The agency downplays her death and denies that the model had an eating disorder. This article from the New York Times reports that many high school age boys that take steroids do it to enhance their body image to attract girls. It states that many are not involved in athletics at all. This is important because it removes the factor of the athlete using them to enhance a career. This article is evidence that it is being done by teenagers for vanity purposes only. The author also lists the high potential for a number of serious side effects. This article will compliment the Kroichick and Stephens article on the same topic. Kroichick, Ron, and Mitch Stephens. "More High School Athletes Risking Steroid Use." San Francisco Chronicle 2 Nov. 2003. 19 Mar. 2007 . This article covers the number of high school students who are estimated to be taking steroids. It quotes the leading authority on steroid use in teens. It will tie in with the Egan article to show the escalating numbers of teens who take body enhancement drugs. The Nowak article is a source for the number of people who seek plastic surgery. It breaks down the numbers by types of surgery. It also reports on the percentage of patients who suffer from a mental disorder. This will connect with the article in the American Journal of Epidemiology that reports high suicide rates among plastic surgery patients.

Reduction of Aggression Essay Example | Topics and Well Written Essays - 750 words

Reduction of Aggression - Essay Example Socio-cultural perspective believes that bullying is due to the presence of specific social groups with different levels of power. Instrumental theorists take aggression as serving a useful function for the individual aggressive behavior to gain some kind of pay-off which makes it worth the risk. Aggression occurs not for the pleasure of lashing out but for the purpose of achieving some benefit (Campbell, 1997). Sep. 11th attacks were examples of instrumental aggression. They wanted to send a message to US. Study shows that children showing reactive aggression were characterized by higher self-control, especially constructiveness, at each age and better adult adjustment (Pulkkinen, 1995). There exist popular and unpopular subtypes of aggressive children who have different peer affiliation patterns (Farmer et al. 2002). Thus there are two social worlds of aggression in school: aggressive children who are marginalized by society and children who are well influenced in the social structure. This view is supported by studies showing that some children who are perceived as popular in social network use physical or social form of aggression to promote and keep their influence and position in the social hierarchy while other aggressive students are picked-on and victimized by seniors (Adler &Adler 1998; Caims & Cairns, 2005). Hence one can conclude that that aggression is part of the general social dynamics in classrooms. Aggression Prevention Methods Many techniques and procedures can be used to prevent or avoid aggression. Some of them are discussed below. The threat of mild punishment might help to reduce aggression. Mild punishment and education when applied in pair has helped to reduce the bullying behavior in students. Anger management is another effective technique. Stress management training approach (Beck and Fernandz, 1996) to anger management, as given below, is an effective three phase process Phase 1 Identification of factors triggering anger Rehearsal of self statement intended to prevent anger (I can handle this). Phase 2 Acquisition of relaxation techniques Coupling self statements with relaxation techniques after exposure to anger trigger. Phase 3 Rehearsal phase Practicing cognitive and relaxation techniques until mental and physical response can be achieved automatically. Making Choices: a Social Development Program This empirically based intervention targets third grade children who are live in a high-risk rural community that is experiencing rapid growth and changing racial and ethnic demographics.( Fraser, n.d.) Works Cited 1. Anne Campbell (1997) Altruism and Aggression Blackwell publishing 2. Barbara Krahe. The social psychology of aggression 3. Ken Rigby (2003) No. 259 Addressing bullying in schools: theory and practice. Australian institute of criminology trends and issues in crime and criminal justice. 4. Kenneth S.Bordens, Irwin A. Horowitz, Social Psychology.

Information Systems Essay Example | Topics and Well Written Essays - 1000 words

Information Systems - Essay Example The payroll information system will have information on the name, monthly salaries and hourly rates of employees. Hourly rates will also be required to facilitate the payment of overtime wages. Additional information such as location, department, employee identification number, and the date of employment would also be added to the system. This system would be updated with information received from the human resources department relating to recruitment of staff at Recruit 4 U three locations as well as separation of staff due to retirement, resignation, redundancies and involuntary termination. The payroll system would be set up to calculate taxes for each employee and would be paid over to the government on their behalf. At the end of each pay period the necessary information would be collected from various locations and this along with the information from head office will be used to run the payroll. Pay slips will be generated for each employee, indicating their gross pay, deductio ns – statutory and otherwise, and their net pay at the end of each pay period. Cheques consisting of the net pay would either be drawn for each employee or sent to their respective bank accounts if feasible. Additionally, a cheque would be drawn for the government in relation to total tax deducted from the employees pay for the period. The relevant entry from this module of the accounting information system would be used to make an entry into the financial accounts of Recruit 4 U.

Analysis of Direct Cost Assignment Example | Topics and Well Written Essays - 750 words

Analysis of Direct Cost - Assignment Example This provision is both advantageous and disadvantageous in that the VectorCal Company will readily acquire iron and steel hence evading searching and high transportation costs. On the other hand, it will be harmful to the company if the steel and iron producing companies in the US decide to charge high prices of their products due to the absence of open markets to trigger competition, which will eventually lead to lower competitive prices in the industry. The other raw materials needed include magnets, cameras, sensors, and compasses that will provide information on nearby vessels or vehicles or other obstacles or hazards. Labor costs incurred will include payments to the engineers and experts involved in the construction of the drone navigation systems. Technological costs will include acquisition costs of inertial sensors, on-board electronics (the motherboard and the navigation board), embedded software (enables Wi-Fi communications, image processing, video data sampling etc.), velocity estimators etc. The technological component ensures efficiency and reliability of the drone navigation systems. Licensing fees of VectorCal Company will form part of the indirect costs. Other indirect costs likely to be incurred by the company include management costs, insurance payments, taxes to the US government, maintenance expenses etc. (Lupashin et al., 2010). DroneIn, company will operate in the same industry as that of VectorCal Company and hence will experience similar costs to those of VectorCal. The construction of the drone navigation systems is standard and this implies that the requirements are similar regardless of the company that constructs the drone systems. However, the only notable difference that will occur will be in terms of how each company will control its costs of production or manufacturing. For both companies, raw materials like iron and steel will be necessary because these are the core metals that are used in the construction

Information Systems Essay Example | Topics and Well Written Essays - 1000 words

Information Systems - Essay Example The payroll information system will have information on the name, monthly salaries and hourly rates of employees. Hourly rates will also be required to facilitate the payment of overtime wages. Additional information such as location, department, employee identification number, and the date of employment would also be added to the system. This system would be updated with information received from the human resources department relating to recruitment of staff at Recruit 4 U three locations as well as separation of staff due to retirement, resignation, redundancies and involuntary termination. The payroll system would be set up to calculate taxes for each employee and would be paid over to the government on their behalf. At the end of each pay period the necessary information would be collected from various locations and this along with the information from head office will be used to run the payroll. Pay slips will be generated for each employee, indicating their gross pay, deductio ns – statutory and otherwise, and their net pay at the end of each pay period. Cheques consisting of the net pay would either be drawn for each employee or sent to their respective bank accounts if feasible. Additionally, a cheque would be drawn for the government in relation to total tax deducted from the employees pay for the period. The relevant entry from this module of the accounting information system would be used to make an entry into the financial accounts of Recruit 4 U.

Reseach Workoholics Essay Example for Free

Reseach Workoholics Essay Is a 40-hour work week too much? Should there be a mandatory cap on the number of hours a person can work? Should there be changes in employment laws to give Americans more relaxation time? A workaholic definition is a noun a person who compulsively works hard and long hours. But the definition in a workaholics eyes is a person who â€Å"values work over any other activity, according to careercast.com. Merriam-webster.com says its a compulsive worker (Productivity) The reasons for someone to become a workaholic are some people dont feel their lives are fulfilled unless theyre engaged in constructive activities. The more they work, the happier they are. Its addictive. Where in the world can they be productive and reap the rewards of their labor but at their job? Workaholics cant be idle. They need to be constantly working. Proving their value Children who were raised in dysfunctional families, or by perfectionist parents, and were made to feel like their best was never good enough can grow up to be workaholics. Spending their adult lives immersed in their work is a way for them to constantly prove themselves and their worth. Escaping problems and negative feelings another reason why people become workaholics is because they lack a sense of control in their lives. They have problems at home they cant fix, or they dont want to deal with, for example. Being at work all the time allows them to escape painful, negative feelings. It also gives them a sense of control they cant find otherwise. Adrenaline rush working non-stop provides an adrenaline rush to some people. Being extremely busy, rushing to meet unrealistic goals, and pushing themselves beyond their limits gives them that intense feeling they crave. That same adrenaline rush- the increased heart rate, the burst of energy, the heightening of their senses- comes from roller coaster rides and other thrilling activities. In 1965, a U.S. Senate subcommittee predicted that as a result of increasing labor productivity from automation and â€Å"cybernation† in other words, the computer revolution. Americans would be working only about 20 hours a week by the year 2000, while taking seven weeks or more of vacation a year. By the mid-1970s, and especially after 1980, median wages weren’t keeping pace with increases in our capacity to produce. But flattening incomes didn’t derail the consumption train. Americans continued to buy more, in part by going deeper into debt, by having more members of the family enter the workforce and by working additional overtime. By the boom times of the late 1990s, Americans worked more than the notoriously workaholic Japanese. To answer the question of limiting the number of hours you can work I think we would have a happier and healthier society if we worked a little less. As of right now, some jobs require a lot of time and energy. Legalizing mandating the number of hours worked is an interesting idea. It would see a drop in stress levels, more family time and participation and healthier workers. This probably wouldnt make too many people happy at first, though, and it would take some getting used to. It is a way to raise healthier families and having less levels of stress that are exhibited in really tough jobs, like ER doctors and nurses, and other highly stressful occupations. American work-life balance according to the Center for American Progress on the topic of work and family life balance, â€Å"in 1960, only 20 percent of mothers worked. Today, 70 percent of American children live in households where all adults are employed.† I don’t care who stays home and who works in terms of gender (work opportunity equality for all – it’s a family choice). Either way, when all adults are working (single or with a partner), that’s a huge hit to the American family and free-time in the American household. The U.S. is the ONLY country in the Americas without a national paid parental leave benefit. The average is over 12 weeks of paid leave anywhere other than Europe and over 20 weeks in Europe. Zero industrialized nations are without a mandatory option for new parents to take parental leave. That is, except for the United States. Lets say someone make $60k/year. Excluding benefits, employee taxes, etc., lets consider this equivalent to $30/hour. ($30/hour x 40 hours x 50 weeks = $60k). Now they want to figure out the hourly number that he/she use to decide if its worth it to do something. For example, if he/she owe a fine on something he/she dont think they should owe, but its only a $5 fine, its not worth spending an hour ($30) to contest it. BUT, its not clear to me if he/she should use $30/hour for this number, because Im only working 8 hours/day. Like, if someone is willing to pay me for 40 hours/week at $30/hour, presumably he/she could get one or two more such jobs. Or should she/he divide that by 3 to get $10/hour because really for every 24 hours, they’re only able to earn $30/hour for a third of them? Because some of these activities he/she would be doing in my off-hours (e.g., theyd have to dispute that fine after work). Or is it something in between?

Self-management of patients with continuing care needs

Self-management of patients with continuing care needs In essence, patient self-management in relation to their health, encompasses a patients ability to handle an illness experience, to cope with undergoing treatment or make suitable lifestyle changes (Mulligan 2009). The concept was introduced to the health field by Kate Lorig who reached conclusions patients health and subsequently health service costs connected to them being an inpatient can be reduced by encouraging self-management (Lorig 2001). These ideas are utilized in the generic long-term conditions model which emphasizes patients are not happy to be in hospital unless it is completely essential (DOH 2010), (Appendix 1). Effective self-management is also widely thought to reduce the likelihood of hospital admission, and many argue patients prefer to be given access to the information necessary to facilitate a respected voice in decision making processes (Gibson et al 2004, Newman et al 2004). Linked to self-management is also the concept of self care described as a requirement for success in controlling many chronic illnesses including diabetes (Berg 2007), and asthma (Cortes 2004). Self care is also described holistically as essential to the well-being of those with chronic illnesses with continuing care needs in nursing homes (Bickerstaff et al 2003), in the community, (Sharkey 2005), in hospital, intermediate, or rehabilitative settings (Singleton 2000, Coleman 2004). Conversely, low self-esteem, low health literacy, and/or deprivation are barriers to utilization of self-management strategies (Williams et al 2011). Those most likely to participate in self-management are young, middle-class females (Coben 2005). Whilst those lacking literacy skills may not manage as well and family care-giving actions differ between ethnic and socio-economic groups (Larsen 2009). People who suffer a disproportionally high prevalence rate for chronic conditions are those with learning disabilities (Presho 2009) and ability to comprehend and enact management regimes might affect the efficacy of education initiatives with this population. The Expert Patient Program, a 6 week, lay-led course teaching self-care, is a prominent initiative expected to be more cost effective than usual care (NSF 2010, Richardson 2007). Although the EPPs effectiveness to enable improvements in patients self management ability regarding physical symptoms has been disputed (Gately 2007). Perhaps this is due to complex combinations of assorted medications, lifestyle adaptations, and bothersome side effects which are implicated as adversely affecting patients perseverance with management plans (Barlow 2002, Touchette 2008). GP business care plans developed in the UK propose introducing courses using self-management handbooks could reduce expenditure on asthma management (Appendix 4). Yet Cortes argues such asthma education programs neglect specific needs of older people identified as price of medication, problems undertaking management plans, poor quality of life, and troubles accessing health care (Cortes 2004). These opinions contradict the development of Lorigs ideas that self-management enables the best quality of life, but since healthcare information has the greatest effects on outcomes when it is goal orientated (Bodenheimer 2002, Barlow 2002, Kralik et al 2004), maybe older peoples self management goals need more attention. Concurrent with increased longevity and lifestyle factors like poor diet, obesity and related chronic disease is predicted to increase greatly in prevalence (Wang 2010, Mulligan 2009, Armstrong 2005, and Keen 2010). Diabetes has well recognized links between weight and illness progression (Patel 2003), and has also recently been blamed for advancing cognitive deterioration through vascular dementia (Luchsinger 2001). Therefore tightening diabetes control in early stages may vastly improve future health as illness limits mobility, and dementia/retinopathy hamper potential to access self-care resources (Sinclair 2000). Notably due to widespread sensitivity over weight, healthcare professionals should be non-judgmental towards patients with chronic conditions, especially considering psychological and psychosocial implications connected to adjustment to an illness, including guilt, fear, stigma, confidence loss, and isolation (Presho 2008). It was observed during a TIDE (Type 1 Diabetes Education) diabetes specialist nurse led session that those with busy manual working lives find it difficult to take time to self-manage by adjusting insulin to activity levels or establishing a routine of carbohydrate counting and insulin adjustment. Others find calculations following the DAFNE (Dose Adjustment for Normal Eating) structure, hard to understand. Several patients who had suffered previous traumatic hypoglycemic episodes felt anxious about reducing insulin intake, and reported differences in advice from GPs, and nurses as well as confusion over new insulin analogues and devices. This indicates understanding patients as unique individuals, timing and convenience of interventions are important. Furthermore providing clear, consistent advice appeared allied to development of positive attitudes towards nurses education interventions. Studies suggest structured education in type 1 diabetes has improved patients maintenance of glucose targets and a reduction in occurrences of hypoglycemia changed peoples attitudes to education (Heller 2009). Also those with greater understanding of and confidence in adjusting insulin appropriate to activity, with less anxiety over following a fixed regime to avoid hypoglycemia achieve top self-management in type 1 diabetes (Whitehead 2008). On a stroke rehabilitation unit, patients with multiple conditions, particularly diabetes, asthma, and Parkinsons had restricted motor function. Yet nurses could provide encouragement for patients to express concerns, to relieve some psychological distress or help empower patients with the required self-confidence to make decisions (Costello 2009). Patients expressed difficulty with waiting for physios to engage in movement improving circulation, but self-administered some medication and carers views and choices underpinned care planning as recommended in Essence of Care benchmarks, via regular carers group meetings (DOH 2010). Chronic disease is the leading cause of death worldwide (Larsen 2005) and literature establishes dependent peoples needs are equality, rehabilitation, and independence. Furthermore security and dignity are important to older peoples mental health (Presho 2008). On a local scale Manchesters operational plan illustrates emergency admissions for asthma is greatest in the North East and prevention is being addressed with annual health checks provision improving recently. Whilst the national continuing care framework commenced in 2007 promises to ensure national equity of access to NHS funding for continuing care (NHS 2010). Significantly Our Health and Wellbeing Today (DOH 2010) suggests national morbidity is greatest from circulatory disease, which is particularly high in lower socioeconomic groups. These groups also have the greatest prevalence of anxiety and depression and have increased likelihood of having chronic conditions such as diabetes, which has led enquiring researchers to suggest depression as a factor that precipitates and perpetuates chronic conditions (Chapman 2005). Socioeconomics is also reported to determine medication adherence in asthmatics (Kaptain 2009). Victim blame might occur if expectations patients follow structured management programs ignore social contexts of illnesses, (Lindsay 2009) so emphasis should be on developing realistic goals. The kings fund review of self-management highlights that patients perceptions of self management differ according to how they receive a diagnosis, and these attitudes can change over time. Differentiation was noted between diagnosis of asthma or diabetes, where it was felt greater clarity existed, than of Parkinsons disease for which diagnosis takes longer (Coben 2005). Disclosing a medical condition could also have implications for patients quality of life, and a study of anecdotes from Parkinsons patients demonstrated those with confidence to disclose their illness subsequently achieved greater measured anxiety reduction (Presho 2008). Notably research shows patients fret significantly about psychological consequences of physical disability (Miller 2006). Concealment could be due to perceived stigma and misconceptions about the disease or depression about associated decline, physical disability and being a burden (Moore Knowles 2006). Alternatively challenges of symptom management such as sleeping problems and fatigue, sexual dysfunction and cognitive impairment might lead to depression (Schrag, Jahanshahi, Quinn, 2001; Schreurs, De Ridder, Bensing, 2000). Similarly emotional responses to asthma can impact upon attitudes towards taking prevention medication which enables control, and alongside non-adherence patient stress increases leading to depression, anxiety or inability to cope (Kaptain 2009). Interventions aimed at managing pre-diabetes and mild asthma, that miss-managed, could contribute to the development of diabetes mellitus and chronic airway disease (Murphy 2007), are well developed and promoted by the charities Diabetes and Asthma UK (Appendix 3). It is especially important to promote good control since poor control negatively impacts on the affected persons quality of life and also their families (NICE 2008). Also individuals reportedly favor self-management because controlling their health affords greater sense of autonomy (Corben 2005). The EPP has incentives of providing greater knowledge about treatment decisions with the underlying expectancy patients have authentic understanding of their own conditions, and greater recognition of patients roles should give them self-confidence to protect future health (DOH 2001). Illness progression might be reduced by lifestyle changes, therefore nurses have a role in promoting patients independence, well-being, and in encouraging active ageing (NMC 2009). In 2005 the Kings fund report highlighted that major challenges to promoting self management were; developing professionals supportive skills, improving services and information available to facilitate patients self-management, and becoming more flexible to fit compatibly around patients other commitments (Rosen 2005). Dorothea Orem created a comprehensive model of nursing which can be applied to individuals to assess level of self-care ability (Appendix 2). Orem conceptualizes nursing as doing for a disabled person with a self-care deficit, or assisting them/family to do for their selves (Orem 2003). Further to this Orem formulated three systems of nursing to apply, of which partially compensatory nursing seems appropriate for stroke patients, whilst a supportive-educative role suits structured education sessions (i.e. TIDE). The effects of an education intervention delivering the DESMOND program (Appendix 5) for patients with type 2 diabetes to newly diagnosed patients over a period of 6 hours measuring cost effectiveness and quality adjusted years are reported by a randomized trial to have positive effects particularly on reducing patients weight and the amount they smoke (Gillett 2010). Issues of self-efficacy and self-management prominent features of the DESMOND that have been found to build patients confidence (Davies 2008, Skinner 2006) are key to developing a sense of well being in rehabilitation (Presho 2008). Nevertheless, concerns nurses might have include doubts about the patients being experts after what is actually a relatively short training period (Lindsay 2009). Moreover, there could be internal conflicts for nurses between applying structural protocols (i.e.) or professional ethics, and accepting a patients wish to continue a harmful behavior or health neglect. Farrell argued in 2004, active teaching on conditions and problem-solving to address medical issues better promotes self-efficacy than passivity (Farrell 2004). Yet it is important patients are equipped with enough knowledge to act as concordant partners and are supported with taking medications (Murphy 2007) (Appendix 7). Involving relatives in demonstrations of using metered dose inhalers is helpful with dependent asthmatic elders because direct patient observation by nurses supervising medication is often impossible once they have returned from hospital, (Schlenk 2004). Ability to encourage self-management requires nurses to listen, and respond to the concerns and preferences of people in their care (NMC Code), as well as sharing in a way people can understand, the information they want or need to know about their health (NMC code). This may include providing written supplementation to verbal information such as education leaflets or management diaries, and allowing adequate time for adjustment and decision making. Patients whose physical function has deteriorated significantly and continues to decline may be in a too highly dependent illness phase to benefit from strategies to return to normal function (Larsen 2009). Cochrane authors conclude evidence showing contracts improve patient adherence to health-promotion in adult asthma studies is limited (Bosch-Capblanch et al 2007), which suggests patients intentions when agreeing to follow advice is unreliable for predicting management outcomes. Patient self-reports are a simpler method of gleaning non-adherence information, are inexpensive, and possible in most settings (Schlenk 2004 cited by Ruppar 2008). Research observes patients with Parkinsons disease using Alexander Technique had a reduction in depression and improved capacity to manage their disability (Clark 2003). The essence of care is about getting to know and value people as individuals, (NMC Guidance for the care of Older People 2009) and nurses can recognize and respect peoples role in their own care. Evidence also suggests motivational interviewing can reduce depressive attitudes towards illness situations and to encourage positive action to improve health outcomes, therefore perhaps GPs and practice nurses should increase these services (Home and Carr 2009). Nurses can arrange social workers to speak to the patient, to engage with their family, find out their needs, compile appropriate packages of care and request doctors provide explanations of the mechanisms causing a stroke in dedicated wards which usually provide speech and language therapy, occupational, and physiotherapy. Dedicated stroke wards are shown by studies to improve outcomes after two years of patients who were independent prior to their stroke vis-à  -vis ADLs without lengthening stay (Glader 2001 and Cochrane Stroke Unit Trialists Collaboration 2007). It can be a stressful time for patients and family having to make continuing care decisions; therefore patients might seek support from others who have been in their situation (Help the Aged 2009). Gathering information allows patients to manage their illness alongside doctors, and sharing plans with friends and family, explaining their importance, can help them to follow them, there are purportedly around 6 million carers in the UK combining caring with paid employment, saving  £57 billion a year in care costs (Campling 2006, Costello 2009). Not every patient has supportive family members so professionals and expert patients, and charities can be significant. Especially interventions tailored to marginalized patients needs such as X-PERT education for type 2 diabetics undertaken in Urdu (Diabetes UK 2009). In critical phases of illness, which may be the point where a patients continuing care needs begin, patients relatives main needs are for information, support and proximity (Henneman 2002). In the case of Parkinsons disease conveying to patients families the hope that there are strategies for managing the condition, particularly in early stages, might reduce fear, negative impact and sense of stigma (Moore Knowles 2006). Managing pain and discomfort is often considered a challenging aspect of caring, and psychological aspects also cause pain. Total illness effects make it important for patients to have supportive family members to listen to them to find out potential causes/remedies (Costello 2009). Practitioners should be sensitive to needs of carers as well as patients, and evidence suggests nurse-led stroke carer sessions, responding to individuals concerns would be helpful (Smith 2004). A study using the stress and coping model (Lazarus and Folkman) to identify a relationship between sleep deprivation and depression in family care-givers found that individuals self-reports underestimated their problems (Carter 2003). People may feel that because they know their relative they are capable of best comprehending and providing for them, and this could lead to guilt about accepting assistance with care (Nolan 2000). Research into respite care suggests family carers expressed needs for information, skills training or education and emotional support (Hanson 2001). To decrease feelings of powerlessness and support independence for those with chronic conditions Larsen proposes five interventions to recommend to carers (Appendix 6) (Larsen 2009). Peak-flow monitoring, allergen avoidance, and the Buteyko method of symptoms control for mild asthma, based on correctly dosing steroids to maintain safe asthma control are found to be effective (McKeown 2003), as are diet, exercise, supplements and anti-diabetic medication as preventative strategies for type 2 diabetes, reducing heart attacks, microvascular disease, and death (Patel 2003). Though some studies suggest effectiveness reduces 1-3 months post intervention (Siminerio 2007). Subsequently insight into self-management adherence remains complex and under-researched, but supports identifying barriers to adherence and taking action to remove these (Touchette 2008). In liberating the NHS the symbiosis of adult social care, carers, and the NHS is recognized and promises are made to improve the convenience of services to patients (DOH 2010). To reiterate, according to the UK governments policy overall evidence suggests self-care results in beneficial outcomes and better service utilization, but this is largely based on primary studies as systematic reviews are reportedly too time consuming (DOH 2005-7). Systematic reviews also indicate clinical benefits for diabetic and hypertensive patients (Jordon and Osborne 2007). Although psychological benefits to patients appear widely well recognized (Lindsay 2009), patient self-determination requires more than medical management, (Greenhalgh 2009). Contrary to commissioners intentions studies show attendance at health services does not necessarily decrease following education sessions, although this may not indicate poor management as it could reflect success of techniques teaching patients confidence to converse with clinicians (Griffiths 2007). Since GPs are also accused of stalling EPP progress, dubious about its efficacy and under referring patients (Jordon Osborne 2007) it follows that nurses might take a key role in involving patients. The basis behind the EPP being best practice are aims to increase patient beliefs in health services efficacy, personal confidence, and ability to self manage (DOH 2010), therefore nurses are following policy implementing programs RCTs suggest achieve these outcomes (DOH 2005-7). Finally research highlights the importance of having clearer, comprehensive, shared definitions of self-management between health disciplines to reduce patient confusion and so professionals collaborate better (Godfrey 2011). References Armstrong, D. (2005) Chronic Illness: Epidemiological or social explosion, Chronic Illness, 1: 26-7 Barlow, J. H., Sturt, J., and Henshaw, H. (2002) Self-management interventions for people with chronic conditions in primary care: arthritis, asthma diabetes: Health Education Journal; Vol 61, issue 4, p 365-78 Barlow, J., Wright, C., Sheasby, J., Turner, A. and Hainsworth, J. (2002) Self-management approaches for people with chronic conditions: a review, Patient Education and Counseling, Vol 48, p 177-87 Berg, G.D., Wadhwa, S. (2007) Health Services outcomes for diabetes disease management program for the elderly: Disease Management; Volume 10, p 226-234 Bickerstaff, K. A., Grasser, C. M., McCabe, B. (2003) How elderly nursing home residents transcend losses of later life: Holistic Nursing Practice; Vol 17; Issue 3, p 159-165 Bodenheimer, T., Lorig, K., Holman, H., Grumbach, K. (2002) Patient Self-management of Chronic Disease in Primary Care: The Journal of the American Medical Association; Vol 288, Issue 19, p 2469-2475 Bosch Capblanch X, Abba K, Prictor M, Garner P (2007) Contracts between patients and healthcare practitioners for improving patients adherence to treatment, prevention and health promotion activities. Cochrane Database of Systematic Reviews (2): Art. No.: CD004808 BTS/SIGN (2008) British Guideline on the Management of Asthma: British Thoracic Society (21.02.11) http://www.britthoracic.org.uk/Portals/0/Clinical%20Information/Asthma/Guidelines/sign101%20revised%20June%2009.pdf Carter, P. (2003) Family Caregivers Sleep Loss and Depression Over Time: Cancer Nursing; Volume 26 Issue 4 p 253-259 Campling, F., and Sharpe, M. (2006) Living with a long-term illness: Oxford University Press Chapman, D. P., Perry, G. S, Strine, T. A., (2005) The Vital Link Between Chronic Disease Depressive Disorders: Preventing Chronic Disease, Public Health research, practice and policy; Volume 2, No 1 Clark, Chambers, C. (2003) Parkinsons disease: Self-Care Measures You Can Take: American Holistic Nurses Guide to Common Chronic Conditions: John Wiley Sons; New Jersey Cochrane (2011) Organised inpatient (stroke unit) care for stroke: Stroke Unit Trialists Collaboration; The Cochrane Database of Systematic Reviews, Issue 3 http://www2.cochrane.org/reviews/en/ab000197.html Corben, S., and Rosen, R. (2005) Self-management for Long-term Conditions, Patients perspectives of the way ahead; The Kings Fund: UK Cortes, T., Lee, A., Boal, J., Mion, L., Butler, A. (2004) Using focus groups to identify asthma self care and education issues for elderly urban-dwelling minority individuals: Journal of Applied Nursing Research; Volume 17, Issue 3, p 207-212 Costello, J. (2009) Caring for someone with a Long-term Illness: Manchester University Press; UK Davies. M. J., Heller, S., Skinner, T. C., Campbell, M. J., Carey, M. E., Cradock, S., Dallosso, H. M., Daly, H. Doherty, Y. Eaton, S. Fox, C., Oliver, L., Rantell, K., Rayman, G., Khunti, K. (2008) Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial: British Medical Journal, Volume 336, No 7642 DOH (2010) BENCHMARKS FOR THE FUNDAMENTAL ASPECTS OF CARE: Benchmarks for Self Care; Essence of Care 2010 (Access 02.03.11) http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_119968.pdf DOH (2010) Equity and Excellence: Liberating the NHS; Her Majestys Stationary Office, UK DOH. (2010) Generic Long Term Conditions Model; (Accessed online 14/02/2011) http://www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_120915 DOH (2005-7) RESEARCH EVIDENCE ON THE EFFECTIVENESS OF SELF CARE SUPPORT http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_081251.pdf DOH. (2010) Self Care Local Business Case Tool User Guide http://selfmanagement.co.uk/self-care-resources (Accessed Online 14/02/2011) DOH. (2010) Making the case for self care education: http://selfmanagement.co.uk/self-care-resources DOH (2001) The expert patient: a new approach to chronic disease management 21st century Gately, A., Rodgers, C., Sanders, A. (2007) Re-thinking the relationship between long term condition self-management education and the utilization of health services: Social science and Medicine; Volume 65, p 934-945 Farrell, K., Wicks, M, Martin, J. C. (2004) Chronic Disease Self-Management Improved with Enhanced Self-Efficacy: Journal of Clinical Nursing Research; Volume 13, No 4, p 289-308 http://cnr.sagepub.com/content/13/4/289.full.pdf+html (04.04.11) Gibson PG, Powell. H., Coughlan J., Wilson A. J., Abramson M., Haywood, P., Bauman, A, Hensley MJ, Walters, E. H. (2004) Self-management education and regular practitioner review for adults with asthma: The Cochrane Library Issue 2. Chichester: John Wiley Sons. Gillet M, Dallosso HM et al (2010) Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis; British Medical Journal, Issue 341, p 4093 Glader, E. L., Stegmayr, E., Johansson, L., Wester, P. O. (2001) Differences in Long-Term Outcome Between Patients Treated in Stroke Units and in General Wards: Journal of Stroke; Volume 32, p 2124-2130 Godfrey, C. M., Harrison, C. M., Lysaght , R., lamb, M. (2011) Care of self care by other care of other: the meaning of self-care from research, practice, policy and industry perspectives: International Journal of Evidence Based Healthcare; Volume 9, Issue 1, p 3-2 Greenhalgh, T. (2007) Chronic Illness, beyond the expert patient: British Medical Journal; Vol 338, p629-31 Griffiths, C., Foster, G., Ramsay, J., Eldridge, S., Taylor, S. (2007) How effective are expert patient (lay led) education programs for chronic disease? British Medical Journal: Volume 334, p 1254-1256 Hanson, E. J., Tetley, J., Clarke, A. (2001) Respite care for frail older people and their family carers: concept analysis and user focus group findings of a pan-European nursing research project: Journal of Advanced Nursing; Volume 30, Issue 6, p1396-1407 Heller, S., Shearer, A. Bagust, D., Sanderson, A, and Roberts, S. (2004) Cost-effectiveness of flexible intensive insulin management to enable dietary freedom in people with Type 1 diabetes in the UK; Journal of Diabetic Medicine, issue 21, 460-467 Heller, R. S. (2009) Structured education in type 1 diabetes: British Journal of Diabetes Vascular Disease; Volume 9, no 6, p 269-272 http://dvd.sagepub.com/content/9/6/269.full.pdf+html (02.03.11) Help the Aged (2009) Common Assessment Framework for Adults proposals to improve information sharing around multi-disciplinary assessment and care planning Jordon, J., Osborn, R. (2007) Chronic disease self management education programs: Challenges ahead; Medical Journal of Australia, Volume 182, Issue 2, p 84-87 Keen, A., Hillson R. (2010) Six years on: delivering the Diabetes National Service Framework; Parliamentary Under State Secretary for health National Clinical Director for Diabetes; DOH (19.02.11) http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_112511.pdf Kaptein, A. A., Klok, T., Moss-Morris, R., Brand, L. P. B. (2010) Current Opinion in Allergy and Clinical Immunology: No 10, p 194-199 Kennedy, A., Reeves, D., et al (2007) The effectiveness and cost effectiveness of a national lay led self care support programme for patients with long-term conditions: a pragmatic randomised control trial J. Epidemiol. Community Health Issue 61; pages 254-261 Larsen, P., Lubkin, I. M. (2009) Chronic Illness: Impact and Intervention; 7th ed, Jones Bartlett, Canada Lindsay, S., Virjhoef, H. J. M. (2009) A sociological focus on expert patients: Health Sociology Review; Vol 18, Issue 2, p 139-144 http://www.atypon-link.com/EMP/doi/pdf/10.5555/hesr.18.2.139?cookieSet=1 Luchsinger, J. A., Tang, M., X., Stern, Y., Shea, S., Mayeux, R. (2001) Diabetes Mellitus and Risk of Alzheimers Disease and Dementia with Stroke in a Multiethnic Cohort: American Journal of Epidemiology; Volume 154, No 7, p 635-641 http://aje.oxfordjournals.org/content/154/7/635.full.pdf+html Michie S, Miles J, Weinmann J (2003). Patient centeredness in chronic conditions: what is it and does it matter? Patient Education and Counseling, vol 51, pp 197-206 Miller, N. (2000) Hard to swallow: Dysphagia in Parkinsons disease; Journal of Age and Ageing; Volume 35, issue 6, pages 614-618 Moore, S., Knowles, S. (2006) Beliefs and Knowledge about Parkinsons Disease: E-Journal of Applied Psychology: Clinical and Social Issues, Volume 2, Issue 1, p 15-21 Mulligan, K., Steed, L., Newman, S. (2009) Chronic Physical Illness: Self-Management and Behavioral Interventions; Open University Press, England Murphy, A. (2007) Asthma in Focus: Royal Pharmaceutical Society of Great Britain; Cornwall Newman S, Steed L, Mulligan K (2004) Self-management interventions for chronic illness Lancet, volume 364, pp 1523-37 NICE (2008) Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over; http://www.nice.org.uk/nicemedia/live/11945/40099/40099.pdf NHS (2004) NHS Continuing Care Report to the House of Commons Health Committee: Stationary Office; http://www.parliament.the-stationery-office.co.uk/pa/cm200405/cmselect/cmhealth/399/399i.pdf (27.03.11) Nolan, M., Delasegga, C. (2000) `I really feel Ive let him down: supporting family carers during long-term care placement for elders; Journal of Advanced Nursing, Volume 31, Issue 4 p 759-767 Orem., D. (2003) Self Care Theory in Nursing: Selected papers of Orem Springer Publishing Company Patel, A. (2003) Diabetes in Focus: Understanding inevitably leads to hope; Pharmaceutical Press, UK Rosen, R., Asaria, P., Dixon, A. (2007) Improving Chronic Disease Management, an Anglo-American Exchange: The commonwealth Fund Report; The Kings Fund Rosen, R., Corben, S. (2005) Self- Management for Long Term Conditions, Patients Perspectives on the way ahead: Managing Long Term Conditions; Working report, Kings Fund Ruppar, T. M., Conn, V. S., Russell, C. L. (2008) Medication adherence interventions for older adults: literature review: Journal of Research and Theory for Nursing Practice, Volume 22, Issue 2, p 114-147 Schlenk E. Dunbar, J., Engberg, S. (2004) Medication non-adherence among older adults: a review of strategies and interventions for improvement: Journal of Gerontological Nursing, Volume 30, Issue 2, p 46 Schrag, A., Jahanshahi, M., Quinn, N. P. (2001) What contributes to depression in Parkinsons disease? Journal of Psychological Medicine, Volume 3, Issue 1, p 65-73 Schreurs, K. M. G., De Ridder, D. T. D., Bensing, J. M. (2000) A one year study of coping, social support and quality of life on Parkinsons disease: Journal of Psychology Health; Volume 15, p 109 Sharkey, J., Ory, M., Browne, B. (2005) Determinants of self-management strategies to reduce out-of-pocket prescription medication expense in homebound older people: Journal of the American Geriatrics Society; Vol 53, Issue 4, p 666-674 Siminerio, L. M. (2007) Is the Diabetes Educator Our Next Endangered Species? Lessons From the American Bald Eagle: Diabetes Spectrum; Volume 20, no 4, p 197-198 Sinclair, A., J., Girling, A. J., Bayer, A., J. (2000) Cognitive dysfunction in older subjects with diabetes mellitus: impact on diabetes self-