Essay --

Depression :1) a state of feeling sad : 2) a serious medical condition in which a person feels very sad, hopeless, and unimportant and often is unable to live in a normal way. Depression is a disturbance in a person’s feelings that will lead one to be unusually low, sad, or empty. Depressed mood is not classified as a psychiatric disorder although it could most certainly be a feature of clinical depression. The state of low mood a person feels can lead to suicidal thoughts, feelings of hopelessness and worthlessness, loss of interest in activities that were once pleasurable, and several other symptoms (3). The introduction of psychoactive drugs in the 1950’s started the era of using drugs to treat anxiety, psychosis, and the ever so popular, depression. The new answer for depression was quickly replaced from therapy, to drugs. After the creation of these drugs the world of psychiatry would forever be changed (1). The years following the surplus distribution of psychoactive drugs led to more research about these â€Å"miracle drugs.† Studies concluded that billions of neural networks in our brain are used to send and receive signals from other firing neurons (2). Several chemicals also called neurotransmitters are distributed throughout the brain. Neurotransmitters such as dopamine and serotonin have been theorized to affect an individual’s mood levels. Depression patients are claimed to have less serotonin than those who are not depressed (3). The problem with this assumed theory is that instead of developing a drug to treat an irregularity, an irregularity was developed to suit a drug. An example of this used elsewhere is by perhaps appealing that all pain conditions are a problem due to lack of opiates (9). Antidepressants are used... ...r it (5). Many people do not realize that antidepressants are prescribed for other anxiety, neurological pain, fibromyalgia, and sleep problems. This should be taken in account when surveys are conducted as to how many antidepressants are prescribed (4). Antidepressants are serious drugs that should be prescribed when necessary and monitored carefully. In depression especially doctors should be sure that antidepressants will help their patients rather than harm them. Medicine should be used to help those who truly need it and not just be prescribed endlessly. Confronting psychological and sometimes physical pain from depression is necessary. Managing some of this pain through psychotherapy might help alleviate the need for so many antidepressants. Overall antidepressants will probably remain controversial and people should be educated about their pros and cons.

Commercial Internet Sites Essay

Go to at least 15 commercial Internet sites such as Yahoo!, MSN, and About.com. Document information on the types of attempts (such as pop-up windows and advertisements) that influence the viewer, including counting the number of references toward social shaping. The websites you consult should be listed in a reference list at the end of the newsletter. Take the information you have gathered and write an article for your company newsletter summarizing your findings and drawing conclusions. The article should be at least 500 words in length and should demonstrate depth of thought as well as originality. The first commercial Internet web site that I am analyzing is the online social networking web site Orkut.   It permits maintaining relationships through pictures, messages, music and videos.   What seem interesting with Orkut are that is permits to establish new connections with people belonging to any part of the world, help to come in contact with old friends and family in any part of the world.   Any individual interested in making friends can open an account on the web site and develop their own profile.   What adds uniqueness to Orkut is the fact that any friend or family member can insert their own testimonials of that person.   In the profile, personal, social and professional information can be demonstrated.  Ã‚   Another unique feature of Orkut is that any person can search for another by simply typing in the name in the search box. MSN is a community web site mainly concerned with email, messaging and social contacting.   This web site is brought out my Microsoft.   The users interested can open an account with the MSN web site and are given an individual username and password.   The user would be getting personalized information from the MSN network.   These include news, sports, weather, local news, etc.   Each user can make changes to the layout, color, themes, etc to the individual web page. Yahoo is a social network web site that mainly provides email, news, searches, messenger, jobs, weather, Horoscope, Health and other information.   The Web site concerns a wide range of areas.   Yahoo has its sources in almost every nation of the world and these provide localized information.   Each user can log into the web site with his or her usernames and password. Google, one of the strongest search engines in the world has extended its services to other areas such as book searches, computation, social network groups, news, maps, etc.   People are mainly attracted towards Google as it search strategy is very strong and would permit the user to use their own initiative whilst search for various aspects in the Internet. Tagged.com is social networking that permits users from various parts of the world to get in contact with old friends and new friends.   It was launched in the year 2004.   The graphic interface of the web site is very appealing and has several innovations such as slides, videos and the music presentation.   It has several reputed news sources such as Wall Street Journal, Business Week Online, Ad week, etc. Travellers Point is a social network that provides personalized information regarding traveling destinations and experiences, photo galleries, blogs, forums, maps, etc.   Users can create their own usernames and passwords on the web site and get upload and download photos and videos of famous travel destinations throughout the world.   The Web site works in association with another organization known as ‘Travel helpers’, which provides expert guidance to travelers. Hikut.com is a social networking web site that provides various features to the users, user such as galleries, blogs, music, videos, polls, groups, quizzes, events, classifieds, etc.   The users can also use several other features on the web site such as chats, interfaces, scrapbook, etc.   The users would have to register on the web site with a user name and a password. Linkedln is a professional social network web site that permits the users to share professional information with other experts and specialists throughout the world.   More than 16 million users have registered from about 150 countries.   Users who have registered include clients, partners and colleagues.   Users can also search for jobs and get in contact with the job seekers. One of the main religious social networking web site in the world is My Church.com.   This web site was launched in 2006 offering services to Catholics in the blogs, forums, messenger services, counseling, calendar events, sermons live telecasts, paying of thanksgivings, etc.   The founders of this web site have combined Internet and technology in a very innovative manner to obtain one of the most advanced Catholic networking web sites in the world. More than 7000 Churches are associated with the web site. One of the major social networking web site in the world concerned with sharing music, videos, photos, etc, is Multiply.   The web site also extends its services to other media other than the Internet including MMS and mobile services.   The web site not only caters to the personal needs of the user, but also to the professional and the academic needs.   Only individuals who are closely related to one another can share media information. Another social networking web site is Friendster that caters to the needs of small circle of friends.   It is utilized more widely in Asia than in any other part of the world.   It has been in competition with several other social networking web sites such as Yahoo 360 and Facebook.   In the year 2006, the web site came out with an innovative discovery, which entitled it a patent.   It demonstrated a method and an online tool to calculate and develop relationships between people. Facebook was a social networking web site launched in the year 2004, meant for the students of Harvard University.   However, as the web site was a strong success, several other universities were added including Boston University, MIT, etc.   Slowly any student belonging to any university in the world was allowed to register on the web site.   More than 58 million users have been registered on the web site.   The site offers the users several features including sending and receiving messages, gifts, placing ads, blogs, etc. References: Facebook (2007). â€Å"Facebook – Home Page.† Retrieved on December 26, 2007, from www.facebook.com Web site. Friendster (2007). â€Å"Friendster – Home Page.† Retrieved on December 26, 2007, from www.friendster.com Web site. Google (2007). â€Å"Google Help Center.† Retrieved on December 26, 2007, from Google Web site: http://www.google.co.in/intl/en/help/features.html HiKut (2007). â€Å"Hikut.† Retrieved on December 26, 2007, from www.hikut.com Web site. LinkedIn (2007). â€Å"Linkedin.† Retrieved on December 26, 2007, from www.linkedin,com Web site. MSN (2007). â€Å"MSN-Home Page.† Retrieved on December 26, 2007, from MSN Web site: http://www.msn.com/ Multiply (2007). â€Å"Multiply – Home Page.† Retrieved on December 26, 2007, from www.multiply.com Web site. My Church (2007). â€Å"My Church – Home Page.† Retrieved on December 26, 2007, from www.Mychurch.org Web site. Orkut (2007). â€Å"About Orkut.† Retrieved on December 26, 2007, from Orkut Web site: http://www.orkut.com/About.aspx Tagged.com (2007). â€Å"Tagged – Home Page.† Retrieved on December 26, 2007, from Tagged.com Web site: www.tagged.com Travellers Point (2007). â€Å"Travellers Point.† Retrieved on December 26, 2007, from www.travellerspoint.com Web site. Yahoo (2007). â€Å"Yahoo Company Information.† Retrieved on December 26, 2007, from Yahoo Web site: http://info.yahoo.com/

Thomas T. Fortune House Journalist Born a Slave Essay

â€Å"Can you imagine being born a slave in Florida and living in a beautiful Second Empire mansion in New Jersey?† Primavera asked. â€Å"It’s a remarkable American history story. I think what’s left of the house could be easily restored to a sufficient level so the story could be told in an incredibly effective way† (Shockley). Thomas T. Fortune was an important journalist in the history of America who was born into slavery in the state of Florida. He was an educated man and one of the most influential African-American journalists of the nineteenth and twentieth centuries. Thomas T. Fortune played an important role in the civil rights movement in America and he deserves to be memorialized in an attempt to remind future generations of the leaders†¦show more content†¦Thomas was able to attend Law School as just â€Å"one of five students in Howards law department for the 1877-1878 term† (Carle 1490). Fortune unfortunately did not finish college and did not receive a degree because of financial hardships. Even though he did not finish law school he still gained a lot of knowledge during the time he was there, â€Å"Fortune gained an understanding of fundamentals, especially in American constitutional law, which was reflected in his writings in later years† (Carle 1493). Thomas T. Fortune held several unsuccessful jobs before he landed his mark as the managing editor of the newspaper New York Globe in 1883, â€Å"thus launching himself at the age of twenty-five into a career as a national public intellectual† (Carle 1494). Thomas T. Fortune’s paper was successful until about the year 1907. â€Å"In 1901 Fortune moved his family to Red Bank, which had a well-established, segregated black community on the Westside, where Fortune bought a twelve room, Second Empire style home a short walk from the train station† (Zipprich). While living in New Jersey he commuted to New York for work once a we ek and the rest of the week he worked from home. During the time his newspaper was active it changed names a couple of times, from New York Globe, New York Freeman, and finally New York Age. Fortune’s purpose of his paper stayed continuous which was to â€Å"presentShow MoreRelatedStriving For Equality By Ida B. Wells, Rosa Parks, Recy Taylor, And Kimberlee Crenshaw1827 Words   |  8 Pagestowards equality and better treatment of black women served as the tipping point and the catalyst for other movements that struck the unjust society’s core and changed it forever. Ida B. Wells, born of slave parents, is a historical woman of color who enacted change for her race and gender. Ida was a journalist and publisher who advocated awareness of the injustices surrounding the lynching and deaths of African Americans. 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Report on Compare and Contrasts approaches to Operations management at Dell and Tesco - Free Essay Example

Sample details Pages: 5 Words: 1548 Downloads: 1 Date added: 2017/06/26 Category Business Essay Type Compare and contrast essay Did you like this example? Operations management focuses on carefully managing the processes to produce and distribute products and services. Major, overall activities often include product creation, development, production and distribution. Related activities include managing purchases, inventory control, quality control, storage, logistics and evaluations of processes. Don’t waste time! Our writers will create an original "Report on Compare and Contrasts approaches to Operations management at Dell and Tesco" essay for you Create order A great deal of focus is on efficiency and effectiveness of processes. Identify the types of Operations/transformation process in each organisation and analyse each organisation operation/transformation activities are adequately designed to meet its customers needs. Dell Computer Corporation Dell assembles desktop computers, laptop computers, servers, enterprise storage devices and workstations. All of these products are assembled to custom specifications afters orders have been placed; therefore, dell holds essentially no finished goods inventory. All of the components that go into these products are purchased from other companies. Even the Dell labelled chasses, keyboards, and mice are manufactured by other companies on contract. Therefore, Dell is quite different from traditional manufacturers in that it does not own or operate any injection moulders, pick and place circuit board assemblers, or sheet metal stamping machines. In addition to its computing products, Dell sel ls branded computer peripherals and consumer electronics such as monitors, printers, PDAs, MP3 players, and LCD televisions, all of which are made by contract manufacturers. Dells operations Selling directly to consumer Single point of Accountability get solutions quickly Build to order production Being the low cost leader in the industry Use of standard based technology The key competencies of Dell are customer focus, manufacturing processes, supply chain management, customer selection, acquisition and retention, customer service and human capital management. Dells strategy has been to match its core competencies with key industry success factors. Dells direct-selling business model revolutionized the computer industry. The organization has maintained a massive marketing budget to push its customized PCs. Although most orders are placed via Dells website, customers may also place customized orders by phone, fax or through limited retail locations. Those ord ers, which now include printers and consumer electronics, are then shipped within one week for significantly less cost than its competitors. Dells differentiation stems from process innovation. The company is very successful in leveraging and harnessing the value of its suppliers and partners technology innovation. This allows Dell to minimize RD spending and improve the cost structure, a strategy that is rarely matched by competitors DellsÂÂ  mission is to be the most successful computer company in the world at delivering the best customer experience in markets we serve (Frequently, 2011). In doing so, Dell will meet customer expectations of: Highest quality Leading technology Competitive pricing Individual and company accountability Best-in-class service and support Flexible customization capability Superior corporate citizenship Financial stability The exceptional performance of Dell Computer in recent years illustrates an innovative respo nse to a fundamental competitive factor in the personal computer industry-the value of time. Organisations set out to perform the same basic function: to transform resources into finished goods. To perform this function in todays business environment, manufacturers must continually strive to improve operational efficiency. They must fine-tune their production processes to focus on quality, to hold down the costs of materials and labour, and to eliminate all costs that add no value to the finished product The PC industry is driven by rapid technological improvements in components, particularly microprocessors, other semiconductors, and storage devices. The improved performance of hardware has been matched historically by increased complexity of software, creating demand for the latest hardware. This means that time is a critical competitive factor in the industry in two ways: First, excess inventory loses value and costs money; second, products incorporating the most advanced t echnologies are in high demand and carry a price premium. As a result, companies that minimize inventory and bring new products to market faster can reduce costs, increase market share, and maintain higher margins. The traditional distribution system of the PC industry is an indirect model. The PC maker sells its products to distributors, who buy products from many manufacturers and then sell them to a variety of retailers, resellers, system integrators, and others, who sell products and services to the final customer. This distribution system was an effective means for distributing high volumes of PCs with a variety of configurations to reach a broad customer base. Dells strategies of direct sales and build-to-order production have proven successful in minimizing inventory and bringing new products to market quickly, enabling it to increase market share and achieve high returns on investment in a highly competitive industry. The impact on the industry of Dells success is seen in the efforts of other leading PC makers and distributors to develop their own direct sales and/or build-to-order capabilities. Dell marketing strategy was simple and basic. Cut out the middleman and sell the product cheaper. Offer great customer service by giving the customer exactly what they want. That is how Dell is about to become the largest company in the world selling computers. They did it by building computers made to order for the customer. By handling all the sales (retail) themselves. If you want a Dell computer you can only get it from Dell. Their marketing strategy allowed them to pass the savings onto the customer. Dell Competitive Priorities on Cost, Quality, Time, and Flexibility by providing customized PC configuration, with short delivery times and affordable prices. Supporting DELLs Competitive advantages through a new operational model Focused on strategic partnerships: down suppliers from 200 to 47 Supplier maintains nearby ship points; del ivery time 15 minutes to 1 hour. Suppliers own inventory until used in productions. Demand pull through value chain. TESCO Tesco PLC is a Retail Company based in the UK. It is the most recognised retailer of groceries in the UK. Tesco mainly deals in the provision of foodstuffs. In addition to these, it also engages in the sale of clothes, electronics, financial services, insurance services, internet services and sale of houses this is its latest business venture. (Slack, N 2007) The operation section of Tesco can fulfil all the above requirements, and then marketers can coordinate between promotions and service delivery. (Ruffian 2000) Customers who come to buy products or goods directly from the Tesco store. They also include those who order for goods and services online or those who have secured a deal with the Tesco to deliver the goods to them personally. (Ruffian et al 2000) ÂÂ  Such customers expect to find most of the goods that they need in the st ore or delivered promptly. They also expect to find a lot of variety in the store. Tesco sets its objectives with the following categories; the first are the customers because these are the main people that bring in revenue to the organisation. Then there are the suppliers; the operations section depends on these groups of people to perform adequately. (Tesco, 2007) Tesco Competitive Priorities Speed: delivery time. Tesco values this because customers can get what they require when they need it. This establishes a good record and makes them come back for more business. Flexibility: different variety of products. Flexibility also applies to the way services or products are delivered. Flexibility applies to creation of new types of products in line with changing customer preferences. Flexibility also enhances dependability within the organisation because speed will have been improved. Cost: is because if an operation process is dependable, flexible, and fast and full of quality then less resources will be spent trying to nullify mistakes. Quality: actually means that the products or services offered by any given Company conform to international or local standards. This aspect is important for two main reasons. Customers expectation: Effectiveness through reduction of costs, increasing dependability and speed. Dependability: is essential because it dictates what kind of image the organisation presents to customers and consequently whether the organisation can be counted on the next time a customer comes back. Conclusion Tesco is an extremely successful retailer that has succeeded through use of technology and finances. Tesco is dynamic and offered varied services and products in the UK and Europe, the chain store will expand as the market is large. Tesco has a highly structured way of choosing its suppliers who ought to have ability to deliver. (Tesco, 2007) The operation management of the chain store is effective and Tesco has a highly structured distribution chain for its products and services. All the above goes to show that the Companys production process is efficient although improvements like performance measurements and encouraging creativity can be able to improve the process further. The basis of analysis should be any two from Competitive Priorities Corporate Strategy: specifies the businesses that the company will pursue, isolates new opportunities and threats in the environment, and identifies the growth objective. Differentiate itself from the competition Choices includ e producing standardized versus customized products and services or competing on the basis of cost advantage versus responsive service delivery. Corporate strategy provides an overall direction that serves as the framework for carrying out all the organizations functions An organisation product or service strategy addresses certain competitive priorities that will win orders from customers such competitive priority is variety. Mass Customization and Marketing Strategy Discuss how theoretical principles, concepts/framework covered in Capacity planning Inventory management Supply chain design Performance measures and Total quality management are appropriate/ inappropriate for managing operations at each of the organisations. Evaluate the mix of concepts/frameworks are discussed

Management and Lithuanian Managers - 1611 Words

VILNIUS UNIVERSITY FACULTY OF ECONOMICS DOMANTAS TRACEVIÄÅ'IUS, ELENA Ã… ½ILYTÄâ€", GEDIMINAS RICKEVIÄÅ'IUS, URTÄâ€" RUPÃ…  YTÄâ€" Cross-cultural comparative management Developing Cross-Cultural Effectiveness Lithuania and China Comparison Prof. DanutÄâ€" DiskienÄâ€" Vilnius, 2012 1. Lithuania‘s cultural profile Parameter Time focus Time orientation Space Power Structure Competition Communication Action Value=1 monochronic past private equality individualism co-operative low-context being Value=5 polychronic future public hierarchy collectivism competitive high-context doing Lithuania 3 4 3 3 2 4 2 4 2. Comparison between China and Lithuania Parameter Time focus Time orientation Space Power Structure Competition Communication Action Value=1†¦show more content†¦Chinese people are used to a relatively strong hierarchical structure. Promotions at work are in many cases based on age before ability. The young, in turn, are deferential and respectful to their older co-workers and business associate, the advice and opinions of an older worker are generally valued more than the words of a younger person. In Lithuania there are differences between young entrepreneurs and older businesspeople. Younger businesspeople generally have a less bureaucratic approach. Management style in China tends towards the directive, with the senior manager giving instructions to their direct reports who in turn pass on the instructions down the line. It is not expected that subordinates will question the decisions of superiors - that would be to show disrespect and be the direct cause of loss of face (mianzi) for all concerned. In a business negotiation or meeting setting space orientation will be private - more physical distance between individual participants and no physical contact but office situation space is more - large open spaces are filled with many desks. ï‚ · Management strategies As a manager you should act in a more flexibl e, improvised manner. If one wants to successfully coordinate work with a Chinese, one tends to have more communication to stay in his mind. They tend to be conservative in management and slow to change those things that are tied to the past. Lithuanian managersShow MoreRelatedAnalysis Of Arcadia Group Ltd.1331 Words   |  6 PagesKingdom department stores for example Debenhams, House of Fraser and Selfridges and also have several hundreds of franchises in foreign countries. The company was primarily founded before World War 2, by an 18 years old boy named Montague Burton a Lithuanian immigrant in Chesterfield in 1903. His initial operation was men’s clothing manufacture, retailing and tailoring operations. The chairman of this group is Philip Green, CEO Ian Grabiner and the finance director is Paul Budge. There are some subsidiariesRead MoreGlobalization Article7776 Words   |  32 PagesgloISSN 1392-1258. EKOnOMIKA 2008 82 GLOBALIZATION AND hUMAN RESOURCE MANAGEMENT Rima ÄÅ'esynienÄâ€" Assoc. Professor vilnius University Department of Management vilnius, saulÄâ€"tekio al. 9 Tel. (370 5) 236 6134 e-mail: rima.cesyniene@ef.vu.lt Globalization represents the structural making of the world characterized by the free flow of technology and human resources across national boundaries as well as the spread of Information Technology and mass media presenting an ever-changing and competitiveRead MoreEssay on Reflections on Cultural Aspects of International Business3278 Words   |  14 Pagesbusiness situations. My company is a global management consulting firm with more than 75 offices around the world and its employees representing more than 120 countries. I am a Financial Analyst whose daily duties among other things involve decision support to over 30 offices in the Americas including offices in the U.S., Canada, Mexico, Chile, Argentina, Colombia and Brazil. My team consists of 5 analysts – 2 Americans, 1 Chinese, 1 Indian and 1 Lithuanian – American (myself - born in Lithuania (theRead MoreIkea Global Retailer Essay17554 Words   |  71 Pagestotally successful in dealing with this complex notion of culture especially among employees across borders. Indeed, IKEA’s managers tend to forget to take the many particularities of national and regional cultures into consideration, they deal with everywhere in the world. Although it came out that in many countries which are culturally close to Sweden the leader and managers efficiently transmit the core beliefs and values to the employees. 2 http://www.geert-hofstede.com 2007-05-08 ACKNOWLEDGEMENTS Read MoreHiring the Elderly: an Ethical Dilemma5321 Words   |  22 Pagesthe labour market, and a tax allowance being found to be the most suitable means for that in Latvia. The information used is mainly derived from published material in form of internet publications, relevant textbooks, and personal interviews with managers of companies and the elderly employees. Table of Contents Scrooge vs. philanthropist 4 Urgency or Demographics of Trouble 4 Age Discrimination at its Finest 5 Price of Experience or First Out 5 Unrealised Advantages or Last In 6 Read MoreDifferent Qualities Of Leadership Based On The Situations2514 Words   |  11 Pagessample of the diversity of concepts in regards to leadership, which are similar in certain areas and differ in others. The leadership qualities vary from one leader to another, depending on their status, for example, a military officer, politician or manager (Lord, Brown, Harvey, Hall, 2001) WORKING ENVIRONMENT The working environment is the place where workers deal with people; this can affect a worker’s performance if not done properly. In general, the working environment can change one’s way ofRead MoreAnalysis of Internal Audit Function in Poland Empirical Research Findings6214 Words   |  25 PagesB USINESS, MANAGEMENT AND EDUCATION ISSN 2029-7491 print / ISSN 2029-6169 online 2011, 9(2): 236–247 http://dx.doi.org/10.3846/bme.2011.16 ANALYSIS OF INTERNAL AUDIT FUNCTIONING IN POLAND – EMPIRICAL RESEARCH FINDINGS Edita BieliÅ„ska-Dusza Department of Strategic Analysis, Cracow University of Economics, ul. Rakowicka 16, 31-510 Krakà ³w, Poland E-mail: edytadusza@gmail.com Received 18 November 2010; accepted 15 January 2011 Abstract. The purpose of the article was to present the researchRead MorePerformance Appraisal Hrm Absolute Standards4401 Words   |  18 Pages+98-21-88814576 Abstract Performance appraisal is one of the most important processes in human resource management, because it has a great effect on both the financial and program components of any organization. There is a verity of methods for the appraisal of employees performance. Obviously, no method can claim that it has an integrated approach in performance appraisal. Therefore, human resource managers should select an appraisal method which is most efficient in their organizations. In this paperRead MoreAnalysis Of Upton Sinclair s The Grapes Of Wrath 3839 Words   |  16 Pagescycle that the lower class unceasingly endures to no avail. The illusory American Dream is an endeavor that Jurgis Rudkus, of The Jungle, travailed over to no end. The origins of Upton Sinclair’s The Jungle stem in 1906, and follows the plight of a Lithuanian family and the miseries that plague them upon their arrival in the United States. Here was a population, low-class and mostly foreign, hanging always on the verge of starvation, and dependent for its opportunities of life upon the whim of men everyRead MoreTypes of Organizations and Leadership Styles5738 Words   |  23 Pagesenvironment as well as identify what leadership can mean to an organization’s bottom line. Most importantly, the desire to accomplish the organization’s goals is crucial to both the leader and the manager in the organization, yet how they achieve them varies. â€Å"Leaders provide vision and inspiration† while â€Å"managers provide the resources and expect results† (Ofori Toor, 65). Effective leaders are often referred to as being coaches that guide employees along the way. The mere presence of a leader encourages

Death, Dying and Other Ethical Dilemmas Free Essays

Death, dying and other ethical dilemmas are issues that all Intensive Care Units (ICUs) throughout the world have to face and address. In the Current Opinion in Critical Care, Vol 16, No 6, December 2010, p. 640, Dixon-Woods and Bosk, writing on the topic of â€Å"Death, dying and other ethical dilemmas† under the journal’s section of ‘Ethical, legal and organizational issues in the ICU’, have stated that â€Å"Recent ethnographic work suggests that ethical dilemmas associated with end-of-life care in ICU clearly persist, even if clinicians are now more open about patients’ chances of surviving. We will write a custom essay sample on Death, Dying and Other Ethical Dilemmas or any similar topic only for you Order Now An Australian study identified how decisions and actions made outside the ICU—such as proceeding with surgical procedures with very poor prognosis or admitting moribund patients who had sustained severe respiratory or cardiac arrest—led to a higher than expected rate of non-booked admissions. Staff believed these to be the result of futile interventions by staff outside the ICU that then resulted in ICU staff having to manage the patient and family through the dying process. ICU staff believed that this practice was detrimental to families by offering false hope of recovery, and that they were left to ‘clear up the unfinished work of medical staff’. Other studies have also documented the problems faced by staff confronted by patients whose potential for recovery is, at best, marginal, or when patients’ ‘significant others’ seek to influence ICU priorities and distribution of resources. Tensions exist between the critical care clinician’s view of the ICU as a place for caring for patients who can be salvaged, and an external view of the ICU as a place appropriate to send desperately ill, dying patients. Patients admitted to ICU despite ICU staff’s belief that they are not candidates for intensive care lead to role conflicts and other dilemmas for staff. The conflict is embedded in whom ICUs serve, the relative ease with which non-ICU clinicians can ‘turf’ their most critical patients to ICUs, the tensions ICU clinicians experience when delivering what they believe to be futile care, and the despair that family and clinicians share when having to abandon hope. † This administrative ethics paper takes a look at the issues contained in the article of the aforementioned journal, Current Opinion in Critical Care, Vol 16, No 6, December 2010, and applies these issues to the situations faced by ICUs today and in particular, the ICU healthcare personnel at the 6-bedded ICU at the San-Fernando General Hospital (SFGH), a general multi-disciplinary 680-bedded hospital situated in the south of the island of Trinidad and which serves a catchment area of 600,000 people. Trinidad and Tobago is a twin-island republic in the West Indies, south of the archipelago with a population of 1. million people. The SFGH also has a 4-bedded HDU (high-dependency unit). Brainstem death The future plan for brain-dead patients whose hearts have been resuscitated by doctors in the Emergency Department (ED) of the SFGH following a cardiac and or respiratory arrest at home, poses an ethical dilemma for the healthcare personnel at the SFGH. Should these patients be admitted t o the ICU which has only six beds to serve a population of 600,000? Shouldn’t these ICU beds be kept for patients with potentially reversible and salvageable pathology? Emergency physicians at the SFGH defend their decision to resuscitate such patients on the grounds that they cannot predict with any certainty which patients have reversible brain function and which do not. The present practice at the SFGH to provide ventilator support for these patients in the ED instead of the ICU while tests of brainstem function are being carried out, is frequently met with severe criticisms from relatives and loved ones who claim that the best is not being, and cannot be, done for such patients in the ED as opposed to the ICU. And to a certain extent, this is true bearing in mind the chronic shortage of doctors and nurses in the ED. Frequently therefore, here in Trinidad, the ICU personnel have no choice but to transfer such patients to the ICU for monitoring and cardio-respiratory support. Passive Euthanasia â€Å"While active euthanasia is illegal, passive euthanasia, or allowing a patient to die naturally, is legal everywhere. Passive euthanasia includes withdrawing basic needs such as hydration and nutritional feeding† (Fremgen, 2009, p. 304). The Ministry of Health, an arm of the Government of Trinidad and Tobago, has issued a written protocol/policy for the discontinuation of life-support from patients on whom the diagnosis of brainstem death is confirmed but, for such discontinuation, written consent is required from the relatives. â€Å"The person should be pronounced dead, and there is no need for the permission of the surrogates to cease treatment, although there are still questions about consent for donation† (Garett, Baillie, McGeehan and Garett, 2010, p. 253). But intensivists here in Trinidad face an ethical dilemma because forty-five percent of the population consists of people of East Indian descent who, because of their religious and cultural background, do not readily agree to the discontinuation of ventilator support from their loved ones who have been pronounced brain-dead. For similar reasons, they do not readily agree to the donation of organs while the heart is still beating, a situation that has stymied the development of transplant programs here in Trinidad and Tobago. The Surrogate’s Obligation Patient-physician relationship is at the heart of patient management. The trend over the recent years has been towards promoting patients’ autonomy. This model falls apart, however, when the patient loses decision-making capacity. Surrogacy is one means of preserving patient autonomy. Several European countries have recently developed laws defining the physician’s role, as well as patients’ and surrogatesâ₠¬â„¢ rights† (Lautrette, Peigne, Watts, Souweine and Azoulay, 2008, p. 714). â€Å"Each of the principles (the best interests principle and the rational choice principle) entails problems. The best interests principle asks the surrogate to do what is nearly impossible—to judge what is best for another. Furthermore, it does not address the fact that the interests of the patient and the interests of the surrogate may be in conflict. The rational choice principle assumes that we know what the patient would have chosen when competent and after having considered every relevant factor. This is a very broad assumption. We doubt that anyone can know what a person would have done in all circumstances† (Garett, Baillie, McGeehan and Garett, 2010, p. 2). When surrogates refuse to give permission for their brain-dead loved ones to be disconnected from the ventilator, intensivists at the SFGH in Trinidad, well aware of the limitations and constraints of the situation that exists at the SFGH, choose the ethical route and not only discontinue all drug and intravenous fluid therapy but also reduce the settings on, and oxygen therapy going to, the ventilator to as low as i s possible, so as to satisfy the family that the patient has not been disconnected from the ventilator. A do-not-resuscitate order (DNR) is not only written, but is also verbally communicated to the nurses by the doctors in the event of a cardiac arrest. The Cost Factor â€Å"Critical care medicine is expensive and its high cost has been a concern for many years. † (Halpern, 2009, p. 591). Canada’s health care system, including its delivery of hospital-based critical care services, is changing due to fiscal pressures. â€Å"Critical care services should be delivered to those who can benefit from them. Limiting therapy in patients with a poor prognosis may help redirect resources† (Leasa and Sibald, 1997, p. 320). Trinidad and Tobago, like the rest of the world, is currently facing an economic recession and so the Government of the day has to be very prudent in its fiscal spending. The Ministry of Health which is responsible for providing the financial resources for running the health system in the twin-island republic simply does not have the money required for the provision of quality healthcare at this time. ICUs are expensive and as such all attempts must be made by all stakeholders involved in the ICU to ensure that monies spent in this area of the hospital are spent wisely, ethically, effectively and efficiently. Conclusion This administrative ethics paper took a look at various challenges faced by healthcare personnel in ICUs today as they deal with death, dying and other ethical dilemmas. Particular reference was made to the ICU at the San Fernando General Hospital, Trinidad, West Indies. How to cite Death, Dying and Other Ethical Dilemmas, Papers

Sugar Is Not Sugar the Dangers of High Fructose Corn Syrup free essay sample

The Dangers of High Fructose Corn Syrup Rhonda Sullivan DeVry University Sugar is Not Sugar: The Dangers of High Fructose Corn Syrup Every one has seen the infamous TV commercial with the young couple sitting in a park on a blanket, innocently sharing a Popsicle made out of High Fructose Corn Syrup. The female offers her male cohort a portion of the frozen treat, responding to his hesitance with the disreputable claim hosted by the corn industry, â€Å"sugar is sugar. Ironic, this commercial enticing the general public to accept the ill-fated ingredient of High Fructose Corn Syrup, is the epitome of Eve offering Adam the apple in The Garden of Eden. High Fructose Corn Syrup has seemed to invade even the most discrete products in the current day kitchen. Hiding in ketchup, soups, and meats, to name only a few, this overused sweetener has wreaked havoc on the American people; much less the unfortunate, overweight, diseased, diabetic rats that fell victim to its studies. High fructose corn syrup (HFCS) is  a man made, chemically altered, and potentially neurotoxic byproduct, largely at fault for our nation’s health epidemics of obesity diabetes and cardiac disease, but if eradicated from our diet the sequelae of its morbid effects  could be alleviated. Problems Although society is starting to hear more controversial information about the ill health effects of HFCS consumption, what they are not aware of is the dangerous contaminates within it. Chemicals and enzymes used in the processing of corn into HFCS are polluting it with unsafe levels of mercury, and since this heavy metal is neurotoxic, it could very well be to blame for the rapid rise in Autism and other neurological disorders amongst our youth (Geier, King, Sykes, Geier, 2008). To first understand how mercury ends up invading the Nation’s processed food sources, people need to understand how HFCS is developed. As described by Wallinga, Sorensen, and Yablon (2009), through an industrial process, enzymes and caustic soda are used to synthesis the sweetener from corn. Caustic soda is used throughout  the process for many reasons, including its initial employment in the separation of the starch from the corn kernel (Wallinga, Sorensen Yablon, 2009). The problem is, caustic soda is produced in industrial chlorine plants, which many still use a technology relying on the use of mercury, allowing the heavy metal to seep into goods made from its use in processin g (Wallinga, Sorensen Yablon, 2009). Multiple studies done by the Environmental Health and Food and Drug Administration have found commercial HFCS, and many name brand food items with HFCS in their ingredient list, contaminated with mercury (Wallinga, Sorensen Yablon, 2009). An article written by Hyman (2011), presents us with an interesting case, in which a FDA researcher was denied a request for barrels of HFCS in order to test for contaminants. Once she represented herself as an entrepreneur to a new soft drink company, a large vat of the sweetener was sent and used as a part of her study, showing toxic levels of mercury present in some of the samples. The importance one could gather from these findings is that mercury has invaded our food sources, and in all of its forms, it is toxic to the brain (Wallinga, Sorensen Yablon, 2009). Studies show that maternal antenatal consumption of mercury-contaminated food â€Å"adversely affected the IQ, language development, visual-spacial skills, gross motor skills, memory and attention in their offspring† (Schettler, 2001 p. 814). All of these symptoms are similar to conditions of Autism, or Attention Deficit Disorder. An article, supporting mercury provocation of Autism, written by Geier, King, Sykes, and Geier (2008), provides evidence that Autism Spectrum Disorders (ASDs) may result from exposure to mercury at critical times of brain development. It goes so far as to state â€Å"mercury has been found to cause immune, sensory, neurological, motor, and behavioral dysfunctions similar to traits defining ASDs,† and these â€Å"patients who undergo protocols to reduce mercury show significant clinical improvements in some cases† (Geier, King, Sykes, Geier, 2008 p. 383). Also, it is well known through research that mercury can cause neuronal degeneration, and cell death; something that is observed in the brain of ASDs patients (Geier, King, Sykes, Geier, 2008). Schettler (2001) notes a growing rate in the incidence of developmental disabilities corresponding to the increasing prevalence of ADD and ASDs diagnoses. HFCS was first produced on a commercial scale in the 1970s, but became more widely used in the 1980s, when Coca Cola and other soda drink manufacturers started using it in their sweetened drinks (Reshanov, 2012). Bascian, Federico, and Adeli (2005) reveal alarming statistics, stating the use of HFCS has increase 1,000% between 1970 and 1990. Similarly staggering, childhood Autism diagnoses increased 800% from 1990 to 2003 (Rudy, 2009). The consumption rate of HFCS among children has mimicked the increased rate of our youth’s neurologic diagnoses, HFCS consumption is also a major contributor to the increasing numbers of people with obesity, diabetes, and elevated triglyceride levels. Just as every action has a reaction, the intake of HFCS causes a physiological strain of affects that negatively impacts the body. The digestion, metabolism, and absorption of HFCS, differ from that of table sugar, or glucose since biochemically they are different. Because the molecules that comprise HFCS are not bonded, digestion is not necessary, causing rapid metabolism in the liver (Elliott, Keim, Stern, Teff, Havel, 2002). The liver finds storage for these molecules as fat cells, and becoming overwhelmed, releases many in the blood stream. These are known as triglycerides. Elevated triglycerides inhibit insulin production (Kelpe, Johnson, Poitout, 2002), the chemical responsible for controlling our blood sugars. Leptin, our satiety hormone, is regulated by insulin, so when insulin levels are low so are leptin levels (Bascian, Federico, Adeli, 2005 Bray, Nielsen, Popkin, 2004). Obesity seems to be the most obvious epidemic as it related to HFCS consumption. It should be credited to the result of over eating due to HFCSs influence on the appetite suppression hormone leptin. When sufficient levels of leptin are circulating throughout the blood stream, the brain tells the body to no longer eat. When that hormone is diminished, the urge to continue eating is influential. As cited in Parker (2010), Bart Hoebel, who specializes in the neurosciences of appetite, weight, and sugar addiction states, â€Å"when rats are drinking high fructose corn syrup at levels well below those in soda pop, they’re becoming obese – every single one, across the board. † He continues to add to the discussion by saying even rats that are fed a high fat diet, don’t all gain weight (Parker, 2010). Supportive studies using rats show that when fructose was injected into the cerebroventricles of the animals, enhanced food intake was observed, while the same concentrations of glucose injections resulted in a suppression of  appetite (Bascian, Federico, Adeli, 2005. Further, the accumulation of readily converted fat cells, especially in the abdomen (Parker, 2010), doubles as a cause to obesity. When these processes are understood, it is apparent how HFCS contributes to America’s obesity issue. Elevated triglycerides have been well known for a long time in the health community to be a great risk factor for cardiac disease. When a bolus of unbounded molecules directly enter the liver for metabolizing, lipogenesis occurs, causing nonfat food products to be turned directly into fat and fatty acids (Bascian, Federico, Adeli, 2005.  ) Fatty acids, or triglycerides accumulate in the blood stream, at levels that can be considered dangerous, predisposing the person to coronary artery diseases and strokes. Multiple studies done on rats have provided evidence showing the contributory nature consumption of HFCS has on triglyceride levels. For example, a study cited in Bascian, Federico, and Adeli, (2005) showed that when rats were fed a 32% fructose, glucose, or sucrose solution, the fructose fed rats had an elevated triglyceride level. Insulin resistance is directly related to the intake of HFCS. â€Å"Because fructose does not stimulate insulin secretion from pancreatic ? cells, the consumption of foods and beverages containing fructose produces smaller postprandial insulin excursions than does consumption of glucose-containing carbohydrate† (Elliott, Keim, Stern, Teff, Havel, 2002 p. 911). Therefore, if large amounts of HFCS were being consumed that insulin was not acting to control, the result would be uncontrolled circulating blood sugars. In human studies done by Johnson et al. (2009), with high levels of fructose ingestion, it took just one week for the subjects to develop insulin resistance. People that were already predisposed to obesity or unhealthy diets, exhibited insulin resistance after very small amounts of fructose were taken in. Again, the prevalence of these epidemics seems to mirror the widespread utilization of HFCS as a sweetener. Bray, Nielsen, and Popkin (2004) analyzed the relationship of increased HFCS consumption with the development of obesity stating that ironically, the increased use of the sweetener in the United States has mirrored the rapidity of America’s obesity. Cited in Parker (2010), The Center for Disease Control and Prevention recognizes that in the last 40 years, since the introduction of HFCS in the American diet, rates of obesity have â€Å"skyrocketed. † They report that in 1970, about 15% of the American population was afflicted with obesity, but as of now, roughly one third of our adult population is considered obese. The increase in fructose intake in the last twenty years is also associated with the astonishing increase in diabetes diagnoses according to Johnson et al. (2009). These discoveries are beyond coincidental, and highly recognized among experts in the field of nutrition and health. Solutions By abolishing high fructose corn syrup from our diets, we could alleviate the morbidities affiliated with its use. Because of the backlash HFCS is receiving recently, many food manufactures are removing the sweetener from their products. Even though still widely found, reading food labels will allow consumers to purchase goods without HFCS in its ingredient list. Buy products that are not processed, or advertised as â€Å"organic. † Prepare meals at home using whole foods, not prepackaged. Most manufacturers have contact information on their products, allowing consumers to notify them of their discontent with the presence of HFCS in our food. People can contact elected officials, asking for hearings that address why the FDA does not protect our nation from the mercury contamination of HFCS (Wallinga, Soreson, Yablon, 2009). One step New York City’s mayor, Michael Bloomberg, is taking, will propose a stop to all sweetened drinks greater than 16 ounces in size, hoping managed portions will reduce the intake of these drinks (Reshanov, 2012). This appears to be an important step in diet modification for decreased incidents of obesity, diabetes and coronary artery disease, but its presence in even small portions may not change the risk of mercury exposure to developing brains. Just don’t eat it, drink it, or support HFCS in any manner. Although sugar has a bad rap when consumed beyond moderation, it could be reclaimed into our nations diet as a primary sweetener, since it has not shown to have the detrimental effects on health that high fructose corn syrup has. Researchers from the Department of Science and the Princeton Neuroscience Institute report that male rats given HFCS sweetened water in addition to a rat chow diet gained much more weight than those that received water sweetened with basic table sugar along with the chow (Parker, 2010). Many favorite food brands have provided an alternative using sugar to sweeten a product as opposed to HFCS. Examples of these are Pepsi â€Å"Throwback,† and â€Å"Simply† Heinz. To alleviate an extensive craving, many health food stores provide candy sweetened only with cane sugar. Trader Joes is a whole foods store that has a jellybean product with flavors similar to the famous â€Å"Jelly Belly’s† jellybeans, sweetened with only cane sugar. Making home cooked goodies with sugar, also gives the option of adding some additional ingredients with nutritive value while satisfying a weak yearning. Although sugar in excess can still have some unhealthy effects, in moderation it is recognized, metabolized and processed in the body without detriment, and is unknown to harbor neurotoxic mercury or other damaging contaminants. In previously cited findings by Parker (2010), it is apparent when comparing the outcomes of fructose fed rats as opposed to rats fed typical table sugar, that the rats eating fructose suffered ill effects to their health, unlike their glucose fed counterparts. Call to Action . Without actions on behalf of our food and drug administration (FDA), the statistics for obesity, diabetes, and cardiac disease, as well as what may be the contributing factor to the rise in our nation’s neurotoxic afflictions will continue to rise. Mercury contamination in HFCS is completely avoidable, with current technology allowing most chlorine plants to no longer use it (Wallinga, Soreson, Yablon, 2009). Since HFCS was first introduced in the 1970s, its use and consumption by the American people has continued to climb with the Average American eating an estimated 60 pounds per person per year, all concurrent with the â€Å"tripling of obesity rates and a seven-fold increase in diabetes diagnoses† (Hyman, 2011 p. 1). When comparing the ingredient list from a French based McDonalds, to an American McDonalds, there is no HFCS or multiple other unhealthy ingredients in the foreign food choices (Beardsley, 2012). Why does our nation allow poor quality, harmful food additives, disregarding years of well researched information? What makes American’s settle for less, knowing the potential ill health effects? The FDA needs to recognize the negative impacts HFCS is having on the American people, and protect them. Our nation must write, call, or email legislators and representatives to make the FDA aware .