Case Study: Nordstrom

Answer Question 1: How else can Nordstrom continue to provide exceptional customer service and increase brand loyalty? Brands is the relationship between products and customers. It contains a collection of quality and service that customers expect. The loyalty of the customer service for brands is due to meet the expectations of customers, or even better, exceed their expectations, giving customers prefer interesting .Nordstrom , a department store in the synthesis of America ‘s most successful , with the index ranking for customer loyalty high , there are many stories about companies that are spread among customers and others . We have heard the story about the man walked into Nordstrom stores carry tires for automobiles , and demanded a refund . Nordstrom has returned the money to him . Nordstrom It is not attractive selling automobile tires .Now that is customer care . If you buy shoes at Nordstrom , and your feet are not the same number , the sellers will take a number just one side with your legs and a foot to the other to the other side of you , but only charge a shoes . If you have to buy a cashmere sweater blue but according to the ad has been sold , the sellers will certainly make suggestions to find a shirt like this or a similar store competitors competition and will send it to you .Nordstrom has been particularly successful in completing strategic customer service , customer is a centric approach and attentive customer care . The consistent , customer is a centric with innovative thinking has helped to speed up development Nordstrom and stayed for more than a century, after many turbulent economy . Beside, to build brand value, Nordstrom to ensure customer loyalty through brand awareness and ensure it meets the needs , wants of customers . Enhance product awareness , increasing the perceived quality .Enhance perceived value and enhance consumer experience of our customers. Considerate service, return policy surrender unconditionally, email reg imes that include photos of new products for our valued clients and thank you card after purchase are factors to help retailers are not too worry about the price and competition. Nordstrom never focused on the company or its employees, All energy of Nordstrom is put on both the customer, and that is the secret to success of them.

Perdue Case Analysis Essay

Perdue, in the case, seems to have the biggest dilemma: to enter or to not enter the industry of chicken hot dogs. But even within that dilemma, Perdue is faced with even more petty dilemmas should they decide to get into chicken hot dogs or not. In this paper, I do not intend to give a summary of the case and will not beat around the bush by giving my analysis and recommendations spot on. Judging from the facts and figures provided for by the case, I strongly believe that Perdue should get into chicken hot dogs. Why chicken hot dogs The first reason why I believe that Perdue should enter the scene is due to the fact that Perdue has a very good brand perception. From the case, when Poole blind tested consumers, Perdue proved to be an even better brand than the leader, Oscar Mayer. The fact that Perdue hasn’t really gone serious into hot dogs and was still the more preferred, gives us an idea that the brand itself is very crucial or would somewhat suffice when it comes to marketing. Perdue is a brand that is trusted by consumers, only, the brand hasn’t risked much to meet that valuable trust halfway. Another reason why they should venture into the hot dog industry is the stark difference of Perdue from other competitors: everyone has gone to processing foods. Perdue is still tagging behind, heavily dependent on its superb yellow chicken that is not even prepackaged. While they are at an advantage for now because processed meat products would need the supply of raw meat, Perdue should also take into s erious consideration that the competitors will soon have to acquire, and they will, their own supply of chickens through hatcheries. The high demand of processed food will push the competitors to buy out supply to sustain the business. This trend in the industry must be thought over by the Perdue management. They cannot be a brand that is resistant to change, even if they claim to be a very strong one. With that, Perdue has since been at the backburner. Their supply of chickens for the franks is not even enough simply because they are not into the hot dogs business. Competitors will soon gain their own hatcheries and will unseat Perdue in no time. In connection to that, Perdue lacks the facilities for growth. They cannot pack chickens like other poultry companies do for grocers and they do not have the capacity to process the meat into franks. This very much limits Perdue. They have been forever an old provider of fresh chicken and that is all they are about. While it is not entirely wrong, I just think that Perdue should use its good brand image to take chances and without having to necessarily tarnish their good image which they have acquired over a long time. Next, venturing into chicken hot dog does not mean that they have to face the same problems they are having with their current business. Distribution would be not constricting anymore. They can go institutional because that’s the way it’s supposed to be. Lastly, Perdue is competing in a market wherein they have always been stagnantly leading and growing. To think about it, Perdue is stagnating as a company. It has been stuck with the same business for long, as if that is what they can only do with chickens. They are only at retail level, again emphasizing the fact that they are very dependent on this type of business. The reason why they do not do institutional is the fact that they have no means to. But with the chicken franks, they can venture into that segment because they would have to sell the processed meat in places where people usually buy them from: supermarkets. The expansion or growth problem can be solved then. (See The 4P’s on page 6) But Perdue hesitates. They cannot be always like this because a good company accepts change, else it will die out. Perdue, I strongly predict will soon die out. Not all brands can be successful and still be rebellious of some kind, refusing to conform to the industry trends. Entering into the Chicken hot dog industry Even with the strong contentions, I see where the Perdue management is coming from. They’re not experts in the hot dog industry and even after having formulated the best chicken hot dog, dubbed as in the case as â€Å"better than Oscar Mayer†, the smaller dilemmas still prove to be risky to be uncertain of the answers for. So here goes my proposition for Perdue when entering into the chicken hot dog industry. Be autonomous First, I think that rather than leasing two facilities to make the franks, they should just buy their own plants. If Perdue cares so much about their image, how can they risk still leasing out facilities which in turn produce franks different from the desired prototype? Isn’t that an even bigger risk? Destroying the trust and in turn the relationship with the consumers will fatalize Perdue’s very good brand image. If I were a Perdue fan, I would be sad to know that they do not make their own hot dogs and thus, nullifying all the good things I associate them with. Frank Perdue’s three requirements for the would-be hot dog should be followed, after all, father knows best. The franks should be better and costs will definitely be covered by the revenues (as a complete product recall is so much more expensive in the long run than acquiring equipments). I think this is what they have to consider first and foremost. Moreover, judging from the industry and its players which Poole described as terrible or companies that didn’t do much advertising but still made a hit in the industry, the chicken hot dog industry has minimal entry barriers. Longacre and Weaver should be their example. If it was easy for such unknown firms to flourish, how much more for an established brand like Perdue? Another reason why they should have plants is because their competitors do and in the long run, Perdue will lose out in this game of processing costs. More importantly, it has been reiterated in the case that even the supply will need to catch up with the demand. With those projections, production is of utmost importance. Hence, all the more reason to have their own equipments or plants. With that, they have more control over production and of the quality, of course. A very good reason why they are better off entering the chicken hot dog market with their own equipments or plants is that they can tailor-fit their production according to their franks’ needs. Cockrel meat is necessary for the formulated frank, but it is hard to process and needs a stronger machine or else, production costs will increase due to excess capacity, second shifts and will be burdensome due to the very high demand. So that in the case, Moriarty or Perdue need not compromise on the prototype in order to solve other less important issues than product quality. Defy the odds MDM is 85% of the Perdue frank. However, as how this was pointed out in the case, MDM can spell a big difference because it might destroy the brand image Perdue has and of course, it might lessen their power to demand for a premium. But according to studies and official food and drug authorities, MDM is actually safe. There were really just some few extreme cases where negligence gave it all the negative impact. If MDM standards were followed by all, coupled with an extra effort to really not put the consumers to harm by not including meat that cannot be used anymore (because it is worse than scrap already), then people wouldn’t care as much. We all have to know that we eat mostly processed food and not really organic. Even strawberries are dangerous to eat, even more dangerous to eat than a hotdog. The market is very quick to judge that a slight mistake will be detrimental to the industry. Yet they fail to recognize the fact that even the supposedly healthy foods we strive to eat every day have their own impurities. In this case, I think Perdue should push through with their tested prototype. If the taste is better, the people will buy it. Moreover, this is not in the business of supplying fresh chicken meat anymore, this is in the processed meat industry already. And processing meat has to have some impurities but Perdue should limit it to MDM. I think the Perdue management have some erroneous thinking about this case. They automatically equate using MDM as destroying their customer’s loyal base. MDM does not mean that Perdue put some hormones in their chicken. It does not also mean that they changed them in every bit of way. The franks will still be 100% Perdue meat! MDM is just a matter of getting the meat, a processing that anyone in the industry should strategically do. But because there are some stubborn consumer groups who know better than to mind the â€Å"healthy† foods they are eating, Perdue has to counter this possible dulling of brand image too. But this is where Perdue should put its good brand image to use and for marketing sake. The Perdue chicken hot dog The Perdue chicken frank should be processed very sternly, following all the necessary rules and restrictions and should be 100% Perdue meat. The frank should also have nutrients present in chicken and in bone marrows such as iron and the recommended doses of calcium. The frank also has to be exactly the same as the tested prototype because it is supposed to be made of 100% Perdue chicken, and Perdue chicken is the best-tasting, so the frank should be the best in taste too. (see The 4P’s on page 6) Marketing The 4P’s Product * Exactly the same as the prototype * Not devoid of natural nutrients of the chicken and bone (iron and calcium) * 100% Perdue chicken * Cannot be compromised (the ingredients) so as to minimize costs * No second-class of the product to retain Perdue’s good brand image| Place * Distribution (include concessionary) can be expanded because this is entirely a different industry already: processed meat * Not just in the current market of Perdue, but in all other places as where the competitors are (supermarkets)| Price * The recommended price for them to profit at $1.23 per pound| Promotion * Should be promoted by showing off the frank’s attributes not found in the competitors’ * Should emphasize the fact that it is â€Å"carefully processed†, even if it contains MDM meat The marketing will be driven in such a way that Perdue’s stand on having the best chickens is utilized in a different manner: this time the best in quality for chicken hot dogs. Perdue should do a lot of reassuring. Perdue can even make a story just to set the mood: that hot dogs are unhealthy, but cheap and easy to cook that’s why people love them. But Perdue cannot bear the fact that its consumers are not eating healthy or are being cheated on. Hence, the Perdue chicken frank! Perdue can maintain and even expand its horizons by getting into chicken hot dog. They just have to use the right words in their packaging such as â€Å"100% Perdue chicken† and â€Å"passed all processing codes† and they can even go so far as employing a research institute to assure consumers, particularly loyal customers that Perdue hot dog is actually different from the rest. Think of Safeguard with PAMET and other shampoo brands each to their own hair gurus. The marketing should be aggressive and should focus more on how these chicken franks is a product of Perdue so that one will only expect the best from it. Perdue can also have Mr. Perdue to be in an ad, the same way that got their loyal customers hooked. Since Perdue had the highest advertising-to-sales ratio, I think that Perdue’s ads are very critical to this project’s success. Instead of focusing on the quality of chickens for the ad, this time, Mr. Perdue can say about how Perdue thanks its loyal customers for their ever strong support and that the company is expanding by doing different products, such as this chicken frank. He can also go on to say that in Perdue, everything that they make is of superior taste and quality, just like the chickens they sell. I also propose the tagline: â€Å"Only the best chickens make great franks. Only Perdue can.† Positioning So the crucial question is whether this new chicken frank should be positioned as an entirely new product or as an alternative to conventional meat hot dogs. I think that Perdue should position it as the latter. Poultry is far healthier than pork and beef, and chicken franks are not that main stream yet. So, Perdue’s goal of reaching out to the light-users and non-users who are wary of hot dog nutritional content will be realized through this. They should position the Perdue frank like this because I believe this is in line with Perdue’s motto of providing only fresh quality chickens. This will help them maintain if not better their brand image while expanding to this other business of chicken hot dog. Positioning it as a new product is futile in a way because there are companies that have been selling chicken franks. So putting it as new is much more challenging and does not really bring about substantial benefits to the company. Perdue is not known for innovating things, it is known for its superior quality of chickens and it is in line with this that they should propose a favorite food, a frank, that is very much attached to their philosophy as a company. The real chicken is Perdue Perdue risks its growth by thinking too much on maintaining their brand image and their finances in the wrong way. They are afraid to move forward, fearing that they may not be ready for such a launch but also failing to realize that staying under the shadows will make the brand lacklustre. They prefer to risk growth for conventional wisdom that is obsolete. While Perdue can remain to be as it is, competitors will soon become like them and even much more with the franks. It is a no-brainer that the competitors will do some backward and vertical integration too. ——————————————– [ 2 ]. Johnson, Mark H. â€Å"Perdue Farms, Incorporated.† Diss. Darden Graduate School of Business Administration, University of Virginia, 1978. University of Virginia Darden School Foundation. p.19

Fallout Book Report Essay

P.S. I am sorry the summary is so long but I wanted to make sure everything in the book was covered and there being 3 people makes it 2 times longer. The novel is a memoir of the lives of three children of a meth-addicted mother, Kristina, and how her addiction affected their lives. They now live in different homes, with different parents, as well as different last names. Each of them has a different story, some more fortunate than others. Hunter knows about his sisters and new younger brothers, while Summer knows about her brothers and Autumn knows nothing. It starts with Hunter’s story; adopted and raised by his biological mom’s mother and stepfather. He refers to his adoptive parents as â€Å"Mom and Dad.† He works at a radio station in Reno, Nevada. His girlfriend, Nikki, supports him in everything he does. As Christmas approaches, he is living with Nikki and having relationship troubles. Hunter is doing drugs more frequently, and cheats on Nikki with a persi stent radio groupie. All the while, Hunter is feeling like a piece of him is missing because of the lack of knowledge about his father. When he sees him, he knows, but his father is the date of his coworker, Montana. Hunter then gets drunk and calls Brendan (his father) out on his actions about how him raping Kristina produced Hunter. Once that situation is in the past, another problem occurs, as Hunter is approached by Nikki, who hears a voicemail left by Leah on Hunter’s phone about the cheating incident. He is kicked out of Nikki’s house and takes the guestroom in his parents’ house because, thanks to Kristina, his two younger brothers, David and Donald, have moved in and taken his room. Shortly after Hunter has moved back in, he is notified that Kristina will be spending Christmas with them. Autumn’s story takes place at her grandfather’s house in Texas. Her OCD (obsessive-compulsive disorder) and frequent panic attacks make her a loner at school, so her best friend is her Aunt Cora. Although she promises Autumn they will always be friends, she is wooed by her massage therapist professor and taken away from her. A new boy comes to her school and is immediately taken with her. She has a hard time opening up to him and even tells him her parents are dead. His name is Bryce and he ends up being Autumn’s first boyfriend, first kiss and first time. When her aunt announces her engagement, the happiness she gets from her new boyfriend fades and she feels alone. Desperate to make sure he stays with her, she has sex with him without protection. Realizing that being drunk makes everything easier to deal with, she begins drinking to make herself feel better. Her father’s and grandmother’s interruption at Aunt Cora’s wedding only makes things worse, bringing her past to her present; then, Bryce finds out her parents aren’t dead. Devastated about the lying, Bryce leaves Autumn, and to make matters worse her drinking has gotten out of hand and she is almost raped by the groom’s cousin, Micah. The wedding ends when Autumn realizes how lonely she is and begins to wish she is pregnant, and her father finds her and tells her how she came to be. In the process, he convinces her to go to Reno for Christmas to see the mother she never knew. The California foster system took Summer away shortly after living wi th her father when they were abandoned by Kristina. She knows everyone in her family except for Autumn. Her father’s ex-girlfriends have molested and used her, causing her to be thrown in different homes with different problems. Her life is pretty stable in one home until one of the meth-using girls that also lives there molests one of the younger girls; it hits close to home and she is unable to control her anger. She gets in a fight with the meth girl and ends up getting sent to live back with her father and his girlfriend of the moment. The day after the fight, her boyfriend, Matt, saw her face and offered no sympathy, so she ran to his best friend, Kyle, who always showed interest. She ends up cheating on her boyfriend with Kyle by having sex with him. She knows that Kyle uses meth and other drugs but his loving nature has drawn her in. When he and Summer confront Matt about their newfound relationship, she sees the side of Kyle she never wanted to and realizes his addiction and anger may cause problems. The living conditions at her father’s house aren’t the be st; the constant smoking irritates her asthma and as Thanksgiving approaches, she starts to miss Kristina. She calls her, but can’t remember why; she was blown away by her mother’s selfishness and when her father is drunk later that night, he reveals that Kristina only cares about herself. Her father being drunk proves to be a much worse situation than just spilling the truth; his drinking costs him a DUI and he loses Summer. She is sent to another home in Fresno. Leaving her boyfriend and life behind, she is unwilling to move far away. When she gets to her new home, she is immediately taken aback by her new foster father. His demeanor worries her and makes her wonder what secrets the other girls in the house might have. She knows from experience not to get close to the other girls in the house, but one of the girls tells Summer her secrets and becomes attached to her. During the few days Summer is there, she hides her cell phone and planned to meet Kyle. When she sneaks from under her foster sister’s watch long enough to escape, she ends up running away with Kyle for Christmas—he is so in love with her that he even attempts to stop using meth for her, which means suffering through withdrawal. She and Kyle save up money and live out of his car while they head to a ski lodge, where Kyle plans to work. The stories collide when Kyle and Summer get in a car accident and the closest place to them is Reno, Nevada. Summer ends up calling her grandfather to pick her up from the hospital the morning after the blizzard hit and the accident happened. Hunter is out picking up Kristina and his grandfather from the airport after spending the early morning making up with Nikki. He knows that things won’t quite be merry and joyful Christmas morning with the whole family being together. Autumn and Trey show up before Summer gets there and when Trey sees Kristina, they are immediately drawn to each other and spend most of the day before dinner talking to each other. Summer tries to be sisterly to Autumn and Autumn doesn’t know what to make of all of it. When dinner starts, David asks when he’ll be going home and Kristina says she doesn’t know; Donald gets angry and tells her he never wants to go back—that he never wants to be with her again. Hunter is the first one to jump up when Kristina acts offended and he yells at her, telling her the only person responsible for what happened to her was her. Summer jumps in the argument too when Kristina begins to complain that she doesn’t have the resources to take care of her kids or give them a good life. The book ends with a newspaper article saying Marie Haskins has put her new book ‘Monster’, on indefinite hold while Kristina is undergoing chemotherapy for cancer. At this point, Kristina has reunited with her husband, Trey, and with her resources, she is trying to make her life better so she can be the mother she has never been. I can’t personally connect to this book but I can emotionally connect to this book. I have a friend in my life that I like a brother to me and he has parents just like hunter, autumn and summer. Drugs are a very personal matter and mess up your life more than anyone can know until it happens to you. I felt what he felt becaus e he is such a dear friend that all I could do was worry about him and wonder how he was doing in that new foster home he was moved to. I always heard all about the stories and the way he was in the foster home. He said it wasn’t easy and it was painful to know that everyone he loved had bailed out on him. He soon developed many of the problems these kids experienced with drinking and doing other drugs. This life isn’t easy from what I have heard. This book is very easy to relate other books by Ellen Hopkins because all of the books I have read by her seem to be about drugs and complications in life including hardships and suffering. I don’t really watch movies in this type of subject but I did hear that there is supposed to be a movie coming out based on the crank series by Ellen. I’m not sure whether it’s out or not but the books are great and movies tend to ruin the reading of the book. Both crank and glass led up to this point in the book series and was consistent throughout the storyline of all three books. There is so much drug abuse in the books and making right decisions is not one of Kristina’s strong points. I believe that the theme of this book is that drugs can ruin lives especially to the young girls out there. The plot of this story is to tell a story from the perspective from the 3 abandoned children that Kristina left behind. There storied tell about the hardships they went through and how life was for them during this painful teenage years. Even though the plot wasn’t very funny, it is very intriguing and interesting to find out what makes people do this to their own children and why they do the things they do. This story is told from the three kids point of view. And it switched off every so often so it was very suspenseful. The setting of this book is in three different places considering the three different points of view. Hunters’ setting was in Reno while Autumn’s setting was in Texas and Summer’s setting was anywhere the foster system took her. In my personal view the climax of the story was when all three of the children met for the first time and got to be a family together. In conclusion, I would recommend this book to anyone that enjoys reading this type of book seeing as how it has sex and drugs in it. I would definitely restrict this book to anyone under the age of 15 or 16. This book is a lot more profane then the others and I feel that you should be at least old enough to understand the meaning and why the book is how it is. Not many people judge books but I would definitely recommend this book to anyone who wants a good read and interesting enough to make it to when you put the book down you can’t wait to pick it back up. I truly feel her books are amazing and make you see how messed up some situations are.

The international banking market Essay Example | Topics and Well Written Essays - 3250 words

The international banking market - Essay Example International banking activity continued to expand , propelled by banks' substantial purchases of securities and the return of Japanese banks to the international banking market. The cross-border claims of banks in the reporting area increased by $110 billion .select few, most notably Mexico and Turkey. Another notable development in the first half of the year was a sharp increase in deposit flows from developing countries to international banks, arising from an improvement in the external position of oil-exporting countries.. Interbank activity slowed , as was to be expected following the extraordinary surge in lending to banks in the developed countries in the first quarter. To some extent, banks in the reporting area unwound the large interbank positions that they had built up during the first quarter, with funds moving from banking centres in the euro area to London and then being passed on to Tokyo, Zurich, the Bahamas and the Cayman Islands. Despite flows from banks in the United Kingdom to their branches in the Caribbean, reporting banks' claims vis--vis banks in offshore centres continued to decline in the second quarter. ... According to the consolidated banking statistics, Japanese and UK banks were responsible for most of the increase in reporting banks' claims on US banks Deposits by developing countries soar The ongoing contraction of bank credit to developing countries reflects in part weak demand for external financing. Despite strong growth in many countries, this year developing countries are expected to post their largest current account surplus in two decades. The strengthening external position of oil-exporting countries is responsible for most of the improvement. As well as limiting external financing needs, this improvement contributed to a large increase in developing countries' deposits with foreign banks. Flows to US non-banks surpass those to euro area borrowers Purchases of securities also accounted for most of the $57 billion rise in claims on non-bank borrowers in the second quarter. More recent data on syndicated credits show a surge in lending to telecom firms, suggesting that direct lending to non-banks in Europe may have also recovered. Banks in the reporting area continued to purchase substantial amounts of securities issued by non-bank borrowers in Europe. Nevertheless, international bank flows to non-banks in the euro area more than halved to $20 billion, Banks resident in the United Kingdom and the euro area, which had provided massive sums to non-bank borrowers in Banks' cross-border claims on non-banks in the United States have increased since late 1999. Renewed lending by Japanese banks was funded in part through the international interbank market. Taking into account changes in both assets and liabilities, reporting banks moved upwards of $59 billion into banks in Japan in the second quarter, the largest increase in years. Further

Understanding Organizations Through Imagery Assignment

Understanding Organizations Through Imagery - Assignment Example This has led to the growth of corporate social responsibility a move that tries to improve the organizational image within the outside World (Jones, 2013). Possible defects with corporate cultures lies in the way it affects the business management and operations. There exist a thin line between a healthy and unhealthy corporate culture which has a direct effect on the employees, sales and the overall customer satisfaction (Tosi, 2009). A culture that encourages aggressive behavior on the part of employees can be a turn off for the customer and thus drive sales downwards. Furthermore, an unhealthy culture can disrupt the team spirit among employees reducing their level of commitment on improving sales and services to customers (Scott & Davis, 2007). Thus, the top management should strive to ensure they propagate a healthy culture to the employees for a successful retail management. The images that I am most familiar are those that depict an organization as a living organism and an instrument of domination. This is demonstrated in the manner in which an organization struggles to survive within a competitive environment. Employees are subjected to long working hours to ensure service delivery of goods and services to the customer beyond the normal working hours e.g. in supermarkets. Unfortunately, a reduction in consumer purchasing power leads to employees’ retrenchment as the retail outlet try to reduce the operational cost (Jones,

Using a range of company examples from global retailing, critically Essay

Using a range of company examples from global retailing, critically review the extent to which you think competitive advantage is due to the possession of unique resources - Essay Example Gaining competitive advantage by using the resources of the firm can include access to natural as well as other resources which can help organizations to stay ahead of the competition. This paper will discuss about four firms from retail industries and will discuss as to whether the competitive advantage possessed by each of the firm is based upon the unique resources possessed by them. By using different strategic frameworks and theories, this paper will focus upon how firms like Tesco, Carrefour, Wal-Mart and Aeon use their unique resources to gain competitive advantage and remain at the top of their industry. Frameworks and theories which will be used for analyzing the above thesis will range from Porter’s five forces model, Value Chain analysis, VRIO as well as Core Competences. By using these frameworks, this paper will analyze and explore as to how leading firms in retail industry has been able to use their unique resources to remain at the top of industry in which they are operating. Competitive Advantage is considered as the strategic advantage firms have over their competitors in the industry they operate. Achievement of a competitive advantage actually strengthens the position of a firm in the industry and business environment they operate. Competitive advantage theory suggests that businesses should produce and sell high end products and sell them at higher prices in the market. Michael Porter who outlined this theory suggested that organizations need to possess attributes or group of attributes which can actually distinguish them from others in the market. Competitive advantage is based upon the notion of resource based view which outlines that organizations can have certain resources which can actually distinguish from others in the industry. (Stalk, 1992) The resource based view suggests that firms possessing competitive advantage are primarily based upon the application of resources which are at the disposal of the firms. This

Movie Review, Review Example | Topics and Well Written Essays - 1500 words

, - Movie Review Example According to the due procedure of law, the law protects life, offers freedom or affluence. As the movie unfolds, Gideon is put behind bars, faces trail in the court of law and then imprisoned. Another significant thing to know about the procedures of the law is that, the law is above everyone, and this is defined under the 14th amendment. It falls under the clause referred as the Equal Protection Clause. According to this clause, everyone must receive justice as stipulated by the law. In the movie, this clause is reflected when; Gideon appears before Abe Fortas to get an appellate. Abe Fortas applies this clause to illustrate that a common person needs a lawyer. Together with that, attorney’s rights are not in the statute. Amendment 6th and 14th defines attorneys’ rights. According to this statute, the court of law should provide a lawyer, in case the defendant is unable to hire one. Gideon fought for the right of getting a lawyer from the state. With the assistance fro m Abes Fortas, Gideon managed to petition to the Supreme Court, and the appeal was successful. He was to have another trial, and the state gave him a lawyer and he was innocent. Lastly, for fair judgment, there should be change venue. In the second trial, Gideon wished to have his trial in other venues in order to receive fair judgment from different people. This paper shall discuss â€Å"Gideon Trumpet† with a view of evaluating the right to counsel. ... He wanted to know the conditions that necessitate one to have an attorney. Similarly, there is an on ongoing case about Betts vs. Brady, which is a 21 tears decision of the Supreme Court. The lower courts’ decisions are overruled by the Supreme Court decision, which holds that Bets of Mary was not provided with the attorney during his trial. During Maryland’s’ trial, an attorney was given to a person who was unable to hire a Lawyer, but this was only possible if the cases was classified under rape or murder. Having such a decision on hand, the Supreme Court held that, cases that were not classified under ‘rape or murder’ could not take advantage of having a lawyer provide by the state. These cases were classified as special cases, and it was held that, a lawyer was necessary if the defendant was regarded as uneducated, uninformed, having a mental disease of encountering an intricate situation. A major challenge with the special rule implemented was t hat, uneducated person was not entitled to petition for a case. The issue was very twisty that, uneducated person who does not get the advantage of getting an attorney was not capable of petitioning for case since he was incompetent in filling paperwork. Gideon was excluded from this provision and his insistence assisted him in filling for an appeal in the Supreme Court. It is very imperative to recognize the social and legal environment applied. Most of the appeals subject to â€Å"right to counsel issue† and the Supreme Court accept the petitions on different grounds. It is difficult for the Supreme court to implement a precise rule over that matter, and this means that, trials held by the lower courts are always

Monetarization of Environmental Assets Essay Example | Topics and Well Written Essays - 1750 words

Monetarization of Environmental Assets - Essay Example While this approach was reasonable in the past, the industrial revolution and its associated effects such as increased rate of population growth started to cause a substantial degree of human impact on the environment. Over the past two centuries, it has become increasingly clear to most environmentalists that human impacts on the environment are irreversible and this might eventually limit the ability of humans to continue thriving on the planet (Khalil, 1999). Over a period spanning the last three decades, there has been a global concern over this problem and the search is currently underway for the establishment of strategies that will aid in the minimization of human impacts on the environment while at the same time improving the quality of life of the billions of people that are currently living in abject poverty across the globe.Cost-benefit analysis is generally a comparison of the various increases in human well-being (benefits) and the reductions that humanity experiences in social welfare (costs) as applied to a given policy or action.In this regard, for a given policy or project to be able to qualify as being viable as based on cost-benefit grounds, its total social benefits must be found to exceed its total social costs. Whereas cost-benefit analysis is usually conducted for the specific project, the scope of this analysis can easily be extended to wider limits such as the assessment of the policies that have been designed to aid in the combating of climate change (OECD, 2007).

The Interviews Research Paper Example | Topics and Well Written Essays - 500 words

The Interviews - Research Paper Example The first step in carrying out qualitative analysis of informal or semi-structured interview data is to read carefully the transcripts while making notations in the margins (Fields, 2008, p. 183-193). These printed copies of interview transcripts are useful for analysis before they can be entered into the database of the software. It is advisable to break the long respondent soliloquies into single paragraphs in order to reflect the transition from one idea to another. In case one is not using a computer software package for analysis, it would be easier to insert line numbers onto every page of the transcripts to help in referencing in the course of the analysis. The second step entails developing the observations into preliminary interpretive and descriptive categories based on evidence that is presented in the transcripts, the conceptual or theoretical framework used in guiding the research, as well as one’s literature review (Fields, 2008,p. 183-193). Observations made in the first step are extended until possibilities and implications are played out in full. It is prudent at this stage or level to examine additional transcripts in order to determine whether the notion expressed is uniform in the remainder of the sample. Here, there is more engagement with the computer software packages for analysis where documents are entered into the system, and a memo written for every one of them. The memos are derived from the researcher’s field notes, as well as any thoughts they have had concerning the respondent since the interview’s date. The third step of analyzing the qualitative data collected from informal, semi-structured interviews consists of a thorough examination of the preliminary codes developed to further review the interview text (Fields, 2008, p. 183-193). This is done in order to develop pattern codes and

Sigmund Freuds Theories On Psychoanalysis In Cinema Essay

Sigmund Freuds Theories On Psychoanalysis In Cinema - Essay Example The conflict is that the film portrays these Freudian theories, but many of these theories have since been rebuked. The film becomes a satire by showing Freud's teachings, but subtly disputing and showing their errors. With Freud's belief that one's actions are mostly motivated by sexual urges and that these urges are based on the development of psychosexual stages, he limits an institution's ability to correctly diagnose and cure a mental patient. So in the film, although the patients represent various stages of Freud's theory, e.g., anal (Nurse Ratchet), oral (McMurphy), and so on, their treatment is limited by these basic categorizations. If the doctors and Nurse Ratchet did more than treat their basic symptoms they could have focused on true healing and tried to get to the root of the problem. Instead, patients were controlled through medication and lobotomies. Freud's Oedipus complex theory, that every man is in love with his mother and hates his father is illustrated in the film. The female in control of the hospital, Nurse Ratched, represents the mother figure. She controls the blood of patients. Based on Freud's theory, each of the men would love her, as the mother figure. ...The conflict occurs because of Nurse Ratched's abuse of such power. This causes confusion and a love/hate relationship with the men. They feel the urgings to love her as a mother, but are confused by her rejection and abuse.In this example, it would appear to be a reverse Oedipus complex in that the relationship goes the extreme opposite with the patients hating her. Still, the need to please exhibited by some of the patients still exhibits an Oedipus complex. The female figure or mother image is represented in a negative light throughout the film. Vera Harding, Candy, Nurse Ratchet all exert and abuse the power they have over men. Each of the men reacts in his own way: McMurphy resents her power; Chief shuts down emotionally; Billy Bibbitt craves the love his mother withholds.

Ibsen and his discontents Essay Example | Topics and Well Written Essays - 500 words

Ibsen and his discontents - Essay Example bsen, would yet appreciate that marriage, with all its flaws, is still better than its alternative (celibacy) and that human existence (more so in the confines of marriage) can never be perfect. Ibsen, on the other hand, simply asserts that marriage is the root cause of all evil and sadness in the world (Dalrymple, 2005). A gifted yet controversial writer, many people (mostly women) regard Ibsen as the writer who was not afraid to write about the ‘facts’ that others feared to write about. Ibsen looks at marriage and proposes new ways of approaching it that, according to him, will liberate mankind from the relentless strife and turmoil present in marriages. Ibsen first reckons that most people marry for money and that there is no true love in marriages hence. He says that women go for the security and pride in marrying rich made men while men opt for women who are cheap to manage financially. Secondly, Ibsen underlines that societal pressures put a lot of pressure, and thus melancholy, in couples who have to put up appearances in the public which are contrary to their genuine feelings and selves. He adds that notions of respectability and the fear of shame (such as of a struggling/ broken marriage) enslaves married couples and renders their lives meaningless, miserable, degraded and viole nt (Dalrymple, 2005). Ibsen also insinuates that marriages pair people who would not choose each other if circumstances of life had been better/ different. In the wake of these marital and life ‘issues,’ Ibsen offers a solution - philosophical autonomy (Dalrymple, 2005). This is basically the call for each person to live according to their own standards/ principles, put self first (ahead of the partner and children) and pursue their own desires. Theodore disagrees with this remedy and records that he has seen countless such minded parents who abandon their children and so subject them to lives of despair, damage, disease, moral degradation and death. According to Theodore,

Cross Media Assignment Essay Example for Free

Cross Media Assignment Essay In the first part of My Cross Media Assignment, I analysed, ‘L’Oreal Casting Crà ¨me Gloss.’ This advert cast Cheryl Cole, the nation’s sweetheart, in an advertisement for hair dye. This advert inspired me, to develop a beauty product, because it is such a big market here in the U.K. I took a close look at what Cheryl’s make-up was, and it was neutral and fresh, this was, apart from her eye shadow. As a result of this, I decided to design an eye shadow. I conducted research into Barry M’s Dazzle Dust, because their print ad’s are always flamboyant, and are interesting to look at. They use bright eye shadow, and usually darker coloured backgrounds to make the image ‘pop’, and stand out to the audience. The unique selling point of Dazzle Dust, is all the colours that it comes in, this makes the product unique. I decided to take a different route, and develop a product that women can use for the day and then for the night. I matched my product, Day n Night, to my target audience, because I think that women would want to own a product that they can use in the morning, when they go to work, and then they can use it straight after work, as a top up, using different colours, to go out for a drink with her friends. I think that my product appeals to women, because it is compact, useful, and there is a gap in the market for a product like mine. I planned my advert, by going to high street make-up retailer, House of Frasier, and I researched the eye shadow industry, and found that the adverts for the Day are very different from the ones that show a ‘night look’. The ‘Daytime’ look for most eye shadows is, a corporate woman looking clean. She normally has a very light Smokey eye, with a pink tint to blend. Whereas in the night look’ the woman has darker eyes, with black as a liner, and dark greys to blend. I decided for my advert that I would use the same woman, in two different situations, wearing two different styles of eye shadow, so that you can see a visible difference. I constructed my brand identity by using two colours, purple and lilac, the purple represents the night look, whereas the lilac shows the day look. I decided not to give my product a slogan, because I realised that women’s make up doesn’t generally have slogans, because if a woman sees a good advert, she will buy the product, and if she likes it, she will buy it again. I made the product represent all women, because in the U.K it is a frequently occurring thing, to see women go out with their friends after a day at work. I did not use a model for my print advert because I wanted my advert to be relatable to women, and give them a real product, rather than some product the celebrity endorsing it doesn’t use. The workplace I decided to use was a secretary’s desk, trying to show that you do not need to hold down a high paying job, to be able to buy the product. The only regulations that I might possibly face in my advert, is when the women goes out for a drink with her friends. There are restrictions in using alcohol in television or in print adverts, because Alcohol advertisements often portray alcohol as enhancing economic success, fun, attractiveness to the opposite sex, athletic skill, and social popularity, and this is the wrong message to send and is therefore not allowed. To prevent my advertisement to be subject to this, I have made sure that the alcohol is never directly seen, it is always mixed in a glass with something else, and the women are not sexualised, in anyway, and when you see men, looking at the woman with the eye shadow on, it is clear to the audience that they are not drunk, and that they haven’t been drinking. Looking back at my advert, I think that I could improve my television advert, because I do not think that in my storyboard, I showed off the product enough, and it was a little vague. Although I think I did meet the audience’s needs, and I did produce a product that I am pleased with, and I thought, there was a gap in the market for. I think on reflection, that my eye shadow box, was the best thing that I did concerning my whole assignment, and I am entirely pleased with my body of work, although there could have been some improvements made.

Measuring Levels of Patient Dependency

Measuring Levels of Patient Dependency Title: Should patient dependency be used to set nurse-staffing levels in general hospital wards? Introduction: In this section, we perform a literature review to discuss patient dependency in clinical settings, and examine how we can measure patient dependency levels. We also discuss whether patient dependency levels should and could form the criteria for setting nurse-staffing levels in the hospital. We will also analyze the other different methods and criteria that can help to determine nurse staffing levels within the clinical setting. Patient dependency levels indicates the requirements of nurses and the extent to which patients will need nurses for their continuous care. Nurse patient ratios are often used to discuss the nurse staffing levels and these figures indicate whether staffing levels have to be increased or decreased. We would aim our discussion of patient dependency necessitating increase in staffing levels and the patient nurse ratio as indicators of nurse staffing both within general hospital wards and at critical care and emergency units. Evidential Information Patient dependency may just form an important part of nursing staff and workload of an individual nurse. Hurst (2005) conducted an important study on the nature and value of dependency acuity quality (DAQ) demand side nursing workforce-planning methods, which are set in the context of nursing workforce planning and development. Extensive DAQ data was obtained from UK nursing workforce in 347 wards, which involved 64 high quality, and 62 low quality hospital wards. The study gives special consideration to workload and quality contexts. New insights have been generated with this study and Hurst emphasizes that poor quality care is more common in larger wards that have fluctuating and unstable workload and nurse – patient ratio. Smaller workloads having consistent and high workload of nursing staff results in inflexible nurse staffing so staff levels and performed duties remain the same. Studies definitely suggest that nursing activity and staffing differences do form an importan t part of defining and contributing to the quality of the wards with higher staffing levels and more consistent work for nurses at high quality wards and lower staffing levels and irregular services with low nurse-patient ratio in low quality wards. From this evidence, it is possible to provide recommendations for nursing management and practice and probe into more accurate relations of dependency acuity quality in DAQ measures. In a study using assessment of patient nurse dependency systems for determining nurse-patient ratio in the ICU and HDU, Adomat et al (2004) point out that a huge range of patient classification systems or tools are used in critical care units to inform workforce planning, and nursing workload although the application of these methods may not always be relevant, complete or appropriate. The systems or tools used for patient classification and categorization were developed solely for the purpose of more efficient distribution of patient across hospital sections, although now the same systems are used for workforce planning, distribution of workload, determining nurse-patient ratio in critical care settings. However these changes can raise a number of issues related to workforce planning, staffing levels and nursing management in general. Adomat and Hewison evaluate the three main assessment systems used in critical care units to effectively determine the necessary nurse-patient ratio t hat can provide the best quality service in the wards. The application of these tools is to enhance the quality of care by keeping nurse-patient ratio at its optimum. The authors suggest that decisions relating to workload planning and determining the nurse patient ratio are dependent on an understanding of the origins and purpose of the classificatory tools that categorizes patients and measures their dependency on care services. Patient dependency and classification systems as well as patient dependency scoring systems for severity of illness are measures indicating mortality and morbidity although Adomat points out that these dependency measure may not be real indicators or determinants of the nurse-patient ratio that help in measuring nursing input. The costs of providing a nursing service within critical care uses nursing intensity measures to give a framework for nursing management and patient care and also determines the exact role of patient dependency in nurse staffing leve ls. However, components of the nursing role and how it determines standards of care have not been fully determined (Adomat and Hewison, 2004). They point out that careful consideration of patient dependency and classification systems may be necessary to plan, organize and provide a cost effective critical care service. In a similar study, Adomat and Hicks (2003) evaluates the nursing workload in intensive care a there is a growing shortage of nurses in these care units. The problem identified in this shortage lies in the method for calculating the nurse/patient ratio using the Nurse Workload Patient Category scoring and classificatory system use in most intensive care units. The nurse-patient ratio is determined by using the patient category or dependency scales and the general assumption is that the more critically ill a patient is, the more care and nursing time will be required for the patient. Many critically ill patients placed on a high level of mechanical care such as a feeding or ventilator tube and in intensive units may however require less direct personal nursing care than patients who are self ventilating or have been considered to have lower levels of dependence. Thus patient dependence may be addressed by means other than direct nursing care and artificial care and support systems may b used instead of nursing staff. These and other factors show that patent dependency may not be a completely relevant measure for determining nurse –patient ratio or nurse staffing levels and many associate factors have to be considered. This study by Adomat and Hicks use a video recorder to document nurse activity in 48 continuous shifts within two intensive care units and helped to determine the accuracy of the Nursing Workload Patient Category scoring system to measure nurse workload. The data obtained from the video of nurse activity was then correlated with the Patient category scale score that was allocated to the patient by the nurse in charge. The results of this study showed that the nursing skills required in these care units were of low skill type despite the needs of care being complex in general. It was found that nurses spent less time with patients who were categorized as in need of intensive care than those in need and in high dependency range in all units. T he findings indicate that existing nurse patient ratio classifications are inappropriate as nurses spend less and less time with critically ill patients. The authors expose the flaws of classification or scaling systems that tend to correlate care with critical illness. They suggest that radical reconsideration of nursing levels and skills mix should make it possible to increase provisions and levels of intensive care providing the right numbers of staff at the appropriate units where patients need them most suggesting more flexible and alternative approaches to the use of nurse-patient ratios. In a similar study discussing relationship between workload, skill mix and staff supervision, Tibby et al (2004) proposes a systems approach and suggests that hospital adverse events or AE are more likely when sub-optimal working conditions occur. Proper working conditions are thus absolutely necessary to ensure the smooth working of the clinical setting. Tibby and colleagues analyzed the adverse events in a pediatric intensive care unit using a systems approach and observational study to investigate the association between the occurrence of these adverse events and latent risk factors including temporal workload, supervision issues, skills mix, nurse staffing and the interactions between established clinically related risk factors (Tibby et a, 2004). The data was collected form 730 nursing shifts and the analysis was done with logistic regression modeling. The rate of adverse events was 6 for every hundred patient days and the factors associated with increased AE including day shift , patient dependency, number of occupied beds, and simultaneous management related issues although these were considerably decreased with enhanced supervisory ability of the nurses. Decreased number of adverse events have been found to be related to the presence of a senior nurse in charge, high proportion of shifts handled by rostered, trained, permanent staff and the presence of junior doctors. Patient workload factors such as bed occupancy and the extent to which the patient needs help and nursing supervisory levels and level of staffing such as presence of a senior nurse have been found to be associated. This study sheds light on the factors increasing or decreasing adverse events and helps in identifying the issues closely related to the need of regulating and optimizing nurse staffing levels. As we have already suggested through a study by Adomat and Hicks, patients in high dependency units may require more frequent nursing care and higher nurse-patient ratios than critical care units where patients may be supported by artificial methods. According to a study by Garfield et al (2000) high dependency units are increasing in the hospitals and becoming more important as part of a hospital’s facilities. Although the optimum staffing ratio for patients is unknown for such units, the Department of Health and Intensive Care Society recommend a level of one nurse for every two patients. Garfield et al recorded Therapeutic Intervention Scoring System scores and Nurse Dependency Scores in high dependency units over 7 months. The results indicated a weak correlation between nurse dependency score and therapeutic intervention scoring system score. The authors argue that a nurse-patient ratio of 1:2 may be insufficient for the management of a high dependency unit and based on t heir findings recommends a nurse to patient ratio of 2:3. Balogh (1992) points out that the literature on audits of nursing care shows a strong relation between the quality of nursing care provided and nursing labour force and staffing issues. Balogh suggests that all assumptions for setting nurse staffing levels on the basis of variations in patient dependency are unscientific and there are moreover no opportunities to use personal judgment in decision-making within hospitals to determine nurse-patient ratios. Balogh points out that such methods for determining staffing levels as well as audit instruments are outdated and insufficient to optimize service levels. The paper highlights the need for greater flexibility, more decision making power, and a more significant role of nurses’ personal judgment in selection and management of appropriate nurse staffing levels in dependency and critical care units. Conclusion: In this review of literature on the exact role of patient dependency in determining nurse staffing levels, we began by suggesting that it is generally believed that the more critical condition a patient is in, the higher the requirements of direct care suggesting that nurse patient ratio should be high in critical care units. This assumption however has been refuted by studies which shows that such clear criteria may not be sufficient for nurse management and staffing level decisions and other factors have to be considered. These include artificial means of life support and other mechanical devices that minimizes the need for manual staffing and reduces a critical patient’s nursing needs. A related study suggested that high dependency units rather than critical care units should be provided with higher levels of staffing although many other factors such as supervisory levels of senior nurses, skills available and already established method of determining nurse patient ratios s eem to be crucial factors. Along with the approach taken by several authors we can also suggest that personal judgment of nurses on the care needed by patients rather than inflexible scaling or scoring systems should be used by hospitals to determine staffing levels, considering patient dependency levels as well. Bibliography Adomat R, Hicks C. Measuring nursing workload in intensive care: an observational study using closed circuit video cameras. J Adv Nurs. 2003 May;42(4):402-12. Adomat R, Hewison A. Assessing patient category/dependence systems for determining the nurse/patient ratio in ICU and HDU: a review of approaches. J Nurs Manag. 2004 Sep;12(5):299-308. Ruth Balogh Audits of nursing care in Britain: A review and a critique of approaches to validating them International Journal of Nursing Studies, Volume 29, Issue 2, May 1992, Pages 119-133 The importance of data in verifying nurse staffing requirements Intensive Care Nursing, Volume 4, Issue 1, March 1988, Pages 21-23 Lynne Callaway and Edward Major Curtis C. A system of measurement of patient dependency and nurse utilization. Aust Nurses J. 1977 Apr;6(10):36-8, 42. Donoghue J, Decker V, Mitten-Lewis S, Blay N. Critical care dependency tool: monitoring the changes. Aust Crit Care. 2001 May;14(2):56-63. Garfield M, Jeffrey R, Ridley S. An assessment of the staffing level required for a high-dependency unit. Anaesthesia. 2000 Feb;55(2):137-43. Hurst K. Relationships between patient dependency, nursing workload and quality. Int J Nurs Stud. 2005 Jan;42(1):75-84. Hearn CR, Hearn CJ. A study of patient dependency and nurse staffing in nursing homes for the elderly in three Australian states. Community Health Stud. 1986;10(3 Suppl):20s-34s. Miller A. Nurse/patient dependencyis it iatrogenic? J Adv Nurs. 1985 Jan;10(1):63-9. OBrien GJ. The intuitive method of patient dependency. Nurs Times. 1986 Jun 4-10;82(23):57-61. Prescott PA, Ryan JW, Soeken KL, Castorr AH, Thompson KO, Phillips CY. The Patient Intensity for Nursing Index: a validity assessment. Res Nurs Health. 1991 Jun;14(3):213-21. Seelye A. Hospital ward layout and nurse staffing. J Adv Nurs. 1982 May;7(3):195-201. Tibby SM, Correa-West J, Durward A, Ferguson L, Murdoch IA. Adverse events in a paediatric intensive care unit: relationship to workload, skill mix and staff supervision. Intensive Care Med. 2004 Jun;30(6):1160-6. Epub 2004 Apr 6. Williams A. Dependency scoring in palliative care. Nurs Stand. 1995 Oct 25-31;10(5):27-30. For scoring systems Depatment of health – www.dh.gov.uk Department of Health (2000) Comprehensive Critical Care; a review of adult critical care services. London. The stationary office. Its also available from the Department of health website.

How the heart functions as a pump

How the heart functions as a pump The objective of this essay is to show how the heart functions as a pump in transporting oxygen to the different parts of the body and how reduction in coronary blood flow can impair the cardiac function. The first part of the essay describes the location, structure, electrical activity within the heart and how the heart transports oxygen throughout the body. The second part describes how reduced coronary blood flow in case of a disease can impair blood flow and its treatment. The heart forms an integral part of the cardiovascular system whose primary function is the maintenance of hemodynamic and homeostatic functions such as maintenance of body temperature, transport of nutrients to the cells, removal of waste materials, transport of oxygen and hormones. [8,1] Heart Location The human heart is like a cone shaped organ composed of four different chambers and is located obliquely across the chest midline with its tip behind the fifth left intercostal space. It weighs on an average between 250-350 grams in adults and is approximately the size of a human fist. [2] An average human heart beats on an average of 75 beats per minute and pumps more than 200 million litres of blood in 80 years. [3]. Although the heart is located in the centre of the chest cavity its beating action is felt on the left side of the chest cavity since the most powerful pumping action of the ventricles of the heart takes place towards the base of the heart which is located in the left side of the chest cavity. [2] The figure below shows the location of the heart in the body. Fig1: Location of the Heart [8] Lecture Physiology and Anatomy- Cardiovascular System Alan Richardson; slide no. 8 The heart is enclosed in a multi-layered sac known as Pericardium which protects the heart by reduction of friction and prevents excessive expansion. Between the different layers of the pericardium (visceral and the parietal layers), the pericardial cavity is present which holds about 5-15 ml of Pericardial Fluid that reduces the friction created due to the movement of the heart. [3] The heart wall consists of three different layers Epicardium (outer layer), Endocardium (inner layer) and Myocardium (middle layer). The 2picardium and the endocardium are both made of simple squamous epithelial cells and a thin areolar tissue layer. However the myocardium is the thickest amongst all the three layers consisting of the heart muscles and its thickness in each chamber of the heart depends upon the amount of force generated by which chamber during the pumping action. [3] The figure below clearly shows the various layers of the heart wall. Fig2: Layers of the Heart wall [9] Structure of the Heart The heart is divided into two different halves depending upon the kind of blood (deoxygenated or oxygenated) received right and left halves. The heart consists of four different chambers with an atria and a ventricle on each side. The atria have relatively thinner walls since they only have to pump the blood to much shorter distances than the ventricles. [4].The atria connect to the ventricles by means of atrioventricular valves (tricuspid in the right half, bicuspid in the left half). The atrioventricular valves are connected to the base of the ventricles by chord like structures known as the chordate tendinae that prevent the valves from swinging in the opposite direction and thus prevent the back flow of blood into the atria from the ventricles. [3,5] The two atria are separated from one another by means of a muscular wall known as the interatrial septum. [3] The atria and the ventricles are separated by means of a fibrous connective tissue known as annulus fibrosis, this helps i n giving a skeleton for attachment of the muscles of the heart and help in providing the site of placement of the heart valves. [4] The ventricles are the lower and the larger chambers of the heart. The two ventricles are separated from one another by means of a thick muscular wall known as the interventricular septum. The right ventricle is connected to the pulmonary artery by means of the pulmonary semilunar valve while the left ventricle is connected to the aorta by means of the aortic valve. [3]. On the surface of the heart the heart chambers grooves are marked by fatty layers containing coronary blood vessels these layers are also known as Sulci.[3] Blood Flow in the Heart The deoxygenated blood from the various parts of the body flows into the heart by the pair of vena cava into the right atria. The blood flowing from the upper part of the body relative to the heart is carried by the superior vena cava while the blood flowing from the lower part of the body relative to the heart is carried by the inferior vena cava. [8] The cardiac muscles empty their deoxygenated blood into the right atria by the coronary sinus. The deoxygenated blood is pumped from the right atria into the right ventricles through the right atrioventricular valves (tricuspid valve) upon atrial sytole and ventricular diastole. The blood in the right ventricles is then pumped into the pulmonary artery through the right semilunar valve (pulmonary valve) to the lungs for oxygenation upon ventricular systole. However, during the ventricular systole the semilunar valves do not open unless the pressure generated in the ventricles due to contraction (systole) is sufficient to push open the valves, such contraction is known as isometric contraction. The pulmonary artery bifurcates into two smaller branches the left and the right pulmonary artery (one for each of the lungs). The pulmonary vein from the lungs brings the oxygenated blood from the lungs into the left atria of the heart which then pumps the blood into the left ventricle through the bicuspid valve (mitral valve) during atrial systole and ventricular diastole. The left ventricle pumps the blood to the different parts of the body through the aorta through the aortic valve during ventricular diastole. The hearts muscles are themselves are supplied by oxygenated blood from the coronary artery branches present on the aortic arch. [3] The figure below shows the various chambers of the heart along with the flow of blood within the heart. Fig3: Blood Flow within the heart [8] Lecture Physiology and Anatomy- Cardiovascular System Alan Richardson, Slide no 12 Blood enters the chambers during the diastole (relaxation) phase and is pumped out during the systole (contraction) phase. As a result, the blood is under a higher pressure in the systolic phase than the diastolic phase. The blood pressure is the pressure exerted by the blood upon the walls of the blood vessels.[5] The blood pressure on the walls of the artery in a healthy individual lies around 80mm Hg for diastole and 120mm Hg for systole. [4] The valves of the heart prevent the back flow of blood and thereby only allow the unidirectional flow of blood. [5] The circulation of deoxygenated blood to the lungs and oxygenated blood back to the heart is known as pulmonary circulation while the circulation of oxygenated blood to all the parts of the body and deoxygenated blood from the various parts of the body into the heart is known as systemic circulation.[5] The entire process is displayed in the figure below. Fig4: Systemic and Pulmonary Circulation [10] Electrical Conduction within the Heart and Heart Beat The cardiac impulse trigger is generated by the group of specialised cells which together form the sino-atrial node (SA node). The SA node is present in the right atrium near the point of attachment of the superior vena cava. The cells in the SA node generate the impulses spontaneously as they are capable of spontaneous depolarisation, hence they are said to possess automaticity. [6] Due to these spontaneous impulses the SA node forms the atrial pacemaker. These electrical impulses are spread throughout the walls of the atrium by means of specialised pathways known as the Bachmanns Bundle, thereby causing the stimulation of the myocardial walls of the atria to contract and push the blood into the ventricles. The wave of electrical excitation travels from the atrial walls via specialised pathways called internodal tracts from the SA node to the Atrioventricular (AV) node. The AV node is also composed of similar autorhythmic cells as the SA node and is capable of pacing the heart in case the SA node fails in pacing and is located in the right side of the interatrial septum. However the pacing of the AV node is slower than the SA node and it thus provides the critical delay in the electrical conduction system, preventing the simultaneous contraction of both the atria and the ventricles. The distal portion of the AV node is known as the Bundle of His which then divides into the two bundle branches for spreading the electrical excitation to the two ventricles. The bundle branches are present along the interventricular septum and end at the tip of the heart by further differentiating into numerous small fibres known as Purkinje fibres. The Purkinje fibres are responsible for depolarising the individual myocardial cells of the ventricles. Thus causing the ventricles to contract and push the blood into the pulmonary artery or the aorta. [3] Blood circulation and Transport of Oxygen The blood vessels and capillaries are the pipes which carry blood throughout the body for metabolic, waste and gaseous transport. The blood vessels include arteries, arterioles, veins and venules. Arteries carry the oxygenated blood away from the heart with the Aorta being the largest artery. Since the artery carry blood in jerks and under high pressure they are surrounded by smooth muscles which prevent it from collapsing. The resistance to blood pressure is controlled by the autonomic nervous system which controls the width of the artery (lumen) through which the blood passes (vasoconstriction and vasodilation). The arteries further divide into smaller divisions known as arterioles which carry blood to smaller parts of the body. The arterioles are also covered with smooth muscles and like the arteries also resist any changes to the blood pressure. The arterioles further differentiate into smaller blood vessels known as capillaries which possess an extremely thin wall so as to allow the exchange of oxygen with the individual cells and carbon-dioxide from the cells. Apart from the exchange of gases the metabolic exchange of nutrients and wastes are also possible at the capilla ries. Several billions of capillaries then join together to form the venules which are smaller blood vessels carrying the deoxygenated blood from the capillaries to the veins. The veins are the formed by the integration of millions of smaller venules and it carries the deoxygenated blood back to the heart. The blood in the veins does not flow under considerable high amounts of pressure and hence the walls of the veins are not as thick as those of the artery. The veins join together to form the two vena cavas. [8] The transfer of oxygen from the blood into the cells at the capillaries is explained by the process of diffusion. Diffusion is the process of movement of particles from their region of higher concentration to a region of lower concentration. Thus in the capillaries the oxygenated blood has a higher concentration of oxygen than that present outside the capillaries in the surrounding cells. At the same time there is higher concentration of carbon-dioxide in the surrounding cells than the oxygenated blood in the capillaries. Hence the oxygen from the blood in the capillaries diffuses out into the surrounding cells while the carbon-dioxide from the surrounding cells diffuses into the capillaries. Thus the oxygenated blood from the lungs passes into the heart which pumps it into the aorta which divides into the arteries which further divides into arterioles and then capillaries. The capillaries then exchange the oxygen with the cells and take carbon-dioxide from the cells and rejoin to form the venules which then form the veins which return the deoxygenated blood back to the heart. Thus the heart acts a pump in the entire cardiovascular system which transports the oxygen to the different parts of the body and carbon-dioxide from the different parts of the body. The figure below shows the overview of the cardiovascular system. Fig5: The Cardiovascular System [11] Reduced Coronary Blood Flow and Coronary Artery Disease The heart needs to perform all the time in the body and can never relax, hence the cardiac muscles have a high demand for oxygen and have very limited capacity for anaerobic respiration. [7] The chest pain which is felt in the patient due to the obstruction of the blood flow in the coronary arteries is known as Angina Pectoris. This deposition of the plaque and lipid layers within the coronary blood vessels thereby causing the hardening and narrowing of the blood vessels is known as Atherosclerosis. Due to the obstruction the cardiac cells are deprived of oxygen and start anaerobic fermentation resulting in the formation of lactic acid. The lactic acid formation in the heart stimulates the pain receptors present in the heart. [3] Depending upon the type of plaque formation in the coronary blood vessel the angina might be termed as stable or unstable. [8] Thus with the reduced coronary blood flow the cardiac output of the heart is severely impaired since the muscles of the heart are deprived of oxygen and nutrients resulting in tissue death or myocardial infarction. Hence the heart is not able to pump properly and thus has a reduced cardiac output. Myocardial Infarction causes severe pain and can even cause death to the patient. [6] The blood flow to the target cells can be increased by vasodilation and thereby allowing more blood to flow through them. This can be done by using organic nitrate medications which release nitric oxide (NO) into the blood stream. Medications known as beta blockers (ÃŽ ²) which also cause of the coronary artery vasodilation can also help in the treatment of the condition in the same manner. Apart from medications surgically also the condition of reduced coronary blood flow can be treated by coronary bypass surgery where the atherosclerotic narrowing of the coronary artery is bypassed by a blood vessel which is grafted from any other part of the patients body. There also is the possibility of performing other angioplasty operations such as balloon angioplasty, etc. [7] The therapeutic goals in treating stable angina are to improve the coronary blood flow to the target cells and reduce the cardiac oxygen demand. While in the treatment of unstable angina steps are taken to prevent the occurrence of myocardial infarction Conclusion The heart acts as a muscular pump which pumps blood throughout the lifecycle beating at an average of 72 beats a minute and pumping 200 million litres of blood in 80 years. [3] The cardiovascular system consists of several different components, the pump (heart), an extensive piping network (blood vessels and capillaries) and finally a working fluid (blood). The heart receives deoxygenated blood from all over the body pumps it to the lungs for oxygenation and receives the oxygenated blood from the lungs and pumps them to the different parts of the body. The piping network includes arteries, arterioles, veins, venules and capillaries. The capillaries are the site of gaseous exchange where the exchange takes place by diffusion. Reduced coronary blood flow impairs the cardiac output by starving the cardiac cells of oxygen and nutrients carried by the blood.

Lord Of The Flies: Can Someone Be Innately Evil Or Innately Good? :: essays research papers

The difference in the way humans perceive things is part of the complexity of mankind. What is thought of as evil to one person can be seen as good to another, and vice versa. The issue of good and evil is brought up in William Golding’s Lord of the Flies, when innocent boys are set on an island to bear the weight of society on their backs. What happens to them? How do past influences effect them? Are their actions good or evil? The actions of the boys were not a matter of being good or evil, but were actions for survival. A man’s environment does not influence him towards good or evil, nor is he born with it inside. Man has instincts and inner drives that are not matters of good and evil, but of survival.   Ã‚  Ã‚  Ã‚  Ã‚  Humans are always, by natural instinct, going to do what is best for them and their survival. Animals, much like men, kill when in need. For instance, when they feel they are backed into a corner, they will attack, and when they need food, they will kill to eat. In Lord of the Flies, Ralph was being hunted by Jack’s tribe, and in a desperate attempt in his defense, he thrust his spear through a crack at the inspecting savages. Ralph attacked someone of his own kind for his own survival. It can be believed that man is the derivative of others animals, and as such, they have certain instincts that were instilled from birth. The boys on the island later began to resemble the behavior of animals. â€Å"At once the crowd surged after it, poured down the rock, leapt on to the beast, screamed, struck, bit, tore. There were no words, and no movements but the tearing of teeth and claws† (153). William Golding’s description of this scene leads a reader to believe that these boys took on animal like qualities. What kind of human tears with teeth and claws? The boys mistake Simon for their beast and result in ruthlessly killing him. In their state of mind of savagery and hunting, they saw themselves in danger of this â€Å"beast† and their first instinct was to kill anything in sight that had the possibility of being it. Humans and animals have a natural instinct to protect themselves in the face of danger, like attacking when backed into a corner. Lord Of The Flies: Can Someone Be Innately Evil Or Innately Good? :: essays research papers The difference in the way humans perceive things is part of the complexity of mankind. What is thought of as evil to one person can be seen as good to another, and vice versa. The issue of good and evil is brought up in William Golding’s Lord of the Flies, when innocent boys are set on an island to bear the weight of society on their backs. What happens to them? How do past influences effect them? Are their actions good or evil? The actions of the boys were not a matter of being good or evil, but were actions for survival. A man’s environment does not influence him towards good or evil, nor is he born with it inside. Man has instincts and inner drives that are not matters of good and evil, but of survival.   Ã‚  Ã‚  Ã‚  Ã‚  Humans are always, by natural instinct, going to do what is best for them and their survival. Animals, much like men, kill when in need. For instance, when they feel they are backed into a corner, they will attack, and when they need food, they will kill to eat. In Lord of the Flies, Ralph was being hunted by Jack’s tribe, and in a desperate attempt in his defense, he thrust his spear through a crack at the inspecting savages. Ralph attacked someone of his own kind for his own survival. It can be believed that man is the derivative of others animals, and as such, they have certain instincts that were instilled from birth. The boys on the island later began to resemble the behavior of animals. â€Å"At once the crowd surged after it, poured down the rock, leapt on to the beast, screamed, struck, bit, tore. There were no words, and no movements but the tearing of teeth and claws† (153). William Golding’s description of this scene leads a reader to believe that these boys took on animal like qualities. What kind of human tears with teeth and claws? The boys mistake Simon for their beast and result in ruthlessly killing him. In their state of mind of savagery and hunting, they saw themselves in danger of this â€Å"beast† and their first instinct was to kill anything in sight that had the possibility of being it. Humans and animals have a natural instinct to protect themselves in the face of danger, like attacking when backed into a corner.

Comparing Websties of Popular Newspapers -- News Internet Web Computer

Comparing Websties of Popular Newspapers The Internet has become a very powerful tool in gathering news and information. Websites can direct individuals to literally thousands of stories pertaining to world affairs, national news, arts, sciences etc. that would normally not be found in televised or printed news. Not only can the Internet provide a superior quantity of information, but it also gives individuals the freedom of choice in what they read and view. Normal news outlets cannot give an individual this freedom, and due to the flexibility of the Internet, many people are rejecting traditional sources for news and media and obtaining their daily news via the Internet. Still, the newspaper industry has not been blind to the building popularity of Internet news. In fact, many newspapers are discovering that the use of the Internet is a low-cost way to increase readership and to increase revenues through advertising. Because of this, familiar newspapers such as the â€Å"New York Times,† the â€Å"Wall Stree t Journal† and the â€Å"Washington Post† have begun posting daily editions of their papers online. Each newspapers’ website can be viewed via the following links - http://www.nytimes.com/: http://online.wsj.com/public/us: http://www.washingtonpost.com/?LOAD_PAGE&reload=true. The remainder of this paper will compare the strengths and/or weaknesses of each sites’ layout, evaluate the variety of news content on each site, and try to determine the possible readership each paper is attempting to appeal to. These three particular newspapers are chosen due to their comparable fame and resources. This is important when evaluating a paper’s content because limitations in resources could restrict how effectively a paper can cover brea... ...d easily explain the higher focus on the fine arts found the NYT. Although no single newspaper of the three is superior to another, one should easily be able make a selection after evaluating each newspapers’ website for quality layout, diverse and detailed content, and after examining each site in attempt to determine a typical readership for each paper. The NYT and the WP both have skillfully designed websites, while the WSJ website lacks certain elements that make the other two sites seem more clean. However if you consider yourself a businessperson, the WSJ provides a much greater volume of business related stories that either the WP or the NYT. For more coverage of world affairs and the fine arts and sciences, the NYT is the paper of choice. Finally, to obtain additional political information or stories of human-interest, the WP is the paper of choice.

Jean Watson theory Essay

Jean Watson’s Philosophy of Nursing NUR/403-Theories and Models of Nursing Practice August 9th, 2010 Introduction Jean Watson’s theories of nursing are instrumental in today’s structure of nursing. Watson’s theories are being practiced in various health care setting all over the world. One of these theories in the nursing process. This entails first assessing patient, planning, intervention and evaluation. There is multitude of research proving these theories to be effective in treating and caring for patients with this consistent approach. In this paper I will dissect her different carative factors learned and that is being practiced. I will discuss different examples of Watson’s theories of caring and its application. This will depict the level of importance and how valuable this approach certainly is. Nursing is also being based on more scientific approaches that Watson’s bases some of her theories. This is consistent with the changing nature of the philosophy of science and history, and the numerous methods for the advancing knowledge of nursing. Watson (19 99) Watson’s Theories Watson’s research is more focused on the caring aspect of it all. Caring is viewed as the moral ideal of nursing where there is utmost concern for human dignity and preservation of humanity as stated by Watson (1999). This focal point of her theory is the foundation in the science of nursing. Watson believed the center idea for nursing are based on various carative factors. These factors include humanistic- altruistic values, systematic use of the scientific problem-solving method for decision making, gratification of human needs, promotion of interpersonal teaching and learning. They also include qualities such as sensitivity to self and others, the need to instill faith and hope, creating trusting relationships, and promoting acceptance, positive feelings, making provisions for a supportive, protective and corrective mental, physical, socio-cultural and spiritual environment. Watson, J., & Foster, R. (2003). One imperative factor is the development of different transpersonal caring relationship. This is the concept of professional involvement with the participation of one’s entire self, using every dimension of a person as a resource in the professional relationship, This depicts a special kind of human caring relationship, a connection with another person, in high regard for the whole person and their sense of being. Human care begins when the nurse enters the space or field of another person, and is able to detect the other person’s condition, spiritually and emotionally, and can feel this condition within themselves, and responds in a way which the recipient feels open enough to convey and share those feelings longing or needed to be shared. (Watson, 1999). She believed that nurses should have and also further develop an approach of humanism, simply being able to convey common human feelings. Her teachings proves that effective caring promotes health in each individual and their well being. Conducive to health is also what a person’s perception of health is, as states by Watson, (1999). Watson believed that everything around us should be conducive to our wellbeing, whether it being creating a wholesome environment or nursing to our specific needs. For example just simply being in a clean environment can improve a person’s overall mood and thus enhancing chances for recovery. The act showing compassion and empathy is also pertinent to for one to achieve wellness. In experience, just the simple act of smiling conveys the feeling of caring. Cara (2003). For example, upon assessing a patient, just greeting them with a warm smile with direct eye contact can be a comforting feeling. It conveys sincerity and starts the process of a trusting nurse-patient relationship. Cultivating sensitivity to oneself and to others. This carative factor explores one’s ability to self assess as well assessing others. This explores the need of the nurse to feel or to begin to feel an emotion as it presents itself. If one’s own feelings aren’t properly developed or one does not know how to channel their own feelings, showing sensitivity to others may not be very successful. These feelings should be developed for one to interact with others on a genuinely sensitive level. Showing sensitivity among one another creates a higher level of  functioning within transpersonal relationships. Watson (2009). An experience I had with a patient comes to mind. A young man admitted to the hospital with multiple infections. He is observed to be very rude, sarcastic and shows a very negative attitude towards himself and his care providers. Upon receiving report about the patient, I felt reluctant in caring for him. The nurse stated he was unappreciative, obnoxious, demanding, and seemed very bitter. Upon greeting him and physically assessing him, I was cautious to thet kinds of questions I asked him. I was especially cautioushow I asked any questions and also my tone of voice. Upon making sure he had all his comforts and all requests were met I offered to share with him some details about my life. He listened keenly and I felt his interest. Soon after, he started sharing with me very personal details of his life as well. As Watson (1999) explained, nurses should spend uninterrupted time with your patients, commonly referred to as â€Å"caring moments.† He was depressed from being in and out of the hospital every other week. He was newly married and had a newborn baby, which he never got to spend time with or was able to help take care of. That quickly gave me insight to why he had such a negative disposition and also enlightened me to the sensitive manner in which he needed to cared with . Self awareness and actualization is an important component in having meaningful intrapersonal relationships. We should all strive to become more sensitive. This makes us as nurses, more authentic, evoking self growth and awareness to others. The nurse promotes health along with a higher level of functioning when meaningful person to person relationships are created. Humanistic/Altruistic system These values begin at a very early age in human beings. These are from shared experiences and lessons taught by ones parents or the environment. Altruism is a selfless concern for the wellness of others. If one is truly selfless in a humanistic manner, it comes from a place of sincerity. Individuals sometimes give of themselves hoping to get in return but the true approach which Watson teaches wishes nothing in return. Watson, J., & Foster, R. (2003). One’s ability to be altruistic is also  dependent on the level of selflessness. For example, working with ill and sometimes demanding patients day in and day out, one can become weary and can feel no need to go the extra mile for the small comfort of an individual’s need. For example, a individual comes in the hospital newly diagnosed with a fatal illness. The patient comes into the hospital alone, he is poorly dressed and does not seem to take very good care of himself hygienically. He does not requests much help. Even when in pain he did not ask for any pain medication. Upon doing my general assessment, it was easy to assess him emotionally as well. He had no family members with him for any support needed. He was weak from the disease process, he just could no longer take care of himself as he normally does. I thoughtlessly help him to get shaved and washed up before getting comfortable in bed. I also lent a listening ear as I asked him necessary questions about his health. I knew having someone help me out in this manner would make a difference in how I felt, so automatically and selflessly I did the same for him. If there is anything I am able to do for others that takes nothing but a simple effort, then I think the gratitude should be from bringing comfort and satisfaction where needed. This philosophy of offering selflessness to others is pivotal in the nursing role. Establishing a helping and trusting relationship. This factor in nursing has been in use for decades. The element of nursing and trust cannot be divided. Watson believed that different modes of communication establishes rapport and brings forth a caring relationship. She believed in the dynamics associated with a helping trust relationship, congruence, empathy and warmth. This means coming together in agreement, being able to put yourself in ones shoes and showing compassion. Communication varies from verbal to nonverbal ways of conveying messages and feelings. This includes actively listening in a warm manner that connotes empathetic understanding. As nurses we must especially listen to the demands of our patients no matter how big or small the need is. It is especially important to deliver on promises to patients. As it is often stated, it is better to under promise and over deliver. As simple as promising a patient to get them a meal and delivering it in a timely manner is a key example for building and maintaining a trusting relationship. Faith/hope The faith and hope factor can be a sensitive area when providing care. To many, It essential for patients to maintain a level of faith and hope. When a patient has nothing else to hold on to in the recovering process, having faith and being hopeful helps them to hold on to life. This is based on each individual’s belief and their perception of faith and hope, as well as the nurse’s understanding. I believe one has to properly assess the individual to whom this advice is being offered. This is imperative to know how well it will be accepted. It also depends on one’s cultural background. We should all be aware and be respectful of each individual’s beliefs and limitations. As stated by Suliman, Welmann, Omer & Thomas (2009), respect is easily acquired until there is a disagreement with what is recommended, at this point respecting the opposing persons choice becomes complex. In the instance that a patient or an individual can no longer rely on modern science for comfort it help to be able to hold on to your thoughts and beliefs otherwise known as hope. When a patient is given a death sentence from a disease process this may be the only thing that brings some peace of mind. For someone to look to you for your opinion at such a vulnerable moment in life means to me that my job is important to say the least. I have had different opportunities to carefully assess my patient and their life situations. This gave me the chance to divulge my opinions in the best acceptable manner suitable to my patients understanding. Conclusion Watsons’s theories has personally broadened my horizons personally and professionally. Researching her theories and concepts of nursing has given me immense insight on how to view and treat my patients in various situations. I find that her concept of caring is truly what the core element of nursing should be, or as she states it is the† true essence of nursing.†Watson, J. (1999). The nursing concepts developed by Watson have been tried and proven both professionally and personally. She provides many useful concepts  for the overall practice of nursing and the overall element of proving care for any individual. Watson ties together common theories in nursing education and thus the caring approach entity emerged. These carative factors can be implemented in any level of health care settings. It gives simple guidance to nursing and provides for better and more quality patient outcomes. Her approach unites all humanistic entities of the mind, body, and spirits for this caring, unique realm of nursing. Watson, J., & Foster, R. (2003). * * * * * * * * * * * * * * References * * Cara, C. (2003). A pragmatic view of Jean Watson’s caring theory. International Journal for Human Caring, 7(3), 51-61. * * Suliman, W., Welmann, E., Omer, T., & Thomas, L. (2009). Applying Watson’s NursingTheory to Assess Patient Perceptions of Being Cared for in a Multicultural Environment. Journal of Nursing Research (Taiwan Nurses Association), 17(4), 293-300. * * Watson, J. (1999). Nursing: Human science and human care, a theory of nursing. Sunbury, MA: NLN Press, Jones and Bartlett * * Watson, J., & Foster, R. (2003). The Attending Nurse Caring Model: integrating theory, evidence and advanced caring–healing therapeutics for transforming professional practice. Journal of Clinical Nursing, 12(3), 360-365. doi:10.1046/j.1365-2702.2003.00774.x.