Project Risk Management ( Manisha ) Essay - 1319 Words

11. Project Risk Management (Manisha) As explained in Project Charter, in Oct 2014, the Community Living organisation decided to design an upgraded version of CLIVE as CLIVE 2.0. The upgraded version of CLIVE ensures more convenient access to the user community of CLIVE. In order to achieve the goal for CLIVE 2.0, the team has to manage the risks associated with this project systematically by identifying, analysing and responding to project risks. It includes maximizing the probability and consequences of positive events and minimising the probability and consequences of adverse events. This document defines a plan for how the project team will handle risks to achieve the goal. 1. Risks are on the basis of wide range of deliverables such as any migration and update of existing data required before implementation of a new system. 2. Availability of experts as and when it is required. 3. Expertise of skilled workers acquisition reduces time and error free to work on Project deliverables. Risk Guidelines 1. Risk- An uncertain event or condition that, if it occurs has a positive or negative effect on CLIVE 2.0‘s objectives. It’s measure of the inability to achieve overall objectives within defined requirements and constraints and has †¢ Probability of occurrence †¢ Risk Impact †¢ The accepted timeline before consequences will occur, if the risk is not mitigated. If Risk is mitigated : 1. Project schedule must be at deliver on learning time. 2.Show MoreRelatedBusiness Information Systems Management ( Bus5bid )2467 Words   |  10 PagesBusiness Information Systems Management (BUS5BID) Semester 2, 2016 Assignment Part 1 – Mini Case Study IT Leadership at MaxTrade Team and contribution Shilpa Jain 18868992 Question 1 B. Nimesha H. 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Learning Materials Found in the National Library of Philippines Free Essays

Last Saturday though the library is only open till 3pm, I manage to revisit the National Library with a special friend, even though I am very much familiar with the materials that this library use and have, I still push to go there to make a list of these things. As I enter the library, I notice that we first logged to the log book gave by the library guards, and these comes in my first list. I was not able to ask the guard the reason for this, but I am sure that this is a part of their security measure. We will write a custom essay sample on Learning Materials Found in the National Library of Philippines or any similar topic only for you Order Now For instance, on that day, something happened and all on the list that they have with the guard may be use as witness for it. Then, we went to luggage counter to deposit our bags. This is also their way to protect their library from thieves. If you are a first timer in this library, you are required to have a library I. D. Before, when it was my first time, with my classmates, we all pay for the ID, which is worth P50. 00, surprisingly; it is still worth like that. Before you can enter the library as visitor, but now my friend with me, they also require him to have an ID. As I was waiting for my friend to fill up his form in applying an ID for the library, something caught my attention. It was an old Catalog box filled with index cards with list of names and personal information. Then I thought of that maybe these are the ID cards of those who use to be here, just imagine how long this library is running. As we are waiting for the ID, the Elevator caught my attention. The last time we went here, I remember that we used it with my clan. At the right side of the elevator, there you can see the restroom for the user and the office of the personnel of the library. I believe that the office is air conditioned, because the dew and fog made by the air-con which is very visible because of the glass walls. As we go upstairs, students were checking on the computers set for the easy books access. This is the library I saw that uses this kind of technology. You can find here the information that can help you find the books that u need at ease. Once you type the idea of what you need in the book, the computer will give you list of different books, thesis, newspaper, magazines, dissertation and such that is related to your desired book. Aside from that, it will also give you the information about what stations you can find it, author, page, year and lots. If you listed the target books, you will next go to the stations that the computer gave you, for instance the General Books. This station generally composed of books like dictionaries, Bibles, Encyclopedias and such. Each station is air-conditioned but smells like old books. Aside from making the visitors feel comfortable, the main function of this is to take good care of the books, because high temperature will lessen the books’ life span. Each station have place for the visitor like reading stations. These composed of tables and chairs perfect if the book barrower needs a lot of time with the desired books he have. Next item that I have is the small piece of paper given by the library personnel. In this paper, you will write the information you got from the computers of you desired books. This will be given to the library personnel inside the book gallery which will be replaced by another paper containing the book number and book shell of your desired book. This makes the searching easier. Also I notice, in every stations we passed thru, there they have a mini museum of our national treasures and history memorabilia. Before I remember, it took my friends a lot of time here than searching for their books. Aside from that, they also have a photo copy station which becomes very useful during my research making last semester, although pages that are allowed to be copied are very limited. I am not really aware of what is the objective of me going here just to get a list again of the materials that the library have and use, but then I realize at the middle of my list I wrote books. The main reason why people go in a library is they have a need for a certain book, and library without a book in it is not a library. As I was there I also use that opportunity to also read about my present studies in my different subject as part of my advance study. How to cite Learning Materials Found in the National Library of Philippines, Essays

Imc Portfolio free essay sample

Social change and constantly evolving technology has introduced the IMC tools into the mix for successfully achieving growth of an organisation (Belch, et al. 2012). The IMC tools include advertising, direct marketing, interactive and internet marketing, sales promotion, public relations, sponsorship and personal selling. In developing an effective IMC program, marketers must decide which tools could be used, either individually or as a combination. Some tools have disadvantages that can be overcome by the advantages of the other tools. This decision will help them in considering the best way to use/combine them to engage the audience and achieve organisation objectives (Belch, et al. 2012). 1. Table of Articles Article | Source  | Next Generation Research – February 2013 | Bamp;T| Retailers lack big data skills – March 2013| WARC News   | The social TV race – October 2012 | Bamp;T| 1. 2 Summary of Articles Article 1 Next Generation Research (Appendix 1) Thi s article is about the IMC tools of internet/interactive marketing, traditional marketing and advertising. The fragmentation of media channels over the last five years has opened up vast oceans of data which both research companies and businesses are working to translate into actionable insights. Media fragmentation, in turn, means researchers have to be broader with their data collection. While the digital shift may provide the biggest opportunities for brands, it also presents some major hurdles. The article talks about the advent of social media and mobile channels in a big way and how this increases the work that needs to be done to understand the target audience. Article 2 Retailers lack big data skills (Appendix 2) This article is about the IMC tools of internet/interactive marketing and advertising, and how it is necessary to effectively use data collected from mobile mediums. According to Brian Lent, a leading industry figure, it is of great importance for retailers to develop predictive models to get the maximum benefits from having mobile customers. They also argue that there is a need to add data scientists to the mix of behavioural analysts if they wanted to benefit from the surplus amount of data available. Article 3 The social TV race (Appendix 3) This article is about the IMC tools of internet/interactive marketing and advertising through TV medium, and about how the two tools are being integrated. The key factor that is talked about here is the increase in usage of more than a single screen to consume media. Which implies of course, that there has to be an integration between tools and channels. 1. 3 Observations Observation| Comments| Challenges| The challenge with IMC tools is choosing the right mix of tools to reach the right audience. Especially in the case of new tools like ocial media and mobile and tablets, it is important to have a clear idea of the objective to use data collected efficiently. The user database is a goldmine, but only if used correctly and in conjunction with the IMC strategy plan. | Opportunities | The biggest opportunity for marketers is the emergence of new media, such as Facebook and Twitter, and the increased screen space they can capture with the current dual screeners. Marketers are only beginning to understand that the data generated from these sources can be used to the effect of the brand in many ways. They are beginning to apply this knowledge to their IMC strategies to integrate usage of IMC tools – both existing and new – as seamlessly as possible. Adherences/deviations from IMC concepts and principles| Adherence: Marketers are integrating new media with the traditional IMC tools to help understand the consumers and how they wish to interact with the brandDeviations: The tools must be understood and tested to prove that they are being used effectively to create the brands that consumers want, and not brands that the clients wish the consumers to want| Trends amp; future ramifications/ Likely outcomes amp; affects| The articles show that there is a w ider acceptance and adoption of new media over traditional media because the world is becoming more digital by the day. Though there is still the existence of traditional IMC tools, the way marketers choose to communicate with consumers is leaning towards digital, and they are more welcoming to this change. | Impact on industry/brand| The use of more data mining and data scientists will help narrow down the audience to a quite specific degree, thus ensuring less wastage for brands. Likelihood of development| With the emergence of new media and constant innovations in the way communications take place, IMC tools will definitely be further developed to build brands more effectively for the consumers. This can be done by actually listening to consumers and how they feel about the brands they interact with. | 1. 4 Conclusions The fundamental principle of IMC is getting the right message to the right audience. Determining the role of the IMC tools means understanding where and how each t ool fits into the IMC strategy. In selecting which tools to use marketers need to evaluate if the use of the tool, or combination of tools, will generate short -term financial returns while building long-term brand and shareholder value (Belch, et al. 2012). The articles show a trend towards online and interactive tools being used to better understand consumers. The use of new media, such as Facebook, Twitter and Social Gaming Platforms, is providing marketers with new avenues to use both existing IMC tools (i. e. Advertising) and emerging tools (i. e. Interactive Marketing). The articles highlight the use of data mining and the increasing need to use it so that the consumers and the clients get the full benefit of the actual brand. 2. 0 Establishing Objectives and Budgeting for the IMC Program IMC requires the setting of objectives for many reasons, the key one being what needs to be done to solve the marketing communication problem. They guide the development of the IMC plan and also set the benchmark for evaluating the performance of the IMC program (Belch, et al. 2012). There are many methods used for budgeting my marketers – ranging from economic modelling to objective and task methods. Budgeting is a major problem area in an IMC program. This is in part because there is a gap in understanding the relation between the measurement of effectiveness of budget appropriation to communications/behavioural objectives. Marketing managers need to understand the variety of factors that contribute to the allocation of the IMC budget (Belch, et al. 2012). 2. 1 Table of Articles Article | Source  | Don’t forget the objective is advertising – December 2010| Bamp;T| Creating the future – August 2011| Adweek| Down, down prices are down – December 2011| Bamp;T| 2. 2 Summary of Articles Article 1 Don’t forget the objective is advertising (Appendix 4) This article is about how there is a need to understand that the objectives being pursued by agencies are the wrong ones. The objectives being set by agencies had less to do with clients’ business objectives than they did with their ability to measure something. It is important to measure responses, but not only to do so. As much as ways of engaging with people has changed, their instinct hasn’t. They want to be involved and ad agencies need to make that a prime objective over any other. Article 2 Creating the future (Appendix 5) This article talks about the need to communicate with the consumer above all else, while setting objectives, when using the IMC tool of PR with the tool of internet/interactive marketing. Consumer desire to engage with the brand can only be ignited if opportunities created through new media are seized. This article also mentions the importance of client-agency relationships and how brands who know what they want are highly likely to achieve their objectives. Article 3 Down, down prices are down (Appendix 6) This article talks about the price cuts happening all around, within industry and otherwise. The importance of using the right combinations of media tools in the face of budget cuts is stressed on in this article. Agencies need to be rewarded for their ability to do this, rather than compromise on ease of the campaign execution. A huge percentage of a clients media value can be lost in areas such as poor briefing, incorrect objective setting, wrong media choices and non-aligned remuneration models. 1. 3 Observations Observation| Comments| Challenges| The challenge with establishing objectives is not understanding which ones are the right ones to follow, and which ones make the most sense at a certain point of time for agencies and clients alike| Opportunities| The biggest opportunity for marketers is the understanding that the consumer instinct to be connected to the brand can be built on, now more than ever. As marketers understand this and try to creatively pursue consumers, clients understand the need to revise budgeting models and structures as well| Adherences/deviations from IMC concepts and principles| Adherence: Return of Investment is a key goal of clients and agencies alikeDeviations: The approach to getting an ROI is different, with the focus being more on pulling consumers to the brand and keeping them, rather than ensuring one-off sales successes| Trends amp; future ramifications/ Likely outcomes amp; affects| The articles show a return of consumer is king in a big way. But they also show that consumers are keen on engaging with brands that listen. This in turn helps brands achieve their objectives, making it a complementary system. | Impact on industry/brand| Brands will be able to understand their core target audience much better than they ever could. Agencies will be able to channel their creativity into capturing the right consumers for the brands too, and will be rewarded based on their ability to do so| Likelihood of development| The way budgeting is done in industry will definitely be further developed to discover something that works. The objectives will be more closely evaluated too, for the agency as well as the brand| 1. 4 Conclusions The articles have shown the need for a revision of objective setting – for both clients and agencies. There is also an idea of how agencies need to be rewarded for expert use of IMC tools as a whole, rather than cutting costs on using a bulk of one tool. 3. 0 Investment Decisions The media strategy of an organisation must be designed in such a way that it supports the overall marketing and communication objectives, thus delivering the message developed in the IMC program. The basic task of developing an effective media strategy is to select the right media for the target audience, while staying within the budget provided (Belch, et al. 2012). 3. 1 Table of Articles Article| Source  | Marketing is dead – August 2012| Harvard Business Review| Data vs Creativity – April 2013| Marketing Week| Invest in your customers more than your brand – February 2013| Harvard Business Review| 3. 2 Summary of Articles Article 1 Marketing is dead (Appendix 7) This article talks about how traditional IMC tools are dead. There is a shift in the attention given by consumers, because of the internet takeover. Traditional marketing logic doesn’t make the same sense as when it is used in the online world. The article goes on to say how ineffectively the new marketing techniques are being used, and suggests ways to remedy this with effective management of resources used towards the brand. Article 2 Data vs Creativity (Appendix 8) This article is about how there is a growing importance of data in the marketing world which is stifling the creativity of ad agencies and marketing communication agencies. Clients want the ideas to work; they want the numbers to show effectiveness irrespective of anything else. And agencies cannot promise the ideas will work, and have to now convince clients to take the jump and give then a creative license. The nature of creatives is always to question convention and use that experience to help develop themselves, but sometimes that can be at the cost of what the brand needs there and then. Article 3 Invest in your customers more than your brand (Appendix 9) This article is about the need to place the investment from brands into developing the brand-consumer relationship. The challenge is redefining advertising as an investment that makes customers more valuable to the brand, instead of only the opposite being true. 3. 3 Observations Observation| Comments| Challenges| The challenge with investment decisions is that brands aren’t sure where their resources will be effectively used, so they always tend to invest in the wrong places| Opportunities| The biggest opportunity for marketers is the use of new media to generate data that can be used to understand which parts of the program need more resources focused on them| Adherences/deviations from IMC concepts and principles| Adherence: Marketers take the clients opinion into consideration to build brands, but also integrate the consumer into the grand design of the program tooDeviations: The investment decisions will shift from the brand development for the sake of it, to brand development for the sake of consumers| Trends amp; future ramifications/ Likely outcomes amp; affects| The articles signal towards a shift in where resources will be focused when creating an effective media plan and IMC program| Impact on industry/brand| There will be a smarter use of resources, therefore the re will be increased brand loyalty for most brands| Likelihood of development| There will be development for this area of decision making because there is a need to understand where the resources will be most optimally utilised, and where they will be wasted| 3. 4 Conclusions The articles suggest that investments during branding and communication processes need to be made towards the customers rather than just the brand. They also suggest the importance of understanding consumers through data generated and spending to gauge this, to effectively use resources. 4. 0 Message Strategy Decisions There is a need for a consistent message in IMC. No matter how creative the agency and its creative specialists choose to be, the client is the gatekeeper of the creative process. They are responsible, above all else, to ensure that the right messages reach their target audience (Belch, et al. 2012). 4. 1 Table of Articles Article| Source| BM: Australian companies message ‘gap’ – June 2011| Bamp;T| Subway asks youth to devise its expansion strategy February 2013| Bamp;T| Listen to your audience and tell them a story that says ‘I can help’ – February 2013| BRW| 4. 2 Summary of Articles Article 1 BM: Australian companies message ‘gap’ (Appendix 10) This article deals with the gap that exists between what messages Australian companies wish to convey to their audiences and the messages that actually come through the media. This is ineffective use of media, even when the audience is accepting of it. The Australian firms needed to have a clearer understanding of the changing media landscape, and how best to use it effectively. Article 2 Subway asks youth to devise its expansion strategy (Appendix 11) This article talks about how Subway has successfully engaged with its consumers to help build on the brand’s own objective of expansion, and at the same time feel as if they are a part of the core of the brand itself. Article 3 Listen to your audience and tell them a story that says ‘I can help’ (Appendix 12) This article talks about the shift in focus from technology to techniques required for a successful message strategy. The importance of optimising content for individual platforms is mentioned in this article as a key consideration towards reaching the target audience with the right message. 4. 3 Observations Observation| Comments| Challenges| The challenge with message strategy decisions is convincing clients to allow creatives to create something that works for their brand, even if it defies convention. There is also the manner in which companies use new media, more ineffectively than effectively. Opportunities| The biggest opportunity for marketers is the ability to engage with consumers with a brand’s message strategy and involve them through social media channels| Adherences/deviations from IMC concepts and principles| Adherence: The concept of building message strat egy that connects with the target audience is still in placeDeviations: The method with which to build an effective relationship between brand’s core and a consumer is different now, with the advent od social media. | Trends amp; future ramifications/ Likely outcomes amp; affects| The articles show that there is a more dynamic nature to the acceptance of a brand’s message, and an immediate feedback/mental block if there is something the audience strongly agrees/disagrees with. This dynamic nature will only be more so| Impact on industry/brand| The use of more interactive tools, such as Twitter and Facebook, will mean that the exact consumer reactions can me gauged. And the brand can be built around each consumer rather than the opposite being true. | Likelihood of development| There is not much scope of development of a message strategy formation. But rather, the development will be in how the IMC tools of new media can be effectively used to engage consumers| 4. 4 Conclusions The articles convey the general idea that the right message for a brand is one that has an appropriate emotionally connect with their target audience. The more clients engage with their consumers with the right messages, the better relationships they share with them. 5. 0 Measuring the effects of IMC All marketing managers want to know how well their IMC programs are working. If there is something wrong with what is being executed during an ongoing program, the only way to know what it is for sure is to evaluate current strategy. This information is critical to planning because it is the best way to make program adjustments and maintain them (Belch, et al. 2012). Different measures of effectiveness lead to different results. Clearly defined objectives and the use of multiple measures of effectiveness are critical in determining the true effects of an IMC program (Belch, et al. 2012). 5. 1 Table of Articles Article | Source  | Adobe and Facebook collaborate to prove monetary value of Likes – November 2011| Marketing Week| Focus groups are failing – February 2010| AdNews| Firms failing to monitor social media – May 2012| WARC News| 5. 2 Summary of Articles Article 1 Adobe and Facebook collaborate to prove monetary value of Likes (Appendix 13) This article talks about a new tool for measurement of effectiveness of a brand presence on Facebook through analysing the value of a ‘like’. Adobe’s SocialAnalytics tool aggregates brand conversations and measures them as brand values. Along with Facebook, Twitter and WordPress influences are also factored in, giving brands a bigger idea and a better picture of what an online presence could be like for them. Article 2 Focus groups are failing (Appendix 14) This article is about how focus groups are no longer an effective way to measure the effects of IMC tools, mainly because of the advent of technology that goes beyond this method. Neuromarketing is the new focus in this article, and that could be an emerging measurement tool. Article 3 Firms failing to monitor social media (Appendix 15) This article is about the inability of firms to maintain a healthy two-way communication with their consumers because they aren’t well-equipped to. This leaves the feedback loop incomplete, and leaves a hole in the brand building process. With a majority of these corporations failing to even quantify social media or monitor the statistics even, there is a huge data loss they suffer of potential and current customers, thus leading to an ultimate demise of brand awareness. 5. 3 Observations Observation| Comments| Challenges| The challenge with measuring the effectiveness of IMC tools and an IMC program is the diversity of measurement options available, and a lack of compliance as to which one needs to be usedAnother challenge is those companies that exist which don’t even understand the importance of measuring program effectiveness, or what they are missing out on| Opportunities| The opportunity here is the emergence of new tools like the SocialAnalytics tool of Adobe, that will give a comprehensive insight of all new media to the clients and their agencies, and help to analyse if media and spending are being effectively used| Adherences/deviations from IMC concepts and principles| Adherence: Marketers choose to evaluate the effectiveness of campaigns, but go awry on judging them against objectivesDeviations: Considering the shift towards seeking a standardised method to evaluate program effectiveness, it will finally be apparent as to what works and what doesn’t. | Trends amp; future ramifications/ Likely outcomes amp; affects| The articles show that there is a renewed understanding of the need to evaluate campaigns and programs on their effectiveness. Impact on industry/brand| Companies that haven’t been doing this will begin to jump on the bandwagon too, because this will only increasingly become a part of their functioning | Likelihood of development| The measures of effectiveness are going to be greatly developed, just so that there will be lesser reasons for companies to point fingers at agencies if there is something to substantiate their claims| 5. 4 Conclusions There are many research methods that exist, but each one deems effectiveness of an ad in a certain way. The articles talk about a trend towards a standardised measure of effectiveness of IMC tools that will help to evaluate what works and what doesn’t, so as to reduce wastage for brands.

The Natural Essay Example For Students

The Natural Essay The NaturalThe Natural written by Bernard Malamud was a very well written book. I really am not a big fan of baseball but I did enjoy this novel. This book is about never giving up no matter how bad the situations gets. Roy Hobbs wanted to be the best baseball player that ever lived, who broke all the records, and when he went walking down the street he wanted people to say, Hey thats Roy Hobbs,the greatest player of all times. He would have been excellent and could have played baseball for many years, but someone didnt want that. He was shot and it injured him terribly. Hobbs finally made it back and was found by a scout and was sent to play for the worst team in the league. I like how Hobbs never gives up. He goes up against the corrupters, the seducers, and the glory destroyers. No one wanted to let Hobbs play because he was old, they thought he should be at the age to retire not to just begin. This book goes to show that you can do anything if you set your mind to it and if you w ant it bad enough. Hobbs proved everyone wrong. He was worst possible thing happened, he met a girl. He started getting distracted and it a effected his game. Hobbs let a woman mess with his head. When Hobbs would go up to bat, he usually hit a home run but when he met this woman, he started striking out. I guess you could say that she was bad luck. Well, he eventually made is mind get cleared and was back to his old self. Another reason why I liked this novel is because it kind of gives a love story rather than just specifically baseball. Before Hobbs left for the pro and got shot he was very much in love with this woman and wanted to marry he. Before he left he told her he would send for her, but things happened and he never did. Then finally she came back to him. When Hobbs was on his losing streak she stood up in the middle of a baseball game when Hobbs was pitching and just stared at him. He looked up and saw he and everything came together. My idea of the perfect novel is one that just is about love. The best part of this book in my opinion is the very end. Hobbs injury from the bullet wound didnt heal right and the bullet was still inside him after sixteen years had gone by and by playing baseball he was making the wound worse. The doctors advised that if he continued to play that his stomach might burst and cause an instant death and there was nothing the doctors could do but tell him not to play. Do you think he gave up? No. Neither did I. If he had that would totally ruin the entire point of this book. Roy Hobbs ended his career as a American hero, born a winner with the whole dream going for him. He got the game he loves, the woman he thought he had lost, and fame. What a perfect ending to an excellent book. I believe that anyone that reads this book will get a change in heart and might start to look at things differently. If you read this novel and didnt like it then there must he something wrong with you. The Natural is a book for anyone, it shows courage, strength, fame, and love. What more could you ask for in a book! We will write a custom essay on The Natural specifically for you for only $16.38 $13.9/page Order now

Free Essays on Phillipe Bourgois

Philippe Bourgois's In Search of Respect: Selling Crack in El Barrio has shown a great deal of commitment to the work that was involved in completing his research on poverty and marginalization. The field of study on poverty and marginalization by Philippe Bourgois was only twenty blocks from the area in Manhattan's Upper East Side known as East Harlem. However, those twenty blocks between the Upper East Side and the Puerto Rican population of East Harlem represent a social and an economic gap extending from mainstream to marginal. There are two dominant themes that play an important role in the book. The first theme is the structural conditions that impact and marginalize these women and men on a daily basis. The second theme is the search for respect and the reclaiming of dignity by these men and women. Through these themes Bourgois (2002:17) portrays that the people living in El Barrio are known to blame the victim for their misfortune of being the underclass of the United States population and â€Å"living in the inferno† due to their inability to compete with the classes above them who are more able of succeeding since they have greater opportunities to do so. This competition has led the minorities living in such bad neighborhoods, such as the streets of Spanish Harlem, to search for respect and dignity while the American Society is doing the opposite, segregating and separating them from the rest of the society causing ghettoization to take place. Even during the 1930s East Harlem was known as a neighborhood where criminals, thieves, and law-breakers lived. As stated by a Catholic priest in the 1930s, â€Å"all kinds of law-breakers; there are nests of the narcotics, thieving, stealing, cheating and every conceivable kind of law breaking† (Bourgois, 48). Population of the so-called â€Å"Spanish Harlem† is mostly Hispanic, specifically Puerto Ricans who have emigrated from Puerto Rico throughout the 1900s. Puerto Rico was ... Free Essays on Phillipe Bourgois Free Essays on Phillipe Bourgois Philippe Bourgois's In Search of Respect: Selling Crack in El Barrio has shown a great deal of commitment to the work that was involved in completing his research on poverty and marginalization. The field of study on poverty and marginalization by Philippe Bourgois was only twenty blocks from the area in Manhattan's Upper East Side known as East Harlem. However, those twenty blocks between the Upper East Side and the Puerto Rican population of East Harlem represent a social and an economic gap extending from mainstream to marginal. There are two dominant themes that play an important role in the book. The first theme is the structural conditions that impact and marginalize these women and men on a daily basis. The second theme is the search for respect and the reclaiming of dignity by these men and women. Through these themes Bourgois (2002:17) portrays that the people living in El Barrio are known to blame the victim for their misfortune of being the underclass of the United States population and â€Å"living in the inferno† due to their inability to compete with the classes above them who are more able of succeeding since they have greater opportunities to do so. This competition has led the minorities living in such bad neighborhoods, such as the streets of Spanish Harlem, to search for respect and dignity while the American Society is doing the opposite, segregating and separating them from the rest of the society causing ghettoization to take place. Even during the 1930s East Harlem was known as a neighborhood where criminals, thieves, and law-breakers lived. As stated by a Catholic priest in the 1930s, â€Å"all kinds of law-breakers; there are nests of the narcotics, thieving, stealing, cheating and every conceivable kind of law breaking† (Bourgois, 48). Population of the so-called â€Å"Spanish Harlem† is mostly Hispanic, specifically Puerto Ricans who have emigrated from Puerto Rico throughout the 1900s. Puerto Rico was ...

The Nuremberg Trials

The Nuremberg Trials The Nuremberg Trials were a series of trials that occurred in post-World War II Germany to provide a platform for justice against accused Nazi war criminals.   The first attempt to punish the perpetrators was conducted by the International Military Tribunal (IMT) in the German city of Nuremberg, beginning on November 20, 1945. On trial were 24 of Nazi Germany’s major war criminals, including Hermann Goering, Martin Bormann, Julius Streicher, and Albert Speer.   Of the 22 that were ultimately tried, 12 were sentenced to death. The term â€Å"Nuremberg Trials† would eventually include this original trial of Nazi leaders as well as 12 subsequent trials that lasted until 1948.   The Holocaust Other War Crimes During World War II, the Nazis perpetrated an unprecedented reign of hatred against Jews and others deemed undesirable by the Nazi state.   This time period, known as the Holocaust, resulted in the deaths of six million Jews and five million others, including Roma and Sinti (Gypsies), the handicapped, Poles, Russian POWs, Jehovah’s witnesses, and political dissidents.   Victims were interned in concentration camps and also killed in death camps or by other means, such as mobile killing squads.   A small number of individuals survived these horrors but their lives were changed forever by the horrors inflicted upon them by the Nazi State. Crimes against individuals deemed undesirable were not the only charges being levied against the Germans in the post-war era. World War II saw an additional 50 million civilians killed throughout the war and many countries blamed the German military for their deaths. Some of these deaths were part of the new â€Å"total war tactics,† yet others were specifically targeted, such as the massacre of Czech civilians in Lidice and the death of Russian POWs at the Katyn Forest Massacre.   Ã‚   Should There Be a Trial or Just Hang Them? In the months following liberation, many military officers and Nazi officials were held in prisoner of war camps throughout the four Allied zones of Germany.  Ã‚   The countries that administrated those zones (Britain, France, the Soviet Union, and the United States) began to discuss the best way to handle the post-war treatment of those who were suspected of war crimes.  Ã‚  Ã‚   Winston Churchill, the Prime Minister of England, initially felt that all those who were alleged to have committed war crimes should be hanged.   The Americans, French, and Soviets felt that trials were necessary and worked to convince Churchill of the importance of these proceedings.   Once Churchill assented, a decision was made to move forward with the establishment of the International Military Tribunal that would be convened in the city of Nuremberg in the fall of 1945. The Major Players of the Nuremberg Trial The Nuremberg Trials officially began with the first proceedings, which opened on November 20, 1945.   The trial was held in the Palace of Justice in the German city of Nuremberg, which had played host to major Nazi Party rallies during the Third Reich.   The city was also the namesake of the infamous 1935 Nuremberg race laws levied against Jews. The International Military Tribunal was composed of a judge and an alternate judge from each of the four main Allied Powers.   The judges and alternates were as follows: United States – Frances Biddle (Main) and John Parker (Alternate)Britain – Sir Geoffrey Lawrence (Main) (President Judge) and Sir Norman Birkett (Alternate)France – Henri Donnedieu de Vabres (Main) and Robert Falco (Alternate)Soviet Union –Major   General Iona Nikitchenko (Main) and Lieutenant Colonel Alexander Volchkov   (Alternate) The prosecution was led by U.S.   Supreme Court Justice, Robert Jackson.     Ã‚  He was joined by Britain’s Sir Hartley Shawcross, France’s Francois de Menthon (eventually replaced by Frenchman Auguste Champetier de Ribes), and the Soviet Union’s Roman Rudenko, a Soviet Lieutenant-General.   Jackson’s opening statement set the somber yet progressive tone for the trial and its unprecedented nature.   His brief opening address spoke of the importance of the trial, not only for the restoration of Europe but also for its lasting impact on the future of justice in the world.   He also mentioned the need to educate the world about the horrors perpetrated during the war and felt that the trial would provide a platform to accomplish this task. Each defendant was permitted to have representation, either from a group of court-appointed defense attorneys or a defense attorney of the defendant’s choosing.   Evidence vs. The Defense This first trial lasted a total of ten months.   The prosecution built its case largely around evidence compiled by the Nazis themselves, as they had carefully documented many of their misdeeds.   Witnesses to the atrocities were also brought to the stand, as were the accused.   The defense cases were primarily centered around the concept of the â€Å"Fuhrerprinzip† (Fuhrer principle).   According to this concept, the accused were following orders issued by Adolf Hitler, and the penalty for not following those orders was death.   Since Hitler, himself, was no longer alive to invalidate these claims, the defense was hoping that it would carry weight with the judicial panel.   Some of the defendants also claimed that the tribunal itself had no legal standing due to its unprecedented nature. The Charges As the Allied Powers worked to gather evidence, they also had to determine who should be included in the first round of proceedings.  Ã‚   It was ultimately determined that 24 defendants would be charged and put on trial beginning in November 1945; these were some of the most notorious of Nazi’s war criminals. The accused would be indicted on one or more of the following counts:1.   Crimes of Conspiracy:   The accused was alleged to have participated in the creation and/or implementation of a joint plan or conspired to assist those in charge of executing a joint plan whose goal involved crimes against the peace. 2.   Crimes Against the Peace:   The accused was alleged to have committed acts that including planning for, preparation of, or initiation of aggressive warfare. 3.   War Crimes:   The accused allegedly violated previously established rules of warfare, including the killing of civilians, POWs, or malicious destruction of civilian property. 4.   Crimes Against Humanity:   The accused was alleged to have committed acts of deportation, enslavement, torture, murder, or other inhumane acts against civilians before or during the war. Defendants on Trial and Their Sentences A total of 24 defendants were originally slated to be put on trial during this initial Nuremberg trial, but only 22 were actually tried (Robert Ley had committed suicide and Gustav Krupp von Bohlen was deemed unfit to stand trial).   Of the 22, one wasn’t in custody;   Martin Bormann (Nazi Party Secretary) was charged in absentia.   (It was later discovered that Bormann had died in May 1945.) Although the list of defendants was long, two key individuals were missing.   Both Adolf Hitler and his propaganda minister, Joseph Goebbels, had committed suicide as the war was coming to an end.   It was decided that there was enough evidence regarding their deaths, unlike Bormann’s, that they were not placed on trial. The trial resulted in a total of 12 death sentences, all of which were administered on October 16, 1946, with one exception Herman Goering committed suicide by cyanide the night before the hangings were to take place.   Three of the accused were sentenced to life in prison. Four individuals were sentenced to jail terms ranging from ten to twenty years.   An additional three individuals were acquitted of all charges. Name Position Found Guilty of Counts Sentenced Action Taken Martin Bormann (in absentia) Deputy Fhrer 3,4 Death Was missing at time of trial. Later it was discovered Bormann had died in 1945. Karl Dnitz Supreme Commander of the Navy (1943) and German Chancellor 2,3 10 Years in Prison Served time. Died in 1980. Hans Frank Governor-General of Occupied Poland 3,4 Death Hanged on October 16, 1946. Wilhelm Frick Foreign Minister of the Interior 2,3,4 Death Hanged on October 16, 1946. Hans Fritzsche Head of the Radio Division of the Propaganda Ministry Not Guilty Acquitted In 1947, sentenced to 9 years in work camp; released after 3 years. Died in 1953. Walther Funk President of the Reichsbank (1939) 2,3,4 Life in Prison Early release in 1957. Died in 1960. Hermann Gring Reich Marshal All Four Death Committed suicide on October 15, 1946 (three hours before he was to be executed). Rudolf Hess Deputy to the Fhrer 1,2 Life in Prison Died in prison on August 17, 1987. Alfred Jodl Chief of the Operations Staff of the Armed Forces All Four Death Hanged on October 16, 1946. In 1953, a German appeals court posthumously found Jodl not guilty of breaking international law. Ernst Kaltenbrunner Chief of the Security Police, SD, and RSHA 3,4 Death Chief of the Security Police, SD, and RSHA. Wilhelm Keitel Chief of the High Command of the Armed Forces All Four Death Requested to be shot as a soldier. Request denied. Hanged on October 16, 1946. Konstantin von Neurath Minister of Foreign Affairs and Reich Protector of Bohemia and Moravia All Four 15 Years in Prison Early release in 1954. Died in 1956. Franz von Papen Chancellor (1932) Not Guilty Acquitted In 1949, a German court sentenced Papen to 8 years in work camp; time was considered already served. Died in 1969. Erich Raeder Supreme Commander of the Navy (1928-1943) 2,3,4 Life in Prison Early release in 1955. Died in 1960. Joachim von Ribbentrop Reich Foreign Minister All Four Death Hanged on October 16, 1946. Alfred Rosenberg Party Philosopher and Reich Minister for the Eastern Occupied Area All Four Death Party Philosopher and Reich Minister for the Eastern Occupied Area Fritz Sauckel Plenipotentiary for Labor Allocation 2,4 Death Hanged on October 16, 1946. Hjalmar Schacht Minister of Economics and President of the Reichsbank (1933-1939) Not Guilty Acquitted Denazification court sentenced Schacht to 8 years in a work camp; released in 1948. Died in 1970. Baldur von Schirach Fhrer of the Hitler Youth 4 20 Years in Prison Served his time. Died in 1974. Arthur Seyss-Inquart Minister of the Interior and Reich Governor of Austria 2,3,4 Death Minister of the Interior and Reich Governor of Austria Albert Speer Minister of Armaments and War Production 3,4 20 Years Served his time. Died in 1981. Julius Streicher Founder of Der Strmer 4 Death Hanged on October 16, 1946. Subsequent Trials at Nuremberg Although the initial trial held at Nuremberg is the most famous, it was not the only trial held there.   The Nuremberg Trials also included a series of twelve trials held in the Palace of Justice following the conclusion of the initial trial.  Ã‚   The judges in the subsequent trials were all American, as the other Allied powers wished to focus on the massive task of rebuilding needed after World War II. Additional trials in the series included: The Doctor’s TrialThe Milch TrialThe Judge’s TrialThe Pohl TrialThe Flick TrialThe IG Farben TrialThe Hostages TrialThe RuSHA TrialThe Einsatzgruppen TrialThe Krupp TrialThe Ministries TrialThe High Command Trial The Legacy of Nuremberg The Nuremberg Trials were unprecedented in many ways. They were the first to attempt to hold government leaders responsible for crimes committed while implementing their policies. They were the first to share the horrors of the Holocaust with the world on a large scale. The Nuremberg Trials also established the principal that one could not escape justice by merely claiming to have been following orders of a government entity. In relation to war crimes and crimes against humanity, the Nuremberg Trials would have a profound impact on the future of justice. They set the standards for judging the actions of other nations in future wars and genocides, ultimately paving the way for the foundation of the International Court of Justice and the International Criminal Court, which are based at The Hague, Netherlands.

Engineering ethics paper Research Example | Topics and Well Written Essays - 1000 words

Engineering ethics - Research Paper Example This specific branch of Genetic Engineering is called Transgenics (Frewer, 2013). Even though Genetic Engineering has led to the emergence of very superb hybrid and chimeras species of animals and plants and, has also resulted to the discovery of vaccines for various diseases, it is still unethical scientific practice that has always violated the integrity and rights of many animals and the culture of man as well. Many people live in fear of this mysterious technology and a number of animals, both wild and domestic are at risk of being killed in the course of the several Genetic tests. In fact, much concern is on these victimized animals (Ormandy, 2011). Below are some of ethical issues. To the religious world, the Transgenic practice of isolating genes and tissues from one animal and inserting them into another is very immoral and unacceptable act. Such acts are unnatural practices that seek to dismantle the creation design of God. For instance, the harvesting of genes from human tumor and implanting them into tobacco plant has ignited a bitter disagreement religious culture of man and Science (Brad, 2009). During the transfer of genes and cells from an animal to human being, some zoonotic diseases (diseases that are found in both animals and human) may be carried along side. Such diseases include Nipah and Bovine, commonly known as the â€Å"mad cow disease†. These diseases are very lethal and can easily lead to sudden death of man if not diagnosed in good time (Conn, 2008). The genetically modified food has posed health threats to lay society which do not clearly understand how such foods were quickly manufactured in laboratories. It is very evident that genetically modified foods can interfere with normal functioning of the human body and has a long term health effect. Some individuals have rapidly gained weight after eating highly processed and hybrid products. Animal Welfare has been the main concern when it comes to ethical issues in Genetic

Analyze the contemporary challenges facing the u.s. labor movement and Essay

Analyze the contemporary challenges facing the u.s. labor movement and the solutions to revitalize it and help defend workers interests - Essay Example In the middle of the last century labor unions included almost half of the working population. Moreover there was a special department in the US Department of Labor, which took stock of strikes. Now labor unions comprise only small part of American workers and only some part of those workers are the employees occupied in private sector. The main reason is a shift, which took place in the relationship between employers and workers. For centuries labor unions struggled for good conditions for employees. In contemporary world employees are in competition with each other in order to get a better job. American corporations long ago realized that it is more efficient to hire purposeful, responsible, and interested in their job people. Accordingly people, who get a job today, automatically receive all those privileges labor unions had struggled for. Moreover, many corporations give their workers a possibility to become co-owners, offering them an opportunity to get low price stocks of the o wn enterprises. Thereby membership in labor unions for many Americans became senseless. As a matter of fact labor unions cannot find their place in the new system of labor relationship. In the course of time fundamental economic changes had happened in the country. The traditional heavy industry, a stronghold of labor unions, gradually becomes the thing of the past. According to Turner, ‘if unions can not hold their own and adapt to changing circumstances in the core industrial work force, the traditional bastion of labor strength, it is difficult to imagine that national prospects for unions elsewhere can be promising1’. Labor unions also have not been taken in the extremely developing industry of high technologies, and have not been widely accepted in the services sphere. So we can agree with the statement of Robert Baldwin, who claims that one of the factors that contribute to weakling

Epic of Gilgamesh - Brandon Barros Essay Example for Free

Epic of Gilgamesh Brandon Barros Essay The Epic of Gilgamesh is considered one of our first recorded literary pieces and I think it has shaped and influenced our present day lives in many ways. One thing that really caught my attention about this piece is the description of the main character, Gilgamesh. Very similar to movies and stories today, Gilgamesh, is described as a beautiful man. They mentioned him having the perfect body, â€Å"endowed† with beauty, courage†¦. and his beauty being perfect compared to others. He is described as being someone everyman wants to be, someone you can only dream of, they take it a step further and say he is two-thirds God and one-third man. He is the ultimate movie star. I think this began defining beauty and the type of person we would expect to see in stories, plays movies. Gilgamesh is a manly man who is not perfect, he is relatable but he is also something you could never be. It leaves you wanting to be like someone you never could. How might our stories and movies be different if we didn’t set this standard of beauty with our first piece of written literature? The story and quest is timeless and we see the same framework used today in many movies, novels†¦etc. The creation of friendships, enemies becoming friends, death, questioning life, all are common in books and movies today. Gilgamesh’s questions about life and dealing with death reminded me of books like, â€Å"Tuesdays with Morrie†, or the movie â€Å"My Girl.† Both of these movies deal with the lost of a friend and take you through a dark period of grief and reflection. Last year I watched a movie called â€Å"Percy Jackson the Olympians: The lighting thief.† I couldn’t help but notice a very similar concept†¦ a boy is part god and part man, defying the Gods, but also seeks the Gods for wisdom and later becomes a hero. Throughout the story he is questioning the problems in his own life, but at the end he realizes decisions were made in his best interest. It seems that this type of literature has heavily influenced the Greeks as well. Another influence that is mentioned when people talk about the Epic of Gilgamesh is the similarities between characters in the story and â€Å"characters† in a modern day Bible. Utnapishtim seems very similar to Noah, he tells a story of the human society being beyond redemption and being punished by a great flood. Utnapishtim is instructed to build a boat, bring on all creatures and becomes a hero after the great flood. If this story has influenced the modern day bible, then its influence on modern times is priceless. The story of Noah is one of the most popular bible stories ever and is still being reinterpreted today. Within the next 24 months there is a big budget movie called â€Å"Noah† starring Russell Crow and Anthony Hopkins coming out. Over time, I think we will continue to recreate these stories and see them retold from different perspectives. Something that I find particularly interesting is how popular this story has become with Ancient Alien Theorists. The History Channel show, Ancient Aliens, goes into great detail about the Epic of Gilgamesh. They believe that what we consider as old myths and stories were once considered stories about our actual past. Is it a coincidence that the book of Genesis in the Bible has a very similar flood story? A great flood, a man who is not perfect given the order to collect animals, abandon riches, the flood seems to punish mans sin. There is an obvious relationship, is it possible that the Hebrew bible â€Å"borrowed† from this mythological story? Years ago in Iraq they found what many people believe could be King Gilgamesh’s tomb. If he really existed, is there any truth to the story? Is it simply a myth? ~ Brandon Barros

The Usefulness of Financial Statements Essay -- GCSE Business Marketin

The Usefulness of Financial Statements The primary means of communicating the financial effects of organizational activities and transactions of a company to outsiders is the financial reporting system. This reporting system includes communicating financial information through annual financial statements, as well as through reports filed with the Securities and Exchange Commission, voluntary forecasts, and other financial and nonfinancial releases. Financial statements are the main source of financial information conveyed to parties external to the company. The full set of primary financial statements consists of a balance sheet, income statement, and statement of cash flows. External financial statements have a general purpose and are designed to meet the needs of investors, creditors, and other users of the external reports. They are historical in that they communicate activities and events that have already occurred. Financial statements are prepared on an accrual basis; they measure the impact of events and transactions when they occur and not simply when the cash consequences of such events and transactions are realized. Financial statements are useful in evaluating an enterprise's profitability, liquidity, and long-term solvency and equity structure. An analysis is conducted from the perspective of external users of financial statements and it relies on the annual report of a corporation and other publicly available information. Management, of course, also has access to extensive internal financial data, and their concerns extend to subdivisions of the enterprise, such as the performance of subsidiaries, divisions, departments, and operating functions. External reports are intended primarily for stockholders, creditors, directors, and regulators such as the SEC. Although externally reported information is also useful to corporate management at the highest level, it is far too aggregate to be useful for decision making by lower levels of management. And even top levels of management need financial information for decision making with respect to the performance of the various components or segments of the enterprise. It is vital that managers understand how their corporation organizes itself and at what levels the various functions such as manufacturing, marketing, finance, and research and development are performed. Managers ... ...d profits. It is seldom possible to form a judgment about the performance of an individual segment or division by inspecting the records of only that segment or division. All financial information must be analyzed together to serve useful in and out of a corporate entity. Works Cited: Financial Accounting Standards Board, 1978, Statement of Financial Accounting Concepts No.1: Objectives of Financial Reporting by Business Enterprises (Stamford, CT., Financial Accounting Standards Board). Financial Accounting Standards Boards, 1984. Statement of Financial Accounting Concepts No.: Recognition and Measurement in Financial Statements of Business Enterprises (Stamford, CT.: Financial Accounting Standards). American Accounting Association, 1957. Accounting and Reporting Standards for Corporation Financial Statements and Preceding Statements and Supplements (Iowa City, Iowa: American Accounting Association). Parker, R.H., 1979. Evolution of Corporation Financial Reporting (Nigeria, Africa: Thomas Nelson and Sons Limited). Gray, S.J., 1984. Information Disclosure and the Multinational Corporation (New York, New York: John Wiley and Sons).

Management Competencies

Management Competencies – Experience of a Healthcare Manager Context Health care organisations in New Zealand today face similar challenges to those in other highly developed countries (1, 2). With growing aging populations and increasing burden of chronic illnesses the demand for publically funded health and disabilities services continues to grow significantly (1). This increase in need coupled with the advancements in technology has driven the costs of providing publically funded healthcare services to unsustainable high levels (1, 2).Public spending on healthcare has continued to rise at the rate of 6% per year over the last decade with 21% of share of public spending being on health in 2010 (2, 3). In a background of the global economic crisis, District Health Boards (DHBs) who are charged with the provision of publically funded health and disability services are increasingly having to re-engineer their systems and services to provide value in financially constraint envir onments (2).While this at a systems level may mean taking a â€Å"whole of systems† approach with integrated service models (2), at the unit-specific services level it also includes focused attention on productivity, quality, waste reduction and safety. Key Competencies of the Service Manager Management competence is an important determinant of healthcare organisational performance (5). Competence is an individual’s knowledge, skills and behaviours relevant to their practice and performance (6, 7).Evidence from the Management Matter Research Project indicates that â€Å"higher management practice in hospitals is strongly correlated with hospitals’ quality of patient care and productivity outcomes† (8). It reported that improved management practice in hospitals were related to better clinical outcomes, increased patient satisfaction and better financial performance (8). The management role focused in this case is the service manager, a middle management ro le responsible for the strategic development and deliverables of the health service.The role is also accountable for the operational budget and management of staff. This paper explores the experience of the service manager challenged with transforming the health service from a dysfunctional average performing unit to a high performing, progressive and highly respected and valued service. It discusses the competencies of effective management with some reflection by the health service manager on the management approach utilised.Given the challenges of improving performance and developing a highly functional team, the service manager utilised the influential model of leadership style over the traditional reactive and transactional style as the predominant style of management (9, 10). This included engaging the workforce in developing a common vision for the service with clear objectives (11). In order to ensure the service goals were aligned with the organisational goals, an important characteristic of the service manager during this process was having a good understanding of the changing healthcare environment and the organisational priorities (11, 12, 13).Critical to achieving change and success was also his ability to work with staff to collectively determine and communicate the â€Å"Why†, â€Å"What†, â€Å"How†, â€Å"Who† and â€Å"When† elements of managing change. Regular reinforcement of both the positive and negative implications of the situation as well as setting mutually agreed expectations were also important to achieving change (11). This transformational style of management was also instrumental in gaining confidence and trust of staff in order to manage the workforce culture issues of mistrust, low morale and dissatisfaction largely resultant from historical experiences.The evidence for efficacy of this style and the associated competencies has been demonstrated by 2 studies reporting that transformational lead er behaviour has significant positive impact on employee satisfaction and psychological well-being (14, 15). Additional leader/manager behaviours required and demonstrated by the service manager were those that focused on individualised consideration including; creating close working relationships which encourage mutual respect, empowering and including employees in decision making, creating opportunities for employee development through coaching and mentoring and team building (16).The benefits of these behaviours are evidenced in other leadership theories including behavioural (consideration behaviours) approach and leader-member exchange theory (11, 14, 17, 18, 19). Followership and early recognition of the relationship dynamics of a team are also key elements to effective management. Working closely with followers and those with team influential ability is useful when change is likely to be difficult or experience high levels of resistance (11).The use of a collective approach t o resolving a problem and delegating the ownership of solution creation to a staff member with high peer influential ability results in achievement of objectives. The ability of the service manager to move appropriately between directive and participatory type management styles was also important in certain situations (11, 19). This was particularly useful for implementing workplace behavioural expectations like punctuality and managing disrespectful behaviours.A key competency for healthcare manager effectiveness relevant to the management style illustrated above is emotional intelligence (EI) (20). Essentially, this competency recognises the â€Å"importance of highly developed interpersonal skills and the ability to get along with others† to be effective at influencing and negotiating (20). The key attributes of a manager with high EI include self-awareness, self regulation, self motivation, social awareness and social skills (20). A summary of the key management competenc ies relevant to the management style described here is illustrated by the matrix diagram below (Figure 1) (12, 13).In summary, management styles in healthcare that are based upon the principles of transformational and behavioural leadership and utilise the respective competencies are likely to be more successful. Furthermore, while there are specific skills, behaviours and knowledge that describe the key competency domains, their use in practice is interrelated (see Figure 1) and often context-specific. [pic] References 1. The Global Health Policy Summit 2012. Report of the inaugural meeting 1 August 2012. Institute of Global Health Innovation. London: Imperial College London (UK); 2012. https://workspace. imperial. ac. k/global-health-innovation/Public/GHPS_2012_Summit_Report. pdfs 2. Mays N. Reorienting the New Zealand healthcare system to meet the challenge of long term conditions in a fiscally constraint environment. Jan 2013 (revised version). Paper prepared for New Zealand Tre asury Long-term Fiscal External Panel, November 2012, and Chair of Public Finance, Victoria University of Wellington and New Zealand Treasury conference, Affording our Future, Wellington, 10-11 December. http://www. victoria. ac. nz/sacl/about/cpf/publications/pdfs/Nick-Mays-Revised-Conference-Paper-Jan-2013-website-version. pdf 3. Ministry of Health.Health Expenditure trends in New Zealand 2000-2010. Aug 2012. http://www. health. govt. nz/publication/health-expenditure-trends-new-zealand-2000-2010 4. 5. Fine, D. Establishing Competencies for Healthcare Managers. Healthcare Executive. 2002; 172(2): 66-67. (Cited by: Shewchuk R M. O’Connor S, Fine D. Building an Understanding of the Competencies Needed for Health Administration Practice. Journal of Health Care Management. 2005; 50(1):32-47). 6. Filerman GL. Closing the management competence gap. Hum Resource Health. 2003; 1: 7. (Cited by: Santric MM, Bjegovic-Mikanovic VM, Terzic-Supic ZJ, Vasic V.Competencies gap of managemen t teams in primary health care. Euro J Pub Health. 2010; 21(2): 247-253). 7. Parry SB. Just what is a competency? And why should you care? Training. 1998: 58-64. (Cited by: Santric MM, Bjegovic-Mikanovic VM, Terzic-Supic ZJ, Vasic V. Competencies gap of management teams in primary health care. Euro J Pub Health. 2010; 21(2): 247-253). 8. Dorgan S, Layton D, Bloom N, Homkes R, Sadu R, Van Reenen J. Management matters. Why good practice really matters. Healthcare Management Survey. McKinsey & Company. London School of Economics and Political Science. 2010: 1-28. ttp://cep. lse. ac. uk/textonly/_new/research/productivity/management/PDF/Management_in_Healthcare_Report. pdf 9. Rubin RS, Munz DC, Bommer WH. Leading form within: The effects of emotion recognition and personality on transformational leadership behaviour. Academy of Management Journal. 2005; 48: 845-858. (Cited in: Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing stress at work. Identifying a nd developing the management behaviours necessary to implement the HSE management standards. Phase 2. 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf ) 10.Bass BM.. Two decades of research and development in transformational leadership. European Journal of Work and Organizational Psychology. 1999; 8: 9-32. (Cited in: Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing stress at work. Identifying and developing the management behaviours necessary to implement the HSE management standards. Phase 2. 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf ) 11. Banaszak-Holl J, Nembhard I, Taylor L, Bradley E . Leadership and Management: A Framework for Action. Chapter 2. In: Burns LB, Bradley EH, Weiner BJ (editors).Shortell and Kaluzny’s Health Care Management Organisation Design and Behaviour. New York: Delmar Cenage; 2012. p. 33-62. 12. Stefl M. Common competencies for all healthcare managers: The Healthcare Leadership Alliance Model. J Healthcare Management. 2008; 53(6): 360-73. 13. Anderson P, Pulich M. Managerial competencies necessary in today’s dynamic health care environment. Health Care Manager. 2002; 21(2): 1–11. 14. Sosik JJ, Godshalk VM.. Leadership styles, mentoring functions received, and job related stress: A conceptual model and preliminary study. Journal of Organizational Behaviour. 000; 21: 365-390. (Cited in: Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing stress at work. Identifying and developing the management behaviours necessary to implement the HSE management standards. Phase 2. 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf ). 15. AlimoMetcalfe B, AlbanMetcalfe RJ. The development of a new transformational leadership questionnaire. The Journal of Occupational & Organizational Psychology. 2001: 74: 1-27. (Cited in: Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing stress at work.Identifying and developi ng the management behaviours necessary to implement the HSE management standards. Phase 2. 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf ). 16. Shewchuk RM, O’Connor S, Fine D. Building an Understanding of the Competencies Needed for Health Administration Practice. Journal of Health Care Management. 2005; 50(1):32-47. 17. Gerstner CR, Day DV. Meta-analytic review of leader-member exchange theory: correlates and construct issues. Journal of Applied Psychology. 1997: 82; 827-844. (Cited in: Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing stress at work.Identifying and developing the management behaviours necessary to implement the HSE management standards. Phase 2. 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf ). 18. Graen GB, UhlBien M. Relationship based approach to leadership: Development of leader-member exchange theory of leadership over 25 years: Applying a multi domain perspective. Leadership Quarterly. 1995; 6: 219 -247. (Cited in: Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing stress at work. Identifying and developing the management behaviours necessary to implement the HSE management standards.Phase 2: 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf). 19. Yaker J, Donaldson-Fielder E. Management competencies for preventing and reducing stress at work. Identifying and developing the management behaviours necessary to implement the HSE management standards. Phase 2. 2007. http://www. hse. gov. uk/research/rrpdf/rr553. pdf ) 20. Freshman B, Rubino L. Emotional Intelligence: A core competency for health care administrators. Health Care Manager 2002 20(4): 1- 9. ———————– Figure 1: Key Management Competencies for a HealthCare Manager

Journal Writing Essay

During this class I have made two self- discoveries that will positively impact my career goals. Those self- discoveries has helped to mold, and shape me into a student that I have never thought I would be. Those discoveries were that I am an organized learner, because I made a study plan to help me determine when, and how I would study. Being that I have five children, I had to make sure that I had set a schedule so that my course work including study time would not affect my family time and take away from spending time with my children and fiance`. Since these are the competing priorities in my life right now learning to obtain trust and consistency in the home while I have been attending school has also improved because not only do I see my success so does my children and fiancà ©. Knowing that I had that support also has made it possible to do my best in school, setting the pace for them to do the same in school also, whether it be good grades, sports, etc. I know that they will continue to be good at what they do and have proven to do so time after time. Another self- discovery that I have made that will positively impact my career goals is my willpower. Willpower has become my greatest strength. Being able to control what I do, leaded to personal improvement. I realize that lack of willpower not only causes you to lose focus it also allows you to fail to achieve goals. My ability to resist short-term temptations have helped me to meet some of my long term goals already. There has never been a day that I thought that I could not achieve my goals. I kept a positive mindset just so I could keep going. Negativity takes a lot of willpower from you and I think success is a part of having a positive mindset. Having that determination was not easy at first I can say that, but having that willpower and thinking about my future will positively impact my career goals. Two self-discoveries that I believe will positively impact my personal life, o ne is my happiness. If I am not happy there is nothing good that will come out of being unhappy. In my life I noticed that unhappy people wait for something to make them happy. Happy people make themselves happy without hesitation because they choose to have  positivity surround them in all areas of their lives. I am that happy person, I do not feel like being unhappy because it drains energy, it drains potential, it sucks the life out of you, and it keeps you from becoming successful. I am happy because I am not afraid of change, I am valued, and I attend school knowing that I am a success story. I learned to create positive changes in my life. In doing so this has made a positive impact on my personal life. My character will also have a positive impact on my life. Knowing who I am, my beliefs, values, and morals. The clearer I became about what I value and what I believed in the more effective I became not only for me, but for my family, my friends, and my peers. I have this thirst for knowledge and a thirst to make the best out of any situation and this impacts my personal life in so many positive ways because when I know who I am , my children will learn their true identity because they are my children and they share the same DNA. My grandmother use to tell me that I can be different from everyone else and still be blessed and fabulous, and I believed her.So this has played a part in my self- identity. I also had to explore what my heart wanted, so that I could truly identify who I was, the most beautiful thing that could have happened to me was unfolding that I was an excellent mother, a great friend, and a superb student. Knowing these few things lead me to know who I was in the beginning and knowing this has made a positive impact in my personal life. My biggest take way from this course is keeping a growth mindset and knowing that I always have room for improvement. I want to keep ownership over my learning experience. I am in control of my success. I am able to keep this in mind and always grow with it. This is something that I had to develop because when I was younger I had a fixed mindset I did not want to change because I was set in my ways and it felt like everything I was doing had failed me, so I figured that I would quit trying and give up. One day that change I started thinking of other approaches of how to be better and I used trial and error as a way of figuring out what I needed to do. So as I was thinking and applying I realized that I had that growth mindset and I have kept it all through the years. While learning about the fixed mindset and growth mindset I gained a better understanding on what life is really about also and I saw the bigger picture. The way I perceived it to be is to  noticed that if something is not working right the way you are doing it, then try another way and if that works out better than stick with it, but have fun with it and be creative and then you will be successful that way . Life is about trial and error and never giving up no matter what.

buy custom Levalbuterol in Asthma essay

buy custom Levalbuterol in Asthma essay Asthma is one of the most common pulmonary illnesses that affect more than fourteen million people in the United States (CDC, 2008). The prevalence of asthma is increasing in most countries, and estimates show that the numbers are likely to rise by 100 million by 2025 (Bateman et al., 2008). Asthma is characterized by reversible airway obstruction following exposure to environmental allergens or irritants or respiratory viral infection (CDC, 2008). Asthma is also characterized by impediment and irritation that occurs in many patients. Treatment of asthma has always been medications that are aimed at controlling the inflammation as well as the medications for general relief of the severe symptoms. However, the recommended management is the clinical assessment of the symptoms and the lung function assessment of an individual. These are viewed as the measures of the outcomes that result from this condition. Most asthma exacerbations are dealt with in various outpatient systems. However, more severe conditions require hospitalization. These hospitalizations are responsible for the foremost healthcare expenditures by patients. In the United States, these hospitalizations lead to over 400,000 cases of asthma hospitalizations annually. This eventually leads to very high expenditures for asthma related conditions (Bharmal Kamble, 2009). Asthma in both children and adults is associated with an increase in direct expenses, which eventually brings the expenditure to a very high level according to healthcare costs. The main therapy in the treatment of asthma is the administration of 2-receptor agonists which reverse the acute airway obstruction as well as other conditions such as cough. According to Ameredes (2009), levalbuterol and albuterol are the most common short acting 2-receptor agonists in the treatment of asthma. Racemic albuterol is a mixture of two stereo isomers R-albuterol and S-albuterol. Clinical studies have distinguished the two isomers in terms of their affinity. Studies upon isolation of the two isomers have revealed that R-albuterol is responsible for the bronchodilator activity. However, S-albuterol does not possess bronchodilator characteristics, but it acts in association with various pharmacological activities to neutralize the therapeutic effects of R-albuterol (Handley, 2000). Levalbuterol, also referred to as levosalbuterol is an alternative treatment for asthma and other pulmonary illnesses such as Chronic Obstructive Pulmonary Disorder (COPD). It blocks the beta-2-receptor to prevent the constriction of the airways in these conditions, and is therefore called a bronchodilator. Cells in the airways contain receptors that are called beta-2 receptors. Levalbuterol binds and activates the beta-2 receptors and is hence referred to as a beta agonist. This initiates signaling within the cells which results to the relaxation and opening of airways. However, the safety of albuterol and Levalbuterol is generally different. The S-isomer in albuterol has been believed to be inert in nature and its presence in the drug of no consequence. But it is now thought to foreshorten the duration of R-albuterol by compressing its potency (Handley, 2000). The main purpose of this study is to provide a comparative view of asthma related therapies, as well as the outcomes of tre atment after the maintenance treatment of asthma using levalbuterol and albuterol. Literature Review Studies in patient preferences on the type of medication provide crucial information on the evaluation of asthma symptoms as well as the effects of medication on the wellbeing of the patients and the levels of functional activities (Bateman et al., 2008). These studies have been insufficient in evaluating the effectiveness of albuterol in treating asthma. Albuterol has been in use for a long time but is said to be associated with various side effects such as tachycardia and jitters. The introduction of levalbuterol in 1999 has brought an opportunity to assess patient predilections between albuterol and levalbuterol. A stepwise approach to disease management is necessary for the assessment and eventual treatment of asthma. One of the main goals of asthma treatment is to uphold the wellbeing of people as one of the main humanistic upshot measures (Reed, 1985). Today, clinicians use many other measures to manage diseases with a need to control the effects of asthma as well as the wellbeing of the patients. These measures include patient satisfaction as well as other health related measures that are centered on the quality of life. Studies have revealed that patients preferences have a great impact on medication side effects, as well as patients quality of life. Patients compliance with the medication is also necessary for successful control of asthma (Bharmal Kamble, 2009). Disease control measures are also very crucial in reinforcing the positive perceptions of the treatment of asthma. When levalbuterol was approved in 2005, studies suggested that its use resulted in better respiratory parameters as well as fewer hospitalizations that brought about very little, if any, side effects and though it is priced much higher than albuterol since it has a higher duration of action (5-8 hours) as compared to albuterol (4-6 hours), its use led to generally lower treatment costs in terms of hospitalization and subsequent treatments (Carl, 2003). Studies comparing levalbuterol to albuterol revealed that levalbuterol yielded bronchodilation with few side effects. However, these results are not universal and some studies suggest no significant differences in clinical endpoints. The baseline distinctiveness for the two groups of patients (those who were administered with albuterol and those who were administered with Levalbuterol) was very distinctive (Ameredes, 2009). In the medical field, albuterol has been in use for a long time, one of the factors that make it preferable. Due to the mixture of the two isomers (R)-albuterol and (S)-albuterol that are considered inert, albuterol is considered somewhat classical in the medical field. However, the single-isomer formulation that has been manufactured recently is used therapeutically when the other component is deemed to be undesirable. Pharmacology Levalbuterol and albuterol are 2-receptor agonists and they reverse the acute airway obstruction as well as other conditions such as cough. The two drugs serve to reduce the resistance in the airway as they are known to enlarge the diameter of the bronchi or the air passages (Ozminkowsk et al., 2007). These drugs, therefore, help to enhance the overall flow of air both into the lungs and out. The drugs work on the beta-2 receptors resulting in the relaxation of the pulmonary smooth muscles (Perrin-Fayolle et al., 1996). Studies conducted with regard to the metabolism of levalbuterol in the human tissues indicate a 5-11 fold better sulfoconjugation within various human tissues than albuterol. A single dose of the albuterol dosage, whether taken orally or inhaled, results in a higher blood level within the body than levalbuterol (Perrin-Fayolle et al., 1996). Perhaps, this indicates a predominance of the (s)-albuterol, an inactive product, after repeated dosing of the active albuterol. It is estimated that up to 8 % of patients who receive nebulized racemic albuterol develop paradoxical bronchospasm, a condition which is life threatening. This decline in efficacy could be attributed to the composition of racemic albuterol. Levalbuterol is the therapeutically active bronchodilator in racemic albuterol, also referred to as (R)-albuterol. Evidence indicate that (S)-albuterol does not possess any bronchodilatory activity, in fact, it increases the level of calcium in the smooth muscle cells in vitro, which favors contraction and opposes bronchodilation. This also leads to increased in vitro bronchial reactivity of human airway smooth muscles. Clinically, the isomer promoted increased hypersensitivity and increased bronchospasm that is methacholine induced in patients with moderately severe asthma. On the contrary, levalbuterol, when administered as a single isomer, eliminates all the detrimental effects of (S)-albuterol (Bateman et al., 2008) Research has also shown that racemic albuterol and Levalbuterol are important since they produce effects that can be used as prescriptions for cancer treatment. The treatments include corticosteroid strengthening and the diminution of inflammatory mediators. However, on the other hand, (S)-albuterol produces contradictory effects. Studies indicate that the adverse effects associated with albuterol, such as jitters, tychardia and bronchospasms, are less frequent with levalbuterol (Gawchik, 2007). Symptom relief was also perceived to be higher, leading to a greater overall satisfaction with Levalbuterol treatment. However, it is important to bear in mind that while levalbuterol and albuterol help in relaxing the smooth muscles and increasing the flow of air within the airways, they do not actually reduce the speed of the progression of the primary disease (Ozminkowsk et al., 2007). They only help in minimizing the signs and symptoms of exercise and wheeze limitations along with the sho rtness of breath, leading to a better life for the people living with COPD. Improved outcomes Many investigators in their publications from studies have revealed that the use of levalbuterol yields better symptom relief and less frequency of the adverse effects as compared to albuterol. However, their pattern of outcomes cannot be applied universally because other studies propose that there is not a clear difference in clinical endpoints. Ozminkowski Wang (2007), state that the various publications that have resulted from various studies are difficult for doctors to follow. Most of these data highlight the effects of albuterol and levalbuterol in efficiency and safety. This was done by comparing the relief of symptoms and the exhibited side effects of each form of treatment. However, this clinical research provides no superiority of levalbuterol over albuterol. The effects of levalbuterol may be greatest to patients with moderate to severe asthma, especially in cases of racemic albuteol overuse (Ameredes, 2009). When a patient inhales racemic albuterol, he or she has a persistent effect that is caused by (S)-albuterol. This is in comparison to levalbuterol. This suggests potential contradictory outcomes from clinical experiments. One study carried out on children under the age of twelve years evaluated the treatment of asthma in children by caregivers who used either albuterol or levalbuterol. Various interviews were scheduled for caregivers, and the main questions were the satisfaction level of their children with bronchospasms. The caregivers were supposed to report contentment or discontent. The patients were administered with albuterol and levalbuterol for four consecutive weeks. After the first dose, levalbuterol created a greater relief of symptoms compared to doses of albuterol in nearly all patients including those with relentless asthma (Carl, 2003). Ameredes (2009), carried out a research study to find out the distinctive difference between albuterol and Levalbuterol. The objective of this study was to find out whether levalbuterol reduced the costs of treating asthma as compared to albuterol and to find out the various ways that levalbuterol and albuterol were different. He used a correlational research design that brought forward thirty seven patients who were diagnosed with acute asthma. The patients in his sample were children between the ages of 6-18. The results of this study indicate that Levalbuterols potency is 2-fold than racemic albuterol and 90 to 100 fold more than S- albuterol. Ameredes (2009) suggests that there have been highly heterogenous results from various studies that compare the clear differences between albuterol and levalbuterol. In one study, levalbuterol was more effective in suppressing bronchospasm than (R) albuterol and (S) albuterol. However, subsequent research studies revealed that there are equivalences between albuterol and levalbuterol. Some indicated that the effect of 1.25 mg levalbuterol was similar to that of 2.5 mg racemic albuterol, with (S) albuterol showing little measurable effect. The above studies were shot-term, and thus a short-time approach would be used to evaluate the two drugs. This approach, however, did not measure the difference that existed between albuterol and its isomers, if used chronically. Nelson (1998), conducted a clinical trial that would compare albuterol to levalbuterol. The study was based on both children and adults that were diagnosed with acute asthma in the United States. In his study, the patients were selected randomly and assigned levalbuterol or racemic albuterol. This trial was aimed at checking the equivalences of equal amounts of the two drugs. The study was correlational and involved fifteen patients from a local hospital. The study resulted in greater improvements in force expiratory volume in one second in the levalbuterol group as compared to the dose-equivalent of racemic albuterol group. This implied that an equimolar dose of levalbuterol produced better results than albuterol. The dose that produced numerically equivalent bronchodilation as recemic albuterol, 2.5 mg, was 0.63 mg levalbuterol, not 1.25 mg which is the mass equivalent dose. The interpretation of this data shows a particularly damaging effect of S-albuterol (Nelson, 1998). Clinical studies have been carried out in pediatric patients with asthma. According to Gawchik (2007), a randomized placebo-controlled trial was necessary to compare the two drugs. In his study, he discovered that no differences existed in bronchodilation with levalbuterol and albuterol. This was because there was no dose-related correlation in children with moderate asthma. However, the dose-related correlation was found in children with severe asthma. In another study of acutely asthmatic patients between the ages of 6-18 years, there was a conclusion that the more expensive levalbuterol did not reduce the amount of return visits to the hospital for further asthma management as compared to racemic albuterol (PerrinFayolle, 1996). The treatment also did not shorten the length of stay at the emergency department, improve expiratory flow (PEF), neither did it reduce the number of nebulized treatments when compared to racemic albuterol. On the other hand, contrary to this, Gawchik (2007), writes about the new form of albuterol inhalers that are in use in the market since 2009 in a bid to compare albuterol to levalbuterol. He notes that due to the recent changes, the new form is adjusted and better in terms of the security of use due to the fact that they are both human and environmentally friendly. The chloroflouroalkane found in rescue inhalers both in levalbuterol and albuterol have been found to harm the environment. Therefore, the inclusion of hydroflouroalkane has been important as a propellant. This is actually a positive step in the study of the effects of the two types of drugs. Ozminkowski Wang (2007), conducted another age-stratified randomized study with hospital admission rate of the patients presented to the emergency department as the outcome. The study was aimed at finding out the frequency of admission of patients to the emergency section and the return rate after discharge. The objectives of this study were to find out the patient-return rate after treatment in the emergency section and find out the role played by levalbuterol in assisting the quick recovery of patients in the emergency section. The admission rate was lower in the levalbuterol group as compared to the albuterol group (Ozminkowski Wang, 2007). The risk of the admitted group was greater in the albutrerol groups than the levalbuterol group. However, the length of hospital stay in the levalbuterol group was not significantly shorter than the albuterol group and there were no adverse effects in both groups. In this study, the conclusion was that substituting the administration of albuterol with levalbuterol would reduce the number of hospitalizations (Carl et al., 2003). This was supported by another study by Nowark et. al. that showed that levalbutereol was preferrable to albuterol in the treatment of acute asthma. Administration of the same dose showed that improvement was greater in levalbuterol as compared to racemic albuterol. The study also indicated that patients with higher plasma levels of (S) albuterol show slower improvement and have a higher likelihood of hospital admission In the same research, the investigator notes several factors. First and foremost, he acknowlegdes the fact that abuterol is the most commonly prescribed inhaler with beta-2 agonist. In addition, he notes that it is also considered the best drug when it comes to reversal of acute bronchospasm. Due to the equal mixture of (S) and (R)-albuterols, there is little effect of broncholdilating activities. On the contrary, the (R)- albuterol has a better binding effect to beta-2 receptors as compared to the (S)-albuterol (Tripp, 2008). According to the investigator, the creation of levalbuterol was needed for several reasons including fewer incidences of transcient tachycardia; the chance of better tolerability as compared to albuterol; and a higher efficacy than albuterol. A further examination of the research, showed that patients benefit more from levalbuterol. Additionally, the outcomes of the study revealed that levalbuterol was better than albuterol in a sense that patients treated with levalbuterol required less medication after recovery and that they had shorter lengths of hospital stay. A regression analysis revealed that levalbuterol was allied with duration of stay savings. Another study conducted by Truitt, Witko, Halpern (2003), showed similar improvements in FEV and mean heart rate decreased with levalbuterol. This study that was carried out in comparison to albuterol. However, the researchers note that the magnitude of the difference is minute. Therefore, it is important to study these differences together in order to detrmine the most reliable results. Nonetheless, the investigators note that results may be helpful to patients who are affected with arrhythmias, cardiac conditions and structural heart diseases. This is because if the differences are not considered, it may worsen the heart condition. Therefore, the investigators note that the transcient tachycardia that is evident in cardiac patients may be a key indicator of the dose dependancy that is formed with time by patients who use levalbuterol and albuterol (Truit, Witko Halpern, 2003). In another study, Nowak (2008) and his colleagues compared the effects that are brought forth by nebulized levalbuterol. This was in comparison to the ones that are brought forth by racemic albuterol. The subjects were 627 adults who suffered from acute asthma. The subjects were radnomly given the opportunity to use either 1.25 mg of levalbuterol or 2.5 mg of albuterol. This was after twenty minutes of emergency admission and 40 minutes later all the patients received 40 mg of prednisone. The level of expiratory volume was forcefully increased by 40 percent when the patients were administered with levalbuterol, this is in comparison to racemic albuterol. The investigators also discovered that this coresponded to a fourty percent reduction in the subjects who required hospitalization (Nowak, 2008). The effects of levalbuterol were evident in patients who had severe asthma. The high levels of (S)-albuterol in the circulating plasma are thought to be the main cause of overuse of racemic albuterol. The number of relapses in the two groups after a period of thirty days, however, did not differ. In another randomized clinical trial, Carl et al. compared the use levalbuterol with racemic albuterol in over 500 pediatric patients reporting to a hospitals ED. Hospital admission rates were reduced among those receiving levalbuterol in comparison with those receiving racemic albuterol treatments. The study was also seeking to establish the hospital conversion where levalbuterol racemic albuterol was replaced with levalbuterol 1.25 mg every 8 hours or levalbuterol 0.63 mg every 6 hours. Despite that the frequency of levalbuterol was less, the patients required fewer rescue treatments to reduce the symptoms than did those treated with racemmic albuterol. This means that the less frequently scheduled treatments with levalbuterol will lead to reduced workload and reduced number of missed treatments because of unavailability of therapists. This is also supported by Truit et al, who reported that treatment with levalbuterol required one day less of admission, significantly fewer treatments and a 67 % decrease in readmissions within 30 days of discharge after treatment with the 2-agonist compared with racemic albuterol. Other studies reported similar results, indicating that treatment with levalbuterol reported decreased numbers of daily treatments, reductions of staffing and fewer as-needed treatments when compared to racemic albuterol as the acting 2-agonist. Nowak (2008) conducted another study of patients who suffered from acute asthma and another group suffering from chronic obstructive pulmonary disease (COPD). There was a comparison of treatment of levalbuterol and albuterol that were administred in a period of 6 to 8 hours in 1.25 and 2.5 miligrams repectively. There were fewer nebulizations that were requiredwhen it came to the case of levalbuterol. On the other hand, there was an increased need for rescue aerosols in the period of 14 days hospitalization. However, most of the other outcomes were similar in the two groups. This is including the costs and study of the pulmonary functions. In the study by Truitt et. al. (2003), the retrospective chart review on hospitalized patients who had asthma and COPD showed that the results were more or less the same. This therefore led to the conclusion that the benefit of levalbuterol over albuterol is usually greatest in patients who have moderate as compared to severe asthma, particularly t hose with an overuse of albuterol. Side Effects Vitro and animal studies have shown significant outcomes that can be used as a basis of comparison. Many research studies reveal that albuterol is associated with severe effects that raise concerns, such as chest pain and high blood pressure. This could be because of the fact that inhalation of racemic albuterol leads to pushiness in circulating S-albuterol twelve times more than levalbuterol (Ameredes, 2009). Levalbuterol has been acclaimed to be a safer form of albuterol but it comes at increased costs. It costs five times more than racemic albuterol. According to Gawchick (2007), albuterol is purely used for the treatment of symptoms that are occasional but an overdose of the drug can be fatal. One of the precautionary measures that should be taken when using albuterol is that the use should be discontinued in cases of adverse side effects, including hypersensitivity; abnormal heart rhythms; diabetes; epilepsy this is coupled with seizure disorder; and heart diseases. The researcher also notes wheezing, pounding heart, tight chest, nervousness, blood pressure, and chest pains side effect may be a sign of hypersensitvity. Evidence from preclinical and clinical studies suggest that the worsening of asthma symptoms in some patients with continued use of albuterol or its overuse could be contributed by the racemic mixtures of albuterol isomers, which may result from the presence of the (S)-albuterol. The slow phamarcokinetic profile is one significant characteristic of (S)-albuterol. It is metabolized 12 times slower than levalbuterol. This is because it does not have sulfation and elimination enzymes preferrentially specific to levalbuterol. This leads to the differences in circulating levels of the isomers after administration of racemic albuterol. After administering a dose of inhalable racemic albuterol, it has been shown that the circulating levels of levalbuterol are undetectable wheras the levels of (S)-albuterol persisit for as long as 12 hours and may be preferentially retained in the lungs (PerrinFayolle, 1996). Therefore, it is important to consider the physiologic and pharmacologic effects of each isomer within the racemate mixture separately. According to Truit, Witko Halpern (2003), the issue of tolerance is still a bit controversial. There are some researchers that have noted that the overuse of racemic albuterol may lead to some factors that include hypokalemia and even increased mortality. Therefore, due to the lack of bronchodilator activities in (S)-albuterol, there may arise the situation of worsening air activity or rather pro-inflammatory effects. This is because it is metabolized 10-fold slower than levalbuterol (Truit, Witko Halpern, 2003). This could additionally result in the accumulation of (S)-isomer over (R)-albuterol leading to paradoxic bronchospasm. In addition, patients who suffer from asthma or COPD and other cardiac diseases have a likelihood of worsening the situation when they experience tachycardia and this therefore means that they are safer when using levalbuterol as compared to albuterol (Lovtall, Palmqvist, Maloney, Vantresca and Ward 2004). Studies have also discovered poor adherence to med ication by patients who suffer from tachycardia The other main factor that was noted when comparing the two agents is cost. Before the year 2009, the metered-dose inhaler (MDI) that had generic formulations was widely available. There were also versions of albuterol that were much cheaper. They included proventil and ventolin. This fact also applied to levalbuterol. On the contrary, many of the MDI formulations contained a lot of chloroflourocarbon and therefore, this meant that they had to be banned by the FDA (Food and Drug Administration). This was particularly due to environmental reasons. Therefore, the unavailabilty of the MDI has led to the leveling in price of the two agents (Truitt et. al., 2003). However, there are variations in the cost of levalbuterol nebulization as compared to albuterol nebulization. The use of levalbuterol faces various limitations including higher costs, small sample size in terms of testing, inadequate manpower and lack of support by many researchers This however, does not mean that albuterol should be preffered over levalbuterol since there are instances when levalbuteral tends to be widely accepted. First and foremost, there is a need by patients who have severe chronic asthma to get the doses of beta-2 agonist. This happens in spite of the use of controller therapies. A study by Tripp (2008) showed that levalbuterol resulted in Forced Expiratory Values (FEV) that were equivalent to or better than those that were observable in albuterol. The -mediated effects were lower for a single dose of levalbuterol as compared to racemic albuterol. In this studies, treatment of asthma using levalbuterol was cheaper due to the little numbers of hospital admissions (Tripp, 2008). In this particular study, levalbuterol treatment in the emergency department was cost effective because it led to a situation of patients recovering faster and thus reducing the cost of healthcare. Although the (R) -albuterol and (S) albuterol isomers are similar in their molecular weight and their physiochemical properties, their 3-dimensional structure makes them super imposable. This conformational stereochemistry makes their properties distinct and for each isomer which results to them being considered different compounds (Nelson, 1998) As a result, regulatory authorities have demanded that the potential risks associated with the mixtures that make up racemic albuterol be quantified. Levalbuterol was developed to minimize the side effects associated with (S)-albuterol and maximize therapeutic effects. The findings of this study demonstrate that the use of levalbuterol significantly reduces hospital admission rates in patients presenting to the ED with acute asthma when compared to racemic albuterol. The study suggests that levalbuterol has clinical benefits over racemic albuterol in critical care settings, and these benefits are evident in both pediatric and adult patients administered with levalbuterol. The above studies were conducted in geographically distinct ED settings, with varying patient populations, physicians, and socioeconomic conditions demonstrating that substituting racemic albuterol with levalbuterol improves patient outcomes by reducing hospital admissions. Different studies have suggested that levalbuterol produces greater bronchodilation than racemic albuterol and improves discharge rates and health resource use (Ozminkowski Wang 2007). A post-hoc analysis on the patients found that their (S)-albuterol plasma levels negatively impacted their baseline forced expiratory volume in 1 second as well as pulmonary function an hour after ED treatment was commenced. Despite the higher cost of levalbuterol in the treatment of asthma, when the total costs are considered, the differences in the costs are insignificant. The overall costs were similar in the levalbuterol group and the racemic albuterol group. The cost reductions were reported with increasing severity of asthma. This results from reduced hospital admissions and less frequent dosing, making the treatment more cost effective despite its high cost (Nowak, 2006) The clinical and preclinical benefits of levalbuterol observed in the literature cited in this investigation occur due to the difference between the two agents which is the presence of (S)-isomer in the racemic mixture. Despite previous studies suggesting that it is inert, the (S) isomer may instead have some proinflammatory effects. The bronchoprotective efficacy of racemic albuterol progressively declines with regular use, leading to reduced interval between dose and decreased bronchodilation (Nelson, 1998). The above findings indicate that levalbuterol, when used in place of albuterol reduces the number of hospital admissions, and is cost effective in the treatment of acute asthma in the ED setting. This makes the observations provocative and interesting since the only difference between the two agents is the presence of the (S)-isomer in the racemic mixture. The mainstay of therapy for reactive airway diseases has been rapid-onset 2-agonist agents such as racemic albuterol. However, the recent isolation of (R)-isomer levalbuterol has provided a new option for the treatment of asthma and COPD. The use of levalbuterol therapy produces both clinical and economical advantages when compared to albuterol therapy. Buy custom Levalbuterol in Asthma essay