Walmart Management Problems Essay Example | Topics and Well Written Essays - 2000 words

Walmart Management Problems - Essay Example This makes the space for misconstruing contenders and hurting the relationship that the retailer will have with neighborhood providers. This isn't the main issue that Wal-Mart faces different issues incorporate associations, low wages, sex separation, and others that have discolored the name of the store. Wal-Mart Management Problems Looking at the most recent two decades will show how the worldwide economy has experienced an extreme change. In spite of the way that there are distinctive geographic areas around the globe isolated by seas and oceans, improvement in innovation has made the separation contract totally. A portion of the mechanical advancements that have made this conceivable are planes, satellite telecom, PCs, fax machines, web, and others. Innovation has made it feasible for business to extend globally and get various providers from various pieces of the world. Numerous individuals will discuss globalization and it just alludes to the overall financial exercises of free progression of administrations, products, information, capital, rivalry, and open markets. Through globalization, worldwide organizations have had the option to build up themselves in neighborhood markets while nearby organizations have had the option to go worldwide. ... This is on the grounds that it as of now has stores in Asia, Europe, and South America. Its development endeavors are still on, as it has plans of setting up more stores both locally and universally (About Wal-Mart, 2001). The way that the store is number one in the US doesn't promise it will be number one in different nations. This is a direct result of the difficulties that lie ahead with the guidelines of the nation where it will be opening its stores and the neighborhood supplier’s eagerness to gracefully the store with items. The way of life received in the locale will tell a ton if the store will have the option to accomplish its goal of being ready to go while offering clients with quality items and administrations. Notwithstanding globalization being uplifting news for organizations, it has made rivalry to increment with the expansion in number of contenders. The way that everybody is right now worried about the earth and searches for every single imaginable mean in wh ich they can moderate the earth causes condition amicable organizations to have a high ground in ruling the market. Clients will be pulled in to organizations that are out to secure our condition that is now devastated as opposed to organizations that are out to see total pulverization of the little magnificence left in our condition. Becoming environmentally friendly will help in guaranteeing that you have consistent market for your products and enterprises. The Wal-Mart Culture (2004) clarifies Wal-Marts three essential convictions and decides that makes the store unique in relation to its rivals. In any case, Gilman (2004), Jones (1998), and Menzer (2001) give the purposes behind the rate at which Wal-Mart is extending in to the global market. They have a solid conviction that Wal-Mart will command the US showcase later on. Various

Hamlet Fortinbras Death

Hamlet Fortinbras Death Hamlet Analysis Villas Last Soliloquy â€Å"Sith I have cause, and will, and quality, and means/To dot† (IV. iv. 46-47). Hamlet, by William Shakespeare is a disastrous account sonnet that recounts to the narrative of a sovereign named Hamlet, whose father was killed by his uncle. Avenging his dads demise and concluding whether to murder his Uncle Claudius turns into a psychological battle for Hamlet all through the story. There are various characters in the play that Hamlet cooperates with, yet the appropriate responses Hamlet needs wind up originating from inside him. Shakespeare utilizes discourses to show a characters considerations by talking them so anyone might hear, as the character strolls alone in the scene. Villas last talk in Act IV, Scene IV shows an emotional change of his character. He starts as a weakling, persistently deferring the homicide of his uncle. After his change, he chooses to be consistent with himself and complete what he expected from the earliest starting point and the demise of Claudi us gets inescapable. Scene IV starts at the shore of Denmark with the character Fortinbras, who is the sovereign of Norway and old buddy of Hamlets. Fortinbrass armed force is getting ready for a walk on the realm of the Danish ruler as he recently guaranteed would happen. Hamlet gains from the skipper of Fortinbrass boat that Fortinbras is planning to take part in war with the goal that the degree of Norways land can be gotten. Hamlet appreciates and regards Fortinbras for his capacity to make a move when Fortinbras guarantees he will: Witness this military of such mass and charge, Driven by a fragile and delicate sovereign, Whose soul with divine aspiration puffed Makes mouths at the imperceptible occasion, Uncovering what is mortal and uncertain To such fortune, passing and threat dare, In any event, for an eggshell (IV. iv. 48-54). At the point when Hamlet states how he appreciates Fortinbras, he brings up how young and predominant Fortinbrass characteristics are by calling him â€Å"delicate and tender.† Hamlet calls attention to Fortinbrass grit by saying he makes mean countenances (â€Å"makes mouths†) at what lies ahead. This is to be held in high respect in Hamlets eyes since what lies ahead is never truly known and well on the way to be dreaded. Hamlet respects that regardless of what fortune, threat, and demise could do to Fortinbras and his military, they despite everything walk on. The adoration in Hamlets tone and words for Fortinbras rouses him to be the valiant ruler that Hamlet wants to be. The impression given in the content is that Hamlet hears his own words for Fortinbras and needs that regard and respect for his own name. Hamlet starts to contrast himself with Fortinbras. It is suggested that Hamlet understands his shortcomings by contrasting himself with the honorable Fortinbras. Hamlet wants Fortinbrass capacity to control his military and his state. The account shows Hamlets powerlessness to control himself, or his own activities so utilizing Fortinbras as a model is the thing that will wind up pushing Hamlet to turn into the decent man he wishes to be. â€Å"Rightly to be extraordinary/Is not to mix without incredible contention,/But extraordinarily to discover squabble in a straw/When praises at the stake† (IV. iv. 54-57). He is suggesting here, as Fortinbras would concur, typically obvious enormity doesn't mean hurrying into a fight over something inconsequential; nonetheless, while shielding ones respect, in any event, something that appears to be minor merits move to be made right away. From the content, the impression given depicts how Hamlet is being addressed when he realizes his dad was killed by his uncle and still can't seem to take care of business. Here, apparently a change is coming over Hamlet. He is no more bantering in his brain whether Claudius ought to be executed, however acknowledging what he should do so as to secure his own respect and that of his dads. He proceeds here with â€Å"How stand I, at that point,/That have a dad murdered, a mother recolored,/Excitements of my explanation and my blood,† (IV, iv. 57-59). Hamlet currently realizes that he has been living with this disgrace of realizing his dad was executed by his own blood and questions himself as though to state â€Å"How am I remaining here carrying on with my life recognizing what has happened?† â€Å"O, from this time forward/My contemplations be grisly or be nothing worth!† (IV, iv. 66-67). This is the crucial purpose of the play. It as though a revelation at last comes over Hamlet and the entirety of his weakness and re-thinking himself is finished. Hamlet is currently prepared and bold enough to do what he has been decided to do from the beginning. Not at all like the acclaimed, â€Å"To be or not to be†¦Ã¢â‚¬  monologue, Hamlet is done dreading the outcomes of his future activities. Prior to his last monologue, Hamlet could be depicted as prudent and loaded with respectability, however he was as yet a quitter. Hamlet never finished the homicide of his uncle. He would even attempt to rationalize his activities. At the point when Claudius was asking and conversing with God, Hamlet utilized his being â€Å"holy† right now not to execute him. Hamlet was continually putting off his uncles demise. Hamlet turned out to be logically increasingly confounded and the battle between his contemplations and the outcomes appeared to get worseâ€until the motivation of Fortinbras and his great ideals and authority aptitudes helped Hamlet to see plainly what should have been finished. Toward the finish of the account, practically every character passes on, including Hamlet. His passing can't be taken a gander at as gallant nor would it be able to be taken a gander at as dishonorable. He retaliated for his dads demise. That was a significant part of the focal point of Hamlet and he prevailing with regards to doing as such. Fortinbras had a monstrous effect on Hamlets rationale and helped him to get his retribution. Villas last talk in Act IV, Scene IV shows the transformation Hamlet expected to attract the fearlessness to execute the lord. Shakespeare achieves a sensational change of character and uses it to pass on regardless of how incredible the change is, it can in any case end in disaster.

Anna Teytelman Japanese Hip-Hop Extraordinaire!

Anna Teytelman Japanese Hip-Hop Extraordinaire! When most people say they have a UROP, you can immediately imagine them sitting at a lab bench while wearing a white lab coat, safety glasses, and gloves. If Anna Teytelman, a sophomore in Management Science (Course 15) and Mathematics with Computer Science (Course 18C), showed up to her UROP in such attire, her boss would probably, no, definitely, laugh at her and possibly send her to MIT Medical. Anna has every music lovers dream job: she researches Japanese hip-hop for Professor Ian Condry, an Assistant Professor in the Foreign Languages and Literatures (FLL) Department. Annas research is in the area of Japanese popular culture and is focused on Japanese Hip Hop. She studies its evolution from its relatively recent birth and also compares Japanese and American Hip Hop. She explains,On the one hand, Japanese hip-hop admittedly takes a lot of its roots from the American styles, which come from mostly African-American origins. On the other hand, a lot of artists intentionally take a lot of their material from Japanese cultural sources. Some rappers use Japanese poetry styles such as haiku and tanka (ancient 31-syllable poetic form). Another distinctive point is that a lot of underground rappers focus their songs on political events such as the September 11 attacks in the US, the war in Iraq, and Japanese education system reform. Her UROP includes two very interesting aspects: researching information on hip-hop and making website for her lab, HyperStudio. Her supervisor, Professor Condry, has just finished writing a book on Japanese hip-hop, and she is now doing some further research for him. Although the book is far from being published, she highly recommends taking a look at it when it comes out. The second aspect of her job is creating a MetaMedia website that will contain various media for use by MIT faculty and students. With the help of other people in Hyperstudio, which is a media studio jointly sponsored by the FLL Department and Comparative Media Studies, she is helping to lay the foundation for this potentially very useful database. In order to do this, she is currently preparing some of the translated videos and songs that will serve as examples for the points made in Professor Condrys book. Ideally, this website will also be used as a resource for Professor Condrys Japanese Culture classes. To see some sample videos, visit his website at www.iancondry.com. Anna really enjoys her unique UROP, especially learning little random facts about Japanese culture. She likes the flexibility of working on her UROP from home and has the added bonus of shocking people in the lounge by blasting Japanese rap from her laptop while working. She is also particularly proud that her professor has a picture of himself with Snoop Dogg in his office. How many other people can make that claim? Outside of class, Anna plays a ton of intramural soccer (shes lost count of how many teams shes on) and she plays whenever she has the chance. She is also a Resident Associate Advisor at Next House, where she helps run a freshman seminar and tries to make freshmen as comfortable as possible. Her advice is to enjoy whatever you do. No matter where you end up, this is the only thing that in the end you will really wish you had done in college. Clearly, she is following her advice by participating in such a one-of-a-kind UROP! Note: The picture was taken from www.japantoday.com/dbfiles/feature/rap.54.jpg

“Role of Government in Financial Inclusion” - 4322 Words

A RESEARCH PAPER ON â€Å"ROLE OF GOVERNMENT IN FINANCIAL INCLUSION† Submitted By: Hemali Shah (MPM: 2nd Semester) ABSTRACT: Financial inclusion means a group of people should take part in growth activities and help to increase economic growth of the country. We cannot say that financial growth has been achieved by opening a bank account, granting huge loan to a single person and closing the account. First, many people have to open an account in a bank, save money regularly so that loans to needy people may be granted on regular basis. It is a process ensuring easy access and usage of financial system for the rich and poor in the country. The Indian Government wishes that the poor people should be benefited by financial inclusion. They have†¦show more content†¦If this definition is accepted, it follows that despite the plethora of schemes that have been promoted by various governments from pre-IRDP days to the current SGSY, the SHG (Self Help Group) -Bank Linkage Programme is the only formal-sector scheme till date that regards excluded people as regular customers who can take loans again and again, as against being one-time beneficiaries who have to fall back on their own resources once their turn to benefit from the government scheme is over. Who can take part in financial inclusion? The Indian Government wishes that the poor people should be benefited by financial inclusion. They have to be given loans for trading activities or paying back the loan from money lenders. The Reserve Bank of India permits for financial inclusion by allowing banks to grant loan to non-registered bodies, subject to certain norms. By watching the functioning of group activities, the loan may be sanctioned to individuals or groups. The savings, repaying capacity and cash flow are the main criteria. The weaker section of India, still hesitate to take part in financial inclusion. The low income people should be approached by banks personally. They should be asked to open bank account for saving purpose. Small loans may be granted for them to encourage cash flow. At an affordable cost, the low income group should be allowed credit facility. The financial facilities should be arranged for poor people living in rural and semi urban areas. TheShow MoreRelatedFinancial Inclusion Through India Post1215 Words   |  5 PagesFINANCIAL INCLUSION THROUGH INDIA POST Dr. Joji Chandran PhD ABSTRACT India is having the most widely distributed post office system in the world. With 1,55,333 post offices, the India post comes under the Department of Posts which is a part of the Ministry of Communications and Information Technology under the Government of India. The wide distribution network of India post is one important factor that favours india post as a channel for financial inclusion in India. The search of financialRead MoreResearch Study On Vijaya Bank Essay1084 Words   |  5 Pagespast years for its operational areas and overall best performance. †¢ The RBI and Government are provided various schemes under financial inclusion program. †¢ As per RBI guideline every bank will offer no frill account and various service and awareness program to promote financial inclusion program. †¢ The Vijaya Bank provides various services like Business correspondent model, No frill account under financial inclusion program. †¢ The Balance sheet and profit and loss account shows that increase theRead MoreThe Growth And Poverty Improvement Of A Country Essay1539 Words   |  7 Pages INTERNSHIP INTRODUCTION Finance is assumed to be one of the most important tools for the growth and poverty improvement in a country. Financial inclusion is a vision for every country to achieve so that it can provide quality services to its citizens. Govt. Has introduces many schemes to achieve the aim of Inclusive growth and abandoned access to Financial services. Many initiatives, schemes and reforms have been put into the place after independence. Many Cooperative Banks where introduced toRead MoreThe Structure Of The Banking Industry1608 Words   |  7 Pagesthe State Bank of Vietnam (SBV) it has now expanded to several players and has recently enabled MFIs to be part of the formal financial system. However, despite these achievements, there are still challenges that linger and financial inclusion remains an issue. This part explores the current structure of the banking industry and touches on the status of financial inclusion in Vietnam. 4.3.1. Banking Industry Vietnam’s banking sector is fairly recent being founded a little over 2 decades ago. PriorRead MoreBank Of The State Of Jammu And Kashmir1251 Words   |  6 Pageshas not been able to provide financial services to the underprivileged people till this date people are excluded from financial services. Strategies should be made according to the different villages and all efforts must be put to raise the standard of people in the state of Jammu and Kashmir. Bank should make polices for common people to ensure that inclusion of poor is kept in mind. Usually loans are taken because of problems faced by people it may be of financial loan loan for marriages andRead MoreA Market Based Approach For Community Development Essay1400 Words   |  6 Pagesincludes actors from inside and outside of the community to achieve sustainability. My previous essays have addressed the progression of community development from place-based attachment, organizing and advocacy to addressing the need and effect of government involvement. The final stop on the continuum of the community development is to analyze market-based approaches to community development. This paper will look at how a market based approach to community development is an important component ofRead MoreEssay On Microfinance Sector836 Words   |  4 Pagesadequate financing; these numbers highlight the extent of financial exclusion.2 Banks seem to have taken note of these realities and are adopting new technologies and leveraging partners to tap the underserved. This has resulte d in increased financial inclusion in rural areas, especially among those who are opening bank accounts for the first time. Still, despite the best efforts of banks, many are yet to be included in the formal financial system through access to formal credit. Microfinance institutionsRead MoreDigital Payment Is A Way Of Payment1457 Words   |  6 Pagesside capabilities that support the Indian government’s agenda of financial inclusion. For instance, digital banking offers numerous advantages that work towards improving the same, largely riding on the fact that Indian consumers have shown tremendous preference for digital technologies, with growth rates for e-commerce as well as mobile phone adoption far outstripping rates in developed economies. As per Reserve Bank of India â€Å"Financial Stability Report of 2015-16† the share of electronic transactionsRead MoreRole Of Business In Nigeria795 Words   |  4 PagesChairman of Heirs Holding, Tony Elumelu, has said that the federal government’s Ease of Doing Business in Nigeria initiative can only work when the three arms of government, the executive, the judiciary and legislature, work together to put up right business policies that will prepare Nigeria as investment destination. Elumelu, stated this in a key note address at the 2017 National Insurance Conference organised by the Insurance Industry Consultative Council ( IICC) in Abuja. Speaking on the themeRead MoreGlobal Financial Development Report By The World Bank Essay2058 Words   |  9 PagesThis is the second Global Financial Development Report published by the World Bank. It seeks to contribute to enhancing the knowledge of financial inclusion around the world. In the recent times, financial inclusion has become an important aspect for economic and social development of an economy and has become a significant topic of discussion for the policy makers, market practitioners etc. Financial inclusion has been given a lot importance in our country and this can be proven by the recently

Educational Argumentative Essay Topics Tips & Guide

Educational Argumentative Essay Topics Tips & Guide Top Educational Argumentative Essay Topics Choices If you are going to compose an argumentative essay, the very first thing you should do is to understand its key features and structure. Additional it doesn't yet utilised to be doing you have to work with the multiple interactions of 3 things that may comprise a couple of positive scores or with the. You are able to also restate the ideas you have discussed in the body paragraphs in order to make your point valid. The dearth of great support sources will end in a decrease grade. The reader ought to be impressed by the manner in which you defend your ideas. You can't control anybody's opinion, and everyone is eligible to make their own choices, even if it has to do with smoking. When you're picking your topic, bear in mind that it's much simpler to write about something which you currently have interest ineven in case you don't know a great deal about it. If you're strug gling, you always have the option to get help by employing an essay writing service such as ours. Ruthless Educational Argumentative Essay Topics Strategies Exploited There is a range of reasons why students utilize online writing services. Another reason is to observe how well students argue on unique views and demonstrate understanding of the studied subject. If you have to choose the subject of your essay about education, you have arrived at the proper place. New tests, methodology, classes, thoughts and concepts happen each day on the planet of education. Argumentative essay is about arguing and debating on a subject, which is debatable. Argumentative essays are a few of the best that you can write as a student. Moral argumentative essay topics are a few of the simplest to get carried away with. Choosing topics for argumentative essays is very important for your general success. Inspiration to make your own advertising or media argumentative essay topics isn't difficult to discover. When you are finished with your essay, you must not simply check it for spelling and grammatical errors, but nevertheless, it also has to be checked for logical fallacies. It's possible to select an intriguing topic from any area of science. If you successfully determine the objective of language essay than you need to make certain the subject of language essay should fit in the objective. For example, let's say if you're writing about language history essay than you are going to have to incorporate all of the information regarding the history language on the planet no matter any specific region while in specific language history essay, you would chat about history of the language of a certain region. You may support a specific idea whilst criticizing different facets but let the reader decide. The balance between choosing the course you wish to do and the course which you feel you ought to do. On-line education further turns out to be relatively cheaper in comparison to conventional educational approaches. The Foolproof Educational Argumentative Essay Topics Strategy Quite frequently, college essay topics prove to be more challenging than students expected, therefore it may be reasonable to request help. Not just that but students will be in a position to access their online courses and be in a position to follow along with the lecture through powerpoints. Many students know that it's hard to effectively develop an argumentative topic. Many students think that it is a waste of time. When it has to do with writing an argumentative essay, the most essential point to do is to select a topic and an argument you could really get behind. It is essential that the topic you select be something you really care about. So ensure you select a subject, which has values in it. The topic has to be interesting, the topic has to be essential and finally t he topic has to be informative. A decent argumentative essay is called to clearly show your capability to compose a good statement and defend your point with arguments. The conclusion provides the general verdict of the argument. Conclusion as soon as you are done placing all of your information in the body paragraphs, it's necessary for you to compose a conclusion. One particular important and appropriate subject is technology. Lies You've Been Told About Educational Argumentative Essay Topics If it's necessary to compose your whole essay in 1 day, do your very best to give yourself breaks so you don't burn out. The exact same thing you're going to do in your argumentative essay! Be clever pick a topic that you're good in and need to find out more about. It's important to select debatable argumentative essay topics as you need opposing points you may counter to your own points.

Drug Literature Evaluation Saw Palmetto Health And Social Care Essay Free Essays

string(165) " terminal of the first Clozaril intervention, plasma norclozapine concentration was non significantly correlated with weight addition in the entire sample \( r = 0\." Clinical Question # 1: Is saw palmetto proven to be every bit effectual as Finasteride in shriveling or halting the growing of the prostate secretory organ in work forces diagnosed with benign prostate hyperplasia ( BPH ) ? Phosphorus: male patients diagnosed with benign prostate hyperplasia I: proverb palmetto Degree centigrades: Finasteride ( Proscar ) Oxygen: To shrivel or halt the growing of the prostate secretory organ in work forces Thymine: Therapy/ Intervention Search Engines used ( 2 ) : OVID, Pubmed Search footings ab initio used ( based on PICO ) : Ovidi? Saw palmetto AND Finasteride AND BPH Pubmedi? Saw palmetto, finasteride, BPH Consequence: OVID ( 24 ) , PubMed ( 24 ) Search footings really used: Ovidi? Saw palmetto AND Finasteride Pubmedi? Finasteride, Saw Palmetto. LIMITS: English linguistic communication, worlds, work forces Consequence: Ovid ( 58 ) , PubMed ( 35 ) Suggested Articles: 1: Ovid # 28 Title: A prospective, 1-year test utilizing saw palmetto versus finasteride in the intervention of class III prostatitis/chronic pelvic hurting syndrome. Abstraction: Purpose: This survey was designed to measure the safety and efficaciousness of proverb palmetto or finasteride in work forces with class III prostatitis/chronic pelvic hurting syndrome ( CP/CPPS ) . We will write a custom essay sample on Drug Literature Evaluation Saw Palmetto Health And Social Care Essay or any similar topic only for you Order Now Materials and Methods: A prospective, randomized, unfastened label, 1-year survey was designed to measure the safety and efficaciousness of proverb palmetto and finasteride in the intervention of work forces diagnosed with CP/CPPS. Patients were randomized to finasteride ( 5 milligram one time day-to-day ) or saw palmetto ( 325 milligrams daily ) for 1 twelvemonth. Patients were evaluated utilizing the National Institutes of Health Chronic Prostatitis Symptom Index, single spheres ( hurting, urinary symptoms, quality of life and intend hurting mark ) and the American Urological Association Symptom Score at baseline, 3, 6 and 12 months. Consequences: A sum of 64 back-to-back work forces 24 to 58 old ages old ( average age 43.2 ) with a diagnosing of CP/CPPS were every bit randomized to the 2 intervention weaponries. All 64 work forces had antecedently received antibiotics ( continuance of 3 to 93 hebdomads ) , 52 ( 82 % ) had been on alpha-blockade. There were 61, 57 and 56 patients evaluable at 3, 6 and 12 months, severally. At 1 twelvemonth mean entire National Institutes of Health Chronic Prostatitis Symptom Index score decreased from 23.9 to 18.1 in the finasteride group ( P lt ; 0.003 ) , and from 24.7 to 24.6 in the proverb palmetto arm ( p = 0.41 ) . In the finasteride arm the quality of life and hurting spheres were significantly improved at 1 twelvemonth ; nevertheless, micturition was non. Adverse events included concern ( 3 instances ) in the proverb palmetto group and decreased libido ( 2 instances ) in the finasteride group. At the terminal of the test 13 of 32 ( 41 % ) and 21 of 32 ( 66 % ) opted to go on saw palmetto and finasteride, severally. Decisions: CP/CPPS treated with proverb palmetto had no appreciable long-run betterment. In contrast, patients treated with finasteride had important and lasting betterment in all assorted parametric quantities except invalidating. Further surveies are warranted to determine the mechanism and duplicabilit y of these effects in a placebo controlled test. Citation: Kaplan S.A. , Volpe M.A. , Te A.E. EMBASE Journal of Urology. 171 ( 1 ) ( pp 284-288 ) , 2004. Date of Publication: Jan 2004. [ Journal: Article ] Associate in nursing: 2003516940 2. PubMed # 4 Title: Saw palmetto and finasteride in the intervention of category-III prostatitis/chronic pelvic hurting syndrome. Abstraction: Chronic nonbacterial prostatitis/chronic pelvic hurting syndrome is a common entity for which a standardised direction has non been established. Patients frequently have a important symptom composite and impact on quality of life, but really small is known about the efficaciousness of second- and third-line interventions, such as the usage of herbal addendums. Many interventions studied in recent literature include antibiotics, alpha-blockade, anti-inflammatory agents, and cognitive behavioural intercessions such as biofeedback and psychotherapeutics. Citation: Yang J, Te AE. Department of Urology, Weill Medical College of Cornell University, New York, NY 10021, USA. Curr Urol Rep. 2005 Jul ; 6 ( 4 ) :290-5. Review.PMID: 15978232 [ PubMed – indexed for MEDLINE ] Clinical Question # 2: In corpulent patients enduring from schizophrenic disorder, is Clozapine more likely to do weight addition than other untypical major tranquilizers? Phosphorus: corpulent patients enduring from schizophrenic disorder I: Clozapine Degree centigrades: other untypical major tranquilizers Oxygen: control of corpulent patient ‘s schizophrenic disorder with untypical major tranquilizers while non doing an addition in weight Thymine: Therapy/ Intervention Search Engines used ( 2 ) : Trip Database, PubMed Search footings ab initio used ( based on PICO ) : Trip Databasei? Clozapine, weight addition, corpulent, schizophrenic disorder PubMedi? corpulent, Clozaril, weight addition, schizophrenic disorder Consequence: Trip Database ( 32 ) , PubMed ( 37 ) Search footings really used: Trip Databasei? Clozapine, weight addition, corpulent, schizophrenic disorder PubMedi? Clozaril, weight addition, corpulent, schizophrenic disorder, untypical major tranquilizers. Limits: worlds, English linguistic communication Consequence: Trip Database ( 32 ) , PubMed ( 28 ) Suggested Articles: 1.Trip Database # 4 ( nexus to PubMed ) Title: Weight addition during a double-blind multidosage Clozaril survey. Abstraction: Possible variables associated with weight addition during clozapine intervention include dosing, intervention continuance, baseline organic structure mass index ( BMI ) , sex, and plasma norclozapine concentrations. Weight additions during a double-blind, randomized Clozaril survey utilizing 100- , 300- , and 600-mg/d doses were analyzed. It was hypothesized that weight addition was associated with baseline BMI, Clozaril dosing, and demographic factors. The possible part of plasma Clozaril and norclozapine concentrations was explored. Fifty treatment-refractory schizophrenic disorder patients were randomized to 100- , 300- , or 600-mg/d doses of Clozaril for a 16-week, double-blind intervention in a research ward. Nonresponsive patients went onto a 2nd and/or a 3rd 16-week, double-blind intervention at the other doses. Weights of patients were measured every hebdomad. During the first Clozaril intervention, weight addition varied across 3 baseline BMI classs ( normal-wei ght patients [ 4.1 kilogram, P lt ; 0.001 ] , fleshy patients [ 2.6 kilogram, P = 0.05 ] , and corpulent patients [ 0.36 kilograms, non important ] ) and harmonizing to dosing ( 600 mg/d [ 4.4 kilogram ] , 300 mg/d [ 2.6 kilogram ] , and 100 mg/d [ 1.3 kilograms ] ) . Sexual activity had no consequence after commanding for baseline BMI and dose, but the Afro-american race had a strong important consequence despite the little figure of African Americans ( n = 6 ) . At the terminal of the first Clozaril intervention, plasma norclozapine concentration was non significantly correlated with weight addition in the entire sample ( r = 0. You read "Drug Literature Evaluation Saw Palmetto Health And Social Care Essay" in category "Essay examples"16, P = 0.32, n = 43 ) , but seems to be strongly correlated in nonsmokers. Despite its restrictions, this survey indicates that baseline BMI, dosing, and, perchance, the Afro-american race may be major determiners of clozapine-induced weight additi on. Citation: de Leon J, Diaz FJ, Josiassen RC, Cooper TB, Simpson GM. Journal of Clinical Psychopharmacology. Mental Health Research Center, Eastern State Hospital, Lexington, KY 40508, USA. 2. PubMed # 12504074 Title: A reappraisal of the consequence of untypical major tranquilizers on weight Abstraction: Controlled research tests have shown that untypical major tranquilizers have of import advantages over standard major tranquilizers, including a broader spectrum of efficaciousness and improved tolerability profile, peculiarly with respect to neurological inauspicious events such as extrapyramidal symptoms ( EPS ) . Some untypical major tranquilizers, nevertheless, tend to do important weight addition, which may take to hapless conformity and other inauspicious wellness effects. The mechanisms involved in antipsychotic drug-related weight addition are as yet unsure, although serotoninergic, histaminic, and sympathomimetic affinities have been implicated along with other metabolic mechanisms. The untypical major tranquilizers vary in their leaning to do weight alteration with long-run intervention. Follow-up surveies show that the largest weight additions are associated with Clozaril and olanzapine, and the smallest with quetiapine and ziprasidone. Risperidone is associat ed with modest weight alterations that are non dose related. Given the tantamount efficaciousness of untypical major tranquilizers, weight-gain profile is a legitimate factor to see when building an algorithm for intervention due to the serious medical effects of fleshiness. Citation: Nasrallah H. Psychoneuroendocrinology. 2003 Jan ; 28 Suppl 1:83-96. Department of Psychiatry, University of Cincinnati Medical Center, 231 Albert Sabin Way, PO Box 670559, Cincinnati, OH 45267-0559, USA. Mesh Footings: Antipsychotic Agents/adverse effects* Clinical Tests as Subject Worlds Monitoring, Physiologic Obesity/chemically induced* Obesity/epidemiology Obesity/therapy* Overweight/chemically induced* Overweight/epidemiology Overweight/therapy* Schizophrenia/complications* Schizophrenia/epidemiology Weight Loss Clinical Question # 3: Is Crestor ‘s new indicant for the primary bar of cardiovascular disease, considered unique to the drug, or a category consequence of all lipid-lowering medicine drugs? Phosphorus: patients at high hazard of cardiovascular disease I: Crestor Degree centigrades: the â€Å" statin † drug therapy category Oxygen: bar of cardiovascular disease Thymine: Therapy/prevention Search Engines used ( 2 ) : OVID, PubMed Search footings ab initio used ( based on PICO ) : OVIDi? Crestor AND cardiovascular disease AND new indicant PubMedi? rosuvastatin, cardiovascular disease. Limits: worlds, English linguistic communication. Consequence: OVID ( 0 ) , PubMed ( 431 ) Search footings really used: OVIDi? rosuvastatin AND cardiovascular disease AND bar PubMedi? rosuvastatin, Cardiovascular disease bar. Limits: worlds, English linguistic communication. Consequence: Ovid ( 505 ) , PubMed ( 253 ) Suggested Articles: 1.From OVID- Lipid-lowering medicines for primary bar in older grownups: who is high hazard, who is old, and what denotes primary bar? Abstraction: Whether to handle older grownups with statin medicines for primary bar of cardiovascular events remains a clinical riddle. A figure of observations with respect to increasing age stoke this quandary: The association between elevated cholesterin degrees and cardiovascular hazard diminishes ( 1 ) , risk-prediction tools ( such as the Framingham hazard mark ) become less accurate ( 2, 3 ) , back uping clinical test informations become limited, and the decreasing life anticipation versus clip to medication benefit invariably displacements. Additional downsides of lipid-lowering medicines for older grownups include medicine cost, polypharmacy, and possible side effects. Conversely, age entirely makes older grownups inherently high hazard and lipid-lowering medicines cut down cardiovascular events and decease and may hold other good effects. Clinical test informations support secondary bar of cardiovascular events with lipid-lowering medicines for individuals 80 old ages or younger, but informations are light thenceforth. As the figure of individuals 65 old ages or older quickly additions, and more so the figure of individuals 85 old ages or older, this clinical inquiry demands to be addressedaˆÂ ¦ . Citation: Zieman S.J. , Ouyang P. EMBASE Annals of internal medical specialty. 152 ( 8 ) ( pp 528-530, W183 ) , 2010. Date of Publication: 20 Apr 2010. [ Journal: Note ] AN: 20404384 2. PMID: 20026779 Title: Rosuvastatin in the bar of shot among work forces and adult females with elevated degrees of C-reactive protein: justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin ( JUPITER ) . Abstraction: Background: Anterior primary bar tests of lipid-lowering medicine therapy that used cholesterin standards for registration have non reported important lessenings in shot hazard. We evaluated whether lipid-lowering medicine therapy might cut down shot rates among persons with low degrees of cholesterin but elevated degrees of high-sensitivity C-reactive protein. METHODS AND RESULTS: In Justification for the Use of lipid-lowering medicines in Prevention: an Intervention Trial Evaluating Rosuvastatin ( JUPITER ) , 17 802 seemingly healthy work forces and adult females with low-density lipoprotein cholesterin degrees lt ; 130 mg/dL and high-sensitivity C-reactive protein degrees gt ; or = 2.0 mg/L were indiscriminately allocated to rosuvastatin 20 mg day-to-day or placebo and so followed up for the happening of a first shot. After a average followup of 1.9 old ages ( maximal, 5.0 old ages ) , rosuvastatin resulted in a 48 % decrease in the jeopardy of fatal and nonfatal shot as compared with placebo ( incidence rate, 0.18 and 0.34 per 100 person-years of observation, severally ; guess ratio 0.52 ; 95 % assurance interval, 0.34 to 0.79 ; P=0.002 ) , a determination that was consistent across all examined subgroups. This determination was due to a 51 % decrease in the rate of ischaemic shot ( hazard ratio, 0.49 ; 95 % assurance interval, 0.30 t o 0.81 ; P=0.004 ) , with no difference in the rates of haemorrhagic shot between the active and placebo weaponries ( jeopardy ratio, 0.67 ; 95 % assurance interval, 0.24 to 1.88 ; P=0.44 ) . Decision: Rosuvastatin reduces by more than half the incidence of ischaemic shot among work forces and adult females with low degrees of low-density lipoprotein cholesterin degrees who are at hazard because of elevated degrees of high-sensitivity C-reactive protein. Citation: Everett BM, Glynn RJ, MacFadyen JG, Ridker PM. Circulation. 2010 Jan 5 ; 121 ( 1 ) :143-50. Epub 2009 Dec 21. Center for Cardiovascular Disease Prevention, Brigham and Women ‘s Hospital, 900 Commonwealth Ave, Boston, MA 02215, USA. How to cite Drug Literature Evaluation Saw Palmetto Health And Social Care Essay, Essay examples

Solutions to Problems Essay Example

Solutions to Problems Paper When borrowing a constant proportion of the market value of the project, the interest tax shields are as uncertain as the value of the reject, and therefore must be discounted at the projects opportunity cost of capital. 18. Opportunity cost of capital Suppose the project described in Problem 17 is to be undertaken by a university, Funds for the project will be withdrawn from the universities endowment, which is invested in a widely diversified portfolio of stocks and bonds. However, the university can also borrow at The university is tax exempt. The university treasurer proposes to finance the project by issuing $400,000 of perpetual bonds at 7% and by selling $600,000 worth of common stocks from the endowment. The expected return on the common stocks is 10%. He therefore proposes to evaluate the project by discounting at a weighted-average cost of capital, calculated as: Whats right or wrong With the treasurers approach? Should the university invest? Should it borrow? Would the projects value to the university change if the treasurer financed the project entirely by selling common stocks from the endowment? The immediate source of funds (i. E. , both the proportion borrowed and the expected return on the stocks sold) is irrelevant. The project would not be any ore valuable fifth university sold stocks offering a lower return. If borrowing is a zero-NP activity for a tax-exempt university, then base-case NP equals APP, and the adjusted cost of capital r* equals the opportunity cost of capital with all-equity financing. Here, base-case NP is negative; the university should not invest. We will write a custom essay sample on Solutions to Problems specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Solutions to Problems specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Solutions to Problems specifically for you FOR ONLY $16.38 $13.9/page Hire Writer 1 Issue cost and APP The Bunsen Chemical Company is currently at its target debt ratio of 40%. It is contemplating a $1 million expansion of its existing business. This expansion is expected to produce a cash inflow of $130,000 a year n perpetuity. The company is uncertain whether to undertake this expansion and how to finance it. The two options are a $1 million issue of common stock or a $1 million issue of 20-year debt. The flotation costs of a stock issue would be around 5% of the amount raised, and the flotation costs Of a debt issue would be around 139%. Bunges financial manager, Ms. Poly Ethylene, estimates that the required return on the companys equity is 14%, but she argues that the flotation costs increase the cost Of new equity to 19%. On this basis, the project does not appear viable. On the other hand, she points out that the company can raise new debt on a 7% yield, which would make the cost of new debt She therefore recommends that Bunsen should go ahead with the project and finance it with an issue of long-term debt. Is Ms. Ethylene right? How would you evaluate the project? Note the following: The costs of debt and equity are not and 19%, respectively, These figures assume the issue costs are paid every year, not just at issue. The tact that Bunsen can finance the entire cost of the project with debt is irrelevant. The cost of capital does not depend on the immediate source offends; what matters is he projects contribution to the firms overall borrowing power, The project is expected to support debt in perpetuity.

Elements of Plot Essay Example

Elements of Plot Essay Example Elements of Plot Essay Elements of Plot Essay Elements of Plot Setting- The setting was in San Francisco somewhere around 1997. This is modern day life with normal laws and rules. Conflict- The conflict in the short story is man vs. man. Paw-Paw had a conflict with the main character due the grandmother bias to Ian and how the grandmother took everything from her. Plot- 1 Her Paw-Paw coming home and walking really slow. 2 Her Paw-Paw ignored her and was bias to her brother Ian. 3 The girl wanted her Paw-Paw to fix her bow and freaked out because the bow was used on her feet in China. 4 The girl walked in the bathroom on her Paw-Paw and her bare feet which made Paw-Paw insecure. 5 During a bedtime story for Ian the truth came out about Paw-Paw because of a book. Character- the Protagonist was the daughter and the antagonist was the Grandmother. The mother basically did anything her mom told her because of what her mom did for her in the past. The father just tried to make the Paw-Paw do little work and feel comfortable. Ian got everything from his grandmother because in China, men are seen as better than women. Theme â€Å" The theme of this short story was how different people see things differently because of their past. The daughter saw the ribbons as fun and festive because she uses them for dance class. But Paw-Paw saw the ribbons as sinful and full of pain because of what her parents did to her in China. Point Of View- The point of view was 1st person. The girl talked about how she saw the way the grandma was acting and what she was missing because of Paw-Paws visit.

Teaching Children to Count

Teaching Children to Count A childs first teacher is their parent. Children are often exposed to their earliest math skills by their parents. When children are young, parents use food and toys as a vehicle to get their children to count or  recite numbers. The focus tends to be on rote counting, always starting at number one rather than the understanding the concepts of counting. As parents feed their children, they will refer to one, two, and three as they give their child another spoonful or another piece of food or when they refer to building blocks and other toys. All of this is fine, but counting requires more than a simple rote approach whereby children memorize numbers in a chant-like fashion. Most of us forget how we learned the many concepts or principles of counting. Principles Behind Learning to Count Although weve given names to the concepts behind counting, we dont actually use these names when teaching young learners. Rather, we make observations and focus on the concept. Sequence: Children need to understand that regardless of which number they use for a starting point, the counting system has a sequence.Quantity or Conservation: The number also represents the group of objects regardless of size or distribution. Nine blocks spread all over the table are the same as nine blocks stacked on top of each other. Regardless of the placement of the objects or how theyre counted (order irrelevance), there are still nine objects. When developing this concept with young learners, its important to begin with pointing to or touching each object as the number is being said. The child needs to understand that the last number is the symbol used to represent the number of objects. They also need to practice counting the objects from bottom to top or left to right to discover that order is irrelevantregardless of how the items are counted, the number will remain constant.Counting Can Be Abstract: This may raise an eyebrow but have you ever asked a child to count the n umber of times youve thought about getting a task done? Some things that can be counted arent tangible. Its like counting dreams, thoughts or ideasthey can be counted but its a mental ​and not tangible process. Cardinality: When a child is counting a collection, the last item in the collection is the amount of the collection. For instance, if a child counts 1,2,3,4,5,6, 7 marbles, knowing that the last number represents the number of marbles in the collection is cardinality. When a child is prompted  to recount the marbles how many marbles there are, the child doesnt yet have cardinality. To support this concept, children need to be encouraged to count sets of objects and then probed for how many are in the set. The child needs to remember the last number represents the quantity of the set. Cardinality and quantity are related to counting concepts.Unitizing: Our number system groups objects into 10 once 9 is reached. We use a base 10 system whereby a 1 will represent ten, one hundred, one thousand, etc. Of the counting principles, this one tends to cause the greatest amount of difficulty for children. Note We’re  sure youll never look at counting quite the same way when working with your children. More importantly, always keep blocks, counters, coins or buttons to ensure that you are teaching the counting principles concretely. The symbols wont mean anything without the concrete items to back them up.

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

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

Stem-Cell Research Term Paper Example | Topics and Well Written Essays - 1000 words

Stem-Cell Research - Term Paper Example The practical use of blood stem use has been in existence for over 40 years with many clinical trials using tissue derived stem cells (Hug, 2010 104)Today stem cell research has developed into one of the most promising and influential fields of medical science. The nature of its experiments and methods, as well as the results, has also made it easily the most controversial. Its connection with cloning has opened it up to attacks from religious groups and with many believing that the science aims at enabling humans to play god. Stem cells are cells with the ability to divide indefinitely and result in a variety of specialized cells in a process known as developmental plasticity. This ability is common in embryonic cells, and they give the cells the highest potential for growth. Moreover, stem cells can be categorized into three different groups based on their differential abilities. Namely, embryonic, adult, and foetal stem cells, it is worth noting that adult stem cells have only rec ently come to be discovered since the presupposition was they rarely contain stem cells, this has been proved wrong by recent research . Tominipotent cells are to be found in exclusively in early embryos from an individual cell in this category, a complete organism can be formed. On the other hand, pluripotent cells exist as undifferentiated in blastocyst (Popular issues 2012). ... Embryonic Stem Cells One of the distinguishing characteristics of the embryonic stem cell is that it can transform into any other cell ranging from brain to liver cells. The chief source of these cells is the fertilized eggs from couples who are going through the In Vitro Fertilization. The 5 to 6 days old pluripotent embryos can differentiate into any one of the three germ layers (Appasani, 2010 pg 182) After the separation of the stem cells, replication of stem cell into stem cell lines follow that is a tedious process which does not guarantee results. Replication of stem cell lines may go on in culture dishes countless times and through a period of many years. Adult Stem Cells These can be found in both children and adults with the name setting them apart from the other kinds of stem cells. Adult stem cells are evident in human beings, but the process of their isolation and identification is what tasks specialists in this field. Consequently, the there is no clear cut information on whether they have restrictions to a variety of cells in relation to single tissue type or if they can exist as any tissue type (University of Edinburg Para 6). Foetal Stem Cells Unlike the other cell types, the foetal stem is easier to collect and have a lower likelihood of rejection (University of Edinburg Para 9). They are collected from aborted fetuses, the umbilical cord, or the placenta, however, Albeit considerably differentiated; they still have the potential to morph into other cell types making them excellent for transplant. However, the downside of these is that they can transmit condition such as leukemia that may not have been detected in the fetus. Besides, there is a plethora of moral and ethical issues, bearing in mind

Stem-Cell Research Term Paper Example | Topics and Well Written Essays - 1000 words

Stem-Cell Research - Term Paper Example The practical use of blood stem use has been in existence for over 40 years with many clinical trials using tissue derived stem cells (Hug, 2010 104)Today stem cell research has developed into one of the most promising and influential fields of medical science. The nature of its experiments and methods, as well as the results, has also made it easily the most controversial. Its connection with cloning has opened it up to attacks from religious groups and with many believing that the science aims at enabling humans to play god. Stem cells are cells with the ability to divide indefinitely and result in a variety of specialized cells in a process known as developmental plasticity. This ability is common in embryonic cells, and they give the cells the highest potential for growth. Moreover, stem cells can be categorized into three different groups based on their differential abilities. Namely, embryonic, adult, and foetal stem cells, it is worth noting that adult stem cells have only rec ently come to be discovered since the presupposition was they rarely contain stem cells, this has been proved wrong by recent research . Tominipotent cells are to be found in exclusively in early embryos from an individual cell in this category, a complete organism can be formed. On the other hand, pluripotent cells exist as undifferentiated in blastocyst (Popular issues 2012). ... Embryonic Stem Cells One of the distinguishing characteristics of the embryonic stem cell is that it can transform into any other cell ranging from brain to liver cells. The chief source of these cells is the fertilized eggs from couples who are going through the In Vitro Fertilization. The 5 to 6 days old pluripotent embryos can differentiate into any one of the three germ layers (Appasani, 2010 pg 182) After the separation of the stem cells, replication of stem cell into stem cell lines follow that is a tedious process which does not guarantee results. Replication of stem cell lines may go on in culture dishes countless times and through a period of many years. Adult Stem Cells These can be found in both children and adults with the name setting them apart from the other kinds of stem cells. Adult stem cells are evident in human beings, but the process of their isolation and identification is what tasks specialists in this field. Consequently, the there is no clear cut information on whether they have restrictions to a variety of cells in relation to single tissue type or if they can exist as any tissue type (University of Edinburg Para 6). Foetal Stem Cells Unlike the other cell types, the foetal stem is easier to collect and have a lower likelihood of rejection (University of Edinburg Para 9). They are collected from aborted fetuses, the umbilical cord, or the placenta, however, Albeit considerably differentiated; they still have the potential to morph into other cell types making them excellent for transplant. However, the downside of these is that they can transmit condition such as leukemia that may not have been detected in the fetus. Besides, there is a plethora of moral and ethical issues, bearing in mind

Stem-Cell Research Term Paper Example | Topics and Well Written Essays - 1000 words

Stem-Cell Research - Term Paper Example The practical use of blood stem use has been in existence for over 40 years with many clinical trials using tissue derived stem cells (Hug, 2010 104)Today stem cell research has developed into one of the most promising and influential fields of medical science. The nature of its experiments and methods, as well as the results, has also made it easily the most controversial. Its connection with cloning has opened it up to attacks from religious groups and with many believing that the science aims at enabling humans to play god. Stem cells are cells with the ability to divide indefinitely and result in a variety of specialized cells in a process known as developmental plasticity. This ability is common in embryonic cells, and they give the cells the highest potential for growth. Moreover, stem cells can be categorized into three different groups based on their differential abilities. Namely, embryonic, adult, and foetal stem cells, it is worth noting that adult stem cells have only rec ently come to be discovered since the presupposition was they rarely contain stem cells, this has been proved wrong by recent research . Tominipotent cells are to be found in exclusively in early embryos from an individual cell in this category, a complete organism can be formed. On the other hand, pluripotent cells exist as undifferentiated in blastocyst (Popular issues 2012). ... Embryonic Stem Cells One of the distinguishing characteristics of the embryonic stem cell is that it can transform into any other cell ranging from brain to liver cells. The chief source of these cells is the fertilized eggs from couples who are going through the In Vitro Fertilization. The 5 to 6 days old pluripotent embryos can differentiate into any one of the three germ layers (Appasani, 2010 pg 182) After the separation of the stem cells, replication of stem cell into stem cell lines follow that is a tedious process which does not guarantee results. Replication of stem cell lines may go on in culture dishes countless times and through a period of many years. Adult Stem Cells These can be found in both children and adults with the name setting them apart from the other kinds of stem cells. Adult stem cells are evident in human beings, but the process of their isolation and identification is what tasks specialists in this field. Consequently, the there is no clear cut information on whether they have restrictions to a variety of cells in relation to single tissue type or if they can exist as any tissue type (University of Edinburg Para 6). Foetal Stem Cells Unlike the other cell types, the foetal stem is easier to collect and have a lower likelihood of rejection (University of Edinburg Para 9). They are collected from aborted fetuses, the umbilical cord, or the placenta, however, Albeit considerably differentiated; they still have the potential to morph into other cell types making them excellent for transplant. However, the downside of these is that they can transmit condition such as leukemia that may not have been detected in the fetus. Besides, there is a plethora of moral and ethical issues, bearing in mind

Electronic Health Record Benefits

Electronic Health Record Benefits The electronic health record is a mean of organizing patients data making use in the field of information technology. Its purpose is to fulfill the various needs for information not only of patients and healthcare providers but also of other beneficiaries. The implementation of electronic health record system in health care organization is very complex and involves many parameters. Introduction Electronic health record is currently used by 12% of the physicians and 11% of the hospitals nationwide. Industry and government have promoted Electronic health record as a means of controlling costs and improving patients care. The electronic health record has become one of president obama main agenda and the investment necessary to ensure that within the coming years, all of Americas medical records are computerized. Today with the advance of globalization the electronic health record is still highly unlikely to advance in the next five years, governmental, technical and industry advances are adopting, which will drive the electronic health record in the hands of medical providers. The electronic health record (E.H.R) is a digital record of patient health information generated by one or more encounters in any care delivery setting. It contains information of the patient includes demographics, problems, medications, vital signs, past medical history, laboratory data and radiology re port . The electronic health record also promises the removal of many barriers in the medical field such as saving lives, money, and time, but unfortunately the fulfillment of this promise in the real world application has remained with a big question mark due to many factors cost of implementation, privacy and security. The following graph is the result of survey experts at nearly 3000 group practice nationwide. The table below lists barriers to Electronic health record adoption. well known factors such as security and cost are cited as key factors, but other factors which is usability is not mentioned frequent is another barrier to the electronic health record adoption. Usability is a primary concern Usability issues are also a factor why electronic health record implementation fails. In a survey paper primary care physicians were asked the reasons why they did not use the electronic health record system. From the research finding 35% of the physicians listed specific electronic health record usability issues, the most common were: Problems with the screen navigation, and the lack of functioning and the concern that the data will be lost. Anecdotal support for usability and Electronic health record failure comes from Cedars- Sinai medical centre of Los Angeles. They developed a $ 34 million computerized physician order entry system, but only included the input of a few physicians before launching it hospital wide in 2002 without thorough training Physicians who previously used to take notes by hand now required going through nearly a dozen screens and responding through numerous alerts for even common orders. Traditional doctors around 400 of them demanded its removal within three months of its launch. Poor usability can also endanger patients health. The electronic health record should be modernized helping the clinician workflow. In the year 1991, the institute of medicine released a report supporting the idea of implementing the Electronic health record within the coming years. In 2010, researchers believe only a small portion of health providers both public and private implementing the system. The implementation o f electronic health record provides answers to many barriers in the medical world. Background An electronic health record is a digital or electronic record of the patient health information gathered over the history of the patients interaction with the health care system. An electronic health record stores all information concerning the patient health statues. Information varies and includes the following age/sex, medications, and vital signs, past medical history, laboratory data and radiology report. The concept of a medical report goes back to the fifth century B.C developed by the Greek physician Hippocrates, also known as the Hippocratic Oath. Hippocrates described two main goals behind his findings 1- a medical record should accurately reflect the course of disease 2- a medical record should indicate the problem cause of the disease. In the present days, the electronic health record first began to appear in the 1960s. Reported that at least 73 hospitals began to use the electronic health record system. In 1991, the institute of medicine released a landmark report recomm ending the electronic health record be implemented in health system within 10 years. Almost 20 years later, according to the latest researchers only a small portion of health providers have implemented electronic health record. A Meta analysis of diffusion rates of the electronic health record in the United States shows that an uptake has slowed in recent years. The study concludes Electronic health record is the future. President Obama administration has the electronic health record as one of its primarily agenda the investment necessary to ensure that within the next five years, all of Americas medical records are computerized. While still with the advance of globalization the electronic health record is highly unlikely within the next five years, governmental, technical and industry advances are adopting, which will drive the electronic health record in the hands of medical providers. The electronic health record also promises the removal of many barriers in the medical field suc h as saving lives, money, and time. The question is still debatable whether the whole world will move towards the implementation of the Electronic health record. The electronic health record is one of the most important electronic patient data collection of our time and with the expanding population of the world it has become a necessity to implement the system in all public and private hospitals. The G.C.C region Literature review The opinions concerning the positive effects an E.H.R can have on patients health and whether all the healthcares in the world should step in and implement the system. The collection of personal health data is described to have many formats when speaking of systems that manage it. Reduction of the storage necessary to keep paper charts is also a noted as a reason to leverage an E.H.R freeing up of space better used for revenue generation. Paper charts have their own risk associated with them in terms of getting lost, productivity impacts to maintain and retrieve paper records and the resulting negative patient care (Carpenter 2002). An electronic health record system is the collection of data that is central to the patient (Rishel, Handler Edwards, 2005). These opinions agree the importance of the E.H.R and implementation of the system. An E.H.R system exists to facilitate the storage, revival and continuity of the record itself (Gans, Kralewski, Hammons Does, 2005). These opinions also strongly agree with the improvisation of the Medical record with the advances with science and technology. reversing the scenario, an E.H.R system can collect and aggregate information from other sources such as laboratory, X-ray and unstructured data like faxes or handwritten notes ( Wojcik, 2006) the scholar Wojcik agrees strongly with the use of E.H.R talking about the positive of the E.H.R reduces the storage of handwritten notes and stacks and piles of paper. The near term presents providers with realizing the digitization of the boxes of paper that is generated by patient encounters. These paper databases represent the clinical data that is ultimately needed to take EMR systems to the next level. The near term presents providers with realizing the digitization of the boxes of paper that is generated by patient encounters. These paper databases represent the clinical data that is ultimately needed to take EMR systems to the next level. Clinical data is the baseline in whic h all healthcare processes subscribe including decision support, health outcome analysis, billing and claims processing and health maintenance. Correlation and access to this data is what EMR systems seek to facilitate (Handler Hieb, 2007). Electronic health record systems, once materially implemented across the healthcare spectrum, will itself become the framework in which more overarching goals can be accomplished, such as the centralization of a persons health history. With Clinical data as a basis, further utilization of EMR systems can occur. EMR systems, once materially implemented across the healthcare spectrum, will itself become the framework in which more overarching goals can be accomplished, such as the centralization of a persons health history (Gartner. Currently, about 25 percent of U.S physicians are using systems that facilitate electronic health records (Murdock, 2007). E.H.R has become a primary concern in the medical world and the according to past literature re view in this generation we find that it some of the scholars are concerned with the paper works as they say that the E.H.R will help save doctors a lot of time and makes the process more efficient. Some scholars say that paper based system is very negative as it leads to losing important patient data which might confuse the doctor in prescribing proper medication to the patient. There are differences of opinion but according to most scholars the E.H.R is a vital tool in solving many of the issues that both public and private hospitals face around the world Questionnaire Results The questionnaire focuses on the importance of the E.H.R system and its implementation in the United States of America at a nation wide level. With growing medical demands around the world Hypothesis one results Our research finding indicate that the U.S government is encouraging the country medical networks to start using the E.H.R Hypothesis two results Our research finding according to 430 surveyors say that 55.1 % of their medical practices use the Electronic health record system Hypothesis three results Our research finding shows that majority of the surveyors have a positive outlook that majority of the medical practices will start using the E.H.R between the next 1 to 2 years Hypothesis four results Our research finding shows that 41.8% of the surveyors believe that their medical providers will qualify for the Medicare and Medicaid programs Hypothesis five results Our research finding again shows a positive outlook of the near future as 65% of the surveyors say that their practices will qualify for the Medicare and Medicaid programs by the end of 2011 Hypothesis six results Our research finding again shows that the U.S government financial incentive can upgrade the performance of E.H.R surveyors helped us with the conclusion that government financial backing to the Medicaid and Medicare programs can improve the medical performance in the near future Hypothesis seven results Our research finding states the importance of the U.S government testing the E.H.R program before purchasing them according to the surveyors 71% agreed the importance of testing the systems before implementing them nationwide Hypothesis eight results Our research finding concluded that most of the clinicians hire 1-5 physicians which is low according to the demands of medical needs of our current era Case Study Questions and answers regarding on implementing the electronic health record (Case Study). The case study focuses on the systematic reviews and the effects of electronic health record system can have in the medical sector if implemented at nationwide level. In the G.C.C the electronic health record is still new and according to our case study taken from the united states we want to find whether implementing the electronic health record system will add value to the medical sector or not. Will electronic health record improve patients health outcome? In a review evidence results in two study cases came up with the following result In 2004 a systematic review conducted 3 study cases that reported patients outcomes, no benefit was the conclusion In 2008 an analytical survey of several U.S patients found very few data or no association between the use of electronic health records and the improvement of patients outcomes In the end of the study there was no evidence linking between electronic health record with better patient outcomes Will electronic health record improve the quality of care? Evidence proves that the following result might occur on the electronic health record if implemented in practice In 2004 a review of 26 studies analyzed several outcomes related to the quality of patient physician encounters and with the research it discovered a sharp incline in provision of preventing care In 2006 a review on health information technologies and their impact on quality, efficiency and cost findings were: Increased adherence to guidelines based care, advanced surveillance and monitoring and a decline in medication errors In 2007 a study of data from some community health centers over the course of one year concluded that while electronic health record related costs had not been recovered, the quality of care improved In 2008 a review on the advantages and costs of electronic patient Concluded that concerning the influence of EPRs on the quality of care The studies did not clearly identify a clear answer to the questions of Benefit In 2009 a review of 7 countries experience implementing health information systems concluded that they had a neutral experience where neither benefit nor harm between the system implementation and quality of care The conclusion of the study indicates that the electronic health record has a positive effect on the quality of care; however some of the reviews still find it neutral so the opinions of the doctors and physicians are still conflicting. Will the Electronic health record be cost effective? In 2003 cost benefit analysis on the electronic health record in primary care settings concludes that electronic health record can result in positive return on investment In 2007 review on informatics system designed to improve care of chronic disease found that both cost effectiveness and adherence were significantly improved In 2008 report on the United States budget office summarized evidence supporting the practice of health information technologies describes the benefits on cost saving as limited In 2010 assessment on the quality of care resulting from hospital computerization concludes that currently implemented hospital computing might improve process measures of quality but not administrative or overall costs The research cite modest cost benefit associated with electronic health record, however based on results for small trails or projections based on modeling: empirical evidence supporting the cost effectiveness on electronic health record remains limited or conflicting Will the electronic health service save time and improve the efficiency of health services delivery? In 2006 a review of quality measures on the use of electronic health records indicated that the lack of implementing health services has been demonstrated, but the author notes that the outcome is limited to a wider health service provider A systematic review in the year 2008 analyzed six studies that addressed electronic health record with respect to consultation time, one study found the decrease in consultation time and the other found no difference A 2008 report from the United States congressional budget office summarized evidence supporting the adoption of health information technologies described the evidence around efficiency as conflicting In 2009 a review examined the impact on regional health information system and figured that, studies were of variable scope and quality improves the medical data access, timely information, and medical data exchange and improvement in communication and coordination within a region between health care professionals While there are some evidence supporting an association between the electronic health record and efficiency, there is also evidence which does not support this conclusion Will electronic health record improve physicians and patients satisfaction? In 2004 a review found that results were mixed with both the patients and physicians expressing enthusiasm for electronic health record and on the other hand expressing significant concerns about the impact of their use on a variety of outcomes A 2009 review of seven united based studies examined patient satisfaction with the electronic health record and figured that: one out of seven studies reported a positive effect on patient satisfaction, five out of seven studies reported a neutral effect and one out of seven studies reported a negative effect Evidence on patients and physician satisfaction is scarce An interview with Dr Michael Shuskho on the electronic health record As a professional in your field how do you find the electronic health record system? Michael: the E.H.R is an advanced system which is very useful for doctors especially in the current Era. It provides better patient care, and makes a permanent record that is legible that other doctors can review the system and also actually streamlines patient care Will the electronic health record improve efficiency and reduce time Michael: yes, the electronic health record is a valuable system to most of the doctors because it replaces the piles of paper and with a few click on your computer screen the doctor can view all the patients past medical record and send all the information to the other doctor within minutes Is the electronic health record system better than the manual paper based system? Michael: yes, the E.H.R is clearer and safer than the manual system provided that it is used carefully. Exg: a doctor can view patients X-Ray, picture of his electro cardio graph in a much clearer and digitalized form while in the paper based system the pages might wear or get old and by the time the picture of the X-Ray gets more aged, it makes it hard for the doctor to identify the exact diagnosis Is it cheaper to implement an electronic health record? Michael: The electronic health record system is expensive and the start up cost of the Medicaid and Medicare programs is high but in the long term it will eventually become cheaper for the clinics and hospitals to use them What are the barriers that prevents the electronic health record system by being in practice at a larger scale Michael: some doctors who arent familiar with updated technology and use practical manuals prefer not to implement the E.H.R in their clinics. Another barrier to the electronic health record is the upfront cost which is expensive and the some doctors find it hard adapting to the system Dr. Michael one last question before we conclude our interview. In your personal opinion will the E.H.R be mandatory by 2015 in the U.S Michael: I assume the probability that the electronic health record system might be mandatory in the U.S and the government might take actions in seeing that all the practices and clinics use the system The implementation of the E.H.R IN Kuwait and Bahrain Based on our research we have found that the electronic health record still needs to adapt at a global scale and the system is new to the G.C.C countries compared to the western countries such as United States, United Kingdom. Kuwait started using the E.H.R in 2005 in private and public clinics replacing the paper based system. According to the hypothesis questions and results in the U.S case studies it shows clearly that the E.H.R is on the way of improving and use the E.H.R rather than the traditional filing system. Bahrain is also taking a step further in implementing the system and the public and private clinics and with the help of the MGA methodology and the case study we have come with proposed solutions and the benefits that the kingdom of Bahrain and other G.C.C countries will achieve through the E.H.R December 2010 The health ministry in Bahrain will launch its national e-files project early 2011. It will cost the ministry between BD 25 Million to BD 30 million. Files of patients at salmaniya Medical complex and health centers will be converted into e-files. The first phase will cost BD 1.5 million and include all SMC and health care patients. Private hospitals and clinics can also be part of the system by paying a fee The health minister stated that many countries were struggling to meet the challenges of providing adequate health care for citizens. Changing demographics increased patients expectations, a global shortage of health professionals and rising costs associated with innovative technologies and new drugs means that healthcare is consuming an increasingly large proportion of gross domestic product and is becoming a priority for most governments. The minister also discussed Bahrain healthcare agenda through some strategic objectives which includes health promotion and prevention by strengthening primary healthcare services, the provision of quality health services by maintaining international accreditation of facilities and enhancing access to all health care services (Gulf Daily News- [emailprotected]) Plan for online health service Patients in Bahrain may soon be able to manage their healthcare online. Patients know best (PKB) enables people to communicate securely with doctors and nurses, access their medical records and send and receive health data. The medical group was founded two years ago by Bahraini Dr Mohammed Al Ubaydli in the United Kingdom. He has more than 15 years of experience in the medical software and trained as a physician at the Cambridge University. The expert worked as a staff scientist at the national institutes of health and was a management consultant to US hospitals at the Advisory board company and is the author of six books. PKB is the first company to integrate into Britains NHS secures connecting for patients to work online with clinicians. The group was voted as the best social innovation start up at tech crunch europas European start up awards 2010. At least two hospitals in Bahrain as well as others in the UAE and Malta have shown interest in signing up to the initiative. In the U.K, PKB affiliates includes great Ormond St hospital, Thalidomide Trust, Cure Parkinson and Two NHS hospitals will also sign up soon Access Dr Al Ubaydli said hospitals and medical centers that have affiliated with the PKB give their patients an online ability to securely access their medical documents, history and test results, have online consultations with their doctors and receive prescriptions. Once you give the medical record to the patient they can give them to their GP, relatives, social workers and so on he told the GDN. The patient can start an online consultation with any doctor they have added, it works a bit like the face book. They can also reach their doctor at any time say, for example, their child is taking medication but develops a fever at 3am and they can go online and ask the doctor how to adjust their medication. The system asks automated questions that your doctor would ask so that when the doctor sees this in the morning it saves them a lot of time and they can quickly respond with advice. ( Gulf Daily News 8 Dec 2010) The articles concludes the following results The kingdom of Bahrain is taking new measures in implementing the E.H.R in the G.C.C and mena region Many of today healthcares can be solved through networking Globalize E.H.R System Networking communication is an intermediary between practicing doctors implementing the E.H.R in their private clinics or public clinics. The information process is much faster through communication networks which reduces time, saves lives and improves efficiency Exg: Steve Dr Akram Favorite doctor has a patient and needs emergency solution to a problem through a communication network can achieve his goal browsing the Globalize E.H.R network finding solutions through other Doctors specialized in that field. An E.H.R system that works like a face book Doctors can log on their account and log on the system with other health professionals and discuss emergency situations and provide solutions The problems can be solved through fast communication and accurate knowledge the tacit knowledge key challenges to health practitioners implementing the E.H.R in the GCC countries Cost of implementation is not offset by the efficiencies in the E.H.R Technical support needs to be modified due to the advancement in IT Stress on staff and the practice in general was significant A 2007 review article recommended strong physician leadership and a staged approach to successful implementation In 2010 an article challenged conventional assumptions that the physicians were to blame for low uptake of electronic health record. Electronic medical records vary greatly in capability, quality, and cost. Doctors will become enthusiastic users if the electronic medical records are helpful in the care of their patients There are significant challenges associated with implementing E.H.R in the Mena or G.C.C countries Benefits of networking for the G.C.C Region Improves patient care through greater access to information Reduces test result times Decrease paper work for clinicians Integrate communication Helps ensure that patient medical data and stats are there when patients need to find his/ her test results Compliance with privacy regulations Proposed solutions for the electronic health record A 2008 synthesis of 3 qualitative studies identifies essential components of successful electronic health record implementation A project champion Realistic expectation of the challenges of implementing an electronic health record Addressing existing staff attitude towards IT Provide adequate training to staff A systematic review of 7 countries experience implementing health information system in primary care identified the following factors Quality of the graphical user interface and feature functionality Quality of implementation project management Users previous experience with information technology systems The Electronic health record today application The adoption of the electronic health record is difficult to overcome due to the lack of the return on investment. Scholars and writers on the subject noted that health care decision makers find it difficult to demonstrate return on investment to undertake a comprehensive electronic health record system within their organization. The health care costs continue to increase and the fact that the initial investment on equipment can be quite expensive. Another fact that complicates the adoption of the electronic health record is that the data is heavily structured, being recorded in the allotted space. Training is an important issue and this is required by a large amount of population. One should keep in mind that the population has different levels of computer literacy (Upham 2004). These contributors of the electronic health services contributed to a slow increase in the adoption of such systems in many hospitals. In a survey question regarding the E.H.R and the implementation of the m ethod out of 436 who have responded to the question, 35.6% said that they have already implemented the electronic health services. The percentage is expected to grow in the coming years of application. The G.C.C is taking all the necessary step in implementing the system with an enhanced knowledge in the field and the governments should test all the Medicare and Medicaid programs before implementing the system The Evolution of the Electronic Health Record The electronic health record is an open field of debate amongst the doctors, physicians, clinicians and scholars. In the electronic implementation of such records, we may also expect to find populations of patients, integrated access to biomedical literature and interactive environment for offering clinical guidelines or consultative advice. Throughout ages the world is becoming more globalized and in the age of science and technology the computer is being the number one tool. The (local area network) is connected to the full internet, with an integrated access to a wide variety of information sources that are geographically distributed well beyond local institutions. The electronic health record system is expanding worldwide and some of the future implementation An enhanced internet: an internet with much higher bandwidth and reliability, increased response time and financial models that makes the application cost effective and practical is required. Major research effort is underway to address some of these concerns, including the federal next generation Internet activity in the United States exploratory effort that continue to push the state of art in internet technology, and all significant implication for the future of health care delivery in general for computer- based health record in particular Better Education and health care training for health care providers: there is a difference between computer literacy (familiarity with computers and the routine users in society) and the knowledge of the role that computing and communication technology can and should play in our health care system. More medical information training programs and the expansion of existing programs are needed. Junior faculty in health science schools who may wish to seek additional training in this area should be supported Changes in the management and organization of health care institution: health care provide some of the most complex organizational structures in society, and it is simplistic to assume the off shelf products will be smoothly introduced into a new institution without major analysis. Discussion The project mainly discusses on electronic health record system that the implementation of the idea goes back to Hippocrates who laid the foundation in the 5th century and by the following years doctors, physicians, pharmacists and clinicians tried to improvise the idea of the health record system on paper but in the 1960s the standards of the paper based changed to the electronic health record systems and hospitals welcomed the new system which was more efficient and reduces paperwork and time. The electronic health record according to numerous researches and articles emphasized that the system should be introduced worldwide. the G.C.C region is expanding in both size and capacity since the countries like Bahrain, Kuwait, Qatar, Uae opened door to foreign investment in their respected countries. Our research focuses on the implementation of the E.H.R in the U.S and the results of the case study gave us a better understanding on whether to implement the system in the G.C.C countries. The results were positive and the need of the system is becoming compulsory in our world today. Kuwait have already

Describe the Limitations and Constraints of Marketing

P2-describe the limitations and constraints of marketing Limitations and constraints include; Sales of Goods Act 1979 Trade Descriptions Act 1968 Consumer Credit Act 2006 Data Protection Act 1968 Voluntary constraints Direct Marketing Association (DMA) Pressure groups and consumerism Acceptable language Sales of goods act 1979 The sales of goods act needs sellers to trade goods that are as they advertised and described. The good or service has to be of satisfactory quality.Effectively meaning that for an organisation like micro-soft, the goods and services must be described precisely when promoted because the company needs to be able to prove that the product can do what they say. Trading Regulations 2008 This act enables clients to equal treatment from businesses they deal with. Within this act, businesses can’t use fear to sell their products. Businesses can’t lie to promote products for example ‘closing down sale’ when they are going to stay open after t hem sale. So blackberry can’t advertise their products with features that they don’t have.The latest Blackberry boasts the best resolution screen of its kind, which then had to be verified and researched by an independent organisation to see it the statement, was true. Consumer Credit Acts 2006 These acts apply to businesses that offer goods or services on credit or companies that lend money to consumers. To be in this category, businesses must be licensed by the Office of Fair Trading (OFT), this would handle and include the method of calculating APR and the form and content of the agreement.The consumer credit act 2002 defends consumer’s rights when they purchase things on credit. When lending money, companies much have interest rates clearly identified and these can’t be changing them after. The Data Protection 1968 This Act means that any information taken by a salespersons can only be used for the reasoned mentioned when taken , it has to be precise and up to date, it can’t be taken for a longer period of time than the time mentioned when it was taken , and can only be taken properly and lawfully.It must be kept up to date because if someone dies it is put on the up date. Furthermore your information is protected from unauthorised use, and cannot be given on to other companies without your permission. Voluntary codes This is when businesses volunteers that they will never do something or they will always do something. This might include signing a code of practice mentioning specific behaviours and rules ethically, even though it can’t be legally enforced.

Jewish Ghettos Essay - 1820 Words

Jewish ghettos: The basic history of the formation of the Jewish ghettos, including the everyday life and economic hardships faced by the communities. nbsp;nbsp;nbsp;nbsp;nbsp;By definition, a ghetto is an area, usually characterized by poverty and poor living conditions, which houses many people of a similar religion, race or nationality. They served to confine these groups of people and isolate them from the rest of the community because of political or social differences. However, the Jewish ghettos established throughout Europe were more than just a way for the Germans to isolate the Jewish community. They were the first step in making Hitler’s final solution possible. The ghettos were the means of organizing all of the Jews†¦show more content†¦However, there was no real uniformity to these ghettos. The ghettos usually varied with respect to the size of the city in which they were located. The ghettos in small towns were generally not sealed off, which was often a temporary measure used until the Jewish occupants could be sent to a bigger ghetto. Larger cities had closed ghettos, with brick or stone walls, wood en fences, and barbed wire defining the boundaries. In the larger ghettos, guards were strategically placed at gateways and other boundary openings for policing the area. In these larger ghettos, Jews were not allowed to leave the Jewish residential districts (Holocaust),under penalty of severe punishment, often including death. As mentioned earlier, all of the ghettos had the most appalling, inhuman living conditions. The smallest ghetto housed about 3,000 Jews. Warsaw, probably the largest ghetto, held close to 400,000 people. Lodz, the second largest, held about 160,000 (Phillips 304-12). Other areas (mainly Poland) with large Jewish ghettos included Bialystok, Czestochowa, Kielce, Krakow, Lublin, Lvov, Radom, and Vilna(a history 170). Many of the ghetto dwellers were from the local area; others were from neighboring villages. In October 1941, general deportations began from Germany to major ghettos in Poland and further east. Also, Jews from Austria and theShow MoreRelatedEssay on Theresienstadt: A Model Jewish Ghetto3188 Words   |  13 PagesHitler pinpointed the small town of Theresienstadt to be his paradise ghetto, his à ¢Ã¢â€š ¬Ã…“giftà ¢Ã¢â€š ¬?. Located in a scenic community, Theresienstadt had broad streets and a large square surrounded by two large parks and two smaller ones. Here within an area five blocks wide and seven blocks long, over 140, 000 Jews would spend the last months of their lives, and only a few handfuls would survive. nbsp;nbsp;nbsp;nbsp;nbsp;The first Jewish prisoners entered Theresienstadt on November 24, 1941. In the beginningRead MoreThe Jewish Ghettos Of The Holocaust1715 Words   |  7 Pageslife was like in the Jewish ghettos. 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