The Effect on the Cargo Molecules

The paper generally talks about the effect that the mutations have on the cargo molecules. The molecules are specifically those that contain proteins and are therefore referred to as the cargo proteins. The paper therefore looks into the nature of the effect on each of the cargo proteins and gives an analysis of the effect on the proteins which are apparently of the same class. .The paper also delves into the question of cargo selection which essentially involves an ER-derived vesicle and this culminated into the picking of Sec24p which has been found to be able to recognize the v-SNARE Bet1p. The research question that is being tested in the paper is the determination of the protein carriers that are well compatible and binds well with the Sec24p subunit. The hypothesis in this case is the fact that the compatible protein carriers were less affected by the mutations. The essential and the most vital experiment is that which involves the characterization mechanisms of the molecules of cargo recruitment through the Sec24p which is a subunit of the COPII coat. This usually involves the alanine scanning which is basically a mutagenesis approach towards the identification of the mutation characteristics of the Sec24p. This was regarded as pivotal since the data collected gave the suggestion gave multiple independent sites of recognition of cargo. The weakness of the experiment is on the fact that the control experiment consisted of the Sec24p that were sensitive to temperature. This is due to the fact that many of the Sec24p are responsive towards changes in temperature and therefore this isn't a foolproof method of determination of the needed types of the Sec24 which can be compatible to the cargo protein. If I was the one conducting the research then variables like temperature and the fact that some aspects which were compatible with the cargo proteins responded well to the changes in temperature would be done away with. These types of control experiments usually in most cases give the wrong picture and result altogether. The true experiment would therefore be more than that. This might involve the aspects as the solubility of the Sec 24 which was compatible with the protein cargo. This would be more sensible as this would be entirely truth with only a very slight margin for error as opposed to the initial case in which almost all the test subjects would react in an almost similar manner to the experiment and therefore leave a large gap for mistakes.

Defining Social Problems

A distinction is made between the definition of a social problem and sociological problem by Peter Worsley (1972). The latter refers to the problem of explaining social behaviour in terms of a sociological theory, whilst the former is some piece of social behaviour that causes public friction and or private misery and calls for collective action to solve it. The study of social problems is a complex and very controversial undertaking. Broadly speaking, this is not understandable to the average layman whose concepts of what constitutes a social problem is firmly established by the rhetoric of his/hers everyday social discourse and indeed the classification of acts or situations as social problems seem to be a relatively simple exercise. It is becoming more and more evident by present day sociologists and social scientists alike the complexities involved in defining, identifying and classifying a social situation as a social problem. This process has far-reaching implications on the focus, scope and projected recommendations of studies conducted of a particular social situation. There are two major conceptualizations of defining a social situation as a social problem. The first is centered around the self-explanatory phase â€Å"public opinion approach†. This approach contends that a â€Å"social problem cannot exist for a society unless it is recognized by that society to exist† (Blumer, 1971) the inference here is that it is the members of the society that define and construct their social reality and that via socialization these interpretations of societal phenomena and value consensus is conveyed to the offspring. Individuals and social situations that do not conform to the norms and values of society are often viewed as social problems. In Blumer's definition of social problem he uses a broad concept of society but fails to further refine his definition. Merton writing in Contemporary Social Problems also utilizes in his definition of what is a social problem the broad and in my opinion ambiguous term â€Å"people†. His definition of social problems is as follows â€Å"a social definition exists when there is a sizeable discrepancy between what is and what people think ought to be†. One discovers that each society has their own conceptualizations and interpretations of their social world and furthermore as contemporary sociologists, namely M. G. Smith and his pluralist model of society (adapted from the research of J. Furnival of Burma), have suggested different fractions of society have competing and contrasting ideologies. The use of such terms suggests social union and cohesion of meanings and oversimplifies the above mentioned complexities of societies. A branching school of thought emerging from the public-opinion approach in the defining of social problems is in my opinion the quantitative approach. Perhaps realizing the aforementioned pitfalls of the definition proposed by Blumer and Merton some sociologist have attempted to further refine their definitions by assigning a seemingly quantitative value to them. Sheppard and Voss's definition is critiqued by Manis [Contemporary Social Problems] They define a social problem as â€Å"a social condition which a large proportion of society †¦ see as undesirable or in need of attention† Here the quantitative term â€Å"large proportion of society† refines the initial term â€Å"society† and â€Å"people† utilized in the definition of Blumer and Merton respectively. Julian writing in Social Problems, 10th edition, too in his definition utilizes the term † significant proportion of people†, Kornblum includes the term â€Å"most people† and likewise Fuller and Myers in their book The Natural History of a social problem, â€Å"American Sociological Review' quantifies his definition by added the term † a considerable number of people†. Though the inclusion of some additional factor concentrates the overall definition of what is a social problem it still does not give a full representation of the other forces at work that lead to a social condition being classified as a social problem. We have moved from the ambiguity of the term â€Å"society† to saying that it's the majority who decide or define social problems. The supporters of the public opinion approach contend that this approach limits the subjectivity of the researcher. Turner and Beeghley believe that by relying on the public's conceptualization of what constitutes a social problem that the sociologist remain neutral and value-free thereby playing a passive rather than active role in the process of defining social problems, since he/she is unable to impose his values, morals and ethnics. Gross dismisses the proposed objective rational proposed by the supporters of the public-opinon approach. He believes that for the sociologist even to interpret a public response to a social situation as negative or positive, good or bad is in itself a value judgment! This method of defining social problems is not as value free and objective as Beeghley and Tuner insinuate. If one is to speak of the majority, then what of the minority. In all fairness some public-opinion supporters have attempted to address this aspect of the debate around the definition of social problems. Sheppard and Voss have included in their definition the point that not only is a social problem defined by the â€Å"large proportion of society† but by â€Å"powerful elements of it† who see a social condition as undesirable and in need of attention. Julian makes an intuitive juxtaposition of the words to further develop this point. In his definition he contends that a social problem is so defined when â€Å"a significant number of people or a number of significant people† †¦ agree that the condition violates an accepted value or standard†¦. It confuses the definition somewhat since one is unable to determine whether the values of the majority are the ones violated by the social condition and it is thus defined as a social problem or if a social problem is so defined because the accepted values of the powerful (assumption here is that individuals who share the same social status or class have the same values) have been threatened. In the book, Defining Social Problems, there is considerable evidence to suggest that power groups play a significant role in the defining of social problems. Here the writer contends, and correctly so, that a social problem can exist for a number of years and still not be classified or acknowledged as a social problem! A social problem is said to ‘exist when an influential group asserts that a certain social condition affecting a large group of people is a problem that may be remedied by collective action. ‘ This introduces the concept that social problems are ‘subjective, value-laden and culturally informed' a point contested by Manis. Furthermore it's the influence of the power groups derived from their ‘strength, status or sheer number of people' that have significantly impacted on social policy at the national level. The example given was centered around the hysteria of the milk cartoon kids. There arose in the 1950's in the USA an outcry against the seemingly stark increase in the number of kidnappings. This caused a mass hysteria and this ‘social problem' was deemed acute and severe enough to warrant an increase in police surveillance at schools. The situation was not a real social condition but it was considered as such. This is one of the primary concerns of Manis whereby subjectivity in the definition of a social problem may lead to falsehoods. He suggests rather an objective approach which he labels the ‘knowledge values of science'. He links social facts to values and devises an approach to defining social problems based on: intrinsic values, contextual values and social responsibility values. By utilizing his method, he contends, ensures objective results by the sociologist. Though not part of the Marx theory, the labeling theory in this case exists alongside and supports the theory that power groups play a significant role in defining social problems. Howard Becker was instrumental in the development of the labeling theory. Pierre Bordeaux, a Marxist, studied the education system extensively and acknowledges the ability of the powerful to impose their definition of reality on others. The controversy surrounding the definition of social problems is still going strong. Some may ask why is it important to understand how a social situation is classified as a social problem. The implementation of social policies affects everyone and some policies may not always be to our benefit. For example the Mass Marriage Movement in Jamaica looked to encourage couples to marry because some British sociologists thought that single-parent families were having adverse effects on their children and this was considered a problem. Through the research of dedicated Caribbean sociologist we know differently. In conclusion, I adapt the view points of Merton and Roberts, Contempory Social Problems, that social problems ‘vary among societies and it varies in the same society among social groups and from time to time, since both the social realities and the social norms differ and change. Fuller and Myers to develop a rather accommodating definition of a social problem. They wrote ‘Every social problem thus consists of an objective and a subjective definition. The objective condition is a verifiable condition which can be checked as to the existence and magnitude by impartial and trained observers†¦. The subjective definition is the awareness of certain individuals that the condition is a threat to cherished values. ‘

Managing Profitable Customer Relationships

Hardly Davidson has massive engines for motorbikes and has been known to have a friendly relationship with its customers. The company sponsors different motorbike events during which they are able to display modern bikes and their accessories. The brand name has a great reputation and has brought together riders and have welfare benefits for its members. The company has enhanced their rapport through regular communication through the internet. The riders have formed an international network attachment as well as local dealership to enhance their services. The company motivates its customers or riders by giving them pinstops which identify them with the company and so doing create pride of membership. Performance related programs on mileage for those enrolled leads to an advantage in terms of priority in accessing the best accessories for one’s bike. Harley company has been accepted in different countries and its members can rent and ride in countries such as Canada, Australia and the United States. The company has built a good reputation and has a great bond with its numerous customer needs. 1.   What are the key elements of Harley-Davidson’s efforts to build relationship with its customers? The key elements in Harley-Davidson are the involvement of customers in not being just customers but also being dealers. There is customer participation in events sponsored by the company. Membership creates a sense of belonging and enhances the attachment to the company while good communication through the internet connects the company to its customers. Presence of welfare schemes such as sponsorship to events and insurance services motivates the customers. 2.   Can you think of other companies that create such strong relationships with their customers? How do they do that? NASCAR which is the National Association for Stock Car Auto Racing has created a lasting customer relationship through a careful blend of live racing events, compelling web sites with information and entertainment, ensures ample security and organizes parties, cook outs and camps with family members. This creates a friendly environment that enriches the company-to-customer relationship. The Unilever company has created a good relationship through high standards of corporate behavior towards the employees, customers and the society. It is involved in community development activities and this extension of their services to the society attracts more customers. The company has also offered voluntary counseling and testing programs in support of the community. It has also set goals to evaluates the HIV/AIDS roadmap with strategic approaches to reaching out to its customers. A follow up plan for comprehensive care and treatment is organized so that customers are convinced that the company’s objective is to render them the service and the good gesture goes along way in maintaining a good relationship. Offering of medicines at subsidized rates has led to the growth of the company and the humanitarian activities have extended to the provision of health insurance covers. 3.   How else can Harley-Davidson build or deepen its relationships with its customers? Harley Davidson can deepen its relationship by offering medical checkups for the riders before and after an event, a welfare scheme for the member’s next of kin to participate   for future customers as well as training facilities for those aspiring to be good riders. Recommendation To enhance profitable customer relationships, it is important that there is customer involvement and participation in the activities of the company. A good rapport is enhanced through welfare schemes for members to cater for important services such as medical and insurance covers. Good communication between the two parties gives feedbacks and this helps the company in providing the best quality of service. Reference: Paul G.R. Up Close and Personal?: Customer relationship. Don Peppers, Martha Rogers. Managing Customer Relationship. Stanley A.B Customer Relationship Management   

English Study Essay Example | Topics and Well Written Essays - 250 words

English Study - Essay Example I want to let you know that l have met with Dr. XXX and we have discussed my courses for next spring. Also, we have talked about my plan for the dissertation, but our conversation did not end with a particular topic. I do not have a clue yet about the topic I want to research on. Do Arabic learners need to learn the syllable patterns of Arabic and English? Will they be able to pronounce English sound or word appropriately, or intelligibility? Why does Arabic speaker sound like a foreigner? If the Arabic speaker masters English prosody, do they have a native accent of English? Does mimic or video help Arabic learner of English to be as native as different between Arabic and English prosody?Training Arabic learners to place more emphasis on the pattern of the English syllable helps to eliminate the chances of predicted errors. This can be achieved by introducing short syllable patterns and then long syllable patterns in English. In order to achieve this, it is crucial to focus on answe ring questions like: How can we make Arabic learners of English as sound native-like or sound good? How to improve their accent? Does learning prosody make them sound as native-like?Why do Arab learners often make this mistake in this particular sound of English? Is there a solution, tools or technique to help them reduce the error? Is shadowing a good learning technique for fluency and developing native-like prosody?Video and mimic can be good to master prosody. As you can see, I have random ideas and thoughts but all of them are under phonological aspects.

Communist Manifesto Scholarship Essay Example | Topics and Well Written Essays - 2000 words

Communist Manifesto - Scholarship Essay Example However it was his biggest fear. The demand of the consumer, the machines and computers could be best described as the nightmare of labor in Marx vision. Marx calls it the feudal system, the system that works on demand. "This industrial revolution was precipitated by the discovery of the steam engine, various spinning machines, the mechanical loom, and a whole series of other mechanical devices. These machines, which were very expensive and hence could be bought only by big capitalists, altered the whole mode of production and displaced the former workers, because the machines turned out cheaper and better commodities than the workers could produce with their inefficient spinning wheels and handlooms. The machines delivered industry wholly into the hands of the big capitalists and rendered entirely worthless the meager property of the workers (tools, looms, etc.). The result was that the capitalists soon had everything in their hands and nothing remained to the workers. This marked the introduction of the factory system into the textile industry." The computer today can be seen as the new machinery that drives the 24 hour economy and makes labors slaves again in using them. The world is small due to the internet and computers. Imperialism itself in the wealthy countries like the US drive the economy. The world market demand can be done in a minute now. 2. Who are the Bourgeoisie Where did they come from and where are they going (4,5,24) Are they still around Do you know any Best to be named are the bourgeoisie as the rich and powerful top layer of society who had the money to build the factories. Due to "old money" nobles and gained money from profit. Bourgeoisie, one of his arguments is so powerful, that Marx claimed they where out of control. They came from the Feudal society according to Marx still with class antagonisms, with the establishment of new classes, conditions of oppression and new forms of struggles. Marx describes in his book exactly why this is not good. He states in his words: "Our epoch, the epoch of the bourgeoisie, possesses, however, this distinctive feature: it has simplified the class antagonisms. Society as a whole is more and more splitting up into two great hostile camps, into two great classes, directly facing each other: Bourgeoisie and Proletariat. The monthly review states the bourgeoisie as follows: "The class of big capitalists, who, in all civilized countries, are already in almost exclusive possession of all the means of subsistence and of the instruments (machines, factories) and materials necessary for the production of the means of subsistence. This is the bourgeois class, or the bourgeoisie." According to Marx they came " From the serfs

Finding Home in Food Essay Example | Topics and Well Written Essays - 750 words

Finding Home in Food - Essay Example This research will begin with the statement that since his teenage years, Western food has been a source of great attraction and enjoyment to the author. Fast food like burger and pizza had become his favorite since his teenage days. Eating pizza was one of the most pleasurable activities in his young days. The researcher has remembered going to a pizza joint near his school every weekend. Although it was not considered good by his family to have fast food, he used to love it. The author was discouraged from going to these joints. However, he used to manage going there with his friends on weekends. The researcher’s memories are filled with the fun and enjoyment that he has had while going to the fast food joints. He loved the cheese, different toppings and the starters that were all made in a Western way. Going to pizza joints made him feel that he was ‘modern’ in his outlook. For the author, eating fast food was like being a part of the ‘developed’ w orld. He used to look forward to going to pizza joints and enjoy the pizzas. So when the researcher got a chance to travel to the United States, he thought that he was going to have the greatest time in his life. The author knew that it is the country where burgers and pizzas are found in great varieties and sizes. Moreover, there was no one to stop him from having it. So he thought that his time in the USA will be filled with great entertainment and fun. The author thought that he will not miss his home much. However, his journey to the United States proved his thinking completely wrong.... I had thought that fast food is one thing that I cannot live without. Soon I realized that I was wrong. By the fifth day, I started remembering home food. My mind started dwelling on home made food and beverages. On that day, I told my friends that I will order the pizza. I took the number for nearby pizza joint and called them. I went outside my room to avoid my friends from listening to me. When I became sure that no one was listening, I asked the guy on the other end, â€Å"Do you have pizzas with Asian toppings?† The customer care guy gave a long â€Å"mmmmmmm† and said â€Å"No sir, we don’t.† I was quite disappointed and ordered the usual pizza. By this time, i.e. in just five to six days from the time I arrived, I had lost my enthusiasm towards fast food. I was craving for spices and variety in food. Even then I thought that maybe I am feeling home sick and hence, missing the food. I thought that if I have just one dish of Asian food, I will go back to the fast food with the same enthusiasm. However, my heart was saying something else. Fortunately, the confusion between the mind and the heart was cleared very soon. The next day, one of my distant relatives came to visit me. She brought a big Tiffin box full of Biryani, an Asian dish made of rice, chicken and spices, for me and my friends. She said she thought that home made food will make me feel at home. I said it is nothing like that, and that I am quite used to the Western food. My friends coughed to hide their laughter. After all, there was no strength in my statement. They had realized that I was craving for home made food now. However, as I did not want to lose the challenge, I tried my best to hide the truth.

Stakeholders and the regulatory authorities are considered to be Essay

Stakeholders and the regulatory authorities are considered to be significant mechanism for ensuring good corporate governence - Essay Example Corporate governance system of any region helps in protecting the organization before the occurrence of any huge disaster. Many mechanism can be found supporting the development and implementation of corporate governance system; however, regulatory and stakeholders are those significant mechanisms that act as backbone of the structure of CG system1. The reason behind such an important presence of corporate governance is its wide coverage of the areas that does not only include stakeholder interests and shareholder recognition but ethical behaviors of the organizations are also given much priority. Therefore, under the light of a statement â€Å"Stakeholders and the regulatory authorities are considered to be significant mechanism for ensuring good corporate governance†2 paper runs its aim to analyze situation. The global financial crises are also the main concern of the paper that is being diagnosed as a drastic consequence of corporate governance failure3. ... As adaptation of corporate governance is as important as initial business plan of a company; therefore, paper can also be found suggesting proper adaptation and implementation of corporate governance plans, as sit keeps the organizations to run within systematic and defined standards. The legal initiatives taken in the favor of corporate governance are also being investigated where role of some private sector organization is also studied. All the arguments are supported by the authentic evidences, where two major global economies of US and UK can be observed being dealt with special consideration. Role of stakeholder mechanism and role of regulatory mechanism in corporate governance are also analyzed along with locating the lacking elements in the system if any. After investigating through the issue, some of the recommendations are also presented that might be helpful for the betterment of CG structure in different regions4. 2. Corporate Governance Corporate governance is the broad p henomenon that represents a system, which serves in directing and controlling the companies. There are many mechanisms that have been serving in establishing good corporate governance. An appropriate implementation of corporate governance demands the market and regulatory mechanisms, along with the maintenance of the relationship between the management of the organization. By considering recent common scenario in business organizations, shareholders of an organization operate as a major external stakeholder groups. However, in these organizations internal stakeholders are their employees, board of directors and executives. The operations related to corporate governance include

Mortality Essay Example | Topics and Well Written Essays - 500 words - 1

Mortality - Essay Example Mortality affects humans only when alive and upon losing an acquaintance, partner, or family member. Mortality is the darkest concept a human can contemplate. Humans go to great lengths to avoid their mortality. Countless searches for objects to prolong an individual’s life such as the Fountain of Youth, the Ark of the Covenant, the Holy Grail, and other objects that will allow a human’s immortality. â€Å"Epic of Gilgamesh† tells of Gilgamesh’s effort to stay awake or walking on the bottom of the sea in order to obtain immortality. If Gilgamesh part God is searching for immortality, then mere mortals searching is understandable. Humans are willing to pay for immortality. Twilight, Highlander, and other immortal creatures lose something for their immortality. Vampires must walk in the dark with an undying thirst for blood. The Immortals of Highlander must constantly battle other Immortals and live longer than the humans they loved. Still most humans think they want immortality despite the cost. One of the pros of mortality is a short lifespan. For an example, many individuals want more life. Imagine the possibilities of men like Bill Gates, Martin Luther King, Socrates, Alexander the Great, Abraham Lincoln along with many others if they had lived an immortal life. The possibilities would be endless. The pain at losing individuals like the ones above and other important people is another con of mortality. The hurt of a loved one dying is strong. The heartbroken often want to die in order to be with a loved. The dead are not concerned anymore. A short life and pain during times of death are cons of mortality. Illness and pain are another pro of mortality. Enkidu languished from an illness in pain for awhile before expiring. A cancer patient, mentally ill individual locked away, or anyone else with a painful disease prays for death upon a daily basis. Mortality is an escape from the pain of their failing bodies.

Lightweight Community-Driven Approach to Support Ontology Evolution Essay

Lightweight Community-Driven Approach to Support Ontology Evolution - Essay Example The chapter goes on to identify the advantage of ontology evolution, the lack of systematic approach for ontology evolution and explains the motivation for this study. The chapter ends with the objectives of the study and thesis structure. 1.2 Ontology Definitions The term â€Å"Ontology† is derived from its usage in philosophy where it means the study of being or existence as well as the basic categories (Witmer 2004). Therefore, it is now used to refer to what exists in a system model. Definition 1: According to the Merriam-Webster Dictionary (2011), â€Å"It is a particular nature of being or the kinds of things that have existence. Definition 2: Gruber (1993), on the other hand, provides a more concrete definition of Ontology. He defines it as a study which explicitly explains concepts and relationships (Gruber 1993). The set of concepts (e.g. classes, relations, functions) are used to represent and describe domain knowledge. For example, in oil and gas industry there is an established ontology for Statoil in Norway (Association 2008) a standard library related to an oil and gas domain. 1.3 Ontology Editor Ontology Editor is an application which is developed to view and edit ontology. In the past few years many applications have been developed such as OilEd (Bechhofer, Horrocks et al. 2001), OntoEdit (Sure, Erdmann et al. 2002), Protege (Gennari, Musen et al. 2003) and Web-Protege (Tudorache, Vendetti et al. 2008). Further details are explained below about each ontology editor: - OilEd: OilEd was developed in Manchester University. It is a simple ontology editor that provides further guidance in the development of Ontology Interchange Language (OIL)-based ontologies (Bechhofer, Horrocks et al. 2001), which is basically a web-based representation of ontologies organized to make it accessible and usable (Cover, 2000). It is the one which pioneers ontology editing (Bechhofer, Horrocks et al. 2001). - OntoEdit: OntoEdit was developed by the Knowledge Ma nagement Group at University of Karsnuhe Institute AFIB. It provides an ontology development that allows collaboration and inferencing. The method involves three main steps which start with requirements specification, refinement and evaluation. The first step is where the ontology engineers and domain experts meet and work towards identifying the goal of the ontology, description of the domain, and the availability of references. Design guidelines are also established in this step. Then, the team then makes the ontology in the refinement phase. Finally, the ontology requires evaluation according to its requirements specification by identifying possible errors in the ontology and efficiency for enabling collaborative work (Sure, Erdmann et al. 2002). - Protege: Protege was developed by Mark Musen at Stanford University. It is an ontology editor which has come a long way. Protege started in 1987 as a small application, which was aimed at building knowledge acquisition tools. Protege h as then been developed further, providing many new features for each version that has been released. Currently, there are hundreds of individuals and research groups are using Protege (Gennari, Musen et al. 2003). - Web-Protege: Web-Protege is a web version of Protege, also developed in Stanford University. This allows the users who have access to view and edit the ontology from the internet (Tudorache, Vende

Statement of the problem Essay Example for Free

Statement of the problem Essay This study explored the experience of subjective well-being (SWB) among the institutionalized aged: concept of well-being, indicators of the cognitive and affective components, and the factors which contribute towards their sense of well-being. It also looked into the perception of their close associates on the SWB of the elderly under investigation. Specifically, the study addressed the following questions: 1. What is the concept of subjective well-being among the institutionalized elderly? 2. What are the indicators of the cognitive and affective components of subjective well-being? 3. What are the factors which contribute towards the subjective well-being among the institutionalized elderly? 4. How do the close associates of the elderly view the following: the concept of SWB, the indicators of cognitive and affective components, and the factors contributing toward SWB among the elderly? 5. Are there similarities and differences observed in the view of the elderly and their close associates with regard to the experience of SWB among the institutionalized aged? This chapter presents in detail the research design, the description of the participants, the instruments used, the data gathering and analysis procedures. Research Design The present study employed the qualitative research design (Heppner, Kivlighan, Wampold, 1999; McLeod, 2001). Qualitative research involves doing one’s utmost to map and explore the meaning of an area of human experience. Generally it examines people’s words or actions in narrative or descriptive ways more closely representing the experiences of the people involved. It emphasizes the importance of looking at variables in the natural setting in which they are found and the qualitative researchers believe that human behavior cannot be understood outside of its context. According to McLeod (2001), the knowledge generated by qualitative research through eliciting peoples’ stories, sensitive listening, building up an understanding, and checking it out is usually holistic, nuanced, personal, contextualized and incomplete. Key (1997) observes that in qualitative research detailed data is gathered through open ended questions that provide direct quotations, and the interviewer is an integral part of the investigation. The present study was exploratory in nature (Westman, 2004) and employed case study as well as interview method to collect the data. It helped in understanding the concepts and personal meanings and theories held by the people who were being studied. The study also contributed to the understanding of how the elderly in the home for the aged conceived and defined quality of life or subjective experience of well-being in their lives as perceived by their administrators. Case Study. The rationale for including case studies were: (1) case studies strive towards a holistic understanding of cultural systems of action (Tellis, 1997). The interviews on the elderly elicited holistic information and nuances about their life and subjective sense of well-being. Content analysis alone could not do justice to the nuances came across in the accumulated data. According to Tellis (1997), selecting cases must be done so as to maximize what can be learned. (2) Case study is known as a triangulated research strategy (Tellis, 1997). The present study being qualitative, employing triangulation confirmed the validity of the findings (Yin, 1994). Interviews are one of the most important sources of case study information. Interview Method. In a qualitative study human person is the primary collection instrument. Insisting upon measurable outcomes to determine the quality of life is a disservice to elders (Moberg, 2001) and the world has many accounts of what aging looks like from the outside, but we have little insight into what aging looks and feels like and their sense of well-being from the perspective of older adults (Ray, 2002). It is an unquestionable truth that questions about what makes life worth living and what is their subjective experience of well-being to individuals are answered only by asking the individuals themselves. It helped to explore and explain the complexity of the fabric of life entering to its labyrinth, expressing the personal which is always interpersonal. In other words it gave access to the phenomenological data, which is the respondents’ perception, of themselves and their world. Exploring the concept of well-being, the indicators of cognitive and affective components of subjective well-being among the elderly and different features that they thought were helping toward their subjective experience of well being in the given situation of life, the researcher was able to gather the subjective description of the lived experiences of the institutionalized elderly.

Pathophysiology of Systemic Lupus Erythematosus

Pathophysiology of Systemic Lupus Erythematosus Introduction This essay will explore the pathophysiology relating to a call I attended while on practice placement as a student technician. The initial call details were that it was a 45 year old female in pain. On our arrival the patient was sat in a chair and was breathing rapidly and had a very flushed face. After introducing ourselves and gaining the patients consent we then proceeded to take her basic observations and take her history. Most of her observations were within acceptable limits however her blood pressure was slightly high, she had a raised pulse at 120 beats per minute and slightly high temperature at 38 degrees Celsius. On questioning the patient had a localised pain score of 8/10 in her back and a pains in her joints and muscles with a pain score of 4/10. When questioned about her medical history, she stated she had a condition called systemic lupus erythematosus. This is not a condition I had heard of before I, therefore, questioned her more about it. Differential Diagnosis A 20 year-old women patient presented with fatigue, heart palpitations and anxiety. Reviewing the patient’s history revealed that she started experiencing anxiety, fatigue and heart palpitations approximately two years ago when she was still pregnant and she arranged to visit her own doctor. At that time her doctor stated that this was was due to stress. However, her symptoms became worse after she had another child. She stated that before going into labour she experienced premature contractions, headaches, increased fatigue, and swelling of her legs. Her doctor advised her to stay off work and have some bed rest. Shortly after giving birth to her third child, the patient began experiencing several new symptoms. Her knees and ankles started swelling, she also developed sever pain in her knees, wrists, elbows, and fingers. During the winter the patient started feeling painful and her peripheral joints became discolored whenever exposed to cold. She had recently been admitted to hospital in order for tests to be carried out and although she was still waiting for a definative outcome, a rhueamatology consultant she was under stated he was fairly certain that she had stemic lupus erythematosus. Epidemiology According to Somers et al (2007) approximately five people in every ten thousand suffer from systemic lupus erythematosus. Ninety percent of patients who are diagnosed with systemic lupus erythematosus are female (GinzlerTayar 2012; Blank et al 2009). It most commonly develops in women aged between 20 and 40 although anyone of any gender and age can develop it at any time. With regards to ethnic origin systemic lupus erythematosus is more prevalent in those with Afro-caribean, Asian or Chinese ancestry. Although there is a possibility of having a genetic pre-disposition to the disease only 3 of 100 children of those diagnosed with systemic lupus erythematosus will go on to develop it. According to National Health and Nutrition Examination Survey (2004) a survey in which it was observed that 100% of patients with System lupus erythematosus were receiving treatment. Aetiology Although there is no definate cause of systemic lupus erythematosus (Giannouli 2006), there is thought to be several factors increasing the likelihood of developing systemic lupus erythematous they include Genetics {where members of the family have lupus this condition will often increase the childs chances of developing it} (Hemminki 2009). It is also thought it can also be triggered by environmental factors such as trauma, ultraviolet rays and also emotional stress. Gender and hormones is thought to be the biggest factor affecting the chances of developing systemic lupus erythematous as it is proven that it mostly affects women than men especially when they are in menstrual periods or in their pregnancy, it is said to occur nine times more to women in comparison to men (GinzlerTayar 2012). Pathophysiology System lupus erythematosus is an autoimmune disease. The autoimmune system is responsible for fighting foreign and often harmful bacteria in the human system. However with systemic lupus erythematosus the immune system will attack itself, the pathology of this disease is similar to that of rheumatoid arthritis and can affect any part of the body (GinzlerTayar 2012). Systemic lupus erythematosus may also occur in the form of periarticular inflammation that affects the tendon sheaths, the illness causes the patient to experience coexisting fibromyalgia that results to poor sleep, chronic disease, inactivity ,mood problems and depression (Knott 2012). Patients who suffer from this condition have abnormalities when it comes to their immune system, this includes the B cell function, apoptosis and also the T cell function. Systemic lupus erythematous mostly attacks the blood vessels, the skin, the heart, nervous system, liver, lungs and the kidneys (Knott 2012). Unfortunately when System lupus erythematous persists without effective treatment it may result in serious complications such as stroke, heart inflammation, lung damage, blood clots and if the patient is female it may result in miscarriage or pregnancy complications. Research shows that the exact cause of immune deregulation is not yet clear but it may be as a result of interference of endogenous metabolism that affects the function of antigens in the human system (GinzlerTayar 2012). The abnormalities caused by System lupus erythematosus may vary from one ethnic group to another for instance East Asians who have this problem they have extra cytotoxic T lymphocyte antigen-4 while the white populations abnormalities is observed through having more Fc-Y receptors (Hemminki 2009) . For effective diagnosis of System lupus erythematosus it is of essence to deal with specific autoantibodies in order to treat the root cause of the disease (GinzlerTayar 2012). The symptoms of systemic lupus erythematosus will vary from patient to patient as the signs and symptoms displayed will depend on the body part or system that is being affected by the systemic lupus erythematosus (Arthritis Research UK 2014). However there are some generalised symptoms and these are about to be discussed. Dermatological symptoms caused by systemic lupus erythematosus could include rashes and in some cases a specific rash to the cheeks known as a â€Å"butterfly rash† can be identified (Knott 2012). Another common issue for the majority of people with systemic lupus erythematosus find that they become much more sensitive to sunlight. It is also common for the blood vessels under the skin in the joints to become inflamed and this can lead to poor circulation to these areas (this is called Raynauds phenomenon)(GinzlerTayar 2012). Oral ulceration can sometimes occur for this very reason. Blood disorders have been known to develop especially in children, the most common being anaemia. Having anaemia would obviously cause lethargy and low mood (Giannouli 2006). Patients with systemic lupus erythematosus are much more at risk of developing cardiac issues than the general public as the disease often causes inflammation of the blood vessels within the heart, thus increasing the risk of developing atherosclerosis which in turn could lead to a myocardial infarction if one of the blood vessels was to become blocked(Blank et al 2009). If the kidneys were to become inflamed due to the systemic lupus erythematosus, this could cause symptoms including haematuria (blood in the urine). Also, if the kidneys become inflamed this could lead to the patient developing a kidney infection which will result in the patient having moderate to severe back pain (GinzlerTayar 2012). The most common issue for patients suffering from systemic lupus erythematosus is to do with their joints (Somers et al 2007). Most people suffering from systemic lupus erythematosus will develop pain in their muscles, joints and peripheral joints such as joints in their hands and knees can often become inflamed. This can be due to a condition known as Osteonecrosis developing due to the systemic lupus erythematosus (Giannouli 2006). Osteonecrosis is a condition that develops when there is a reduced blood supply to the bones. Osteonecrosis will affect the bones ability to replace old bone with new bone and if an injury is sustained it may never be able to heal properly (Knott 2012). Most patients find that it is worse when they wake up in the morning and as this is a chronic condition, it can often feel better in periods of remission and more painful during a relapse period (GinzlerTayar 2012). Diagnosis The process involves the blood tests including antibody tests, urinalysis and a chest X-ray which is mostly overseen by Rheumatology Consultants whose area of specialisation is autoimmune diseases and also soft tissue treatment. Musculoskeletal symptoms are analysed when trying to diagnose System lupus erythematous and it can be manifested as arthritis or arthralgia in which the patient expresses it as stiffness and pain, when it occurs in System lupus erythematous it can be in the form of migratory or transient pain and it is difficult to be diagnosed since it may be present when the patient makes the appointment with a doctor only to be resolved in the process of evaluation(Ginzler Tayar 2012 and Knott 2012). Systemic lupus erythematosus caused fewer erosions or fixed deformities unlike rheumatoid arthritis which is much more degernerative to the joints (GinzlerTayar 2012). There is also the possibility of around 4% of the patients will suffer from myositis ( which is the inflamat ion of the muscle tissue) and this can be examined by taking a biopsy of muscle tissue (Giannouli 2006). Pharmacology and associated treatment: Unfortunately there is no cure for Systemic lupus erythematosus and the treatment plan is based on symptom relief as opposed to direct treatment of the disease(GinzlerTayar 2012, Blank et al 2007, Knott 2012). Treatment of Systemic lupus erythematosus is very specific to the individual patient and it always depends in manifestation of the symptoms, the disease severity and most importantly the specific organ affected(Giannouli 2006). In order to devise the most appropriate treatment plan the rheumatology consultant will perform a number of diagnostic tests and depending on what the results are will influence the treatment plan (Giannouli 2006). Patients suffering from systemic lupus erythematosus will often need to take a group of medications called non-steroidal anti inflammatory drugs (Knott 2012). This group of medications work by reducing the inflammation in the affected joints and hopefully reducing the amount of pain the patient is in. Some common non-steroidal anti inflammatory drugs are ibuprofen, aspirin and diclofenac sodium (these are all available without a prescription from a pharmacy), the rheumatology consultant may recommend Naproxen or pirixicam in certain circumstances (BNF 2014). With non-steroidal anti inflammatory drugs there is a risk that they may cause damage to the lining of the stomach and could even cause ulceration in the stomach when taken over long periods of time in high doses(Knott 2012). If the patient is taking frequent non-steroidal anti inflammatory drugs they may be prescribed a proton pump inhibitor medication in order to protect the stomach. These medications work by reducing the amount of acid the stomach produced and thus protecting the lining of the stomach (Knott 2012). Common proton pump inhibitor medications include; omperazole, lansoprazole, pantoprazole and esomeprazole (BNF 2014). A further treratment that a rheumatology consultant may consider is the use of a medication called hydroxychloroquine (Giannouli 2006). Hydroxychloroquine was originally an anti-malarial drug however it has recently started being used to treat the symptoms of systemic lupus erythematosus and is a disease modifying anti-rheumatic drug (also known as DMARD)(Knott 2012). Hydroxychloroquine works by reducing the response from the immune system which is causing the symptoms (this is probably the closest treatment to treating the cause as opposed to just the symptoms). It is used as a long term treatment to try and prevent relapses or flare ups of the disease (GinzlerTayar 2012). Corticosteroids may be used in severe systemic lupus erythematosus (GinzlerTayar 2012). They may be prescribed during relapses of the disease. Corticosteroids work by blocking the normal function of the white blood cells and reducing the inflammation response(Knott 2012). However the negative aspect of this is that it leaves patients very vulnerable to infections(GinzlerTayar 2012). Other side effect could include the patients bones becoming more fragile, the skin becoming thinner, hypertension and also weight gain. For this reason corticosteroids will only be used to treat flare ups at the minimum effective dose and then reduce the dose slowly as the symptoms ease. Corticosteroids used in the treatment of this disease are hydrocortisone and predniselone(BNF 2014). Often used in conjunction with corticosteroids during a relapse are a group of medications called immunosuppressants . These medications will work by reducing the action of the immune system and will be used when the immune system is attacking a healthy part of the patients body(Knott 2012). Again these medications will reduce the pateints ability to fight harmful infections and can cause many side effects. Immunosuppresent medications used include: azathioprine, mycophenolate mofetil and cyclophosphamide (BNF 2014). The final medication to be discussed is called Rituximab. Rituximab was originally created to treat blood cancer however an â€Å"off-label† use for this medication is to treat autoimmune diseases. The way Rituximab works is by destroying the B-Cells(The B-Cells which cause the release of antibodies resulting in the symptoms). As with all the other medications there could be side effects the most common being dizziness and vomiting. Rituximab can only be administered intravenoulsy so will normally require hospital admission for the patient to receive it . (Knott 2012) Other interventions include an advice session from the doctor regarding the patients lifestyle and diet may be of vital importance this may help the patient and minimise lifestyle related stress (GinzlerTayar 2012) . The patient may be suggested to work with a support group or even receive counselling as the condition can cause severe and life limiting symptoms while in relapse. Most patients with systemic lupus erythematosus are also advised to avoid the sun as it can aggravate and skin symptoms(Knott 2012). Conclusion Systemic Lupus Erythematosus is a very complex disease and can present itself in many different ways depending on the patient and the part of the body affected. In the pre-hospital environment it is very important to get a detailed history in order to identify whether they have been diagnosed with this disease. Clinicians must remember systemic lupus ertythematosus can limit a patients quality off life while they are having a relapse so it is important to assess each patients individual symptoms and if necessary administer pain relief and position them so they are comfortable. It is also important for ambulance clinicians to be mindful of the patients joints when using moving and handling techniques as this could obviously cause the patient discomfort or even pain due to the condition. References: Arthritus Research UK. (2014). Systemic Lupus Erythematosus. Available: http://www.arthritisresearchuk.org/arthritis-information/drugs/hydroxychloroquine/what-it-is.aspx. Last accessed 20/03/2014. Blank M, Shoenfeld Y, Perl A. 2009. Cross-talk of the environment with the host genome and the immune system through endogenous retroviruses in systemic lupus erythematosus. Lupus. Nov;18 (13):1136-43 Giannouli, S (2006) Annals of rheumatic disease, Anaemia in systemic lupus erythematosus from pathophysiology to clinical diagnosis. 65(2) p144-148 Ginzler E, Tayar J. 2012. Systemic lupus erythematosus (lupus). Updated: January 2012. Available at http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/lupus.pdf#search=sle. [Accessed on February 21, 2014 at 21:30] Hemminki K, Li X, Sundquist J, Sundquist K (February 2009). Familial associations of rheumatoid arthritis with autoimmune diseases and related conditions. Arthritis Rheumatology. 60 (3): 661–8 Knott, L. (2012). Systemic Lupus Erythematosus. Available: http://www.patient.co.uk/health/systemic-lupus-erythematosus. Last accessed 20/03/2014. Somers E, Thomas L, Smeeth L .2007. Incidence of systemic lupus erythematosus in the United Kingdom, Arthritus Rheum 15;57(4) p612 – p618.

Season by Wole Soyinka Essay -- English Literature

Season by Wole Soyinka There seems to be a strange contrast between his choice of the word â€Å"decay†, which suggests things going to ruin and the final sentiment where the word â€Å"promise† indicates hope. I get the sense that Soyinka’s poem is contrived. He feels the urge to speak lyrically about this subject but does not seem to have found his authentic voice, or perhaps the theme is too complex for him to address in a sixteen line poem. This is reflected in lines such as â€Å"Pollen is mating time† which not only fails to make sense but is also rather clumsy. This poem begs comparison with Achebe’s â€Å"Refugee Mother and Child† that redefines aesthetics through comparison with traditional Western sensibilities. He shows the harsh reality of humans on the brink of starvation whilst Soyinka shows humans dependent on, yet in harmony with, nature. Soyinka too redefines some words through context but his spin on the relationship between humans and nature is a more hopeful one. The word â€Å"loved† is in the past tense thus indicating a time gone by. This suggests that the firs...

Poorly Written Essay :: essays research papers

Persuasive Essay â€Å"Poorly Written Communication†   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Poorly Written Communication 2 Thesis: After a poorly written memo caused hard feelings and loss of morale, the company decided to start writing courses, believing that the effectiveness of enhancing written communication skills within a work place is necessary for any successful business.   Ã‚  Ã‚  Ã‚  Ã‚  In â€Å"A case for clear writing† C. Petrini states, the ability to communicate written information in a clear, concise and accurate manner can provide significant benefits to employees and their companies. Poor communication within a work place can cause serious miscommunication, which in ways could cause loss of work time, due to doing the wrong job. Another problem that could dampen works productivity is hurt feelings. This alone could cripple a business by causing lack of productivity and lack of morale. If you ever plan to expand, your business and have a successful one, you need good writing skills.   Ã‚  Ã‚  Ã‚  Ã‚  If our business continues to have a lack of writing ability, it could result in personnel quitting or total lack of respect in the end. There are many other areas in which this could affect our business but one, which would really be an eye opener, is a possible lawsuit. In the article â€Å" The you understood† P. Vassallo it says When writing we don’t have the luxury of using vocal intonations or body language to add to our meaning. If you call someone crazy in writing, you suggest either that person lacks sanity or that you lack judgment.   Ã‚  Ã‚  Ã‚  Ã‚  A writing workshop would benefit our business in many ways. The first thing that comes to mind is higher morale, Since the workshop would teach us to write clear and concise papers, this could cause less confusion with the employees when reading bulletins published by management and a lot less hurt feelings. As stated in â€Å" Improving your technical writing† by R. Ramsey, the ability to write competently is a requirement for success in any field.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Poorly Written Communication 3 Written communication should be treated as sales letters. I did my research and found A local college that offers a 20-hour class on professional writing and improving poor writing skills within a business. The college informed me that it offers offer two different classes one for higher management and one for all the other employees. The two courses are 20 hours in length and each can handle 25 students. After a closer look at what is being taught in the courses I have listed a few of the topics covered I feel that are important to

Common Man as Tragic Hero in Death of a Salesman Essay -- Death Salesm

Common Man as Tragic Hero in Death of a Salesman What is tragedy? While the literal definition may have changed over the centuries, one man believed he knew the true meaning of a tragic performance. Aristotle belonged to the culture that first invented tragic drama – the ancient Greeks. Through this, he gave himself credibility enough to illustrate the universally necessary elements of tragic drama. In The Poetics, Aristotle gives a clear definition of a tragedy, writing that it is â€Å"an imitation, through action rather than narration, of a serious, complete, and ample action, by means of language rendered pleasant at different places in the constituent parts by each of the aids [used to make language more delightful], in which imitation there is also effected through pity and fear its catharsis of these and similar emotions.† Basically, Aristotle thinks a tragedy should be witnessed rather than related, use poetic imagery instead of dry language, and have a logical flow with an inevitable conclusion at the end tha t evokes a heightened emotional response from the audience. Ever since Aristotle applied logic to art in The Poetics, playwrights from all time periods and cultures have attempted to prove him wrong. Utilizing intuition and writing from the soul, many have succeeded and many have failed. However, the most commercially successful theatrical performances have tended to follow Aristotle’s rules of drama. Aristotle maintained that all tragedies be driven by plot and that the characters simply be plugged into the story line. Leading the charge is the Tragic Hero, the man (not woman) who ultimately suffers the tragic fate. As defined in The Poetics, the Tragic Hero is, â€Å"the man of much glory and good fortune... ...oman’s world and demonstrated the tragic possibilities that exist within a common man’s universe. In so doing, he expanded the definition of Tragic Hero and helped to revolutionize tragic drama beyond the twentieth century. Works Cited Epps, Preston H. (trans.). 1970. The Poetics of Aristotle. Chapel Hill, N.C.: The University of North Carolina Press. Guth, Hans P. and Gabriel L. Rico. 1993. Discovering Literature. â€Å"Tragedy and the Common Man† by Arthur Miller. Upper Saddle River, NJ: Prentice Hall. Murphy, Brenda and Susan C. W. Abbotson. Understanding Death of a Salesman: A Student Handbook to Cases, Issues and Historical Documents. The Greenwood Press â€Å"Literature in Context† series, Claudia Durst Johnson, series editor. Westwood, CT, London: 1999. Miller, Arthur. Death of a Salesman. 50th Anniversary ed. New York: Penguin Books, 1999. Common Man as Tragic Hero in Death of a Salesman Essay -- Death Salesm Common Man as Tragic Hero in Death of a Salesman What is tragedy? While the literal definition may have changed over the centuries, one man believed he knew the true meaning of a tragic performance. Aristotle belonged to the culture that first invented tragic drama – the ancient Greeks. Through this, he gave himself credibility enough to illustrate the universally necessary elements of tragic drama. In The Poetics, Aristotle gives a clear definition of a tragedy, writing that it is â€Å"an imitation, through action rather than narration, of a serious, complete, and ample action, by means of language rendered pleasant at different places in the constituent parts by each of the aids [used to make language more delightful], in which imitation there is also effected through pity and fear its catharsis of these and similar emotions.† Basically, Aristotle thinks a tragedy should be witnessed rather than related, use poetic imagery instead of dry language, and have a logical flow with an inevitable conclusion at the end tha t evokes a heightened emotional response from the audience. Ever since Aristotle applied logic to art in The Poetics, playwrights from all time periods and cultures have attempted to prove him wrong. Utilizing intuition and writing from the soul, many have succeeded and many have failed. However, the most commercially successful theatrical performances have tended to follow Aristotle’s rules of drama. Aristotle maintained that all tragedies be driven by plot and that the characters simply be plugged into the story line. Leading the charge is the Tragic Hero, the man (not woman) who ultimately suffers the tragic fate. As defined in The Poetics, the Tragic Hero is, â€Å"the man of much glory and good fortune... ...oman’s world and demonstrated the tragic possibilities that exist within a common man’s universe. In so doing, he expanded the definition of Tragic Hero and helped to revolutionize tragic drama beyond the twentieth century. Works Cited Epps, Preston H. (trans.). 1970. The Poetics of Aristotle. Chapel Hill, N.C.: The University of North Carolina Press. Guth, Hans P. and Gabriel L. Rico. 1993. Discovering Literature. â€Å"Tragedy and the Common Man† by Arthur Miller. Upper Saddle River, NJ: Prentice Hall. Murphy, Brenda and Susan C. W. Abbotson. Understanding Death of a Salesman: A Student Handbook to Cases, Issues and Historical Documents. The Greenwood Press â€Å"Literature in Context† series, Claudia Durst Johnson, series editor. Westwood, CT, London: 1999. Miller, Arthur. Death of a Salesman. 50th Anniversary ed. New York: Penguin Books, 1999.

Recruitment and Retention

Demand for academic staff in Higher Education has been increasing2 and may be expected to continue to increase given the Government’s intention that participation in Higher Education should increase substantially amongst those aged 18 to 30 years old. At the same time, recruitment and retention problems have been growing in prominence (HEFCE, 2003) and there has been a long-standing concern that the sector faces a ‘retirement bulge’, as academics from the 1960s expansion reach retirement.Consequently, there is concern about the adequacy of the future supply of academics. Other substantial changes in Higher Education in the past 10 to 20 years are likely to have contributed to the tightness of the academic labour market3. Polytechnics were granted university status in 1992, changing their funding regime, their focus and the demands on staff. The number of students has grown substantially, a growth which has not been matched by staff increases resulting in a large i ncrease in the student:staff ratio.Changes in funding have led to much greater emphasis on research output (through the Research Assessment Exercise, the RAE), teaching quality (through the requirements of the Quality Assurance Agency, the QAA) and on academics raising research and consultancy funds. Other changes include tighter contractual terms (affecting holidays and hours worked), an increase in the use of short-term and hourly-paid contracts and the loss of tenure. Overall, these changes have tended to alter the nature of the job, reducing autonomy and increasing the workload, including that of administrative and teaching tasks.At the same time, both the salaries and status of academics are perceived to have deteriorated relative to alternative careers (Halsey, 1992; Keep et al. , 1996). Substantial change in the nature of any job is likely to increase turnover, as a mismatch develops between the nature of the job to which people were recruited and the actual job. If these cha nges tend to reduce the quality of the job, rather than just change it, and if the applicant requirements are not altered (and, probably, lowered), recruitment will also become more difficult.Both turnover and recruitment difficulties will be exacerbated by a relative decline in pay. Overview of the study Against this background, the study was designed to identify the factors which lead to individuals entering and leaving academic employment in the English Higher Education sector. Although the main focus was entry and exit from the sector, recruitment to and retention by individual institutions can shed light on this and was also investigated.For the purposes of the study academic employment was defined as jobs in higher education institutions (Universities and Colleges of Higher Education) whose main function was academic teaching or academic research, irrespective of the contractual terms of the job holder. Thus lecturing (e. g. Professors, and Lecturers) and research staff (e. g. Research Assistants, post-docs and Senior Research Fellows) are included, but academic-related staff (e. g. technicians) are not. Full-time, part-time, permanent and temporary staff within these groups are included4.Two main groups of academics were excluded from the study: those in Further Education Institutions and those on clinical rates of pay. The resources of the study precluded inclusion of these two groups5. Following discussion with the DfES, it was decided to focus on staff at English HEIs. This was done in order to prevent differences in the funding and structure of the HE sectors obscuring the analysis. Two exceptions to this rule are the analysis of the HESA data on research students and the chapter on international comparisons of pay (Chapter 4). These are discussed in more detail in sections 1. . 1 and 1. 1. 2 below (and in further detail in Appendix C and Appendix D). The study had five, inter-related, strands: †¢ a literature review to establish the nature of the recruitment and retention problems and to identify previous evidence on the factors affecting recruitment and retention; this was conducted from March to May 2003; †¢ analysis of HESA staff and student data, 2001/02, to provide a descriptive analysis of turnover in academia, to identify the basic characteristics of employment in the sector and to identify the student supply into academia6; a comparative analysis of pay, using 2001 data, both for comparable employment nationally and for academics in Higher Education internationally, in order to establish the competitiveness of academic pay; †¢ qualitative research within universities exploring human resource policies and practices and factors affecting entry and exit from the sector; the fieldwork was conducted between July 2003 and July 2004; 4 However, the coverage of hourly paid staff is severely limited, owing to limitations in the HESA data (see below) and to practical difficulties of sampling for the survey (see b elow). Inclusion of the former would have extended the study to Further Education Institutions. The latter have different terms, conditions and employment patterns from other academics in HEIs and so a larger sample would have been required to adequately cover this group. Staff on clinical rates accounted for five per cent of academic staff (HESA Individualised Staff Record 2001/2). 6 Analysis of more recent HESA data and of trends over time is contained in HEFCE (2005a) and HEFCE (2005b). 3 quantitative surveys of academic staff and of research students to identify factors which affect recruitment into academia and retention; the fieldwork was conducted between May and July 2004. The research findings are affected by the policies and practices in effect at the time. To assist the reader, the DfES has produced a list of relevant Higher Education initiatives since the survey fieldwork. These are listed in Appendix H. Below, essential aspects of the methods are described. Further deta ils of the methods appear in appendices. Appendix A describes the qualitative research.Appendix B discusses the quantitative surveys of academic staff and research students. Appendix C describes the HESA staff and student datasets. Appendix D describes the data used for the intra- and international pay comparisons. Appendix F describes the model used for the analysis of the likelihood of students entering academia. Appendix G describes the econometric analysis of job satisfaction and intentions to leave academia. 1. 1. 1 HESA staff and student data7 For staff, the HESA Individualised Staff Record for the academic year 2001/02 was used.The analysis was confined to institutions in England and to staff who were not on clinical grades. The sole exception to this is chapter 4, where the focus is expanded to the whole of the UK, to maintain consistency with the international comparisons analysis. For the study’s purposes, the Individualised Staff Record data has two important limit ations. Firstly, they exclude employees8 whose total academic employment is below that of 25 per cent of a full-time academic (i. e. those with short hours or with substantial management and administrative responsibilities are excluded)9.One of the implications is that hourly-paid staff will be substantially under-reported and is unlikely to be representative of hourly-paid staff as a whole. Secondly, the data relating to leavers suffer from a high level of nonreporting: around 60 per cent of leavers’ destinations are missing10. Therefore the findings on movement out of the sector must be treated with caution. For students, the Combined Student/Module Record for the academic year 2001/2 was used. This was combined with the First Destination Supplement (FDS), relating to those students who left in 2001/2.The analysis was not limited to students from English higher education institutions because the appropriate pool of domestic entrants into Higher Education academic post is th e whole of the UK. It is important 7 Note that the University of North London was not included in either the staff or student data supplied by HESA because the university has asked that its individual data is not released. 8 Strictly, they exclude contracts whose total academic employment is below that of 25 per cent of a full-time academic, as the record reports contracts rather than individuals.For more information see Appendix C. 9 However, there are staff in the Individualised Staff Record with their FTE recorded as less than 25%; the majority of these records relate to staff who arrived or left during the year. 10 Internal work by HEFCE that matched the 2001-2 survey with that for the following year using staff code, data of birth and sex, found that 20% of those for whom the destination was not known remained at the same institution, 5% were found at a different institution and the remainder could not be matched with a record in the second year.This latter group are made up of those who left the sector and those who remained but whose record in the second year did not match with respect to one of the three criteria. 4 to note that the destination of postgraduate research students in the FDS has a particularly low level of response (38%). Further details are given in Appendix C. 1. 1. 2 The comparative analysis of pay The comparative analysis of pay uses data from national labour force surveys (and censuses in nine countries. These were chosen to illustrate the types of countries to and from which most international movement with UK academia occurs.They include the main English–speaking countries to which UK academics move (the USA and Australia), together with other English-speaking nations (New Zealand and Canada), three European countries (Denmark, France and Sweden) and Japan. The analysis of the labour force survey data used in the international comparisons used data from the whole of the UK. This was to increase the sample size. However, we w ould not expect to find significant differences within the UK. Identifying higher education academics was done using information on occupation and industry where available.In most countries we were able to obtain a sample group that matched the UK sample. Exceptions to this were the US, where the sample also included academic staff at state colleges, who also conduct teaching undertaken in the FE sector in the UK, and Australia and New Zealand, where it is possible that our sample excludes some researchers who have no teaching responsibilities. We discuss the implications of this in Chapter 4 and Appendix D. Comparisons were made in both nominal and real terms. Earnings were converted using exchange rates to make nominal comparisons.In order to account for differences in the cost of living, purchasing power parity exchange rates developed by the OECD were used to make real earnings comparisons. Further details are given in Appendix D. 1. 1. 3 The qualitative and quantitative survey research Qualitative research was conducted in thirteen English universities and quantitative research conducted in a subset of these. A structured sample of universities was selected to ensure coverage of different types of universities (new, old and colleges of Higher Education), universities in London and elsewhere and universities with differing research ratings.Institutions with fewer than 200 academic staff and most specialist institutions11 were excluded. Small institutions were excluded because economies of scale in setting up the quantitative survey meant that their inclusion would have led to a smaller survey, as the project resources could not increase the sample through an increased number of institutions. Specialist institutions were excluded for similar reasons. (This did not reduce the subject coverage, as subjects taught in specialist institutions are also found in other HEIs. The purpose of the qualitative research was to identify factors which might affect recruitm ent and retention, including human resource practices and staff preferences. Qualitative interviews were held with senior staff with responsibility for 11 ‘Specialist institution’ is a classification developed for funding purposes and refers to institutions where 60 percent or more of funding is allocated to one or two cost centres. 5 human resourcing and, in eight of the universities, interviews were conducted with heads of two departments, and a sample of their academic staff and research students.A survey of academic staff was conducted in ten12 of these universities. The survey covered both research and lecturing staff. Full-and part-time staff were included, but hourly paid staff were excluded (see Appendix B). The questionnaire collected data on personal characteristics, employment history, views on aspects of the job and career intentions. The survey was web-based. A total of 2805 staff responded, a response rate of 32 per cent. Survey data have been re-weighted to be representative of university academic staff in English HEIs.For more information on the weighting and other issues relating to the staff survey see section B. 1 of Appendix B. A survey of research students (full-time and part-time) was conducted in nine of the universities, where research students were those undertaking a Masters degree mainly by research or a doctorate. The questionnaire collected data on personal characteristics, employment history and career intentions. The survey was web-based. A total of 1330 research students responded, a response rate of 29 per cent. Survey data have been re-weighted to be representative of research students in English HEIs.For more information on the weighting and other issues relating to the staff survey see Section B. 7. Further details are given in Appendix B. 1. 2 Nomenclature Throughout this report the following nomenclature is used: †¢ Student when referring to the student survey refers to research student. †¢ ‘Ac ademic’, ‘academic staff’ refers to those employed in higher education institutions on either the research grade or the lecturing grade. †¢ University is used to refer to all higher education institutions, whether a university or a college. New and old universities. New13 universities are those that received university status in 1992 (when polytechnics and many colleges of Higher Education converted to university status) or later; old universities are those which had university status before this date. 1. 3 Report layout The structure of the report is as follows. The next chapter sets the scene by presenting evidence on turnover and recruitment and retention problems in higher 12 The aim had been to survey staff and students in twelve universities.Unfortunately, not all the universities were able to supply the sample, either due to data protection considerations or due to difficulties providing an email contact list. 13 This nomenclature is in common use now , but, previously, ‘new university’ was used to denote universities established in the 1960s and early 1970s. Perhaps the term was also used in the nineteenth century to refer to the redbrick universities when the sector was expanded in the Victorian era. 6 education. It also presents evidence on the factors affecting recruitment and retention of academics.Chapter 3 then describes the structure of academic employment in Higher Education, including the grade structure and contractual status, and the main characteristics of academic staff. This description is used to raise some of the factors which might affect recruitment and retention. Chapter 4 continues with the theme of structure, focusing on pay, and examines relative pay to investigate whether pay differences may be a cause of recruitment and retention difficulties. Both domestic and international comparisons are made.

Poverty Revised Essay

Introduction Disability is recognised as one of numerous factors, for example gender, age and class that interact to deprive individuals and keep them poor. Nonetheless, with several competing main concerns on the development agenda, the relevance of disability to America’s national goals of reducing unemployment and poverty and attaining growth can not be ascertained. However it is clear that the poverty and disability are correlated. This paper will try and analysis the following question: Although poverty is both a cause and a consequence of disability, poverty and disability reinforce each other. Poverty Poverty is an imperative and an emotional problem. In 2006, the Census Bureau released its yearly report on poverty in the America stating that there were almost 36 million poor people living America in a small increase from the previous year. To comprehend poverty and disability in America, it is vital to look behind these figures and to look at the real living situation of the persons the government consider to poor to get the whole picture of the situation that is created by poverty and disability. Today, the issue of poverty and disability in America is creating a major concern as an issue that hinders the economic development goals of America. The issue is both an economical and a social problem. (Riis, pp120) What is disability? Defining the word disability is intricate and controversial. There is no collectively agreed upon meaning of disability. In the past disability was viewed as primarily a medical situation, with the medical or physical problem located in an individual. This medical or physical model was disputed by disability activists who later re-conceptualised disability as mainly a social occurrence. Although resulting from intellectual or physical impairment, disability as got social repercussions and also health ones, a full accepting of disability acknowledges that it has a great human rights aspect and is frequently connected with social segregation, and increased level and susceptibility to poverty. Disability a result of intricate interaction between the practical limitations resulting from an individual’s physical, mental or intellectual state and the social and physical surroundings, It has several dimensions and is far-off than a person medical or health problem. (Hoogeveen, pp 86) The impact of disability on poverty Poverty is both a consequence and cause of disability. The connections between poverty and disability are well known. Disabled people many amongst the poor according to the World Bank estimates, 20% of the world’s poorest people are disabled (Elwan, pp66) Disability affects both the individual and also their families and also carers too. Disabled persons are more susceptible to poverty- The beginning of disability normally has severe, bad financial costs for an individual and his/her household. One disabled person in America summed it up like this: â€Å"If people become disabled, they have to pay a lot for health care and rehabilitation† (Thomas 2005) The economic expenses of disability have got three aspects: direct expenses of treatment; foregone earnings from disability; and indirect expenses to others who offer care. A study in California found out that the average expenses of disability were more than 9% and it amounted to 2 – 3 times the output losses from poor nutrition (Colin. Pp98) Disability is both a cause and consequence of poverty. Eliminating poverty is unlikely to be attained except the rights and requirements of people having disabilities are responded to. According to the U.N one person in 60 people has a disability in America in many cases the young ones and the poor are many among the disable. The reason why disability contributes to poverty is that it; Disability confines access to education and employment, This results to economic power and social exclusion. Poor persons who have disabilities are then caught in a vicious cycle of disability and poverty, each one of them being both a cause and consequence of the other. A large amount of disability is avertable. Attaining the global development objectives for economic, social and also human growth will without doubt decrease the levels of disability in America.   Specific issues are still needed, not only for deterrence, but also to make sure that people having disabilities are able to take part wholly in the development course, attain a just share of the of development benefits, and assert their rights as complete and equal members of community. (Colin, pp100) Rights & Social Exclusion There is a significant and essential distinction between disability and other kinds of disadvantage. Individuals with disabilities can organise themselves to assert their human rights after their extra practical requirements, for example, mobility aids have been availed.   Persons with disabilities have got a right to be incorporated in all issues of life. For them to fight for the right of inclusion, persons with disabilities require to reside in an environment where they are  Ã‚   empowered.   However, persons with disabilities encounter several barriers in achieving equal openings; environmental and accessibility barriers, lawful and institutional obstacles, and attitudinal obstacles which result in social exclusion of these people. Social exclusion is frequently the toughest obstacle to surmount, and is typically associated with one feeling ashamed, fear and rejected. Negative stereotypes are normally associated to disability. People with disabilities are usually consigned a low social standing and in some other cases are considered worthless. Such treatment of people with disability in turn denies them opportunities thus increasing their level of poverty. More so as stated earlier the family members are left with the burden of carrying for these groups hence spending their income on health, medical and upkeep of such a person consequently reducing economic empowerment to the family. (Groce, pp32) The â€Å"social model† of disability An increasingly general criticism of conventional approaches to disability in America, mainly from persons with disabilities is that, their requirements are marginalised by being classified as â€Å"special† or â€Å"different† from those of the populace as a whole. These conventional approaches are being criticised for being motivated by a view that persons with disabilities require assistance to adjust to society’s demands. Such an approach runs the danger of favouring technological or medical resolutions which emphasise variation rather than promoting inclusion. In return such an approach also may hinder the disabled to purse certain opportunities thus enhancing or confining economical status. (Groce, pp33) Increased level exclusion and vulnerability Poverty and disability strengthen one another hence, contributing to an increased level exclusion and vulnerability. The bulk of persons with disabilities discover their situation have an effect on their probability of schooling, working for a livelihood, enjoying their family life, and taking part as equals in the social life. Consecutively, disability aggravates poverty, through increasing seclusion and economic hardship, not only for the person but in times for the affected family also. Kids with disabilities are most possibly to pass away young, or be neglected, emaciated and poor. Persons with disabilities who can no get good education are later unable to find good/no employment, pushing them more severely into poverty. Getting out of the vicious cycle of poverty and disability turns out to be very hard, the consequence of the cycle of poverty and disability is that persons with disabilities are generally among the poor and their literacy levels are significantly lesser that the rest of the nation population. (Riis, pp120) Figure 1: The disability and poverty vicious cycle   Women with disabilities Women with disabilities experience a twofold discrimination on the basis of gender and of impairment; their literacy levels are lower than that of male. Recent researches illustrate that women having disabilities are twice or three times more probable to be victims of sexual and physical abuse compared to women without disabilities. More so the are likely to suffer greater susceptibility to reproductive health issues. There is some lack of responsiveness as regards to women with disabilities and reproductive health requirements. In many times, it is assumed that they are not part of the target groups since being disabled is linked with being sexless. Such discrimination and stereotype of way thinking condemn such women to poverty and thus increase the level of poverty they are already experiencing. In cases where disable women are sexual abused it becomes so difficult to handle physical and psychological instability at the same time. Thus many well be highly affected by such an issue and they may not recover they psychological stability this only compounds there present state. (Hoogeveen, pp 87) The costs of disability Disability not only affects the person, but it impacts on the whole society. The price of excluding persons with disabilities from getting an active participation role in community life is costly and has to be carried by society, in particular   those who take on the weight of caring. This segregation many times results to losses in productivity and individual potential. The United Nations estimates that 15% of the entire national population is negatively affected in one manner or another as a consequence of disabilities. The expenditure of disability has three aspects; The direct expenses of treatment which includes costs of travelling and access; The indirect expenses to those who aren’t openly affected (‘carers’); The opportunity expenses of earnings foregone from inability. Some of the major factors creating this association (on top of the capability limitations imposed by the disables themselves) are the incorrectly limited prospects and self-underpinning combinations of economic and social prejudice, unreachable built surroundings and costly, socially isolations, and counterproductive disability national policies and establishments usually faced by persons with disabilities. As an outcome, they are regularly denied access to learning and employment opportunities, and thus, are usually forced to depend on others especially in their families and also communities for support and economic sustenance. As a result, disabled persons, irrespective of their financial environments, seem to experience a higher than average probability of living in poverty (Riis, pp122) Conclusion Persons with disabilities seem to be amongst the highly economically and socially marginalized populations in America. Poverty and Disability seem to go hand in hand, creating a cycle of increasing causation (Ann, pp56) Disabled individuals are more possibly to be poor than those who are not disabled and individuals living in poverty are highly likely to turn into disabled than those who are rich (Ann, pp56) Many national, international aid organizations and scholars concurs that poverty and disability are underlying intertwined. In America the level of poverty has been on the increase and this is causing a lot of concerns to the society and the federal government. Basically this will continue to be an issue and it needs to be tackled as an economical and social issue.    Reference: Ann, E.: Poverty and disability: A review of the literature. Background Paper for the World Development Report 2002/2003 Washington, DC: World Bank; 2004, pp56 Colin, B: A Legacy of Oppression: A History of Disability in Western Culture. In Disability Studies: Past, Present and Future edited by Len Burton and Mike Oliver. Leeds, UK: The Disability Press; 2005, Pp98-100 Groce, N: Global Survey on poverty and Disability Yale School of Public Health, New Haven, Connecticut, USA; 2004, pp33 Hoogeveen, J: Measuring Welfare for Small but Vulnerable Groups: Poverty and Disability in America; Journal of America Economies 14, no; 2005, pp86- 87 Riis, J (2001): How the Other Half Lives; New York: Dover Press; 2001, pp120-122

Elimination of Waste in a Lean Manufacturing Environment

Many things can be done in a manufacturing enterprise in order to increase its performance. Special consideration should be given to the activities where the most benefit can be attained. The elimination of waste is the most important contributor to improvement in a lean manufacturing environment. The efforts for the elimination of waste begin on the manufacturing floor and include all areas of the enterprise all the way up to management. The whole organization plays a part in the continuous efforts to eliminate waste. It is the responsibility of management to provide the proper training and tools so that all personnel can properly participate in these activities. Once the personnel is actively searching for and eliminating waste, proper care must be taken in order to not introduce new sources of waste into the system. One important aspect to consider in the elimination of waste is that waste must not be transferred to vendors, customers or another area within the enterprise. Vendors cannot be expected to bear the burden of improper methods of waste elimination without undesirable consequences and likely introduction of new wastes. The transfer of waste to the customer is a dangerous and undesirable proposition since they are the reason the manufacturing enterprise exists in the first place. Working closely with the customer leads to a better understanding of their requirements and improved mutually beneficial processes or methods can be implemented. This allows the elimination of additional waste where the original demands of the customer may have forced areas within the manufacturing enterprise to contain waste. In order to truly remove waste it must be eliminated from the system entirely and not simply transferred within the system (Goldratt, 2004). Waste exists in all areas of an organization. This is an important reason why successful efforts to eliminate it can have such a huge impact on the organization’s performance. Tools such as 5S programs, Standard Operating Procedures, total productive maintenance, or visual management tools and techniques can be implemented to aid in such efforts (NWLEAN, Inc. , 2013). According to Lean principles there are eight major areas of waste. They are referred to as the Eight Deadly Wastes: 1. Overproduction – Making or doing more than is required or earlier than needed. This waste can tie up significant working capital that could be sed for other purposes. 2. Waiting – For information, materials, people, maintenance, etc. An organization must look to eliminate or minimize any wait-times by ensuring that items arrive only when they are truly needed. 3. Transport – Moving people or goods around or between sites. Although some is necessary, this is potentially a huge waste with poorly planned distances or number of moves. 4. Poor process design – Too many/few steps, non-standardization, inspection rather than prevention, etc. An organization should strive to eliminate any non-value adding activities within the process. 5. Inventory – Work-in-progress, papers, electronic files, etc. An understanding is needed of how long it takes to replenish each item in order to truly reflect the real customer demand and not mask waste such as excessive queue times, unbalanced workloads, unreliable suppliers, or misunderstood customer needs. 6. Motion – Inefficient layouts, unplanned downtime, poor ergonomics in offices, etc. If there is any type of unnecessary movement of people or machines then there is motion waste. 7. Defects – Errors, scrap, rework, non-conformance; poor quality controls, process documentation or machine capabilities, etc. Strive to eliminate all causes of defects through mistake proofing and statistical methods of process control. 8. Personnel resources and creativity – This is the waste of not using people’s mental, creative, and physical abilities. Everyone can be a successful contributor toward the organization's goal and elimination of waste. Availability of appropriate resource levels at all times can be achieved through good communications, teamwork, proper training, and by avoiding over-skilled personnel to be used for mundane tasks (Juran Institute, Inc. 2013). In-line with Mr. Pareto’s famous rule, 80% of the benefits during the implementation of lean principles exist in the elimination of waste. Many tools exist in order to achieve and maintain meaningful results. It is with the proper implementation of these tools that successful elimination of waste can be achieved. Some tools will have more impact than others depending on the organization so careful planning and imple mentation is needed in order to achieve real improvements with the best possible benefits.Works CitedGoldratt, E. M. (2004). The Goal: A Process of Ongoing Improvement. GreatBarrington, MA: The North River Press Publishing Corp. Juran Institute, Inc. (2013). Retrieved Jul. 11, 2013, from Juran: http://www.juran.com/ NWLEAN, Inc. (2013). Retrieved Jul. 10, 2013, from The Northwest Lean Networks: http://nwlean.net/

Premium Development Case

New England Health Maintenance Organization (HMO) is a regional not for profit managed care company that has its headquarters in Boston, MA, with over 500,000 enrollees within 25 different plans including Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. A consortium of employers has shown interest in bidding on a managed care contract to be offered to the consortium’s 75,000 employees whom are locate in and around Nashua, New Hampshire. The consortium of employers includes companies such as IBM, Ford, and Prudential Insurance.The approach that New England has to the premium development is that the premiums received from the employers must cover the cost of the providing required healthcare services, also known as medical costs, and the costs of administering the plan and of establishing reserves, also known as other costs. Reserves are necessary to ensure that funds are available to pay providers when medical costs exceed the amount collected in pre mium payments (3901-3-13 Health Insurance Reserves, 2010). Due to New England HMO being a not for profit corporation, there is not explicitly include any type of profit element within the premium.A requirement to the reserve is set sufficiently high in order to ensure there are enough investments available to fund product growth and expansion. Therefore, part of the reserve requirements does constitute a profit. (Premium Development Case Study, 2007) A base per member per month (PMPM) is used in setting premiums by estimating the PMPM for each aspect of the plan’s coverage benefits. Setting the premiums also utilizes historical utilization as well as cost data. The co-payments are used a source of revenue to decrease medical cost and lessen the premiums.New England HMO adds fifteen percent to the total medical PMPM to cover any administrative costs that may incur and an additional five percent added for the reserve. The Individual Rate Factor is set at 1. 216 and the Family R ate Factor is set at 3. 356. The application of the given information allows the calculations to develop based on the levels of three co-payments, low, moderate, and high. The historical utilization and historical data for facility services is the same, regardless of the level of patient’s level of co-payment.The average fees are as follows: Inpatient Acute Care Services – Average daily free-for-service charge$1,200. 00 Surgical Procedures per case$1,300. 00 Skilled Nursing$430. 00 Mental Care – Average Daily Cost $540. 00 Emergency Room Care per visit$190. 00 The following services were calculated by dividing the cases, days, and/or the visits per year by 1,000. ServiceCalculationResult Inpatient Acute Care400/1,0000. 4 Skilled Nursing Facility Care25. 2/1,0000. 0252 Inpatient Mental Care64. 4/1,0000. 0644 Hospital Based-Surgery41. 7/1,0000. 0417 Emergency Room Care132/1,0000. 132Next, in order to attempt to find the base PMPM cost, the utilization data is mult iplied historical cost. Once this is completed, the product is then divided by twelve. For instance, the inpatient acute care cost is calculation by multiplying $1,200. 00 by 0. 4, then dividing by twelve. The cost would equal $40. This process will be used to calculate the remaining inpatient services. Using the information provided by the consortium, substance abuse as a base PMPM cost of $0. 41, while the base PMPM for outpatient services is $3. 43. The facility services total cost is $54. 25.Upon calculating the base PMPM costs, the patient co-payment adjustment factors must be determined. The high patient co-payment for acute services in Table 2 shows that the co-pay cost adjustment factor is 0. 9642 and 0. 9200 for the co-pay utilization adjustment factor (additional inpatient services information is located within the Premium Development Case Study). Once all factors have been defined, the adjusted PMPM cost can be calculated by multiplying the cost by the historical data and the historical utilization by utilization, then multiplying the two products and dividing by twelve.For example, for Inpatient Acute Care adjusted PMPM calculation is as follows: (1,200*1) * (0. 4*1)/12, which 40. The remaining inpatient services are calculated in the same manner, however the substance abuse adjusted PMPM cost and outpatient procedures adjusted PMPM cost is its base PMPM cost. In the end, once all adjusted PMPM costs have been calculated, the total is equal to $44. 74. Much of the information for the physician services is provided within the case study. In order to calculated the adjusted PMPM cost, the calculation is as follows: (3,400*utilization) * (175,000*cost)/1,000)/12For example, (3,400*1. 8900/4000) * (175,000*1. 6834)/1,000)/12 = 39. 44. The adjusted PMPM for physician services equals to $27. 24. The inflation rate is five percent; this plays a significant role within the analysis as like any other business, costs rise over time. In order to calculate the inflation adjusted PMPM cost for inpatient services, the adjusted PMPM cost is multiplied by the sum of 1 and the inflation rate of five percent, or 0. 05. ; this equal to $50. 79. The same calculations are done in order to solve the adjusted PMPM costs for the physician services. The total of this is $114. 9. The total medical PMPM amount is the sum of the physician services inflation adjusted PMPM cost ($114. 39) and then inpatient services adjusted PMPM costs ($50. 79), which equals to $165. 18. All other expenses are calculated by multiplying the total medical PMPM amount by the administrative expense percent. Therefore, $165. 18 * 0. 15 equals $24. 78. In order to calculate the reserve, the total medical PMPM amount is then multiplied by the reserve percentage. Therefore, $165. 18 * 0. 05 equals $8. 26. These amounts combined will equal the total other expenses, which calculated to equal ($8. 6 + $24. 78) $33. 04. The inflation adjusted PMPM is calculated in the same manner as other services. This amount will equal $34. 69. The total PMPM amount is equal to $199. 86. In order to calculate the final figure, the monthly premium rates, the total PMPM amount is multiplied by the premium factor rate, which is 1. 216 for single and 3. 356 for family. The single monthly premium rates will equal $199. 86 * 1. 216, which equals $243. 03. The family monthly premium rates will equal $199. 86 * 3. 356, which equals $670. 73.