Medical Products Liability Lawsuit Case - 895 Words

Medical Products Liability Claims in the Wake of Coleman v. Medtronic The California Court of Appeals’ decision in Coleman v. Medtronic has made it easier for plaintiffs to pursue medical products liability claims. In the landmark 2014 decision, the court held that the state law tort claims asserted by the plaintiff were not federally preempted. The decision is part of a growing body of medical products liability law regarding the circumstances under which a state law claim can impose parallel requirements to those under the Food, Drug Cosmetics Act (FDCA) and, therefore, avoid federal preemption. The Facts of the Case John Coleman filed a product liability lawsuit against Medtronic, Inc., and Medtronic Sofamor Danek USA, Inc. (collectively, Medtronic), alleging that he suffered painful complications after a spinal surgery in which Infuse, Medtronic s federally-approved bone fusion medical device, was used in an â€Å"off-label† manner. The Federal Drug Administration (FDA) granted Infuse premarket approval for use in certain types of spinal fusion surgeries, including Anterior Lumbar Interbody Fusion (Anterior Fusion). The type of surgery Coleman underwent — Posterior Fusion — was promoted by Medtronic but not approved by the FDA. As detailed in court documents, studies funded by Medtronic found that the medical device could cause bone growth in the spinal canal, but the company did not report the adverse events to the FDA. Medtronic was also aware that adverseShow MoreRelatedProduct Warning Labels and Protection Against Liability Lawsuits1478 Words   |  6 PagesProduct Warning Labels and Protection Against Liability Lawsuits We have all purchased a new consumer product with several labels, stickers, and product inserts containing warnings, disclaimers and oversimplified directions. The warnings can actually be humorous at times as illustrated in the following examples:  · On Sears hair dryer: Do not use while sleeping  · On Marks Spencer Bread Pudding: Product will be hot after heating.  · On Rowenta Iron: Do not iron clothes on bodyRead MoreEssay Mcdonalds V Liebeck - Mcdonalds Coffee Case650 Words   |  3 PagesLiebeck v. McDonald’s, also known as the McDonald’s Coffee Case, is a 1994 product liability lawsuit. This lawsuit became one of the most famous in the US history because after the court’s awarded Stella Liebeck $2.9 million, after she was severely burned by the coffee she brought from McDonald, there were debates over tort reform in the US. Stella Liebeck, a 79-year-old woman was in the passenger seat of her grandson’s car, while she ordered a coffee from McDonald’s. Liebeck’s nephew parkedRead MoreToyota Manufacturing Liability And Negligence Regarding A Toyota Motor Corporation Vehicle934 Words   |  4 Pagesconsumers, which puts Toyota at risk for being held liable concerning product liability and subsequently negligence. One such case involving product liability and negligence concerning a Toyota Motor Corp. vehicle is Saylor v. Toyota Motor Sales, U.S.A, Inc. In order to understand our rights as consumers we will examine, the specifics of the Saylor v. Toyota case, the outcome concerning product liability and negligence in the case, as well as our rights as consumers concerning recalls on vehicles,Read MoreEssay on Tort Reform1698 Words   |  7 PagesTort Reform A tort is wrongful interference against a person or property, other than breaches of contract, for which the courts can rectify through legal action. The reform effort is aimed at reducing the number of unnecessary lawsuits that burden the court system while still allowing injured parties compensation when they’ve been wronged. This latest effort at tort reform has given rise to the same spirited rhetoric that might be found in a courtroom. With the prominence of the tortRead MoreBusiness Personal Liability Exposure Risk1513 Words   |  7 Pagesposes the risks of loss and liability in the case of tort negligence or breach of contract. However, the business legal structure of a given organization greatly determines the risk of exposure to personal liability (Bevans, 2006). The paper investigates and compares the risk of exposure to personal liability in five business entities and explores how the risk can be mitigated. Business personal liability risk is classified as limited and unlimited. In unlimited liability, the personal assets in additionRead MoreThe Issue Of Tort Reform1230 Words   |  5 Pagesactions seeking damages for the impacts to their products. Advocates use the terminology to limit the ability and potential damages available to individuals who take legal actions against companies. In 2002, the consumer advocacy organization Center for Justice and Democracy investigated the U.S. tort reform and saw th at the rally was actually a massive national PR effort initiated by the tobacco industry to reduce or eliminate exposure to liability law suits. Concerned by the increasing regularityRead MoreZoom Car Company Essay986 Words   |  4 PagesCase Example D The main legal issues that have come about from this case are very important for many reasons. Zoom Car Company is being sued on part of Daniel Boone for them to pay for his medical expenses resulting from being dragged from his car and being beaten. The reason behind this is his compass that was installed in his car by Zoom Car Company was faulty which lead him in the wrong direction where he got lost and ended up in a horrible situation. Daniel Boone is suing for his medicalRead MoreTort Reform1420 Words   |  6 Pagescentury that the distinction between intentional and unintentional acts was made (Columbia Electronic Encyclopedia). In recent years, tort law has become the center of scrutiny through the increase in tort costs, insurance liability costs, and the number of frivolous lawsuits made. This scrutiny has lead to the creation of tort reform. Tort reform is a movement to reshape the way consumers can access the courts by restricting their right to sue and limiting the award that could be received (Crane)Read MoreThe Violation Of The Duty Of Care1565 Words   |  7 PagesElement one is duty of care, meaning there is a legal obligation imposed in circumstances where harm could be reasonably foreseen to occur to others. This element can be found by applying the ‘neighbour principle’ established in the Donoghue v Stevenson case. The neighbour principle states that a person must take reasonable care to avoid omission which you can reasonably foresee would be likely to injure your neighbour. Element two is breach of the duty of care. The plaintiff has the burden of proof toRead MoreNegligence Is An Important Legal Principle1587 Words   |  7 Pagesduty of care, which means that there is a legal obligation imposed in circumstances where harm could be reasonably foreseen to occur to others. This element can be found by applying the ‘neighbour principle’ established in the Donoghue v Stevenson case. The neighbour principle states that a person must take reasonable care to avoid acts or omission which you can reasonably foresee would be likely to injure your neighbour. Element two is breach of the duty of care. The plaintiff has the burden of

The Conflict Between Conflict And Dispute - 1827 Words

In a world where violence is habitual, inevitably being used as the answer or defensive take on conflict, it is abolishing all signs of harmony, compassion and unity to each other. This is apparent as it overcrowds the daily newsfeed with reoccurring articles about conflict and its detrimental effects on society. History confirms, when violence is used by either the government or by the people, the other party in countries which are occupied by foreign powers generally fight back. It seems that even with the historic and much emphasised teachings of Dalai Lama, Gandhi and Nelson Mandela; to use non-violent ways of protest, there is still a proliferation of violence. It seems that the world is still turning its face and accepting violence as an ordinary act. This is unhealthy and unacceptable in countless ways. Many people do not know the difference between conflict and dispute because they may seem similar, although, they are quite different. Conflict and disputes are distinct but with a common denominator; both causing the effect of trouble and both approached by violence. Disputes are short-term problems, are relatively easier to solve and generally involve negotiable interests while on the other hand, conflicts are long-term, deeply rooted and involve non-negotiable interests such as value/moral differences and denial of basic human needs (Sprangler Burgess, 2012). To recapitulate, conflicts are much more severe and easily noticed however, disputes are of aShow MoreRelated Conflict Essay1096 Words   |  5 PagesCONFLICTS AND DISPUTES ARE INEVITABLE Conflict is defined as the behaviour due to which people differ in their feelings, thought and/or actions. Collins (1995) states that the conflict is a ‘serious disagreement and argument about something important’ and also as ‘a serious difference between two or more beliefs, ideas or interests’ (cf. Kumaraswamy, 1997, p. 96). In general it is believed that conflicts are the underlying cause of disputes. In other words, dispute is a manifestation of the deepRead MoreDispute Resolution : A Conflict Diagnosis Approach1690 Words   |  7 PagesDispute Resolutions Many people go to litigation for resolving disputes without knowing the alternatives that may possibly be more beneficial to them. The textbook, â€Å"Alternative Dispute Resolution: A Conflict Diagnosis Approach† is a great book that defines and explains the different types of dispute resolutions that can be used to settle a conflict. Some of the dispute resolutions discussed in the book are suitable for specific disputes. And the different type of dispute resolutions has differentRead MoreMediation, Conciliation and Arbitration in Conflict Management1405 Words   |  6 PagesCONCILIATION AND ARBITRATION IN CONFLICT MANAGEMENT Outline a. Introduction b. Definitions of conflict c. Conflict management d. Negotiation, Mediation, Conciliation and Arbitration as in Conflict Management e. Recommendation f. Summary/Conclusion Introduction Conflict is a natural phenomenon in every human societal living. It exits whenever people or groups disagree over which goals or values to pursue and the method and timing to be adopted in that regard. Since conflict is inevitable, it must be properlyRead MoreA Brief Note On Alternative Dispute Resolution And Other Forms Of Helping Professions1462 Words   |  6 PagesAlternative Dispute Resolution Conflict resolution is used in various aspects of counseling and other forms of helping professions. It is vital that conflicts between opposing parties are managed in order for progress to be achieved. By maintaining a controlled environment during the negotiation process, the two parties will often be able to come to a resolution of their differences. Sometimes it can be difficult for two parties to work together without the help of a third party to assist in theRead MoreDispute Resolution Innovations1082 Words   |  5 PagesDispute Resolution Innovations Introduction This paper will discuss innovative alternative dispute resolutions and how they may be used in a controversial conflict scenario. The writer will discuss these methods using an actual conflict scenario, describing how individuals involved in the conflict will benefit from these innovative methods rather than costly courtroom litigation. Alternative dispute resolutions are clearly the most beneficial conflict solution regardless of gender, cultural influenceRead MoreConflict, Dispute, And Negotiation919 Words   |  4 PagesDistinguish between the concepts of conflict, dispute, and negotiation. Examine their differences as well as how they relate to each other. Conflict is â€Å"a struggle; clashing of views or statements†. (Cope, 2014) A dispute would be a controversy or disagreement that pushes a person’s buttons to make them prove another person wrong. (Cope, 2014) Negotiation however, is the process or attempt at resolving a conflict that has elevated into a dispute. People come across conflicts daily as humans andRead MoreNatural Resource Conflicts And Conflict1456 Words   |  6 Pagesresearch on land use conflicts, Land conflicts and Livelihoods, Mining and Customary land Use, Customary Land use Tenure in Liberia, Land Use Conflicts between Communities and Concessions companies in Liberia, Sime Darby Concession conflict in Liberia will focus on the domestic literature, followed by the Concept of Conflict, Conflicts Analysis Tools/Model and summary of the chapter. 2.2 Land Conflict and Livelihoods Thomson and Kanaan (2003), propounded that the origin of Conflicts in human societyRead MoreConflicts Within The Workplace Are Inevitable1428 Words   |  6 PagesBUS 3021 Theme 1 Conflicts in Organisations Conflicts within the workplace are inevitable. Conflict is ever present for organisations and how these conflicts are dealt with defies the difference between how they operate. In this essay I will be considering organisational conflicts and discuss whether conflict is something organisations can resolve. I will be discussing the nature of work and how this impacts on individual’s in their everyday organisational life. Due to the current climate the governmentRead MoreCauses Of Conflicts Of A Construction Industry : A Communicational Approach Essay941 Words   |  4 PagesA review of Mitkus, T.,Mitkus, S.(2014). Causes of conflicts in a construction industry: a communicational approach. Journal of social and behavioral sciences, 110, pp.777-786 Mitkus, T.and Mitkus, S. are the authors of this paper. The paper was published by Elsevier in 2014. Construction conflicts reduce the profits and also have a huge influence on stakeholders’ investments. However, Yiu and Cheung (2006) state that construction conflicts sometimes are inevitable because there are a lot of peopleRead MoreEmployee Relations And The Workplace956 Words   |  4 Pagesor as individuals (Leat, 2008, p. 3; Waiganjo Nge the, 2012). Conflict at the workplace is the inevitable issues that stem from interaction between employees and employers. On the other hand, a strike is an industrial action and a collective way in which employees voice their dispute once negotiations do not bear fruits. According to Odhong Omolo (2014, p. 147), employee relations examines various facets of correlation between employees as well as with their employers. The concept of employee

The Role Consumerism Plays in Modern Day American Society

Consumerism plays a significant role in modern day American society. We have an almost inherent need to establish happiness based upon our purchases and assets. The American middle class is a segment of consumer that many companies seek to court. The relatively moderate to high level of disposable income and purchasing ability in this particular demographic is hard fought for by companies. This leads the notion that companies are vying for their products and goods to be purchased and establish brand loyalties in highly competitive market industries. Markets ranging from general retail stores, car manufacturers, airlines, clothing, energy services, and even healthcare markets must compete for consumer business. With the current challenging economic climate, retailers and companies have had to adapt to significant challenges with rather non-conventional methods. Other than cleaver marketing campaigns and catchy commercials; there are several new methodologies that industries are utilizing to attract consumer interests. With the ever increasing force of technological change and adaptation we are seeing a dramatic shift in the way empirical data is being utilized as a means of targeting consumer interests relative to a sales growth and revenues. In direct response to this companies and industries have began to use a highly specific and somewhat intrusive method of obtaining data on consumers. The somewhat elusive and controversial practice of data mining is becomingShow MoreRelatedEssay on Criticisms of Consumerism and Materialism in Fight Club1134 Words   |  5 Pagestrying to meet society’s consumerist criteria; seeking the false promise of the American dream. This is the reality presented in Fincher’s Fight Club (1999), one of â€Å"the rawest, most hot-blooded, provocatively audacious, dangerous movies to come of out Hollywood† (Morris, 1999). Through the diverging personalities of the films central characters, Fincher provides a satirical analysis and powerful criticism of consumerism, â€Å"echoing countless social critics who bemoan the emasculating effects of consumerRead MoreHow Music Has Influenced The World980 Words   |  4 Pages American culture has influenced the world over the last few centuries. Each day we visually perceive how the diversity of music impacts our day to day life. Music has played a consequential role in the devel opment of how diverse America is today. From the Charleston to the Duggie, music has evolved over countless years. The 1970s music industry transitioned the rebelliousness of the 1960s to the jubilant musical compositions of the 1980s. The American recording industry in the 1970s was a coalescenceRead MoreConsumerism in Post World War II Essay1479 Words   |  6 PagesConsumerism in Post World War II After WWII why did the economy prosper and what role did consumerism play in the 1950s? After WWII many economists predicted a recession in the American economy. It is easy to do so when at the peak of post war unemployment in March 1946 2.7 million searched for work. In 1945 people were laid off from their jobs. However, â€Å" in 1945 the US entered one of its longest, steadiest, periods of growth and prosperity† (Norton 829). How could this be? WithRead MoreMarketing Apple Fanatics : Self Identity1307 Words   |  6 PagesAs a company, Apple is known throughout the globe for more than their high-quality and revolutionary products; Apple is a household name because of the publicity surrounding their devoted fans. These fans camp outside Apple Stores days before a product is released, sometimes just to preorder the product. They eat, sleep, and breathe Apple, earning them the name iSheep. Fans of other brands lack the same publicity, but they maintain the same level of devotion. Many people exclusively wear Nike orRead MoreThe Invasion of Consumerism into the lives of a Post-Modern Family 1762 Words   |  8 PagesThe Invasion of Consumerism into the lives of a Post-Modern Family Consumerism is taking place everywhere. Whether we like it or not, it has come to invade our everyday modern lives. Steven Miles, a lecturer in sociology at the University of Plymouth says How we consume, why we consume, and the parameters laid down for us within which we consume have become increasingly significant influences on how we construct our everyday lives (1). Consumerism has even gotten to the point of affectingRead MoreConsumerism : A Social And Economic Order Within America Propelled Essay1777 Words   |  8 Pagesthey make significant and abiding social change. A social and economic order within America propelled, perhaps unconsciously, by the people, is consumerism. Originating in the nineteenth century, consumerism revolutionized the way individuals thought, behaved, and interacted with each other. Coming into full bloom during the Industrial Revolution, consumerism fueled a new desire for material goods, unnecessary for and unrelated to basic survival. The idea for mass production, a cheaper and more profitableRead More Movie Review: Fight Club Essay766 Words   |  4 PagesFight Club shakes the foundations of our democratic nation, spits on our capitalist society, and makes all who watch it look at the American way of life differently. In a country driven by consumption, one can imagine the movie Fight Club rubs certain people the wrong way. When Edward Norton was asked why he decided to take the role as the main character in Fight Club, he replied, â€Å"to piss off America.† Each American since childhood has been told repeatedly that democracy equals freedom, but is thisRead MoreAnalysis Of The Article Native American Headdresses Facts For Kids 1476 Words   |  6 PagesOutfitters According to the article â€Å"Native American Headdresses Facts for Kids†, 18th and 19th century Plain Indians (Native Americans who resided on the Great Plains and Canadian Prairies) introduced the world to the Feathered war bonnet as a way to place honor and respect among the men who demonstrated bravery and valor. The article explains that during the time, Plain Native American tribes sought to see the eagle as the greatest and best bird amongst all birds;Read MoreEssay about 1920s in The Great Gatsby1008 Words   |  5 PagesFitzgerald is both a representation of this distinctive social and historical context, and a construction of the composer’s experience of this era. Beliefs and practises of the present also play a crucial role in shaping the text, in particular changing the way in which literary techniques are interpreted. The present-day responder is powerfully influenced by their personal experiences, some of which essentially strengthen Fitzge rald’s themes, while others compete, establishing contemporary interpretationsRead MoreConsumerism As An Engine Of Change3258 Words   |  14 Pages2014 Mercedes S-Class: Consumerism as an Ideology and an Engine of Change In no century did consumerism play a larger role than the twentieth century. How Americans spent their money affected the nation, and how the nation reacted affected the consumer. This established an incredibly cyclical, yet dynamic environment with long term implications. John Lucaks starts his book, A Short History of the Twentieth Century, by writing that the twentieth century was the American century (3). Gary Cross

Target Corporation and Hackers - 909 Words

Target Corporation acknowledged a breach in their systems just as the 2013 holiday season was in full swing. The hacker have taken the information of nearly 40 million credit and debit cards from shoppers who shopped in its stores over the initial three weeks of the holiday season. This is the second biggest penetration of its kind announced by a United States retailer, of which Target is the third largest retailer. Apparently, the hackers worked quite speedily with the operation lasting from the day before Thanksgiving to Sunday December 15, 2013. These nineteen days are part of the large kickoff to the Christmas sales season. Target is said to be working with federal law enforcement and other experts to avert comparable future attacks. The company has not and does not seem to have an intention of revealing exactly how the system was compromised. It is known, however, that the company did not find the attack alone. Continuing, it seems that the retail giant was notified by partners of the attack. Specifically, â€Å"the retailer was alerted its systems might have been compromised by credit card processors who had noticed a surge in fraudulent transactions involving credit cards that had been used at Target† (Spencer, 2014). Now it also seems that the online systems were not affected rather only the company’s physical locations were compromised. Timing was clearly a factor in the attack. The holidays are known to be a high-risk time for all types of crime but specifically ofShow MoreRelatedCyber Security : Target Corporation880 Words   |  4 PagesOn Dec 19, 2013 Target Corporation announced to the world that they had suffered a major data security breach. Due to Target Corporations poor stance on network security, hackers were able to steal over 40 million payment card records, encrypted PINs and 70 million customer records during the Black Friday sales week. Initial reports indicated that it was malware placed on their Point of Sales (POS) system, but that was just the tip of the iceberg of the breach. If there had been better securityRead MoreFinancial And Business Implications Of Target Corporation Essay1562 Words   |  7 PagesAbstract Target Corporation was affected by the security breach it was the largest breach that ever happened. This document will explore how many people were affected, what is the effect on Financial and Business implications from the data breach, Lawsuits against the target company, How did the company handle the crisis like when did the company discovered the breach and when did the customers were notified. Introduction About target: Target store was first opened on May 1st 1962 Minneapolis ofRead MoreComputer Networks And The Internet1379 Words   |  6 Pagessimple fact of having an unprotected computer network, law enforcement not up to par, and a challenge is all a hacker needs to cash in; sometimes personal, but for the most part, just business as usual. Hackers once admired in the 1960’s are now dangerous and a threat to big box corporations, small businesses, and personal computer users. Data breaches are the most lucrative business for hackers still. An example of data breaching is Computer Memory Racking or also known as memory consumption or memoryRead MoreThe Security Breaches Of The Target Store Corporation Essay1306 Words   |  6 Pagesimplement to ensure that data are secure for the Northcentral University. This paper will summarize the security breaches of the Target Store Corporation over the previous year and make recommendations in the form of information technology security best practices to strengthen the University’s infrastructure. Summarize Major Security Breaches The Target Corporation was exploited in December 2013 and then again in 2015. These breaches included customer’s personal identifying information and retailer’sRead MoreThe Revolutionary Rise Of Technology1192 Words   |  5 Pagesbecome increasingly interconnected, businesses must focus extra resources and awareness to the security of their own connections. It seems almost every week new headlines emerge regarding a new group of hackers breaching security systems and bringing an organization to its knees. The corporations that were attacked came from a broad range of industries, indicating the problems of data hacking is not confined to any particular industry. Industries such as health medical providers, financial firmsRead MoreThe Aftermath Of The 2008 Financial Crisis1274 Words   |  6 Pagesand even humans. Corporations, governments, hospitals and even individuals are at risk of cyber security breaches. The growing amount and sophistication of cyber-attacks has heightened the concerns of the FSOC. Cyber security breaches pose a threat to the financial sector in many ways, whether if it’s monetary or even for a personal agenda. Most recently Target and Sony were victims of a massive data breach, which greatly impacted both organizations. The Target corporation hack posed a seriousRead MoreCyber Security And Business Organizations1517 Words   |  7 Pagesbiggest concerns of corporations as demand for more transparency in business grows, and e-Commerce and e-Business optimization continues to evolve. Cyber attacks are malicious criminal acts of deception over the internet to infiltrate personal and business information system networks, data, infrastructures, or any mobile computer devices with the intent of stealing information, proprietary intellectual properties or identity theft. From 2013 - 2014, big businesses such as Target, Home Depot, NeimanRead MoreTarget: The Largest Data Breach/Attack Essay1215 Words   |  5 PagesIn December 2013, Target was attacked by a cyber-attack due to a data breach. Target is a widely known retailer that has millions of consumers flocking every day to the retailer to partake in the stores wonders. The Target Data Breach is now known as the largest data breach/attack surpassing the TJX data breach in 2007. â€Å"The second-biggest attack struck TJX Companies, the parent company of TJMaxx and Marshall’s, which said in 2007 that about 45 million credit cards and debit cards had been compromisedRead MoreComputer Hacking Is The Scale Of The Problem Essay972 Words   |  4 Pagesmore and more of a threat in recent years and is being brought to the public eye more often. Large and small corporations alike, as well as individuals are at risk of losing personal information to hackers, opening up doors to cyber-attacks and theft. Statistics show that half of American adults have been hacked this year alone (Pagliery). Security experts and law enforcement say that hackers are actively scanning merchants’ networks for ways to gain remote access to their systems. The Department ofRead MoreCyber Security and Technology Essay1097 Words   |  5 Pagesthe major treat to all sensitive information in cyberspace. Cyber terrorism can be defined as the use o f computers and technology to cause server disruption or widespread fear in society. Through cyber terrorism data that is sensitive to major corporation and government alike are in danger of being hacked then used against them. Cyber security helps defend against cyber-attacks by tracking the attackers back to the source and hacking them. This way security can gain access to their files to help

Geography- Development Free Essays

GNI stands for Gross National Income, therefore it basically finds the average of all the income the List the shortcomings of GNI per capita as an indicator of development. If a country has a GNI, that doesn’t mean that everyone in that country is rich or living a good life. Because GNI is an average, there will always be people below the average and way above it too. We will write a custom essay sample on Geography- Development or any similar topic only for you Order Now Therefore GNI cannot tell us whether there are poor people or even if there is equality in the country, there might be more poor people than rich people but the money the rich people are making is very superior that it makes the average pretty high. Explain the concepts of underlying PPP. PPP stands for Purchasing Power Parity and it is defined by a number of units of a ountrys currency needed to buy the same amounts of goods and services in a country as $1JS1 would buy in the United States. PPP examines a wide range of goods and services, including food, transport, clothing and housing. It provides a measure of what people can actually afford regardless of the local value and exchange rate of their currency. Explain why the three variables used to calculate the PQLI were chosen. The three variables: literacy, life expectancy and infant mortality were used to calculate the PQLI because they are three indicators of quality of life that were thought to be particularly important. Literacy rates are linked to the level of education the population is receiving, life expectancy is linked to how well the health of the population is and how advanced the doctors are and infant mortality shows how advanced the healthcare is. How does the HDI differ from the PQLI? HDI (Human Development Index) uses three measures to generate index and two of the three measures are the same: literacy and life expectancy. However, rather than using infant mortality, the HDI uses GDP per capita on a PPP basis. This was done to balance the social measures of development with an economics measure, as control f personal resources and wealth was seen as an important aspect of people’s quality of life. 5. What is your preferred indicator of development? My preferred indicator of development is Literacy rate because that tell us whether the population is educated or not, if it is then most of then could get a decent Job, therefore they can have a decent life with resources at their reach. Some people could have really good Jobs because they were given the chance to learn and get an education. When there is a high literacy rate in a country, one can tell that the healthcare will be advanced because the education is good. Therefore there will be low death rates and high life expectancy. 2/11/2013 Why people who live in rural area susceptible to food insecurity: they depend on agriculture for food, they have limited alternative sources of income or employment (for example: floods and droughts) and they are vulnerable to crisis, prone to natural diseases, depend on farming, The key issues regarding Child and Female hunger: one child is dying every 5 seconds of hunger, child hunger is inherited, they lose their curiosity, motivation and e ven the will to play, many leave school prematurely, stops physical and mental growth. Women are the primary food producers but they are more affected by hunger and poverty than men, 7 out of 10 of the world’s hungry are women and girls, their hunger is the reason why we have a low birth-weight child. 2. Read: the origin of disparities, living conditions and land ownership p. 33 Poverty remains in the world despite economic growth in many regions, the world is more unequal than it was a decade ago. NICs (Newly Industrialising Countries) such as South Korea and Taiwan have a quite high level of GNP per capita. How to cite Geography- Development, Papers

International Trade and Tariff free essay sample

Tariffs Explain the various impacts of an import tariff in small nations vs. large nations. The impact of an import tariff in a small nation is entirely unlike then an import tariff from a larger nation. When smaller nations imposes a tariff, it does not affect world prices, however the price of the importable commodity will start to rise, usually by the amount of the tariff for manufacturers and trade in the small nation. When large nations impose a tariff, it will reduce the volume of trade. Large nation tariffs also improve terms of the nation’s trade. Since the volume of trade is being reduced, it tends to lesson the nation’s welfare. However it also can improve the nation’s welfare. It depends on the welfare of the nation to if it actually rises or falls depending on the two conflicting forces. What are the three main reasons governments prefer using a tariff to restrict imports versus quotas? A few reasons why tariffs are better option than import quotas is because, tariffs can generate revenue for the Government, import quotas can lead to administrative corruption, and import quotas can cause smuggling. We will write a custom essay sample on International Trade and Tariff or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The reason the government can make money off of tariffs is because there can be a percentage put on imported goods that will generate extra money. There are millions of different things that are imported into a country and the small percentage of tariffs generates a lot of revenue that would be lost of the government unless their trade had an authorizing fee on goods being imported. This can lead to administrative corruption, if there are no restrictions on importing goods then the government has the ability to pick and choose who can import and who cannot. This can give the custom officials a lot of power since they would have the ability to favor and only allow certain corporations. Tariff system helps to rid the possibility of corruptions. This not just the price, but also the quantity sold through supply and demand. Smuggling can occur with an import quota when there are large shortages. A tariff cannot provide a set number on the goods or products that are coming into the country so the number of imports will increase when the demand for it goes up. Should our government use a weak dollar exchange rate policy to make imports more expensive in order to help our exporters? The weakening of the U. S. dollar means that the dollar has fallen in value compared other currency. The weak dollar is good for exports, but not good for importers. The value of currency will decrease when the demand for that specific currency is low, which will make importing goods more expensive. A weak dollar can make things difficult for exporters that are selling to the United States. If a foreign company wants to sell goods to the U. S. it either needs to up the price of the product or sell it at a lower price because of the exchange rate. What roles do the IMF and WTO play in trade and the use of tariffs? The IMF or International Monetary Fun is an global business of countries that strives to guarantee the constancy of the worldwide financial and economic system. The IMF tries to make sure that there is balanced growth to international trade, it promotes exchange constancy and helps to give countries a way to balance payment issues. Tariff rate data comes from the IMF database and the country’s authority figures. The WTO or World Trade Organization is a global company that works on the rules of trade between two countries. It helps to ensure that international trade moves smoothly and generously. It also gives countries a helpful and just outlet for dealing with arguments over importing issues. The WTO regulations permit a nation to defend certain businesses if the elimination of tariffs would have detrimental side effects, such as the loss of necessary national trade.

Resort and Spa Management Samples for Students †MyAssignmenthelp.com

Question: Discuss about the Resort and Spa Management Answer: Introduction: The study is enlightened with the concept of resort and spa management procedures in the present business market. In this particular study, some current issues and challenges that the spa and resort industry is confronting in present are manifested well. Moreover, a number of recommendations are brought out in order to resolve those challenges and complexities. Apart from this, some emerging trends is elaborated to make understand about its affect on the resort and spa business in future. The prime objective behind resort and spa management is to deliver higher quality of service to the customers and make them enjoy their leisure time. Resort and Spa Management: Current issues and Challenges As opined by Lo, Wu and Tsai (2015), the resort and spa industry is currently facing major issues and challenges for changing business environment and increasing global competition. One of the major problems they confront is related to escalating renovation and construction cost. Whereas, Lin (2015) argued that changing and merging technology is the prime reason behind the difficulties the industry face in present. As stated by Lagrosen and Lagrosen (2015), lack of the skilled workers is the reason that they fail to meet the expectations of the customers in enjoying their leisure time. As the growth of resort and spa business relies less on capital and more on its human resources. Vezzoli et al. (2015) has supported the viewpoint that nowadays renovation is required in keeping the same business position in the market. The increased capital requirements increases the reconstruction cost. Many of the spa and resort businesses that have good market position tend to improve the physical condition of the service area. This primarily helps them to provide visual satisfaction to their customers. Reconstruction also causes escalating the operating cost that results more expenses and less saving as well as less investments. It has been found that the management bodies of the resort and spa industry confront difficulties in managing the operating cost with renovation and hence expenses overlap the income. Resort and spa industry is facing complexities in finding the ways to restrict the expenditure without sacrificing their service quality. In managing the new business operations, the managers need to think the ways more effectively. Failure in proper management results generating low degree of competitive advantages. This further results less income as well as less profit which acts as hitches in the path of success. As per the statement of Enderwick (2013), the business system of resort and spa industry is rapidly moving towards internet based technology. Changing and merging technology allows the managers to operate the business in more easier and flexible way. However, the rapid change in technology makes the business confront challenges in operating the new system properly and effectively. This is the reason that lies behind the failure of proper operational management in resort and spa industry. As people come for enjoying their leisure time to the fullest extent through having their services, their expectations lies on the highest level. Through effective utilization of the new technology, they can fulfill customers' expectations. Most of the businesses fail to identify as well as quantify the business benefits from proper integration of technology. It has been found that most of the current systems and business operations are under-utilized. Hence, they fail to fully integrate as well as o ptimize the new business systems. In the emerging technology period, large number of new business is entering in the existing market. This increases the competition for the firms that are already existed in the market. As the new firms start up their business, they can easily incorporate new systems that deliver strong competition to the existed firms. It is difficult for the existed firms to restructure the entire system through integrating new technologies. On the other way, Torres and Kline (2013) represented completely a different viewpoint that demonstrates human resource as the most powerful assets that the resort and spa industry have. Due to lack of skilled workers, they fail to retain its existing customers and attract the new ones. The service of this particular industry highly depends on numeracy and literacy skills as well as customer handling skills of the workers. Their ineffective effort in pursuing the business goal might create more challenges in the present scenario. In this twenty first century, the ways of thinking of the customers has changed from the ways they used to do the same in 90's. Therefore, the service providers are always in the stage of constant change in strategic policies that help to attract the customers. Apart from this, shrinking or compression of the workforce along with union issues affects the working environment. This changing labor condition decreases the effective role of the service providers. Besides, it has been seen that some of the businesses provide less benefit to the service providers in order to restrict the benefit cost. This causes increasing employee grievances and lowering the service quality. Thus, the spa and resort industry confronts challenges in balancing the entire expenditure along with delivering satisfaction to both its employees and customers. However, it has been found that these are the major challenges and difficulties the resort and spa industry confronts in the present scenario. The challenges mentioned above are interrelated with other. The emerging technology raises the need of adopting new system in order to gaining comparative advantages. Further, the new system requires reconstruction of the existing business systems and operations that increase the cost. As the technology have been changing rapidly, the business operations and the working environment changes constantly. As a result, the service providers are divorced from the roles and procedures and hence it affects the employability skills of the workers which decline the service quality. Recommendations After analyzing the current issues and challenges that the resort and spa industry confronts, the study brings out a number of recommendations. Through discussing about the recommendations, the study addresses the pathways of resolving the problems. It is important to mention that the recommendations would cover each of the challenges that are discussed in the above section. Recommendation for escalating renovation and construction cost: The resort and spa industries are in financially challenging environment as the renovation and construction cost increases gradually. In this context, it is suggested that the management bodies of this industry should make proper budget plan and monitor the operations as per the budget. The budget plan is the road map of the business operations that direct the entire process in a certain way (Zimina, Ballard and Pasquire 2012). Before making budget plan, the historical results and the current cost trends should be considered in order to predict the future financial health. This way, the future financial result will possible to be outlined and thus they can balance the income and expenditure. Apart from this, the managers should pursue proper budget management process so that the operations would not exceed the amount set in budget plan (Lahdenper 2016). Recommendation to deal with changing and merging technology: Improper integration of modern technology is the prime reason behind confronting difficulties in operating the new system. It is recommended that the spa and resort industry should hire experts and provide training programs to its service providers. The employees should be provided training programs of using the new system in more effective way by the experts (Mithas, Krishnan and Fornell 2016). Moreover, the training programs will help to motivate the employees to use the modern technology and improve their employability skills. It is mentioned that the modern technologies are incorporated but under-utilized in most of the spa and resort businesses. The hired expert would direct the service providers in utilizing the new techniques to the fullest extent (Ostrom et al. 2015). Recommendation to deal with lack of the skilled workers: In the above section, it has been suggested that the employees should be trained by hired experts that would improve their employability skills. Moreover, the study suggests through employing new workers who have high skill as well as experience, the industry can improve their entire labor performances. Besides, the employees should analyze the changes in the choices and preferences of the customers as the service providers are the one who directly communicate with the clients. The study further suggests the employers should provide more benefit packages to the employees in order to motivate them in delivering quality service to the customers. The employers should enhance the customers and clients satisfaction without maximizing the cost (Devambatla and Nalla 2015). Analysis of emerging trends within resort and spa industry In this particular section, the study demonstrates five emerging trends in the resort and spa industry. The customers want more mobile accessibility As per the statement of Ramos et al. (2015), huge number of consumers use smart phones and similar devices to take any kind of services. Therefore, nowadays it is essential to incorporate mobile technology in the business to move towards further steps. It has been found that most of the service industry improves their service quality through involving mobile technology. When the customers receive the service details in their mobile phones, they find it is easy to take the service. The resort and spa industry should allow point of sales payments through using smart phone devices. The customers want more health conscious resorts and spa services In this present century, the consumers become more conscious about their health and well beings. Most of the customers want to take services from the organizations that focus on wellness and healthy environment. The services that include healthy environment are in high demand. Therefore, the resort and spa industry needs to make their service environment healthier in order to attract more customers. The resort and spa are investing more in technology Hanson, Lind and Muendler (2015) opined that the organizations would able to gain comparative advantages and make growth through investing capital in incorporating technology. In this modern world, it is essential to operate the business in innovative ways. Sustainability It has been seen that people prefer to invest in the services which are environmentally friendly and green. Therefore, the resort and spa industry would need to invest more capital for the wellness in the working environment. Social media engagement Moncrief, Marshall and Rudd (2015) stated that the social media is one of the most powerful tools that the organizations take advantage of. The resort and spa industry should involve themselves more in the social media to keep the customers update about their services. Justification of the effect of the trends on future of the resort and spa industry Effect of incorporating mobile accessibility The researcher assumes that the more mobile accessibility would attract more customers. The organizations can represent their service in more attractive ways in the mobile software to grab the attention of the clients. As a result, the resort and spa industry would able to attain sustainable growth and development in the long run. Effect of creating healthier service environment As the customers become more health conscious, the healthy environment will able to attract large number of customers. Through paying more attention to the wellbeing of the customers and the clients, the resort and spa industry would able to provide additional benefit to them. This will attract both the customers and the new employees. The researcher expects that it would help the resort and spa industry to make sustainable growth. Effect of investment in technology The researcher assumes that the resort and spa industry might face increasing expenditure in the short run, but the investing in technology would reduce the cost in the long run. This would help the business to maximize their revenue through minimizing the cost. Effect of Sustainability In this context, the researcher assumes that sustainability would be beneficial in the long run. This would help to enhance their business more in both the domestic as well as global market. Effect of engaging social media engagements The researcher states that most of the customers crave for social media engagements. Thus, the resort and spa industry would able to stay connected more with the customers. Conclusion: The researcher concludes that the resort and spa industry is presently confronting several issues regarding escalating reconstruction cost, emerging technology use and lowering skills of the workforce. In this regard, the study brings out some suggestions to deal with these challenges. The study further describes five specific emerging trends in the industry along with the justification how it would affect the future of the industry. Bibliography Devambatla, L. and Nalla, D., 2015. An Approach to Improve Employability Skills: ebridge.Journal of Engineering Education Transformations,28(23), pp.131-138. Enderwick, P. ed., 2013.Multinational Service Firms (RLE International Business). Routledge. Hanson, G.H., Lind, N. and Muendler, M.A., 2015.The Dynamics of Comparative Advantage(No. w21753). National Bureau of Economic Research. Ibisworld.com.au. (2016). Market Research Reports Analysis | IBISWorld AU. [online] Available at: https://www.ibisworld.com.au/ [Accessed 17 Apr. 2016]. Lagrosen, Y. and Lagrosen, S., 2015, September. Entrepreneurial Learning for Quality and Competitiveness: A Study in the Spa-Industry. InEuropean Conference on Innovation and Entrepreneurship(p. 392). Academic Conferences International Limited. Lahdenper, P., 2016. Formularising two-stage target-cost arrangements for use in practice.International Journal of Managing Projects in Business,9(1), pp.147-170. Lin, I.Y., 2015. Marketing Global Luxury Spa and Wellness Trends, Experiences, and Challenges.Handbook of Research on Global Hospitality and Tourism Management, p.185. Lo, A., Wu, C. and Tsai, H., 2015. The impact of service quality on positive consumption emotions in resort and hotel spa experiences.Journal of Hospitality Marketing Management,24(2), pp.155-179. Mithas, S., Krishnan, M.S. and Fornell, C., 2016. Research NoteInformation Technology, Customer Satisfaction, and Profit: Theory and Evidence.Information Systems Research,27(1), pp.166-181. Moncrief, W.C., Marshall, G.W. and Rudd, J.M., 2015. Social media and related technology: Drivers of change in managing the contemporary sales force.Business Horizons,58(1), pp.45-55. Ostrom, A.L., Parasuraman, A., Bowen, D.E., Patrcio, L., Voss, C.A. and Lemon, K., 2015. Service research priorities in a rapidly changing context.Journal of Service Research,18(2), pp.127-159. Ramos, S., Armua, C., Arenal, A. and Ferrandis, J., 2015. Mobile Communications and the Entrepreneurial Revolution.Emerging Perspectives on the Mobile Content Evolution, p.32. Statista. (2016). Statista - The Statistics Portal. [online] Available at: https://www.statista.com [Accessed 17 Apr. 2016]. Torres, N.E. and Kline, S., 2013. From customer satisfaction to customer delight: Creating a new standard of service for the hotel industry.International Journal of Contemporary Hospitality Management,25(5), pp.642-659. Vezzoli, C., Ceschin, F., Diehl, J.C. and Kohtala, C., 2015. New design challenges to widely implement Sustainable ProductService Systems.Journal of Cleaner Production,97, pp.1-12. Zimina, D., Ballard, G. and Pasquire, C., 2012. Target value design: using collaboration and a lean approach to reduce construction cost.Construction Management and Economics,30(5), pp.383-398.

Kiss Of The Spider Woman Essay Paper Example For Students

Kiss Of The Spider Woman Essay Paper In the play Fences, which was written by August Wilson, Bono, Gabe, and Alberta are all very important people in Troys life. Bono is Troys best friend, and through him the reader learns that Troy is a very strong character. Through Gabe, people can see some of the guilt Troy has inside. Alberta helped Troy escape from his problems, and have a few laughs every once in awhile. Each one of these characters tells the reader something different about Troy. Throughout the years, Bono has always been there for Troy. They have been friends for about eighteen years. Bono never hesitated to tell Troy anything, especially his opinion on Alberta. ?I know what Rose means to you, Troy Im just trying to say I dont want to see you mess up.? (p.63) Bonos words show the reader how much he cares about Troy. Bono was always straightforward with Troy. He even said, ?Thats right. I know you. I know you got some Uncle Ramus in your blood. You got more stories than the devil got sinners.? (p.13) Much of Troy is shown in Bono because he has been with him through the good times and the bad. Another character who has helped reveal complexities about Troy is Gabe, Troys brother. Gabe has a metal plate in his head; caused by his time in War World II. The government in return gave Gabe monthly checks. The only way Troy was able to pay for his house was through the governments money. ?Thats the only way I got a roof over my head?Cause of that metal plate.? (p.2 8) When Gabe moved in with Miss Pearl, Troy started to feel guilty. He was feeling culpability because not only was Gabes money paying for Troys house, but now he was paying money to Miss Pearl that could have been Troys. When Gabe said, ?Got me two rooms. In the basement. Got my own door key too.? (p.25) Troy felt very guilty. He could have used that money for his own family. Also, almost weekly Troy had to pay $50 to get Gabe out of jail. Neighbors complained that he was disturbing the peace. Gabe added to Troys character tremendously. Alberta is another character that helps reveal some of the complexities of Troy. Alberta is the woman with whom Troy had an affair. She helped Troy escape from his everyday life problems. When asked about Alberta, Troy had replied, ?She gives me a different understanding about myself. I can step out of this house and get away from the pressures and problems?be a different man.? (p.69) When he is with Alberta he feels that he does not have anything t o worry about. This is shown when Troy says, ?I aint got to wonder how Im gonna pay the bills or get the roof fixed. I can just be a part of myself I aint never been.? (p.69) Alberta also helped Troy realize the value of responsibility. When Alberta passed away, Troy was the only one who originally had to take care of Raynell, until Rose said she would. Alberta was very important in this play. Throughout this play, many of Troys complexities are shown through other characters. Through Gabe, Bono, and Alberta, Troy shows all of his complexities as a man.

Juveniles Essays - Criminology, Juvenile Court, Juvenile Delinquency

The Juvenile Justice system of New York City and North Carolina share many similarities. The juvenile justice system is separate and different from the adult criminal justice system. Adults are held fully responsible for their behavior. They can be arrested, charged with a specific crime, tried before a jury of their peers, found guilty or not guilty, and, if found guilty, sentenced according to the seriousness of the crime and the interest of the state. Young people are treated differently, having many, but not all, the rights of adults. Juveniles are not arrested, but rather are taken into temporary custody. Juveniles have no right to a trial by jury but instead are subject to a hearing before a judge, at which time the juvenile may be adjudicated as undisciplined or delinquent. The judge?s decision on the disposition (or sentence) is based on meeting the juvenile?s needs and interests and the interests of the state. The court attempts to do what is best for the juvenile to help make sure he/she is not brought into the juvenile justice system again or the adult system later. Detention of juveniles in New York City began shortly after the opening of the New York State penitentiary in 1797. Prior to that time, as juvenile crimes were rare, the state preferred to allow parents to deal with the misbehavior of their children - a practice rooted in English common law. Parental authority was the accepted first tenant of youth treatment, and the state was hesitant to assume the failing parent's duties. By the end of this year, New York may be the only state in the nation that treats all 16 and 17 year-olds as adults in criminal matters. Most states have raised the age of adulthood to 18 in criminal matters and Massachusetts, Wisconsin and North Carolina are considering raising the age to 18. In a front page article Sunday in The New York Times, reporter Mosi Secret chronicles the situation across the country with a focus on New York State

Social Conditions and Social Problems

Ancient egypt and india comparasion Essay Example

Ancient egypt and india comparasion Essay Example Ancient egypt and india comparasion Essay Ancient egypt and india comparasion Essay The gender structure of ancient Egypt and India is different in many different ways. Most of these things change as time goes by but back then most of them are really different. In Egypt women were granted more freedom while in India women were like propertys and were controlled by completing every men in their family. (Anne Wallace Sharp, S. Gambits) In India if a woman husband die, she is not allowed to remarry and can not be independent. (S. Gambits) While in Egypt remarrying is totally normal and fine. If a marriage isnt working well in Egypt, the two needs to solve it quietly and the wife would go back to her parents home. (Anne Wallace) The hot weather in Egypt caused everyone including men and women to shave their head and wear wigs. (Anne Wallace) The weather in India is not that bad so they all still have their own hair and women really liked to accessories. (S. Gambits) Man of higher Verna in India is allowed by law to take any woman he wished. He can also sell is wife and children if he wanted or needed to. Assortment. Com) Women in Egypt are treated with respect and they were as equal as men. (Anne Wallace) There are many things that are similar between ancient India and Egypt too. Men spends most of their time out of the house doing field work or business in both India and Egypt. As for the women they were all expected to bear a child and keep the house running. At a young age girls were taught that their lives would center around their homes and families. Anne Wallace) Men are highly respected because of course they are men. All women loves to be pretty now and back then. They all own gold Jewelries and accessories themselves with the best items. (Anne Wallace) That is Just the wealthy though because the peasants have to work in fields and do all the house work. Men are highly respected in both places because they do all the hard work and the family depended on them. Both boys and men are to work in the fields for the peasants. (Anne Wallace, escorted. Com)

Characterize Phaedra in terms of her sense of morality essays

Characterize Phaedra in terms of her sense of morality essays We often think of morality in terms of right versus wrong or good versus evil. If a person chooses wisely and makes good decisions, they have morals, but if a person is evil then they have no sense of morality. Phaedras situation is complicated and cannot easily be characterized in terms of good versus evil. While she knows it is wrong to love her stepson and tries to hide these feelings, she makes bad decisions during the course of the play which eventually lead to her death, and the death of Hippolytus. Although Phaedra is a good person and knows right from wrong, her sense of morality does come into question which unfortunately produces a terrible outcome. If a person knows right from wrong, yet still cannot control their urges or impulses, this doesnt necessarily make them evil or lacking morals, as in the case of Phaedra. Phaedra is married to Theseus, yet is in love with his son Hippolytus. Very early on in the play we can see that Phaedra is tormented by this love and knows it is wrong. In order to prevent herself from acting on these feelings, she has Hippolytus banished from their kingdom. O heavy weight of misery! My eyes beheld the son in the fathers countenance. At length I dared to rebel against myself. I spurred my spirit to persecute him, striving thus to banish the enemy I worship by assuming a stepmothers proverbial cruelty. I clamored for his exile till my cries tore my dear enemy from his fathers arms (1473). I have a just abhorrence of my crime; I hate my life, abominate my lust; longing by death to rescue my good name and hide my black love from the light of day (1473). Although banishing Hippolytus from the kingdom is not the act of someone we would consider to have great morals, Phaedra knows this is the only way to hide her secret. She feels she is doing what is best for everyone involved, thus showing that she is not an evil person. When t...

Curriculum Essay Example | Topics and Well Written Essays - 250 words

Curriculum - Essay Example These include the â€Å"explosion of technology, recession, public sector innovation, and new commitment to attain standards† (23). In a gist, the authors foresee the growing demand for public schools to maximize funding and resources while attaining their goals at the same time. The three forms of schooling that Hill and Johnston have observed and foresee to be the new direction for public schools are virtual, hybrid and broker schools. Virtual schools are those that offer online courses where students get access to education through computer technology; hybrid schools are schools that combine fulltime, contractual and technology-driven instructors, whereas broker schools are schools that hire teachers on a contractual or pay-per-course basis. The implications of these different school forms to curriculum and instruction are tremendous. As the authors provide, there will be flexible hours of schooling, lesser tasks among school leaders and teachers, and a wider coverage of in struction. However, the authors overlook the point that the transformation may greatly impact the quality of instruction to be provided. Basically, individual monitoring may be less, thus assessment of individual needs and success will be inadequate. Moreover, the transformation might neglect students with special needs, thus making NCLB efforts in vain. Work Cited Hill, Paul and Johnston, Michael.

The advent of the internet age and mobile technology Essay

The advent of the internet age and mobile technology - Essay Example With this virtual shrinking of distances between people comes the ability to be much more customized in terms of solutions and marketing. To be sure, the ability of companies to remain competitive in today's global business climate depends on their ability to anticipate and meet the personal needs of each individual with whom they conduct transactions. Technology enables businesses to detect various degrees of individual interest in various subjects, and then match marketing campaigns in a way that is most likely to resonate with various categories of people. A more standardized approach may have been necessary back in the day when companies depended on a certain amount of business within a particular defined geography and set of hours in order to deliver goods and services most efficiently within those constraints. Standardization was also a marketing tool designed to reassure potential consumers of a particular product or service that the purchase were making was identical in quality to those of other who are making the same purchase. In the pre-internet age, when product information and research was not as readily available as it is today, such an assurance would have been very important to consumers who would otherwise have little reason to be confident that their purchases would meet their needs. Today, howev

The Pluralist framework of industrial Relations in the UK has been Essay

The Pluralist framework of industrial Relations in the UK has been replaced with HR management Discuss - Essay Example Over the years, this relationship has gradually improved and become highly developed in response to conditions and terms of employment. Among scholars and practitioners of labour issues, there have been arguments regarding industrial relations (IR) and Human Resources (HR) management. The debates have been centred on whether pluralist framework of IR has been replaced with HR management or not. According to Salmon (2000), IR is a multidisciplinary field that studies the relationship of employment in both employment situations and in the unionized workforce. On the other hand, HR management refers to an organizational function that concentrates on recruitment, management, and providing direction to employees in a given organization (Armstrong, 2006). The pluralist framework is a system of managing industrial/ employee relations, which determines the employment relationship and resolves conflict through the institution of trade union recognition and the process of collective bargaining at enterprise, industry, and national level. On the other hand, HR management is a strategic and integrated approach to the management of people. HR management is about employees’ management. Recent evidence about HRM application suggests that there is a decline in the collective aspects of the employment relationship in favour of individualism.

The Scarlet Letter Research Paper Example | Topics and Well Written Essays - 1250 words

The Scarlet Letter - Research Paper Example Overuse of symbolism A. Mystic â€Å"A† and the embroidered badge B. Imagination of the Letter â€Å"A† in lines of red IV. The theme is a reflection of the author’s life A. Metaphors vs. direct narration B. Ambivalent depiction of women C. Hawthorne’s family life V. Inadequate depiction of historical context A. English spoken in that era VI. Dual nature of characters A. Chillingworth’s angelic and demonic nature B. More than one aspect of human nature The Scarlet letter has been defined as a fine piece of art that readers would want to return to during any era. What sets it apart is the high level of intellect and originality of thought as opposed to the crude, violent and warm depictions of most other novels of similar nature at that time. Yet it has been criticized heavily for its slow progression and failure to involve the readers through drama, action and violence. The powerful impact of vivid imagination, sublime messages and sophisticated lit erary discourse is constrained to some extent by the lack of action, overuse of symbolism and inadequate historical depiction in Hawthorne’s â€Å"The Scarlet Letter†. The Scarlet letter begins with in a village setting where Dimmesdale and his companion Moose are on a peace mission. However, considering the persistent theme of adultery in the novel, the Scarlet Letter does not touch upon madness and jealousy which reduce its effectiveness (Bloom 7). It is only when Chillingworth is brought into limelight in the story does the author give an account of the romance and obsessive feelings that accompany jealousy (Bloom 7). Therefore, the warmth and passion that should’ve accompanied the subject was not present. Furthermore, there was ample scope for a lot of action since liberation is the topic of focus throughout the novel. This is one of the major issues in the novel where no such action is depicted. Hawthorne seems to have confined the characters to the Puritan setting whereby these individuals are engaged in cognitive behavior of thinking, interpreting and speculating as well as feeling, loving and hating; however, rarely are they seen doing anything. From the theme of the novel, readers would expect violence, assault, rape, suicide as well as extended romance; however, all this is rarely described as happening in the novel. This lack of depiction results in little ‘drama’ in the story as the scope of the theme has not been fully exploited by Hawthorne. Although, the absence of passion and the cold and ingenious fantasy cannot be termed as weaknesses of The Scarlet Letter, they tend to make the story less touching to even the most intelligent of all readers. A little more hideously human and crude depiction of natural violence and love could have left more impact on the readers. Nevertheless, the high level of intellect and sophistication delivered in this work of Hawthorne leaves the reader with a feeling of having a fine a nd delicately crafted piece of work. Most importantly, however, the overuse of symbolism has been criticized. Authors have claimed that symbolism has been used to the extent of producing a mechanical effect in the novel has been criticized (James 55). For instance, the thought of the â€Å"mystic A† that is imprinted on the shirt of the young minister along with the embroidered badge that Hester is destined to wear are evidence of such overuse (James 55). This suggestion should have been

Marketing Principles and Applications Coursework

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Employment relations Essay Example | Topics and Well Written Essays - 1750 words

Employment relations - Essay Example agement style, a remnant of Theory X, merely treated employee relations this way, alongside seeing them as not valuable assets of the organization and not to be consulted for decision-making. The autocratic manager dictates orders to his staff and takes no recognition of consulting the employees on relevant decisions. Leaders in this kind of environment tend to control the situation. This kind of management style persisted for a very long time, until the democratic management style came in. At present, employee relations are more focused on ascertaining a productive people resource, a trend that was missing in the last decades. Employee relations are dealt with by resolving labor conflicts and informing the management about concerns that relate to employee welfare and long-term economic security. In a democratic workplace environment, human resource management gives more emphasis on employee development and their welfare, including pay and benefits, workplace condition, and job secur ity, supporting the growing knowledge that people resource is the most important of all resources. It may be inferred that in the past decades, employee relations was aligned to achieving economic production and was its ultimate goal, to the point that job security was always influenced by the rise and fall of the production market. This signifies a lack of prioritization of employee welfare, and placing them in second fiddle to economic production and profits. Rubinstein and Kochan (2001) state that the last two decades of the twentieth century was a time of tumultuous change and debate over what goal should corporations serve, and how the system of labor-management relations should be reformed. This is indicative of a growing concern for human resources, which may have been influenced by the emergence and reinforcement of several motivation theories. The past has also witnessed a corporate world in which shareholders and investors were reasserting control over corporations in order

Case Study Of A Patient With Diabetes Mellitus Nursing Essay

Case Study Of A Patient With Diabetes Mellitus Nursing Essay Patient Mr. NCS is a 53 year old Chinese man with the height of 1.72m, and weighs 82kg where his BMI is 27.7kg/m2 (overweight). Patient runs his own business and is currently staying with his wife and 3 children. He claims that he does not smoke and does not drink at all. According to the patient, the paternal side of his family has family history of hypertension and kidney failure where else for the maternal side, hypertension was known to be the family history. Patient has no known drug or food allergy. Patient was known to have had hypertension 15 years ago and also a history of pulmonary tuberculosis 35 years ago. Patient denied of being diagnosed with diabetes mellitus in the past. As for drug history, patient was only on 10mg of lovastatin (tablet) once at night and according to the patient, he was compliant to the medication. 1.2 Clinical Progress Patient was admitted into Accident and Emergency department and complained of shortness of breath (SOB) and mild giddiness. He also complained of having chest pain and a first episode of shortness of breath earlier before he was admitted into the hospital. On examination, he was found to be alert and conscious. Venous blood gas sampling was done and pH was found to be 7.306 (low), pCO2 was 44.2mmHg, pO2 was 45.8mmHg and HCO3 was 24.7mmol/L. Blood pressure was found to be 157/95mmHg, pulse rate was 72bpm, SPO2 was 97%, body temperature was 35.4 °C and respiratory rate was 21 breaths per minute. Reflo value was also obtained and it was found to be 17.1mmol/L and blood ketone was 0.9. Lungs were clear and abdominal was soft and non tender. Cardiovascular testing was done and it showed dual rhythm no murmur. The initial impression of this patient by the general practitioner in the hospital was impending diabetes ketoacidosis. Patient was immediately given 6 units Actrapid subcutaneousl y and the GP also planned to give O2 3L/min and to prescribe GTN 1/1 subcutaneously and Aspirin 1/1. Later on day 1 of admission, patient complained of increased in sweating, shortness of breath, body weakness and vomiting for 3 times in the morning. Patients blood pressure was 123/76, pulse rate was 82bpm, SPO2 was 99% and respiratory rate was 20 breaths per minute. When patient was asked, he mentioned that he has not done body check up and blood pressure measurement for at least 5 years now. Later in the afternoon, patient complained of excessive sweating and lack of appetite for the past 3 days. Patient then denied of having any chest discomfort or shortness of breath, headache and abdominal pain. Besides that, patient also complained of having polyuria and needed to wake up more than 3 times at night for micturation. He also complained of having polydypsia, lethargic and vomiting for 2 times in the morning. Patient was examined and he was found to be alert and conscious where he responded fully to Glasgow Coma Scale (GCS). Patient was also found to have good hydration and his ca pillary refill time (CRT) was less than 2 seconds. Vital signs were obtained and temperature was back to normal, 37 °C, blood pressure was 151/69, SPO2 was 97%, pulse rate was 88bpm and reflo value was 14.6. The management plan by the local GP was to continue monitoring the reflo value, prescribe 10mg lovastatin (tablet) once at night and 10mg amlodipine (tablet) once daily and have the patient to rest in bed. As patient was able to tolerate orally, IV drip was off and patient was allowed to take fluid orally. On day 2, patient was found to be comfortable. However, patient complained of having poor oral intake and that he was sweating profusely. He was still feeling mild giddiness and lethargic but no more chest or abdominal pain. Vital signs were observed and temperature was 37 °C, blood pressure was 128/84, pulse rate was 96bpm and reflo was 14.9mmol/L. Fundoscopy was also done and patient was found to not have any signs of retinopathy and chest X-ray was found to be clear. The management plan for day 2 was to continue 10mg amlodipine once daily, allow fluid intake orally, continue reflo monitoring 4 hourly and to trace and review the fasting blood sugar (FBS). On examination, patient was found to be alert and responded well to the GCS with the score of 15/15. Blood pressure was taken and it was 145/100 when patient was lying down and 130/90 when patient was standing. Renal profile was normal except for low potassium level of 3.0mmol/L. Impression for this patient was newly diagnosed d iabetes mellitus. Further management plan for this patient was to conduct a stress test on patient after discussing with the specialists and to monitor patients blood pressure for both lying down and standing up position 4 hourly for a day. Further plan was to start 500mg metformin (tablet) twice daily, 150mg aspirin (tablet) once daily, 20mg lovastatin (tablet) once at night, trace urine full examination microscopic examination and to refer the patient for diabetic counseling. Besides that, local GP also decided to off amlodipine and to change it to 4mg perindopril (tablet) once daily. Table 1 : Patients laboratory findings on Day 2. Sodium 129 mmol/L à ¢Ã¢â‚¬  Ã¢â‚¬Å" [135 145mmol/L] Potassium 3.0 mmol/L [ 3.5 5.0mmol/L] Creatinine 83  µmol/L [27 62  µmol/L] Glucose fasting 14.1 mmol/L [3.9-5.0mmol/L] Total Cholesterol 5.7 HDL 0.82 Triglycerides 6.7 AST 24 IU/I [10-37IU/I] ALT 45 IU/I [10-65IU/I] Bilirubin 11  µmol/L [2-24  µmol/L] INR 1.03 Trop I 0.02 CKMB 0.5 Disease Overview and Pharmacological Basis of Drug Therapy. Disease Background The prevalence of diabetes mellitus (DM) varies vastly from population to population and throughout the whole wide world. In United Kingdom (UK) itself, diabetes prevalence increased from 2.8% in the year of 1996 to 4.3% in the year of 2005. The incidence of type 2 DM showed an increase from 2.60/1000 person-years in 1996 to 4.31/1000 person-years in 20059. As much as the incidence of DM is increasing, it was estimated that up to half a million more have not had their condition diagnosed and treated10. Diabetes mellitus (DM) is a disorder in which blood glucose level is persistently above the normal range. This hyperglycaemia is thought to be due to either deficiency of insulin secretion or resistance to the action of insulin, or it could also be a combination of these6,7. DM is classified into four different types which include Type 1 DM, Type 2 DM, DM due to specific mechanisms and diseases and lastly, gestational DM8. Only type 2 DM will be discussed further here. Type 2 DM is normally caused by a combination of insulin resistance and decreased insulin secretion to overcome the resistance. It is the more common form of DM and it comprises of approximately 90-95% of the total DM cases8. The common risk factors associated with type 2 DM include increasing age, high caloric intake, overweight, central adiposity and sedentary lifestyle8. In type 2 DM patients, insulin secretory peaks every 5-10 minutes seen in normal subjects are hardly or absolutely not seen. In normal cases, when intravenous glucose is administered into a humans body, this will stimulate normal insulin secretion and is illustrated by a biphasic pattern, with an initial peak rising immediately 3-5 minutes after the administration, and lasted for 10 minutes, then followed by a deliberat e and more progressive phase, which lasts throughout the glucose infusion period. In type 2 DM, initial phase insulin secretion is not seen and the late phase occurs later and to a lesser extent11. For the diagnosis of DM, hyperglycaemia must be established before confirming that the patient has DM. Persistent hyperglycaemia needs to be confirmed and in order to do so, at least two plasma glucose measurements must be taken on separate days. There are three different types of plasma glucose test that can be used which include casual plasma glucose, fasting plasma glucose and oral glucose tolerance test (OGTT). According to WHO, there are three main criteria to be met to confirm diabetes in patients. The first would be symptoms of diabetes which include thirst, polydipsia, loss of weight and polyuria are seen in patients and their casual plasma glucose à ¢Ã¢â‚¬ °Ã‚ ¥ 11mmol/L. The other two would be if patients fasting plasma glucose à ¢Ã¢â‚¬ °Ã‚ ¥ 7.0mmol/L and patients 2-hours plasma glucose à ¢Ã¢â‚¬ °Ã‚ ¥ 11.1mmol/L during OGTT being conducted by giving the patient 75g of glucose load6. OGTT is the most effective test to detect glucose metabolism disorder where it assesses the rate of glucose excretion after administration of glucose. OGTT is strongly recommended when fasting blood glucose is within 7.0-7.8 mmol/L in the diabetic range where OGTT is practical to clarify the diagnosis6,8. Summary of Drugs Pharmacology Aspirin Aspirin with the dose of 150mg is used as an anti-platelet agent or as prophylaxis to cardiovascular events. The mechanism of action of aspirin as an anti-platelet agent is strongly associated with the permanent inactivation of prostaglandin synthase and cyclooxygenase12. It also inhibits the formation of thromboxane in the platelet concurrently. The common side effects of aspirin include bronchospasm, gastrointestinal haemorrhage and also other forms of haemorrhage13. Lovastatin Statin reduces the risk of cardiovascular disease events without taking into account of the serum cholesterol concentration and is often used as the drug of first choice in the primary and secondary prevention of cardiovascular disease. The mechanism of action of statins involves competitive inhibition of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, which is the enzyme involved in the synthesis of cholesterol13. As liver is the major site of cholesterol biosynthesis, it appears to be the main target organ for the statins14. Statins can cause several muscular adverse effects which include myositis and other side effects include gastrointestinal disturbances, sleep disturbances, dizziness, paraesthesia, fatigue, sexual dysfunction and alopecia13. Metformin Metformin is so far the only biguanide available in the market now. It is an antihyperglycemic agent that improves glucose tolerance in patients with type 2 DM by decreasing both the intestinal absorption of glucose and the hepatic glucose production, and improves insulin sensitivity in the tissues. Metformin was also found to have potentially favourable effects on decreasing serum lipid levels and fibrinolytic activity15. Gastrointestinal side effects such as nausea, abdominal pain and diarrhoea are common with metformin and may persist in some patients13. Lactic acidosis due to metformin is rare, and the risk of this complication is higher in patients with renal impairment13,15. Amlodipine Amlodipine falls in the calcium channel blockers group which act by interfering with the inward entrance of calcium ions via slow channels present in the active cell membranes. They act mainly on the myocardial cells and the vascular smooth muscle cells which then lead to reduction of myocardial contractility. It affects both the electrical impulses and vascular tone within the heart where they may be depressed or diminished13. 2.2.5 Perindopril Perindopril is an angiotensin converting enzyme (ACE) inhibitor where it acts by inhibiting the conversion of angiotensin I to angiotensin II. ACE inhibitors are the preferred initial drug to be used for hypertension13. ACE is the enzyme that converts angiotensin I to angiotensin II where angiotensin II causes increase blood pressure, systemic vasoconstriction, Na2+ and fluid retention and etc16. Thus, ACE inhibitors act by directly blocking the formation of angiotensin II and also increase the bradykinin level at the same time. This results in reduced vasoconstriction and increased vasodilation through the release of bradykinin. The common side effects of perindopril include profound hypotension, dry cough, angioedema, rash and gastrointestinal disturbances13. Actrapid (Soluble Insulin) Insulin plays an important role in the regulation of carbohydrate, protein and fat metabolism where it helps to increase the glucose utilization in human body. Actrapid, soluble insulin, is a short acting form of insulin where it is normally injected into patients 15 to 30 minutes pre-meal. Actrapid is normally given in emergency cases especially in patients suspected with diabetic ketoacidosis4. It is normally administered subcutaneously as it gives a rapid onset of action (30 to 60 minutes) and a longer duration of action of up to 8 hours. One of the potential problems of insulin is hypoglycaemia where patients can be advised on how to avoid it13. 2.2.7 Glyceryl Trinitrate (GTN) Nitrate plays a key role in the prophylaxis and treatment of angina. It causes direct relaxation on vascular smooth muscles and also dilation of the coronary vessels which improves oxygen supply to the heart. Dilation of the blood vessels results in reduction of preload and afterload and thus, myocardial oxygen consumption is reduced17. Sublingual form of GTN is one of the most effective drugs to provide a fast symptomatic relief of chest pain but it is of short duration of action. Dose of 300mcg is appropriate as the starting dose for patients who have not used GTN before previously. Side effects of nitrates include postural hypotension, tachycardia, dizziness, throbbing headache and possible nausea, vomiting, flushing and heartburn13. 2.2.8 Oxygen Oxygen is normally prescribed for patients experiencing hypoxia to raise the alveolar oxygen tension and to lessen the workload of breathing in patients. There are generally four types of oxygen therapy which include long term oxygen therapy, short burst oxygen therapy, emergency oxygen and ambulatory oxygen. It is commonly given in emergency cases to achieve oxygen saturation within the normal range, just like in this case. The administration of the correct oxygen concentration is important as inappropriate concentration of oxygen may result in serious or fatal outcomes13. Evidence for Treatment of The Condition. Metformin Metformin is one of the main therapeutic drugs used in managing Type 2 DM and many clinical studies have been conducted to support the clinical use of metformin in the management of type 2 DM. In one of the Cochrane Review, it confirms that metformin as a single agent is one of the key therapeutic options for type 2 DM in patients with overweight or obesity problems, as it may prevent some cardiovascular complications events and mortality as well. Just as mentioned in this patient, he is a newly diagnosed diabetes patient who is overweight and he was given metformin 500 mg twice daily. In the study, 29 trials with 5259 participants were included in the analysis, comparing metformin (2007 participants) with sulphonylureas (1167), placebo (702), diet (493), thiazolidinediones (132), insulin (439), meglitinides (208), and glucosidase inhibitors (111). Obese patients who are given metformin as blood glucose control agent showed a superior benefit than glibenclamide, chlorpropamide, or insulin for any diabetes-related consequences (P = 0.009), and for mortality (P = 0.03). Besides that, patients assigned to metformin as a single therapy showed a significant greater benefit for blood glucose control, weight, dyslipidaemia, and blood pressure18. Besides that, the Comparative Outcomes Study of Metformin Intervention versus Conventional (COSMIC) study was done to compare the incidence of serious adverse effects, mortality and hospitalization in patients receiving metformin and also those who are on other usual care treatments. Among the patients, 7,227 of them received metformin and another 1,505 of the patients received usual care. To the end of the study, there were only 89.7% of the metformin group and 76.9% of the usual care group remained receiving their initial intended treatment. Serious adverse events were reported in 10.3% of the metformin group and in 11.0% of the usual care group, where both the groups reported similar adverse events. Cardiovascular events were found to be the most ordinary cause of death in DM patients where 0.7% occurred in metformin group while 0.9% in usual care group19. A population-based cohort study was also done to study on the mortality rates with the use of sulphonylureas compared to metformin. The mean age of the patients was 66.3 ±13.4 years old where 43.4% were female and their mean length of follow-up was 4.6 ±2.1 years. A greater risk of mortality was observed with higher daily doses of the first-generation sulfonylureas and glyburide but not metformin20. 3.2 Insulin secretagogues (Sulphonylureas and Meglitinides) Sulphonylureas is another group of antidiabetic treatment used after metformin in Type 2 DM. Patients blood glucose level remained high on day 2 and thus should be monitored closely after administering metformin. If blood glucose level has not been brought down, addition of sulphonylureas or meglitinides should be considered. The sulphonylureas act by enhancing insulin secretion. The sulphonylureas act at the pancreatic ÃŽÂ ²-cell membrane by causing closing of ATP-sensitive potassium (K+) channels. Closure of the channels occurred when sulphonylurea binds to the sulphonylurea receptor (SUR) subunit of the K+ channel. Meglitinides, which is not a sulphonylurea, act through the same mechanism where it also binds at the sulphonylurea binding site. Examples of sulphonylureas include tolbutamide, gliclazide, glibenclamide and glimepiride. Meglitinides is referred as an alternative to sulphonylureas as it does not cause additional stimulation of insulin excretion when patient failed to respond to maximal dosage of sulphonylureas. Examples of meglitinides include repaglinide and nateglinide21. Adding on a sulphonylurea or meglitinide to metformin as a therapy to type 2 DM was found to have a better control of blood glucose level. 318 patients (61 from metformin group, 126 from glimepiride group and 131 from glimepiride + metformin group) completed the study to compare the effectiveness of metformin monotherapy, glimepiride monotherapy and the combination treatment in controlling blood glucose level. It was found that the greater efficacy of combination treatment in reducing HbA1c levels than either glimepiride alone (p Comparison was conducted in a study where 124 patients were randomly given either repaglinide 1 mg daily or glimepiride 1 mg daily. The dose of study drug was given over an 8 week titration duration, which then followed by a 12 months treatment length. FPG levels, HbAlc values and PPG levels significantly fall from baseline in both groups after 6 and 12 months of treatment. However, after 12 months, fasting plasma insulin (FPI) levels on the other hand were significantly increased in the repaglinide group (p So far, the most commonly reported adverse event in sulphonylureas was hypoglycaemia. 605 people over 34,052 person-years were diagnosed with hypoglycemia during sulphonylurea therapy, which equals to an annual risk of 1.8%24. There is also high risk of hypoglycaemia in diabetic patients who are taking ACE inhibitors at the same time. Therefore, the use of sulphonylureas in this patient should be used in caution as he is currently taking perindopril as his anti-hypertensive drug. Several studies suggested that there is an increase in mortality due to cardiac events in patients treated with sulphonylureas. In one of the studies, 120, 4138 and 1537 patients were given a first-generation sulfonylurea, glyburide monotherapy and metformin monotherapy respectively. 24.8% of the total deaths were found to be due to an acute ischaemic event. Those given first-generation sulfonylurea monotherapy had the highest mortality (67.6 deaths per 1000 person-years), compared with metformin monotherapy users (39.6 deaths per 1000 person-years). As higher doses are used, higher rates of death are observed as compared to those who are on lower doses20. Other less common side effects of sulphonylureas include weight gain, nausea, diarrhoea, gastrointestinal pain and cutaneous reactions such as rashes, urticaria and pruritus21. Further Management Thiazolidinediones, gliptins (GLP-1) mimetic, also known as exenatide and insulin administrations are the further management in type 2 DM if the above oral anti-diabetic agents are not able to control the high blood glucose level. Pioglitazone and rosiglitazone are examples of thiazolidinediones where they are the newer oral anti-diabetic agents which are more expensive but present better adverse effects profiles. A thiazolidinedione can be added on instead of a sulfonylurea as second-line therapy if sulphonylurea is contraindicated or not well tolerated or it can be added on to the sulphonylurea therapy if metformin is contraindicated. Another recommendation is to add on a thiazolidinedione to metformin plus sulphonylurea when the blood glucose is not well controlled and the use of insulin therapy is not suitable25. Two randomised trials were conducted and in the first study, 317 patients who are already on metformin received an add-on therapy of pioglitazone at the dose 15-45 mg/day and another 313 patients received gliclazide at the dose 80-320 mg/day instead. In the second study, 319 patients who are already on sulphonylurea therapy were randomly assigned to receive add-on therapy of pioglitazone at the do se 15-45 mg/day and another 320 with metformin at the dose of 850-2,550 mg/day. After 2 years, the mean reduction in HbA1c from baseline was found to be 0.89% for pioglitazone and 0.77% for gliclazide addition to metformin. The reduction in mean FBG after 2 years was statistically significant between the two add-on therapies where a decrease of 1.8 mmol/L for pioglitazone and a decrease of 1.1 mmol/L for gliclazide was seen (p Another option is adding on a GLP-1 mimetic agent as third-line therapy to first-line metformin and a second-line sulfonylurea25. Effectiveness of exenatides in bringing down the blood glucose level in type 2 DM patients was extensively studied. One of the studies includes patients at the age of 22-76 years old and had type 2 DM treated with at least the maximally effective dose of a sulfonylurea as monotherapy for at least 3 months. After a 4 weeks single-blind, placebo period, 377 patients were randomized (60% men, age 55 ±11 years, BMI 33 ±6 kg/m2, HbA1c 8.6 ±1.2%) and began either at 5  µg subcutaneous exenatide twice daily(before breakfast and dinner; arms A and B) or placebo for 4 weeks. Patients in arm B were then increased to 10  µg bd of exenatide. At week 30, HbA1c changes from baseline were -0.86 ±0.11, -0.46 ±0.12, and 0.12 ±0.09% ( ±SE) in the 10- µg, 5- µg, and placebo arms respectively (p à ¢Ã¢â‚¬ °Ã‚ ¤ 0.001). FPG values also showed a significan t reduction in the 10- µg arm compared to the placebo arm (P à ¢Ã¢â‚¬ °Ã‚ ¤ 0.05) 28. If all else fails to control blood glucose, insulin therapy should be introduced in patients with poorly controlled type 2 DM. It was believed that there is possibility that the oral anti-diabetic agents mentioned above might be useful in combination with insulin therapy in enhancing better blood glucose control, reducing insulin dose requirement, or minimizing side effects of insulin therapy. A study was conducted to compare the efficacy of adding once-daily basal insulin with switching to twice-daily premixed insulin in type 2 DM patients uncontrolled by oral anti-diabetic agents (OADs). It was a 24 weeks period clinical trial where 371 patients with poor glycaemic control (FBG à ¢Ã¢â‚¬ °Ã‚ ¥120 mg/dl, HbA1c 7.5-10.5%) were randomized to once-daily morning insulin glargine plus glimepiride and metformin or to only 30% regular/70% human NPH insulin (70/30) twice daily without any OADs. It was found that mean HbA1c decrease from baseline was significantly better in the presence of O ADs than the one without OADs (p = 0.0003). More patients reached HbA1c à ¢Ã¢â‚¬ °Ã‚ ¤7.0% without confirmed nocturnal hypoglycemia (45.5 vs. 28.6%, p = 0.0013) with glargine plus OAD than with only 70/30 NPH insulin. In addition, decrease in FPG was greater with glargine plus OAD (p Conclusion In this patient, he was newly diagnosed with type 2 DM and was given metformin 500mg twice daily initially to control his high blood glucose level, which was appropriate according to the guideline. If blood glucose is still not well controlled, changing of medication or further management as above should be considered. As hypertension and overweight are risk factors of DM, hypertension should be well managed in this patient and the patient should be advised on complying with his medication. Besides that, patient should also be advised on healthy diet and lifestyle to control his weight.