Sleep and Time Essay Example for Free

Sleep and Time Essay Reasons why I should not fall asleep on duty. If I was to get called to a traffic accident or a domestic dispute I would not be able to respond because I would be asleep. Therefore I would not be able to complete my duties as a military police officer. Being a military police officer I should up hold the standards and the law appointed to me by the United States army. If I was asleep during an active shooter event that may take place at a bank or maybe the commissary, possibly even the PX in Hainerburg housing I would not be able to respond accordingly do to my current state. Being a military police officer means that I will be discipline physically and mentally tough, trained and proficient in my officer tasks and duties. For instance if I was asleep on shift and there was a bomb threat at the generals quarters whatever patrol I am I would not be able to respond accordingly to the situation. This could lead to possibly danger for patrols that are in the area. Say I am patrol 2-1 and a bomb threat is at the general’s quarters. Mohawk would call patrol to 2-1 to the scene and along with the patrol supervisor 2-0 to handle the scene and secure the area making sure that no civilians are in the area within a hundred feet of where the possible bomb threat is. On top of the bomb threat being in the generals quarters there is also an active shooter going on in the commissary. Then a bank heist occurs at Andrews’s federal credit union bank. People would be counting on me to be awake and to fulfill my military task and duties while patrolling the clay kasern area. Patrols 2-5 along with the patrols 2-4 would need backup and assistance at the generals quarters for the bomb threat and the bank heist at Andrews federal credit union. Patrol 2-3 and patrol 2-2 would most likely respond to the active shooter in the commissary. But if everything was handled and taken care of at the generals quarters and or Andrews federal credit union. Patrol 2-2 and patrol 2-3 needed assistance I patrol 2-1 would not be able to assist them. Being asleep during shift is no laughing matter, this is also a serious crime and you can be issued an article 15 for your actions. Another reason why not to fall asleep during shift is because if youre asleep during shif t and your battle buddy pulls up beside you to relieve you from duty he could just be a Blue Falcon, take a picture of you, and show your leadership. Reasons behind falling asleep during shift is due to the fact of not going to bed at reasonable times and or being exhausted from recent activities the night  prior. Falling asleep during shift is not the right answer. The right answer is to get out of your patrol vehicle and to stay active within the community and housing area that you may be patrolling at that time. If I was asleep on shift and there were kids play across the street and say one of them got injured or even taken from some kidnapper. Since I would be unconscious I would not be able to perform my military police duties and subdue the kidnapper using my police skills and levels of force. Let’s say that batman is real. If I was asleep during something important within the streets of Gotham, and we got a call because the joker was robbing a bank. I wouldnt be able to assist batman or my fellow military police officers with the apprehension of the evil villain, The Joker. All of this occurred because one day one guy thought he could do what no one else thought they could do or get away with sleeping on shift.during a crisis of up most urgency for that matter. Sleeping at work can lead to death. Possible security breaches can occured and people can be in danger. If I was walking down the street one day, Then I see a stranger, he might come up and ask me what I want to be, and I’ll tell him that I am a military police officer sworn to assist protect and defend the post and community from evil. This also ensures people that I am not a bad person because I help people. But it can all be thrown away if I fall asleep on shift and don’t do my job. According to Wikipedia Sleeping while on duty or sleeping on the job refers to falling asleep while on the time clock or equivalent, or else while responsible for performing some active or passive job duty. In some workplaces, this is considered gross misconduct and may be grounds for disciplinary act ion, including possible termination of employment. In other types of work, such as firefighting or live-in caregiving, sleeping at least part of the shift may be a part of the paid work time. While some employees who sleep while on duty in violation do so intentionally and hope not to get caught, others intend in good faith to stay awake, and accidentally doze. Sleeping while on duty is such an important issue that it is addressed in the employee handbook in most workplaces. Concerns that employers have may include the lack of productivity, the unprofessional appearance, and danger that may occur when the employees duties involve watching to prevent a hazardous situation. In some occupations, such as pilots, truck and bus drivers, or those operating heavy machinery, falling asleep while on duty could put  lives in danger. The frequency of sleeping while on duty that occurs varies depending on the time of day. Daytime employees are more likely to take short naps, while graveyard shift workers have a higher likelihood of sleeping for a large portion of their shift, sometimes intentionally. A survey by the National Sleep Foundation has found that 30% of participants have admitted to sleeping while on duty. More than 90% of Americans have experienced a problem at work because of a poor nights sleep. One in four admit to shirking duties on the job for the same reason, either calling in sick or napping during work hours. Employers have varying views of sleeping while on duty. Some companies have instituted policies to allow employees to take napping breaks during the workday in order to improve productivity while others are strict when dealing with employees who sleep while on duty and use high-tech means, such as video surveillance, to catch their employees who may be sleeping on the job. Those who are caught in violation may face disciplinary action such as suspension or firing. Some employees sleep, nap, or take a power-nap only during their allotted break time at work. This may or may not be permitted, depending on the employers policies. Some employers may prohibit sleeping, even during unpaid break time, for various reasons, such as the unprofessional appearance of a sleeping employee, the need for an employee to be available during an emergency, or legal regulations. Employees who may endanger others by sleeping on the job may face more serious consequences, such as legal sanctions. For example, airline pilots risk loss of their licenses. In war time in the United States, if a sentry falls asleep on duty, he may face the death penalty under the Uniform Code of Military Justice. During the Korean War, a soldier was sentenced to 10 years of hard labor for falling asleep at his post, but was freed early following a reversal by the Court of Appeals. In 1968, New York police officers admitted that sleeping while on duty was customary. February 2008 – the pilots on a go! airline flight were suspended during an investigation when it was suspected they fell asleep mid-flight from Honolulu, Hawaii to Hilo, Hawaii, re sulting in their overshooting Hilo Airport by 15 miles before turning around to land safely. Air traffic controllers in October 2007 – four Italian air traffic controllers were suspended after they were caught asleep while on duty. March 2011 – the lone night shift air traffic controller at Ronald Reagan Washington National  Airport fell asleep on duty. During the period he was asleep two airliners landed uneventfully. In the weeks that followed, there were other similar incidents and it was revealed that other lone air traffic controllers on duty fell asleep in the towers. This led to the resignation of United States air traffic chief Hank Krakowski and a new policy being set requiring two controllers to be on duty at all times. Bus drivers in March 2011 – a tour bus driver crashed while returning from a casino in Connecticut to New York City. Fifteen people were killed and many others injured. Though the driver, who was found to be sober, denied sleeping, a survivor who witnessed the crash reported that he was speeding and sleeping. Police officers/s ecurity guards in December 1947 – a Washington, D.C. police officer was fined $75 for sleeping while on duty. October 2007 – a CBS news story revealed nearly a dozen security guards at a nuclear power plant who were videotaped sleeping while on duty. December 2009 – The New York Post published a photo of a prison guard sleeping next to an inmate at the Rikers Island penitentiary. The photo was allegedly captured on the cell phone camera of another guard. Both guards were disciplined for this action, the sleeping guard for sleeping and the guard who took the photo for violating a prison policy forbidding cell phones while on duty. The inmate was not identified. Other instances have occurred in March 1987 – The Peach Bottom Nuclear Generating Station was ordered shut down by the Nuclear Regulatory Commission after four operators were found sleeping while on duty. Other cases have occurred where people have fallen asleep at work like these air traffic controllers. According to CNN Travel a NTSB air traffic controller was suspended for failing to respond to two planes heading into Ronald Reagan Washington National Airport has told investigators that he had fallen asleep, according to the National Transportation Safety B oard. The controller, a 20-year veteran, indicated that he had fallen asleep for a period of time while on duty, according to a statement released Thursday by the safety board. He had been working his fourth consecutive overnight shift (10:00 p.m. to 6:00 a.m.). Human fatigue issues are one of the areas being investigated, the statement read. Federal Aviation Administration chief Randy Babbitt said earlier Thursday that the FAA and the National Transportation Safety Board are investigating the incident and that the air traffic controller has been suspended from all operational duties. An FAA  official speaking on background said the controller was given a drug test after the incident. The official said the drug test was standard procedure and did not know the results. NTSB: Controller fell asleep and people ask how safe are air traffic control towers? The situation began at 12:10 a.m. Wednesday, when an American Airlines plane attempted to call the tower to get clearance to land and got no answer, said Peter Knudson, a spokesman for the safety board. The plane had been in contact with a regional air traffic control facility, and a controller at that facility advised the pilot that he, too, had been unable to contact anyone at the tower, according to a recording of air control traffic at the website liveatc.net.1012, the controller said, using the airlines flight number, called a couple of times on landline and tried to call on the commercial line, and theres no answer. â€Å"The tower is apparently unmanned. â€Å"Apparently asked why by a pilot, the controller later responded, Well, Im going to take a guess and say that the controller got locked out. Ive heard of this happening before. Fortunately, its not very often, he said. Knudson said the plane landed without incident in a situation termed an uncontrolled airport. About 15 minutes later, a United Airlines flight also failed to reach the tower but landed without any problems, he said. After that, the controller in the tower was back in communication. Knudson said one contr oller was staffing the tower at the time this occurred. The controllers admission that he was asleep during the landing emergency underscores concerns about the effect of fatigue on under slept controllers at work. In 2007, then-NTSB Chairman Mark Rosenker wrote in a letter to the FAA that four plane incidents provide clear and compelling evidence that controllers are sometimes operating while fatigued because of their work schedules and poor use of rest periods. That fatigue has contributed to controller errors, Rosenker wrote. The incidents cited by the NTSB were: On March 23, 2006, an incident in which a Chicago air traffic controller cleared a plane to take off from a runway on which, 15 seconds earlier, he had cleared another aircraft to cross. The pilot of the departing plane stopped when he saw the other craft in the taxiway intersection. The controller told investigators he had slept only four hours during a nine-hour break between shifts. In an August 19, 2004, incident a Los Angeles controller cleared one passenger jet to take off and another to land on a runway at the same time. The pilot in the landing  aircraft noticed the other on the runway and pulled his plane up 12 seconds be fore they would have collided. The controller said he had slept five or 6 hours before coming to work. On September 25, 2001, an incident in which a Denver air traffic controller approved a request from a cargo plane pilot to take off from a runway that had been closed for construction. The aircraft came within 32 feet of hitting lights that had been installed in the construction zone. The controller said hed slept only two hours between work days. On July 8, 2001, an incident in which a Denver controller cleared one passenger plane to cross a runway where another was about to land. The landing pilot hit the brakes, stopping 810 feet from the other plane. The controller said he had worked three shifts in two days. Of the most recent incident, Babbitt said, In my 25 years as a professional airline pilot, Ive never seen anything happen like this. â€Å"I am outraged by it, Babbitt said. Were going to make sure something like this never happens again. Babbitt stressed that, because of a backup system, neither plane was out of positive radar contact, nor were they out of communication with the FAA, thus allowing both to land safely. â€Å"That said this should not have happened, Babbitt said. We should not have had this gap in communication. We had to rely on a backu p system, which shouldnt have happened. Transportation Secretary Ray LaHood ordered the FAA on Wednesday to schedule two controllers on the overnight shift. It is not acceptable to have just one controller in the tower managing air traffic in this critical air space. I have also asked Babbitt to study staffing levels at other airports around the country, he said. Knudson said its not uncommon for planes to land at uncontrolled airports. He said control towers at some fields across the country shut down for the night, and planes still land. However, he could not comment on whether that practice was ever used at Reagan National. The American Airlines flight, which was coming from Miami, had 91 passengers and six crew members aboard, airline spokesman Ed Martelle said. The United Airlines flight was arriving from Chicago with 63 passengers and five crew members, spokeswoman Megan McCarthy said. American Airlines had no comment on the situation, saying it was leaving it to the FAA to handle. United Airlines noted that the National Transportation Safety Board is reviewing the incident, and McCarthy said the airline is conducting its own review. So even after all of these discussions and people’s arguments some say that  they sleep because it is customary and some say it’s because of not enough sleep but the truth is, is that it’s all wrong. Falling asleep on duty as a patrol is very bad and you should not do it. It can cause a lot of trouble and for no reason. Main things people have to worry about are staying awake and staying alert and ready to complete their jobs that they have to do. Most people don’t realize how people can fall asleep but it’s all too easy which sucks because the easier something is to do, the easier it is to do it often. I personally don’t like that I get tired but I fight it by staying active and doing things to take up time will working. I try to do walking patrols frequently and take short breaks outside my vehicle to stretch out and stop feeling cramped in my patrol car. Being asleep on duty is not a good thing because it can get you in trouble and being in trouble is never a good thing. It leads to not being trusted, not included in certain events, and no one wants to be around a trouble maker. Staying awake and focused on the tasks ahead is a great way to stay out of trouble and not asleep. Staying awake on shift is important in so many ways and for some people it’s hard to believe that it’s just that important. In Japanese culture it’s actually a good thing if you fall asleep at work because it s hows people that you are just sleeping because all the hard work you have been doing. There are rules to this though. One rule is you must sit up and look engaged (despite the fact that youre asleep). It must appear that you could wake up at any moment and do something great. Second rule it’s easier to get away with if youre the boss. Sleeping at work is a sign of confidence — it shows youre indispensable to the company and can get away with it. Junior staff can also get away with it because no one notices them. If this was the case for everywhere my life would be great. But alas†¦ it’s not so don’t sleep on shift. Sleeping on duty is just as bad as sleeping with a tiger that will eat you. If you wake up with the tiger and it’s going to eat you well you’re pretty screwed. Just like if you wake up to your leadership in front of you†¦. You’re pretty screwed. If life gives you lemons†¦.. Squirt them in your eyes so you can stay awake for shift. Then think about how much better off you will be now that you’re not in trouble. Staying awake on shift is crucial to surviving through your day. If you don’t stay a wake you can cause bodily harm to yourself because you will most likely be getting dusted off out back for your actions. Other ways of punishment for sleeping is writing  a RBI the most spectacular punishment ever known to man. If there can be only one man left standing between a RBI and getting corrective action the RBI will always win. Thus why you should never fall asleep during duty hours because it’s very bad. If you’re falling asleep while driving you’re definitely in the wrong and you need to pull over. Don’t try to be a hero and fight through it. Instead get out and wake up for a bit because that’s a million times better than crashing your patrol vehicle. After doing some research I’ve found out ways that can help me stay awake during work. Listen to music thats energizing to you. If possible, dance or sing along, even if you just bob your head or hum. Music thats irritating or jarring may keep you awake better than music thats familiar. Just do your co-workers a favor and remember to use headphones! Listen quietly instead of loudly. Its a common misconception that blasting music loud will help keep you awake. Actually, turning the music down to a very low l evel is more effective. It forces you to try to listen closely in order to hear the instruments, lyrics, and percussion. If youre having difficulty discerning the lyrics, then the volume is just right, because this means your minds working. Expose yourself to bright light, preferably, natural daylight. Your bodys internal clocks are regulated by your exposure to sunlight. This means you can trick your body into believing it should be awake even when it feels tired. Step outside, even just for a bit. If you can step outside (even on a cloudy day) or look out the window for a full minute, youll be more alert. Work the artificial lights. Even if youre in an environment where theres artificial light, brighter is better. Wherever you work, see if you can replace the light fixture or add a lamp that will brighten your workspace. Chew ice. If you chew ice, its almost impossible to fall asleep. The chilling temperature keeps the brain on its toes, even while you are driving late at night, exhausted, and what you really want to do is fall asleep. Chewing anything, even if its just your pen or pencil, causes your body to think you are about to eat. Your body will prepare for food intake by releasing insulin, which will make you m ore alert. Splashing cold water on your face helps out a lot. If its a little cold, take off your sweater or jacket so you stay on the chilly side. Open a window or put on a small fan, pointed at your face. The reason your body responds the way it does to cold is that its prepping itself to work to keep you warm. Your body needs to  regulate your internal temperature to keep all of its organs functioning. So if it detects ice or extreme cold, it will work to keep itself awake longer. Use your sense of smell. A pungent scent — good or bad — can make you more alert very quickly. Aroma therapists often recommend essential oils of the following plants to stimulate the nervous system and reduce fatigue. Open the bottle and take a big whiff of the following when youre feeling drowsy: Rosemary, Eucalyptus, blue gum, Peppermint, Coffee. Beans or brewed, both work: a study has shown that simply smelling coffee can awaken a person. Of course, not all of us have essential oils stored in our file cabinets. Using hand lotions or burning candles with these same scents could help. Herbs like rosemary and peppermint can often be found fresh or dried at a grocery store; for a little pick-me-up, take a pinch and roll it between your fingertips and smell it. Eat healthy. Eating can help you stay awake, as long as you avoid a full stomach. As most of us know, eating to excess often makes us sleepy, so dont eat a full pizza or that 12 oz. steak during lunch. Munch on snacks all day rather than having a big meal. The key is to not get a spike of sugar intake (followed by the inevitable crash). Predictably, the same goes for caffeine: break your coffee, soda, or energy drink consumption down into small doses. Avoid breakfasts that are high in carbs (muffins, toast, pastries, bagels, etc.). Youre giving your body a reason to crash at about 11 AM because it gets a sugar spike early on. Put a small handful of sunflower seeds in your cheek and crack them open one at a time, using only your teeth and tongue; this will require just enough active thought and tongue movement to prevent you from dozing off, and the salt of the sunflower seeds is invigorating and stimulating; spit out the sunflower husks into a paper cup as you go, as quietly as possible so as to not disturb others around you. Try stretching. Stretching and twisting your body can help improve blood circulation, which helps keep you awake. Rolling your head/neck for about 20 seconds can help as well. Use acupressure and Massage any of th e following points to improve circulation and ease fatigue: The top of your head. Lightly tap it with your fingertip or use a scalp massager. The back of your neck and Back of your hands. Right between the thumb and index finger is best. Just below the knees and also the Earlobes. Try simple exercises like jumping jacks, push-ups, crunches, and squats. Dont push yourself like you do in the gym; instead, just exercise enough to get your  blood flowing and keep your coworkers from noticing your strange behavior! Stay on your feet as much as possible. If youre sitting most of the time, get yourself up every 20-30 minutes. If you need any motivation to stand more of the time, consider this: people who stay seated for less than three hours a day add almost two years to their life expectancy. If you have to sit down, get the most uncomfortable chair you can find. Try not to sit in anything that will make you sore if you stay there. Make sure the back is upright, forcing you to sit up very straight. Dont allow your head to rest on anything — your hands, the desk, the wall. Take a short walk. Some people take a short walk to re-energize them. Its generally thought to be a good distraction, especially if youre sitting in front of a computer screen all day long. Studies show that taking short breaks from work actually helps your productivity. So if youre worried about missing that deadline, dont stress! Walking breaks will help you. (You can let your boss know.)Take a power nap. If you have the time, sleeping for just 15-20 minutes can increase your alertness by leaps and bounds if you have a cup of coffee (or any other form of caffeine) right before you fall asleep. The caffeine will take about 20 minutes to begin working, so you shouldnt have any trouble falling asleep right away, and youll wake up refreshed. Sleeping just 20 minutes helps activate the right hemisphere of the brain, which is responsible for processing and storing acquired information. Have a regular bedtime and a healthy diet. Brains benefit greatly from schedules. If you go to bed and wake up at the same time every day, even the weekends, your brain know when its time to sleep and fall into a pattern. Getting proper nutrition will also ensure that your body has the proper energy throughout the day without having to resort to naps for extra strength. How much should you sleep to ensure that youre properly rested? Adults need anywhere from 7-9 hours of sleep per night. If you are pregnant or older, you may need even more sleep, anywhere from 10-11 hours. Some recommend going to sleep with your curtains halfway open. The early morning sunlight will send signals to your I’m gay body to slow production of melatonin and start production of adrenaline, making it easier to wake up. Focus your mental powers. It sounds hard, but dont let your mind go into the fuzzy stage. When your mind starts to go blank, think about something, whether its a joke, a movie, or anything else to keep your mind working. Even thinking  about something that makes you mad can be extremely helpful. Unless theyre drinking, you typically dont see an angry person abruptly fall asleep. Falling asleep down range used to be punishable by death and also it can get you in a lot of trouble and can get your squad or team or platoon or company or somebody else’s team squad platoon or company killed and then you’re done for because you’re dead. If you were to fall asleep while as the gunner position in your vehicle you are at risk for attack and put everyone’s lives around you in danger. If there was a n attack you would most certainly die or worse someone else might die and that would be on you. Sleep can be just as important to your mission as having enough food, water and ammunition. Although it may not always be possible to get a full night’s sleep while you’re deployed, developing healthy sleep patterns and habits can help build your resilience, improve your ability to deal with necessary periods of sleeplessness and prepare you to perform your best during a mission. Getting enough quality sleep is especially important for leaders making decisions critical to mission success. Sleep is a biological need – like air, food, or water – and is critical for sustaining the mental abilities needed for success on the battlefield. The average adult requires seven to eight hours of good quality sleep every 24-hour period to sustain operational readiness. Sleep is also incredibly restorative. It helps the body repair itself, it builds resilience by boosting the immune system and it gives people a foundation to help them tackle their tasks each day. Getting enough regular sleep will also improve learning, memory and performance. When you donâ€⠄¢t get enough sleep, it can be harder to perform your best on the battlefield. For example, lack of sleep may result in: Slower reaction times, Poor concentration, weakened immune system, Negative moods and lack of motivation, impaired memory and judgment. When being deployed having sleep is very important and people depend on you to get the job done. Doing PT before shift also comes in as a factor of why people may be sleepy before shift. Doing PT is energizing but also can be very tiring at the same time. Doing your best to not fall asleep on shift is important enough. But on top of that you have to worry mostly on your mission at hand. That is staying focused and getting to calls and responding with all the training that you have received over your time in the army. Since I’ve only been in for 9 months I’m still pretty bad at all this so I’m sorry for falling asleep. I  honestly think I suffer from sleep apnea. It could also be that I’m narcoleptic which is pretty bad. If you were to talk to people back home about how much I sleep they would say that they were surprised that I wasn’t in a coma. I use to sleep standing up at my job at Winn-Dixie as a cashier. It was only a few times but still it h appened. I use to come home from school and sleep till about 10pm and I got home at 4pm. I had a bad problem with doing my homework with this problem. I’m sorry I fell asleep SGT P. I know I’m not the best soldier but I try not to mess up and get yelled at. I’m mostly quite all the time just so people can just over look me and try not to notice me. I feel like I shouldn’t be where I’m at sometimes because the way people talk to me. I guess it’s just a normal PVT thing so I always just let what people say to me not try to affect my day or what I’m doing. Falling asleep is stupid and is very much punishable by Article 15. I need to keep trying to get squared away with everything so that maybe one day I can just be a squared away soldier that you don’t have to worry about. Joining the army has changed who I am today and I’m so thankful for that. I had to right an RBI in basic and it was about fraternization I know what you’re thinking I surprised it’s not about sleeping but when its really comes down to it we all mess up and we are all sorry about it and I’m going to try my hardest to not mess up again. I would end it here but I have 2000 more words so I’m just going to keep going and talk more about the army and my goals from here on out and why I shouldnâ€⠄¢t sleep. 10 amazing reasons why you should not sleep on shift/work/duty. #1 you can’t provide covering fire or any kind of fire if you are passed out sleeping in your cot back at the fob when you should be helping your battle buddies out and not being a blue falcon. #2 when you’re working the road you need to be awake to respond to calls and to be there for the people that live in housing if they need you. It’s your position so don’t mess it up and maybe you will get a high five at the end of shift. #3 If you are trying to be the best then it doesn’t help to get totally shit faced the night prior to coming into work and not being able to handle it. This leads to people being angry and disappointed. #4 you can literally get people killed by falling asleep. #5 says you have watch tower duty when you’re deployed and you fall asleep and the base gets ambushed. Once everything’s said and done you might as well hope that you’re dead because yo u’re going to be in some deep shit. #6 if a little girl comes  up to the car and tries to get help and she sees that your asleep she might get kidnapped because she was lost and needed help and you couldn’t provide for her. #7 if there was a fire and a pregnant mother was trapped in the house still the fireman is all busy and you’re the only one left to help. Looks like there are 2 lives that you will always have on you conscious because you weren’t there to save the day. # 8 when Mohawk calls you to the desk and he has some cases to do you won’t be able to respond because your asleep way to go.#9 If you were asleep on duty and your co-workers call you back for something you won’t be able to come cause your asleep. The sad thing about it was they were throwing you a surprise birthday party and now your just a sad disappointment to them all.# 10 last but not least you let yourself down and that should mean something to you so shame on you if it doesn’t cause you’re a really horrible person. Working shift has its ups and downs mostly its downs. A shift worker is anyone who follows a work schedule that is outside of the typical 9 to 5 business day. In the past few decades the United States has become increasingly dependent upon shift workers to meet the demands of globalization and our 24-hour society. From a competitive standpoint, shift work is an excellent way to increase production and customer service without major increa ses in infrastructure. According to the Bureau of Labor Statistics, millions of Americans are considered shift workers, including doctors and nurses, pilots, bridge-builders, police officers, customer service representatives and commercial drivers. However, while shift work does create potential productivity advantages, it also has many inherent risks. Some of the most serious and persistent problems shift workers face are frequent sleep disturbance and associated excessive sleepiness. Sleepiness/fatigue in the work place can lead to poor concentration, absenteeism, accidents, errors, injuries, and fatalities. The issue becomes more alarming when you consider that shift workers are often employed in the most dangerous of jobs, such as firefighting, emergency medical services, law enforcement and security. Managers and policy makers who are responsible for writing and enforcing rules regarding employee work hours must address the specific issues of a 24-hour work force in order to succeed and benefit from such a labor force. Although addressing these issues may require some investment up front for training and other measures, the bottom line is that improved sleep in  workers may lead to improved productivity. In fact, to ignore the needs of the shift worker is reckless and irresponsible when you consider that billions of dollars in yearly costs, thousands of deaths, and some of the most notorious of modern catastrophes such as the failure of the Space Shuttle Columbia and the crash of the Exxon Valdez have been attributed to human fatigue. According to the International Classifications of Sleep Disorders, shift workers are at increased risk for a variety of chronic illnesses such as cardiovascular and gastrointestinal diseases. Whether this is related to the fact that shift workers are awake and active during the night hours or because they tend to get fewer hours of sleep overall than traditional workers is not known. Also, shift workers often miss out on important family and social events due to their work schedules. Most managers recognize that understanding and addressing these issues improves employee morale, performance, safety and health, and can dramatically improve the bottom lin e of the company. People who work in the transportation industry face some of the most serious challenges. They battle fatigue because of their irregular sleep schedules and endure long ted  ious hours at the controls or behind the wheel. In fact, research suggests that driver fatigue behind the wheel caused by sleep deprivation is one of the leading safety hazards in the transportation industry. According to the International Classifications of Sleep Disorders, shift work sleep disorder is a circadian rhythm sleep disorder. Circadian rhythm refers to the ~24hr rhythmic output of the human biological clock. It is considered a disorder because of the frequency with which people suffer from sleep disturbance and excessive sleepiness in trying to adapt to a shift work schedule. The main complaint for people with shift work sleep disorder is excessive sleepiness. Other symptoms include: Insomnia, Disrupted sleep schedules, reduced performance, Difficulties with personal relationships, Irritability/depressed mood. Unfortunately, treatment for shift work sleep disorder is limited. Both behavioral and pharmacological remedies can help alleviate symptoms. Some research indicates that the body may never fully adapt to shift work, especially for those who switch to a normal weekend sleep schedule. But there are ways of getting adequate sleep while doing shift work. For some shift workers, napping is essential. It can be extremely effective at eliminating fatigue-related accidents and injuries  and reducing workers compensation costs. Although most employers do not allow napping in the workplace, a ban on napping may soon prove to be a legal liability. Thus, efforts to make workplace policies nap-friendly may soon gain popularity as the issue increases in global significance. I strongly agree with a nap friendly work place. Although not everyone who works odd hours has shift work sleep disorder, a lot can be at stake. People with shift work disorder have higher rates of absenteeism and accidents r elated to sleepiness than night workers without the disorder. Memory and ability to focus can become impaired, and shift workers who are sleep-deprived often get irritable or depressed, says Wesley Elon Fleming, MD, clinical assistant professor at Loma Linda University and director of the Sleep Center Orange County in Southern California. Their relationships and social life can suffer, too. Shift workers also face potential health problems, researchers have found. Overall, those who work night or rotating shifts seem to have a higher risk of ulcers, insulin resistance, metabolic syndrome, and heart disease. Nearly everyone has days when they feel sleepy. But for some people, excessive sleepiness actually gets in the way of daily work, childcare and even leisure activities. This is known as hypersomnia, recurrent sleepiness that makes people want to nap repeatedly, even at work. Not surprisingly, the problem of daytime sleepiness usually starts at night. Even missing just a few nights’ sleep, or not getting enough uninterrupted sleep, can slow you down and sour your mood. People who have problem sleepiness are often advised to go to bed and get up at the same time every day, including on weekends. But randomly setting an ideal bedtime can lead to more frustration if you suffer from insomnia and already have trouble falling asleep. Another approach to getting into a consistent schedule is to try going to bed 15 minutes earlier each night for four nights. Then stick with the last bedtime. Gradually adjusting your schedule like this usually works better than suddenly trying to go to sleep an hour earlier. Regular mealtimes, not just regular sleep times, help regulate our circadian rhythms. Eating a healthy breakfast and lunch on time rather than grabbing a doughnut and coffee in the morning or a late sandwich on the run also prevents energy deficits during the day that will aggravate your sleepiness. Plan to finish eating meals two to three hours before bedtime. If you do all of this you should be feeling good for work and get a good  night’s sleep. Many times have people done stupid things and gotten away with them. It just so happens I wasn’t so lucky and I had to write this paper on why I shouldn’t sleep at work. I have looked up reasons why not to and people’s ideas on how to even stay awake for work. I’ve talked about what a bad person you are for doing and when you do you put everyone around you in danger and their lives. I’ve given some pretty detailed stories of other people that fall asleep at work as well. Putting all of this in one paper is really long and hard and very, very tiring. I again am super sorry for falling asleep during shift and I know now from so much research that it is an issue not only for me but for many people across the world. I promise that I will use some of these techniques I have learned to stay awake on shift and to never be looked at as the guy who fell asleep. I don’t want to be a disappointment to you any longer and I hope that we can move past this and move forward as a best as possible so we can still be an efficient team. Along with Birdwell.

An Analysis of Mexico for Investment

An Analysis of Mexico for Investment Infrastructure and market capabilities and the risks and potential bottlenecks The growth and prosperity of Mexico depends upon various factors. The country is trying to grow through a combination of industrial growth, service sector growth and public welfare measures. All these depend highly on infrastructure and the competitiveness of the country. The country has to develop its infrastructure and complement the growth measures through interventions in the labour market as well as other sectors that keep the competitiveness of the country at par with the counterparts. Infrastructure: Infrastructure is a much needed ingredient for the development of any country. With its leftist leanings, mexico had monopoly over most of the infrastructure areas such as energy, roadways, railways and ports. Recently, we can see the trend changing. Mexico is looking to bring in private investments into some sectors and to reform almost all of the major sectors such as telecommunications and energy. Energy: President Enrique Peà ±a Nieto recently introduced a legislation which is due to be passed in April. Once passed, this would end a 75 year old era of monopoly on oil production. The public oil company Pemex will be more autonomous and will have a greater control over its activities. The government has also given PEMEX permission to create tie ups with private players over the world in order to sharpen the RD in the field of oil related energy research. This move also has an agenda of tapping into the vast reserves of shale gas. The government also introduced more private partnerships in the energy segment apart from oil and natural gas. However, Mexico still has a long way to go in the energy segment and to create a sustainable energy infrastructure. With the growth in a lot of segments demanding high amounts of power, the infrastructure should be able to support the extra demand. Telecommunications: The president has introduced some new regulations in the telecom sector to make it more consumer friendly and economical. The regulations aim at enforcing strict regulations that would reduce the call charges. Plans to double the connectivity in next few years. Introduce foreign investments in telecom sector up to 49%. To control the influence of the three giant telecom companies who currently hold most of the markets Even though such measures are introduced, the infrastructure needs to withstand the increased demand. The services industry and other industries are increasing its dependence on the telecom sector. Transportation Mexico in its recent times have increased its spending on the transportation infrastructure. There is an increase in spending on ports and roadways. The world’s largest cable suspended roadway bridge was constructed in Mexico. The investment into transportation infrastructure is a good sign and takes care of the increased demands due to trade. Labour markets: Mexico has a highly unionized labor population. Most of the workers are a part of one or the other unions. The labour laws are rigid and laabour welfare oriented. Many welfare measures are available for the employees and hence, it creates a condition that is not helpful for the industrial growth. The result is that the cost of labour increases and the competitiveness decreases. In order to grow, Mexico needs to simplify the labour laws to make it more balanced. Unionism is good to protect the rights of the workers but after a limit, it becomes restrictive and impedes growth. Some of the other potential risks or weaknesses are High crime rates. Drug trade and other illegal activities form a major part of economy. Overdependence on USA Weak infrastructure for education, legal and research. High levels of poverty and inequality in the society Financial Environment The financial system of mexico has been stable and moderately strong. The banks have been able to perform well even in the face of crisis situations. Even though there have been changes in the business patterns, the banks have continued to show resilience. The reform measures that have been carried out have increased the stability of the system, develop it and regulate it much better. The frequent crisis has resulted in a better system with respect to risk reduction and regulations. Even though the system has been stable, there are major challenges in the system. Highly integrated with the US economy and its financial system and hence vulnerable to problems in these economies. The credit to private sector and financial intermediation are lower than the average of Latin American counties and other emerging economies. The seven largest banks are accountable for 82% of assets. Five of these banks are subsidiaries of foreign banks. Regulation, supervision and licensing has issues that needs to be sorted. The increasing NPAs in the system would make the banking system weak in future crisis. Organizational and managerial factors in Mexico and the applicability of current management practices The organizational structure in Mexico is highly hierarchical. The employees and the management prefer rigid hierarchical structures for management. The same hierarchy can be seen in the whole decision making process as well. The higher level employees are generally seen as more experienced and hence need to know the operations well. Consulting with a lower level employee is not encouraged. The decisions have to be made by the bosses and the subordinates deliver exactly what is needed, according to the company principles and directives. Disagreements are not expressed publicly. Companies show a paternalistic attitude towards the employees. The country is an extremely relationship oriented country with a fluid time culture. Relationships are given importance over deadlines and they play a crucial part in business decisions and managerial functions. The Mexicans are very flexible in terms of change. But the changes should be slow and well planned. Even though the resistance to change may be low, the fallouts may be large if the change is swift and not so well planned. Collectivism is a phenomenon that is common and teams are given preference over individuals. The current managerial practices are implementable in the country with a few tweaks. However, there are some managerial practices that cannot be implemented easily in Mexico. Flat organizational structures are hard to implement as it would encourage a dilution of hierarchy and a more fluid structure. Being a rigid hierarchical society, the model may not be easily accepted. The Mexican employees work based on clear cut directions. Hence, a business model that encourages self managed work groups or one which requires that the employees have an entrepreneurial mindset may not work well in this culture. The managers have to behave in a more paternalistic nature to gain support and respect from the employees. Even though public dissent and disagreement may not happen, the employees may not respect a manager who does not take care of the welfare of the subordinates.] The business relations have to be based on trust and understanding more than anything else. The business decisions needs to include the nuances of relations and thus should be sensitive towards it. Justification for choosing Mexico Mexico as a country stands out in comparison with its peers in Latin America as well as in the league of emerging nations. The country is a well-balanced economy led by a government who has a solid hold on the macroeconomic policies. These policies and developmental activities have bought the country to a level of self-sustainability. The country has a clear vision for its future. The political stability and the policy uniformity make it a powerhouse of development. Most recently, the Pact for Mexico shows the importance the government gives to development and reforms. The country balances economic development, industrialization, and social welfare very well. The government realized that as the country progresses, it not just needs industries, but also needs a good policy for social welfare. The current health and education related policies showcase this desire to make the people’s lives better. Even though the country falls short on a lot of counts, the future prospects are good. Culturally, socially, economically, financially and politically, the county provides the right mix for growth and prosperity. The proximity to USA and the oil reserves make the country a very high potential destination. In short, the philosophy of the country to grow without compromising on the policies and welfare of the citizens is the reason for the choice.

Strategic Management: An Introduction

Strategic Management: An Introduction Strategic management is the art and science of formulating, implementing and evaluating cross-functional decisions that will enable an organization to achieve its objectives. It involves the systematic identification of specifying the firms objectives, nurturing policies and strategies to achieve these objectives, and acquiring and making available these resources to implement the policies and strategies to achieve the firms objectives. Strategic management also integrates the activities of the various functional sectors of a business, such as marketing, sales, production to achieve organizational goals. It is generally the highest level of managerial activity, usually imitated by the board of directors and executive team. Strategic management hopes to provide overall direction to the company has ties to the field of organization studies. Strategic planning is a management tool, period. In short, strategic planning is a disciplined effort to produce fundamental decisions and actions that shape and guide what an organization is, what it does, and why it does it, with a focus on the future. Strategic management also allocates the right amount of resources to the different parts of your business so that those assigned to particular goals have what they need to meet their objectives. This ranges from providing your workers with the right supplies to enacting systems by which employees receive the necessary training, all work processes are tested, and all information and data generated is documented. To effectively manage your business strategically, every inch of your company must have its needs met in these ways. Furthermore, one must know that two businesses cannot be same and there should be some basic differences between them. Because of this, the goals and the plans of action are different for each business. Plus, the strategies for long term and short term development should be different and these need to be applied separately. QUESTION 1: Explain how someone can be a manager but not a leader, a leader but not a manager, and both a manager and a leader. A manager is a person with a job of overseeing one or more employees or department to ensure these employees or departments do their job or assigned duties as required. A manager helps others to get more done by motivating the employees, providing directions , making sure the employees working together towards a common goal, and providing feedback. A new manager may be responsible for a small team or a small project. Usually a senior manager will watch over his or her work. The manager will have to learn the strengths and weaknesses of the team members, instruct a work to the team members, guiding team members to reach goals, provide the tools needed by the team and motivate them to do their task. Usually , a new manager has limited responsibility for money issues and little chances to approve or make an expenditures. They have to review and approve timesheets for their employees and may have the chances to approve expense accounts. The term of manager is not the same for leader since the two terms are not the same. A manager must ensure the appropriate delivery of human resources and funding to meet the routine daily productivity objectives. The manager is known as detailed oriented. Mangers don not see the overall picture and are less interested regarding the long-term corporate goals and mission. They are worried about details; as a result, they do not make them a good leader. Some managers may have certain leadership qualities but they remain too focused on their daily operations and are unable to provide direction and vision to the organization. A manager plans, organizes, leads, and controls whereas a leader influence others through communication, motivation, discipline, direction and dynamics Typically, the goals are set for a beginning manager by someone higher ranking in an organization. Here , the manager have to develop a plan to achieve the goal set. They have to provide feedbacks to their employees as they work with those plans. To be a manager , developing skills at all level is important . At a beginning level , examples of two area where a manager need to focus their skill development are the ability to manage their meetings and developing their own planning tools such as to do a list. A leader is different from manager. A leader is a person who has vision, a drive and a commitment to achieve that vision, and the skills to make it happen. A leader see a problem that needs to be fixed or a goal that needs to be achieved. A leader is also a person who guides others towards a common goal, showing the employees by example and creating an environment in which other team members feel active and involved in any process or task. A leader is a good listener. Leaders have to keep their mind open to others ideas. They can come up with new ways to accomplish the goal set. It is the leaders job to make sure that everyone in the group is being heard. Leaders have to listen to the team members ideas and listen their criticism for improvements. Leaders have to be focus all the time. They have to keep on remind themselves and the team members of the goals and mission. Staying on track and keep the team members on track ,the team will stay motivated and more productive. As leader of the group, it is important that you schedule time to meet with your team to establish and check-in about the goals you hope to achieve. Leaders also have to be organized. Leaders are responsible in a lot of things and might be very busy sometimes. A leader can set the tone for the team. A leader who is organized helps motivate team members to be organized as well. As a leader, youre responsible for a lot and youre probably going to be very busy at times. However, you still need to find time to talk with your team. A good way to do this is to set frequent group meetings, so that no question or concern goes too long without attention. Leaders also have to be decisive. Although an important part of being a leader involves listening to the people surrounding, they have to remember that they are not always going to be able to reach a compromise. When this happens, dont be afraid to make the final decision, even if some team members disagree with the plans. Confident is the most important characteristics of a leader, leaders have to believe themselves and the success of the team members. Show others that you are dedicated, intelligent, and proud of what you are doing. A manager basically directs resources to complete predetermined goals or projects. For example, a manager may engage in hiring, training, and scheduling employees in order to accomplish work in the most efficient and cost effective manner possible. A manager is considered a failure if they are not able to complete the project or goals with efficiency. . On the other hand, a leader within a company develops individuals in order to complete predetermined goals and projects. A leader develops relationships with their employees by building communication, exampling images of success, and by showing loyalty. As an example of a manager, A company CEO directs Wong, one of the companies up and coming managers, to hire enough new employees to provide the company with a customer service department. Wong undertakes his project with enthusiasm. He hires only those employees who can work the assigned hours, will accept the modest pay, and have experience working in customer service. He trains his new employees to perform the job to his expectations and assigns the employees to their new positions. Wong measures his success in terms of efficiency, calls handled per hour, and cost effectiveness, for example did he meet his budget?. However, Wong did not anticipate that of the employees he hired, only a handful would remain working six months later. Moreover, as an example of a leader, Ahmed obtains the same assignment as Wong. Ahmed hires employees that he believes he can develop a working relationship with, versus just those employees who will worked the assigned hours and take the modest pay. Ahmeds goal is to hire a diverse group of employees, some of who do not have any customer service experience, who he feels he can develop a personal connection. A large part of Ahmeds training involves team building, telling successful stories, and listening to each employees own desires for what constitutes a fulfilling job. Ahmed still assigns his employees their job duties and schedules at the end of training, and he also measures success in terms of efficient and cost effectiveness, but he also measures success in terms of low employee turnover, employee morale, and employee development. Ahmed feels proud when one of his employees obtains an advance level position a year or two after being hired. The skills to be a leader or a manager are not exclusive in nature. A leader who only displays leadership skills will be ineffective when it comes to checking time cards, completing employee reviews, and scheduling employee vacation time; things that employers require their managers to do on timely bases. Similarly, a manager who spends all his/her time completing paperwork and reading reports; only creates more problems for him or her because they lack a developing relationship with their employees. Many companies, one person may play the role of both leader and manager. In others, these roles are carried out by different people. And in many cases, the roles overlap and leaders need to manage and managers need to lead. However, it is critical that both roles are performed effectively for a company to succeed, especially a company with employees. Without a vision for the future, a company has no direction and no goals for which to strive. Good leaders are made not born. If you have the desire and willpower, you can become an effective leader. Good leaders develop through a never ending process of self-study, education, training, and experience. As a manager who would like to become a better leader to inspire your employees into higher levels of teamwork, there are certain things you must be, know, and, do. These do not come naturally, but are acquired through continual work and study. Good leaders are continually working and studying to improve their leadership skills. Leaders an d managers also have much different conceptions of work itself. Leaders develop new approaches to long-standing problems. Leaders work in high-risk positions because of a strong aversion to mundane work. Conversely, managers view work as an enabling process. Managers tolerate practical, mundane work because of a strong survival instinct that makes them risk-averse. They are good at reaching compromises and mediating conflicts between opposing perspectives, but lack the influence to avoid future conflicts. QUESTION 2: Identify two very different organizations that compete on a cost leadership strategy and explain how they do this, i.e. find out what they do that enables them to keep their prices low. The cost leadership strategic is to gain a competitive advantage. Make it into a simple word, cost leadership is reduce the cost to fight with their competitor in same industry. The organization who need to earn more profit, must reduce the cost to ensure they are not waste any resource. The cost who has reduce more, the company will gain more profit and easy to survive in the market share. Anakku Anakku as famous is selling the baby product. The company is celebrated 38th anniversary in Malaysia in 2011. Therefore, the company has their advantage to survive in this market. Anakku produce the baby products get it the mission is built on a strong, solid foundation of premium quality, safety and reliability. The product have been sell by Anakku are fashion-wear for babies and toddlers, feeding equipment, toiletries, diapers, accessories, strollers, playpens and more. Baby Kiko Creating style glamour, fun comfort for the little ones. Is the brand name of Baby Kiko. Baby Kiko is a brand extention from KIKO. Baby Kiko is establishing in Malaysia for over 20 years. Baby Kiko is one of the most widely recognized baby brand in Malaysia, known for quality, trendy style, and marketing creativity. The product that have been sell are toddler clothing, feeding accessories to weaning products, baby cleansing to baby skincare products. Cost Leadership Strategic Both companies have completed their cost leadership strategic, therefore, both company can survive in the market taking a long period time. Each of them has the plan to reduce the cost and increase their profit. Not even thought, both companies also using the Michael Portal 5 force to operate the companies. And they no using too much of advertising to promote their product, so that, the cost will follow decrease. Next, most of the products like cloth or accessories are make by them. The pattern and the design had been created, so, the companies will produce it with their own manufactory. Follow by this, both companies will try to reduce the damage of the product. They will make sure the product is good. The after-sales service is one of the parts they can do, and get the feedback from the customers, and get to improve better to the customers need. Within the Michael Portal 5 forces, First of all, the bargaining power of supplier. For the Baby Kiko Company, all the product are make by own, so that, the raw material of they used is direct from the manufactory, so the price of the product can easy to under control. An opposite, about the Anakku Company, some if the products like car seat or toys are manufacture from the supplies. Mostly, the Anakku Company will control by the supplier. But, for the Anakku Company, the main product for sell is clothing and the accessories like bottles, teethers, feeding accessories and etc. If the supplies increase the price, so they will change the supplier to get the raw material and try to product good product for their customers. Next, the bargaining power of customer or buyer is one of the forces that both companies used. The price had been set and the customers no have too much or no have power to argue to reduce the price. The entire product had been fix price, unless the company does the promotion like discount, so the customer will get the lower price of the product. Both companies have provided onsite service and after-sale service. And some of the product will give about 1 week to 1 year of warranty depend on the product. The threats of the entry of new competitor will also influence the cost. If got new competitor join into this industry, the company will spend more money to do promotion as like discount or adverting to attract people. This kind of money will increase the cost, so the profit will been decrease. Otherwise, both company had been survive in Malaysia taking a long period time, they have their own popularity in this country. For the Anakku Company, they mostly are produce the safety and useful product. The product no easy to damage and some of the product have the warranty to attract the customer to buy it. This is the advantage for them and no need scare about the new competitor to try to attack them. Besides that, the Baby Kiko Company more is based on the creative and innovative product to attract customers. The design and the fashion are new and look nicely. Based on the customers, they will take feedback and get the new the information to produce the product. Those are the advantage of the both companies; the new competitor does not have too much power and cost to survive. Other than that, the intensity of competitor rivalry it may also influence the cost. Take a basic word, who can get the lower cost, who will win in the market. Therefore, the company must have the power and the capacity to run the business. For Anakku Company, they have many branches in the Malaysia. It will easy to target market and the customers. Anakku Company as a wholesaler otherwise as a retailer. They retail the product directly to the customer, so that, the cost will not be too high to be taken. The technology of Anakku Company use is high-tech machine. According the above statement, the Anakku Company does not have too much of advertising. Running the business around 30 years, the popularity has the value on their customers. For Baby Kiko, they usually are wholesale to the stores that are really preferred to sales. Some hypermarket like Partson or The Store, we can see Baby Kiko product. Wholesale to other store, it can deduct the cost of employee and no need searching the place to run over the business. The customers who are prefer to sell the product, they will delivery it. It may reduce the cost with it. Not even that, Baby Kiko Company also though the internet to promote the product. One of the major website is Facebook to promote. It is free of charge and also can attract more people to know the new product. Other than that, the labour force it may influence the cost available. Anakku Company is more focus on the retail sale, so that, the employee will taking more and more, so the cost relative will increase. From the manufactory to the store, they are too many employees to work. But, the Baby Kiko no taking too much of employee, because they have using the technology like machine or wholesale to other seller. The cost taking is the transportation fee. At last, which companies keep the lower cost; it may easy and expand the business. Besides that, properly using the raw material and do not simply waste too much. Because the waste will direct influence the cost. Have a good plan of cost leadership, the company more easy to survive in the market share. Nursing Case Study: Osteoarthritis (OA) Management Nursing Case Study: Osteoarthritis (OA) Management Introduction Over 60% of adults in England suffer from a chronic health problem (Department of Health 2004). Osteoarthritis (OA) is among the most common chronic conditions, particularly among older adults, and is a cause of considerable pain and disability among affected individuals. The prevalence of OA has been estimated at 2.5% in the overall population, increasing to 12% among those aged 65 years and over (Wood 1999). OA is a complex condition with multiple risk factors of age, sex, overweight or obesity, genetics, and biomechanical factors (e.g. joint injury or occupational or recreational use). It is possible for OA to develop in any synovial joint but the spine, hip, knee, hands most commonly affected, either in isolation or in combination (Steven and Finlayson 2005). Typical symptoms of OA include joint pain, stiffness, limited movement, crepitus and swelling, and symptoms may be static, relapsing or progressive (Steven and Finlayson 2005). Structural changes within the joint may also oc cur in the absence of any symptoms. OA places a considerable burden on healthcare resources, with data published in 2002 showing this condition to be responsible for over 11 million GP visits and more than 114,500 hospital admissions (Arthritis Research campaign 2002). OA also impacts significantly on the economy. In 1999–2000, it was estimated that a total of 36 million working days were lost due to OA alone, resulting in  £3.2 billion in lost productivity (Arthritis Research campaign 2002). It is therefore important that OA is managed effectively in affected individuals. This paper discusses a patient that I have nursed with osteoarthritis and examines the effectiveness of their care in the management of this condition. Patient case history Mrs Smith is aged 78 years and lives independently in a two-storey house with her husband, aged 82 years, who is her main carer. She has osteoarthritis of the knees, hips and hands and also has hypertension and diabetes. She is taking four medications for these conditions. Eighteen months ago, she underwent emergency hospital admission for a urine infection. After being discharged from hospital, assessment showed her to be at an increased risk of repeated admissions due to her multiple pathology, polypharmacy and previous hospital admission. The care she had received prior to hospital admission was below standard and self-management of her condition was poor. Her GP referred her case management to a community matron who worked alongside a multidisciplinary team of healthcare professionals (I was a member of this team) and her husband to co-ordinate her care and help Mrs Smith reduce her risk of future hospital admissions. The community matron was involved in Mrs Smith’s progra mme of care for a total of two months, after which time co-ordination of her care was handed back to her GP. At the initial assessment, Mrs Smith was found to be experiencing high levels of pain which affected her sleep patterns and showed symptoms of depression. She also reported relationship problems. At present, her pain is being managed effectively through a combination of pharmacological and non-pharmacological interventions which include self-management; she reports normal sleeping patterns and shows no signs of depression. Her relationship with her husband has also improved and Mrs Smith is now no longer at increased risk of future hospital admissions. Managing individuals with chronic conditions The care and management of chronic conditions should address individual needs and expectations. The government has set Public Service Agreement (PSA) targets for improving outcomes for people with chronic conditions. These include reducing emergency bed days by 5% and increasing the number of older adults who are supported to live at home by 1% by 2008, from the 2003/4 baseline (Department of Health 2005). With the aim of meeting these targets, the NHS and Social Care Model was developed to help Primary Care Trusts (PCTs) and social care organisations improve care for individuals with chronic conditions (Department and Health 2005). From 2005, all PCTs are required to provide personalised care plans for those individuals who are most at risk. Initiatives such as the Expert Patient Programme are included in this model and will be discussed later. Providing high-quality care for older adults The NHS Plan set out a programme of reforms for the NHS (Department of Health 2000). Based on the underpinning principles of this plan, the National Service Framework for Older People was implemented to ensure that the needs of older adults are adequately addressed in these reforms (Department of Health 2001). This will be achieved by ensuring high standards of care are provided for all patients, improving access to care, and developing services which promote independence. The Essence of Care, published in 2001, sets out benchmarks for clinical governance covering eight areas of care which identify required standards for high-quality care and indicators for best practice (NHS Modernisation Agency 2003). NHS reforms have led to changes in the role of nurses, providing new opportunities for nurses to extend their existing roles, together with the introduction of new roles such as the community matron in the community setting and modern matrons in the hospital setting (Department of Health 2001). [Client: since we don’t discuss care in the hospital setting elsewhere, I haven’t discussed the role of the modern matron any further] This paper will examine the role of the nurse as part of a multidisciplinary care team in the care of Mrs Smith. Care and management of osteoarthritis in older adults The management of OA in adults becomes increasingly complex with advancing age (Holman and Lorig 1997). Since there is no cure for OA, the main therapeutic goals are to minimise the effects of the disease and over time. Effective care involves building long-term interpersonal relationships between healthcare providers and patients, carers, family members, other care providers, and those organisations involved in providing care and support. A holistic approach to assessment and treatment is required that considers the physiological, psychological and social needs of the individual in relation to their quality of life and daily activities (Salaffi et al. 1991). Both the National Institute of Clinical Excellence and the Royal College of Physicians have recently published guidelines for the care and management of osteoarthritis in adults (National Collaborating Centre for Chronic Conditions 2008; NICE 2008). The care of Mrs Smith will be discussed in the context of the recommendations ma de in these guidelines. Assessment The single assessment process for older adults was introduced in 2000 as part of the NHS Plan (Department of Health 2000). This requires an assessment of the individual’s health and social care needs to take place in a single assessment and was designed to standardise the assessment process and raise standards of assessment practice. During Mrs Smith’s assessment, her concerns, expectations and level of knowledge about her condition were discussed, together with the effect that her osteoarthritis had on daily activities including personal hygiene, climbing stairs, getting up from chairs, etc, and on her sleep patterns. Her levels of pain and mood were also assessed. Mr Smith also participated in the assessment, in order to gain his perspective on his wife’s condition and to establish how well he was coping as her carer, and also to identify any specific health need he might have. Further specialist assessment of Mrs Smith and her ability to undertake daily activi ties, together with an environment assessment, were undertaken by an occupational therapist. Mrs Smith’s level of knowledge about her condition was poor. Three other key issues were also identified during the assessment, namely pain management, depression/anxiety and relationship problems. Mrs Smith reported increasing pain in her joints, particularly her knees and hips prior to her admission to hospital which was so bad she was unable to sleep at night. The care she had been receiving prior to this had not effectively addressed this increasing pain. Screening and assessment showed Mrs Smith was suffering from mild depression. She reported feeling distress that she was no longer able to undertake many household tasks that she used to be able to do or participate in recreational activities with her husband that she used to enjoy. The increasing pain she had been experiencing prior to her hospital admission also contributed to her feelings of depression. She reported feelings of anxiety over fears that she may be made to leave her home as she could no longer manage to c limb the stairs. Mrs Smith showed negative feelings regarding her past care and was initially pessimistic about the likely effectiveness of the proposed treatment in the current care plan. Mrs Smith expressed concern that her relationship with her husband was suffering because her pain and lack of sleep made her irritable and short tempered. An additional factor compounding these problems was her husband’s poor hearing which served to make her more irritable. All of these issues are common among adults suffering from OA (Farmer et al. 2008), and is important that their care plans effectively address these needs. The nurse plays a pivotal role in the assessment of individuals with chronic conditions and it is important for the nurse to establish a successful therapeutic relationship with the patient and their carer(s) as early as possible in the process. Effective communication and building trust is central to this relationship and it is necessary to gain the perspective of both the patient and carer to develop a thorough understanding of individual needs. Development and implementation of a personalised care plan Empowering patients to take part in decisions regarding their care is central to the government’s health service policy agenda (Department of Health 2000). The empowerment of older adults is also addressed in the NSF for Older People (Department of Health 2001). Research suggests that patient empowerment may help to strengthen patient’s ability to self-manage their condition (Corben and Rosen 2005). It is also beneficial to involve families and carers in the decision-making process, with the consent of the patient. A personalised care plan was developed for Mrs Smith with the involvement of both her and her husband, which was tailored to meet her individual goals. This plan enabled high-quality, patient-centred care to be delivered via a multidisciplinary team of healthcare professionals which included her GP, nurse, physiotherapist, occupational therapist and community matron. Social services were also involved in providing additional support for both members of the co uple. Taking account of Mrs Smith’s multiple pathology and polypharmacy and the use of research-based evidence were both of major importance when developing this care plan. Interventions within the care plan and the individual roles of healthcare providers Non-pharmacological interventions The provision of education and advice and muscle strengthening exercises were the two core interventions in Mrs Smith’s care programme. Research has shown that patients frequently report better outcomes when they receive education and advice as this empowers them to become more involved in their own care and equips them with the knowledge and skills required for self-management (Holman and Lorig 1997). Educating both Mrs Smith and her husband about her condition and methods of self-management formed a key component of her care plan and discussions were primarily nurse-led. Encouraging self-management is essential for all chronic conditions and providing a framework for self-management is an integral aspect of care (National Collaborating Centre for Chronic Conditions 2008). The Expert Patients Programme (EPP) was introduced in 2003 following the success of the Stanford Self-management Programme in the United States (Department of Health 2006). Research which provides the rationale for this programme suggests that patients who have trained in self-management have greater confidence and use their skills and knowledge to improve their overall quality of life. These individuals subsequently require fewer healthcare resources, leading to long-term cost savings. Self-management courses are run trained by lay leaders rather than healthcare professionals. To date, the success of EPP in the UK has been limited compared with that of other rehabilitation programmes for chronic conditions (Bethell et al. 2007). A physiotherapist taught Mrs Smith to perform a series of gentle exercises to strengthen the supporting muscles around her knee which she was then able to perform on a daily basis by herself at home. An occupational therapist recommended a number of modifications to Mrs Smith’s home to make performing daily tasks easier. These included the installation of a raised toilet seat and wall bars in the bathroom. The occupational therapist also arranged the provision of shock- absorbing shoes to help reduce the pain in Mrs Smith’s knees and hips. Due to Mrs Smith’s limited mobility, opportunities for visits outside the home were restricted. However, social services arranged for both members of the couple to attend weekly bingo sessions at their local community centre which provided the opportunity for social interaction with other older adults which both members of the couple found beneficial. Pharmacological interventions Oral paracetamol and the use of topical NSAIDs for the knee were prescribed for Mrs Smith. Paracetamol and topical use of NSAIDs are the currently recommended first-line treatments for knee OA (NICE 2008). Paracetamol alone was not sufficient to control Mrs Smith’s high levels of pain in her knees. Since her antihypertensive medication was a calcium channel blocker, the use of NSAIDs were not thought to be contra-indicated and were unlikely to show drug interaction with her other medications (Luque et al. 2006). Following discussions with Mrs Smith, a decision was taken not to prescribe anti-depressants initially but to monitor her symptoms of depression and revise her care plan if necessary. Throughout Mrs Smith’s programme of care, the role of the nurse involved making regular home visits to assess Mrs Smith and her husband. Monitoring the effectiveness of the interventions implemented is essential if the goals identified within the care plan are to be achieved. Regular reviews of the care plan should be made and changes made as required based on the outcome of ongoing assessments. Prior to the involvement of the community matron, Mrs Smith’s GP practice was responsible for co-ordinating her care. The community matron is a relatively new clinical specialist position within the NHS, introduced specifically to provide support for people with long-term complex conditions (Department of Health 2004). Working alongside GPs, community matrons perform various roles which enable patient’s need to be met within the community rather than in hospital (Bassett 2005). The role of the community matron in this instance was in short-term case management. Addressing the carer’s needs Evidence suggests that the health needs of carers are frequently overlooked (Hare 2004). It is also important that carers receive adequate support as feelings of isolation and being unable to cope are common (Department of Health 2004b). Mr Smith’s health needs were assessed during the initial assessment and addressed accordingly. Mr Smith suffered from angina for which he was already taking medication, and poor hearing. A follow-up specialist assessment of his hearing identified the need for a hearing aid which he received. The health of both patient and carer was then assessed by the nurse during subsequent home visits. Success of the care programme Mrs Smith’s care programme had a successful outcome. Her symptoms of depression reduced and her relationship improved once her pain was being managed more effectively and she was able to sleep better. Her mobility improved and confidence increased such that she was able to start taking short walks outside her home with her husband. She was also able to undertake more tasks within the home. Education about her condition led her to realise that OA is ‘not the end of the world’ and that life can still be enjoyable, provided her condition continues to managed effectively. Mr Smith also received support from the healthcare team which helped to re-enforce his role as her main carer and extend his knowledge about his wife’s condition, which better equipped him to care for her effectively. Mrs Smith’s care was delivered using the appropriate frameworks for older adults and those with chronic conditions and was in line with current management guidelines. Osteoarthritis and ageing OA is more common among older adults and will therefore frequently co-exist with other age-related comorbidities such as cardiovascular disease, diabetes and hypertension, as demonstrated in the case of Mrs Smith. Because of this multiple pathology, polypharmacy is common and drug regimens are often complex (Gorard 2006). Polypharmacy may increase the risk of drug-drug interactions and drug-related adverse events. In some cases, drug-drug interactions may counteract the effect of a particular drug (Cotter and Martin 2007). For example, if beta-blocker or angiotensin-converting enzyme inhibitor antihypertensives are co-administered with non-steroidal anti-inflammatories (NSAIDs), the hypotensive effect of these drugs may be reduced due to sodium retention by the NSAID (Luque et al. 2006). Furthermore, older adults may also consume over-the-counter preparations (e.g. vitamins and analgesics) which also have the potential to interact with prescription drugs. Age-related changes in both drug pharmacokinetics and pharmacodynamics may be observed, and increased drug sensitivity may increase the risk of drug accumulation and toxicity in older adults (McGavock 2006). Other factors which should also be considered when prescribing drugs for older adults are (1) cognition – whether the patient is able to understand and follow their treatment regimen; (2) vision visual impairment may prevent them from being able to identify their tablets correctly; (2) ability to swallow or fear of swallowing – some patients may be unable to swallow large tablets or may be afraid to do so for fear of choking. It is therefore very important to ensure that a full drug history is taken for every patient and other relevant factors are also taken into account. Ethical and legal issues in the management of chronic illness NHS funding for individuals with chronic illness has been the subject of considerable controversy in recent years. Advances in medical technology have allowed healthcare providers to considerably prolong the life of many individuals with chronic conditions and this ability, coupled with the increasingly ageing population, have presented an unsolved dilemma of how to provide comprehensive care with limited resources (Waldron 2006). Until recently, some patients have been caught up in a so-called ‘postcode lottery’ whereby drugs and services may be available to individuals living in one region of the UK, but not another. This is considered by many to be against the founding principles of the NHS which was introduced with the vision of providing free medical care for all (Donnelly 2008). While it must be acknowledged that at the time of its conception sixty years ago, no one could have predicted the extent of future increases in population size within the UK, or the shift t owards an increasingly ageing population which have placed an ever increasing burden on services ill-equipped to meet demand. Nonetheless, regardless of the extent of available resources, these should be distributed fairly to all within the population regardless of location or any other factors. Living wills are an issue which may concern individuals with chronic conditions, particularly those receiving end of life care. There may be circumstances in which some individuals may not wish to receive life-prolonging treatment and it is important that decisions and choices regarding their care can be communicated to care providers if they themselves are unable to do so. Allowing individuals to refuse life-prolonging treatment may be viewed by some as a step towards euthanasia which considers the right of an individual to choose when and how to die and which has been the subject of intense debate for a number of years. The NSF for Older People (Department of Health 2001) addresses some of the ethical issues surrounding the care of older adults, in particular infringement of their dignity and unfair discrimination in access to care. This framework includes standards for (1) reducing age discrimination, ensuring that NHS services are provided on the basis of clinical need and that social services do not use age as a barrier to restrict access to services; and (2) treating older adults as individuals and allowing them to become involved in decisions regarding their care (i.e. promoting patient empowerment, as discussed previously). The Evercare programme also addresses the right of older adults to receive high-quality patient-centred care. This programme was introduced in the UK in 2003 after demonstrating success in the United States. It is designed to improve care for older adults who frequently have multiple pathologies and social problems, who may be receiving poor care, and who are often admitted to hospital as emergency admissions for reasons that may have been preventable with higher standards of care. Those patients at highest risk of future hospital admission are identified for enrollment in the programme. A role of the community matron would be in identification of those individuals who may be benefit from this programme and in their case management. The principles of the programme include the provision of personalised, holistic care aimed at promoting independence, comfort and improved quality of life, and avoiding adverse effects of polypharmacy. Conclusions The management of chronic conditions such as OA presents a greater challenge in older adults with multiple pathologies, where successful outcomes may be dependent on a number of co-morbidities. The need for a full understanding of drug-drug interactions and age-related physiological changes is essential for accurate drug prescribing in this group of patients where polypharmacy is common. Effective management of Mrs Smith’s condition was achieved through a combination of self-management and health and social care. Effective care involved a holistic approach to assessment and treatment from a multidisciplinary team of health and social care providers. Within this team, nurses played a pivotal role in the community setting (and were also involved in providing care in hospital setting during her hospital admission). There are a number of ethical and legal issues surrounding the care and management of chronic conditions, particularly in older adults where age discrimination and infringement of dignity have been highlighted as widespread problems. Initiatives such as the Evercare programme have been implemented to address these issues but their success has yet to be demonstrated on a national level. Bibliography Arthritis Research Campaign 2002, Arthritis: the big picture. Arthritis Research Campaign, London. Bassett, S. 2005, Community Matrons: Improving the care of patients with long term conditions, Modernisation Agency. Bethell, H. J. N., Evans, J. A., Turner, S. C., Lewin, R. J. P. 2007, ‘The rise and fall of cardiac rehabilitation in the United Kingdom since 1998’, Journal of Public Health, vol. 29, pp. 57–61. Corben, S. Rosen, R 2005, Self-management of long-term conditions: patients’ perspectives on the way ahead, King’s Fund, London. Cotter, L. E. Martin, U. 2007, Student British Medical Journal, vol. 15, pp. 337–82. Department of Health 2000, The NHS Plan: a plan for investment, a plan for reform. Retrieved 25th July 2008 from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002960 Department of Health 2001, National Service Framework for Older People. Retrieved 25th July 2008 from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4003066 Department of Health 2001, Implementing the NHS Plan – modern matrons: strengthening the role of ward sisters and introducing senior sisters. Retrieved 25th July 2008 from: http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Healthservicecirculars/DH_4004789 Department of Health 2004, Chronic disease management: a compendium of information. Retrieved 25th July 2008 from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_062820 Department of Health 2004, The NHS Improvement Plan: putting people at the heart of public services. Retrieved 25th July 2008 from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4084476 Department of Health 2005, Supporting people with long term conditions. An NHS and social care model to support local innovation and integration. Retrieved 25th July 2008 from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100252 Department of Health 2006, The Expert Patient Patient’s Programme. Retrieved 25th July from: http://www.dh.gov.uk/en/Aboutus/MinistersandDepartmentLeaders/ChiefMedicalOfficer/ProgressOnPolicy/ProgressBrowsableDocument/DH_4102757 Donnelly, L. 2008, NHS at 60: a vision which we still believe. Retrieved 25th July 2008 from: http://www.telegraph.co.uk/news/uknews/2171506/NHS-at-60-A-vision-in-which-we-still-believe.html Farmer, A., Korszum, A., Owen, M. J., Craddock, N., Jones, L., Jones, I., Gray, J., Williamson, R. 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The Nature of Evil in William ShakespeareÂs Othello Essay -- William

William Shakespeare’s Othello uses different and unique techniques in his language to express the nature of evil throughout the play. Verbal twists and the characters most importantly stress the act of evil. Iago, most of all is portrayed as the “villain” or “protagonist in the play. Shakespeare uses this character to set the basis of evil. Each plot point is spiraled further into tragedy due to the nature of Iago and his manipulative language towards the other main characters. Corruption overcomes the Venetian society as Iago uses his crafty skills of deceit. The plan to have Othello turn against the ones he loves is the perfect example of evil’s nature. The power struggle is evident between these two. This situation is the start to Iago’s plan to corrupt the society and take Othello’s place. The root of Iago’s “evil” is jealousy indeed, in turn changing into a power hungry manipulator. Iago is tired of acting like one "courteous and knee-crooking knave" like he always appears to be [I. i. 46]. Since Iago is reluctant to choose to be a master, he is the servant that bites off the fame and "keep yet their hearts attending on themselves," still showing his service to his master but instead is more self-preserving with no attachments at all towards the master [I. i. 52]. Irony is used diligently in Shakespeare’s unique language style. Referred by Othello as “honest Iago”, the irony is very evident in this title. Iago is everything but honest but this proves how easily led and manipulated Othello is. The traits Iago possess are unexpected to a normal villain. He comes across as charming and smart, he can also be referred to a wolf in sheep’s clothing. For example, he knows Roderigo is in love with Desdemona and figures that he ... ...or a most attractive, popular, good-natured, charming, selfish, cold-blooded and utterly unscrupulous scoundrel.” (pp. 333-34) [Grant: Studies in Shakespeare, Houghton, Mifflin and Company, 1886, pp. 205] This excerpt further explains Iago’s nature being exactly how Shakespeare intended yet a little different than what the average reader would think of him. The nature of evil is strictly evident as the play comes to an end, yet it is viewed as an opinion or a theory whether Iago is truly “evil.” Ironically, Iago’s words speak louder than his actions, proving how legitimate Shakespeare’s use of language for the character was. This dynamic use of language is significant because it can alter the thought of the reader whether Iago was truly evil or just using military tactics to better him. Iago and his use of language set the main plot for every characters outcome.

Tragedy Through Misreading in William Shakespeares King Lear Essay

Tragedy Through Misreading in William Shakespeare's King Lear Shakespeare’s tragedy, King Lear, portrays many important misconceptions which result in a long sequence of tragic events. The foundation of the story revolves around two characters, King Lear and Gloucester, and concentrates on their common flaw, the inability to read truth in other characters. For example, the king condemns his own daughter after he clearly misreads the truth behind her â€Å"dower,†(1.1.107) or honesty. Later, Gloucester passes judgment on his son Edgar based on a letter in which he â€Å"shall not need spectacles†(1.2.35) to read. While these two characters continue to misread people’s words, advisors around them repeatedly give hints to their misinterpretations, which pave the road for possible reconciliation. The realization of their mistakes, however, occurs after tragedy is inevitable. Gloucester and Lear, create their eventual downfalls due to their inability to read deceit. Though these characters share the same tragic flaw, the means by which they make their errors is completely different. Gloucester remains a poor reader because he is quick to believe his sense of sight. When his illegitimate son, Edmund, reveals a deceitful letter designed to incriminate Edgar, Gloucester is quick to believe him. â€Å"Abominable villain†(1.2.74) he cries out before he even examines the letter with his reading glasses. Edmund’s trickery is conducted cleverly, but Gloucester’s lack of disbelief is unexplainable. Even though Gloucester is a fundamentally good man he tends to have a pessimistic view on his situation, as well as the rest of the world. Gloucester displays his inability to read and comprehend reality once more when he begins to read the skies. â€Å"... ...able to regain his ability to see but it is during the last act of the play in which the circumstances are completely out of his control. These characters both die because they are pushed way past the limits of human fortitude and competence. When Lear tells Gloucester â€Å"A man may see how this world /goes with no eyes† (4.6.146-47) he displays both of their misfortunes, but it is too late to prevent ultimate tragedy. Shakespeare proposes that their tragic saga is a mere game to the heavens. â€Å"As flies to wanton boys, are we to th’ gods,/They kill us for their sport† (4.1.37-38). This line generalizes the overall simplicity behind the tragedy of King Lear. Even though Gloucester and Lear made terrible, fatal errors the reader feels at the end as if it is intended to be their destiny. Work Cited Shakespeare, William. King Lear . New York: Oxford UP, 1994.

Pfizer Industry Analysis

An Economy and Industry Analysis Focus Industry: Pharmaceutical Industry Focus Company: Pfizer, Inc. (PFE – NYSE) Pharmaceutical Industry Classification The pharmaceutical industry seems to be an intermingling of growth and expansion stage. This is mainly due to the fact that there are so much research and development (R&D) work being conducted in the industry, creating growth in the industry. At the same time, various players in this industry have started to acquire or merge with their respective competitors, in order to expand and diversify product line, market share, or new markets. The worldwide pharmaceutical sales has continued to grow faster than most segments of the world economy – driven by strong demographic trends of the world population: aging population in many countries, lengthening of average life expectancy, and rising incidence of chronic diseases. This industry is a non-cyclical industry, as the products, drugs and medication, are geared towards consumers and markets that are not prone to price changes, inflation, or economy fluctuations. Consumers in the market might lean towards product lines in the lower end of the affordability spectrum, rather than higher end – purchasing generic products in the market. Pharmaceutical Industry Application of Porter’s Five Forces Industry Competitors and Intensity of Rivalry In general, the main competitors for the pharmaceutical industry are Pfizer ($45. 2B in 2003 sales), GlaxoSmithKline ($35. 2B), Merck ($22. 5B), Bristol-Myers Squibb ($20. 7B), Abbott Laboratories ($19. 7B), and Johnson & Johnson ($19. B). However, with the recent spur in mergers and acquisition (M&A) activities in various industries, the pharmaceutical industry had a significant merger in August 2004 between two France competitors – Sanofi-Synthelabo and Aventis – creating Sanofi-Aventis, one of the top three pharmaceutical companies with Pfizer and GlaxoSmithKline. The rivalry among the current competitors in this industry is intense due to the competitive nature of product develo pment and patent profitability. Each competitor is spending billions of dollars in their respective R&D efforts to discover new products and patents to continue the stream of prescribed and over-the-counter drugs produced and sold to consumers in the market. The rivalry is also intense due to the regulation set forth by Federal Drug Administration (FDA) in US and other governmental regulators in various countries of the world, where stringent requirements and scarce allocation of patents are given out to companies developing new drug products. However, due to such intense rivalry, numerous companies have started to merge (like Sanofi-Aventis), or form alliances or joint-ventures in creating new products, to compete with other competitors. Bargaining Power of Buyers In the world of pharmaceutical, the buyers are basically wholesale distributors such as Cardinal Health Inc. , McKesson, and AmeriSourceBergen. These wholesale distributors play the middle-man role in selling and distributing all pharmaceutical products to various buyers like pharmacies, hospitals, HMOs, clinics, and mail-order companies. The concentration of buyers are high due to the fact that there are only a select few key buyers that make huge purchases from all the players in the pharmaceutical industry. As such, buyers do have above average bargaining power that allows the wholesale distributors to dictate the price of the products. However, all the pharmaceutical companies have distributor agreements that help curb the bargaining from being overzealous. Bargaining Power of Suppliers Suppliers to the pharmaceutical industry players are in abundance. The industry does not suffer from scarce resources as the raw materials (both active and inactive ingredients) are always available from various drug ingredient makers and distributors. As such, the suppliers are low in concentration and without much bargaining power. Most of the suppliers are similar and as such, easily interchangeable, without much risk or hassle. With the globalization of economy, the market of available suppliers is even bigger than it used to be – resulting in even lower concentration of suppliers and giving the pharmaceutical industry more power in bargaining for the prices of drug ingredients. Threat from Substitute Products For the brand prescription drugs, the main substitute would be the generics or competitors’ similar prescription drugs. However, this internal threat between competing products does not change the dynamics of drugs that are produce in the safety of patent. The larger threat that the pharmaceutical industry faces is from alternative medicine such as herbal medicine, acupressure, acupuncture, massage therapy, homeopathic medicine, and other growing fads of self-remedy. The effect of alternative medicine is limited however to the critical and chronic degree of the diseases and illnesses that could be treated or prevented. Threat of Potential Entry The threat of potential entry for this industry at this stage (growth and expansion) is definitely low. This is mainly due to the enormously high barrier to entry in obtaining capital and resources for R&D efforts to produce patents. Due to the scarcity of patents and large amount of capital required for the numerous years of research and development, it is close to impossible for new smaller companies to enter this industry at this time. Each of the players in this industry is spending billions of dollars each year just to conduct researches and perform studies, which hopefully will result in the development of an effective and efficient drug that can be patent. Other than that, there are also legal and regulatory obstacles that prevent new competitors, from the FDA and other governmental structures. Other Influencing Forces Due to the nature of the drug products, there is intensive regulatory and legal implication that affects this industry. A good example of how the government and political environment influence and dictate the direction of the pharmaceutical industry is through various regulations by the FDA and Department of Health and Human Services (DHHS), involving patent protection, product approvals, pricing controls, and product liability. The demographic evolvement in the world is another factor that should be considered. As the baby boom generation ages and life expectancy rises, demand for pharmaceuticals are soaring. In the US, seniors aged 65 and older currently represent only 13% of the population but account for 34% of all prescriptions written and more than 40% of drug sales. Approximately 80% of seniors in the US use prescription drugs on a regular basis. According to a United Nations study, the number of people worldwide aged 60 or older will grow from 593 million in 1999 to close to 2 billion by 2050. Recent technological developments and breakthroughs have changed the way new drugs are discovered, how they are tested, the precision that it affects the diseases, and how the drugs are being delivered or distributed to patients. The recent development in stem cell research will definitely create more opportunity for growth in the pharmaceutical industry, especially in the European Union a

Muslim views on medical and sexual questions Essay

Transsexuals are people who believe that their mind is trapped within the body of someone who is of the opposite sex. Many of them who are unable to have the necessary sex organ change operation end up committing suicide. However in the terms of shariah law, it is not allowed for men and women to change their gender to the opposite sex. If one goes against the Shariah law, then he/she will be violating the commandments of the Qur’an and Hadith. The Shariah has also gone to the extent where women are not allowed to dress as men, and men are not allowed to dress as women. It is noted in an Hadith that Prophet Muhammed (pbuh) cursed those men who imitated women and those men who imitated women. If one was to undergo a sex change, then he/she will be altering the natural features and organs that Allah had blessed them with. Many patients have problems with their sex lives, so they seek the help of a doctor or in such cases, they are recommended to go to sex counselling sessions. However it is not allowed for Muslim physicians to engage such conversations. If a husband and wife had problems in their sexual lives, then they would consult a doctor of their own sex. They should then give a broad outline of their problem and not go into such detail. The Muslim doctor would not be allowed to find out such explicit details or show the patient videos that demonstrate such sexual acts. However during sexual therapy lessons, explicit video films which demonstrate such explicit acts may be shown to the patient. It is totally against the Shariah Law for the patient to watch such explicit acts. Some people take advantage of mentally retarded people by having sex with them. So in order to reduce the chance of them falling pregnant, they can be sterilized. This is cause due to their mental state, they would be unable to care for the child. Methods of contraception such as the use of pills can be used instead of using the method of sterilisation as it would mean that all chances of a future hope of pregnancy will be lost. It is not allowed for the mental patient to be castrated but medicine can be administrated which would suppress their sexual urges. Recent studies show that homosexuality is genetically inclined. In Islam, homosexuality is forbidden so it is merely a plot from Shaytaan who’s aim is to make homosexuality more acceptable in our society. The main duty of a Muslim psychiatrist is dissuade his/her patient from indulging in such haram acts. The act of homosexuality has been condemned in the Qur’an and Hadith. Brain-stem death is accepted in the field of medicine as doctors have been entrusted in confirming that a person is dead. In Islam, a person is only considered dead when his soul has left its body. The body then becomes cold and stiff. If left for a long period of time, then the body begins to decompose. If these signs are visible, then the person is considered to be dead in terms of the Shariah. If these signs are not visible, then the person is not considered to be dead. In this case, whether a brain-stem dead person is dead or not is not relevant. In either case, the persons organs are not allowed to be removed from the body. The organs and limbs of a deceased person belongs to Allah, so the person has no right in deciding as to whom his organs are donated to. If a fellow human is dying and the only option of survival is of eating another humans limb and another human gladly offers the too, it will not be allowed.