Red Bull Marketing Analysis

Red Bull is the leader of the energy drink market. This company created in 1984 by Dietrich Mateschitz performs an annual turnover of more than 3 billion Euros. As we will see in this report, polemics, nonconformist, genius marketing are, among others, the ingredients that made Red Bull the star product of Energy Drink Segment in the world. For more than 20 years, Red Bull has managed to establish itself brilliantly in the world, which, despite the widespread economic gloom, has always taken a growing interest for this new drink. In this report, we will analyse Red Bull and the environment in which the company evolves, its target and positioning trough marketing tools. It will enable us to understand how Red Bull managed to reach its leader position and to think about some recommendations to further improve its strategy. Why did we choose Red Bull? Most of the people have one day see or heard about the brand Red Bull. Red Bull is an energy drink that comes from the adaptation of the Thai energy drink â€Å"Krating Daeng†, which means â€Å"Red Bull†. There are several reasons that explain why we choose Red Bull Company. The first reason of our choice results in a cultural factor. In fact Red Bull is a product that is targeting young customers. It means that, students are the most concerned by Red Bull so this is a product that can affect any of us. Besides it is a â€Å"trendy product† in others words a fashionable product: nowadays everyone has already tasted a Red Bull. The second reason that pushes us to choose Red Bull Company was because of their Marketing communication, which is revolutionary. Some observers say that Red Bull uses an â€Å"anti-brand† strategy. In fact, the company avoided usual methods of marketing, relying more on what is called ‘buzz marketing' or word-of-mouth: â€Å"viral marketing†. A brand image was created and cultivated which associated the drink with youth culture and extreme and adventure-related sports, such as motor sports, mountain biking, snowboarding†¦ In addition, we also choose Red Bull because without Red Bull there would not even be a market for the other products currently crowding the shelves. Thus, sales of the drink grew quickly from the beginning and Red Bull dominates the world’s energy-drink market with a 40% market share. Finally, what influences our choice too, was because Red Bull even being the leader has to face on how to build on its incredible sales growth and about all, and has to face the health issues concerning the effects of drinking Red Bull. Executive Summary A thorough analysis of Red Bull concludes that the company was set up the Energy Drink Market thanks to its own product, Red Bull energy drink. In fact, without Red Bull there would not even be a market for the other products currently massing the shelves. Now Red Bull is energizing people around the globe, touching down in over a hundred countries worldwide. The Red Bull consumers can be divided into two segments: Students (and Clubbers) and workers. Each of them uses the Red Bull energy drinks to meet their personal needs. At the same time they can obtain physical edges, mental edges or just consumption for pleasure. The ambitions of Red Bull are: maintaining the top-brand status in the energy drink market and clearly distinguish themselves from their competitors, who are marketing almost the same product but with extremely low prices. Red Bull uses every ways of marketing to reach their target groups. Their marketing is mainly based on the â€Å"3 pillars of Red Bull: Sampling, Advertising and sponsoring†. In this way Red Bull is not just promoting their energy drink but is also selling a lifestyle, seemingly people are willing to be a part of this Red Bull extreme sports lifestyle. Due to these extensive marketing efforts Red Bull obtained, and still is maintaining, the largest market share (70%) in the energy drinks market. As initiator of the energy drinks market, Red Bull holds a truly unique product. However the competition is high. Their main objectives are: maintain the lead and expand the market to Asia and Western Europe. To achieve these objectives they can create new products â€Å"Black Red Bull† and focus on new target group such as the younger’s (13-15) and the older (35-50). Company Presentation Dietrich Mateschitz founded the company Red Bull GmbH in 1984. GmbH is the German equivalent of a limited liability company; it stands for ‘Gesellshaft mit beschrankter Haftung'. The company's origins, though, lie in the owner's time spent in Asia. He came across products known as ‘tonic drinks' and saw the chance to market functional drinks outside Asia. One of these tonics, which came from Thailand and was used by workers to stay awake during their shifts, was called Krating Daeng or ‘Red Bull'. Mateschitz approached the manufacturers of the drink and bought the foreign licensing rights in exchange for a 51% stake in his company. When Mateschitz launched the drink in his native Austria, he decided to target young professionals, rather than factory workers, as this younger segment of the population was more affluent and more appreciative of a trendy marketing campaign. The Austrian market has been the first to commercialize the blue and red can with its famous slogan â€Å"It gives you wings†. Today, Red bull company has a turnover of 3 billion euro a year which increased of 7,9% in 2008. The drink is present in 160 countries in the world and it’s the third soda drunk in Europe just behind Pepsi and Coca. Red Bull operates within the energy drinks sector of the soft drinks market. This product is an example of a ‘functional' drink. Functional foods respond to consumer interest in well being and performance. The major multinational soft drinks companies are investing in the area of functional drinks, developing their own brands and buying up existing ones. This is seen as being important, given that their traditional soft drinks markets are at the maturity stage in many countries. For these multinationals, new functional drinks offer opportunities for renewed business growth. Nevertheless, the product was forbidden in some European countries because of the taurine effects and a high rate of caffeine with the European precaution law. But for a few years, mentality evolves and countries are more open-minded and could commercialise this product. In 2010, Red bull is present in 25 European countries but not yet in Denmark for health safety as the Canada. This drink is supposed to give energy to the costumer thanks to a mixture of different ingredients (caffeine, guarana, taurine). The main target is the teenagers and young adults (16-35 years old). We can observe that, it would be pertinent to target teenagers in order to appeal more consumers of energy drink. This drink is sold four times more expensive than others drinks; today it’s  £ 1,60. We can find this product in shops but also in nightclubs. Red Bull has an aggressive international marketing campaign. The numerous sponsored activities range from extreme sports like windsurfing, snowboarding, skateboarding, kayaking, wake boarding, cliff diving, surfing, skating, freestyle motocross, rally, Formula 1 racing (World Champion 2010), and break dancing to art shows, music, and video games. In keeping with their target market of young males, Red Bull has also enlisted help from celebrities, such as Eminem that would appeal to this group (sponsoring the Red Bull â€Å"Em See Battle Rap championships†). It also hosts events like the Red Bull Flugtag and other such contests. Red Bull also sponsors soccer teams, with clubs in Austria, Germany, The United States and Brazil featuring the Red Bull trademark in their names. By associating the drink's image with these activities, the company seeks to promote a â€Å"cool† public image and raise brand power. In addition, the slender container is used to suggest a â€Å"sexier† image than some other cola counterparts. The Red Bull brand is associated with a designer image, energy-giving properties and glamorous lifestyles. These brand qualities have been developed through company sponsorship of sporting activities such as: motorsports, winter sports, base jumping, mountain biking; and cultural events such as the Red Bull Music Academy.

Bio-Psychosocial Model of Health and Illness

BIO-PSYCHOSOCIAL MODEL OF HEALTH AND ILLNESS INTRODUCTION The medical model has been the predominant approach used by physicians in diagnosing and management of diseases and illness in most Western countries. The biomedical model of illness and healing focuses on purely biological factors, and excludes psychological, environmental, and social influences. According to this model, good health is the freedom from pain, disease, or defect. It focuses on physical processes that affect health, such as the biochemistry, physiology, and pathology of a condition.It does not account for social or psychological factors that could have a role in the illness. In this model, each illness has one underlying cause, and once that cause is removed, the patient will be healthy again, (Alloy, Jaconson,& Acocella,(1999). The bio-psychosocial model of understanding disease process arose from the context of changing conceptualisations of mind and body and the emergence of new fields of enquiry, including h ealth psychology, medical sociology, behavioural medicine and psychoneuroimmunology, Barlow,D.H. & Durand V. M. (1999). According to Engel (1977, 1980), human beings are complex systems and illness can be caused by a multitude of factors, not just a single factor such as a virus or bacteria. This is an attempts to move away from a simple linear model of health, to assess the effects of the combination of factors involved in illness, that is; biological (for example, virus & genes), psychological (for example, stress, behaviours, & beliefs) and social/environmental (for example, employment & neighbourhood).Engel (1977) argued that the best and most effective way of dealing with disease and illness is by the application of the three approaches that are related to human health. According to him the three interact in a very complex way and all play a significant role in human functioning in the context of disease and illness. Health is therefore better understood and managed when the th ree approaches are combined rather than handling it from a purely biomedical perspective.The biopsychosocial model of understanding diseases and illnesses is also similar to the World Health Organization’s definition of health ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO, 1946). BIOMEDICAL MODEL The biological model was the leading approach of understanding diseases and illnesses since the 19th century. It gained strength from researches in physiology and medicine that led in identification of infectious agents that cause diseases,(Maher & Maher,1985). It evolved from a Greek physician Galen’s germ theory concept of pathogens in 200 AD.He declared pathogens as the sole disease causing agents. The medical model therefore aimed at doing researches to identify all pathogens that caused diseases for the purpose of providing the right diagnoses for different diseases. For the proponents of this model, every illness is a symptom of a particular disease which has also been caused by a particular pathogen. The model also later focused on normalizing genetic related abnormalities and injuries. The model therefore focused on the physical processes such as the pathology, the biochemistry and physiology of disease and illnesses (Hoeksema, 2001).The biomedical model uses the traditional reductionist biomedical model of medicine that presumes that every disease process can be explained in terms of an underlying deviation from the normal function such as a pathogen, genetic or developmental abnormality or injury,(Sarno:1998). This argument presumes that illness is always due to abnormalities in the body's working systems. It is the basis of modern Western medical practice. It works on the theory that every bodily malfunction has an identifiable and diagnosable physiological cause that can also be managed or treated using the conventional medicine.The biomedical model tends to t ake a curative approach to illness (Price,1978). According to Sarason & Sarason, (2005). Biomedical approach focuses its attention on physical symptoms and therefore the normal physical state is a state of being whole and without any physical, mental disease and free from any pain, so that all the parts of the body can carry on their proper functions fully. According to Alloy, Jaconson, and Acocella (1999), the biomedical model compares abnormal behavior to any other disease and therefore has specific causes and specific set of symptoms.Therefore the medical model also implies that the abnormal behaviour is biogenic, that is, it results from a malfunction within the body especially the brain. This suggests that psychological symptoms are due to structural abnormalities in the brain’s neurotransmitter systems, or faulty genes. Biogenic theories of abnormal behavior have been in existence since ancient times. In the middle ages and the renaissance, they coexisted with supernatu ral theory which believed that abnormal behavior was caused by God or more often by the devil (Hoeksema, 2001).In the eighteenth and early nineteenth centuries, religious explanations were gradually replaced by biological explanations. The newly dominant medical approach was soon strengthened by a series of important breakthroughs which was done through biomedical researches and therefore several previously unexplained behavior patterns were found to result from brain pathologies((Hoeksema, 2001). Such discoveries strengthened greatly the biogenic theory of abnormal behavior. Medicine was therefore increasingly assumed would ultimately discover the cure for ‘madness’ as it was commonly called.On this assumption, any case of mental abnormality was referred to a medical professional, (Alloy, Jaconson, Acocella,(1999). According to the proponent of this model, the abnormal behavior should best be handled by physicians in hospitals and by means of drugs and that the whole p roblem of deviant behavior should be conceptualized in medical terms such as symptoms, syndromes, pathology, mental illness, patient, diagnosis, treatment and cure,(Price,1978). EVALUATION OF THE MEDICAL MODEL STRENGTHS:The medical model introduced objectivity in the understanding and management of diseases and illnesses by applying scientific methods of research, diagnosis and treatment. The model has also given insight into the causes of some conditions, such as Alzheimer's disease, an organic condition causing confusion in the elderly, (Alloy, Jaconson, Acocella, (1999). According to Sarason, & Sarason (2005), by use of the biological model, treatment is quick and, relative to alternatives, and sometimes cheap and easy to administer.It has proved to be effective in controlling serious mental illnesses like schizophrenia allowing patients who would otherwise have to remain in hospital rather than to live at home. Finally the sickness label has reduced the fear of those with mental disorders. This is because historically, they were thought to be possessed by evil spirits or the devil, majority of them especially women, who were burned as witches, (Maher, & Maher: 1985). CRITICISMS OF BIOMEDICAL MODEL One of the critics of biomedical model of mental illness was Thomas Szasz.In his book â€Å"The Myth of the Mental Illness’ (Szasz, 1961), he postulated the so called most of what was commonly referred to as mental illnesses were merely ‘problems in living’. According to him the whole concept of mental illness was a myth as it could not withstand the laid down biomedical diagnostic procedures. For Szasz, psychiatrists over-relied on social criteria rather than medical standardized procedures to diagnose mental disorders. He argued that mental assessment relied on the patient’s coping skills for example, with families, friends and social responsibilities to determine a disorder ((Szasz, 1961).Szasz argued that psychiatric diagnosis, was unlike physical diagnosis all about social judgment. According to Szasz, the ‘sick’ label also deprives people of the responsibility for their behavior and relegates them to a passive role that makes it hard for them to return to the normal behavior. After many years in the biomedical research, evidence shows there still remained many patterns of abnormal behavior for which no medical causality was identified, yet the biomedical researchers were confident that such causes were eventually to be found,(Price,1978).Biomedical model does not take into account the role of social factors or individual subjectivity in diagnosis and treatment of diseases and illnesses. The model overlooks the fact that the diagnosis (that will affect treatment of the patient) is a result of negotiation between the doctor and the patient, (Annandale,1998). Using reductionism method of both research and diagnosis in the biomedical model, the model attempts to reduce the explanations of health an d illness to the smallest possible factors.Nevertheless human beings and ill-health are not this simple. There may be a lot of different causes from social to psychological to genetic. The biomedical model is a single-factor and therefore looks for the cause, rather than a range of contributory factors, (Alloy, Jaconson, Acocella, 1999). Using biomedical model, there lacks the mind-body distinction. The mind and body are considered separately and they do not affect one another, which research has proved is not the case. Health is traditionally equated to the absence of disease.A lack of a fundamental pathology was thought to define one's health as good, whereas biologically driven pathogens and conditions would render an individual with poor health and the label â€Å"diseased†. However, such a narrow scope on health limited our understanding of wellbeing, thwarted our treatments efforts, and perhaps more importantly, suppressed preventive measures, (Sarno, 1998). PSYCHOLOGIC AL MODELS OF UNDERSTANDING TO DISEASE PROCESSES In contrast to the medical model, thoughts, feelings and behaviours affect our health and well-being.Recognition of the importance of these influences on health and disease is consistent with evolving conceptions of the interactions between the mind and the body and represents a significant change in medicine and the life sciences,( Baum & Posluszny, 1999). There are psychological theories that argues that the mind prays a pivotal role in matters related to diseases and illnesses. According such theories, disturbed or abnormal behavior for example may be explained physiologically and also psychologically.Conditions like Schiszophrenia and depression have both physiological and psychological explanations of causality and management. Some of the psychological perspectives of that deal with health and well-being of human beings are; The Psychodynamic Perspective: Psychodynamic approach to abnormal behaviour assumes that abnormal behavior arises or originates from unconscious unresolved psychological conflicts. According to Sigmund Freud(1925) behaviour is motivated by internal or psychological forces. Abnormality according to him is caused by an imbalance in the internal forces that motivate behaviour.He believed that mental illness arises from unresolved conscious conflicts, which usually occur in early childhood According to Freud, the unconscious forms about 90% of the human mind, and the remaining 10% is conscious. People are not able to access the contents of their own unconscious mind. Traumatic memories, inappropriate desires, and unresolved conflicts are buried in the unconscious mind by ego defense mechanisms such as repression. The contents of the unconscious mind for example, a childhood trauma, may still influence behaviour and this can lead to abnormality (Santrock,2007).According to psychodynamic proponents, another source of abnormality arises from extremes either from id or from the superego; Weak eg o: According to psychodynamics, the well adjusted people have a strong ego, that is, they able to cope with the demands of both the id and the superego by allowing each to express itself at appropriate times. If, however, the ego is weakened, then either the id or the superego, whichever is stronger, may dominate the personality leading to deviant behavior and neurotism.Unchecked id impulses: Freud argued that, if id impulses are unchecked they may be expressed in self-destructive and immoral behaviour. This may lead to disorders such as conduct disorders in childhood and psychopathic behaviour in adulthood. Too powerful superego: According to Freund, a superego that is too powerful, and therefore too harsh and inflexible in its moral values, will restrict the id to such an extent that the person will be deprived of even socially acceptable pleasures. According to him this would create neurosis, which could be expressed in the symptoms of anxiety disorders, such as phobias and obses sions.The Behaviourist Perspective This approach believes that behavior is learned based on reinforcement. Therefore it is sustained its consequences. Therefore the maladaptive behavior is learned through reward while it can also be relearned, (Slavin, 2003). The proponents of this model argues that deviant behavior can be managed through; Shaping: This involves guiding behavior toward goals by reinforcing the many steps that lead to success. Extinction: This approach involves removing reinforcers from previously learned behavior until the behavior disappears.Extinction burst: This process involves the increase in levels of behavior in the early stages of extinction. Positive reinforcement: This a technique of sustaining a desired behavior for example, applying praise after doing something desirable. Negative reinforcement: this is a technique of escaping from an unpleasant or a way of preventing unpleasant behavior from occurring. Punishment – consequences that weaken behavi or; punishment like reinforcement is in the eye of the receiver and the impact on behavior, (Slavin, 2003). Cognitive Theoretical Model:The cognitive perspective maintains that peoples’ way of interpreting situations determine their emotional and behavioral symptoms,(Hoeksema, 2001). Abnormal behavior is a product of negative or erroneous thinking and perception about oneself and of the environment. The proponents of this theory argue that the human being is not a passive organism, but is capable of processing information and comprehend the relationship between cause and effect. According to Beck (1921), maladaptive behavior may result from faulty or distorted interpretation of the reality.Therefore false or negative view of the world can easily lead to illness or abnormal behavior. For example, a negative view of oneself can lead to negative interpretation and negative expectations of the future. These negative belief systems and erroneous view of the world can lead to depre ssion, (Halligan,& Aylward,(Eds. ) 2006). Accord to Albert Ellis (1959), the goal of cognitive therapy is to help people change their irrational beliefs into rational beliefs. This is done by the therapist creating insights in a person’s mind through the process of disputing the client's irrational beliefs, (Santrock,2007).Humanist Model of Abnormal Behaviour According to the humanistic approach and existentialists theories, symptoms of abnormal behavior arise when people are not allowed to pursue their full potential and instead they are made or try to conform to others wishes,(Hoeksema,(2001). According to Carl Rogers, â€Å"The organism has one basic tendency and striving: to actualize, maintain, and enhance the experiencing organism† (Rogers, 1951). According to him, abnormal behavior can be managed through working to remove incongruences, defense mechanisms, and developing positive personal self-regard.SOCIOCULTURAL APPROACHES Interpersonal theorists focus on the role of interpersonal relationships in shaping normal and abnormal behavior. Family system theorists suggests that abnormality among individual family members is the result of dysfunctional patterns of interaction within families that encourage and maintain psychopathology,(Hoeksema,2001). Social structural theorists on the other hand focus on the influence of structural factors in the environment and cultures on individuals’ behavior, (Barlow & Durand,1999). The Role of Psychological State in health mattersCurrent psychological researches especially in the field of Psychoneuroimmunology (PNI), indicate that psychological state can influence the body immunity through the nervous system. The studies suggest that, not only can psychological state influence health, but beliefs may also influence health directly. In particular, research has focused on the capacity of psychological factors (such as mood, thought suppression and stress) to modify immune functioning,(Ogden, 2004). A ccording to various studies, positive mood is associated with better immune functioning, whereas negative mood is associated with poorer immune functioning (Stone et al. 1987). Humour appears to be particularly beneficial (Dillon, Minchoff & Baker, 1985). Certain coping styles (such as suppression and denial) may relate to illness onset and progression (e. g. Kune et al. , 1991), while thought expression through writing or disclosure groups may improve immune functioning,(Pennebaker et al. , 1988; Petrie, Booth & Pennebaker, 1998). Kiecolt-Glaser and Glaser (1986) argued that stress causes a decrease in the hormones produced to fight carcinogens (factors that cause cancer) and repair DNA.In particular, cortisol decreases the number of active T cells, which can increase the rate of tumour development. This suggests that experiencing stress while being ill could exacerbate the illness through physiological changes. So if the illness itself is appraised as being stressful, this itself may be damaging to the chances of recovery. According to Ogden (2000), chronic illnesses, such as asthma, AIDS, cancer, coronary heart disease and multiple sclerosis, are another important areas of health that research indicates that psychological factors play important role.Coronary heart disease (CHD) for example, is caused by hardening of the arteries (atherosclerosis), which are narrowed by fatty deposits. This can result in angina (pain) or a heart attack (myocardial infarction). CHD is responsible for 33 per cent of deaths in men under 65 and 28 per cent of all deaths. It is the leading cause of death in the UK, killing 4300 men and 2721 women per million in 1992. It has been estimated that CHD cost the National Health Service in the UK about ? 390 million in 1985/86, (Ogden, 2000).Many risk factors for chronic heart disease which are modifiable have been identified, for example, smoking, alcohol, obesity, sedentary lifestyle, perceived work stress and high blood pressure. Acc ording to Friedman and Rosenman (1959,’78) type A behaviour is characterized by excessive competitiveness, vigour, energy, alertness, confidence, loud speaking, rapid speaking, tense clipped speech, impatience, hostility, interrupting, frequent use of the word ‘never’ and frequent use of the word ‘absolutely’, In the 1980s Karasek developed a job demand/job control model of stress.He proposed the ‘job demand control hypothesis’, whose aim was to reduce job strain. According to Karasek and Theorell, (1990), there are two aspects of job strain; job demands and job autonomy (which reflects the person’s control over the speed or the nature of decisions made within the job). Karasek’s hypothesis suggests that high job demands and low job autonomy predict CHD. He later in his included the concept of social support, which he defined in terms of emotional support (trust and social cohesion between co-workers) and instrumental socia l support (the provision of extra resources and assistance).All the above conditions involve in their therapy psychological related techniques that includes; exercises, behavior modifications and cognitive therapies. A Multi Perspective Approach to Disease and Illnesses The model recognizes four systems centered on the person; organs, the whole person, behaviour, and social role function. It also considers the four contextual factors that influence these systems, that is; personal factors, physical environment, social environment, and time.This model also draws attention to two important components of any holistic model of health, choice (free-will) and quality of life, (McKeown,1979), This approach advocates the importance of looking at health and human behavior from scientific, psychological and social cultural approach. According to this model abnormal behavior is therefore effectively dealt with from these three points of view. Psychologically the unobservable events of the mind , such as attitudes, memories, and desires are unquestionably involved in most of psychopathology(Alloy, Jacobson &acocella,1999).According to Ndetei(2006), Culture and religion also play an important role in the development and management of psychopathology. Over the last century, health behaviours have played an increasingly important role in health and illness. This relationship has been highlighted by McKeown’s book, The Role of Medicine (1979), which discusses the decline of infectious diseases in the nineteenth century, which forms the focus for medical sociology. It also highlights the increasing role of behavior in illness in the twentieth century.The commonly held view is that the decline in illnesses such as TB, measles, smallpox and whooping cough was related to the development of medical interventions such as chemotherapy and vaccinations. But McKeown showed that the decline in infectious diseases had already begun, before the development of medical interventions. He claimed that, looking back over the past three centuries, this decline is best understood in terms of social and environmental factors. McKeown also examined health and illness throughout the twentieth century.He argued that contemporary illness is caused by an individual’s own behaviours, such as whether they smoke, what they eat and how much exercise they take, and he suggested that good health was dependent on tackling these habits. It has been suggested that 50 per cent of mortality from the ten leading causes of death is due to behaviour. If this is correct, then behaviour and lifestyle have a potentially major effect on longevity. For example, Doll and Peto (1981) estimated that tobacco consumption accounts for 30 per cent of all cancer deaths, alcohol 3 per cent, diet 35 per cent, and reproductive and sexual behaviour 7 per cent.Approximately 75 per cent of all deaths due to cancer are related to behaviour. More specifically, lung cancer (the most common form) acco unts for 36 per cent of all cancer deaths in men and 15 per cent in women in the UK. It has been calculated that 90 per cent of all lung cancer mortality is attributable to cigarette smoking, which is also linked to other illnesses such as cancers of the bladder, pancreas, mouth, larynx and oesophagus, and to coronary heart disease.And bowel cancer, which accounts for 11 per cent of all cancer deaths in men and 14 per cent in women, appears to be linked to diets high in total fat, high in meat and low in fibre, Doll and Peto (1981). In summary The proponents of the biopsychosocial model argue that the biomedical model alone does not take into account all of the factors that have an impact on a patient's health. Biological issues, as well as psychological factors such as a patient's mood, occupation, intelligence, memory, level of education and perceptions are all considered when making a diagnosis.The biomedical approach may not, for example, take into account the role sociological factors like family, social class, or a patient's environment may have on causing a health condition, and thus offer little insight into how illness may be prevented. A patient who complains of symptoms that have no obvious objective cause might also be dismissed as not being ill, despite the very real effect those symptoms may have on the patient's daily life.The biopsychosocial model of understanding disease process accomplished a milestone that brought about a dramatic shift in focus from disease to health, recognizing that psychosocial factors (for example; beliefs, relationships, and stress) greatly impact recovery, the progression of and recuperation from illness and disease. While the traditional biomedical models of clinical medicine focused on pathophysiology and other biological approaches to disease, the biopsychosocial approach emphasize the importance of understanding human health and illness in their fullest contexts. CONCLUTION:This model recognizes human beings as co mplex systems and illness can be caused by a multitude of factors, not just a single factor such as a virus or bacteria. Biopsychosocial model therefore attempts to move away from a simple linear model of health and looks at the combination of factors involved in illness; biological (for example, a virus), psychological (for example, behaviours, beliefs) and social (for example, employment). Since in biopsychosocial model , illness is regarded as the result of a combination of factors, the individual is no longer simply seen as a passive victim of some external force, such as a virus.Acknowledging the role of behaviours such as smoking, diet, exercises and alcohol, for example, means that the individual may be held responsible for their health and illness. From this perspective, health and illness exist on a continuum. Rather than being either healthy or ill, individuals progress along a continuum from healthiness to illness and back again. The biopsychosocial model of understanding disease process maintains that the mind and body interact, and therefore it considers psychological factors as not only possible consequences of illness but as contributing to all the stages of health, from being healthy to being illness.Current Application of Biopsychosocial Model: The biopsychosocial model of illness seems to be a significant advance upon the biomedical model of illness. It has been used as the basis of a system for classification of various aspects of illnesses as found in various diagnostic tools for example, Diagnostic and Statistical Manual of Mental Disorders(DSM), and the International Statistical Classification of Diseases. The apply the biopsychosocial model of diagnosing diseases and illnesses and have therefore become the international criteria for mental illness.REFERENCES 1. Alloy, L. B. , Jaconson,N. S. , Acocella,J. (1999). Abnormal Psychology: Current Perspectives (8th. ed). Boston: Mcgraw-Hill . 2. Barlow,D. H. & Durand V. M. ,(1999). Abnormal Psy chology: An Integrative Aproach. Boston:Core Publishing House. 3. Baum, A. & Posluszny, M. D. ,(1999). Health psychology: Mapping biobehavioral contributions to health and illness. Annual Review of Psychology, 50, 137–163. 4. Bruns D, Disorbio J. M. , (2006). Chronic Pain and Biopsychosocial Disorders. Practical Pain Management, March, volume 6, issue 2. 5. DiMatteo, M.R. , Haskard, K. B. , & Williams, S. L. , (2007). Health beliefs, disease severity, and patient adherence: A meta-analysis. Medical Care, 45, 521-528. 6. Doll R, Peto R. Mortality in relation to smoking: 20 years' observations on male British doctors. Br Med J. 1976 Dec 25;2(6051):1525–36. 7. Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science;196:129-136. 8. Frankel, R. M. , Quill, T. E. , McDaniel, S. H. (Eds. )(2003): The Biopsychosocial Approach: Past, Present, Future. Rochester :University of Rochester Press. . Gatchel, R. J. & Oordt, M. S. , (2003). Clinical health psychology and primary care: Practical advice and clinical guidance for successful collaboration. American Psychological Association: Washington, D. C. 10. Halligan, P. W. , & Aylward, M. (Eds. ), (2006). The Power of Belief: Psychosocial influence on illness, disability and medicine. Oxford University Press, UK. 11. Hoeksema, S. N. , (2001). Abnormal Psychology (2nd ed). Boston: McGraw Hill. 12. Maher, B. A. , & Maher, W. B (1985). Psychopathology: From the Eighteenth Century to Modern Times.In G. A. Kimbe & K. Schlesinger(Eds), Topics in the history of psychology(295-329). 13. McKeown’s book, The Role of Medicine (1979), The Lancet, Volume 371, Issue 9613, Pages 644 – 645, 23 February 2008. 14. McLeod, S. A. , (2008). Medical Model – Treating Mental Disorders. http://www. simplypsychology. org/medical-model. html 15. Ndetei D. MSzabo,C. P. ,Okasha,T. ,J. M. ,(2006). The AfricanTextbook of Clinical Psychiatry and mental Health. Nairobi: The African medic al and Research Foundation (AMREF). 16. Ogden, J. (2012).Health Psychology: A Textbook (5th ed. ). Maidenhead, UK: Open University Press 17. Price, R. H. , (1978). Abnormal Behaviour: Perspectives In Conflict(2nd. ed. ). New York: Holt, Renehart and Winstorn. 18. Slavin R. E. , (2011). Educational Psychology: Theory and Practice (10th Edition). ISBN-10: 0137034350. 19. Santrock, J. W. ,(2007). A Topical Approach to Human Life-span Development (3rd ed. ). St. Louis, MO: McGraw-Hill. 20. Sarason, I. G. & Sarason B. R. ,(2005). Abnormal Psychology: The Problem of maladaptive Behaviour(11th. d. ). New Delhi: Prentice-Hall of India. 21. Sarno, J. E. (1998). The Mind-body Prescription: Healing the Body, Healing the Pain. Warner Books. ISBN 0-446-52076-4. 22. Stone, A. A. ,Bovbjerg,D. H. ,Neale, J. M. , et (1992). † Development of Common cold Symptoms following experimental rhino virus†Behavioral Medicine. Fall,115-120. 23. Szasz, T. S. , (1961), The Myth of Mental Illness, New York: Holber-Harper, 24. World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946.

Obesity and Genetics

Obesity is characterized by a high amount of body fat or adipose tissue. This condition is common, but varies from individual to individual. There are other factors that play a role in obesity other than eating too much of the wrong foods, not exercising, or age, and gender. This factor is genetics. People with genetic risk factors that affect energy metabolism and result in an inborn susceptibility to gain weight are much different than a person who loses weight normally. Most people don’t understand that obesity can be caused by a genetic disorder that they have no control over. People that suffer from obesity are looked down upon by society because people consider them lazy or unable to control themselves around food, when actually they may eat healthier diets than an average size person does and exercise more frequent as well. People that are obese are greatly discriminated against, their denied employment because their considered a health risk, their also denied positions that are public related such as bus’s and cabs, airplanes, as well as amusement parks, and people treat them as social failures because of this. Obese people can’t walk outside of their homes without being gawked at or harassed and hurt verbally. This making it harder for them to cope with their disorder and just to avoid the criticism most isolate them self’s from the world, psychologically leading to depression, feelings of rejection, or shame, and anger issues, as well as unhealthy living and socialization skills. Motivation is dissipated and social interactions may become limited as a result. References: Obesity and Genetics. (2005, January 1). Retrieved from http://www.medicalmoment.org/_content/risks/jan05/286751.asp

Connection Between Human and Nature Research Paper

Connection Between Human and Nature - Research Paper Example However, over the years, this connection between man and nature is seen to have been steadily dwindling as a result of scientific and technological innovation. Humans in some degree are trying to segregate and themselves from nature either through alternative ways of satisfying his or her basic needs. Personally, I ascribe to the school of thought that advances the theory that humans are part of nature and that a connection between the two exists. However, other schools of thought advance the theory that humans are only God’s creation and do not have any connection with other animals or nature at large. For this reason, I am motivated to attempt and create artistic impressions that communicate, support and will be able to remind the whole universe how important our connection with nature is, especially in these times of persistent natural disasters. Almost each and everyone living human being depend on nature by consuming the products of nature for survival. For instance, in m y culture, an essential or staple food for humans is rice which is a product of nature which keeps people of my culture connected to nature. I will utilize rice and its various characteristics in an artistic way to try and illustrate the connection humans have with nature. In addition, I will also investigate works by other prominent contemporary and historical artists that have illustrated in one way or the other, the connection between humans and nature. Discussion One day as I sat in my room looking at my roommate who spends almost all his days and nights seated on a chair playing computer games and consuming un-natural junk food, and barely steps out of the room, an inkling struck me. Is there a connection between humans and nature? How does this relationship between human and nature work? I decided that I would use art to visualize my thoughts regarding the connection between human and nature. To do this, I chose to use rice since coming from South Korea where rice is the stapl e food consumed by almost every Korean on a daily basis, it indicates the existence of the connection between human and nature even if one is living in a city. In my artwork, I use rice to represent people. According to my understanding of nature, there are three different kinds of people. There are those people like my roommate who cannot live without technology whose only true connection with nature is food. However, this group of person depend on a lot of junk food which are in some way unnatural and thus their connection to nature is very weak. In my artwork, I use whole white rice to represent this group of persons. The other group of people are those who live in towns or cities and depend on technology too, but still want to reconnect with nature through the type foods they consume or their environment. This group I represent using half white and half brown rice. The third group of people are those native people living in jungles or in natural environments and wholesomely depe nding on nature for their survival. I represent this group of people with whole brown rice. Why white and brown? Rice is naturally brown when it is first harvested. As it is being refined, it becomes whiter. This in relation to humans and nature, before the advent of civilization, humans wholly depended on nature for everything. With time, and through science and technology, this dependence and connection have gradually diminished. Therefore, using brown to represent people who are still connected to nature, and white for those who

Summary of research article Essay Example | Topics and Well Written Essays - 1000 words

Summary of research article - Essay Example There is dire need to investigate the widespread and misleading conceptions regarding the adolescent life. Talai has carried out a research along with Kelvin Barclay and Kathleen Foley at the Park Royal School and the Royal Haven School in Quebec. The research was meant to study the nature and significance of friendship in the life of an adolescent as it is in the Western culture. Amit-Talai has emphasized that the friendship’s nature in the life of an adolescent reflects in his/her friendship as an adult, which adds to its value. Amit-Talai asserts that various social and psychological factors that exist in the life of an adolescent influence the nature of friendship he/she enters into. It is quite common for the students to encounter a lot of changes when they are in the phase of secondary school. The onset of puberty inculcates drastic changes in the nature and attitude of both genders, on the physiological part. On the sociological part, adolescents assume much more respon sibilities in school and home and also, in the workplace occasionally. The adolescents also experience a shift in their relationships with their peers when they enter their puberty and gain the sense of sexuality. A vast majority of students feel a change in their learning tendency and the environment as well. Many families change their residence as the children move from childhood to adolescence. The change of location causes the adolescents to change their schools. However, it must be noted that the physiological and sociological changes brought about by the adolescence are not the only factors that play a decisive role in determining the structure of an adolescent friendship. After conducting the research, Amit-Talai found that the rules in both the Quebec secondary schools that were involved in the study were too strict to allow the students time to socialize in an informal manner in their private lives. Such a lack of time to promote intimate informal relationships in the life of an adolescent significantly declines his/her tendency to maintain a healthy friendship, though the lack of time does not completely eradicate the friendship at all. According to Paine (cited in Amit-Talai 235), friendship is a â€Å"dyadic, confidential and personal relationship†. There is a category of friends called as â€Å"just friends† that are indeed, the â€Å"â€Å"purest† form of friendships, voluntary and operating outside of any specific context, with no structural or cultural supports†. (Fischer 108 cited in Amit-Talai 235). However, the secondary students studied by Amit-Talai in her research express a blurred relationship of friendship in the sociological context. It is commonly thought of adolescents that their life is full of leisure as compared to that of the adults. Amit-Talai says that there is no doubt in the fact that many adolescents do not work and only study, yet the school and related activities like homework consume a major po rtion of their time. â€Å"Adolescents who are not at work do not necessarily have more â€Å"free time† as a result† (Amit-Talai 237). Amit-Talai has also noticed a manifold increase in the number of working students in the secondary schools in Quebec since early 1975. In order to entertain their social concerns, many secondary school students work along with their studies. Such social concerns include but are not limited to shopping, outing

Should Service Learning Be a Requirement for College Graduation Essay

Should Service Learning Be a Requirement for College Graduation - Essay Example In such programs, students work with communities to solve real-life problems, which not only helps them learn their role as citizens but also inject a sense of social responsibility in their minds. Service learning is of two types, which include directly concerned and not directly concerned service learning programs. In directly concerned programs, students are engaged in activities, which are related to the educational major whereas in not directly concerned programs, students need to provide their services in such programs, which have no direct concern with the educational majors of the students. Let us come to the point that whether service learning should be a requirement for college graduation or not. I firmly believe that it should be a part and a requirement for college graduation due to a number of reasons. One of the major reasons is that service-learning programs enhance learning abilities of the students. Such programs not only improve students’ critical thinking an d decision-making abilities but also prepare them for future because students may need to do such work at some point in future. Through participating in such programs, students learn the ways to apply their skills and knowledge to real life problematic situations, which they may encounter in their professional lives. Service learning makes students prepared for their future professional roles and responsibilities. Such programs make students aware of the workplace environment at an early stage, which helps them adjust in any workplace environment in a very short span of time. Such programs enhance personality development of the students and improve their workplace skills and abilities. Service-learning programs allow students to translate their theory learning into practice, which is a very positive aspect of service learning. Service learning not only provides opportunities to the students to get experience of real work but also help them enrich learning and renew communities. Coll eges and universities should maintain such resources, which they can use to provide learning opportunities to the students. Service learning has become a necessity for the success of students in professional life. Today, many of the students struggle when they enter their professional lives because sometimes they are not mentally equipped with the workplace environment that is provided to them and sometimes they take a lot of time being trained for the job. Service learning eliminates all such possibilities by preparing students mentally for work. One more thing, for which service learning seems essential at college level, is that it enables students identify the roles, which they will need to play in society in future. When students engage in community activities, they become aware of their social roles and responsibilities in a very young stage of life. It is a fact that a society can sustain its existence only if its citizens, both young and adults, are aware of their roles in th e society. Service-learning programs serve this purpose very well. Opponents of service learning say that such programs are unnecessary because they are not relevant to the educational majors of the students. They say that sometimes students who have selected management as their major are selected for the service-learning programs in which they have to take care of patients is the hospitals. Similarly,

Aviation Essay Example | Topics and Well Written Essays - 750 words - 3

Aviation - Essay Example This paper will discuss the design of Eurocopter x3, comparing it to conventional designs with reference to aerodynamics. Conventional helicopters have a rotor that is supported above the body/fuselage of the craft. The rotor rotates at high speed to provide the lift required for vertical take off and landing (Watkinson, 2004). In addition, the rotor provides the thrust to make the craft move horizontally and laterally. In addition to the main rotor, the conventional helicopter has a tail rotor to develop thrust in addition to countering the torque produced by the main rotor (Watkinson, 2004). Alternatively helicopters may be fitted with ducted fans or NOTAR systems to perform the same functions. This however, is not the case with Eurocopter’s x3. The Eurocopter x3 Demonstrator is a machine that has been designed as a foundation for the Hybrid Helicopter. What this basically means is that the machine integrates the principles of the helicopter with those of fixed wing crafts with the result being optimized performance. The x3 is based on the design and features of existing models with the main additions being two short wings and the lack of a tail rotor (Vion-Lanctuit, 2010). In addition, each of the two short wings bears a propeller. The x3 has objectively been designed to have the main rotor to provide lift and thrust like other helicopters. The main rotor has five blades which means it has the capacity to provide higher lift and thrust compared to those that have two blades, other factors held constant. The two propellers supported by the short-span fixed wings provide additional thrust thus allowing the machine to achieve speeds that conventional helicopters cannot. Owing to these additional features, the helicopter can reach speeds beyond 230 knots or 267 mph (Whittle, 2012). This speed far exceeds the speed achievable by conventional helicopters which stands at about 140 knots or 160mph at the

Control Over IT & Cyberspace in Aviation in the United States Essay

Control Over IT & Cyberspace in Aviation in the United States - Essay Example 5 D. RFID†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 5 2. Future Study on Technology†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 II. Communication and Networking†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 1. United States Aviation (boarder Management)†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 A. Helping hand to police department†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 B. Using worldwide information sharing†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 2. People in the ground†¦Ã¢ € ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 8 A. Traveling Agencies†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 8 III. Cybercrime in Aviation†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 9 IV. Possible elements of threats†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 10 V. Conclusion†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.... 10 VI. Bibliography†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢ € ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 12 Technology in Aviation Current Technology Overview As a crucial element in the competitive marketplace innovation in the technology is vital for the air transport industry. Technological achievements greatly influenced aviation field when more computer- and web-based applications, techniques and tools are applied in the daily work of aviation sectors. In the recent years the Internet and web-based applications became some of the main technological achievements and advantages in the world, which main positive and efficient feature is to help millions of people to ease the process of finding and accessing necessary information quickly and precisely. It is expected that in the future more than three billion people would be using the global air transport system. The air travel passengers of the future would expe ct information and personalization whenever and wherever they travel. According to 2009 SITA Report, there are five new technologies that will simplify and smooth the air travel journey for passengers within the next five years. Such technologies include Web 2.0, mobile devices, Near Field Communications, biometrics and RFID. It is expected that these five new technologies will meet the changing and increasing needs and expectations of worldwide travelers in addition to improving their air travel experience starting from the flight choice decision and ending with the landing at the final destination. Web 2.0 Until recently there were two types of aviation-related websites, including aviation news and websites about aircraft markets providing the platform to trade for sellers and buyers. However, the modern Internet users and passengers require improved communication through interaction and participation. That is why, integration of Web 2.0 into aviation industry helped to open such websites as Flightblogger, AirplaneGeeks, UncontrolledAirspace, PlaneBuzz, RunwayGirl, Flightaware, and many others. These websites created â€Å"user-powered† passengers of the Web 2.0, who can communicate, interact and share information and flight experience. Popular social websites like Facebook, Twitter, YouTube and others have special aviation-related categories and groups. Websites like aviationclub.aero and avpronet.com became popular social networks dedicated to aviation, including forums, photo albums, walls for posting notes, etc. Linked-In helps to connect

Is capitalism sustainable Essay Example | Topics and Well Written Essays - 1500 words

Is capitalism sustainable - Essay Example Thus reduction in these capitals will lead to destruction of the human capital. Contributions of capitalism to the society depend on their profit and growth. Thus the existence of capitalism also leads to reduction in human and social capital. With the increasing cost of production and diminishing social values the sustainability of capitalism is reduced. (Heslam 2002). The growth model used by the capitalism seems to be uncertain due to its dependence on depleting natural resources. Rapid decline in natural capital will be a challenge to the economic capital. Climate crisis, income disparity, and scarcity of financial and social; resources in the global economy are affecting the sustainability of capitalism. Capitalism has helped the development of financial system in countries through increased income from investment and employment opportunity to the society. Thus the existence of capitalism is necessary for improvement in society. Sustainability of any system depends on the energy procured by it. Without energy, sustainability becomes impossible. Capitalism acquires its energy from the environment through extraction. But it does not provide consideration for restoring the energy extracted by it. This makes energy reduction in the environment. It is termed as physical entropy. Capitalism is based on the concept of profit. Without economic benefit, no restoration of energy takes place. Future generations' benefits are not the mission of capitalism. It insists on making profit with the resources in the environment. It undertakes only financially profitable activities. Reduction of wastes and pollution carried out by firms depends on the profitability from that process. Individual's self interest is only considered in capitalism. Energy renewal is carried out to support current consumption and restoring of energy for future generations is not considered. Thus, capitalism inescapably dislocates social energy throu gh weakening the personal relationships in society. In order to ensure maximum economic efficiency, impartial and impersonal relationship between people is necessary. For efficient functioning of market economies, competency instead of cooperation is required. In a more productive business environment social relationship gets less time and energy. In a price based marketing there is no place for trust and personal relationship. It reduces the personal relationship in the society. It is termed as disorganization of social energy through devaluation of personal relationships. In capitalism resources from the society are used for making profit. However, there is no consideration for restoring the social capital which is essential for maintaining effective personal relationships in the society. Investment in the society for the benefit of future generation does not provide any economic incentives for the business capital. Relationship in the capitalistic society depends on its financial benefit for them. Investment in social capital is tr eated as waste of resources in capitalism In an economy people exchange their resources with other people for mutual benefit. Transformation of physical energy in raw materials with the help of social energy in human resources is carried on in capitalism. It is exchange on the basis of profit. Economic capital takes out energy from natural and social capital. Social and

Pros and Cons of ARNP Independent Practice Research Paper

Pros and Cons of ARNP Independent Practice - Research Paper Example 2012). Nursing practices play a decisive role in the professional field so that the health needs of the individuals get fulfilled effectively. The ARNP Independent Practice tends to influence the nursing practice in the form of developing the nursing communities as per the desired level. Notably, this particular practice has a major influence on determining the combination of environmental health ideas and areas of varied nursing practices that significantly aid in lessening the gaps prevailing in the existing global healthcare system (Health Foundation Inc. 2012). In relation to the above context, certain advantages of a nurse practitioner owning a practice or ARNP Independent Practice become quite apparent. In this regard, one of such advantages includes providing the opportunity of specialization as well as maximizing patients’ care. Apart from this, the other advantage of ARNP Independent Practice lays in enhancing the ability of the nurse practitioners towards focusing on different interest areas including alternative therapy and women’s health among others. From the viewpoint of the nurse practitioners, it is worth mentioning that by performing the job roles as an independent healthcare provider, such healthcare professionals will avail the opportunity to work in a collaborative manner with different people. This might result in developing their skills of problem-solving, resolving any sort of conflict, dealing with unnecessary changes and executing effective strategies towards establishing a beneficial practice (Barberio, 2010). On the other hand, certain disadvantages or barriers relating to a nurse practitioner owning a practice are also quite apparent. In this regard, it can be apparently observed that experiencing excessive stress is one of the crucial factors, which restrict the nurse practitioners to own a practice,

Investment In Social Media Research Paper Example | Topics and Well Written Essays - 1750 words

Investment In Social Media - Research Paper Example As such, business owners and online shoppers are finding it irresistible. However, even as more business owners continue to use social media for business, they face the challenge of measuring the time they should consume online and assessing the value of social media investment (Ghali, 2011). Specifically, business owners lack the knowledge of determining the Return on Investment (ROI) with respect to social media investment (Burg, 2013). This paper seeks to address ROI in perspective of social media and equally draw the relationship between social media, E-commerce and social commerce. Moreover, the paper will also discuss marketing through social media. It is quite clear that business owners encounter various challenges with respect to investing in social media. Among the social media challenges they face include lack of time, lack of knowledge on how to determine the return on investment, and absence of social media operational skills. Nevertheless, determining the social media RO I remains as the fundamental problem to most business owners (Kelly, 2012). In addressing this challenge, we should first define ROI. ROI is the most common profitability ratio that establishes the efficiency of an investment. In this context, ROI will measure the returns from a social media investment. However, it is factual that calculating ROI is difficult, may not be perfect, and depends on the applied returns and costs. Actually, there is no universal way of measuring the ROI of the social media commitments (Kelly, 2012). As such, some business owners tend to count how many Facebook fans and Twitter followers they have or how many retweets and likes they enjoy. However, this may not be an effective measure of ROI. We can measure ROI using metric tools that foster conversion measurement and  optimized CPM, which enables Facebook ads to reach the target audience (Burg, 2013). This enables the investor to know who clicked through their ads thus enhancing future business planning . In addition, we can measure ROI by analyzing interactions by multiplying the number of received likes by the number of friends of those likes witnessed the action. This defines how far the advert went. Moreover, we can analyze traffic to determine the ROI in social media efforts (Harden & Heyman, 2011). Indeed, different social media understand the business owners need to evaluate their ROI in social media and thus there is a provision for built-in analytics tools for following engagement, likes, and shares (Burg, 2013). This helps the marketers to determine how often people find the marketer’s page through the social sites. For example, on Facebook, one can analyze the comment to like a ratio of posts while on Twitter, one can analyze the retweets to tweet ratio. Notably, the higher the ratios, the higher the ROI is. In addition, we can analyze the website analytics against pay per click or the average cost of those PPC campaigns per person in relation to the free social m edia placements (Burg, 2013). This derives a clear picture of the effectiveness of the social media investment. Another mode of measuring ROI is by determining the number of people that has a potential of interacting with the marketer while using the social media (Ghali, 2011). This enables th

Dell Essay Example for Free

Dell Essay 4. Is Dell’s strategy working? What is your assessment of the financial performance that Dell’s strategy has delivered during fiscal years 2000-2008? Use the financial ratios presented in the Appendix of the text (pages 240-241) as a basis for doing your calculations and drawing conclusions about Dell’s performance. Selected Financial Statement Data for Dell Inc., Fiscal Years 2000 – 2008 (in million, except per share data) | February 1, 2008| February 2, 2007| February 3, 2006| January 28, 2005| January 30, 2004| February 1, 2002| January 28, 2000| Results of Operations| | | | | | | | Net Revenue| 61,133| 57,420| 55,788| 49,121| 41,327| 31,168| 25,265| Cost of Revenue| 49,462| 47,904| 45,897| 40,103| 33,764| 25,661| 20,047| Gross Margin| 11,671| 9,516| 9,891| 9,018| 7,563| 5,507| 5,218| Gross Profit Margin| 19. 1%| 16.6%| 17.7%| 18.4%| 18.3%| 17.7%| 20.7%| Operating Expenses| | | | | | | | + Selling, general and administrative| 7,538| 5,948| 5,051| 4,352| 3,604| 2,784| 2,387| + Research, development and engineering| 693| 498| 458| 460| 434| 452| 374| + Special charges| -| -| -| -| -| 482| 194| Total operating expenses| 8,231| 6,446| 5,509| 4,812| 4,038| 3,718| 2,955| Total operating expenses as a % of net revenues| 13.5%| 11.2%| 9.9%| 9.8%| 9.8%| 10.4%| 10.9%| Operating Income| 3,440| 3,070| 4,382| 4,206| 3,525| 1,789| 2,263| Operating profit margin| 5.6%| 5.3%| 7.9%| 8.6%| 8.5%| 5.7%| 9.0%| Investment and other income (loss), net| 387| 275| 226| 197| 186| (58)| 188| Income before income taxes extraordinary loss, and cumulative effect of change in accounting principle| 3,827| 3,345| 4,608| 4,403| 3,711| 1,731| 2,451| Provision for income taxes| 880| 762| 1,006| 1,385| 1,086| 485| 785| Net Income| 2,947| 2,583| 3,602| 3,018| 2,625| 1,246| 1,666| Net profit margin| 4.8%| 4.5%| 6.5%| 6.1%| 6.4%| 4.0%| 6.6%| Earnings per common share: Basic| 1.33| 1.15| 1.50| 1.20|  1.02| 0.48| 0.66| Diluted| 1.31| 1.14| 1.47| 1.18| 1.01| 0.46| 0.61| Weighted average shares outstanding: Basic| 2,223| 2,255| 2,403| 2,509| 2,565| 2,602| 2,536| Diluted| 2,247| 2,271| 2,449| 2,568| 2,619| 2,726| 2,728| | | | | | | | | Cash Flow and Balance Sheet Data| | | | | | | | Net cash provided by operating activities| 3,949| 3,969| 4,751| 5,821| 3,670| 3,797| 3,926| Cash, cash equivalents, and short-term investments| 7,972| 10,298| 9,070| 9,807| 11,922| 8,287| 6,853| Total assets| 27,561| 25,635| 23,252| 23,215| 19,311| 13,535| 11,560| Long-term debt| 362| 569| 625| 505| 505| 520| 508| Total stockholders equity| 3,735| 4,328| 4,047| 6,485| 6,280| 4,694| 5,308| Profitability Ratios | January 28, 2000| February 1, 2002| January 30, 2004| January 28, 2005| February 3, 2006| February 2, 2007| February 1, 2008| Gross Profit Margin| 20.7%| 17.7%| 18.3%| 18.4%| 17.7%| 16.6%| 19.1%| Operating Profit Margin| 9.0%| 5.7%| 8.5%| 8.6%| 7.9%| 5.3%| 5.6%| Net Profit Margin| 6.6%| 4.0%| 6.4%| 6.1%| 6.5%| 4.5%| 4.8%| The chart shows the Profitability Ratios of Dell from 2000 to 2008. In general, from 2000 to 2008, the profit of Dell was quite stable. As we can see, Dell’s strategy is still working and makes a lot of money for Dell every year. However, there was no remarkable increase. The net profit margin has been about 5% during Fiscal Years 2000 – 2008. | January 28, 2000| February 1, 2002| January 30, 2004| January 28, 2005| February 3, 2006| February 2, 2007| February 1, 2008| Return on total assets (ROA)| 14.4%| 9.2%| 13.6%| 13.0%| 15.5%| 10.1%| 10.7%| Return on Stockholders Equity (ROE)| 31.4%| 26.5%| 41.8%| 46.5%|  89.0%| 59.7%| 78.9%| Return on invested capital (ROI)| 28.6%| 23.9%| 38.7%| 43.2%| 77.1%| 52.7%| 71.9%| The chart indicates ROA, ROE and ROI of Dell from 2000 to 2008. From 2000 to 2008, ROA has been stable because Dell built a lot of manufactory. However, ROE and ROI had very impressive increase since 2000. In 2006, ROE reached the peak 89% and ROI reached the peak 77.1%. It proved that Dell has used the monetary capital invested in its operations and the returns to those investments very effectively. | January 28, 2000| February 1, 2002| January 30, 2004| January 28, 2005| February 3, 2006| February 2, 2007| February 1, 2008| Long term debt to capital ratio| 0.09| 0.10| 0.07| 0.07| 0.13| 0.12| 0.09| Long term debt to equity ratio| 0.10| 0.11| 0.08| 0.08| 0.15| 0.13| 0.10| The chart shows 2 leverage ratios of Dell: Long-term debt to capital ratio and long term debt to equity ratio. These ratios are quite important because they measure creditworthiness and balance sheet strength. As we can see, all the ratios were very low, under 0.2 which had very good effect to the creditworthiness and balance sheet strength. Besides that, they could also help Dell to borrow additional funds if needed. In conclusion: Through the analysis, we can say that Dell’s strategy is still effective. It helps Dell to earn a lot of money every year. However, although Dell has gained profit during Fiscal Years 2000 – 2008, there was no remarkable increase in profit and it seemed to be stable. Dell’s strategy has been very successful when it helped the company to control the cost very well and run the company very smoothly. 5. What does a SWOT analysis reveal about the attractiveness of Dell’s situation in 2008? Dell SWOT analysis Strengths: * World’s largest PC maker. * One of the best known brands in the world. * First PC maker to offer next-day, on-site product service. * Direct to customer business model. Uses latest technology. * Dell has remarkably low operating cost relative to revenue because it cuts out the retailer and supplies directly to the customers. * Dell’s Direct Model approach enables the company to offer direct relationships with customers such as corporate and institutional customers. * Dell’s direct customer allows it to provide top-notch customer service before and after the sale. * Each Dell system is built to order to meet each customer’s specifications. Reliability, Service and Support. * Dell boasts a very efficient procurement, manufacturing and distribution process allowing it to offer customers powerful systems at competitive prices. * Dell is able to introduce the latest relevant technology compared to companies using the indirect distribution channels. * Dell is not a manufacturer; Components are made by the suppliers and Dell assembles the computers using relatively cheap labor. The finished goods are then dropped off with the customer by courier. Dell has total command of the supply chain. * Dell turns over inventory for an average of every six days, keeping inventory costs low. * Dell is enhancing and broadening the fundamental competitive advantages of the direct model by increasingly applying the efficiencies of the Internet to its entire business. Weakness: * A huge range of products and components from many suppliers from various countries. * Computer maker and not the computer manufacturer, making DELL unable to switch supply. * Dell lacked solid dealer / retailer relationships. * No propriety technology * Not attracting the college student segment of the market. Dell’s sales revenue from educational institutions such as colleges only accounts for a merely 5% of the total. * Dell’s focus on the corporate and government institutional customers somehow affected its ability to form relationships  with educational institutions. * For home users, Dell’s direct method and customization approach posed problems. For one, customers cannot go to retailers because Dell does not use distribution channels. * Customers just can’t buy Dell as simply as other brands because each product is custom-built according to their specifications and this might take days to finish. Opportunities: * Diversification strategy by introducing many new products to its range. * Personal computers are becoming a necessity now more than ever. Customers are getting more and more educated about computers. Second-time buyers would most likely avail of Dell’s custom-built computers because as their knowledge grows, so do their need to experiment or use some additional computer features. * The internet also provides Dell with greater opportunities since all they have to do now is to visit Dell’s website to place their order or to get information. * Since Dell does not have retail stores, the online stores would surely make up for its absence. It is also more convenient for customers to shop online than to actually drive and do purchase at a physical store. Threats: * Competitive rivalry that exists in the PC market globally. * New entrants to the market pose potential threats. * The threat to become outmoded is a pulsating reality in a computer business. * Price difference among brands is getting smaller. * Dell’s Direct Model attracts customers because it saves cost. Since other companies are able to offer computers at low costs, this could threaten Dell’s price-conscious growing customer base. * With almost identical prices, price difference is no longer an issue for a customer. They might choose other brands instead of waiting for Dell’s customized computers. * The growth rate of the computer industry is also slowing down. Today, Dell has the biggest share of the market. If the demand slows down, the competition will become stiffer in the process. Dell has to work doubly hard to differentiate itself from its substitutes to be able to continue holding a significant market share. = Technological advancement is a double-edge sword. It is an opportunity but at the same time a threat. Low-cost leadership strategy is no longer an issue to computer companies therefore it is important for Dell to stand out from the rest. 6. Which company is competitively stronger—Dell or Hewlett-Packard? Use the weighted competitive strength assessment methodology shown in Table 4.2 of Chapter 4 to support your answer.

Strategic Decision Making Case Study: Zara

Strategic Decision Making Case Study: Zara Introduction ZARA is the brand of the Spanish retail group, INDITEX SA. Its one of the well known performers in a retail market in recent years its stores can now be found in the most important shopping districts of more than 400 cities in Europe, the Americas, Asia and Africa. With year-on-year sales increasing at around 25% over the last 5 years, it has become one of the worlds fastest growing retailers (Lopez, 2009). Task 2 Strategic decision A strategic decision is what is thought to be a long-term investment and which is helpful in changing the direction of business undergoing in any organization. Such a decision can be a lot risky as the market changes very rapidly but if it turns out to be successful it give a competitive advantage over its competitors. The decision will be made by the top level management in a company and the shareholders will be consulted for that (Harris,ÂÂ  1998). Example For taking an example of a strategic decision we can take a look at their working with a design driven strategy, they produce about 11000 styles per year which means that they produce about 1000 new styles every month which is managed by a team consist of experts in design and development fields of over 200 people. This means that every member of the team on average is producing around 60 styles a year. As a result of that in zara stores a customer can always find a customer can always find new and latest products. This comes out to be a successful strategic decision in order to gain the competitive edge and higher profits in the market (Machuca, 2005). Tactical decision The second type of decision is called tactical decision making. Such a decision may be made by a group of managers but the shareholders are not involved in it as it is a medium term decision and have a lesser effect then a strategic decision. The result of such a decision can be seen within a period of less than a year or so and it has no contribution in changing the direction of the business. (McKinne) Example An example of such a decision is Zaras unique approach to advertising and marketing. It an additional factor within their business model which adds a lot to their success. They spend 0.3% of total revenues on advertising and marketing. This percentage is very less as compared to the competitors in their markets as on average companies like GAP and HM spend about 3-4 % of their total revenue for the similar expense this shows that Zara is successfully maintain a cost advantage to their competitors in marketing activities. For completing with its peers successfully Zara uses different useful locations, store layouts and the life cycle of its products as an effective marketing tool. they open their stores in primes markets to get the maximum visibility. And as mentioned earlier their product are in stores for a very small period of time which provokes the customer to visit time and again and make a rapid decision about purchasing as they might not get that product again when they visit the store even next day. Zara also spend heavily to the layout of their stores each store is remolded after every five years to keep up with the current trends (Gallaugher, 2008) Operational decisions Operational decisions are those which are made on regular basis the effects of such decisions are often minimal and usually do not last for more than a week of so these decisions are mostly done by staff and do not require much of an attention by the top level management (Harris, 1998). Example The example of such a decisions at Zara is its Centralized Logistics and Distribution they have maintain a control and have optimized their supply chain very effectively at many different levels. Within a week there are two orders or prescribes specific days and hours with usually prepared overnight shipments in La Coruna. (Felipe et al., 2010) There are specific times for trucks to leave and shipments to arrive at stores, the garments are pre-hung, already labeled and priced even those which are set by air.ÂÂ   As a result of this clearly defined rhythm, not on the supply chain works smoothly but also the customers know the time and days to visit the stores to get the fresh arrivals and new designs. It is very interesting to know that where in industry a standard time of 6 months has to get the product from sketch to store Zara does this in a remarkable short time of just 2 weeks (Vitzthum, 2001) Task 3:Â  Information needed for decision making Following is the explanation of the type of information required for strategic and tactical decision making. Human intelligence such as information from store managers and market research and information technology such as PDA devices are being used in order to form a hybrid model for flow of information from where houses to stores. Manager present at Zara stores use hand handheld device to send the standardized information about the feedback by customers and ordering needs directly to in house designers. This not only support and helps in making strategic decisions along with the rapidly changing trends and customers demand but also make the company be aware about the merchandise which is less desirable. The competitors of Zara completely rely on information technology which the unique approach being used by Zara makes them manage their inventories well helps them create a link between demand and supply and also helps in controls the problems occurring due to obsolete merchandise. For supporting the operational decisions Information from the distribution centers and from the production facilities, gives a better view to the manager of a certain store about the availability of garments at the stores this also helps in adjusting their orders and passing on information needed by the customer. (123HelpMe.com, 2010) Task 4:Â  Competitors intelligence The competitive intelligence is a process of monitoring the activities of rivals in market. It helps to know about competitors plans and review the own strategies for taking successful decisions (Arik, 2010). Main competitors of Zara are HM and Gap. HM OPENS its distribution centers in the region it has its stores in order to cut down the lead time and transportation cost. It also heavily investing in advertisement which helps them cater large market size and capture attention of a lot of customers worldwide. Another risk which is reported to the Inditex group it works by reinvesting all its profits in opening new stores HM is Sweden based retailer that spent heavily in advertising and is a close competitor of Zara. HM opens its distribution center in the country of its operations so as to cut down on lead time and transportation cost. (Pankaj and Jose, 2006) The process which id adopted by Zara of obtaining the market information is very different from its competitors. Many of them majorly rely on small elite design teams that plan all the needs of the business. Their stores have a very little autonomy in deciding which products they should out in display or which to go for sale because the quantities and planned and shipped according to the forecasts. Where the speed of Zara in product development is far better than anyone in the market (123HelpMe.com, 2010). When it comes to Strategic Partnerships and Cost of Production Most of Zaras competitors have 100% outsourcing to cheap Asian countries. Zara does not use Asian outsourcing unlike its competitors such as Gap, Benetton, and HM and 80% of Zaras materials are manufactured in Europe with 50% made in Zara controlled facilities in the Galicia region of Spain . The cost of production in Spain is 17-20% more expensive than Asia this gives a cost advantage to it competitors in regard to labor and expands their market worldwide (123HelpMe.com, 2010). The information and communication technologies being used by the competitors of Zara are quite different the cost spent by Zara in this regard is less than 0.5% of its total revenue and the it employees account for about 0.5% of Zaras total workforce. And if we take a look at its competitors they spend on average 2% of their total revenue on it expenditures and have 2.5% of their total workforce devoted to it. Which certainly makes their working far better in these areas? This is the global age and these gimmicks are demand of the time so Zara should pay some more attention to it both financially and strategically (123HelpMe.com, 2010). Task 5:Â  Importance of Business-To-Business for Zara Business to business commerce is a form of E-commerce involving business to business transactions, servicing customers, working with other businesses and the exchanging of products or services. B2B opens up a global market at little cost, reduces the costs of sales and promotions and can increase demand. This term specifically defines the electronic collaboration among different enterprisers. The B2B is a lot more important for Zara to promote its business activities at a bigger level and to cater a bigger market. It makes sure the world about the about the presence of variety of products available in its stores. Zara is even new to e-commerce as it launched it website in 2009 (Alisa, 2009). As compared to its competitors Zara is offering cheaper rates and a good quality product that is why many dealers would want to make a purchase to save their expenditure on high prices designers clothes of same quality. This will also give the benefit of saving time and money because after taking the order the product may be delivered to the door step of the customer. And other e-commerce retailers who are involved with fashion will be looking carefully to what Zaras online store can bring to online shoppers. The pace of which your ordinary high street stores are moving online and developing e-commerce solutions is set to lead to a more intensified competition for online sales, and more focused e-commerce marketing strategies. (DeltaQuest, 2010) Canada and China: Cybercrime and Cryptocurrency Canada and China: Cybercrime and Cryptocurrency Bitcoin, Cyber-crime, Cryptocurrency, Canada, China. Cyber-crime is a byproduct of the information age and is growing very fast worldwide (FBI, 2017). As technology has advanced so have the criminals methods to exploit the internet. Cyber-crime can be described as the use of a computer, a network or other electronic device to facilitate a crime, Interpol makes a distinction between two types of cyber-crime (INTERPOL, 2017): Advanced cyber-crime attacks on computer software or hardware; Cyber-enabled crime financial crimes, crimes against children and terrorism are more prevalent since the introduction of the internet. These types of crime in the past would have been likely to be conducted by small groups or even individuals, but new trends according to Interpol show organized criminal gangs worldwide have embraced technology to further their profits be it from illegal gambling, sale of fake goods, theft, fraud etc. Since 2009 the criminals now have a new virtual currency also labelled as a cryptocurrency called Bitcoin which is used by many to conduct transactions on what has become known as the dark web. The dark web can only be accessed through encryption software and this area of the internet is largely un-policed and users can remain anonymous. The anonymity is an ideal scenario for the criminal to work in. This paper will discuss firstly the give a brief overview of cyber-crime and the origins of bitcoin in more detail. Secondly how this electronic currency technology is being used for legal and illegal purposes. And lastly how governments around the globe are trying to regulate this electronic currency, with a major focus on the Canadian government and Bill C-31. Criminality is nothing new it has been part of lives for centuries, crime as such has not changed over the years only the tools used to carry them out have developed. Criminals have learned to use technology to hide themselves in the shadows and use technology to further profit. The biggest technological advancement in the last thirty years has been the internet. The internet has revolutionized our lives in so many ways from ease of communications, e-commerce to the large wealth of knowledge on line. Cyber-crime comes in many forms but it is primarily aimed at computers, computer infrastructure and other connected devices. With the large spread of the internet and smartphones, now nearly 3.2 billion people on the planet have access to the internet (ITU, 2015). It increases the pool of people that criminals have access to. When this is compared to decades ago when computers were only used by government agencies, research and financial institutes, crime in this area was limited to those who had the expertise and access to these devices (Clough, 2015). Now a small group can conduct crimes on a global scale without the restrictions of physical location to perform the crime. Bitcoin is an electronic virtual currency that allows users to conduct transactions between themselves (peer to peer) over an electronic network without the need for a third party namely a financial institution (Nakamoto 2008). Bitcoin was released in January 2009 by Satoshi Nakamoto which there is little known about as this was an alias used by the inventor (Powers 2014). The Bitcoin software is open source and in order to use the currency a user must obtain a wallet, there are two common types of wallets. Firstly the software wallet and the secondly the mobile wallet (Bitcoin 2017). The software wallet is mostly stored on a users hard drive, with the mobile wallet being stored on mobile devices such as android phones, IOS phones and tablets, giving the user the flexibility of have a currency attached to a mobile device. These wallets contain both a public and private key, the public key is what a user will share with other Bitcoin users in order to have them send bitcoins over the internet, whereas the private key is used by the owner of the bitcoins to make payments from the wallet (Miller 2015). The back bone of this cryptocurrency is the public ledger called the blockchain, this ledger records who owns what bitcoins and records transactions that take place. No one controls or owns the blockchain its all in the public domain. Transactions on the blockchain cant be reversed, the blockchain is only written too and are confirmed by the peer to peer network. Nakamoto has placed a limit of just under 21 million bitcoins, once that limit is reached, no more bitcoins can be made. Bitcoin is viewed as being the electronic equivalent of cash, as no financial institutes are involved no personal information is required when creating a personal wallet or purchasing Bitcoins. This anonymity has drawn scrutiny from some sectors to Bitcoin because some criminals have adopted the currency instead of conducting business in more traditional financial ways (Miller 2015). Just like any currency, Bitcoin can be used to purchase many of the everyday things in life the same way that we use traditional cash or credit cards. You can transfer Bitcoin to relatives, donate to charity, and this was what Bitcoin was created for to be a replacement for current systems. The first Bitcoin ATM was opened in Vancouver, Canada in 2013. In its first week of operation, the ATM performed over 10,000 independent transactions with a third of users being first time Bitcoin buyers (Wagner 2013). Across the world, entire city areas are accepting this cryptocurrency Bitcoin as payment for a range of goods and services. In the Germany City of Berlin, the borough of Kreuzberg, has the highest number of businesses accepting Bitcoin on the planet. This is expanding across the globe because every day more and more businesses are authorizing Bitcoin as a means of payment (Small 2015). Kirkpatrick (2017) refers to an interview with David Decary-Hetu, an adjunct professor of criminology at the University of Montreal, There are many helpful and legal reasons for having bitcoin, Decary-Hetu says, noting that large established companies such as Dell Computer, Expedia, Microsoft, and PayPal, each accept bitcoin, and are clearly not dealing in illegal goods. Small (2015) stated the total market value of the Bitcoin currency is currently estimated at slightly below $7.6 billion. The main argument for the regulation of virtual currencies and Bitcoin is that because of the anonymity offered to the buyer of such currencies, criminals have advantage over law makers and law enforcement. This anonymity helps obscure the identities of those purchasing drugs, money laundering, illegal paraphernalia and terrorist financing with the use of Bitcoin. Kirkpatrick (2017) again in his interview with Decary-Hetu says There is no way to tie your identity to your online bitcoin wallet address, if you do it properly, noting that when users try to convert cryptocurrencies to traditional money they may lose that anonymity. Thats where sloppy people are going to get arrested. China In China, the government banned Bitcoin in December 2013. The Peoples Bank of China does not give Bitcoin any legal status, refuses to recognize it as a currency, and has misgivings about Bitcoin as a central authority does not regulate it (Ponsford 2015). This was not always the case as in May 2013, the Chinese government unofficially gave its blessing to the currency when the government sponsored a documentary that was shown on state television to inform the public about Bitcoin (Small 2015). Because of the interest that came from the documentary, a surge of Chinese clients downloaded Bitcoin software, more than any other country for the last seven months of 2013. Before the ban, China accounted for the most Bitcoin exchanges and as a result Bitcoins value plummeted nearly twenty percent in a single day after the announcement (Small 2015). Canada In Canada, the government in 2014 stated that Bitcoin was not legal tender. The government however did state that it was a payment system (George-Cosh 2014) and as such should be taxed as a commodity when Bitcoin is exchanged for Canadian currency. Canada was the first jurisdiction in the world to pass concrete legislative measures to deal with Bitcoin and other virtual currencies. Bill C-31 was passed into law in June 2014, which made reporting requirements on the use of virtual currencies like Bitcoin. These measures are similar in nature to regulations on other financial transactions in the country. Bill C-31 made it law that Bitcoin be regulated as a money services business, requiring users to register with the Financial Transactions and Reports Analysis Centre of Canada (FINTRAC). These Bitcoin regulations would apply to both domestic and international Bitcoin operators (Ponsford 2015). The summary of Bill C-31 stated (in part): Division 19 of Part 6 amends the Proceeds of Crime (Money Laundering) and Terrorist Financing Act to, among other things, enhance the client identification, record keeping and registration requirements for financial institutions and intermediaries, refer to online casinos, and extend the application of the Act to persons and entities that deal in virtual currencies and foreign money services businesses [emphasis added]. Legislation that specifically altered the definition of money services business stated: (4) If subsection 256(2) comes into force, then on the latter of January 1, 2015 and the day on which that subsection comes into force, money services business means an entity (a)(iv) dealing in virtual currencies, as defined by regulation Other legislative provisions incorporated virtual currency language, including foreign businesses directing services at a Canadian person or entity. This legislation has had effects on Bitcoin use in Canada, because firstly it regulates virtual currency as a money service business; secondly imposes registration with FINTRAC to combat money laundering and terrorist financing; thirdly extends to both users inside and outside of the jurisdiction, or services within Canada; fourthly prevents banks from dealing with unregistered users (Ponsford 2015). References bitcoin.org (2017). Available: https://bitcoin.org/en/choose-your-wallet. Last accessed 18/03/2017. Calumn Jeffrey and Tobias Feakin. (2015). Ungerground web. ASPI Special Report. March 2015. Daniel Miller. (2015). Bitcoin explained: the digital currency making millionaires. Available: http://www.abc.net.au/news/2013-12-02/bitcoins-the-digital-currency-explained/5119034. Last accessed 19/03/2017. David George-Cosh. (2014). Canada Says Bitcoin Isnt Legal Tender. Available: http://blogs.wsj.com/canadarealtime/2014/01/16/canada-says-bitcoin-isnt-legal-tender/. Last accessed 12/03/2017. Dr. Mike McGuire (University of Surrey) and Samantha Dowling (Home Office Science). (2013). Cyber-dependent crimes. Cyber crime: A review of the evidence. p4-p5. FBI. (unknown). What we Investigate. Available: https://www.fbi.gov/investigate/cyber. Last accessed 16/02/2017. Jeffery Powers. (2014). January 3, 2009: Bitcoin Introduced, 1983: Computer Machine of the Year. Available: http://dayintechhistory.com/dith/january-3-2009-bitcoin-introduced-1983-computer-machine-year/. Last accessed 19/03/2017. Jonathan Clough (2015). Principles of Cybercrime. 2nd ed. Cambridge: Cambridge University Press. p6. Keith Kirkpatrick. (2017). Financing the Dark Web . Communications of the ACM. 60 (3), p21-p22. International cyber security protection alliance. (2012). Detailed Findings. Impact of cyber crime on businesses in Canada. ICSPA (4),p3, p16. INTERPOL. (2017). Cybercrime. Available: https://www.interpol.int/Crime-areas/Cybercrime/Cybercrime. Last accessed 18/02/2017. International Telecommunication Union. (2015). ICT revolution and remaining gaps. ICT Facts and Figures 2015, p1. Kurt Wagner. (2013). Worlds First Bitcoin ATM Opens In Vancouver, Canada. Available: http://mashable.com/2013/10/30/bitcoin-atm-2/#HUU2o4zadsq7. Last accessed 18/03/2017. Matthew P. Ponsford . (2015). A Comparative Analysis of Bitcoin and Other Decentralised Virtual Currencies: Legal Regulation in the Peoples Republic of China, Canada, and the United States . Hong Kong Journal of Legal Studies Volume 9 (2015) . p51-p70. Satoshi Nakamoto. (2008). Bitcoin: A Peer-to-Peer Electronic Cash System. Stephen Small. (2015). BITCOIN: THE NAPSTER OF CURRENCY. HOUSTON JOURNAL OF INTERNATIONAL LAW. 37 (2), p585-p640.

Concepts Of Medicine Adherence And Its Economic Burden Nursing Essay

Concepts Of Medicine Adherence And Its Economic Burden Nursing Essay Even though 45% of all medications prescribed in the UK are for older people, it is postulated that up to 50% of older people are non-compliant with their medication (SCIE, 2005). The prescription of various medicines is central to medical care and the overall drug costs account to about 10 percent of NHS expenditures. Surveys carried out in literature enlighten us with the fact that approximately 30% to 50% of patients do not use of take their medications as recommended by their prescriber. (1). Statistics show that in 2007- 2008, the NHS in England spent  £8.1 billion on drugs if as many as 50% of the patients dont take their medications as recommended, this could mean that  £4 billion worth of medicines were incorrectly used (2) . Furthermore the additional cost of unused or unwanted medicines within NHS totals up to  £100 million each year. On top of that the estimated drug cost of unused or unwanted medicines in the NHS is around  £100 million annually (3). A Cochrane review Interventions for enhancing medication adherence concluded that improving medicines taking may have a far greater impact on clinical outcomes than an improvement in treatments (4). Therefore if the prescription is inappropriate in the first place it not only translates as a loss to patient but also involves the healthcare system and the society. The costs included here are both personal and economic. Concepts of Adherence and terminology There are three major terms which are commonly used in the literature to describe medication-taking behaviours i.e Compliance, Adherence and Concordance (5). According to Pound (6) initially, the term compliance was used to illustrate the medication taking behaviour, which was then replaced by the term concordance. The term compliance came into disfavour because it suggested that a person is passively following a doctors orders, rather than actively collaborating in the treatment process (3) Whereas concordance refers to the anticipated outcome of the consultation between doctors and patients about medicine taking It is viewed as successful prescribing and medication taking based on the partnership with the patient (6). However the most current, fashionable and accepted terminology is adherence, which is defined by McElnay (7) , as the extent to which a persons behaviour (in) in terms of taking medicines, following diets or executing lifestyle changes, coincides with advice given by health care professionals Adherence shifts the balance between professional and patient about the prescribers recommendations. Pound (6) states that the above mentioned three terminologies tend to be used interchangeably but are incorrectly applied. Adherence can be viewed as the central aim, concordance is the process used to apply the central aim compliance is the outcome of the process. The benefits of medication might be restricted thereby causing a further deterioration in health as a consequence of non-adherence. . On top of this the economic costs do not only translate to wasted medicines only but also include the knock on costs which arise from increased demands for healthcare if (on the whole) health deteriorates. It is hence due to this reason that non-adherence is a major issue and should not only be seen as the patients dilemma. A fundamental drawback is represented in the provision of the healthcare, which is often due to a failure in completely agreeing with the prescription in the first place or to recognise the appropriate support that the patients might require later on during the treatment. Hence addressing non-adherence is by no means about getting patients to take additional medicines. Therefore tackling the issue of non-adherence involves the initial understanding of patients opinion on the medicine and then the various reasons to as why they are/m ight be reluctant or unable to use them. Causes of non-adherence There are many causes of non-adherence however they fall into two main overlapping categories i.e intentional and unintentional. Both types relate to the lack of an established pattern of medication taking which led to the incidental omission of medicines and may be experienced concurrently (8). Purposeful or intentional non-adherence occurs when a patient makes a specific decision not to take the prescribed medication. The anticipation of drug-related side effects and general dislike of taking medicines are common causes of intentional non-adherence (9). While accidental or unintentional non-adherence occurs as a result of forgetting or misunderstanding instructions about the drug schedule .Unintentional non-adherence is proposed to be range from a random departure to medication omissions from a prescribed treatment regimen (10). Hence the main features of unintentional non-adherence focuses on altering medication contingent on self assessment or perceptions of mental health, stress or anxiety, forgetting to take medicines or simply altering the doses of medicines to fit in with daily chores. A research carried out by Svensson (10) Kippen (11) showed that older people adherent with their medication often link the administration of medication to specific lifestyle events, location, time, and patterns of daily activities. Below table 1.3.1 shows the common perceptions and characteristics of adherent and non adherent medication taking behaviors. Table 1: Shows common perceptions and characteristics of adherent and non adherent medication taking behaviours. Perceptions related to medication taking behavior Intentional Non-adherence Unintentional Non-adherence Feeling unnatural taking medicines Fears of prescribing errors/addiction Life style change/ Disruption to daily routine Adverse effects of medicines Lack of faith in the prescriber Drug related memory loss/ Forgetfulness Long term risks of medicines Failure to accept diagnosis Altering dosing regimen Past experience of medicines Dislike of taking medicines Being asymptomatic Lack of comprehension of the need to take medicines. Testing medicines against symptoms Period of illness Vulnerable group of people Of all the age groups, medication taking behaviour in older people is of the highest concern. This is due to multiple reasons as described by Huges (12). Firstly, older people are highly likely to suffer from multiple diseases. Secondly, older people frequently administer three or more medicines concurrently to manage these conditions and third as a result of poly pharmacy, they are increasingly likely to mismanage their medicines (13). Furthermore, research shows the following as different lay beliefs by older people on medicine taking The need to reduce the symptoms of hypertension, to feel physically better (14). Fear of complications and desire to control blood pressure (10). Positive confidence in the prescriber (15). Apart from the elderly, another age group, where non- adherence is becoming a significant problem is in the pediatric population. In one of the studies carried out by Bush (16) it has been shown that one-third of the children in grades 3 to 7 reported they had used one or more prescription or non prescription medications in a 48 hour period. Adherence plans for children often require innovative approaches to encourage active participation in caring for their own health and how to use their medications appropriately. Consequences of medication non-adherence No matter how much critical the conditions are a patient might stick to his medication regimen, thus reflecting a loss of the health care system with increased use of medical resources, such as GP visits, unnecessary additional treatments, emergency department visits and hospital admissions. One of the recent research shows that about 3-4% of UK hospital admissions are as a result of avoidable medicine related illness (17) between 11 and 30 % of these admissions result from patients who dont use their medicines as recommended by their prescriber (3). In a similar manner, in 2006-2007, figures show that that the NHS expenditures on hospital admissions (excluding critical care costs) was approximately about  £ 16.4 billion (18). And the estimated costs of admissions, within the same year i.e. 2006 2007, resulting from patients not taking their medicines as recommended was found to be between  £36 and  £196 million respectively (18). Hence a reduction in these admissions and associated costs would be expected as the overall medicines adherence increases. Factors affecting medication adherence In accordance to WHO some of the main common factors reported to have a significant effect on adherence include: poverty, low level of education, illiteracy, poor socioeconomic status, unemployment, unstable living conditions, lack of effective social support networks, long distance from treatment centre, high cost of medication, changing environmental situations, high cost of transport, family related issues and culture lay beliefs about illness and treatment. In accordance to WHO the common belief of patients being the sole responsible for taking their treatment is misleading and most often reflects a misunderstanding of how other factors affect peoples behaviour and the capacity to adhere to their treatment. Adherence, in short, is a multidimensional phenomenon which is determined by the interplay of five different sets of factors, each of which are termed as dimension by WHO (5) . Each of these dimensions are listed as under and shall be discussed in detail Social/ economic factors Provider-patient/ health care system factors Condition related factors Therapy-related factors Patient related factors Social and economic dimension It includes limited access to health care facilities, medication costs, low health literacy, limited English language proficiency, unstable living conditions (homelessness), lack of family/social support network, and cultural beliefs about illness and treatment. Among these factors few shall be discussed in detail as under English language proficiency Both low health literacy and limited English language proficiency are barriers to adherence that deserve special consideration. Health literacy can be defined as the ability to read, understand and act on health information so that appropriate health decisions can be made. The risk of unsafe use of prescription medicine, is high among people with low health literacy and limited proficiency in English language due to the complex nature of the printed information that is available and because these people often do not receive adequate verbal communication or sufficient time from health care providers. Older adults with low health literacy may have trouble reading health information materials, understanding basic medical instructions, following prevention recommendations and adhering to medication regimens. Social factors Medication adherence is positively associated with social support and the availability of help from family and friends. Better outcome to treatment is observed in people who have social support from their friends/family (who assist them with their medication regimens) Cultural beliefs and attitudes Adherence to therapy, may overall be affected as a consequence of different attitudes which the patient may have towards health and medicine. Addressing these issues by the health care professionals is of prime importance so that the patients can get the most out of their medicines without compromising their health In case of adults, different components of health and healing cannot be explained by no one list. Therefore each individual must be considered on individual basis. Two major key components are requisite i.e asking non-judgmental questions listening, when it comes down to understanding the process of gaining an insight into patients beliefs (regarding health and healing) Patients belonging from various ethnic minorities bring along their practices in the health care system. This sometimes puts the health care professionals at test, who have been professionally trained in the light of western philosophy and medicine. Although groups of people may have beliefs or practices in common, yet that doesnt mean that they all can be classified under the same category. Within groups , the major differentiating factors include health status, educational level, sexual orientation etc (5). Respect Taking care of elder patients who belong from such backgrounds where they receive a great amount of respect (e.g. British Asian community ) should involve the element of respect combined with kindness. If they are approached with an attitude that consists even a tiny fraction of scolding or telling off, they might show resentment towards the adherence of medicine even though it may put their lives at risk. Therefore to put such patients at relieve it is of prime importance to show respect towards them . Traditional therapies and cause of illness Literature shows that two components such as religion and spirituality can play a vital role in the overall understanding of illness in its broadest sense among older people (19). The will of God for an improper behaviour, exposure to cold wind, natural causes etc are all different factors which older patients believe are major culprits for causing illness (20). This consequently leads them in such a situation where they end up giving God a chance to heal them or alternatively they seek help from a folk healer, try home remedies or pray for the treatment of their illness. An excellent example of this can be viewed within the Chinese culture where health may be seen as finding norm between ying yang, which is much more like hot and cold (21). Now patients who follow Chinese health belief may try such approaches which targets at restoring the balance between ying and yang (using different varieties of food and herbs). Likewise, some Asian ethnic groups rely solely on traditional remed ies for the treatment of long term conditions (21). At this stage it is also important to mention that the patient may not be cooperative if he believes that the health care provider may disapprove information surrounding the use of non-traditional remedies. This may ultimately lead to different interactions with the prescribed medications. Medication For some patients the preference lies in the dosage form or the size or colour of the medication. For example some cultures in Latin America view injections as more potent in comparison to oral medications. Likewise it is believed that Western medications are too strong by Chinese older patients hence therefore they might choose to not take the full dose of medicine (22). Health care system dimensions It includes different factors such as provider-patient relationship, provider communication skills, patient information materials written at too high literacy level, restricted formularies (changing medications covered on formularies), poor access or missed appointments, long waiting time and lack of continuity of care (23). The quality of the HCP-patient relationship is one of the most important health care system-related factors impacting adherence. Adherence to medicines can be increased as a result of good relationship between the patient and the HCP (which features the element of reinforcement and encouragement from the HCP), however there are many factors which have negative effect (24). These include lack of training and knowledge for health care providers on managing chronic diseases, lack of incentives and feedback on performance, poor medication distribution systems, short consultations, overworked health care providers, weak capacity of the system to educate patients and provide follow up, lack of knowledge on adherence and of effective interventions for improving it. Condition related dimensions It includes Psychotic disorders, severity of symptoms, chronic conditions, depression, lack of symptoms, mental retardation (25). Among these factors few shall be discussed in detail as under Chronic conditions and lack of symptoms Information within literature supports the fact that adherence to such treatment options (often declines as the time progresses) where medications have to be taken on an unlimited basis for the management of a chronic ailment. Example of two perfect clinical conditions which would fit into this profile include high BP and osteoporosis (26) , in which the symptoms are totally invisible to the patient. Furthermore, in the absence of symptoms these ailments lack the cues which would motivate the patient to adhere towards his treatment regimen. Depression A study carried out by Krueger (28) showed significantly lower rates of medication adherence among people with chronic illnesses and who are depressed. It is therefore crucial for the HCPs to be aware of the devastating impact, depression has on adherence consequently on regular basis should assess older patients who are sad all the time or who report symptoms of sleeping disturbances to eliminate the possibility of clinical depression. The slow onset of the pharmacological actions posed by different classes of antidepressants is classified as one of the major factor that contributes towards decreased adherence among elder patients. Adding on to that if the patient begins to experience the side effects (before even the symptoms are relieved), might consequence discontinuation of the therapy at a very early stage. In a similar fashion, a research conducted by Kemyttenaere (29) shows that once the patients (suffering from depression) start feeling bette,r they might stop the antidepre ssant therapy midway. Psychotic disorders A patients experience with unpleasant side effects is mainly one of the key causes which drives them from continuing their antipsychotic therapy. Literature shows that interventions which focus mainly on the persons attitude and beliefs about medications 9rather than on the knowledge) helps improve adherence. The addition of two key ingredients i.e Behavioral techniques motivational interviewing within compliance therapies, have proven to be very effective in improving medicines adherence among patients who suffer from psychotic disorders (31). Therapy related factors/dimensions It can be sub-divided into other different factors such as duration of therapy, lack of immediate benefit of therapy, frequent changes in medication regimen, actual or perceived unpleasant side effects, medications with social stigma attached to use, treatment requires mastery of certain techniques, complexity of medication regimen and treatment interferes with lifestyle or requires significant behavioural changes. Research by Tabor (32) Krueger (27) showed that decreased adherence is associated with medications with a social stigma attached to its use and with medications which require following complex regimen ( e.g. duration of therapy, number of daily doses required, or therapies that interfere with a persons lifestyle. Adherence can also be affected by other factors e.g. if administration of a medication requires the mastery of specific techniques like injections (32). In a similar fashion, when medications such as antidepressants are slow to produce effects, the patients/older person may believe that the medication is not working and might stop taking it. Likewise the side effects of a medication too can lower adherence if the patients start believing that they cannot manage or control them (25). Patient related factors/dimensions They can be sub-divided into two major factors i.e psychological/behavioral factors and physical factors. Psychological factors include fear of dependence or possible adverse effects, knowledge about disease, motivation, perceived risk to disease benefit of treatment, understanding reason of medication need, confidence in ability to follow treatment, feeling stigmatized by the disease, frustration with health care providers , psychosocial stress, expectations towards treatment and substance (alcohol) abuse. Physical factors include issues like swallowing problems, hearing, visual cognitive impairments and impaired dexterity or mobility. Few of these physical and psychological factors can be discussed in detail as under: Psychological factors that influence adherence The WHO proposes a foundation model for medication adherence which is based on three major factors i.e. motivation, information and behavioural change. Behavioural change has been found to be influenced effectively by making interventions based on this model (33). In accordance to WHO, adherence and non-adherence are different behaviours. In order to change behaviour, information is a prerequisite, but in itself it is insufficient to achieve this change. Hence at this stage behavioural and motivational skills are critical determinants. Motivation and information work largely through the behavioural skills to produce an impact on the behaviour. However, when the behavioural skills are uncomplicated or are familiar, the two aspects i.e motivation and information can produce a direct effect on the behaviour (33). Physical Factors that influence adherence The risk for non-adherence among older patients is increased due to physical and cognitive limitations. Visual Impairment Decreased ability to perform activities of daily living and an increased risk for depression is associated with vision impairment (34), (35). Furthermore there are many other medication safety issues associated with vision loss. A persons ability to read patient information leaflets, prescription labels, determine the colour and markings distinguishing a medication is affected by low vision and blindness. Therefore consequently people who cannot read prescription labels or distinguish among different medications have to rely on their memory or depend on someone else for help and hence may not be able to take their medications correctly. Hearing Impairment Hearing loss is directly related with age. The natural aging process not only affects the ability to detect sounds at lower levels but also the capability to understand speech at a normal conversation level (36). This condition does gets worse with age and is progressive. It is therefore important to not assume when a deaf person nods his head in acknowledgement that he/she has understood, as he/she might be relying on a family member or a companion to explain later (36). Impaired Mobility Older patients with poor mobility may have difficulty in self administration of medicines or in obtaining medicines from the pharmacy (37). Cognitive Impairment Poor medication adherence is associated with Impaired cognition (25). Elderly patients with memory problems and cognitive impairment may have difficulty in understanding when to take, how to take or how much to take their medications. Others factors also include as swallowing difficulties and impaired dexterity. PREDICTORS OF medication non-adherence Predictors of medication non-adherence can be a useful tool in the improvement of medicine adherence among older adults. Few of the non-adherence warning signs (38) include failure to fill in a new prescription, failure to fill in prescription for choric medication or failure to obtain refills as often as expected for medications taken on chronic basis. Below are some of the more common predictors of medicines non-adherence (38): Forgetfulness Lower cognitive function or cognitive impairment. Lack of insight into illness Lack of belief in benefit of treatment. Belief that medications are not important or are harmful. Complexity of medication regimen Tied of taking medications. Inconvenience of medication regimen. Side effects or fear of medication side effects. Missed Appointments. Substance Abuse Limited English language proficiency. Role of NICE (National Institute of Clinical Excellence): The issue of non-adherence to medicine is a very important issue in its own essence. After assessing and understanding the impact of non adherence on the NHS the NICE (National Institute of Clinical Excellence ) came into action and published a guidance in January 2009 (Medicines Adherence: Involving patients in decisions about prescribed medicines and supporting adherence) to tackle and address this core issue (of non adherence). Before moving further it would be essential here to describe the role of NICE in terms of its function. NICE was established as a special health authority on 1st April, 1999 is an independent organisation that provides national guidance on promotion of good health and prevention and treatment of ill health in England and Wales (39). The institutes main purpose is to offer NHS health care professional advice on how to provide patients with the maximum attainable standards of care and to decrease the variation in the quality of care . Furthermore, NICE is not part of the European Medicines Evaluation Agency (which assess the efficacy and safety of drugs), only licensed drugs on the basis of their added value relative to existing practice in the NHS are assessed by NICE (40). It has four programmes that produce guidance which are mentioned as under (39): Public health guidance Clinical Guidelines Interventional procedures Health technology appraisals ( for surgical interventions, pharmaceuticals, medical devices, etc) Most programmes take into account both the elements of cost-effectiveness (how well an intervention works relative to its cost) and effectiveness (how well an intervention works) NICE has an annual budget of 33 million pounds annually with over 250 full-time staff members working at offices based in London Manchester. The processes NICE uses in the development of its guidance are highly consultative, evidence based and transparent. It also involves all relevant stakeholders, including policy makers, health professional managers, specialist, academics, representatives of health care industries, general public and patients (39). The guidance that NICE produced to address the issue of medicine adherence was CG76 Medicines Adherence: Involving patients in decisions about prescribed medicines and supporting adherence. This guideline was produced taking into account the patients views as to what they perceive as barriers to effective medicines adherence and thus encourages healthcare professionals to have a discussion with patients about their prescribed treatment especially for long term conditions. In addition to this the guidelines also open a pathway for dialogue and negotiation between the patient and the health care professional regarding their medication. A quick summary of the guidelines is as mentioned below Summary of the NICE guidelines Bullet-points below quote from summarise recommendations from the CG76 guidelines (41). The key recommendations from NICE guidelines are as under Table 1: Shows the key recommendations from NICE CG76 guidelines. Involving Patients: Improve communication with patients Increase patient involvement in the decision making process about their medicines. Understand the patients perspective on their condition and possible treatments. Provide information about their condition and possible treatments. Supporting Adherence: Assess adherence levels Identify adherence issues Address adherence issues Review medication and its effective use Improve communication between health care professionals in the care pathway. From www.nice.org.uk/pdf/CG76fullguidelines.pdp Significance of the Study Community Pharmacists are the health care professionals which are most readily accessible to the general public and therefore continue to be the first line of Healthcare. They are experts on medicines and represent an important link in the chain of the health care professional team. Thus the main objective of this research project will be to provide a new insight as to what the community pharmacists reflect/perceive about these NICE CG76 guidelines. Hence their views and opinions will be assessed and analysed with regards to these NICE recommendations (as this would help in the implementation process). Any differences in the views of the pharmacists or any disagreement on the effectiveness of the NICE guidelines would mean that further investigation could be required to improve or update these recommendations. Hypothesis: H0 = There will be no statistically significant relationship between the years of experience of the pharmacists and the awareness of NICE CG76 guidelines. H1 = There will be a statistically significant relationship between the years of experience of the pharmacists and the awareness of NICE CG76 guidelines. H0 = Majority of the community pharmacists will not agree (on to a large extent) that CG76 recommendations have been effective in the improvement of medicines adherence among their patients. H1 = Majority of the community pharmacists will agree (on to a large extent) that CG76 recommendations have been effective in the improvement of medicines adherence among their patients.