Knowledge Attitude Practices Repeat Cesarean Health And Social Care Essay

Knowledge Attitude Practices Repeat Cesarean Health And Social Care Essay Cesarean delivery is defined as the birth of a fetus through incisions in the abdominal wall and uterine wall . An increase of in the cesarean delivery has been observed worldwide. However, the World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15%. According to the WHO, cesarean delivery rate of more than 15% is indicative of inappropriate use of resources . According to Department of Health, the Philippines 2006 national cesarean rate is 24%. In Davao Medical Center (DMC), the rate as of 2008 is recorded at 19% as depicted in the OB-Gyne departments annual cesarean review statistics. In the US, most common indication of cesarean section is repeat cesarean which accounts for 35% of all cases as reported by the United States Public Health Service. The rates have been steadily increasing due to a higher number of sections for fetal distress as electronic fetal monitoring has been used extensively for presumed fetal compromise, the many breech presentations delivered abdominally as well as the increasing acceptability of cesarean delivery by maternal request. Before the 1970s, deliveries by cesarean section were considered as an indication for cesarean section in the subsequent pregnancies, reflecting a concern that uterine scar tissue might rupture during labor. However, in the 1980s, the dictumonce a cesarean, always a cesarean, espoused by Craigin (1916) was revised in many countries, and a trial of labor in women with history of cesarean section was proposed as an attempt to reduce cesarean section rates. However, an apparent increase in the incidence of uterine rupture and concern about maternal and fetal safety have challenged the choice of vaginal delivery in women having a scarred uterus. As a consequence, clinicians are increasingly being faced in deciding the mode of delivery in pregnant women whose first delivery was by cesarean section. This scenario has also been observed in the Philippine setting. DMC, as a specific case, recorded increasing cesarean deliveries accounting to a third of all deliveries for 2008, of which, 11.53% for repeat CS while 19.8% for primary CS. In contrast, Vaginal Birth after Cesarean Section is a measly 1.2% of the total deliveries for 2008. This is due to the fact that patients who underwent VBAC were admitted for imminent delivery. Majority of these patients were not prepared during their prenatal visits and were unaware of the complications and risks of VBAC. The confounding reason of such practice is primarily economics: the high cost of undergoing an elective CS delivery as compared with the cost of vaginal delivery. These patients would rather risk undergoing VBAC without the benefit of intrapartum monitoring specifically for those attempting to deliver at lying-in clinics or at home. Based on the National Institute of Child Health and Human Development (NICHD) study, the incidence of uterine rupture is low at .2-.7% (Landon,2006). But despite its low incidence, ACOG guidelines on VBACS specifically mentioned that VBAC be performed in an institution where an obstetric, anesthesia, pediatric, and operating-room staff is available. This scenario provided impetus for the conceptualization of this study which is aimed at determining the knowledge, attitudes, and practices of repeat C-section patients and their willingness to undergo vaginal birth after C-section at DMC. Review of Related Literature In 2004, the number of C-sections had reached an all-time high, accounting for 29% of all births or 1 million babies (National Center for Health Statistics). This is despite the convention that vaginal delivery is associated with less maternal and fetal morbidity and mortality as compared with repeat cesarean section (Chauhan, 2004). For example, observational studies data from around 90,000 deliveries, have shown an increased risk of neonatal respiratory morbidity among term infants delivered by caesarean section (3.5-3.7%) compared with vaginal birth (0.5-1.4%). The following maternal risks significantly increase with increasing number of repeated caesarean deliveries: placenta accreta, injury to bladder, bowel or ureter, ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, blood transfusion requiring four or more units and the duration of operative time and hospital stay (Russen et. al. 2004). Moreover, authors speculated that a prolonged inter-pregnancy interval may allow time for the previous cesarean delivery scar to reach its maximal tensile strength before the scar undergoes the mechanical stress and strain with a subsequent intrauterine pregnancy (Shipp et. al., 2000). Menacker et al. (2006) noted that cesarean rates fell between 1991 and 1996, and then began to rise rapidly. In 2004, over 29% of all births were by cesarean section. The rise in both the total and repeat cesarean rate has been widespread for women of all ages, races, medical indications, and for all infant gestational ages. The study also noted steep decrease in VBAC rate from 1996 to 2004 (see Figure 1). From this trend, the authors opined that the influence of recent medical opinion discouraging VBAC has had a strong effect on practice patterns, and had led to greater uniformity as well as a large increase in repeat cesarean deliveries by 2003. Figure 1 (Source: Menacker et al. pp. 236) The dramatic increase in cesarean sections over the past two decades has been significantly driven by repeat C-sections. In response, clinical guidelines recommending vaginal birth after cesarean-section (VBACS) have been promulgated by international organizations from different countries such as the United States, Canada, Europe, New Zealand and Australia. It is construed that adherence to these guidelines would reduce the number of repeat C-sections, lower the overall C-section rate and improve both the quality and the cost of health care. While these guidelines have received professional endorsement, their implementation has been clouded by issues of patient acceptance and provider payment. Neff (2004) discussed the risks and benefits of VBAC. Successful VBAC generally is associated with shorter maternal hospitalizations, fewer infections, less blood loss and fewer transfusions, and fewer thromboembolic events than cesarean delivery. However, a failed trial of labor may be associated with major maternal complications, such as hysterectomy, uterine rupture, operative injury, increased maternal infection, need for transfusion, and neonatal morbidity. Multiple cesarean deliveries are associated with an increased risk of placenta previa and accreta. With VBAC (Landon, 2004), the incidence of maternal death is extremely low. The incidence of perinatal death is less than 1 percent, and is more likely to occur during a trial of labor than an elective repeat cesarean delivery. Uterine rupture during a trial of labor after a previous cesarean delivery is a life-threatening complication directly associated with attempted VBAC. The patients obstetric history influences the risk of uterine rupture. A previous vaginal birth significantly reduces the risk of uterine rupture. Also, the longer the length of time between deliveries, the lower the risk of rupture. Women who attempt VBAC who have interdelivery intervals of less than 24 months have a two- to three-fold increased risk of uterine rupture compared with women whose interdelivery interval is more than 24 months. A study conducted Hopkins and Potter (1998) on C-sections patients in Brazil concluded that while many women fear the pain associated with childbirth and the consequences of a vaginal birth for the baby, they do not clamor for C-section delivery. Obstetricians were observed to have overplayed these fears to their advantage thereby overly estimating safety of C-section delivery. In fact, it has become a routine practice and is considered as safe or safer than a vaginal delivery. The study further documented that majority of first-time mothers in public and private hospitals wanted to deliver vaginally and considered vaginal birth superior in terms of recuperation. A majority believed that vaginal delivery does not have effect to their or their partners sexual life. Though majority was found to have considered normal childbirth more painful than a cesarean, but most also believed a cesarean causes a lot pain after the delivery. Less than 33% agreed that a cesarean is safer for the baby and less than 20% of women agreed that a C-section is safer for the woman. Objectives of the Study The objectives of the study are twofold: To come up with a profile of the knowledge, attitudes and practices (KAPs) towards vaginal birth after C-section (VBACS) among repeat C-section patients Determine whether the KAPs of the respondents significantly influence their willingness to undergo VBACS Statement of the Problem This present study seeks answers to the following questions: What is the profile of the respondents in terms of their knowledge, attitudes and practices about VBACS? What is the frequency distribution of the respondents in terms of their willingness to undergo VBACS? Do the KAPs of the respondents significantly influence their acceptance to undergo VBAC in their next delivery? Does counseling about VBACS affect the respondents willingness to undergo vaginal birth after C-section? Conceptual framework It is hypothesized that the KAPs of the respondents toward VBAC significantly influence their willingness to deliver vaginally after having experienced C-section in their previous delivery. Significance of the Study The most common reason that a C-section is performed is that the woman has had a prior C-section delivery. DMC is not spared from the increasing trend of repeat C-section rate. Since vaginal delivery is undoubtedly associated with less maternal and fetal morbidity and mortality, not to mention, medical supplies and other hospital resources, there is a need to find ways in order to reduce repeat C-section rate in DMC. DMC, a tertiary and referral hospital in the Southern Mindanao Region, has no available data on KAPs of women towards VBACS. Thus, the range information that this investigation will generate could provide baseline information that can be used to design appropriate interventions aimed at reducing the overall C-section rate in the institution. One of which is by counseling and encouraging patients to undergo VBACS. One of the significant risks when considering VBACS is uterine rupture because it has been the belief and fear of many repeat cesarean patients that a previously scarred uterus is too weak to withstand trial of labor hence discouraging them from going into VBACS. The information that would be gathered from this study would be of help in counseling repeat C-section patients ante-nataly and post-nataly to enable them to plan their preferred spacing intervals for the subsequent pregnancies. This is because women with prior C-section birth is considered high risk and so to optimizing maternal well being and healthcare. Moreover, data about the knowledge, attitude and practices of patients who had prior CS birth on VBACS would be of help to assess the level of acceptance of these patients and hopefully allay their fears thereby coming up with the best informed choice. Lastly, the results of the investigation could spur future research in the subject VBACS. Dependent Variable The willingness of the respondents to undergo vaginal birth after cesarean section in their next delivery Independent Variables The profile of the respondents in terms of their knowledge, attitude and practices towards vaginal birth after cesarean section. MethodOLOGY Design A descriptive cross-sectional survey design would be employed to address the research questions. Setting Outpatient department of the OB clinic in Davao Medical Center Respondents and Sampling All patients who had a prior C-section birth seen at the high risk clinic of the DMC OB OPD will be included in the sampling frame from February to April 2010. The sample size will be determined using the model , where n is the sample size, N is the population size and e is the margin of error. Inclusion Criteria All patients who had a prior CS birth will be included in the study. Exclusion Criteria Patients who will not give their consent will be excluded from participating. Data Extraction The questionnaire will be pilot tested among ten patients with previous CS at the DMC OB OPD. A structured survey form will be used for gathering data about the respondents KAPs towards VBACS and their willingness to undergo vaginal delivery (see Attachment 1). The principal investigator (PI) will conduct a one-on-one administration of the survey form. Prior to gathering information pertinent to the questions in the survey, informed consent (see Attachment 2) will be secured by the PI. After data gathering, the principal investigator will counsel the respondents about VBACS, its indication and absolute contraindication, complications and the VBACS ACOG guidelines. A post-test question will be done on their willingness to undergo VBACS after being counseled. Ethical Consideration Approval from the hospital ethics committee will be sought before the study will be conducted. After thoroughly discussing the nature, methodology and objectives of the study to the respondent, a written consent will be asked from each participating patient. Data Analysis The KAPs of the respondents towards VBACS will be profiled using descriptive statistics such as the mean, standard deviation, frequency and percentage distribution. Their willingness to undergo vaginal delivery before and after counseling about VBACS will also be described using frequency and percentage distribution. Logistic regression analysis will be used to determine whether or not the KAPs of the respondents significantly influence their willingness to undergo VBACS. Time Frame The study will be conducted in February-April 2010. Budget Materials: 10,000.00 Miscellaneous: 8,000.00 Total: 18,000.00

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Ancient Egyptian Burial A profound belief in life after death is why burials in ancient Egypt are so elaborate. There was two different ways to artificially preserve bodies. When the Ancient Egyptians buried their dead they did not want the bodies to be washed away by the floods. They also didn’t want to use up valuable farmland for cemeteries. The dead were buried close to the villages in the higher elevated dry deserts that covered the Nile. One-way of preserving a body was the linen and plaster method. The body would be wrapped in many layers of preservative linen. This would give the body the look of mummies that are in today’s movies. The idea of wrapping the bodies in linen was to preserve as much as the body’s features as possible. The linen and plaster was used to hold the shape of the face. Another widely used method of preserving bodies has to do with Natron. Natron is a natural salt that is found in Egypt. The salts would dry out the body parts so rotting would go slow. Salts were used to â€Å"pickle† a dead body. The Egyptians experimented with many different ways of mummifying. Only kings and their royal wives were buried in pyramids. Funerals depended on how much money you had. There were many different burials for different people. The poor, craftsmen and artists, nobles and courtiers, royal family, and the kings had different methods in which they were buried.   Ã‚  Ã‚  Ã‚  Ã‚  The poor people didn’t have very elaborate funerals. They were just buried in the sand. Given the gifts of a pot, some food and some other small goods is what poor people used to survive in the world after life. Craftsmen and artists were buried with a little more care but the burials were still not fancy at all. Buried in the fetal position they were basically just thrown in the dirt and mud. The nobles and courtiers were sometimes given the gift of a tomb. The nobles and courtiers were buried in shafts that sometimes were nice.

Christianity Essay -- Jesus Messiah Story Christ Essays

Christianity   Ã‚  Ã‚  Ã‚  Ã‚  Christianity is one of the major religions of mankind. It has been the dominant religion in Europe and America, Christianity has also spread throughout the world and has a greater number of adherents then any other religion.   Ã‚  Ã‚  Ã‚  Ã‚  The Jewish teacher known as Jesus of Nazareth founded Christianity. Christianity drew on the expectations for a Messiah common in the region during these centuries. Jesus was born in Bethlehem, near Jerusalem, and grew up in the town of Nazareth. He was educated from the Pharisaic school of thought and was practicing as an observant Jew. He was not preaching to non-Jews so therefore only Jews could follow him. they started to think of him as their Messiah. As he traveled through towns in Judea he gathered small groups of followers. He chose twelve from these groups and they became known as the twelve apostles. They traveled around the world preaching. According to the gospels, he created great excitement among the people. In 30 CE Jesus traveled to Jerusalem. There he was hailed as the Messiah. Others denied that he was the messiah and regarded him as a revolutionary. The Romans feared that Jesus wanted to lead an uprising, and they considered him an enemy of the state. Jesus was tried before Pontius Pilate, the Roman governor. He eventually agreed to have Jesus crucified. According to the gospels, Jesus rose from his grave, and went back to his followers for forty days and preaches.   Ã‚  Ã‚  Ã‚  Ã‚  Before 45 CE a man named Peter co...

FDI in Real Estate of India and China Essay -- Foreign Direct Investme

FDI in Real Estate of India and China FDI refers to the investment made by a foreign individual or company in productive capacity of another country for example, the purchase or construction of a factory. FDI also refers to the purchase of a controlling interest in existing operations and businesses (known as mergers and acquisitions). Multinational firms seeking to tap natural resources, access lucrative or emerging markets, and keep production costs down by accessing low-wage labour pools in developing countries are FDI investors. Foreign direct investment (FDI) is the movement of capital across national frontiers in a manner that grants the investor control over the acquired asset. Thus it is distinct from portfolio investment which may cross borders, but does not offer such control. Firms which source FDI are known as ‘multinational enterprises’ (MNEs). In this case control is defined as owning 10% or greater of the ordinary shares of an incorporated firm, having 10% or more of the voting power for an unincorporated firm or development of a greenfield branch plant that is a permanent establishment of the originating firm. Types of FDI: Greenfield investment: direct investment in new facilities or the expansion of existing facilities. Greenfield investments are the primary target of a host nation’s promotional efforts because they create new production capacity and jobs, transfer technology and know-how, and can lead to linkages to the global marketplace. Greenfield investments are the principal mode of investing in developing countries. Mergers and Acquisitions: occur when a transfer of existing assets from local firms to foreign firms takes place. Cross-border mergers occur when the assets and operation of firms from different countries are combined to establish a new legal entity. Cross-border acquisitions occur when the control of assets and operations is transferred from a local to a foreign company, with the local company becoming an affiliate of the foreign company. Mergers and acquisitions are the principal mode of investing in developed countries. The pros and cons of FDI as a source of development Attraction of FDI is becoming increasingly important for developing countries. However this is often based on the implicit assumption that greater inflows of FDI will bring certain benefits to the country’s economy. FDI, like ... ...rmats, some of which are: †¢ Builders and developers can construct the property and then hand it over to the retailers. †¢ There is also the possibility of exploring joint venture collaborations. In this format the builder shall be responsible for identifying and acquiring land, constructing the building and further be responsible for the maintenance and the upkeep of the premises. The retailer in this format shall then be responsible to bring in the brands in the building. This format provides the construction industry an extended scope of getting into retail in a joint venture format. This shall not be limited to the FDI scenario but can work well in the Indian retail industry scenario as well. This type of model lets the core business, which is construction, development and maintenance, get a value addition from another industry segment. Relaxing the existing 100 acres norm for the FDI inflow into real estate sector would help speed up construction works in the economy. It is difficult to get 100 acres in the urban areas, to enable foreign firms to build on plots starting from 25 acres against the current stipulation of 100 acres (applicable only in integrated townships). FDI in Real Estate of India and China Essay -- Foreign Direct Investme FDI in Real Estate of India and China FDI refers to the investment made by a foreign individual or company in productive capacity of another country for example, the purchase or construction of a factory. FDI also refers to the purchase of a controlling interest in existing operations and businesses (known as mergers and acquisitions). Multinational firms seeking to tap natural resources, access lucrative or emerging markets, and keep production costs down by accessing low-wage labour pools in developing countries are FDI investors. Foreign direct investment (FDI) is the movement of capital across national frontiers in a manner that grants the investor control over the acquired asset. Thus it is distinct from portfolio investment which may cross borders, but does not offer such control. Firms which source FDI are known as ‘multinational enterprises’ (MNEs). In this case control is defined as owning 10% or greater of the ordinary shares of an incorporated firm, having 10% or more of the voting power for an unincorporated firm or development of a greenfield branch plant that is a permanent establishment of the originating firm. Types of FDI: Greenfield investment: direct investment in new facilities or the expansion of existing facilities. Greenfield investments are the primary target of a host nation’s promotional efforts because they create new production capacity and jobs, transfer technology and know-how, and can lead to linkages to the global marketplace. Greenfield investments are the principal mode of investing in developing countries. Mergers and Acquisitions: occur when a transfer of existing assets from local firms to foreign firms takes place. Cross-border mergers occur when the assets and operation of firms from different countries are combined to establish a new legal entity. Cross-border acquisitions occur when the control of assets and operations is transferred from a local to a foreign company, with the local company becoming an affiliate of the foreign company. Mergers and acquisitions are the principal mode of investing in developed countries. The pros and cons of FDI as a source of development Attraction of FDI is becoming increasingly important for developing countries. However this is often based on the implicit assumption that greater inflows of FDI will bring certain benefits to the country’s economy. FDI, like ... ...rmats, some of which are: †¢ Builders and developers can construct the property and then hand it over to the retailers. †¢ There is also the possibility of exploring joint venture collaborations. In this format the builder shall be responsible for identifying and acquiring land, constructing the building and further be responsible for the maintenance and the upkeep of the premises. The retailer in this format shall then be responsible to bring in the brands in the building. This format provides the construction industry an extended scope of getting into retail in a joint venture format. This shall not be limited to the FDI scenario but can work well in the Indian retail industry scenario as well. This type of model lets the core business, which is construction, development and maintenance, get a value addition from another industry segment. Relaxing the existing 100 acres norm for the FDI inflow into real estate sector would help speed up construction works in the economy. It is difficult to get 100 acres in the urban areas, to enable foreign firms to build on plots starting from 25 acres against the current stipulation of 100 acres (applicable only in integrated townships).

Ch01 Organizations and Organization Theory

Chapter 1: Organizations and Organization Theory Current Challenges of Organizations †¢ Globalization o Markets, technologies, and organizations are becoming increasingly interconnected †¢ Ethics and social responsibility o The list of execs and major corporations involved in financial and ethical scandals continues to grow †¢ Speed of responsiveness o Globalization and advancing technology has accelerated the pace at which organizations in all industries must roll out new products and services to stay competitive †¢ The digital workplace In today’s workplace, many employees perform much of their work on computers and may work in virtual teams, connected electronically to colleagues around the world †¢ Diversity o By 2050, it is estimated that 85% of entrants into the workforce will be women and people of colour What Is an Organization? Organizations: social entities that are goal-directed, are designed as deliberately structured and coordinated activi ty system, and are linked to the external environment Types of Organizations †¢ Multinational corporations †¢ Small, family-owned shops †¢ For-profit versus non-profit organizationsOrganizations exist to do the following: 1. Bring together resources to achieve desired goals and outcomes 2. Produce goods and services efficiently 3. Facilitate innovation 4. Use modern manufacturing and information technologies 5. Adapt to influence a changing environment 6. Create value for owners, customers, and employees 7. Accommodate ongoing challenges of diversity, ethics, and the motivation and coordination of employees Perspectives on Organizations Closed System †¢ A system that is autonomous, enclosed, and not dependent on its environment †¢ Don’t truly exist today Early management concepts such as scientific management, leadership style, and industrial engineering were closed-system approaches Open System †¢ A system that must interact with the environment to survive †¢ It both consumes resources and exports resources to the environment, and must continually adapt to the environment An Open System and its Subsystems [pic] Organization Configuration †¢ Technical core o Includes people who do the basic work of the organization o The primary transformation of inputs to outputs occurs here o Includes production department, teachers and classes, medical activities in hospitals, etc. Technical Support o Helps the organization adapt to the environment o Technical support employees such as engineers and researchers scan the environment for problems, opportunities, and technological developments o Responsible for creating innovations in the technical core †¢ Administrative Support o Responsible for the smooth operation and upkeep of the organization, including its physical and human elements o Includes HR activities like recruiting and hiring, making compensation/benefit plans, employee training, etc. †¢ Management A disti nct subsystem responsible for directing and coordinating other parts of the organization o Top management provides direction, strategy, goals, and policies for the entire organization or major divisions o Middle management is responsible for implementation and coordination at the departmental level [pic] Dimensions of Organization Design Structural Dimensions 1. Formalization ? Pertains to the amount of written documentation in the organization, including procedures, job descriptions, regulations, and policy manuals, describing behaviour and activities ?A large state university would be high on formulization and a small, family-owned business would be low on formulization 2. Specialization ? The degree to which organizational tasks are subdivided into separate jobs 3. Hierarchy of authority ? Describes who reports to whom and the span of control for each manager ? The hierarchy is related to span of control (the number of employees reporting to a supervisor), and when the span is na rrow, the hierarchy is tall, and vice versa 4. Centralization ? Refers to the hierarchical level that has authority to make a decision ?When decision making is kept at the top level, the organization is centralized ? When decisions are delegated to lower organizational levels, it is decentralized 5. Professionalism ? The level of formal education and training of employees ? It’s considered high when employees require long periods of training ? Professionalism is measured as the average number of years of education of employees 6. Personnel ratios ? Refer to the development of people to various functions and departments ?Includes the administrative ratio, the clerical ratio, the professional staff ratio, and the ratio of indirect to direct labour employees ? A personnel ratio is measured by dividing the number of employees in a classification by the total number of organizational employees [pic] Contextual Dimensions 1. Size ? The organization’s magnitute as reflected i n the number of people in the organization ? Because organization’s are social systems, it’s typically measured by # of employees 2. Organizational technology ? Refers to the tools, techniques, and actions used to transform inputs into outputs ?It concerns how the organization actually produces the products and services and includes things such as flexible manufacturing, advanced info systems, and the Internet 3. Environment ? Includes all elements outside the boundary of the organization ? Key elements include the industry, government, customers, suppliers, and the financial community 4. Goals and Strategies ? Define the purpose and competitive techniques that set it apart from other organizations ? Goals are written down as an enduring statement of company intent ?A strategy is the plan of action that describes resource allocation and activities for dealing with the environment and for reaching the organization’s goals 5. Culture ? The underlying set of key va lues, beliefs, understandings, and norms shared by employees ? These values may pertain to ethical behaviour, commitment to employees, efficiency, or customer service Performance and Effectiveness Outcomes †¢ Managers adjust structural and contextual dimensions and organizational subsystems to most efficiently and effectively transform inputs into outputs nd provide value †¢ Efficiency refers to the amount of resources used to achieve the organization’s goals, and it is based on the quantity of inputs necessary to produce a given level of output †¢ Effectiveness is the degree to which an organization achieves its goals †¢ Stakeholder is any group within or outside an organization that has a stake in the organization’s performance †¢ Stakeholder approach assesses the satisfaction of stakeholders as an indicator of the organization’s performance (also called constituency approach) †¢ Major stakeholders and what they expect: Owners/sto ckholders: financial return o Employees: satisfaction, pay, supervision o Customers: high-quality goods/services, service, value o Creditors: creditworthiness, fiscal responsibility o Management: efficiency, effectiveness o Government: obedience to laws and regulations, fair competition o Union: worker pay, benefits Community: good corporate citizen, contribution to community affairs o Suppliers: satisfactory transactions, revenue from purchases The Evolution of Organization Theory and Design Historical Perspectives †¢ Efficiency is everything o Frederick Winslow Taylor developed scientific management, which claims decisions about organization and job design should be based on precise, scientific procedures †¢ How to get organized Administrative principles focuses on the total organization (looks at the organization as a whole) o For example, Henri Fayol proposed 14 principles of management, such as â€Å"each subordinate receives orders from only one superior† and â€Å"similar activities in an organization should be grouped together under one manager† o These gave organizations fundamental new ideas for estabilishing high productivity and increasing prosperity o Administrative principles contributed to the development of bureaucratic organizations, which emphasized designing and managing organizations on an impersonal, rational basis through such elements as clearly defined authority and responsibility, formal recordkeeping, and uniform application of stand rules †¢ People o Hawthorn Studies are a series of experiments on worker productivity that began in 1924 o It attributed employees’ increased output to managers’ better treatment of them during the study †¢ Environment Many problems occur when all organizations are treated similar, which is the case with scientific management o Structures and systems that work in the retail division will not be appropriate for the manufacturing division o Consistency means t hat one thing depends on other things, and for organizations to be effective, there must be a â€Å"goodness of fit† between their structure and the conditions in their external environment o Some organizations experience a certain environment, use a routine technology, and desire efficiency, and in this case, bureaucratic controls would be appropriate o But today, almost all organizations operate in a highly uncertain environment Contemporary Organizational Design Today’s organizations and managers are shifting from a mindset based on mechanical systems to one based on natural and biological systems †¢ Chaos theory suggests that relationships in complex, adaptive systems – including organizations – are made up of numerous interconnections that create unintended effects and render the environment unpredictable †¢ Many organizations are shifting from strict vertical hierarchies to flexible, decentralized structures that emphasize horizontal colla boration, widespread info sharing, and adaptability †¢ Learning organization is an organization in which everyone is engaged in identifying and solving problems, enabling the organization to continuously experiment, improve, and increase its capability Efficient Performance versus the Learning Organization †¢ From vertical to horizontal structure †¢ From routine tasks to empowered tasks †¢ From formal control systems to shared information †¢ From competitive to collaborative strategy †¢ From rigid to adaptive culture ———————– Transformation Process Environment Raw Materials People Information resources Financial resources Input Subsystems Boundary Spanning Production, Maintenance, Adaptation, Management Boundary Spanning Products and Services Output Top Management

Successful People

How to Become a Successful Person Knowing how to become a successful person is essential for every person. It gives him an easy way for a good living. The characteristics of a successful person is different for every person, it depends on how they view it. My view about a successful person is someone who has the right balance in happiness between family and career and is happy in who he/she is and what he/she does. The first thing to become a successful person is to have skills.A successful person eeds to become the specialist in their Job area, no matter how difficult the situation is. Next is to have self-confident, never look down in yourself, because when you do it, that's when you will fail. Passion is also an important need, because success can be obtained by many people, but maintaining the drive to reach the goals requires a passion to achieve it. Beside all of that, there is one thing that is hard to be earned. Why do so many of us fail to act? We know what we must do, yet w e lack the will to do t.In another word, we lack of the courage. Success cannot exist without courage, many people who cannot be success are those who have the highest training and ethics, but lack of the courage. So what we need to overcome failure is having the will to act. A successful person is not afraid to take risk and make difficult decisions, and the important thing is they are ready to accept the responsibility of it. The next step to be a successful person is focus, creative, and optimistic. Why do we need to be focus?Because it is our drive that pushes us forward and keeps our momentum, but without focus we will Just move for the sake of motion. Why do we need to be creative? Because when we stuck with the old ideas, we can make the new ones. And why do we need to be optimistic? Because, an optimist can see the opportunity in every difficulty, optimism is in the heart of a successful human being! After having and being all of that, the next step is what needs to be done. Find the goal of your life can be a good start.After that define the meaning of success as you ee it, you can't be success if you dont know what it means to you, so set clear goals and be realistic. Trust other people to do their Job so you can focus on your own Job. Being surrounded by successful people is also a way to create a culture of success, they can make you become enthusiastic and even connect you to other people that can change your life. Stay away from distractions is also an important thing to become successful. There are always distractions and it is your choice to stay away from them or not.The last is gather as much information as you can, make intellectual connections from it and use it to make your life better. So listen, study, learn, and understand everything that you think is important. The characteristics that you need to have, what you need to be, and thing that needs to be done are all important. Things that you need to have and you need to be are the basic that must be in you, and then use all of it to do the things that need to be done. Each part plays a role that is vital to turn someone into a successful person. Adrian Kohar Accounting 1

CVS business proposal Essay

Introduction In the United States, CVS is the largest pharmacy retail organization. This company operates over 6100 retail stores and specialty stores countrywide and has employed over 170,000 workers. There is a necessity of offering a wider range of prescription medication options and selections system-wide in a struggle for serving the consumer base of CVS Pharmacy more consistently and effectively. The purpose of this paper is to select a more realistic good or service for an existing industry. The paper will identify the market structure, along with elasticity of the product and will also include the way the pricing will relate to elasticity of the product. Furthermore, the paper will include the way the changes in the quantity supplied as a result of the pricing decisions will affect marginal cost and marginal revenue. Moreover, the paper will focus on the non-pricing strategies, and will explain the way the changes in the business operations could alter the mix of fixed and variable costs in line with the strategy. Market Structure The market structure of CVS Pharmacy is an oligopoly. It is a market structure in which a small number of organizations sell either differentiated or standardized products in which other organization’s entry is difficult. In this market structure, the control of the firm is limited over price of the product due to mutual interdependence (with the exception of when there is conspiracy surrounded by the organization) and in which there is a non-pricing rivalry (McConnell and Brue, 2004). The oligopoly turn out is the most common structure of big -business as the establishment of trust was limited in the United States. Evasion of pricing rivalry has turned out to be nearly automatic with four or five larger firms accountable for most of the output of every industry. If an organization were to drop the prices, it is expected that their competition will do the same and all will undergo a lower profit. Conversely, it is unsafe for any singular firm to increase their prices as the others will hold the prices with the intention of gaining a share of the market. â€Å"The safest strategy is to never lower prices and raise prices only when there is abundant evidence that the other firms will also raise prices. When business conditions permit, the price leader will raise their prices with the expectation that others will follow (McConnell and Brue, 2004). Price Elasticity â€Å"Price elasticity tells how much of an impact a change in price will have on the consumers’ willingness to buy that item. If the price rises, the law of demand states that the quantity demanded of that item will decrease† (Jennifer Tuck, Chron Small Business, 2013). Price elasticity of demand indicates the decrease in the quantity demanded. Elastic-demand indicates that the consumers of the goods or service are extremely sensitive to a change in prices. Generally, a product which has numerous substitutes or is not a necessity has demanded elasticity. Elastic demand indicates that the customers of the product are not extremely sensitive to price alterations. Upon analysis of elasticity of pharmaceutical products, it is certain that pharmaceutical products cannot be considered as a necessity. Medication is considered to be a basic item, essential for the prevention and treatment of ailments and disease and, consequently, they have a particular, non-substitutive tenacity and thus are not a necessity. It indicates, consequently, that they cannot be considered as elastic. (Tom Vander Beken, 2007). While it is factual for some branded goods with little rivalry, the demand for more crowded beneficial classifications where there are generic equivalents or rival satisfying substitutes can be highly elastic. It indicates that changes in price are met in relation to the quantity with larger changes demanded. For pharmaceutical makers, the primary goal is to realizing the degree of price elasticity. Pharmaceutical makers, for better understanding price elasticity, utilize a range of methods for assessing price elasticity, comprising quantitative research, qualitative research, and retrospective data analysis assessing the effects of a number of levels on prescription demand (Brent L. Rollins, Matthew Perri, 2013). Marginal Cost & Revenue A way to determine the quantity of profit maximization is to conclude where marginal revenue equals marginal costs. Rather than computing the profit for all levels of sales; total revenue and total variable costs are considered. Marginal revenues and marginal costs are considered in a similar way like marginal profit, thus defining the amount of change for all sales’ levels (Huter, 2012, p.2). Pricing & Non-Pricing Strategies CVS needs to think through numerous elements impacting its’ business. Pricing strategies, rivals and their current products, consumer demands and suppliers are examples of these elements. For pricing strategies, CVS should consider closeouts, discounts, product bundle pricing, penetration pricing, geographical pricing, and membership or trade pricing. For non-pricing strategies, options comprise: enhanced service quality, longer opening hours, advertising, and extended warranties (Kimmons, n.d.). By pricing similar products in a different way they must focus on regional demographics because geographic pricing enables the maximization of profit. For promoting unique or new products at provisional price drops, penetration pricing is the most effective. Finally, bundle pricing and closeouts can be engaged when several seasonal goods need to be sold off to avoid a loss (Kimmons, n.d.). Enhanced service quality, longer hours and advertising needs to be included in the non-pricing strategies. Advertising grabs the attention of the consumer to the brand and engages them, making them conscious of promotions and sales. Longer hours enables the organization the opportunity to service more clients—â€Å"the fisherman with the biggest net catches the most fish†. In the end, the automated verification and dispensing systems’ implementation will boost the quality of the service, particularly in the pharmacy to enable more pharmacists to be able to counsel the patient and provide better customer service. Barriers to Entry In the retail pharmacy industry, cost is the main barrier to entry. Economies of scale, as an incumbent, enable CVS to purchase larger quantities at lower rates due to a longer relationship with suppliers because they are purchasing in bulk. These advantages allow CVS to lower prices while maintaining profit. New entrants would not be capable of adequately competing with the old firms and do not enjoy these same benefits (Anonymous, 2012). Current Global Economic Conditions In the past six months, global economic conditions have developed. Policymakers of advanced economy effectively resolved two of the major short-term threats to global activities—the threat of a sharp monetary reduction in the United States and a euro area breakup. In response, according to the latest World Economic Outlook of IMF, financial markets have rallied, and financial constancy has developed. In 2013, the report predicts real global growth of Gross Domestic Product of 3.3% on a basis of yearly average, almost the similar as the 3.2% growth perceived in 2012, and the International Monetary Fund anticipates the growth to increase to 4% in 2014 (Thomas Helbling, 2013). The Pharmaceutical Industry of United States is one of the supporters of the US Economy. It has been perceived that the Pharmaceutical Industry of the United States is developing quickly and is demonstrating no indications of slowing down. The growth of the pharmaceutical industry in the U.S. is also recognized as playing a very important part in the pharmaceutical industries around the world. Some experts have said that in the development of the United States’ pharmaceutical industries, media has played a key role. Experts have seen the major influence in the way the media has provoked health awareness among the people. Current Business Cycle’s Stage of the U.S. Economy Currently, the economy of the United States is in a stage of mid-cycle expansion. As indications of economic development seem to be gaining momentum, equity markets have solidly performed this year. In recent times, a boom in domestic energy and an increase in the housing market have been seen; while employment carries on to develop and grow. Early this year, the fiscal cliff’s resolution stopped a self-inflicted damage to the economy, letting development force to endure. â€Å"The index of US Leading Indicators—made up of 10 economic components that historically have had strong predictive power on GDP growth—also appears to confirm that growth remains intact.† (Matthew Rubin, 2013). However, current indications are becoming a reason for concern. The overdue impacts of payroll tax modification and monetary reduction through repossession has seemed to surprise financiers. Current Credit Market Conditions For consumers and for business loans, interest rates are lower this year compared to any other year. Credit exchange of U.S. government like discount, FFR and Prime rate are much lower. For example, there is a Prime rate of 3.25% and 10% more consumer loans are being given by the financial institutions. Still, loans for business are restricted and not given as easily as in the previous years. (â€Å"Beige book,† 2013) All these signs demonstrate that the market is starting to move and customers are beginning to buy and are content with the existing economy. CVS Pharmaceutical can invest in the market on this uptick by marketing with intention of attracting more customers. Conclusion The market structure of the CVS Pharmacy is an oligopoly. It is a market structure in which a small number of organizations sell either differentiated or standardized products in which other organization’s entry is difficult. Price elasticity of demand indicates the decrease in the quantity demanded. Elastic-demand indicates that the customers of the service or good are extremely sensitive to change in prices. CVS needs to think through numerous elements impacting its’ business so they may run smoothly. If CVS modifies the way they do business, they can impact their bottom line in many ways. In the past six months, global economic conditions have developed. Policymakers of advanced economy effectively resolved two of the major short-term threats to global activities—the threat of a sharp monetary reduction in the United States and a euro area breakup. The Pharmaceutical Industry of United States is one of the supporters of the US Economy. It has been perceived that the Pharmaceutical Industry of United States is developing speedily and is demonstrating no indications of lowering down. Currently, the economy of United States is in a stage of mid-cycle expansion. As indications of economic development seem to be gaining momentum, equity markets have solidly performed this year. References Anonymous. (2012). What Are Barriers to Entry, Retrieved from http://www.wisegeek.com/what-are-barriers-to-entry.htm Board of Governors of the Federal Reserve, Twelfth District–San Francisco. (2013). Beige book. Retrieved from website: http://www.federalreserve.gov/monetarypolicy/beigebook/beigebook201304.htm?san_francisco Brent L. Rollins, Matthew Perri, 2013 Pharmaceutical marketing, Jones & Bartlett Publishers, 01-Feb-2013 Huter, S. (2012). How to Calculate the Profit-Maximizing Quantity, Retrieved from http://www.ehow.com/how_6713701_calculate-profit_maximizing-quantity.html Kimmons, R. (n.d.). Pricing Vs. Non-pricing Strategies. Retrieved from http://smallbusiness.chron.com/pricing-vs-nonpricing-strategies-14166.html Matthew Rubin, 2013, Director of Investment Strategy, Strategic spotlight, an update to economic business cycle, retrieved from: http://www.btinvest.com.sg/experts-views/strategic-spotlight-an-update-on-the-global-business-cycle/ McConnell, C. R., Brue, S. L., & Flynn, S. M. (2009). Economics: Principles, problems, and policies (18th ed.). Boston, MA: McGraw-Hill Irwin. McConnell, C. and Brue, S. (2004). Economics: principles, problems and policies, 16 ed. 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