Business Plan Essay Example | Topics and Well Written Essays - 1000 words - 6

Business Plan - Essay Example Stern measures have to be taken by the tour operators as far as safety and health assessments are concerned as Controls are not rigorous. This would help to safeguard the agency also against any litigation. Assessments of health and safety should be carried out throughout the tour (Daily Mail, 2006). While tour operators have to rely on the guarantees provided by the hotel authorities, BE should ensure that its terms and conditions of joining the tour are well laid out while setting up the business as tour operators could be subject to civil liability (AHS, 2007). While WTO predicts international travel will grow annually at the rate of 4.1% up to 2020 but various factors pose a risk to tourism. These include economic stability, world terrorism, and global climate changes. The UK travel sector is just recovering from the recent airport chaos and the threat of terrorist attack. Fear of terrorism affects global travel demand and the targets set by BE is a very optimistic figure. Tourism is a very sensitive sector and destination factor is very important. BE intends to focus on the affluent class and predominantly on adventure tourism. The company has not attained any experience in this segment and it would be advisable to have another sector and segment to fall back upon initially till it gets established. The number of holidays on offer should be limited to start with. Security situation puts holiday firms in a difficult situation (Reuters, 2007). Lessons can be learnt from the giants in the industry who have been able bring a turnaround despite the effects of football World Cup, avian flu, terror threats and the hot summer in UK (Mall, 2007). This has required a dual measure of huge investments and cost-cutting in various areas. BE plans to build brand awareness in the first year but would have to consider the consolidation taking place in the UK travel market as big firms are merging. This definitely means less competition but there is an oversupply of

Social Policy Essay Example for Free

Social Policy Essay Explain the meaning of the term ‘social policy’ and discuss how social policy is applied in practice, drawing upon the major milestones in the development of the British welfare state. For the purpose of this assignment I intend to discuss in great detail social policy and how it is applied in practice, using examples from mainly voluntary sectors. I will also discuss the introduction of the Beverage report in 1948 and Margaret Thatcher’s move to the new right approach in 1979 in regards to being the two major milestones within the development of the welfare state. Social Policy is a study of the social services and the welfare state, the welfare state being anything that helps people get back on their feet after hardship, this is not always in regards to money it can sometimes relate to resources. Social Policy it looks at socially constructed issues such as divorce, unemployment, crime and it aims to improve them by making positive changes. Social policy also looks at vulnerable people in society such as single parents, elderly people, disabled people and looks at ways in which they can be supported. Social policy is not always legislation it can be looked at more along the lines of trial and error, almost like guidelines or aims something to be worked towards achieving. It is not always effective depending on how beneficial or valuable it is and whether or not people choose to conform. Although most sociologist wouldn’t agree on social policy and the definitions may vary depending on whether the sociologist is left or right wing. Left wing approach supports social equality and discourages hierarchy, whilst looking out for and supporting disadvantaged individuals within society. In contrast to this is the right wing approach which accepts hierarchy and social inequalities, and views them as inevitable. It is very much a functionalist approach seeing hierarchy as necessary for society to function. Ways in which social policy is put into place are through projects such as The New Economic Foundation also known as the NEF they work with people within society as well as the government, businesses and academic sources to help improve society as a whole tackling all areas surrounding the nvironment, economy and society. NEF are an independent registered charity who are funded by, grants and donations, individual followers and earned income â€Å"Our individual supporters gave a total of ? 121,860 this year† (NEF, 2013). There is also David Cameron’s Big Society, which aims to concentrate on welfare being provided more through voluntary sectors rather than the state, this in turn aims to give communities more control over issues such as public service s, schools and housing. It also encourages and financially supports people working towards a better future, to enable them to improve their circumstances. â€Å"A strong, diverse, well-capitalised and sustainable social investment market in the UK, through which social sector organisations can access appropriate and affordable finance and support to grow their impact on society. † (Big society, 2013) There are believed to have been two major milestones in the development of the British welfare state, one of which was the implementation of The Beverage report in 1948, this was introduced by William Beveridge after the war to help maintain control. The Beveridge report was very much a left wing approach, based on and supported by social democracy, he had the idea that everybody needs to work together in order to reduce inequalities and believed it was the responsibility of the government to help and support citizens who needed it. He identified 5 social evils that needed to be overcome in order for society to function, Ignorance (education) , squalor (housing), want (need), idleness (unemployment) and finally disease (health) for the purpose of his assignment I will be concentrating on disease, this was combated by the introduction of the National Health Service, most commonly known as the NHS. This was introduced in 1948 and provided free healthcare for the state, it provided security from the cradle to the grave. The second of the major milestones was Margaret Thatcher’s move to the new right approach in 1979, as a conservative her approach was very much a right wing approach, she questioned the social democracy, she reduced welfare spending and she sold off council houses. Margaret Thatcher also challenged the method of delivering welfare. Social democracy which was favoured by the UK government following the war was based on the theory of John Keynes  and was implemented through the Beveridge report, this theory believed it was necessary for the government to intervene within the economy and thought society should work together to help each other, the strong supporting the weak. The new right theory which was dominant in 1979, supported the capitalist system and believed it was cable of providing wealth for everyone, they believe that the government should not intervene with the market system via taxes, or welfare as the market system makes sure prices and wages meet supply and demand ensuring employment for all. It sees the welfare state as being unnecessary and although it shouldn’t be eliminated entirely they believe it should follow a residual model, which is basically only the deserving poor should be given minimal benefits, thus making the rich richer and he poor poorer. Margaret Thatcher’s challenging attitude towards the delivery method of welfare introduced welfare pluralism, also known as mixed economy welfare, meaning that the welfare is not provided only by the state it is made up of 4 different sectors. Government agencies, which is the welfare state, advantages of this would be that there is very little chance of bankruptcy within this sector as the government can raise taxes to maintain welfare for those who require it, this way of providing welfare also ensures that only qualified individuals can work within this sector maintaining a high standard of care which can be equally distributed throughout the whole country, the disadvantages of this method of welfare are that specialist care such as elderly people is overlooked and it is possible that they would benefit more from voluntary care rather than the state, it creates higher taxes as people now have longer life expectancies and it can also create dependency upon the state giving people no motivation. Voluntary Organisations, which is charities this can be cheaper as volunteers and donations are used, and as previously discussed can attend to specific needs better than the state such as elderly, people suffering with HIV or dea ling with domestic abuse. Disadvantages of this are that if the charity fails to get funding the care may not be available long term, also due to funding welfare may not be distributed evenly across the country. In addition to this volunteers may lack qualifications and training. Private Sector, which is profit making companies because of their profit making nature the quality of care can often be better in the hopes to attract business, there is also more of an element of choice within this sector. Although like the voluntary sector if the business ends the service provided will be terminated, and the private sector is only really available to those with money. Informal Sector, this is where welfare is provided by the family. Although it promotes independence and saves the government money it is very much a New Right view upon which the care responsibilities fall on women and in some cases young children who are more often than not lacking in resources. As you can see Margaret Thatcher and William Beveridge had a huge impact on the development of the British welfare state, whether some would agree or disagree that all changes where positive they have never the less influenced the British society we live in today. Although there is still controversy in regards to certain aspects of the welfare state, recently there has been argument by Iain Duncan Smith, the Secretary of State for Work and Pensions in regards to pensioners and their benefits â€Å"Wealthy elderly people who do not need benefits to help with fuel bills, TV licences or free travel should return the money, the work and pensions secretary says. † (BBC, 2013). This has created huge controversy as people feel that after such a long time of paying into the system that they are deserving of these benefits and may also discourage people from paying into the system in future, this is a situation in which the trial and error of social policy would be applicable. Reference List: NEF. (2013). Who funds us. [Online]Available: http://www. neweconomics. org/pages/who-funds-us. [Accessed 10th May 2013]. Big Society Capital. (2013). OUR VISION AND MISSION. [Online] Available from: http://www. bigsocietycapital. com/our-vision-and-mission. [Accessed 10th May 2013]. BBC News UK. (2013). Iain Duncan Smith urges wealthy elderly to hand back benefits. [Online] Available from: http://www. bbc. co. uk/news/uk-22327335. [Accessed: 10th May 2013].

Rewriting The Yellow Wallpaper -- The Yellow Wallpaper Essays

Rewriting   "The Yellow Wallpaper"   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Elizabeth Cady Stanton and Charlotte Perkins Gilman rank as two of the most outstanding champions of women's rights who were active during the nineteenth century. Both professed a deep and personal faith and both were wise enough and secure enough to develop their own ideas and relationship with their creator. In 1895 Stanton published The Woman's Bible, her personal assault on organized religion's strangle-hold on the women of the world. Gilman published her short story "The Yellow Wallpaper" in 1892. She wrote the story, she said, "to save people from being driven crazy" (Golden 52). The heroine of "The Yellow Wallpaper" finds her only escape from the oppression of a condescending spouse is a headlong descent into madness. Stanton and Gilman met at least once, about 1896 according to Gilman's autobiography. "Of the many people I met during these years I was particularly impressed by Elizabeth Cady Stanton. To have been with her . . . seemed to establish connection with a splendid period of real heroism" (Gilman 216). Perhaps if the philosophies of these two great women were to come together, at the perfect moment, they would possess the potential to save the heroine of "The Yellow Wallpaper." The following scenario might prove feasible. ---------- An Obstacle Charlotte Perkins Gilman l I was climbing up a mountain-path With many things to do, Important business of my own, And other people's too, When I ran against a Prejudice That quite cut off my view. ---------- The Yellow Wallpaper by Charlotte Perkins Gilman amended, with apologies, by Margaret A. Stanton ---------- The heroine of "The Yellow Wallpaper"... ... Elizabeth Cady Stanton/ Susan B. Anthony: Correspondence, Writings, Speeches. Schocken Books, NY: 1981. Gilman, Charlotte Perkins, The Living of Charlotte Perkins Gilman. University of Wisconsin Press, Madison: 1990. Gilman, Charlotte Perkins, "The Yellow Wallpaper" The Heath Anthology of American Literature, Second Edition. Gen. Ed. Paul Lauter. D. C. Heath and Co., Lexington, MA: 1994. Golden, Catherine, ed. The Captive Imagination: A Casebook on The Yellow Wallpaper . The Feminist Press at The City University of NY: 1992. Stanton, Elizabeth Cady. The Woman's Bible. NY European Pub. Co.: 1895-98. Northeastern U. P., Boston: 1993. Note 1 The poem "An Obstacle" by Charlotte Perkins Gilman is used as an epigraph by Catherine Golden, ed. The Captive Imagination: A Casebook on The Yellow Wallpaper (The Feminist Press: NY City UP, 1992) vii.   

A Review of Saint Augustine’s Virtue and the Human Soul Essay

In Augustine’s article â€Å"Virtue and the Human Soul,† happiness is discussed in great detail. What makes a man happy? How do we obtain this happiness and where does happiness reside? Can this happiness be lost? Augustine answers these questions by the notion of one’s â€Å"chief good.† He explains that a man’s chief good is the reason behind all happiness. If one is not happy, it is because they have not found their chief good, and therefore cannot be happy until they find it (Augustine 264-267). â€Å"Happiness is in the enjoyment of man’s chief good. Two conditions of the chief good: 1st, Nothing is better than it; 2nd, it cannot be lost against the will† (Augustine 264-267). As human beings, we all want to be happy and live enjoyable lives. However, Augustine believes that only one type of person can fully achieve happiness, the man who both loves and possesses their chief good (Augustine 264-267). He describes three other cases when happiness is not obtained. First, one who seeks what he cannot obtain suffers torture (Augustine 264-267). This means that someone who strives for something that they will never be able to reach is not happy. Secondly, one who has got what is not desirable is cheated (Augustine 264-267). This is saying that someone who has received happiness in a way that they do not like, or has received happiness that they do not want, can never be happy. Thirdly, one who does not seek for what is worth seeking for is diseased (Augustine 264-26 7). This final case is when someone seeks happiness through things that are wrong and not worth having. In all of these three mentioned cases, one’s chief good has not been found. Augustine continues in the article by discussing how man’s chief good is not inferior to man itself, but more as an equal to man. The chief good then must be something that is never lost against the will (Augustine 264-267). The chief good, once properly in the heart of a man, can never be taken away. It resides fully in the inner workings of man and is buried so deep within that nothing could ever take away the happiness. â€Å"For no one can feel confident regarding a good which he knows can be taken from him, although he wishes to keep and cherish it. But if a man feels no confidence regarding the good which he enjoys, how can he be happy while in such fear of losing it?† (Augustine 264-267). For example, when you go to a pet shop and see all the cute puppies. You want to hold them and pet them, and it makes you so happy for that brief period. However, you know that the happiness can be taken away from you, because you don’t own the puppies, you don’t get to take them home. Ultimately, you walk away sad, and wishing you could hold on to that happiness just a little longer. It is hard to be confident in a happiness that you know can be taken away from you at any time, and it’s equally as hard to have no confidence in your happiness because you live in fear of never being happy. Augustine continues his discussion of what makes a man. The question lies in the discussion between man being of the body only, of the soul only, or both. He talks about this to determine where man’s chief good resides, and from where it is discovered. â€Å"Man’s chief good is not the chief good of the body only, but the chief good of the soul† (Augustine 264-267). Augustine states that a person’s chief good is found in the soul and that the soul gives life to the body. The soul provides bodily pleasure, pain, strength, beauty, swiftness, etc. Without the soul, there would be no body, and without the body, no soul. They work together in order to achieve the chief good for man. Augustine gives the example of a coachman who works for him. The coachman does the most satisfactory job of caring for the horses, all because Augustine has provided the funds and bounty to the coachman. Can any one deny that the good condition of the horses is due to Augustine? (Augustine 264-267). His point is that without his money and horses, the coachman would never be able to do the job he was assigned, and because of Augustine in this example, the coachman can provide the happiness and care to the horses. This relates to the body being a direct worker of the soul. The body is the outward laborer of the soul’s control. Augustine’s article is summed up in the discussion of virtue. â€Å"Virtue gives perfection to the soul; the soul obtains virtue by following God; following God is the happy life† (Augustine 264-267). Augustine debates whether or not virtue exists on its own, or if it can only exist within the soul. He says virtue must exist on its own because the soul must have something to follow after in order to attain that virtue. Virtue must be gained; it is not already contained within the soul. This virtue, according to Augustine, belongs in the pursuit of God. As mentioned before, Augustine believes that one’s chief good cannot be taken away against one’s will. Therefore, it must remain that God is the virtue one seeks. Through following God, one’s chief good, happiness, and virtue can be both loved and possessed (Augustine 264-267). After reading and re-reading this article, I feel I have finally found the true meaning of what Saint Augustine was saying. Happiness cannot just be attained by the snap of a finger, by a simple glimpse of hope. Happiness must be sought after in a way that completely fills the soul and in a way that one can feel they are completely confident in their happiness. I agree with Augustine’s argument for the pursuit of God in finding happiness. I believe that God is the creator of happiness and virtue, and that through him anyone can find their chief good. My question to the class is this: do you agree with Augustine’s argument of happiness only coming from within the soul and God, or do you believe happiness can be obtained to its fullest potential in a different way? Work Cited Augustine, Saint. â€Å"Virtue and the Human Soul.† Vice and Virtue In Everyday Life. Comp. Christina Hoff Sommers and Fred Sommers. Belmont, CA: Wadsworth Cengage Learning, 2010. Print.

Great Famine Essay

Buba – A boil that is caused by the Bubonic Plague, usually on the neck, armpit, or groin and causes excruciating pain. Flagellants- Group of people that whipped themselves to rid them of sins, in belief that Black Death was God’s punishment on humans for wickedness. Crecy-A city in Northern France 1346, English longbowmen scored a great victory over the French knights and crossbowmen. Agincourt- near Arras in 1415, the chivalric English soldier- King Henery V gained the field over vastly superior numbers. Joan of Arc- A peasant girl that convinced the French government the dauphin needed to be crowned and to expel the English out of France. She dressed as a man and fought in the war, but was caught and burned at the stake for being a witch. Representative assemblies- the beginnings to modern government like the English Parliament and German Diets Nationalism- The feeling of unity and identity that binds together people. The English had strong nationalism after winning the war. Babylonian Captivity- referring to the seventy years the ancient Hebrews was held captive in Mesopotamian Schism- Another word for division, in this case the division of the French and English and their Popes. Conciliarists- believed that reform of the church could best be achieved through periodic assemblies, or general councils, representing all the Christian people. Statue of Kilkenny- â€Å"there was to be no marriages between those of immigrant and native stock† To make sure there was no racism in Ireland Merchant- The fine you have to pay the lord to get a woman married. Banns- Public announcements that are posted on the church door that says who is getting married. Jacquerie- French Peasant uprising named after a mythical laborer. Racism- Discrimination based on ethnicity, Irish were discriminated mostly Dalimil Chronicle- A survey of Bohemian history pervaded with Czech hostility toward Germany Peasant Revolts- Peasants make large groups and try to over throw the leader, happened in Fladers. Review Questions 1. The Great Famine caused the population decline in the early 14th century. The famine wide out a large potion on the population. Infants, children, and elderly people were susceptible to disease and now the workingman had a reduced diet. These tough conditions made it difficult to support a family, so no babies were being born. So in the 14th century there was population decline. 2. The bacteria that caused the bubonic plague was found in the blood stream of rodents and it traveled through fleas. Overcrowding, poor sanitation, lack of personal hygiene, and poor nutrition encouraged the disease to spread dramatically through Europe. The land values drastically dropped. Narrow streets filled with refuse and human excrement were as much as cesspools as thoroughfares. The extreme overcrowding was everywhere. 3. The short and long-term causes of the Hundred Years’ War were the English claimed Aquitaine as in ancient inheritance. However, the French was strongly expansionist (French Policy). Economic factors about the wool trade and control of Flemish towns served as justification between France and England for the next centuries. The spreading of commerce with England threatened their prosperity. 4. The French overall had their land regained and won the war. They however lost thousands of soldiers and civilians as well as hundreds of thousands of acres of farmland causing the economy to be left in shambles. England spent over 5 million causing to have a massive net loss to go along with the loss of thousands of soldiers. They did however gain the power of representative assemblies such as Parliament. 5. The Babylonian Captivity weakened the prestige of the church because the current pope was asked to move to Rome while sick and at near death. Once he died, the clergy elected Urban VI to pope. He acted insane and cardinals â€Å"excommunicated† him from pope. Soon a new pope was chosen, Clement VII. Cardinals that supported the Concilliar Movement elected a new pope as well, making three popes at once. 6. The Conciliarists Movement was revolutionary. It was a belief the reform of the church would be best achieved through periodic assemblies, or general counsel, representing the Christian people. 7. (who is he) John Wyclif was an advocate for the Conciliarists Movement. Wyclif was a threat to the institutional church because he said that churches should be stripped of their property. He told people that they are their own churches if they just read the bible. His followers, Lollards, allowed woman to preach and were like by many. 8. After the Hundreds Years’ War there was little to no employment for knights. Many of those nobles turned to crime called fur-collar crime. This was where the nobles would steal from the rich and tell the poor that they had to pay a fee so that they wouldn’t hurt them. They gained a great deal of money, but after long suffering by peasants they began to get angry and revolt. 9. The French Peasants’ Revolt of 1358 was caused by heavy taxation by the French from the Hundred Years’ War. Plus plague, famine, and being harassed by fur-collar crimes, they went through the countryside killing nobles. Peasants brought about the English Peasants’ Revolt of 1381 because of the demand for higher wages and the governments fail to represent their wants. Also frozen wages and head tax were contributing reasons.

Emergence Of Professional Assessment Within Social Work Social Work Essay Essay Example

Emergence Of Professional Assessment Within Social Work Social Work Essay Essay Example Emergence Of Professional Assessment Within Social Work Social Work Essay Essay Emergence Of Professional Assessment Within Social Work Social Work Essay Essay This essay aims to discourse the outgrowth of professional appraisal within societal work and see the part a qualified societal worker is able to offer to the appraisal procedure over that of a well-meaning and skilled unqualified worker. The treatment will be illustrated utilizing appropriate statute law and policy, with mention to service users with larning disablements and older people. The NHS and Community Care Act ( 1990 s. 47 ) places a statutory responsibility on local governments to measure any individual who may be in demand of services. Its induction prompted a sea alteration from antecedently service-led attacks towards user-led appraisal, advancing client demand and positions ( Branfield and Beresford, 2006 ) . However, despite being the fastest turning country of societal work, the protection of grownups is compromised by a deficiency of dedicated, comprehensive statute law. There is, for illustration no grownup equivalent to the Children Act ( 1989 ) to put out statutory responsibilities for local governments. In the absence of such statute law, the Department of Health published the No Secrets counsel ( DH, 2000 ) which makes recommendations for pattern and provides definition for vulnerable grownups as, those in demand of services because of mental or other disablement, age or unwellness, and/or those who are unable to care for themselves or unable to protect themselves from important injury or development. Owing to this, service users with larning disablements and vulnerable older people are likely to fall into said class. In order to discourse appraisal, it is of import to first specify it. Thompson ( 2002 ) refers to the holistic procedure which provides overview of the state of affairs. Crucially, it is merely with this holistic apprehension that practicians can accurately measure which support should be offered, while the process Thompson refers suggests that appraisal should non be an stray juncture. Good appraisal hence requires several phases ; viz. readying, informations aggregation, burdening so analysis of the information gained and in conclusion utilizing this information to inform intercession ( Milner and OBryne, 2009 ) . While these phases are non uniformly adhered to, they provide a procedure which validates the importance of holistic appraisal which is flexible, brooding and multi-agency ( Beckett, 2010 ) . Lack of multi-agency working is commonplace when bureaus fail ( DH, 2001 ) , and the serious instance reappraisal of Steven Hoskin, a vulnerable adult male with learning troubles who was abused, tortured and finally murdered ( BBC, 2007 ) , found overpowering grounds that bureaus were working in isolation, non sharing information and therefore neglecting to run into the demands deemed necessary in No Secrets ( DH, 2000 ) . Steven s reappraisal indicates bureaus were familiar with his exposure every bit good as the hazard posed by his relationship with Darren Stewart, a adult male with a diagnosed personality upset and history of anti-social behavior. Assessment in any instance, but peculiarly in complex 1s such as Steven s require bureaus to work together, intending societal workers must hold entree and overview of all available information in order to accurately measure both service user demands and possible hazards ( Walker and Beckett, 2003 ) . While a societal worker was involved in Steven s instance, the bulk of contact was with helpers who may non hold benefitted from faculties in Inter-Professional Education ( IPE ) which support better apprehension of bureau and professional functions ( Adams et al, 2005 ) . It could therefore argued that a qualified worker would hold understood the importance of sharing information, given that they must besides adhere to societal work Code of Ethical motives which calls for communicating and partnership working, and for bureaus to keep and portion clear, impartial and accurate records ( GCSS, 2002 ) . Sharing information AIDSs professional opinion, regards appraisal and aids deriving a holistic image of service user lives ( Doel and Sharlow, 2005 ) . Despite his built-in exposure, marks bespeaking this were non acknowledged and his serious instance reappraisal indicates that he told of holding no money, increasing his intoxicant ingestion every bit good as multiple calls to the constabulary. Despite constabularies, societal services and Ocean Housing all separately keeping important information sing anti-social behavior at his reference no action was taken. Failure to safeguard persons at hazard contravenes Articles 2 and 3 of the European Convention of Human rights and grownup protection, which like that of a kid, should be triggered when person is at hazard of harm of which there was grounds ( ECHR, 1950 ; DOH, 2000 ) . While independency is encouraged, a categorization of larning disablement should connote support is needed throughout the life-course, most peculiarly for those ( like Steven ) who are without protective societal webs, day-to-day modus operandis and nearby households who are willing to help ( Flynn, 2007 ) . Steven s demands were assessed as substantial and should hold had hebdomadal visits ; nevertheless out of the 18 planned merely 11 took topographic point before support was discontinued by Steven in August 2005. In this clip appraisals were non reviewed and risk appraisals uncompleted, despite FACS counsel saying they should be undertaken even when hazard is low ( DH, 2003 ) . Whilst Steven did hold some contact with Community Care helpers and NHS forces, both were considered un-attuned to his larning disablement, therefore chances to place maltreatment missed and concerns non passed on. Dolgoff et Al ( 2009 ) suggest that practicians will frequently know what the right calls are in pattern owing to gut feelings and Sullivan ( 2011 ) argues experient societal workers can intermix analysis ( such as prioritisation of information and hazard ) with instinct to do determinations in hazardous, complex ad unfamiliar state of affairss. While non sole to qualified staff, the ability to use replete aboard theoretical models, Sullivan arguably places qualified practicians in advantageous places during appraisals. Steven was known to associative with persons presenting as friends who used this place to work and ease maltreatment. Adults with larning disablements have an increased exposure to exploitation and such incidents have since been termed mate offense ( Williams, 2010 ) . Le Riche and Tanner ( 1998 ) recommend that community attention appraisals address countries including presentation, domiciliary cleanliness, and ideally company kept by clients. Stating marks of maltreatment were arguably apparent environmentally, socially and physically and a qualified worker may hold better recognised them and so initiated safeguarding processs as per the societal policy and counsel taught exhaustively in societal work instruction ( DOH, 2000 ; Trevithick, 2005 ) The decease of Gemma Hayter has a figure of tragic similarities to Steven Hoskin, including hapless information sharing ( despite multi-agency engagement ) , failure to reexamine appraisals and associations with known anti-social equals ( 2010 ) . Cardinal to the weaknesss in Gemma s instance nevertheless was the deficiency of lucidity in relation to her status which resulted in her falling through spreads in services. Assessment was refused in August and October 2007 and once more in November 2009 due to the deficiency of a diagnosing of larning disablement and, while she was assessed in 2008 by mental wellness services ; this was non referred on for societal attention appraisal. Appraisal at these occasions may hold identified demand and hazards related to societal operation every bit good as potentially recognizing of the hazard associated with her exploitatory equal group. Arguably personalisation may hold better supported Gemma as it assesses demand and hazard on exposure non me rely medical conditions every bit good as recognise client position and supply liberty ( Faulkner and Sweeney, 2011 ) . While preoccupation with hazard can ensue in those so defined being excluded from decision-making ( Langan and Lindow, 2004 ) ; important to Steven and Gemma s instances are the deductions of the choices made to withdraw with grownup services. While societal workers must recognize service users right to do determinations which may be considered unwise ( DOH, 2005 ) , it must besides be acknowledged that important premises were made about Gemma s mental capacity, despite no appraisal taking topographic point. Indeed, picks in both instances to withdraw were non decently investigated by any of the cardinal bureaus or staff ( Flynn, 2007 ; SCR, 2010 ) . It must be recognised that any individual who has capacity has the right to decline such services ( MHA, 2005 ) , nevertheless, where there is identified hazard the Risk and Choice Framework ( DH, 2007b ) recommends a multi-agency reappraisal meeting should be called to see if alterations can be made to re-engage the client and a haza rd appraisal updated to reflect the determination, which, in Gemma s instance this was non done. Again, a qualified societal worker with cognition of grownup protection and hazard may hold supported this. Many grownups, peculiarly those with learning troubles are capable to multiple subjugations, likely to populate in poorness and be exceptionally socially excluded ( Flynn, 2007 ; p. 21 ) . Awareness of this possible impact is indispensable to the function of societal work, and one could reason that without cognition and preparation of anti-oppressive pattern ( AOP ) , unqualified practicians are at hazard of appraisals which may be insensitive but besides damaging to both their relationship and to the service user s results ( Laird, 2007 ) . Jupp ( 2005 ) states that appraisal must be a procedure of alteration with the service user at the Centre ; necessitating practicians to hold an apprehension of how the impact of power instabilities. However, given service user demands are efficaciously graded utilizing the Fair Access of Care Services protocols ( DOH, 2010 ) ; the procedure can be disempowering, potentially perpetuate feelings of subjugation and appear contrary to AOP values ( Braye and Preston-Shoot, 2003 ) . The decease of JK , a 76 adult female who lived on her ain in Cornwall prompted a serious instance reappraisal which found two nucleus appraisals were undertaken by unqualified staff despite assorted wellness and societal demands which would inherently do appraisal more challenging ( SCR, 2009 ) . While the National Framework for Older Peoples ( 2001 ) provinces risk can be self-determined ; JK s workers were reported as baffled between pick and hazard despite concerns being raised by her household sing exposure, hazard of fiscal development and the conditions at her place which were reported to be both unhygienic and insecure. A qualified worker with the accomplishments and cognition of identifying and measuring hazard and apprehension of safeguarding processs possibly would hold initiated processs for safeguarding every bit, while JK possesses the right to remain at place, she is at hazard by virtuousness of possible fiscal maltreatment reported. However, despite contact with un qualified workers, hazards were non considered and safeguarding processs non initiated in line with protocol ( DH, 2000 ; DH, 2001 ) . It is of import that societal workers operate a two manner duologue, listening to and understanding service user positions every bit good as pass oning comprehension of the client s wants and feelings without doing premises about depleted capacity ( Richards, 2000 ) . However, while there were no reported concerns in relation to a capacity, appraisal was non undertaken by a appropriately qualified worker therefore, whilst JK wished to stay at place, it would hold been the duty of a qualified worker to guarantee that she understood the effects of these determinations ( DOH, 2005 ) . Bing person-centred in appraisal is of import when working with older people and Smale and Tuson ( 1993 ) discourse the usage of an exchange theoretical account as the default place in appraisal as it assumes the service user, justly, as the expert in their life. Knowledge of such theoretical accounts and theories are taught in societal work instruction and have added value in pattern with older people as practicians face extra struggle as older people s relationships with services can frequently be negative ; linked to neglecting wellness ( mentally and physically ) , poorness and old age ( Richards, 2000 ) . While Puting Peoples foremost ( DH, 2007 ) asks that control is passed back to service users, appraisal can hence be associated with farther loss of independency and considered something to fear intending societal workers must be cognizant of the potentially detrimental impact this may hold on power kineticss ( Kaufman, 1994 ; Seale, 1996 ) . Morrow-Howell ( 1992 ) raises conc erns that unqualified workers can overlook of import issues sing older people, and a qualified worker with apprehension of Ecological Theory may hold recognised the importance of JK s isolation and limited micro-systems interaction on her wellbeing. As such they may hold capitalised on strong familial bonds and back uping visits to from household and to community Centres ( Bronfenbrenner, 1979 ; Greene and Watkins, 1998 ) . While JK was recognised as disputing to prosecute, appraisal can function as an intercession itself ( Mellor and Soloman, 1992 ) and offered an chance to speak which can back up a narrative which enables self-problem resolution and katharsis ( Blaug, 1995 ) . Whilst non ever easy ( Birchall and Simmonds, 2004 ) , a qualified societal worker may hold been better equipt to cover with JK disputing behavior and reluctance to prosecute by utilizing their interpersonal accomplishments to suitably disputing, show sensitiveness, regard and positive respect and guarantee positive and synergistic organic structure linguistic communication through eyes contact and active hearing which reflect accomplishments gained through prosecuting service user faculties in societal work preparation ( Egan, 1986 ) . Supplying older people the services and safety they require necessitates a professional and caring substructure which promotes information sharing and professional treatment nevertheless, Manthorpe and Martineau ( 2011 ) indicate that the bulk of serious instance reviews place shortages in interagency communicating and a deficiency of lucidity as to take bureau as common topographic point despite inclusion in No Secrets ( Penhale et Al, 2007 ; 2000 ) . JK s serious instance reappraisal indicates that referrals were non acknowledged and a deficiency of ownership or lead professional ; assessors hence should hold used the relevant policies including Single appraisal procedure ( DH, 2003b ) ; local safeguarding processs, Mental Capacity Act ( 2005 ) and terminal of life programs which would hold both indicated bureau answerability and potentially afforded JK a more dignified decease by consideration of alleviative attention during her last four hebdomads when her wellness deteriorated. A recent study undertaken by Community Care ( 2010 ) found that, of people asked ; 42 % of appraisals were undertaken by unqualified societal workers. Such determinations have been justified on the premiss that this allows qualified workers to concentrate on more complex affairs proposing a reactive, instead than proactive attack to societal work with grownups ( Barclay, 1982 ; Dickens, 2010 ) . Indeed, while the Single Assessment Process ( DH, 2003b ) provinces that assessment must be carried out by a competent, trained professional regardless of qualified position, appraisal requires practicians to do of import opinions which can hold life-changing deductions for service users. It is hence becomes amongst the most ambitious countries of societal work, necessitating accomplishments and cognition which derive from experience and preparation ( Coulshed and Orme, 2006 ) . Despite this, with moves to call-centre manner responsibility squads where unqualified workers are routinely the p oint of first contact for referral, the importance of appraisal is at hazard of being undermined ( McGregor, 2010 ) While it could be argued that such accomplishments, values and cognition discussed in this assignment could be maintained by unqualified staff, there are unimpeachably certain countries of strength which qualified societal worker possess. Nolan et Al, ( 2001 ) discourse how appraisals can be as compromised by resources as by limited cognition and accomplishments hence, while unqualified societal workers may be called on to measure to free up qualified staff, there is a demand to protect the professional nature of societal work, which means guaranting that those who complete appraisals have sufficient preparation that they are able to be held accountable without being scapegoated ( Dustin, 2007 ) . Therefore, while unqualified societal workers do non inherently lack the accomplishments, cognition and values per sae ; without the degree of preparation, ability to reflect, supervising and answerability required by societal work organic structures, unqualified workers themselves are th e 1s who are vulnerable and as such it can be argued that all the same force per unit areas and duty of qualified workers should non be expected of them, which possibly validates the place that appraisals should be carried out by qualified societal workers.

Free Essays on Emily Dickenson

In the poem, â€Å"I’m Nobody,† by the famous poet Emily Dickenson, she talks about people being a nobody. Quite a few people believe that being a nobody symbolizes failure. This statement is completely false. Being a nobody can make a person work harder and realize they actually deserve what they receive in life. A somebody does not always work as hard because they are given large amounts of gifts for no reason by the hundreds of people they know. Also, in the time the poem was written, people were only considered â€Å"somebody† if they were so rich they did not have to work. The reader might agree with the author because being a nobody can make a person work much harder so they can succeed. A nobody may also notice that since they are not given any extras in life, they deserve everything they achieve. An unknown person without any friends is more likely to work harder than a movie star with tons of money and a great deal of friends because they are not given any shortcuts to a problem. For example, if a nobody goes to a hotel, trashes their room and is extremely loud during the night, they will probably get kicked out and have to pay for all of the expensive items they ruined. If a somebody did the same thing they might not have to pay for the damage or get kicked out simply because of what their position is in social stature. So the majority of nobodies are going to work much harder to get out of a situation than a somebody. The reader might agree with Emily Dickenson because being a somebody can make a person indolent. When a person is a somebody, it could make them not try as hard because they are given things that they do not have to work for. To illustrate, pop stars always get free items sent to them just for being a somebody. This makes them indolent because they can just sit around without doing anything and still receive gifts. Emily Dickenson also implies this in her poem when she wrote, â€Å"To tell your name the livelon... Free Essays on Emily Dickenson Free Essays on Emily Dickenson Emily Dickinson As one of the most remarkable writers of all time, Emily Dickinson accomplished many achievements during times in her hometown, Amherst. Her source â€Å"of knowledge of ecstasy and despair that infuses her poetry† (Hertzburg) remains unknown. She experienced love and loss through her life that could have inspired her to fulfill her writing career. Although â€Å"she lived in one town, in one house, all her life, little is known about her†(Hertzburg). Born to Edward and Emily Dickinson on December 10, 1830, Emily had two siblings, a brother named Austin and a sister named Lavinia, and of all three, Edward, her father, favored Emily (Brooks). She started schooling in 1840, and attended Amherst Academy and Mount Holyoke Female Seminary where she was loved for her wit and free spirit (Internet). After seven years at the academy, she â€Å"retired from the community† (Hertzburg) almost never coming out of her house. Dressing all in white, Emily would speak only to her friends from around corners never revealing her face (Brooks 452-453). Reverend Charles Wadworth, Samuel Bowles, and Thomas Wentworth Higginson became the three loves of her life. Reverend Charles Wadworth, an older, married man (Hertzburg), met Emily in 1855 then stopped correspondence with her in 1882(Internet). Around 1858, she fell in love with Samuel Bowles who edited the Springfield Daily Republican, and published one of her earliest poems (Hertzburg). In 1878, Samuel Bowles died, and inspires the writing of â€Å"Success is counted sweetest† (Internet). Thomas Wentworth Higginson received many of Emily’s works and then gave advice, but he was ignored. They shared love in the late 1870’s, and his influence shows in her writings (Brooks 455). Emily, living to be 56 years old, died on May 15, 1886, leaving us with over 1800 poems (Internet). Themes included: death, love denied, and isolation; these themes related to her life making her... Free Essays on Emily Dickenson Emily Dickinson’s â€Å"Because I could not stop for Death† is a remarkable masterpiece that exercises thought between the known and the unknown. Critics call Emily Dickinson’s poem a masterpiece with strange â€Å"haunting power.† In Dickinson’s poem, â€Å"Because I could not stop for Death,† there is much impression in the tone, in symbols, and in the use of imagery that exudes creativity. One might undoubtedly agree to an eerie, haunting, if not frightening, tone in Dickinson’s poem. Dickinson uses controlling adjectives- â€Å"slowly† and â€Å"passed†- to create a tone that seems rather placid. For example, â€Å"We slowly drove- He knew no haste / †¦We passed the School †¦ / We passed the Setting Sun- ,† sets a slow, quiet, calm, and dreamy atmosphere (5, 9, 11, 12). â€Å"One thing that impresses us,† one author wrote, â€Å"is the remarkable placidity, or composure, of its tone† (Gr eenberg 128). The tone in Dickinson’s poem will put its readers’ ideas on a unifying track heading towards a boggling atmosphere. Dickinson’s masterpiece lives on complex ideas that are evoked through symbols, which carry her readers through her poem. Besides the literal significance of - the â€Å"School,† â€Å"Gazing Grain,† â€Å"Setting Sun,† and the â€Å"Ring†- much is gathered to complete the poem’s central idea. Emily brought to light the mysteriousness of life’s cycle. Ungraspable to many, the cycle of one’s life, as symbolized by Dickinson, has three stages and then a final stage of eternity. These three stages are recognized by Mary N. Shaw as follows: â€Å"School, where children strove†(9) may represent childhood; â€Å"Fields of Gazing Grain†(11), maturity; and â€Å"Setting Sun† (12) old age† (21). In addition to these three stages, the final stage of eternity was symboli zed in the last two lines of the poem, the â€Å"Horses Heads† (23), leading â€Å"towards Eternity† (24). Dickinson fathomed the incomprehensible progre... Free Essays on Emily Dickenson In the poem, â€Å"I’m Nobody,† by the famous poet Emily Dickenson, she talks about people being a nobody. Quite a few people believe that being a nobody symbolizes failure. This statement is completely false. Being a nobody can make a person work harder and realize they actually deserve what they receive in life. A somebody does not always work as hard because they are given large amounts of gifts for no reason by the hundreds of people they know. Also, in the time the poem was written, people were only considered â€Å"somebody† if they were so rich they did not have to work. The reader might agree with the author because being a nobody can make a person work much harder so they can succeed. A nobody may also notice that since they are not given any extras in life, they deserve everything they achieve. An unknown person without any friends is more likely to work harder than a movie star with tons of money and a great deal of friends because they are not given any shortcuts to a problem. For example, if a nobody goes to a hotel, trashes their room and is extremely loud during the night, they will probably get kicked out and have to pay for all of the expensive items they ruined. If a somebody did the same thing they might not have to pay for the damage or get kicked out simply because of what their position is in social stature. So the majority of nobodies are going to work much harder to get out of a situation than a somebody. The reader might agree with Emily Dickenson because being a somebody can make a person indolent. When a person is a somebody, it could make them not try as hard because they are given things that they do not have to work for. To illustrate, pop stars always get free items sent to them just for being a somebody. This makes them indolent because they can just sit around without doing anything and still receive gifts. Emily Dickenson also implies this in her poem when she wrote, â€Å"To tell your name the livelon... Free Essays on Emily Dickenson Emily Dickinson’s â€Å"Because I could not stop for Death† is a remarkable masterpiece that exercises thought between the known and the unknown. Critics call Emily Dickinson’s poem a masterpiece with strange â€Å"haunting power.† In Dickinson’s poem, â€Å"Because I could not stop for Death,† there is much impression in the tone, in symbols, and in the use of imagery that exudes creativity. One might undoubtedly agree to an eerie, haunting, if not frightening, tone in Dickinson’s poem. Dickinson uses controlling adjectives- â€Å"slowly† and â€Å"passed†- to create a tone that seems rather placid. For example, â€Å"We slowly drove- He knew no haste / †¦We passed the School †¦ / We passed the Setting Sun- ,† sets a slow, quiet, calm, and dreamy atmosphere (5, 9, 11, 12). â€Å"One thing that impresses us,† one author wrote, â€Å"is the remarkable placidity, or composure, of its tone† (Gr eenberg 128). The tone in Dickinson’s poem will put its readers’ ideas on a unifying track heading towards a boggling atmosphere. Dickinson’s masterpiece lives on complex ideas that are evoked through symbols, which carry her readers through her poem. Besides the literal significance of - the â€Å"School,† â€Å"Gazing Grain,† â€Å"Setting Sun,† and the â€Å"Ring†- much is gathered to complete the poem’s central idea. Emily brought to light the mysteriousness of life’s cycle. Ungraspable to many, the cycle of one’s life, as symbolized by Dickinson, has three stages and then a final stage of eternity. These three stages are recognized by Mary N. Shaw as follows: â€Å"School, where children strove†(9) may represent childhood; â€Å"Fields of Gazing Grain†(11), maturity; and â€Å"Setting Sun† (12) old age† (21). In addition to these three stages, the final stage of eternity was symboli zed in the last two lines of the poem, the â€Å"Horses Heads† (23), leading â€Å"towards Eternity† (24). Dickinson fathomed the incomprehensible progre...

Biography of Emmett Chappelle, American Inventor

Biography of Emmett Chappelle, American Inventor Emmett Chappelle (born October 24, 1925) is an African-American scientist and inventor who worked for NASA for several decades. He is the recipient of 14 U.S. patents for inventions related to medicine, food science, and biochemistry. A member of the National Inventors Hall of Fame, Chappelle is one of the most distinguished African-American scientists and engineers of the 20th century. Fast Facts: Emmett Chappelle Known For: Chappelle is a scientist and inventor who received over a dozen patents while working for NASA; he devised ways for scientists to measure plant health and detect bacteria in outer space.Born: October 24, 1925 in Phoenix, ArizonaParents: Viola Chappelle and Isom ChappelleEducation: Phoenix College, University of California at Berkeley, University of WashingtonAwards and Honors: National Inventors Hall of FameSpouse: Rose Mary PhillipsChildren: Emmett William Jr., Carlotta, Deborah, and Mark Early Life Emmett Chappelle was born on October 24, 1925, in Phoenix, Arizona, to Viola White Chappelle and Isom Chappelle.  His family farmed cotton and cows on a small farm. As a child, he enjoyed exploring the desert environment of Arizona and learning about nature. Chappelle was drafted into the U.S. Army right after graduating from Phoenix Union Colored High School in 1942 and was assigned to the Army Specialized Training Program, where he was able to take some engineering courses. Chappelle was later reassigned to the all-black 92nd Infantry Division and served in Italy. After returning to the United States, he went on to study electrical engineering and earn his associates degree from Phoenix College. He then earned a B.S. in biology from the University of California at Berkeley. After graduating, Chappelle went on to teach at the Meharry Medical College in Nashville, Tennessee, from 1950 to 1953, where he also conducted his own research. His work was soon recognized by the scientific community and he accepted an offer to study at the University of Washington, where he received his masters degree in biology in 1954. Chappelle continued his graduate studies at Stanford University, though he did not complete a Ph.D. degree. In 1958, Chappelle joined the Research Institute for Advanced Studies in Baltimore, Maryland, where his research on single-celled organisms and photosynthesis contributed to the creation of an oxygen supply system for astronauts. He went on to work for Hazelton Laboratories in 1963. Innovations at NASA In 1966, Chappelle began working at NASAs Goddard Space Flight Center in Greenbelt, Maryland. His work as a research chemist supported NASAs manned space flight initiatives. Chappelle pioneered a way to develop the ingredients ubiquitous in all cellular material. Later, he developed techniques that are still widely used for the detection of bacteria in urine, blood, spinal fluids, drinking water, and foods. Chappelles research helped NASA scientists develop a way to remove soil from Mars as part of the Viking program. In 1977, Chappelle turned his research efforts toward the remote measurement of vegetation health through laser-induced fluorescence (LIF). Working with scientists at the Beltsville Agricultural Research Center, he advanced the development of LIF as a sensitive means of detecting plant stress. Chappelle was the first person to identify the chemical composition of bioluminescence (the emission of light by living organisms). Through his studies of this phenomenon, he proved that the number of bacteria in water can be measured by the amount of light given off by that bacteria. He also showed how satellites can measure luminescence levels to monitor the health of crops (growth rates, water conditions, and harvest timing) and enhance food production. Chappelle used two chemicals produced by fireflies- luciferase  and  luciferin- to develop a technique for detecting adenosine triphosphate (ATP), an organic compound found in all living organisms: You  start out  with the fire fly  which you  have to obtain by the way. Either you catch it yourself or you pay the little kids to run around  catching  them for you. Then you  bring  them into the lab. You chop off their tails, grind them up and get a solution out of these ground-up tails...You add adenosine triphosphate to  that  mixture and you get  light. Chappelles method for identifying ATP is unique in that it works outside of earths atmosphere- meaning it could, in theory, be used to identify extraterrestrial life. The field of exobiology- the study of life beyond the planet Earth- owes much to Chappelles work. The scientist himself, in an interview with The HistoryMakers, said he is inclined to believe there is life beyond Earth: I  think its  likely. Its not life as we know it here on Earth. But I think its likely that theres, there are organisms up there that reproduce. Chappelle retired from NASA in 2001 to live with his daughter and son-in-law in Baltimore, Maryland. Along with his 14 U.S. patents, he has produced more than 35 peer-reviewed scientific or technical publications and nearly 50 conference papers. He has co-authored and edited numerous other publications on a variety of subjects. Accolades Chappelle earned an Exceptional Scientific Achievement Medal from NASA for his work. He is a member of the American Chemical Society, the American Society of Biochemistry and Molecular Biology, the American Society of Photobiology, the American Society of Microbiology, and the American Society of Black Chemists. Throughout his career, he has mentored talented minority high school and college students in his laboratories. In 2007, Chappelle was inducted into the National Inventors Hall of Fame for his work on bioluminescence. He is often included on lists of the most important scientists of the 20th century. Sources Carey, Charles W. African Americans in Science: An Encyclopedia of People and Progress. ABC-CLIO, 2008.Dunbar, Brian. â€Å"Goddard Scientist Inducted Into National Inventors Hall of Fame.† NASA, NASA.â€Å"Emmett Chappelle.† The HistoryMakers.â€Å"Fireflies Light Gains New Uses in Medical and Technical Research.† The New York Times, The New York Times, 25 Aug. 1975.Kessler, James H. Distinguished African American Scientists of the 20th Century. Oryx Press, 1996.

Human Resource management Assignment Example | Topics and Well Written Essays - 2750 words

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LEGAL ENVIRONMENT PAPER Essay Example | Topics and Well Written Essays - 3000 words

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Case Study Anylsis Essay Example | Topics and Well Written Essays - 2500 words

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Summer Intern at Haitong Securities Company Limited Term Paper

Summer Intern at Haitong Securities Company Limited - Term Paper Example Opportunity was awarded in the marketing department as to assistant marketing manager. During internship, it provided an extensive practical learning exposure to the investment arena. It was also very beneficial from point of view of applying theoretical concepts studied mainly in course UD. This report is aimed at providing detailed review of learning experience as internee at Haitong International Holdings Limited. It will provide overview of firm, its products, portfolios and its analysis, practices to entertain customer in satisfying manner, individual projects assigned and overall evaluation of learning experience. In the end it will also provide concluding note regarding suggestions to firm for improvements. INTRODUCTION INTERNATIONAL HOLDINGS LIMITED 1- ESTABLISHEMENT Haitong International Securities Group Limited (â€Å"Haitong International† or â€Å"the Group†; Stock Code: 665.HK) is a subsidiary of Haitong International Holdings Limited (â€Å"Haitong Intern ational Holdings†). It is incorporated in Hong Kong and wholly owned by Haitong Securities Company Limited (â€Å"Haitong Securities†). It was established in 1973 and enlisted on Hong Kong Stock Exchange since August 1996 (Haitong, 2010a). 2- SCOPE Haitong International Securities Group Limited is renowned group with standing as leader in the Greater China region. The group provides total quality services in the domain of corporate finance, asset management and brokerage services. It has broad clientele encompassing global and local institutional and corporate clients as well as individual investors (Haitong, 2012b). Its network has more than 210 sales offices spreading across over 120 cities with 13 branches in Hong Kong and Macau. Mainly in China the Group has 2 representative offices in Beijing and Shanghai and 5 investment consultancy centers in major cities including Beijing, Shanghai, Guangzhou, Shenzhen and Hangzhou. Its broad network is serving over 4 million re tail clientele services with over 12,000 institutional and high net worth clients (Haitong, 2010b). 3- SERVICES Haitong International Securities Group Limited is striving to become a leading global player in the international financial services industry. Its goal also includes standing a leadership position in the Greater China region. It is dedicated to provide total quality corporate finance, asset management and brokerage services to its clients (Haitong, 2010f). The operations of Haitong Group can be broadly categorized in following three areas (Haitong, 2010e): A- Corporate finance: under this title Haitong Securities provide wide range of services including IPO sponsorship, underwriting and placements, financial advisory, compliance advisory, institutional clients’ services and research. B- Assets management Haitong Securities provide services with respect to public funds, mandatory provident fund, private funds, alternative investment funds, Capital Investment Entrant Scheme and discretionary accounts services. C- Brokerage services Under brokerage umbrella its serves client with securities and derivative products, futures and options, bullion and foreign exchange, IPO subscription and financing services, online trading, margin financing, wealth management, agency and trustee services, stock borrowing, equity-linked note, structured product investment, bond investment and research.   1- 2- 3- 4- CERTIFICATIONS AND REWARDS Being renowned and well known financial services

Capital structure of CVS Essay Example | Topics and Well Written Essays - 750 words

Capital structure of CVS - Essay Example Therefore, equity financing effectively increases the weighted average cost of capital. 3. Schedule out & calculate EVA. Is it good or bad and what brings EVA up & down for CVS There are various ways of measuring a firm's performance. One way is to use accounting measures such as return on equity, return on assets, etc. Another way is to use market measures and determine the firm's performance by looking at the stock's value. These measures, however, do not provide an effective evaluation of firm performance. One such measure that determines the true value-creating performance of a firm is Economic Vale Added (EVA) analysis. This analysis attempts to determine the net contribution to value by a company's investment decisions which other measures fail to provide. This means the after-tax returns of the company should exceed the cost of capital invested. EVA is calculated as follows: EVA = (ROIC - WACC) x Invested Capital Formula for Return on Invested Capital (ROIC): ROIC = Net Income / Liabilities + Shareholders Equity ROIC for CVS = 11.4% Invested Capital = market capitalization = 262,500,000 (common stock * share price) EVA for CVS is: 7,875,000 EVA is dependent on return on invested capital as well as the cost of capital. Higher ROIC and a lower cost of capital can increase EVA significantly. 4. Look at EVA & how do you need to change bank statements to create the best capital structure An EVA of 7,875,000 means this is the net contribution to value added by the company's investment decisions. Higher EVA can alter the capital structure by increasing the proportion of equity to debt. However, every company has a target in terms of maintaining... Weighted average cost of capital is the discount rate used to convert expected future cash flow into present value for all investors. Using the book value of debt and equity, CVS is 26.2% financed by debt and 73.8% financed by equity1. Cost of equity can be calculated using the capital asset pricing model. There are various ways of measuring a firm’s performance. One way is to use accounting measures such as return on equity, return on assets, etc. Another way is to use market measures and determine the firm’s performance by looking at the stock’s value. These measures, however, do not provide an effective evaluation of firm performance. One such measure that determines the true value-creating performance of a firm is Economic Vale Added (EVA) analysis. This analysis attempts to determine the net contribution to value by a company’s investment decisions which other measures fail to provide. This means the after-tax returns of the company should exceed the cost of capital invested. EVA is calculated as follows: Look at EVA & how do you need to change bank statements to create the best capital structure? An EVA of 7,875,000 means this is the net contribution to value added by the company’s investment decisions. Higher EVA can alter the capital structure by increasing the proportion of equity to debt. However, every company has a target in terms of maintaining an optimal capital structure that minimizes cost of capital and maximizes shareholder wealth. A higher equity and lower debt in the capital structure substantiates.

117 Research Paper Example | Topics and Well Written Essays - 1250 words

117 - Research Paper Example In fact, most research findings prove that Apple’s competitive advantage is in its ecosystem and not just the hardware and software prowess. Apple use Exclusivity Technique which works by making the selected customer subset feel like kings due to the premium offers it gives. Through this strategy, Apple has been in a position to create and sustain a unique customer relationship while reducing marketing costs at the same time. To make it effective, Apple deliberately restricted the flow of most of its products more so iPhone and tablets to a number of mobile phone providers and customers. While most firms use the marketing mix concept on the seller perspective, Apple applies it from the buyer’s perspective. This means that the company aims at delivery quality to ensure customer satisfaction, offer long-term solutions to customers, create what customers imagine and ensure convenience. Apple’s marketing mix is incorporated in the five Ps: Price, Place, Product, Promotion, and People. An integrated marketing communication approach is relied upon by the company to help it in achieving objectives linked to the marketing campaign by using a variety of promotional methods (Wernick p.34). The main components of IMC strategy are advertising, public relations, personal selling, and sales promotion Apple Inc. puts a lot of emphasis on Research and Development (R&D) and marketing communication strategies. It does all these to make sure there is brand loyalty among customers who derive satisfaction from the Apple Inc. products. In a unique way, though one of the largest companies in the world, it has managed to run as a small company, which is the best strategy in surviving through difficult times. To make sure this is effective, the company relies on small but capable firms and shifts Brand Focus Apple where it capitalizes on the Minimalist approach to its

Capital structure of CVS Essay Example | Topics and Well Written Essays - 750 words

Capital structure of CVS - Essay Example Therefore, equity financing effectively increases the weighted average cost of capital. 3. Schedule out & calculate EVA. Is it good or bad and what brings EVA up & down for CVS There are various ways of measuring a firm's performance. One way is to use accounting measures such as return on equity, return on assets, etc. Another way is to use market measures and determine the firm's performance by looking at the stock's value. These measures, however, do not provide an effective evaluation of firm performance. One such measure that determines the true value-creating performance of a firm is Economic Vale Added (EVA) analysis. This analysis attempts to determine the net contribution to value by a company's investment decisions which other measures fail to provide. This means the after-tax returns of the company should exceed the cost of capital invested. EVA is calculated as follows: EVA = (ROIC - WACC) x Invested Capital Formula for Return on Invested Capital (ROIC): ROIC = Net Income / Liabilities + Shareholders Equity ROIC for CVS = 11.4% Invested Capital = market capitalization = 262,500,000 (common stock * share price) EVA for CVS is: 7,875,000 EVA is dependent on return on invested capital as well as the cost of capital. Higher ROIC and a lower cost of capital can increase EVA significantly. 4. Look at EVA & how do you need to change bank statements to create the best capital structure An EVA of 7,875,000 means this is the net contribution to value added by the company's investment decisions. Higher EVA can alter the capital structure by increasing the proportion of equity to debt. However, every company has a target in terms of maintaining... Weighted average cost of capital is the discount rate used to convert expected future cash flow into present value for all investors. Using the book value of debt and equity, CVS is 26.2% financed by debt and 73.8% financed by equity1. Cost of equity can be calculated using the capital asset pricing model. There are various ways of measuring a firm’s performance. One way is to use accounting measures such as return on equity, return on assets, etc. Another way is to use market measures and determine the firm’s performance by looking at the stock’s value. These measures, however, do not provide an effective evaluation of firm performance. One such measure that determines the true value-creating performance of a firm is Economic Vale Added (EVA) analysis. This analysis attempts to determine the net contribution to value by a company’s investment decisions which other measures fail to provide. This means the after-tax returns of the company should exceed the cost of capital invested. EVA is calculated as follows: Look at EVA & how do you need to change bank statements to create the best capital structure? An EVA of 7,875,000 means this is the net contribution to value added by the company’s investment decisions. Higher EVA can alter the capital structure by increasing the proportion of equity to debt. However, every company has a target in terms of maintaining an optimal capital structure that minimizes cost of capital and maximizes shareholder wealth. A higher equity and lower debt in the capital structure substantiates.

Research Topic Paper Example | Topics and Well Written Essays - 1250 words

Topic - Research Paper Example The role of custodial parents by the grandparents is a multiethnic issue as the literature review section will indicate. The research in discussion below will also point out the different effects the role of being custodial parents has on different individuals and especially the grandparents and the grandchildren and what efforts if any has the state taken to deal or assist in this matter. Literature Review Overview The US census results of year 2005 were the first to openly show interest in the growing number of grandparents who have become custodians of their grandchildren. According to those results, there was an average of 5.7 million grandparents living with their grandchildren and acting as their parents. In line with multiethnic issues, the results further indicated that of the 5.7 million grandparents, 8% were African Americans, 16% were Hispanics and the rest were Caucasians. In a large state like Colorado which also is a multiethnic state, the results are almost similar wit h those indicated nationally and this statistics have been on the increase (U.S. Census Bureau, 2006). Theoretical model The best theory to explain the change of grandparents’ role to that of custodians of their grandchildren is the life course theory. ... According to Phua and Kaufman, 2008, it is with this light therefore that the life course of grandparents change and they now adopt the role of parents for their grandchildren. For the Hispanics and African American for example, the immigration, racial stereotypes and other ethnic difficulties of living in a foreign land contributes to the life course changes as it leads to changes in their social, cultural and structural lives which are contributing factors to the reasons why grandparents are left with custodial burden (Phua and Kaufman, 2008). Impacts of custodial grand parenting Numerous literatures have pointed out the impacts associated with this research topic to both the grandparents and the grandchildren. According to the National Institute of Mental Health and Population Reference Bureau, grandchildren who are in custody of their grandparents grow up with more emotional and behavioral problems compared to those raised by the parents (Scommegna, 2012). This is especially diff icult when it comes to adolescent grandchildren. The research also indicates that in homes where there is low income (mostly among African-Americans and Hispanics), the behavioral problems are likely to escalate. The problem however is not so rampant among the whites majorly because most of their custodial care starts when the children are young. Research findings by America Association for Marriage and Family Therapy indicate that grandparents also face their share of different impact. Some of these identified impacts include the legal problem and process of acquiring custody of their grandchildren. This is especially so in case of divorce where the parents are still alive. The other is the financial impact. Most grandparents are retired and therefore have no steady flow of

Information Technology Ethics Essay Example for Free

Information Technology Ethics Essay Definitions -the right to be alone – the most comprehensive of rights, and the right most valued by people. (Justice Louis Brandeis, Olmstead v. US, 1928) -the right of individuals to control the collection and use of information about themselves. Legal Aspects Protection from unreasonable intrusion upon one’s isolation. Protection from appropriation of one’s name or likeness.  Protection from unreasonable publicity given to one’s private. Protection from publicity that unreasonably places one in a false light before the public. RECENT HISTORY OF PRIVACY PROTECTION Communication Act of 1934 -it restricted the government’s ability to secretly intercept communications. However, under a 1968 federal statute, law enforcement officers can use wiretapping if they first obtain a court order. Wiretapping the interception of telephone or telegraph communications for purpose of espionage or surveillance. Freedom of Information Act (FOIA) (passed -1966, amended-1974) provides the public with the means to gain access to certain government records such as the spending patterns of an agency, the agency’s policies and the reasoning behind them, and the agency’s mission and goals. Fair Credit Reporting Act (1970) this act regulates the operations of credit-reporting bureaus, including how they collect, store, and use credit information. it is designed to promote accuracy, fairness, and privacy of information in the files of credit reporting companies and to check verification systems that gather and sell information about people. Privacy Act (1974) declares that no agency of the U.S. government can conceal the existence of any personal data record-keeping system, and that any agency that maintains such a system, must publicly describe both the kind of information in it and the manner in which the information will be used. the Central Intelligence Agency (CIA) and the law enforcement agencies are excluded from this act. the Organization for Economic Cooperation and Development (OECD) â€Å"Fair Information Practices† are often held up as a model of ethical treatment of consumer data for organization to adopt. Summary of the 1980 OECD privacy guidelines Principle Guideline Collection limitation Limit the collection of personal data. All such data must be obtained lawfully and fairly with the subject’s consent and knowledge. Data Quality Personal data should be accurate, complete, current and relevant to the purpose for which it is used. Purpose Specification The purpose for which personal data is collected should be should be specified and should not be changed. Use Limitation Personal data should not be used beyond the specified purpose without a persons consent or by authority of law. Security Safeguards Personal data should be protected against unauthorized access, modification, or disclosure. Openness principle Data policies should exist and a â€Å"data controller† should be identified. Individual participation People should have the right to review their data, to challenge its correctness, and to have incorrect data changed. Accountability A â€Å"data controller† should be responsible for ensuring that the above principles are met. Children’s Online Protect Act (COPA)(1998) The law states that a website that caters to children must offer comprehensive privacy policies, notify their parents or guardians about its data collection practices, and receive parental consent before collecting any personal information from children under 13 years of age. European Company Directives 95/46/EC (1998) requires any company that does business within the borders of 15 Western European nations to implement a set of privacy directives on fair and appropriate use of information. Summary of the European Data Privacy Principle Notice Tell all customer what is done with their information. Choice Give customer a way to opt out of marketing. Onward Transfer Ensure that suppliers comply with the privacy policy. Access Give customer access to their information. Security Protect customer information from unauthorized access. Data Integrity Ensure that information are accurate and relevant. Enforcement Independently enforce the privacy policy. Better Business Bureau Online (BBB Online) and TRUSTe independent, nonprofit initiatives that favor an industry-regulated approach to data privacy which concerned about the government regulation that could have a negative impact on the Internet’s use and growth, and that such regulation would be costly to implement and difficult to change. The BBB Online Seal adheres that the website has a high level of data privacy. The seal program identifies online businesses that honor their own stated privacy policy. The TRUSTe’s main rule is that websites should openly communicate what information it gathers, its use, to whom it will be shared, and does the consumer has a choice of opting out. Gramm-Leach-Bliley Act (1998) -this act required all financial-services institutions to communicate their data privacy policies and honor customer data-gathering preferences by July 1, 2001. This was to make them take actions to protect and secure customers’ nonpublic data from unauthorized access or use. KEY PRIVACY AND ANONYMITY ISSUES GOVERNMENTAL ELECTRONIC SURVEILLANCE Federal Wiretap Act (U.S. Code Title 18 Part 1, Chapter 119, Wire and Electronic Communications Interception and Interception of Oral Communications) it requires processes to obtain court authorization for surveillance of all kinds of electronic communications, including e-mail, fax, internet, and voice, in criminal investigation. A court order must be issued based on probable cause before a wiretap can commence. roving tap government authority to obtain a court order that does not name a specific telephone or e-mail, but allows them to tap any phone lines or internet accounts that the suspect uses. Electronic Communication Privacy Act of 1986 (ECPA, U.S Code Title 18, part 2, Chapter 206) standards for access to stored e-mail and other electronic communications and records. ECPA amended Title III (Omnibus Crime Control and Safe Streets Act of 1968) extended the title III’s prohibitions against the unauthorized interception (use of person’s oral or electronic communications). -this act failed to address emerging technologies such as wireless modems, cellular, data networks, etc. thus, this communication can still be legally intercepted. Foreign Intelligence Surveillance Act of 1978 (FISA) allows wiretapping of aliens and citizens in the U.S. based on a finding of probable cause that the target is a member of a foreign terrorist group or an agent of a foreign power. Executive Order 123333 (U.S. Pres. Reagan, 1982) legal authority for electronic surveillance outside the U.S. It permits intelligence agencies to intercept communications outside the U.S. without a court order. Communication Assistance for Law Enforcement Act (CALEA, 1994) it covers radio-based data communication. The Federal Communications Commission (FCC) required providers of Internet phone and broadband services to ensure that their equipment can allow police wiretaps. USA Patriot Act of 2001 Gives sweeping new powers to Domestic law enforcement and International intelligence agencies. It contains several sunsets that gives the government much more surveillance capability. Sunset provisions – can terminates itself or portions after a specific date unless further actions is taken to extend the law DATA ENCRYPTION Cryptography – the science of encoding messages so that only the sender and the intended receiver can understand them. Encryption – the process of converting an electronic message into a form that can be understood only by the intended recipients. Public key encryption system uses two keys Message receiver’s public key readily available Message receiver’s private key kept secret Private key encryption system Single key to encode and decode messages RSA (named after Rivest, Shamir and Adleman) – is a public key encryption algorithm, the basis for much of the security that protects Web consumers and merchants. PGP ( Pretty Good Privacy) – uses 128 bit encryption that represents a total of 2128 . DES (Digital Encryption Standard) – the standard for encryption, it employs a 56 bit key that represents 7.21016 . (It can now be crack using brute methods) AES (Advanced Encryption Standards) – requires crackers to try as many as 1.11077 combinations. IDENTITY THEFT occurs when someone steals key pieces of personal information to gain access to a person’s financial accounts. fastest growing form of fraud in the United States. Phishing – is an attempt to steal personal identity data by tricking users into entering the information on a counterfeit Website. Spear-phishing – is a variation in which employees are sent phony emails that look like they came from high-level executives within their organization. Spyware – is a term for keystroke-logging software that is downloaded to users computer without adequate notice, consent, or control for the user. It creates a record of keystrokes entered into the computer with or without internet and will send to the email of the spy when internet connections are available. Identity Theft and Assumption Deterrence Act of 1998 the congress passed this act to fight identity fraud, making it a federal felony punishable by a prison sentence of 3 -25 years. researchers estimated that 1 of 700 identity crimes were led to conviction. CONSUMER PROFILING Companies openly collect personal information about Internet users. They also obtain information without users permission through the use of cookies. marketing firms uses this information in building databases that contains consumer behavioral data. They want to know about who the users are, what they like, how they behave, and what motives them to buy. Cookies a text file that a website puts on your hard drive so that it can remember your information later on. Affiliated Websites – is a group or collection of websites served by a single advertising network. 3 Types of Data Gathered POST – it is entered into a blank fields on an affiliated website when a consumer signs up for a service. GET – it reveals what the consumer requested product in a specific store. Click-Stream Data it is the tracking of the information the user sought and viewed. 4 Ways to Limit/Stop deposit Cookies Set browsers to limit or stop cookies or browse the web using the incognito browsing mode which will remove all marks of your browsing. Manually delete cookies in your hard drives. Download and install cookie management program. Or use anonymous proxy websites to browse websites. However, some websites lock users to browse in their page when cookie is disabled. Personalization software – it is used by marketers to optimize the number, frequency and mixture of their ad placements. It is also used to evaluate how visitors react to new ads. Types of Personalization Software Rule-based – used business rules that are tied to customer provided preferences or online behaviors to determine the most appropriate page views and product information to display. Collaborative Filtering – offers consumer recommendations based on the types of product purchased by other people with similar buying habits. Types of Personalization Software (Continued) Demographic Filtering – it augments click stream data and user supplied data with demographics information associated with user zip codes to make product suggestions. Contextual Commerce – associates product promotions and other e-commerce offerings with specific content a user may receive in a new story online. Platforms for Privacy Preferences (P3P) shields users from site that don’t provide the level of privacy protection  they desire. Instead of forcing users to find and read through the privacy policy for each site they visit, P3P software in the computers browser will download the privacy policy for each site, scan it and notify users if the policy does not match their preferences. The World Wide Web Consortium, an international privacy group whose members include Apple, Commerce One, Ericsson, and Microsoft, created P3P and is supporting its development. TREATING CONSUMERS DATA RESPONSIBILITY -Strong measures are required to avoid customer relationship problems. Code of Fair Information Practices – most widely accepted approach to treating consumers data responsibly. Guidelines of Code of Fair Information Practices and the 1980 OECD an organizations collects only personal information that is necessary to deliver its product and services. Company ensures that the information is carefully protected and accessible only by those with a need to know, and that consumers can review their own data and make corrections. Company informs customers if it intends to use it’s information for research or marketing, and it provides a means for them to opt out. Chief Privacy Officer (CPO) executive to oversee data privacy policies and initiatives. Duties of CPO Avoid government regulations and reassure customers that their privacy will be protected. Stop or modify major company marketing initiatives. Training employees about privacy and checking the companies privacy policy for potential risks. Figuring out if gaps exist and how to fill them. Developing and managing a process for customer privacy disputes. WORKPLACE MONITORING Employers monitor workers – Ensures that corporate IT usage policy is followed Fourth Amendment cannot be used to limit how a private employer treats its employees. – Public-sector employees have far greater privacy rights than in the private industry. Privacy advocates want federal legislation – To keeps employers from infringing upon privacy rights of employees. SPAMMING the transmission of the same email message to a large number of people. Spammers target individual users with direct email messages, building their mail list by scanning Usenet postings, buying mail lists or searching the web for addresses. extremely inexpensive method of marketing. used by many legitimate organizations. can contain unwanted and objectionable materials. Controlling the Assault of Non-Solicited Pornography and Marketing(CAN-SPAM)  the act says it is legal to spam provided that the message meet a few basic requirements: (1) spammers cannot disguise identity, (2) there must be a label in the message specifying that it is an ad or solicitation, and (3) include a way that the recipient can stop the receiving of spam. The act failed to slow the flow of spam but instead, it actually increased the flow of spam by legalizing it. ADVANCED SURVEILLANCE TECHNOLOGY Advanced surveillance technology provide a new data gathering capabilities, however, these advance can also diminish individuals privacy. Advocates of the technology argue that people have no legitimate expectations of privacy in a public place. Camera Surveillance is one of the most common advanced system used in surveillance nowadays. It has the capability to record events, detecting unusual behaviour, automatically capturing important events, and used in monitoring day to day events in different places. Facial Recognition Software There have been numerous experiments with facial recognition software to help identify criminal suspects and other undesirable characters. It has been first tested by the Rampart Division of the Los Angeles Police Department and yielded a result. Global Positioning System (GPS) These are chips placed in different devices to monitor locations of the  users. It is useful in locating callers of 911, parents monitoring their children, etc.

Inotropes, Vasopressors and Vasodilators

Inotropes, Vasopressors and Vasodilators Suruchi Hasija, Jatin Narula ,Vandana Maravi. ADRENERGIC RECEPTORS AND SIGNALING PATHWAYS The main control over cardiac contractility is provided by the ÃŽ ²Ã¢â‚¬â€œadrenergic signaling pathways and that over the vascular tone by both ÃŽ ±- and ÃŽ ²Ã¢â‚¬â€œadrenergic pathways. The ÃŽ ± and ÃŽ ² receptors are stimulated by catecholamines circulating in the bloodstream and those released locally from the adrenergic nerve endings. The two main subtypes of ÃŽ ²Ã¢â‚¬â€œadrenergic receptors (ÃŽ ²Ã¢â‚¬â€œARs) in the cardiovascular system are the ÃŽ ²1 and ÃŽ ²2 subtypes. Myocardial ÃŽ ²1 and ÃŽ ²2-AR stimulation leads to increased contractility, whereas vascular ÃŽ ²2-AR stimulation induces vascular smooth muscle relaxation. Drug binding to myocardial ÃŽ ²Ã¢â‚¬â€œARs activates stimulatory G protein. This leads to activation of the enzyme adenylate cyclase that catalyzes the conversion of ATP to cAMP. A cascade of intracellular reactions finally leads to the physiological effect of increased myocardial contraction or vasodilation. The ÃŽ ±Ã¢â‚¬â€œadrenergic receptors (ÃŽ ±Ã¢â‚¬â€œARs) are further classified as ÃŽ ±1 and ÃŽ ±2 subtypes. ÃŽ ±1-AR on vascular smooth muscles are the main mediators of vasoconstriction. ÃŽ ±2-AR on the neurons function in a negative feedback loop to control ÃŽ ±-adrenergic vasoconstriction. Stimulation of ÃŽ ±1-AR coupled to G protein activates phospholipase C which in turn raises intracellular Ca+2. Stimulation of ÃŽ ±2-AR coupled to inhibitory G protein inhibits adenylate cyclase, thereby lowering intracellular Ca+2. INOTROPES Inotropy or contractility is the intrinsic property of the cardiac myofibril. It defines the amount of work that the heart can perform at a given load. Contractility is primarily determined by the availability of intracellular calcium. Depolarization of the cardiac myofibril leads to the entry of a small amount of Ca+2 into the cell which triggers the release of additional Ca+2 from intracellular storage sites (sarcoplasmic reticulum). The binding of Ca+2 to troponin, displacement of tropomyosin from the binding site on actin and formation of actin-myosin crossbridges eventually leads to contraction of the myofibril. All inotropic agents act by increasing intracellular calcium. Catecholamines, phosphodiesterase inhibitors and calcium sensitizers are the broad classes of available inotropic agents. Catecholamines Catecholamines comprise the major type of available inotropic agents. Their chemical structure includes a catechol ring, catechol hydroxyl groups and variable side chains. Endogenous(present naturally in the body) catecholamines include epinephrine, norepinephrine and dopamine, and synthetic catecholamines include isoprenaline, dobutamine, dopexamine and fenoldopam. Besides acting directly on adrenergic receptors, some catecholamines may act indirectly by releasing or inhibiting reuptake of norepinephrine at the nerve terminal or by metabolism to form norepinephrine. Table 1: Site and mechanism of action of sympathomimetics Table 2: Haemodynamic effects of catecholamines and phosphodiesterase inhibitors CO=cardiac output, dp/dt=force of myocardial contraction(change in pressure/time), HR=heart rate, SVR=systemic vascular resistance, PVR=pulmonary vascular resistance, PCWP=pulmonary capillary wedge pressure, MVO2=myocardial oxygen consumption Modified from Lehmann A, Boldt J: New pharmacologic approaches for the perioperative treatment of ischemic cardiogenic shock. J Cardiothorac Vasc Anesth 19:97-108, 2005. Epinephrine Epinephrine, a naturally occurring catecholamine, is secreted from the adrenal medulla. The effects on ÃŽ ²Ã¢â‚¬â€œARs predominate at lower doses and on ÃŽ ±Ã¢â‚¬â€œARs at higher doses (> 0.1  µg/kg/min). It increases heart rate (HR), stroke volume (SV) and coronary blood flow (CBF). The rise in blood pressure (BP) results from increase in HR and cardiac output (CO). Systemic vascular resistance (SVR) decreases at low doses (ÃŽ ²2-AR effect) but increases at high doses (ÃŽ ± effect). It is metabolized in the liver by the enzymes catechol-O-methyl transferase (COMT) and monoamine oxidase (MAO), and the metabolites are excreted in urine. It has arrhythmogenic potential. In cardiac surgical patients it is used as an infusion at 0.01-0.4  µg/kg/min to wean patients with poor ventricular function off cardiopulmonary bypass (CPB). (Tables 1 and 2) Norepinephrine Norepinephrine is the postganglionic neurotransmitter in the sympathetic nervous system. It acts on ÃŽ ±1–AR, ÃŽ ±2–AR and ÃŽ ²1–AR, and has negligible action on ÃŽ ²2–AR. The ÃŽ ²1-AR action predominates at lower doses, thereby increasing inotropy, SV and CBF. It increases BP and SVR; but decreases HR. The CO remains unchanged. It has arrhythmogenic potential. The clinical dose range is 0.01 to 0.1  µg/kg/min. Like epinephrine, it is easily oxidized. It is metabolized by COMT and MAO and taken up by the sympathetic neurons. It decreases renal, hepatic, mesenteric and splanchnic blood flow. Dopamine Dopamine is a neurotransmitter in the central and peripheral nervous system. It is the immediate metabolic precursor of norepinephrine and epinephrine. It acts on ÃŽ ±Ã¢â‚¬â€œARs, ÃŽ ²Ã¢â‚¬â€œARs and dopaminergic receptors (DA1-DA5). At 0.5-3  µg/kg/min it increases renal and mesenteric blood flow (dopaminergic effects), between 3-8  µg/kg/min it increases HR and contractility (ÃŽ ²-AR effects) and, above 8  µg/kg/min it causes vasoconstriction (ÃŽ ±-AR effects). Intravenous dopamine does not cross the blood brain barrier. It is metabolized in the liver by COMT and MAO. Isoprenaline Isoprenaline has pure ÃŽ ²Ã¢â‚¬â€œAR agonist activity. It causes an increase in HR and contractility (ÃŽ ²1-AR effect) and decreases SVR (ÃŽ ²2-AR effect). CO increases due to combined ÃŽ ²1 and ÃŽ ²2-AR effect. It dilates pulmonary, skeletal, renal and mesenteric vascular beds. It is indicated in the treatment of pulmonary hypertension, bradycardia (especially after orthotopic heart transplantation), heart block and conduction abnormalities. It is used in the dose 0.01 to 0.1  µg/kg/min. it is metabolized in the liver by COMT. It is arrhythmogenic. Dobutamine Dobutamine is primarily a ÃŽ ²1-AR agonist and has positive inotropic effects. It causes modest increase in HR (ÃŽ ²2-AR effect) and decrease in SVR (ÃŽ ²2-AR effect). The clinical dose range varies from 2-15  µg/kg/min. It is particularly indicated in patients with myocardial pump failure. Its chemical structure lacks the hydroxyl group of catecholamines. It is metabolized in the liver, although not by COMT and MAO. It increases SV, CO and CBF. The arrhythmogenic potential is less than other catecholamines. Dopexamine Dopexamine is a synthetic analog of dopamine. It has potent ÃŽ ²2-AR and dopamine agonist properties and little ÃŽ ²1-AR and ÃŽ ±-AR activity. It causes vasodilation, increase in HR and inotropy. CO and renal blood flow are increased. It is used in the dose 1-10  µg/kg/min. It undergoes methylation and sulfation in the liver and is taken up into the tissues via extraneuronal catecholamine uptake mechanisms. Unlike other catecholamines, it lacks arrhythmogenic potential. Fenoldopam Fenoldopam mesylate is a dopamine DA1 receptor agonist that causes systemic and renal arteriolar vasodilation. It increases renal blood flow at doses of 0.05-0.1  µg/kg/min and reduces BP at 0.1-0.3  µg/kg/min. Phosphodiesterase inhibitors Phosphodiesterase inhibitors act by preventing the breakdown of cAMP, thereby prolonging its physiological response. They do not act via ÃŽ ²-AR stimulation. Their addition to a catecholamine has a synergistic effect in increasing inotropy. They also produce vasodilation and are termed ‘inodilators’. They improve myocardial diastolic relaxation (positive lusitropic effect) and augment coronary perfusion. The clinically used phosphodiesterase inhibitors include amrinone, milrinone and enoximone. Amrinone Amrinone is a bipyridine derivative. It provides positive inotropy and decreases SVR. The decrease in SVR is apparent immediately after administration, whereas positive inotropy is appreciable after 10-15 minutes. They are particularly useful in heart failure by increasing forward flow. It is administered as a bolus loading dose (0.5-1.5 mg/kg) followed by infusion (5-20  µg/kg/min). The potential side effects are thrombocytopenia (2-3%), gastrointestinal upset, myalgia, fever, hepatic dysfunction, ventricular arrhythmias and allergy. Milrinone Milrinone is a derivative of amrinone and is 20 times more potent. It does not cause fever or thrombocytopenia. It is administered as a bolus loading dose (50  µg/kg over 10 minutes) followed by infusion (0.375-0.75  µg/kg/min). Enoximone Enoximone is an imidazole derivative that has more pronounced vasodilatory effect than inotropic effect. It is administered as a bolus loading dose (0.5-1 mg/kg) followed by infusion (5-10  µg/kg/min). Levosimendan Levosimendan is a new inotropic agent belonging to the class of calcium-sensitizing agents, i.e., it sensitizes the myocardium to the actions of calcium. It has vasodilating and anti-ischemic properties mediated by opening of K+-ATP channels. The haemodynamic effects include increase in SV and CO and reduction in filling pressures, mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP) and SVR. It also promotes lusitropy. It is useful in patients with compromised left ventricular function, difficulty in weaning from CPB and right ventricular failure. It is used in a loading dose of 12  µg/kg over 10 minutes followed by an infusion of 0.1  µg/kg/min. Calcium chloride Calcium ions play an important role in excitation-contraction coupling in the cardiac myofibrils. It has positive inotropic effect that is effective after CPB and in the short-term treatment of myocardial pump failure. The rise in BP occurs secondary to increased inotropy and vasoconstriction. However, it can attenuate the ÃŽ ²-AR effects of epinephrine in the postoperative cardiac surgical patients. It is administered in the dose of 2-4 mg/kg every 10 minutes. Calcium Gluconate the clinically available compound of calcium ,contains less than half of ionized calcium and has to be metabolized in the liver before action. VASODILATORS Vasodilators cause relaxation of arterial smooth muscle thereby reducing SVR and MAP. In addition, they also have venodilating property. They aid discontinuation of CPB by decreasing preload, right and left ventricular afterload, improving lusitropy and CBF. They are useful in the perioperative treatment of systemic and pulmonary hypertension, myocardial ischemia and ventricular dysfunction complicated by excessive pressure or volume overload. Sodium nitroprusside Sodium nitroprusside (SNP) acts by acting as a substrate for the formation of nitric oxide (NO) in the vascular endothelium. Binding of NO to its receptor induces a conformational change in the enzyme guanylate cyclase and production of cGMP from GTP. cGMP is the second messenger that eventually leads to vascular smooth muscle relaxation via numerous intermediate steps. SNP predominantly causes arterial and arteriolar vasodilation, but at high doses venodilation also occurs. Reflex tachycardia is apparent with its administration. SV and CO are increased only if the preload is maintained with intravenous fluids. SNP has a potential to cause ‘coronary steal’ phenomenon in patients with coronary artery disease as the epicardial coronary arteries also dilate diverting blood away from the stenosed endocardial coronary arteries. It decreases pulmonary vascular resistance (PVR) and MPAP. It abolishes hypoxic pulmonary vasoconstriction and may contribute to hypoxia. The infusion rate is 0.5  µg/kg/min, and titrated to effect. It is reconstituted in a dextrose-containing solution. SNP is sensitive to light, therefore the infusion syringe and tubing are wrapped with opaque material to prevent light induced structural breakdown of the drug. Cyanide toxicity may occur with the use of SNP above 1.5 mg/kg acute dose or 8  µg/kg/min chronic infusion. SNP is used during hypothermic CPB to promote uniform cooling by preventing cold induced vasoconstriction, to reduce the perfusion pressure, to reduce afterload by decreasing SVR and to increase pulmonary blood flow by decreasing PVR. Nitroglycerin Nitroglycerin (NTG) acts by the same mechanism as other nitrates. NTG is primarily a venodilator and reduces ventricular preload and myocardial oxygen consumption. NTG is of particular importance in patients with congestive heart failure as it unloads the left ventricle. It has modest effects on SVR and BP. It reduces PVR. The starting dose of intravenous nitroglycerin is 0.5  µg/kg/min which may be titrated to effect. Attention must be paid to the fluid status as CO may drastically reduce. At higher doses systemic vascular dilation occurs. NTG is helpful in coronary artery disease because it causes epicardial coronary artery dilation. It is metabolized in the liver. Methemoglobinemia occurs at high infusion rates. Intravenous nitroglycerin has a half-life of 1-3 minutes. Tolerance develops when administered for more than 8 hours. Nitric oxide Nitric oxide (NO) is the endothelium derived relaxing factor. Its mechanism of action has been described above. It has a very short half-life of 5 seconds. Inhaled NO promotes pulmonary vascular dilation. It can be used upto 80 parts per million (ppm) in patients with severe right ventricular failure and pulmonary arterial hypertension. As inhaled NO is rapidly taken up by the heme group of guanylate cyclase, it only acts locally in the pulmonary vascular bed causing pulmonary vasodilation. It has no systemic effects. Phenoxybenzamine Phenoxybenzamine is a non-competitive ÃŽ ±1 and ÃŽ ±2-AR blocker. It decreases PVR and SVR, thereby increasing CO. It is used to promote vasodilation during deep hypothermic circulatory arrest for uniform cooling and for the treatment of pulmonary hypertension. Phenoxybenzamine is a very potent and long acting vasodilator. It was traditionally used for afterload reduction, pulmonary vasodilatation, and in adrenal tumors such as pheochromocytoma. Phentolamine, a shorter acting agent is now more commonly used. VASOPRESSORS Vasopressors act on arteries and arterioles to increase SVR (ÃŽ ±-AR effect). They have some ÃŽ ² –AR effect also. Catecholamines such as norepinephrine, and epinephrine and dopamine at high concentrations are potent vasoconstrictors. In addition, sympathomimetics such as phenylephrine, methoxamine, ephedrine, metaraminol and mephentermine are also vasoconstrictors. They are metabolized by COMT and MAO. Phenylephrine Phenylephrine is a pure ÃŽ ±1-AR agonist and its primary action is to increase SVR. Reflex bradycardia may be seen. Vasoconstriction of renal, splanchnic and other vascular beds occurs. Coronary perfusion pressure is increased due to increase in diastolic pressure. The intravenous bolus dose is 50-100  µg and infusion rate is 0.5-1.0  µg/kg/min. Its effect is apparent in 1 minute and lasts upto 20 minutes. It is commonly used to increase SVR and therefore the perfusion pressure on CPB. Mephentermine Mephentermine has direct action on ÃŽ ±-AR and ÃŽ ²-AR, and indirect action by releasing norepinephrine at the nerve terminal. It increases CO and SVR. Its acts immediately on intravenous injection and it’s action lasts 30 minutes. It is used in 15-45 mg bolus doses and as 0.1% infusion titrated to effect. Vasopressin Vasopressin,a hormone of the anterior pituitary is a potent vasoconstrictor. It mediates vasoconstriction by inhibiting K+ ATP channels on vascular smooth muscles and blunting the rise in cGMP (due to NO and ANP) and cAMP (due to ÃŽ ²2-AR stimulation). It is one of the modalities of treating vasodilatory shock after CPB. It is used in the infusion dose of 0.01-0.1 U/min for this purpose. At higher doses it has the potential to cause renal and splanchnic vasoconstriction. It is also administered as a bolus dose of 40 U i.v. during cardiopulmonary resuscitation. Suggested reading Hoffman TM. Newerinotropesin pediatric heart failure. 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