Older People With Strokes

Older People With Strokes An estimated 150,000 people have a stroke in the UK each year (Scottish Stroke Care Audit 2005/2006) with a mortality of over 67,000 (British Heart Foundation, 2005) . It is the third most common cause of death in England and Wales, after heart disease and cancer (NHS, 2001).This is in accordance with the report published by World Health Organization stating, stroke is the third highest cause of morbidity and mortality in the developed countries of the world, immediately following ischemic heart disease and malignant diseases(WHO, 2008).Because strokes are common and lead to substantial disability and ill-health, a large proportion of the NHS budget is spent on treating people who have suffered a stroke. The direct cost of stroke to the NHS is estimated to be  £2.8 billion. The cost to the wider economy is  £1.8 billion (NHS, 2001).Thus a needs assessment of this population group might help understand the intricacies of this issue. This assignment aims at giving a brief account of the factors influencing the health of people who have suffered stroke and further plan and justify a health needs assessment for the same. It will also attempt to provide a critical analysis of a relevant health policy and its impact on the affected population. Stroke: Definition and Risk Factors The World Health Organization defines stroke as a condition caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue. The effects of a stroke depends on which part of the brain is injured and how severely it is affected. A very severe stroke can cause sudden death (WHO, 2008). Various physiologic and medical conditions can precipitate stroke. The risk factors can be categorised into biological, environmental, socioeconomic and behavioural. There is often an interplay of two or more factors that attribute to morbidity. Biological: These include age, gender and genetic predisposition. The single most important factor that increases the chances of stroke threefold is the age of the individual (Fisher, 2001). Age People most at risk for stroke are older adults, particularly those with high blood pressure, who are sedentary, overweight, smoke, or have diabetes. Incidence rises exponentially with age and majority of them occur in persons older than 65 years (Fisher, 2001). Wolfe, Rudd Beech (1996) states that the risk of stroke doubles with each successive decade over the age of 55. Older age is also linked with higher rates of post-stroke dementia. Gender In most age groups except older adults, stroke is more common in men than in women. However, it kills more women than men, regardless of ethnic groups (Fisher, 2001). This may be partly due to the fact that women tend to live longer than men, and stroke is more common among older adults. Women account for about 6 in 10 stroke deaths (NHS, 2001). Race and Ethnicity In as diverse a population in England and Wales, the minority population, especially those belonging to the African and South Asian origin, face a significantly higher risk for stroke and death from stroke than the English (Wolfe, 1996). They also have a higher prevalence of obesity, diabetes, and hypertension than other groups. However, studies suggest that socioeconomic factors also affect these differences. Lifestyle Factors Smoking: People who smoke a pack a day have almost two and a half times the risk for stroke as nonsmokers. Smoking increases both hemorrhagic and ischemic stroke risk (Wolfe, 1996). The risk for stroke may remain elevated for as long as 14 years after quitting, hence an earlier quit is recommended (NHS, 2001). Diet: Unhealthy diet (saturated fat, high sodium) can contribute to heart disease, high blood pressure, and obesity, which are all risk factors for stroke(Winter, 2001). Physical Inactivity: Lack of regular exercise can increase the risk of obesity, diabetes, and poor circulation, which increase the risk of stroke. Alcohol and Drug Abuse: Alcohol abuse, including binge drinking, increases the risk of stroke. Drug abuse, particularly with cocaine or methamphetamine, is a major factor of stroke in young adults. Anabolic steroids, used for body-building and sports enhancement, also increase stroke risk. Heart and Vascular Diseases Heart disease and stroke are closely tied for many reasons. People who have one heart or vascular condition (high blood pressure, high cholesterol, heart disease, diabetes, peripheral artery disease) are at increased risk for developing other related conditions (British Heart Foundation, 2005). High Blood Pressure. High blood pressure (hypertension) contributes to about 70% of all strokes. Hypertensive people have up to 10 times the normal risk of stroke, depending on the severity of the blood pressure in the presence of other risk factors. Hypertension is also an important cause of so-called silent cerebral infarcts, or blockages, in the blood vessels in the brain (mini-strokes) that may predict major stroke. Controlling blood pressure is extremely important for stroke prevention. A meta-analysis of nine prospective studies, including 420,000 individuals followed for 10 years, found that stroke risk increased by 46% for every 7.5-mm Hg increase in diastolic blood pressure (Fisher,2001). Atrial Fibrillation. Atrial fibrillation, a major risk factor for stroke, is a heart rhythm disorder in which the atria (the upper chambers in the heart) beat very quickly and nonrhythmically (British Heart Foundation, 2005). Between 2 4% of patients with atrial fibrillation without any history of TIA or stroke will have an ischemic stroke over the course of the year. Of those with atrial fibrillation, the risk generally is highest in those older than age 75, with heart failure or enlarged heart, coronary artery disease, history of clots, diabetes, or heart valve abnormalities (Winter, 2001). Diabetes Heart disease and stroke are the leading causes of death in people with diabetes. Diabetes is second only to high blood pressure as the main risk factor for stroke. The risk is highest for adults newly diagnosed with type 2 diabetes and patients with diabetes who are younger than age 55. African-Americans with diabetes are at even higher risk for stroke at a younger age (Wolfe, 1996). Diabetes is a particularly strong risk factor for ischemic stroke, perhaps because of accompanying risk factors, such as obesity and high blood pressure. Obesity and Metabolic Syndrome Obesity may increase the risk for both ischemic and hemorrhagic stroke independently of other risk factors that often co-exist with excess weight, including diabetes, high blood pressure, and unhealthy cholesterol level (Winter, 2001). Weight that is centered around the abdomen (the so-called apple shape) has a particularly high association with stroke, as it does for heart disease, in comparison to weight distributed around hips (pear-shape). Stroke being a syndromic illness, the health needs of those at risk and post stroke survivors are varied and need due consideration. Health Needs Assessment in Stroke Survivors Health needs assessment according to the NHS health needs assessment workbook is a systematic review of the health issues facing a population leading to agreed priorities and resource allocation that will improve health and reduce inequalities. This ensures that any action taken minimises harm to health, and may improve it for those with the most to gain. In particular, stroke is a leading cause of adult disability (Raina, 1998). The trajectory of care for stroke is of sudden onset, acute hospital care followed by rehabilitation and return to community living. Of new stroke survivors, an estimated 56% go directly home after acute care, 32% go to inpatient rehabilitation, and 11% go to long-term care facilities (NHS, 2001). Stroke survivors returning to the community often have difficulties performing every day activities like dressing, eating, and mobility that can last well into the first year post-stroke (Mayo, 2002). It is also commonly associated with cognitive changes (e.g., 26. 3% of ischemic stroke survivors are diagnosed with dementia (Desmond, 2000)). Caregivers provide essential support to these individuals when they return home with varying levels of physical and cognitive difficulty. The assessment of health needs, involves a combination of epidemiological assessment of disease prevalence, the evaluation of the effectiveness of treatment and care options, and their relative costs and effectiveness, analysis of existing activity and resource data, and application of this knowledge to populations (Bowling, 2009). Thus according to pallant (2002) it is important to identify the needs not wants so as to achieve measurable improvement from an intervention. As this involves time and efforts and results in considerable long term benefits for those who undertake it and for the population assessed. Hence it has attracted the interest of policy makers, health economist and health professionals to satisfy individual and population needs to optimize resource utilization (Lari Gari, 2005). In the present context the aim of health needs assessment for stroke is to lower the incidence of stroke, directed at reducing smoking, reducing socio-economic deprivation, lowering blood pressure and encouraging healthy lifestyles (Stevens, et al., 2004) Thus the health needs of stroke survivors during various phases of their post stroke recovery period as discovered in the literature are summarized as follows Biological aspect Biological pathology of post-stroke is neuromuscular function impairment which hinge on the lesion area on the brain. Undoubtedly, sensory-motor assessment such as visual field defects, bladder in dysphasia, sensory impairment and muscle power weakness (Klara, 2006). Also, motor paralysis is still a major problem in stroke condition that presents a weakness on the affected side particularly upper and lower extremities, due to lack of muscle tone generation and imbalance of nerve impulse from cerebral cortex which leads to flaccidity and spasticity (Fawcus, 2000). Therefore in order to evaluate post stroke management and care, use of a variety of standardized tests before physical rehabilitation training can help to assess the general and specific needs of the patients. For example, the Modified Ashworth Scale (MAS) can assess muscle spasticity, the Medical Research Council Motor Power Score (MRC-MPS) can measure motor power and strength of isolated group of muscle and Likert-type scales use to count pain condition (Fasoli et al. 2004). In addition, the Barthel Index can evaluate functional skills of activity of daily living (Shah et al. 1989). These instruments and therapeutic modalities can assess the accurate physical condition and abilities of the stroke survivor and help perform strategic plan for his rehabilitation. Physical aspects After the stabilization of the patients medical condition the clinical emphasis is on preparing the patients to return home. The most important physical competency to be monitored in the stroke survivors by the health professionals at this stage are related to activity of daily living (ADL skills). As Gresham (1986) suggests independence in ADL will continue to be a suitable hallmark of physical restoration. Therefore the aspects that need consideration include education and training of stroke survivors and care givers to help them safely perform the activity of daily living and adapt the training received in the hospital to the home environment. For example, in the home environment bathrooms may be smaller, hallways may be narrower, carpets may be difficult to manage, and stairs may be difficult to negotiate. The sudden transition to the home with an absence of health professionals with whom to consult as needed may also make caregivers anxious. As a result, caregivers may need advi ce from peers and/or health care professionals on how to manage the care recipients various needs (Cameroon Gignac, 2008). They may require additional training, and they may need additional emotional support to address fears and anxiety associated with starting to provide care in the community. Emotional and needs Stroke survivors need continued practice and support in their activities of daily living and would benefit from the opportunity to test their skills in the home environment under the supervision of rehabilitation professionals and/or nurses (Pallant, 2002). These professionals could appraise and provide feedback about their functioning ability with the aim of enhancing stroke survivors skills and confidence. Emotionally, stroke survivors need support from social workers and/or family and friends to manage their mounting anxiety and uncertainty about their skills and competence in the community(Cameroon Gignac, 2008). The types of resources include access to community care agencies, on-going rehabilitation, and support groups. Behavioural needs The first and foremost priority in post stroke rehabilitation is to control the modifiable risk factors in stroke survivors. Several modifiable risk factors that contribute to development and progression of stroke include hypertension, cigarette smoking, diabetes mellitus, excessive alcohol consumption, lack of physical activity, dietary and hyper-cholesterolaemia (Gariballa, 2004). Multidisciplinary team approach not only helps in prevention but also to identify the susceptible population at risk. It is the primary health care team including clinical governance who leads the team (Pallant, 2002). Studies have shown that hypertension is the single most attributable factor for stroke. Smokers are at three fold risk of stroke when compared with non- smokers and 10 fold risks when in combination with raised systolic blood pressure (Wolfe, Rudd Beech, 1996). Diabetes accounts for 10-20% of all strokes whereas epidemiological studies have confounded that alcohol consumption has direct do se dependent effect (Lindley,2008). Thus patients and care giver counselling in improving the lifestyle related factors and regular monitoring of the patients during post stroke rehabilitation is mandatory for long term benefits. However in order to make the life of the post stroke survivors and the care givers more comfortable appropriate policies and their implementation should be the highest priority of the government and the Department of Health. Policy analysis in post-stroke from National Stroke Strategy [version 2008] (Department of Health, 2008) From the information available, the national stroke strategy tried to give data, advice and support for clear and easy implementation of treatment plan. This policy provides opportunity for stroke survivors to participate and express their health needs. Also, this persuades all institutional services of stroke to prepare pertinent information and health support into the system service to help people access information and care easily. For instance, if stroke survivors need to change service and treatment, healthcare team should explain factual information and transfer them to the right modalities by finding an accurate therapy to support them. Furthermore, if there is a voluntary organization service to serve nearby stroke patients home, health professionals should advise them to encourage joint activity in their society. Conclusively, this guiding principle explores peoples need and open people to feed back information on stroke service attribute. The essence of involving people in developing service and treatment programme lies in the policy makers view to incorporate stroke survivors and carers in decision making for development of strategic plan, focus management, delivery and scrutiny of appropriate service, to provide special tools and assistive support in case of severity. The strength of this stroke policy is evident from the relevant points and emphasis on the step by step sequencing of services regarding important concerns. Besides, guideline pattern has highlighted the key words that refer to reading awareness including consistency of cartoon painting which is easy to capture in perceptual context and comprehension. However, there are a few weaknesses of informative system that cannot explain the details of further information if people need to read in-depth and cannot show the feature of voluntary organization for connection of services. Examine how to serve life after stroke, assessment and rehabilitation Having completed basic stroke treatment, the life after stroke needs to be evaluated with an objective for providing a good quality of life and design services for people who have had a stroke and are supported to live with independence with possible availability of resources at their home and environment. The policy aims at stroke survivors and relatives requirement of high-quality rehabilitation training and medical support in order to promote better movement/mobility in day-to- day life, self hygiene and cooking, adequate communicative skills, distress/depression management problem solving ability and sexual behavioural understanding. The outstanding Information can help many readers and healthcare providers to realize and understand the overview of stroke patients. All healthcare professionals should follow this guideline on rehabilitation by concentrating on individual patient needs and differing needs of some ethnic groups depending on their culture and belief in environmental society. In addition, the plan of strategy has underlined the end-of-life care by considering severe stroke survivors who seem not to get better and help them join the right service programme with the right caregiver such as special care and needs, choice of place of death and assessment of the satisfaction of patients relatives about the end-of-life care. Therefore, the life after stroke policy is to distinguish, to follow and depict the important roles of healthcare team but which cannot see the pitfalls of service process. If the action plan can be manipulated, according to the patient requirement from the hospital to strokes home and community, the end result will definitely be much better. Analyse the process of health service in long-term care support In order to analyse the policy service system of stroke, the stroke strategy has to be formulated to facilitate easy-to-access services and to receive concomitant service from interdisciplinary team for long-term needs of stroke survivors. Outstandingly, provision of long-term care is essential and has become a part of health promotion because post-stroke pathology is different in each patient that needs to be rehabilitated in different modality intervention programmes. Nevertheless, this policy of long-term care support is difficult to manage a range of different rehabilitations because the activity involves various dimensions and a combination of facilities for different stroke cases and hence difficult to meet the complex social care needs. Apart from this, the stroke policy provides only an overview of immediate management and does not explain how to set the long-term care and support for stroke survivors. Although the long- term care process can lead to a better quality of life after stroke, there are many factors that need to be planned, especially related to the individual stroke condition. The guidance should be planned and made elusive in terms of mild, moderate and severe stroke in long-term care and support which is necessary for reflection of different short and long term goals to be achieved in rehabilitation training. However, the policy services merely shows peoples needs assessment and do not describe the effective planning that meets individual needs particularly related to long term care and hence should be considered accordingly to the level of stroke condition to identify specific social care needs, including the purpose of longer-term follow-up with evaluation in multispectral collaborative services. Discuss home modification, return to work and community participation To improve the quality of life in post-stroke environment, the stroke policy makers provide only with a framework for adapting the home to be compatible with patients needs for him/her to be independent but do not give details of provisions for daily life activities. The conceptual strategy has illustrated general requirement of services for transportation and housing management by pondering over housing needs related to adaptation and modification but does not analyse specific factors that may have both positive and negative impact on the development of post-stroke skills as well as that may obstruct independence in functional ability at their homes. Nevertheless, there are no details of home modifications that are mandatory in sample such as slope area, stairway, toilet, bed room and kitchen. Conclusion From the above it is clear that the burden of disease due to stroke and the its impact during the recovery period deeply affects the life of the survivor. The high incidence and prevalence of disease make it necessary to implement appropriate measures to prevent first ever and recurrent strokes. Moreover a well planned rehabilitation of the stroke survivors is vital for improved prognosis. Conclusively an assessment of the health needs of this population group can be used to optimize health care services and facilities in the best interest of the survivors. This can also be used by the policymakers in improving the relevant provisions in meeting the health needs of the deprived. Word count : 3352

Animal Experimentation Essay -- Ethics, Animal Cruelty, Chimpanzees

Two months ago I went to see the film â€Å"Rise of the Planet of Apes† at the theater. This film was about chimpanzees that were exposed to animal research to find a cure for Alzheimer’s disease. Consequently, one of the chimpanzees tested with the Alzheimer’s cure developed an enhanced genetic intelligence that lead to the freedom of the other captive chimpanzees. Although this film was a science fiction movie, during the film, there were scenes that depicted cruelty towards chimpanzees. These scenes made me concerned about how inhumane people are towards research chimpanzees. Even with a sense of ethic, I believe animals should deserve respect and consideration. However, there were some scenes during that movie that also made me think about how animals such as chimpanzees were an essential part of human lives. Chimpanzees in the film were experimented on to find a cure for people with Alzheimer’s disease. This demonstrated that chimpanzees themselves su ffered to promote the welfare of humans. This exemplary movie leads to the question, Should animal experimentation be permitted? This question introduces to the controversy of two arguments whether animal experimentation should be permitted or not. In addition to this question, researcher Jerod M. Loeb, from the article, â€Å"Human vs. Animal Rights: In Defense of Animal Research,† concerns about animals, but cannot hinder to improve medicine or other advance for the welfare of humans. On the other hand, philosopher Tom Reagan, contributing to the book, â€Å"Ill-Gotten Gains,† is against animal experimentation. He argues that conducting experimentation on animals â€Å"exacts the grave moral price of failing to show proper respect for animals’ inherit value, whatever the benefits for the research... ...ntists against the cruelty of animals, often refers to an optimistic step to the advance in scientific knowledge preventing future diseases in humans and animals as well. It is time to put out this grief more than anything to some important subject revolving around the world, â€Å"animal experimentation.† Many might dispute; others might concur to the same idea. In the end, I respect both beliefs; both Loeb and Reagan make powerful arguments to support their beliefs. However, Loeb’s dynamic belief has self-motivated me to believe that animal experimentation should be attempted and should not be hindered. Throughout this journey of disagreements of both sides, animal experimentation has once again demonstrated that can be capable to develop new medicine for the welfare of humans, benefit animals as well, and advance in scientific knowledge to prevent future diseases.

An Investigation Into The Rate of Reaction of The Catalase Enzyme :: Papers

An Investigation Into The Rate of Reaction of The Catalase Enzyme Introduction: In this experiment I will attempt to investigate the factors that effect the rate of reaction of the catalyse enzyme. Catalyse is an enzyme found in food such as potato and liver. It is used for removing hydrogen peroxide because of the shape of the hydrogen peroxide molecule; this type of reaction is when a molecule Is broken down into smaller pieces called catabolic reaction. Enzymes are proteins e.g. catalyse. They are made in cells. A catalyst is something that speeds up a reaction. One molecule can usually be used many times. All enzymes work at different pHs because they have different jobs to do but you cant use a ph which isn't suitable for that particular enzyme which you are using, other wise the enzyme will de nature. Enzymes also react with tempreture but like the ph the temperature cant be unsuitable to the enzyme other wise it will de nature or slow down the enzymes which would make it very difficult to obtain accurate and reliable results. A carbohydrase enzyme is different to a catalyse enzyme and other enzymes because enzymes have different patterns (shape). Enzymes are like keys to different substrates like e.g. fat, sugar and the substrates are like keyholes. Mass of potato Volume Of Oxygen Average 1g 1.8ml 1.8ml 1.6ml 2ml 2g 2.6ml 1.10ml 2.5ml 2ml 3g 4.2ml 3.6ml 3.8ml 4ml 4g 4.9ml 4.9ml 4.9ml 5ml 5g 5.5ml 5.1ml 5.6ml 5ml 6g 5.7ml 6ml 6ml 6ml As you see from the preliminary results there where a lot of problems along the way but this is only to help me set out the proper results

Julius Nyerere & African Socialism Essay

Socialism as quoted by Julius Nyerere as â€Å"the attitude of the mind† and often defined as a system of social organizations producing and distributing goods that are owned collectively or by a centralized government that often plans and controls the economy. In a socialistic society it is the attitude of mind, and not the rigid adherence to a standard political pattern, which is needed to ensure that the people care for each other’s welfare. In order to understand African socialism better we need to clearly understand how a society operates. In a socialist society the means of production are owned by the workers rather than by a rich minority of capitalists or functionaries. Such a system of ownership is both collective and individual in nature. Socialism will not be a utopia simply created in people’s minds. It will be the product of economic and social development. Now African socialism is a belief in sharing economic resources in the â€Å"traditional† African way. Many African politicians supported the â€Å"traditional† African way that is often referred as African Socialism. Julius K. Nyerere who was one of them who later became the President of Tanganyika (East Africa) in 1962 and was President of Tanzania (Tanganyika and Zanzibar) from 1964 to 1985. A Socialist and Pan-Africanist, was a force for moderation and racial harmony. He worked in close cooperation with the British authorities in his homeland. However, advocates of African socialism claimed that it was not the opposite of capitalism or a response to it, but something completely different. They claimed their socialism was merely recapturing the spirit of what it was to be African. Many believed that Africa was far behind capitalist states in terms of economic development and to compete fairly with them they needed a different appeal to unite them. German economist Werner Sombart in 1906, in his definition of American Capitalism stated, â€Å"America is the Canaan of capitalism, its promised land. † Capitalism is regarded as an economic system distinguished by private ownership of the means of production and the production of commodities for sale. The modern business corporation is an original creation of the American imagination. It was first fashioned to extend local markets, then, it became an indispensable means to create a national market. Both American industrialization and capitalism were crucially dependent upon the corporate form of organization. Thus arising a political process whereby economic power can become translated into governmental policy. American capitalists had almost a free hand in gaining control of a country unimaginably rich in natural resources. In straight-out contests of strength with both organized and unorganized workers American capitalists usually triumphed. The very philosophy of individualism facilitated the adoption of slavery in the American history. President, Nyerere had to steer a difficult course by the late 1960s Tanzania was one of the world’s poorest countries. Like many others it was suffering from a severe foreign debt burden, a decrease in foreign aid, and a fall in the price of commodities. The objective of socialism in the United Republic of Tanzania is to build a society in which all members have equal rights and equal opportunities, in which all can live in peace with their neighbors without suffering or imposing injustice, being exploited, or exploiting. The nature of Tanzanian society was on rural development. People were encouraged (sometimes forced) to live and work on a co-operative basis in organized villages or ujamaa (meaning ‘family hood’ in Kishwahili). It is important to realize that the policy of ujamaa Vijijini is not intended to be merely a revival of the old settlement schemes under another name. The Ujamaa village is a new conception; â€Å"Understanding that what we need to develop is people, not things, and that people can only develop themselves. † Ujamaa villages are intended to be socialist organizations created by the people, and governed by those who live and work in them. They cannot be created from outside, nor governed from outside. No one can be forced into an Ujamaa village, and no official at any level can go and tell the members of an Ujamaa village what they should do together, and what they should continue to do as individual farmers. According to Julius Kambarage Nyerere â€Å"I have said that a millionaire can be a good socialist. But a socialist millionaire is a rare phenomenon. Indeed he is almost a contradiction in terms. The appearance of millionaires in any society is no proof of its affluence; they can be produced by very poor countries like Tanganyika just as well as by rich countries like the United States of America. † He also goes on to say that a millionaire can be a socialist; he may value his wealth only because it can be used in the service of his fellow men. But the man who uses wealth for the purpose of dominating any of his fellows is a capitalist. On the other hand the white population of the U. S. A. descended from European immigrants who, most energetic and independent elements of their peoples, crossed the ocean to escape oppression, persecution and poverty. From the first settlements on the Eastern coast, with its commercial towns, they gradually expanded over the entire continent, exterminating in continuous fight the Indian natives, clearing the forests, subduing the wilderness, and converting it into cultivated land. American capital soon played the chief role in opening up the Western wilds by digging canals and building railways. Through its friends in Congress it was rewarded for this service to the nation with big allotments for exploitation, paying not more than the bribes, the form by which the politicians got their share of the profits. Founded on the principles of individual liberty and self-determination the nascent United States provided fertile ground for the seeds of Capitalism. Conditions such as slavery, explosive growth in the number of banks, America’s powerful drive to expand its territory, neutral trade during the war between Great Britain and France, and ultimately, the Industrial Revolution enabled American Capitalism to grow into a thriving jungle. Ayn Rand, a Russian-born, American novelist and philosopher says,† America’s abundance was created not by public sacrifices to the common good, but by the productive genius of free men who pursued their own personal interests and the making of their own private fortunes. â€Å"

Cause and Effect Technology

11/10/11 Cause and effect Todays technology has good and bad effects but distraction is, in my opinion the major result. Todays’ technology has its good effects and bad effects on society. But distraction is a really bad effect on society. Yes, technology is good, better communication between people and major advancements. But little things such as cellphones, gps and much are major distractions on an everyday life. These distractions could happen while you’re in school, at your job and even when you are driving. In school, in my high school experience at least 99% of the students have cellphones.I always saw them text-messaging non-stop without paying a bit of attention to the class that was going on. Most of the time I was one of them, and I regret it because most of the time I didn’t pay attention to what the teacher was saying. Cellphones are not the only distraction computers are as well. I used to see a lot of students fight for a computer at school just so they could go on their favorite social networking site, all these distractions due to technology. Technology is also a huge distraction in the work place.I haven’t had a lot of experiences in a workplace environment but I’ve seen a lot of misfortunes just because of a cellphone. My friend recently got fired from his job because he couldn’t leave his phone a lone, his boss was right you either do the job or keep texting outside of the workplace. Last but not least, distractions while you are driving. This is the most common one and the most dangerous one. A lot of people love texting while on the road they rather answer a text message rather than worrying about their own life or even worse, other human beings life. Not only cellphones influence people while driving, GPS as well.People start laying with their GPS while driving without noticing what is in front of them, I’ve seen a couple of accidents that happened because of someone using a GPS. Also music and music players distract you a lot, this has happened to me a couple of times. People get so into songs that they start daydreaming and don’t realize they are indeed driving. Is really dangerous specially when someone has their earphones in while driving because they are locked to the music. Technology affects everyone, not only teenagers or young adults. Technology is a huge distraction and could be dangerous to society in a way or another.

Attack on Pearl Harbor: Usa in World War Essay

Pearl Harbour is a lagoon harbour on the island of O’ahu, Hawaii. Most part of the harbour is a naval base for the United States Navy and it is also the headquarters of United States Pacific Fleet. It was attacked by the Japanese navy in a surprise military air strike. The attack took place in the early hours of December 7 1941 and lasted for around two hours. The following day USA declared war on Japan and thus the entry of USA in World War II. Reason for the attack â€Å"Yesterday, December 7, 1941 – a date which will live in infamy – the United States of America was suddenly and deliberately attacked by naval and air forces of the Empire of Japan. The United States was at peace with that nation and, at the solicitation of Japan, was still in conversation with its Government and its Emperor looking toward the maintenance of peace in the Pacific. Indeed, one hour after Japanese air squadrons had commenced bombing in Oahu, the Japanese Ambassador to the United States and his colleague delivered to the Secretary of State a formal reply to a recent American message. While this reply stated that it seemed useless to continue the existing diplomatic negotiations, it contained no threat or hint of war or armed attack. It will be recorded that the distance of Hawaii from Japan makes it obvious that the attack was deliberately planned many days or even weeks ago. During the intervening time the Japanese Government has deliberately sought to deceive the United States by false statements and expressions of hope for continued peace. The attack yesterday on the Hawaiian Islands has caused severe damage to American naval and military forces. Very many American lives have been lost. In addition American ships have been reported torpedoed on the high seas between San Francisco and Honolulu. Yesterday the Japanese Government also launched an attack against Malaya. Last night Japanese forces attacked Hong Kong. Last night Japanese forces attacked Guam. Last night Japanese forces attacked the Philippine Islands. Last night the Japanese attacked Wake Island. This morning the Japanese attacked Midway Island. Japan has, therefore, undertaken a surprise offensive extending throughout the Pacific area. The facts of yesterday speak for themselves. The people of the United States have already formed their opinions and well understand the implications to the very life and safety of our nation. As Commander-in-Chief of the Army and Navy, I have directed that all measures be taken for our defense. Always will we remember the character of the onslaught against us. No matter how long it may take us to overcome this premeditated invasion, the American people in their righteous might will win through to absolute victory. I believe I interpret the will of the Congress and of the people when I assert that we will not only defend ourselves to the uttermost but will make very certain that this form of treachery shall never endanger us again. Hostilities exist. There is no blinking at the fact that our people, our territory and our interests are in grave danger. With confidence in our armed forces – with the unbounded determination of our people – we will gain the inevitable triumph – so help us God. I ask that the Congress declare that since the unprovoked and dastardly attack by Japan on Sunday, December seventh, a state of war has existed between the United States and the Japanese Empire.† Bibliography * www.eyewitnesshistory.com * about.com * Wikipedia * www.history.com * www.worldwar2history.info * www.history.navy.mil * www.u-s-history.com * www.wtj.com ( War Times Journal ) * www.law.ou.edu * www.bbc.co.uk * education.nationalgeographic.com

An Analysis on Customer Care Strategy of Sainsbury

1. 0 Company Introduction Sainsbury’s was founded in London in 1869 as one of the nations’ oldest retailers. It also provides a unique illustration of transformation that has occurred in retailing and in shopping and eating habits since the mid-19th century. It grew to become the largest grocery retailer in 1922, pioneered self-service retailing in the UK, and had its heyday during the 1980s. Now it is the third largest chain of supermarket in the United Kingdom with a share if the UK supermarket sector of 16. 3%.The supermarket chain operates three store formats: regular Sainsbury’s store (â€Å"Main Mission†), Sainsbury’s Local and Sainsbury’s Central (convenience stores and smaller supermarkets in urban locations—â€Å"Mixed Mission†) and Sainsbury’s â€Å"Main Plus† (hypermarket) stores. 2. 0 An Outlook of Sainsbury’s Customer Care Strategy Sainsbury aims at building on and stretching the lead in food. B y sharing customers’ passion for healthy, safe, fresh and tasty food, Sainsbury’s will continue to innovate and provide leadership in delivering quality products at fair prices.Sainsbury will continue to accelerate the development of non-food and service following the principles of quality and to provide a broader shopping experience for customers. Sainsbury commits to reach more customers through additional channels, and it commits to manage its business with integrity. 3. 0 Development of Sainsbury’s Customer Care Strategy Strategy refers to a plan of action designed to achieve a particular goal. 1. Sainsbury should know who Sainsbury’s customers are Sainsbury should know that every member of the community is the potential customer.Sainsbury should reach the total community. Every citizens living around the stores can be Sainsbury’s customers, as well as another companies can be the customer group of Sainsbury. 2. Sainsbury should know the needs of customers Customers need to be understood. Sainsbury comes up with the strategy that it commits to provide quality food with fair prices, which makes consumers delight. Customers need to feel welcome. Sainsbury’s staff serves every customer with a smiling face. Customers need to feel important.Once any customer has some recommendation or suggestion, he can directly approach to managers to point it out. 3. Sainsbury should know how to determine needs Sainsbury puts out questionnaires to citizens to find what they really want to buy when shopping in the supermarket and then determine their goods. It is a way to analyse needs in terms of the development objectives of Sainsbury. Sainsbury’s also set up suggestion box in its supermarkets to listen to customers’ needs. Through different ways such as community meetings and feedback, Sainsbury determines customers’ needs. 4. Sainsbury should response to needsSainsbury shows the real interest in the needs of sp ecial group, such as babies; they display their special tools and foods. Sainsbury ensures that every goods displayed on the shelves represent the real living needs for all customers. Sainsbury holds feedback meetings in order to response customers’ needs, and it commits to handle and solve customers’ complaints. 5. Sainsbury should give access to services Sainsbury never limit the service to the boundaries of Sainsbury’s store building. Sainsbury broadens its service range outside of the supermarkets and Sainsbury carries on deliver service.Sainsbury not only offers the regular stores for its customers, but also provides smaller supermarkets in urban locations as well as shopping online services. 6. Sainsbury should get stakeholders and senior managers’ support Sainsbury establishes a committee to get cooperation and support from the stakeholders and senior managers. They give financial support to promote Sainsbury’s operational environment as wel l as intelligence support to improve Sainsbury’s operational situations. Both of their supports are necessary to the development of Sainsbury. 7. Sainsbury should deliver competencySainsbury analyse its existing services to determine if their service is suitable for their customer care projects and whether the service meets the needs of customers. Sainsbury offers delivery service to customers and Sainsbury provides a search engine in its website to help customers to find the nearest store. 8. Sainsbury should give continuously analyses methods and procedures for improved efficiency. Sainsbury reduces its delivery time and time to supply new goods. Sainsbury has fax and website address to connect with customers. The employees are all trained and professional enough to serve the customers.Sainsbury makes sure that its customers know the standards of service in the stores. 9. Sainsbury should manage an effective communication Sainsbury develops a communication strategy that inf orms all information and provides channels to feedback. Sainsbury trains its employees to develop skills for successful interpersonal communication to introduce goods to customers. Sainsbury uses handbooks to advertise and inform customers’ about special events. Sainsbury puts clear signs to inform customers about the classification of all goods. 4. 0 Sainsbury’s standards in details 1. Employees Sainsbury’s employees should be passionate about working in a customer-facing environment *Sainsbury’s training divided into 4 steps:? basic introduction to Sainsbury’s ? introduce to employees their role and all the basics they need to know to work productively and safely ? develop employees to grow in their role and deliver to the required performance standards ? advanced training covers how to manage and supervise in its employees’ role *Employees are eligible for a colleague discount card when they completed 6 months service *All colleagues with one year’s continuous service can take up to 13 weeks’ unpaid leave for each child nder 5. They are also special provisions allowing time off for parents with disabled children up to 18. *Colleagues are able to exchange a portion of their salary for childcare vouchers which are non-taxable and exempt from National Insurance contributions and therefore represent a saving for colleagues who receive them as part of their total reward package. *The life assurance at the rate of four times staff’s annual basic salary in the event of death in service. *Sainsbury offers eligible colleagues the opportunity to apply for a career break for up to one year. Sainsbury would like to reward its long-term employees *Sainsbury always welcomes applications from people from any background. 2. Customers *Sainsbury is looking for people who can deliver the highest level of customer service each and every day *Customers can access a whole range of different services and meet togethe r in a safe environment. *Sainsbury hosts â€Å"community dinners† with local stakeholders to get to know customers better and understand any issues they have. *Sainsbury always supplies quality food to its customers Sainsbury creates ranges of food covering all customers’ needs *Sainsbury helps every customers cut their cost while shopping *Customers can buy goods online which will save a lot of money and time. *Sainsbury kids range is nutritionally balanced, so you can be sure you are making good, healthy choices for your children. *Sainsbury offers organic food. *Sainsbury provides customers various food recipes covering every type of meal, dish and ingredient; they really can try something new every day. *Sainsbury has the â€Å"store locator†, customers can find the nearest Sainsbury’s shop quickly. . Suppliers and Subcontractors *Sainsbury makes a deal with developing countries in order to support fair trade. *Sainsbury requires its suppliers and su bcontractors to provide fresh and healthy foods. *Sainsbury requests its suppliers and subcontractors to deliver their goods in the quickest time. *Sainsbury commits to settle accounts with suppliers and subcontractors as soon as possible. *Sainsbury requires its suppliers and subcontractors to register in a formal organization. *The suppliers and subcontractors of Sainsbury need to have a formal address and e-mail address to contact. . Community *For Sainsbury, this is not about providing great service and quality products, it’s also about making a positive difference to the communities and being a good neighbour. *Sainsbury provides local jobs for local people, and buys from local suppliers. *Sainsbury carries on Active Kids and Local Charity of the Year schemes. It helps kids who are in poverty to go to school and have medical check. *Sainsbury maintains longstanding partnership with Comic Relief, which is a local charity organization, to donate clothes and medicines and n ecessaries to rural areas. Sainsbury provides its customers options about charities to do good things on kids or social while they are shopping. 5. Environment *Sainsbury commits to reduce our impact on the environment. *Sainsbury sources products from all over the world, which means they have an important part to play, both in the evolving environmental debate, and in doing what they can do to reduce their carbon and wider environmental footprint. *Sainsbury was praised for having â€Å"excellent sustainable farming and fish policies† and the â€Å"high proportion of sustainable products available† in a survey. Sainsbury searches the latest ideas in engineering and building design, which could dramatically help them reduce their carbon footprint. *Sainsbury develops â€Å"carbon positive† stores or provide heat and recycled water to customers’ homes. *Sainsbury commits to reduce energy, packaging, food waste and wasting. 5. 0 Ways in which the Standards Were Established Customer care standard is more detail than customer care strategy and it direct how to carry on the project. A customer care standard normally covers areas of management practice, broken down into these sections: †¢ Employees Customers †¢ Suppliers and subcontractors †¢ Community and environment 1. Employees: *Clear employ article: EMP1: Organisations have a clear employ article and conditions and the procedure to ensure faith. EMP2: Organisations should secure the personal information for its employees. Safe and healthy working conditions: EMP3: Staff can get enough training to ensure the safety while working. *Faith salary system: EMP4: Staff has a clear mind about the time and method in paying salary. *Organisation engages in treat existing and potential employees’ variety.EMP5: Encourage the variety of the employees and welcome the new staff. *Encourage its staff improve in their career: EMP6: Organisations offer many kinds of training to h elp employees developing in their career. *Organisations are not allowed to molest any employees in any way. EMP7: Organisations should have the relevant articles to ensure the teenagers working in the national standards. 2. Customers *Organisations set up an equal relationship with its customers: CUS1: In the condition of respecting customers, organisations have clear business articles.CUS2: The information of customers can be used in the condition that is allowed by customers. CUS3: Organisations have the procedure to settle complaints in especially time. CUS4: The recommendations of the customers are fully considered. *Organisations ensure the safety of the products in the reasonable range: CUS5: The products or service have a clear illustration about the information like use, composition, and conservancy. CUS6: Organisations have the responsibility to protect the weak group. 3. Suppliers and subcontractors: The simple data and information about the supplier and subcontractor can be easily found in the website. SUP1: clear and crystal standards to select suppliers. SUP2: The information can only be used in the condition that are allowed by suppliers and subcontractors. SUP3: Organisations have the procedure to solve the conplaints from suppliers in ruled time. *Organisations offer money to suppliers in agreed standard. SUP4: Have the procedure to ensure suppliers and subcontractors get funds according to the agreement. Organisations encourage suppliers and subcontractors to carry on necessary business convention SUP5: Organisations should ensure the suppliers and subcontractors gain the training and exercise about the safety knowledge. *Organisation has an honest relationship with the suppliers and subcontractors 4. Community *Organisations promote the business environment on community: COM1: Organisations should consider the influences on the plan and action. COM2: Organisation has the action to promote the development of the community.COM3: Ensure to brin g up customers in the ruled area. *Organisations need to be sensitive to the local culture and economic structure: COM4: Organisation should have the procedures to ensure that its products or service will not threaten the safety. 5. Environment *Organisation reduces the use of energy and the emission of waste: ENV1: Organisations should point out clearly that the influences of its service and goods to local environment and the solutions. ENV2: Organisation takes charge of supervising and reducing the impact on local environment.ENV3: Have the procedure to ensure that its employees and suppliers are encouraged to the exercises of protecting the environment. ENV4: Encourage the use and abandon of the environmental friendly of the products. 6. 0 Methods Used by Qualitative Research and Quantitative Research to Gather and Analyse Information from Customers with Respect to Their Impressions of Sainsbury’s Customer Care 1. Qualitative Research Qualitative Research seeks out the â⠂¬Å"why† of its topic through the analysis of unstructured information and it does not rely on statistics or numbers.Qualitative research is used to gain insight into people’s attitudes, behaviors, value systems, concerns, motivations, aspiration culture or lifestyles. It is used to inform business decisions, policy formation, communication and research. Focus groups, in-depth interviews, content analysis and semiotics are among the many formal approaches that are used, but qualitative research also involves the analysis of any unstructured material. Sainsbury chooses interview as the way to carry on qualitative research.Interview is a technique that is primarily used to gain an understanding of the underlying reasons and motivations for people’s attitudes, preferences or behavior. Interviews can be undertaken on a personal one-to-one basis or in a group. The interview is put in the appendix A. Sainsbury interviewed 100 people and makes a conclusion that most of the customers are satisfied with the stores, and they think the goods are mostly cheap. Besides, people interviewed are all satisfied with the environment in Sainsbury, and they think the stores are light and clean, which really delights them.However, the customers are too many so that it is usually crowded, especially in holidays and discounts. What is more, most of the stores are set in downtown and it makes difficult for people who live in suburbs to buy in the stores. 2. Quantitative Research Quantitative research is used to measure how many people feel, think or act in a particular way. These surveys tend to include large samples. The objective of quantitative research is to develop and employ mathematical models, theories and/or hypotheses pertaining to natural phenomena.Sainsbury chooses questionnaire as the method to give a quantitative research. Questionnaire is quantitative preferred and freedom of respondent. The questions have to be relatively simple and there is no inte rviewer bias. The questions usually are literacy problems and there is no control over who completes it. The questionnaires are presented in the appendix B. These questionnaires are handed out to 1,000 people. Sainsbury makes a conclusion through research by questionnaires.Most regular customers of Sainsbury think the dominating reason contributes them to buying in Sainsbury is the fair price with good quality. Customers focus on price while shopping dominates 73%. Around 87% of customers think the service attitude in Sainsbury is passionate and 72% of customers think the environment in Sainsbury is bright and clean. Moreover, 53% of Sainsbury’s customers gain salary between 5,000 to 10,000 and 27% of its customers gain salary between 1,000 to 5,000; customers gain salary less than 1,000 or over 10,000 both dominate 10%.Through the comparison of the data from 2007 to 2010, customers’ attitude about the goods price has changed. More people think the goods are cheaper an d the increase in the attitude of acceptable is more visible; less people hold the view that the goods are expensive in Sainsbury. There are two diagrams presented in appendix C and appendix D. 7. 0 The Review of Sainsbury’s Customer Care Strategy Review is an evaluation of an operating process or a business outcome. Sainsbury chooses â€Å"comparing to customer feedback analysis† to review its customer care strategy.Before Sainsbury carry on another new customer care strategy, it makes a survey among its customers and makes a conclusion. After carrying on for a period of time, Sainsbury does a equal number survey among customers and makes a conclusion through comparing and analyzing the data: Sainsbury increases its opening hour and it makes customers life more convenient; Sainsbury promotes its employees moral and passion in serving customers. However, Sainsbury should update its goods in a high frequency and strengthen the arrangement after customers’ selecti ng goods.Sainsbury chooses â€Å"Third Party Assessment† as another method to review its customer care strategy. Sainsbury hires Mckinsey & Company to give a overall assessment about its customer care strategy and standard by using professional methods, ways, and procedures. The conclusions are made below: Sainsbury does well in caring about customers’ healthy lifestyle and delivering a healthy lifestyle to its customers; That Sainsbury encourages its customers to give a hand to local charity and people need help is a light point in Sainsbury’s strategy.However, Sainsbury must promote its after-sale responsibility and its after-sale quality. Some sorts of service, such as point out the use structure of some special goods, need to be highlighted. 8. 0 Recommendation There are some weaknesses in Sainsbury’s customer care. The relationship between suppliers and Sainsbury sometimes is not equal; The after-sale services are sometimes not enough; The safety env ironment in Sainsbury is not secured enough.In response to this, Sainsbury should point out a clear after-sale responsibility and promote the after-sale service quality; Sainsbury need to inform suppliers and subcontractors about the loss before the change of the business articles; Sainsbury need to strengthen the supervision on the safety environment and it is necessary to hand out the safety handout to employees to guarantee their safety while working. 9. 0 Reference Books: —-Scottish Qualifications Authority, Creating a Culture of Customer Care. —-Bryman, A. (1988a), Quantitative and Qualitative in Social Research, Routledge, London.Websites: http://www. sainsburys. co. uk/sol/index. jsp http://zhidao. baidu. com/question/13903776. html http://zh. wikipedia. org/ 10. 0 Appendix Appendix A 1. What do you think about the service at Sainsbury? 2. What goods do you think we should add to our goods list? 3. What service do you think we should add? 4. What reason contribu tes you to consume in Sainsbury? 5. What do you think about the quality of Sainsbury’s goods? 6. What do you think about the quantity of Sainsbury’s goods? 7. What do you think about our recommendation system? 8. What do you think about the environment in Sainsbury? . What do you think about the prices of our goods? 10. Why do you consume in Sainsbury? What attracts you to consume? Appendix B 1. What contributes you to buying in Sainsbury? A. fair price B. good quality C. convenient D. else 2. The frequency you shopping in Sainsbury every month? A. over 15 B. 10~15 C. 5~10 D. under 5 3. What do you think about the kinds of goods in Sainsbury? A. complete B. so-so C. small 4. What do you think about the prices of goods in Sainsbury? A. cheap B. middle level C. expensive 5. What aspect do you focus on when shopping? A. rice B. quality C. brand 6. What do you usually buy in Sainsbury? A. necessaries B. vegetables C. clothes 7. What do you think about the quality of goods in Sainsbury? A. good B. so-so C. bad 8. What do you think about the service attitude in Sainsbury? A. passionate B. acceptable C. bad 9. What do you think about the environment in Sainsbury? A. bright and clean B. so-so C. mess and uncomfortable 10. Can you find the goods you need easily? A. yes B. a little difficult C. only find with the help of assistant 11. Are there big supermarkets around your house?A. yes B. no C. unsure 12. What big supermarket do you usually consume? A. Wal-mart B. Tesco C. Sainsbury D. else 13. What is your gender? A. male B. female 14. What age group are you in? A. under 18 B. 18~25 C. 25~45 D. over 45 15. What salary group are you in? A. under 1,000 B. 1,000~5,000 C. 5,000~10,000 D. over 10,000 Appendix C Appendix D [pic] People’s attitudes about the prices of Sainsbury’s goods ———————– [pic]The salary level monthly of Sainsbury’s customers 10,000 1,000~~5,000 5,000~~10,000