On Rhetoric, or the Art of Eloquence, by Francis Bacon

On Rhetoric, or the Art of Eloquence, by Francis Bacon Father of the logical strategy and the principal significant English writer, Francis Bacon distributed Of the Proficience and Advancement of Learning, Divine and Human in 1605. This philosophical treatise, proposed as a prologue to an all encompassing examination that was rarely finished, is isolated into two sections: the initial segment comprehensively thinks about the excellency of learning and information; the second spotlights on the specific demonstrations and works . . . which have been grasped and attempted for the progression of learning. Section 18 of the second piece of The Advancement of Learning offers a resistance of talk, whose obligation and office, he says, is to apply motivation to creative mind for the better moving of the will. As indicated by Thomas H. Conley, Bacons thought of talk appears to be novel, yet what Bacon needs to state about talk . . . isn't as novel as it has now and again been spoken to, anyway intriguing it may be something else (Rhetoric in the European Tradition, 1990). On Rhetoric, or the Art of Eloquence* from The Advancement of Learning by Francis Bacon 1 Now we plummet to that part which concerneth the delineation of convention, appreciated in that science which we call talk, or specialty of expressiveness; a science astounding, and magnificently very much toiled. For despite the fact that in obvious worth it is mediocre compared to shrewdness, as it is said by God to Moses, when he handicapped himself for need of this workforce, Aaron will be thy speaker, and thou shalt be to him as God; yet with individuals it is the more powerful: for so Salomon saith, Sapiens corde appellabitur prudens, sed dulcis eloquio major a reperiet1; implying that significance of knowledge will push a man to a name or reverence, yet that it is expressiveness that prevaileth in a functioning life. What's more, regarding its working, the copying of Aristotle with the rhetoricians of his time, and the experience of Cicero, hath caused them in their works of talking points to surpass themselves. Once more, the excellency of instances of expressiveness in the speeches of Demosthenes and Cicero, added to the flawlessness of the statutes of expert articulation, hath multiplied the movement in this workmanship; and along these lines the deficiences which I will note will rather be in certain assortments, which may as handmaids go to the craftsmanship, than in the principles or utilization of the workmanship itself. 2 Notwithstanding, to mix the earth a little about the underlying foundations of this science, as we have done of the rest; the obligation and office of talk is to apply motivation to creative mind for the better moving of the will. For we see reason is upset in the organization thereof by three methods; by illaqueation2 or misconception, which relates to rationale; by creative mind or impression, which relates to talk; and by energy or love, which relates to ethical quality. Also, as in arrangement with others, men are fashioned by tricky, by urgency, and by intensity; so in this exchange inside ourselves, men are subverted by inconsequences, requested and implored by impressions or perceptions, and shipped by interests. Nor is the idea of man so sadly worked, as that those forces and expressions ought to have power to upset explanation, and not to build up and advance it. For the finish of rationale is to show a type of contention to make sure about explanation, and not to entangle it. The finish of ethical quality is to secure the expressions of love to obey reason, and not to attack it. The finish of talk is to fill the creative mind to second explanation, and not to persecute it: for these maltreatment of expressions come in however ex obliquo3, for alert. 3 And subsequently it was incredible shamefulness in Plato, however springing out of an only scorn to the rhetoricians of his time, to regard of talk yet as a voluptuary workmanship, taking after it to cookery, that marred healthy meats, and help unwholesome by assortment of sauces to the joy of the taste. For we see that discourse is considerably more familiar with decorating what is acceptable, than in shading what is malicious; for there is no man however speaketh more sincerely than he can do or think: and it was brilliantly noted by Thucydides in Cleon, that since he used to hang on the awful side in reasons for domain, in this manner he was ever denouncing against expert articulation and great discourse; realizing that no man can talk reasonable of courses shameful and base. Furthermore, in this manner as Plato said exquisitely, That righteousness, in the event that she could be seen, would move extraordinary love and love; so observing that she can't be appeared to the sense b y corporal shape, the following degree is to demonstrate her to the creative mind in vivacious portrayal: for to demonstrate her to reason just in nuance of contention was a thing at any point mocked in Chrysippus4 and a significant number of the Stoics, who thought to push temperance upon men by sharp controversies and ends, which have no compassion for the desire of man. 4 Again, if the expressions of love in themselves were flexible and faithful to reason, it were valid there ought to be no incredible utilization of influences and implications to the will, more than of bare recommendation and evidences; however in respect of the persistent rebellions and seditions of the expressions of love, Video meliora, proboque,Deteriora sequor, 5 reason would get hostage and servile, if expert articulation of influences didn't practice and win the creative mind from the expressions of love part, and agreement an alliance between the explanation and creative mind against the expressions of love; for the expressions of love themselves convey ever a hunger to great, as reason doth. The thing that matters is, that the warmth beholdeth only the present; reason beholdeth the future and aggregate of time. What's more, in this way the current filling the creative mind more, reason is ordinarily vanquished; however after that power of expert articulation and influence hath caused things future and remote to show up as present, at that point upon the revolt of the creative mind reason prevaileth. 1 The savvy hearted is called observing, yet one whose discourse is sweet picks up insight (Proverbs 16:21).2 The demonstration of getting or ensnaring in a catch, in this way entangling in an argument.3 indirectly4 Stoic scholar in Greece, third century BC5 I see and support the better things yet follow the more regrettable (Ovid, Metamorphoses, VII, 20). Closed on page 2*This content has been taken from the 1605 release of The Advancement of Learning, with spelling modernized by editorial manager William Aldis Wright (Oxford at the Clarendon Press, 1873). 5 We close hence that talk can be not any more accused of the shading of the more regrettable part, than rationale with fallacy, or ethical quality with bad habit. For we know the principles of contraries are the equivalent, however the utilization be inverse. It appeareth likewise that rationale differeth from talk, not just as the clench hand from the palm, the one close, the other everywhere; except significantly more in this, that rationale handleth reason precise and in truth, and talk handleth it as it is planted in prevalent attitudes and habits. What's more, along these lines Aristotle doth astutely place talk as between rationale on the one side, and good or common information on the other, as partaking of both: for the confirmations and exhibits of rationale are toward all men impassive and the equivalent; yet the verifications and influences of talk should vary as per the evaluators: Orpheus in sylvis, entomb delphinas Arion 1 Which application, in flawlessness of thought, should expand up until now, that if a man ought to talk about something very similar to a few people, he ought to address them all individually and a few different ways: however this politic piece of expressiveness in private discourse it is simple for the best speakers to need: while, by the watching their all around graced types of discourse, they leese2 the volubility of use: and subsequently it will not be out of order to prescribe this to better request, not being interested whether we place it here, or in that part which concerneth policy.â 6 Now in this manner will I drop to the deficiences, which (as I said) are nevertheless attendances: and first, I don't discover the insight and ingenuity of Aristotle all around sought after, who started to make an assortment of the famous signs and shades of good and shrewd, both basic and near, which are as the misconceptions of talk (as I contacted previously). For example:â Sophisma.Quod laudatur, bonum: quod vituperatur, malum.Redargutio.Laudat venales qui vult extrudere merces. 3 Malum est, malum est (inquit emptor); sed cum recesserit, tum gloriabitur!4 The imperfections in the work of Aristotle are three: one, that there be nevertheless a couple of many; another, that their elenches5 are not attached; and the third, that he imagined however a piece of the utilization of them: for their utilization isn't just in probation, yet substantially more in impression. For some, structures are equivalent in connotation which are contrasting in impression; as the thing that matters is incredible in the puncturing of that which is sharp and that which is level, however the quality of the percussion be the equivalent. For there is no man yet will be somewhat more raised by hearing it stated, Your adversaries will be happy of this, Hoc Ithacus velit, et magno mercentur Atridae, 6 than by hearing it said just, This is detestable for you.â 7 Secondly, I do continue additionally that which I referenced previously, contacting arrangement or preliminary store for the furniture of discourse and status of development, which appeareth to be of two sorts; the one in likeness to a shop of pieces unmade up, the other to a shop of things instant up; both to be applied to that which is visit and most in demand. The previous of these I will call antitheta, and the last formulae.â 8 Antitheta are theories contended ace et contra7; wherein men might be all the more enormous and arduous: however (in, for example, can do it) to maintain a strategic distance from prolixity of section, I want the seeds of the few contentions to be thrown up into some concise and intense sentences, not to be refered to, yet to be as skeins or bottoms of string, to be unwinded everywhere when they come to be utilized; providing specialists and models by reference. Star verbis legis.Non est interpretatio se

Rachel Carson’s Silent Spring Essay

All through time, American mentalities towards the significance of the earth have decreased. American ranchers have started to utilize harms, for example, parathion, which has started executing animals and people. Rachel Carson, a prominent scholar, distributed her novel Silent Spring in 1962, wherein she represents the requirement for American mentalities towards the earth expecting to change, through comprehension â€Å"plain folks†, a denouncing tone, and engaging symbolism. Rachel Carson gives instances of justifiable â€Å"plain folks† to communicate her contention to the peruser. It was said that, â€Å"†¦In California plantations showered this equivalent parathion, laborers taking care of foliage that had been dealt with a month sooner crumbled and went into stun, and got away from death just through talented clinical attention.† She at that point proceeds to ask, â€Å"Does Indiana despite everything raise any young men who meander through woods or fields and may even investigate the edges of a river?†¦Ã¢â‚¬  These particular models represent the amount Americans don't see that they are making torment one another, and in extreme cases causing demise. Rachel Carson, in delineating her point that American mentalities toward the earth need to change, blames American ranchers who are utilizing parathion and different toxic substances, which are the reason for death to people and fowls which carrying mischief to the earth. What Rachel Carson is attempting to get Americans, particularly American ranchers, to see is that so as to stop all the executing and damage to nature, and to one another, they have to stop the utilization of parathion and different toxins. Rachel Carson utilizes a denouncing tone to communicate her emotions towards her contention that Americans don't stress over the earth enough. All through the choice, Carson shifts based on what is befalling the dark feathered creatures, to what is befalling the people. Both the people and the feathered creatures are kicking the bucket because of the ranchers utilizing parathion. In the content, she says that â€Å"The Fish and Wildlife Service has thought that it was important to communicate genuine worry over this pattern, calling attention to that â€Å"parathion treated regions comprise a potential risk to people, residential animals, and wildlife.’† Following this statement, Rachel Carson proceeds to blame ranchers for the loss rundown of â€Å"some 65,000 red-winged dark feathered creatures and starlings.† Carson clarifies that, â€Å"†¦The issue could have been comprehended effectively by a slight change in rural practice.† Through this statement, Carson is charging the American, particularly American ranchers, of doing whatever it takes not to utilize rehearses other than harms, for example, parathion, to keep the flying creatures and animals out of the yields. Rachel Carson utilizes unmistakable symbolism to communicate her proceeding with solid emotions towards Americans absence of demeanor toward nature and it expecting to change. In the content, Carson makes reference to â€Å"Who settled on the choice that gets under way these chains of poisonings, this ever-enlarging wave of death that spreads out, similar to swells when a rock is dropped into a still pond?†. While this is both a comparison and a non-serious inquiry, the manner in which the writer states â€Å"†¦like swells when a rock is dropped into a still pond?† causes the peruser to have the option to envision dropping a stone into water when they were more youthful and helps them to remember what that resembled. Carson likewise portrays, â€Å"Who has set in one container of the scales the leaves that may have been eaten by the creepy crawlies and in the other the abandoned loads of many-toned quills, the dormant survives from the winged creatures that fell before the unselective club of insecticidal poisons?† While the peruser may contemplate internally; for what reason would she say she is contrasting leaves that have been eaten by scarabs and dead fowls? One can really envision setting these two things in two distinct heaps. Rachel Carson utilizes diverse expository gadgets all through her novel Silent Spring. She utilizes the explanatory gadgets to demonstrate her point that American perspectives toward the earth needs to change. She unequivocally accepts that the mentalities need to change, and she discovered numerous approaches to demonstrate her point and cause the peruser to concur with her.

Workshop in Development Practice COLUMBIA UNIVERSITY - SIPA Admissions Blog

Workshop in Development Practice COLUMBIA UNIVERSITY - SIPA Admissions Blog Kelly Heindel is a SIPA student who recently spent her spring break focusing on her Workshop in Development Practice course. I asked Kelly to talk about the project and to share some pictures. Thanks Kelly! One of the main reasons I decided to attend SIPA was for the Workshop in Development Practice course taught during the final semester of study.   Labeling the workshop as a course is a bit misleading.   It is more of an experience.   As the student services office explains, “Officially, it is a spring-semester course for second-year masters degree students in the EPD program, but workshop activities begin in the fall semester through the course on Methods for Development Practice.” After gaining a firm understanding of the current methods and theories for development, students are placed in consulting teams of 4-6 people and assigned a client.   Clients are typically UN agencies, NGOs, or private firms working on corporate social responsibility projects.   The client chooses an assignment for the team that can include, evaluation of ongoing organizational activities, designing a monitoring and evaluation system for a current project, recommendations for improvement or sustainability of a development initiative, and many more. My team’s client is the International Institute for Rural Reconstruction (IIRR).   IIRR uses a participatory development approach or “people-centered method” by working directly with local NGOs to build the capacity of communities to overcome challenges such as poverty and natural disasters.   One of their newest initiatives has been a community managed disaster risk reduction project on Nias Island in Indonesia.   Nias Island was greatly affected by the tsunami and earthquake in 2004 and 2005, and is still trying to rebuild physically but also economically. Over 80 UN agencies and other NGOs descended upon the island after the disasters, but most have since left.   IIRR is attempting to fill this gap by helping a local NGO, Caritas Keuskupan Sibolga (CKS), build the capacity of local communities to reduce their vulnerability to disasters through environmental management, livelihood generation, and community organizational activities. Our consulting team is conducting an independent evaluation of this project to determine the effectiveness and relevance of this approach on Nias Island.   The evaluation is a semester long project and includes a total of four weeks of field research where we conducted surveys, focus groups, and interviews with the local staff and beneficiaries of the project to inform our evaluation and subsequent recommendations. At the end of the semester we will present our findings to IIRR’s executive board and also to faculty and students at SIPA.   Being able to take classroom teachings directly out into the field is really a unique experience.   While stressful at times, the workshop has been extremely rewarding and has assisted in shaping my career goals.

Renal Three Types Of Renal Glycosuria - 1261 Words

Renal glucosuria, or renal glycosuria, is a condition in which the kidney expels glucose out of the body through urination regardless of normal or low blood glucose levels. Under normal circumstances, kidneys that are functioning properly will reabsorb the glucose that is present in the blood that is filtered by the kidneys. If the kidney is functioning properly, sugar is only eliminated when there are excess of glucose in the bloodstream, a condition known as hyperglycemia. Renal glycosuria is rare in occurrence, and in most cases is benign. There are three types of renal glycosuria: Type A, Type B, and Type O. Type A renal glycosuria is characterized by low threshold for glucose by the kidneys and its impaired ability to reabsorb†¦show more content†¦It is speculated that other genes might be involved and external environmental factors may have influence as well. The reason behind the speculation is that scientists have been inconclusive in determining whether the gene is a recessive trait, dominant, or codominant. It is mostly known to be autosomal recessive trait, but certain cases of renal glycosuria demonstrated characteristics that best fit under co-dominance with incomplete penetrance (Lee, 2013). The hypothesis that other genes or external factors are involved in the exhibition of renal glycosuria best explains the discrepancy in the amount of glucose present and the frequency of glucosuria. Renal glycosuria can occur in both males and females. It does not appear more frequently in one race or ethnicity than it does in another. In fact, it has been observed in other mammals as well. Okapis (a mammal indigenous to Central Africa) with renal glycosuria have been studied extensively regarding their diet, stress, and pregnancy (Vercammen 2014). The study concluded that diet and stress had minimal impacts, if any, on renal glycosuria. During pregnancy of one of the okapis, the pregnant okapi expelled lower amounts of glucose in her urine. The reaso n for reduced glucose levels in the urine during pregnancy is that the okapi needed to absorb more glucose to sustain the extra energy needed toShow MoreRelatedEssay on Chronic Renal Failure830 Words   |  4 Pagesto Marshall and Bangert (2008), the kidneys have three major functions: firstly, the kidneys excrete waste from plasma in the blood. Secondly, they maintain extracellular fluid volume and composition. Lastly, the kidneys play a role in hormone synthesis. There are many diseases that might infect the kidneys and affect their functioning. One of these diseases is renal failure (kidney failure), a dangerous disorder. Stein (2002) defines renal failure as a condition in which the kidneys are lessRead MoreHow Glucagon Is The Other Hormone Produced By The Islets Of Langerhans905 Words   |  4 Pagesof glycogen are depleted, the body will go into ketosis. 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Prehaps if Victoria was offeredRead MoreIntegrative Pathophysiology Of Diabetes Mellitus1042 Words   |  5 Pageslarger amounts of insulin until it can no longer meet the body’s demands fo r insulin, and then causes a rise in the body’s blood glucose levels (Stoppler, 2014). This is what caused type 2 diabetes (Insulin Resistance and Prediabetes). Most people aren’t aware that they have insulin resistance until it develops into type 2 diabetes (Insulin Resistance and Prediabetes). Kussmaul respiration is the act of rapid, deep, and laboured breathing, which is often referred to as air hunger. This is characteristicRead MoreTest Tests And Its Effect On A Patient Of A Wide Range Of Disorders, Diseases, And Conditions827 Words   |  4 PagesUrinalysis is a test done on urine in order to diagnose a patient of a wide range of disorders, diseases, and conditions. There are several urinalysis test such as pH, ketones, specific gravity and glucose to name a few. 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Both types result in the inability to use blood glucose for energy, either the pancreas does notRead MoreThe Common Types Of Diabetes Mellitus Essay2400 Words   |  10 Pagesnot curable and can affect the body, lifestyle and social interactions for the patient. If not controlled this condition can lead to major organ damage and death. The most common types of diabetes mellitus are type one immune medicated diabetes mellitus (IMDM) and accounts for 10% of the Australian population. Type two non-insulin dependent diabetes which is considered as lifestyle induced and accounts for 85% of Australians (Diabets Australia, 2015). Medical professionals are also diagnosing a

Analysis Of The Play Antigone - 1117 Words

In the reading Siddartha, the protagonist, Siddartha, is a man who comes to the realization that he is lacking in life and that the materialistic treasures of the world, such as power, wealth, and sex, do not satisfy him anymore. He then embarks on a long journey to fill the void inside of him and search for the enlightenment that he craves. Before he experiences his awakening, he faces many obstacles and fights many battles between his internal values and the values of the world. Likewise, the play Antigone is the story of a tragic hero who defies the rules of her society in order to do what she feels is morally just. She is eventually charged with treason and sentenced to death by the society because of her act of heroism. It is made†¦show more content†¦It had to be found, the pristine source in one s own self, it had to be possessed! Everything else was searching, was a detour, was getting lost† (Hesse 5). These thoughts that were running through Siddartha’s mind clearly demonstrates how much he disagrees with his family’s ways. The sheer thought of Siddartha following in his father’s footsteps brings him immense dissatisfaction. Even though his father is a noble and good man, Siddartha believes that his father lacks what he is ultimately searching for, enlightenment. Siddhartha experiences multiple instances of conflict between his search for truth and traditional social structure and addresses it by seeking out new experiences. This is displayed when Siddartha is leaving the Brahmins and says, â€Å"But there is one thing that the so clear, so vulnerable Teaching does not contain: it does not contain the secret of what the Sublime One himself has experienced, he alone among the hundreds of thousands. That is what I thought and realized when I heard the Teaching. That is why I am resuming my wandering – not to seek a different, a better teaching, for I know that there is none; but to leave all teachings and all teachers and to reach my goal alone or die† (Hesse 32). Here, Siddartha is explaining that his method of achieving enlightenment is different from the standards of his people. The Brahmins maintain the culture and method of having a teacher who isShow MoreRelatedAnalysis Of The Play Antigone 933 Words   |  4 Pageswhom th ey worshiped. In the play Antigone by Sophocles, the audience is exposed to the roles of men and women in an ancient Greece society known as Thebes. Although ancient Greece was a male-dominant society where women had as much freedom as a slave, Sophocles’ main character in the play, Antigone, is an example of a brave, strong-minded woman who goes against the limitations that were unfairly set upon women during that time to do what she believes is right. 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During these days, men were dominant and held all of the power, so women were automatically treated as less. Antigone and Creon portray the conflicting sides between male and female, and Ismene and Haemon portray opposing sides to Antigone and Creon’s actions. Antigone, Ismene, C reon, and Haemon each show differencesRead MoreAnalysis And Comparison Of Ophelia And Antigone1485 Words   |  6 PagesAnalysis and Comparison of Ophelia and Antigone Analysis of Antigone Antigone s story begins in the middle of things as the audience is expected to be aware of her background. Antigone firmly believed that she and her sister were the final victims of a curse that was placed upon their family long ago. The rest of her family members had already paid the price of the evil, and it was, therefore, their destiny to die as well. 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In addition, Antigone was also one of the most famous tragedies ever to be written. The setting of the play is set in front of the Palace, Thebes, and Ancient Greece. Though most Greek playwrights were from Athens, their plays are hardlyRead MorePathos In Antigone978 Words   |  4 PagesAntigone and Aristotle’s definition of tragedy The beauty of tragedy is its ability to capture the audience and evoke a particular emotion in it. Tragedy, as Aristotle defines it, â€Å"accomplish[es] by means of pity and fear the cleansing [katharsis] of these states of feeling† (Poetics 1449b 27-28). Aristotle claims that tragedy offers some certain value for the audience – a social and psychological value – through the empathy it sets in place for the audience. Sophocles’ tragic play, Antigone, isRead MoreAntigone Character Analysis1422 Words   |  6 Pages Antigone, the final play in a series including Oedipus Rex by Sophocles, discusses the ideas of leadership, family, and choices. It features two central characters: Antigone, a girl who chooses to illegally bury her brother, and Creon, a king who decrees the burial of the brother to be illegal. Upon the first encounter of the text, it appears that Antigone is the â€Å"hero† of the play, but on further analysis, one realizes that the tra gic hero, as defined by Aristotle, is actually Creon. The idea

The Drugging of our Children Free Essays

Dr. James Schaller of the Medical College of Pennsylvania (Life Script; James Louis Schaller, MD) believes that one must rule everything out first and then see the actual problem before considering edication. It is common in this day and age for people to accuse the hyperactive child of their parents not knowing how to raise or control them. We will write a custom essay sample on The Drugging of our Children or any similar topic only for you Order Now Dr. Michael D. Fraser states that parenting style is not a cause of ADD and ADHD but that it’s hereditary and can even have to do with things like low birth weight, diet, and allergies. Needleman stated that, â€Å"It has also been claimed that exposure to lead can cause delinquent behavior in children†. The number one symptom of ADD or ADHD is â€Å"Often fidgets with hands or feet or squirms in seat†, stated by Peter Breggin, MD. Null only gets facts and stories from people that have been negatively affected by the use of psychotropic medications and doctors that are against the use of them. The audience is only able to wrap the mind around tragic situations that’ll lead to agreement with the argument presented. It was observed that as children got older, school shootings became more common. The cause of this was claimed to be that into this answering their own questions like â€Å"Weren’t guns easy to access in the 1950’s and 1960’s? † In fact, yes, it was Just as easy, if not easier for children to get heir hands on guns then also. Physicians looked further into the children committing these acts. Miguel Humara, Ph. D states that, â€Å"The most effective form of treatment for ADD and ADHD are cognitive behavioral therapy, and psychotropic medication†. All of the children featured in the film had a history of being on some sort of psychotropic medication, the most common being Ritalin. These drugs are most commonly meant for people ages eighteen years or older, but doctors were being lazy and Just prescribing these drugs to small children also. Comparing an eighteen ear old on Ritalin to a seven year old on it, they had different side effects. While the eighteen year old was experiencing headache and vomiting, the seven year old was hallucinating and unconsciously doing violent acts. Obvious to viewers that these had long term consequences to younger aged children. This information makes sense and is valid from people with first-hand experience, but what about the people with no horrendous side effects? What about the doctors that do rule out everything before trying out medicine? These things should have also been addressed throughout the film for accurate accusation. The argument is strong and makes the audience think about medicating young children and is definitely persuasive in making them agree. This argument makes the audience think more in depth of the side effects of medication on young children in both their short term and long term effects. Null, throughout the entire film, speaks to the audience through the credibility of doctors, educators, and parents that have lived through experiences. This is an effective way to grab the attention of the audience with real life stories of victims. It makes the audience feel as if they know the victim and can have sympathy or their experience and therefore be able to agree with the argument, making the argument effective. In reality, young children are going to be a bit hyper and squirmy in their childhood and shouldn’t be look at as diseased or troubled. They need time to grow up and understand acceptable behavior. Though teachers and parents quickly make the assumption that there is something wrong, doctors need to be the ones to make the ultimate decision. Therefore, drugging of young children is the result of self- diagnoses, teacher diagnoses, and lack of medical attention and care for those with ADD and ADHD. How to cite The Drugging of our Children, Papers

Organizational Strategies and Effectiveness-Samples for Students

Question: Discuss about the Impact of Culture and Values on Organizational Behavior. Answer: Impact of culture and values on organizational behavior Culture refers to the behavioral norms created by the society. A person is highly influenced by the culture in which they live. Culture in an organization refers to the shares the beliefs, assumptions and values that how the company will govern its activities in the organization. The organization culture provides set of standards and boundaries which helps the company to stick to their goals along with exploring their capabilities as well. A good organizational culture includes emphasis on teamwork, results, initiation of innovation etc. In the culture, values and behavior of internal process makes it more unique and identified in the target market. The culture helps the organization in process of civilization and systematic workflow in organization. The essay explains about the impact of value and culture on the activities of the organization; resulting it to initiate efficiency and positive growth in the market. The culture of the organization is also driven by various dimensions w hich are explained below: Value refers to an individuals perception towards a particular thing. Values under an individual include attributes like, freedom, pleasure, honesty, obedience etc. It refers to the ethics of treating actions etc. In terms of marketing value refers to the difference between customers perception towards benefits attainted and the cost of the product. The report states the relation between culture and values; along with the consequence of different value system in different cultures which affect the organizational behavior (Zheng, Yang, McLean, 2010). Now a days businesses have adapted interest in the culture and values of business process. In terms of business culture refers to the adaptions and attributes which differentiate two groups from each other. In another terms culture is also explained as the principles inherited by the firm to execute its business in day to day activities. This forms a behavior resulting to culture of the organization. Perhaps it can be said that culture includes repetitive behavior of organization or individual. Further behavior is driven by three forces which are: Human Nature: Nature is inherited in a person and shared by all the human cultures universally. Also nature of a person depends upon the surroundings in which they exist. Culture: culture is a process which is collectively programmed by all the natural and artificial resources. Culture is learned, understood and then adapted within time. Personality: it refers to the component which is an additional set of unique features present in the being which is not shared or similar to anybody else. Personality is partly inherited and partially taught (Guest, 2011). The above three factors explain the factors present in the behavior of the organization, but the organizational behavior is a wide concept depending upon various dimension. In terms of an organization corporates values are the values which are inherited in an organization which also represents the culture of the organization. Values in an organization help the company in setting up goal and aligning to the objectives of the organization. The core value of an organization helps the company to stay in focus and initiate activities concerning the organizational behavior. Both culture and values are the ethical implication of rules in an organization which are interlinked. The basic relationship between culture ad values of an organization is that culture is environment of the society under which the companies sustain. Also culture is the ongoing process prevailing in the environment. And in relation to culture, values refer to the morale of the organization on the basis of which they wi ll hold their business activity.. Some of the values which a company shall have in a good culture are integrity, customer focus, confidentiality, qualitative efficiency etc. A company will adapt such efficiencies only when the culture in which the organization is prevailing includes aforementioned features. So it can be said that the behavior and the values which an organization are inherited from the culture only. Also if an organization changes its values and belief then subsequently either that organization will part of another culture or that behavioral change will slowly become a part of the culture as well. The management of the organization is highly influenced by the organizational behavior and responses. Thus it shall be noted that the organizational behavior shall be positive towards adapting managerial changes. Organizations prevailing in a same culture have almost same organizational beliefs and values. Culture needs to shift with time in order to maintain and make sure that the interests of the customers are aligned. Success of a business also depends upon the type of culture under which the company exits. Like, there is a culture which evolves slowly then the growth of the company will also take time to grow. Similar, if there is cut throat competition in the culture then the companies need to upgrade their values in such a way so as to survive in the business environment. Thus it can be said culture and values both are interlinked and interdependent process (Linnenluecke, Griffiths, 2010). The culture and values influence the organizational behavior and activities as well. Basically the type of work which the business is going to conduct depends upon the values and standards created by business only. Performance of an organization refers to the degree of achievement of mission of the organization. Efficient performance of the organization does not mean that the organization is working efficiently instead there can be some issue in the organizational culture and environment as well. The culture of the organization has also an emphasis on the performance of the organization. It shows that strong culture influences the employees of the company to work better and obtain the values defined by the organization. Also culture works as a social factor which is highly responsible to influence and change the behavior of employees in the organization. Also the organizational culture helps the firms to help the employees to become a part of the organization and initiate effectivene ss in the organization, further the employees helps the company to attract new trainees and retain the efficient staff (Mills, Smith, 2011). The organizational culture also helps the employees to understand the events, objects in a better way which contributes to the behavior as well. The culture enhances the performance of the organization. Keeping all the other factors constant, the culture is one of the major factors affecting the growth of the organization in the market. Also it provides sustainable aggressive advantage to the organization. When an employee joins the organization, the first thing through which they are influenced and motivated is the culture and behavioral aspect of the organization. The new joiners initiate to adopt the culture prevailing in the organization. If the culture is supportive to the caliber of the employee, the company will work well in the business environment. But if the culture contradicts with the behavior of the organization, then the growth of the company might take a downward turn. The culture of the organization also helps the company in motivating the organization towards achievi ng the goal defined to them. It totally depends upon the discretion of the culture on the basis of which the behavior of the organization is affected; resulting to which the values and objectives of the organization are achieved. The organizational culture shall be flexible and adaptable to change. Through this the company will become more efficient and responsive to change in the market. The change management of the organization will become more effective due to which the organization focus better on the satisfaction of the customers. Greater satisfaction of employee will lead the company to gain competitive advantage in the business environment. The culture of the organization also decide the reward management of the company, it is a major aspect which decides the satisfaction level of the employees of the organization. Further the culture of the organization is explained by Hofstede by defined five major dimensions which affect the organizational practices and behavior. The cultures are explained as follows: Individualism versus collectivism: individualism refers to the degree to which employees prefer to act separately rather than working as a group of members. Whereas collectivism refers to the process under which people wish to hold activities collectively in groups. Masculinity versus femininity: masculinity refs to degree of roles which are defined for the males of the society. High degree of masculinity shows that the culture has separate roles for both the male and female in the society. Whereas femininity refers to the degree under which the roles are defined in such a way that there is no gender difference among people (Beugelsdijk, Kostova, Roth, 2017). Uncertainty avoidance: it refers to the degree of culture under which there is better structured situations to analyze uncertainty. High degree under this parameter refers to the organization incompetence to take risk and manage uncertainty with the help of rules. Long term and short term orientation: in short term orientation, people accept the changes where as in long term organization look for future and value thrift. Power distance: it refers to the degree which depends upon the distribution of power in an organization. Thus, concluding the above statement it can be said that the organizational culture largely influence the behavior and performance of the organization. The culture is a variable factor depending upon various other aspects. The culture helps the organization in initiating the objective of the organization. Hence, the values and behavior of the organization and its employees depends upon the culture in which they survive. References Beugelsdijk, S., Kostova, T., Roth, K. (2017). An overview of Hofstede-inspired country-level culture research in international business since 2006. Journal of International Business Studies, 48(1), 30-47. Guest, D. E. (2011). Human resource management and performance: still searching for some answers. Human resource management journal, 21(1), 3-13. Linnenluecke, M. K., Griffiths, A. (2010). Corporate sustainability and organizational culture. Journal of world business, 45(4), 357-366. Mills, A. M., Smith, T. A. (2011). Knowledge management and organizational performance: a decomposed view. Journal of knowledge management, 15(1), 156-171. Zheng, W., Yang, B., McLean, G. N. (2010). Linking organizational culture, structure, strategy, and organizational effectiveness: Mediating role of knowledge management.

Critically evaluate the conceptual and theoretical Essay Example

Critically evaluate the conceptual and theoretical Essay 1.It seems no consideration of terrorist act s definition can get down without the statement: One adult male s terrorist is another adult male s freedom combatant, ( Laqueur, 1987:302 ) . And this statement seems to be at the bosom of what many consider to be the job with supplying a definition of terrorist act: it all depends on position. Surely specifying terrorist act has neer been a more of import or necessary exercising, with many political groups and administrations around the universe holding to cover with terrorist activity, there is an of all time greater demand to understand its nature. A definition of terrorist act is required, among other grounds, to implement international Torahs, to guarantee international cooperation and make up ones mind on violative action ( Ganor, 2002 ) . The sheer scope of definitions of terrorist act is possibly best illustrated by Schmidt and Jongman ( 1988 ) who cite 109 different definitions. By analyzing these definitions for significances, it is possible to name the factors most normally found to be of import. Force or force appears in 83.5 % of definitions, a political motive is in 65 % , reference of panic or fright is in 51 % , menaces in 47 % . The staying classs include psychological effects, differences between the victims and the marks and planned actions. Why the confusion? How is it possible that merely 65 % of definitions contain reference of political motive when it is normally cardinal to terrorist activity? Possibly the reply lies in the gap quotation mark from Laqueur ( 1987 ) that it all depends on the position. Ganor ( 2002 ) points to the evident duality sometimes set up in the literature between national release and terrorist act. While national release has been considered a justified terminal to contend for, can terrorism truly be used as a justified agencies? Again, it all depends on position. From Syria s official place, it does non back up terrorist act but does back up national release. Unfortunately, the agencies it uses to accomplish this terminal are considered by many to be terrorist act. We will write a custom essay sample on Critically evaluate the conceptual and theoretical specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Critically evaluate the conceptual and theoretical specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Critically evaluate the conceptual and theoretical specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Possibly underlying Syria s place, like that of the Irish Republican Army ( IRA ) is what Taylor ( 1988 ) considers the moral justification. The moral justification can be used by both authoritiess and independent administration to warrant actions that might otherwise look similar to terrorist Acts of the Apostless ( Ruby, 2002 ) . This clearly raises one of the cardinal jobs in the definition of terrorist act, over which much attempt has been expended in the literature: should terrorism be defined by its agencies or its ends? Garrison ( 2004 ) comes down strongly on the side of ends, reasoning that terrorist act should be defined by its effort to consequence a alteration in society by utilizing panic. Garrison ( 2004 ) sees terrorist act as a tool that is used by many different groups and, in that sense, does non let differentiations to be made between these groups. To do differentiations it is necessary to see terrorist act s purpose. In this definition so, the targeting of civilians is non a necessary and sufficient status for placing terrorist act ( Garrison, 2004 ) . An alternate point of view focal points on the agencies of terrorist activity to specify terrorist act ( Cooper, 2001 ) . Ganor ( 2002 ) points out that a terrorist and a freedom combatant may hold the same ends, but they are pursued in different manners. Here, so, aiming civilians becomes the cardinal point of definition. Concentrating on the act itself makes a bunk of the word picture made between national release and terrorist act in its ultimate purposes. Alternatively Ganor ( 2002 ) negotiations of the different types of unconventional warfare usually carried out between a province and an administration of some signifier. When an administration contending against the province onslaughts military marks, that is guerrilla warfare, when the administration attacks non-military marks, that is terrorist act. This means that freedom combatants, revolutionists and nihilists could be either terrorists or legitimate battlers involved in guerilla warfare. To what extent are these definitions dichotomous? Clearly they are non one stresses political terminals, and the other stresses the agencies. Each efforts to except the other s definition to a certain extent, while admiting its legitimacy to some extent. Legal systems around the universe, nevertheless, do non hold the luxury of this elusiveness. This means that some states use political or spiritual terminals in specifying terrorist act and some focal point on the Acts of the Apostless carried out ( Ramraj, Hor A ; Roach, 2005 ) . The troubles in specifying terrorist act can be made even clearer when sing how definitions are frequently either over- or under-inclusive ( Shanahan, 2005 ) . Is a terrorist ever a radical? Shanahan ( 2005 ) points out they many authoritiess may perpetrate terrorist Acts of the Apostless to stay in power. Terrorists frequently attack both military and non-military marks, thereby doing loss of life and hurt to both civilian and non-civilian marks. Shanahan ( 2005 ) even argues that onslaughts on military forces can be Acts of the Apostless of terrorist act. Further, definitions of terrorist act in footings of menaces to life and limb do non include harm to belongings. Even more bewilderingly, it is non ever possible to separate between alleged combatants and non-combatants . In decision, specifying terrorist act is so hard, one author who has been analyzing it for many old ages has resorted to explicating that we know terrorist act when we see it ( Cooper, 2001 ) . While this may be true, from an international legal position this subjective definition is non sufficient. In world, different groups cleaving to definitions of terrorist act that suit their political intents. Academicians have tried to umpire this definitional brawl, with some limited success. Some strong definitions of terrorist act have been distilled, but the existent litmus trial is whether these can be universally adopted. Sing the utmost troubles in definition illustrated by the easiness of over-inclusive or under-inclusive classs, cosmopolitan acceptance of a definition of terrorist act seems improbable. 2.Northern Ireland foremost came into being as a consequence of guerilla warfare by the Irish Republican Army ( IRA ) in the 1920s. The IRA was contending against Britain to make a province independent of the UK. In 1921 the Anglo-Irish Treaty was signed which partitioned Ireland into a southern independent democracy and Northern Ireland, each with their ain authoritiess. Publicly, the UK authorities saw the divider as an ineluctable move designed to avoid a civil war. The IRA continued their run to seek to throw out the British authorities from Northern Ireland. But, this had small consequence and until 1968 the UK authorities did non interfere with the Northern Irish authorities ( White A ; White, 1995 ) . While the IRA continued to run between 1920 and the mid-1960s, they were made illegal in the 1930s and merely carried out sporadic runs over that clip ( Thane, 2001 ) . It was nt until the late sixtiess that the IRA all of a sudden rose to unprecedented prominence. In the 1960s a mostly peaceable motion for civil rights began to develop ( White A ; White, 1995 ) . Analogues have been drawn between this rise of feeling and the civil rights motion in the US ( McGarry, 2001 ) . The Irish run originally centred on deriving rights for Catholics life in Northern Ireland. Through the 1960s tensenesss rose as the runs met opposition from the Royal Ulster Constabulary and Protestant demonstrators. Finally the British ground forces was mobilised in 1969 to assist squelch public perturbations. Over the following few old ages force exploded and the Irish authorities failed to maintain it under control. An of import factor in the rise of the IRA was a split that occurred in 1970 in the IRA from which the Provisional IRA emerged as the more violent and hawkish wing. One of the Irish authorities s last actions was to present internment in August 1971, an act designed to incarcerate those thought to be members of the IRA. The IRA, nevertheless, maintained that in this monolithic operation to collar 342 people, merely 30 were existent IRA members ( Mulholland, 2003 ) . The event to force the state of affairs over the border was Bloody Sunday 1972 when the British ground forces shooting dead 14 unarmed demonstrators. Mulholland ( 2003 ) argues that this lead to the prostration of resistance to political force. Soon afterwards the UK authorities efficaciously reimposed direct regulation and the Irish Parliament was dissolved. After this, the IRA saw a monolithic rise in its rank, particularly from within the Official IRA, and units in Northern Ireland ( Smith, 1995 ) . The ground for the rise in the IRA s power has been examined in several different ways. Many have focussed on the sudden public groundswell of sentiment that force was non merely justified, but required. White ( 1989 ) has suggested the causes of the societal revolution which the IRA made manifest prevarication in the mobilization position. The traditional position is that economic inequalities result in rebellion, but the mobilization position puts greater accent on the costs and benefits of action, reasoning that people s grudges remain comparatively stable. Turning to Ireland in the 1970s, several factors are seen to be of import in the changing manner people view guerilla warfare. White ( 1989 ) argues that it is province repression which can be seen with the British ground forces and internment that makes people place an unfairness. Second, people believe that others feel the same manner and, eventually, they decide that force is possible and it will be effectual. White ( 1989 ) finds support for this thesis in his interviews with political militant, indexing of bombardments and shots carried out in Derry every bit good as steps of economic want. Further grounds for this thesis, specifically concentrating on province repression was found in a survey carried out by White and White ( 1995 ) . They found two dimensions of province repression. The first is official repression, an illustration of which is the internment. The 2nd is informal province repression, as carried out by the British ground forces. This theory goes portion manner to explicating the rapid rise of the IRA, but the point has been made by Bell ( 1973 ) that the state of affairs had been ripe for a revolution in Ireland for 50 old ages, so why did it non get down until 1969? Many causes were involved: foremost, the civil rights run lowered people s tolerance of subjugation. Second, the British ground forces, through their actions, lost regard in Catholic eyes. Third, the security forces did non look able to maintain control. Fourth, there seemed to be an advantage at that place, if merely person could take it. For Catholics, while Stormont was non legitimate, it had at least been able to exert authorization in the yesteryear. This was no longer the instance. For all these chief grounds, people began to take their support for the British ground forces and travel it over to the IRA ( Bell, 1973 ) . In decision, there were a figure of different factors that affected the rise of the IRA between 1969 and 1974. There was a reduced belief by members of the Irish community that the official governments could maintain control of a state of affairs gyrating into force. This was combined with a turning belief the costs of an rebellion were outweighed by the likely benefits. Increasing degrees of force were spurred by lifting degrees of repression directed against the people by the authorities. A mobilization position leads to the thought that these influences, along with others, turned public sentiment in favor of the IRA. This displacement in sentiment led to a big addition in IRA rank, which allowed it to well increase its operations to the extent that, by 1974, it had become one of the strongest terrorist groups in Western Europe. Mentions Bell, J. ( 1973 ) . The Escalation of Insurgency: The Provisional Irish Republican Army s Experience, 1969-1971.The Review of Politics, 35( 3 ) , 398-411. Cooper, H. ( 2001 ) . Terrorism: The Problem of Definition Revisited.American Behavioral Scientist, 44( 6 ) , 881-893. Ganor, B. ( 2002 ) . Specifying Terrorism: Is One Man s Terrorist another Man s Freedom Fighter?Police Practice and Research, 3( 4 ) , 287-304. Garrison, A. ( 2004 ) . Specifying terrorist act: doctrine of the bomb, propaganda by title and alteration through fright and force. Criminal Justice Studies: A Critical Journal of Crime, Law and Society, 17( 3 ) , 259-279. Laqueur, W. ( 1987 ) .The Age of Terrorism. Toronto: Small, Brown and Company. McGarry, J. ( 2001 ) .The Northern Ireland and the Divided Universe: Post-agreement Northern Ireland in Comparative Perspective. Oxford: Oxford University Press. Mulholland, M. ( 2003 )Northern Ireland: A Very Short Introduction. Oxford: Oxford University Press. Ramraj, V. , Hor, M. , A ; Roach, K. ( 2005 ) . Introduction. In: V. Ramraj, M. Hor, A ; K. Roach ( Eds. ) .Global anti-terrorism jurisprudence and policy. Cambridge: Cambridge University Press. Ruby, C. ( 2002 ) . The Definition of Terrorism.Analysiss of Social Issues and Public Policy, 2( 1 ) , 9-14. Schmidt, A. P. , A ; Jongman, A. I. ( 1988 ) .Political Terrorism: A New Guide to Actors, Writers, Concepts, Data Bases, Theories, and Literature. North-Holland: Transaction Books. Shanahan, T. ( 2005 ) .Doctrine 9/11: Thinking about the War on Terrorism. Chicago, IL: Open Court. Smith, M. L. R. ( 1995 ) .Contending for Ireland? The military scheme of the Irish Republican Movement. Oxford: Routledge. Taylor, M. ( 1988 ) .The Terrorist. London: Brassey s Defence Publishers. Thane, P. ( 2001 )Cassell Dictionary of Twentieth Century Britain. London: Cassell Reference. White, R. ( 1989 ) . From Peaceful Protest to Guerrilla War: Micromobilization of the Provisional Irish Republican Army.The American Journal of Sociology, 94( 6 ) , 1277-1302. White, R. , A ; White, T. ( 1995 ) . Repression and the Broad State: The Case of Northern Ireland, 1969-1972.The Journal of Conflict Resolution, 39( 2 ) , 330-352.

Walgreens Strategic Analysis Essay Example

Walgreens Strategic Analysis Essay Example Walgreens Strategic Analysis Paper Walgreens Strategic Analysis Paper Veronica Washington 0180175 Walgreens Pharmacy (WAG) An Industry Leader at the Inflection Point The following report is an in-depth discussion of Walgreens Pharmacy with an analysis and assessment of the company’s strategic initiatives. Each strategy yields a direct purpose of diminishing the influence of a specific force from Porter’s 5-force Model as the supporting data culminates an outlook on the company’s future. COMPANY OVERVIEW Charles Walgreen of Chicago, Illinois, pioneered the first Walgreens in 1901, with corporate headquarters now located in Deerfield, Illinois. In the company’s 100-year reign as the prescription industry leader, Walgreens changed from war bonds, soda fountains, and restaurants to 24-hour store access, nationwide locations, easy-to-use online stores, and health care clinics. 6,400 stores now operate in all 50 states including Puerto Rico, with 30% open 24 hours. By 2010, Walgreen’s aspires to operate 7,000 stores nationwide and pave the way for the organic growth of 13,000 sites. As of December 2007, Walgreens employs 226,000 associates, hiring 25,000 in 2007 (WAG Annual Reports, 2007). According to the company’s 2007 annual reports, â€Å"Walgreens has been listed on: Fortune magazine’s Most Admired Companies in America list†¦ranked 44th on the Fortune 500 list of largest U. S-based companies†¦[and] ranked the leading online drugstore. † (WAG Annual Reports, 2007) In the past 2 years especially, Walgreens embarked on several ventures that will enable them to have first-mover advantage in the healthcare industry. CURRENT FINANCIAL INFORMATION In 2007, Walgreens increased net sales by 13. 4% to $53. 7 billion and increased net income by 16. 6% to $2. 4 billion. Long-term investments, which have consistently increased by roughly $100 million dollars each year since 2004, reflect company profits (WAG Annual Reports, 2007). In the 2007 operating cash flow analysis, Walgreens yielded a yearly total over $23 million in deferred taxes that arose for tax relief in advance of tangible asset depreciated accounting expenses. While net cash flows in the operating sector dropped by $80 million in a single year production, sales, and delivery continue to expand. In the 2007 investment cash flow analysis, the company directed $6. billion toward short-term investments (auction rate securities) available for sale amounting to an accumulated $6. 8 billion (WAG Annual Reports, 2007). With a staggering $1. 8 billion spent on new additions in 2007, this perceived overextension by shareholders of the company’s business and intangible asset acquisition of $1. 1 billion doubles the amount of cash used in the invested activities of 2006 (WAG Annual Reports, 2007). Employee termination and salary cuts yielded a 50% drop in proceeds received from company life-insurance policies. The $5. million proceeds of 2007 pale in comparison to the $10. 7 million received only a year before. Walgreens spent $2. 4 billion in investing activities during 2007, more than that of 2005 and 2006 combined (WAG Annual Reports, 2007). In the 2007 financi al cash flow analysis, net proceeds were $850 million. With a $141 million debt payment, $1 billion in stock repurchases, $310 million cash dividends to shareholders, and a $214 million bank overdraft sum, Walgreen’s 2007 net cash used for financing activities rose to $626 million from 2006’s $413 million (WAG Annual Report, 2007). In summation, the initial cash and cash equivalents of 2007 declined from $920 million in January to $255 million by the end of December resulting from the company’s overextension, and may result of losing their position as the industry leader in the near future (WAG Annual Reports, 2007) POWER OF BUYERS According to Porter, a buyer who has power â€Å"can always find an equivalent product, [then] play vendor against [one] another† (Porter, 2008). Consumers reap the benefits of an industry that pays for repeat business. In 2007, Walgreen’s pharmacists took 157,000 prescription transfer calls from neighboring competitors. (WAG Annual Reports, 2007) Mark Wagner, VP of Operations, announced that after reviewing the 2007 compiled transfer logs of the company, â€Å"72% of all prescription transfers [in 2007] are competitor coupon-related issues † (WAG Annual Report, 2007) Walgreens remained static in their decision to offer any type of compensation to new customers or transferred prescriptions until October 2008. Walgreens customers receive an average of four prescriptions on monthly basis from the pharmacy (WAG Annual Reports, 2007). With 65% of the sales revenue of the company coming from the pharmacy, Walgreens declines to bargain with out-of-pocket customers over price. Regardless of a climbing prescription drug-price trend, demand remains elastic because customers demand choices of similar, less expensive medications if authorized by their doctor. The amount of reimbursement Walgreens receives from Medicare, Medicaid, and Worker’s Compensation falls drastically, as incremental revenues from those sources decreases (Stewart, 2006). According to Lueck, â€Å"Medicare and Medicaid comprise 25 percent of the federal budget, and the government cannot afford to spend at the current rate† (Lueck, 2008). In order to maintain relationships with customers, retail pharmacies resorted to buying sections of Medicare Part D insurance companies: AARP Walgreens vs. CVS Caremark (Caremark Rx Inc. , 2007). RIVALRY AMONG EXISTING COMPETITORS From Porter’s point of view, â€Å"the degree to which rivalry drives down an industry’s profit potential depends, first on the intensity with which companies compete and, second, on the basis on which they compete† (Porter, 2008). Other than retail pharmacies, hospital pharmacies, mail-order pharmacies, internet pharmacies, international pharmacies, vitamin stores, and homeopathic treatment providers attempt to maintain market share in the healthcare industry (Lueck, 2008). Walgreens largest competitor, CVS Pharmacy, fell short of Walgreen’s sales revenues by $7 billion in 2007 (WAG Annual Report, 2007). Contrary to Porter’s model of rivalry, the healthcare industry is experiencing massive growth. Growth is not a force, but only a factor; and as Porter mentions, â€Å"high growth rate will not guarantee profitability if customers are powerful†¦Ã¢â‚¬  as stated in the last section (Porter, 2008). Tom Charland, CEO of Merchant Medicine, in his prophetic wisdom forecasted an â€Å"increased scarcity of physicians and midlevel practitioners in many markets and the increased use of pharmacists. † (Berman, 2007) This justifies the idea that most baby-boomers will spend several hours a week in doctor’s offices receiving treatment for maladies that require prescriptions. Because of meager prescription profits, customers gain little when switching from one pharmacy to another. As Jeff Rein, VP of Walgreens, understands, â€Å"95% percent of our patients pay only the co-pay required by their insurance plans. † (WAG Annual Report, 2007) This removes Wal-Mart’s $4 prescription plan from the picture. POWER OF SUPPLIERS In Porter’s words, suppliers with power â€Å"can squeeze profitability out of an industry that is unable to pass on cost increases in its own prices. (Porter, 2008) To make up for excessive inventory costs for new medication Walgreen’s must decrease labor hours and work more efficiently. For corporate executives in retail pharmacies like Mark Wagner of Walgreens, â€Å"the end solution is to cut costs†¦and the biggest cost in stores is payroll. † (Merrick, 2008) With manufacturers keeping new FDA-approved substitute (generic) medications at bay by creating expensive time-released versions of the ori ginal, retailers spend more money than ever before on shelf space (Merrick, 2008). The following demonstrates a sample of what Porter means by suppliers having power when they â€Å"offer products that are differentiated† (Porter, 2008). In March 2008, analysts at Citigroup Inc. announced, â€Å"AstraZeneca will have more time to market the product†¦Seroquel XR, a once-daily version of the [original] drug†¦ slowly [converting] patients to the patent-protected drug before a generic version of Seroquel becomes available† (Merrick, 2008). Generic companies defending their rights to enter the market state brand name manufacturers received patents through inequitable conduct (Merrick, 2008). While CEO of Astra Zeneca, David Brennan remains â€Å"pleased with the courts decision to uphold [our] valid intellectual property, healthcare companies like Walgreens suffer exorbitant inventory costs at lower vendor allowances for keeping both brand and newly arriving formulations (Merrick, 2008). STRATEGIC ANALYSIS The significance of this report’s title, â€Å"An Industry Leader at the Inflection Point†, speculates that Walgreens cannot remain myopically moving forward now that competitors are strategically placing modes of â€Å"creative destruction† in the healthcare industry. For example, Walgreens is following suit to retake power from buyers, a force seen in previous paragraphs, with a revolutionary prescription problem-processing center, POWER. These 24-hour call centers will automatically fix any third-party insurance rejection errors at all 6400 store locations, leaving pharmacists and pharmacy technicians more time to devote to prescription accuracy, efficiency, and patient consultation. Alan McNally, Walgreen’s new CEO as of October 22, 2008, justifies the use of POWER so â€Å"the company’s founding base of competitive advantage will bring vital market share, stockholder optimism, and customer sentiments of timeliness and prescription safety back to Walgreens† (WAG Annual Reports, 2008). Despite Walgreens’ ability to gain back market share by utilizing POWER, this evolution of problem-solving workflow is the company’s first major step in â€Å"creative destruction. Since an estimated â€Å"25-30% of work in the pharmacy originates from processing and troubleshooting third-party claims†, Walgreens shows no sign of maintaining current hourly needs for technicians when POWER operations begin (Merrick, 2008). The excess reserves saved from this venture will allocate finances for greater stockholder dividends and ensure the company’s progressive movement into staying one-step ahead of the competition (Merrick, 2008). Acc ording to the 2008 annual reports released in November, the salary expenditures saved from cutting technician hours will help support funding for the accumulated $1. billion dollar long-term debt in 2008 (WAG Annual Reports, 2008). Formerly discussed in the section, â€Å"Power of Suppiers†, Walgreens showed vulnerability to brand-name manufacturer’s new formulations marketed to physicians as more effective and safer than their FDA-approved generics. The county’s nation-wide recession that tumbled into a worldwide pandemic has been reason enough for many consumers to forgo reinstating their prescription insurance plans in 2009 and instead shop around for bargain generics (Lueck, 2008). Porter describes the country’s turmoil perfectly by announcing America is in the â€Å"Age of Anxiety,† as he reminds readers that in the US â€Å"restructuring destroys about 30 million jobs per year† (Porter, 2008), To combat consumer demand for lower cost prescriptions, Walgreens has aggressively marketed the Walgreens Drug Program in 2008. This discount program offers consumers the option of choosing from a list of 400 price-approved and quantity-approved generic medications at a 90-day supply for $12 (WAG Annual Reports, 2008). To attract customers to less expensive and more readily available generic medications, Walgreens built the discount rogram to show how much each customer can save while receiving a therapy that is exactly or similar to what their doctor prescribed. The only cost associated with this plan is a one-time $20 fee for using the service pennies compared to the hundreds of dollars each month otherwise spent on prescription healthcare covera ge. The idea of Walgreens creating healthcare clinics where customers can go and receive treatment for common symptoms arose from competitor initiatives to capture a segment of the market not dominated by Walgreens. The purpose of this tactical approach was to lessen the force of rivalry in the industry. As of November 2008, Walgreens â€Å"operate[s] more than 600 health and wellness clinics in our stores and on employer worksites [with] plans to expand to 800 sites by the end of fiscal 2009 (WAG Annual Reports, 2008). While data on this new mode of investment has not been conclusive or forecasted in expected yearly revenue, Walgreens intends on honing company expansion in this market to counter aggressively competitor initiatives. STRATEGIC ASSESSMENT The watershed of massive change for Walgreens culminated amidst what economists are calling a worldwide recession. Like all prosperous profit seeking companies, Walgreens managed to find ways to cut hours while increase efficiency that paved the way for higher shareholder dividends in 2008. CEO Alan McNally describes Walgreens’ strategy as â€Å"a successful triumph in a frantic market† leading on with a direct correlation of the yearly highlights to â€Å"an increase of $. 11 in common share dividends for 2008† (WAG Annual Reports, 2008). Despite the company’s massive growth of long-term debt, the strategic positioning of POWER centers in high volume areas and payroll cuts began the combat against the emerging inflection point issues discussed. More than 1 million people enrolled in Walgreens discount card program in 2008. The company anticipates numbers to increase significantly at the beginning of Medicare reinstatement in January 2009 as members become more proactive in finding lower prescription costs. Constructed on gaining the business of customers upset with their current prescription coverage, the iscount care program cultivated an increase of gross market share to 17. 6% of the retail prescription market in 2008. According to the new annual reports, in August 2008 Walgreens priced a $1. 3 billion five-year bond offering to be â€Å"used in the repayment of short-term debt under its commercial paper program and general corporate purposes† (WAG Annual Reports, 2008). The bond’s primary purp ose of financing the expansion of Walgreens’ Take Care Clinics around the country will reinforce goals of insatiable growth in the United States. As the beginning stages of these clinics develop, Walgreens will have a better idea of the market’s reaction. SUMMARY OF STRATEGY These market-enhancing strategies formulated by observing frustrated consumers over the years yield a successful and progressive outlook for Walgreens. While Walgreens’ presence in communities nationwide will continue to expand, the systems and processes which customers receive service will undoubtedly change. As services become increasingly automated and salaries are cut to supply overhead costs of the latest technologies and capital investments, Walgreens’ initiatives to solidify their position as the market leader will continue to be a tantalizing puzzle for the company’s corporate executives. REFERENCES Berman, D. (2007,  January  17). CVS Raises Caremark Bid, Pressuring Express Scripts. Wall Street Journal   (Eastern Edition),   p. A. 4. Retrieved November 9, 2008, from Wall Street Journal  database. (Document ID:  1195592291). Caremark Rx Inc. : Advisory Firm Urges Holders To Accept Offer From CVS. (2007,  March  14). Wall Street Journal   (Eastern Edition),   p. A. 12. Retrieved October 25, 2008, from Wall Street Journal  database. (Document ID:  1232229641). Lueck, S. (2007,  September  19). Politics Economics: Democrats to Revisit Medicare Provisions. Wall Street Journal (Eastern Edition), p. A. 12. Retrieved October 23, 2008, from Wall Street Journal  database. (Document ID:  1337919191). Merrick, A. (2008,  March  19). How Walgreen Changed Its Prescription for Growth. Wall Street Journal   (Eastern Edition),   p. B. 1. Retrieved October 20, 2008, from Wall Street Journal  database. (Document ID:  1448083011). Merrick, A. (2008,  October  9). Walgreen Abandons Bid for Longs; Drug Chain Cites Weak Economy, Withdraws $2. 7 Billion Offer. Wall Street Journal   (Eastern Edition),   p. B. 1. Retrieved November 9, 2008, from Wall Street Journal  database. (Document ID:  1570234871). Stewart, J. (2006,  November  8). Common Sense: Letdown Over Deal By CVS, Caremark Offers Opportunity. Wall Street Journal   (Eastern Edition),   p. D. 2. Retrieved November 9, 2008, from Wall Street Journal  database. (Document ID:  1158307411). Porter, Michael E. (2008. Jan) â€Å"The Five Competitive Forces that Shape Strategy. † Harvard Business Review. Porter, Michael E. (2008. Nov) â€Å"Why America Needs an Economic Strategy† Business Week Walgreens Annual Reports, The (2007, Dec 31). Questions and Answers for Shareholders. Retrieved October 10, from Walgreens Co. Website: http://files. shareholder. com/downloads/WAG/460812286x0x147120/C3FF93FD-4E51-4F5A-94FD-C0D058A9A911/Walgreen_AR_07. pdf Walgreens Annual Reports, The (2007, Dec 31). Management’s Discussion and Analysis of Results of Operations and Financial Condition. Retrieved October 10, from Walgreens Co. Website: http://files. shareholder. com/downloads/WAG/460812286x0x147120/C3FF93FD-4E51-4F5A-94FD-C0D058A9A911/Walgreen_AR_07. pdf

Microeconomics Term Paper. Monopoly or oligopoly Essay

Microeconomics Term Paper. Monopoly or oligopoly - Essay Example An oligopoly is an imperfect competition among the few firms and it applies to an industry that has a few competing firms. Each firm competing in this imperfect market has enough power just like the other firms to prevent it becoming a price taker. However, each firm that competes in an oligopoly is subject to inter-firm rivalry to prevent it from viewing the market demand curve as its own. In the modern economies, oligopolies are the dominant market structures that characterize the production of capital and consumer goods and other industrial materials such as steel and aluminum. The U.S. steel industry, for example, experienced the emergence of mini-mills that had lower capital costs in the 1980s. The mini-mills came up as a new industry segment that developed when the US steel industry had declined because of the Japanese competition. Nippon Steel Company, a Japanese firm was created to match the size of steel companies in US and acted as a key factor in the growth of the Japanese steel industry. The Japanese steel industry invested heavily in modern technology that served to increase the steel production by a percentage of 2216 in a period of 30 years between 1950 to 1980. As such, the mini-mills and imports had gained a quarter of the US market each by 1980 forcing many previous steel-based companies diversifying into new markets (Collard-Wexler & De Loecker, 2013). This situation led to several changes in the market. The US government restricted imports to a quarter of the total internal market to save the US steel industry. Other changes that occurred include the investment of $ 9 billion in the increase of technological competitiveness, weakening of stringent pollution control laws and increasing labor productivity by cutting workers wages. The value of the dollar failed and increased import prices discouraging foreign competition. This stabilized the mini-mills to increase their market

What If Essay Example | Topics and Well Written Essays - 1750 words

What If - Essay Example If we are unable to establish some form of communication with others 'out there', there option of diplomatic advancement becomes extremely constrained. Hence, it is highly unlikely that we would be able to colonize any other planet. If we assume that the population of Eden2 can be communicated with, then it is in our best interest to take a diplomatic approach. By virtue of our assumption that they may be more technologically advanced then Earth, it would be illogical for us to choose invasion. The odds are we would be stopped, or eliminated from existence. Either way we do not leave a good impression of our species with the population of Eden2. Alternatively they may have evolved a society that is non-violent or even pacifist; however, it would be illogical to think that they would not have defences of some sort, especially given their advancement in technology. For example, they may have an impenetrable barrier around the planet or their places of dwelling; or firepower that is activated by too close an approach to their planet or dwelling; or they may be able to disarm their foe by way of being able to phase-shift (i.e. become invisible). Hence, we would need to approach in a friendly manner, take a slightly submissive role as guests in their part of the galaxy who looking for somewhere to live. We could assume that the population of Eden2 would want something in exchange for allowing us to colonize their planet, regardless of how friendly we are. As they may have more advanced technology it is unlikely that we would have much to offer in exchange. Alternatively, They may want something from us that we do not want to give, which leaves a lot to the imagination and calls into question many other assumptions that are better elucidated in my next sci-fi book (assuming my first gets published!). However, the idea that another species would engage in Earth behaviours such as reciprocity, 'scratch my back I'll scratch yours', or 'survival of the fittest', is purely a human concept. As we are currently unable to, and most of us not interested in, communication with the myriad of species we now co-habit with, we are unable to conceive of different ways of negotiating or problem-solving. We have only our human perspective as the frame of reference from which to draw on, and so likely we are projecting our human concepts onto another species.Given their probable higher levels of technology we could assume that they have advanced sociological systems as well, seeing as they have not used up all the natural resources on their planet, nor are nearing exte rmination of themselves through technology advancement. Although, from an Earth perspective, we have no evidence to support the assumption that advanced technology will ensures survival, given our present predicament. In the short-term, Earthlings can look forward to an extended life-span as compared to 100 years ago, thanks to technologic advancement. However, we also have decreased fertility rates and rising 'grey' populations in the West; overpopulation and appalling poverty in 'developing' nations; as well as mass species extinction and ecological breakdowns; pollution, depleted natural resources and global warming. The evidence suggests that advancements in our technology will not ensure our survival. Assuming that Eden2 has advanced socially, we could assume that they would be open to diplomatic negotiations regarding our colonization of their planet. Being socially advanced they would need to have ways of accommodating other

Permanent Vascular Access For Hemodialysis Health And Social Care Essay

Permanent Vascular Access For Hemodialysis Health And Social Care Essay Introduction: A progressive rise in the number of patients accepted for renal replacement therapy has been reported world wide . Permanent vascular access (VA) is the life-line for the majority of these patients, when hemodialysis is the treatment of choice. Thus, the successful creation of permanent vascular access and the appropriate management to decrease the complications is mandatory. A well functional access is also vital in order to deliver adequate hemodialysis therapy in end stage renal disease (ESRD) patients. Unfortunately, despite the advances in hemodialysis technology, in the field of vascular access in the last years the introduction of the polytetrafluoroethylene (PTFE) graft and the cuffed double lumen silicone catheter were the only changes. But the cost of vascular access related care was found to be more than fivefold higher for patients with arteriovenous graft (AVG) compared with patients with a functioning arteriovenous fistula (AVF) . It seems that the native arteriovenous fistula that Brescia and Cimino described in 1966 still remains the first choice VA . Thereafter, vascular access still remains the Achilles heel of the procedure and hemodialysis vascular access dysfunction is one of the most important causes of morbidity in this population . It has been estimated that vascular access dysfunction is responsible for 20% of all hospitalizations and the annual cost of placing and looking after dialysis vascular access in the United States exceeds 1 billion dollars per year . Nowadays, three types of permanent vascular access are used: arteriovenous fistula (AVF), arteriovenous grafts (AVG) and cuffed central venous catheters. They all have to be able to provide enough blood flow in order to deliver adequate hemodialysis, have a long use-life and low rate of complications. The native forearm arteriovenous fistulas (AVF) have the longest survival and require the fewest interventions. For this reason the forearm AV, is the first choice, fol lowing by the upper-arm AVF, the arteriovenous graft (AVG) and the cuffed central venous catheter as a final step . History of vascular access Vascular access for hemodialysis is closely associated with the history of dialysis. Glass needles were employed as vascular access when hemodialysis came into view in 1924. The first haemodialysis treatment in humans was carried out by Haas G who used glass cannulae to acquire blood from the radial artery and reverting it to the cubital vein . Venipuncture needles were used as means for blood acquisition from the femoral artery and its reinfusion to patient by vein puncture, in 1943 by Kolff W. . Regular hemodialysis treatments were possible in 1950s through the use of a medical apparatus ( Kolff s twin-coil kidney ), thus projecting the problem of a reliable, capable of repeated use vascular access. Today, the artery-side-to-vein-end-anastomosis has become a standard procedure . In 1952, Aubaniac had described the puncture of the subclavian vein . In the 60s, by using Alwalls experience, Quinton, Dillard and Scribner developed arteriovenous Teflon shunt . This procedure involved two thin-walled Teflon cannulas with tapered ends were inserted near the wrist in the forearm, one into the radial artery and the other into the adjacent cephalic vein. The external ends were connected by a curved Teflon bypass tube. Later, the Teflon tube was replaced by flexible silicon rubber tubing. After the advancement of permanent vascular access, the possibility of maintenance hemodialysis was a fact and therefore a groundbreaking procedure. In the subsequent years many variants of the AV shunt were used, with the majority of them concerning temporary vascular access from the onset of chronic dialysis treatment compensating for the time of AV fistulas absence or maturity. In 1961, Shaldon performed hemodialysis procedures by inserting catheters into femoral artery and vein, using the Seldinger-technique . Over time, vessels in different sites were used, including the subclavian vein jugular and femoral. In 1962 Cimino and Brescia described a simple venipuncture for hemodialysis . In 1963 Thomas J. Fogarty invented an intravascular catheter with an inflatable balloon at its distal tip designed for embolectomy and thrombectomy . The first surgically created fistula was placed in 1965, followed by further 14 operations in 1966. In 1966 Brescia, Cimino, Appel and Hurwich published their paper about arteriovenous fistula. Appell had performed a side-to-side-anastomosis between the radial artery and the cephalic antebrachial vein. One year later, in 1967, M. Sperling reported the successful creation of an end-to-end-anastomosis between the radial artery and the cephalic antebrachial vein in the forearm of 15 patients using a stapler . In the next few years this type of AV anastomosis received popular approval. However this procedure was cast aside as first choice AV, due to the increasing numbers of elderly, hypertensive and diabetic patients with demanding vessels and high risk of a stea l syndrome. End-to-end-anastomoses are still a common place technique in revision procedures. In 1968 Rà ¶hl L. published thirty radial-artery-side-to-vein-end anastomoses . After anastomosis was performed, the radial artery was ligated distal to the anastomosis, thus resulting in a functional end-to end-anastomosis. Today, the artery-side-to-vein-end-anastomosis has become a standard procedure . In 1970, Girardet R. and Brittinger W.D. described their experience with the femoral vein and artery for chronic hemodialysis. Experimental trials have been done by several authors in order to establish a permanent vascular access using subcutaneous tunnel. Brittinger W. was the first to implant a plastic valve as a vascular access in an animal model but unfortunately his efforts did not proceed to a human one . Moreover during the early 70s, Buselmeier T.J. developed a U-shaped silastic prosthetic AV shunt with either one or two Teflon plugged outlets which communicated to the outside of the body. The U-shaped portion could be totally or partially implanted subcutaneously . Subsequ ently pediatric hemodialysis patients were extremely favored by this procedure. New materials for AV grafts were presented in 1972, one biologic and two synthetic.. In 1976, L.D. Baker Jr. presented the first results with expanded PTFE grafts in 72 haemodialysis patients . In the years to come several publications indicated the benefits and the shortcomings of the prosthetic material in question remaining the primary choice of graft for hemodialysis VA to date. The same year two authors, Mindich B. and Dardik H. had worked with a new graft material: the human umbilical cord vein. . Regrettably so, this material did not succeed in becoming a revolutionary graft material due to its inadequate resistance against the trauma of repeated cannulation and their complication (aneurysm and infection). After the subclavian route for haemodialysis access was firstly introduced by Shaldon in 1961, it was further processed in 1969 by Josef Erben, using the intraclavicular route . In the next 20 y ears or so, the subclavian vein was the preferred access for temporary vascular access by central venous catheterization. Today, due to phlebographic studies revealing a 50% stenosis or occlusion rate at the cannulation site, subclavian route has been discarded. The subclavian stenosis and occlusion predispose to oedema of the arm, especially after creation of an AV fistula . The first angioplasty described by Dotter et al who introduced a type of balloon, was immensely conducive to the resolution of one of the most significant predicaments in vascular surgery and vascular access surgery . In 1977 Gracz K.C. et al created the proximal forearm fistula for maintenance hemodialysis, a variant of an AV anastomosis . An adjustment of this AVF became quite significant in the old, hypertensive and diabetic patients on the grounds that it allows s a proximal anastomosis with a low risk of hypercirculation . In 1979 Golding A.L. et al developed a carbon transcutaneous hemodialysis access device (CATD), commonly known as button, as a blood access not requiring needle puncture . As a procedure of third choice, these devices were expensive and never gained widespread acceptance. Shapiro F.L. described another type of A.L. button, a device similar to that developed by Golding . Angioaccess classification Years after the initial efforts to create the appropriate vascular access in order to perform a safe hemodialysis, modern Nephrologists have now the possibility to select the appropriate access for their patients. So the first distinction is made between temporary and permanent VA . Temporary VA with expected half-life less than 90 days, peripheral arteriovenous shunts and non cuffed double lumen catheters are included . Mid-term VA with expected half life in 3 months to 3 years include veno-venous accesses (tunneled cuffed catheters and port catheter devices) and arteriovenous internal shunts, requiring vascular graft synthetic (PTFE) or biologic (saphenous vein, Procol, etc.) material ,or external shunt. Long-term VA with an expected half-life more than 3 years includes virtually the native arteriovenous fistulas and the new generation of PTFE grafts . Acute hemodialysis vascular access They are used for urgent hemodialysis and should be easy to insert and available for immediate use. Currently there are available two types of such accesses: Non-tunneled dialysis catheters and cuffed, tunnelled dialysis catheters. Double-lumen, non-cuffed, non-tunnelled hemodialysis catheters are the preferred method for immediate hemodialysis when a long term access is not available. They are made of polymers which are rigid at room temperature to facilitate insertion but soften at body temperature to minimize vessel injury and blood vessel laceration. The proximal and distal lumens should be separated by at least 2 cm to minimize recirculation . These catheters can be inserted into the central veins: femoral, jugular, or subclavian veins . The femoral artery can be used as an access central vein when all others central veins have been excluded. A modified Seldinger guide wire technique is used for their insertion. Image guided assistance in placing these catheters is recommended to avoid or minimize some of the immediate insertion complications, but non-cuffed catheters are also suitable for use at the bedside of the patient The 2006 National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) guidelines recommend, after internal jugular or subclavian vein insertion, identifying radiographically any potential complications and confirming tip placement prior to either anticoagulation or catheter use . These guidelines also recommend ultrasound vessel identification prior to insertion. In general, now the subclavian catheters should be avoided because of the high incidence of vein stenosis and thrombosis. The maximum blood flow with this class of catheters is usually blood pump speeds of 300 mL/min, with an actual blood flow of 250 mL/min or less . Femoral catheters have to be at least 18 to 25 cm in length in order to have lower recirculation. The routine use-life of these catheters varies by site of insertion. In general, internal jugular catheters are suitable for two to three weeks of use, while femoral catheters are usually used for a single treatment (ambulatory patients) or for three to seven days in bed bound patients . However, the KDOQI guidelines suggest that non-cuffed, non-tunnelled catheters be used for less than one week and that cuffed, tunnelled catheters be placed for those who require dialysis for longer than one week . More recently a non-cuffed, non-tunnelled triple-lumen dialysis catheter has been developed. The purpose for third lumen is for blood drawing and the intravenous administration of drugs and fluid. In a multicenter, prospective study, blood flow rates and infectious complications were similar with double lumen catheter . Infectious complications are the principal reason why the catheter must be removed. Permanent Vascular Access Taking into consideration patient factors such as life expectancy, comorbidities, and status of the venous and arterial vascular system is very important in order to prescribe the appropriate access. Other factors are determined by the type of access itself, as arteriovenous fistula (AVF), arteriovenous graft (AVG), or TC which have a different effect on circulatory system. Also the duration of their functionality and the risk for infection and thrombosis are important factors to consider. Each type of surgical anastomosis has advantages and disadvantages . In 2002 the American Association for Vascular Surgery and the Society for Vascular Surgery published reporting standards according to which three essential components of VA should be mentioned: conduit (autogenous, prosthetic), location and configuration (strait, looped, direct, etc.) . Arteriovenous fistula An AVF is the preferred type of vascular access; it has the lowest complication rates for thrombosis (~ one-sixth of AVGs) and infection (~ one-tenth of AVGs) . There are 3 types of AVF s: à ¢Ã¢â€š ¬Ã‚ ¢ First type when artery and vein are connected in their natural position, either with a side-to-side or a side-artery-to-vein-end anastomosis. à ¢Ã¢â€š ¬Ã‚ ¢ Second type, where a vein is moved to connect to an artery in end-to-side fashion to either bridge a larger anatomical distance, or to bring the vein to the surface where it is accessible for cannulation and requires a tunnel to position the vein in its new location. à ¢Ã¢â€š ¬Ã‚ ¢ Third type where a vein is removed from its anatomical location and, is connected to an artery and vein in end-to-end fashion. Both second and third type requires the formation of a tunnel . End-to-end anastomoses are now rarely performed, since the complete disruption of the artery imposes a risk for peripheral ischemia and thrombosis. The most common surgical technique today is the side-to-end anastomosis. However technical problems as cutting the end of the vein in an oblique angle may create functional problems due to stenosis. An anastomosis more proximal in the arterial system should be smaller to prevent steal and limit maximal fistula flow, with the inherent complication of ischemic steal or heart failure . Arteriovenous fistula creation is often performed under local anaesthesia, with low morbidity and requires time for maturation. Data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) indicate that AVFs should mature at least 14 days before use . Fistula size and flow increase over time, of 8-12 weeks and the initial blood flow rates has a range of 200-300 mL/min. Placement of AVFs should be initiated when the patient reaches CKD stage 4, or within 1 year of the anticipated start of dialysis. A physical examination should document blood pressure differences between the upper extremities and an Allen test should be performed, the lack of a well-developed palmar arch predicts a higher risk for vascular steal symptoms if the dominant artery is used for forearm fistulas creation due to inadequate collateral circulation . Ultrasound must be done before surgical implantation because it can provide information for maximal surgical success by mapping arteries and veins; eg, a preoperative arterial lumen diameter >2 mm is associated with successful fistula maturation, while a diameter of 600 mL/min, a diameter >0.6 cm with discernible margins, and be at a depth of 0.6 cm (between 0.5 and 1.0 cm) from the surface 6 weeks after creation. In fistulas that are maturing successfully, flow increases rapidly post-surgery, from baseline values of 30-50 mL/min to 200-800 mL/min within 1 week, generally reaching flows >480 mL/min at 8 weeks .The AVFs must be evaluated 4-6 weeks after placement, and experienced examiners (eg, dialysis nurses) can identify non-maturing fistulas with 80% accuracy . Arteriovenous graft AVGs were the most commonly used type of dialysis access in the US however, they do not last as long as AVFs and have higher rates of infection and thrombosis . Grafts present a second choice of VA when AVF are not able to be performed because of vascular problems. They can be placed in the forearm, the upper arm, and the thigh, and can have a straight, curved, or loop configuration. They may offer a large surface area for cannulation. AVGs can be cannulated about 2-3 weeks after placement, although there are studies suggesting that immediate assessment after placement for PTFE AVGs is possible . This interval is needed in order to allow the surrounding tissue to adhere to the PTFE conduit, to reduce the postsurgical oedema and the risk for local complications such as perigraft hematoma and seroma . Tunnelled hemodialysis catheter TCs are used when AVFs or AVGs arent possible to be created for several reasons such as multiple vascular surgeries, that lead to vascular thrombosis or when patients have severe peripheral vascular disease or very low cardiac output. Its more often in paediatric and very old patients. Unfortunately they are associated with the highest infection rate and they are not a very long-term access option. Studies have revealed that central venous catheters are colonized within 10 days of placement; however, colonization of the catheter biofilm does not correspond to positive blood cultures or clinical signs of bacteremia . Recently Power A. et al published their experience with 759 TCs. The survival rate at 1,2 and 5 years was 85%, 72% and 48% respectively. The infection rate was 0.34 per 1000 catheter day showing with careful and appropriate use of TCs, they can provide effective and adequate long term hemodialysis and rates of access related infection almost similar to AVGs . Hemodialysis vascular access in children The choice of replacement therapy in children is variable. The registry of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) reports that of patients initiating renal replacement therapy in paediatric centres : one quarter of children underwent preemptive renal transplantation, one half were started on peritoneal dialysis and one quarter were started on hemodialysis. Kidney transplantation remains the preferred therapy for paediatric patients therefore, many paediatric patients receive maintenance HD through an indwelling catheter in perspective of short HD period . In the United States less than 800 paediatric patients receive maintenance HD therapy, therefore surgical experience and clinical data for fistulae or grafts creation in small patients is limited due to rare need for such procedures. Smaller patients, especially those less than 10kg, are very demanding in surgical and nursing skill, this is significant reason the majority of smaller patients re ceive PD for their maintenance dialysis modality . Peritoneal dialysis is much more common in infants and younger children , significantly due to problems of vascular access. However, hemodialysis can be performed successfully in infants and very young children, as well . Children who will join in hemodialysis will need evaluation of their vasculature for placement of an arteriovenous (AV) fistula, arteriovenous graft, or cuffed double lumen catheter. The use of an AV fistula, the recommended type of vascular access in adults, is limited in children due to the size of their vessels. In the 2008 NAPRTCS annual report, vascular access for hemodialysis included external percutaneous catheter in 77.7 percent of patients, internal AV fistula in 12.3 percent, and internal and external AV shunt in 7.3 and 0.7 percent, respectively . K/DOQI has encouraged greater use of AV fistulas in larger children receiving hemodialysis who are not likely to receive a transplant within 12 months, with a goal of achieving more effective dialysis with fewer complications (eg, infection) than occurs with catheters. The choice of catheter size and configuration depends on the size of the patient. It is suggested by studies that in children as small as 4 to 5 kg a dual-lumen 8 Fr catheter can be well tolerated, and as the child becomes larger in size, a larger volume access can be placed . Vascular access should be able to provide sufficient blood flow and adequate dialysis with a Kt/V greater than 1.2. Kt/V is influenced further by the recirculation rate. Because flow rates in paediatrics vary by the size of catheter, which varies by the size of the patient, a recommended flow rate of 3 to 5 mL/kg/min is acceptable in most patients . Vascular access complications and Survival Studies have shown a mortality risk dependent on access type, with the highest risk associated with central venous dialysis catheters, followed by AVGs and then AVFs . The CHOICE study examined mortality based on access type in 616 hemodialysis patients for up to 3 years of follow-up. Central venous catheters and AVGs were associated with approximately 50% and 26% increased mortality, respectively, compared with AVFs with prevalence in men and elderly patients . Despite these findings and the KDOQI recommendations, dialysis access data from 2002-2003 showed that only 33% of prevalent hemodialysis patients in the US were being dialyzed via AVFs. Contrary in Europe and Canada, the majority of the patients (74% and 53% respectively) were being dialyzed via AVFs . Vascular access admissions continue to fall, with more procedures now performed in an outpatient setting, and are 45.1 percent below levels noted in 1993. By two-year time period, the adjusted relative risks of all- cause and cardiovascular hospitalization among hemodialysis patients vary little when compared to the reference period of 1997-1998; the risk of hospitalization for infection, however, is now 18 percent greater than in the reference period, while that of a vascular access hospitalization is 30 percent less. Among African American patients, the relative risk of an all-cause hospitalization or one related to infection is almost equal to that of white patients; the risk of a vascular access hospitalization, however, is 24 percent higher. In our previous work with 149 hemodialysis patients who had undergone 202 vascular access procedures (177 Cimino-Brescia fistulae and 25 PTFE grafts we found that the Cimino-Brescia fistula was used as the first choice of vascular access in all patients except one in the elderly group. PTFE grafts were the second or third choice in 7 patients younger than 65 and 15 in the elderly group (p: NS). The only reason for technique failure was vascular thrombosis in both groups (p: NS). Other complications were: aneurysms (10/48 and 14/101, p: NS), infections (0/48 and 2/101 p: NS) and oedema (0/48 and 6/101, p: NS). (Table à ¢Ã¢â€š ¬Ã‚ ¦.. Five-year technique survival of the first AV fistula in the two groups was 35% and 45% respectively (log-rank test, p: NS). (FIGUREà ¢Ã¢â€š ¬Ã‚ ¦..) Our findings suggested that there was no difference in vascular access complications across age groups and the survival of the first AV fistula is independent of age. Other encouraging results include a 22.9 percent fall in dialysis access admissions since 1999 for peritoneal dialysis patients, among hemodialysis patients, admissions for bacteremia/septicemia continue to rise sharply, reaching 112 per 1,000 patient years similar to the rate of 109 for vascular access infections, and possibly reflecting an increased use of cuffed catheters. In 2010 USRDS Annual Data Report hospitalization in 2008, increased again, to a point 45.8 percent above their 1993 level. In 2007-2008, women treated with hemodialysis were 16 percent more likely to be hospitalized, overall, than male. They also had a greater risk than men of cardiovascular, infectious, and vascular access hospitalizations 11, 14, and 29 percent greater, respectively. Recently unpublished our data are more different than those we published in 1998. We found in 189 patients that female had more possibility to start HD with double lumen catheter than male and also patients with heart failure ind ependent of sex. Female patients had PTEF grafts as first vascular access (p=0,023) and the elderly patients had more complications and more vascular access procedures (p=0.026). Non-tunnelled double lumen catheters complications The non-tunnelled double lumen catheters complications concern the insertion, the infection and thrombosis of the vessel. The severity and likelihood of insertion complications varies with the site of insertion. The complication rate and the severity are lowest in the femoral position. The primary problem is perforation of the femoral artery. Bleeding usually resolves within minutes of direct compression. Large femoral or retroperitoneal hematomas occur occasionally . Subclavian insertion complications are potentially more serious. Over-insertion of guide-wire can occasionally lead to atrial or ventricular arrhythmias. The vast majority of these are transient and hemodynamically insignificant . Penetration or cannulation of the subclavian artery can lead to hemothorax, which in some cases requires a thoracotomy tube. Cases of pericardial rupture and tamponade also have been described . Subclavian insertion from the left has an increased risk of atrial perforation which can present with acute hemopericardium upon initiation of dialysis. The incidence of pneumothorax varies from less than 1 percent to mor e than 10 percent of insertions, depending on the skill and experience of the physician. The risk of pneumothorax is greater from the left than right side, since the pleura and dome of the lung are higher on the left . Due to high rate of catheter-induced subclavian stenosis and subsequent loss of the ipsilateral arm for future hemodialysis access internal jugular vein insertion, particularly the right internal jugular vein is the preferred site of insertion. At internal jugular insertions carry a higher likelihood of carotid artery penetration, but a lower risk of pneumothorax (0.1 percent). Ultrasound guided cannulation of the vessel is recommended to minimize these complications. The location of the catheter tip in subclavian and internal jugular insertion should always be confirmed by fluoroscopy or x-ray prior to the initiation of hemodialysis or the administration of anticoagulants. Ultrasound-guided catheter insertion is lesser likelihood of arterial puncture or pneumothorax . Prevention and treatment of catheter thrombosis are important clinical issues. To prevent formation of thrombus, both lumens of the double lumen catheter are instilled with heparin following hemodialysis. The amount injected should only fill the catheter lumen to minimize systemic heparinization. Anecdotal evidence suggest that chronic anticoagulation with warfarin or low molecular weight heparin may also prevent catheter thrombus, due to either intraluminal clot or fibrin sheath formation . Lytic agents such as urokinase and alteplase are effective in treatment of catheter thrombosis. Alteplase has effectiveness rates in thrombosis treatment comparable to that observed with urokinase . However if non-cuffed catheters cannot have adequate blood flow then they should be exchanged. Ventral vein catheters are associated with the development of central vein stenosis . This complication appear s to occur more often with subclavian (40 to 50 percent of cases in some studies) than with internal jugular insertions (up to 10 percent) . It has been proposed that central venous cannulation creates a nidus of vascular injury and fibrosis. The rapid blood flows associated with the hemodialysis catheter then create turbulence that can accelerate endothelial proliferation, eventually leading to venous stenosis . The K/DOQI guidelines therefore recommend avoiding placement in the subclavian vein, unless no other options are available. If central venous thrombosis is detected early, it responds well to directly applied thrombolytic therapy or to percutaneous transluminal angioplasty when the fibrotic stenosis can be crossed with a guidewire . The infection risks associated with temporary double lumen catheters include local exit site infection and systemic bacteremia, both of which require prompt removal of the catheter and appropriate intravenous antibiotic therapy . Bacteremia gene rally results from either contamination of the catheter lumen or migration of bacteria from the skin through the entry site, down the hemodialysis catheter into the blood stream . Skin flora, Staphylococcus and Streptococcus species, are responsible for the majority of infections. There is conflicting evidence concerning the risk of infection based upon the site of insertion. In the largest prospective randomized study, the risk of infection was not reduced with jugular versus femoral venous catheterization . A prospective nonrandomized studies suggest that the infection risk appears to sequentially increase for hemodialysis catheters inserted into the subclavian, internal jugular, and femoral veins, respectively . Overall, compared with the subclavian vein, the internal jugular vein remains the preferred access site in ambulatory patients because of the high rate of central vein stenosis associated with subclavian vein catheterization (see above). In the Intensive Care Unit, either femoral or internal jugular vein placement is satisfactory, with the use of ultrasound making internal jugular vein placement safer. The best solution is to prevent the infection by proper placement technique, optimal exit site care and management of the catheter within the HD facility . Arteriovenous fistulas complications Complications of AVFs can be divided into early and late causes. Early causes include inflow problems such as small or atherosclerotic arteries, or juxta-anastomotic stenosis so a pre-operative evaluations for suitable access sites has to been performed . The aetiology of this acquired lesion is not entirely clear, but may be related to manipulating the free end of the vein, torsion, poor angulation, or loss of the vasa vasorum during anatomic dissection. This lesion often can be adequately treated with angioplasty or by surgical revision . Outflow problems may include accessory veins that divert blood flow from the intended superficial vessel to deeper conduits, or central venous stenosis in patients with prior central venous catheters. Vessels smaller than one-fourth of the fistula diameter are usually not hemodynamically relevant. Juxta-anastomotic stenosis and accessory veins are the most common causes for early failure AVFs when pre-operative evaluations for suitable access sites have been performed . Late causes for failure of AVFs include venous stenosis, thrombosis, and acquired arterial lesions such as aneurysms or stenosis. Venous stenosis may become apparent as flow decreases over time, worsening weekly Kt/V ([dialyzer clearance _ time]/body volume) or increasing recirculation. Native fistulas typically will not thrombose until flow is severely diminished. Static pressure measurements, which are helpful in graft monitoring, do not appear as helpful in AVFs, since collaterals surrounding the stenosis area often develop, effectively masking the rise in fistula outflow resistance. Stenotic lesions can be treated by angioplasty. Thrombectomy of fistulas, although technically more challenging than in AVGs, is often successful and if flow is re-established, primary patency is longer than in grafts . Aneurysms may form over the course of years as the fistula increases with increased flow and, unless associated with stenotic lesions, are more a cosmetic than functional concern. If the skin overlying the aneurysm is blanching or atrophic, or if there are signs of ulceration