The film ‘Salvador’

The film ‘Salvador’ revolves around the genocide and the grim happenings of the early 1980s in El Salvador, involving the military dictatorship. This Oliver Stone’s, first prominent film has James Woods and James Belushi in the cast, who play an veteran photojournalist Richard Boyle, and a DJ Dr. Rock respectively. The movie portrays the horror unleashed by the right-wing squads through their gorilla warfare. The film has all the ingredients of an adventure film in right proportions. Boyle’s attachment for liquor and drugs leaves him unemployed despite being capable of good work. When things keep going bad for Boyle, he decides to go to El Salvador with his best friend Dr. Rock, for a freelance lucrative work amidst the prevailing turmoil, not realizing what was in store for them. Rock too doesn’t have any DJ assignments. While entering El Salvador, Boyle and Rock happen to witness the execution of a student at the hands of the military, which make them reconsider their decision. They now realize that El Salvador is a more serious and dangerous war, than they were expecting. Boyle learns that the actual situation at hand is much worse than that portrayed in the US press, after he sees a severed ear collection of a right wing military officer. Boyle also recognizes several prominent US military and CIA personnel, with whom he had served in Vietnam, who are now not willing to account for their presence. In El Salvador, Boyle meets Maria with whom he falls in love. He also meets a Newsday reporter John Cassady, and a Catholic nun Cathy Moore. His initial cynicism gives way to heightened passions and anger through his association with Maria and observation of Cathy’s humanitarian efforts. After realizing the devastating situation around him, Boyle becomes determined to change the situation, in the course of which he puts his life to risks. The assassination of Archbishop Romero has been filmed with passion and truth. Clad in white robe, the archbishop is clearly contrasted from the dark brick wall behind him. Giving his sermon, the archbishop accuses Washington of favoring the military dictatorship, and prays to God to end the violence and sufferings. The archbishop is assassinated by someone from the government, which soon has people fleeing for their lives, and the military personnel attacking unarmed people. Boyle ensures that he is available wherever there is any action, be it the military headquarters, the guerrilla camps or even the US embassy (Goodman, 1986). When the Archbishop Romero is assassinated, Boyle is there close to the assassin. The film brings to life, the happenings in El Salvador, through appropriate settings, locations and laudable performances. For instance when Boyle and Cassidy photograph the dead bodies at a dumpsite, El Playon; the dreadful situation is evident from Boyle’s dirty face, a handkerchief around his neck and the terrain they work. In Santa Ana, Cassady takes his last memorable picture. He films a plane flying overhead while the military and guerrillas are fighting. The plane is flying into the town subsequent to the restoration of military aid by the US. Cassady meets his end while taking the shot exposing American assistance to the government. Cassady had always believed that one has to go closer to get the truth, however if it’s too close, you die. Boyle promises the dying Cassady that he will take his all important photos out of El Salvador. The death of Cassady reminds viewers of the real photographer John Hoagland of Newsweek who died in action while in El Salvador (McClennen, 2007). The settings used in the film are very realistic, integrating the prevailing poverty and terrain with the existing turmoil. Although the movie is claimed to be a true story, not all events shown can be corroborated or verified from records. Neither can they be easily dismissed as having been added to heighten the sentiments of the viewers. However the film makers have taken pains to acknowledge variations whenever adopted, like the scene in which Boyle and Maria are caught at the border. The production of the movie was itself plagued by several adversities. The film is a heart touching one, the effects of which would be with the viewer for a long time, after viewing it. REFERENCES McClennen S., (2007) Salvador Section 3: Media analysis. [Electronic Version] Downloaded on 16th September 2008 from http://www.personal.psu.edu/users/s/a/sam50/cinergia/mf/salvador.htm Goodman W (1986) Screen: ‘Salvador’ by Stone. The New York Times. March 5, 1986 [Electronic Version] Downloaded on 16th September 2008 from http://movies.nytimes.com/movie/review?res=9A0DEFDB1F3AF936A35750C0A960948260

Enrich your life and improve your health Essay

Friendships can be good for you. Find out about the connection between your health and friendship, and how to promote and maintain healthy friendships. By Mayo Clinic staff Friendships can have a major impact on your health and well-being, but it’s not always easy to build or maintain friendships. Understand the importance of friendships in your life and what you can do to develop and nurture friendships. What are the benefits of friendships? Good friends are good for your health. Friends can help you celebrate good times and provide support during bad times. Friends prevent loneliness and give you a chance to offer needed companionship, too. Friends can also: †¢ Increase your sense of belonging and purpose †¢ Boost your happiness †¢ Reduce stress †¢ Improve your self-worth †¢ Help you cope with traumas, such as divorce, serious illness, job loss or the death of a loved one †¢ Encourage you to change or avoid unhealthy lifestyle habits, such as excessive drinking or lack of exercise Why is it sometimes hard to make friends or maintain friendships? Many adults find it hard to develop new friendships or keep up existing friendships. Friendships may take a back seat to other priorities, such as work or caring for children or aging parents. You and your friends may have grown apart due to changes in your lives or interests. Or maybe you’ve moved to a new community and haven’t yet found a way to meet people. Developing and maintaining good friendships takes effort. The enjoyment and comfort friendship can provide, however, makes the investment worthwhile. What’s a healthy number of friends? There’s no need to aim for a specific number of friends. Some people benefit from a large and diverse network of friends, while others prefer a smaller circle of friends and acquaintances. There are also different types of friendship. You may have a few close friends you turn to for deeply personal conversations, and more casual friends with whom you see movies, play basketball or share backyard cookouts. Consider what works for you. Overall, the quality of your relationships is more important than the specific number of friends you have. ****A friend is a trustworthy companion, who cherishes the special moments and memories of your life with another person, forming a friendship. I agree that Friendship is the most important aspect of our lives because the main ideas of friendship are trust, honesty and sharing similarities. Another important thing about friendship can offer is support and help. Friendship is the most important because of the trust, honesty and sharing similarities with a person or people as no one likes to feel alone. Having trust and honesty so you know that you have a great friendship is big and would impact your life in so many ways also having these similarities will make your friendship strong and long-lasting. Just like in Up the movie Russell and Mr Frederickson had a bond and a friendship that included all these things trust and honesty and also similarities such as the love for wilderness and Kevin and Doug at the end of the movie. Which is a great thing to have and would be the most important aspect on Mr Fredricksens and Russell as they have no one else to turn to for trust and honesty. In the film Up it shows friendship and how important it can be. Carl and Ellie give a great example of a strong friendship from the beginning of the film it shows finding each other and becoming close friends to standing by each other til the end. This friendship showed similarities of adventure, trust and loyalty. we need trust, honesty, sharing similarities to make a friendship, and this is why friendship is the most important aspect of our lives. Friendship plays an important role in our lives, to a large extent. Which a friendship could last your whole life and improve your life for the better like carl and Ellie’s friendship. †To have a friend and be a friend Is what makes life worthwhile.†

Analysis of Newspaper Article-Free-Samples-Myassignmenthelpc.com

Analyse Newspaper Article of your Choice. The article that has been chosen for analysis is based on the â€Å"Tillerson sacking† decision that has been taken by Trump. The dismissal of Rex Tillerson from the post of the Secretary of the State was a decision that was taken by Donald Trump with an aim to reduce the divisions of the US administration related to the key issues of foreign policy. The argument on which the entire analysis of the article will be based is â€Å"whether the moves made by Donald Trump were able to reduce the divisions related to the decisions made about the key foreign issues† (Hammond, 2018). I do not agree with the â€Å"America First† movement that had been taken by Trump when he moved into the White House for the first time. The President of America mainly tried to develop its policies related to the foreign policies of the country. Trump has failed in the attempts that were undertaken by him over the years (Acharya, 2014). However, I agree that Trump has taken many steps regarding the shifts to be made from the orthodox methods of governing the country by the Republican and the Democratic presidents in the past. He has made many alliances in order to expand the democratic order of the country that is liberal in nature. The President has withdrawn the US alliance with many important treaties like the Trans-Pacific and the Asia-Pacific Partnership. The country has also withdrawn from the climate change related deal that is signed by greater than 170 countries. The above two deals were made under President Obama and Trump took back the key initiatives that were taken by the previous government. The nuclear agreements that were made by the country with Iran are also under serious jeopardy after the various decisions taken by President Trump (Aradau & Huysmans, 2014). I disagree with the dismantling of policies that have been undertaken by the US government during the last year. The President has been in the position for over a year now and still he has not been able to deliver the promises that were made by him regarding the changes in the foreign policies of the country. The President has not been able to bring any developments in the policies and the international treaties made by the country during the last year (Temby, 2015). I agree with the reviews that were made by the research firm named Gallup regarding the worst image of the leadership of the United States of America that has been formed in the last year. The leadership of the country under Trump was found to be weaker as compared to 134 other countries in the world. The New York Times has reported that the president was totally unable to deliver according the huge promises that were made by him during the last year. The approval of the US leadership was found to be the lowest of about 30% under the governance of Trump (Baylis, Smith & Owens, 2017). I agree with the poll that was undertaken by the organization named Pew Global which in the past year which depicted that more than thousands of the citizens of USA were not happy with the leadership of Trump. The policies related to global issues that were made by Trump were also not satisfactory for the people of his country. The poll further depicted that the support that was gained by Trump was even lesser than the support which was received by George W. Bush after the major controversy that had occurred in the country related to Iraq (Fierke & Jorgensen, 2015). I agree with the step that was taken by Trump regarding the dismissal of Tillerson from the position of Secretary of State and further appointment of Pompeo in the same position. As has been discussed in the article this can be a suitable step for the development of the country and increasing the harmony between the United States of America and the other countries. The reason being that the policies related to global warming may be formed in a better way by Pompeo as compared to those formed by Tillerson (Hammond, 2018). However, the change in the Secretary of State may not have significant effects on the foreign policies that will be formulated by the US government in the future. The nature of the President regarding the ways by which he deals with the officials of the government can still lead to problems related to the formulation of policies. I agree that the ways by which Trump performs his responsibilities may lead to many issues between him and the officials of the government. The foreign policy of USA has been the most affected by the decisions that have been taken by Trump during the year of his tenure. The dismissal of Tillerson and the appointment of Pompeo in the position of Secretary of State can help in the improving the position of USA in the style of leadership that is followed (Holmes & Traven, 2015). I agree with the fact the governing style of Trump depicts that lack of experience and the lack of knowledge regarding the international problems as well. This has further led to an ad hoc process of governing the country by the President. I disagree with the fact that the decision that was taken by Trump regarding the change of the Secretary of State was entirely wrong. The number of conflicts between Tillerson and President Trump has been high and they had difference in opinions in many situations. The appointment of Pompeo can further help the government in making changes in the foreign policies and making improvements in the international affairs of the country (Kelley & Simmons, 2015). The analysis can be concluded by stating that the steps undertaken by Trump to develop the foreign policies of the country were not successful initially. However, the appointment of Pompeo in the position of the Secretary of State can be a huge step towards the development of the country and the improvement of the international relations. The major reason behind making this statement is that the less knowledge of the President regarding international affairs can be complemented by the huge knowledge base of Pompeo. Acharya, A. (2014). Global International Relations (IR) and Regional WorldsA New Agenda for International Studies.  International Studies Quarterly,  58(4), 647-659. Aradau, C., & Huysmans, J. (2014). Critical methods in International Relations: The politics of techniques, devices and acts.  European Journal of International Relations,  20(3), 596-619. Baylis, J., Smith, S., & Owens, P. (Eds.). (2017).  The globalization of world politics: an introduction to international relations. Oxford University Press. Fierke, K. M., & Jorgensen, K. E. (2015).  Constructing International Relations: the next generation. Routledge. Hammond, A. (2018).  Tillerson sacking will not reverse Trump’s foreign failures.  The Age. Retrieved 14 March 2018, from https://www.theage.com.au/world/north-america/tillerson-sacking-will-not-reverse-trump-s-foreign-failures-20180314-p4z4at.html Holmes, M., & Traven, D. (2015). Acting rationally without really thinking: The logic of rational intuitionism for International Relations theory.  International Studies Review,  17(3), 414-440. Kelley, J. G., & Simmons, B. A. (2015). Politics by number: Indicators as social pressure in international relations.  American journal of political science,  59(1), 55-70. Temby, O. (2015). What are levels of analysis and what do they contribute to international relations theory?.  Cambridge Review of International Affairs,  28(4), 721-742

CURRENT ISSUES IN FINANCIAL REPORTINGED IFRS7 Essay

CURRENT ISSUES IN FINANCIAL REPORTINGED IFRS7 - Essay Example (IFRS News 2006). In addition, the IFRS also deals will amending the existing risk disclosure requirements for other insurance contracts of the IFRS 4. Recently, most companies and huge industries in the United States and Europe has come to comply and revised their system in order to adapt their system into the new field of financial strategy. This means that these financial instruments are also applicable to financial and non-financial institutions. This is because the extend of the disclosure strictly requires the dependency of the institution's extent of their entity's used of their financial instruments and its exposure to its risk. One example that can define this explanation is the loan commitment (as an un recognized financial instrument). Prior to any information being disseminated in the institutions, it was announced that the latest disclosure requirements are applicable for periods starting before on after 1 January 2007 (IFRS News, 2006). Through this, all of the institutions are encouraged to submit their application. We all know that there are a lot of financial instruments, which have been designed for various institutions and will all of these; one of the most distinct assets that the IFRS 7 holds amongst of them is that has a way of providing boundaries to financial institutions which can help them protect and at the same time sustain their financial operation. Also, since it was implemented to disclose their financial records, the IFRS 7 allows them to have a further understanding on how each institution can further generate a more profitable income for the next five years. At some point, this method works in favor for the institutions. One of the unique and interesting features that I found regarding this was that it is distinctly divided into two sections. The first covers disclosures are about the figures in the balance sheets or income statements, while the other deals with the risk disclosure. (IFRS News, 2006). From this division, we can see that there is a unique way of approaching the financial aspect of the each institution, such that the second section is the one who solves or takes charge with the risk disclosures that normally and consistently arise from a financial instrument, giving the approach and the system, an eye to oversee the whole situation, through the perspective of the management. Furthermore, the information, which was provided for disclosure and also for the main personnel in the management division, is the one that disclosed the information. This new scope or system of developing the financial instrument is quite interesting such that for the past years, if we would look into the picture and scenario of businesses and corporations that have probably was on the top chart once in the business reviews and then suddenly disappeared, or have lost their momentum into the big picture, have a common analogy and reason behind the collapse of their institution, can be rooted mostly from the dysfunction in the management system with regards to their perspective on financial stability. Thus, since the IFRS 7 holds the new method

Excel and word Assignment Example | Topics and Well Written Essays - 1000 words

Excel and word - Assignment Example 4: Frequency distribution for labour hours Bin Frequency 0-1000 0 1001-1100 5 1101-1200 1 1201-1300 2 1301-1400 4 1401-1500 3 1501-1600 6 1601-1700 2 1701-1800 1 1801-1900 0 More 0 Graph 1: Histogram for labour hours The frequency distribution table and the histogram confirms dispersion of observed values on the variables and the slight skewedness. Section B Graphical representation of variables is one of the strategies for identifying their correlation. The following graph shows consistency in changes among all the variables across the considered months. Graph 2: Comparative graph of the variables across the considered months The observed consistency in the variables’ trend suggests possible association among them. A more clear causal effect relationship can be observed from correletion coefficientthat is shown in the following table. Table 5: Correletion coefficients    Overhead costs Direct labour hours Machine hours No. Of set ups Overhead costs 1 Direct labour hours 0.7 03705 1 Machine hours 0.74701 0.680397 1 No. Of set ups 0.555748 0.321948 0.333965 1 The table identifies the strongest association between overhead costs and direct labor hours and machine hours because of the highest coefficient, 0.74701, as compared to coefficients for the other overhead cost drivers. Analysis of variance however offers the most accurate causal effects relationship and the tables bellow shows the regression analysis results. Table 6: ANOVA table for multiple regression analysis ANOVA    df SS MS F Significance F Regression 3 5284.197 1761.399 16.63454 1.17E-05 Residual 20 2117.761 105.8881 Total 23 7401.958          The low significance value, 1.17E-05 that is lower than 0.05, means that the null hypothesis is rejected to the effect that the cost drivers have significant... Advantages and disadvantages of using a spreadsheet package to compile statistical calculations Operating spreadsheets in calculations has both advantages and disadvantages with which users interact. One of the associated advantages is the ease with which an individual can learn about spreadsheet features and apply the features in analysis. Readily available functions for calculations facilitates these as users can easily identify the functions’ locations and use them at the click of a tab. Spreadsheet functions are also organized into categories with distinct features and this allows users to predict, with ease, location of a function for use. The overall display of input values also offer references to facilitate learning of spreadsheet operations. Another identified advantage with spreadsheets is the ability to develop them within a short period and with significant ease. Users’ ability to design and develop spreadsheet also means that the data analysis tools are cheap. Spreadsheets are also flexible to handle both simple and complex data analysis and this make s them applicable to diversified users and professions. Programmed features of spreadsheets with â€Å"built-in capabilities, functions, and tools† also offer an advantage of spreadsheet and empower users in data analysis (Lau and Gugden 2011, p. 247). Most spreadsheets are also readily available with operation systems and from vendors and the accessibility promote training on the spreadsheet applications and familiarity with different spreadsheet features (Tennent and Friend 2011, n.p.). Spreadsheets also allows for multiple representation of data through â€Å"numerical, graphical, and algebraic representations† (Stacey, Chick and Kendal 2004, p. 107).

Naming rights Essay Example | Topics and Well Written Essays - 750 words

Naming rights - Essay Example Different Business enterprises like those concerned with the manufacturing of sports goods, sports wear, watches and soft drinks might be potential sponsors. Sports brands offer a lucrative market as according to sources: ‘Marketing professionals around the world recognize the power of sports brands and content as a consumer draw. As Associate General Manager I would select companies like Nike, Reebok and a firm like Uni Lever as sponsors. These are firms which are promoting products that are environmental friendly and promote health.I would then explain the respective co operates firm the advantages of investing in our project-To build a new stadium. In addition to the core benefits, media exposure, signage, and customer respect there are other benefits as well. In Greene’s opinion naming rights play two important roles: ’First, in supporting larger finance packages with other revenue streams and second, as a single source of finance’. Our Mission statemen t is to boost sport oriented activities. Sports not only encourage healthy bodies but healthy minds as well. The creation of sports man spirit encourages healthy competition. Negative feelings like jealousy and sorrow would be eliminated from society.In order to ensure that the stakeholder brand maintains our image, we shall audit the brand owner’s strategies ...

Analyzing Black Historical Sites Essay Example | Topics and Well Written Essays - 1250 words

Analyzing Black Historical Sites - Essay Example The aftermath of the end of slavery raised the need for various reforms. Racial discriminations still went on in the US, and minor cases of slavery were still prevalent. The African American society held talks and rallies to empower each other and fight for their rights. The bay area in California was a place where radical changes within the African American society that revolutionized the fight against racism. The freeing of prisoners through the underground railroads was prevalent in the bay area. Economic development amongst the African American took root in the bay area leading to the establishment of estates by both men and women. Perhaps the most influential woman of this era was Mary Ellen Pleasant who raked a total sum of US $30,000,000 in the stock market that she used in the fight for equality. She has been christened â€Å"the mother of human and civil rights in California†. Her contribution to black history remains phenomenal as she had a massive amount of wealth t hat she did not hesitate to contribute to the struggle for equality. The Mary Ellen Pleasant Memorial at 1661 Octavia, San Francisco, California, was setup in memory of her dedication to the liberation of the black people in California. Her incessant effort to aid the African American society has ranked among the outspoken women of her era of slavery, segregation and violation of numerous civil and human rights of African Americans. Mary Ellen Pleasant Memorial Park and its Background The Mary Ellen Memorial Park is the smallest park within San Francisco preserved in honor of the abolitionist Mary Ellen Pleasant and her work in the era. The park is adorned with six gigantic eucalyptus blue gum trees that run down along Octavia Street. The six trees the only surviving ones out of the 20 that Ms. Pleasant herself had planted along the street. The City of San Francisco landmarked these trees to protect them from human interference. This street was once filled with the property of Mary Ellen Pleasant along its full length from Bush to Sutter. Her house once occupied this street, boasting 30 rooms and an entertainment avenue for several people back in the day. It was famous for cards, liquor and beautiful women. To others, this boarding house provided jobs for the African Americans. However, this house burnt down in 1925, and in its place Green Eye’s hospital built the Healing Arts Building1. A plaque adorns the front of her former 30-room home in her honor at the intersection of Bush and Octavia Streets. The disc-shaped plaque within the southwest corner of this intersection has a brief history of life and works of Mary Ellen Pleasant written on its cement structure2. The park remains a historical site for African Americans as it stands for the appreciation of the work of Mary Ellen Pleasant, whose philanthropy led to the efficacy of the black struggle in the freeing of slaves and the Civil War. Mary Ellen Pleasant was born at around 1814 as a slave in the East Coast, but she fled by boat in 1852 to San Francisco to establish herself in the bay area. She legally identified herself as white in the society to avoid being bound to slavery again and to empower herself financially. The Fugitive Slave Act would have led to her recapture in California so she developed a new identity with freedom papers, Mrs. Ellen Smith. She mixed with the top crop of the society

Scavenger Hunt Research Paper Example | Topics and Well Written Essays - 2000 words

Scavenger Hunt - Research Paper Example Question 2: sexually transmitted infections (STIs) that can cause infertility The two main sexually transmitted infections that cause infertility are gonorrhea and Chlamydia (Wingood & DiClemente, 2002). Gonorrhea is caused by bacteria and dwells in the bodily fluids. It is contacted through vaginal, anal or oral sex. It leads to a condition known as epididymitis and Pelvic inflammatory disease (PID) (Fogel & Woods, 2008). This is due to the infection of the urethral tract and the vaginal duct. Chlamydia is also caused by bacteria that stay in vaginal fluid and semen. It left untreated Chlamydia causes infertility where a condition known as epididymitis and PID causes the infertility (Covington, & Burns, 2006). Question 3: Giardiasis The disease is commonly known as Beaver fever (Veliah, 2005). It is a gastrointestinal illness that is exhibited by serious diarrhea. The disease is caused by a parasite that is known as Giardia Lamblia. This is disease is water-borne and it affects the human intestines where it affects over 200 million populace globally every years (Langford, & Langford, 2002). The disease is reported to have affected about 90 communities in the United States in the years between 1964 and 1984 (Caveney, Jones & Ellis, 2012). Question 4: peer-reviewed journal article on smoking cessation Michele A Faulkner, (2009), Smoking cessation: an economic analysis and review of varenicline, Journal: Clinical Economics and Outcomes Research, Vol. 1, issu 1. Pgs 25-30 is a peer reviewed article that addresses the attempts in reducing the use of tobacco. The article raises concerns that despite the many efforts in reducing the use of tobacco the rate of smoking continues to go high leading to premature death and morbidity. There are economic costs related to smoking which include health care costs and loss of productivity (AJHP, 1986 & Callahan, 2000). The main program raised in the article is the varenicline novel mechanism aimed at addressing the ability to r educe the addiction and withdrawal symptoms (Michele, 2009). Question 5: Durham Region with the highest percentage of births to teenagers According to various findings it has been established that Oshawa area in the Durham Region has the highest rate of births to teenagers which replicates the place the mother was living at the time the child was born (Smithard, 2009). The high births rates are as a result of availability of less expensive housing and the supports and motivation from the mothers (Goldin, Reinert & World Bank, 2007; Vargas, 2009). Question 6: The difference between angina and a heart attack Angina is a term that is applied by doctors to refer to the pain in the chest as a result of insufficient oxygen supply to the heart muscles (Jevon, 2012). This form of pain is identical to the pain as a result of heart attack (Jackson, 2004). On the other hand heart attack is a long lasting damage to the heart muscle which might lead to inability of the tissues to function well d ue to lack of blood supply. The heart muscles need regular oxygen supply which is initiated through the blood (Ramaiah, 2008). Question 7: The Cost of Type 2 Diabetes in Canada The type 2 diabetes is along life state where

Global operations management Essay Example | Topics and Well Written Essays - 2000 words

Global operations management - Essay Example To increase its influence and reach more customers in various parts of the world, Huawei has also entered into partnerships with numerous companies. Theories of Internalisation The term internationalisation is descriptive of the methods that are used by business organisations to adapt their numerous operations, in regards to company policies, resources and organisational structure, to suit foreign environments (Dunning 2006). Before embarking on the process of internationalisation, business organisations have to take into account factors such as the geographic distance of the overseas market being considered, the different company associated operations that the company will engage in the foreign branch, and the level to which the company would like to integrate corporate activities (Mitgwe 2006). There are different theories that seek to explain the ways through which internationalisation may occur. ... Dunning’s Theory in the Internationalisation of Huawei According to Dunning’s OLI model, foreign subsidiaries usually demonstrate higher productivity rates than their local counterparts due to the existence of ownership competitive advantages (Dunning 2006). Dunning’s eclectic (OLI) model stipulates that there are three critical elements that are evident in any firm that invests in a foreign branch or subsidiary. The three factors are location advantages, ownership advantages, and internalisation advantages (Dunning 2009). Ownership advantages have to do with the existing conditions that accompany of foreign direct investment (Contractor 2007). For example, to be successful in foreign investment, a firm has to have comparative advantages over other foreign corporations before it determines that a branch will be set up in a foreign nation. Location advantages have to do with the extent to which foreign business-related conditions are favourable to the company in q uestion (Sethi, Guisinger, Phelan, and Berg 2003). Internalisation factors, on the other hand, have to do with how well the multinational corporation can internalise ownership advantages in order to prevent the escalation of transaction costs which are naturally incurred in the course of international production. The Huawei Technological Corporation is a firm that was launched long after other telecommunications corporations had already been launched in the Western nations (Dunning 2009). Huawei therefore focused more on meeting particular objectives in order to realise its internationalisation. Huawei has traditionally used low cost as a technique to enter markets in both developing and developed nations. Huawei also invests in developed nations mainly to realise the adoption of new technologies.

Why do governments in less developed countries have difficulty in Essay

Why do governments in less developed countries have difficulty in restraining money supply growth in order to control inflation - Essay Example As explained, if in this particular situation, a country’s central bank opts for reduction in money supply in order to get rid of the inflation present in the economy, it will lower the gross domestic product even more and only strengthen the stagnation present in the economy even more. This situation, if continued as a long term policy, will lead to demand pull inflation in the long run. This is because on one hand the national output will be at a low level and on the other, due to a high population growth ate in these less developed economies, soon the aggregate demand will rise to a staggering level which, if tamed through a further reduction of money supply, will lead to a stagnation inflation spiral. (Chandavarkar, 1996, 9) Another problem courting these less developed economies is high rate of unemployment. Now a reduction in money supply, as explained above will discourage investment and thereby lower the level of output. As usual a lower level of output is also associated with a low level of employment. So this policy in course of time will make substantial addition to the pull of unemployed laborers of the less developed economy. The less developed economies have to bear with a certain level of inflation in order to experience growth and thereby ensure employment. Therefore, if a reduction in money supply is taken by the central bank as a policy to tame inflation in such economies it will only lead to long run aggravation of other economic maladies. (Lipsey and Harbury, 1992, 252) Furthermore, the less developed economies are typically characterized with black marketers who manage to bluff the government and thereby run a parallel economy. In such an economy, often inflation is caused by unethical storage of goods with a view to inflate the price artificially and hence reap the profit. In such cases

The role of scientific paradigms in the assessment of thought Essay Example for Free

The role of scientific paradigms in the assessment of thought Essay Thomas Kuhn, in his work entitled The Structure of Scientific Revolutions, discusses the very nature and necessity of what he calls scientific revolutions. In this particular work, Kuhn sees an apparent parallelism between political revolutions on the one hand, and scientific revolutions on the other. Kuhn writes, â€Å"Scientific revolutions†¦ those non-cumulative developmental episodes in which an older paradigm is replaced in whole or in part by an incompatible new one† (2000, p.503). On a preliminary note, paradigms are frameworks in and through which we approach phenomena, in general. They are models, so to speak. The idea is rather simple. Let us consider the choice of models in epistemological theory. The traditional epistemological schools of thought [rationalism and empiricism] have different models. The model adopted by the rationalists was pure mathematics, whereas the empiricists adopted experimental or empirical science. As one may have already noticed at this point, it is not difficult to see why rationalism and empiricism stand as rival epistemological theories. The choice of model is significant to their fundamental disagreements. Naturally enough, different models employ different methodologies, different methodologies in turn, generate different types of knowledge, which, consequently, have different criteria of proof or validity. Scientific development, as Kuhn contends, may appropriately be characterized by paradigm shifts and this he calls scientific revolutions. It is important to note that scientific developments do not occur in a vacuum. For the aforementioned reason, there is a felt need to situate scientific developments in the historical context within which they are conceived, proposed and ultimately, institutionalized and integrated as part of society’s shared knowledge. This is to say that scientific revolutions are also proper objects of historical analysis and discourse in as much as political revolutions are. Kuhn contends that there is a parallelism between political and scientific revolutions. As pointed out earlier, it is important to note that he characterizes scientific revolutions as â€Å"those non-cumulative developmental episodes in which an older paradigm is replaced in whole or in part by an incompatible new one. † Kuhn’s characterization emphasizes two important points. First, â€Å"that there is a replacement of an old paradigm by a new one†. Second, â€Å"that the new paradigm is not merely something new; it is also incompatible with the old paradigm†. This is to say that the incompatibility or the irreconcilability of the new paradigm with the old paradigm serves as warrant for the necessity of such a revolution. Although there are significant differences in both scientific and political developments, Kuhn argues that one may be justified in using the notion of revolution as a metaphor for understanding them. He writes, â€Å"Political revolutions are inaugurated by a growing sense often restricted to a segment of the political community, that existing institutions have ceased adequately to meet the problems posed by the environment that they have in part created. In much the same way, scientific revolutions are inaugurated by a growing sense, again often restricted to a narrow subdivision of the scientific community that an existing paradigm has ceased to function adequately in the exploration of an aspect of nature to which that paradigm itself had previously led the way† (2000, p.503). Kuhn’s parallelism is thus, founded on the idea that in both cases, a sense of malfunction [in our institutions as for the case of the political, and in our paradigms as for the case of the scientific] necessitates for the occurrence of a revolution. References Kuhn, T. (2000). â€Å"The Structure of Scientific Revolutions. † The Philosopher’s Handbook. Ed. Stanley Rosen. Random House: New York.

Frederick Douglass Essay Example for Free

Frederick Douglass Essay Frederick Douglass was born a slave in 1818, a time when slaves were forbidden to have an education he succeeded in teaching himself to read and write. In Frederick Douglass’ Learning to Read, the audience was given a front row seat that allowed a glimpse inside the true depth and extent of slavery. Douglass expressed emphasis on literacy and the impact it had on slavery by revealing how slavery was detrimental not only to slaves but slave owners, how the path to educate himself caused mental anguish, and how literacy became his key to freedom. In the beginning, the master’s wife viewed Frederick as her equal and didn’t see anything wrong with educating him. Douglass said of his first teacher â€Å"She at first lacked the depravity indispensable to shutting me up in mental darkness (346), then she realized that educating a slave meant giving them a voice. Slavery had the power to turn a kind and caring person into a callous and cruel brute. â€Å"Under its influence, the tender heart became stone, and the lamblike disposition gave way to one of tiger like fierceness† (Douglass 346). She ceased to instruct him and made sure nobody else would. â€Å"Mistress, in teaching me the alphabet, had given me the inch, and no precaution could prevent me from taking ell† (347). Frederick Douglass was a brilliant man and determined to learn how to read. Douglass turned children into teachers and through an exchange of bread successfully learned how to read. In Learning to Read, Douglass wanted to name the boys who helped him as â€Å"a testimonial of the gratitude and affection I bear them†(347), but instead stated where they lived. Douglass writes about the steps he took when learning to read and goes as far to include where the children lived that help him succeed establishes accurate logic. The path Frederick Douglass traveled to pursue his education was a roller-coaster of emotions. Douglass was twelve when he came across the book The Columbian Orator, it contained material that spoke out against slavery, and with hope at his fingertips he came face to face with reality. â€Å"behold! That very discontentment which Master Hugh had predicted would follow my learning to read has already come, to torment and sting my soul to unutterable anguish. †(Douglass 348). He was still a slave, no longer ignorant of the truth but still without the answer. â€Å"I often found myself regretting my own existence, and wishing myself dead; and but for the hope of being free† Slavery was so horrific that he envied the clueless slaves and even contemplated death, but it was hope that saved him. Douglass’ use of loaded language appeals to the emotions of the audience. In Learning to Read, Douglass is eager to hear the word abolitionists, although he didn’t know what it meant he associated the word with hope. â€Å"If a slave ran away and succeeded in getting clear, or if a slave killed his master, set fire to a barn, or did anything very wrong in the mind of a slaveholder, it was spoken of as the fruit of abolition†(348,349). From a city paper he reads about the petition to abolish slavery in the District of Columbia, and at the pier he is encouraged to runaway to the north, where he could be free. Douglass wrote â€Å"I consoled myself with hope that I should one day find a good chance. Meanwhile, I would learn to write. †(349) A lump of chalk, any solid surface and another clever method would provide Douglass with the tools necessary to learn how to write. Frederick Douglas was a slave who succeeded in learning to read and write establishes his credibility and authority. Douglass’ views on the importance of literacy and the impact it had on slavery was effective by accurately using logic, appealing to emotions, and establishing ethical credibility In Learning to Read, Frederick Douglass gives a first-hand account of the struggles he faced to free himself, mentally and physically, from slavery. Through his persistence to learn to read and write he discovers that knowledge is the key to freedom.

The difference between management and leadership

The difference between management and leadership Management and leadership are critical elements in the ongoing success of any business. Yet, there has been, and continues to be, a long standing debate over whether good management or good leadership is more important and holds more value to a companys success. Each of these topics have been both written about, and discussed, heavily over the years and drawn countless opinions from both sides about each ones importance Some believe that management holds greater importance because of its reliability and stability, and tends to deal the daily results and performance while others believe that leadership is most critical because it is believed to deal with higher thinking and creativity relying on an individuals character traits, does not appear to be teachable, seems to be inherent in some people and not others, and is responsible for setting direction and laying out the pathway that a business will follow. In the opinion of this writer trying to set one above the other is a flawed approach and that those who hold these ideas have yet to come to the realization that management and leadership are two sides of the same coin. Without one the other is incomplete, and it is a balance of each of these in varying measures at varying times that will yield success. Both good management and good leadership represent very different traits within people and it is a combination of these traits that is necessary for both individual and company performance. This becomes more evident after carefully examining the arguments for both management and leadership, the different traits and characteristics that managerial and leadership ability possess, and how each contribute to positive outcomes. When these traits are put in the context of a crisis situation it becomes apparent how vital both are to the result. Management has long been considered by many organizations to be the most important aspect of an organization. This is why many organizations find that defined and structured management practices are more useful than leadership because it focuses on the structure of an organization, where as leadership is more focused on social interactions and innovation (the so-called big picture), whose outcomes many times are unknown, thus making them a little instable (Kearsley, 2005). For this reason many managers use innovation not to change how things are done, but to improve the ability of its people and its resources control to improve its efficiency (Elliott, 2002). This becomes useful in the day to day activities placing leadership as a secondary contributor. Still, in a changing society and marketplace where organizations are forced to constantly evolve effective leadership that can develop and communicate a vision becomes a necessity to not only compete, but excel both today and in the f uture. Managements focus has mainly been in administrative duties such as the what and when, where as leadership is more imaginative and emotional, which focuses on the why and how (Kearsley, 2005). The why and how the questions are the ones needed to find innovated new ways of doing things, which will assist them in developing and keeping a competitive advantage. A challenge because even though the outcomes of the innovations of leadership can at times be questionable they are essential to an organization especially when the work environment becomes unstable and innovation can assist an organization adapt. What accentuates the need for leadership even more than maintaining a competitive edge is the fact that it in todays society the hierarchical aspect of organizations have become more intricate and ones superior (manager) has become less defined (Rogers Tierney, 2004). As such, leadership becomes important in the completion of tasks especially with the heavy emphasis placed upon a groups successful performance within an organization today and a leaders ability to form a group into a cohesive unit. Before this hierarchical change there was a specific top down flow to an organization so that only those at the top needed leadership abilities because everyone else followed what they said, so management was more important to the organization. Now that we compete globally this dynamic has changed and control cannot be achieved without having a more flexible approach to management and leadership as a result of the expanding environment they have come to be in. In this way leadership has dev eloped into a more significant and critical aspect relative to that of management because leaders dont control; they influence (Rogers Tierney, 2004, p. 79). This goes beyond the scope of good management. Management is supposed to maintain a set structure within an organization through the use of control. If control has become less attainable, and stifles the flexibility of a company to effectively adapt and innovate then one now needs to be able to exact influence rather than control an organization and must adapt to continue to be a viable enterprise. This represents one reason as to the necessity for both management and leadership in cooperation to yield success. Management sets what must be done and leadership helps them accomplish that despite a lack of direct control. This effectively debunks the argument in favor of management over leadership. But, what about the arguments supporting the value of leadership and its role to the organization? Many hold the idea that leadership is more important to an organization. One argument in favor of this idea is that education. They believe that leadership is inherent and cant be taught. Leadership has been likened to that of a pathfinder. Being innovators they are searching for something never before done and as such they have nothing from which to learn from (Hodgson, 1987, p. 13). Innovation is creativity, you arent taught it you just know it. In a sense this is true, most scholars readily agree that leadership is based upon experience, but many fail to realize that experiences can be taught. When looked at in the form of learning a sport a person can study the rules of a sport and it will help their understanding of the game, but to be truly good at something it is necessary to go out and play (Doh, 2003). So, the key to teaching leadership is to put people in situations where they are forced to lead. But, a person must understand that teaching can only go so far and just becaus e you have been taught something doesnt mean you will be a master at it, nor does it mean that youll successfully administer leadership (Doh, 2003). When dealing with people a leader faces diverse challenges in personality and capability and their ability to be flexible and provide both the direction and opportunity for those under their influence to be successful and feel they are contributing is critical to the success of the endeavor. An example would be that many people have been taught how to play chess, but even though they know how to play doesnt mean they are going to masters (Doh, 2003). Another argument in favor of leadership is that it can be seen a form of social problem solving in that it is necessary in resolving conflict within to help direct it along the path that management has set down to reach an organizations goal making leadership and management necessary for an organization to achieve its goal (DeChurch et al.,2011, p. 153). But this is only half what defines the necessity of both aspect within an organization. It is also necessary to consider the views of time that each aspect takes. That management has its eye always on the bottom line, the leader has his eye on the horizon meaning management focuses on the present and leadership focuses on the future (Kearsley, 2005, p. 265). It is necessary for an organization to have both if it wants to be successful. This can be examined within the firefighter, firelighter debate within the Leadership Debate. This debate explains that management within a project takes the stance of a firefighter with regards to its problems, only facing them when they occur, where as leadership takes the firelighter approach in that they try to anticipate and prevent problems from occurring (Leadership, 2005). When looking at the two one could say the author believes the firelighter is the more desirable approach in by focusing on the future and preventing problems from occurring could increase efficiency and success, but this is only useful so far as problems can be predicted or anticipated, which in a fairly unpredictable world is generally difficult. As such it is necessary to also hold not only the leadership approach, but management approach as well because if a person fails in predicting a problem the management approach is able to account for this failure and more expediently correct the problem. A study done by the British Royal Navy in the effort to find management and leaderships effect on performance showed that leadership characteristics were more emotional in nature while managements were more im personal and focused on order and consistency to complex operations, but neither alone brought about top performers, but a blend of both were necessary for the success in an increasingly complex and volatile business environment (Young Dulewicz, 2008, p. 28). From this study it can be extrapolated that managerial and leadership approaches are counterpoints within a business. This becomes apparent when looking at organizations within a time of crisis. When examining an organization in a time of crisis one must focus on the managerial aspect, which are the operations and contingency plans, as well as the leading aspect which focuses more on people and emotion. In looking at leadership in a crisis it becomes twofold because many see a crisis as an opportunity to change; as such leadership must first stabilize the organization so they can adapt to the crisis (Heifetz, Grashow Linsky, 2009). This is contrary to the view held by management that a crisis is in fact an emergency and a company needs to make an effort to weather the burdens. In this way leadership becomes a necessity in a crisis due to its ability to cope with social pressures. In a time of crisis when an organization is forced to adapt there are many conflicting emotions within the workers. A leader has the capability to orchestrate the inevitable conflict, chaos, and confusion of change so that the disturbance is productive rather than destructive, which will enable the organization to work as a cohesive unit to further their goals (Heifetz, et al., 2009, p. 66). This is possible because those who possess leadership capabilities tend to possess emotional intelligence, which enables them to understand their own emotions and control them. As a result they can better empathize with others members of the organization (Young Dulewicz, 2008, p. 26). This helps gain loyalty and trust towards a leader, improving their ability to work towards a common goal. Despite the necessity for leadership during a crisis management is just as important as change being an adaptation of an organizations original practices rather than a complete overhaul of their practices (Heifetz, et al., 2009). A good example of this is when Best Buy changed its strategy to one established in store boutiques to better capture the female buyers interest rather than solely focusing on the male buyer in an effort to avoid a looming crisis (Heifetz, et al., 2009). They were effective beca use despite a drastic change the majority of the overall business scheme was left intact and the manager who put this ups the ability to effectively convince others that it was necessary and gains their support to follow through. However, not all change occurs in time to prevent a crisis. In such instances an organized plan, which is constantly monitored for flaws, is necessary to ensure transitional ease throughout this period of adaptation. This is the idea of a contingency plan; which can only be successful through the application of skilled management. Contingency plans are necessary during a crisis because that occasion is usually characterized by complexity and dynamism (Elliott, 2002, p. 146). This complexity makes it difficult to enact change unless an organization has made preparation in case of troubles to lessen the affect felt by the crisis and to support these changes throughout the crisis. This explains the necessity for a systematic approach for dealing with real crises so that the organization continues to function normally in most of its operations (Keefe Darling, 2005, p. 49). In order to achieve this goal it is necessary to have administrative skills, which can only exist within good management skills. Also due to necessity of a flexible nature of a contingency plan they must be constantly updated to account for a changing environment (Mitome, Speere Swift, 2001). This requires someone to constantly monitor the plan to ensure it is up to date and / or make effective changes and adaptations to the plan as required a nd communicate them to the organization without interfering in daily operational activities. As has already been stated leadership is useful for social interaction and decisiveness, through the use of innovation. As such it is lacking in the necessary qualities to set up and maintain a contingency plan. However contingency plans are not solely managerial functions. Two problems found within an organizations contingency plan require the additional support of leadership abilities in order to fix. The first was because the chaotic environment and unpredictability of a crisis made it very difficult to build a contingency plan that could cover every eventuality. Resulting in necessity to keep the plan flexible so that it is possible, no matter the situation, a plan could be adapted to suit whatever need (Mitome et al., 2001). This flexibility makes leadership necessary so that in the case of crisis the organization can be decisive in its adjustments, thus decreasing the time of adaptation. As has already been stated leaders are pathfinders (Hodgson, 1987, p. 13). So during a time of crisis when things are unknown it is up to a leader to see the solutions and managers to follow that solution they are give. This would hopefully enable an organization to return to normal business practices in a timely manner. The other problem is in how contingency plans are used during a time of crisis. It is common for organization to use small teams to find a solution for their problem because, generally, they outperform individuals (Elliott, 2002, p. 148). This makes it necessary to have a leader who can unify the team to a common goal and improve the coherence of team members to quicken the development of a solution. Without a leader to coalesce the efforts of management in a directed problem solving approach any answer might be delayed and result in a sub-optimal conclusion. It becomes quite apparent the necessity for both leadership and management are necessary within a crisis situation because they must develop next practices while excelling at todays best practices (Heifetz, et al., 2009, p.65). In other words management is important because it can help prepare for crisis helping to minimize the damage it causes and through the continuation of normal practices so that the organization still has the ability to develop next generation practices. The importance of management and leadership in a time of crisis can be seen by the failure in relief distribution in the aftermath of the Haiti Earthquake which resulted because of the lack of a contingency plan that took into account the conflicts that could arise between various authorities and agencies and determine ways to prevent them. This still might have been prevented, but if not for the lack of leadership within the organization which failed to come to an agreement (Piotrowski, 2010). This shows that b oth a strong contingency plan and leadership abilities is needed because if the contingency plan is strong everything is planned and little can go wrong, but in the case that it fails leadership can minimize the damage. It has become clear of the necessity for both management and leadership. The comparison between a leader being a pathfinder and management being a path follower is in part true (Hodgson, 1987). But managements do not merely follow a path they reinforce it and improve its foundation enabling leadership to continue to grow. Their relationship is similar to that of a building. Leadership goes up, while management builds within. If a company was devoid of effective leadership it may not be able to maintain a competitive position within the market place through the effective identification and development of plans, strategies, tactics and business acumen to target positive results. And, without effective management a leaders vision, ideas, and direction may not be sustainable which might limit a businesses long term competitive position and success. The reason being that leadership is within focus of people while management is the focus administrative duties. An organization needs both le adership and management to be effective just like Yin and Yang to provide balance to the ongoing performance within an organization. While leadership provides vision, resources, and communication management provides execution identifies challenges and opportunities and communicates both throughout the company, and back-up to the leaders who can in fact adapt plans and direction continuously for success.

Electronic Trade and Money Laundering :: Economics

Electronic Trade and Money Laundering ELECTRONIC TRADE — FEATURES AND EXPECTATIONS Electronic trade is a reality that reveals and promises both rapid and exponential growth. Its constant progress, as well as increasing innovation in electronic payments, has for long been the subject of wide attention, especially for regulatory bodies, in respect of the opportunities for money laundering that these new instruments can provide, and of the responses that regulatory systems can and must develop in their regard. Detailed reports on the wholesale implementation of the new payment systems are available from the Bank for International Settlements. These reports show that, with greater or lesser speed, such systems are taking on a global dimension. Innovation continues incessantly; and rumours spread every day about the development of newer instruments, residing even in the most familiar tools such as mobile telephones." Aside from unpredictable shocking events, which could thwart the advance and availability of technological resources, electronic trade is eventually likely to become the norm, at least in the most advanced countries. It will spread over all markets, just as other instruments — cars, household appliances, telephones — have done before, because it is equally effective, cheap, and within everybody's reach. The main factors still inhibiting widespread diffusion are security risks — such as problems of transparency and symmetry of information; a need for defence from intrusive technologies; a call for guarantees against threats deriving from fraud, embezzlement, counterfeiting, false identities and privacy. These risks are likely to be scaled down, as the diffusion of the new instruments enlarges the market in such a way as to make lawful behaviour thoroughly prevail — which in turn will make the market itself more reliable. Under such conditions, obstacles and constraints that interfere with market development will not be able to resist its inner pressure, or will turn into discriminations and losses in commercial competition, which is positively unwelcome for the economies involved. It is certainly not by chance that in this matter the governments of many countries have so far shown a 'wait and see' attitude. NEW INSTRUMENTS AND MONEY LAUNDERING RISKS In its broadest sense, money laundering includes whatever activity is apt to disguise the source of illicitly earned wealth, dissolving the tracks that can lead back to it. To this goal, whatever means the economic and financial system can supply is beneficial. Experience has shown that money launderers prefer environments featured with poor control, high risks that justify high losses and profits, multiplier effects, little transparency and thus asymmetric information, ease of manipulation, chance of connivance or illicit profit sharing. In this perspective, the internet is an ideal environment. The access to new technologies is more effective, and at

Standardized Testing Essay -- Standardized Testing Essays

Standardized Testing Scholar Bill Ayers believes standardized testing in schools does not accurately measure what is necessary to be successful in life. Ayers insists that Standardized tests such as the American College Test (ACT) and the Scholastic Aptitude Test (SAT) measure specific facts and function which are among the least interesting and slightest important information that children should know. In an article titled â€Å"Testing the Right Way for Talent†, written by Hugh Price, argues the fact that standardized tests fail to capture the qualities that are necessary to be successful in the business world. Another article labeled â€Å"Implementing NCLB Assessment and Accountability Requirements in an Imperfect World† composed by Stuart Kahl, is in agreement with both Price and Ayers. According to Bill Ayers, Hugh Price and Stuart Kahl, standardized tests are uncalled excuse for a traumatic and stressful time in a child’s life. Hugh Price and Stuart Kahl are among the large majority of people who do not believe one test is able to accurately measure what a child knows. Price states, â€Å"High-stakes standardized tests, like the Scholastic Aptitude Test, the SAT, fail to capture the qualities most essential for success in the corporate world, such as creativity, drive and leadership† (Price). Price claims that although these tests are able to rate children in topics such as Math, English and History, what really makes one who they are is more than book smarts, but their personality and leadership skills are also necessary. In addition to Price believing this fact, Kahl also articulates against standardized testing. In his article that analyzes The No Child Left Behind Act of 2001, Kahl is aware of the fact that ... ...ort and a motivation behind the tests may as well perform better than those who are not. Whatever the reason may be, many people, including Price, Kahl, and Ayers do not support standardized testing. These authors all have one opinion in common; they are all against testing for the sake of the children, because of the pressures kids already endure without the pressures of testing. They all claim that tests may be an unfair way to rank children in the world today due to: teachers not teaching children the right material in preparation for the test, family upbringing, and even worrying the children would affect the test results. As Ayers indicates, one single test could not determine where a child stands in the business world, due to the fact that the test analyzes specific topics on school and nothing about their personality or more personal traits.

The Indian Mutiny of 1857-1858: Causes and Consequences :: British History

The Indian Mutiny of 1857-1858: Causes and Consequences Under the administration of the Marquess of Dalhousie (Governor-General 1848-56), the last of the independent Indian states, including the wealthy Muslim state of Oudh, were annexed by the British. To consolidate this new territory, some degree of Westernisation was introduced: an Indian railway and road system was developed and the first three Indian universities were founded, creating a tier of higher-caste men educated according to the British system but not fully incorporated into those careers of civil service and army awaiting them. Child marriage and the practice of suttee previously had been abolished and, in 1856, a regulation was passed requiring sepoys to serve overseas thereby losing caste. Both the annexation and consolidation heightened tension between government and population and mutiny was inevitable when the Indian section of the army was allocated cartridges smeared with the fat of cows and pigs, unclean to both Hindu and Muslim elements. The mutiny lasted thirteen months: from the rising of Meerut on 10 May 1857 to the fall of Gwalior on 20 June 1858.The sepoys were quickly joined by large numbers of civilians supporting the reinstatement of both a Moghul and a Maratha emperor and by landlords, particularly those of Oudh, penalised by the new administration and its policy of exporting raw materials for manufacture in Britain. Historians agree that the mutiny was characterised by violent reprisals on either side but, at least in British historical tradition, the most significant events are the massacres at Meerut, Cawnpore and Lucknow; post-mutiny literature dwelling on the fate of women and children especially. The mutiny, regarded by many as India's first War of Independence, was to have important consequences and the structure of British India was to be re-organised extensively. Increasingly, India came under direct Crown rule as the British East India Company was dispossessed of its functions and, in 1877, Queen Victoria was crowned Empress. Despite the severity of European reprisal as each territory had been regained and its subsequent defensive proposals of military alteration, a measure of conciliation had been introduced to administrative policy. Integration of the higher castes and princes was now considered important, land policy was revised and plans for radical social change were shelved. The Indian Mutiny of 1857-1858: Causes and Consequences :: British History The Indian Mutiny of 1857-1858: Causes and Consequences Under the administration of the Marquess of Dalhousie (Governor-General 1848-56), the last of the independent Indian states, including the wealthy Muslim state of Oudh, were annexed by the British. To consolidate this new territory, some degree of Westernisation was introduced: an Indian railway and road system was developed and the first three Indian universities were founded, creating a tier of higher-caste men educated according to the British system but not fully incorporated into those careers of civil service and army awaiting them. Child marriage and the practice of suttee previously had been abolished and, in 1856, a regulation was passed requiring sepoys to serve overseas thereby losing caste. Both the annexation and consolidation heightened tension between government and population and mutiny was inevitable when the Indian section of the army was allocated cartridges smeared with the fat of cows and pigs, unclean to both Hindu and Muslim elements. The mutiny lasted thirteen months: from the rising of Meerut on 10 May 1857 to the fall of Gwalior on 20 June 1858.The sepoys were quickly joined by large numbers of civilians supporting the reinstatement of both a Moghul and a Maratha emperor and by landlords, particularly those of Oudh, penalised by the new administration and its policy of exporting raw materials for manufacture in Britain. Historians agree that the mutiny was characterised by violent reprisals on either side but, at least in British historical tradition, the most significant events are the massacres at Meerut, Cawnpore and Lucknow; post-mutiny literature dwelling on the fate of women and children especially. The mutiny, regarded by many as India's first War of Independence, was to have important consequences and the structure of British India was to be re-organised extensively. Increasingly, India came under direct Crown rule as the British East India Company was dispossessed of its functions and, in 1877, Queen Victoria was crowned Empress. Despite the severity of European reprisal as each territory had been regained and its subsequent defensive proposals of military alteration, a measure of conciliation had been introduced to administrative policy. Integration of the higher castes and princes was now considered important, land policy was revised and plans for radical social change were shelved.

Emergency department patient satisfaction Essay

Customer service initiatives in healthcare have become a popular way of attempting to improve patient satisfaction. The effect of clinically focused customer service training on patient satisfaction in the setting of a 62,000-visit emergency department and level 1 trauma center is investigated. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse and overall satisfaction. These results suggest that such training may offer a substantial competitive market advantage, as well as improve the patients’ perception of quality and outcome. A practitioner’s response to the case study is also included. Customer service initiatives in healthcare have become a popular way of attempting to improve patient satisfaction. The effect of clinically focused customer service training on patient satisfaction in the setting of a 62,000-visit emergency department a nd level 1 trauma center is investigated. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse and overall satisfaction. These results suggest that such training may offer a substantial competitive market advantage, as well as improve the patients’ perception of quality and outcome. A practitioner’s repsonse to the case study is also included. You  have requested â€Å"on-the-fly† machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated â€Å"AS IS† and â€Å"AS AVAILABLE† and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of th e translation functionality and any output derived there from. Hide full disclaimerTranslations powered by LEC. Translations powered by LEC. Headnote visit emergency department and level I trauma center. Analysis of patient complaints, patient compliments, and a statistically verified patient-satisfaction survey indicate that (1) all 14 key quality characteristics identified in the survey increased dramatically in the study period; (2) patient complaints decreased by over 70 percent from 2.6 per 1,000 emergency department (ED) visits to 0.6 per 1,000 ED visits following customer service training; and (3) patient compliments increased more than 100 percent from 1.1 per 1,000 ED visits to 2.3 per 1,000 ED visits. The most dramatic improvement in the patient satisfaction survey came in ratings of skill of the emergency physician, likelihood of returning, skill of the emergency department nurse, and overall satisfaction. These results show that clinically focused customer service training improves patient satisfaction and ratings of physician and nurse skill. They also suggest that such training may offer a substantial competitive mar ket advantage, as well as improve the patients’ perception of quality and outcome. INTRODUCTION Recent changes in healthcare have led to increasing competition and the perceived commercialization of the healthcare provided to patients. At the same time, a need for reaffirmation of the importance of the patient-physician relationship has been expressed in the midst of such powerful forces (Laine and Davidoff 1996; Glass 1996; Pellegrino and Thomasma 1989). One aspect of the patient-physician relationship deserving further study is the role of customer service training in healthcare. While numerous customer service training tools exist in business and industry, no studies have clearly delineated the efficacy of customer service training for patients in a clinical setting. This study examines the effect of a required customer service training program taught by healthcare professionals on patient and family complaints, compliments, and satisfaction in a high-volume high-acuity emergency department. METHODS Patient Base All patients presenting to the Emergency Department at Inova Fairfax Hospital, Falls Church, Virginia, between May 1, 1994 and April 30, 1995 formed the control group, representing the period prior to emergency department customer service training. Patients presenting to the emergency department between May 1, 1995 and April 30, 1996 formed the study group, representing the period following customer service training intervention. The mechanism of patient complaint/compliment analysis and the survey criteria were identical in the control and study periods. Patient acuity was assessed by three measures: the number and percentage of patients admitted to the hospital; the number and percentage of patients with Current Procedural Terminology 1996 (CPT) evaluation and management (E/M) codes 99281-99285, (Kirschner et al. 1996); and a nursing acuity rating scale (EMERGE, Medicus Systems, Evanston, Illinois). Inova Fairfax Hospital is a 656-bed not-for-profit institution that is a teaching h ospital, regional referral center, and level I trauma center. Customer Service Training All emergency department staff involved in patient contact (physicians,  nurses, ED technicians, registration personnel, core secretaries, social workers, ED radiology, and ED respiratory therapy) were required to attend an eight-hour customer service training program. The numbers and types of staff involved in training are listed in Table 1. Because of logistic limitations, emergency medicine residents attended a focused fourhour required training course. The eight-hour program consisted of the following modules: basic customer service principles, recognition of patients and customers (Are they patients or customers?), service industry benchmarking leaders, stress recognition and management, communication skills, negotiation skills, empowerment, customer service proactivity, service transitions, service fail-safes, change management, and specific customer service core competencies. (More detailed information on the content of these modules is listed in Appendix 1.) These core comp etencies follow: making the customer service diagnosis (in addition to the clinical diagnosis) and providing the right treatment; negotiating agreement resolution of patient expectations; and building moments of truth into the clinical encounter. Following the initial required training, new physicians or ED employees were required to attend identical customer service training within four months of their initial employment. Additional mandatory customer service training updates were offered three times per year and included modules of conflict resolution, customer service skill updates, advanced communication skills, and assertiveness training. Patient Satisfaction Data Patient satisfaction data in both the control and study groups consisted of patient complaints, patient compliments, and a telephone patientsatisfaction survey conducted by an independent research firm (Shugoll Associates, Rockville, Maryland) that was blinded to the study hypothesis and course content. Patient complaints and/or compliments were systematically identified from all available means, including verbal, written, telephone, or electronic mail sources. Sources of patient complaints, data analysis, and categorization of complaints were identical in the control and study groups, which was coordinated by hospital quality improvement analysts. ED  staff were instructed to report all potential complaints and concerns, regardless of how minor, to appropriate physician or nurse managers in both the control and study periods. Complaints were logged into a central office and were investigated initially by three authors (TM, RC, DR). In cases where classification of type of complaint differed, additional information and/or clarification was sought from staff, patients, and family. Any discrepancies were resolved by group-consensus techniques. All complaints and the classification thereof were independently reviewed and verified by quality-improvement analysts. Patient complaint and compliment letters were referred for comment or clarification to appropriate ED staff in both the control and study periods. Outpatient satisfaction surveys were conducted by an independent research firm (completely blinded to the study and its hypothesis) utilizing a 50-item questionnaire to identify key factors in customer satisfaction. This survey instrument was validated on a sample of more than 3,000 patients prior to implementation in either the control or study group. The study used a telephone survey on a randomized number table basis to 100 ED outpatients per quarter (Appendix 2). Logistic regression analysis performed on these data identified 14 areas of more important/key attributes in the ED (see Table 2). Patient compliment and complaint data, as well as acuity data, were subjected to a two-tailed ttest and the Fisher Exact test. Patient satisfaction surveys were subjected to a two-tailed t-test with a 95 percent confidence level. Patient Turnaround Times Patient turnaround times (TAT) were calculated from time of initial arrival in the ED to either discharge or transfer to an inpatient unit. Turnaround times were routinely calculated on each patient and on an aggregate basis by day, month, quarter, and year. RESULTS ED Volume/Acuity Neither ED volume nor acuity changed to a statistically significant degree between the control and study periods, based on both admission percentage and nursing acuity (see Table 3). Analysis of CPT 96 Evaluation and Management Codes showed a statistically significant increase in codes 99283 and 99285, with a similar decrease in codes 99281 and 99284. The number of pediatric patients did not change in a statistically significant fashion during the study period. The only payor mix category to rise in a statistically significant fashion was managed care (p < .01), with a nearly identical decrease in commercial insurance. Neither compliments nor complaints correlated with payor category. Patient Turnaround Time Mean patient turnaround time dropped from three hours and 24 minutes (204 minutes) to three hours and seven minutes (187 minutes), but this difference was not statistically significant, nor did the percent of patients at one and two standard deviations from the mean change in a statistically significant fashion. Patient Compliments The total number of patient compliments rose from 69 in the control period to 141 in the study period, an increase of more than 100 percent (p < .00001) (see Table 3). Patient compliment letters consistently mentioned warmth, compassion, and skill of the emergency care provider as the reason for contacting management to praise the ED staff. There was no statistical difference between males and females among patient compliments. Patient Complaints Patient complaints dropped from 153 in the control period (2.5 complaints per 1,000 ED visits) to 36 in the study period (0.6 complaints per 1,000 ED visits), (p < .00001) (see Table 3). Complaints about perceived rudeness, insensitivity, or lack of compassion on the part of ED staff dropped most dramatically. Two-thirds of complaints in the study period were a result of waiting times, billing, or delays in obtaining an inpatient bed, compared to 30 percent in the control period. Nevertheless, complaints regarding waiting times, billing, and wait time for an inpatient bed still decreased 50 percent in the study period (p < .001). There were no significant differences in patient complaints based on age or sex, confirming results of the study by Hall and Press (1996). Patient Satisfaction Survey Data Baseline survey data were subjected to logistical regression analysis that indicated that 14 surveyed areas formed a core group of key satisfaction attributes. All of these 14 attributes showed increases in the study period (p < .001, see Table 2). The largest increases were in the following areas: skill of the emergency physician, skill of the nurse, likelihood of returning, overall quality of medical care, doctor’s ability to explain condition, diagnosis, and treatment options, and triage nurse’s sensitivity to pain. DISCUSSION The patient-physician and patient-nurse relationships are arguably the oldest in the history of medicine. These relationships have recently been described as being under siege because of an increase in the tension between the art and science of medicine, as well as the strains attendant to changes in the economic structure of healthcare (Glass 1996). To this list may be added a third causative factor: the lack of rigorous, formal training for healthcare professionals in the customer service fundamentals of the patient-provider relationship. The fundamentals of such training are closely tied to what has traditionally been described as the art of medicine or the concept of beneficence (Pellegrino and Thomasma 1989). Physicians have for the most part learned appropriate patient interaction skills through observing their mentors and peers during the course of graduate medical education. However, there has only recently been substantial study of this important subject (Buller and Buller 1987; Aharony and Strasser 1993). While customer service has been emphasized in American business and industry in recent years (Zeithamal, Parasuraman, and Berry 1990; Jones and Sasser 1995; Reichheld 1996; Berry and Parasuraman 1991; Berry 1995), few training modules are specifically targeted toward physicians and healthcare professionals. For this reason, the authors created an eight-hour customer  service training course for their ED providers, based on principles of adult education, benchmarks from the customer service industry (Sanders 1995; Spectre and McCarthy 1995; Carlzon 1987; Connelan 1997), experience in the clinical setting, and the existing literature on patient satisfaction (Pelligrino and Thomasma 1989; Thompson and Yarnold 1995; Thompson et al. 1996; Bursh, Beezy, and Shaw 1993; Rhee and Bird 1996; Dansk and Miles 1997; Hall and Press 1996; Eisenberg 1997). This literature emphasizes the importance of communication skills, managing information flow, actual versus perceived waiting times, and the ex pressive quality of physicians and nurses. All of these concepts were built into the training modules, including practical clinical examples of behaviors reflecting these and other concepts. Our philosophy in designing this course was simple. Customer service is a skill for which we hold our staff accountable but in which they had never formally been trained. We believed that this dilemma required, at a minimum, two sentinel events to occur. First, the department needed to have a clearly articulated and easily understood cultural transformation to a solid commitment to customer service. Second, staff members needed education in a practical, pragmatic fashion regarding precisely how such customer service principles could be applied in the clinical setting. Just as advanced cardiac life support, advanced trauma life support, and pediatric advanced life support courses can be used to improve cardiac, trauma, and pediatric resuscitation, respectively, we believed customer service outcomes could be improved by well-designed, mandatory, rigorous application of customer service training. The training was provided by active clinicians involved in day-to-day patient care activities (TAM, RJC). We believe this clinical credibility may have played an important part in the customer service transformation, inasmuch as the staff knew the trainers were well aware of the inherent problems of applying pragmatic customer service skills in a busy emergency department. The data from this study strongly support the hypothesis that clinically based, formal customer service training grounded on these principles can  dramatically decrease patient complaints, increase patient compliments, and improve patient satisfaction, at least in a high-volume, high-acuity ED. Patient complaints dropped by over 70 percent and compliments more than doubled during the study period, such that patient compliments actually exceed complaints in our 62,000 patient visit emergency department and level I trauma center. National data indicate that ED complaints average between three to five per 1,000 emergency department patients, although no data are available regarding rates of patient compliments (Culhane and Harding 1994). Our emergency department was slightly below that national standard level even during the control period. Analysis of the patient satisfaction survey data revealed an extremely important trend. Specifically, patients rated skill of the emergency physician, overall quality of medical care, and skill of the ED nurse as three of the most improved areas during the study period compared to the control period, despite the fact that there were no changes in the ED physician staff during the study and there was very little turnover among ED nurses. This strongly implies that patients rate the quality of care and the skill of the physician and nurse based on elements of the customer service interaction. These data suggest an important causal relationship between the technical component of care and the patient caregiver interaction, which has not been previously demonstrated. It is important to recognize that both customer service and technical skills are competencies to which hospitals and healthcare systems should hold their staff accountable on a daily basis. Hospitals spend substantial dollars to ensure that their staffs are technically competent to deliver quality medical care (Herzlinger 1997). However, to ensure that customer service is effective, clinically based customer service training is essential to give staff the appropriate skills in the clinical setting to deliver service competently. This concept is indirectly supported by data from Mack and colleagues (1995), who found that satisfaction with interactive aspects of emergency medical care produced higher correlations with measures of future intention to use the service than did satisfaction with medical outcomes themselves. Their study, however, did not undertake interventions to improve the interactive,  communicative aspect of healthcare in that setting. Similarly, Smith and colleagues (1995) evaluated the effect of a four-week training program, focusing on patient interviewing, somatization, patient education, and self-awareness, that was taught to first year internal medicine and family practice residents. Their data were not conclusive, but suggested that some but not all aspects of patient satisfaction could be improved by such training. This study tends to confirm the work of Thompson and colleagues (1996) that demonstrated in a much smaller sample size that expressive quality and management of informatio n flow to the patient had an effect on patient satisfaction. However, their study did not assess the impact of strategies and techniques for ED staff to improve patient satisfaction by improving expressive quality. While several studies (Thompson et al. 1996; Thompson and Yarnold 1996; Dansk and Miles 1997; Hall and Press 1996) have emphasized the importance of waiting time and exceeding patient expectations regarding length of waiting time, our study demonstrates a dramatic improvement in patient satisfaction without a statistically significant reduction in patient turnaround time. This supports the work of Bursch and colleagues (1993), who found in a study of 258 patients that the five most important variables for patient satisfaction were the amount of time it took before being cared for in the ED, patient ratings of how caring the nurses were, how organized the ED staff was, how caring the physicians were, and the amount of information provided to the patient and family. However, the study did not assess strategies to improve satisfaction based on this knowledge. All of this information was built into the training modules to assist staff with practical strategies to manage waiting time effe ctively using information flow, queuing theory, and verbal skill training. The implications of the higher ratings of the skill of the emergency physicians and nurses are intriguing and could have a far-reaching impact on healthcare. Perhaps the strongest implication is that perceived skill stands as a marker for quality and/or outcome in the mind of patients and their families. It has been shown repeatedly that patient compliance increases with confidence in the physician (Frances, Korsch, and Morris 1969;  Sharfield et al. 1981; Waggoner, Jackson, and Kern 1981; Schmittdiel et al. 1997). While our study did not directly assess improvements in outcome, quality of care, or appropriateness of care, it certainly appears that patients rated the skill of the healthcare providers as a key quality characteristic in this survey. Furthermore, the fact that ratings of quality of medical care and likelihood of returning also increased dramatically speaks to the importance that effective customer service training may have in offering a competitive market advantage to hospitals and healthcare institutions. This is particularly important as the concept of customer loyalty is closely tied to the likelihood of a patient or their family returning to that healthcare institution. As the focus on outcomes management and evidence-based medicine increases, it is important to take into account the effect that customer service skills have on patients’ perceptions of quality and outcome. This study may be subject to several criticisms. First, while statistical data on patient compliments and complaints obtained substantial statistical significance, the number of patients contacted for the outpatient satisfaction telephone survey may have resulted in sampling bias. While a larger sampling is planned in the future, the patient satisfaction survey data trends were consistent throughout all quarters and appear to be a valid statistical tool, despite the number of patients sampled. Second, it was not possible to blind those responsible for investigating and classifying complaints and compliments. However, we did attempt to reduce or eliminate possible reporting or observer bias by identifying complaints from all sources and ensuring that all complaints and their classification were reviewed and approved by an author who was not involved in ED operations and by quality improvement analysts. Third, information is not available on national or regional trends of patient compl aints and/or satisfaction during the study period. It is possible that the data in this study may reflect local, regional, or national trends toward decreased complaints and increased satisfaction, either globally throughout healthcare or in ED patients specifically. However, this is highly unlikely as no such trends have been previously reported, nor would such trends fully explain the data from this study, even if they were present. The data on patient acuity  indicated an increase in CPT codes 99283 and 99285, suggesting a slight trend toward higher patient acuity. This could mean that patients with higher levels of acuity are more satisfied and less likely to complain. No data are available to either prove or disprove this possibility, but the trend toward higher acuity would not appear to completely explain the dramatic improvement seen in this study. Furthermore, the patient-satisfaction telephone survey excluded inpatients, who comprise a larger percentage of patients in the 99285 service code. Further study is needed to delineate the relationship of ED patient acuity to satisfaction. Despite these potential limitations, this study demonstrates that clinically based customer training for ED staff can decrease patient complaints and increase patient satisfaction in a large volume, high-acuity ED, and that satisfaction is independent of patient turnaround times. Furthermore, the data support the concept that patients rate the skill of the emergency physician, overall quality of medical care, and skill of the ED nurse significantly higher after such training is provided to the ED staff. Additional studies in ED with different volumes, acuities, and geographic locations are needed to demonstrate whether these results can be duplicated. Studies of the impact of customer service training in other healthcare settings would also be of benefit. Nonetheless, clinically focused customer service training has been shown in this study to improve patient satisfaction and ratings of the skill of physicians and nurses. If verified by other studies, customer service training should be considered an important part of graduate and undergraduate medical education to improve both the art and science of the patient-physician relationship. The clinically based customer service training described in this study is now a required part of competency based orientation for all physicians, nurses, residents, and support staff in the emergency department. All professional and non-professional staff interviewed for positions in the emergency department are advised of the institution’s strong commitment to customer service training and the necessity of attending the required training course. As healthcare increasingly emphasizes accountability for customer service in its staff, it is increasingly important that practical and effective customer service training is provided. While not directly addressed in this study, the data on ratings of quality of medical care, skill of the physician and nurses, and likelihood of returning strongly suggest that effectively completing the customer service transition offers a competitive market advantage to hospitals and healthcare systems. References Aharony, L., and S. Strasser. 1993. â€Å"Patient Satisfaction: What We Know About and What We Still Need to Explore.† Medical Care Review 50 (1): 49-79. Berry, L. L. 1995. On Great Service: A Framework for Action. New York: Free Press. Berry, L. L., and A. Parasuraman. 1991. Marketing Services: Competing Through Quality. New York: Free Press. Butler, M. K., and D. B. Buller. 1987. â€Å"Physician’s Communication Style and Patient Satisfaction.† Journal of Health and Social Behavior 28 (4): 375-88. Bursh, B., J. Beezy, and R. Shaw. 1993. â€Å"Emergency Department Satisfaction: What Matters Most?† Annals of Emergency Medicine 22: 586-91. Carlzon, J. 1987. Moments of Truth: New Strategies for Today’s Customer-Driven Economy. New York: Ballinger Publishing. Connelan, T. 1997. Inside the Magic Kingdom. Austin, TX: Bard Press. Culhane, D. E., and P. J. Harding. 1994. â€Å"Quality in Customers: Great Expectations.† Presented to the American College of Emergency Physicians Management Academy, Boston, Massachusetts, May 19, 1994. Dansk, K. H., and J. Miles. 1997. â€Å"Patient Satisfaction with Ambulatory Healthcare Services: Waiting Time and Follow-up Time.† Hospitals and Health Services Administration 42 (2): 165-77. Eisenberg, B. 1997. â€Å"Customer Service in Healthcare.† Hospitals and Healthcare Services Administration 42 ( 1 ): 17-32. Frances, V, B. M. Korsch, and M. J. Morris. 1969. â€Å"Gaps in Doctor-Patient Communication. Patient’s Response to Medical Advice.† New England Journal of Medicine. 280: 535-49. Glass, R. M. 1996. â€Å"The Patient-Physician Relationship: JAMA Focuses on the Center of Medicine.† Journal of the American Medical Association 275: 147-48. Hall, M. F., and I. Press. 1996. â€Å"Keys to Patient Satisfaction in the Emergency Department: Results of a Multiple Facility Study.† Hospitals and Healthcare Administration 41 (4): 515-32. Herzlinger, R. 1997. Market-Driven Health Care. New York: Free Press. Inova Health System. 1997. â€Å"Outpatient Satisfaction Research.† Shugoll Research. Rockville, MD. Jones, T. O., and W. E. Sasser, Jr. 1995. â€Å"Why Satisfied Customers Defect.† Harvard Business Review 73: 88-99. Kirschner, C. G., R. C. Burkett, G. M. Kotowicz, et al. 1996. Physicians’ Current Procedural Terminology-CPT 96, ed 5. Chicago: American Medical Association. Laine, C., and F. Davidoff. 1996. â€Å"PatientCentered Medicine: A Professional Evolution† lournal of the American Medical Association 275: 152-56. Mack, J. L., K. M. File, J. E. Horwitz, and R. A. Prince. 1995. â€Å"The Effect of Urgency on Patient Satisfaction and Future Emergency Department Choice.† Health Care Management Review 20: 7-15. Pellegrino, E. D., and D. C. Thomasma. 1989. For the Patient’s Good: The Restoration of Beneficence in Health Care. New York: Oxford University Press. Rhee, K., and J. Bird. 1996. â€Å"Perceptions in Satisfaction with Emergency Department Care.† Journal of Emergency Medicine 14: 679-83. Reichheld, E E 1996. â€Å"Learning from Customer Defections.† Harvard Business Review 74: 56-69. Sanders, B. 1995. Fabled Service: Ordinary Acts, Extraordinary Outcomes. San Diego: Pfeiffer and Company. Schmittdiel, J., J. V. Selby, K. Grumbach, and C. P. Quesenberry. 1997. â€Å"Choice of a Personal Physician and Patient Satisfaction in a Health Maintenance Organization.† Journal of the American Medical Association 278 (19): 1596-1612. Sharfield, B., C. Wray, K. Hess, and E. M. Smith. 1981. â€Å"The Influence of Patient-Practitioner Agreement on Outcome of Care.† American Journal of Public Health 71: 127-31. Smith, R. C., J. S. Lyles, J. A. Mettler, et al. 1995. â€Å"A Strategy for Improving Patient Satisfaction by the Intensive Training of Residents in Psychosocial Medicine: A Controlled, Randomized Study† Academic Medicine 70: 729-32. Spectre, R., and P. D. McCarthy. 1995. The Nordstrom Way: The Inside Story of America’s #1 Customer Service Co mpany. New York: John Wiley and Sons. Thompson, D. A., P. R. Yarnold, D. R. Williams, and S. L. Adams. 1996. â€Å"Effects of Actual Waiting Time, Perceived Waiting Time, Information Delivery, and Expressive Quality on Patient Satisfaction in the Emergency Department† Annals of Emergency Medicine 28: 657-65. Thompson, D. A., and P. R. Yarnold. 1995. â€Å"Relating Patient Satisfaction to Waiting Time Perceptions and Expectations: The Disconfirmation Paradigm.† Academic Emergency Medicine 2: 1057-62. Thompson, D. A., P. R. Yarnold, S. L. Adams, and A. B. Spaccone. 1996. â€Å"How Accurate Are Waiting Time Perceptions of Patients in the Emergency Department?† Annals of Emergency Medicine 28: 652-56. Waggoner, D. M., E. B. Jackson, and D. E. Kern. 1981. â€Å"Physician Influence on Patient Compliance: A Clinical Trial.† Annals of Emergency Medicine 10: 348-52. Zeithamal, V. A., A. Parasuraman, and L. L. Berry. 1990. Delivering Quality Service: Balancing Customer Perceptions and Expectations. New York: Free Press. You have requested â€Å"on-the-fly† machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated â€Å"AS IS† and â€Å"AS AVAILABLE† and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors fo r your use of the translation functionality and any output derived there from. Hide full disclaimerTranslations powered by LEC. Translations powered by LEC.