Finance and Growth Strategies Essay Example | Topics and Well Written Essays - 2750 words

Finance and Growth Strategies - Essay Example In fact, more mature companies tend to have better payout ratio, with regular increases in the rates. The firm's dividend policy is generally affected by a number of factors like; 1. Future Expansion Plans and Capital Requirements: If the company has expansion plans, diversification plans etc. then it will prefer to have a large reserve of its resources and funds readily available for the new venture. The requirement could be in the form of capital for setting up a new production facility or liquid funds to launch a marketing blitz for a new range of products or tapping a new market. 2. Competitive Environment: Today we are living in an era of globalization and liberalization. This has led to intense competition in many sectors and industries. This is particularly the case for companies in consumer goods and retail industry. Beckett-Camarata et al. (1998) present a conceptual overview of relationship management in a rapidly changing global environment: "In a global economy, all system members are interdependent and are customers. Companies are restructuring (i.e. downsizing) to fund only those core competencies that are key to their profitability and long-term survival. Managing relationships with their customers - especially with employees, channel partners, and strategic alliance partners - is critical to the firm's long-term success" (p71) Therefore companies try to reach all stakeholders in equal measure. For the customers it tries to rationalize the prices in order to attract them towards the product while it is equally crucial that the company tries to keep all its stakeholders in good humor, by paying out good returns on their respective holdings. 3. The overall business scene in the sector/s: Dividend payout decisions are also influenced by the number of companies and the kind of requirements that the business sector has. For example the diamond exploring companies in some of the South African countries do not generally find intense competition and the sector itself is a specialized one, with labor intensive inputs in the industry. In such a scenario, the company will have a committed number of investors and financers who understand the sector well and realize its potential benefits and drawbacks. On the other hand, a telecom services company will have intense competition not only from with the regional telecom companies but from other companies as well. Therefore, in such a scenario the company will be hard pressed for remaining in good books of the investors, coming from a wider spectrum of society. 4. Profit earned during the financial year: Dividend is certainly dependent upon the revenues and profits earned during the year. If the company can keep apart a sufficient amount, in addition to reserves and other liabilities, then the investors can expect better payouts. 5. Political scenario prevailing in the country/ region: The dividend policy is indeed impacted to a great extent by the political environment prevailing in the country or the region. If the political class is supportive of firms' business activities and the firm can chart out a future course of action, the firm can be quite liberal in its payout policy as well. But,

Drinking and Driving in the United States Essay

Drinking and Driving in the United States - Essay Example Overview Drunk driving is an avoidable problem especially with self responsibility. Increasing number of arrests might have little to do against this offence. Alcohol tends to damage the Central Nervous System of an individual. When the BAC level is at .10 percent the ability to take proper decisions gets damaged and the drivers lose control on the steering. He lacks the alertness necessary to understand if a danger lay ahead in the street and the response time is delayed. The vision is also disturbed due to a high BAC level. In some cases there might be difficulty in understanding the traffic signal colors and the capacity to differentiate them (Goodenough, Wallance and McGuire, 12-15). Drunk drivers might also face the problem of driving safely during the night or redeem from the glare of light in minimum possible time. Under such situation and in the absence of self awareness is an individual the enforcement of the law comes to play a role. However apart from the level of enforcem ent, it is important for the public to know the laws. Background Any decision of a driver which is impaired by alcohol intake can result in danger for others or the driver taking abnormal risks. It might lead to the driver taking improper turns and misjudgments regarding the speed and the right roads. Jerky movements and sharp turns might result owing to drunk driving. This might alarm the other travelers or the normal drivers. In US a Blood Alcohol Content (BAC) of .08 or more is considered to be above the legal ceiling in all the states (NHTSA). As per the NHTSA findings, in 2003 less than 9 percent of the drivers with a BAC of 0.08 percent or more and involved in crashes involving deaths were repeat offenders of drunk driving who were under one or more accusations of DWI (driving while intoxicated) – â€Å"Drivers with a BAC of 0.08% or higher involved in fatal crashes were eight times more likely to have a prior conviction for DWI than were drivers with no alcohol in the ir system.† (CDC; Wren) Position statement: Drunk driving being a criminal offence in US, is one of the major causes of deaths due to motor accidents in the country. Appeals and Evidence In the United States of America drunken driving is included under the specific criminal offence of DUI or Driving Under Influence. The most striking as well as pitiful information that makes it justified to regard drunk driving as a criminal offence is that in 2008 deaths due to dunk driving contributed to 32 percent of total car accidental deaths in 2008. According to National Highway Traffic Safety Administration in 2007 amongst the motor vehicles related fatal accidents around 32 percent were the outcome of alcohol impaired driving especially with drivers having BAC of .08 or more. During the span 1995 to 2006 incidences of injuries related to motor vehicle collisions admitted was 8272 out of which motor cycle and mopped crashes contributed to 12 percent and amongst them 24.5 of the motorcy clists and 39 percent of moped operators were impaired by alcohol (Christmas, Brintzenhoff, and Schmelzer, 305). When notes in absolute terms, the total deaths come to 37261 and 11773 were due to drunk driving. During the night the drivers were more likely to drink and hence death

Practice Nurses Role in Treating Chlamydia

Practice Nurses Role in Treating Chlamydia The practice nurses role in treating chlamydia and improving the sexual health of the nation Introduction Chlamydia treatment has been the focus of considerable research interest in the past few years. A huge proportion of what used to be called NSU, or was even undiagnosed non-specific pathology, is now recognised as being due to the chlamydia pathogen. It has now achieved the unenviable status of being considered responsible (numerically) for the greatest amount of sexually transmitted disease in the UK today (Duncan 1998) Given the fact that it is now therefore recognised as being a major contributing factor in the overall picture of sexual health, we must examine ways in which the NHS is set up to tackle the problem. (HPA 2003) As with many health related issues such as this there are a number of subsidiary issues that must be considered in relation to the main theme. These include the role of the screening process in trying to contain the prevalence of chlamydial infection, the practice nurse’s role in that screening process, the current thoughts on the treatment of chlamydia and the practice nurse’s role in not only the treatment, but also the partner tracing activity that is vital to try to stop the spread of the disease. (Fenton et al 2001) The practice nurse is generally ideally placed within the primary healthcare team to act as a central liaison point for many of these activities If we start by considering the whole issue of screening. On one level, one could be forgiven for thinking that the issues relating to screening are actually rather simple. We know that many cases of chlamydia are actually asymptomatic (see on). Given the fact that it can cause considerable damage and is eminently treatable, why not screen for it and get rid of it? Sadly, it is not as simple as that. (Simms et al 1996) The National Institute for Clinical Excellence (NICE) has set up the National Chlamydia Screening Programme (NCSP). It quotes its rationale for doing so as: Genital Chlamydia trachomatis is the commonest Sexually Transmitted Infection (STI) in England Genital chlamydial infection is an important reproductive health problem ~ 10-30% of infected women develop pelvic inflammatory disease (PID). A significant proportion of cases, particularly amongst women, are asymptomatic and so, are liable to remain undetected, putting women at risk of developing PID. Screening for genital chlamydia infection may reduce PID and ectopic pregnancy. The study itself was exemplary in design with an entry cohort of nearly 8,000 patients. The authors considered the efficacy of several different methods of screening and then compared the results of the programmes against the costs of allowing the disease to continue untreated in the community and these include all the sequelae of infertility, pelvic inflammatory disease and ectopic pregnancy in women together with the complications that can occur in the male partners (infertility again) and prostatitis. (Berry et al 1995) The paper even covered the incidence of both pneumonia and eye infections in their children. The structure of the study was quite comprehensive insofar as it compared the results of four separate groups One group received no screening at all, a second group were screened if they exhibited mucopurulent cervicitis, the third group included all women who were less than 30 yrs. old and the last group was all women irrespective of symptoms. The actual screening tool was the Polymerase chain reaction (PCR) which is a very specific and sensitive antibody based test. It was performed on either urine or direct cervical samples. (Barlow et al 2001) The study protocol then called for all positive testing patients to receive treatment with doxycycline for seven days. The analysis section of the paper is both long and complex. We shall therefore condense our examination of this part of the study into an examination of the results. The overall treatment costs of treating all of the medical complications of chlamydial infection was calculated as $676,000. Each of the positive screening strategies produced a significant reduction in the expected cost of complications that was greater than the cost of the actual screening exercise. A condensation of the tabulated results is shown here: Screening method Screening costs ($) Medical costs ($) Total cost ($) Number of PID cases PID cases prevented No screening 676,000 676,000 152 CDC criteria 55,000 390,000 446,000 88 64 Women 75,000 297,000 372,000 67 85 Universal screening 120,000 270,000 391,000 61 91 The results need little explanation, as it can be clearly seen that both the costings and the number of cases prevented argue strongly for a case for screening. The only point of contention is the decision on the population that the health care system will fund for screening. Overall, the authors state that their regime reduced the incidence and prevalence of pelvic inflammatory disease by 60% when compared to the unscreened group. The other significant factor was that, taking all groups as an average, they noted a total healthcare saving of about $50 per woman screened, and this clearly does not take any account of any associated comorbidity, pain and suffering that is caused by the chlamydia infection A further corollary can be drawn from the results. The authors went on to provide an impressive statistical analysis of the comparative costs of different community groups with different rates of prevalence. Of great importance to our considerations here was the fact that the authors concluded that the cost of screening was cost effective when the incidence of infection in a population of asymptomatic women was above 1.1%. when the incidence rose above 11% then they found that the screening of all women and their partners became the most effective strategy. To some extent, this study can be considered the â€Å"gold standard† for most of the studies in this area. It is well conceived, meticulously executed and well and thoughtfully analysed to give meaningful results which are of great practical importance. Despite such comments it should be noted that there are a number of negative points to be considered in this particular study. The universal treatment constant was the seven day doxocycline treatment. We should note (as the authors did) that there is therefore a potential for non-compliance with the whole seven day regime, and this may introduce a potential source of bias in the figures(Haddix et al.1995). We can also point to other studies that have addressed this particular problem with a one dose treatment regime (azithromycin). It is fair to note that despite the potential for bias, extrapolation to these other studies does not appear to show significant differences in the overall results (Lea et al 1997) The issue of screening, although covered reasonably comprehensively in the last paper, certainly as far as matters of cost are concerned, is examined further in the paper by (Duncan et al. 2001). This paper approaches the issues from a different perspective. It includes the issues of male screening And takes an overview of the Public Health issues from a sociological viewpoint, which makes it, (in our examination of the current literature), almost unique. We should note that we have already addressed the issues faced by the NCSP, but the other major public document in this area is the report commissioned by the Chief Medical Officer (CMO 1998). It is instructional to discuss the recommendations of this group as they differ significantly from the screening criteria used in the previous paper. The recommended groups for screening here are the following: Everyone with symptoms of chlamydia infection, All those attending genitourinary medicine clinics, Women seeking termination of pregnancy.1 Opportunistic screening of young sexually active women under 25 years Women over 25 with a new sexual partner or two or more sexual partners in the past year. In the context of our considerations here, we should note that the advisory group identified the optimum sites for screening as the primary healthcare team (family planning clinic) as well as the usual GUM clinics. (Stokes 1997) The Duncan paper is particularly well written and a major point that comes from it is in sharp contrast to that found in the Howell study. One of the criteria that they suggest for screening males in the population is that women may find that being screened has connotations of being dirty and unattractive A positive result is said to be associated with promiscuity. The authors suggest that not screening men not only fosters gender inequalities but it reduces the Public Health impact on the Man’s responsibilities for sexual health. (Pierpoint et al 2000) There is no argument that this is a valid point, but the paper does not produce any evidence to show that male screening has a positive impact on the cost-effectiveness of the screening procedure. (Stephenson et al 2000) The paper does however, contrast these statements with the accepted fact that women are actually easier to target than men, as they are generally heavier health care users than men in the major at risk age range. (Oakeshott et al 1998) The paper points to the need to tackle the issues of sexual inequality, as it could be considered that the screening programmes may have less than the desired effect if they are perceived by women to be little more than surveillance of their particular sexual habits. It draws a clear analogy between a women only screening programme for chlamydia and the well established women only cervical cytology screening clinics. The paper quotes (Holgate et al 1998) in the comment: The potentially adverse consequences of sexual intercourse a private event can be surveyed and treated through screening services a publicly based and funded system . It is women who transcend this private, public dichotomy and find their lives scrutinised in a manner alien to men . The focus is commonly upon women both as transmitters and contractors of relevant viruses as both those whose cervixes are surveyed and whose sexual activity comes under surveillance. The paper then has a long middle section which, as a critical analysis, is little more than a diatribe against women being singled out for screening. It is fair to say that all of the arguments put forward are valid, to a degree, but are presented with a strongly feminist viewpoint, which is both understandable and worthy of merit form a sociological standpoint. The arguments are not however, convincing from a scientific, financial or practical perspective. The conclusions of the paper are entirely justified in calling for a greater understanding of the woman’s point of view when organising and running screening clinics, in order to broaden their appeal to the target groups. (Santer et al 2000) With specific reference to the role of the nurse in the primary healthcare team screening for chlamydia we can now turn and examine an excellent paper by Grun (et al 1997) which looked at two different methods of screening for chlamydia in a nurse run primary healthcare setting. The study set out to try to accurately determine the prevalence of chlamydia in the North London area using the ligase chain reaction (LCR) technique which is similar to the PCR mentioned earlier. (Butt et al 2001) This particular study used the rather labour intensive cervical scrape method for sampling, which had the added benefit that cervical cytology could be assessed at the same time. The paper is quite detailed in its description of its method and appears to be rigorous in its execution. It is worthy of our consideration here because of it’s direct relevance to our prime consideration. The results and conclusions of the paper make for interesting reading One of the more significant conclusions was that, on the basis of their findings, if there was a policy of simply screening all women aged 25 and all women who had had two or more partners in the past year, they would have detected 20 out of a possible 23 positive chlamydia infections in their cohort. The authors make a salient comment that including other screening criteria such as marital status (which has been suggested by other authors [Lossick JG, et al 1996]), would have made no statistically significant impact on their detection rate. They also make the comment, in line with the other authors we have examined, that selective screening appears to be more cost effective than universal screening, although the actual cost implications were not specifically considered in this paper. In contrast to the Howell paper, it suggests that screening become a viable tool when the community prevalence rate approaches 5% The fourth paper to be reviewed is the more recent paper by Adams (et al 2004). This paper takes a more general overview of the whole issue of chlamydia in the UK. This is effectively a meta analysis of nineteen different papers (selected from 357 studies) which report the incidence of chlamydia as tested by the PCT method on urine samples. This is significant as it is the first meta analysis to be carried out on UK data. (Armitage et al 2001) The results are extremely detailed and many are only of marginal relevance to our considerations here. We shall restrict our comments to those aspects that are specifically relevant. Firstly, the authors comment on the current prevalence of 8.1% of the population testing positive in the under 20 age group, progressively diminishing to 1.4% in the over 30 group. The significance of this is that it is very much lower than other studies. For example studies set in GUM clinics put the prevalence in the under 20 age group in the region of 17% and antenatal clinics at about 12%. (Piementa et al 2003) This may therefore have relevance in targeting of specific at risk groups. It should be noted that this study gave no data with regard to the incidence of chlamydia in the male population. (Dixon et al 2002) Our comments made earlier about the asymptomatic nature of the bulk of the infections, is borne out in the fact that only 8% of those tested and found to be positive, actually volunteered that they had any genital symptoms (of any sort). Another important consequence of this study is the fact that it highlights the comparatively high detection rate to be found in attenders at primary healthcare team premises. This shows a gap in the reasoning and recommendations of the National Sexual Health and HIV Strategy for England (D of H 2002) which currently suggests targeting GUM clinics and family planning centres as prime sites for screening centres. Following on from the reasoning expounded in the last paper, we can look at a provocatively entitled article by Kufeji (et al 2003)† Who is being tested for genital chlamydia in primary care?† The paper makes the point that we already have enough evidence to clearly identify the target populations that are the most likely to give a good yield as far as screening is concerned (viz. the most â€Å"at risk† groups). The raison d’à ªtre of this paper was to compare the characteristics of the actual groups screened with the characteristics which we know to be representative of the groups most likely to be at risk. The corollary of this reasoning being that if the two groups do not match then all the calculations made about the cost effectiveness of a selective screening process do not hold water. (Kinn et al 2000) The most striking feature of this paper is the fact that we know (Adams et al 2004) that the maximum age incidence for chlamydia is in the sexually active under 20 age group and the incidence rapidly decreases with age to the over 30 age group. Kufeji and his co-workers found that the majority of the tests done (63%) were done on the over 25 yr. age group where we would expect the results to be positive only in about 1.5% of the population. Adams’ findings were confirmed with a positive rate of 13.3% found in the under 20 yr. olds tested. The paper also point to the fact that the practices studied had a comparatively high healthcare staff to patient ratio. In the practices where the ratio was lower, even less opportunistic testing was done. (Shefras et al 2002) This correlates to the finding that the Townsend score ( of social deprivation) correlated highly with both a reduction in the amount of testing and an increase in the prevalence of chlamydia. In the words of the authors the study points to the fact that screening programmes for chlamydia in primary healthcare settings suffer from â€Å"a selection bias and social desirability bias, and they do not aim to provide complete descriptive information on testing patterns across a population.† It should be noted that this particular study was not just on a small sample. The authors took as their entry cohort all of the 119 General Practices in Nottingham which collected a total of over 7,000 samples. The authors note that the number of tests done in General Practice is increasing at about 35% per year. It follows that if a significant number of these are inappropriately targeted, this has profound implications for the related costings of the exercise. One other salient point in this study was the fact that only 1 in 40 tests were done on men. (Chernesky et al 1999) The last major paper that we shall review in this section is the paper by Cassell (et al 2003) this deals with the thorny issue of partner notification when screening turns up a positive result. Hitherto contact tracing had largely been in the realms of the GUM contact tracing nurse. With the expansion of the screening role into the realms of General Practice and other clinics, the contact tracing role has also expanded and may well have lost some of it’s efficiency due to both a lack of skill, time and resources. (D of H 2002). Cassell and her colleagues have tried to investigate the extent to which this perceived reduction in contact tracing may be responsible for the relentless increase in the overall incidence of chlamydia. (Radia et al 2001). The study was done by postal questionnaire to all GPs in Nottinghamshire. They got a 56% response rate. Arguably the most significant finding of the study was the fact that 86% of respondents considered that chlamydia testing was part of the remit of the primary healthcare team, while only 40% considered that partner notification was a primary healthcare team role. The rationale for this was, that most of the non-contact tracing respondents felt that it was their role to inform the patient that they should inform their partners. Given the fact that we have evidence from the Duncan paper that women tend to equate a positive test with promiscuity and being â€Å"dirty†, it is perhaps not surprising that a substantial number of partners do not get told. If you add to this number the unknown number of chlamydia infections that may have come from clandestine or extramarital liaisons, then this number may be higher still. This is clearly both hypothesis and conjecture but it would seem to be dictated by common sense. The paper goes into considerable detail about the reasons why different primary healthcare teams have different practices, but rather worryingly a surprising 20% treat chlamydia with a dose of antibiotic which is less than the currently recommended therapeutic level recommended by the Central Audit Group for Genitourinary Medicine, (Stokes et al 1997) The difficulty of a postal questionnaire study is that there is an intrinsic bias in the study design. It is quite conceivable that the 56% of primary healthcare teams who responded were the ones who may have been sufficiently motivated to be positive about matters to do with chlamydia and may therefore have been better informed that those who did not respond. In the words of the authors â€Å"our study probably over-represents primary healthcare teams already testing for chlamydia and may exaggerate the extent of good practice.† The paradox outlined by this study is that while the majority of GPs and their teams are already willing to assume the mantle of diagnosing and managing chlamydial infection, the same majority agree that contact tracing is the main difficulty in managing these patients. The study made enquiries relating to the presence of follow up strategies which were designed to minimise the risk of further infection and found that there was â€Å"very little evidence to be found† other than by putting the onus on the patient to tell their partners. It follows from this observation, and the authors put it quite succinctly: If testing in primary care continues to increase without adequate support for partner notification, much of the resource used in testing women will be wasted. (Griffiths et al 2002) If we accept the premise that an increasing amount of chlamydia screening will be done in General Practice in the future, it is likely that an increasing proportion will fall to the practice nurse or the family planning nurse specialist. (Stokes et al 2000). If this is the case, then it is common sense to maximise the benefit of chlamydia screening by supporting the healthcare professionals with time and resources to perform proper contact tracing to minimise the risk of re-infection. (EHC 1999) Conclusions In this review we have selected six primary papers which each represent a significant contribution to the evidence base in our knowledge of the rationale for screening and treatment of chlamydia infection. (Sackett 1996) From our examinations it is clear that there is a considerable disparity in the figures pertaining to the prevalence of chlamydia infection in the community. The paper by Adams (Adams et al 2004) gives us a partial rationale for this and that is that studies done in different areas of health care practice will yield different results because they have a different clientele. It is not, perhaps, surprising that a study done in a GUM clinic will report different prevalences than a study done in a General Practice setting. The common factor that runs through all of the papers examined is the fact that it is rare to find that men are screened. Generally the figures suggest about 2-5% of men are screened when compared to the number of women. There is no evidence to suggest that they have lower infection rates than women and, according to Duncan (et al 2001), there are a number of very good sociological reasons why men should be screened as frequently as women. The fact of the matter is that women are subject to screening with much greater frequency than men and therefore bear the brunt of both the indignity and the responsibility. There is no doubt however, that the case for screening and treatment and contact tracing is made on both economic and health grounds. It is equally clear that the practice nurse has a central role in the efficient administration of all of these vectors to varying degrees. The advent of nurse prescribing (Legge 1997) will make the practice nurse as valuable in this area as they already are in both the screening and contact tracing roles. The only concern here is that according to Kufeji (et al 2003) we are collectively targeting the wrong population in terms of efficacy and efficiency. References Adams EJ , A Charlett, W J Edmunds, and G Hughes 2004 Chlamydia trachomatis in the United Kingdom: a systematic review and analysis of prevalence studies Sex. Transm. Inf., October 1, 2004; 80(5): 354 362. Armitage P, Berry G, Matthews J. 2001 Statistical methods in medical research. Malden, MA, 2001. Barlow RE, Cooke ID, Odukoya O, et al. 2001 The prevalence of Chlamydia trachomatis in fresh tissue specimens from patients with ectopic pregnancy or tubal factor infertility as determined by PCR and in-situ hybridisation. J Med Microbiol 2001;50:902–8 Berry J, Crowley T, Horner P, et al. 1995 Screening for asymptomatic Chlamydia trachomatis infection in male students by examination of first catch urine. Genitourin Med 1995;71:329–30. Butt A, McCartney R, Walker A, et al. 2001 Economic advantages of ligase chain reaction for diagnosis of genital Chlamydia trachomatis infection in GUM clinic attenders. Sex Transm Infect 2001;77:227–8. Cassell JA , M G Brook, R Slack, N James, A Hayward, and A M Johnson 2003 Partner notification in primary care Sex. Transm. Inf., June 1, 2003; 79(3): 264 265. Chernesky M, Lee H, Schachter J. 1999 Diagnosis of a Chlamydia trachomatis uretral infection in symptomatic and asymptomatic men by testing first void urine in a ligase chain reaction assay. J Infect Dis 1999;170:1308-11. CMO 1998 Chief Medical Officer. Main report of the Chief Medical Officers Expert Advisory Group on Chlamydia trachomatis. London: Department of Health , 1998. Dixon L, Pearson S, Clutterbuck DJ. 2002 Chlamydia trachomatis infection and non-gonococcal urethritis in homosexual and heterosexual men in Edinburgh. Int J STD AIDS 2002;13:425–6. D of H 2002 (I) Department of Health. The national strategy for sexual health and HIV: implementation action plan. London: DoH, 2002. D of H 2002 (II) Department of Health. Action plan for the sexual health strategy for England. London: DoH, 2002 Duncan B, Hart G. 1998 Screening for Chlamydia trachomatis: a qualitative study of womens views. Prevenir 1998; (suppl 24): 229. Duncan B, Graham Hart, Anne Scoular, and Alison Bigrigg 2001 Qualitative analysis of psychosocial impact of diagnosis of Chlamydia trachomatis: implications for screening BMJ, Jan 2001; 322: 195 – 199 EHC 1999 Effective Health Care. Getting evidence into practice. York: University of York, 1999. Fenton KA, Korovessis C, Johnson AM, et al. 2001 Sexual behaviour in Britain: reported sexually transmitted infections and prevalent genital Chlamydia trachomatis infection. Lancet 2001;358:1851–4. Griffiths C, Cuddigan A. 2002 Clinical management of chlamydia in general practice: A survey of reported practice. J Fam Plann Reprod Health Care 2002;28:149–52. Grun L Julia Tassano-Smith, Caroline Carder, Anne M Johnson, Angela Robinson, Elizabeth Murray, Judith Stephenson, Andrew Haines, Andrew Copas, and Geoffrey Ridgway 1997 Comparison of two methods of screening for genital chlamydial infection in women attending in general practice: cross sectional survey BMJ, Jul 1997; 315: 226 230 Haddix AC, SD Hillia, WJ Kassler. 1995 The cost effectiveness of azithromycin for Chlamydia trachomatis infections in women. Sexually Transmitted Diseases 1995 22:274-80. Harry T, Saravanamuttu K, Rashid S, et al. 1994 Audit evaluating the value of routine screening of Chlamydia trachomatis urethral infections in men. Int J STD AIDS 1994;5:374–5 Holgate HS, Longman C. 1998 Some peoples psychological experiences of attending a sexual health clinic and having a sexually transmitted infection. J R Soc Health 1998 Howell MR , TC Quinn, CA Gaydos. 1998 Screening for Chlamydia trachomatis in asymptomatic women attending family planning clinics. Annals of Internal Medicine 1998 128:277-84 HPA 2003 Health Protection Agency, SCIEH, ISD, National Public Health Service for Wales, CDSC Northern Ireland, UASSG. Renewing the focus. HIV and other sexually transmitted infections in the United Kingdom in 2002. London: Health Protection Agency, 2003 Kinn S, Macnaughton J, Noone A, et al. 2000 Chlamydia trachomatis in primary care: knowledge and practice in Glasgow. Br J Gen Pract 2000;50:214–15 Kufeji O, R Slack, J A Cassell, S Pugh, and A Hayward 2003 Who is being tested for genital chlamydia in primary care? Sex. Transm. Inf., June 1, 2003; 79(3): 234 236. Lea AP, HM Lamb. Azithromycin. 1997 A pharmacoeconomic review of its use as a single-dose regimen in the treatment of uncomplicated urogenital Chlamydia trachomatis infections in women. Pharmacoeconomics 1997 12:596-611. Legge. A 1997 Nurse prescribing is a success BMJ, Feb 1997; 314: 461. Lossick JG, et al. 1996 Recommendations for the prevention and management of Chlamydia trachomatis infection, 1996. MMWR 1996;42:1-37. Oakeshott P, Kerry S, Hay S, et al. 1998 Opportunistic screening for chlamydial infection at time of cervical smear testing in general practice: prevalence study. BMJ 1998;316:351–2. Pierpoint T, Thomas B, Judd A, et al. 2000 Prevalence of Chlamydia trachomatis in young men in north west London. Sex Transm Infect 2000;76:273–6. Pimenta JM, Catchpole M, Rogers PA, et al. 2003 Opportunistic screening for genital chlamydial infection. II: Prevalence among healthcare attenders, outcome, and evaluation of positive cases, Sex Transm Infect 2003;79:22–7 Radja N, Slatter E, Thin N, et al. 2001 A tale of 2 cities: a comparison of demographic details, source of referral, spectrum of infection and contraceptive practice in patients under 16 years attending genitourinary medicine clinics in London and Swansea. Int J STD AIDS 2001;12:361–4. Sackett, (1996). Doing the Right Thing Right: Is Evidence-Based Medicine the Answer? Ann Intern Med, Jul 1996; 127: 91 94. Santer M, Warner P, Wyke S, et al. 2000 Opportunistic screening for chlamydia infection in general practice: can we reach young women? J Med Screen 2000;7:175–6. Shefras J, Edmondson S, McNulty C. 2002 Countywide survey of the current practice of chlamydia detection in primary care. J Fam Plann Reprod Health Care 2002;28:145–8. Stephenson J, Carder C, Copas A, et al. 2000 Home screening for chlamydial genital infection: is it acceptable to young men and women? Sex Transm Infect 2000;76:25–7. Stokes T. 1997 Chlamydia infection in UK family planning clinics. Br J Fam Plan 1997;23:47–50. Stokes T, Bhaduri S, Schober P, et al. 1997 GPs’ management of genital chlamydia: a survey of reported practice. Fam Pract 1997;14:455–60 Stokes T, Mears J. 2000 Sexual health and the practice nurse: a survey of reported practice and attitudes. Br J Fam Plann 2000;26:89–92 Wilson JS, Honey E, Templeton A, et al. 2002 A systematic review of the prevalence of Chlamydia trachomatis among European women. Human Reproduction Upda

It Takes a Thief :: Short Stories Stealing Burglary Essays

It Takes a Thief The thief moved slowly through the long stone hallway, not making a sound. He virtually clung to the grey walls, just another shadow in the dark. He paused for a moment, stretching every inch of his six foot frame, eyes and ears straining in the blackness. There it was again, the sound of sandaled feet echoing through the hall. Dropping down and touching the floor, he felt vibrations reverberating through the stone. And they were coming closer! He swore softly, and looked around quickly. Spotting a door, he hurriedly said a prayer to whatever god was willing to listen, and he stepped through it. He noted that he was in a large, empty candlelit room, but that was all he looked at for a moment. Breathing a sigh of relief, he wiped his brow and pushed back his shoulder length black hair, revealing a large, pointed ear. "You're getting to old for this Thronn," he whispered in the silence. Two hundred years. He was two hundred years old. That was really nothing but a pinch of salt in the life of an elf, but the constant pressures of his profession was starting to wear on him. Being a thief added a lot of stress to one's life. This job especially. Usually, he came out ahead, but not this time. His mouth quirked up in a cynical grin at the though of the mere two hundred gold that he was getting for this job. Raiding the castle of Lord Paraxel was not his idea of sane, not even his idea of insanity. But, he had needed the money at the time. He shook his head angrily and looked up. A lapse like that could easily cost him. Finally, his head clear, he scanned the room. It was bigger than he had originally thought and, he smiled, it was the very room he was looking for: the armory. Cabinets were in numerous places along the floor, and numerous weapons were hanging along the walls. Reaching into his belt pouch, he drew out a scroll that his employer had given him. He'd been told that when he was finished reading it, the weapon that glowed would be the one to take. He looked at the scroll with revulsion. He never had liked magic very much, even though he'd always had a way with it. Suddenly, with a flick of his wrist, a dagger appeared in his right hand. It Takes a Thief :: Short Stories Stealing Burglary Essays It Takes a Thief The thief moved slowly through the long stone hallway, not making a sound. He virtually clung to the grey walls, just another shadow in the dark. He paused for a moment, stretching every inch of his six foot frame, eyes and ears straining in the blackness. There it was again, the sound of sandaled feet echoing through the hall. Dropping down and touching the floor, he felt vibrations reverberating through the stone. And they were coming closer! He swore softly, and looked around quickly. Spotting a door, he hurriedly said a prayer to whatever god was willing to listen, and he stepped through it. He noted that he was in a large, empty candlelit room, but that was all he looked at for a moment. Breathing a sigh of relief, he wiped his brow and pushed back his shoulder length black hair, revealing a large, pointed ear. "You're getting to old for this Thronn," he whispered in the silence. Two hundred years. He was two hundred years old. That was really nothing but a pinch of salt in the life of an elf, but the constant pressures of his profession was starting to wear on him. Being a thief added a lot of stress to one's life. This job especially. Usually, he came out ahead, but not this time. His mouth quirked up in a cynical grin at the though of the mere two hundred gold that he was getting for this job. Raiding the castle of Lord Paraxel was not his idea of sane, not even his idea of insanity. But, he had needed the money at the time. He shook his head angrily and looked up. A lapse like that could easily cost him. Finally, his head clear, he scanned the room. It was bigger than he had originally thought and, he smiled, it was the very room he was looking for: the armory. Cabinets were in numerous places along the floor, and numerous weapons were hanging along the walls. Reaching into his belt pouch, he drew out a scroll that his employer had given him. He'd been told that when he was finished reading it, the weapon that glowed would be the one to take. He looked at the scroll with revulsion. He never had liked magic very much, even though he'd always had a way with it. Suddenly, with a flick of his wrist, a dagger appeared in his right hand.

Media Communications Feedback Essay

Well, after a careful review of your plan, I noted the following issues. You need to address them before implementing the plan. The target population of your message is predominantly African-American women aged 20-49. The statistics you are using do not include other groups who could be a contributing factor to the high levels of infections and deaths. For instance, what are the figures for infected males in the community? For you to achieve better results, you should consider including men in your campaign. At the same time, you did not identify the major causes of infection. Why, for instance, are other groups not affected? If the causes are related to socio-economic and cultural factors such as poverty and unemployment, then your goal would be to pressure service providers such as as Non-Governmental organizations and the government to address those issues. The age difference of your target group means that members could have different interests. Therefore, you should have specified different programs that appeals to each age group. The T. V and radio stations you chose appeals mostly to the youth; what about those aged over forty? Similarly, the presenters you have in mind are not appropriate for this particular campaign. You need role models who could be a good example to the audience. In this regard, it is useful to involve community members who know how to relate with your target group (Galea et al, 2002, 297). Therefore, look for somebody who has been involved before in community projects, and not music celebrities: this category of people may have negative influences due to their lifestyles. Your slogan will not achieve the desired behavioral changes. Texting and talking about HIV/Aids helps in networking: however, you need an approach that will change their lifestyles, such as through participation in education seminars. Your challenge, therefore, is to â€Å"market changes in behavior by using strategic communication† (Siegel and Doner, 2004, 42). How will you determine if you are achieving your goals? The Academy for Educational Development identifies evaluation as one aspect of determining whether stated goals are being realized (AED, 2010). Thus, you should identify the instruments you will use to assess whether your target group is responding positively to the program. Consider conducting a survey after three months to collect data about their sexual activities. Lastly, I think you should conduct a primary research yourself before taking action. The data you got from the surveillance report should act as secondary information to guide your own research. In fact, a primary research is necessary when planning to implement any project. Nevertheless, your overall plan identifies a marginalized group that requires help. However, to achieve the best results, have the best plan. Success. References Academy for Educational Development. (2007). Health Communication Partnership. Accessed May, 08, 2010 < http://www. globalhealthcommunication. org/projects/health_communication_partnership Doner M. , Siegel L. (2004). Marketing public health: strategies to promote social change. New York: Jones & Bartlett Learning’ Galea, S. , et al. (2002). Access to resources for substance users in Harlem, New York City: Service provider and client perspectives. Journal for Health Education and Behavior. New York: Society for Public Health Education

Business Research Methods Essay

1. Distinguish among the following sets of items, and suggest the significance of each in a research context: a. Concept and construct – A concept is a generally accepted collection of meanings or characteristics that are concrete whereas a construct is image or idea invented for a particular theory or research problem; a construct is an abstract concept. To successfully perform a research, we must form common ground; hence, the need for concepts and constructs. b. Deduction and induction – a deduction is a conclusive inference while an induction is a conclusion from one or more pieces of evidence. c. Operational definition and dictionary definition – an operational definition is a definition based on measurement criteria that have empirical reference while a dictionary definition is based on synonyms. d. Concept and variable – a concept is a generally accepted collection of meanings or characteristics associated with certain events while a variable is value or set of values related to a property being studied. e. Hypothesis and proposition – A hypothesis is a is a declarative statement that states a belief while a proposition is a statement about concepts that may be regarded as true or false. f. Theory and model – a theory is a set of systematically inter-related concepts, definitions and propositions that are advanced to explain and predict phenomena while a model is a representation of a system that is constructed to study some aspect of the system. g. Scientific method and scientific attitude – The scientific method deals with rationalism and empiricism: formal structured proofs and observable, concrete data; the scientific attitude deals with curiosity 2. Describe the characteristics of the scientific method a. Direct observation of phenomena b. Clearly defined variables, methods and procedures c. Empirically testable hypotheses d. The ability to rule rival hypotheses e. Statistical justification f. Self-correcting process 3. What are the differences among the research approaches (and thinking styles) that guide the predominant kinds of studies done in operations research, marketing, finance and/or organizational behaviour? – There are six different styles of thinking: Postulational – rational and idealistic, Self-evident truth – fairly rational and idealistic, Method of authority – fairly rational and idealistic, Literary – informal and interpretative, Untested opinion – Very informal and fairly idealistic and finally, there is the scientific method which is empirical and rational. 4. Here are some terms commonly found in a management setting. Are they concepts or constructs? Give two different operational definitions for each. a. First-line supervisor – concept; person directly in charge of line workers; person reporting to unit manager b. Employee morale – construct; that which is measured by how an employee feels toward the job; that which is measured by how often an employee reports for work on time c. Assembly line – concept; area where the items are assembled; area where line workers spend most of their day d. Overdue account – concept; account balance that is past 30 days; an account where the amount owed is past 60 and less than 25% has been paid toward the balance. e. Line management – concept; person to whom all line supervisors report; head of each functional area f. Leadership – construct; quality defined by how many persons emulate this person; quality defined by a rating by asking persons how good a leader is the subject under study g. Price-earnings ratio – concept; the measure of how much an incumbent makes in reference to an average in the same job position; the amount someone makes in reference to others in similar jobs, having similar education and experience and within similar industries, in the same region. h. Union democracy- construct; the measure of how people say they have a say in the union; the measure of how the union heads have proceeded to do what the majority of the members asked. i. Ethical standards – construct; the value tha t an employee places on a variable; the untested opinion of how employees feel about the ethics within a company on a scale of 1-10. 5. In your company’s management development program, there was a heated discussion between some people who claimed: â€Å"Theory is impractical and thus no good†, and others who claimed: â€Å"Good theory is the most practical approach to problems†. What position would you take and why? – I would take neither side. Both statements have their value and can be argued at length. In support of the first statement: this falls into one of two categories: untested opinion or self-evident truth. Some say that theory is the opposite of fact and does not form a practical approach to problems, for solutions require facts. In support of the second statement: theory forms a systematic set of concepts, definitions and propositions that are advanced to explain and predict phenomena. Therefore, theory can be used as a good starting point for factual explanations. In my opinion, good theory and fact-based rationale are necessary; a good balance of both is required. 6. An automobile manufacturer observes the demand for its brand (DV) increasing per capita income increases (IV). Sales increases also follow low interest rates (MV), which ease credit conditions. Buyer purchase behaviour is seen to be dependent on age (IVV) and gender (IVV). Other factors influencing sales appear to fluctuate almost randomly (competitor advertising (EV), competitor dealer discounts (EV), introductions of new competitive models (EV)). a. If sales and per capita income are positively related, classify all variables as dependent, independent, moderating, extraneous or intervening. b. Comment on the utility of a model based on the hypothesis – DV depends directly on IV. MV is a secondary independent variable affecting the DV. The EVs are used to show variables that occur randomly or those that can be safely ignored. The IVVs are used to show variables that theoretically affect the DV, but have not actually been empirically in the study. 7. You observer the following condition: â€Å"Our female sales representative have lower customer defections than do our male sales representatives†. a. Propose the concepts and constructs you may use to study this phenomena – concepts and constructs: male definition; female definition; customer; customer defections (construct) b. How might any of these concepts/constructs be related to explanatory hypotheses? – the explanatory, or casual hypothesis, of female reps having lower customer defections than male reps can be tested by using research questions, built from concepts, constructs and definitions 8. You are the office manager of a large firm. Your company prides itself on its high quality customer service. Lately complaints have surfaced that an increased number of calls are being misrouted and dropped. Yesterday, when passing by the main reception area, you noticed the receptionist fiddling with his hearing aid. In the process, a call came in and would have gone unanswered if not for your intervention. The particular receptionist had earned a poor review for the last 3 months. Your inclination is to urge this 20-year employee to retire or to fire him. You know the individual is well liked and is seen as a fixture in the company. a. Pose several hypotheses that might account for dropped or misrouted calls. – the employee is too old to handle the load; employee cannot afford a proper hearing aid, the lack of which causes problems in directing calls properly, or answering calls in a timely manner; there is a problem with the phone routing system; there is a problem with the main phone at the call desk. b. Using the double movement of reflective thought, show how you would test these hypotheses – fact: calls are being misrouted; induction: why are calls not reaching their proper destination; hypothesis: any of the above; deduction: calls will be misrouted if the operator’s h earing aid is mal-functioning. 9. The Institute of Transport Engineers, a nationwide trade association with thousands of members, was dissatisfied with the way that State Farm arrived at its dangerous intersection list. a. If the ITE were to conduct a study of its own, what constructs and concepts would they define differently? – concepts and constructs defined differently: dangerous intersection; crash claim b. What hypotheses would ITE formulate to guide its version of the dangerous intersection study? – dangerous intersections have already been identified by engineers; dangerous intersections lack certain security features; dangerous intersections have a high volume of accidents 10. Identify and classify all the variables in the army’s â€Å"dud-shell† research – a. Dud shell (DV) b. Shell that explodes (IV) c. Persons coming into contact (EV) 11. What was Myra’s hypothesis for the army’s dud-shell research? What was the army’s hypothesis? – She believed that the dud-shell was incorrectly defined; she hypothesized that the dud-shells defined by the army were not all dud-shells, but were comprised of both dud-shells and shells that have a delayed exploding time; Myra’s hypothesis was: Civilians were coming in contact with potentially dangerous shells that could explode when manipulated. The army’s hypothesis was: shells that did not explode on impact were inert. 12. Graph your inductions and deductions in the following statements. If there are gaps, supply what is needed to make them complete arguments. a. Repeated studies indicate that economic conditions vary with – and lag 6 to 12 months behind – changes in the national money supply. Therefore, we may conclude that money is the basic economic variable. – induction: what causes economic conditions to vary; deduction: available money causes an alteration in economic conditions. b. Research studies show that heavy smokers have a higher rate of lung cancer than no smokers; therefore, heavy smoking causes lung cancer. – induction: does smoking increase the risk of lung cancer? Deduction: smoking does increase the risk of lung cancer. c. Show me a person who goes to church regularly and I will show you a reliable worker. – induction: what makes a reliable worker? Deduction: a regular church patron makes a reliable worker.