Non-Invasive Diagnostic Techniques

Non-Invasive diagnostic techniques| | X-rays| An X-ray machine is essentially a camera. Instead of visible light, however, it uses X-rays to expose the film. X-rays are like light in that they are electromagnetic waves, but they are more energetic so they can penetrate many materials to varying degrees. When the X-rays hit the film, they expose it just as light would. Since bone, fat, muscle, tumors and other masses all absorb X-rays at different levels, the image on the film lets you see different (distinct) structures inside the body because of the different levels of exposure on the film. Ultrasound| Ultrasound or ultrasonography is a medical imaging technique that uses high frequency sound waves and their echoes. The technique is similar to the echolocation used by bats, whales and dolphins, as well as SONAR used by submarines. | Thermography| | MRI| MRI scanners vary in size and shape, and some newer models have a greater degree of openness around the sides. Still, the basic des ign is the same, and the patient is pushed into a tube that's only about 24 inches (60 centimetres) in diameter.The biggest and most important component of an MRI system is the magnet. There is a horizontal tube — the same one the patient enters — running through the magnet from front to back. This tube is known as the bore. But this isn't just any magnet — we're dealing with an incredibly strong system here, one capable of producing a large, stable magnetic field. The strength of a magnet in an MRI system is rated using a unit of measure known as a tesla.Another unit of measure commonly used with magnets is the gauss (1 tesla = 10,000 gauss). The magnets in use today in MRI systems create a magnetic field of 0. 5-tesla to 2. 0-tesla, or 5,000 to 20,000 gauss. When you realize that the Earth's magnetic field measures 0. 5 gauss, you can see how powerful these magnets are. Most MRI systems use a superconducting magnet, which consists of many coils or windings of wire through which a current of electricity is passed, creating a magnetic field of up to 2. 0 tesla.Maintaining such a large magnetic field requires a good deal of energy, which is accomplished by superconductivity, or reducing the resistance in the wires to almost zero. To do this, the wires are continually bathed in liquid helium at 452. 4 degrees below zero Fahrenheit (269. 1 below zero degrees Celsius) [source: Coyne]. This cold is insulated by a vacuum. While superconductive magnets are expensive, the strong magnetic field allows for the highest-quality imaging, and superconductivity keeps the system economical to operate. |

A Student’s Dilemma

The purpose of this memo is to identify the ethical dilemma Helen is trapped into and her responsibilities towards making the correct decision. Helen Kanell is a final year student with a 4. 0 average grade point at the Empire State University. She is also the president of Beta Alpha Psi, the accounting student honor society. Being a president of such honorable society requires a great deal of responsibility and time commitment. Helen is already appointed a position at the Big & Apple LLC. Yet, Helen plans to complete her studies with at least a 3. 90 GPA to qualify for the highest academic honor â€Å"summa cum laude. However, she is currently maintaining a B average in four out of five of her courses and needs to get an A at least in one course to be eligible for summa cum laude. In order to resolve Helen’s dilemma her best friend lick the copy of the Accounting 544 from the accounting department and gives it to Helen prior to the final exam. Before arriving to a conclusion Helen should consider her responsibilities towards the University, herself, and several other related groups. Maintaining academic integrity of the University should be Helen’s first priority. It’s her duty to follow the University’s Code of Conduct to uphold its reputation. Sue should be honest to the accounting department because she represents the accounting honor society, Beta Alpha Psi. As a leader of such honorable society cheating will not set the right example for rest of the student body. Helen’s should not take a decision which will cause her to be unfair to all those students who worked hard for the exam. It’s her responsibility to be fair to other student in the class and the department. As stated by the Golden Rule â€Å"we should treat other the way we want to be treated. No one would like to be cheated, therefore, Helen’s should not put fort her own interest and be unfair to others. Helen’s responsibility towards Big & Apple LLC is to act in a trustworthy and reliable manner. One of the reasons the company has hired is so that they can trust Helen with their financial and confidential information. She should understand the consequences of cheating in such situation because it can have a huge impact on her career. Instead of taking the wrong path to achieve success Helen should discuss her situation and seek for appropriate advice form her professor. Although, Helen’s best friend is concerned about her situation its Helen’s responsibility to report her best friends misdeeds to the professor of Accounting 544. Helen’s responsibility is to make her friend realize the consequences of her wrongdoings. She should make her friend understand the ethical values of what’s right and what’s wrong. Cheating is not an easy way out of difficult situations. Helen’s responsibility to herself is to avoid doing things which would lower her self-esteem. She should alert herself that cheating is unethical way of achieving success and would cost her much more than expected in her career. Making the right decision will give her peace of mind and she won’t have anything to regret for in future. Ethical values of honesty, integrity and trust should guide Helen in making the right decision in such situation. People with these values tend to think in the best interest of others. These ideals guide every individual to achieve greater success. If I was Helen I would not choose the path of dishonesty under any circumstances. My ethical values would not permit me to take advantage of the final exam cheat sheet. Instead, I would put my full concentration on my studies and work hard towards that A. To seek advice I would go to the Accounting 544 professor. I would discuss my crucial situation with him/her to resolve my dilemma. My decision would not change even if the Empire State University has an honor code and provides a $5000 award to students that graduate summa cum laude. Regardless of how difficult the situation could get its unethical for me to cheat to achieve such an honorable award. I believe the path of fraudulence will never lead a person to a successful profession, as well as life

The Glass Menagerie

A persons life isn’t always what it’s expected to be. Every ones lives tell a completely different story, whether it’s sad or it’s joyful. Tennessee Williams shows a great example of three peoples lives in his play â€Å"The Glass Menagerie†. In The Glass Menagerie, Tennessee Williams uses several different themes throughout the play, including control in Amanda, Laura and Tom’s lives. Laura is one of the characters that gets a lot of control in her life, by her mother Amanda. â€Å"We have to be making some plans and previsions for her. She’s older than you. † (Williams 763) Amanda is the one speaking in the quote above, she is speaking to Tom. Amanda is saying that they need to be making plans and changes in Laura’s life. She technically wants to control Laura’s life. Amanda is the mother of Tom and Laura but she tries to control everything they do. Amanda is the controller of her son and daughter, Tom and Laura. She either controls what they do or tries to control their future. â€Å"†¦ it would be nice for your sister if you brought home some nice young man from the warehouse†¦ (756) Amanda says that to Tom. â€Å"Laura, are you going to do what I asked you to , or do i have to get dressed and go out myself? † Amanda says this to Laura. As you can tell Amanda is very bossy, she wants Tom to get Laura a nice young man from the warehouse and commands Laura to go somewhere for her. Laura usually does what her mother says but Tom sometimes yells back her and makes a big ar gument start. On the other hand Tom gets controlled by his mother, Amanda, but he tries to defend himself. Whenever Tom and Amanda argue Tom tries to defend himself by talking back to her, for example, â€Å"House, house! Who pays the rent on it, who makes himself a slave to-† (759) Tom is complaining to Amanda how he is the one who pays the rent when she is trying to accuse him for doing nothing. In every argument that they have, Tom doesn’t let it go, he keeps it going. Williams had several different themes in The glass Menagerie. Control was one that stood out to me. Obviously Amanda was the overall controller. She tried to control Laura and Toms lives. â€Å"You smoke too much. A pack a day at fifteen cents a pack, how much would that amount add up to in a month? † (764) Amanda tries to control Toms smoking habits, but he’s a grown man and he decided to smoke and she has to deal with it now. She is not always going to have control over him or even Laura’s life. When i read this play, i could kind of relater to Laura’s life. Control is also in my life, from my parent. They simply want me to have a better life, sort of like Laura in the play. â€Å"I want you to be someone in life and want you to have a career that you enjoy doing. (My parents) My parents don’t want me to end up working at a fast food restaurant for the rest of my life, they want me to continue my education so i can end up with a career that will pay me the big bucks. I’m pretty sure anyone has some kind of control in their lives. Control was one of the themes that Tennessee Williams used in The Glass Menagerie. Control in this play is important becau se it is one of the main themes, and shows how peoples lives can be when we might think it’s the total opposite. The Glass Menagerie A persons life isn’t always what it’s expected to be. Every ones lives tell a completely different story, whether it’s sad or it’s joyful. Tennessee Williams shows a great example of three peoples lives in his play â€Å"The Glass Menagerie†. In The Glass Menagerie, Tennessee Williams uses several different themes throughout the play, including control in Amanda, Laura and Tom’s lives. Laura is one of the characters that gets a lot of control in her life, by her mother Amanda. â€Å"We have to be making some plans and previsions for her. She’s older than you. † (Williams 763) Amanda is the one speaking in the quote above, she is speaking to Tom. Amanda is saying that they need to be making plans and changes in Laura’s life. She technically wants to control Laura’s life. Amanda is the mother of Tom and Laura but she tries to control everything they do. Amanda is the controller of her son and daughter, Tom and Laura. She either controls what they do or tries to control their future. â€Å"†¦ it would be nice for your sister if you brought home some nice young man from the warehouse†¦ (756) Amanda says that to Tom. â€Å"Laura, are you going to do what I asked you to , or do i have to get dressed and go out myself? † Amanda says this to Laura. As you can tell Amanda is very bossy, she wants Tom to get Laura a nice young man from the warehouse and commands Laura to go somewhere for her. Laura usually does what her mother says but Tom sometimes yells back her and makes a big ar gument start. On the other hand Tom gets controlled by his mother, Amanda, but he tries to defend himself. Whenever Tom and Amanda argue Tom tries to defend himself by talking back to her, for example, â€Å"House, house! Who pays the rent on it, who makes himself a slave to-† (759) Tom is complaining to Amanda how he is the one who pays the rent when she is trying to accuse him for doing nothing. In every argument that they have, Tom doesn’t let it go, he keeps it going. Williams had several different themes in The glass Menagerie. Control was one that stood out to me. Obviously Amanda was the overall controller. She tried to control Laura and Toms lives. â€Å"You smoke too much. A pack a day at fifteen cents a pack, how much would that amount add up to in a month? † (764) Amanda tries to control Toms smoking habits, but he’s a grown man and he decided to smoke and she has to deal with it now. She is not always going to have control over him or even Laura’s life. When i read this play, i could kind of relater to Laura’s life. Control is also in my life, from my parent. They simply want me to have a better life, sort of like Laura in the play. â€Å"I want you to be someone in life and want you to have a career that you enjoy doing. (My parents) My parents don’t want me to end up working at a fast food restaurant for the rest of my life, they want me to continue my education so i can end up with a career that will pay me the big bucks. I’m pretty sure anyone has some kind of control in their lives. Control was one of the themes that Tennessee Williams used in The Glass Menagerie. Control in this play is important becau se it is one of the main themes, and shows how peoples lives can be when we might think it’s the total opposite.

Is Islamic Financing better for Real Estate financing than the Essay

Is Islamic Financing better for Real Estate financing than the conventional Financing - Essay Example (Tarek El Diwany, 2003) While conventional banking is more of a profit oriented business seeking interest on the finance provided to the consumer, being part of the capitalistic interest based financial system, etc. (Kabir Hassan and Mervyn Lewis, 2007) Islamic banking activities are mostly clustered around three parts of the world; Middle East, South Asia and Southeast Asia. It is further reported that Islamic banking system provides services in the real estate sector in many Muslim countries and banks have started special windows to attract petrodollars from the Muslim people. It is further reported there is high scope for investing Islamic financing in real estate market in Singapore, Malaysia, Saudi Arabia, Pakistan, Bahrain and other Muslim nations as it offers more ethical and efficient alternatives as compared to the interest based conventional banking system.(M. Mansoor Khan and M. Ishaq Bhatti, 2008) Since the Islamic financing has strong foothold in many of the Muslim count ries and provides services in various fields, it is believed that Islamic finance is better than the conventional financing system with regard to the financing in real estate sector as it provides more customer oriented services unlike the conventional banking where profit is the first objective of the organization. Hence the present study is proposed into the research of Islamic financing system and conventional financing system, and which is the best suited in the area of real estate financing to the public. Zamir Iqbal et al (2009) mentioned that the conventional financing system which is based on debt financing has taken a set back after the recent credit crisis that started with the initial collapse of the sub prime real estate market in the United States in 2007. Islamic banking and finance represents the worldwide phenomenon that is taking place in Malaysia, Indonesia, the United

Case Study 2 Assignment Example | Topics and Well Written Essays - 500 words

Case Study 2 - Assignment Example This can be achieved through advertising an attribute of the brand in the form of a campaign. According to the case study, Cingular used Virtual Laguna Beach in order to promote the aspect of communication. This aspect acted a form of promotion which comprised of information from diverse social events. Through these interactions, the users received bonus rewards including VoIP access, cell phone animation and skins for instant-messaging players. On the other hand, Pepsi increased their in-world skills through publishing an in-world ‘zine that offers new areas in the world. This has enabled users to rack up MTV dollars for the Pepsi-branded items and other in-world purchases (Klaassen, 2007). Lastly, Secret extended its campaign through virtual booths whereby avatars aired some of their secrets for a chance to win a virtual cash prize. This case study also highlights that this scheme does not have a business model. However, the MTV network has a plan to charge for its integration into Virtual Laguna Beach. This case study also reveals brand interaction should entail a reward especially in the virtual world (Klaassen, 2007). This is because most visitors in Virtual Laguna Beach are usually exposed to these brands hence; they interact voluntarily just like in the real world. The second case study talks about the Bank of America. In most financial services that are provided all over the world, online banking is considered as a major breakthrough in the innovation sector. In 2005, the Bank of America came up with a different and radical product which broke the paradigm. Scholars assert that the online banking service concept is used to solve some of the contemporary banking issues. For example, it enables consumers to open new accounts. This concept operates in a peculiar manner such that when a consumer buys anything using the BoFA Visa Debit Card, the bank usually rounds off the figure to the nearest buck and

Unit 3 Critical Thinking Assignment Example | Topics and Well Written Essays - 750 words

Unit 3 Critical Thinking - Assignment Example To get rid of the continuous complaints and the lack of respectful communication among the staff members, I would come up with a complaint and suggestion box. In this particular box, every nurse who had a complaint could raise it through the box as well as providing the best solution that he/she thinks can solve the matter in question. I would undertake this by making a committee, I being the head of this and deputized by the assistant administrator. Every member of the committee will have his/her well-defined role, and having a mutual agreement of working towards achieving the common goal. The characteristic, in this case, is coming up with the best solutions for the current mess that have overwhelmed the nursing staff in this particular organization. For all the problems raised by the members, the committee would come with the best solution for each and after that arranging for a meeting to be attended by the whole staff. In this meeting, I would outline all the complaints raised and give the solution for each by inviting all the employees to participate in this opening forum. Finally, I would implement the strategies and have a peaceful and committed staff. Personally, this would be a suitable approach for me, in the process of providing optimal quality care for the neonate. â€Å"The application of team building is one of the leadership skills that have emerged to deliver the best outcomes within different organizations† (Holland & Roberts, 2013, p. 73). In this particular scenario, the through teamwork, the two groups realized that indeed they were working towards the achievement of the same goal. â€Å"This is the first and most important step in the process of defining a relationship between the teamwork members† (Lawson & Hennefer, 2010, p. 123). This approach provided a better communication strategy as well as methodology since, in the process of achieving the common goal; providing the most

Microsoft Introduction Research Paper Example | Topics and Well Written Essays - 750 words

Microsoft Introduction - Research Paper Example Bill Gates was the first president while Paul Allen was the executive vice-president (Nell 12) Microsoft a corporation, like others has goals, vision and mission. The vision of Microsoft is to create accessible innovative technology, which sheds light on its mission which is to make people and businesses all over the word to realize their potential. The company’s main focus is on software products and services where they develop and also license them. Microsoft operating systems is among its products that mainly allow a computer to operate. Microsoft has packaging software called Microsoft Office that is used in an office set up which include word processor and spreadsheet among others (Randall 22). Microsoft has had three C.E.O’s since it was found with Bill Gates as the first one and Steve Ballmer being the second. Sadya Natella is the third and current C.E.O of Microsoft. He has been working with the company for more than two decades and he is famous for pushing vigorous changes in the company’s culture and products. This has led to him having a reputa tion of proven potential and capability of being the C.E.O of a big corporation like Microsoft. The company’s main headquarters is on One Microsoft way, in Redmond, Washington, United States of America. Microsoft has put a lot of effort to make sure most parts of the world are experiencing its availability. Branches of Microsoft are mainly found in the United States of America with its subsidiaries in more than seventeen countries. Some of these countries are France, India, Canada, Nigeria and Peru, which mostly deal with its software and programming industry. Microsoft is estimated to have one hundred and twenty eight thousand employees (128,000). Microsoft has been focusing keenly on expanding its markets in all the continents of the world to keep up with competition in the computing world. There are three subsidiaries that I have chosen for this project and they are Microsoft

Economics Article Example | Topics and Well Written Essays - 500 words

Economics - Article Example About $607bn (Â £380bn) of investments and tax increases are intended, including decline in the defence finances, the end of a employee tax celebration, transform to Medicare stipend and elevated individual taxes. The poorer are positioned to drop child and earnings credit, but Mr. Obama has made less references to other portions of the incentive deal is set to end ahead of tax cuts. The fiscal cliff is about to give results because Congress is unsuccessful to arrive at a deal on shortage following a stand-off above the US debt at maximum levels in mid-2011 (Wible 74). Congressional Republicans have alleged ever since previous weeks US elections that they are released to elevating income by tax alterations and finishing loopholes, but resist tax increase on the rich. The president has always resisted expanding the Bush-age tax cuts for wages over $250,000 a year, but confers into Republican claims in 2010 when the tax cuts were previously reconsidered for restoration. Mr Obama would not like this to happen again. He told that he was positive that the White House and Congress could arrive at an agreement to evade the "fiscal cliff", as the US financial system could not have the funds for it. He proposed the quick expansion of all the dying tax cuts apart from the top prices, tracking a more complete alteration of the tax code as well as several of the US largest profited programmes, together with the Social Security in 2013. In doing so, he detach himself from his personal party who want mutual tax increases and cuts to occur as it is an arrangement to give Mr. Obama a better negotiating position. Doing this would generate more doubt in the financial marketplaces. House Speaker has programmed a reaction to Mr. Obama, as the White House intended to assemble the congressional leaders, when in cooperation they are anticipated to

Political Organization Essay Example | Topics and Well Written Essays - 250 words

Political Organization - Essay Example It could be said that there are two structures with regards to organizational politics. One of it is more oriented to the organization’s needs as a whole, while the other focuses on the needs of the individuals within the organization. The former is called the Theory X form, while the latter is called the Theory Y form. Velazquez pointed that a â€Å"group may genuinely believe that X is in the best interest of both the organization and itself, whereas the person may genuinely believe instead that Y, which conflicts with X, is what is in the best interest of the organization† (p.485). One structure is very rigid and is aimed toward group progress more than individual development, while the other foregoes group progress for the sake of the development and welfare of individual persons within the organization. The problems raised from organizational politics are usually found in the various methods of political tactics done to meet a group’s or individuals’ objectives for the organization, and also at times out of self-interest. Velazquez posited that â€Å"the fact that political tactics are usually covert means that they can be easily become deceptive or manipulative† (P.485). The issue of trust will always be a constant problem in organizational politics. Many times, power groups within an organization would have their credibility held in question. It cannot be helped that sometimes selfish interests get ahead of professional individuals or groups. This would result to distrust among people within the organization. To remedy this, steps must be taken to make actions more transparent; thus, gaining confidence among those within the

Reading report Essay Example | Topics and Well Written Essays - 250 words

Reading report - Essay Example Just as a few teachers improve the virtue of youth while others corrupt them, South Side may improve some children and corrupt those other children who are â€Å"left to it by their parents, with no one to educate them about what they are seeing† (Young, 7). All children do not have the mitigating influence of parents who discuss and educate them about the sitcom’s content. Again, many people are like Eichmann, and are â€Å"unable to take another’s standpoint† (Young, 8). In such cases, South Side may not engender critical reflection. It may also make Cartman a role model for those who blindly imitate behavior on television and remain thoughtless and manipulative. Young is right in contending that South Side plays a positive role in philosophy by igniting debate and discussion. South Side may serve as the gadfly which instigates philosophical reflection, but it is definitely not the equivalent of a Socratic

Leadership 1 Assignment Example | Topics and Well Written Essays - 750 words

Leadership 1 - Assignment Example This paper compares and contrasts these two leadership models. In addition, this paper also explicates under what conditions these theories would be utilized, what is important about them, and how they would be significant to the nursing profession. In defining leadership, Couig (2012) elucidates the four elements that make up leadership. Firstly, there must be a procedure or course of action between a leader and his or her adherents. Secondly, the leader must have authority or control over the adherents. Thirdly, leadership must occur in a group set-up with a universal target, and fourthly, projected objectives must be achieved. Leadership theories are based on these elements. Situational leadership theory was coined in by Hersey and Blanchard in the 1970s and was originally referred to as life-cycle theory. At first Ledlow and Coppola (2010. p. 73) notes that "Hersey and Blanchard identified four possible styles of leadership: telling, selling, participating, and delegating". Telling involves giving instructions to the followers on how to behave and conduct their activities; selling denotes giving directions while at the same time encouraging followers; participating involve crating connections or affiliations; and delegating involve allocating specific roles to followers but at the same time offer supervision (Ledlow and Coppola, 2010). According to this theory, the leader is obliged to consider the range of attributes available in a particular state of affairs in order to make an informed decision. According to Couig (2010), the leader is also obligated to alter or transform his leadership approach and align it with the level of preparedness of adheren ts, their level of motivation, and capability. For instance, employees with low levels of motivation require a different approach as compared to those with high motivation levels. The second leadership theory is

Unwrapping Technology Essay Example for Free

Unwrapping Technology Essay Today’s educators have an endless pool of technological teaching aids at their fingertips. The Worldwide web has put teaching programs, learning apps, downloadable content, and all manner of communication at the availability of everyone. This information is readily and easily accessed. There are electronic whiteboards, video creating and editing programs, Ipads, learning games regarding all subjects, and an endless pool of help and ideas that can facilitate teaching, learning, and communication. Teachers can utilize them all to help students reach each of the standards implemented in NETS-S. The standards for this bracket include creating videos that record and document school or community functions, gather data, use digital tools and resources, use information gathering technologies, learning to identify and solve computer problems, explore curriculum from perspectives of other cultures, evaluate and determine credibility of resources, and among other things engaging in online collaborative learning projects. All standards work together to create an informed student who has the basic tools needed to become successful in a swiftly advancing technological world. Among the many standards and requirements expected to be learned by 6th-8th graders almost all of them are right on the mark and can easily be implemented in the classroom, especially number 2. Standard number 2 refers to creating animations or videos that document school or community events. This age group is constantly taking photos or videos for their own social outlets. Tapping into this type of media will be inspiring for the students and can encourage learning through a skill they enjoy and identify with. Learning through the use of technology can be a wonderful experience for students. There are many ways technology can be used to enhance lessons or engage the students, where more primitive manners of teaching such as straight lecture and note taking can be dry and quite frankly lose the interest of the students. One such tool is the electronic whiteboard. The electronic whiteboard allows the teacher to project images for their computer onto the board in the front of the class. A teacher can prepare a slide show, power point, or show movies or videos regarding the subject being taught. This can draw the attention both visual and auditory of the class. Watching a movie where a science experiment is done can be more intriguing than just listening to a speech about it. Ipads are another great tool that can be used to create an enjoyable learning experience. They can be used to play learning games or even as a manner for communication for certain handicapped students. All of the NETS-S standards and requirements are reasonable there are some that may not be implemented or may be difficult to support. For example: Creating â€Å"original animations or videos documenting school, community, or local events. (NETS-S, 2008) may be difficult if the school does not have video equipment or programs to support this type of activity. Each school will have its own set of standards and available tools that need to be taken into consideration when trying to follow standards. Teachers may have limited resources to work with but they can attempt to apply for grants from sites such as Grant Wrangler (http://grantwrangler. com/) and Teachers Count (h ttp://www. teacherscount. org/teacher/grants. shtml). The resources are out there but need to be sought out and found. The one expectation that I feel is missing from the standards are relatively fast typing skills. Typing skills can be quite a useful skill to teach and can aid students from this age group up as they begin to have more and more typed assignments given. The usage of programs such as â€Å"Word† and becoming familiar with it will also be helpful from this age all the way up to college. By giving them these two tools we are preparing them for their future. The NETS-S standards are put in place to help nurture students to evolve into capable and involved community members. The technological world we live in is changing more rapidly than ever and it is in the benefit of both student and teacher to learn and advance with the times so they can be knowledgeable and stay at the forefront of these changes. As educators it is part of our job to prepare students for their future, and much of our future lies in technology, NETS-S is helping us do that. Reference: NETS-S . Retrieved from http://www. iste. org/docs/pdfs/nets-s-2007-student-profiles-en. pdf? sfvrsn=4

Dementia Care Training for Nurses

Dementia Care Training for Nurses Improving Dementia Care Training for Registered General Nurses and Adult Student Nurses: examining the need, efficacy, content and barriers. This Independent Project aims to explore the efficacy of current provision for Dementia care training for Adult branch Student Nurses and Registered General Nurses (RGN’s). A range of audits and research literature on this area of special interest will be examined to obtain a better picture of the situation with an aim to discover a recommendation for whether more training in this area is needed. The content and provision needs of training will also be explored with barriers to effective care and training critically analysed. Introduction Dementia is an umbrella term used to describe a wide range of symptoms caused by certain diseases or conditions associated with decline in a person’s cognitive abilities such as memory, personality changes, impaired reasoning and use of verbal language, which are severe enough to reduce a person’s ability to perform every-day activities (Chater and Hughes 2012). The most common of these diseases is Alzheimer’s reference. Dementia is progressive and incurable, therefore it is vital these people are supported and cared for by nurses who have been trained with the skills and knowledge needed to deliver high quality evidence based care. ADD IN STRONG REFERENCE THAT TRAINING IMPROVES QUALITY EVIDENCE-BASED CARE. There are currently 800,000 people with dementia living in the UK, with these figures expected to rise by 40% over the next 12 years and by 156% over the next 38 years due to an ageing population. Evidence from the Department of Health (2012) shows that 95% of these people are over the age of 65 and are therefore more likely to have complex medical needs. As a result; they spend increased time in acute hospital wards under the care of RGN’s, making training in this area for this group of health professionals a contemporary issue which needs exploration (Department of Health 2012) . The rising number of patients with dementia presents a challenge for all acute hospital trusts and many different health professionals. Such patients experience higher mortality rates and are more likely to have longer lengths of stay than others, they are also more at risk of falls and other incidents whilst in hospital (Cornwell et al 2012). Aside from the cost implications to the NHS when trusts do not get to grips with this challenge, the patients are not getting appropriate care – they are not ‘living well with dementia’ (Department of Health 2009). The National Dementia Strategy set a clear vision that people with dementia and their carers should be helped to live well with dementia, no matter what the stage of their condition or where they are in the health and care system. Through examination of Dementia training efficacy, it is hoped a recommendation will be made to improve the lives of those living with Dementia through changes in Dementia Care training for RGN’s. Following initial exploration of evidence available surrounding Dementia care training, the following issues will be addressed and critically analysed: Why is Dementia Training for RGN’s needed? How can the efficacy of training on Dementia care for RGN’s be improved? What content should be used in Dementia care training? What are the barriers to implementation of Dementia care training? Why is Dementia Training for RGN’s needed? Patients admitted to acute hospital wards with dementia have comparatively poorer outcomes regarding length of stay, mortality and further institutionalism (DH 2009, Alzheimer’s Society 2012). In addition, this group of patients place higher demands for nursing care, are more likely to functionally decline during admission and suffer increased rates of delayed discharge. This can result in permanent decline in health and added costs to NHS trusts (Mukadam and Sampson 2011). Though thought by many to be due to their complex health needs (REFERENCE), The Health Foundation (2011) has suggested a significant reason for these poorer outcomes is lack of professional understanding by RGN’s in providing appropriate care. Improvement in Dementia care is currently a nationwide health initiative reference. National audits over the last 5 years have recommended implementation of dementia services such as dementia lead nurses, standardised assessment and care protocols and compulsory staff training (DH 2009, Harwood et al. 2010, Thompson and Heath 2013, RCP 2013). Yet there are many recent reports of poor and sometimes negligent care suggesting these recommendations have not yet been followed or implemented (Leung and Todd 2010, Francis 2013, RCP 2013). Results from the National Audit of Dementia Care in general hospitals indicated that nurses working on acute wards rated significantly lower adequacy of training than nurses working on care of elderly wards. Other audits such as Counting the Cost report (Alzheimer’s Society 2009) indicated that more than half of nurses had not received any pre or post registered dementia training. Elliot and Adams (2011) further identify the lack of understanding around Dementia, meaning the needs of older people with Dementia are not addressed in many acute hospital settings. As can be seen, the need for specific training in Dementia care for RGN’s is strong. There is evidence to support positive influence on effective care with training. The National Audit of Dementia Care in General Hospitals (NAD 2012) was commissioned by Healthcare Quality Improvement Partnership to address the concerns of care for people with dementia (Tadd et al. 2011). These audits aimed to identify hospital’s provision of assessment, care models and staff training. Following the 1st round of audits in 2011 a report by Thompson and Heath concluded that the main barriers to providing good care were lack of understanding of the condition, not enough time to care and failing to communicate with patients. Improvements are not as forthcoming in dementia assessment on admission to acute wards. Results from the 2nd round audit of NAD acknowledge that there had been improvement in implementation of staff training frameworks in hospitals since the 1st round audit and represented an improvement in care as a result (Royal College of Psychiatrists 2013). The 2nd round report highlighted that approximately 75% of hospitals now provide dementia awareness training to nurses, although almost 50% are still failing to provide dementia awareness training as part of induction programmes. The report suggests that further improvement is required in providing better and more consistent staff training, as despite some progress, there appears to be a gap between actual training and written reports (RCP 2013). As a result, the recommendations outlined and analysed in this Independent project may be of some use in raising positive statistics. How can the efficacy of training on Dementia care for RGN’s be improved? It is the evaluation of this evidence which aims to generate key recommendations for provision of Dementia care training. Elliot and Adams (2011) were able to show improvements in needs met where specific education for RGN’s is provided by a Dementia Nurse Specialist (recommendation number 1). This shows the role of the Dementia Nurse Specialist to be vital in improving the efficacy of Dementia training and infiltrating best possible evidence-based care into clinical practice. However, despite this, the minimal numbers of Dementia Nurse Specialists currently practicing has to be identified as a limiting factor. In many trusts and academic institutions, there is no availability for a Dementia Nurse Specialist to provide training, therefore limiting efficacy even when extensive training is to be provided (Knifton et al. 2014). In terms of training content, it is well documented that evidence used should be reliable and credibly underpin clinical practice as this promotes evidence –based practice and better health outcomes (Jeffs et al. 2013). Evidence based practice is vital in all nurses’ roles (REFERENCE NMC CODE). REFERENCE suggests up to date qualitative and quantitative research is the only knowledge and information base which should be used to allow best care to be provided, hence placing important value of increased use of evidence based research in training sessions. Currently, Moyle et al. (2008) suggests the lack of research used to underpin Dementia training for RGN’s is limiting ability to not only provide best care but also identify those living with Dementia (Chang et al. 2009) RECOMMENDATION 2. However, barriers to evidence based care remain even when high quality evidence is used to support training. Smith-Strom and Nortvedt (2008) have identified that RGN’s ofte n find evidence difficult to interpret and evaluate while Oermann (2009) suggests very little of the content is retained to be implemented into practice. This suggests RGN’s may also need training on evidence based practice and processing research (REFERENCE). Gerrish (2008) suggested the knowledge and skill of the individual nurse prior to receiving specific training heavily influenced their ability to improve their practice following. This suggests multiple training sessions on Dementia may be needed before practice can be changed and improved (REFERENCE). RECOMMENDATION 3. What content should be used in Dementia care training? Tadd et al. (2011) explain that one reason for increased functional decline is that care of patients on acute wards is prioritised from the perspective of the medical condition for which they have been admitted, often overlooking their mental health condition. Most acute wards follow rigid, task driven routines such as drug rounds, meal times and washing, while staff lack the necessary skills required to provide proficient dignified care. This form of nursing can cause increased anxiety and delirium resulting in poorer outcomes for individuals (Tadd et al. 2011, Calnan et al. 2013). Alzheimer’s Society (2009) report that patients admitted to acute hospital wards for longer periods are more likely to suffer from permanent worsened effects of dementia and physical health. They are more likely to receive prescribed antipsychotic drugs and to be discharged to residential care rather than their home (Thompson and Heath 2013). Leung and Todd (2010) acknowledge that specialist services do exist in some trusts and that training in managing behaviour, using life stories and implementing dementia care mapping are all good techniques that can help nurses to improve quality care. Dementia care mapping is an observational method of recording interactions that take place between individuals and nurses over a period of time (Ervin and Koschel 2012). This enables evaluation of what works and doesn’t work for patients, it is a useful way of tailoring person-centred care to help staff understand the experience of dementia from the patient’s perspective while rating quality of care given (National Institute for Health and Clinical Excellence and Social Institute for Care Excellence 2007) (NICE-SCIE). Alzheimer’s Society (2013) suggest that nurses must challenge their task driven ward environment and provide a more flexible approach providing care from the patient’s perspective as this is achievable and beneficial to patients. Leung and Todd (2010) reported that most nurses have received little or no training and are ill equipped to deal with the many challenges that face both patients and nurses. Additionally NICE (2013) state that nurses suggest dementia education programmes should include identifying signs and symptoms, communication and person-centred care methods, treatment to include medicine administration and how to monitor side effects, particular emphasis was placed on requirement to assess pan. Nurses also suggested that learning about the impact of dementia on the individual and managing challenging behaviour would be useful. Dementia training is not a compulsory element of the pre-registered nursing curriculum although this has been recommended to the Nu rsing and Midwifery Council (NMC) by several national organisations. (NICE-SCIE 2007, Alzheimer’s Association 2009, All-party Parliamentary Group on Dementia 2012, Higher Education for Dementia Network 2014 (HEDN)). The NHS Confederation (2010) recognise that providing dementia training to staff could benefit hospital trusts in several ways. These include nurses being equipped to identify those with dementia, therefore being able to implement care pathways appropriate to patients. Effective management of patients with dementia helps avoid disorientation and anxiousness which could reduce the amount of time spent attending to challenging behaviour and allow staff more time to care for all patients on an acute ward. What are the barriers to implementation of Dementia care training? Even when effective dementia training has been provided, barriers to good quality evidence-based care remain and it is important these do not go unnoticed. Identification and knowledge of these barriers alone can minimise their limiting factor (reference). Acute hospital settings pose many challenges to both patients with dementia and the nurses caring for them. Yet Harwood et al. (2011) report that there is little evidence of research aimed at investigating these challenges and the provision of detailed policies on how to deal with them. Patients with dementia are more likely to find an unfamiliar environment unsettling, frightening and confusing due to the nature of impaired cognitive ability (Moyle et al. 2008). This accounts for literature suggesting that an acute ward environment comprised of identical doorways and bed spaces causes added confusion to patients (Reference). This often creates increased disorientation, aggression or withdrawal (Leung and Todd, Thompson and Heath 2 013). This further challenges the nurse’s role in maintaining nutritional, personal hygiene and drug administration tasks as individuals can no longer respond to familiar faces, environment and daily routines (Tadd et al. 2011). Barriers Overcoming the barriers The government accepts improvements are needed and is pinning hopes on the  £3.8 billion Better Care Fund, which will was launched in April 2015. The pot has been earmarked for joint projects between the NHS and local government to encourage more integrated care. STUDENT NURSES 2015 report: Dementia education to bestandardised at degree level some nursing degrees offer only three hours of dementia education throughout the whole three-year course. How this should change following the dementia core skills framework, but it doesn’t state how many hours students will be required to undertake. Student nurse attitudes towards working with the elderly Future plans for RGN’s HEE 2013 Mandate targets. – ensure that tools and training opportunities in dementia are available to all staff by the end of 2018. Current training requierments of RGN’s in relation to Dementia training References Department of Health (2009) Living well with dementia: a national dementia strategy. The Stationery Office, London. National Institute for Health and Clinical Excellence/Social Care Institute for Excellence guideline (2006) Dementia: supporting people with dementia and their carers in health and social care. NICE/SCIE, London.

Public Transportation | Construction Essay

Public Transportation | Construction Essay Public transportation is an essential service that must be provided by the government to its citizen. Yet, it still an issue faced by most of developing countries all over the world including Malaysia. As it begins to transform itself to become a developed country in 2020, it is a crucial to have comfortable, reliable and affordable world-class public transportation system to meet the target. According to Ministry of Transportation (2012), by having efficient transport network, several main transport issues faced by urban populations such as high traffic congestion during peak periods, cancellations and frequent delays of service and poor access to public transport services and network can be solved immediately. As part of government commitment to develop better system for public transportation, Malaysia has invested in many public transportation planning and development program over the years. For example under 9th Malaysia Plan (2006-2010), RM 31.8 billion was allocated to improve the public transportation performance. (Government of Malaysia, 2006). An additional RM 35 billion was further allocated under Budget 2009 (2009 2014) to enhance the public transportation services in Malaysia, for the allocation of new buses and provision of better infrastructure facilities (Bernama, 2008). However, the utilization rate of public transportation is still poor and the use of private vehicles is continuously rising. This scenario indicates that there are probably several flaws within the previous and current approach (PEMANDU, 2012). Since public transportation is very important to the social and economic life of the citizens, a new plan of massive improvement under Government Transformation (GTP) Program, the National Key Result Area (NKRA) has been launched in November 2009. There are 6 initiatives under this program and one of them is UPT-NKRA. It stands for NKRA Urban Public Transportation. The objective of UPT-NKRA may different based on the phase of its implementation. Below are several objectives that need to be achieved in 2010 and 2012. Improving the public transport modal share from 11% to 15% by the end of 2010 and to 25% by the end of 2012 during the morning peak period of 7am to 9pm in the Klang Valley and will subsequently adapt and apply successful initiatives to Penang and Johor Bahru; Improving reliability and journey times;   Enhancing commuters comfort and convenience; and   Improving accessibility and connectivity so that the percentage of the population living within 400 metres of a public transport route increases from 63% to 80% in 2012. (Source: Ministry of Transport Malaysia 2012) In the real world, government policies may not achieve the target and the actual needs. Most of developing countries have contributed so many efforts towards providing better public transportation. However, the implementation always faced with many difficulties. In Pakistan for instance, it was found that, factors like overstated role of the private sector, lack capacity among public transport organizations, negligence in the development of high-capacity public transport, failure to use existing land and integration difficulty had been identified as major problems led to the unsuccessful of their policies (Imran, 2009). The continuous failure to serve the demand of citizens to enjoy better public transportation service is not good for a developed country to be. In Malaysia, proper planning and significant improvement only had been seen in several main cities such as Kuala Lumpur, Klang Valley and Penang. On the other hand, Kota Kinabalu, the capital city of Sabah that is experiencing rapid population growth and tremendous economic activities still have to depend on bus to bring them into their destinations. This research will try to analyse the impact of public transportation policy on public bus transportation in Kota Kinabalu. Government policy at federal, state and local level will be analysed together with several issue in public transportation. Besides, the feedback of various stakeholders mainly from the government and respective authoritative body, private bus-operators as well as the public users will be taken into account. PUBLIC TRANSPORTATION IN MALAYSIA Kota Kinabalu and its Public Transportation Kota Kinabalu is the capital city of Sabah which is populated by people from various ethnics, races and religions. It is located within the rapidly developing West Coast Division  [1]  . Over the years, this city is experiencing several infrastructure developments. Many shopping complexes and commercial buildings had been erected and these have encouraged more business and trade activities. Kota Kinabalu is considered as an urbanizing city due to its economy and population growth. In 2010, the total estimate number of population in Kota Kinabalu is 452, 058 (Statistics Department, 2011) with average household income RM 2487 per month (Economic Planning Unit, 2011). Apart from becoming a centre for education, business and social activities, Kota Kinabalu also have a number of attractive destinations for the local and international tourists. It was reported that, domestic and foreign visitors entered Sabah through Kota Kinabalu is 100,000 in 2004 and increased to 600, 000 in 2010 ( Sabah Tourism Board). To date, bus (includes express bus, minibuses and vans) still served as the main mode of public transportation to the local residents of Kota Kinabalu. The public bus system is operated by various private companies featured with variable quality. They provide travelling network and service in the urban, sub-urban and intercity areas. The main terminal is located in front of Wawasan Plaza Building where the urban and suburban buses pick and drop their passenger all over again. Another terminal is located in Inanam provides intercity buses service towards long distance travels such as Kudat, Ranau, Sandakan, Tawau, Lahad Datu and Semporna. Taxicabs also still operate in this city but the service focus at the several main areas only such as at the airport, hospitals and terminal bus. Besides, a railway system known as Sabah State Railway also operated in this city. However, the destination coverage is limit to several areas where it connects Kota Kinabalu with Tenom and several other to wns in between this railway it provides daily services for commuters, travelers, as well as for cargo transportation. Players in Public Transportation: Government Entity Government entity is the important stakeholders in public transportation. Any policy formulated by the government will affect the whole public transportation system in our country. Based on the interpretation provided by Land Public Transport Act 2010, government entity defined as the federal government, or any state government, state authority or local government; and any ministry, department, office, agency, authority, commission, committee, board, council or other body, corporate or unincorporate, of the Federal Government, or of any State Government or local government, whether established under written law or otherwise. In Malaysia, federal government is most responsible party to ensure the better performance of public transportation throughout the country. Only this level of government able has the power to approve and grant funding to any plan and project suggested by the subordinates governments. This is clearly mentioned in the Laws of Malaysia (1997) where the responsibilit y for financial allocation to regional authorities or local authorities lies with the central government (Vigar et al, 2000). Not only responsible in allocate money to be distributed to the subordinates government but also federal have the power to approve or disapprove any project and program proposed by the lower governments. As transport matters are a federal listed responsibility under the Constitution of Malaysia., the improvement of the public transport system can only be carried out with central governments approval since the Transport Ministry holds absolute power over transport planning (Laws of Malaysia, 1997). There are several department and unit under the federal administration works for public transportation namely Land Public Transport Commission, Road Transport Department Commercial Licensing Vehicle Board in Sabah and Sarawak and many more. Land Public Transport Commission (LPTC) Land Public Transport Commission is established on 3 June 2010 after the formulation of Land Public Transport Commission Act 2010 by Parliament in May 2010. This commission gained its full powers under the Land Public Transport Act 2010 and coming into force on 31 January 2011. By the establishment of this commission, the functions of Commercial Vehicles Licensing Board, Department of Railways and the tourism vehicles licensing function of the Ministry of Tourism in Peninsular Malaysia have been made inapplicable. However, LPTC only have jurisdiction power over peninsular Malaysia. The commercial Vehicles Licensing Board, Department of Railways and the Ministry of Tourism still continue to exercise their respective powers in Sabah and Sarawak. The table shown below summarize the power description of LPTC. Powers Descriptions Planning Master plan to ensure comprehensive, integrated and sustainable infrastructure development. SPAD shall propose policies and plans in relation to or affecting land public transport, and develop strategies in line with the approved policies and plans with a view to achieving a safe, reliable, efficient, responsive, accessible, planned, integrated and sustainable land public transport, while ensuring the provision of affordable services for the carriage of passengers and competitive services for the carriage of goods.(The Land Public Transport Act 2010) Regulatory Monitoring and regulate standard of performance of operators through licensing. Regulating all matters pertaining land vehicles such as train, bus and taxi services as well as road and rail-based freight transport Enforcement Enhanced powers encompassing powers to audit, investigate, suspend/revoke license, seize vehicles, and penalise operators. Carry out with close cooperation with other enforcement agencies such as the Royal Malaysian Police and the Road Transport Department. Source: Land Public Transportation Commission Official Website, 2012 Road Transport Department This department is established on 1 April 1946 with the purpose to synchronize all aspects related to transportation all over the states. In line with the establishment of this department, various acts relating to land transportation had been formulated for example Road Traffic Ordinance 1958 and Land Transportation Act 1987. Both aim to uniform and standardize the national transportation law as well as to provide guideline to the department officers in exercising their duties. This department is under the Land Unit of Ministry of Transportation in Malaysia. It is responsible to provide counter service for vehicle and driving licensing as well as to enforce Land Transportation Act 1987 to ensure well behaved drivers and safety of the roads users. Commercial Licensing Vehicle Board Sabah (CLVB) Commercial Licensing Vehicle Board in Sabah is established under Commercial Vehicles Licensing Board Act 1987. As stated in the act, the member of the board in Sabah must be appointed by the Minister and shall consist the a chairman, a deputy chairman, a representative of the State Ministry charged with the responsibility for transport, a representative of the Road Transport Department, a representative of the Federal Ministry charged with the responsibility for matters relating to the licensing of commercial vehicles and not more than six persons who in the opinion of the Minister have had wide experience or special knowledge in matters relating to transport. CVLB is set up to assist the development of commercial transport industry by establishing policies to ensure a sufficient and efficient commercial transport service (ww.malaysia.gov.my) Local Government The position of local government in Malaysia is stated in Federal Constitution. By virtue of items 4 and 5 of Ninth Schedule of Federal Constitution, local government outside the Federal Territories of Kuala Lumpur, Labuan and Putrajaya is a subject under the State List. All local authorities outside the Federal Territories will be under the exclusive jurisdiction of States Government. There are 146 local councils in Malaysia made up of city councils, municipal councils, district councils, and special authorities and Kota Kinabalu City Hall is among of them. KKCH is only responsible to provide bus terminals, provide road lighting in their territory Problem Statement Since the last three decades, government at the federal and state as well as at the local level had created various policies and plans to improve public transportation especially in urban areas. To date, significant improvement on public transportation had only been seen in several main cities such as Kuala Lumpur. The difference of this city from the others is that, apart from having various mode of modern transportation such as Light Rail Transit (LRT) and Monorail System, Kuala Lumpur also have an integrated public bus system namely RapidKL which is characterized with attractive appearance, safety, standardization and reliable schedule of journeys. Kota Kinabalu, one of the developing cities in Malaysia relies predominantly on buses for public transport since the past until present time and it will likely to continue to be so for years. However, it is still not well-developed and people still perceived it as inadequate, less comfortable, less physically-attractive, non-punctual an d unsafe. The only noticeable changes is the introduction of city bus service in 2009 which is still not give big implication to the performance of public bus transportation. As an effort to make continuous improvement on public transportation, UPT-NKRA is then launched in 2009. After almost 3 years of its implementation, certain cities begin to show the improvement on their public transportation services. Based on the GTP Annual Report 2011, 470 RapidKL buses were introduced, which increased the frequency of buses across the Klang Valley. As of 31 December 2011, up to 4.04 million more passengers used the RapidKL bus service in comparison to the preceding year. According to the prime minister, Dato Seri Najib Tun Razak, results of the NKRA of improving urban public transport have been promising as more people are taking the bus as their mode of transport (Bernama, May 18, 2012). Recently, the coordinator of the working group on public transportation in Malaysia, Mr. A. Sivarajan urged the government to re-evaluate national public transport policy in order to provide a more effective and efficient system to consumers (Bernama, October 25, 2012). According to the working group, several main problem as the concentration of bus service within Kuala Lumpur, the unsafe locations of bus stops, the non-passing of bus at certain bus stops area and poor network connectivity had been identified. The above-mentioned scenario convinced the researcher of the need to analyse the government public transportation policy. Based on the assumption that the public transportation policy is vague and implicit to the other states and cities, there is a need to critically assess the policy in the context of public bus transportation in Kota Kinabalu. In trying to critically analyse the policy, it is equally important to explore the issues in public transportation and to examine the feedback of the various stakeholders regarding government effort to improve public transportation though its policy implementation. Research Objectives To analyse the public transportation policy regarding the public busin Kota Kinabalu To scrutinize the public transportation policy at federal, state and local level To examine the feedback of main stakeholders regarding government policy and public bus improvement in Kota Kinabalu To explore the issues associate with public transportation To recommend solutions for policy improvement purpose Research Questions In respond to the listed objectives, several questions had been formulated and will be answered through the research. The questions that take into account are: What are the government policies regarding public transportation in Kota Kinabalu? What is the position of bus in public transportation policy? How public bus transportation in Kota Kinabalu develops from the policy implementation? What is the stakeholders feedback towards the implementation of public transportation policy in Kota Kinabalu? How the issues affect the implementation of public transportation policy in Kota Kinabalu? Scope of Study This study will be conducted in Kota Kinabalu. The focus is to analyse how the government policy affects public bus transportation in Kota Kinabalu. For the purpose of policy analysis, it will cover the period since 1990 to present. The respondents of this study will be the representative from government and other authoritative bodies such Kota Kinabalu City Hall (KKCH), Road Transport Departments, Commercial Licensing Vehicle Board (CLVB), and private bus-operators as well as public bus users. This study would be conducted from February 2012 to June 2013. Limitation of Study The first obstacle that will be confronted by the researcher is limited accessibility to the desired data. Since this research employed historical method, the access to some existed data may not be granted. For example, government documents such as budget and policy plan that is perceived consist of confidential information will not be easily given. Besides, some of required data may not be available due to poor record system such as ineffective newspaper cutting service. The absence of these sources creates difficulty in tracing the chronology and meaningful trend of the public transportation policy and progress in Kota Kinabalu. Therefore, in order to get sufficient information, the data findings will not focus to one single area only. Several places need to be visited and more key actors need to be interviewed. The second obstacle is the availability of the key person (respondent). In qualitative research that used interview method to collect the data, difficulty will arises when the respondents cancel the interview appointment due to other commitments. Some of the respondents especially those at the top level management usually busy and often going outstations. This situation will possibly caused the problem to collect and analyse the data within the time framework. Therefore, the researcher must always follow up with the respective respondents and plan the interview schedule in organized manner together with the backup plan. Significance of Study The finding of this research is important for future planning purpose. It acts as a feedback to the current public transportation policy. The policy makers will be able to decide whether to change or to maintain the status quo of the policy based on the information provided. Besides, it also will contribute to the body knowledge of public transportation literature especially in the context of Sabah. It was found that here were few studies done to analyse the public transportation policy and none of them found to discuss the topic in regards with the public bus transportation. Thus, it creates difficulty to the researchers to find convincing and strong statement to support the findings. At the same time, it will serve as a source of reference to the future researchers who seek information regarding this topic. The findings also will offer valuable information to public users as they will get cleared pictures and more understanding about the policy progress and how to improve the public bus transportation in Kota Kinabalu. Definition of Terms and Concepts Policy According to Dye (1984), public policy is defined as whatever government choose to do or not do. Dye definition is too broad to be really meaningful but by defining policy in such a way, it is possible to determine the actual or working policy of a government based on what government do or not do (Gunggut, 2006), As for him , it is not enough to look at the written documents such as laws and cabinet decisions but what is actually being done or not being done by the government. In this paper, policy refers to any action and effort the government want to do and not to do including any program, plan and project that being formulated to serve the public interest. Policy Analysis Dye (2000: 4) defined policy analysis as the description and explanation of the causes and consequences of government activities. For him, an analysis of a public policy should be exhibit a primary concern with explanation rather than prescription which is means the policy analyst should attempt to develop or test general propositions about the causes and consequences of public policy and to accumulate reliable search findings of general relevance. Public Transportation Public transportation is defined as transportation by a conveyance that provides continuing general or special transportation to the public (Tran Kleiner, 2005). It excludes school buses, charter and sightseeing service and includes various modes such as buses, subways, rail, trolleys and ferry boats (Ibid) Unilever Case Study Analysis: SWOT Unilever Case Study Analysis: SWOT INTRODUCTION: There are many kinds of business everywhere; where there are many issues related to the growth of the company and Different strategies will enable different companies to reach those goals. Unilever is a company started in 1930 formed of Dutch Margarine Company and British based lever brothers. Unilever holds a wide range of products which include food, personal care, beverages, canned foods, ice creams and many more which are worlds best consumer brands. The case study describes a lot of information regarding Unilevers business strategies, key elements of Unilevers path to growth, how they rejuvenated and restructured the companies slow moving performance to wide range of brands across the world. BRIEF CASE STUDY: Unilever was created in 1930 as an outcome of merger with dual chairpersons and headquarters one in Netherlands and other in United Kingdom. This is of one the giant and best competitors in the industry which holds wide range of products. The two chairpersons have launched a strategy in early 2000 to recover the companys performance which was said to be lackluster. With the new strategies the company showed a significant progress and has gone through many dealings over the next years, this made the company to open 20 new acquisitions worldwide and increased the sales of the company. Thus the companys business was restructured, renovated and improved through its acquisitions. Then their came companies likes nestle which effecting the growth of Unilever. Unilever then started efforts to attract and motivate young, talented and innovative managers from outside its company. TASK 1: SWOT : A planning technique which is used for summarizing the key issues and evaluates the Strengths (S), Weaknesses (W), Opportunities (O) and Threats (T) in any business is called an SWOT analysis. Analysis is the brief study of any case how they are going to be obtained, who are responsible for causing it and solving it by planning which involves internal and external factors of a business or an organization; internal factors are classified as strengths(S) or weaknesses (W) and external factors are classified as Opportunities (O) or Threats (T). Strengths are those characteristics of a person or a company that are useful to achieve the goals. Weaknesses are the characteristics of a person or a company that is destructive to achieve the objective. Opportunities and threats are the external factors that are helpful in achieving and damaging the business performance respectively. The figure1 show the illustrative diagram of SWOT analysis. The internal factors include personal, finance, manufacturing capabilities, etc and the external factors may include technological changes which may cause changes in products and processes that is inventing a new product or making the product better which include quality of the product and the consumer desire, market influences due to unemployment rates effect the company and price factors is one of the important thing to keep in mind , market place is one more thing which is very important that is the company or a business should be located in a convenient environment to the consumers to attract and the product should be user friendly. Another important factor is that its external appearance the packing and the name of the products should be eye catchy. At last he customer relations should be friendly and consumer satisfaction is very necessary. Other than these there are some more factors which may be changing due to econ omic and social factors and competitive positions which may create new opportunities or threats. SWOT analysis is useful in decision making when most wanted these include nonprofit organizations, individuals. It is the only method for classification and has its own weaknesses. A SWOT which produces no strategies is of no use whereas which generates important strategies is useful. Unilever had a very tough competition during that time when it was bringing about the changes it was probably at this stage that these companies had moved forward with there various strategies. Skills, assets, finance, facilities are the resources which are used in any business to compete in the industry. In the same way Unilever used their own resources to grow as giant company. They have implemented SWOT analysis and implemented new business strategies and rejuvenated their company from lack lust to significant progress in sales. It has concentrated on marketing and advertising its business and gained increased pricing with supermarket vendors. Unilever was lagging in sales when compared with nestle, Procter Gamble, Kelloggs etc its path of growth strategy which met considerable uncertainty which made Unilever to undertake a series of actions by cutting the companies profile to reach corporate goals and introduced 20 new acquisitions worldwide and restructured the company into two divisions one includes all food products and other household and personal care. Then started other two new businesses across the world. The external market factors such as technological changes, social factors, and other companies growth made a very big impact on the consumer preferences and Unilever had to cut its revenue growth. Later it continued to obtain more products across the world and these products gave managers to make their own decision making to set priorities by introducing new initiatives. Unilever has even motivated and attracted young talented managers from outside the company to join their company. According to Unilevers SWOT analysis the strengths of the company are recognized as it is a global company with strong brand profile with worlds best brands and maintains strong relation with its retailers. But coming to its weaknesses it has insufficient management of brands and doesnt not connect with customers. And inability to maximize acquisitions has reduced spending for R D. Thought it has got many opportunities by introducing many products by changing customer preferences and increase in productio n of quality goods. There are threats equally which cause decrease in revenues with high market competition, increasing the number brands and exchange rates. There are many growth expectations, risks, profit margins in food and house hold industry which is composed of many sectors and sub sectors by challenging the change of customers preferences with challenging rival firms to gain market shares. Then with competitive achievement by creating attractive products through acquisitions and with capability of growing sales of the brands which existed and improve margins. For all this the many key to success was advertising the products. By improving the profits of the company not only included shifting sales of the products but also boosting efficiency and unit costs. There were three factors which worried in 2000, the consolidation pressures in food industry which bothered were slower growth rates in food industries, rapid consolidation among grocery markets that is between branded manufactures and private manufactures for good self space in the grocery stores. In the United States for several years the food industry was miserable and was expected to continue for few more years due to more women working and decreasing house hold sizes, single parents and singles. But the food industry in Europe, Asia, Africa and other less developed countries were attractive. Thought the competition between branded and private manufactures was a never ending issue, private manufactures improved their quality of products by growing market shares. Then there came many giant super markets and gave an opportunity for private brands with attractive prices below branded products and even provided checkout scanners to help the customers know price difference which tempt them to BRIEF SWOT ANALYSIS OF UNILEVERS CASE STUDY STRENGHTS WEAKNESSESS Global company. Reduced spending for R D. Best Brands. Inability to maximize acquisitions. Strong relation with retailers. Insufficient management of brands. Dual Leadership. OPPURTUNITIES THREATS Increasing in need of quality products. Decrease in revenues. Changing customer preferences. Strong competition. Increase in brands. shift to the private brands. Due to the heavy competition among them manufactures had to cut down the costs of the products, number of versions of the products and weed out weak brands and concentrate on those brands which were popular among the customers and those could develop into global brands. Introducing dual headquarters by dividing the food industry which consisted of 6 categories and household industry which consisted of 8 categories there were many benefits such as improving food and household industry by focusing more on them regionally and globally. Accelerating decision making and successful integration of R D though there were some critics that Unilever has been paying more for some of its acquisitions such as acquire Amora Maille. Unilever as of then in 2003 had been seen as a growing organization which probably had all the necessary requirements to make it a force to recon with, during the Path to Growth strategy many aspects of the company had come out some of them included the strengths, weaknesses, opportunities and threats. Strengths, probably the biggest strength that the company had at that time was the correct selection of the brands and the products it had in store unilever had done many researches and had to make many decisions to get the right combinations products that where to be sold it also had the right ideas to increase the sales and all the leading brands to help its cause. Unilever was very good at that time even if the financial aspect was taken into consideration it could experiment with various aspects of its store cause had the financial backup which was required at that time to help it implement various ideas and deal with the market pressures, for any company to improve its sales marke ting always plays a very important role this was probably there biggest strength as the marketing strategy applied by them managed to grab peoples attention as they easy to be connected to and much more simplistic and realistic. Unilever did manage all its clients very well considering that during a phase when they where cutting on the brands it would have been a risk to out anything at that time but it was very well managed by the company. Mainly the fact that unilever was now looking to make the higher range or the brands which where more famous as there core brands which made it much easier for them to advertise considering that it is much easier to promote a very well known and a trusted brand rather than a normal or new brand to increase the sales. Weaknesses, though unilever had a very good policy and all the right objectives to make a difference in the industry it couldnt happen basically due to the lack of proper organization, it was actually much like a bureaucratic organization where things where divided between too many people and it had become difficult to get the ideas moving due to the lack of proper organization, it probably all started with the fact that the company had to deal with too many brands in the first place it would obviously have the impact when the Path to Growth strategy came up cause of the then 1600 brands only 400 brands where retained and rest all where either removed or replaced, that shows that due the lack of proper organization and too many brands being part of it didnt help it in making the changes it wanted to in a better and quickest way. The organization was probably one field in which the company was lacking because it was felt that at the top of the company as there were too many people mak ing decisions and these decisions had to be put forward and this delayed the process of improvement for the company. Opportunities, during this phase of development and renewing it content and upgrading of the stock it turned out to be very fruitful as it provided many working opportunities for people it was at that time that many people where starting to get full time work, during this phase a lot of acquisition also took place with the major brands which resulted in some alterations in plans to that which were planned. SlimFast which is a private company is another acquisition of Unilever after implementing path to growth strategy in 2000 the company bargained an agreement to purchase slimfast diet foods. It had strong sales and network and has a special space in every super market and drugstores these products were made from natural ingredients and added vitamins and minerals to provide good nutritional profile. It also maintained a very good relationship with Food and Drug Administration (FDA) and other agencies. Unilever has concentrated more on this Slimfast since the company was growing fast and attracted the customers to buy more of it for healthier and long living life .Management of Unilever utilized the opportunity to globalize the product in other countries like Europe, Australia due to increase in the percent of obese. According to the world health organization percent of the obese was increasing gradually. UNILEVERS TOP COMPETITORS ? Figure: Competitors Performance Comparison http://finance.aol.com/company/unilever-plc-amer/ul/nys/top-competitors Ben Jerrys acquisitions which produces one of the finest ice creams anywhere in pint cartons and wholesale at groceries. Their sales slogan was Vermont finest All Natural Ice cream. They never use any artificial flavors thought the cost is little more it is worth the price. According to the time magazine Vermont makes the best ice cream in the world with 29 flavors in pint cartons and 45 flavors in bulk cartons. There products were distributed throughout the world. On demand Ben jerry operated three manufacturing plants where Vermont plant produces super premier ice cream and frozen yogurts where as spring field produces ice cream, lot fat ice creams in bulk, pint cartons and half gallons. Dreyers and Haagen-Dazs were the two major competitors of Ben jerry and other competitors were Colombo frozen yogurts, Kemps ice cream and star bucks. Ben Jerry produces a wide range of ice creams products like sticks, bars, frozen yogurt pops etc. Though Haagen- Dazs was the global market leader followed by Ben jerry it had an insignificant market share in United States where as Haagen- Dazs was more significantly sold in foreign markets. Both Ben jerry and Haagen-Dazs produced ice creams with cookies and candies in it. Bestfoods was a global company across the world almost in 60 countries which was busy in manufacturing and marketing the food products. Bestfoods profits are almost from outside of the United States that is almost 60 percent of its profits. It is one of the best managed food companies among United States who has much number of employees working with in their company in which half of them were at non US locations. The company increased payments for 14 successive years has its revenues grow by7.8 percent annual rate and suddenly slow downed during the period of 1997 and 1999. Then the company introduced a strategy with four core elements. Globalization of the companys core consumers: Products which are new in the market are needed to be globalized that is the products which are less popular among the consumers, are needed to be advertised and market those products to increase its sales and profits of those products. Few such products are knorr product line, salad dressing and food service operations. The advertising of such kind of products was done very well in order to get those products globally recognized and be accepted among many big brands and soon they became household names. Improvement in cost effectiveness: With changing customer preference the quality of the products must be improved and therefore there should also be improvement in cost effectiveness as the quality improves cost increases. Cost effectiveness is nothing but it is a way by which you show to a customer that a certain is product is worth using or is better than other product or the money u spend on it is worth it. Cost effectiveness in simple would be defined as showing the worth of the product. Looking for new market opportunities: Extending the product sales all over the world via new product introductions and extending sales of the products which are existed in the market. It is very important for any company to be always alert and look for opportunities to extend the business to a large scale and see it in a bigger picture based on the opportunities it gets. Using free cash to make new acquisition: With expanding the products and brands company has created 60 acquisitions in the global market. After struggling a lot in June 2000 best foods agreed to be acquired by Unilever. Best foods were the largest acquisition undertaken by Unilever by as far as concerned and which makes a largest combination of food companies in 12 years. Management of Unilever believed that combining and assimilating bestfoods would result in pre tax cost saving, better efficiencies in business process, synergy in distribution marketing, reformation of general and administrative functions and improved economies of scale. By creating robust business in United States market, increasing strengths of Unilever and best foods in Europe, building of best foods in Latin America to speed up the growth of Unilever brands, by distributing strengths in Asia- pacific to grow and sped up Bestfoods brands and increasing the sales of Unilever products by food service channel of Bestfoods. The work culture was so casual to make the atmosphere fun and lively with communication between the management and employees. The company respected the employees suggestions and respected them even paid the employees a reasonable salary Finally Unilever has announced sale of Bestfoods Backing Company to Canadian food and super market group known as George Weston for $ 1.76billion though Unilever declared to divest Bestfoods Baking Company and Unilever other products and bakery products does not exit any more at Unilever. Bestfoods has 19plans across the United States with a strong management team and was entirely US based. It was one of the best distributing for delivering the baked products which are really baked fresh and sent directly to the retail stores. With its dedication and hard work Bestfoods sales has increased its profit margins by 8 percent. Later again Unilever announced to sell 19 Bestfood brands across North America to ACH food companies which is a supplementary of Associated British Food. By successfully combining the operations of bestfoods with Unilever by the year end of 2003 the two companies had been merged in 63countries across the world TASK 2: Path to Growth: Path to growth strategy was initiated in 2000 and was restructured for several years for better and significant results. The key elements of this Unilevers path to growth strategy were cutting down its brands from 1600 brands to 400core brands to achieve top line sales and increase profits by advertising the brands which are more popular and leading brands across the world and concentrating on R D. Another important key element was divesting underperforming brands and theirs companies and introducing more innovated things to enhance the internal development of the organization and making new acquisitions. Unilevers years of slow performance and its lack of corporate strategy in the competition industry with low number of brands and ordinary performance in growing markets with a little global presence made to create a path to growth strategy which was a 5 year growth plan which made them to concentrate on more brands and product innovations for internal and external growth of the company. And made the company to grow with acquisitions. According to FitzGerald and Bergmans path to growth strategy they predicted to manufacture double digit wages per share growth and superior positions. Focusing on the key brands by advertising and marketing made business grow higher and build brand value and increased brands prices. The case study shows Unilever as a global company according to SOWT analysis after introducing the path to growth strategy the company had really increased its sales and with introducing more number of acquisitions and cutting down the cost of revenues. As the acquisitions like Slimfast, Ben jerry and best foods were rapidly growing their market across the world building a very strong profile and providing customers attractive products and offers. Slim fast has 20%anual growth rate with strong sales and distribution all over the world and also maintained good customer relation. Where Ben jerry was worlds giant ice cream products and yogurt maker with strong brand equity. Bestfoods was USs 10 largest foo d products company with a strong global position. The two key elements of the Unilevers new business strategy was to cut down on the number of brands that were being sold or being marketed by the company, at that time Unilever was operating with as many as 1600 brands and much more products due to this the cut down on the number of products and brands was considered, the 1600 brands that where part of the company were cut down to as many as 400 core brands, the core brands mostly included all the famous and popular brands which are generally very popular among people, this idea came up as to make sure that the products where sold and by doing this it would not be much of a problem for the marketi8ng of these products as most of these brands where already day to day and very famous brands which people would generally prefer buying, which would mean that it would take much less an effort to connect to the people and more over the marketing was also done in such a way that people where able to connect to it very easily, the other key e lement of the unilevers strategy was to remove all the underperforming companies or brands and introduce some other new brands or companies in order to enhance the internal development of the organization and make new acquisitions which would enhance the sales of the company and make it more likable for the people this strategy was designed to increase the sales of the company and get rid of the companies which where not much in demand . Weaknesses according to SWOT analysis showed the company has dual leadership, insufficient management of brands and reduced R D after all this slow performance and small global presence the management has introduced path to growth strategy, which increased the company sales with cutting down it costs and introducing more acquisitions resulted in globalizing the company. As a result there were few expectations to achieve a double digit growth and securing a better position in global market for food and household products by increasing the quality of the product to gain pricing power and attract more customers. But according to the strategy plan the targets which were set was really high that is top line sales growth of 5-6 percent annually, increasing profits, and plan to complete by the end of 2004. If we look and analyze the path to growth strategy we can tell whether the strategy is working or not, we can say that it is working by its success rates and increase in profits and increase in brands and acquisitions that is the consumer preferences have changed due to which the products quality has changed and prices have changed the leading brands sales have increased from 75 percent to 93 percent. Food and personal care industry have increased its profits consistently. Operating assets have also improved by 9 percent. Acquisitions like slim fast, Ben jerry and best foods have gradually improved its growth and established its acquisitions all over the world. But the other side it is completely not yes, Unilever was gaining profits significantly after introducing new strategies but it was losing too yes it reported a net loss of $318M as the competitions was increasing and new brands were coming in to the market and rivals were introducing new strategies to compete Unilever. In th e year 2004 sales grew only by .4 percent leading brands by .9 percent so this proves that Unilever was lagging behind competitors in terms of innovation and advertising. Unilevers lack of advertising and marketing failed to improve sales. The company was small and not globalized. In this case Unilever attracted the new young talented manages to join their company with innovated ideas to increase its company profits by new methods of advertising and marketing. To justify Unilever strategies it maintained dual headquarters and dual chairpersons which reduced effective thinking and slow downed the decision making. Unilever is divided into Unilever Plc and Unilever NV. This made Unilever to focus on the needs of the customers and increase its sales profits in various industries like food, personal case, and household industries all over the world. As customers demand the products which are of the best quality and branded but at the same time convenient, cheap and attractive. The market for household products have been decreased its profits as the numbers of single parents have been increased and the rate of females working out have been increased and the demand for the healthy and high quality food has been increased. The consumers preference of the products such as its look, quality of the product and nutritional values has been increased by providing a strong competition against its giant competitors and private manufactures. This allows Unilever to focus on the need of its customers by increasing its sales. In 2003 Unilever executing its path to growth strategy by increasing its operating margins to over 15percent, but the sales of the leading brands growth as slowdown and raised questions among the investors and retailers that whether company brands could deliver some 5-6 percent of growth in revenues in the next coming years. TASK 3: Unilevers current business Strategies: Ever since the ‘Path to Growth strategy ended in 2005 there has been a 15% increase in the sales and development in the overall progress of Unilever. After the ‘Path to Growth came to an end a new process was developed by Unilever called as the Brand Imprint which helped the marketing teams in understanding how the business could face risks as well as opportunities from the social, economic and environmental issues. In this process each brand was scrutinized by a team looking into various aspects of it such as the direct as well the indirect impacts of the product, it also checked how the brand would go ahead in the future looking at the products possibilities of growth both from a customer and a stakeholders point of view. The outcome of the Brand Imprint is that the process has helped in making important decisions for the company keeping the future in perspective it also developed in addressing social missions, social and environmental issues. The Brand Imprint provided a perfect experience to find some systematic and measurable ways to explore different brands and improve the brands by addressing social issues, helping people the product well and reducing the environmental issues. When the S.W.O.T analysis was done on the ‘Path to Growth strategy many different aspects of the strategy where scrutinized using the SWOT analysis in which it dealt with many aspects such as the strength, weakness, opportunities and the threats that are being faced. After the analysis it came out that it had been very useful to determine the various aspects attached to it. Unilever for years had been a slow developing company, though the company had the right infrastructure and the capital but it couldnt utilize it properly that was basically the reason why the path to growth and various other strategies where starting to come up to help the company to increase the sales of the products and improve the business. Path to growth played a major part in the development of the company. The Path to Growth strategy did prove to be quite a useful thing considering the fact that during this period almost all of the unsuccessful brands where removed or replaced and the brands which where trusted and kept managed to increase the sales by 75% to 93%. Unilevers growth was considerably slow during this phase because the company was at that stage making very drastic changes and for these changes to come up and make a difference was something unexpected but the companys growth was obvious in certain fields thanks to the new strategies that had come in to improve the sales of the company so as to improve the business of the company. It was due to the fact that the company probably took way too much time u started and implement its plans that it caused the success to be not as higher as expected. Many business analysts and commentators felt that most of the strategies of the path to growth where working fine but there was always a speculation that what ever progress was talking place was happening too slow considering the competition the market was in with at that time, it was also felt that as the basic functionality of the business was spread among way too many people made the management way to complex and it would have been better off if it was simpler. It did work out fine when it came to the advertising of the product and getting it known to the people as it was more public oriented and it used the sources to the full extent to connect to the people. It did experience a drastic growth during that period as the analysis had proved that the company had the highest growth percentage as compared to any other company during that period it did bring in high profits to the company but looking at the whole picture it did prove to be a huge loss for the company considering the fa ct that they faced a countable loss in the revenue margin and that proved to be the difference, though it did have the right amount of sales and customers due to the slowness of there analysis to sort out and remove or replace the stuff did make a difference to analysis in the larger picture. But the company did grow during that time which might as well have effected the revenue cause many new store where started and large number of employees where starting to be employed on a full time basis. It did do quite well on the international market as well. By looking at the way the company had grown during this stage is quite remarkable many business analysts and commentators had felt that they probably had the right scheme of action because during that time they where handling 1600 brands and which was way too much and among those were quit few brands which hardly made any diff to the company so then the whole idea of brands cut based on the market outlook and sales reports was looked into to classify as to which of the products or brands where fast selling and which had the scope to sell more. It was that idea to cut down on the number of brands and start promoting only few brands which where much easier to be marketed and which where more likable by the people by which it would increase the sales and also make the marketing of these products easier cause when you are promoting bigger brands which are often very well known to public would mean that u don have to spend much on the marketing. Did the company experience growth during this period? Yes, would be the right thing to say voiding the minor things which might effect the outcome but it did see the light of success though slowly and there process and ideas where starting to get implemented in a better way and in a more successful way to deal with the growth of the company, the process of cutting down on the under selling companies was probably the decision that started to turn the tide for the company as it was when the losses where starting to be covered and it was mor