The Challenge Facing Managed Care Organizations

The greatest challenge for managed care organizations (MCOs) in our current time is how to obtain lower priced medical fees. As we all know, American health care should essentially be a nonprofit enterprise. However, the privatization of American health care holds that health care in general and hospitals in particular are increasingly operating on a for-profit basis. In fact, the for-profit hospital sector has accounted for a relatively constant share (about 15 percent) of hospital beds over the last twenty years (Morrisson, 1999). This is why recently the U.S. Congress tries to push more â€Å"consumer-directed† health plan options to avoid cash-strapped managed care organizations (MCOs) to boost their deductibles, raise premiums and even defy federal law by authorizing policy holders to buy prescription drugs from low-cost vendors in Canada (Smith, 23 September 2004). Managed care organizations (MCOs) often apply the traditional fee-for-service models, which do not provide adequate financial controls and utilization incentives for physicians and hospitals to contain the costs of providing healthcare. Under managed care, the needs of the patients are balanced with efforts to provide cost-effective care. Typically, MCOs enroll subscribers by promising to provide all necessary medical care in exchange for a fixed monthly premium. The MCO also contracts with hospitals, physicians, and other healthcare providers to dispense the necessary medical care to its enrollees at a discounted reimbursement rate. In exchange for accepting reduced fees, the caregivers gain access to the MCO’s enrolees (Kirby, Sebastian & Hornberger, 1998). A problem with managed care is that employers who offer a health maintenance organization (HMO) to their employees often pay the premium as long as the HMO premium was not higher than the fee-for-service premium. This behavior by employers creates distorted incentives for the HMO in controlling its costs. Enthoven (1993) suggested that this incentive distortion can be corrected when employers design better alternatives for their employer contributions. The employer could contribute a fixed-dollar amount for health insurance with the employee paying the full difference between plans. The greater the portion of the marginal premium paid by the employees is, the stronger the incentive is to choose lower-cost plans. For example, if the employer pays 80 percent of the premium and the employee pays the remainder, then the employee pays only 20 percent of the difference between the low (let’s presume here) HMO premium and the higher fee-for-service premium. HMOs and other managed care arrangements are organized on a prepayment basis that appear in a wide variety of forms. An HMO could hire physicians on a salary, contract with a preexisting group practice of physicians, or contract with physicians who maintain a fee-for-service practice. According to Luft (1991), â€Å"Because specific social, legal, historical, political, and economic aspects of the medical care environment have shaped delivery systems such as the HMO, it is not reasonable to expect that the typical HMO could be transplanted intact to another country† (p. 173). The key to HMO cost savings is the organization’s wide range of medical services, both inpatient and outpatient. In this way, the HMO can receive the cost savings implied by reduced hospital use. This may be difficult to manage in systems where there are separate financing mechanisms for primary care physicians and inpatient care. As Luft (1991, p. 180) remarks. â€Å"If there were no way to shift funds from the ‘hospital side’ to the ‘physician side,’ it would be difficult to reward clinical decision makers for the development of more cost-effective practice styles.† This is why three areas appear to offer a magnitude of opportunities where MCOs can assist patients, these are ambulatory care, mental health and the alternative therapies. Firstly, ambulatory care-sensitive conditions reflect the quality and availability of primary care services, since they are readily treatable without the need for hospitalization. There are differences in the hospitalization rate for ambulatory care sensitive conditions. Shenkman et al. (2005) had indicated that specialty ambulatory care is important for many children with chronic conditions. However, access to such care may be constrained within managed care environments. The use of primary care providers (PCPs) as gatekeepers for managed care organizations (MCOs) is one commonly used strategy to control specialty care use. Studies of the impact of gatekeeping on children's receipt of specialty care have resulted in mixed findings. Some studies found more specialty care use in gatekeeping MCOs, compared with non-gatekeeping MCOs. Other researchers found that the replacement of a gatekeeping system with an open-access model increased specialty visits among a group of children with chronic conditions. Although the focus on gatekeeping in general yields some important information, MCOs use many other strategies concomitantly with their PCP gatekeepers, such as capitated payments, financial incentives, and prior authorization procedures. The use of these concomitant strategies may meet the unique needs of children with chronic conditions, including their need for specialty physician care. On the other hand, managed care had been significant contributor on delivery systems for mental health services. Taylor et al. (2001) had indicated that direct and indirect persuasion to provide more cost-effective treatments has been one consequence. The cost-saving qualities and the effectiveness of group interventions have produced clear expectations for an increased use of therapy groups. In the research of Taylor et al. (2001), they compared perceptions and uses of group treatments on a national sample of managed care organizations and mental health providers. Implications of differences and similarities between directors of managed care organizations and treatment providers are examined and discussed across five response categories (familiarity/training perceived effectiveness, likelihood of reimbursement/referral, daily use and expectation for future use). Taylor et al (2001) favored the approach where MCOs calibrate treatment referral/reimbursement decisions. Recently published comparison outcome studies and meta-analyses can and should empirically guide the present treatment delivering systems. Lastly, many managed care organizations have already begun to integrate complementary and alternative medical therapies (CAM) with conventional medical providers. Medical practitioners are obligated to assess CAM therapy with patients. Alternative therapies require professionals to rethink staff competency, patient assessment, and patient-focused care. Medical leaders must understand CAM trends and therapies to better integrate these concepts into health care policy, standards of care, and ethical decisions (Parkman, 2001). Among ambulatory care and mental health care, alternative therapies, or CAM, offers the most favorable and cost-efficient strategy for MCOs. This is because the aging â€Å"baby boom† generation is beginning to experience chronic but non-life threatening conditions, such as joint pain, headaches and menopause-related complaints and they are willing to explore options other than prescription drugs. For health plans, the attraction of offering alternative care products lies in retaining and attracting new members, diversifying their services from competitors in a congested managed care market and in attempts to address current or proposed state mandates (West, 1997). In 1997 alone, expenses for professional services were $21.2 billion, a 45% increase over the earlier 1990 data. Expenses for professional services, herbals, vitamins, diet products, books, and classes totaled $27 billion. Five surveys conducted since 1990 have reported frequent use of CAM, ranging from 30% to 73% by patients suffering from conditions such as cardiovascular disease, cancer, arthritis, HIV and AIDS, multiple sclerosis, and chronic musculoskeletal pain. Furthermore, the demand for CAM by the general public is increasing, despite the fact that its use is largely paid by consumers without coverage by third-party payers. In 1997, Americans spent an estimated $13 billion for visits to CAM providers and an additional $2 billion for commercial diet supplements and over-the-counter megavitamins (Pelletier & Astin, 2002). Managed care should not only focus on cost savings, but they should also look into diversifying their services. MCOs have generally contributed to the decline in the U.S. health cost growth rate. Their potential will continue to be limited to the extent that employers fail to offer true financial advantages to consumers who choose the low-cost health plans. Thus, more reforms in the policies should be reviewed and revised so that more people could benefit from the quality health care everyone deserves. References Enthoven, A.C. (1993). The History and Principles of Managed Competition. Health Affairs, supplement, 24-48. Kirby, E.G., Sebastian, J.G. and Hornberger, K.D. (1998, Jan/Feb). The Effect of Normative Social forces on Managed Care Organizations: Implications for Strategic management/Practitioner Response. Journal of Healthcare Management. 43(1):81-106. Luft, H. (1991). Translating the U.S. HMO Experience to Other Health System. Health Affairs 10:172-186. Morrison, I. (1999). Health Care in the New Millennium. NY: John Wiley & Sons, Inc. Parkman, C. (2001, February). Alternative Therapies Are Here to Stay. Nursing Management, 32(2): 36-40. Pelletier, K.R. and Astin, J.A. (2002, Jan/Feb). Integration and Reimbursement of Complementary and Alternative Medicine by Managed Care and Insurance Providers: 2000 Update and Cohort Analysis. Alternative Therapies in Health and Medicine, 8(1): 38-44. Shenkman, E., Tian, L. and Schatz, D. (2005, June). Managed Care Organization Characteristics and Outpatient Specialty Care Use Among Children With Chronic Illness. Pediatrics, 115(6): 1547-1555. Smith, C. (2004, Spetember 23). Senate Panel Examines Health Care Choices, Insurance Costs. Knight Ridder Tribune. Taylor, N.T., Burlingame, G.M., Kristensen, K.B., Fuhriman, A. et al. (2001, April). A Survey of Mental Health Care Provider's and Managed Care Organization Attitudes Toward, Familiarity With, and Use of Group Interventions. International Journal of Group Psychotherapy, 51(2): 243-264. West, D. (1997, November 10). MCOs Integrating Alternative Care. National Underwriter, 101(45): 58.   

Los Angeles Rams Football Club V. Cannon

Los Angeles Rams Football Club v. Cannon 185 F. Supp. 717 (S. D. Cal. 1960) Plaintiff prays for an injunction to restrain defendant playing football or engaging in related activities for anyone other than the plaintiff without the plaintiff’s consent during the term of a contract or contracts allegedly entered into by the parties on November 30, 1959, and an order declaring the existence of a valid written contract or contracts. Defendant denies he ever entered into a contract or contracts as alleged and further claims, as defenses to plaintiff’s claims, fourteen affirmative defenses.Cannon never formally accepted the contract offered, therefore it is only an offer. The Commissioner never signed the contract so this makes not valid. There did not come into existence a valid written contract or contracts binding upon plaintiff and defendant there is no basis upon which to consider plaintiff’s claims for equitable relief or defendant’s affirmative defenses i n opposition thereto. Specifically, therefore, I make no findings as to the issues of fraud and deceit, or any other of the equitable issues raised by defendant’s affirmative defenses.Judgment will be for defendant, with costs†¦. Sample v. Gotham Football Club, Inc. 59 F. R. D. 160 (S. D. N. Y. 1973) Defendant is the owner and operator of a professional football team popularly known as the â€Å"New York Jets. † On September 1, 1968, it entered into three separately executed written agreements with plaintiff under which plaintiff was required to render services as a professional football player for the 1968, 1969 and 1970 football seasons. Each document represents the agreement between plaintiff and defendant for a different year.The current dispute only pertains to the contracts covering the 1969 and 1970 football seasons. The New York court of appeals has stated that when the terms of a written contract are clear and unambiguous the intent of the parties must be ascertained from the language used to express such intent. Plaintiff argues that an injury was sustained during the performance of a three-year contract he is entitled to his salary for the remaining term of the contract. Defendant argues that they were three separate one year contract and would only be liable to pay for the season the injury took place.After determining that the exercise of the option clause had the effect of creating a new contract with the plaintiff, the Fifth Circuit concluded: [I]t follows that Hennigan was not entitled to compensation for the 1967 football season from the Chargers. He suffered no injury while in the performance of any services required of him after the option was exercised. Consequently, he is not entitled to payment under paragraph 15 (the injury provision) The result reached above concerning Sample’s second claim is thus on all fours with Hennigan.Reviewing the dispositions, the court denies plaintiff’s cross-motion for summar y judgment on both its first and second causes of action†¦. Eckles v. Sharman 548 F. 2d 905 (10th Cir. 1977) This is an action by the owner of a professional basketball team for breach of contract by a former coach and for the inducement of that breach by the owner of another professional basketball team. Judgment was entered on a jury verdict for $250,000 against the coach and for $175,000 against the inducing owner.We reverse and remand with directions. We have repeatedly held that a verdict may not be directed unless the evidence all points one way and is susceptible of no reasonable inference which sustain the position of the party against whom the motion is made†¦. On the record presented it may not be said, as a matter of law, that the option and pension clauses were unessential and hence severable. Neither can it be said, as a matter of law, that without the resolution of the controversy ver those clauses Sharman agreed to the assignment of the contract to the owner s of the Utah Stars. The pertinent intent questions required factual determination by the jury under proper instructions. The court erred in directing a verdict against Sharman and in favor of Mountain States on the liability issue. The judgments are severally reversed and the case is remanded for a new trial in accordance with this opinion. National Football League Players Ass’n v. National Football League Management Council 233 Cal. Rptr. 147 (Cal. Ct. App. 1986The Raiders and Management council content that the arbitrator exceeded his powers in that he made an error in law by failing to apply the doctrine of mitigation of damages. They further content that the award violates public policy and that the award was incorrectly calculated. We affirm the judgment. Pastorini’s dispute with the Raiders clearly falls within the ambit of section 301(a) of the labor Management Relations Act, which pertains to â€Å"suits for violation of contracts between an employer and a la bor organization representing employees in an industry affecting commerce†¦. Therefore, we must apply federal substantive law†¦. However; we may also rely on the state law if it is compatible with the purposes of federal law†¦. We conclude that offset is inapplicable in the instant case and that the arbitrator did not make an error of law. This court may reverse the arbitrator’s award only if there is a manifest disregard of the agreement, totally unsupported by principles of contract construction†¦. No such manifest disregard appears in the instant case. The judgment is affirmed.Alabama Football, Inc. v. Stabler 319 So. 2d 678 (Ala. 1975) Stabler filed a complaint on December 4, 1974, seeking a declaratory judgment and other relief, contending that the defendant had breached its contract with Stabler by failing to pay the balance due in 1974 under the contract between the parties; that the terms of the contract prohibited him from negotiating a contract w ith any other professional football club; and that irreparable damage would result to him if the contract was not held to be null and void.After a hearing, the trail court entered its judgment on January 6, 1975, holding that the contract between Stabler and Alabama Football, Inc. had been breached by Alabama Football, Inc. and that Stabler was free from any obligation under any terms of the contract. Since there was substantial evidence from which the trail court could have concluded that appellant was unable to perform its contract with Stabler, we find no basis for reversal on this point†¦.

Causes of the Second Punic War Essay

The Second Punic war â€Å"was the greatest and most dangerous one Rome was compelled to fight on their way to the conquest of the Mediterranean. † With 17 years of battle causing heavy casualties to be suffered on both sides, the Second Punic War has proven to be an important time period in the Roman and Carthaginian empires. For Rome, the end of the war meant â€Å"the defection of most Southern Italy† (Kagan 232, 1995) and many economic problems. For Carthage this meant the end of their rise to power, and the realization that the idea of Mediterranean control being based in Africa rather than Europe was no longer a possibility (Kagan 233, 1995). Both empires had a lot at stake upon entering the war, but as will be discussed, many historians believe that eventual conflict was inevitable. Past grievances and battles pitted the Romans and Carthaginians against one another ultimately leading to the Second Punic War and the resulting downfall of Carthage. The ancient sources written by Livy, Polybius Dio Cassius and Appian place a great deal of blame on Hannibal in starting the Second Punic War. Though some of the authors justify his actions to an extent, Hannibal’s invasion of Saguntum is pinpointed as the immediate cause of the Second Punic War. Dio Cassius and Appian find little sympathy in the motives behind Hannibal’s actions. As discussed by each of the writers, Hannibal’s father, after the loss of Sicily, harbored extreme hatred toward the Romans and instilled these feelings into Hannibal from a very young age. All four authors mention an oath taken by Hannibal at age nine in which he vowed revenge against the Romans for their unjust actions. Livy writes that this oath â€Å"bound Hannibal to prove himself, as soon as he could, an enemy to the Roman people† (Kagan 93-94, 1975). Sure enough, upon ascending to power, â€Å"as if Italy had been decreed to him as his province, and the war with Rome committed to him,† (Kagan 95, 1975) Hannibal marched toward Saguntum with the knowledge that this would get a rise out of the Romans. Ultimately, Livy asserts that the blame is dependent on â€Å"whether it was allowed to be done by the treaty† (Kagan 103, 1975). Polybius outlines three clear causes of the Second Punic war. First, as other ancient authors, Polybius points to Hannibal’s oath and longstanding grudge against the Romans. However, he continues to explain the reasons for Hannibal’s rage, the First Punic War, which Polybius calls â€Å"the most important cause of the subsequent war† (Kagan106, 1975). At the close of the mercenary war, Carthage did all it could to avoid conflict with Rome, eventually costing them Sardinia and large indemnities that were to paid to the Romans both immediately and over time. This unequal treaty on the part of the Romans is the leading factor in Carthage’s hatred toward Rome. Thirdly, Polybius credits the Carthaginian successes in Ibera as the third leading cause of the Second Punic war. Having secured a great deal of territory and further motivated by victories, Carthage felt that they were strong and powerful enough to take on Rome. It is for this reason that Hannibal chose to attack Saguntum at this time to elicit a response from the great empire. Upon being confronted by the Romans, Hannibal does not concede the real underlying causes for his attack, but insists instead that it is retaliation for the Carthaginian leaders put to death by Roman arbitrators in Saguntum. Polybius makes an interesting point that this failure to disclose his true motives may have caused more blame to fall on Hannibal’s shoulders. Polybius writes, â€Å"he had not said a word of the real cause, but alleged the fictitious one of the matter of Saguntum; and so go the credit of beginning the war† (Kagan 107, 1975) This assertion is important to consider in analyzing the ancient sources, as many contain a pro-Roman bias. Polybius recognizes that the immediate action that brought the war was that of Hannibal, but also that â€Å"we must acknowledge that the Carthaginians had good reason for undertaking the Hannibalian war. † (Kagan 109, 1975). In his essay â€Å"The Case for Rome,† Frank argues that â€Å"the nations came to blows because the Barcid family were able to keep alive the bitter feelings aroused by former defeats† (Kagan 118, 1975). As with Polybius, Frank discusses the true nature of the attack versus the excuse for battle Hannibal was stating. Throughout the exchange of embassies and the lead-up to the Roman and Carthaginian battles, Hannibal never wavered from his assertion that Carthage was seeking revenge for those officials who had been executed in Saguntum. Frank continues on to state his opinion that the war between the two empires was not inevitable, but rather a matter of Hannibal and the Carthaginians wanting to restore their pride. In comparing Frank to other modern authors, he is much less sensitive to the wrongdoings on the part of Rome. Frank faults Hannibal for the beginning of the war, justifying the alliance with Saguntum and accusing Hannibal of starting a war based on illegitimate grudges. In his essay, Frank claims that â€Å"an unwelcome war had been thrust† (Kagan 119, 1975) upon Rome. In analyzing the other modern sources, it is evident that Frank’s view is the uncommon one and that Rome was in fact an instigator in the Second Punic war. While Hallward acknowledges the anger of Carthage as a factor in Hannibal’s actions, he is also quite hard on the Romans for their unjust actions following the First Punic War. â€Å"In 237 B. C. , the Romans, with no shadow of right, had forced Carthage to surrender Sardinia and to pay an additional indemnity of 1200 talents† (Kagan 120, 1975). Hallward acknowledges that it was outside the moral and legal realm of Rome to seize Sardinia and force the payment of such steep indemnities. He continues to discuss the limitations imposed on Carthage with the Ebro treaty. As Rome grew more concerned with Carthage’s advancements in Spain, they took advantage of the times to impose the treaty and restrict Carthage from advancing past the Ebro River. An important aspect of the Ebro treaty is the implications that came with it. This treaty implies that Rome would not hinder Carthaginian expansion up to the River. Though dates are unclear, had the alliance with Saguntum already existed, it was an â€Å"implied obligation on Rome not to use the town [Saguntum] as an instrument to hinder Carthaginian expansion within the sphere recognized as open to her† (Kagan 120, 1975). Rome failed to stay out of Carthage’s way and became a bother and a hindrance in their quest for expansion. In Saguntum, Rome â€Å"intervened to bring into power, not without bloodshed, a party hostile to Carthage and to promote friction with the neighboring tribe of the Torboletae, who were subjects of the Carthaginians† (Kagan 120, 1975). Not only was this alliance against unjust in that it was against the spirit of the treaty, but it was also spiteful on Rome’s part. In the eight months in which Saguntum and Carthage were battling, Rome was hesitant to send support. Saguntum was â€Å"unimportant and distant, and the material interests of Rome were protected in the Ebro treaty† (Kagan 121, 1975). However, in spite of having so little to gain, Rome pursued an alliance with this nation to hinder Carthage and impose themselves in the Carthaginian realm. All of these actions on Rome’s part were harsh reminders of the unfair treatment Carthage had received since the First Punic war. Though past grudges played a key role, Rome’s continued hostilities and instigatory actions gave good cause for the hateful feelings to continue, and ultimately led Carthage, under Hannibal’s command, to seizing Saguntum as a way of bringing forth a response from Rome. Throughout his essay, Scullard asserts that Hannibal and Carthage were within their legal and moral right in seizing Saguntum. Scullard bases this conclusion on his analysis of the treaties that existed between Rome and Carthage at that time. He first addresses the treaty made with Lutatius in 241. He states that Carthage was within their rights because â€Å"Rome’s alliance with Saguntum was later than the treaty of Lutatius, so that the town was not included in the list of Rome’s allies whom the Carthaginians had promised to respect† (Kagan 123, 1975) In regards to the Treaty of Ebro, he points to the simple geographical fact that Saguntum was located 100 miles south of the Ebro River, well in the domain which Carthage had been promised. Also in regards to this treaty, Scullard mentions a similar point to Hallward in that Saguntum â€Å"could not in equity be used by the Romans as a handle to check Punic expansion in the south† (Kagan 124, 1975). Scullard also addresses Hannibal’s hatred of Rome which is discussed in so many other sources. Scullard asserts that though there is evidence and cause for the hatred, Hamilcar moved into Spain with â€Å"the intention of re-establishing his country’s lost empire,† not seeking revenge. Based on the treaties which had been made, and the unjust actions of Rome, Scullard states â€Å"Rome had no legal ground to restrain Hannibal from attacking Saguntum, he was within his legal rights and was no treaty breaker† (Kagan 124, 1975). As with the other modern writers, Errington acknowledges the anger of Hannibal but does not point to these emotions as the cause for war. Instead, Errington recognizes the wrong doing of Rome in the events leading up to the Second Punic war. It is vital to understand that â€Å"the peace of 241 and Rome’s subsequent annexation of Sardinia were presented as the bitter Barcid disappointment which precipitated another war 23 years later† (Errington, 53). It is crucial to understand the reasoning behind Hannibal’s anger, rather than condemn him as a tempered, vengeful leader. Errington continues to write about the â€Å"unwarranted interference with Carthage’s friends in Saguntum. † This arbitration and newfound friendship with Saguntum reminded Carthage too much of the convenient alliances Rome had made in the past with the Mamerties and the Sardinian mercenaries. Errington 55-56). In concluding, he addresses the â€Å"Roman traditions† regarding the Punic war, which firmly blamed Hannibal for the beginning of the war. He evaluates these claims as simplified and â€Å"grotesquely wrong† (Scullard, 60) asserting that the Romans played a part in inviting the war through their actions against Carthage. In Kagan’s chapter on the Second War, he gives an in depth background which allows the reader to fully grasp and understand the circumstances which led to the actions and emotions of both empires. The peacetime between the two wars was crucial in leading up to the second Punic war. During this time, Romans involved themselves in a war in Sardinia at the request of the mercenaries. This involvement against Carthage â€Å"was a clear violation of the treaty of 241 and without any respectable pretext† (Kagan 253). The Romans knowingly and blatantly broke the treaty which had been formed between the two nations. Once involved, Rome took advantage of their situation and demanded Sardinia and massive indemnities from Carthage. The Carthaginians were forced to reluctantly accept, but they resented that their treaty had been violated and that they taken advantage of. This resolution â€Å"reflected the relationship of power between Rome and Carthage at a time when Carthage was unnaturally weak† (Kagan 255). As the empire gained it’s power back through Spain, they became more confident in their abilities to match up against Rome, and Rome became more nervous regarding their ability to do so. Kagan discusses the alliance made between Saguntum and Rome and concludes that either way, Rome was in the wrong. Had the alliance occurred beforehand, it should have been included in the treaty, but had it been afterward, then it was a direct violation of the Ebro treaty. Either way, Rome was in the wrong to try to prevent Carthage from taking Saguntum, a city of little importance or value to the Roman empire. Kagan, like other authors, addresses the Roman tradition of blaming Hannibal’s oath and anger. Kagan argues â€Å"the rejection of the wrath and the oath leads to a diminution in the responsibility of Carthage. It is possible to see its behavior as entirely reactive and defensive† (Kagan 270, 1995). In Hannibal’s quest to restore the empire which had been taken fro him, Carthage pushed through Spain in the territory they were permitted. In this view, Hannibal’s attack on Saguntum broke no treaty and was justified by any fair understanding of the Ebro treaty† (Kagan 270, 1995). Each of the authors offered a similar story, but the bias and blame was placed differently in each piece. The ancient writers seem to fall into the trap of the â€Å"Roman traditions,† faulting Hannibal heavily for the vengeance he felt toward Rome throughout his life. However, as we move to the more modern authors, it is apparent that Carthage’s actions were simply a consequence and reply to those of Rome. Hannibal was within his rights of both treaties when he attacked Saguntum, and it was not the right of Rome to become involved. Carthage had been undermined by Rome on several occasions, and they were right to stand up against Rome in the eyes of further injustice. While the immediate blame for the Second Punic war may fall on Hannibal and his invasion of Saguntum based on Roman hatred, it is important to realize that the underlying causes of the war were in fact instigated by Rome and their policies in the preceding decades.

Country Analysis (Libya) for International Business Class Essay

Country Analysis (Libya) for International Business Class - Essay Example The Encyclopedia of Nations (2010) delves deeper to reveal the details; the maximum hours of work per week are 48, the minimum age for employment is 18, the average monthly wage is 270 dinars (converting to US$100). Foreign workers do not enjoy all the rights as Libyans and there exists restrictions on income repatriation. Other considerations to make about employment in Libya include the fact that Gaddafi regime made a great deal of effort in preventing the growth of a viable private sector. On a socio-cultural aspect, language is of particular importance to business planners in Libya. Economy Watch (2011) indicates that the major languages spoken in Libya are Arabic, Italian and English, all of which are widely used in the major cities in Libya. Arabic is however the official language in Libya (CIA World Factbook, 2011). This indicates that diversity of languages in Libya is not huge and business planners can therefore undertake activities focused on the three major languages. The fact that the three are largely understood makes it even easier to interact with Libyans while doing business. The ethnic population in Libya is predominantly Berber and Arab who make up 97% of the Libyan population. The remaining 3% consists of Italians, Greeks, Indians, Pakistani, Egyptians, Turks, Tunisians and Maltese among other nationalities in no particular order (Economy Watch, 2010; CIA World Factbook, 2011). According to the US State Department (2011) there are small Tebou and Tuareg ethnic communities in Southern Libya that are mainly nomadic or semi-nomadic. Besides North Africans, West Africa and sub-Saharan nationalities contribute the major portion of the non-Libyan population in the country. Whereas news of ethnic tensions is not common in Libya, the recent uprising was initially observed to follow ethnic patterns unlike the wave of uprisings that characterized the North African and Muslim World in general (Bancroft-Hinchey, 2011). The implications of this to the bus iness planners involves planning to win over the majority and targeting the smaller ethnic populations besides the fact that absence of ethnic tensions means that under a stable regime Libya is an attractive place for business. Gender considerations especially in the labor market in Libya are an extension of the position of the woman in the rest of the society. Encyclopedia of Nations (2010) observes that although Libyan labor law provides for equal opportunities for men and women in the labor market, traditional societal restrictions of women in terms of out-of-home activities ensure that this law is not practical. SIGI (2007) indicates that efforts to address such issues of inequality have been hampered by the fact that it is illegal to form rights groups independent of the Libyan state. Therefore, business planners need to ensure they strike the perfect balance that will adhere to Libyan labor law while at the same time not upsetting the Libyan society in terms of gender issues. The next issue of consideration with regard to socio-cultural factors in Libya is religion in terms of diversity and the extent to which it is influential to culture. A general view of the religious outlook of Libya is provided by Economy Watch (2010), which gives the figures as 97% Muslim and 3% for the rest. Nation Master (2011) provides more comprehensive information indicating that the 97% of Muslims are actually

Airline regulation Essay Example | Topics and Well Written Essays - 500 words

Airline regulation - Essay Example deregulation of the industry, it is reported that many airline companies have opted to merge or engage in airline alliance, which are characterized as virtual mergers to circumvent government restrictions (Doganis, â€Å"Flying Off Course†). An implication of these mergers is that the few surviving consolidated airline companies may exhibit oligopolistic behavior. This may include monopolizing of routes and charging excessive rates for some fares. In this regard, the industry competition is somehow diminished. Other airline companies may experience substantial profit reduction as their service offerings become relatively less competitive as compared to big industry players. In view of the above, the government must intervene by implementing policies that would promote competition within the airline industry. By enforcing policies such as the prohibition of oligopolistic/monopolistic business practice, the government is able to promote greater efficiency in the market (Samuelson & Nordhaus). As the government deregulated the airline industry, airlines have become better equipped in negotiating their operating arrangements with different airports as well as their entry and exit routes. Furthermore, these airline companies have become better in levying airfares and supply flight based on market demand (Doganis, â€Å"The Airline Business†). The deregulation boded well for both airline companies and their customers. However, with the anti-competitive practices discussed above, the objective of the deregulation is being violated. Given this, the government should somehow tighten its control over the industry such that competition and consumer welfare are promoted. With the September 11 attacks, the airline industry experienced economic shock as people became traumatized of flying. Furthermore, security restrictions rendered traveling more difficult. Considering this, thousands of employees were laid off as major airlines filed for bankruptcy. To address

Protection Improvements Option for HMMWVs Assignment - 1

Protection Improvements Option for HMMWVs - Assignment Example According to the U.S. Army representative remarks at the recent Association of the U.S. Army’s â€Å"AUSA Winter† symposium held in Ft. Lauderdale, Fla., Feb. 24-26, 2010, â€Å"The HMMWV Recap requirement exists to address needed repair and rework of existing HMMWVs used in tactical operations while at the same time modernizing through upgrade existing HMMWVs to improve their operational capability† (Scott para 2-3). Under the new approach of revamping the HMMWVs, one option is to develop a single integrated system to be kept on the chassis of HMMWV after taking down its body to fit the new capsule structure on it to be integrated with the current subsystems of the HMMWV. This approach would facilitate not discarding most of the parts of the HMMWV (Scott para 9). The capsule approach can provide the protection improvement needed in up-armored HMMWV because of reduction in weight helping in its load carrying capacity and mobility. Designing of the capsule adds to the protection level in the internal and external body structure of the HMMWV (Scott para 10). As per the US Army TWV Strategy Report, adding armor kits to the vehicles was an afterthought; the vehicles were not designed to carry 3000+ pounds in weight, which is affecting the performance of the vehicles. Considering the future demands on the fleet, the proposed solution stated above would offer the perfect balance in the 3-Ps (Payload, protection, and performance) besides offering a sophisticated fleet, robust enough to host varied modern electronics, essential during any war operations. The proposed capsule approach option is cost-efficient to fulfill the sustainability and affordability issues arising in the future particularly on the right mixing of quality and quantity parameters (7-9). A good thing about the proposed protection improvement option is the cost-effectiveness of the Small Combat Tactical Vehicle Capsule (SCTVC)  approach, developed by Chris Berman, a former Navy SEAL, and the founder and president of Granite Tactical Vehicles – the designer of the SCTVC approach (Scott 6-7).

Reaction paper 3 Assignment Example | Topics and Well Written Essays - 500 words

Reaction paper 3 - Assignment Example Thus, showing how Lardo acquires new meaning as a result of the campaign as an exotic consumption item for the local and middle-class consumers (Alison 455). Therefore, the article explains the meaning of the movement in different areas. The entire article emphasizes on the impacts of the Slow Food Movement. In Italy, the movement succeeded in developing cultural space for a new consumer politics kind of performance. The article explains further that the Slow Food resists the easy categorization in any familiar political narratives terms. Though, it is evident that the promotion has penetrated to the politics process heart in societies of liberal democracy. Hence, the article explains the theory behind the food politics. Alison shows how the movement of Slow Food manifestos encourages the cultural diversity idea. The article explains that the movement urges consumers to purchase niche-marketed foods. Though, with the kind of promotional politics, there can be no guarantees of ideological outcomes. It is evident in the article that, the cultural marketing authenticity politics may have been unexpected results for the direct producers. The entire article explains the formation and impact of the European Union. The article explains the contribution of the union and community in making the world a better place in terms of economic fields, peacekeeping and climate changes. Thus, the main objective of the article is to define the European Union and determine its impact on the European nations in terms of development in economy. The article points out some of the factors that promoted economic development by the new community or union. It emphasizes that the political and economic unification of the involved nations paved way for the integrated economy. In addition the common market concept got extended in the mutual trade of the union; thus promoting the economic

Ajax Programming Method Essay Example | Topics and Well Written Essays - 750 words

Ajax Programming Method - Essay Example Several applications such as ‘Google Suggest’ and ‘Gmail’ use the technique of Ajax. These services have encouraged and started the period of Ajax oriented web software (Pitafi, 2007). Ajax performs as client concentrated technique. In the initial phase, Ajax runs slowly because of the size of scripts, but afterwards it covers up for the initial deferral by becoming extremely cooperative to the reaction of the client. Thus, the initial delays are negligible as the overall increase in bandwidth makes Ajax an accurately feasible technique for software solution (Pitafi, 2007). Ajax has its own advantages and disadvantages. Thus, it is not good for all software applications. Software which involves offline accessibility is not suitable for Ajax model. It is more beneficial when high degree of communication is required between the software application and the user such as data entry application, data triangulation program and in software which necessitates asynch ronous actions (Pitafi, 2007). In a typical work environment, there are different application programs. While certain applications are large scale in nature and their performance and dependability are of supreme importance in organizations, other applications can be small and less vital. The maintainability of such application also differs from one application to the other. Therefore, it can be depicted that Ajax is not effective for every software application. In general, large scale commercial software which involves professional team and long run maintenance are better functioned by Java and .Net methods rather than Ajax. Ajax is more appropriate for applications where programming tasks are simpler, requirement of professional team is lesser and maintainability is of low importance. Ajax is a useful technique for designing rich, information based software. Ajax is not just a fad; rather the content developed by Ajax can significantly be used by several organizations in order to c reate value for the stakeholders (Walsh, 2012). DQ 2: Characteristics Ajax denotes a set of technologies and procedures which let webpages to be collaborative such as desktop applications. In comparison with other web applications, Ajax has different characteristics. Ajax distorts the edge of webpages and applications. In Ajax technique, the web server sends data to the browser for displaying information. Ajax has no intellectual ability, only information that is send by server to the web browser which makes the technique efficient. When the HTML document concentrates towards the browser window, Ajax runs behind the user interface and acts as a brain of the browser. Ajax can perceive incidents such as key press and mouse click and accordingly react on these actions without making new circuit to the server. Thus, by using Ajax, web application runs as desktop application because it can react faster, in accordance with user action. Furthermore, Ajax can unceasingly update the webpage by drawing information from behind the server, therefore providing user the feeling of using desktop application (OpenAjax, n.d.). The Ajax method is being utilized in chat applications. The chat technique in internet does not require asynchronous communication and also

Psychology Research Paper Example | Topics and Well Written Essays - 750 words - 1

Psychology - Research Paper Example With regard to these chapters, this paper assesses the role played by nature in a child’s development. Many scholars argue that genetics determine human development (Kendra 2). Genes determine heredity and every individual has genes from his or her parents- mother and father. These genes are responsible for determining characteristics such as skin colour, height, weight and the colour of one’s hair. They also determine how a person acquires cognitive skills as well as directing the mental processes and physical features. Genes are passed from one generation to another. The two main types of genes-dominant and recessive, determine a child’s physical look. They also influence the rate at which a child grows (Gilbert 22). Therefore, children may start doing some activities earlier than others depending on their genetic characteristics. For instance, some can begin sitting without assistance by the age of 6 months. This may be delayed or may come early in other children. Genes are also responsible for genetic disorders such as cystic fibrosis and cerebral palsy (Kendra 7). If a parent has such disorders, they are likely to pass them onto their children who will also do the same to the future generations. However, the environment under which a child grows also largely determines the physical and biological development of a child (Berger 50). A foetus that is exposed to chemicals and pollutants develops in a different manner compared to one that develops in a clean womb (Kendra 9). For example, Fetal Alcohol Syndrome caused by exposure of a foetus to alcohol while in the womb leads to physical as well as cognitive malfunctions. Nutrition influences physical and social development (Gilbert 41). A well fed child grows up to be healthy and enjoys all childhood activities. On the contrary, a poorly fed child is weak and may not enjoy what other children do since play and learning is hindered by malnutrition.

Information and Librarians in the Digitial Age Personal Statement

Information and Librarians in the Digitial Age - Personal Statement Example I have always had faith in myself and in God to do what is best for me throughout my life. I had worked for the library during my high school and college years, starting as a page. My interest in libraries began here that while I was shelving books and skimming through the pages, I discovered the love for books and reading. My longevity with one organization has taught me to work as a team player, to communicate constructively, exhibit flexibility, handle problems and show commitment. Some strength I possess is that I am an energetic, highly motivated person which I think can make me survive the rigors of graduate work. I am a self-starter, who is able to take on new challenges. In order to achieve common goals, I am able to work well with others. My short-term goal is providing the best care for my son, Nasir. My family is very supportive of my going to graduate school, especially since I will be the first female from either side to attain a master's degree. My long-term dream has been to pursue a Master's degree in the Library field. My goal has been to learn a lot from my supervisors and co-workers on how libraries work throughout the years. I have always felt I would be a good leader and teacher. I have worked in the library field for eights years. I have loved libraries since I was a little girl, always looking up information. This love continued in college, where I worked as a page at DeKalb County Public Library, Decatur, Georgia. I wanted to be around books as much as possible. I enjoy library work because I have access to all the information in the world at my fingertips, in both print and electronic form. I learn something new every day, and Iinteract with people of all ages and from all walks of life. I use my interviewing and teaching skills, and I have learned indispensable computer skills as a bonus. Librarianship has been a good fit for me. What I like best about being a librarian is helping people use the library resources. I try to be outgoing by establishing eye contact with patrons and asking them if they need assistance. There is so much to teach the public about libraries, and there are so many resources available. From finding a book on the shelf to using the Internet, people need help, but they often don't ask for it. The librarian has to be outgoing. As I am a graduate of Bachelor of Science Degree in Computer Information Systems, I discovered that working in a library is a lot of fun. My job gives me an opportunity to use my information seeking skills as well as to indulge my web publishing and instruction interests. I feel now is the right time to pursue my degree. I want to develop my educational background and continue working in the library field. In order to move ahead in my career, I would need to obtain a degree to reflect my skill in working in this field. If in order, the program at UNT will provide me with the comprehension I need to become a librarian. If admitted into the UNT program, I would like to pursue administration. The librarian of today is not like the librarian of yesterday due to the impact of technology that has transformed the profession. Where before there were just printed materials in the library, now information highways through the use largely of the Internet is largely what the student has to deal with. Public libraries are busy, vibrant community centers that are open days, nights, weekends and even some holidays.

Pharmacology assignment Example | Topics and Well Written Essays - 2500 words

Pharmacology - Assignment Example The effect of the new drug on the action of warfarin will be investigated in 12 healthy participants. The investigation is based on an open label study that would utilize a multiple dose design. To analyze the interaction between the two drugs in terms of the way JP234 would induce the metabolism of a single dose of warfarin, both R and S enantiomers were initiated through the CYP450 metabolic pathway. The study will be done based on the assumption that the new drug has been studied in vivo whereby in vitro metabolic studies will be consulted in determining whether JP234 is a substrate or an inhibitor the enzymes involved in the metabolism of warfarin. The study results will help in determining any possible interaction, such as whether PJ234 inhibits or induces the metabolism of warfarin. The mode of warfarin action in this case is based on its impact on the synthesis of vitamin K. The study will thus be able to portray the impact of drug interaction after eliminating warfarin. This will be considered from the results obtained from the group in which only the PJ234 is administered, as compared to the group whereby both the PJ234 and warfarin drugs are administered. JP234 is well tolerated during clinical trials and there is no contradiction associated with it. The drug when administered is effective in doses of 50, 75 or 100mg once daily. The drug is metabolized in the liver and has a half life of about 24 hours. In vitro studies indicate that the drug can induce CYP2C9. Patients with chronic atrial fibrillation should be anticoagulated to hinder thromboembolism from taking place (Goodman, 2005). Patient taking JP234 are recommended to take warfarin that is partly metabolized by CYP2C9. JP234 is an antiarrhythmic drug and is usually excreted in the liver just the same as warfarin. The PJ234 drug is considered an inducer of CYP2C9 which

Understanding Organizational Performance Essay Example for Free

Understanding Organizational Performance Essay The focus of this paper will be on investigating an organization, their performance management system and our recommendations for the future. Historically performance management is defined as evaluation a firm through metrics such as return on investment and economic value added. Our analysis will cover not only the financial performance of our chosen firm, but also their values in behaviors as well as their objectives. Thus, we will ascertain if the current system of performance management held by the firm is aligned with their objectives and appropriate for their situation. 1.1 – Why is strategic performance management important? Strategic performance management is a process where an organization develops its objectives, mission, and strategy, and measures and guides itself through management of key performance indicators or other success factors. Czarnecki (1999), states that measuring your organizations performance through each of the areas of most impact is essential for thoroughly assessing your performance. Thus when a firm like TESCO is preparing to make decisions they need to analyze a relevant data which can be converted into actionable information on their performance objectives. 1.2 – Describe the structure and plan of the investigation The structure of this investigation will be to first discuss the organization and its activities in the sector. Secondly, we will discuss the history of performance management of the organization and the relation between their systems and the actual performance. Finally, we conclude with highlighting any areas of improvement and making recommendations for seni or management. 2.0 – Performance Management in TESCO TESCO has employed a system called the TESCO steering wheel to handle performance measurement. This process is similar to the balanced scorecard created by Norton and Kaplan. The TESCO steering wheel was implemented in the late 1990’s and served as part of the critical expansion that the firm underwent as they explored innovative retail formats, product lines, and geographic areas. It can be attributed to their newfound success. 2.1 – Introduction to TESCO The organization that we will be investigating will be TESCO. TESCO is one of the largest retailers in the world and an organization which has shown success in utilizing strategic performance management. There are several styles of performance management which range from Porter’s five forces, to lean management, to the chaos model. The model which was discovered in 1996 and has been one of the most popular is the balanced scorecard. This model which was discovered by Norton and Kaplan has been used by  ¾ of European and Fortune 500 organizations (Balanced Scorecard, 2010). TESCO is unique in that it has implemented this model successfully. In 1995, Tesco surpassed its competitors Sainsbury’s as the top superstore in the United Kingdom. This catapulted its market shares from 15.4% in 1988 to about 29% in 2004. Acquisitions include the famed convenience superstore, TS plc and almost 900 stores around the UK. TESCO has a 30% market share in the United Kingdom and is dominating the market over its competitors. 2.2 – Why are they in business (Stakeholder or Shareholder?) TESCO is in business and highly successful because their founder was a driving force in setting up a foundation of a thriving market in the UK early on. He believed in piling products high and selling them at a cheap price. Since, the company has gone public they have placed close attention to the desires of the shareholders and places the fifth perspective of the steering wheel (financial) as a big component in the performance of their executives. Spitzer (2007) stated that holistic performance measurement enables management to continually assess the fruits of their labor with conducting a review. 2.3 – Strategic performance management of TESCO In regard to investing in their workforce, TESCO believes strongly that human capital is one of their most precious resources. The organization has their â€Å"options programme† which is designed to focus on long-term strategic goals for employees. They also have on job training, which is a cost effective way to ensure that their staff is capable of performing well. Tesco Leadership Framework is directed at three key themes to guide behavior in all employees. These behaviors link to nine critical success factors. The critical success factors can be segmented in several levels of assessment. This aids management in selecting the staff with the capacity to become high performing contributors to organisations. As part of the long term  strategy of the corporation, discovering future leaders is of the utmost importance. TESCO states that they will select leaders wherever they can be found in the organization for advancement. Promotions are a regular occurrence as over 2,900 man agers were promoted internally in the United Kingdom and literally thousands more in international locations. The Options programme is a more infrequently used as only 1 in 30 employees are enrolled while basic training and development happens about every 1 in 10 members of TESCO. Before beginning their development plan, each member of the TESCO staff selects gaps in their skills and competencies. The Personal Development Plan has a section where they can select this information for their line managers to check on in the future. 2.4 – What is strategic performance management? Who says so? The balanced scorecard is the most widely used standard for performance management. As mentioned before, performance management is defined as reaching objectives which can be quantified financially. Performance most times is just simply put as achieving success in your business operations. Therefore, performance means process and manner of functioning to attain beforehand objectives which you set out to achieve. Therefore, behavior must be tied to a result which will be judge throughout the fiscal year of operations for the firm. The balanced scorecard is an excellent tool to keep the organization planning and strategizing forward rather than assessing their operation based on past results. Performance management in many organizations is conducted and reported by line managers who are continuously overseeing employees and operations and giving a formal review at designated times. The values, mission, and objectives of the organizations are intertwined with the financial value added so that the process is flexible and requires less dialogue unless a major event occurs. 2.5 – Is performance management evident at a strategic level in TESCO? On the executive level of the firm compensation is closely tied to the performance of the firm which is common for most public firms. Earlier in 2012 it was found that performance bonuses were slashed to 16.9 per cent of the maximum. This was due to the fact that TESCO was behind its competitors in the UK in terms of sales in 2011 and the top 5,000 managers felt the pain of the company’s shortcomings. 3.0 – TESCO’s Activities and Environment TESCO is a global organization with facilities in over 14 nations and their headquarters being in the United Kingdom with 260 million plus as clients available at their hub. Their outlets have several different types of styles from hypermarket, to non-food item stores, to membership clubs. If one would take into consideration the enormous size of TESCO, it is easy to see that they would require a strategic performance management system which is flexible and nimble. Jones (2012) states that global organization need to have a holistic approach towards managing their operations and not a segmented method. This is crucial in the retail market. The retail market is nonetheless a competitive industry with commoditized stores and international competition in many of the markets the TESCO operates in. Therefore, TESCO has chosen the balanced scorecard approach which has given them success. 3.1 – What activities does TESCO engage in and in what sector? TESCO is a global grocery and merchandise corporation which was founded in the United Kingdom. The organization started IN 1919 with the retail sale of groceries and has diversified its product mix to include electronics, furniture, clothing, and books. Therefore, the company operates in multiple sectors and has a presence on every continent. The company used the aggressive strategy and approach of Jack Cohen to become one of the largest retail outlets on the planet behind only Carrefour and Wal-Mart. Sectors include: Groceries, electronics, financial services, petrol, telecommunications, clothing, music downloads 3.2 – What context does TESCO’s performance management fit in? Organizational performance can be viewed from a number of perspectives. We see that through the eyes of the customer TESCO was perceived as supplying excellent value and service. This perception was sufficient to place them as the top brand when they surpassed Sainsbury. Organizational performance can also be evaluated through financial, social, and environmental perspectives. This is where performance management at TESCO fits in. The TESCO steering wheel is a model internally shows that the firm has a holistic view towards management (Paul, 2008). This relationship exemplifies the relationship with decision making and performance where executives place emphasis on making decisions based on how far reaching the impactions are. 3.3 – Are TESCO’s performance measurements appropriate to that context? Yes, their performance measurements are actively aligned with the core assets which are integral to the success of  their organization. 4.0 – Managing Performance to Improve Decision-making: Specific example in IT Services The British retailer recently implemented a programme called Step Change, to advance its IT efficiency. Tesco placed a large amount of capital in information technology across its operations in the hopes it will keep up with the 21st century trends which lead to more mobile payments, ecommerce and efficiency gains through IT. In the earlier part of 2008, food sales over the internet made large gains of 49% higher in the last financial year, which lead to even more investment. 4.1 – What type of strategy does TESCO adopt? TESCO implements the balanced scorecard through the TESCO steering wheel. The steering wheel has 5 perspectives which cover different areas. The corporate vision and strategy of TESCO is motivated by its customer base, products, services, and the industry that it operates in. Upper management understands that margins can be slim in an industry where competition is tight and becoming a strong brand with heterogeneous image is important. Corporate strategy is inherently focused on financial gain which can be problematic of other objectives are not met (Graham, 2005). The component has lent itself back to business school basics by relying on the teachings of Porter’s five forces model. The model teaches that bargaining power of suppliers, customers, substitutes, buyers, and competitors are working against at any one moment in time. ASDA and Sainsbury due pose threats to TESCO domestically in the UK as they are established have developed brands which are perceived to have equal or greater value in the eye of the customer. Nevertheless, the threats of suppliers moving to their competitors are slimmer as TESCO has made great strides in infrastructure. The Perspectives Customer – Being an affordable and friendly retailer is crucial for TESCO. The customer is seen as the focus as competing products and sales channels can be seen more frequently with technology. Internal – Operations which are run smoothly with excellent customer service leads to keeping costs low and clients happy. TESCO is proactive in this area by offering club cards, and loyalty program with discounts and rewards. Learning – This perspective is seen through training, learning and focused supervision on employees so that they are nurtured to achieve their potential. Financial – Increasing sales,  optimizing investments, and keeping the shareholders happy are the focus of this perspective. Community – Corporate social responsibility is a key word as it relates to this perspective. TESCO was known to have a high carbon footprint, and it has strived to not only reinvest in the community, but reinvest it operates so that there is a keen interest in having a positive social impact. 4.2 – How does TESCO formulate its strategy? TESCO formulates its strategy based on the desires of the customer. According to Terry Leahy, Tesco’s Chief Executive, he states this clearly when he says â€Å"Let me tell you a secret, the secret of successful retailing. It’s this: never stop listening to your customers and giving them what they want.† This is the methodology which makes the organization one of the most successful in the world as every little contribution counts as long as it is helping build the bond between TESCO and its consumer base. This is the rationale behind the corporate strategy which is measured by the TESCO steering wheel. Axson (2010) stated that long term decision making is more soundly aligned with a balance array of operational strengths. This supports the decision which management has made it this firm. 4.3 – What are TESCO’s performance objectives? Does performance match expectations? TESCO’s performance objectives are essentially its 5 perspectives which are different areas covered in the steering wheel. Because the steering wheel is like the balanced score card it has a method of leading to performance which addresses TESCO’s impact on the triple bottom line (people, planet, profit) and allows the company to match and exceed expectations in several areas. Lunger (2007) states that the 21st century problems facing each and every organization requires incorporation of corporate stewardship into your overall strategy. 4.4 – How does TESCO inform its decision-making through performance? What tool does it use? TESCO utilizes the Balanced Scorecard method which is closely aligned with its corporate strategy. 4.5 – Critical evaluate of the tool, its benefits, limitations and it’s appropriateness to TESCO’s strategy The benefits of the tool also stem into the fact as it became a symbol of cohesion and empowerment within the firm. TESCO’s leader, Sir Terry Leahy, stated that he did not want strategy to be the work of only an isolated few individuals in the firm but the work of all of his employees. That is when the company started using the steering wheel in all  of their locations. Sir Terry Leahy ended up shutting down the strategy department completely (Jones, 2012). This was definitely seen as a controversial move as it meant that the executive level where not the sole contributor to what historically is the vision of the firm. The limitation of TESCO’s strategy here is that it is somewhat segmented in its approach as there will be no stores which are identical because they will all be run independently with their own steering wheels. This works agai nst the model that many retailers have at claiming to offer the same experience at every location. 4.6 – Identify areas for improvement A weakness for the company would be performance in the UK. Therefore development of Domestic operations is a major area of improvement for TESCO. The New CEO who succeeded Sir Leahy, Clarke, has vowed to make it an objective to have their profits in the UK become strong and growing. This is an admission of the company falling short of its expected performance for the most recent year. Part of the reasoning behind is the spectacular growth internationally of TESCO due its profits lent to underlying underperformance domestically as it has lost ground to ASDA and Sainsbury and the last three years. Crisis Management and Quality control falls under the community and customer perspective of the TESCO wheel (Marr, 2009). TESCO is reported to not have performed well in the backlash of a recent issue with suppliers and its grocery line. Recently, in early 2013, the media in the United Kingdom reported that horse meat had been found in some meat products sold by this organization, particularl y burgers. The company was quick to state that this was unacceptable activity. 5.0 – Conclusion and Recommendations 5.1 – Review and summary of your investigative findings The overall review of the findings of our report shows that TESCO is in good financial condition and its corporate strategy has achieved its objectives. The strategy has always been customer centric but it has been fruitful in economic value added and financial performance. Austerity has been a large issue in the European Union over the last few years and can bear the brunt of the blame in the lagging performance that TESCO has domestically in comparison to overseas. TESCO has seen strong growth in the United States as well as Asia. The dividend policy is forward looking at TESCO and the  overall change in management still needs time for the market to evaluate. When Sir Terry Leahy left TESCO stock crashed but has recovered. Still, the defensive position in the UK which TESCO has built over the years is proving to be vital as they weather the forces of competition domestically. 5.2 – Recommendations for identifying areas for improvement In regard to operations management, I would recommend that Tesco continue their use of the TESCO Steering wheel and invest stronger in internationally markets like Asia. Tescos highest growth came in Asia where profits grew by 30% to  £570m in 2011 (Hawke, 2011). The need to focus on the community and internal perspectives with innovations is what I see as the focus for the future. The opportunity to win back business from their competitors will require emerging a corporate citizen who cares about loyalty and the well-being of their consumer base will go a long way. This can be obtained by re-examining the performance management systems and not believing that their historical strength will continue to prove valuable in a competitive retail market. TESCO recently invested 500 million GBP as a stimulus package called â€Å"Building a better TESCO† and it has shown lackluster results thus far (Hawke, 2011). In terms of corporate strategy, I believe that creating a performance management group which oversees the effectiveness of the steering wheels domestically would be a great next step. Hope (2012) argued that utilizing your performance management tools sometimes entails injecting the human element into the equation. TESCO uses steering wheels in all of its location and loyalty cards to keep customers feeling connected and appreciated. If TESCO invests in a performance management team which can monitor remotely the performance of the UK stores in community and financial perspectives they can consistently support growth in these locations where their performance is not as strong as overseas. 5.3 – Implementation plan for recommendations Overall, TESCO’s use of strategic performance management has been successful and I would recommend keeping the steering wheel intact. The model fits naturally with their objectives and mission for the future. This has been instrumental in overcoming threats from other organizations as well as allowing them to focus on growth potential. Recommendation #1 is to invest in Asian markets more aggressively in 2013. This recommendation can be  implemented by identifying areas for growth in existing markets where TESCO has a presence and building more stores. Establishing sales channels in these markets was a strategic investment which the company has already made and can be further utilized to extract and attract more profits. Recommendation #2 is to establish a performance management team to oversee domestic steering wheel systems for TESCO. The success of the corporation has been about measuring less with their tools and focuses more on customers. The focus of this team would be to provide more support to underperforming stores by supplementing by coaching them through their steering wheel templates and shopping lists. References Business Case Studies UK. â€Å"How training and development supports business growth† Graham, Kenny, (2005), â€Å"Strategic Planning and performance management† Taylor and Sons Marr, B., (2009), Delivering Success: How Tesco is Managing, Measuring and Maximizing its Performance, Management Case Study, The Advanced Performance Institute. De Wall, Andre, (2007). â€Å"Strategic Performance Management: a managerial and behavioral approach†. Unknown Axson, David A. (2010), â€Å"Best Practices and Planning and performance management† Wiley John and Sons. Katter, P. John, Heskett L. James, (1992), â€Å"Corporate Culture and Performance† Kotter Associates. Hope, Jeremy, (2012), â€Å"Beyond Performance Management, how and when to use 40 tools† Harvard Business Review. Hawke, Alex, (2011), â€Å"TESCO Reports record profits of 3.8 Bn† Guardian.co.uk Marr, Bernard, (2006), â€Å"Strategic Performance Management† Butterworth-Hineman, Oxford. Lunger, K., 2007, â€Å"A performance Management Primer: Why you need more than a dashboard to manage your strategy.† TESCO PLS (2010) (2011) from Tesco Corporate Paul, R. (2008) Balanced Scorecard: for Government and non-Profit Agencies. Canada: John Wiley Marr, Bernard, (2010), â€Å"The Intelligent Company, Five Steps to success with evidence based \management† Wiley, Oxford. Jones, Steve. 2012, â€Å"Strategic Performance Management, A Case Study at TESCO† Czarnecki, Mark T. (1999), â€Å"Managing by Measuring, how to improve your organization’s performance through effective benchmarking†. The Benchmarking Network Spitzer, Dean, (2007), â€Å"Transforming Performance Measurement: rethinking the way we measure†. AMACOM.

Beer Brewery Company In Canada Marketing Essay

Beer Brewery Company In Canada Marketing Essay Molson is a successful beer brewery company in Canada. It was found in 1786, which made it the second oldest Company in Canada so far. Molson Company is recognized as the most preferred beer brand in Canada and it also possess the fourth largest market share in global beer industry. Molson Company faces a challenge in 2007 due to its unsuccessful marketing strategy. The campaign intended to engage with the target market of age 19 -24 through social media. This campaign held a contest, Cold Shot, which encouraged students to compete with other college students by posting as many pictures as possible. This contest ended up creating unexpected negative publicity against the Molson Campaign. Many students and administrators complained about the harm of reputation brought by this contest. As a result, Molson Campaign had to pull the promotion under the public opinion. There are three alternatives that allow Molson Company to engage with the target market. The first alternative is Microblogging, which encourages students to update their status through social network while they are drinking. Molsons drinkers could also follow up the latest Molsons events on site. The second alternative is to build a Molson Educational Center to promote legal drinking message for students and young adults. Young adults are invited to visit the educational center to explore more about Molsons history and experience different fun activities in the center. The last alternative and also the recommendation for Molson campaign is to create Molson Apps that educates students to avoid overconsumption of alcohol through playing the information games. Students could win different valuable awards by playing it. As more games are played by students, the more awards they can get. This does not only enhances Molsons relationship with target audience but also successfully promotes the correct drinking behavior they should have toward their future drinking. Identification of the Problem Molson Company, currently, is facing a challenge in reestablishing its brand as a brand that promotes and encourages responsible alcohol consumption. Molsons problem is to determine if it should continue to use the social media sites for future promotions in marketing its brand. Due to the previous failure in social media marketing, Molson Company has caused various universities colleges to worry about the academic achievements of students. The irresponsiveness of the Molson Company supporting outrageous alcohol consumptions towards students has discouraged them on their studies. In addition, as the Molsons campaign Cold Shot of posting party pictures of students in campus to gain the title of number one party school in Canada encourages foolish behaviors and underage drinking. As a result, universities and colleges are concern about how Molsons activities have neglected the institutions reputations/ images and its student bodies. Situation Analysis Internal Factors: Strengths: Molson is consider as the most preferred brand with a huge percentage of the market share in Canada of 41%, as well as, in the world market around the globe with 3.8%. Due to the development of social media marketing, Molson has started begin involved in social media platform such as Facebook with by approximately 19,000 followers who are interested in Molson. Besides Facebook, the company also manages a variety of social media like Twitter, Flickr, and Youtube. While selling its products to the public, the company has tried their best to be responsible for its commitment for alcohol responsibility as well. Weaknesses: For now, the company is on a huge blame due to an improper promotion activity, Cold Shot. By targeting college and university students, the marketing strategy was issued due to its direction of morality and ethics in encouraging irresponsible drinking and behaviors. Its unsuccessful campaign had harmed the brand image and received negative perception by adults including professors, administrators, as well as, those who have a negative feeling for the company and beer. External environments Political Environment All the provinces in Canada have their different laws and rules for alcohol regulation as well as advertisement of alcohol. It should be specified that advertising must not be related to the consumption of alcohol and should not imply alcoholic consumptions can enhances social acceptance, personal success, and enjoyment of any activity or will resolve the personal problem (Canadian Center of Substance Abuse). If the company wants to maximize the effect of its advertising, it has to be more sensitive not to make ethic and moral issues like it did previously with the Cold Shots campaign with colleges and universities. Social Environment Currently, the social responsibility has been stressed for beer companies so that all the beer companies are presenting its social responsibilities to avoid the blames form the public and society. Molson is providing the responsibility section when its visitors come to approach its official website. Among what the company puts on the section as all kinds of responsibilities, they also offer Governance and Ethics and Alcohol Responsibility on What Matter to Us sections (Molson Coors). Especially on Alcohol Responsibility, they have Global Alcohol Policy and Our Views for better understanding for consumers. Besides, the website provides the company policies, case studies as well as the full details retrieved from the Global Actions on Harmful Drinking website (Molson Coors official website). Competitive Environment Molson is an influential competitor among powerful competitors in the beer market, the moral and ethic issues of the company can be critical. Actually the current flow of the beer market in terms of volume consume, A- B InBev maintained top volume share with 18.3% in 2011. Among the top competitors there are: SAB Miller with 9.8% Heineken with 8.7% Carlsberg with 5.6% China Resource Enterprise with 5.4% Tsingtao Brewery with 3.6% Grupo Modelo with 2.9% Beijing Yanjing Brewery with 2.9% Molson Coors with 2.9% Molson maintained its percentages since 2010; however, it lost its 8th position to Beijing Yanjing, and now Kirin Holdings is a threat to Molson in terms of volume share. (Passport GMID) SWOT Matrix Strength Canadas most preferred brand with 41% market share Rank 4 in the world holding 3.8% market share worldwide Had 19,000 members on its Facebook profile Engaged with social medias like Twitter, Facebookà ¢Ã¢â€š ¬Ã‚ ¦ and more. Molsons acknowledges as a firm commitment to alcohol responsibility (Molson, 2009) Opportunities Average users of Facebook are fairly young, usually between the ages of 18-21, who are interactive with friends in open and trusted setting social networking sites Social network users likes to interact with their favorite brands profile Social network sites allow fast and effortless spread of message that includes viral marketing campaign. (Word of Mouth) Weakness The failure of the Cold Shots Facebook promotion gave Molson Company a bad reputation since it encourages irresponsible behavior and underage drinking. Threats Limited control on social media sites since it is open for public to posts and comments about a firm or its product Social media sites allow mashups which lead to issues of control and ownership on contents. Organization Objectives To reestablish its brand as a company that cares about social responsibilities rather than a company who only tries to sell alcohol for money. To promote and encourage responsible alcohol with the use of social media.   Analysis of Alternative Before going on to the alternatives, Molson will run year round campaign call a volunteer days. The volunteer day hosted by Molson Company is on monthly basis. The campaign is to encourage those who are brand loyal to participate in local community and help out local rehab centers. Molson believe that engaging brand loyal consumers to local alcoholic rehab center allows them to understand the flaws of irresponsible drinking can cause. Whoever participates might have a chance to win free sport event tickets in a random. The reason we want to launch this campaign with the alternatives is to continue the firms goal of being socially responsible to its community and re-established its brand reputation. Alternative #1: Microblogging about drinking at events The first alternative is Microblogging about drinking Molson Canadian at events. The microblog is a year round blogging site. Applicants must register and create an account before they can blog on it. Site filtrations with questions will be add-on through the registration process to eliminate unlawful age drinkers to view the site. Molson Canadian will be posting dates of various sponsor events on this site to allow audience to visit the events. The microblogging encourage him or her to blog about the current events that is happening and the location theyre at and what they are drinking. Through this site the participant can also access and update their status on Facebook or Twitter through this site. This allows the friends of the Molson drinkers to follow up with Molson Company. On top of posting statuses, Molson Canadian also encourage Molson drinkers to post cool stories of their fun night out. Monthly draws of the best pick funny stories is able to win cash prize, Molsons wearable product, and sport tickets. Alternative #2: Building a Molson Educational Center. Another alternative is to build a Molson Educational Center. The center is similar to a museum. It will include: A small replica of the brewing plant to show the brewing process of the prefer beer in Canada Beer tasting only for 19+ A history lesson of Molson Company Theater to play short movies/videos of responsible and irresponsible drinking scenarios A talk show to educated audiences in responsible drinkers from personnel in local alcoholic rehab centers. Fun activities of experiencing ride check, breathalyser, foggy goggles with affiliated personnel from the local police station Workshop to create customized beer bottle to bring home. Gift store to purchase Molsons items, mugs, hats, t-shirts, and more. To promote and encourage legal drinking message, the education center is only available to 19+ of aged universities and colleges students/drinkers and adult tourists. Illegal entries of 18 and under are not permitted. Securities will be standing at the front door to check IDs before entries. Even though this is a great idea but the cost of this will be too large for the company to handle. Alternative #3: Molson Application The third alternative, Molson Canadian decided to create a mobile application that is designed to store social media platforms, games applications, with features of educational alcohol consumption facts. The mobile application is able to update automatically to gives consumers the latest information in online communities, events, games, and educational facts. The application is personalized, where participants can create their own avatar, set up their choice of background, and more. Molson want to give participants a sense of ownership within carefully defined parameters to customize the App. The application is divided in three sections Games: The main objectives for all Molson games are (1) to not over doze in alcohol and (2) to maintain good behaviour. Coins can be collected throughout the games and after winning the game. Collecting coins can trade real items like Molsons mugs, hats, t-shirts, customized beer bottle of users choice, movie tickets, or even Ipad. If player loses, the game will end with an alcohol consumption fact to educate players Videos: Molson will display educational videos like fun facts of alcohol consumptions, possible causes of irresponsible drinking, Molson events, drinkers talk from rehab centers to educated consumers. Social media platform The Molson application will also be interlinking with the social media platform like Facebook and Twitter to generate interaction between the brand and the target audience. Through the application, Molson wants to drive in more traffic to the fan pages and ensures that there is a continuous interaction in current events, campaigns and discussions. But for sure, applications and fan pages will be evaluated on the basis of what kind of community is being created or whether the community would fit within company and societys expectations. Recommendation Molson Company should continue to benefit from the numerous opportunities to market their products, no matter if its using social media platforms, or more. After much consideration, alternative #3 is believed to be the best one. Picking this option allows Molson Company to closes the gap between fun and education in a way it benefits both. The application is one of the most complete mobile sources for consumers. With the understanding of young people are closely attached with their mobile nowadays, Molson wants to create an application that allows audiences to access it all time. With just a touch of a button, people are able to connect to games, social media sites and informational facts of alcohol consumption. Through this application, Molson Company wants to attach various messages to the target audiences and promote and encourage target audiences to generate a responsible drinking habit with educational facts. In addition, the alternative can also create awareness for Molson prim arily through social media platforms, with the application and some traditional media directing consumers to Molsons Facebook site to generate more traffic. Maybe future promotional campaign can become viral through the fast and effortless spread of messages. Unlike before, every activity and promotion that is engaged by Molson will be carefully evaluated on the basis of what kind of community is being created. Promotions or contents that even hint at improper or excessive of behavior or use of products, Molson will eliminated it. Molson Coors Brewing Company. (2009, October 24). Corporate responsibility overview Retrieved October 24, 2009 from http://www.molsoncoors.com/responsibility/great-brands-the-right-way

Review of literature on Postoperative Pulmonary Complications

Review of literature on Postoperative Pulmonary Complications According to Polit and Hungler (1999) the task of reviewing research literature involves the task of reviewing research literature involves the identification, selection, critical analysis and written description of existing information on the topic. Related literature which was reviewed is discussed under the following headings. Studies related to overview of the postoperative pulmonary complications. Studies related to chest physiotherapy and incentive spirometry. Studies related to overview of postoperative pulmonary complications Soledad Chumillas (1998) posited that pulmonary function is commonly altered after surgery, particularly in patients who have had chest or upper abdominal surgery. The physiological changes observed are directly related to anaesthesia (general or regional) and to the type of incision and surgical technique employed, and are reflected by decreases in total pulmonary capacity and pulmonary volumes and by a parallel decrease in Pa02. Yoder (2009) said that thoracic and upper abdominal surgery is associated with a reduction in vital capacity by 50% and in functional residual capacity by 30%. Diaphragmatic dysfunction, postoperative pain, and splinting make these changes. After upper abdominal surgery, patients shift to a breathing pattern with which ribcage excursions and abdominal expiratory muscle activities increase. Postoperative patients maintain adequate minute volume, but the tidal volume is very low and the respiratory rate increases. These abnormal breathing patterns, along with the residual effects of anesthesia and postoperative analgesics, inhibit cough, impair mucociliary clearance, and contribute to the risk of postoperative pulmonary complications. David Warner (2005) described that many factors responsible for PPCs are related to disruption of the normal activity of the respiratory muscles, disruption that begins with the induction of anaesthesia and that may continue into the postoperative period. The effects of anaesthesia can persist into the postoperative period, though via different mechanisms, as the effects of surgical trauma come into play. These are most pronounced following thoracic and abdominal surgery, and arise from at least three mechanisms. First, functional disruption of respiratory muscles by incisions, even after surgical repair, may impair their effectiveness. Postoperative pain may cause voluntary limitation of respiratory function. Finally, stimulation of the viscera, such as provided by mechanical traction on the gallbladder or esophageal dilation, markedly decreases phrenic motor neurone output and changes the activation of other respiratory muscles, in general acting to minimize diaphragmatic descent. Other factors that may contribute to PPCs include: 1) Reflex stimulation during surgery, and release of inflammatory mediators by drug administration, increasing airway resistance and limiting expiratory gas flow from the lung; if severe this can produce hyperinflation with risk of barotrauma and gas exchange abnormalities. 2) Impairment of normal mucociliary transport by anaesthetic gasses and endotracheal intubation which may delay clearance of pathogens and promote retained secretions 3)Impairment of lung inflammatory cells function by prolonged anaesthesia and surgery, which could increase susceptibility to postoperative infections 4) Impaired upper airway reflexes postoperatively, with may increase the risk of aspiration, and 5) Incomplete reversal of neuromuscular blockade. Rochelle Wynne and Mari Botti (2004) postulated that the pathogenesis of postoperative pulmonary dysfunction is associated with anomalies in gas exchange, alterations in lung mechanics, or both. Abnormalities in gas exchange are evidenced by a widening of the alveolar-arterial oxygen gradient, increased micro vascular permeability in the lung, increased pulmonary vascular resistance, increased pulmonary shunt fraction, and intrapulmonary aggregation of leukocytes and platelets. Variations in the mechanical properties of the lung lead to reductions in vital capacity, functional residual capacity, and static and dynamic lung compliance. Woerlee (2009) listed certain performance criteria for the respiratory system of a surgical patient. They are: The lungs must have sufficient oxygen to oxygenate the blood. The pulmonary circulation must eliminate carbon dioxide from the body to prevent carbon dioxide accumulation. The client must be able to generate a productive cough, otherwise mucus accumulation will occur resulting in atelectasis and/or lung infection or pneumonia. The client must be able to significantly increase their respiratory minute volume to compensate for factors such as increased postoperative metabolic rate, elevated body temperature, possible infections, pneumonia, etc. Poor performance in significantly raising and sustaining an elevated respiratory minute volume results in exhaustion and respiratory failure. Postoperative pulmonary complications account for a substantial portion of the risks related to surgery and anaesthesia and are a source of postoperative morbidity, mortality and longer hospital stays. The current basis for our understanding of the nature of Postoperative pulmonary complications is weak; only a small number of high quality studies are available, a uniform definition has not emerged, and studies have focused on specific patients and kinds of surgeries. Current evidence suggests that risk factors for Postoperative pulmonary complications are related to the patients health status and the particular anaesthetic and surgical procedures chosen. Age, pre-existing respiratory and cardiac diseases, the use of general anaesthesia and overall surgical insult are the most significant factors associated with complications. Election of anaesthetic technique, postoperative analgesia and chest physiotherapy seem to be the preventive measures that are best supported by evidence. (J.C anet, V.Mazo, 2010) J.C.Hall ., et.al (1991)evaluated the relationship between postoperative pulmonary complications and various putative risk factors in a prospective longitudinal study of 1000 patients undergoing abdominal surgery. Transient subclinical events were studied by defining postoperative pulmonary complications as positive clinical findings in combination with either positive sputum microbiology, unexplained pyrexia, or positive chest roentgenographic findings. The overall incidence of postoperative pulmonary complications was 23.2%(232/1000). These findings supplies clinicians and clinical nurse with a simple means of identifying patients who are at high risk of postoperative pulmonary complications after abdominal surgery. Postoperative pulmonary complications contribute significantly to the overall perioperative morbidity and mortality. Pulmonary complications occur significantly more often in patients undergoing elective surgery of the thorax and abdomen. These include atelectasis, infections including bronchitis and pneumonia, respiratory failure and bronchospasm. Sharma (2000). The study findings of Brooks-Brunn (1995) revealed that atelectasis and infectious complications account for the majority of reported pulmonary complications. Risk factors were thought to exaggerate pulmonary function deterioration, which occurred both during and after surgical procedures. 18 risk factors were reviewed regarding their Pathophysiology, impact on preoperative, intra operative and postoperative pulmonary function in this study. Identification of risk factor and prediction of postoperative pulmonary complications are important. Preoperative assessment and identification of patients at risk for postoperative pulmonary complications can guide our respiratory care to prevent or minimize these complications. Postoperative pulmonary complications were investigated in a total of 41 paediatric recipients who underwent orthotopic liver transplantation. Atelectasis was seen in 40 cases (98%) of the 41 recipients, and occurred in the left lower lobe in 28 cases (68%), and in the right upper lobe in 25 cases (61%). Radiographic pulmonary edema occurred on 23 occasions in 18 recipients (45%). Five recipients experienced two episodes of pulmonary edema during their ICU stay. Pleural effusions were observed in 21 cases (52%), of which 18 had right sided effusion and 3 had bilateral effusions. Pneumothorax occurred in 3 cases. Pyothorax, hemothorax, bronchial asthma and subglottic granulation occurred in one case each. The present study demonstrated that postoperative pulmonary complications are frequently observed in paediatric recipients undergoing orthotopic liver transplantation. (Toshihide et.al.,1994). Kanat et al., (2007) studied the risk factors for postoperative pulmonary complications in upper abdominal surgery. They concluded that pulmonary complications are the most frequent causes of postoperative morbidity and mortality in upper abdominal surgery. A prospective study on 60 consecutive patients was conducted who underwent elective upper abdominal surgery in general surgical unit. Each patients preoperative pulmonary status was assessed by an experienced chest physician using clinical examination, chest radiographs, spirometry, blood analysis, anaesthetical risks, surgical indications, operation time, incision type, duration of nasogastric catheter and mobilization time. Complications were observed in 35 patients (58.3%). The most complications were pneumonia followed by pneumonitis, atelectasis, bronchitis, pulmonary emboli and acute respiratory failure. They recommend a detailed pulmonary examinations and spirometry in patients who will undergo upper abdominal surgery by ch est physicians to identify the patients at high risk for postoperative pulmonary complications, to manage respiratory problems of the patients before surgery and also to help surgeons to take early measures in such patients before a most likely postoperative pulmonary complications occurrence. Serojo et al., (2007) in a prospective cohort study, studied risk factors for pulmonary complications after emergency abdominal surgery. Pertinent data were collected through interview and chart review and their association with the occurrence of postoperative pulmonary complications were analyzed. 286 consecutive children were included and 75 (28.2%) developed postoperative pulmonary complications. Pulmonary complications are frequent among children undergoing abdominal surgery and lead to increased length of hospital stay and death rate. Kilpadi ,et al., (1999) in a prospective study of respiratory complications, conducted a study for a period of six months with total samples of 584 patients, who underwent elective or emergency surgery. He found that 81 of them had 13.9% of respiratory complications, 68% had pneumonia and others included pleural effusion, empyema and exacerbation of asthma. Felardo et al., (2002) investigated the postoperative pulmonary complications after upper abdominal surgery. Two hundred and eighty three patients were followed from pre to postoperative period. A protocol including a questionnaire, physical examination, thoracic radiogram and spirometry was used during preoperative period. Sixty nine (24.4%) patients had pulmonary complications in 87 events registered. Pneumonia was the most frequent event 34% (30/87) followed by atelectasis 24% (21/87), broncho constriction 17% (15/87), acute respiratory failure 13% (11/87), prolonged mechanical ventilation 9% (8/87) and bronchial infection 2% (2/87). Pulmonary complications occurs more frequently than cardiac complications. The complication rates for upper abdominal and thoracic surgery are the highest. A better understanding of the risk factors associated with postoperative pulmonary complications is essential to develop strategies for reducing these complications. In any individual patient the benefit from a surgical procedure should be weighed against the risks it imposes. When possible, stabilization of respiratory status is advisable before surgery. (Muhammed Aslam, Syed Hussain, 2005). Decline in pulmonary function after major abdominal surgery is thought to be identified in daily assessment by observation of breathing and pain intensity. Measurement of pulmonary function is usually not included in the assessment of the patient in postoperative period. The aim of this study was to investigate the relationship between clinical observation of breathing and decline in pulmonary function and pain. Eighty nine patients admitted for elective major, mild and upper abdominal surgery, participated in the study. Clinical observation of breathing covered the following parameters like abdominal expansion, side expansion, high thoracic expansion, paradoxical breathing, symmetry of thorax expansion, ability to huff and signs of mucus retention. Pain intensity was assessed at rest and during breathing exercises and during coughing using a visual analogue scale. Peak expiratory flow rate were performed on the preoperative day and for seven postoperative day. A poor correlation is found between clinical observation of breathing and pulmonary function after abdominal surgery. (Johannes vandeleor et al ., 2003). Fung et al., (2010) compared postoperative respiratory complications in obese and nonobese children following surgery for sleep-disordered breathing. All obese children who had undergone adenotonsillectomy for sleep-disordered breathing from 2002 to 2007 were compared with age- and gender-matched controls. Length of hospital stay and the incidence, severity, and location of respiratory complications were compared.  Forty-nine obese children were identified (20:29, female: male). Overall, 37 obese children (75.5%) and 13 controls (26.5%) incurred complications (P = 0.000). Ten obese patients and two controls incurred major events (P = 0.012); 36 obese children had minor complications versus 12 controls (P = 0.000). Obese children had significantly more upper airway obstruction (19 vs. 4, P = 0.0003), particularly during the immediate postoperative period. The mean hospital stay was significantly longer for the obese group (18 vs. 8 hours, P = 0.000, mean difference of 10 hours). He concluded that Obesity in children significantly increases the risk of respiratory complications following surgery for sleep-disordered breathing. Sixty patients were studied to determine the incidence of postoperative pulmonary complications and the value of preoperative spirometry in producing pulmonary complications after upper abdominal surgery. On the day before the operation and for 15 days after the operation, each patients respiratory status was assessed by clinical examinations, chest x-ray, spirometry and blood gas analysis. A chest physician and surgeon monitored patients for pulmonary complications independently. In this study postoperative pulmonary complications developed in 21(35%) patients (pneumonia in 10 patient, bronchitis in 9 patients, atelectasis in 1 patient, pulmonary embolism in 1 patient) of 31 patients with abnormal preoperative spirometry, 14 patients showed normal preoperative spirometry, 7 patients showed complications. It was concluded that postoperative pulmonary complications was still a serious cause of postoperative morbidity. (Kocabas et al.,1996). Study conducted by Ephgrave et al., (1993) revealed that postoperative pneumonia was a major complication that had been linked to micro aspiration of pathogens originating in the gastrointestinal tract. 140 patients who had undergone major surgeries were selected. Postoperative pneumonia is present in 26 (18.6%) of 140 patients. Postoperative pneumonia is a morbid postoperative complications associated with presence of gastric bacteria during operation and transmission of gastric bacteria to the pulmonary tree after surgery. Studies related to chest physiotherapy and incentive spirometry Chest physiotherapy is an important therapy in the treatment of respiratory illness. It is very important to carry out this procedure in children for the purpose of loosening secretions from the lungs. Morran, et al., (1993) has done a randomized controlled trial on physiotherapy for postoperative pulmonary complications. A sample size of 102 patients undergoing cholecystectomy were assigned to control group and study group. The patients in the control group did not receive chest physiotherapy, while patients in the study group received chest physiotherapy. The study proved that without chest physiotherapy 21 patients developed atelectasis and 19 patients developed chest infections whereas with chest physiotherapy 15 patients developed atelectasis and 7 developed chest infection and 40 patients developed no complication. The author concluded that routine prophylactic chest physiotherapy significantly decreased frequency of chest infection (p