The Significance Of The Cultural Homogenization Process Tourism Essay

The implication Of The Cultural Homogenization Process Tourism Es theorizeCulture is be in many ways and different authors rent different views astir(predicate) assimilation for example Hofstede (1994) defines culture as the collective programming of the mind, which distinguishes the members of adept group or course of study of people from other. (Cited in harry, 2004) where as Belhassen and Caton (2006) have difined culture as the sum total of learned beliefs, values and usance that serve to direct the consumer behavior of members of a especial(a) society. According to Richard(1994) culture is the blend of values, morals, behavioral norms, cuisine, and language. Therefore in this essay we will fail the process of Cultural homogenisation to worldwide hobbleism and cordial reception labor.Needle (2004) indentified world-wideization as a practice to describe the growing public exposure of cultures to become homogenous which results in advance technology and announceme nt. Products and operate ar becoming more identical beca mapping of the growing list of product any everyplace the globe and also in spite of common ethnic differences Levitt (1984). According to (Scheytt) 2007 the past of globalization can be seen as former(a) as 14th century but most dramatic changes were sight in 1960s. Latter WTO (1999) bought about shift in occupation from countrified to manufacturing because of the industrial revolution. As a result the common restructuring of Western atomic number 63 and America that was well up known by accumulating industrial production of goods and services which is known as Fordism. Baum (2006) distinguishes fordism by mega consumption and production of goods, teddy dash off of hours and with senior high wages. According to Sharpley (2003) the basis for modernity was established by the nineteenth century at the time of industrialization and urbanization of the society. Therefore the routine operators pounced and started provi ding software tours which involved major hotels like Hiltons and Sheraton in us who thereafter took their business to Mexico, Florida and Caribbean which was observed by Holloway (2006).However it was noted by Mlkula (2004) that in early 1970s that the system of pile production and consumption started encountering problems confront because of the fordism management because of the excess production. Likewise the upcoming countries like Taiwan, Korea and Japan go about high price competition from the western economies. This together resulted in high vegetable oil prices by the oil exporting countries which resulted the world economy to calm as the US power weakens which led to static and highly blow up economies as per Baker (2004). As a result Pizam (2005) realized that the oil prices in 1970 were a threat to deep shipping manufacturing which leads to major crisis. However Pizam (2005) noted that in 1980s and 1990s by acquiring the labour from the third world countries allowe d deep sea shipping to be more established which added to progressive stabilization of oil prices and also cutting down of labour cost.Ritzer (1993) defines Mc Donaldization as the process by which the principles of the fast- food for thought eateryargon coming to dominate more sectors of our society. Walton (2009) says that cultural homogenization is called as Mc Donaldization he also added by formula that they consist of intravenous feeding foundation they are efficiency, calculability, predictability and control. The main objective of any company is to go multi earthal to maximize profit through low labour as well as securities industrying advantages says Tribe (1995). Further Youell (1998) says that globalization is in general seen in touristry and hotel industry, where on the other side multinational companies operates global level. For example Star alliance and World alliance.Lucas (2004) added by formula that the circumstance globalization has been repeatedly used to portray that modern technology and converse channels has made world smaller and this consequently is a thought of a global village. According to Sharpley (2003) globalization process is observed globally in the society that indicates that world is becoming a global village. As globalization has a major part and spread all over the world through media, business etc. Mandell and Kohler (1990) points that development technology has a major government agency in compressing time and place, as a result the enterprises are able to do their business on a global scale through internet. He also stated that genuine and developing worlds has allowed for interdependencies among nations due to the facilitation on cultural exchanges. Page and Connell (2006) futher added by saying that tourism helps to post and preserve culture by generating financial support and by instigating community pride. He also adds by saying that the acclivitous of western culture creates a major problem to develop ing nation to to adapt different views, attitudes and behavior etc. for eg tourist places like capital of Nepal and Nepal have seen noticeable westernization oh home culture. Bocock (199378) also points that the present world brands that are made, packed and sold in a particular fashion of that particular cultural values of that country. The organization which uses global marketplaceing techniques endlessly hold back in mind the culture of that comp nonpareilnt where the particular organization is held and consequently products are being manufactured and sold in that particular percentage. A good example which clearly indicates that value of a particular region is shown up by Mc Donalds. The name Donald Mc Donalds is very overmuch famous in Japan than Ronald Mc Donald just because the R lumbering is not used in Japanese language. The menu which served in Mc donalds is totally different which are served in Mc is US or UK .The meal which served in Mc is corn soup and squirt tea flavored milkshakes. Therefore this example says that globalization has caused uniformity but does not always undermine national cultures. Shaw and Williams (2004) also says that marketing plays a vital role to send such information to the local audience. He also adds by saying that the improved technology and vast media images has made so low-cal for the audience to know about the products and their services. Shaw and Williams (2004) says especially in tourism industry internet plays such a vital role that it provides all the information to the people and also helps in promoting particular destinations. According to Schiffman and Kanuk (1991) the supplier use means of communication to convey the message to the consumers and also make the consumers reacts in a desired way.According to Holloway (2006) there was big decline in late 1980s where the global market which more behaved in a individualistic way. As per the increase enquire for consumers and because of the improved tech nology the remove of the consumers increased dramatically. People were not just happy with sun cleanse they were ensureing for more adventure in their holidays. Page and Connell (2006) came out with an in the raw idea of heterogeneousness which allowed the homogenous products to be delivered in that way. Looking at this trend of heterogeneity Thomson (1992) named the above trent as post modernity that came in late 1980s and 1990s. he also add by saying that as the name suggest post modernity, the people will look for more different varieties and also for more individualistic products. Holloway (2006) further added by saying that because of improved technology and also a vast computer address of information through internet consumers have become more learned and therefore they know the place to travel. Walker and Miller (2008) noted that the global market has a tremendous increase in the niche tourism products like ecotourism, heritage tourism etc. Sharpley (2003) examined tha t the difference between the universe and portrayal of reality has declined in post modernity for example Cindrella go in Florida and Lego Land near Windsor. The new ideas what tourism and hospitality industry has bought is the packet boats for maturement tourism, green tourism, gay tourism which allows people from all category to explore the tourist places all over the world.Todays niche market for ageing population is increasing considerably. The trend of changing demographics has lead to observe the international arrivals from this senior group will account for over 16 of global trips says (Smith and Jenner) 1997. The tourism market serves accordingly to the consumers inevitably and wants as the market is segmented on disposable income and travel habits of this mature market. For example specials atomic pile for older people. Toursh and Hargie (2004) that UK firm SAGA has tapped this market totally globally. Similar Swarbrooke and Horner (2004) says that even package holida ys and fly drive holidays are in so much of demand to meet the consumers needs and wants. He also adds by saying that this package holidays allows the consumers to be more flexible. Fly drive packages are those holiday packages which allows the consumers to turn out as u go and select their own accommodation provided by the operators. And this market has not only impacted in that particular region or country but it has been used in the global market in todays world. Swarbrooke and Horner (1996) have also put light on the green consumers which deals with the environment issues very seriously. For example TUI its a leading German tour operator company which provides environment checklist to all the hotels in which they provide services. And another example is of British airways where they try and create an environment awareness of miscellaneous issues related to ecotourism. Swarbrooke and Horner (2004) has examined that more and more consumers are more into the packages than the ear ly counterpart. As this package provides everything for the customers from meal to accommodation and also for all types of customers from two to 3 starts hotels to leisure travelers.As noticed by Holloway(2006) gay and lesbians markets are one of the upcoming markets in hospitality and tourism industry. They are also named as Pink Market. Therefore the importance is given to this category of consumers as well where they take one domestic and two foreign trips per years. Holloways also adds by saying that outlet 4 travel UK is the first call midsection who caters to such markets.Thus in conclusion to this essay we can say that due to such advance technology and communication in hospitality and tourism industry globalization do facilitate the homogenization of consumers needs and wants. As the example shown in the essay about the fast food viewed differently by American and the Korean we can say that the homogenization of culture was also evident, but there were exceptions where con sumers from different cultures perceived things differently. And on the other side due to such advanced technology and mass promotion it is very easy for the consumer to get information and get more educated and sophisticated and gain different experiences which led to cultural heterogeneity as opposed to the concept of globalization and cultural convergence.

Case Study: Urachal Carcinoma in a Young Man

Case essay Urachal Carcinoma in a Young ManA r ar part of urachal carcinoma in a young person manYoung Kwon Hong, Haeyoun Kang1, Moon Hyung Kang, dong Soo ParkINTRODUCTIONUrachal carcinoma accounts for less than 1% of bladder crabby persons and approximately 40% of vesical glandular carcinomas. Historic all(prenominal)y, patients tend to impart a poor prognosis, with 5-year survival judge of 6.561.0%. Therefore it is im appearanceant to detect the disease as early as possible. Most urachal pubic louses have been account at the middle or honest-to-god age, and it is hard to think that urachal remnant has malignant change in a young man at the age of twenties. Here we introduce a very rare urachal cancer parapraxis in a young man and we would like to remind that urachal remnants have potential to change from friendly to malignant as earlier than expected.CASE REPORTA 26 year hoar man visited our clinic with unadulterated hematuria starting a few months ago. Urinalysis sh owed many RBC, and CT scan showed a 4.0 x 6.8 cm sized lobulated cystic mass everywhere the bladder loft which was located midline to the right side. The mass has calcified thick wall with fly-by-night contrast enhancement (Fig 1). Cystoscopy showed a ball-shape extrinsic mass from the bladder attic with intact bladder mucosa (Fig 2). With an impression of urachal cancer laparoscopic surgery was performed. tv camera port was placed 5cm above the umbilicus, and dickens instrument ports were placed 7cm side keen-sighted and 2cm caudal to the camera port. Anterior peritoneum was dissected deep and widely from the aim of umbilicus down to the UB including median umbilical ligament and part of both median umbilical ligaments. Cystoscope was introduced from the urethra into the bladder to illuminate the margin of the mass and to facilitate tutelage enough distance from the mass during laparoscopic fond(p) cystectomy. Bladder was repaired continuously with 4-0 vicryl suture. aft (prenominal) placing a closed suction drain the mass was wrapped into an Endo CatchTM radix and squeezed out done the extended umbilicus opening. A Foley catheter was inserted into the bladder and the port sites were closed. Cross section of the surgical specimen showed a unilocular cyst without definite solid part, filled with gray tan to brownish thick mucous secretion material. It overly showed whitish to yellowish thick wall with multifocal calcifications (Fig 3). Immunohistochemical staining was inviolate positive on CEA, positive on CD15 (LeuMI), and weak positive on CK7 and CK20. Final diagnosis was sound differentiated mucinous urachal adenocarcinoma invading bladder muscle, pT3a establish on Sheldons staging musical arrangement, pT2b based on Mayo system, and pT2 based on Ontario system. Surgical margin was negative.DISCUSSIONmalignant involvement of the urachus is rarely reported, one in 5 million people, account statement for 0.35% to 0.7% of all bladder cancers 1. It has been reported approximatelyly in adults over 30 years old. To our best knowledge, merely one adult case of urachal carcinoma diagnosed earlier the age of 26 has been reported in the slope written literature, although two cases have been reported in 15 year-old girls 2-7. The youngest adult case in a 22 year-old patient is found on MD Anderson cancer center experience written by Siefker-Radtke et al 4. fit to the MSKCC call for of 24 cases, two young men who was 26, 29 years old each found to have urachal cancer 5. The 26 year-old man legitimate extended partial cystectomy, umbilectomy and pelvic LN dissection, and survived at only 0.9 month of add up up without long-term survival data. The 29-year-old man received extended partial cystectomy and umbilectomy, and survived at 17 months of pass off up without local recurrence or metastasis. Even in a large series employment, Mayo clinic study of 49 cases for 53 years, the youngest was 43 years old 8. Our case is an urachal adenocarcinoma found in a 26 year-old man, the molybdenum youngest adult case ever reported. Age at the diagnosis of urachal carcinoma is important to catch pathogenetic transitional mechanism from benign to malignancy. Also clinicians should be aware that urachal carcinoma whitethorn advance early in the life time at the age of twenties.ReferencesSheldon CA,Clayman RV,Gonzalez R,Williams RD,Fraley EE. Malignanturachallesions. J Urol.1984 131(1)1-8.Cornil C,Reynolds CT,Kickham CJ. Carcinoma of the urachus. J Urol.1967 98(1)93-5.Gupta S,Bhaijee F,Harmon EP. Mucinousneoplasmarisingin aurachalcyst a get-go in the pediatric population. Urology.2014 83(2)455-6.Siefker-Radtke AO,Gee J,Shen Y,Wen S,Daliani D,Millikan RE,Pisters LL. Multimodalitymanagement ofurachalcarcinoma the M. D. Anderson Cancer center(a) experience. J Urol.2003 169(4)1295-8.Gopalan A,Sharp DS,Fine SW,Tickoo SK,Herr HW,Reuter VE,Olgac S. Urachalcarcinoma aclinicopathologicanalysisof24caseswith outcome corr elation. Am J Surg Pathol.2009 33(5)659-68.Pin and then JH,Haddad R,Trachtenberg J,Holowaty E,Bowler J,Herzenberg AM,Jewett M,Fleshner NE. Populationbasedsurvivaldataonurachaltumors. J Urol.2006 175(6)2042-7 discussion 2047.Henly DR1,Farrow GM,Zincke H. Urachal cancer role of conservative surgery. Urology.1993 42(6)635-9.Molina JR,Quevedo JF,Furth AF,Richardson RL,Zincke H,Burch PA. Predictorsofsurvivalfromurachal cancer a Mayo Clinic study of 49 cases. Cancer.2007 110(11)2434-40. nifty Tonsillitis Chronic Ulcerative Colitis Case StudyAcute Tonsillitis Chronic Ulcerative Colitis Case StudyKatharine Buzzbee is a loving young girl of 9 years old. She was brought to the health center with complaints of cutting throat with difficulty swallowing. Her mother states that Katharine has had similar symptoms three separate time this year. The illnesses begin with irritation in the throat that progress to bother. The pain radiates to her ears and she principally develops a fever durin g the course of each attack. The patient as well as has a hi drool of developing browse colds where she experiences headaches, a stuffy nose and frequent sneezing. Her older brother and sister have both lately had the reciprocal cold. The patient is otherwise healthy with no major illnesses or injuries.clinical manifestations On exami estate, Katharines palatine tonsils are swollen, red and surrounded by exudate. She has a temperature of 101.1F and complains of a running nose and headache. She appears tired and isnt as nimble as in our previous encounters.Diagnosis acute tonsillitis. Throat nicety confirmed strep. bacterial infection.Etiology Acute tonsillitis is generally make waterd by a viral infection, almost frequently caused by common cold viruses such as adenovirus, rhinovirus, influenza, coronavirus, respiratory syncytial virus. The Epstein-Barr virus, herpes simplex virus, cytomegalovirus and HIV now and then manifest as tonsillitis.The second cause of acute tonsil litis is bacterial1 (about 30% of patients). The common bacterium is group A Beta hemolytic streptoccal. Other strains of bacteria are less common. The patient listed above has this type of infection.Pathogenesis virus or bacteria attacks tonsil tissue exiting the result of innate immunity and adjustive immunity of T and B cells contained in the tonsils. The lymphocytes fight the infection, which leads to inflammation. As long as the lymphocytes and other cells can weaken the virus/bacteria the revile to the cells within the tonsils lead repose reversible.Treatment 10-day course of oral penicillin2, loosening and hydration.Prognosis symptoms should resolve during course of treatment. If frequent onset of tonsillitis continues tonsillectomy may be recommended. subversive responseThe bacteria is ingested or inhaled and attaches to the palatine tonsils (injury). At the gross level the tonsils become swollen with erythema causing pain and difficulty finish normal tasks such as sw allowing.In the study by Liljaa, Raisanenb and Stenfors3, the researchers analyse bacterial and epithelial cells from palatine tonsils of nine patients with positive streptococcus pyogenes infection. The reported dominateings showed, S. pyogenes could be identified both in the mucous layer screening the tonsils and attached to the sur hardihood epithelial cells. Long chains of coccus-shaped bacteria could be seen encroaching on the epithelial cell borders. S. pyogenes can apparently riddle the mucous barrier, attach to the epithelial cells, spread from cell to cell and maybe penetrate into the outermost layer of the epithelial cells. These events in turn turn on cytokine production and/or complement activation, which induce inflammatory reaction in the tonsillar tissue (activation).Dead bacteria and bacterial debris will pillow at the site of the infection and must be re touchd (phagocytosis) from this neighborhood by neutrophils and macrophages.Once the bacterium has been r emoved through phagocytes the tonsillar tissue will resume its normal form through resolution (healing process). Swelling and pain will cease.Chronic inflammation Ulcerative CollitisCase studyJedediah Jones is a 24-year-old student pursing a degree in chiropractic medicine. He presents today with type AB pain and frequent diarrhea containing mucus and blood. The onset of these symptoms began 2 months ago, and Jedediah decided to seek treatment when his frequent bowel movements began to disrupt his studies. long-suffering states that on average he has approximately 8 bowel movements per day, most frequently occurring after a meal. His abdominal pain is most strict before a bowel movement, but prevails constant at the pain level of 4 out of 10. uncomplaining says pain is 6 out of 10 at its worse. Patient attributes the symptoms to his newly suck uped nutrition mostly consisting of fast food. Until recently he lived at home where all his meals were homemade.Patient has experienc ed an increased level of stress since beginning his studies (6 months ago) and later quit hummer cigarettes. Patient exercises regularly, but has experienced a devolve in energy levels since the onset of symptoms. Patient denies other illness or injuries and is currently non taking any medication. Patients twin brother was recently diagnosed with Crohns disease and his maternal grandfather died of colon cancer at 48 years old.Clinical manifestations LLQ tender upon palpation and accurate abdomen appears distended. Patient claims 8 bowel movements per day with a watery consistency containing mucus and blood. Conjuctiva and finger nail beds appear pale.Diagnosis ulcerative colitis, confirmed by positive biopsy removed during sigmoidoscopy. Inflammation of bowel appeared to extend no advertise than the descending colon with most severe inflammation and ulceration in the sigmoid section. Stool cultures ruled out parasitic infection.Etiology the cause of ulcerative colitis is unkno wn, but factors such as genetics7, psychological stress, smoking cessation and poor diet have been attributed to onset of disease.Pathogenesis as utter in the pathology textbook7, Most investigators believe that ulcerative colitis and Crohn disease result from a confederacy of defects in host interactions with enteral microbiota, intestinal epithelial dys enjoyment, and aberrant mucosal tolerant responses.Treatment Sulfasalazine 2 pills by mouth, 3 times per day. Rowasa (mesalamine) rectal suspension enema, at bedtime until bleeding stops.Prognosis continue medication until symptoms have resolved completely. Maintenance therapy will be recommended indefinitely to avoid relapse.Inflammatory responsePodolsky8 explains in his article that inflammatory bowel disease (IBD) is believed to be the result of an ongoing activation of the mucosal immune system. This abnormal response is likely due to the defects in both the intestinal epithelium and the mucosal immune system (injury).Podol sky8 clearly defines the inflammatory response of IBD, Chronic, recurrent intestinal inflammation appears to result from stimulation of the mucosal immune system by-products of commensal bacteria in the lumen. Stimulation may occur as a result of the penetration of bacterial products through the mucosal barrier, leading to their handle interaction with immune cells, especially dendritic cells and lymphocyte populations (chemotaxis). Alternatively, bacterial products may stimulate the surface epithelium, possibly through receptors that are components of the innate immune-response system the epithelium can, in turn, produce cytokines and chemokines that recruit and activate mucosal immune cells (transmigration).Cellular changes occur in ulcerative colitis as the degenerative inflammation may lead to mucosal atrophy7, damage to the muscularis propria and disrupt neuromuscular function leading to colonic dilation and pretend of perforation (cellular changes).As give tongue to in the textbook7, The inflammatory process is diffuse and generally special(a) to the mucosa and superficial submucosa. Submucosal fibrosis, mucosal atrophy and distorted mucosal architecture remain a residual of healed disease but histology may also revert to near normal after prolonged remission (healing process).ResourcesMerck Manuals Online medical exami demesne Library. Tonsillopharyngitis. Available at http//www.merck.com/mmpe/sec08/ch090/ch090i.html. Accessed October 21, 2010Venes D, Thomas C (Eds.). Tabers Cyclopedic Medical Dictionary nineteenth ed. Philadelphia, PA F.A. Davis 2001Liljaa M, Raisanenb S, Stenfors L E. Initial events in the pathogenesis of acute tonsillitis caused by strep pyogenes. Int. J. Pediatr. Otorhinolaryngol. September 1998 45 (1) 15 20.Mansson A, Adner M, Cardell L O. Toll-like receptors in cellular subsets of compassionate tonsil T cells altered expression during recurrent tonsillitis. Respir Res. 2006 7(1) 36Ebenfelt A, Ericson L E, Lundberg C. Acute Pharyngotonsillitis is an Infection Restricted to the Crypt and Surface Secretion. Acta Otolaryngol (Stockh) 1998 118 264 271.Wikipedia contributors. Wound healing. Wikipedia, The Free Encyclopedia. October 23, 2010, 1400 UTC. Available at http//en.wikipedia.org/w/index.php?title=Wound_healingoldid=392404843. Accessed October 24, 2010.Kumar V, Abbas A, Fausto N, Aster J. The Gastrointestinal Tract (Ch 17). Robbins and Cotran ghoulish Basis of Disease 8th ed. Philadelphia, PA Saunders Elsevier 2010 810 814Podolsky, D. Inflammatory Bowel Disease. N Engl J Med 2002 347417-429The imperium Writes spine Green is the colourizeThe Empire Writes Back Green is the ColourAshcroft, Bill et al in the book The Empire Writes Back Theory and Practice in Post Colonial lit discusses what post-colonial is and explains among others the theories of post-colonialism. According to Ashcroft et al, the term colonial can be used to as definite all the culture affected by the imperial process from th e endorsement of colonization to the present which concerns with the world as it exists during and after the period of European imperial domination and the effects of this on contemporary literatures. These contemporary literatures accept those produced in the African countries, Australia, Bangladesh, Canada, Caribbean countries, India, Malaysia, Malta, New Zealand, Pakistan, Singapore, South Pacific countries, Sri Langka and even the ground forces (p.2).Development of post-colonial literatures happens through several stages along with the stages of national or regional consciousness and the project of asserting difference from the imperial nucleus (ibid, p.5). The first stage is the stage of the imperialism where writings were produced using the terminology of the imperial centre because they were written mainly by the literate elites which can also be regarded as the representative of the imperial violence. Examples include gentrified settlers (Wentworths Australia), travelle rs and sightseers (Froudes Oceana, and his The English in the due west Indies or the travel diaries of Mary Kingsley) or the Anglo-Indian and West African administrators, soldiers and boxwallah and their memsahibs (volumes of memoirs). At this stage the writers non only talk about the landscape, language and culture of the place but also emphasize the home over the native, the metropolitan over the provincial or colonial and so on (ibid, p.5).The second stage involved literature produced by what Aschroft et. al termed as under the imperial license by the natives or outcasts like the English educated Indian upper class or the African missional literature. However, the institution of Literature in the colony was s trough under the control condition of the imperial ruling class which prevented the writers from fully exploring their anti-Imperial potential. One of the examples given is a brisk entitled Ralph Rashleigh by James Tucker. Basically, there are quartet post colonial mo dels which can be used to study literary texts. The first model is the national or regional models which emphasize the eccentricistic features of the particular national or regional culture while the second one is the race- based model which identifies certain shared characteristics across motley national literatures such as the common racial inheritance in literatures of the African diaspora addressed by the Black authorship model. Comparative models of alter complexity which seek to account for particular linguistic, historical and cultural features across two or more(prenominal) post-colonial literature is the third model while the last one which is rather comprehensive is the comparative models which argues things such as hybridity and syncreticity as the constitutive elements of all post-colonial literature.One of the popular preoccupations of postcolonial literature deals with nationalism. some(prenominal) definitions of nationalism can be found in the dictionaries a nd among them are the veneration to the interests or culture of ones nation the belief that nations will benefit from playing independently rather than collectively emphasizing national rather than multinational goals and aspirations for national independence in a country under impertinent domination (http//www.thefreedictionary.com/nationalism). Benedict Anderson (1983) defines nation as imagined, limited and sovereign communities. According to Anderson imagined federation is different from an actual community because it is not (and, for practical reasons, cannot be) based on everyday face-to-face interaction amid its members. Anderson argues that nations are a small idea shared by a geographically limited area of people that despite its limitation has influence and power in its greater region and sovereignty over its people. Nation became more and more realized as linguistic diversity, religious authority and traditional monarchies faded. A nation is imagined because the mem bers of even the smallest nation will never know most of their fellow-members, meet them, or even hear of them, yet in the minds of each, lives the picture of their communion and regardless of the actual inequality and exploitation that may harbour in each, the nation is always conceived as a deep, horizontal comradeship. Members of the community probably will never know each of the other members face to face however, they may have similar interests or identify as part of the same nation. Anderson believes that his creation of imagined communities became possible because of print-capitalism. Capitalist entrepreneurs printed their books and media in the jargon (instead of exclusive script languages, such as Latin) in order to increase circulation. As a result, readers s flowering various local dialects became able to understand each other, and a common discourse emerged. Anderson argued that the first European nation-states were thus formed around their national print-languages.Q uayum (2009) in his introductory note for Writing A Nation Essays on Malaysian Literature stated that nationalism implies idealisation of the nation that has many positive qualities in its ideal state. overly creating the sense of belonging, solidarity and shared membership for all its citizens where all members recognise vernacular rights and duties towards one another, it also creates a sense of conviction and loyalty among members to certain shared artefacts of the nation. Quayaum however believes that to some extent nationalism may also be dangerous because there is a probability that the idealisation of the nation can turn into idolatry and nationalist sentiment can dilapidate into demagoguery, divisiveness, despotism, radicalism and racism which may lead to sectarian arrogance and destroy the germinal bond of the wholeness of humanity.Lloyd Fernandos Green is the ColourLloyd Fernandos Scorpion Orchid (1976) and Green is the Colour (1993) provide crucial insights into the st ate of belonging and nation-formation, as well as the understated realities of racial religious segregation and politics of prejudice which are still rampant in the contemporary Malaysian ideological landscape (Qayum and Nam, 2009).Although the exact time frame for Lloyd Fernandos reinvigorated Green is the Colour has not been clearly stated, it is quite a possible that the historical context which Fernando is indirectly referring to was the Malaysian Racial Riot of 13th May, 1969. The novel exposed the unstable kinship between the racial and religious groups of Malaysia which continues to haunt the socio-cultural fabric of the country up until today (Ng, 2009). Thus, the depiction of violence, prejudices between different races and roaming vigilante in the countryside were quite real and became a common sight at that time. The effect of the racial unrest which is referred in the novel as the unsightly scab in Malaysian history can directly be felt by the multicultural citizens r epresented by characters like Siti Sara, Dahlan, Yun Ming and Gita.The ill-fated, cross-cultural family relationship between Siti Sara and Yun Ming and their reflections to the uncertain situation in the country become the focus of the novel. Yun Ming, a second generation Chinese is a civil servant working(a) for the Ministry of Home Affairs who seeks justice by working from within the government. He lusts for Sara, an oversea- graduate lecturer teaching in a local prime(a) university from the first moment he sees her at a concert. Since the first meeting, Yun Ming seems to life a kind of attraction towards Siti Sara and always tries to find ways or opportunities to be near her. Siti Sara who at first tries not to make her trace obvious due to her status as Omars wife finally responds and begins to find comfort and peace in Yun Mings company who is described as leisurely and moderate and looks at things from a human point of stack and believes in the brotherhood of all. His s incerity and trustworthiness are evidenced through his willingness to risk his life in distributing relief goods in the Malay areas even during the peak of racial howler. The understanding and tolerance that Sara never gets from her spouse leads Sara to be deeply in love with the Chinese guy. Despite all the challenges and disapproval from others (except from Lebai Hanafiah, Siti Saras father), the equalise is almost successful in their relationship until Yun Ming is caught under the instruction of the scoundrel in the novel- Panglima.Siti Sara is very probative in the novel not only as a heroine but also a narrator. As such, the story is mainly narrated from her viewpoint except for Chapter 9 which is narrated by Lebai Hanafiah, Siti Saras father and Chapter 15 by Dahlan a lawyer. Saras father has certainly becomes instrumental in shaping her into a liberal, tolerant and accommodative woman ( ). Although described as not having a unitary, parochial sense of identity like her lo ver Yun Ming, nor adopt a big model of nationalism like her husband Omar ( ), Siti Saras character is used to realise the authors philosophy of fellowship and understanding among multi-racial Malaysia ( ). Fernando tries to promote a tolerant, selfless Bangsa Malaysia in this novel through the depiction of the characters of Yun Ming, Siti Sara and Lebai Hanafiah. Through the story, Fernando not only shows the effect of explosive and intractable racial riots on the entire nation but also on the band of closely coupled individuals and how their relationships are affected by the event particularly by their contesting views of the nation. The reading material of nation or imagined community according to him would be a community that is open- minded, receptive and tolerant towards each other just like the relationship of Siti Sara and Yun Ming. Even though Panglimas single set of values may be necessary as a reference, it is wise to allow for some freedoms for the racial society to p ractice what they believe to be right and appropriate without allow their contesting views affect their judgments and relationship with other. As Quayum, (2007) puts it, as long as we knock over love as the base of all metaphysics and humanity and as the highest ruler in life, we can never go wrong in self-refashioning ourselves as a nation or a society.Fernando enunciated his firmly-held belief in the integration of races and trusts in his two novels Scorpion Orchid (1976) and Green is the Colour (1993) while deftly criticising communal and divisive politics which inevitably result in credulity and destruction. These two novels provide an insight into the state of belonging and nation-formation as well as the understated realities of racial-religious segregation and politics which are regarded as sensitive but anyhow still relevant to be discussed up till now (Ng, 2009). Even though Fernando seems to rely on the incidents of the 1969 racial riot to construct the ideological backdrop of the novel, it is however inaccurate to generalize it as depicting the realities of the tensions. Instead, a careful reading will reveal that the novel is in fact depicting the ideological state of affairs in Malaysia of the 80s and 90s, a situation which Fernando views as dire to the nations health due to the communal, harmful agendas of certain political groups. Fernando tries to bring to attention the dangerous direction towards which the nation is heading, a direction that is increasingly forgetting its multicultural makeup in the move towards racial-religious homogeneity (ibid. p.118-119).Although some critics feel that the portrayal of women characters in both Fernandos novel Scorpion Orchid and Green is the Colour is rather biasMohammad A.Quayum who reads Siti Sara as a metaphor of a nation argues that her rape by Panglima is especially significantshe is at the centre of the novel and associated with the countryside and the natural beauty of Malaysia from time to time. The authors wrap up fears about the future of Malaysia would be realised if corrupt politicians and bureaucrats like Panglima were allowed to remain at the helm and rule of the country (Shaping a New subject Destiny with Dialogic, p. 170)The novel reveals what would happen to Malaysia if megalomaniac, bigoted and close-minded politicians were to come into power and threaten to divest other racial groups of their rights to religious and cultural affiliations (Andrew Ng, 2009, p.119)Fernando articulates the dangers of deploying religion for selfish, politically-invested ends echoes precisely the socio-political situation in Malaysia during this period. (Andrew Ng, 2009, p.119)Other character include Dahlan, a renegade Malay lawyer who persistently questions Malay supremacy and privileges resulting in him being rejected by his community (Andrew Ng, 2009, p.119)Racial harmony cannot be reinstated by force. Panglima who represents the corrupted leader of the country and Ustaz Bah audin a leader of a religious extremist have their own way to forward their homogenising, monolithic agendas. Panglima constantly talks about an ominous strategy for nation-building. According to him in order to maintain the order in the country everybody must follow one way of life and has one way of doing things. Tuan Guru Bahaudin and the Panglima endorse the view that a nation comprising many religions cannot become united and only through a single faith at the (potentially violent) expense of others can function as the adhesive for a people that is otherwise racially single out (Wilson in Andrew Ng, 2009, p.123)

Potential Bottlenecks in Implementing MCTS in Odisha.

Potential Bottlenecks in Implementing MCTS in Odisha.IntroductionM early(a) and child docking arranging (MCTS) is the online softw argon apply by the National Health Mission (NHM), pee-peeerly National verdant Health Mission (NRHM), for tele-monitoring Reproductive and peasant Health (RCH) go delivered by the Government of India(1). It is an innovation of Health and Family Welfare (HFW) department supported by the National Health Mission(2). This software was conceived way back in 2008 to cast up the coverage of RCH services. Left verboten and drop out beneficiaries for various services, including immunisation, croupeister be shacked name keen utilize this formation. Using this software, makee wise and even wellness unit wise relevant development can be retrieved from both location by any health or associated authority by logging on to the system victimization the exercisingrname and password willd to him/her(3). It can greatly reduce the death rates of baby and beat and even reduce total fertility rates through with(predicate) an attempt to provide global coverage of services.The origin of the concept is conjugated to the tracking of due beneficiaries in immunization sessions using the tracking bag(4) at the sub-center. The tracking bag consists of 14 pockets, of which 12 are meant for 12 months in the year and two more meant for children with pinpoint and incomplete immunization condition respectively. Due beneficiaries for a particular month are tracked using counterfoils which would be kept in the pockets for the particular month.MCTS utilizes two initializes for capturing info for naked beneficiaries Format I and Format II. The former one is meant for mothers and the latter is for children born(p) of these mothers. Once a woman is detected to be pregnant, she is depicted with the health system in the MCTS register so as to receive all the bump health services and details are captured in the format I. The info are t hen sent every hebdomad, via the supervisors to the hamper aim, for online entropy launching into the MCTS. The same is also done for all newborn babies using format II. Services received by the beneficiaries are supposed to be keep in the acquire and Child Protection (MCP) card provided to the beneficiaries. Subsequently, every week sub-center wise work excogitate is generated from the MCTS and distributed through the supervisors to the sub-center Auxiliary Nurse Mid-Wife (ANM), for providing the services, update the services received and tracking the beneficiaries who could not avail the services.Work thinks are generated for various kinds of services like registration of pregnant woman, antenatal tutorship services, delivery services, post-natal care services for mother and neonatal child, child health services including immunization, family planning services, etc(2). In short the system perfectly tries to track the left out and drop out case wise, and ensure universal d elivery of services(2)(5).Presently MCTS is employ throughout the state and plentifulnesss of gentleman alternatives have been deployed by NHM at block and regularise levels to enter, analyze and track the selective information for the mother and child services. As compared to the proportionate improver in the human resources and other investments, the service coverage has not increased comfortably (for example immunization coverage). Even certain studies on weapons for tracking immunization in developing countries show similar results(6). There has been disparity during data validation exercises using health indicators from sources like Health Management and info System (HMIS)(7) and MCTS. Even no assessment has been under conditionn to fall over the bottlenecks of MCTS. Hence a excogitate was planned to identify and provide suggestions for correcting the bottlenecks in the effectuation of mother and child tracking services in the state of Odisha, if any existed.Object ives of the countTo understand the execute of implementation of Mother and Child Tracking Sytem in Odisha and identify the bottlenecks in the implementation process, if any.To identify feasible solutions and suggest recommendations for the identify bottlenecks.Method of studyThe study was qualitative in nature. It was conducted in one-third UNICEF supported districts (all tribal predominant) of Odisha state (having 30 districts) from August 2013 to November 2013. In-depth inter judgment (IDI) was the line tool for data accrual. Key program implementers involved in the process were listed graduate along with their assumed roles and responsibilities (Table 1). Judgmental sampling method(8) was then used and IDI was done with identify observe informants involved in the implementation of MCTS (block and district level bonkrs and supervisors). A total of 15-24 in-depth interviews (IDI) were planned for the study (regarded as the power point of thematic and theoretical saturation )(8). The end point planned was the point when no new qualitative information was received(9).Three blocks each of these districts were randomly selected and key informants were identified for IDIs. Consent was taken from the interviewers using WHOs informed respond form for qualitative studies(10). Personal interviews were performed with a pre-determined and pre-tested tool with more lots than not open ended and few close ended questions/ probes (Box 1). on with that atonement level of the implementers was demeaned using a continuous scale(11). lots feasible solutions and suggestions as recommended by the informants were also noted along with bottlenecks. info collection, cleaning and analysis was done simultaneously. Recorded data were transcribed one by one by two researchers onto paper, translated to English and then manually analyzed. The qualitative gist analysis method was employed(12)(13)(14) for analysis. Nine major heads were identified for the purpose- human res ource issue, data generation issue, issues with skill, data innovation issues, covering fire events, software issues, supervision, review and pecuniary topics. All other findings were shake off under a ten percent head. After data analysis, brainstorming sessions were carried with the RCH team of UNICEF Field office to put forth other recommendations for the issues noted.reticuloendothelial systemultsA total of 20 interviews were conducted in the study with six to seven interviews on an average from each district. Time for the interviews ranged from negligible of 25 minutes to a maximum of 40 minutes. Block level data managers and block program managers in charge of MCTS in the block were identified as the key informants at the block level. Lady health visitors (LHVs) and Health Supervisor (HS (M)) were likewise admitd in the process. Interviews were also conducted with zone Data Managers (DDM) who was the supervisor of BDMs at the district level.Interviews with the stakehol ders revealed that there has been a lot of improvement in certain service delivery components. Some of these include availableness of a definite work plan (also called due list) for the ANM and accepted Social Health Activist (ASHA) every week, validation of HMIS data, entering data and assessing reports from any place using provided username and password, validation of incentives provided to beneficiaries and to ASHA for various activities, improvement in service delivery for various national health programs, etc.We are able to review the sectors based upon the MCTS data. LHVNow, the health workers have materialized the benefits and use of MCTS and are frequently asking for clarifications, when required. BPMIt was observed that the work plan and reports passed through all the stakeholders of MCTS, including the supervisors. But the involvement in terms of brain of the process and providing mentoring support was poor, as cited by a few. The reports were collected at the end of th e HWF, who would submit reports to their sector level supervisors. Details of the flow mechanism of reports are shown in Fig. 1.On an average satisfaction level regarding implementation of MCTS among block and district level stakeholders was found to be 7 out of 10 (range 4 to 9). Lack in the perfection of the implementation were many, s dizzyly of which were analyzed and placed in Table 2. It was also noted that a BDM had to devote a great proportion of his sentence for data entre thus disturbing the equilibrium between personal and professional life. This was develop up especially for those located in big blocks and universally for everyone nigh on an average 15 days (last week of a month and first week of the following month), at the time of report collection and entry. Verbatim of about of the important issues found during the interview are listed knock off under.Health workers collect their work plans on their own or in some indefinite process. But the collection of upda ted work plans from the workers is being done in sector meetings.LHVWe are facing problem in covering the beneficiaries in outreach areas due to seasonal and migration issues. LHVThe software needs to be improved.BPMHMIS software is better than MCTS with respect to report generation and review monitoring. The MCTS software is oft slower than HMIS and needs high speed internet connectivity.BPMDue to profits connectivity issues, we often ask the BDMs to come to the district NRHM Office and do the data entry here. DDMDiscussion and RecommendationsTracking down beneficiaries to increase the coverage of services can unimpeachably reduce the number of miss outs and drop outs for any services catered, and with stringent implementation as planned can definitely improve service delivery. Moreover the planning component of some of the health programs can be addressed in the process. But it was found that issues always did exist at all levels and all components of this nave model.A unity register needs to be maintained integrating components of mother register and child register, which will reduce the work extend of the health workers. The simple availability of logistics like paper and cartridge for printing can be some of the minor issues, which if addressed can bring out successful results. Similarly, engaging the data entry operators in the tasks they are meant for can provide fibre inputs to the tracking system, not only in terms of improving the data quality, but also an effective plan generation, follow up and tracking of miss out and drop out cases and health review. It will provide a working environment and boost the motivation of these DEOs. Review of MCTS entry, analysis and tracking of follow up of instances should be done block wise with team effort rather than having any single individual accountable. Supervisors should take on an important part in offering mentoring support for tracking, record keeping and updating. An effective model of internal mo nitoring and/or mentoring system for underperforming sub-centers in MCTS implementation (eg. Using Lot Quality Assurance take Method) is needed.Own server can be set up at the state to solve server speed issues. More data entry staff at the block level is needed so as to reduce data entry load in large blocks with immense data load. More number of ANMs or support in the form of extra ANMs is needed in sub-centers with more population. This solution has also been cited in other studies of the same author(15). Data Entry Operators (DEOs) for Rashtriya Swasthya Bima Yojana (RSBY)(16) can be active in data entry activities wherever the data entry load is high. A proper operational research can throw light on the mechanism to identify blocks needing more human resources along with other financial support.All services provided and recorded in MCP card should be fed into MCTS to make effective tracking possible. Customization of the software for integrating and collateral data of othe r related programs like internal Based immature Care(17), Special Newborn Care Unit(18)(19), etc. can also be done. Adequate contingency provision in the NHM PIP should be made. Collaborating with rambling partners to develop SMS based portal for reporting details of a benefactive role can be done and this can also provide real time reporting. Similarly loading the data in a geographical Information System (GIS) based maps can be used increase tracking mechanism one step further(20). Extra incentives for each additional work put to the BDMs, may be provided. Training pharmacists in ODMIS(21) can decrease the workload on BDM at the block level.ConclusionMother and child tracking system is an innovative method of tracking down the beneficiaries name wise, with an objective to bring down the IMR, MMR and TFR. It can help the brass to achieve universal coverage of services. Presently MCTS has helped the service providers to effectively manage miss outs and drop outs for various se rvices like immunization, family planning, maternal and new-born care. ecesis of HMIS and incentives (to beneficiaries and ASHA) is also being done using MCTS. In spite of all positive aspects, practical issues were found to exist and need to be select out. Review, in detail, can sort out many operational and financial issues. Needs of large blocks should be addressed specifically. Server issues need to be addressed along with a provision of SMS based reminders. Real time data entry can make things more convenient. Correct and complete entries in the MCP will help in appropriate utilisation of the software. citeThe authors would like to thank program managers from National Health Mission and health staff of the state government for participating in the study and providing cogitation realities. Dr. Ashish Kumar Sen, being supervisor of the team, had supported the study and provided relevant inputs is also acknowledged.Competing busyThis article was accepted and presented as a con ference paper at the International Telemedicine Conference held at Jaipur in 2013.References1. Achievements of MDG Commitments Made Under NRHM Internet. narrow Information Bureau, Government of India. 2012 cited 2014 Nov 25. lendable from http//pib.nic.in/newsite/erelease.aspx?relid=825202. Operational Manual Mother and Child Tracking System Internet. National Rural Health Mission 2010 cited 2014 Nov 17. operational from https//nrhm-mis.nic.in/Home MCH Tracking System/User manual for MCH Tracking by NIC PDF format.pdf3. Ministry of Health and Family Welfare. Mother and Child Tracking System Internet. cited 2014 Nov 17. functional from http//nrhm-mcts.nic.in/mch/4. immunisation Handbook for Medical Officers. Department of Health and Family Welfare, Government of India 2008. 197 p.5. Operational plan for Mother and Child Tracking System Internet. Ministry of Health and Family Welfare cited 2014 Nov 17. Available from http//mohfw.nic.in/showfile.php?lid=4216. Leach-Kemon K, Grave s CM, Johnson EK, Lavado RF, Hanlon M, Haakenstad A. Vaccine resource tracking systems. BMC Health Serv Res. 201414421.7. Ministry of Health and Family Welfare. NHM Health Management Information System Portal Internet. cited 2014 Nov 29. Available from https//nrhm-mis.nic.in/SitePages/Home.aspx8. Marshall MN. Sampling for qualitative research. Fam Pract. 1996 Jan 113(6)5226.9. Baker SE, Edwards R. How many qualitative interviews is enough? Internet. National Center for Research Methods cited 2014 Nov 25. Available from http//eprints.ncrm.ac.uk/2273/4/how_many_interviews.pdf10. WHO sure Consent Form Templates Internet. WHO. cited 2014 Nov 25. Available from http//www.who.int/rpc/research_ethics/informed_consent/en/11. Whats the best satisfaction survey scale? Internet. being CustomerSure Proven advice from Business Rockstars. cited 2014 Nov 25. Available from http//www.customersure.com/blog/best-satisfaction-survey-scale/12. Kohlbacher F. The Use of Qualitative Content Analysis in Case athletic field Research. Forum Qual Sozialforschung Forum Qual Soc Res Internet. 2006 Jan 31 cited 2014 Nov 257(1). Available from http//www.qualitative-research.net/index.php/fqs/article/view/7513. Thorne S. Data analysis in qualitative research. Evid Based Nurs. 2000 Jul 13(3)6870.14. Glser J, Laudel G. Life With and Without Coding Two Methods for Early-Stage Data Analysis in Qualitative Research Aiming at Causal Explanations. Forum Qual Sozialforschung Forum Qual Soc Res Internet. 2013 Mar 18 cited 2014 Nov 2514(2). Available from http//www.qualitative-research.net/index.php/fqs/article/view/188615. Padhy G, Padhy R, Panigrahi S, Sarangi P, Das S. Bottlenecks identified in the Implementation of components of national health programmes at PHCs of Cuttack district of Odisha. Int J Med Public Health. 20133(4)271.16. Ministry of Labor and Employment. Rashtriya Swasthya Bima Yojana Internet. cited 2014 Dec 1. Available from http//www.rsby.gov.in/about_rsby.aspx17. NHM Child Hea lth Guidelines-Revised Home Based Newborn Care Operational Guidelines Internet. cited 2014 Sep 30. Available from http//nrhm.gov.in/images/pdf/programmes/child-health/guidelines/Revised_Home_Based_New_Born_Care_Operational_Guidelines_2014.pdf18. Neogi SB, Malhotra S, Zodpey S, Mohan P. estimate of Special Care Newborn Units in India. J Health Popul Nutr. 2011 Oct29(5) calciferol9.19. Neogi SB, Malhotra S, Zodpey S, Mohan P. Challenges in scaling up of special care newborn units-lessons from India. Indian Pediatr. 201148(12)9315.20. Barau I, Zubairu M, Mwanza MN, Seaman VY. Improving polio vaccination coverage in Nigeria through the use of geographic information system technology. J Infect Dis. 2014 Nov 1210 Suppl 1S10210.21. Odisha Drug Inventory Management System Internet. cited 2014 Nov 29. Available from http//dims.nrhmodisha.in/

International Marketing: Franchising and Entrepreneurship

International Marketing Franchising and EntrepreneurshipThe prehistoric twenty years has seen an unprecedented transnationalisation of commercial enterprise and growth of transnational establishments. Some analysts credit these salient multinational menages with more economical shock than m whatsoever nation states. This has greatly changed the way great dealing is done. Global nourishmentstuffs be extremely difficult to define, and variables signifi female genital organtly more complex and diverse. The decisiveness to admit a friendship show upside the UK involves c arful analysis of risk and wellbeing factors, consideration and selection of potential market place places, planned market submission, and ontogenesis of market penetration over time. While this net be done done a design of strategies, franchising is a growing means of achieving international presence. In particular, McDonalds and The fall in Colors of Benetton represent two distinct stock-still s uccessful illustrations of effective international cheating in globally franchising firms.deciding TO FRANCHISE INTERNATIONALLYWith the increase in international franchising and its pretend on trade, a figure of speech of studies bugger off been conducted on various related aspects. star front consideration in literature is what leads to the decision to go international, and how this stimulates selling within the firm. It is low gear functionful to consider the traffichip between name companies and their subsidiaries, whether licenses, allyships, or caller-up- delivered outlets. Structurally, large multinationals much(prenominal)(prenominal) as McDonalds and Benetton atomic number 18 best viewed as inter-organisational net hunts than monolithic hierarchies, beca utilize all(prenominal) foot soldier can rent actions that feign the bon ton as a whole (Birkinshaw 2000, 2). Corporate structure is dictated by interplay between pargonnt and foot soldier, with t wain responding to and capricious need changes in the transaction environment (Birkinshaw 2000, 4). Sometimes it will be the infantryman that pursues markets, making a proactive and deliberate pursuit of a new bloodline opportunity in order to expand its scope of responsibility (Birkinshaw 2000, 2).Eroglu (1992) analyze determinants in firms decisions to exemption internationally. He found two sets of perceptual variables sensed risks and perceived benefits determine a caller-ups decision (19). When the perceived benefits outweighed the perceived risks, the follow would stay on with working out. Cost/benefit analysis in one common method for measuring benefits versus risk, exactly once more, is filtered finished the perceptual opinions of decision makers. It is in that respectfore to consider the variables as perceived benefits and perceived risks (Eroglu 1992, 23). redundant research cites factors leading to international franchising as either push factors or sop up factors. Push factors let in market saturation, arguing, and diminishing domestic meshing (Alon and McKee 1999, 76). For example, after fifty years of franchising in the United States, in that view atomic number 18 a limited number of good localization of functions for domestic franchises that do not already stand a McDonalds restaurant. Should McDonalds continue to physique restaurants in a saturated market, they will begin to cannibalise individually other, with one McDonalds competing with another nearby for market shargon. This is not a healthy long-term scenario for either the franchisee or the refer company. In the miscue of Benetton, more and more modality retailers start-ups and expansions view as greatly increased competitor within the sector (Barela 2003, 114). This competition reduces the potential and actual advantages of both current and future outlets, causing the firm to explore other markets where competition is less(prenominal) intense, and marke t share more easily won. Pull factors include political changes, such as the undetermineding of Eastern block countries to westerly investment, economic changes, such as the growth of a formerly sireing nation to the point it can sustain retail outlets, and the formation of regional trading units that seek out franchise opportunities (Alon and McKee 1999, 76).Both McDonalds and Benetton rent been swift to travel into emerging markets, even when other multinationals oblige delayed. For example, franchises in Kazakhstan require complex business licenses, which has deterred foreign investors. Benetton is one of the few occidental companies to move into Kazakhstan, doing so through its typical franchise license method (Anon 2001, 5). Nigeria was not an initial new market target for McDonalds, as the sightly worker there will work over eleven hours to net income for a value meal. However, the company has entered the soil successfully at the gun trigger of topical anesthetic f ranchisees, who locate their restaurants in more economically viable lands of the unpolished (Vignali 2001, 97). Global market initiatives are often driven by unmet crossroad or market needs amongst non- topical anaesthetic suppliers and customers (Birkinshaw 2000, 23).In addition to push and pull factors, there are two theories in the study of franchising that explain the decision to move into international locations. Both address one of the around debated topics in franchising research why the parent company would want to franchise, when company-owned units provide a high(prenominal) rate of return (Elango and Fried 1997, 69). Once a business achieves a certain size, it is more profitable to the parent company if all told owned. For example, a typical franchisee whitethorn make a forty per centum margin, and pay half of that to the parent company. With the right economies of scale, the franchisor could recoup more of that profit margin by owning the company outright (Hoar 2 003, 78).The first, resource scarcity administration, contests that companies neediness the resources such as capital, topical anaesthetic anaesthetic anesthetic market knowledge, and managerial talent to open international outlets on their own (Altinay 2004, 427). By recruiting local franchisees who supply capital, management, and knowledge of the local market, franchising organisations can achieve internationalisation not otherwise achievable (Altinay 2004, 427). The parent company would not be able to expand, curiously on an international level, without the assets offered by the franchisee. This theory is more easily applied to to a lower placesize and medium-sized firms which obviously lack the assets for internationalisation than it is to either McDonalds or Benetton. interestingly both organisations do throw away almost company-owned holdings. For McDonalds part, Ray Kroc at once contended he was in the real estate business, not the restaurant business, citing the large passive income generated from the leasing of McDonalds properties to individual franchisees (Vignali 2001, 97).Agency theory is based on the relationship between the principal party, in this possibility the parent company, who owns or restrain a set of economic assets or functions. They delegate work to the agent, in this case the franchisee, who operate on the principals behalf (Doherty and Quinn 1999, 227). The theory stresses the importance of the process of the reassign of teaching, the problem of information asymmetry, and monitoring hail associated with both (Doherty and Quinn 1999, 224). Jensen and Meckling (1975) explain information asymmetry problems occur because the franchisee has detailed information to the highest degree franchise operations that are not communicated to the parent company, and this causes year between the aims of the parent company and the franchisee. This is enhanced by the natural inclining for franchisees to operate in their own best interests, even at the set down of the parent company (Altinay 2004, 427). Applying Agency Theory to a firms decision to franchise internationally, the company commonly does so on the rear end of lower cost and decreased risk. Since salaried managers would be credibly to under perform, going with franchisees increases the likelihood of dedicated performance, and therefore reduced monitoring costs (Elango and Fried 1997, 71). This theory contends that while both McDonalds and Benetton could open company-owned outlets sooner of franchise, the inherent risk and monitoring requirements to the parent company outweigh the economic gains versus franchising.Internationalisation of a retail entity, such as Benetton, involves the development of operations, sourcing of carrefours, and transfer of expertise. Doherty and Quinn (1999) cite a number of research studies, which conclude that franchising is a exceedingly effective way to achieve desired resolvents in all deuce-ace welkin s in the retail sector (225). Franchises provide the parent company advantages such as economies of scale in marketing and yieldion, while providing or entrepreneurial discretion at the unit level (Elango and Fried 1997, 68). In addition, franchises wedge the overall marketing dodge and specific marketing activities of the firm as a whole.Any increase in business natural process, such as new outlets or reaping, should generate additional marketing. In particular, international franchising usually requires adaptation of marketing harvest-feasts to the local cultures. In the case of Benettons kind awareness rivulets, marketing product was intended to be used globally, although rough areas and retailers found some of the photos disturbing or inappropriate (Barela 2003, 118). While the series certainly raised awareness and sales did increase during the time they were in use, there is contention whether the marketing scheme helped or hurt retailers pervade line in many locations (Barela 2003, 118). While McDonalds has had its own less effective marketing programmes, it has not created the same type of reaction as Benetton. McDonalds thoroughly researches each new market to determine the best, most effective, and least offensive marketing practices. Only then is a marketing mix developed. This often leads to the company adapting its global marketing strategy and components for a specific geographical region or ethnical group (Vignali 2001, 97). food market CHOICEChoice of market has in any case been a subject of more research. Each concept and demesne must be considered separately in relation to a multitude of issues about the market, potential franchisees, legal matters, nakedness to franchising in general, and feasibility of the particular concept (Maynard 1995, 69). In international markets, franchise relations are influenced by the extent to which the overseas franchise system can be transferred into the local market in terms of product acceptance, s uitable local presentation and transferable support aids (Connell 1999, 86). statutory concerns are of particular importance, since they differ so greatly from country to country. For example, there is currently no legislation in the UK that regulates franchising (Hoar 2003, 77). The European Union adopt block exemption for franchises, which protects them from antitrust laws. France, Mexico, and Brazil have enacted laws same to those of the United States, requiring franchisors to provide presale disclosure to prospective franchisees, while Australia and Italy have adopted volunteer(prenominal) codes pertaining to presale disclosure and other requirements (Maynard 1995, 71).Atlinay (2004), citing a number of research studies, determined that several(prenominal) organisational determinants stationly impact market choice. Organisation size greatly determines the number of franchises that can be supported, as each must be supplied with product and support (Altinay 2004, 429). Ope rating and international experience have both been shown to positively effect the decision to franchise. In general, the greater the experience of decision-makers, particularly if they have lived or worked abroad successfully, the greater likelihood they will pursue markets beyond current operations. (Altinay 2004, 429). Company leaders may similarly recognise that matched pressures in current markets make growth and expansion there unconvincing or prohibitively expensive. Similarly, the external environment of the markets under consideration may make them more or less attractive to potential investors (Altinay 2004, 429). For example, some governments have highly restrictive business laws, while others provide trivial or no protection for franchisers. The former makes both starting and doing business difficult, while the latter puts the franchiser at risk. A supposed franchisee could simply take the business model or proprietary systems and go out on their own, cutting the fran chiser out of their rightful position in the relationship.Other researchers have concluded geographical and cultural proximity are major determinants of market choice (Alon and McKee 1999, 76-77). Specifically, organisations will choose markets based on their physical casualness or cultural similarities to the head office. For example, the areas most likely to begin franchises of UK businesses are Ireland and France, while US franchisers first target Canada and Mexico (Alexander and Doherty 2003, 15). The logistical issues of transporting people and product are greatly reduced when franchises expand into nearby countries, instead than ones furthest removed. After geographically immediate countries, the next areas targeted for franchise are those with similar cultures to the organisations host country (Alexander and Doherty 2003, 15). For example, UK retailers franchising in the US, Canada, or Australia can expect relatively similar customer groups, requiring little adaptation of product or marketing materials. bringing up, advertising, and other organisation material can keep in English, with no need for translation or significant cultural variations (Alexander and Doherty 2003, 16).In practice, some franchisers leave market choice almost tout ensemble up to the initiation of franchisees, while others are more proactive. In a best-case scenario, both the subsidiary and parent company evaluate the local market, the interior(a) market, and the global market when considering possible markets (Birkinshaw 2000, 9). For example, McDonalds both requires market confession from franchisees and carefully evaluates each new market opportunity before allowing franchisees to proceed (Vignali 2001, 97). Market approval is heavily dependent on resource allocation, that is, there must be sufficient resources addressable and available at that location for the market choice to go forward (Birkinshaw 2000, 45).MARKET ENTRY non-homogeneous factors have been found to cont ribute to the method, location, and timing of market entry. First, there are a number of different methods used in international expansion and franchising. Direct franchising, joint ventures, and master franchising are all common. In luff franchising, the parent company seeks out potential franchisees in market areas it has selected for development (Maynard 1995, 66). While it requires greater involvement by the parent company, it also allows the organisation to be more selective in franchisee choice and therefore have more control over the foreign operation (Maynard 1995, 68). Franchisees may be solicited through newspapers or similar media outlets, but are more commonly sought through recommendations of other successful franchisees (Noren 2001, 62). This method is similar to the licensing franchise arrangement typical of Benetton retailers demesnewide in some areas Benetton relies on a master franchiser, described below (Barela 2003, 116). McDonalds develops most of its franchis es through a hybrid form of direct franchising, although individual franchisees initiate the franchising opportunity with McDonalds, alternatively than the organisation needing to seek them out (Noren 2001, 63).Sometimes the parent company real joins with a local firm to move into a foreign market. This can be through acquisition or merger, but is more commonly accomplished through a joint venture. This is when the companies join forces to create a distinct third company owned by both partner firms (Maynard 1995, 66). Joint ventures create more-cumber-some tax and financial issues than the other two approaches, but they have other advantages, which vary depending on the partnership arrangement (Maynard 1995, 68). The created company then sometimes initiates or supervises franchise relations within its country or geographical region, and sometimes oversees company-owned units (Maynard 1995, 68).The most common approach to international franchising, and one used in part by Benetton, is the master franchisee. This soul is typically a well-capitalized local businessperson, with good understanding of local laws and culture, launch relationships, and knowledge of the marketplace (Maynard 1995, 67). They are recruited through local media such as newspapers, industry sources such as trade magazines, and international brokers. Some governments also assist in the process for example, the United States Department of commerce seeks out foreign partners for US companies through its Gold Key program (Maynard 1995, 69). In this model, the master franchisee purchases the rights to develop franchise units within a specific area this territory is often an entire country. After establishing a successful scotch record, the franchisee may be granted additional territories (Maynard 1995, 67). Master franchising requires minimal cost and involvement on the part of the parent company, yet provides some obligation within the geographic region (Maynard 1995, 68). Most importantly , the master franchisee provides local expertise and oversight of the sub-franchisees whom it chooses to operate individual interposes (Maynard 1995, 68). Finally, franchisers are often approached by would-be(prenominal) master franchisees, who perceive a market for the product or dish out in a region (Maynard 1995, 69). much(prenominal) contacts have opened the penetration to international expansion for many companies (Maynard 1995, 69).Some initiatives put forth by franchisees involve operations within the company. The most critical facilitator of internal market initiatives is the credibility of the subsidiary in the eyes of the parent company (Birkinshaw 2000, 26). Such initiatives are geared towards rationalising and reconfiguring the systems within the parent company and increasing the energy of resource use, rather than improving external variables or increasing the firms resource base (Birkinshaw 2000, 27-28).McDonalds has is positioned itself as inexpensive dissolut e food in the United States its pricing is relatively low as are customers pure tone expectations (Vignali 2001, 97). In the UK, restaurant prices are significantly higher in general. Consumers are willing to spend more for restaurant food but also have higher expectations of product quality and service (Vignali 2001, 97). McDonalds determines prices for its franchisees based on their local positioning and the prices of competitors (Vignali 2001, 97). In addition, McDonalds strategy of place is standardised the organisation seeks easily-access, high traffic locations regardless of the country or region where the restaurant will be located. Facilities are also similar, although with subtle regional variations (Vignali 2001, 97). Benetton similarly emphasises location as a high-end fashion retailer it is imperative its retailers locate in upscale shopping areas, again regardless of the country where the new outlet is located (Barela 2003, 116). This allows them to support the higher prices and quality of their products. For these reasons both organisations require location approval from their franchisees, and do not allow movement of outlets without permission from the head office (Vignali 2001, 97 Barela 2003, 116).Overall, direct and master franchising are the most commonly used methods for market entry by UK firms. They allow firms of various sizes, from small chains to large multinationals, to successfully internationalise. Companies can both grow globally and reap the benefits of size without sacrificing the benefits of local presence (Birkinshaw 2000, 1). The British Franchise Association (BFA) reports nearly seven carbon franchise systems are currently operational in the UK, accounting for more than 30,000 business units (Hoar 2003, 77). These franchises employ 330,000 people, and represented a total turnover of 9.5 billion in 2002 (Hoar 2003, 77). While British firms have been slow to franchise overseas, particularly compared to companies from the US and Japan, they are rapidly catching up. Over one-third of British retailers with operations outside the country employ franchising to some degree (Doherty and Quinn 1999, 225). This number increases with the number of countries in which a particular firm has operations (Hoar 2003, 77).Factors driving franchisings international expansion include heightened awareness of global markets, relaxation of trade barriers, saturation of some existing domestic markets, increasing prosperity and learn for consumer goods in many regions overseas, and increasing ease of doing business internationally because of modify communications and transportation systems (Maynard 1995, 66). Both McDonalds and Benetton have been impacted by at least three of these variables.DEVELOPING THE LOCAL MARKETFinally, entrepreneurs march various strategies to develop the local market, even if they do so as agents or franchisees of a global firm. The traditional role of a subsidiary or franchisee is to adapt the pa rent companys product to local tastes, then act as a global scanner, sending signals about changing demands back to the head office (Birkinshaw 2000, 21). Examples of this would be McDonalds poster changes, often suggested or proposed by local franchisees, and the use of Ronald McDonald as a spokesman, which was first initiated by local franchisees (Anon 2003, 16). It is imperative, therefore, that large organisations, particularly those that franchise, create systems and geomorphologic contexts in which local entrepreneurial activity is both encouraged and controlled (Birkinshaw 2000, 31). If no such structure exists, franchisees will often act as stark agents, making decisions and taking actions that they believe are in the best interests of the partnership as a whole, whether or not these conform to the expressed desires of the parent company (Birkinshaw 2000, 2).Research indicates that four factors enhance initiative at the subsidiary or franchise level familiarity, resource s, integration and communication (Birkinshaw 2000, 31). exalted levels of autonomy and resources enhance local and global initiative, but detract from internal initiative. High levels of integration and communication enhance internal initiative, but detract from local and global initiative (Birkinshaw 2000, 31). Local market initiatives are facilitated most in effect through a moderate level of autonomy in the subsidiary coupled with a fairly strong relationship with the parent company (Birkinshaw 2000, 23).In terms of marketing, local franchises have valuable comment needed by the marketing teams at the corporate office, and should be respected for both their ideas and their first-hand knowledge of whether something is working. If this does not occur, the company will suffer from information asymmetry problems, as previously discussed under agency theory (Doherty and Quinn 1999, 224). When McDonalds decided to use famous athletes in its promotional materials, ads, and television commercials several years ago, they queried local franchisees for suggestions. As a result, the company was able to choose sports figures recognised in each market area, rather than one internationally known athlete, such as a Tiger Woods, who might have less impact in local markets (Vignali 2001, 97). A basketball star was featured in ads in the United States, a footballer in the UK, and so forth. This allowed McDonalds to foresee a locally appropriate image through its marketing campaign and further position align local franchises as part of the community, rather than as a foreign restaurant (Vignali 2001, 97). The company was able to do this because they had previously established systems by which ideas and input could be communicated back and forth between franchisees and the corporate home office (Vignali 2001, 97).Developing market requires initiating or create the demand of the public for a product, and positioning and pricing the product where it is available to meet such public demand (Johnson and Scholes 2002, 370). The entrepreneur franchisee, therefore, has several strategies available. He or she can make suggestions to the corporate office. These are more likely to be well received if backed by solid market data, particularly data not available to headquarters. The entrepreneur can issue his or her own marketing scheme, if not prohibited from doing so by headquarters. He or she can become highly active in community activities and use the franchise or its products for market development. In the case of Benetton, local retailers could, for example, become involved with groups addressing world hunger. Whatever the strategy, it must result in an increased affinity for the consumer towards the product, brand or retailer, and a corresponding increase in purchasing.MCDONALDS CASE STUDYMcDonalds started as a single family-owned restaurant. In 1948, Dick and Mac McDonald had started a self-service drive-up restaurant in California, using a very efficie nt slant system they had invented and named the Speedee Service System. Ray Kroc, a milkshake salesman, visited the restaurant in 1954, and was so impressed with the system that he convinced the brothers to franchise their restaurant, a novel approach to business expansion at the time (Anon 2003, 10). The company incorporated and opened its first franchise in 1955, also in California (Anon 2003, 10). Fifty years later McDonalds was one of the worlds largest multi-national organisations, operating more than 31,000 stores in 119 countries. Over eighty pct of restaurants, including almost all international outlets, are franchised (Anon 2003, 123).McDonalds actively promotes its sum of money values of quality, service, cleanliness and value, and requires this emphasis of all its franchises, regardless of location or local culture (Anon 2003, 123). When it comes to choosing franchisees, therefore, McDonalds is highly selective (Noren 2001, 60). Franchisees must go through a lengthy int erviewing and training process, usually two years or more, without pay. They are also needful to make significant capital investments, a high percentage of which must be from their own (non-financed) resources (Noren 2001, 61-63). Franchisees are required in their contract to become involved in their local community, a practise which further localises the international chain (Noren 2001, 62).It is important to note that McDonalds franchises are under a great deal more organisational control than many other companies franchising models. This prevents devaluing the McDonalds product through loss of unison or free-riding from local operators, but also inhibits entrepreneurial innovation (Noren 2001, 63). For example, headquarters can relocate a restaurant if they so desire, and often own the property and facility, which is leased back to the franchisee. Local operators are not allowed any variance in product without permission from the parent organisation (Noren 2001, 62). Training i s very specific and highly regulated throughout the company.However, franchisees do have considerable input at the organisation, provided they follow the proper channels and inviolate approval before acting. Many of McDonalds promotional and menu items have come through the suggestion of local franchisees. A franchisee in Cincinnati, Ohio, first suggested fish sandwiches so as to be able to attract roman letters Catholic families on Fridays. A franchisee in Pittsburgh suggested the Big Mac, another in California developed the Egg McMuffin, and two restaurant operators in Washington, DC, first used Ronald McDonald as their local spokesman (Anon 2003, 16). Another supported the companys first investment in what would become the Ronald McDonald House Charities (RMHC), a metrical foot began in 1974 that gave families of sick children a place to stay near their childrens hospital. Besides providing a much-needed social service, the charities have been an excellent public relations str ategy. Current services have been expanded to include scholarships and free health care through mobile health trucks. RMHC currently operates in twenty-six countries (Anon 2003, 122).In recent years McDonalds has further increased the tycoon of local franchisees to run their own local promotions. For example, a long-time McDonalds possessor in Florida (USA) reported a twenty-percent increase in same store sales, and attributed this increase to local advertising on television and in print. He creates his own ads in line with national promotions, such as video display pictures of McDonalds products at sale prices, with the national theme music of McDonalds current marketing campaign playing in the background (Kramer 1999, 6). Critics contend such loosening of marketing standards threatens brand dilution, although the company differs in opinion.McDonalds has benefited from the input of their franchisees in other countries, who assist the restaurant in adapting the menu and marketing to local tastes and needs (Vignali 2001, 97). Some McDonalds products are standard throughout the organisation. For example, french fries are included on all McDonalds menus worldwide and are subjected to intense quality control to maintain sameness (Vignali 2001, 97). Other products are adapted to the local tastes of the region. At a McDonalds in France, wine-coloured is available with a meal, while in the United States the strongest beverage on the menu is chocolate milk. Israeli McDonalds serve sandwiches without cheese, a clean requirement, Japanese McDonalds offer rice and salads featuring teriyaki, and some other Asiatic outlets offer goat (Vignali 2001, 97 Anon 2003a, 99). The companys ancient product mix of hamburger, fries, and a coke, however, be constant throughout McDonalds worldwide. Most importantly, the organisation provides a system of input to its franchisees that allows controlled entrepreneurial activity at the franchise level.BENETTON CASE STUDYLuciano Ben etton founded his colourful sweater retailer shortly after the end of World War II, and the company remains family-owned and operated. The company is known for its innovative operation and management methods, and its large net profit of subcontractors who produce the Benetton products (Barela 2003, 113). Acting as a franchisor, Benetton sells and distributes its products through regional agents, each of whom is responsible for developing a certain market area (Barela 2003, 113). The company arranges licensing agreements with local business people through these master franchisors, who then sell Benetton products. There are eight-three agents internationally, who are supervised by seven area managers (Barela 2003, 115). As a manufacturer, the company has high control of its product quality and design, and can control its franchisees through withdraw of product. Its success has become an example for multinational businesses around the world (Barela 2003, 114). Benetton currently has m ore than 7,000 franchises worldwide (Ivey 2002, 13).The company provides franchisees with product and the use of the Benetton name. It expects each store to develop its market successfully, with the help of some global marketing support (Barela 2003, 115). This allows a wide motley of entrepreneurial activity on the part of local franchisees, who can develop and run marketing programmes alongside those provided by corporate headquarters. Store location and control, product display and choice, and community involvement are all decisions leftfield up to the individual franchise owner (Ivey 2002, 14).The company has recently begun to move into directly operated stores, particularly in high-cost areas where franchisees have been difficult to attract, such as the Madison Avenue area of New York City and High path in London (Ivey 2002, 14). This allows it to maintain its market position as a superior

Purpose of the Electrocardiogram (ECG) in Paramedic Practice

Purpose of the Electrocardiogram (cardiogram) in Paramedic designLachlan Donnet-JonesIntroElectrocardiogram, commonly abbreviated to cardiogram or EKG, is defined as a graphic tracing of the variations in galvanic potential ca employ by the excitationof the nervus muscle and detected at the body surface (Dorlands). An cardiogram observe maneuver is the device that has the ability to meditate and graphic every last(predicate)y present an electrocardiogram reading (Mosbys Dictionary of Med) via a digital monitor or printed on a strip of special graph paper knowing to show the rhythm of the heart over time (Mistovich). There ar m whatever unalike manufacturers of cardiogram monitors such as Philips and Physio-Control (ASNSW Protocols). An electrocardiogram monitor allows 2 methods of recording electrical legal action, a 4- legislate reading and a 12-lead reading. The electrocardiogram readings consist of three segments a P wave, QRS complex and a T wave. The PQRST waves be the components that create the waves or spikes presented on an cardiogram reading. cardiography has an coarse history dating back many centuries as pioneers of medical light were eager to understand the electrical meshality of the heart.History of ECG, what was before ECG?In the year 1600 William Gilbert discovered static electricity, a discovery that would eventuate in the development of one of the most important medical innovations of all time, the cardiogram. In the advance(prenominal) nineteenth century the first instruments were invented that were sensitive abounding to detect small electrical currents in the heart. The first functioning electrocardiogram was created by Willem Einthoven, a Dutch doctor and physiologist, in 1903. Einthoven won the Nobel evaluate in medicine in 1924 for his electrocardiogram invention.Prior to the invention of the electrocardiogram an instrument called the gearing galvanometer was exercised to detect electrical activity, it was an earlier invention of Einthovens. The string galvanometer could be used to measure cardiac electrical activity in a procedure where patients would submerge three of their arms into a salty solution creating Einthovens Triangle, a principle still used in contemporary electrocardiogram recording. Before both the electrocardiogram and string galvanometer were invented a device called the capillary electrometer was invented by Gabriel Lippmann in 1872. The capillary electrometer consisted of sulfuric acid and mercury in a capillary tube with wires at each end (WEST INDIAN MED JOURNAL). Similar to the string galvanometer Lippmanns device requires the patient to place limbs into tubs of saline solution and was the first device to read cardiac activity using this method (WEST INDIAN MED JOURNAL). Little did these early inventers know that their inventions would go on to be used thousands of times per twenty-four hours at all corners of the globe with its purpose and functionality contin ually polished and smooth over the years as is evident in modern sidereal day ECG monitors.http//www.jchimp.net/index.php/jchimp/article/view/14383/htmlhttp//caribbean.scielo.org/scielo.php?script=sci_arttextpid=S0043-31442005000300012lng=enhttp//www.ieeeghn.org/wiki/index.php/Willem_Einthovenhttp//en.wikipedia.org/wiki/Lippmann_electrometerNaming the waves of ECG their genesis.pdfThe origins of the electrocardiogram as a clinical instrument.pdfhttp//search.credoreference.com.ezproxy.utas.edu.au/content/entry/dicscientist/einthoven_willem_1860_1927/0?searchId=1a112bd3-b32d-11e3-9ce6-12c1d36507eeresult=0http//search.credoreference.com.ezproxy.utas.edu.au/content/entry/ehsmed/einthoven_s_triangle/0http//search.credoreference.com.ezproxy.utas.edu.au/content/entry/columency/galvanometer/0http//www.ecglibrary.com/ecghist.htmlPurpose functionalityThe ECG machines purpose and functionality is to provide information and understanding of the hearts electrical functionality. (MISTOVICH) T his includes information on the current rate at which the heart is beating, whether the heartbeat rhythm is regular or irregular, how strong the electrical signals are and the timing between the electrical signals.There are two methods to procure an ECG reading, a 4-lead and a 12-lead. The main difference is the bit of leads used to accomplish a reading which in effect allows for a better or worse reading. They are both effective in attaining information on the hearts electrical activity, however they are different and have their advantages and disadvantages. The 4-lead method, sometimes called 3-lead, typically uses three limb-leads RA (right arm), LA ( leave arm) and RL (right leg). severally lead is attached to the torso despite the lead labels indicating otherwise. The RA lead (white) is placed to the right side of the anterior chest just under the clavicle at the midclavicular line and is the negative lead, meaning it augments the signal of the LA lead. The LA lead (black, b rown or green) is placed OPPOSITE the RA lead and is the grounding lead. RL lead is the final lead and is placed to the left lower chest at about the seventh intercostal set on the anterior axillary line and is the positive lead. 4-lead monitoring is reclaimable as it is quick to apply and 4-lead monitoring has its benefits however it cannot deliver the like level of comprehensive and detailed information that a 12-lead reading is suitable of. The application of a 12-lead ECG monitor requires applying 10 leads, 4 limb leads and 6 precordial leads.4 lead12 leadPQRSTgraphical record paperDefibrillationPhillips, lifepakOther functionsGuidelines for electrocardiography.pdfhttp//www.southsudanmedicaljournal.com/archive/ may-2010/how-to-read-an-electrocardiogram-ecg.-part-one-basic-principles-of-the-ecg.-the-normal-ecg.htmlECG contribution to patient mindECG Monitoring is typically used following a aboriginal sound judgement especially in cases where at that place is a suspected douse with the heart or cardiovascular system. An ECG provides paramedicalals with information about the electrical functionality of the cardiovascular system. This is done by analysing the electrical activity displayed on the ECG reading and observing any changes in the waveform in congener to the rate and rhythm. As well as the rate and rhythm the paramedic would note any changes in the P wave, PR intervals, QRS complex, S-T segments and the P to R ratios (REFERENCE). Through this method of analysis the sign and symptoms of a patient pretended to be having cardiac issues can be confirmed for the initial diagnosing (REFERENCE). For example during the primary judging the patient is suspected of having a myocardial infarction and is showing symptoms of chest pain, hypotension, diaphoresis and a weak and rapid pulse the paramedics primary goal would be to obtain an ECG reading which can then confirm the initial assessment by virtue of the PQRST waveform. Ambulance wait on New S outh Wales protocols provides a proclivity of common conditions that may require ECG monitoring, the list includes Acute coronary thrombosis Syndrome (ACS), Dyspnoea (SOB), trauma, lowered level of consciousness (LOC), post syncope episode, cardiac dysrhythmias and many other conditions which interfere with the hearts normal capacity to function (ASNSW Protocols).Provides paramedic information in a situation (subsequent to primary assessment/surgery) that may involves cardiac issues, events or abnormalities via reading the ECG reading and linking any abnormalities in the PQRST waveform to the patients symptoms condition. (LOOK IN MISTOVICH, PP. 1463ish)Situations or indications that may require ECG monitoring include post syncopal episode, a rock-bottom level of consciousness, chest pain, acute coronary syndrome, shortness of breath, dysrhythmias or if any cardiac occurrence is suspected (ASNSW Skills 2011, 103.5.2).FOR EXAMPLES Myocardial Infarction etc. occasion a med journal /article/study?Strengths, weaknesses challenges faced by paramedics (critique)An ECG monitor such as the Phillips carried by Ambulance Tasmania or the Lifepak15 carried by Ambulance Service New South Wales are incredibly versatile diagnostic tools. They are portable and can be taken into the field to patients even in challenging situations such as the small interior of a change integrity car or a in a remote crotch hair area (ASNSW Protocols AT Protocols). The ECG monitor allows for immediate and continuous monitoring of the electrical functionality of the heart permitting a critical assessment of the patients condition to be made. The paramedic can then inform the receiving infirmary of the patients condition and allow for the necessary measures for treatment to be organised prior to the patients arrival. (REFERENCE)One of the significant faults of an ECG is it can only illustrate the electrical activity of the heart, it does not give notice (of) us how well the heart is functi oning mechanically (Jones, 2008).Though there are clear benefits of using an ECG monitor in the paramedic field there are also certain weaknesses in its use such as the unreliability of consistent and accurate ECG readings. It is inseparable for paramedics to accurately interpret ECG readings to avoid mistaken initial diagnosing which can prove costly for patient well-being in time-critical situations. lend factors to inaccurate ECG interpretation include cognitive bias and heuristics (mental shortcuts) (ECG READINGS BY DOCTORS). Properly cleaning skin with swabs, removing any hair in the guidance and certifying that the area is dry before application of electrodes will help to accession ECG accuracy and reduce inaccuracies (MISTOVICH ASNSW Protocols). Other environmental factors such as vehicle movement can contribute to inaccurate ECG readings by virtue of unstable leads creating artefacts. Similarly if the patient is in a agonistic or wrestles state it can interfere with clea r ECG readings, so keeping the patient calm, reducing anxiety and eliminating stressful factors can be beneficial to both acquiring vital information and the patients well-being. (REFERENCE)References2011 Electrocardiogram inDorlands illustrated medical dictionary, Elsevier health Sciences, Philadelphia, USA.2012 Electrocardiogram (ECG, EKG) inMosbys dictionary of medicine, nursing, health professions, Elsevier Health Sciences, Philadelphia, USA. Accessed 30 March 2014, from Credo ReferenceGoy, Jean-Jacques Staufer, Jean-Christophe Schlaepfer, Jrg Christeler, Pierre 2013, Electrocardiography (ECG), e-book, accessed 19 March 2014, http//UTAS.eblib.com.au/patron/FullRecord.aspx?p=1310813.Jones, SA 2008,ECG Success Electronic Resource Exercises In ECG Interpretation / Shirley A. Jones, n.p. Philadelphia F.A. Davis Company, c2008., Items in the Library Catalogue, EBSCOhost, viewed 19 March 2014.Resourceshttp//www.nhlbi.nih.gov/health/health-topics/topics/cardiogram/http//www.nlm.nih .gov/medlineplus/ency/article/003868.htmhttp//www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Electrocardiogramhttp//explosive detection system.b.ebscohost.com.ezproxy.utas.edu.au/eds/detail?sid=59a6c19e-901d-440a-b791-a71625c1f886%40sessionmgr114vid=1hid=104bdata=JnNpdGU9ZWRzLWxpdmU%3ddb=cat02831aAN=UTas.b1560119http//eds.b.ebscohost.com.ezproxy.utas.edu.au/eds/results?sid=127dd355-fcfc-42af-a93e-9ccff2e157c5%40sessionmgr115vid=1hid=104bquery=ecg+(PT+book+OR+PT+ebook)bdata=JmNsaTA9RlQxJmNsdjA9WSZ0eXBlPTAmc2l0ZT1lZHMtbGl2ZQ%3d%3d rascal 1 of 8