The Importance Of Being The Eldest Child Essay - 1413 Words

Being the eldest child comes with many perks, but also jobs you need to undertake. As the older one among your siblings you often get the bigger rooms, more freedom, and get new things earlier. As an older brother I have responsibilities when it comes to my family. Being the older sibling, I have roles I need to fulfill. There are often times the younger ones would copy what I do and pick up some of the habits I do without knowing it. I am also the go-to person when my parent needs help doing something. I am often stuck with tasks like taking care of the small problems of my younger siblings or house chores. There are times where I would be held responsible when my parents put me in charge. Especially when my parents aren’t home. There are also times where I sometimes feel that the blame is always on me rather than my younger sibling. But complaining doesn’t change anything. After all, I am the older one and my parents trust me more. The definition of an older sibling means that I was the first born. However, being the first born comes with many task I did not sign up for, like being the role model for my younger siblings. My brother Milton and I always got along with one another, even though we fought all the time. I could remember we would fight for the stupidest things, like who gets to sit where on a car. As we got older the aggressiveness got less and less, and our relationship were stronger than ever. Throughout our childhood, we had similar interests, liking theShow MoreRelatedBirth Order Personality Traits Essay743 Words   |  3 Pagessame family can turn out so differently, with completely different personalities and ways of solving problems. Recognizing the immense influence of family dynamics on young children can clear up a lot of the confusion. For example, eldest children look to their parents as role models for their behavior, and may become perfectionistic as parents expect them to act like little adults. Middle children may become more dependent on peer approval and their friends because theyRead MoreEssay about Birth Order1163 Words   |  5 PagesBirth Order Does being the eldest child make people highly intellectual, people pleasing, perfectionists? Are the middle children always impatiently competing for parental attention by rebelling against the rules? Are all last-born children the spoiled, selfish, favorites? Birth order, a highly controversial topic, is defined as the dynamics of an individual’s place in the family compared to that of their siblings. Birth order has been in a fiery discussion for over one hundred years; some say it’sRead MoreMy Sibling And I Have Very Different Personalities1739 Words   |  7 Pagesfriends could sleep over. 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In the inner chambers the ch’ongbu was only out ranked by her mother and grandmother in-law. Out of all the female members ofRead MoreFamily Dynamics Of Hispanic Families976 Words   |  4 Pagesfor and being responsible to one’s family and prioritizing family needs over personal ones (Castellanos Gloria, 2007; Sy Romero, 2008). Marianismo. In a culture strongly influenced by gender construction, marianismo is a value that emphasizes the self†sacrifice females must make while also stressing the importance of the family caretaker role Latinas are expected to fulfill in the family (Sy, 2006; Stevens, 1973). The female experience in the Latino family is of particular importance as LatinaRead MoreSolve the Problem1318 Words   |  6 Pagesdescribed in Ch. 5 of the text are the following: searching for the problem, expressing the problem or issue, investigating the problem or issue, and producing ideas. * Stage one of the creative process – searching for the problem – emphasizes the importance of responding to problems in triggering one’s creativity (Ruggiero, 2009). * Stage two centers on expressing the problem or issue in numerous ways and finding the most creative and helpful ideas. * Stage three objectives is obtaining theRead More Importance of Family in the Short Story, Cakes Essay996 Words   |  4 Pagesusually slept until noon. From Downtown, Giovanni Vitale came home at the end of the workday on the BMT subway to his wife, Lisa, to their three kids Anna, Steve, and Johnny. After dinner they would all listen to the Philco. Then Giovanni and the eldest kid, Johnny, eleven, walked three long blocks and two short blocks, past the old people who fanned themselves on the stoops, to Carlo’s shop on Seventeenth Avenue (4). The first paragraph evokes the normal and typical structure of the Italian-AmericanRead MoreTitus Andronicus: An Anachronistic Obsession over First Born Sons1260 Words   |  6 PagesAdding to the consequence of first born sons in Titus Andronicus is the fact that the play opens with Caesar’s eldest son, Saturninus. Saturninus is asserting his right to rule Rome. He exclaims, â€Å"Plead my successive title with your swords/I am his firstborn son that was the last,† in an effort to remind the Romans that he is in the rightful position to succeed his father as he is the eldest (Shakespeare 1.14-5). 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Night Creature Crescent Moon Chapter 41 Free Essays

â€Å"Stand back.† Mandenauer pointed his gun at Henri’s head. â€Å"Old man, you try my patience,† Elise muttered. We will write a custom essay sample on Night Creature: Crescent Moon Chapter 41 or any similar topic only for you Order Now Confusion swept over his face. â€Å"What did I do?† â€Å"You can’t shoot someone with a soul.† â€Å"Since when?† Her mouth moved as if she was counting to ten. I kind of thought she was. â€Å"We’ve been over this. Put the gun away.† â€Å"Never.† But he did lower it. â€Å"What do you suggest? A mad werewolf, soul or no, is not something I plan to let run free.† â€Å"I’m with him,† Adam said. Elise stared at Henri as if he were a brand-new science experiment. â€Å"I wish I could cage him until I’m certain what we’re up against† Adam and I exchanged glances. â€Å"I’ve got a cage,† I said. â€Å"I’d forgotten,† Mandenauer murmured, and Elise shot him a glare. â€Å"That’s not something that should be forgotten.† â€Å"I’m ancient.† He sniffed. â€Å"Sometimes I forget.† â€Å"One day you’ll forget to shoot the bad guys, and then you’ll be dead.† â€Å"Perhaps.† He didn’t appear concerned. â€Å"We must hurry and incarcerate Henri before the sun disappears.† A flurry of activity ensued, followed by a frantic trip to the mansion; then we practically dragged Henri through the swamp, and tossed him into the cage. Not a minute too soon. I turned the key on the padlock as he came awake with a howl of agony. His body bent; his clothes tore; hair sprouted from every pore. I’d seen him change from wolf to man; now I watched as he went from man to wolf. That had to hurt. His too human eyes peered at us from behind the bars. When I’d seen them before they’d been full of hate and hunger. Now the hunger was there, but the hate was gone. He paced back and forth, whining, pawing the ground, then throwing himself against the bars until he bled. â€Å"Give him the serum, Elise,† Mandenauer ordered. She’d already pulled a vial from the pocket of her shorts and snapped gloves onto her hands once more. Another migraine she didn’t need. â€Å"What’s de matter with him?† â€Å"The hunger is maddening. On the night of the full moon I have to run as wolf. Without this,† she held up the vial â€Å"I’d kill. I wouldn’t be able to help myself. For him, the same thing must happen under the crescent moon.† She shook her head. â€Å"One night a month is bad enough.† â€Å"Why is he whining?† I resisted the urge to cover my ears, the pathetic noise grating on my nerves like sandpaper. â€Å"Killing sickens him,† she whispered, â€Å"but he can’t resist the desire.† Elise walked to the cage, and Henri slammed against it right in front of her. â€Å"Be careful,† I called. â€Å"He can’t hurt me. I’m a werewolf already.† In a lightning-fast movement, she reached inside and grabbed Henri’s snout. Then she poured the contents of the vial down his throat. When she was through, he actually licked her hand before falling asleep. â€Å"Does Damien still get furry every full moon?† I asked Elise. â€Å"My touch cured him.† â€Å"But you can’t cure yourself?† Something flickered in her eyes, and she looked away. â€Å"Not yet† â€Å"And Henri? What’s his problem?† â€Å"I’m not sure. I’d like to take him back to the lab and figure that out.† â€Å"No,† Adam said flatly. â€Å"I can fix him,† Elise insisted. â€Å"I haven’t spent much time in the lab since this.† She lifted her palm. â€Å"Works better than any medicine. But not so long ago, I lived there. I’m sure I can discover what his secret is.† â€Å"You can’t kill him. If he dies, I’m cursed.† â€Å"The curse might be lifted. His soul is restored.† â€Å"De only way to know is for him to die. I’m not willing to take that chance.† â€Å"He’ll be safe with me. You should see the compound we built Impregnable this time.† â€Å"This time?† I asked. â€Å"Last one went boom. But the werewolves survived the blast.† â€Å"That really sets my mind at ease,† Adam muttered. Cassandra, who hadn’t said a word since we’d gotten here, moved closer to the cage. â€Å"I think I might know why your cure didn’t work.† â€Å"I’m all ears,† Elise said. â€Å"Henri was made a loup-garou through voodoo, not by science or by being bitten.† Cassandra stared at each of us in turn. â€Å"A voodoo curse can only be removed by voodoo.† My heart kicked against the wall of my chest. â€Å"You can fix him? Why didn’t you say so?† â€Å"Not me.† â€Å"Who?† â€Å"Only the one who placed the curse can take it away.† My shoulders slumped. â€Å"She’s gotta be long dead.† â€Å"Exactly.† Cassandra’s eyes met mine. â€Å"But the dead can rise.† â€Å"Zombie.† Elise’s eyebrows shot toward her silky blond hair. I was amazed that in her profession she could still be surprised. â€Å"Zombies are dangerous,† Mandenauer muttered. â€Å"And unpredictable.† â€Å"You’ve seen one?† Cassandra asked. â€Å"Ja.† â€Å"You know someone who can raise a zombie?† â€Å"I did.† He sniffed. â€Å"That means he killed the guy,† Elise said. â€Å"Grandfather, sometimes it’s better to keep them alive.† â€Å"Wait a second.† I held up a hand. â€Å"He’s your grandfather?† That the head werewolf hunter had a granddaughter who was a werewolf was a little hard to digest. â€Å"Yes,† Elise confirmed. â€Å"Neither one of us is too happy about it.† I could imagine. Adam turned to Cassandra. â€Å"Tell me about raising de woman who cursed my family. Could you do it?† â€Å"Not me, no. I’d need to find a practitioner powerful enough to perform that kind of magic. I’m not even sure it’s possible to raise someone who’s been dead that long.† Adam’s shoulders slumped. I moved closer and slipped my hand into his. â€Å"Until then, let me try,† Elise urged. I understood why Adam didn’t want to give anyone power over Henri. In relinquishing his grandpere, Adam relinquished control over his own and Luc’s destiny. But we’d exhausted our options. Protecting Henri wasn’t getting us anywhere. We needed the experts’ help. Adam must have thought the same thing, because he squeezed my hand and said, â€Å"OK.† The night passed; the sun rose; Henri became a man again. A very crazy man. Elise was forced to sedate him to get him back to the compound in Montana. She’d been right. The knowledge of all he’d done had sent him over the edge. He did a lot of moaning and muttering. If I hadn’t almost been one of his victims, I might have felt sorry for him. As it was, I was glad to see him go. Cassandra decided to take a trip to Haiti, courtesy of the Jager-Sucher society. â€Å"Mandenauer wants me to discover more about voodoo, zombies, and this goddess-of-the-moon question. I’m game.† She’d hired a local to run her store and take care of Lazarus when I refused to. Cassandra and I were friends, but I drew the line at snake-sitting. â€Å"I think we’ve proved I’m not a moon goddess,† I said. â€Å"Maybe. Maybe not. It won’t hurt to look into things a little more. You want Henri cured, don’t you?† â€Å"For all I care, Henri can burn in hell.† â€Å"He probably will. But if we can make certain Adam and Luc don’t follow him there – â€Å" â€Å"I’ll do anything,† I said. â€Å"That’s what I thought I made a few calls after you traveled to Ife and spoke to Erzulie.† â€Å"Do not tell me I’m a lost priestess of the voodoo nation. I’m a cryptozoologist from Boston. Period.† Cassandra’s shoulders shifted, as if something were crawling down her neck. â€Å"I think I sent you to Ife.† â€Å"What?’ â€Å"I performed the ceremony. The magic came from me.† Cassandra appeared sheepish. â€Å"I might be more powerful than I thought† â€Å"That’s good news, isn’t it?† â€Å"Don’t tell Mandenauer. He gets weird when people talk about power.† I couldn’t imagine why. â€Å"What’s next for you?† Cassandra asked. â€Å"I don’t know.† She tilted her head. â€Å"Love, marriage, mommyhood. I see it in the cards.† â€Å"You don’t read cards.† She put her hand over mine. â€Å"Your future is with them.† â€Å"I haven’t seen Adam or Luc since Henri went away.† Three days ago. I’d hung around the mansion waiting. Pathetic but true. I’d have to get a job soon, considering Frank hadn’t paid me. Since his butt was in jail, courtesy of me, I didn’t mink he was going to. Before Mandenauer had left he’d told Detective Sullivan there’d been one rabid wolf in the swamp and he had killed it. Case closed. I had no reason to hang around. â€Å"Adam loves you,† Cassandra said. â€Å"I’m not so sure.† â€Å"He put his son in your protection. There’s no greater love than that.† â€Å"Henri found a gris-gris under Luc’s pillow.† â€Å"Really? I guess that’s the love charm you were so worried about.† She narrowed her gaze. â€Å"You want me to give you one to counteract the magic?† â€Å"He burned it.† She peered into my face. â€Å"And you still love them both, don’t you?† â€Å"Desperately.† I’d realized sometime over the past few nights I’d slept alone that I’d fallen for Adam before I’d even met Luc. The gris-gris was irrelevant, even if it weren’t dust. â€Å"Maybe you need to say good-bye to your first love before you move on to the last one.† At my confused expression, she continued. â€Å"Simon. You’ve never really put him to rest† â€Å"And how do you suggest I do that? Another gris-gris?† She smiled and squeezed my hand. â€Å"Only you can say good-bye to him, Diana.† I wasn’t sure how I’d say good-bye to a dead man, but I certainly couldn’t do it long-distance. I packed my things and went to Chicago, where I’d buried Simon four years ago. The place no longer felt like home. I’m not sure it ever had. The cemetery was peaceful, deserted. No one would see me talking to a headstone. â€Å"You were right, Simon. There’s more in this world than anyone could imagine.† I sat on the grave and ran my hand over the grass. â€Å"I had to break my vow, and I’m sorry. I couldn’t clear your name. I’d only hurt more people. I figured you’d understand.† Absently I pulled out the gris-gris that contained the fire iris petal. A little truth wouldn’t be so bad. Where was Simon now? Had he truly come to me in the swamp? Was there any way of getting him back? Did I want to? When I touched the sack, the tie fell off, and when I peered inside, I discovered the petal had disintegrated into dust The wind swirled the particles away. I guess some truths are better left unknown. â€Å"I still miss you,† I said. â€Å"I probably always will, but I have to say good-bye.† The breeze, warm despite the autumn chill off Lake Michigan, stirred my hair. I wanted to smell Simon’s aftershave, hear his voice, feel his love, know that he’d heard me. I closed my eyes and wished for him, but he was as gone as the wind. When I opened my eyes, Adam was there. Talk about magic. â€Å"You scared me to death, cher. I thought you’d left for good.† How had he found me? â€Å"Cassandra,† I said as I got to my feet. He shrugged, then indicated Simon’s grave with a tilt of his head. â€Å"You were saying good-bye.† â€Å"I can’t live in the past anymore.† â€Å"Me, neither.† Hope lit my heart and probably my face, because he held up his hand. â€Å"There’s something I have to tell you. Luc and Sadie did a love spell.† â€Å"I know.† He started. â€Å"You do?† I nodded. â€Å"I was going to destroy it, but Luc can’t find de gris-gris.† â€Å"Henri burned it. One of his insane little mind games.† â€Å"But†¦ I still feel de same way.† â€Å"Which is?† â€Å"Crazy mad in love with you.† â€Å"Ditto,† I said. â€Å"And your little boy, too.† Adam gave me a rare smile. â€Å"I never thought I’d love anyone but my son.† â€Å"I never thought I’d love again.† â€Å"I guess we were both wrong.† He tugged on my hair. â€Å"What you think about fixing up de mansion?† â€Å"I thought you hated the place.† â€Å"Kind of grew on me. Lots of good memories there now.† My face heated at some of them. â€Å"I can’t promise a certain future.† I lowered my gaze to Simon’s headstone. â€Å"Who can?† After several moments of silence, Adam said, â€Å"Mandenauer offered us jobs.† â€Å"Us?’ He nodded. â€Å"We’d be perfect.† â€Å"What would we have to do?† â€Å"Same thing we’ve been doing.† I wiggled my brows. â€Å"He’s going to pay us for that?† Adam snorted. â€Å"He wants you to chase down rumors of paranormal beasts. He wants me to kill werewolves.† I frowned. â€Å"That sounds dangerous.† â€Å"I’ve been doing it for years, cher† â€Å"What about Luc? We can’t both traipse off, tra-la-la.† His lips curved. â€Å"You’re thinkin’ like a mother already.† I was. When had that happened? â€Å"You sure you want a ready-made family?† he asked. â€Å"I’m sure I want you and Luc.† â€Å"There’ll be no more children.† â€Å"I’ll be lucky if I can handle the one we have.† â€Å"You’ll do fine,† he said. â€Å"The boy was crazy about you from day one. That’s why he did de love spell. Couldn’t bear to lose you. I have to say I understand why, but he’s still grounded.† I stifled a laugh at the notion of being grounded for performing a voodoo love spell. My life certainly had taken a turn for the strange. â€Å"I figure if we take Mandenauer’s offer we can take turns bein’ away from home.† â€Å"Home,† I murmured. â€Å"That sounds nice.† Adam reached into his pocket For an instant I thought he’d brought another belly chain. I still wore the one he’d given me. I planned never to take it off. â€Å"Partners?† he asked, and held out his hand. In his palm lay a circlet of interlinked silver fleurs-de-lis with a moonstone center. The ring was so beautiful, I ached to put it on. But not yet â€Å"When you say partners†¦?’ â€Å"I’ll understand if you don’t want to marry me. Who knows when I might change under de crescent moon?† â€Å"I’d still love you, even then.† He just shook his head. â€Å"The only way I’ll do this is if we’re married,† I insisted. â€Å"I adopt Luc. I’ll protect him if you can’t Once that’s settled, we take the jobs, help save the world. Together, we’ll face whatever comes.† He hesitated so long, I feared he’d take back the offer and the ring. At last he slipped the silver circlet onto my finger, sealing the deal without saying a word. But there was one thing that still bugged me. â€Å"Did you really believe everything that was between us was the result of magic?† â€Å"I still believe that.† My startled gaze flicked to his. â€Å"What?† Reaching out, he touched my cheek. â€Å"Don’t it feel like magic to you, cher?† I couldn’t speak, could only nod, as he took my hand, then led me away from my past and into a bright new future. How to cite Night Creature: Crescent Moon Chapter 41, Essay examples

Nursing Practice Act free essay sample

I came to realize just how fare we have come. My article includes information on the scope of practice for the nursing profession. The’re alson many different responsabilities of nurses, and the exams and prcedures they go though to become licensed are something else. There are a lot of things that a person can do to lose their license. The’re are also many avenues you can take in nursing, there are a lot of opertunities to grow. The definition of Nursing Practice is to provide individuals and groups with nursing care requiring specialized knowledge, judgment, and skill derived from the principles of biological, physical, behavioral, social, and nursing sciences. A nurses scope of practice focuses on identifing patterns of human responses to actual or potential health problems amenable to a nursing regimen. They are to execute a nursing regimen through the selection, performance, management, and evaluation of nursing actions, assessing health status, and to provide health counseling and health teaching. We will write a custom essay sample on Nursing Practice Act or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The scope of practice includes administering medicatons, treatments, and to execute regimens that are by authorized personal. The scope of practice also includes teaching, administering , supervising, delegating, and evaluating nursing practice. The standards related to the RN’s responsibilities in implementing the nursing process and as a member of the nursing profession is to be knowledgable in your work, always use the best possible route, and always make informed decisions. An advanced practice nurse is a registered nurse who has been certified under a certain chapter to practice in a certain field, by the board of nursing. They have certified registered nurse anesthetist, clinical nurse specialist, certified nurse- midwife, and certified nurse practitioner. Nurse practitioners have to also obtain prescriptive authority, which grants them the authority to prescribe medication. The nursing licensure requirements for a new graduate is first to send in an application for the licensure. The application has to include evidence that the applicant has completed requirements of a nursing education program approved by the board or approved by another jurisdiction’s board that regulates nurse licensure. The application will also include information requied by the board. There will be an application fee required by section 4723. 08 of the revised code. You also have to pass a background check that was brought into effect after June 1, 2003. The board of nursing may revoke, suspend or refuse to grant a nursing license, if a person is found by the board to have committed fruad in passing an examination required to obtain the license. A nurse can also have there license suspended or revoked if caught selling, giving away, or administering drugs or therapeutic devices for other than legal and legitimate therapeutic purposes. To renew a license that was issued for a two-year renewal period you have to have 24 hours of continuing nursing education. At least one hour of the education must be directly related to the statutes and rules pertainig to the practice of nursing in this state. The law and rule that sets the requirements for schools of nursing is section 4723. 07. Section 4723. 07 explains the different precedures and precautions that have to be taught to maintain proper sanitation and cleanliness. Handeling and disposal of needles and other sharp instruments. Wearing and disposal of gloves and other protective garments and devices. All in all the responsibilities of the Ohio state Board of Nursing is to assume and exercise all the powers and perform all the duties required of it by chapter 4723. In the nursing world everything has to go through the Board of nursing and they decide everything by vote. The board of nursing follows specific guidelines that are all mentioned with in the Nursing Practice Act and it is constantly changing. To continue on into advanced practice nursing you have to aquire your masters degree. It is also illegal to call yourself an RN with out being licensed but the board of nursing. The Nursing practice Act is where you want to look to find out what you have to do to get certain licenses and certifications.

Globalization and Internationalization †MyAssignmenthelp.com

Question: Discuss about the Globalization and Internationalization. Answer: Introduction Globalization of market is concerned about meeting the preferences of the buyers in the markets all over the world. This helps the organizations in reducing the marketing costs involved along with creating new market opportunities. Technology is the most influential force that pushes the world towards converging commonality. It is used by the consumers to gather information and making purchases from different parts of the world and used by the companies to obtain raw materials and products from different places and to sell the finished products abroad (Pearson, 2017). This report focuses on the fact that the success and failure of the firms is enabled or constrained by the institutions (formal and informal) which can often be referred to as the rules of the game. Also, this report focuses on the ways which will enable the managers to solve the problems faced by them. Globalization and Internationalization Globalization is a process with the help of which the cross border economic, socio-culture and political relations are established and maintained and the geographic distance becomes the matter of least importance. The term internationalization appears to be identical with globalization but there is difference between the two. Internationalization relates to increasing importance of international relations, trade, treaties and alliances, etc. Technology has contributed to a lot of extent in todays era to support the process of globalization by providing ease by the way of e-commerce, promoting cultural globalization through television and telephone and facilitating 24/7 trading by supporting the financial sector. Globalization has resulted into the integration of internationalization of markets and businesses and has altogether changed the manner in which the modern organization perform their business activities. The goods, services and technology are shared across the boundaries which not only benefit the organizations but also the countries by enabling them to establish international relations with different countries. Global Business Environment Global business environment is the environment in different autonomous nations outside the home environment of the organization which influences the decision making process of such organization in relation to the use of resources (Hamilton Webster, 2015). Institutional based view Firms achieves success or faces the failure as the result of opportunities and threats present in the business environment. It is often referred to as the rules of the game which means that the success and failure are enabled or constrained by the institutions i.e. formal and informal. Formal Institution Formal institution can be defined as the institution represented by laws, regulations and rules enforced by the home and host country (Garrido, Gomez, Maicas, et. al., 2014. In simple words, formal institution consists of the entire political system governing the nation which can be either democracy or totalitarianism also known as dictatorship. Various practices are covered under the applicable laws such as common law, civil law, theocratic law, etc. which govern their functioning under the legal system. Informal Institution Informal institution can be defined the institution represented by ethics, cultures and norms (Peng, Wang Jiang, 2008). It involves the way of doing things and the choice between what is right and what is wrong among the alternatives available. It also involves the values and beliefs that guide the behavior of individual and firms. Resources based view The success of a firm is also dependent upon its own strengths and capabilities to deal with the external environment. A resource-based view basically focuses on the internal resources and capabilities of the firm. It is an approach used to achieve competitive advantage by developing their internal factors to deal with the external environment. It has a strong relationship with the performance of the firm in terms of achieving the competitive advantage. Skills The existing resources are used in a new way to exploit the external opportunities by acquiring new skills for each different opportunity (Jurevicius, 2013). Moreover, skills also involve the talent, knowledge and experience possessed by employees, managers and other members of the organization which cannot be replicated by other organizations in the global business environment (Enriquez-De-La-O, 2015). Management skills possessed by the top management which is responsible for controlling the entire organization acts as a key to success if done with full expertise. Capabilities The resources possessed by an organization consists the part of its distinctive capabilities which provides the ability and strength to compete with other organizations in the marketplace (Management Study Guide, 2017). The internal resources and capabilities provides the ability to meet the preferences of the customers with latest technology, flourishing ideas to maintain competitive advantage over others and to deal with the unstable environment by adopting secure bases for formulating strategy.(MBA Tutorials, 2017). Capabilities also involves the ability to adapt and change the internal and external resources of the organization in accordance with the changing global business environment. Challenges faced by Managers Entering the global market involves a high amount of risk which must be identified and assessed on time by the managers in order to prepare themselves against the impact of high-risk and unfortunate events. Ethnocentrism is one of the important challenge faced by the managers during the course of communication to different cultures which could even lead to heavy financial losses in the long run (Parker Buzz, 2017). Another challenge involves the inflexibility and inability to adopt the practices of different culture in order to meet the preferences and expectations of the consumers of foreign countries. The managers are challenged with the various constraints led down by the formal and informal institutions and therefore are required to arrive at a proper decision based on such formal and informal institutions and then come out with a strategy in order to deal with the situation (Globerman, 2017). It requires proper research to be made by them with the view to gather knowledge and intelligence regarding the trade and investment barriers in the cross border country such that the nature of government intervention can be identified. Therefore, when a situation arises where the behavior of the form is governed by both formal and informal institutions and the formal constraints appear to be unclear then the managers must take help of the informal constraints in order to reduce the uncertainties and provide a level of constancy in operations. Also, the managers and the chief executives must take proper steps to undertake continuous monitoring of the business environment relating to culture, taste, preferences and technological variations such that appropriate changes can be made in the products on time and adverse conditions can be prevented. Conclusion Rapid globalization of markets along with technological revolution has changed the entire scenario of the market. Technology has helped the organization to eliminate the inefficiencies out of their international operations by making the use of innovative production and distribution techniques in order to boost the competitiveness in the global business environment. The challenges faced by the managers must addressed with the in-depth business environment analysis such that variations required to be made can be easily interpreted in advance and does not cause any discrepancies in the future. It may adopt risk management and scenario planning to deal with the various risks which may arise in the course of business. References Enriquez-De-La-O, J. F. 2015. Resource-Based View and Dynamic Capabilities Resource-Based View and Dynamic Capabilities. Retrieved November 25, 2017 from https://unipub.lib.uni-corvinus.hu/2171/1/VT_2015n11p50.pdf Garrido, E., Gomez, J., Maicas, J. P. and Orcos, R. 2014. BRQ Business Research Quarterly. Retrieved November 25, 2017 from https://www.sciencedirect.com/science/article/pii/S2340943614000024 Globerman, S. 2017. Assessing The Global Business Environment Retrieved November 25, 2017 from https://cbe.wwu.edu/files/assessingglobalbussenviro.pdf Hamilton, L. and Webster, P. 2015. The International Business Environment. Oxford University Press. Jurevicius, O. 2013. Resource Based View. Retrieved November 25, 2017 from https://www.strategicmanagementinsight.com/topics/resource-based-view.html Management Study Guide. 2017. Resource Based View - The VRIN Characteristics. Retrieved November 25, 2017 from https://www.managementstudyguide.com/resource-based-view.htm MBA Tutorials. 2017. Rbv Resource Based View Retrieved November 25, 2017 from https://www.mba-tutorials.com/strategy/1174-rbv-resource-based-view.html Parker Buzz. 2017. challenges faced by managers during cross cultural communication. Retrieved November 25, 2017 from https://www.parkarbuzz.com/challenges-faced-managers-cross-cultural-communication/ Pearson. 2017. Globalization. Retrieved November 25, 2017 from https://catalogue.pearsoned.co.uk/assets/hip/gb/hip_gb_pearsonhighered/samplechapter/0273752634.pdf Peng, M. W., Wang, D. Y. and Jiang, Y. 2008. An institution-based view of internationalbusiness strategy: a focus on emerging economies. Journal of International Business Studies. pp. 1-17.

How to Write a Sample of Explanation Essay

How to Write a Sample of Explanation EssayIf you are interested in doing a sample of explanation essay, make sure you first know what you are looking for. Have you started doing one because you want to improve your grades in school? Or, do you think you have a good idea of what you want to write, but just need a little guidance on what kind of essay to write? Whatever your reason, getting help from an experienced writing teacher can be valuable, especially if you are new to the essay writing field.Here is a common example of how a sample of explanation essay is written. Let's say that you are working with your class as their teacher on a new learning strategy, and the question you want to ask them is this: 'How will we become more successful in our classroom?' There are several ways that you could go about making this question.One way you could ask it is: 'What we would like to know is how can we become more successful in our classroom. What specific steps do we need to take to achie ve success? Is there anything else we can do to make the classroom more successful?'Or, you could look at it from another angle. Let's say that you have had a bit of a rocky experience with your boss, and you need to build the relationship up again. Your question might be: 'How can we both build this relationship? Where do we start? What do we have to do to get to where we want to be? How can we best build a rapport?'In all these examples, you are asking questions about how we can make progress. You are looking for specific things that we can do to better ourselves, or to develop relationships. In the next article in this series, we will examine how to write a sample of explanation essay that is not based on these examples.The most common questions that people write in the sample of explanation essay are those that are focused on actions, accomplishments, and specific behaviors that we want to change. In this way, the explanation is more like a conversation.To recap, in this article , we looked at three important elements in any sample explanation essay. As we see, each of these elements is critical for creating a helpful essay, and a great way to learn how to write a good one.

Hiv Pathophysiology Essay Example

Hiv Pathophysiology Essay Pathophysiology of the human immunodeficiency virus Nancy R. Calles, MSN, RN, PNP, ACRN, MPH Desiree Evans, MD, MPH DeLouis Terlonge, MD Objectives 1. 2. 3. 4. 5. Provide an overview of the healthy immune system. Describe the human immunodeficiency virus (HIV). Describe the major components of the HIV life cycle. Identify the various HIV types and subtypes. Discuss HIV’s effects on the immune system. Overview The human immunodeficiency virus (HIV) is a retrovirus belonging to the family of lentiviruses. Retroviruses can use their RNA and host DNA to make viral DNA and are known for their long incubation periods. Like other retroviruses, HIV infects the body, has a long incubation period (clinical latency), and ultimately causes the signs and symptoms of disease, here AIDS. HIV causes severe damage to the immune system and eventually destroys it by using the DNA of CD4+ cells to replicate itself. In that process, the virus eventually destroys the CD4+ cells. Key Points 1. The immune system protects the body by recognizing invading antigens on pathogens (bacteria, viruses, fungi, and parasites) and reacting to them. 2. T lymphocytes, or T cells, regulate the immune system and destroy antigens. . HIV continuously uses new host cells to replicate itself. 4. The HIV life cycle includes six phases: binding and entry, reverse transcription, integration, replication, budding, and maturation. 5. Once HIV is in the circulatory system, it targets the CD4+ lymphocyte. 6. Two types of HIV cause AIDS: HIV type 1 (HIV-1) and HIV-2. 7. Primary infection refers to the time when HIV first enters the body. 8. Clinical latency refers to the time before onset of symptoms and complications in the HIV-infected individual. In HIV-infected adults, this phase may last 8-10 years. 9. We will write a custom essay sample on Hiv Pathophysiology specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Hiv Pathophysiology specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Hiv Pathophysiology specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Early signs and symptoms of HIV can include candidiasis, lymphadenopathy, cervical carcinoma, herpes zoster, and peripheral neuropathy. 10. Late signs and symptoms of HIV and AIDS-defining illnesses can include the development of lifethreatening infections and malignancies. The Healthy Immune System The immune system protects the body by recognizing antigens on invading bacteria and viruses and reacting to them. An antigen is any substance that induces a state of sensitivity and immune responsiveness. These antigens interact with antibodies and immune cells, initiating an immune response. This process destroys the antigen, allowing the body to be free of infections. Types of antigens include bacteria, viruses, fungi, and parasites. When the immune system is weakened or destroyed by a virus such as HIV, the body is left vulnerable to infections. The immune system consists of lymphoid organs and tissues, including the bone marrow, thymus gland, lymph nodes, spleen, tonsils, adenoids, appendix, blood, and lymphatic vessels (Figure 1). All components of the immune system are vital in the production and development of lymphocytes, or white blood cells. B lymphocytes (or B cells) and T lymphocytes (or T cells) are produced from stem cells in the bone marrow. B cells stay in the bone marrow to complete the maturation process, but T lymphocytes travel to the thymus gland to complete their maturation. There T lymphocytes become immunocompetent, multiply, and become more differentiated. 7 HIV Curriculum for the Health Professional cells, T-suppressor cells, inhibits or suppresses immune responses. Normal CD8+ cell count is between 300 and 1,000 cells in adults and children. The normal CD4+:CD8+ ratio is between 1. 0 and 2. . T cells can secrete cytokines (chemicals that kill cells), such as interferon. Cytokines can bind to target cells and activate the inflammatory process. They also promote cell growth, activate phagocytes, and destroy target cells. Interleukins are cytokines that serve as messengers between white blood cells. Recombinant (laboratory synthesized) interleukins are currently being studied in clinical trials for patients with HIV infection. Tonsils and Adenoids Thymus Lymph Nodes Spleen Peyer’s Patches Appendix Bone Marrow Lymph Nodes Lymphatic Vessels Phagocytes Phagocytes include monocytes and macrophages, large white blood cells that engulf and digest cells carrying antigenic particles. Found throughout the body, phagocytes rid the body of worn-out cells, initiate the immune response by presenting antigens to lymphocytes, are important in immune response regulation and inflammation, and carry receptors for cytokines. Dendritic cells, another type of phagocyte, also are antigen-presenting cells. They have long, threadlike extensions that help trap lymphocytes and antigens and are found in the spleen and lymph nodes. Neutrophils are granulocytic phagocytes that are important in the inflammatory response. Figure 1. Organs of the Immune System B Lymphocytes The main function of B lymphocytes is humoral (antibody) immunity. Each B cell can recognize specific antigen targets and can secrete specific antibodies. Antibodies function by coating antigens, which makes the antigens more vulnerable to phagocytosis (engulfing and ingestion of invading organisms by leukocytes and/ or macrophages), or by triggering the complement system, leading to an inflammatory response. Antibodies are highly specialized serum protein molecules. They are grouped into five classes, each having a specialized function: immunoglobulin G (IgG), IgA, IgM, IgE, and IgD. Complement The complement system consists of 25 proteins. Complement can induce an inflammatory response when it functions with antibodies to facilitate phagocytosis or weaken the bacterial cell membrane. The complement proteins interact with one another in a sequential activation cascade, promoting the inflammatory process. Despite the heavy artillery that the immune system has against foreign predators (Figures 2 and 3), HIV defeats it over time. T Lymphocytes T lymphocytes have two major functions: regulation of the immune system and killing of cells that bear specific target antigens. Each T cell has a surface marker, such as CD4+, CD8+, and CD3+, that distinguishes it from other cells. CD4+ cells are helper cells that activate B cells, killer cells, and macrophages when a specific target antigen is present. There are two main types of CD8+ cells. The first type, cytotoxic CD8+ cells, kills cells infected by viruses or bacteria, as well as cancer cells. The second type of CD8+ 8 HIV’s Structure HIV consists of a cylindrical center surrounded by a sphere-shaped lipid bilayer envelope. There are two major viral glycoproteins in this lipid bilayer, gp120 and gp41. The major function of these proteins is to mediate recognition of CD4+ cells and chemokine receptors, thereby enabling the virus to attach to and invade CD4+ cells. The inner sphere contains two single-stranded Pathophysiology of the Human Immunodeficiency Virus Stem Cell Lymphoid Precursor Platelets Myeloid Precursor Helper T-Cell Eosinophil Monocyte H-Cell Cytotoxic T-Cell Suppressor T-Cell Neutrophil Mast Cell Basophil Macrophage Plasma Cell Figure 2. Cells of the immune system White Blood Cells Neutrophils Lymphocytes Eosinophils Basophils B-Cells T-Cells CD4+ CD8+ In charge of the army Summons B-cells, natural killer (NK) cells, macrophages Plans for a direct attack Binds directly to antigen and kills it Figure 3. Immune response by white blood cells 9 HIV Curriculum for the Health Professional copies of the genomic material, RNA, as well as multiple proteins and enzymes necessary for HIV replication and maturation: p24, p17, reverse transcriptase, integrase, and protease (Figure 4). Unlike other retroviruses, HIV uses nine genes to code for the necessary proteins and enzymes. The three principal genes are gag, pol, and env. The gag gene encodes core proteins. The pol gene encodes the enzymes reverse transcriptase, protease, and integrase. The env gene encodes the HIV structural components known as glycoproteins. The rest of the genes—rev, nef, vif, vpu, vpr, and tat—are important for viral replication and enhancing HIV’s infectivity rate. cells make their way to the lymph nodes and eventually to the peripheral blood, where viral replication becomes rapid. CD4+ lymphocytes that are recruited to respond to viral antigen migrate to the lymph nodes. These become activated and then proliferate via complex interaction of cytokines released in the microenvironment of the lymph nodes. This sequence of events makes the CD4+ cells more susceptible to HIV infection, and it explains the generalized lymphadenopathy characteristic of the acute retroviral syndrome seen in adults and adolescents. In contrast, HIV-infected monocytes allow viral replication but resist killing. Thus, monocytes act as reservoirs of HIV and as effectors of tissue damage in organs such as the brain. The HIV life cycle includes six phases: binding and entry, reverse transcription, integration, replication, budding, and maturation (Figure 5). HIV’s Life Cycle Host cells infected with HIV have a shortened life span as a result of the virus’s using them as â€Å"factories† to produce multiple copies of new HIV. Thus, HIV continuously uses new host cells to replicate itself. As many as 10 million to 10 billion virions (individual viruses) are produced daily. In the first 24 h after exposure, HIV attacks or is captured by dendritic cells in the mucous membranes and skin. Within 5 days after exposure, these infected Binding and Entry The envelope proteins gp120 and gp41 bind to CD4+ cell receptors and coreceptors on the outside of CD4+ cells HIV Structure Envelope Envelope Proteins gp120 gp41 Matrix Proteins p17 Core Proteins p14 RT RNA Integrase Protease Figure 4. The Human Immunodeficiency Virus 10 Pathophysiology of the Human Immunodeficiency Virus sCD4 CD4-lgG Reverse Transcriptase Inhibitors Zidovudine Didanosine Zalcitabine Stavudine Lamivudine Nevirapine Reverse transcription Protease Inhibitors Saquinavir Indinavir Ritonavir Nelfinavir Tat Antagonists Penetration Uncoating Trans- TransIntegration cription lation Assembly Release HIV HIV Double-stranded unintegrated DNA cDNA Host chormosome Proviral DNA CD4 and chemokine receptors Genomic RNA Viral mRNA Nucleus Cytoplasm Figure 5. The HIV life cycle This depiction of the HIV life cycle shows the sites of action of some antiretroviral agents. and macrophages. The chemokine receptors CCR5 and CXCR4 facilitate viral entry. T-cell tropic viruses require CXCR4 to bind, and macrotropic strains of the virus require CCR5. R5 is the most common virus transmitted during acute infection, and later during infection X4 is the virus that is most common. The presence of a homozygous inactive mutation of the CCR5 allele has caused resistance to infection by the R5 virus. The joining of the proteins and the receptors and coreceptors fuses the HIV membrane with the CD4+ cell membrane, and the virus enters the CD4+ cell and macrophage. The HIV membrane and the envelope proteins remain outside of the CD4+ cell, whereas the core of the virus enters the CD4+ cell. CD4+ cell enzymes interact with the viral core and stimulate the release of viral RNA and the viral enzymes reverse transcriptase, integrase, and protease. incorporation must occur for the virus to multiply. The conversion of HIV RNA to DNA is known as reverse transcription and is mediated by the HIV enzyme reverse transcriptase. The result is the production of a single strand of DNA from the viral RNA. The single strand of this new DNA then undergoes replication into doublestranded HIV DNA. Integration Once reverse transcription has occurred, the viral DNA can enter the nucleus of the CD4+ cell. The viral enzyme integrase then inserts the viral DNA into the CD4+ cell’s DNA. This process is known as integration. The CD4+ cell has now been changed into a factory used to produce more HIV. Replication The new DNA, which has been formed by the integration of the viral DNA into the CD4+ cell, causes the production of messenger DNA that initiates the synthesis of HIV proteins. Reverse Transcription The HIV RNA must be converted to DNA before it can be incorporated into the DNA of the CD4+ cell. This 11 HIV Curriculum for the Health Professional Budding The HIV proteins and viral RNA, all the components needed to make a new virus, gather at the CD4+ cell membrane to form new viruses. These new viruses push through the different parts of the cell wall by budding. Many viruses can push through the wall of one CD4+ cell. These new viruses leave the CD4+ cell and contain all the components necessary to infect other CD4+ cells. Subtypes are unevenly distributed throughout the world. Subtype C currently accounts for more than half of all new HIV infections worldwide. Africa has most subtypes, although subtype B is less prevalent. There are no known subtypes of HIV-2. Effects on the Immune System The pathogenesis of HIV is basically a struggle between HIV replication and the immune responses of the patient, via cell-mediated and immune-mediated reactions. The HIV viral burden directly and indirectly mediates CD4+ T-cell destruction. There is destruction of mature CD4+ cells; CD4+ progenitor cells in bone marrow, the thymus, and peripheral lymphoid organs; as well as CD4+ cells within the nervous system, such as microglia. The result of this destruction is failure of T-cell production and eventual immune suppression. There are many mechanisms of CD4+ cell depletion by HIV infection. Direct HIV-mediated cytopathic effects include single-cell killing as well as cell fusion, or syncytium formation. The syncytium is a fusion of multiple uninfected CD4+ cells with one HIV-infected CD4+ cell via CD4–gp120 interaction. This fusion results in a multinucleated syncytium, or giant cell, which may ultimately serve as a means to produce many virions. The host’s natural immune responses also play a role in CD4+ cell depletion, mainly through cytotoxic CD8+ T-cells, antibody-dependent cellular cytotoxicity, and natural killer cells. Other mechanisms include autoimmune responses, anergy, superantigen-mediated activation of T cells, and programmed cell death (apoptosis). HIV can infect many types of cells. The spread of HIV outside lymphoid organs to the brain, spinal cord, lung, colon, liver, and kidney usually occurs late during illness. Table 1 gives a partial list of cells susceptible to HIV infection. The immune systems of HIV-infected children undergo changes that are similar to those in adults. B-cell activation occurs in most children early in the infection, evidenced by the presence of hypergammaglobulinemia (gt;1. 750 g/L) with high levels of anti–HIV-1 antibody. This reflects both dysregulation of T-cell suppression of B-cell antibody synthesis as well as active CD4+ enhancement of B-lymphocyte humoral response. Also, as HIV disease progresses through more severe immunosuppression and depletion of CD4+ cells, the CD8+ count increases, yielding an overall decrease in the CD4+:CD8+ ratio. Maturation The new virus has all the components necessary to infect other CD4+ cells but cannot do so until it has matured. During this process, the HIV protease enzyme cuts the long HIV proteins of the virus into smaller functional units that then reassemble to form a mature virus. The virus is now ready to infect other cells. HIV Types There are two types of HIV that cause AIDS: HIV type 1 (HIV-1) and HIV-2. We know little about HIV-2. Studies have shown striking similarities but also important differences between HIV-1 and HIV-2. They have the same modes of transmission and are associated with the same opportunistic infections, but HIV-2 appears to progress more slowly. Most HIV-2 cases are found in western Africa and in countries related to western Africa in some way such as Portugal, France, Angola, Mozambique, Brazil, and India. Various subtypes of HIV-1 have been found in specific geographic areas and in specific high-risk groups. A person can be coinfected with different subtypes. The following are HIV-1 subtypes and their geographic distributions: Subtype A: Central Africa, sub-Saharan Africa Subtype B: South America, Brazil, United States, Thailand, Europe, Caribbean, India, Japan Subtype C: Brazil, India, South Africa Subtype D: Central Africa, sub-Saharan Africa Subtype E: Thailand, Central African Republic, Southeast Asia Subtype F: Brazil, Romania, Democratic Republic of Congo (Zaire) Subtype G: Democratic Republic of Congo (Zaire), Gabon, Thailand, Russia, Central Africa Subtype H: Democratic Republic of Congo (Zaire), Gabon, Russia, Central Africa Subtype I: Cyprus Subtype O: Cameroon, Gabon 12 Pathophysiology of the Human Immunodeficiency Virus Table 1. Cells Susceptible to HIV Infection System Hematopoietic Cell †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ T-cells (CD4+ OR CD 8+) Macrophages/monocytes Dendritic cells Fetal thymocytes and thymic epithelium B-cells NK cells Megakaryotic cells Stem cells Microglia Capillary endothelial cells Astrocytes Oligodendrocytes differentiating symptom that is often absent is the presence of a runny nose or nasal congestion. During primary infection, the CD4+ count in the blood decreases remarkably but rarely drops to less than 200 cells/? L. The virus targets CD4+ cells in the lymph nodes and the thymus during this time, making the HIV-infected person vulnerable to opportunistic infections and limiting the thymus’s ability to produce T lymphocytes. HIV antibody testing using an enzymelinked immunosorbent assay or enzyme immunoassay may yield positive or negative results depending on the time of seroconversion. DNA PCR and RNA PCR will be positive, but confirmation with Western blot analysis may yield an indeterminate result because seroconversion can take up to 2–8 weeks to occur. The average time to seroconversion is 25 days. Central Nervous Large Intestine Other †¢ Columnar epithelium †¢ Kupfer cells (liver †¢ Synovial cells †¢ Placental tophoblast cells Clinical Latency/Asymptomatic Disease (Clinical Stage 1) Although patients recently infected with HIV usually experience a â€Å"clinically latent† period of years between HIV infection and clinical signs and symptoms of AIDS, evidence of HIV replication and host immune system destruction exists from the onset of infection. Early during this time, referred to as Clinical Stage 1 , the immune system produces antibodies in an attempt to protect itself from HIV. This is when the â€Å"viral set point† is established. The viral load of the set point can be used to predict how quickly disease progression will occur. People with higher viral load set points tend to exhibit more rapid disease progression than those with lower viral load set points. During latency, HIV-infected patients may or may not have signs and symptoms of HIV infection though persistent lymphadenopathy is common. In HIVinfected adults, this phase may last 8–10 years. The HIV enzyme-linked immunosorbent assay and Western blot or immunofluorescence assay will be positive. The CD4+ count is greater than 500 cells/? L in children over 5 years of age. Adapted from Levy L. A. Microbiological Reviews, 57:183-289, March 1993 Clinical Categories of HIV Infection Children infected with HIV often have severe disease when first evaluated, or they may develop AIDS over time, much like adults infected with HIV. Infants and young children normally have higher CD4+ counts than those of adults. The normal CD4+ count in children varies with age, but it is equal to the adult value by the time the child is 6 years old. Immunologic and clinical categories are used to evaluate the HIV disease status in children and to make treatment decisions. Primary Infection, or Acute Retroviral Syndrome Primary infection refers to the time when HIV first enters the body. At the time of primary infection with HIV, a person’s blood carries a high viral load, meaning that there are many individual viruses in the blood. The number of copies of virus per milliliter of plasma or blood can exceed 1 million. Newly infected adults often experience an acute retroviral syndrome. Signs and symptoms of acute retroviral syndrome include fever, myalgia (muscle pain), headache, nausea, vomiting, diarrhea, night sweats, weight loss, and rash. These signs and symptoms usually occur 2–4 weeks after infection, subside after a few days, and often are misdiagnosed as influenza or infectious mononucleosis. An important Mild Signs and Symptoms of HIV (Clinical Stage 2) HIV-infected people may appear to be healthy for years, and then minor signs and symptoms of HIV infection begin to appear. They may develop candidiasis, lymphadenopathy, molluscom contagiosum, persistent 13 HIV Curriculum for the Health Professional hepatosplenomegaly, popular pruritic eruptions, herpes zoster, and/or peripheral neuropathy. The viral load increases, and the CD4+ count falls is between 350-499/ uL in children older than 5 years. Once patients are in this stage they remain in stage 2. They can be reassigned stage 3 or 4 if a condition from one of those occurs, but they cannot be reassigned to Clinical Stage 1 or 2 if they become asymptomatic. References 1. Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics. Philadelphia: W. B. Saunders; 2004. 2. Bullock BL, Rosendahl PP. Immunity: Pathophysiology Adaptations and Alterations in Function. Philadelphia: Lippincott; 1992. . Centers for Disease Control and Prevention. (1994). 1994 revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR Recomm. Rep. 1994;43(RR-12):1–10. 4. Lusso P. (2006). HIV and the chemokine system: 10 years later. EMBO J. 2006;25:447–456. 5. Montero J, Nadler JP. Pathophysiology of HIV Infection. In HIV/AIDS Primary Care Guide. Crown House Publishing L imited; 2005:1–14. 6. Noble R. Introduction to HIV types, groups and subtypes. http://www. avert. org/hiv-types. htm. Accessed June 24, 2009. 7. Azevedo-Pereira JM, Moniz-Pereira J, Santos-Costa Q. HIV-2 infection and chemokine receptor usage— clues to reduced virulence of HIV-2. Curr. HIV Res. 2005;3:3–16. 8. Klatt EC. Human Immunodeficiency Virus. Pathology of AIDS. University of Utah; 1999. 9. Ungvarske PJ, Flasderud HJ. Overview and Update of HIV/AIDS: A Guide to Primary Care and Management. Philadelphia: W. B. Saunders; 1999. 10. U. S. Department of Health and Human Services, National Institutes of Health, National Institute of Allergies and Infectious Diseases. Understanding the Immune System and How It Works. Bethesda, MD; 2007. Advanced Signs and Symptoms of HIV (Clinical Stage 3) HIV-infected patients with weakened immune systems can develop life-threatening infections. The development of cryptosporidiosis, pulmonary and lymph node tuberculosis, wasting, persistent fever (longer than one month), persistent candidasis, recurrent bacterial pneumonia, and other opportunistic infections is common. These patients may be wasting, or losing weight. Their viral load continues to increase, and the CD4+ count falls to less than 200-349 cells/? L in children older than 5 years. Clinical Stage 4 Patients with advanced HIV disease, or AIDS, can continue to develop new opportunistic infections, such as Pneumocystis jirovecii pneumonia (formerly Pneumocystis carinii pneumonia), cytomegalovirus infection, toxoplasmosis, Mycobacterium avium complex, cryptococcal meningitis, progressive multifocal leukoencephalopathy, Kaposi sarcoma and other infections that commonly occur with a severely depressed immune system. The viral load is very high, and the CD4+ count is less than 200 cells/? L in children older than 5 years. At this point in the disease course death can be imminent. 14

Marketing Project Essay Example

Marketing Project Essay Example Marketing Project Essay Marketing Project Essay Executive Summary Wentworth Industrial Cleaning Supplies is an organization whose potential is currently clouded by their lack of competitive strategy. Through analysis of their current situation, several key issues were identified: * Market Research is ineffective and unimplemented * Product line ignores majority of market * Roles of key personnel are illogical and inefficient * Relations with distributors are hostile and unsustainable * Profits and growth is stagnant in an advancing industry * Communication mechanism is fragmented After evaluation of the alternative courses WICS has for consideration, recommendations to address and rectify each issue were chosen. Through assigning specific tasks to the marketing department and enabling a communication mechanism along the personnel chain, objectives and opportunities can be shared. By making strategic role changes to the territorial and area managers, redundancies can be eliminated and the goal of developing and maintaining a unified network can be achieved. Through the addition of a big-tickets sales team and the outsourcing of economy chemical for use in private labels, WICS can gain a larger market share and sustain increased profits for years to come. In combination, these actions provide the basis for the development of a large-scale, well-branded organization with responsiveness to growth and opportunities in the market. Issues with Current Operations Market Research WICS lacks the marketing insight to target clients appropriately. As a solely premium brand, market research is crucial to customer perception and increasing the 40% share of customers willing to pay premium prices for WICS products. Moreover, new lines or line extensions are difficult to launch when there is no market research. In an evidently growing industry, the inability to provide an appealing value proposition to 60% of the customers has caused WICS to halt sales growth and struggle to keep its current market share. Furthermore, the justified frustrations of the area managers cannot be resolved until WICS is able to give them appropriate job descriptions and requirements contingent on the nature and changing behaviour the industry derived from market research. Product Line â€Å"Only 8 percent of customers describe their experience as superior, yet 80 prevent of companies believe the experience they provide is indeed superior† Roger J. Best Current Segments Opportunity for Growth Distributors claim â€Å"WICS products are basically no better than anyone else. This is a dangerous mentality when they are currently responsible for actively promoting and marketing WICS products. Their products, priced in the premium category, are reliant on promotion to build a strong perceived value. Furthermore, only 40% of consumers are willing to pay premium prices, leaving 60% of end users uninterested in WICS. This presents a unique marketing challenge for WICS- the need to expand to reach a greater s hare of the market while upholding their image as a premium manufacturer. Role Distribution For managers, a lack of job autonomy creates a feeling of resentment towards superiors and inhibits productivity. (Quote OB Book). Furthermore, the current incentive program stresses disproportionate selling techniques by placing heavy emphasis on hunting at the expense of neglecting farming attained accounts. This focus on hunting new accounts has resulted in acquiring unprofitable accounts that do not allocate a sufficient amount of their total purchases to WICS products. It is expensive and frustrating for distributors to maintain these clients, and they ultimately add little value to the corporation. Finally, the allocation of area manager duties (exhibit 6) results in low productivity by emphasizing ineffective selling techniques and needlessly excessive time spent on demonstrations Communication Discrepancies Internal communication is crucial for any functioning business competing in any industry. The marketing vice president de-motivates his staff members by projecting low confidence in their abilities and using threatening tactics to scare employees into scrambling to do their work for the sake of maintaining their jobs (OB BOOK). Moreover, SSDs feel neglected in the sense that they lack direct communication to management level WICS employees and/or the ability to relay their concerns/recommendations via area managers. Distributor Relations The perceived subjection to â€Å"pressure tactics† and the lack of belief in WICS products amongst distributors is an ongoing promotional issue that must be immediately addressed. As well, the combination of WICS current high minimum buy-ins and lack of communication between SSDs and management level WICS staff has yielded an environment retardant to growth for WICS products. WICS’ refusal to grow geographically with its respective SSDs is limiting both to SSD relations and company growth. Requiring SSDs to beta test WICS products is detrimental to both WICS brand image and once again, SSD relations. Because the products currently require timely demonstrations, high sales costs for SSDs have occurred. Recommendations Additional Duties for Territorial Managers The territory managers will be responsible for hunting new distributor clients that would work with WICS and assigning them to an area manager. The territory manager will allocate the new distributor to a manager in accordance with the ratio that we have in place: 1 Territory Manager: Area Managers – 4:1 Area Manager: SSD’s 2-4:1, based on size of SSD 1 Territory Managers: Area Manager – 4:1 4 2-4 Teea Manager – 4:1 Maintaining this ratio will allow territory managers to operate more effectively. Reallocation of Area Managers’ Duties Currently, the Area Managers’ roles and expectations are outdated and ineffective. Their duties need to be reallocated to give more autonomy to the Area Managers when hunting new clients. In this way, they can use their discretion when choosing which methods they prefer to use with their clients, based on their skills and what they feel is most effective. We propose they no longer push the demonstrations onto the SSDs, and instead offer sample Kits that the SSDs would give out to customers to sample the product before making their buying decision. Consequently, the Area Manager will cut this time in half and instead give information sessions for SSD staff about the DIY Sample Kits, negotiate lowering margins, and implement new products. Another 20% of the Area Managers’ time will be spent on the relationship with the SSD’s. Creating and Motivating Personnel Network WICS’ distributor network will be more interactive, fostering communication amongst all three key players- SSD’s, Territorial and Area managers. The Area managers will visit distributors on a weekly basis to receive feedback, address concerns, and discuss routine business logistics. In addition, distributors will receive a bi-monthly visit from their allocated territory manager, who will ensure that any feedback on the effectiveness of the area manager is heard and acted upon. Similarly, there will be weekly communication between territory managers and area managers. This will allow any corporate objectives to be reached, and to share ideas on tactics for reaching sales goal. The evaluation of the SSD’s roles will be done by area managers, with autonomy to create and execute incentive programs within a given budget. Although area managers will have the ability to identify the measurement tactics and rewards for managers, the general incentive drivers will be determined based on sales goals by the marketing department and manager. This will allow the company to emphasize sales of particular products, balance goals for growth with those of customer maintenance, and deliver a customizable incentive program to distributors that will ensure a strong partnership. For Area Managers, incentive programs will be designed and measured by Territorial managers. In a similar fashion to the distributor incentive structure, this method will allow WICS to balance their need for resonant, customized rewards with their efforts to align progress with corporate objectives. Drivers for measuring area manager success may include looking at feedback from SSD’s to evaluate communication and negotiation skills, looking at results in efforts to attract new customers, and evaluating their ability to foster an effective and profitable network through working with their subordinates and superiors on the WICS personnel chain. As area managers are a key link between WICS management and their front-line sales force, it will be essential to harness the competitive nature of the individuals working as area managers through recognition and reward. As a result, winners of incentives and titles will be well-publicized with the corporation, and the objectives by which measurement and designation of winners are achieved will be constantly re-evaluated to ensure that it is meaningful. Providing Raw Materials for Private Labels Only 40% of end users are willing to pay premium prices leaving the majority of customers within the janitorial cleaning supplies industry unaddressed by WICS. In order to maintain active growth, WICS needs to address the unserved 60% of the market. There are two typical ways to approach this problem ) create economy product lines 2) create a flanker brand The first solution not only poses the problem of diluting WICS premium brand image, but also presents the problem of cannibalization. The second approach, although separating WICS from the name of its economy brand, still faces strong opposition as SSDs will be hesitant to hold products that are directly competitive with their private labels. A more innovat ive and successful approach is to being providing SSDs with competitive incentives to sign over their private label outsourcing to WICS. In doing so, WICS will promise to match or provide SSDs a lower price for the raw core materials required to create their private labels. WICS will not pursue/take over any private label outsourcing activities if the prospects prove to be unprofitable, however it will strive to reap economies of scale in the production their raw chemicals, and to strengthen their vested interest in the market segments by sharing in the growth and profitability of the economy lines of the distributors. Hunting and Farming Tactics for Market Share Development WICS will be most successful in its business development efforts if it targets customers using the most successful tactics. For new, high-end customers willing to pay premium prices, tactics such as spotters, use of personal network, research and cold-calling can be used. This will allow WICS to identify potential large-contract clients and either reach out to them via connections or cold-call and pitch their value proposition. Examples of events in which WICS can capitalize on the need for industrial cleaning products include: * Sporting Events- 1992-1996 is the most concentrated time in history for the Olympic games- with two games in 1992, and two more in 1994 and 1996, WICS has the opportunity to capture huge contracts and expand into other sporting event clients * Airlines- in 1992 alone, 86 new airlines were launched. WICS should aim to approach start-up companies in travel and high-growth tech segments for potential contracts * Malls- with Mall of America opening in 1992, WICS should capitalize on the opportunity to develop a sales pitch aligned specifically with the needs of retail malls. Through the sale of chemicals to distributors private labels, Wentworth now holds a vested interest in 100% of the industry. As a result, they have the opportunity to pair with SSDs to farm current customers and pitch a full-package contract in which the SSD private line and WICS products cover all the needs of the client. Special Sales Force Big Ticket Clients With the aforementioned large-scale contract opportunities, WICS needs to devote highly effective salespeople specifically to the attainment of big-ticket sales. The strategy behind acquiring such â€Å"big-ticket† clients involves partnership with market leaders from the other three segments in the institutional maintenance chemical market (EXHIBIT 1). Through partnership, it becomes possible to offer such big clients with massive cleaning requirements in every segment with relatively cheap product bundles. Product bundles are able to be priced as low as necessary to entice clients to pursue them exclusively because of economies of scale. Market research would determine viable market leaders that suit WICS brand image to be pursued by WICS Special Sales Force. The Special Sales Force would initially comprise of two management- level staff members (SEE NEW ORG. CHART) who strictly work towards pursuing the logistics of â€Å"big-ticket† clients. This number can expand as WICS grows contracts and profitability in new sales segments. Further advantages of creating product bundles with the other three respective segments in the institutional maintenance chemical market is utilizing partners as spotters. Spotter perks involves exchanging market research, customer information, and referring prospective customers. Furthermore, some big tickets clients may present unprecedented marketing opportunities for WICS. For example, if the product bundles are successful in attaining most of the purchasing of one or both of the Olympic games, WICS could always offer further discounts in exchange for soft advertising such product placement. Implementation of Strategic Recommendations: * Within the next 6 months: The measures taken during the next six months are going to lay the groundwork for WICS to become more efficient, reduce costs, forge better relations with SSDs and staff, and increase market share. Firstly, area and territory managers need to be retrained into their new roles with in the company. This training needs to be carefully implemented, and WICS needs to ensure that the staff are happy with the changes and behind the revamped corporate strategy. Once staff understand their new roles, the infrastructure and products must be ready. The chemical products need to be available for sale as soon as possible for the area managers to start sales. Area managers need to get to work on private label sales as quickly as they can in order to begin penetrating the market. As well, the do-it-yourself kits need to be made and sent out to distributors so that customers can begin testing WICS products without the distributors and area managers having to worry about the timely demonstrations. With the new roles in place, the feedback mechanism will immediately begin so that the distributors begin to feel the shift in customer focus that WICS will be adopting. With the increased support from all WICS staff, and the lower cost of sale, this will motivate the distributors to push WICS products more, without the pressure from area managers, and will grow market share and sales for WICS. * Long term goals: As adoption rates of WICS raw chemicals increase, the company should work towards an objective of serving products in 100% of the industrial cleaning market’s segments. This will be achieved by a combination of increased sales in the WICS line, representing 75% of the market, and the addition of private label products which serve the remaining 25%. This goal should be attained within the next three years, and the mechanism for its realization is the ability of area managers to negotiate and finalize outsourcing contracts with their distributors.