Evidence Based Healthcare Research Social Work Essay

Evidence Based Healthcare Research Social Work Essay Evidenced Based Healthcare and Research: Appraisal. In the United Kingdom the concept of Independent Living and Self-directed Support has become an established approach for the delivery of health and social care services, that it is currently the preferred residential alternative for people with learning disabilities (Binnie Titchen 1999). Independent living can be defined as enabling independence by receiving the right support how and when it is required (Morris 2004). It has now become a key principle in various government policy documents such as the Valuing People Now Strategy (UK Department of Health, 2009) and the Personalisation through Person-Centred Planning initiative (UK Department of Health, 2010). This assignment aims to present a detailed critique of a qualitative study entitled How adults with learning disabilities view independent living (Bond Hurst 2010). A critique can defined as a balanced evaluation of the strengths and limitations of a research article, in order to determine its credibility and/or applicability to practice (Gamgee 2006). This study is a welcome contribution to the current health and social care research domain because whilst independent living is the preferred residential option, it is not at all clear whether it is suitable for all people with learning disabilities, moreover if there is in fact sufficient empirical evidence to support this notion. It is therefore imperative to establish a sound evidence base that draws upon the lived personal experiences of those with learning disabilities. Using an acknowledged framework A Step by Step guide to critiquing a quantitative study (Coughan et al., 2007) the relative worth of the evidence in support of i ndependent living will be judged systematically. As well as exploring the significance of independent living as an essential nursing intervention and its application to modern clinical practice. Ryan-Wenger (2003) suggests that in analysing published articles it is important to ascertain two fundamental aspects of a critique which can be subdivided into elements that influence the robustness of the research methodology also known as integrity variables and elements which influence the believability of the research such as writing style, author(s), report title and abstract otherwise known as credibility variables. The latter seems to be the most logical place to commence. Evaluation of the Journal Article Polit and Beck (2006) state that writing style should be such that it attracts the reader to read on; this paper is well written, comprehensive and concise. The structure and layout of the paper is well organised with a logical consistency and free from jargon in comparison to some papers where the author(s) can be opaque in their approach. However slight reservation is reserved concerning the level of proof reading as there seems to be some grammatical and typographical errors which can be found on pages 288 and 289. Both authors appear to have a sound background in learning disability from both a social context and educational settings. As indicated in the acknowledgements the authors qualifications indicate that they have a degree of knowledge in this field and this piece of research seems to be a part of a taught component of their masters programme. The report tile seems to be descriptive and succinct, although it lacks specificity of the research methodology used in the study. This can be very useful for others who are searching for this type of paper. Although the term qualitative research is mentioned under keywords the title itself could be more specific. As a result the report title is ambiguous and merely eight words in length. Meehan (1999) states that a title should be between ten to fifteen words long in order to clearly identify the purpose of the study for the reader. This paper presents both an accessible and detailed version of the abstract, but are both helpful? The accessible form includes information on the subject and the number of participants, whereas the detailed form provides an outline of the methodology used, ethical framework, findings and recommendations. On balance the summaries present a clear overview of the study, however it does beg the question in what sense is the accessible form accessible? and to whom? It seems that the authors are trying to be politically correct rather than logical because how many service users actually read the British Journal of Learning Disabilities?. It seems that this is a knee jerk reaction which has been applied incorrectly; it would be more suitable if the document was aimed at informing an audience with learning disabilities such as Valuing People (UK Department of Health, 2001) which caters to a wide range of readers. The easy -read version is aimed at service users whilst the denser version is aimed at professionals and service providers. Having identified and analysed variables that affect the credibility of the research presented, how believable the work appears, the authors qualifications and their ability to undertake and accurately present the study. The robustness of the research methodology and the integrity of the findings will be appraised in order to determine the trustworthiness of the study and its applicability to nursing practice. The authors state the aim of the study is to explore the views of nine people with learning disabilities who have already achieved independence and wish to contribute to the debate of independent living. The authors suggest that this style of living is now viewed as desirable, but what is the reality for people who live with learning disabilities? This concept of desirability is held as problematic by the authors who choose to study and present the reality of living independently as opposed to the notion of general and conventional wisdom. A study conducted by Barlow Kirby (1991) concluded that people in receipt of self-directed support had more life satisfaction than those in residential care. This finding is further supported by the publication of Independent Living (HM Office for Disability Issues, 2007). The decision to suspend judgement about independent living is justifiable and is supported by other researchers in the field of learning disabilities; as there are several impli cations for service users, professionals and service providers. This is for a number of reasons for instance promoting choice and control (OBrien, 2002), health issues (Priest Gibbs, 2004), vulnerability (Cooper, 2002) and the ability for those with learning disabilities to access services (Jansen et al., 2006). The literature review conducted by the authors demonstrates an appropriate depth and breadth of reading around independent living. The majority of studies included are of recent origin being less than five years old; the few historical studies included put the concept of living independently into context. The authors successfully identified conflicts between the literature by comparing and contrasting findings (Burns and Grove., 1997), because although evidence exists to show people who have moved from larger institutions prefer smaller group homes (Forrester-Jones et al., 2002) there is still no accurate data detailing the number of people with learning disabilities living independently (Beadle Brown et al., 2004). However the authors failed to mention how they conducted their search and information on the databases used to gather papers in their review. The authors did however, use primary sources of information as opposed to secondary sources and anecdotal information, which attes ts to the integrity and value of the study presented. Bond Hurst (2010) ascertained the narratives of nine people with learning disabilities via the use of semi-constructed interviews within their methodology. The authors are to be commended for their attention to detail in terms of their ability to design and structure interviews so as to accommodate the needs of the participants. As well as conducting interviews at times and venues convenient to them. The interview structure included open-ended questions to assist understanding as communication emerged to be a key barrier for some people with learning disabilities. The authors report on a number of theoretical issues that have been adapted for the participants in order that they might fully participate in the research process. The structure of the interviews was devised using the Canadian Model of Occupational Performance (Canadian Association of Occupational Therapists, 1997), but is this model applicable to the United Kingdom population and to which care setting? Bond Hurst (2010) adopted thematic analysis within their methodology in assessing the narratives. The data collected was audio taped and later transcribed into coded themes, which is acknowledged in general research literature to be good practice. On balance, the authors adhered to the steps in the research process and it is conveyed between the fluidity of phases. The critique subsequently moves onto considering the ethical framework. This research paper was supported by the local ethics committee and all participants in the study gave informed consent. Although it is not clear whether or not it was an National Health Service (NHS) ethics committee. However, the authors sought to ensure their working methods complied with the Data Protection Act (1998) but not with all government legislation applicable to the study such as the Mental Health Act (1983). Although there is mention about accessibility, the authors failed to ensure the participants had the capacity to make informed decisions as defined in the Mental Health Act (1983). In relation to the number of participants, the sample size is small and therefore may not be reflective or wholly representative for all people with learning difficulties. Small samples are more likely to be at risk of being overly representative of small subgroups within a target population (Coughan et al., 2007). Th erefore slight reservation is held as the authors did not mention whether they sought to remove overall bias by generating a sample that is likely to be representative and generalisable to the target population. Parahoo (2006) states that for a sample to truly reflect of the population it represents the authors must generate a probability sample. The participants in this study were recruited via convenience sampling using a third party (Melton 1998); however several variables could have an affect on the sample which can lead to it being distorted such as the vast age range. The authors are to be commended however, in their efforts to maintain the confidentiality of their participants by offering them the choice to provide their own pseudonyms. In the discussion the authors identified seven themes from their data analysis which reflected the views of all the participants and in turn addressed the aims of the study. Their findings supported the four key principles as stated in the Valuing People policy document, and ways in which people can be supported to achieve this includes increasing social inclusion, increasing autonomy and choice for people and raising awareness of the vulnerability of those with learning disabilities. However the study also highlighted that the majority of participants struggled with the more complex aspect of living independently, such as money management and budgeting. The government has recently introduced Direct Payments as part of a nationwide transformation in social care services, which involves paying money directly to an individual in need to take control of their own support and care services. This initiative will aid finance management as it enables service users to have control over the c are they receive and how they receive it. The majority of participants maintained that when comparing their current lifestyle of independent living to that of their previous lifestyle it was clear that they wanted to remain living independently. Application to Clinical Practice This section will explore the significance of independent living as an essential nursing intervention and its application to modern clinical practice. Gates Atherton (2001) state that there is a need for evidence of effectiveness in health and social care. The most important aspect of being a practitioner regardless of ones vocation, is that collectively we as professionals seek the best evidence available on which to base our practice (Coughan et al., 2007). The evidence in support of independent living is limited and not entirely accurate, therefore when evidence is presented it should not be taken on face value. As Cullum Droogan (1999) put it not all research is of the same quality or high standard therefore as a learning disability nurse and social worker it is important being a care provider that although a paper has been published it can be critically appraised. This paper is of central relevance to our practice in ensuring that the lifestyles of people with learning disabil ities are informed by valid and reliable evidence. This research paper adds value to the current literature available in support of independent living however caution must be expressed as it is not solely about living independently. The concept of independently living cannot be advocated for everyone; each person is different and therefore require different levels of support which will meet their needs. The publication of Valuing People (UK Department of Health, 2001) the key document that prompted a change in the way health and social care services operate. The paper made Person-Centred Planning a central component of service reform, and outlined four key principles namely: Human Rights, Independence, Choice and Social Inclusion (Mansell and Beadle-Brown, 2004). This means that people with learning disabilities should be valued members of society, treated with dignity and respect whilst having the same rights and choices as everybody else (OBrien, 2002). Furthermore, people with le arning disabilities should feel empowered to take control over the care that they receive in order to plan and live their lives independently. Previously, people with learning disabilities were shunned away from the community and susceptible to abuse. The Community Care Act (1990) was introduced as a result of both political and social changes in attitudes towards the treatment of people with mental illnesses. In line with Mental Health Act (1983) the aim was to remove the stigma associated with mentally ill people away from isolation towards social inclusion (Social Role Valorisation, Wolfensberger, 1983). But does independently living mean that you get social inclusion? Currently we are seeing a culture of people who require support being effectively excluded from society, waiting for the next support worker to cook their meals, help with personal hygiene and general cleaning. This is a downward spiral in our society which is putting a demand on our system. As a care provider in line with the General Social Care Council and the Nursing and Midwifery Codes of Conduct (2008), it is our duty to advocate in the best interest of the client at all times but who is actually making the decisions? Bond Hurst (2010) highlighted how closely health was linked to independent living and that many of the participants suffered from chronic conditions such as asthma, diabetes and arthritis. Is it a case of compromising funding for services at the expense of overlooking health issues? It seems that the authors make a plausible case that people with learning disabilities are being seen as not a priority as they carry a disproportionate burden of health inequalities among our population. The reality for people with learning disabilities is far from the projected lifestyle of independence (Emerson UK Literature). It is a challenge to support people with learning disabilities, several factors need to be considered to prevent potential disregard. Jansen et al., (2006) points out the need to adopt integrated care approaches in treating those with learning disabilities. This will involve working with different agencies (interagency team working) and different types of professionals (multidis ciplinary team working) in order to provide an holistic service to meet their needs. Current research shows that a disabled person is likely to be in contact with at least ten different care professionals in their lifetime (UK Department of Education, 2003). Issues can arise through out this time which may lead to lack of continuity and communication. Therefore, a sufficient amount of training and awareness is needed to ensure that all staff are qualified and skilled to ensure equity of service provision. When caring for patients it is essential as a practitioner to adopt the current best practice. To determine what this is one must be able to critically appraise evidence that is presented to them (Basset and Basset., 2003). This paper focused on the lived experiences of nine people with learning disabilities about the reality of living independently. In critiquing this paper, the authors successfully highlighted the importance of independent living as an essential nursing intervention however there were also some limitations, the most important being limited verification of the data. Furthermore the narratives of the participants were highly subjective and findings non-generalisable, thus the notion of independent living is not to be applied to all that have a learning disability, or vulnerable adults with complex needs. As recommended by the authors, further accurate, reliable and valid research is needed that will add value to the evidence-base domain. Total Word Count: 2,452 Excluding Headings and References

Socio-economic Factors and Postnatal Depression Relationship

Socio-economic Factors and Postnatal Depression Relationship (a) Objectives of the project and any related information The aim of his project is to study the relationship of socio-economic factors with postnatal depression in Spanish mothers. This will be done both at individual and area–based level. The main hypothesis of the research is that unemployed mothers, with low education and low income have higher risk of developing postpartum depression. Besides a geographical comparison among four different areas within the Spanish cities of Barcelona, Bilbao, Madrid and Seville will be done. An area-based deprivation index will be used for testing the complementary second hypothesis of the study which is that the communities more deprived have higher prevalence of postpartum depression than the less deprived ones. (b) Work which has led up to the project Postpartum depression is one the most common disorders suffered from mothers within the first 12 months after childbirth. Several studies places its average prevalence around 10-15% (24) and needs to be considered as a public health problem that can affect, besides to the mother and to her environment, to the emotional development and well-being of the children. Postpartum depressions also needs to be differenced from the baby-blues and the puerperal psychosis, a more severe type of depression. The baby blues is mainly caused for the hormonal alterations and, although might have the same impact on the mood as a depression, the symptoms normally disappear within two weeks after giving birth without any treatment. The puerperal psychosis affects on average to a 0.1 – 0.2 % (24) of mothers and hospitalisation is usually required. The postpartum depression and can last several weeks or months and, if not treated, can lead to a chronic recurrent depression. The most common symptoms of the postpartum depression are sadness, emptiness, exhaustion, low energy, feeling incapable of taking care of the baby, guiltiness. The signs are similar to any other depression disorder, but with a special focus on the life changes and relationship with the new born. Regarding the causes of the there are many research that have studied the predictors or risk factors for developing a postpartum depression, and based on two existing literature reviews on the topic (22) (24) the main predictors of postpartum depression could be categorised as follows: Physical and biological factors: poor physical health, negative body image and bodyweight. Psychological factors: antenatal depression, previous psychiatric illness and childcare stress. Social factors: low education level, low income, unemployment and social support. This study will focus on the social factors and within them, the ones related to the socioeconomic status: education level, income and employment. They can lead to unequal rates in postpartum depression that, as socially determined, could be avoidable. In the past the relationship of socioeconomic status and depression has been underlined in many studies worldwide (10) (18) (22) but in the particular case of Spain no research that take into account these factors and their impact in postnatal depression prevalence have been found. Spain is one of the European countries that is suffering the most consequences of the global recession that begun in 2007. The economic crisis is having dramatic impact in the labour market, public sector and therefore in population lives. The socioeconomic status is related with higher psychiatric morbidity, but in an economic crisis context, because of the additional uncertainty about the future, the mental health of the population tends to get worse. There are already studies taking place in Spain that are founding increases in mental health problems since 2007, especially in families that are experiencing unemployment (17). The current unemployment rate in Spain is 23.2% raising until 24.3% in case of women versus 22.2% in men and up to 50.7% in population younger than 25 years old (14). But these rates are not equally geographically distributed. There are Spanish regions that because of their past productive framework are suffering bigger economic struggles. As said above no studies that relate postnatal depression and socioeconomic factors in Spain are known, that is why this research will test the association between socioeconomic status and postnatal depression at the individual level and then will compare with Spanish areas with unequal deprivation indexes. On top of this there are studies that encourage to use both the area deprivation index and individual socioeconomic status, as these two measures make independent contributions to the health outcome (28). Although the results of this study will not be able to be compared with past records on postpartum depression this could be a starting point for further studies of the impact of the crisis on the mothers’ mental health and about its geographical disparities. (c) Study design and methods to be used in investigating this problem and potential limitations Design A longitudinal cohort study will be conducted for this research. Because of the nature of the outcome this is the most appropriate type. The onset of the postpartum depression is within 12 months after birth, and the longer periods of evaluation will predict higher prevalence (24). A single point of collection of data would minimise therefore the results. Study population and sample Pregnant women that are 18 years old or older and who are registered in the Spanish maternity services and live in Barcelona, Bilbao, Madrid or Seville will be invited to participate in the study The exclusion criteria will be individuals with psychiatric illness in the previous year. The sample size was calculated based on equivalent measures found in existing literature regarding the socioeconomic individual exposures (income, employment status and education) (LITERATURE) and in an area-based deprivation index and their association either with postnatal depression or similar outcomes. The desired power of the sample (90%), the potential non-responders and the loss over the course of the follow up was also considered in the calculations. The area-based deprivation index that will be used in this study was created in 2001 in Spain (8) in order to identify the socioeconomic conditions of the measured areas. The information needed for feeding the index is available in the National Census Institute (INE) and could be updated with the data of 2014. This index allows to identify the more disadvantaged areas within a city. Although it was associated in its origin with rates of mortality, it was created with the aim of studying wider range of social inequalities in health in Spain. This area-based deprivation index is created from the following socioeconomic indicators: manual workers, unemployment, temporary workers, total low education, and youth low education. The geographical units for the composition of the index are the census tracts of the cities of Barcelona, Bilbao, Madrid and Seville. (2.358 in Madrid, 1.491 in Barcelona, 510 in Seville y 288 in Bilbao). The index will be divided in 4 quartiles from the more deprived to less deprived measure. In each city one census tract for each quartile will be selected. The sample will be selected through multi-stage cluster sampling. The census tract will be the primary sample unit. Then sample of individuals will be selected from a primary care centres where pregnant women living in each one of the tract are registered. Four primary centres in each city will be selected. SAMPLE SIZE   THE POPULATION BETTER DEFINED Data collection Spain has a universal health system, everyone has the right and free access to it. When a women becomes pregnant it is registered and monitored by her assigned general practitioner, gynaecologist and paediatric medical doctors, during and after her pregnancy, in the primary care centre of her neighbourhood. Every pregnant women in the centres selected will be invited to participate in the study, with the exclusion criteria of women who had any psychiatric disorder in the previous year. They will be informed about the study in their first visit to their GP and appointments for filling in the questionnaires during their next visit and during pregnancy will be planned. 3 questionnaires will be used during the 4 interviews scheduled. During pregnancy: Baseline questionnaire with socio-demographic questions, employment status and type, income, education, marital status, number of children and address of residence. Three months after delivery: Social support questionnaire and the Edinburgh Postnatal Depression Scale questionnaire Six months and twelve months after delivery: Edinburgh Postnatal Depression Scale questionnaire All the questionnaire will be self-reported. The Edinburgh Postnatal Depression Scale is a 10 items questionnaire used to screen postpartum depression. The validated Spanish version will be used (9) The social support questionnaire is the Spanish abbreviated version (6 items versus 19) of the MOS Social Support Survey (23). Statistical analysis The main outcome of the study is postpartum depression defined as a categorical variables derived from the results of the Edinburgh Postnatal Depression Scale. The cut-off point of the validated Spanish version for a positive outcome is 11. Cases will be considered when women report positive outcome the 3 times of follow-up against women who reported zero, once or twice (non cases). Main exposures are level of income, education, and employment status (socioeconomic status measures), and area-based deprivation. Other covariates selected for the baseline and social support questionnaires will be included as possible confounders or effect modifiers. The sample characteristics will be describe through univariate and bivariate statistics. Multivariable logistic regression will be used for testing the association between main exposures and outcomes adjusted for the others covariates. Initially each main exposure will be modelled individually with the outcome, only age-adjusted. Secondly each exposure it will be adjusted by other covariates, then by covariates and other socioeconomic status exposures and the area-based deprivation. Finally the model will be fully adjusted with all exposures and covariates together. The statistical software STATA will be used. Other Potential limitations As in all the longitudinal studies there is the risk of loss during the follow–up. This is already considered in the calculation of the sample size. The self-reported questionnaires could lead to the common limitations of these types of tools: response bias, the restrictive nature of the scale-based questionnaires, understanding, lack of introspective ability etc. The social support questionnaire is a reduced version because this study wants to focus in the socioeconomic risk factors of postpartum depression. It was included because social support is considered also an important predictor of postpartum depression. More extensive version could be included in future studies. Also, further analysis that include structured interviews to measure the outcome could be performed. However the positive results of this questionnaires for finding significant associations it is validated by multiple previous studies (CITATION). Study organisation The principal applicant is the main coordinator of the study, has extensive experience in social epidemiology and is specialised in socioeconomic determinants on health. It is also a lecturer in statistic in for medical science and will be responsible of the data analysis. The co-applicant is a UCL member of the social epidemiology department and a visiting lecturer of the Basque Public University (UPV) in Spain. It will be responsible of the coordination and communication with the Spanish team. The local co-applicant was a member of the research group who developed the area-based deprivation index used on this study and a professor on social epidemiology in the UPV. It will coordinate the Spanish team who will conduct the field work. The research assistants will conduct the field work and the logistics and communications with the primary care centres. One research assistant will be recruited in each city. (d) Timetable using Gantt chart or similar diagram (e) Ethical issues All participants will be informed and will need to sign a written consent prior to any analysis of the data. All the data will be anonymous and treated confidentially following the current Spanish and UK laws of Protection of Data. Ethical approval will be submitted to the UCL and the UPV. I am still a bit confused with sample calculation: For example in the paper below, that is measuring social support and PPD as a binary outcome.Which effect should I focused in? If I calculate the sample size from it, would I alsoneed to use in my study the same questionnaire they are using in this paper and same follow up time? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390689/ ANNE here is the useful info that I found in the paper (copied and pasted direct from paper) à ¢Ã¢â€š ¬Ã¢â‚¬ ¹Incidence of depression was calculated in women who were not depressed at baseline based on proportions of new cases at follow-up in that sample. 55 of the 386 without antenatal depression had depression at follow-up, indicating case incidence of 13.9%. table 1 unadjusted association between education/income and incidence of depression (ie new events). So suggests OR=0.49 (low versus high ie high > low OR=2) and even steeper for income But these are unadjusted so after adjusted the measure of effect would probably be attenuated ie smaller. If there is no better data, then you could use this, for examplelow educ vs high educsampsi0.174 0.093, p(0.9) but see if you would have power to look at low > middle education etc. For income as above using numbers from table 1 And for the sample calculation of area based deprivation and PPD, I could use papers of association between income inequality and PPD? OR What about this one? http://www.ncbi.nlm.nih.gov/pubmed/24392759 The undjusted results are: low-SES community 26.2% (104/397) had depression, compared with 14.8% (24/162) high-SES community If I do calculation in STATA sampsi 0.26 0.14, p(0.8) My sample size would be for each group N1= 190 N2= 190 But when I use my are based deprivation index I might use different percentiles to categorise lower and higher deprived areas (four at least) What would be the sample size in this case for each percentile? ANNE if you use quartiles for deprivation, then you would need to consider not just low > high, but as for education low > middle, then middle > high, and high > higher. If incidence is 26% in highest deprivation and14% in lowest, then if you think the association is linear, then you can estimate inicidence in intermediate groups e.g. 26, 22, 18, 14%. So you need to choose the sample size for these e.g. sampsi 0.26 0.22, p(0.9) etc. After all these sample size calculations, choose the largest. Then in your proposal just report that you based sample size on the sample size per group needed to find the smallest difference between SE groups. remember if your sample size calculation says 3200 per group, and you have 4 groups, then your sample size with be 32004. You will also need to include extra in the sample because there will be non-responders eg 40%. Also maybe 20% loss over the course of your follow up. For example, if number per group is 3200, and 4 groups possible, and 60% response and 20% loss during follow-up,then you will need (3200 x 4) / (0.6 x 0.2). You also asked if you need to use the same measures as the paper uses if you use if for sample size calculation. As long as you state thatyour measures are comparableit is okay. Q10 REFERENCES

Les Miserables :: essays papers

Les Miserables "Les Miserables" is about a man, Jean Valjean, who has just been released from the galleys after 19 years of imprisonment. He is in search of food and shelter, but all the taverns and inns in D----- have rejected him, because he is a former convict. He then meets a woman in front of the church who tells him to go to the house where the bishop lives. Although the bishop knows Valjean is a convict, he takes him in, and gives him food and shelter. However, Valjean is still tempted to steal from the bishop. He takes his silverware, and flees. Valjean is caught by the police, and forced to return to the bishop's house. The bishop gives Valjean a second chance, by telling the police that the silverware was a gift, and giving him the silver candlesticks in addition. Valjean is instructed to start a new life as an honest man. In M---- sur M----, Valjean invents a new manufacturing process, and earns a great fortune. He has his own factory, and has been elected Mayor Madeline, a new name, to begin a new life. In his factory, works a woman, Fantine, who has given up her child so that she could work to begin a new life, as well. Her daughter, Cosette, was left with the Thenardiers. She was treated terribly, and was forced to eat under the table, with the dog. Meanwhile, Javert, an officer in the galleys where Valjean served, denounces Valjean, because he claims he recognizes him as a former convict. However, he later changes his point of view, claiming that he has found the real Valjean, who is being charged with stealing a branch off an apple tree. Valjean could not live knowing that someone else may be charged more harshly because of the crimes he had committed in the past. Valjean announced his true identity to save the man. He returned to his factory to collect all his money, and then to escape from the police. Javert eventually caught Valjean. At this time, Fantine, who was deathly sick, thought that Valjean had brought Cosette to her. When Javert arrested Valjean, Fantine died. Valjean was sent to the galleys again, but escaped, by faking his death.

Biblical References in The Matrix :: Film, Movie, Matrix

While many may appreciate The Matrix for it’s over-the- top fight scenes, there is much to be gained from the film’s biblical references that gives us a deeper and richer understanding of the film. The Matrix series is much more than an action-packed sci-fi thriller. After one view of this film for the second and third time, we start to notice a great deal of symbolism. This symbolism starts to paint a completely different picture than the images of humans battling machines. It is a religious story, with symbols deeply set in the Christian faith. The Matrix contains religious symbolism through its four main characters, Morpheus, Neo, Trinity and Cypher. In that each character personifies the â€Å"Father,† the â€Å"Son,† â€Å"Satan,† and the â€Å"Holy Spirit† of the Christian beliefs only shown through the amazing performances of the actors. A critic by the name of Shawn Levy said "The Matrix slams you back in your chair, pops open your eyes and leaves your jaw hanging slack in amazement."(metacritic.com) The protagonist Thomas Anderson in the series is one of billions of humans connected to the Matrix, he is a quiet programmer for the "respectable software company" Metacortex. Thomas Anderson is the character in the movie whose later alias becomes â€Å"Neo†. Which an anagram for â€Å"the one† a name that is most profound parallel to the Bible. Coincidence I think not. Neo is the Christ-figure in The Matrix who is sent to liberate men from their fallen and enslaved state Zion that is the last human city on earth, paralleling the Zion of the Bible. Morpheus and other believers herald him as the â€Å"One.† Neo or Christ sets humans free from the matrix or sin as agent Smith who in terms is Satan. Neo has a resurrection scene at the end of the first installment of The Matrix. In this scene Smith kills him, and his coming back to life serves as a testament to his power, and sets the stage for Neo’s final sacrifice at the end of the third movie. It is the scene at the end of the trilogy when Neo makes his Christ-like death. After this sacrifice, Neo is lifted into the sky, the same way one might describe Christ’s resurrection. Neo's performance was so good that famous hollywood director Quienten

Nietzsche and the Prophet Essay -- Philosophy Philosophical Essays

Nietzsche and the Prophet According to Friedrich Nietzsche’s Thus Spoke Zarathustra, the meaning of human existence is to make room for the â€Å"Superman†: a superhuman who perseveres in its capacity for unlimited self-creation. (Pg. 49)[1] In order for humankind to embrace its self-creative nature and allow for the transcendence into this superhuman condition, however, we must first learn to destroy our present tables of values; it is our desperate adherence to traditional (religious) values which prevents us from actualizing our potential for self-creation. It is important to note, however, that it is not the creation of these traditional values in and of itself that Nietzsche condemns. After all, self-creation is not only a positive thing but, is the true essence and meaning of human existence. Rather, it is our insistence on treating these values and beliefs (e.g. the existence of God) as permanent and a priori which sickens him. When we perceive these values and beliefs as permanent , it numbs both the ability and motivation for human beings to self-create the future or, what he calls, the â€Å"self-creating will†. As Nietzsche’s protagonist states, â€Å"God is a supposition; but I want your supposing to reach no further than your creating will...Willing liberates: that is the true doctrine of will and freedom... (Pg.’s 110-11) Manifest in Nietzsche’s vision of human self-creation, however, is a fundamental tension between the past and the future. On the one hand, he tells the reader that because everything is past and begs destruction, it is disgusting for anyone to blindly adhere to traditional value systems. Yet, on the other hand, the future (Superman) is fundamentally connected and, perhaps, even indebted to th... ...Nietzsche, Friedrich. 1961. Thus Spoke Zarathustra. Translated by R. J. Hollingdale. Penguin Books: London. [2]. Later on in the text, we see that this entails Zarathustra rising up and becoming the teacher of the eternal recurrence: that all things, including human existence, recur eternally. As his animals tell Zarathustra, â€Å"For your animals well know, O Zarathustra, who you are and must become: behold, you are the teacher of the eternal recurrence, that is now your destiny! That you have to be the first to teach this doctrine...that all things recur eternally and we ourselves with them, and that we have already existed an infinite number of times before and all things with us†. (The Convalescent; Pg. 237; italics original) Upon hearing the prophet’s words, however, we see that Zarathustra is not ready to become the teacher of the eternal recurrence.

Developing Marketing Strategies and Plans MCQS Essay

1. A key ingredient of the marketing management process is insightful, ________ marketing strategies and plans that can guide marketing activities. a. creative b. measurable c. macro d. micro e. niche Answer: a 2. According to a chapter story about H&M clothing stores, H&M is able to put products out quickly and inexpensively by all of the following EXCEPT ________. a. having few middlemen and owning no factories b. buying large volumes c. having extensive experience in the clothing industry d. having a great knowledge of which goods should be bought from which markets e. having total control of its distribution channel from the time the goods are produced until the time they are sold Answer: e 3. The task of any business is to deliver ________ at a profit. a. customer needs b. products c. customer value d. products and services e. improved quality Answer: c 4. In a hyper competitive economy such as ours, a company can win only by fine-tuning the value delivery process and choosing, providing, and ________ superior value. a. communicating b. selecting target markets with c. composing d. developing e. researching Answer: a 5. The traditional view of marketing is that the firm makes something and then ________ it. a. markets b. sells c. distributes d. prices e. services Answer: b 6. Today, the â€Å"mass-market† is actually splintering into numerous ________, each with its own wants, perceptions, preferences, and buying criteria. a. micro markets b. market targets c. macro markets d. customer cliques e. demographic units Answer: a 7. The first phase of the value creation and delivery sequence is ________ that represents the â€Å"homework† marketing must do before any product exists. a. choosing the value b. market research c. target marketing d. service consideration e. projective thinking Answer: a 8. The last step in the value creation and delivery sequence is ________ the value where the sales force, sales promotion, advertising, and other communication tools announce and promote the product. a. developing b. distributing c. communicating d. reversing e. researching Answer: c 9. The Japanese have refined the value delivery process to include a component that emphasizes ________. a. zero servicing b. zero customer feedback time c. zero promotion d. zero dependency on intermediaries e. zero marketing costs Answer: b 10. The ________ is a tool for identifying ways to create more customer value. a. value chain b. customer survey c. brand loyalty index d. promotion channel e. supplier database Answer: a 11. The ________ identifies nine strategically relevant activities that create value and cost in a specific business. a. value proposition b. value chain c. mission statement d. annual report e. manager’s log Answer: b 12. The ________ in the value chain cover the sequence of bringing materials into the business (inbound logistics), converting them into final products (operations), shipping out final products (outbound logistics), marketing them (marketing and sales), and servicing them (service). a. operations process b. manufacturing process c. primary activities d. secondary activities e. tertiary activities Answer: c 13. Procurement, technology development, human resource management, and firm infrastructure are handled in certain specialized departments and are called ________. a. materials handling b. support activities c. inventory activities d. primary activities e. benchmark activities Answer: b 14. The firm should estimate its competitors’ costs and performances as ________ against which to compare its own costs and performance. a. competition b. standards c. challenges d. benchmarks e. moveable standards Answer: d 15. The firm’s success depends not only on how well each department performs its work, but also on how well the various departmental activities are coordinated to conduct ________. a. core strategies b. satellite businesses c. core values d. core business processes e. core technologies Answer: d 16. With respect to core business processes, all the activities involved in gathering market intelligence, disseminating it within the organization, and acting on the information is referred to as the ________. a. market sensing process b. market research process c. target marketing process d. market pulse process e. deployment process Answer: a 17. With respect to the core business processes, all the activities involved in researching, developing, and launching new high-quality offerings quickly and within budget are referred to as the ________. a. new product process b. new offering realization process c. product development process d. product launch process e. return on investment process Answer: b 18. With respect to the core business processes, the ________ is considered to be all the activities involved in defining target markets and prospecting for new customers. a. customer acquisition process b. customer relationship management process c. fulfillment management process d. customer prospecting process e. customer equity process Answer: a 19. A good way to describe the ________ would be discuss all the activities involved in building deeper understanding, relationships, and offerings to individual customers. a. customer acquisition process b. customer relationship management process c. customer prospecting process d. customer fulfillment management process e. customer equity process Answer: b 20. Another way to describe a value delivery network (partnering with specific suppliers and distributors) is to call it a ________. a. teamwork group b. cabal c. domestic power center d. link to relationships e. supply chain Answer: e 21. The key to utilizing organizational core competencies is to ________ that make up the essence of the business. a. make the competencies pay for themselves b. own all intermediaries who come in contact with your goods and services c. own and nurture the resources and competencies d. emphasize global promotions e. segment workforces Answer: c 22. We can say that a ________ has three characteristics: (1) It is a source of competitive advantage in that it makes a significant contribution to perceived customer benefits, (2) it has applications in a wide variety of markets, and (3) it is difficult for competitors to imitate. a. core competency b. business strategy c. core technology d. strategic business unit e. winning strategy Answer: a 23. Core competencies tend to refer to areas of special technical and production expertise, where ________ tend to describe excellence in broader business processes. a. process benchmarks b. distinctive capabilities c. core business values d. value statements e. mission statements Answer: b 24. George Day sees market-driven organizations as excelling in three distinctive capabilities: ________, customer linking, and channel bonding. a. target marketing b. market research c. fulfilling customer needs d. market sensing e. customer service relationships Answer: d 25. Competitors find it hard to imitate companies such as Southwest Airlines, Dell, or IKEA because they are unable to copy their ________. a. product innovations b. distribution strategy c. pricing policies d. activity systems e. logistics system Answer: d 26. One conception of holistic marketing views it as â€Å"integrating the value exploration, ________, and value delivery activities with the purpose of building long-term, mutually satisfying relationship and co-prosperity among key stakeholders.† a. value creation b. value proposition c. value management d. value research e. value chain Answer: a 27. Holistic marketers achieve profitable growth by expanding customer share, ________, and capturing customer lifetime value. a. undermining competitive competencies b. building customer loyalty c. milking the market for product desires d. renewing a customer base e. inspecting all market share data Answer: b 28. The holistic marketing framework is designed to address three key management questions. Which of the following is one of those questions? a. Value claims—how does the company deal with value erosion? b. Value proposition—how can value propositions be made profitable? c. Value chain—are there weak links in the company’s value chain d. Value network—how can a company effectively network? e. Value exploration—how can a company identify new value opportunities? Answer: e 29. The customer’s ________ reflects existing and latent needs and includes dimensions such as the need for participation, stability, freedom, and change. a. competence space b. resource space c. emotional space d. relationship space e. cognitive space Answer: e 30. The companies ________ can be described in terms of breadth—broad versus focused scope of business; and depth—physical versus knowledge-based capabilities. a. business mission b. core strategy c. cognitive space d. competency space e. resource space Answer: d 31. The collaborator’s ________ involves horizontal partnerships, where companies choose partners based on their ability to exploit related market opportunities, and vertical partnership, where companies choose partners based on their ability to serve their value creation. a. resource space b. competency space c. cognitive space d. rational space e. service space Answer: a 32. Business realignment may be necessary to maximize core competencies. Which of the following would be one of the steps in this realignment process? a. Reviewing all macro relationships. b. Reviewing global outreach projections. c. Redefining the business concept (the â€Å"big idea†). d. Reviewing successes from e-commerce (if any). e. Revamping the ethics statement. Answer: c 33. ________ allows the company to discover who its customers are, how they behave, and what they need or want. It also enables the company to respond appropriately, coherently, and quickly to different customer opportunities. a. Network management b. Strategic management c. Marketing management d. Customer relationship management e. Total quality management Answer: d34. To respond effectively and provide value delivery, the company requires ________ to integrate major business processes (e.g., order processing, general ledger, payroll, and production) within a single family of software modules. a. human resource management b. internal auditing management c. internal resource management d. strategic management e. marketing management Answer: c 35. With respect to value delivery, ________ allows the company to handle complex relationships with its trading partners to source, process, and deliver products. a. a value matrix b. a global distribution policy c. a business development strategy d. business partnership management e. total quality management Answer: d 36. Successful marketing requires having capabilities such as understanding ________, creating customer value, delivering customer value, capturing customer value, and sustaining customer value. a. customer loyalty b. customer per c. customer retention d. customer value e. customer benefits Answer: d 37. According to a McKinsey research study, which of the following is one of the main challenges that marketing must face in the twenty-first century? a. The threat of ethics-based lawsuits. b. Doing more with less. c. Hostile takeover attempts. d. Increasing control by big government. e. Being independent of the distribution process. Answer: b 38. Strategic planning in the twenty-first century calls for action in three key areas. Which of these key areas deals specifically with devising a long-term game plan for achieving long-run objectives? a. Creating a viable business opportunity. b. Producing a strategic fit. c. Developing an investment portfolio. d. Expanding core competencies. e. Establishing a strategy. Answer: e 39. Most large companies consist of four organizational levels: the ________, the division level, the business unit level, and the product level. a. board of director level b. major stakeholder level c. management team level d. corporate level e. strategic level Answer: d 40. The ________ is the central instrument for directing and coordinating the marketing effort. a. strategic plan b. marketing plan c. tactical plan d. customer value statement e. corporate mission Answer: b 41. The ________ lays out the target markets and the value proposition that will be offered, based on an analysis of the best market opportunities. a. organizational plan b. strategic marketing plan c. corporate tactical plan d. corporate mission e. customer value statement Answer: b 42. In which of the following plans would we most likely find directions for implementing and addressing daily challenges and opportunities in product features, pro motion, merchandising, pricing, sales channels, and service areas. a. The tactical marketing plan. b. The target marketing plan. c. The deployment plan. d. The product launch plan. e. The product development plan. Answer: a 43. If you wanted to find out more about target markets and the organization’s value proposition, which of the following types of plans would most likely contain information that might be useful to you in your quest? a. The marketing plan. b. The organizational plan. c. The strategic marketing plan. d. The tactical marketing plan. e. The marketing mix plan. Answer: c 44. The ________ process consists of corporate, division, business, and product planning. a. implementing b. controlling c. innovation d. planning e. competitive Answer: d 45. All corporate headquarters undertake four planning activities, the first of which is ________. a. defining the corporate mission b. establishing strategic business units and assigning resources (SBUs) c. assigning resources to each SBU d. assessing growth opportunities e. understanding target markets Answer: a 46. A clear, thoughtful mission statement provides employees with a shared sense of purpose, direction, and ________. a. profitability b. target market feasibility c. opportunity d. continuous improvement e. quality products Answer: c 47. Mission statements are at their best when they reflect a ________. a. market b. strength c. competency d. vision e. value Answer: d 48. Which of the following terms matches to the phrase â€Å"it is a single business or collection of related businesses that can be planned separately from the rest of the company†? a. Strategic business unit. b. Diverse business unit. c. Growth business unit. d. Niche market unit. e. Specialized business unit. Answer: a 49. Market-penetration, product-development, and market-development strategies would all be examples of ________ strategies. a. concentric b. conglomerate c. horizontal d. intensive growth e. integrative growth Answer: d 50. A(n) ________ is when a company might seek new businesses that have no relationship to its current technology, products, or markets. a. concentric strategy b. conglomerate strategy c. horizontal strategy d. intensive growth strategy e. integrative strategy Answer: b 51. Which of the following terms most closely matches to â€Å"the shared experiences, stories, beliefs, and norms that characterize an organization†? a. Organizational dynamics. b. A business mission. c. An ethical/value statement. d. Customer relationships. e. Corporate culture. Answer: e 52. The first step in the business unit strategic-planning process deals with which of the following? a. Goal formulation. b. Business mission. c. Strategy formulation. d. Program formulation. e. SWOT analysis. Answer: b 53. When a business gets to know market segments intimately and pursues either cost leadership or differentiation within the target segment it is referred to as a ________. a. defined strategy b. focused strategy c. value-added strategy d. competitive advantage strategy e. customer-focused strategy Answer: b 54. If a firm pursues a ________ strategy, it must be good at engineering, purchasing, manufacturing, and physical distribution. a. differentiation b. overall cost leadership c. focus d. domestic customer relationship e. market share Answer: b 55. To keep their strategic alliances thriving, corporations have begun to develop organizational structures to support them and have come to view the ability to form and manage partnerships as core skills. This is called ________. a. value managed partnership b. synergistic partnership c. centralized partnership d. partner relationship management e. win-win relationship management Answer: d 56. Traditionally, most businesses focused on stockholders. Today, the focus is on what are called ________. a. stakeholders b. partners c. regulators d. consumer triads e. supply-chain relationships Answer: a 57. A ________ is a written document that summarizes what the marketer has learned about the marketplace and indicates how the firm plans to reach its marketing objectives. a. strategic plan b. marketing plan c. sales plan d. target market plan e. competitive analysis plan Answer: b 58. Which of the following permits senior management to grasp the marketing plan’s major thrust? a. The situation analysis. b. The marketing strategy. c. The executive summary and table of contents. d. Financial projections. e. Implementation and controls. Answer: c 59. Most marketing plans cover ________. a. one year b. two years c. three years d. four years e. five years Answer: a 60. The most frequently cited shortcomings of current marketing plans, according to marketing executives, are lack of realism, insufficient competitive analysis, and a ________ focus. a. long-term b. profit c. short-run d. product e. price Answer: c

Business Plan Final Essay

Castle’s Family Restaurant Business Plan: Stage III Executive Summary The purpose of this business plan is to understand the restaurants business and its operations to improve its customer service and its employee relations. The Castle Family Restaurant has eight restaurants that operate under one regional manager that also acts as the Human Resource Manager for the restaurants. The goal is to develop a plan that can decrease the travel time of the regional manager so; that he, Jay Morgan, can save on gas due to high gas prices since each restaurant is located in the northern California area. The objective is to introduce a HRIS application and one vendor that can assist in the developing of the HR department and ease the transitioning of one individual HR manager to multiple employees. There are restaurants with profits in mind and provide the same food and service while the Castle’s Family believes in family, partnerships and developing relationships with one another for a great customer service. Introduction The Castle’s Family Restaurant has eight restaurants in northern California with about 300-340 employees. Most of the employees are part time with about 40% of them full-time. This business plan is to determine strategies that will eliminate the Human Resource position from Jay Morgan, so that he can reduce his travel time to all eight locations and to develop an HR department for the restaurants. In addition, the business plan is to enable Jay Morgan to concentrate on his operation manager duties. Company Review The factors that cause many issues to the Castle’s Family restaurant business are having one individual with so many responsibilities. Therefore, hiring an HR manager to schedule, recruit, hire and assist the employees in their needs will help in creating order. In addition, the restaurant must hire an assistant to help in the administration work; it will decrease the amount of  paperwork for the general manager. And each restaurant must have a manager to overseas the employees and the operation of the restaurant. The managers will conduct meetings monthly to provide the sales, revenues and customer services of each restaurant. Managers can communicate through emails, phone calls if they have questions for each other, or have any concerns. A needs assessment must be conducted to determine if an HRIS is needed for the company. In order to have a successful restaurant business every factor must be considered. For example, customer service to the customers is a big factor becau se that is what brings in the revenue. For a restaurant to have a successful business they must have the right food for their customers to enjoy and to assist the customers any way they can. In the last year, there had been some speculation into how the government will help the small restaurants and that the fiscal will prevent any type of savings in when tax time comes around. These HRIS and vendor application that will be stated in this business plan is there to develop and help maintain the restaurant’s H R department and increase growth in the company. Business Analysis We have acquired an HRIS system that will help in developing the HR department to provide easy process for the employees. The Sage HRIS application is an innovative way to ease the transition from traditional HR to a strategic HR. The Sage applications provide variety of options to assist in the HR process. For example, the payroll application should be implemented to help the restaurant establish tax, earnings, and deduction codes to perform critical payroll functions and to modify the system to the restaurant’s needs. This is the first time Castle’s Family Restaurant is developing a HR department, having the right tools to run a department the right way will allow less mistakes to be made; with eight different locations, adding the sage application will help in the transitioning all locations into one. Furthermore, it is critical for a company to have leadership to help establish the employee’s strengths and improve their weaknesses. In addition, the sageâ€⠄¢s time and attendance can help manage the employee’s attendance and work time. The system enables you to collect, analyze, and take control of employee’s attendance and labor data. The  application will help the company in providing perks to employees that always come to work on time. In addition, the performance management application tracks employee’s performance; help identify their critical skills to help the employees in their career development. Furthermore, I have compare and contrast a vendor that would benefit your company. These two vendors provide great services but one match your company’s true values and its missions. The Castle’s Family Restaurant need a vendor that can help in developing long lasting relationship and demonstrates positivity so that individuals can be their best. Furthermore, automation is viable to reduce the need of human errors that can results in more major consequences. Automation errors can occur at any time, the solutions are easy to fix, and automation provide easy data that can be change, delete and edit. HRIS Type/Comparison The type of HRIS that the Castle Family Restaurant should implement is the Sage application as I have stated before. In order for such application to be developed a vendor must be selected to help in the process. The sage application is a best fit for the company because it has a group of team that can help in assisting in any technical difficulties. When developing new HR department, errors will consist and questions will need to be answered. Therefore, a new training program will need to develop to increase each employee’s skills and performances in the Human Resources Department. The Sage application has the career enhancement training; they have created a system that can help in detecting IT skills, leadership’s skills, etc.; that can benefit your restaurant. The application has an easy to read system. The vendors that I have selected are the ADP and the Rideau Recognition Solutions. The ADP provides all services for domestic international, small or large companies, it does not matter where you operate, and they are there to assist in developing the business. The Rideau Recognition Solutions provide services that inspire employees to succeed to the vendor’s belief. Their expertise is to help their clients build positive relationships with their people to reflect the company’s values and increase customers’ expectations. The Rideau main purpose and their definition of a business are being inspirational and providing inspiration to others. While  ADP is well recognized company that can assist in developing an HR department, and have the tools to performed the job, but because of the deep meaning and relationship that can develop with the Rideau Recognition Solutions and the restaurant being a family company; I believe that the Rideau is the best solution for the Castle’s restaurant. HRIS Vendor Recommendation I have recommended that your company, The Castle’s Family Restaurant, to choose the Sage HRIS application and the Rideau Recognition Solution as your vendor. They have the right tools that can establish the restaurant business, and their tools can assist in the development of the HR department. In the restaurant business there will be a lot of risks such as food poising, slip and fall and property damages. Once these types of risks occur this is where the HR department comes in to assist in resolving the situation. This why there should be training when these disadvantages come to light. The sage applications have the proper tools to help decide the professional way to handle such situations. The HRIS application provides professional training to each individual HR employee. While these risks can occur, another problem that cans cause small businesses disadvantage are the fiscal cliff which this year small business operators tax rate has increase by 5 percent. Furthermore, knowing these disadvantages will allow you, the Castle’ Restaurant to prepare yourself as a restaurant. In addition, using these vendors and HRIS system will permit better training; and develop great communication between the HR department and the employees and managers for great customer service. It is important to know the negative factor and a positive factor on owning a small business restaurant and to prepare for any tactics on a professional level. In conclusion, I recommend the Sage as your HRIS application and the Rideau Recognition Solution as your vendor. Conclusion The Castle’s Family Restaurant has been operating on one person basis, with eight restaurants to oversee. There are many duties to maintain to assure a  smooth business; with such issues that can arise in each restaurant, developing an HR department to oversee these tasks will reduce risks that can occur. I have concluded that the Sage HRIS and Rideau Recognition Solution are the chosen application and vendor for your company to help in the developing your restaurant business. The application and vendor will and can assist you in many different factors and help improve employee communication. References Frumkin, Paul. â€Å"How ‘fiscal cliff’ deal impacts small restaurateurs, franchisees.† Nations’s Restaurant News. Jan 9, 2013. Retrieved on 8/24/2013 < http://nrn.com/latest-headlines/how-fiscal-cliff-deal-impacts-small-restaurateurs-franchisees>