Having heard about Blade Runner as a classic in it own right, I had high expectation from the science fiction/dystopian film featuring Harrison Ford directed by celebrated director Ridley Scott. It promised to be action packed, visually stunning and adventurous in terms of plot, narrative structure and animation effects. A good movie, for me, means integrity of vision, empathetic narration, and realism within the plot’s determining genre, i.e. the story must be believable within the definition of the genre it belongs to. I will analyze my experiences with this movie based on the above mentioned criteria.

Blade Runner, 1982, directed by Ridley Scott, is based on the Philip K. Dick science fiction novel Do Androids Dream of Electric Sheep? The dystopian theme played out in the movie, set in a futuristic Los Angeles, makes the location apt because the complexity and interpenetration of living surfaces, work spaces and general infrastructure present a complex setting suited to the idea of the plot (Bukatman, S., 2008).

The moral dilemma which is central to the dystopian post human epoch visualized in the movie allows for the actors to bring a range of human emotions through suggestive placement, timing, behavioral traits and locale in the film (Bukatman, S., 2008). Jordan Cronenweth does a spectacular job with the cinematography given that the topography and the method used to unravel the plot is one rife with visual challenges. The way a futuristic dislocation is established in a book may be a matter of verbal descriptions, but to signify this information visually is a matter of using the appropriate symbols in the right combinations of action.

The background shots shows a futurist Los Angeles landscape further nuanced by sets which create two parallel levels of urban existence; the lower part of the city is dangerous, and is occupied by the poor, the underprivileged and the replicants who are mere slaves to the rich class, who live above (Bukatman, S., 2008). The placement of the higher classes above the lower classes is stratified, and made more diverse by establishing a variety of heterogeneous cityscapes. This lack of centralization, seeming to rejecting cinematically the idea of location by creating diverse spots of action which are all part of a conceptual unity delivered on the promise for visual and narrative brilliance.

The film succeeds spectacularly within the coordinates of film noir for its path breaking visual and auditory effects. The thematic integrity of dystopia is maintained to great effect and director’s vision stands vindicated by its cult status. With literary fidelity in mind however we will have to concede with calling it a considerably successful adaptation. The integration of necessary elements from the book, by way of futuristic sets, and great editing and visual effects made the story come alive.

Harrison Ford as Decard does a commendable job, displaying a range of emotional expressivity; from the tender suggestion romance with his robot colleague to the final dilemma trying to confront his own existential dilemma. The layers of meaning are further developed by showing how the upper class is subjecting humanoids to slavery and hints at the question of race, identity and human dignity by suggesting that man is defined by the role he plays in society (Bukatman, S., 2008). Consequently, can someone who is fixed to the performance of his duty with no scope for his personal emotional development be called human?

Thus this film delivers on all my criteria, and I am at liberty to say this film worked for me. Because it satisfied my experience with the things I was looking for, namely action, integrity and visual effects way ahead of its time.

Works Cited

Bukatman, S., Blade Runner; BFI Modern Classics. British Film Institute, 2008.

Introduction

Apple Inc is a leading American corporation that manufactures computer software and consumer electronics. The company is credited for designing products such as the Macintosh range of computers, the iPad, iPhone, and the iPod. Computer software made by this company range from the iLife, the safari web browser, the iOS, and the iTunes among others. The company is currently operating over 350 stores in various countries around the world alongside an online store that offers both software and hardware. In this year, Apple Inc was ranked as the largest company in the globe with regard to market capitalization (Seitz 5). It is equally a company with the largest market in the world with regard to both revenue and profit generation. The company was founded in 1976 and later incorporated the following year. Before the year 2007, this company was known as Apple Computer Inc. The shift to the current name reflects the ongoing innovation in its range of products and market diversification. By September last year, this company had nearly 50,000 employees on full term basis. Apparently the company has a very established reputation in the electronics industry. The shares of this company are traded on the NASDAQ stock exchange market.

History

Apple was founded by the late Steve Jobs, Ronald Wayne and Steve Wozniak in the year 1976.  The company was later incorporated the following year (Young and Simon 35). From 1976 to 1980, the company concentrated on the production and sale of the Apple I and Apple II computers. With the introduction of computer designers in the late 70s, the company adopted the Apple III computers. The later was geared at enhancing a competitive advantage over both Microsoft and IBM. With the incorporation of Xerox PARC in 1979, the company launched the development of Apple Lisa. This company later went public and generated the highest capital in history following the IPO. Between the year 1981 and 1985, the company faced a battle of choices between products with regard to the Macintosh and the Lisa. Later in 1983, the Apple Lisa was given priority over the Macintosh and thus became the first personal computer traded by the company (Reder 185- 209). Though the Lisa had the graphical user interface, its marketability was limited by its high pricing. The sale of the Macintosh was launched in 1984 but its marketability was equally limited by high pricing. The company later shift to the Laser writer which traded well at a customer friendly price.

Having survived several struggles, the company launched the Macintosh Portable in its range of products in the year 1989. Later in 1991, the company launched the powerbook and system 7. The later upgraded the operating system and subsequently increased revenue generation for the company. With the success offered by the introduction of the Macintosh, the company launched the Centris to compete with other consumer software on the market. The later did not amount into any profits for the company following consumer dissatisfaction. The company later plunged in to the design of alternative products from 1991(Reder 185- 209).

In order to create a better computing platform, the company partnered with both Motorola and IBM in the year 1994. During the same year, the company launched the power Macintosh.  Apple Inc returned to profitability in the period between 1988 to 2005 following market diversification (Wong 23). The company also managed to acquire several properties and companies during this time. Later in 2006, the company began manufacturing Intel based computers which subsequently increased its profitability. The introduction of the iPhone, the iPod, and the iPad in the period between 2007 and 2011 has subsequently increased the market share and profitability for the company. The company is currently headed by Tim Cook following the retirement and subsequent death of Steve Jobs.

Market

Apple is a company based on consumer goods and competes with various other consumer goods companies. However, to foster a competitive advantage over its rivals, the company runs a unique advertising strategy for its products (Ahrens 34). Having established a unique reputation in the range of its products, the company enjoys a very large customer base around the entire globe. Apple Inc has diversified its market and range of products to increase its profits and market share. Among its highest traded products is the iPod which enjoys global recognition.

Global Business Development Strategies

With the lead role in innovation and research in the technology industry, the company led the globe with the introduction of the iPod. This made Apple Inc a major market stakeholder in music players. The company later plunged into the phone industry in the year 2007 with the introduction of the iPhone (Brigham 58). The company has greatly revolutionalized both the music, phone and computer industry by signing major companies into its services and products (Merrion 2). Among its main strategies in global business is the diversification into innovative products that are considered difficult to launch and operate by its rivals. The differentiation in its products allows it to command a relatively high market price. The company has equally vested a lot of its resources in research and innovation.

Conclusion

Apple Inc is a leading multination corporation in the technology industry. Though the company faces stiff competition from IBM, HP, and Dell, its business strategies have always put it on top. The company is currently enjoying an added competitive advantage in the technology industry following the successful plunge in to both the music and phone industry.

Works Cited

Ahrens, Frank. “Apple Set to Open in Japan First Retail Store Outside United States.” America‘s Intelligence Wire 27 Nov. 2003: 34.

Brigham, Daves. Intermediate financial management. Mason, Ohio: Thompson South- Western. 2007. Print.

Merrion, Paul. “Inventor of Music Player Takes a Bite Out of Apple.” Crain’s Chicag  Business 28 Nov. 2005: 2.

Reder, Margo. Case Study of Apple, Inc. for Business Law Students: How Apple’sBusiness Model Controls Digital Content Through Legal and Technological Means.” Journal of Legal Studies Education 26 (2009): 85-209.

Seitz, Patrick. “Apple Sees Healthy “iPod Economy.” Investor’s Business Daily 5 Dec. 2005:  A5.

Wong, May. “Apple Sets Pace in Consumer Electronics.” America‘s Intelligence Wire 15  Dec. 2005: 23.

Young, Jeffrey and William Simon. iCon Steve Jobs: The Greatest Second Act in the Histor  of Business. Hoboken, New Jersey: John Wiley & Sons. 2005. Print.

The emerging direction of modern social theory is possibly nowhere more apparent than in the interest it lavishes upon the nature of the self, identity of the self and individual prejudice (Eliot, 2001).  In his most well-know work named The Structure of Social Action (Parsons, 2010); he described the ‘voluntaristic theory of action’.  According to this theory, any kind of social action entails decision-making by individuals that pays attention upon completion of the objective and is guarded by thoughts and situations (Parsons, 2010).  A player can either be an individual or a group.

Instrumental Actual Self: “How does an individual carryout himself/herself to influence other people for obtaining either positive or negative response”?  This is an influential actual self as the character traits of an individual normally serve as instruments which eventually would direct the response from other people.  An individual can be understood well through the actions and through the interaction with the society (Elizabeth, 2005).  “The physical characteristics of a person are purely hereditary, but the psychological characteristics of a person are partly hereditary and partly conditioned by the environment.  According to psychologists, personality is a dynamic concept that describes growth and development of a person’s psyche (Frederiksen, 1982) ((ICMR), 2003).”  Personal characteristics or personality in short will help to garner attention from others and also helps in self introspection with the help of the feedback obtained from others.

Expectant Actual Self:  The question derived from this component of self construction is, “What characteristics do one have that would enable him/her to have an expectation of positive experiences with others”?  The feedback provides numerous useful insights on personal or individual expectation particularly after an explicit conduct, act, or behavior.  It is basically an assessment tool that would enable an individual to constantly evaluate and monitor the social progress in life (Anderson, 2000).  For instance, an individual’s participation in activities like sports would enable the individual in evaluating various behavioral characteristics like shyness, outwardness, competitiveness, selflessness, and ability to work under pressure.  Through expectant actual self, individuals can get to know better about their attitudes, competencies, and preferences thus making well-versed and suitable decision about a number of issues in life (Baum, 2011).

Similarly, the environment that an individual is exposed to also plays a very significant role in shaping individual personality.  “Environmental factors include the culture of the society in which an individual is brought up, the norms set by the parents, teachers and other social groups with which the individual interacts, and other situations and experiences he undergoes in his life ((ICMR), 2003).”

Monitored Actual Self: This component of self triggers the characters that an individual portrays related to the individual goals that are aimed to be attained in life.  It has a co-relationship with the actual self monitoring (Baum, 2011).  Through this lens, individuals receive information regarding the steps that are to be taken for pursuing goals and ambition in life.

In The Social System (Parsons, 1991), Talcott Parson measures pattern variables as being extremely broad in the potential orientations an individual can encompass in a given circumstance.  These pattern variables form the core qualities of social interactions which eventually replicate a definite set of options for an individual’s point of reference and patterns of communications.  The following are the five basic pattern variables as defined by Parsons:

(1) Self vs. Collective Interest, (2) Universalism vs. Particularism, (3) Achievement vs. Ascription, (4) Specificity vs. Diffuseness, & (5) Affectivity vs. Affective Neutrality (Parsons, 1991).

Moreover, the pattern variables listed above, according to Parson, can be clustered on the basis of their significance to the individual’s assessment orientation or motivational course in a particular social system.  He suggested the universalism-particularism and achievement-ascription pattern variables are strongly associated to value orientation when compared to the other variables that he defined.  On the contrary, specificity-diffuseness and affectivity-affective neutrality are very strongly associated to individual’s motivational orientation.

The pattern variable self-collective is rooted within the value and motivational orientation patterns and can, consequently, be looked upon as an impartial or a holistic pattern variable.  The blend of the pattern variables and the assessment of potential interrelationships amid variables can present the foundation for a widespread assessment of any form of social interaction (Parsons, June 1956).

Social stratification gains relevance at this point.  Social Stratification, in view of structural-functionalism, can be defined as “The differential ranking of human individuals who compose a given social system and their treatment as superior and inferior relative to one another in certain socially significant respects (Parsons, 1991).”  A few sociological theorists state that society is a stable and orderly system which has interrelated elements which eventually serve a specific function.  According to Anthropologist Bronislaw Malinowski, culture helps the people of the society to satisfy their biological needs and integrative needs like religion and art.  As already mentioned above, societies in which people share a common language and core value system are more likely to live in accord and agreement (Cherry, 2010).

The functional essential of integration is of particular concern with reference to law as it involves the common adjustments, the interrelations, of the aforementioned subsystems as specific concerns to their offerings to the resourceful operation of the overall society (Tumin, 1953).  Integration seeks to preserve stability and to evade instability and, in the worst-case scenario, collapse.  Societal community and its functional essential of inner integration are perceived as the one that the legal system most candidly serves in a society (Parsons, 1991).  Morality is based on delineated consequences to a few definite choices whereby some may be categorized as immoral, evil, and unlawful.  According to the social conflict theory, compliance is attained when individuals connect to the society through the various elements (R.J. Alston, 1995).  However, it is very important to note that, any kind of social action involves decision-making by the members of the society which in turn pays attention upon achievement of an objective and is defended by opinions and circumstances (Parsons, 2010).

Experience: Experience is another predominant element that plays a larger role in determining the course of an individual’s life and also as a family.  For instance ambition of an individual is not something that is decided instantaneously but rather it is a long in-built issue that was conceived after watching psychologists at work.  An inherent component of the past experiences of individual is the result that would be obtained after psychologist counselors helped restore broken families, drug addicts and helped those whose fate hate had been sealed as hopeless and impossible to rehabilitate.  Through personal experience, individuals tend to build their own self-esteem along with good values and appreciate others thus enabling me the individual to fit in perfectly in the wider society (Quick, 2011).

Among the various other elements that play vital roles in shaping up and individual, Culture has an equally important role.  Culture, according to sociologists, forms the central ingredient of human behavior.  In all societies, people try to either control their environment, live in agreement with it or are acquiescent to whatever happens in their environment (Mullins, 2005).  Their culture and beliefs may strengthen their compliance in respect to their environment.  All these cultural elements can, certainly change with time, as people are exposed to a variety of ways of dealing with their environment (Bégin, 2006).  Culture steers the mind and influences the ways people observe issues, act politically, prioritize decisions, manage their lives and essentially on ways they think about a particular issue.  It is not appropriate to separate self-awareness and cultural awareness.  Individuals need to go beyond the meaning of culture itself in order to have a better awareness of how culture influences our personal lives.  Culture can be thought of as an evolutionary process that has been established, accepted, and internalized over a period of time, by a majority of members of the society.

References List

(ICMR) ICFAI Center for Management Research, 2003. Introduction ot Organizational Behaviour [Book]. ICFAI Center for Management Research (ICMR):  - Hyderabad.

Anderson Donn R. Character Education: Who is Responsible, – 2000. [Journal] // Journal of Instructional Psychology (Vol: 27, No: 3). . - pp. 139-142.

Baum J. Contrada & A. , 2011.  The handbook of stress science: biology, psychology, and health [Book]. - Springer Pub: NY . p. 24.

Bégin Diane Sarah Organizational Culture Counts, January 10, 2006. [Article] // Practice Knowledge Center. pp. 1-4.

Cherry Kendra Social Learning Theory – An Overview of Bandura’s Social Learning Theory- 2010. - [Online] // About.com.  December 16, 2010. - http://psychology.about.com/od/developmentalpsychology/a/sociallearning.htm.

Eliot Anthony Concepts of the Self, 2001. [Book]. Cambirdge: UK.

Elizabeth Donald C. Reitzes & Mutran J. Self-Concept as the Organization of Roles, Importance, Centrality and Balance- 2005. [Journal] // The Sociological Quarterly. pp. 647-667.

Frederiksen Lee W. Handbook of Organizational Behavioural Management, 1982. [Book]. Interscience – Wiley: New York .

Mullins Laurie J. Management & Organizational Behavior, 2005. [Book].  McGraw Hill: New Jersey.

Parsons Talcott Suggestions for a Sociological Approach to the Theory of Organizations- June 1956.I [Journal] // Administrative Science Quarterly (Vol: 1, No. 1). pp. 63-85.

Parsons Talcott The Social System , 1991. [Book].  Routledge: London.

Parsons Talcott The Structure of Social Action; A Study in Social Theory with Special Reference to a Group of Recent European Writers, 2010. [Book]. General Books LLC: Tennesse.

Quick Debra L. Nelson and James Campbell Organizational Behavior: Science, The Real World, and You (7th Ed) , 2011. [Book]. - Boston, South-Western College Pub: Massachusetts, United States.

R.J. Alston R. Harley, & K. Lenhof Hirschi’s Social Conflict Theory: A sociological Perspective, 1995. [Journal]. - [s.l.] : Journal of Rehabilitation - 4 : Vol. 67.

Tumin Melvin M. Some Principles of Stratification: A Critical Analysis- 1953. [Journal] // American Sociological ReviewVol. 18, No. 4.  pp. pp. 387-394.

Health IT plays a very important role in the Accountable Care Organizations and the Patient-Centered Medical Homes. In most cases, little attention is given to the delivery-system that is required to improve the coordination and quality of the health care and lower the spending rates. Accountable Care Organization and the Patient-Centered Medical Home are two models that are mainly discussed for delivery system reform. They also offer opportunity to enlarge the efficiency of the care coordination. Care coordination helps to improve the appropriateness, efficiency, timeline and the quality of clinical decisions and care, in that way, the quality and efficiency of the health care is improved. The main goals involved in care coordination include: the transfer of medical information such as medication lists, medical history and test results properly from one participant to another in patient care. These can only be efficient when the health information technology is involved and very well utilized.

According to some physicians, PCMH is the model of care that gives the patient’s needs the first priority. Gerlach (2010) says that it provides the most efficient and effective care to the patients by including the use of health information technology, behavioral health services, health maintenance, patient education, and providing preventive services through health promotion. Medical homes are responsible for providing the patient’s health care needs or it takes the responsibility of arranging care with other professionals who are well qualified (Shortell & Gillies 2010). Provider members of ACOs work collectively across the specialties in order to develop delivery of care programs that focus on coordinating care and outcomes. The ACOs encourage most hospitals and physicians to incorporate care by holding them responsible for both cost and quality.

PCMH and ACO models play a role in improving the quality of health care and reduce the costs. For instance, one of their major objectives is to deliver high value products and good quality services. These can be achieved by coordinating care, consolidating multiple level of care to the patients, being accountable for the quality of care, efficient delivery and having a brawny primary care foundation. Health information technology therefore, helps to ensure that all these are well achieved.

PCMC’s and ACO’s try to provide a solution to control the costs of Medicare by ensuring that the country avoids spending or paying for wasteful procedures, and authorizing nurses and doctors to offer more efficient and high quality care. Some of the rules that are used in the models include; providing equal care among populations, providing care in the right setting, supporting the well being of all individuals, providing timely, convenient, responsive services, efficient services, and should easily access to appropriate care and information when required. Other principles include identifying measurable outcomes and availability of information that helps in providing and planning for the patients effectively. In order to make the two models, PCMH and ACOs successful, it is very necessary to use the HIT (Health Information Technology). HIT should integrate across the health care system from one care site to the other (Gerlach 2010). The modern information technology commonly used includes computers, servers, and database management systems. Technology is capable of supporting the rural access to health care which is very critical when it comes to caring for all the patients.

The implementation of the ACOs and PCMH has various challenges that mainly concern the direct control of the primary care practice. First, the model, PCMH, doesn’t provide direct incentives to the other providers collaboratively with the primary care providers in order to optimize health outcomes even though it calls for practices of primary care to take the task for coordinating and providing care across the health care continuum (Shortell & Gillies 2010). Another challenge is that most primary care practices have no financial arrangements that enable them to share the savings.

The information technology helps in the implementation, processing and even the storage of some important data on health care. Meaningful use of IT is actually intended to enable the significant improvements in the health of the population via a transformed health care delivery system. Currently, in the year 2011, NCQA instituted more stringent certification standards. NCQA has also built on various standards with increased accent on patient-centeredness that actually includes a stronger focus on the integration of behavioral health. In addition, it helps in the management of chronic disease and therefore improving the quality of patients with the use of patient surveys. All the activities in improving the patient’s conditions are more efficient with the use of IT. It is therefore important to note that IT also plays a major role in the two model’s well performance.

The two models of the delivery-system reform tend to redirect the delivery system towards the improved quality and the reduced cost mainly with the use of health IT. ACOs need a stable primary care core in order to succeed and provide the effective delivery-system infrastructure beyond the primary care practice to enable the realization of the PCMH model. The combination of both the models and the use of HIT are all essential for the implementation and success. Due to the information above, it is clear that health information is very much involved in the current rules related to the ACOs and the PCMH. It is therefore necessary for you to incorporate it in the planning in order to improve the quality and accessibility of healthcare information and facilities.

References

Gerlach L. (2010). Meaningful Use, PCMH, ACO: One Escalator, Three Destinations. Retrieved on  November 15, 2011 from http://www.nwrpca.org/health-center-news/150-meaningful-use-pcmh-acone-escalator-three-destintations.html

Shortell SM, Gillies R, Wu F (2010). United States Innovations in Healthcare Delivery. Public Health Reviews

Exploring Better Ways on How to Respond to Problems of Obesity in the Modern Society

Introduction

Obesity is the state of a person being overweight with excess body fat. This medical condition among many individuals has specifically caused several problems to many individuals especially living in the urban areas. Most often than not, these problems included lower life expectancy, diabetes, heart ailments and other medication conditions that alarmed the attention of medical experts who are trying to find out more about obesity, its causes, its effects and possible ways of treating it (Dollman, et al, 2005, 892). While some other types of obesity are caused by genetic and endocrine disorders, majority of the type of obesity that is rampantly growing in the society today is that of the common aspect of being caused by excessive energy-rich food intake and lack of physical activity.

With modern technology most often than not giving the best path of living to modern individuals, there is a less requirement for one to move. Take for example the existence of television. An average person living in the urban areas has been observed to have been spending at least six to eight hours each day (Schmidt, et al, 2007, 487). This could either be a continuous practice or a staggered one; nevertheless, eight hours of sitting in a couch is still eight hours. That precious accumulation of time that has not been used in any particular physical activity has already slowed-down the body’s utilization of energy. Another report notes that many among those who follow such practice even embrace another practice that is also considered unhealthy and that is eating junk foods while watching television for hours. Up to at least 45% of the current rates pertaining to individuals suffering from obesity has been noted to follow the said lifestyle (Dollman, et al, 2005, 896); assuming like as if television and junk food are tandems that cannot be separated.

Other causes of obesity, as supported through academic surveys include that of the occurrence of too much leisure among human individuals living in the urban areas. The fact that transportation has provided a lot easier process of travelling to most people; it has also become a matter of concern for those who are obese and are currently facing the need to adjust their lifestyle, but cannot do so because of the fact that there are “better options” to living in a modern place like the city. All the activities mentioned herein are noted to have a specific impact on people developing cases of being obese. This is the reason why in the discussion that follows, exploring possibilities on how to manage obesity through the new found procedures of medication in par with that of the implicative relation of the matter on the need to follow the basic ways of living shall be better defined herein.

Different Ways of Dealing with Obesity

There are two primary ways of dealing with obesity. One is that of the modern process while the other entails for a more traditional approach. The first approach is dependent on the new innovative ways of finding out how obesity occurs and pairing it up with the most considerable procedures of dealing with the matter through in-house exercise and medication. Most often than not, the cases that are submitted for this course of development and improvement entails for the close monitoring of a mentor who is expected to serve as a motivational manager to the patient or client being served. Some approaches even include therapeutic approaches that are sure to give attention to the specific health needs and status of the patients. Most often than not, these therapies last for weeks to a month or so with an indicative recording process that entails for the progress report of the patient in a then-to-now comparison process. Medication usually is included in the therapies especially concerning special medical conditions of the patients being dealt with.

The other procedure that is currently given attention to is the traditional way of dealing with obesity. Usually termed as “going to the basics”, clients or patients are asked to undergo a self-check procedure which would entail on their willingness to change their lifestyle. The changes that they are to make need not be based upon the new ways of beating up themselves to lose weight. Instead, it shall involve a relative condition on adjusting their regular ways of living. This could involve their daily activities such as going to work, school or simply involving an adjustment on their regular recreational activities as well as an adjustment on their most comprehensive points interests, specifically involving their food choices. Patients who are to be involved in this course of development are to be assessed with regards their psychological conditions as well. As for example, if a person who is obese is specifically experiencing depression, then dealing with the depression is an important part of the treatment and lifestyle adjustment that the client should be addressed with. The basic beauty of the traditional approach to treating obesity is the fact that it does not need to enforce pressure on the client being helped. Instead, it simply motivates one to follow the basic pattern of living without the need to incur specific programs that are dedicated towards a fully recorded progress report (Schmidt, et al, 2007, 489). In this regard, it is very important that the individual has his own attention focused on the matter hence living him with a good essence of solving the actual problems he is dealing with. This approach shall provide the client a self-imposed achievement that does not only deal with actual problem of obesity but also that of the course from which the occurrence of depression is resolved (Dollman, et al, 2005, 892).

Conclusion

Most often than not, experts on health and psychological issues confer to the need of differing both the medical and the traditional way of dealing with obesity. Notably, it could be observed that somehow, those who believe in the medical approach of developing the progressive state of the obese patients entail for the intensive need of enforcing or at least empowering the patients to become involved in the process hence being convinced that they need to undergo the therapy if they want develop into a healthier state of living. Notably though, it could be analyzed that not all pressure-stressed operations on dealing with obesity end up successful. On the other end, the traditional approach entails for the utilization of the actual being of the patient being treated and has a relative indication on how well they are able to adjust their lifestyle without being forced. This way, they are expected to intend to follow a process that would specifically fit their condition and their desires of getting better.

True, the traditional ways specifically empowers the patients in defining their own course of development. It shall also provide them a more considerable understanding on how they are supposed to take matters seriously especially on the part of personally realizing their need to readjust their lifestyle. Understandably, the traditional way of dealing with obesity considers that every person is unique, and that every case of obesity is also unique. Given this, it is expected that every person who is suffering from obesity deserves to be treated according to his own case. The traditional approach to adjusting one’s lifestyle towards the healthful course then entails the creation of a more refined therapy that would deal with both the medical and the psychological issues that are being dealt with by obese individuals. Considering the comparative level of the process of applying the traditional approach in comparison with the medical procedures of health development, it is shown in this discussion that dealing with obesity is assumed to have a great dependence on the actual situation of the patient or client being helped.

References:

Dollman J, Norton K, Norton L (December 2005). “Evidence for secular trends in children’s physical activity behaviour”. Br J Sports Med 39 (12): 892–7.

Schmidt DS, Salahudeen AK (2007). “Obesity-survival paradox-still a controversy?”. Semin Dial 20 (6): 486–92.

World Health Organization. Obesity and Overweight. http://www.who.int/mediacentre/factsheets/fs311/en/. (December 5, 2011).

Employers always find themselves in a dilemma when conducting recruitment drives. This dilemma becomes further complicated when ethical standards and values such as smoking and nonsmoking are imported into the recruitment exercise. As others remain undecided about the prospects of restricting the recruitment exercise to nonsmokers, the gains to be accrued from such a consideration are becoming increasingly apparent. It is becoming clearer that preferring nonsmokers to smokers in employment is more advantageous than being ambivalent towards the idea.

In the first place, Dalsey and Park (2009) quote the Center for American Progress, which was released in 2006 to explain that employers who do not hire smokers will have dramatically lower health care and health insurance costs. This is because; smoking increases the risks of respiratory infections yet the organization may have to settle the medical bills of the clients. This will heighten the organization’s expenditure.  The same development allays even the claims of rebuttals who maintain that adopting an indiscriminate recruitment approach ensures multiplicity of talents and skills.

Conversely, Dewees and Daniels refer to Tomkowicz and Lessack report of 2006 to argue that it is apparent that employers who do not hire smokers are motivated by their ability to reduce the resentment of smokers by non-smokers arising from the perception that smokers take breaks that are more frequent at work and increase the health care burden on non-smokers. The gravity behind this above claim is verified by the fact that smoking divides the personnel into two camps: while the nonsmokers will feel that, they are being polluted and being exposed to the dangers of passing smoking, the smoker will always see the assertion that he walks away when smoking as a needless bother. This eventually brews discord in an organization and eventually interferes with organizational performance. The smoke that lingers around the smoker will also widen this chasm further, as nonsmokers and the smoker will differ on the idea that the smoker remains outside for some minutes after smoking.

At the same time, while referring to the Arizona Republic and Sulzberger 2011 report, McShulskis (2011) waxes polemical that it must be remembered by employers that they can provide a safer and healthier workplace for all employees by ensuring the workplace will be smoke-free. Although opponents of this idea are likely to cite discrimination and the contravention of the rights of the smoker, yet, it remains an indisputable fact that by keeping smokers away from recruitment exercise, the entire workplace is guaranteed of fresh air and is totally freed from the dangers that accost passive smoking.

Greenberg (2009) remains poignant that as is elaborated by Center for American Progress (2006), Sulzberger (2011), and the Proactive Employer (2011), it has been discovered that employers who do not hire smokers will benefit from higher productivity among workers. In the first place, the time spent by smoking employees as they excuse themselves out of the working area for a smoking session will have been totally extirpated.  Similarly, the ability of smoking to drive a wedge between smoking and nonsmoking employees will have entirely been annulled. On the other hand, there is no benefit that can be accrued, by incorporating smokers into the recruitment exercise. While the positive attributes that are extant among smokers can be found among nonsmokers, the positive attributes that are spotted among nonsmokers cannot be found in smokers.

Conclusion

Any reason that would be advanced to gainsay the standpoint above cannot stand, given that all the propositions are feasible. Likewise, citing the locking out of smokers during recruitment drives as being tantamount to discrimination is in itself a fallacy since smoking is not a disability. Smokers can make resolutions to emancipate themselves from addictions, since smoking is a habit that can be both learned and unlearned.

Bibliography

Dalsey, Elizabeth & Park, H. Sun. “Implication of Organizational Health Policy on  Organizational Attraction,” Health Communication. 24 No. 1 (2009): 71-81.

Dewees, N. Donald and Daniels, J. Ronald. The Cost of Protecting Occupational Health, Journal  of Human Resources, 21 No. 3 (2010): 381-396.

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A known case of asthma on medication, B.T.’s signs and symptoms show a severe exacerbation of asthma, a life-threatening medical emergency which is best managed at the emergency department (Global Initiative for Asthma [GINA], 2010, p. 71).  During an exacerbation, the “patient experiences increasing shortness of breath, coughing, wheezing, and chest tightness” (Pruitt & Lawson, 2011, p. 50).  These manifestations may happen alone or in combination and may build up over minutes to hours depending on the nature and severity of the attack.  Despite treatment, B.T. exhibited difficulty of breathing .  The best action of the wife at this time would have been to call for help like 911 that could dispatch an ambulance and have him brought to the nearest emergency room while initiating treatment.  However, the nearest facility could have been the clinic which provided immediate care.

Assessment.

Along with providing prompt treatment, a short history and physical examination relevant to the exacerbation are done.  B.T.’s relevant history is his unresponsiveness to the given treatment at home, with the use of accessory muscle for breathing and with inability to lie down secondary to dyspnea.  It appears that the cause of his present exacerbation is anxiety.  It has been suggested that the connection between anxiety and asthma may be part of a wider relationship between “psychological distress and chronic disease” (Cooper et al., 2007, p. 1).  B.T. is also highly allergic to dust and pollen.  Allergens and irritants activate exacerbations, resulting to an inflammatory cascade that obstructs the airway (House & Ramirez, 2008, p. 122).

In the physical examination (P. E.), exacerbation and severity are assessed through the patient’s ability to speak, respiratory rate, pulse rate, use of accessory muscles, and other signs (see Table 1).  Any complicating aspects such as pneumonia and pneumothorax are recognized.  GINA (2010a) strongly recommends functional assessments such as PEF (peak expiratory flow) and FEV1 (forced expiratory volume) and measurements of arterial oxygen as P.E. alone may not fully show the severity of exacerbation.  As shown in Table 1, B.T.’s manifestations (unable to lie down, use of accessory muscles, respiratory rate of 42/min, pulse of 124/min, PaCO2 48mm Hg, and SaO2 88%) all fall under the severe category.  Succeeding measurements are intermittently done until there is a clear response to treatment.  Oxygen saturation is closely monitored.  Chest X-ray is not routinely done in adults but performed if complicating factors are suspected and for those needing hospitalization.  Arterial blood gases (ABGs) are not regularly measured except for patients with PEF of 30 to 50% predicted, unresponsive to initial treatment, or when deterioration is a concern.

As outlined in GINA (2010a, pp. 73-74), the following treatments are usually provided concurrently to attain the fastest resolution of the exacerbation:

1.  Oxygen is given by nasal cannulae or by mask to attain arterial O2 saturation of 90%.  Oxygen treatment is measured through pulse oximetry.

2.  Rapid acting inhaled B2 –agonists are given at regular intervals through meter dose inhaler (MDI) and a spacer device.

3.  Better bronchodilation may be achieved with a combination of nebulized B2-agonist with ipratropium bromide, an anticholinergic, and should be given before considering methylxathines.

4.  Except for the mildest exacerbations, systemic glucocorticosteroids are used because they hasten resolution, especially if the rapid acting inhaled B2-agonist did not achieve lasting improvement, the exacerbation continues to build up even when the patient is already on oral glucocorticosteroids, and past exacerbations required oral glucocorticosteroids.

Table 1. Severity of Asthma Exacerbations.  From GINA (2010b, p. 21).

5.  The combination of high-dose inhaled glucocorticosteroids and salbutamol in one study provided better bronchodilation than salbutamol alone in acute asthma and better benefit than supplementing systemic glucocorticosteroids across all factors (GINA, 2010a, p. 74).

6.  Intravenous magnesium sulphate (2g infusion over 20 minutes) is not routinely recommended but may be given to patients unresponsive to initial treatment.  It has also been shown to decrease hospitalization rates.

The treatments not recommended for acute asthma exacerbations include sedatives which are strictly avoided due to respiratory depressant effect, mucolytics which may aggravate coughing, chest physiotherapy which may heighten patient distress, excessive hydration, antibiotics except for concomitant bacterial infection like pneumonia, and epinephrine which is indicated for anaphylaxis and angioedema but not for asthma attacks (GINA, 2010b, pp. 19-20).

Check treatment response.

Assess patient’s signs and symptoms, PEF, and oxygen saturation.  Consider measuring ABGs if with hypoventilation, severe distress, exhaustion, and PEF 30-50% predicted.  Give supplemental oxygen as indicated and medications as prescribed.  Preferred patient outcomes are better ventilation and oxygenation and reduced respiratory distress.  There is good response to therapy if there is a continued 60 minute response, distress is absent on P.E., PEF greater than 70%, and O2 saturation is more than 90% (GINA, 2010a, p. 72).

Assess if for discharge at emergency department or for hospitalization.

Patients usually need hospitalization if with a FEV1 or PEF less than 25% predicted or personal best before treatment, or FEV1 or PEF less than 40% after treatment.  Patients with lung function of 40-60% predicted after treatment may be discharged as long as sufficient follow-up is accessible in the community and compliance is guaranteed (GINA, 2010a, p. 74).

For discharged patients at emergency room.

GINA (2010a, pp. 74-75) recommends a 7-day course of oral glucocorticosteroids, along with bronchodilator therapy.  B. T. was prescribed with both, although the oral glucocorticosteroids was only for five days.  Based on symptomatic and objective improvement, the bronchodilator is used as needed until the patient returns to the pre-exacerbation use of rapid acting B2-agonist.  Ipratropium bromide is discontinued.  Inhaled glucocorticosteroids are started or continued.  Inhaler and peak flow meter use for home treatment monitoring is assessed.  B.T. did not demonstrate the proper use of MDI with spacer.  First, the mouthpiece cap is removed from the spacer and the MDI.  The MDI is then placed into the end of the spacer without the cap.  Make sure that the MDI is fully pushed. The space and the MDI are shaken together two or three times.  Then holding the MDI upright with the index finger on top and thumb on the bottom, the mouthpiece is placed in the mouth, closing the lips tightly around the mouthpiece.  The patient exhales normally and then presses down firmly on the canister releasing one dose of medication.  The patient inhales slowly and deeply. If the patient inhales too fast, the coaching device on the spacer sounds.  The spacer is removed from the mouth while holding breath for 5 to 10 seconds, then exhale normally.  After use, detach the MI from the spacer and put on the capon the MDI and spacer (GINA, n.d.).  B.T. should also be advised on the possible side effects of his medications.

Patients have a better home treatment response if discharged with peak flow meter and action plan.  The precipitating factors of exacerbation and the action plan are reviewed.  The patient or family is counseled to get in touch with the primary health care professional or asthma specialist within 24 hours after discharge, then to follow-up after a few days to ascertain that treatment is continued until baseline control parameters are achieved.  B.T. was advised to contact a pulmonary specialist; however, he was not provided with sufficient education on the precipitating factors of his attack, as well as a peak flow meter and an action plan.

Other Components of Asthma Therapy

The goal of asthma therapy is to attain and sustain control of the clinical manifestations for protracted periods (GINA, 2010b, p. 8).  When asthma is controlled, most attacks are prevented, troublesome symptoms are avoided, and the patient can be physically active.  Thus, the management of B.T.’s exacerbation is just one of five interrelated components of asthma therapy.  The rest of the components are to: (1) develop patient/health care provider (HCP) collaboration, (2) recognize and decrease exposure to risk factors, and (3) evaluate, treat, and monitor asthma (GINA, 2010a, p. 53).

Develop patient/HCP collaboration.

Successful management of asthma entails the development of collaboration between the afflicted and the health care team.  The goal of this collaboration is guided self-management, giving patient the capacity to control one’s condition with assistance from health care professionals.  The partnership is reinforced as the patient and HCP discuss and concur on treatment goals, create a personalized self-management plan, and occasionally assess the patient’s treatment and degree of asthma control.  Education is an essential part of all interactions.  Asthma education is a continuing process that is crucial to “achieving control, improving outcomes, and minimizing medication use” (S. Corbridge & T. Corbridge, 2010, p. 32).  As such, incorporated into every patient visit is a needs assessment of the patient’s major knowledge deficiency, followed by targeted education.  Personalized action plans, created in partnership with the patient, have been shown to improve patient-provider communication and outcomes (Kaya et al., 2009).  Individualized action plans help patients modify treatment in response to changes in the degree of asthma control, as signified by symptoms and/or PEF, according to written preset plan.

Identify and lessen exposure to exacerbating or risk factors.

Steps avoiding the risk factors should be taken for better asthma control and reduced medication needs.  Completely avoiding some of these factors are nearly impossible because patients react to multiple factors commonly present in the environment.  Medications that sustain asthma control are thus important because when the asthma is controlled, the patient is less susceptible to these risk factors (GINA, 2010b, p. 11).  Those with moderate to severe asthma are advised to receive a yearly influenza vaccination.

There are many strategies that the patient and family can employ to avoid some triggering factors.  For B.T. who is highly allergic to dust and pollen, some measures include staying indoors when there is a very high count of pollen.   Carpets can be changed with hard floorings.  On B.T.’s anxiety, once detected, the degree of anxiety should be identified.  He should be encouraged to discuss his feelings and his present condition.  Advise effective coping approach such as meditation and physical activity to alleviate tension.  Desired results are B.T.’s awareness of his anxiety, successful use of support systems, and use of positive techniques (Pruitt & Lawson, 2011, pp. 51-52).

Assess, manage, and monitor asthma.

The goal of asthma therapy can be achieved in most patients through an uninterrupted sequence that involves (GINA, 2010b, p. 12):

(1) Evaluating asthma control where each patient is assessed to establish present treatment regimen, compliance to the present regimen, and degree of asthma control.

(2) Treating to attain control.  As per level of control, treatment is directed by stepping up or down in a sequence of five steps.  Therapy is stepped up for uncontrolled asthma and continued until control is attained.  If there is control for at least 3 months, treatment is stepped down.  As necessary, reliever medication is provided at every step for speedy symptom relief.  Controller medications are given at steps 2 through 5 as preventive measures against symptoms and attacks.  Patients with unacceptable degree of control at step 4 are assessed as having “difficult- to-treat-asthma.”  Specialized care may be needed such as with an asthma specialist.

(3) Monitoring to sustain control.  Constant monitoring is essential to sustain control and ascertain the lowest step and treatment dose to lessen cost and adverse effects.  Treatment is occasionally modified in response to loss of control (GINA, 2010b, p. 16).

Asthma is a serious disease that can place severe restrictions on daily life if uncontrolled and can be fatal. It is a considerable burden not just in health care expenditure but also of lost productivity and diminished participation in family life (GINA, 2010a, p. ii).  However, it is a disease that can be controlled and managed with the partnership of the patient and health care providers.  Awareness of the latest guidelines in asthma therapy such as the Global Initiative for Asthma (GINA) is imperative to achieve the goals of treatment and return B.T. to his optimum level of functioning.

Universal Intellectual Standards of Quality Thinking

In this case study, I have applied clarity, accuracy, precision, relevance, depth, consistency, and fairness.  Clarity portrays the strength in the writer’s position as to how the subject being discussed is thoroughly understood and is conveyed effectively to the reader.  The main gauge is to ascertain how well others are able to understand the position being forwarded. By removing aspects that could mislead like ambiguity or double meanings, one forwards an idea without any distraction.   Accuracy was observed at all times as the medical field uses exact standards.  The next thing is to ascertain that the data being used are precise.  Precision reflects how well one has gone to specific details on a certain subject.  It shows the extent one has painstakingly taken to enhance depth on what is discussed.  If changes are needed, the appropriate corrections are adopted.  This is possible by being consistent on the data and indicators so that the reader can identify with situations or issues presented.  To get this across, fairness was observed so that the work is devoid of any biases.  Lastly, relevance is very important to keep the work in focus.  Nursing is composed of many different facets, it would be good to take extra care in making sure that everything is connected to the topic and that the necessary components have been discussed.

American Nurses Association (ANA) Standards of Professional Performance

In the clinical decision-making process, I have applied quality of care, education, collaboration, research, and resource utilization.  Quality of care is essential in the nursing profession.  It ensures that the patient receives safe, effective, and excellent nursing care, as well as respect and compassion.  I applied education to obtain and maintain current nursing practice especially applicable to asthma patients.  Treatment guidelines are constantly updated as new studies find the more effective approach.   Likewise, I applied research as it is an essential element in health care; it helps in developing treatments that offer the best level of care.  With research, significant advances are made in health and treatments and new changes are implemented.  It can also explain the newest findings on the pathophysiology of disease which aids in the patient’s understanding and acceptance of his or her condition.  I applied collaboration which is an important component in asthma therapy.  Collaboration helps in achieving the goal of therapy by providing the patient an ability to deal with his condition with assistance from health care providers and other support systems like the family.  Lastly, I applied resource utilization to improve safety and effectiveness of therapy while minimizing cost.  Resource utilization also educates the patient and his family on the cost, benefits, and risks of treatment options making them informed consumers.  They are also guided in recognizing and securing available and suitable services to address health needs.

References

Cooper, C. L., Parry, G. D., Saul, C., Morice, A. H., Hutchcroft, B. J., Moore, J., & Esmonde, L.(2007).  BMC Family Practice, 8(62), 1-7.

Corbridge, S., & Corbridge, T. C.  (2010).  Asthma in adolescents and adults: Guideline-baseddiagnosis and management.  American Journal of Nursing, 110(5), 28-38.

Global Initiative for Asthma.  (2010a).  Global strategy for asthma management and prevention,updated 2010.  Retrieved November 18, 2011 from http://www.ginasthma.org/pdf/GINA_Report_2010.pdf

Global Initiative for Asthma.  (2010b).  Pocket guide for asthma management and prevention(for adults and children older than 5 years).  Retrieved November 18, 2011 from http://www.ginasthma.org/pdf/GINA_Pocket_2010a.pdf

Global Initiative for Asthma.  (n.d.).  How to use the able spacer.  Retrieved November 18, 2011from http://www.ginasthma.org/other-resources-able-spacer.html

House, D. T., & Ramirez, E. G.  (2008).  Emergency management of asthma exacerbations.

Advanced Emergency Nursing Journal, 30(2), 122-138.

Kaya, Z., Erkan, F., Ozkan, M., Ozkan, S., Kocaman, N., Ertekin, B. A., & Direk, N.  (2009).

Self-management plans for asthma control and predictors of patient compliance.  J .Asthma, 46(3), 270-275.

Pruitt, B., & Lawson, R.  (2011).  Assessing and managing asthma: A global initiative for asthma update.  Nursing2011, 41(5), 46-52.