Month: January 2018

Uses Of Different Redundant Array of Independent Disks (RAID) In Workplace

Performance is expandedbecause the server has more axles to peruse from or compose to when information is gotten to from a drive.

 

Accessibility is expandedbecause the RAID controller can re-make lost information from equality data. What is equality? Equality is essentially a checksumof the information that was composedof the plates, which gets composed alongside the first information (Wada, 2009). RAID should be possible in programming on a host, for example, Windows FTDISK volumes, or in equipment on the capacity controllers. The server is getting to the information on equipment based RAID set never realizes that one of the drives in the RAID set went terribly. The controller re-makes the information that was lost when the drive went terribly by utilizing the equality data put away on the surviving plates in the RAID set.

 

There are various distinctive ways drives can be gathered together to shape RAID sets. The diverse systems used to gathering drives are calledRAID sorts. RAID sortsare numbered from 0 to 5. The numbers speak to the level of RAID being utilized. Assault levels 0, 1 and 5 are the most common.Combinations of RAID sorts may be utilized together. For instance, you can make two RAID 0 sets, and after that consolidate the RAID 0 sets into a RAID 1 set. This will give you the execution advantages of RAID 0, with the accessibilityadvantages of RAID 1.

 

To survive various commute disappointments in a RAID 10 setup, you ought to make different RAID 1 mirrors, and after that stripe over the mirrors utilizing RAID 0. The length of different commute disappointments happen in particular mirror sets; the RAID set is still accessible(Wada, 2009). In the event that you make two RAID 0 stripe sets and mirror those together, losing a solitary circle inside of the stripe compels all entrance to happen from the reflected stripe set.

 

The RAID sort you ought to utilize relies on upon the kind of utilization you are running on your server. Strike 0 is the speediest. Strike 1 is the most dependable and RAID 5 is a decent mix of both.

Note any special concerns when using each with Windows Serve.

Recent Cases of Child and Elder Abuse – Criminology

The elderly and children are special group of the population which is more likely to be prone to abuse. According the (Moua, Lor, Vang, & Xiong, 2016), there has been a rise in cases of child and elderly abuse in the United States. These abuses vary depending on the group and include psychological, physical and financial abuse for the elderly, physical and sexual abuse for children. The following are two cases of recent abuse for tan elderly and a child in the United States.

Horrific Torture and Killing of Scott McMillan, 3

Scott McMillan died on November 2015 after prolonged negligence and abuse by his parents (Sabin, 2015). Scott McMillan was often tossed to the ceiling and left to fall to the floor and the cries from the kid were reported as mere creams by his parents. His parents, Jillian Tait and Gary Lee Fellenbaum were said to repeatedly beaten the kid with frying pan and hanged him upside down and as they left for drinking spree.

Moreover, Scott McMillan was tied to the seat by electric tapes by his father, Fellenbaum, and abused (Sabin, 2015). He was also beaten when the boy refused to eat and left in the shower when his became unresponsive.

The case represents physical, psychological and emotional abuse of a minor. The medics who attended Scott McMillan revealed that the child had several scars both new and old; indicating prolonged physical abuse of the kid. These abuses caused physical harm as well as emotional and psychological torture to the young kid. The two parents went to a greater extend of tossing the child to the ceiling and leaving him to fall to the ground (Sabin, 2015). This created severe pain to the child. The local authorizes and the medics that attended to Scott McMillan revealed that the child had suffered multiple head injuries and punctured body.

A 71-Year old Woman Beaten by a 59 Year Old Man in Fresno County

According to the (Fresno County Sheriff’s Office, 2015), Brent Nelson, 59 of Coalinga was accused of kidnapping and causing physical abuse to a 71 year old woman. The sheriff’s office further notes that the victim was admitted in hospital with broken ribs, head injuries and punctured lungs. Nelson is 6’10”, 320lbs. while the victim is 5’6”, 130lbs. The two knew each and were considered friends for the past one year prior to the kidnapping of the woman. Nelson would occasionally visit the elderly to help her with her chores.

Nelson called the victim on December 9th 2015, offering to take her out for an ice cream (Fresno County Sheriff’s Office, 2015). This occurred after they had an argument before and Nelson told her that he wanted to make things right. On reaching Coalinga, Nelson told the woman that he had no money to pay for the ice cream. The woman offered to pay but told him that she had left her purse and told Nelson to drive her back so she could pick her purse. On the way, Nelson got upset and begun to beat the woman. On reaching the woman’s home, she tied her hands and leg, throwing her on the bed. The woman could not reach for her phone to call for help. However, Nelson drove back, untied her and begged her not to report the matter to the police. He stayed in her house all the night, leaving in the morning.

However, the victim informed a friend that she had been hurt and needed medical attention. On seeing the severity of the injuries, the victim’s friend called an ambulance, which took her to hospital. Although she had claimed that a stuck of wood had injured her, the Sherriff’s office later found that the woman had lied because she feared if she told the truth to the local law enforcement, Nelson would kills her.

Sheriff’s department in Fresno County took report of her abuse and found that Nelson could have been in possession of some fire arms. The offender was later arrested with the help of California high patrol. He was found to possess past criminal records and the case was placed under investigation.

The woman underwent physical and psychological abuse. The fact that the offender, Nelson tied the elderly woman after beating her subjected her to great pain and suffering. The woman was old and being tied, beaten and living under fear added more psychological torture to her.

How the Credibility of the Sources Were Determined

Although internet offers access to many published materials, it does not guarantee that all the contents are reliable. It is important that source of information is critically evaluated to determine its credibility. To ascertain the credibility of the sources of the information discussed, the publishing websites were scrutinized to ensure they were recently updated. The website that was used to obtain the information about the abuse of the elderly woman was government website, whose information was updated regularly. The website that provided the case on the child abuse was also recently updated, with physical address, in addition to telephone and email contacts. Moreover, the information from the website was published by an individual with professional knowledge in the area of investigative journalism.

Federal and State Domestic Abuse Laws – Texas

Federal and State Domestic Abuse Laws

Violence perpetuated against the loved ones are often confusing, degrading and frightening. The federal government in realizing the overburden of the state and local criminal justice department has developed a number of laws to deal with domestic violence (Dempsey, 2011). This was done with the declaration of domestic abuse as a national crime.  In addition, the various states have enacted numerous legislations to complement the state laws in fighting against domestic abuse.

Federal Domestic Abuse Laws

            The Violence against Women Act

The 1994 Violence against Women Act (VAWA) was enacted and passed by the Congress in 1996. The VAWA established the national domestic violence hotline and stipulated programs to help end violence against women. In addition, VAWA created a number of protections to the battered spouse, including confidentiality of new home address and changes in the immigration laws that allowed permanent residency to the affected spouse. Examples of cases that fall under the purview of the VAWA include stalking, sexual assault, dating and domestic violence.

According to (Sacco, 2015) the VAWA has two major provisions, the grants and the provisions on investigations and prosecutions. After its passage, the VAWA had an immediate impact on the investigations and prosecutions of violence against women. The act established penalties and new offenses for violation of stalking, the protection order, where an abuser crossed a state border to harass or abuse a victim or forced a victim to cross a state order under duress and proceeded to harm the victim. Moreover, the act issued orders for states and territories to enforce protection orders issued by other tribes, territories or states. It also allowed for enhanced sentences for repeat sex offenders, as well as the funding of the Attorney general to develop training programs to assist the parole and probation officers in helping released sex offenders.

Moreover, the VAWA allowed for pretrial detention of sex offenders, restitution to victims of federal sex offence and provision of civil remedy, which allows victims of sexual offence to seek penalties from their assailants and provisions that allowed the victims to demand that their assailants be tested for sexually transmitted infections (Sacco, 2015).

The VAWA created a number of grant programs for a number of activities related to domestic abuse crimes (Sacco, 2015). The programs developed include programs aimed at preventing domestic crimes, investigation and prosecution of domestic crimes, collaboration between the judicial, private and law enforcement and the programs that cater for needs of special population such as the old, disabled, minority communities and young. These grants are administered by the CDC, department of justice, Violence Against Women, Office of Justice programs and the Department of Health and Human Services.

Texas Domestic Abuse Laws

            Texas recognizes a number of crimes under its domestic abuse laws (Eigenberg & Moriarty, 1991). Under the Texas state domestic abuse laws, an crime is categorized as domestic violence if     the crime is committed against someone the offender has been dating or dated in the past and if it is committed against a household or family member. The domestic crimes in the state of Texas are categorized as continuous violence against the family, domestic assault and aggravated domestic assault. In addition, crimes that involve current or former spouse, someone who lives with the offender, family member by blood, marriage or adoption, foster parent/child, a person who is or had romantic relationship with the offender and a child of current or former spouse are categorized as domestic violence in the state.

Domestic Assault

Under the Texas domestic abuse law, an individual is guilty of domestic assault of one commits an assault against a family member, current or past dating partner or member of the household. According to (Nachtigall, 2014), domestic assault is treated with the utmost seriousness in the state than any other domestic offence. The Texas Domestic Violence Statute, Penal Code, Title Five, Chapter 22, Section 22.01 defines assault as intentional or reckless bodily injury to another person, intentional threats with bodily injury or intentional body contact that offender reasonably knows the victim will find offensive/provocative (“Offenses Against the Person,” 2018).

The assault can be categorized as Class A Misdemeanor is the offender has no prior domestic conviction, while the crime will be termed as third degree felony if the offender involved in assault has a prior conviction in domestic violence. However, domestic crimes in Texas attract varying penalties, third degree felony can attract 2-10 year prison sentence, while Class A misdemeanor attracts a prison term of up to one year. Examples of offences under the domestic assault include bodily harms to partner, child or household member, intimate strangulation, rape and wife battering.

The domestic assault laws in the Texas have profound impact on child custody decisions. The Texas laws prohibit parents from being joint conservators of the child if there has been a proven case of sexual abuse by one of the parent towards the other in the past two years.

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Avon’s External Environment Analysis

Many external factors influence firm’s strategic direction, action and its internal processes as well as the organizational structure (Kearney, Hisrich, & Antoncic, 2013). These external factors can be categorized as those in the remote environment, industry environment and the operating environment. Avon is one of the leading multinational corporations that specialization in the production and sell of beauty products in Asia, Latin and North American and the Asian pacific. The company has a host of factors in its external environment, which influences its strategic directions.

An analysis of the external environment within the Avon Inc. reveals that the company’s strategic decisions are influenced by factors in the remote environment such as technology, social, political, ecological and economic factors (David, 2010). The political situations in the emerging markets influence the firm’s decisions to invest in such markets. Moreover, the economic and social factors in the emerging markets form important factors that influence the firm’s strategic directions. These remote factors are beyond the control of the company and they exert great influence on the strategic direction that the company adopts. For example, political instability in the African market has witnessed less investment in such market by the company. The strong economic and social development in the North and Latin America and Europe has seen the company concentrate in such markets.

The other external environmental factors that influence the strategic direction of Avon are the market competition and the firm’s competitiveness. The beauty products market is very competitive, with major competitors of Avon being Revlon, and Mary Kay Inc. However, the huge financial base and the specialization adopted by Avon offers the company a competitive advantage over other cosmetics players in the market. According to (David, 2010) the revenues of Avon exceeds those of its closest competitors.

SWOT Analysis- Threats and Opportunities

            The major opportunities for Avon Inc. are the emerging markets in Africa, Eastern Europe and Middle East, the increasing demand for the anti-aging products, the strong research and development history of the company. Moreover, the 2005 restructuring allowed Avon to free more funds that were devoted to advertisement, which created an opportunity for the expansion of the company market share (David, 2010).

However, the company faces numerous threats in form of other major players in the market such as Proctor & Gamble and Unilever (David, 2010). These companies have increased their market portfolio to include beauty products and thus threatening Avon market share. In addition, the economic downturn in the emerging markets threatens the company profitability. Other sources of threats include government regulations, for example the U.S Federal Trade Commission law of 2006 that regulated U.S businesses.

Five Forces Analysis

According to Porter, the nature of competitiveness in the market is influenced by five forces, the potential entry of new competitors, rivalry among firms, potential entry of substitutes, the bargaining powers of consumers and suppliers (David, 2010, pg. 74). The beauty products market is competitive and the countercyclical nature of the market has seen the entry of new competitors such as Amway. Moreover, the entry of substitute products, such as the “green” products threatens the demand for Avon products in the market.

Strategic Group Map

The strategic group map is the analysis of firms that offer similar products in a particular industry (Short, Ketchen, Palmer, & Hult, 2006). Avon Inc. faces competition from companies such as Amway, Proctor & Gamble and Unilever. Despite the presence of these firms, Avon continues to be the leader in the market, largely due to its huge financial base, strong research and development and its adoption of specialization. This has allowed Avon to sustain its growth and profitability in the market for many years.

Evidence Based Practice – Hourly Rounding

Background of the problem

            Hourly rounding is defined as “a systematic, proactive nursing intervention designed to anticipate and address the needs of hospitalized patients.” Studies have indicated hospital stay elevate the stress experienced by patients and their families. Since the patient and their families are subjected to hospital environment where he/she is required to undergo various tests and treatment monitored by physicians, nurses, doctors and other healthcare personnel(Mitchell, et al., 2015). These conditions make the patients to be vulnerable emotionally and social. In most cases, the patients are required to use nurse call button in order to have their needs met. In extreme situations, patients experience falls, reduces satisfaction rating, skin breakdown and ulcers.

Read also Evidence-Based Practice (EBP) Summary

Stakeholders

            Stakeholder involved in this evidence-based practice include: patients and the nursing staff who are the crucial stakeholders. Other important stakeholders include: nursing quality staff, customer service staff, clinical nurse specialists for the unit, chief nursing officer of the main hospital, director of nursing for the unit, the nurse manager of the unit, staff nurse and other direct care givers and patient families.

PICOT questions

            The PICOT question developed for this evidence-based practice, hourly rounding project was “On a medical acute care setting (P), does the implementation of the hourly rounding (I), compared to no hourly rounding (C),helps to improve patient satisfaction by reducing anxiety and decrease use of call bell (O) over one year period (T)?”

The purpose

            The purpose of this hourly rounding project was to determine whether implementation of hourly roundingpromotes patients satisfaction, safety and quality of health care delivery by reduce patients falls, reduce patient use of call bells/light, reduce in pressure ulcer and skin breakdown as well as increase patient satisfaction ratings(Halm, 2009). This involves synthesizing the evidence related to the impacts of hourly rounding program on the improvement of the quality health care delivery, patients’ safety and satisfaction in acute care setting by reducing anxiety and decrease use of call bell(Blakley, et al., 2011).

Read also Hourly Rounding In Improving Patient Outcome – Sample Paper

The measurement that were taken before and after the implementation of evidence-based practice were the percentage in patient satisfaction rating, the percentage of patients that experienced anxiety, the percentage of patient falls, the percentage of patient use of call light/bells and the percentage of patient with pressure ulcers and skin breakdowns.

Rationale

            Many studies have indicated that intentional checking on patients at hourly interval is the core approach of improving patients’ needs as well as enhance patient satisfaction and safety. Published articles indicates that purposeful and systematic rounding by health professional especially nurse on-duty significantly improve patient satisfaction(Wood, 2009). Further studies have shown that proactive and systematic nurse rounding such as hourly rounding is the key mechanism of reducing fear and anxiety. Survey have suggested that equipment alarms, bathroom assistance, personal assistance and pain management were main cause of pushing the call bell. Statistics indicated that hourly rounding reduced the use of call bell by an average of 37 %. In addition, the hourly rounding reduce patient falls by 52 % and pressure ulcers and skin breakdowns by 14 % because the nurse rounding helps patients to change directions(Mitchell, et al., 2015). The program also increased patient satisfaction rating by 12 %. These statistics have been supported by many studies that focused on hourly rounding.

Comparing And Contrasting Two Articles – Gender: A Useful Category of Historical Analysis Vs On medicine women and white shame-ans

Gender: A Useful Category of Historical Analysis

            This article attempts to present chronology of the word ‘gender’ through the lenses of history. For over a long period of time, scholar have made use of figurative allusion with grammatical terms to instigate traits of sexuality or character. It is only recently that scholar introduced the world ‘gender’ into encyclopedia of social science and dictionaries (Scott). The scholar begun to use the word ‘gender’ when describing the social organization in regards to the relationship between the sexes. The connectedness of the word ‘gender’ and grammar is full of unexamined possibilities and explicit. It is full of unexamined possibilities in the sense that many Indo-European language have third group of neuter or unsexed (Donaldson). On the other hand, it is explicit by the fact that the use grammar follows a formal rules that observe the adherence of feminine or masculine designation.

The author of this article indicated that gender has been often used in many article to refer to female. The approach favors the argument by the earlier social scientists, theorists of patriarchy and feminist historian (Scott). For several year, the world gender has been used to demean women based on social and economic achievements in the society. However, in the late 20th century, the use of the word gender has been commonly used to describe the equality in relations with feminine and masculine.

On medicine women and white shame-ans

            This article began by presented how Chief White Cloud and White Swan Women exchanged their vows. The author narrated vividly the dressing mode of the bride and bridegroom in which all the outfit was made from polyester suede (Donaldson). The second scene in the article presented about the Women’s Studies in which the non-native were borrowing native spiritual practices. The incident was demonstrated when young women questioned the bitterness expressed by the native Indian American since they didn’t want White American to imitate their cultures (Appadurai). When asked the student vehemently expressed their white American took their resources, lands and now they want to take their cultures.

The two scene highlighted the complex and volatile issues affecting what the author refers to as “New Age Native Americanism” (NASA). The article described the scene as a misappropriation of American Indian tradition to be an alternative sources of spirituality and knowledge. For example, the marriage of Chief White Cloud and White Swan women was performed with the bride and bridegroom addressed on Native Indian clothes yet the two are supposedly to be British (Donaldson). On the other hand, NASA is seen as the most useful movement for feminist transformation. According to this article, non-native women uses Indian tradition as an avenue of avoiding patriarchal biases of monotheistic religion and gain access to empowerment.

            The core theme of this article was to present events that involves the use of cultural diversity such as dressing mode to express the social identity of certain people in the society (McClintock). For instance, the author presented the use of native cultural practices and names by non-native to disguise themselves in order to be accepted as part of the society in which the cultural practice is practiced. From the article, it is clear that cultural practices such as dressing modes and names have specific means to particular communities in the society.

Comparison

Both article highlighted the issues of feminism and masculine in the society and how it has evolved over a long period of time. For example, in the first article the author presented the step that lead to the adoption of the world gender in the modern social science (Donaldson). The use of the world ‘gender’ by the American feminists was meant to emphasis fundamentally social quality of distinctions based on sex. According to Scott, the use of ‘gender’ was to highlight the avoidance of using biological determinism when referring to sexual difference or sex. In addition, the use of the world ‘gender’ in the first article was to emphasis the relational aspect of normative definitions of femininity (Scott). In the first article, Scott quoted Natalie Davis stressing the importance of understanding ‘gender’ from the historical perspective of women and men.

“It seems to me that we should be interested in the history of both women and men, that we should not be working only on the subjected sex any more than an historian of class can focus entirely on peasant. Our goal is to understand the significance of the sexes, of gender groups in the historical past. Our goal is to discover the range in sex roles and in sexual symbolism in different societies and periods, to find out what meaning they had and how they functioned to maintain the social order or to promote its change” – Natalie Davis.

Similarly, the second article emphasized the importance of understanding feminism from Native American knowledge and from the much wider spectrum of New Age Native Americanism. In this case NANA existed as a unique subgenre of New Ageism and involves the determination for the alternative spiritualties and lifestyle.

Another similarity of the two articles is that both have contributed to a more captivating discussion about feminism based on the cultural misappropriation and misinterpretation of certain words. The two articles laid down the foundation for comprehensive understanding of feminism and masculinity from the perspective of cross-cultural relationships. Further, the two articles extended their discussion and highlighted the influence of popular feminisms and the impacts of academic feminist community in the modern society (Scott). For example, in first article the author used chronological events to explained how the term ‘gender’ was integrated into the dictionaries and encyclopedia of social science. Similarly, the second article used NASA to present how modern American society influence the changes in the spiritual and cultural practices.

Contrast

Yet the two articles comprehensively advocated for the equality of women in the society and academic feminist community, each article attracts different critiques based on the arguments presented. For example, the first article approach the issue of women inequality using misinterpretation if certain words such as ‘gender’ (Scott). This means that the author of the first article focused her arguments around the term ‘gender’. Throughout the article, the author demonstrated how many scholar used the term ‘gender’ to refer to women. Some her critiques may argue that before the term ‘gender’ was included in the dictionaries and encyclopedia of social science, the scholar were correct use two words interchangeably.

In contrast, the second approach the issue of feminism from lifestyle and spiritualism. The author of this second article centered his arguments on cultural practices. Although, the two articles highlighted the influence of academic feminists in the community in the understanding of women inequality, the theme of the first article was centered on the term ‘gender’ and the second article was centered in the cultural practice (Donaldson). This means that critiques of the second article focuses on the misappropriation of native culture, while those of the first article focuses on the skewed interpretation of feminism. Another contrast between the two article is that the first article employed the various theories including the Marxist and historians to explain the inclusion of the term ‘gender’ into the encyclopedia of social science and dictionaries as one way of avoiding skewed interpretation of the term, while the second article used integrated real life.

Download full sample paper comparing and contrasting the two articles or order a unique paper at an affordable price.

The Importance and Use of Theories in Health Education

  1. Describe the main points of each of the health behavior theories in your own words.
  2. Select two health behavior theories and go to the professional literature and locate two articles related to programs. Use two health behavior theories from the following list:

Precede-Proceed Model; Health Belief Model; Stages of Change Model; Social Cognitive Theory; Stage Theories of Organizational Change or Community Organization theories. Briefly describe the behavioral theory and why each theory contributes to the program planning strategy for each program.

Complete this assignment as a Word document. The paper should be approximately two pages in length, double-spaced using 12-point Times New Roman font, using references to support your response.

CVS Pharmacy Company Analysis

Internal environmental analysis CVS

            CVS Pharmacy is rated as the biggest pharmacy health care provider in the United States of America. CVS pharmacy provide various service in different parts of the United States which include claims processing, formulary management, plan design and administration, specialty pharmacy, mail order pharmacy service and pharmacy benefit management (Calia, 2014). It is approximated that CVS pharmacy runs 7,000 stores and operates in 49 states of the United States and in the District of Columbia. CVS delivers services and products to their customers through their own stores, third party organization and subsidiaries. In addition, the company allows the customers to place their orders online by login onto CVS.com. Recently, the company expanded its operations by acquiring Caremark Corporation in 2007, thus allowing the company to take over the operations of Caremark’s pharmacy stores.

Core competencies

            CVS pharmacy is one of the leading corporation in terms of market share in the retail drug industry. The company has managed to put together its capabilities and resources and utilize them to create a core competencies that make the CVS pharmacy to maintain its position as competitive in the drug industry. The core competencies of CVS pharmacy is the unique ability of innovation and production of new products and services that makes its competitors very difficult to mimic, thus enjoying its competitive advantage in the market over its rivals (Ryder, 2010). The CVS has been in the forefront introducing innovative services and products into the market. According to Rekers (2010), CVS pharmacy had 4,300 CVS brand products that ranged from beauty products, general merchandise and vitamins. Further analysis indicated that CVS pharmacy’s outstanding customer service propels the company to be the leading drug store in the United States.

Read also Virginia Pharmacy Technician Study Guide

The excellent customer service, eager and capable workforce have been identified with CVS pharmacy and many customers who directly or indirectly consumes products and services of the company have recognized the outstanding customer service offered by the company. Another core competency associated with CVS pharmacy is unique marketing capability which is always driven by innovation (Dinesh, 2011). So far, CVS pharmacy is the only corporation in the retail drug industry that is implementing ExtraCare Loyalty program. This program does not only helps the company to attract new customers but also helps to retain the largest base of the existing customers. Analysis indicated that CVS pharmacy has tailored its marketing mix in order to serve and attract customers from different demographics such as all income groups, gender, racial and age.

Capabilities

            CVS pharmacy’s capabilities are founded on the impressive knowledge resource deeply rooted in the company. The company has branded itself as the leading innovator in the retail drug industry in the United States due to its advance technology and techniques it utilizes to transfer and exchange of knowledge. Some of the current techniques and technology that CVS pharmacy have implemented include the use of RX connect, which facilitates secure and quick pharmacists communication hence enhancing accuracy on the prescriptions fill (Van, 2014). Other knowledge resources that CVS pharmacy uses include CVS Rapid Refill and automatic prescription refill system. These systems facilitate and allows the customers to place an order for prescription refills 24 hours a day through a touch-tone telephone. Another capability that CVS pharmacy have demonstrated in the retail drug industry is the strong market.

The strong market is derived from the innovative marketing techniques which continuously develop unique and new service and products. The capability of the CVS pharmacy to adjust market mix of product and services to match the preference and needs of wide range of customers drawn from all demographic has helped the company to achieve customer satisfaction. This strong innovative thinking capability witnessed in CVS pharmacy is credited to dedicated, motivated and strong human resources (Calia, 2014). The combination of marketing resources and innovative resources makes CVS pharmacy one of the companies with strong capabilities in the retail drug industry. For example, some of the CVS pharmacy’s strong marketing capabilities include: big discount marts, direct access path that leads directly from the front door to the pharmacy, preferred products categories of baby boomers and innovative and creative store design that changes the shopping experiences for the customers.

Strong financial resource is another aspect that make CVS pharmacy to create strong brands and acquisition of companies that helps CVS to expand its product line. Financial resources also enables the company to acquire patents and reorganize its brands to conform to strategic merger with competing companies (Van, 2014). For instance, CVS pharmacy was able to acquire Accendo insurance and SilverScript insurance, hence becoming eligible to be national provider of drug benefit to beneficiaries meeting the criteria of the Federal government’s Medicare Part D program. Following the merger of CVS and Caremark Company, CVS pharmacy is currently the largest retail drug store in the United States.

Lastly, innovative and creative technology, effective marketing strategies, result-oriented, enthusiastic and energetic human resources enables CVS pharmacy to have proficient operation capabilities. For example, CVS pharmacy implemented Visible Improvement in Profit, Execution and Results (VIPER) system and cutting down the expenses of inventory, which is clear indication of efficient operations (Dinesh, 2011). VIPER system improves monitoring of compensation, treasury, bank reconciliation, sales/audit, merchandising, marketing, operations, pharmacy and store operations hence increasing efficiency of the operations. in addition, VIPER system enhance accountability of the transactions carried out through point-of-sale systems hence reducing the cases of losses associated with fraudulent and processes of deficiencies.

SWOT analysis

Strengths –          Quality service and fully integrated pharmacy

–          Pharmacy benefit managers

–          Prices charged

–          Over 7,600 retail locations

Weak –          Stopping these sale equals profit loss

–          Selling tobacco and alcohol which does not align with company mission

Opportunities –          Possibly implemented an all-natural line to the brand

–          Socio-cultural trend towards health conscious

Threats –          Government regulations such as legal and regulatory proceedings, government inquiries, audits, investigations, litigation matters, restrictions and FDA

–          Saturated market

Resource-based view

Tangible resources

            Analysis indicated that CVS is the household name since most health care providers prefer their brand in the United States and District of Columbia. For many years, CVS pharmacy has remained the leader in the market for health care provider in the United States. Current statistics indicated that 91 of the top 100 drugstore market have their operations controlled by CVS pharmacy. Further analysis indicated that CVS pharmacy is the majority or second largest shareholder in 68 stores in the present market (Ryder, 2010). During the year 2009 the net sales of CVS pharmacy brand increased by $11,257 to $98,729 which is an increase of 12.87 % as compared to the previous year 2008. The growth in customers base and general acceptance by customers of the CVS pharmacy’s new and existing product and services are attributed to the increase in revenue. Within the same period of time, gross profit increased by $2.204 million which is a growth of 11.27 % from the previous year.

Currently, CVS pharmacy has a long-term debt in terms of bond with a maturity period ranging from 5 to 10 years. Similarly the CVS pharmacy has cash and cash equivalent of $1086 million by the end of year 2013. CVS pharmacy operations are divided into three segments: corporate segment, retail pharmacy segment and pharmacy services segment. The pharmacy services segment runs over 49 retail specialty pharmacy stores, six mail service pharmacies and eighteen specialty mail order pharmacies all distributed across 25 states, District of Columbia and Puerto Rico (Dinesh, 2011). CVS pharmacy operates 7,025 retail drugstore falling under retail pharmacy segment. Of this 6,964 are operated as a pharmacy online website (CVS.com). In addition, CVS pharmacy and its subsidiaries have a workforce of approximately 211,000 employees. This include about 26,000 physician assistant, nurse practitioners and pharmacist. Of the total employees, it is approximated that 84,000 work as a part-time employees, which means that they work for less than 30 hours per week.

Intangible resources

            It is important to understand that it is not only tangible resource that make CVS pharmacy to be the most competitive, but also intangible resources contributes immensely. For example, the very talented employees always strive to improve operations in the corporate segment, pharmacy segment and front store. Fortune 500 magazine ranked CVS pharmacy at position 19th making it the nations’ largest drug chain standing (Dinesh, 2011). These achievement are attributed to the integrated efforts of the management and employees. Another important intangible assets that make CVS pharmacy is exceptional customer service. For example, the use of ExtraCare card loyalty program.

Analysis indicated that CVS pharmacy has the most resourceful, well-organized, competent and efficient customer service employees as compared to its competitors. The customer service employees are always ready to assist the customers meet their demands. In order to ensure that CVS pharmacy’s knowledge is passed on from the mentors to the newly recruited employees, the company promotes a team-oriented atmosphere. The company also use various information system platforms to facilitate its pharmacy service segment. The incorporation of information technology enable the organization to centralize the storage of data generated from fulfilling other PBM clients’ service contracts, adjudicating retail pharmacy claims and filling mail service prescriptions.

Value chain analysis

            Value chain analysis indicated that CVS pharmacy remains competitive advantage over its rivals by preparing and selling medicine/drugs in prices that other companies finds it difficult to mimic since they risk being squeezed out of the market (Ryder, 2010). also, CVS pharmacy engages in retailing basic consumable good other than medicine/drugs, something that its rivals finds risks to engage in. during the deliveries of supplies and orders, CVS advice customers on the use of prescription and over-the-counter drugs hence enhancing the trust of consumers. Additionally, CVS pharmacy provide its consumers with miscellaneous items such as light refreshments, magazines, cosmetics and candy

Morbid Obesity Research Paper

Part 1: Analysis of the Morbid Obesity Process in General

Introduction: Definition of Morbid Obesity

Morbid obesity is a condition associated with individuals who register a body mass index (BMI) of more than 40, which constitutes more than 50% or 100% above what their ideal body weight should be (Sturm & Hattori, 2013). The BMI is a test used in the estimation of body fat content and helps in the determination of an individual’s health based on a correlation between size, height, and weight (Sturm & Hattori, 2013). Despite the fact that BMI does not provide perfect measurements, it does however provide a general estimation of an individual’s ideal range weight for their height.

Pathophysiology and Epidemiology/Prevalence/Risk Factors

According to the Centers for Disease Control and Prevention (CDC), in the United States, more than 50% of the adult population are either overweight or obese, which translates to approximately 120 million adults (Brethauer, Kashyap, & Schauer, 2013). Out of this group those who suffer severe obesity constitute about 20 million adults (Brethauer, Kashyap, & Schauer, 2013). Adults living with morbid obesity in the United States amount to at least 24 million. This problem of obesity is becoming a health epidemic with more people around the world being diagnosed with this condition. In the United States, between the year 1980 and 2010, the prevalence of obesity has increased from 15% to 36% with the prevalence of extreme obesity in women being at 8.2% while that of men at 4.4% (Brethauer, Kashyap, & Schauer, 2013). That said, research has shown that compared to white males, women and minorities are affected the most by obesity and morbid obesity. With 17% of adolescents and children suffering from obesity, the situation appears to be worse especially because the prevalence of obesity in this age group has tripled from 1980 (Brethauer, Kashyap, & Schauer, 2013).

The understanding of what causes morbid obesity is based on the logic that when energy usage is exceeded by caloric intake then one’s total body fat increases (Zhang, et al., 2014). When one eats, the body uses the calories from the food to run body functions and when the calories are not fully utilized, the body converts them and stores them as fat. Morbid obesity is thus a result of too much fat being stored in the body. That said, behavioral factors play a major role in the development of morbid obesity, for instance, there is a strong correlation between people’s eating habits, exercising habits or physical output and the development of morbid obesity (Zhang, et al., 2014). Be that as it may, how an individual’s body stores energy or fat can be affected by genetic factors, which makes certain individuals more susceptible to developing morbid obesity compared to others (Zhang, et al., 2014).

Clinical Presentation/Symptoms

Morbid obesity is associated with over 30 comorbid conditions. 15% to 25% of obese patients present with diabetes mellitus and insulin resistance (Brethauer, Kashyap, & Schauer, 2013). Debilitating joint disease is also common in patients with morbid obesity because of the stressing effect that excess weight has on the back and joints. In morbidly obese patients, conditions such as abdominal hernia, venous stasis disease, stress urinary incontinence, and gastro esophageal reflux are contributed to by intra-abdominal pressure, which is as a result of increased abdominal fat (Brethauer, Kashyap, & Schauer, 2013). Liver failure due to fatty deposits in the liver is also a common presentation especially after the liver progresses to nonalcoholic steatohepatitis (NASH). Type 2 diabetes, blood lipid abnormalities, heart disease, gallstones, reproductive problems, metabolic syndrome, certain cancers, obesity hypoventilation syndrome, stroke, sleep apnea, and osteoarthritis are some of the serious and complicated health problems associated with morbid obesity (Zhang, et al., 2014). According to (Pour, Norouzzadeh, & Heidari, 2015), risk factors such as obesity, smoking and hypertension affected the symptoms of Acute Coronary Syndrome with both younger and older patients exhibiting a lesser chance of experiencing typical symptoms.

Natural history of Morbid Obesity

Primarily, adipose tissue is stored in the abdominal cavity and subcutaneously, with males more likely to deposit fat in the abdominal compartment while females being more likely to deposit fat in the peripheral tissues. Peripheral fat is less metabolically activity compared to central or visceral fat, which is often associated with increased risk of cardiovascular atherosclerotic disease, high blood pressure, type 2 diabetes, dyslipidemia (Brethauer, Kashyap, & Schauer, 2013). It has been observed fairly accurately that in the development of obesity, the number of fat cells are continually on the increase and as they grow higher amounts of cytokines are released and consequently lower amounts of adiponectin are released (Brethauer, Kashyap, & Schauer, 2013). Consequently, lipid metabolism and glucose are affected negatively resulting in the proinflammatory state associated with obesity. This state of low-grade inflammation has been implicated in the development of the hypercoagulable state, and coronary and vascular artery disease seen in patients with morbid obesity (Brethauer, Kashyap, & Schauer, 2013).

Diagnostic Testing

In the determination of morbid obesity, a patient’s BMI is one of the most significant indicators together with any noteworthy comorbid conditions such as cancer, heart disease, or arthritis, which are often chronic. To uncover previously undiagnosed comorbidities thorough physical and history examination would need to be carried out. A thorough history examination should also reveal obstructive sleep apnea, which often goes unrecognized in patients with morbid obesity. A baseline electrocardiogram (ECG) should be carried out on patients being evaluated for morbid obesity because obese patients are at greater risk for cardiovascular disease.

Medical Management/Treatment Plan including goals of treatment, pharmacological and non-pharmacological treatment including rationales from evidence-based studies

There are two main options in the treatment of morbid obesity: Non-surgical treatment and surgical treatment. Under the non-surgical option of treating morbid obesity there are conventional methods recommended for weight loss such as medication, exercise, and dieting. While these options may work in the short-term, for people who present with morbid obesity, these options may not solve the problem permanently, resulting instead in the ‘yo-yo syndrome’ where weight lost is continually gained back and lost again often with serious health and psychological consequences. Since the development of obesity may involve central pathophysiological mechanisms such as neuroendocrine hormone dysfunction and impaired brain circuit regulation, anti-obesity drugs may be prescribed in addition to other management therapies to reduce fat absorption and appetite (Zhang, et al., 2014).

Under the surgical option of treating morbid obesity there are certain procedures such as Laparoscopic Adjustable Gastric Banding and the Gastric Sleeve that have helped patients improve their health and enhance their quality of life by maintaining significant weight loss (Alexandrou, et al., 2015). In the effort to lessen nutrient absorption and stomach volume, and to induce faster satiety, Bariatric surgeries performed on morbidly obese individuals have been successful.

Morbidly Obese Patients and Family

Morbidly obese children and adults alike face numerous challenges in their lives and often become withdrawn from society through experiencing instances of stereotyping, stigma, and rejection, which takes a toll on their health and psychological wellbeing. This often results in anxiety, body image concerns, avoidance of physical activity, suicide, self-harm, depression, low self-esteem, and binge eating (Flint, 2015). This further strains their relationships with their families who have to care for them, assist them with mobility, contribute financially to cater for their medical expenses and non-standard lifestyle that requires modifications in nearly all areas, transportation, dietary needs, specialized equipment, and modified structures at home. To help morbidly obese patients and their families to co-existing positively and supportively, the preservation of patients’ dignity remains at the core where the family ought to receive caregiver training and education that uses supportive language, and respectful communication (American Diabetes Association, 2016).

Conclusion

Morbid obesity is an ultimately fatal disease with those living with the disease living in a difficult state. To make the management and care of morbid obesity more effective and streamlined, the needs and perspectives of patients, care providers and the family members of the patients must be understood. To optimize opportunities and to avoid substandard approaches in the provision of the best care for morbidly obese patients, lessons should be continually learned from the current and past experiences of caring for the morbidly obese patients.

Measures Used by Governments and Central Banks to Manage the Economies of their Countries

The governments and their central banks can influence the economy of their countries through a number of measures (Attinasi & Klemm, 2016). When the rates of inflation rise, the interest rates rise, similarly, recession can cause many business to close down and rise in unemployment rates within a country. In order to mitigate such effects on a country’s economy, the governments and the central bank can develop policy measures that can cushion its local companies and control the inflation and unemployment rates.

One such measure that the government, through its central bank, may use are the fiscal policy measures. The fiscal policy measures include taxation measures and government expenditures. The government can manage their economies through increase/reduction of expenditure or an increase or reduction in taxes (Attinasi & Klemm, 2016). For example, if a country is faced with recession, the government can choose to increase the levels of its borrowing. Through increased spending in infrastructure, governments will inject more money to the economy and this help in creation of employment opportunities. This also creates a multiplier effect, where higher spending will occur due to the initial injection of the money. The increased aggregate demands are important in cushioning the country out of recession.

However, if the government faces higher inflation rates, the government can increase taxation to reduce demand and consequently reduce the rates of inflation (Attinasi & Klemm, 2016). The increase in taxation is done with a reduction in the government spending. This ultimately reduces the money in circulation within the country and thus reduces the inflation rates.

The other measure is the monetary policy, which is carried out by the central bank of a country, such as the Federal Reserve in the U.S. Monetary policy is mainly concerned with the management of the interest rates and the supply of money in circulation within a country (Ryoo & Skott, 2016). The monetary policy has been employed by the central banks to stimulate economic growth or slow down the rate of growth for fears of inflation.

The major tools of the monetary policy include the changes in the commercial banks’ reserve requirements and the open market initiatives (Ryoo & Skott, 2016). The central bank or Federal Reserve in the U.S can set the amount of money the commercial banks can withhold without lending, called the reserve ratio. In doing so, the Federal Reserve or the central bank exercises direct influence on the amount of cash that is available for loans. The open market operations, mainly done by the Federal Reserve concern the daily purchase and sale of the bonds in a move to inject or limit the money under circulation.

The monetary and fiscal policies are economic measures can be considered as short-term measures since their results can be felt within a reasonable shorter time. However, sometimes, the government can undertake long-term measures to influence the country’s economic growth (Bripi, 2015). For example, a country may increase import duties on certain products to protect local industries. Also, the government may develop policy measures that limit the amount of imports, to help cut the country’s deficit. Moreover, a country may decide to reduce tax on certain important imports in order to spur infrastructural development. All these measures provide long-terms measures with which the government can influence its economic growth.

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