Thursday, October 31, 2019

WHY HAS PRISON EMERGED AS A PROMINENT FORM OF PUNISHMENT FOR MOST Essay

WHY HAS PRISON EMERGED AS A PROMINENT FORM OF PUNISHMENT FOR MOST CRIME AND WHAT ARE ITS FUNCTIONS IN RELATION TO WIDER SOCIETY - Essay Example In the last seven decades, a strong emphasis on rehabilitation, gave way to the focus of justice and fairness. In this case, sentences mainly reflect just deserts rather than utilitarian motive. There is also an emphasis on incarceration which reduces crime in the society. The crime control model has also become popular. Additionally, four major goals are emphasized in the modern prison and punishment sector which include retribution, incapacitation, deterrence, and rehabilitation. The three goals aim at protecting the general public (Smith, 2008, p. 6). Prisons are intended to serve four distinct functions: punishment, deterrence, ensuring public safety and security, and rehabilitation of a criminal offender (Flynn 1998). When a criminal is socially isolated and confined in prison, the intention is to remove this threat from society; a threat to the established social order in a region, thereby ensuring that his deviance can no longer disturb peaceful and compliant society members. Deterrence speaks to rehabilitation, changing an offender’s beliefs, values, perceptions and motivations to effectively restore his position in society and re-socialise him according to established societal norms related to morality and social harmony. The main goal of imprisonment is to give the offender adequate time to reflect on his criminal experiences and find, ultimately, repentance and remorse for these behaviours (Hanser 2012). The main function of prison is correction, ensuring that individuals who do not comply with established laws designed to uphold established social norms are punished according to their criminal deeds; hence through correction becoming more socially compliant. In essence, prisons serve as obedience education institutions. This has been the basic premise of utilising prisons to correct offenders throughout the modern era, suggesting that prisons could serve as centres of moral instruction to ensure that,

Tuesday, October 29, 2019

Employee Empowerment Essay Example | Topics and Well Written Essays - 2750 words

Employee Empowerment - Essay Example This implies that lower level managers and supervisors are expected to implement decisions made by top-level managers, which increases rigidity. Employees of the company are expected to follow strictly their supervisors and managers decisions without question. According to the employees, delegating some decision-making powers to them would enable them act promptly to improve the efficiency and manufacturing processes of the company for better performance. However, due to the bureaucratic nature of the company, the managers and the supervisors deny the employees such powers. The overall effect has been that the employees of the company are demoralized resulting in high labor turnover and subsequently the poor performance of the company in terms of productivity. It is based on this situation that the employees of this organization have made an appeal that they be reasonably empowered. Current Literature about Employee Empowerment Employee empowerment is a subject of great concern to bu siness and human resource managers. Employee empowerment refers to the strategy or philosophy that involves allowing workers to make decisions that affect their work according to Linda (1997, p.202). Bowen and Lawler (1995, p.35) on the other hand define employee empowerment as the act of enhancing employees’ involvement in organizational processes and decision-making. It basically involves delegating some decision-making powers to employees on matters affecting their jobs so as to ensure that organizational goals are achieved. Some of the ways of empowering employees include: allowing employees to take part in the decision-making process, delegating powers to them and offering them leadership positions (Wooddell 2009, p.16). Employee empowerment can be used to improve productivity, performance, service quality, customer and employee satisfaction, and the efficiency of an organization. Demirci and Erbas (2010, p.143) argue that companies need to manage and improve their emplo yees’ performance. This is achievable through empowerment. Empowerment, according to Demirci can be formulated through by considering four main dimensions namely: knowledge, power, information, and rewards. Alternatively stated, empowerment is the product of the four elements, information, knowledge, power, and reward. The dimensions are derived by taking into consideration the power of empowerment in enhancing the efficacy of employees. Lack of any one of the four elements might lower the overall degree of empowerment according to Shulagna (2009, p.49). Organizations now widely appreciate the fact that bureaucratic leadership in which where decision-making is squarely placed on the hands of top-level managers hampers flexibility and timely execution of duties down the line. On the other hand, it has been established that placing all decision making responsibility on the hands of lower level employees is a recipe for chaos and purposeless conflict (Bowen and Lawler 1995, p.78 ). Taking note of these facts, it is crucial for organizations to ensure that employees are engaged in decision-making by being empowered. The organization needs to develop a culture where employees are given the right to participate in decision-making especially on issues touching on their work. This will help in improving the effectiveness of the organization. Bowen and Lawler (1995, p.80) note that employee empowerment is an extremely powerful tool that organizations in the modern business environment need to implement as a way of improving their performances. One of the main results of employee empowerment is job satisfaction according to Wooddell (2009, p.15). Studies have shown that employee empowerment has a direct relationship with job satisfaction. In this regard, empowerment increases the satisfaction

Sunday, October 27, 2019

Generic Design and Construction Process Protocol (GCDPP)

Generic Design and Construction Process Protocol (GCDPP) 1.0 Introduction The construction industry is a large and complex industry comprising many types and sizes of organizations and a diverse range of professionals and other representative bodies. Consequently, the biggest problem is conflicts in the industry between both clients and contractors and the contractors and their sub contractors (Cooke and Williams, 2009). This most often is as a result of non-clarification of roles or breach of the contract procedures by one of the parties because of lack of communication and co-ordination. Poor productivity and quality within the industry have also been attributed to lack of advance management of the processes by both Latham (1994) and Egan (1998). Professional bodies have therefore introduced various plans of work as attempts to facilitates processes within the industry. In this report, the updated RIBA plan of work which was designed by British architects was employed to plan the execution of a project (CTG) from appraisal to completion. Alternative maps for the same project were produced using the Generic Design and Construction Process Protocol (GCDPP) which was developed in 1995 in other to identify the potential benefits and problems that might be encountered in the use of the process protocol. 2.0 Current plan of work 2.1 Context The Department of Business Innovation and Skills (DBIS) intends to construct a new project, Centre for Technology in Government (CTG), which is a 250,000 square feet facility built to house world class super computers and nuclear weapons design staff. The building site is located in Liverpool, UK and the allowed budget for the project is ÂÂ £50,000,000. The client had explicit goals and therefore appointed a cross-functional team from the start to translate the needs into a design brief. The cross-functional team, after the conceptual design stage, identified various functional and operational requirements (FORs) which were grouped by room type. These FORs became the basis for requests of proposals that resulted in design and build contract 2.2 Procurement method It is important to briefly explain the procurement method used to execute the CTG project because the procurement method and type of contract employed will have implications on the plan of work (Clamp et al, 2007 p 32). Single stage tender (assumption) design and build contract was used; the client, DBIS selected CTG to execute the project because of the business relationship they shared as well as the fact that, the constructor was needed at the design stage to give advice on the constructional method and buildability of the concepts. The client-led design ended at the conceptual stage (RIBA stage C) and the contractor was therefore provided with conceptual designs. 2.3 RIBA Plan of Work The Plan of Work (RIBA, 1997) was originally published in 1963 as a standard method of operation for the construction of buildings, and it has become widely accepted as the operational model throughout the building industry (Kagioglou et al, 1998). It was developed from the view point of the architect to provide a frame work for a standardised method of operation for the design, construction and management of buildings (Poon et al, 2003). This plan of work was developed to meet the needs of the traditional forms of contract and breaks down the entire construction into 5 key stages. There key stages are further broken down into 11 sub-processes as shown below 2.4 RIBA plan of work in GC Ltd There is, however, a slight variation to the work stages primarily because of the procurement method (Design and Build) used. This is because the cross functional team assembled by the client produces conceptual designs that were grouped into FORs which formed the basis of the request for proposals. Detailed designs (RIBA stage D) and technical designs stage (RIBA stage E) were produced by the contractor before tender action while production information stage (RIBA stage F) proceeded after mobilisation stage (RIBA stage J). Figure 2.1 shows the plan of work used in executing the project from the perspective of the constructors which is seen to differ slightly from the plan of work in appendix 1 Figure 2.1 Adoption of RIBA plan of work for Contractor Appendix 2 shows the detailed mapping of each of the above sub processes. 2.4.1 Preparation As a constructor, the first stage of involvement was to review the employers (Department for business innovation and skills) conceptual requirement that has already been identified with the cross-functional team. The constructor (GG ltd) receives the conceptual brief containing the FORs by room type and also confirming key requirements and constraints as well as the Construction (Design and Management) Regulations. The in-house quality management procedures that will be applied on the project is determined. These culminate into the contractors brief. Since GC ltd already has an in- house design team, they assist in the preparation of the contractors brief. The construction company at this stage appoints one of its in-house staff to act as the CDM co-ordinator. During the review, some questions may arise, especially concerning site conditions and operational hazards. It is the responsibility of the contractor to provide all such information to the design team and the CDM co-ordinator. The design team advises on the need for additional consultants for the project. Documents that will accompany the tender submission are identified and the pre-tender programme drawn up. This process in mapped out in detail in appendix 2. 2.4.2 Design development Once the conceptual designs are fully reviewed and understood by the contractor and his team, he authorizes the final layouts. The design team then develops the project brief into developed designs including, the structural elements, the services systems and the general architectural layout. The initial cost plan is updated and the CDM co-ordinator ensures that all health and safety regulation have been considered at this stage. 2.4.3 Technical design This is the last stage of design development before production information is prepared. The detailed designs are produced and all approvals obtained including that of building regulations. The health and safety file is updated by the CDM co-ordinator and the cost plans and cash flows also updated by the quantity surveyor. The stage D report will form the basis of the tender documents. This process in mapped out in detail in appendix 2. 2.4.5 Tender action Once the detailed developments are obtained, the contractor with the CDM co-ordinator prepares the draft initial construction phase plan. The quantity surveyor advises on the preliminaries, the contingencies and the work sequences and proceeds to prepare the contract sum analysis. The CDM co-ordinator, the quantity surveyor and the other design team members contribute to the stage report prepared by the lead consultant. The report includes all the documents intended to be used for tendering. The contractor checks the report to ensure compliance and the tender documents are submitted. The submitted tender documents are evaluated by the employers agent and any queries responded to by the contractor and his team. Once the contract is awarded to the winning firm (GC Ltd), there is negotiation between the employers agent and the contractor before final adjustments are agreed. 2.4.6 Mobilization The employers agent confirms to the client that the contractor (GC ltd) has been duly selected. The contractor is then appointed and the tender documents become the contract documents with certified copies sent to the contractor. His insurances for the project are checked by the employers agent. The site is handed over the contractor and he proceeds to develop his initial construction phase plan with his team and the CDM co-ordinator. Statutory approvals and other detailed planning permission are also obtained. 2.4.7 Production Information The final proposals are translated into precise technical instruction for pricing and construction purposes, which is the preparation of detailed drawings, schedules and specifications. The health and safety file is finally updated by the CDM co-ordinator. The contractor, the design team the quantity surveyor and the CDM co-ordinator reviews all process to ensure compliance with brief and procedures. 2.4.8 Construction This is where actual construction of the CTG building takes place in accordance with contract agreements. Further information is supplied to the contractor as and when deemed necessary. At this stage the contractor, his team and sub contractors are typically involved. 2.4.9 Rectification period After construction to practical completion, final inspections are done and the project is handed over. The contract document allows the contractor to be paid half the amount in the final certificate with the other half released after a predetermined period (6 months), defects liability period. Within which all faults and problems are corrected by the contractor. 2.5 Appraisal of RIBA in CTG project The RIBA plan of work was one of the first expressions of building process by members of the building team (Poon et al, 2003) and has been tried, tested and accepted. It has been widely adopted as the basis of calculating consultants fees as well as gives a vivid description of work stages (Clamp et al, 2007). Adopting design and build as procurement route while employing the RIBA plan of work in the CTG project resulted in hybrid process which improves the plan of work especially in the area of flexibility and eliminates sequential flows which, Sheath et al (1996) argues that, have caused problems of fragmentation and poor co-ordination between project team members. CTG, as a project that will house the designing and testing of nuclear weapons, it requires the involvement of all major stakeholders, as such the client, DBIS assembled a cross-functional team including the contractor, in order to better identify his needs and requirements and identify any possible constraints on development and eventually produce a holistic brief. The adoption of the cross-functional team approach had the advantage of improving co-ordination and communication from the design stage throughout to the project (Kagioglou et al, 1998). It was also necessary to involve the constructors early in the design phase in order to eliminate any claims and counter claims for costs, quality and time between the various parties of the contract (Gunaskaran and Love, 1998). This will ensure buildability and reduce the incident of rework and waste in the design process and construction process. Having established the cross-functional team, weekly meetings were held to review all aspec ts of the design. Since it is a single stage tender, it became the responsibility of the contractor to produce the developed designs and technical designs prior to tender action. In order to facilitate the continuous review of the design by the cross-functional team, the contractor broke the technical design into mini phases as follows; all layouts and setting outs, pile caps and ground beams, structural steel work, substructure, super structure, detailed security services and services systems. There were series of reviews and the final review was during the tender action. Once the contract was signed and mobilisation got underway, the production information was produced concurrently. Construction commenced immediately mobilisation is complete. Daily visits by the cross functional team ensured co-ordination and team work all through the construction. RIBA plan of work guarantees flexibility in the basic outline, in that it can be modified to suit any form of procurement used by simply re-arranging the sub processes (Clamp et al, 2007). The RIBA plan of work, 2007 appears to be very elaborate an simple to understand and use because it maps out the main process at the higher level indicating the sub processes and the outputs at each stage. The details of the sub processes can also be mapped out indicating the activities involved and the parties responsible for those activities. Finally the adoption of the design and build and employing a cross-functional team ensures better understanding of requirements, better translation to drawings, more effective and efficient construction process devoid of any conflicts and unnecessary variations eventually leading to a satisfied client and a satisfied contractor. In every building contract there is some degree of risk (Clamp et al, 2007). Balance of speculative risk will lie almost wholly with the CTG contractor in this project with the client bearing the conceptual risk which involves matters that are key to operational efficiency such as scheme. All the major disadvantages that have been associated with RIBA; linear fashion (Jamieson, 1997; Cooper et al, 2004), lack co-ordination and communication (Sheath at al 1996, Kagioglou et al, 1998), buildability issues and biasness towards the architect (Poon et al, 2003) have been catered for by the adoption of the design and build procurement system as well as the introduction of the cross functional team (including the contractor) at the very beginning of the CTG project. However there are still a number of issues that remains unresolved and primary among them is the absence of a mechanism to transfer all the knowledge that will be shared by the entire CTG project team to similar projects in the future because both success and failure can offer important lessons for the future (Kagioglou et al, 2000). Finally, throughout the entire project, subcontractor and suppliers are only involved from the mobilisation stage (RIBA J) 3.0 The Generic Design and Construction Process Protocol 3.1 Background The Generic Design and Construction Process Protocol (GDCPP) was funded by the Engineering and Physical Science Research Council (EPSRC) under the Innovative Manufacturing Initiate (IMI) and undertook by the University of Salford with a leading number of industrial partners, including clients, architects, contractors, subcontractors, consultants, suppliers and IT specialists during 1995-98 (Lee et al, 2000). The main aim of this project was to develop a Generic Design and Construction Process Protocol for the construction industry by considering the lessons learnt through a number of decades in manufacturing New Product Development (NPD). This was achieved by comprehensive reviews of the construction and manufacturing industries, interactive workshops with the project industrial partners, case studies in the manufacturing and construction industry and other research and data collection tools and techniques (Aouad et al, 1999). There are eight key principles involved in process protocol for process as follows which are originated from manufacturing process. Whole Project view, a consistent Process, Progressive Design Fixity, Co ordination, Stakeholder Involvement team work, Feedback, Process Flexibility, Customisable Process. (www.processprotocol.com). The model identifies the various activities involved in the complete execution of the project as well as the responsible parties produced on a horizontal- X and vertical Y axis respectively resulting in a form of a responsibility matrix. The parties responsible for activity within each phase can be a single person, a firm or a complex network of people (depending on the size of the project) who have been grouped in to activity zones. Consequently, eight (8) activity zones have been identified by the model and are listed below Development Management Project Management Resource Management Design Management Production Management Facilities Management Health Safety, Statutory legal Management Process Management Change Management The design and construction process (X- axis) have been broken down into 10 distinct phases. These 10 phases are grouped into 4 broad stages: Pre-Project, Pre-Construction, Construction and Post-Construction. (www.processprotocol.com). These 4 stages are briefly explained below 3.2 Pre-Project Stage The Pre-Project Phases (0-3) relate to the strategic business considerations of any potential project which aims to address a clients need. Throughout the Pre-Project Phases the clients need is progressively defined and assessed with the aim of: Determining the need for a construction project solution, and Securing outline financial authority to proceed to the Pre-Construction Phases (Cooper et al, 2005 p 76) These phases have been mapped out in detail in appendix 4 Phase zero: Demonstrating the Need Phase one: Conception of Need Phase two: Outline Feasibility Phase three: Substantive Feasibility Study Outline Financial Authority 3.3 Pre-Construction Stage At this stage (4-6), the defined clients need is developed into an appropriate design solution through a logical sequence, with the aim of delivering approved production information (Cooper et al, 2005 p78) These phases are listed below have been mapped out in detail in appendix 4 Phase four: Outline Conceptual Design Phase five: Full Conceptual Design Phase six: Coordinated design, Procurement Full Financial Authority 3.4 Construction Stage The Construction Phases (7-8) is solely concerned with the production of the project solution. It is here that the full benefits of the co-ordination and communication earlier in the Process may be fully realised. Potentially, any changes in the clients requirements will be minimal, as the increased cost of change as the design progresses should be fully understood by the time on-site construction work begins (Cooper et al, 2005 p78). The phases involved are listed below. Refer to appendix 4 for detailed maps Phase seven: Production Information Phase eight: Construction 3.5 Post-Construction Stage Upon completion of the Construction Phase, the Process Protocol continues into the Post-Construction phases which aim to continually monitor and manage the maintenance needs of the constructed facility (Cooper et al, 2005 p 80). This is the last phase of the model Phase 9: Operation Maintenance 3.6 Gates There are gates (soft and hard) in between the phases mentioned above. Soft gates are review points during the process which require a decision to be made, but does not require the temporary overhaul of the whole project until a decision to proceed is made. They enable concurrency while hard gates are review points during the process which may require the temporary overhaul of the project until a decision to proceed is made. (www.processprotocol.com). 3.7 Applying the GDCPP to the CTG project The backgrounds of the construction parties are very variant and they therefore have varying skills, it is therefore critical that parties understand and appreciate the interdependence and responsibilities of one another (Poon et al, 2003). However contract-led restrictions of previous models have prevented the involvement of the various parties in the early stages of the project life (Cooper et al, 2005). The GDCPP aims to improve co-ordination of the entire design and construction process (Lee et al, 2000) and try to address the key areas of the process that have been identified for improvement. The first benefit of adopting the GDCPP in the CTG project in that, it extends the recognized construction industrys involvement beyond completion (cooper et al, 2005) and therefore covers the entire lifespan of the project as can be seen in appendices 3 and 4. This will increase the commitments of all parties to the contract especially the contactor and the sub contractors as they continue to bear some contractual risks within the project even after practical completion. Moreover, risk and value management starts right at the beginning of the project and runs through all the phases as can be seen in appendix 3 and in more detail in appendix 4. This has been absent from the RIBA plan of work. Since the client, the cross-functional team, contractors, subcontractors and suppliers are involved at an early stage, there will therefore be a complete identification of all possible risks and hence an early adoption of strategies to mitigate them. With a project of CTGs nature, variation of requirements at any stage will have serious cost implications on the project, as such the introduction of phase reviews (as can be seen on appendix 3) which aim at reviewing work in each phase and approving progress to the next stage while employing the hard or soft gates is an added advantage. This will assure high quality of work performance (Kagioglou et al, 1998). The backbone of the successful execution of the CTG project will be a good relationship between parties (Jamieson, 1997; Cooper et al, 2005). More often than not, problems have ranged from litigation, lack of trust, lack of communication and lack of knowledge sharing between parties as they have perhaps never worked together probably will never do again (Lee et al, 2000). Therefore the involvement of all stakeholders and using strategic partnering arrangements will allow involvement of all parties from the requirements capture phase as shown on appendix 3 and this fosters a te am environment and encourages appropriate and timely communication and decision making (Lee et al 2000) and because stakeholders are identified, their responsibilities will be explicitly identified. Feedback is an important concept which aims to regulate and improve performance (Poon et al, 2003). The inclusion of the legacy archive with the process protocol is an added advantage. It gives the players within the industry an opportunity to draw from the success or failures of past projects upon which the current or future projects. Furthermore, the adoption of standardised deliverables assist in smooth project delivery as every team knows what is to be produced and at what stage. This is the only way continuous improvement can be sustained. However, the first problem that will come to the mind of members of the construction industry is the extent of involvement of IT in the process. Poon et al (2003) argue that, apart from describing the activities in the map, it is also necessary to use multiple computing skills, which include electronic data interchange, artificial intelligence, integrated databases, inter/intranet application and document management systems in order to analyse activities. The whole set of activities might seem cumbersome and too complicated for non-computer literate users. The roles of the process management and change management activity zones seem to lean much toward the activities and roles of the project manager within the context of construction. Therefore, there could be conflict of responsibilities within these activity zones as they operate within the project. This is the case because of the fundamental difference between construction and manufacturing in relation to the product, the processes and the tracking of changes that occur. Though the process protocol is generic and has the advantage of flexibility, it is quite difficult to fit the protocol into an ongoing project because it has its own definitions and terminologies which could possibly result in confusion if blended with the terminology of the one going project. 4. 0 Production activities An activity is a well defined task in a project which usually requires a certain amount of time to complete and absorbs a portion of the projects financial budget (Waller, 2002). In the CTG project, there are many production activities, however, casting the foundation have been chosen for appraisal 4.1 Casting the foundation A cross functional process map shown in appendix 5 is used to depict how a typical foundation slab within the CTG project is cast indicating the processes cutting across several functions. According to the transformation theory, the emphasis is on the translation of the concrete into the foundation and slab (Koskela, 2000). However, in order to ensure the foundation is cast according to the drawings, checking/inspection is done intermittently as can be seen on the map, this brings us to the flow model: there are waiting, inspection and moving together with the transformations (Koskela, 2000). This is so because, once the formwork in place and the foundation is cast, it has to be inspected. As depicted on the map there are such inspections which involve, waiting and moving as the entire foundation is cast. The effect of these is the eventual extension to the time required to execute the particular operation. There are some non value-adding activities that are important, an example being the time allowed for the concrete to harden before the forms are struck and preparation of the excavated surfaces after excavation. There are other non-value adding activities that need to eliminate an example being the time spent in undertaking all these inspections. In order to improve the efficiency of this process, focus should be on the elimination to the non-value adding processes. 5.0 Conclusion The RIBA plan of work still has its advantage of simplicity and adaptability to various procurement methods. However the GDCPP proves to be more holistic in its approach towards customer satisfaction. The GDCPP is easily adopted in the CTG project primarily because of the size and complexity of the project. The cost that may be incurred through implementation of the protocol will be offset in the communication, co-ordination and team work which will eventually be created. This may however not be the case in relatively smaller projects. The introduction and sustenance of the protocol will fail due to poor process change within companies and will even fail more should managements try to adopt shortcuts by expecting individual workers to execute new working practices without training. Effective implementation and adoption of the protocol requires continuous training and education. This training needs to start from management level down to the last worker.

Friday, October 25, 2019

Morals of Ode on the Death of a Favorite Cat (Favourite) :: Ode to the Death of a Favorite Cat Essays

Morals of Ode on the Death of a Favorite Cat (Favourite) It is very difficult to understand what a writer mean when they write a poem, because you have to get in to a frame of mind that you think the writer was in when they composed the poem. In the Ode on the Death of a Favourite Cat, Drowned in a Tub of Gold Fishes, Thomas Gray uses a cat and fish to teach a moral. In the Ode on the Death of a Favourite Cat, Drowned in a Tub of Gold Fishes the setting was set in the first stanza. The poem gave you an idea that it took place in a very nice house that had a large china vase, that held water, also it give the allusion that in this vase were flowers and fish. It describes beautiful blue tinted flowers in bloom and the fish as angel like Beta fish, which had a coat of amour made in gold with the hint of royal purple. When Gray went into describing a fluffy black and white tabby cat with deep green eyes. The cat's name is Selima and she is perched at the top of the vase watching the fish glide through the water. Selima was planning to eat the fish as soon as she could catch them. So she slowly reached with her paw to nab one of the fishes, her first attempt fails so she thinks again of how she can reach them. Eventually she falls in and tries to get out eight times while crying for help from a forgiving soul. No one seems to hear her and she drowns in the water where the fish swam. Thomas Gray asks two questions " What female heart can gold despise? What cat's averse to fish?" (lines 23 and 24) the meaning of those questions are that some gold is not meant for women and these fishes were not meant to be eaten by Selima. Also the "female" could reflect the cat since cats are generalized has feminine and "gold" referring to the fish. Gray also states "Malignant fate sat by, and smil'd" (line 28) which leads me to believe that fate was laughing at the cat and not helping it cause fate knew what was going to happen. In line twenty-nine "The slipp'ry verge her feet beguil'd" is an illusion to that the cat thinks it has balance and yet she does not cause she falls into the fish bowl.

Thursday, October 24, 2019

Office Management Essay

According to Npower (Business Case Studies) Often these decisions are administrative in nature and can be implemented quickly and tend to carry a little risk and are smaller scale, but are never the less important choices that people have to make to fulfil their role. Strategic Decision Implementing that laptops are to be used by partners while out of the office would be a strategic decision. There are lots of problems with the partners being out of the office and with the use of laptops as communication tools this will provide a direct link between the office staff and the partners. I believe that this is a strategic decision as with the right planning and overseeing the development this could really be a step forward for Classic Interiors because work can be exchanged between partners and the office and messages can be passed on effectively meaning that there won’t be a build-up of work or office staff with no work and communication between everyone will be made a lot easier. Operational Decision Stipulating a lunch time for each staff member would be an organisational decision. The current system for lunch time is not convenient as the employees get to decide when they go as long as one of them is in the office. I believe this is an operational decision because if affects the day to day running of the organisation. If the administrators were set a lunch hour each they would have to stick to it and get used to working alongside the time set. Role of Office Manager Operational Planning Process As the office manager my role in establishing a new routine for lunch hour would be to organise a meeting to communicate the proposed changes with administrators and gain their views. Then I would create a plan to put forward to the administrators and partners. When a decision has been reached and the new plan is put into action I would have to oversee the progress of the plan gathering feedback at every opportunity. Issues There is increased frustration between partners and administrators due to the partners carrying out task they believe the administrators could be doing which would free up more time for the partners. The solution to this would be to for all administrators to be trained how to use the specialist interior design software, this would enable them to alleviate the work load from the partners and feel more involved in the design side of their work. This would likely be time consuming to train the administrators but the overall outcome would be beneficial to the company. The relationship between partners and the administrators is suffering due to the partners being out of the office as communication is often via short telephone messages and emails which has led to information being mis-communicated. The solution would be to introduce the use of PDA’s (Personal digital Assistants) for partners to be able to communicate with administrators. This would enable the administrators to contact the partners if a problem arises while carrying out work so that no mistakes are made and also they would be able to check their diaries to make appointments without the chance of double booking. Instant messaging could also help with communication as they are received instantly and can be replied to in seconds. Financial Planning and Budgetary Control Financial Planning According to Jim Priebe (ehow) A financial plan is like a blue print. It is a description of what you want to achieve and the tools you need to achieve it. Financial planning is the process of asking questions to ensure that you manage your risk against unexpected events. Managers need to be able to exercise control over the organisation that they manage to make sure that financial plans are being achieved both for the long term and the short term. Benefits of financial planning are: 1 Reducing the risk of a financial crisis. 2 Allows you to understand how each financial decision made affects other areas of finance. Barriers of financial planning are: 1 It can be time consuming 2 Can be costly as will involve accountants. Budgetary Control Budgetary control is precise control of an organisations operations through establishment of standards and targets concerning income and expenditure. Continuous monitoring is required to be effective. Benefits of budgetary control are: 1 Coordinates activities across departments. 2 Provides a record of organisational activities. Barriers of budgetary control are: 1 Budgets can demotivate staff. 2 May cause competition for resources. Effective Delegation Delegation is the distribution of tasks by the office manager. Giving responsibilities to employees to carry out the work but the work will remain liable to the office manager. When delegation is carried out properly very good results and high productivity can be achieved. The Process of Delegation Delegation can be very difficult. The process of delegation is: 1 Define the task 2 Select the Individual 3 Explain what must be achieved (clear instructions) 4 Discuss requirement to completion 5 Agree a deadline 6 Be there for support 7 Always give feedback Benefits Time management would be a benefit of delegation as this would allow partners to delegate work so that they have a more manageable work load. Delegating tasks will motivate staff and increase productivity. Barriers Forcing someone to do a task that they don’t want to or are not capable of would be a barrier, this can be seen in the case study when Izzy asked one of the administrators to just follow what had been done before. This lead to the administrator getting upset and Izzy feeling unable to approach anyone else. This could have been avoided by management setting out a procedure for staff to follow and allocating the task to someone suitable. Confusion about who is ultimately responsible for tasks is a barrier to effective delegation, this can be seen in the case study as partners are frustrated because they believe that administration is responsible for some of their tasks. This can be corrected by training administrators to make the delegation process easier. Leadership Models I think Tomi uses democratic leadership. As Tomi involves the staff in the decision making process of meeting times and encouraged staff to offer their opinions which made the administrators feel like what they said mattered. I believe Izzi uses Autocratic Leadership. When Izzi was in charge she would decide the times of meetings even when it was inconvenient to the others meaning work started to suffer which she then thought they could not manage and devised a new procedure which is hopeless but Izzi cannot see this. Staff find it difficult to communicate with her. Autocratic Leadership works where there is no need for input on the decisions and Democratic leadership works when a leader seeks help and guidance from staff to make decisions. Democratic leadership The impact of this leadership style is that it gives staff a voice and they are able to communicate better with management. Democratic leadership style encourages better cooperation and motivates staff because they feel well informed in everything that affects their work. Autocratic Leadership The impact of this leadership style is that it fails to motivate staff and they feel forced to do things managements way although It is not always the best way and staff become stressed being pushed. Autocratic leadership style encourages no communication between staff and management as management make all the decisions based on what they feel is best for the organisation. References Hamel, G. (2008) ‘What is strategic Decision Making’ http://smallbusiness. chron. com/strategic-decision-making-23782. html Npower. ‘Developing people through decision making’ http://businesscasestudies. co. uk/npower/developing-people-through-decision-making/tactical-decisions. html Priebe, J. ‘What is the purpose of Financial Planning’ http://www. ehow. com/info_7755005_purpose-financial-plan. html

Wednesday, October 23, 2019

Future stage Essay

Choose the stage that has been the biggest challenge for you, thus far. Explain what you have learned about a â€Å"future stage.† How will this information benefit you as you reach that stage? Choose at least three specific goals you have set for yourself as you continue through your lifespan and how you will achieve those goals. How has this course helped you determine those goals? I would have to say Stage 6 universal ethical principle orientation adopt an internal moral code base on universal values that takes precedence over social rules and laws. I have learned that even if you need something don’t steal it. Stealing is the most worst thing you could ever think of. This has reach me not to steal even though I don’t but I will never steal. My three goals is to have money to get what I want not to steal, earn things, and reach to get what and the things I would like to have in life. Choose the stage that has been the biggest challenge for you, thus far. Explain what you have learned about a â€Å"future stage.† How will this information benefit you as you reach that stage? Choose at least three specific goals you have set for yourself as you continue through your lifespan and how you will achieve those goals. How has this course helped you determine those goals? I would have to say Stage 6 universal ethical principle orientation adopt an internal moral code base on universal values that takes precedence over social rules and laws. I have learned that even if you need something don’t steal it. Stealing is the most worst thing you could ever think of. This has reach me not to steal even though I don’t but I will never steal. My three goals is to have money to get w Choose the stage that has been the biggest challenge for you, thus far. Explain what you have learned about a â€Å"future stage.† How will this information benefit you as you reach that stage? Choose at least three specific goals you have set for yourself as you continue through your lifespan and how you will achieve those goals. How has this course helped you determine those goals? I would have to say Stage 6 universal ethical principle orientation adopt an internal moral code base on universal values that takes precedence over social rules and laws. I have learned that even if you need something don’t steal it. Stealing is the most worst thing you could ever think of. This has reach me not to steal even though I don’t but I will never steal. My three goals is to have money to get what I want not to steal, earn things, and reach to get what and the things I would like to have in life. hat I want  not to steal, earn things, and reach to get what and the things I would like to have in life.

Tuesday, October 22, 2019

buy custom An International Business essay

buy custom An International Business essay In the digital era, each individual in the world is connected to another person by using several communication technologies like mobile phones and the internet. This situation suggests that telecommunication empowers the way people communicate and helps business to run their daily activities. The variety of communication devices also enables people to experience different way of communication such as voice communication by using telephone, mobile phones, handy talky etc; data communication by typing in instant messaging, SMS (Short Message Service), or sending facsimile; and video communication through video streaming and video conference. In addition, the popular BlackBerry smart phones represent this breakthrough as they let users to experience many types of communication. Interestingly, BlackBerry smart phones also represent the globalization and the international business as the products and the accessories are manufactured in different countries. Research in Motion (RIM), the BlackBerrys brand owner, is a Canadian company that manufactures BlackBerry phones in Mexico or Hungary, outsources the accessories from Chinese manufacturers that employ low-wage labors from India and other Asian countries, and sells to the consumers all over the world while outstripping the market share of a Finnish company, Nokia. The case of mobile phones industry also happens in other industries and it provides us the lesson that to sustain in international marketplace, a company should keeps pace with competitors. In the following discussion, we will elaborate how a company can compete in the international business by advancing not only the product features and specifications but also paying attention to non-technical issues such as languages, cultural factors, and business ethics. Under such circumstances, we need to understand how the international business works in order to keep updated the recent business practice. Learning Curves The interesting point of the international business is we can learn several methods of business practices from other countries. In Japan, for example, there is a management system, called Just-In-Time, which helps a manufacturer to reduce the costs of production by managing the upply chain effectively. This method is field-proven to support Japanese automobile manufacturers to gain the competitive advantage in the automobile industry in North America and in Europe. Immediately, American automobile manufacturers respond to the challenges by implementing another method of supply chain management. Meanwhile, Volvo, a Swedish automobile manufacturer, chooses to implement the JIT system in their manufacturing facilities. The question is then what make the JIT system is so powerful? Basically, Just-in-Time (JIT) concept refers to the Japanese management philosophy that has been practiced in the countrys manufacturing companies since early 1970s. The famous implementation of Just-in-Time (JIT) is in Toyota manufacturing plants when the person in charge for managing the supply chain, Taiichi Ohno, also recognized as the father of JIT, develops and refines the the concept in order to meet costumers demands with minimum delay (The Institute for Manufacturing, 2008). Therefore, the implementation of JIT will improve several key success factors in manufacturing such as speeding up the time-to-market of products, costs reduction, and manageability of current resources and plan for future needs. Business Etiquette and Cultural Differences Another reason to master the international business is to obtain literacy. Understanding the background of partners and competitors from different countries and companies can help us to earn their respect and confidence as well as give us a competitive edge in dealing with them. Dealing a business with Chinese companies is different from Japanese or Swedish, for instance. Although globalization makes many Chinese businesses to align with western conventional methods, Chinese business etiquettes and cultures are still very dominant in their homeland. Thus, building a business in China will require a certain amount of understanding toward their unique culture and business etiquettes within it. In addition, Chinese business deals usually start from referrals as the business relationship generally starts from the basis of someone's recommendation. Thus, understanding this nature, a businessperson should respect the value of good reputation whilee making deals with Chinese businessperson. Other risks in conducting international expansion are culture and language. According to various studies, culture is often an underestimated factor in managing corporate businesses. These studies also reveal that those companies that are unsuccessful to take culture as an important business consideration often find themselves in a disappointing circumstance (Kwintessential, 2011). Today, however, realizing the global environment we are living in, companies are becoming increasingly cultural sensitive. There are various examples of corporations that hired people from various backgrounds and discover a synergy within their cooperation. Ethical Issues in International Business Another important aspect in international business is ethics. Business ethics refers to various moral and ethical problems that can arise in business activities. A study focuses on how each individual involved within trade activities are burdened with special duties and obligations that must be performed. It emphasizes the importance of ethical guidelines in making business decisions. The importance of ethical guidelines has been increasingly popular because of several reasons. First, there is s growing public awareness that societies have the right to expect business to function within ethical boundaries. Conclusion This paper only elaborates three aspects of international business: learning curves, business etiquette and cultural differences, and ethical issues. From these three aspects alone, we already learn that international business greatly influences us in how we take advantages of the diverse marketplaces all over the world. In addition, we also learn that cultural factors have significant influences in the successful relationship with foreign partners. The case of Mattel that subcontracts the manufacturing of toys in China and then are forced to recall their Cars toys due to they contain impermissible lead is one example of the impact of cultural factors. It happens because the subcontractor is found to subcontract to other companies due to the relationship of the companies owners. Buy custom An International Business essay

Monday, October 21, 2019

Are rules necessary essays

Are rules necessary essays My opinion on this issue is that I do think that rules are necessary; there are a lot of reasons why we need rules in our society. Legal and non-legal rules are both needed in our community. Most legal rules are enforced to keep the individuals of this society to feel safe, to make them know that walking down the street is not dangerous; the effect is it makes people be able to live their life without worrying if they are going to be in danger. There are rules everywhere in this community, the roads, home, religion, family, school and also social clubs, and in this essay I shall demonstrate why exactly rules are necessary. An example of a legal rule and its punishment in this society is murder, killing someone is the most disgusting act anyone can imagine. The punishments for murder is 25 years to life in jail and also in some other countries if committing death earns death, and they shall get hanged. Sometimes people commit murder on accounts of manslaughter and some accounts are in as self defence, a popular definition would say that it is the deliberate killing of a person, but most people don't regard self defence as murder. It is also a measure for governments to order people to kill others (in times of war for example), and people are more inclined to kill to order if the murder label is removed. Well back on track again, the punishments for murder, helps individuals in this society feel safe and make criminals more aware of what they are facing when they commit a murder. But the punishment doesnt necessarily stop criminals from not killing. We cant have murderers running lose around the streets , so locking them away is increasing the safety in the society. Having criminals in jail creates discipline and teach the criminals why they are in jail in the first place, they should all be thought a lesson. Rape is another legal rule that I think has a good reason why the criminals that commit these hideous crimes shou ...

Sunday, October 20, 2019

Is a Two-Page Resume Ever Acceptable

Is a Two-Page Resume Ever Acceptable There is a lot of confusing information out there these days about how long a resume should be. While a resume that goes on for pages is unlikely to be read by a hiring manager, not putting in enough information can have the same effect. Now that many resumes are no longer submitted on paper but in digital format, the old rules for resumes make little sense. Keep in mind that hiring managers are interested in finding the right candidate for the job, and the resume quickly tells them whether or not the applicant is eligible for consideration. What About One Page Resumes?One argument is that one page resumes are fine for recent graduates or those who don’t have much work experience. While this might be true, the custom is to try and keep a resume short and to the point. This makes sense since a hiring manager or recruiter may have many of them to check over in order to fill a job position.Are Longer Resumes Acceptable?More experienced workers may require more than one page to li st their previous job positions, skills and experience or already have a resume that takes up more than one page. This is particularly true for those with a lot of work experience or advanced degrees. Now, with social media, personal websites and sites such as LinkedIn, a job seeker can add information to those sites so recruiters can find added information. The good thing about personal websites and LinkedIn is that you can include as much as you wish.Do You Include All Your Jobs?You don’t have to include every job you’ve ever held. Instead, keep it to the last ten years of employment. The important thing is to aim your resume toward the job for which you are applying. A recruiter’s job is to find the best candidates for the position, so if you are qualified for the job and point it out in your resume, you can go to the top of the list of candidates.Do Bullet Points Help?Using bullet points add to your resume by making it quick to scan for the recruiter to pick up important information. It also makes it less likely that an important job qualification will not be missed. Use caution, however, to not overdo using bullet points. Use your qualifications that respond to the job ad.What About Job History?Including your entire job history isn’t necessary for a resume, and neither is listing everything you did in each job. What the recruiter is interested in are the things you did that benefitted the company such as increasing productivity, saving the company money or other benefits. Use this type of approach to show how you would be an asset. This lets the recruiter know quickly whether you are a match for the job position.Should I Chop My Resume or Add to It?By now, you’ve chopped out all unnecessary information but you find your resume is still over one page long, and you are faced with the decision of making the print small to make it fit on one page or of using a second page that is mostly a large blank space. What do you do? T hinking about if you were the person reading it, would you be happy trying to read tiny print or would you prefer a second page, even if it only has a few lines of text? Rather than give the recruiter eye strain, it is better to include the second page. If you really feel that space shouldn’t go to waste, use it to show volunteer work, awards and organizations so the recruiter can see into your personality.Having a good resume is a start to getting that great job. TheJobNetwork takes all the stress out of job hunting by doing the search for you. After you sign up for job match alert and enter your qualifications and job requirements, TheJobNetwork toils around the clock searching for the jobs that match and sends you alerts to notify you when job listings are found.

Saturday, October 19, 2019

The Yellow Wallpaper Journal Essay Example | Topics and Well Written Essays - 250 words

The Yellow Wallpaper Journal - Essay Example For one, the newly born baby could have implicitly provided the impetus for her nervousness and depression (postpartum depression): â€Å"It is fortunate Mary is so good with the baby†¦And yet, I cannot be with him, it makes me so nervous† (Gilman 381). Secondly, the woman felt that she was a burden to her husband, which could be an effect of her inability to raise the baby herself and not to be able to perform her role and duty as wife and mother: â€Å"I meant to be such a help to John†¦and here I am a comparative burden already!† (Gilman 381). Further, transferring temporarily to a new home, while their home is being repaired could also cause nervousess and depression: â€Å"The repairs are not done at home, and I cannot possibly leave town just now!† (Gilman 385). In addition, always being left alone, since the job of her husband as a physician was perceived to be demanding, could also have contributed to her condition. This was exacerbated by the f act that John does not want her to write or delve into other activities which could exhaust her and make her more nervous. The overbearing control was noted to have caused her to feel afraid of her husband: â€Å"The fact is I am getting a little afraid of John† (Gilman 386). Thus, the woman’s fears and anxieties to perform the role and responsibilities as a wife and mother increase the preponderance to stress and contributed to her nervousness and

Friday, October 18, 2019

Journal entries 1 and 2 Assignment Example | Topics and Well Written Essays - 1000 words

Journal entries 1 and 2 - Assignment Example After the preliminary greetings and a few questions on his part about my background (both educational and social), which I later figured out was to make him comfortable as well, we got down to the interview. The questions I asked were not direct hence required further explanations after the â€Å"yes† or â€Å"no† and this is what made the interview take long. All the questions were structured in such a way that they would eventually provide answers my objectives without having to necessarily ask directly. The challenges he provided that the nurse educator encountered when performing his roles were from both a subjective and objective view and since he had an experience of over thirty years as a nurse educator, these views were from a professional eye. According to him in his interview, there were many challenges some which were easily solved and expected but others which were unexpected, unsolvable and which had made quite a few number of the nurse educators opt to change career, move to another specialty of nursing and others leaving nursing all together after losing their license to practice (especially those that could not keep their professional and personal involvement with student apart) (Clarke, 2006). The biggest of these challenges was time management especially since one had duties as a teacher, a faculty member, other administrative roles and even the personal life. Other than that, the other challenge was on ensuring cultural competence and gender sensitivity when teaching and even socializing since students and faculty members had different cultural beliefs (I am experienced in this area and it will not become a problem to me). The nurse educator also had the challenge of ensuring that the teaching was fostering the cognitive, affective and even psychomotor development in line with the nurse educator competency and roles (Bastable, 2008). The other minor challenges included: coming up with an unbiased

Is the Nation state finished Essay Example | Topics and Well Written Essays - 1000 words

Is the Nation state finished - Essay Example This implies that the concept of nation states came after establishment of nations from the efforts of nationalists who were seeking sovereignty. However, there are also theories suggesting that nation state concept came around as an effort to unify already existing states. Borrowing from both views it seems that concept of nation state was founded after establishment of states. For example, some nation states such as Germany and Italy arguably came into existence as a result of nationalists efforts through campaigns to unify the state. Earlier on both these states were divided into several states small states and the unification began on the basis of cultural movements and later on evolved thereby acquiring political significance. For example, there is the case of the Volkish movement in Germany that comprised mainly of German speaking people from different states which later gained political significance. This implies that there is some substantial truth in claiming that the concep t came after creation of states. Away from matters revolving around origin of the nation states, there are more pressing and imminent matters with regard to its future. There are concerns over the existence of nation states due to current influential factors such as globalization. Globalization is the unification and integration of states with an aim of sharing views, ideas, and products in the wake of modernization. Amid these increased interactions among states there are concerns over the effects of globalization to individual sovereignty of states. This is because globalization may seem to somewhat exploit some states hence undermining sovereignty (Kennett, 2008, p.3). For example, there are claims that in such relations between nation states with distinct economic levels, low economy states are prone to exploitation from the high economy states. Moreover, in the modern day there has been increased threats on the security of many nations especially with the

Word Essay Example | Topics and Well Written Essays - 500 words

Word - Essay Example The first imperative ethical issue facing him is the fact that he has setup a system that allows him to trace information such as emails sent among his fellow employees. This is a violation of communication privacy that is usually avoided in majority of work places. Additionally, Mr. Child’s has setup the system through passwords that gives him the absolute access to all the information. These passwords do not allow other employees to access imperative work information. Moreover, Mr. Child’s has been working overtime without the instructions of his employers. This is another instance where he violated work ethics that guides the general time period, which employee should perform their duties. Consequently, he was found guilty of creating a vulnerable system through Digital Subscriber Line that allows unauthorized persons to access the Company’s information from online sources. This is a violation of the ethics that guide the privacy of a company’s information. The ethical issue in the case study provided, involves poor management of information among the employees specifically caused by Child’s actions. It affects the company’s efficacy of modus operandi in regard to their access to information. Indeed this scenario involves decision making in order to eliminate undesirable modes of information management within the company. Consequently, the case is more than legal as it entails making decisions ascribed to work ethics within a department. The case study presents a scenario where there is poor inter-personal relationship between Mr. Child and other employees. There is also poor information management majorly due to violation of communication ethics. Mr. Child and his employer seem to be the cause of the problem thus they are important in determination of the final outcome. Another crucial way, which can facilitate decision making in this case is facilitating dialogue between Mr. Child and his Employers outside the court. This can be done by a

Thursday, October 17, 2019

Importance of Maintaining Accurate Financial Statements Research Paper

Importance of Maintaining Accurate Financial Statements - Research Paper Example The paper will explore why accurate financial statements are important for outside business interests Customers Customers are external parties that deal with the company by purchasing its products and services and are therefore interested in the financial statement of a company that needs to be accurate. Customers would be interested in the accurate financial statement for them to be able to know how the company spends its funds and manages its debts. Accurate statement of financial position and statement of comprehensive income will show the customers how the company is performing in terms of the profits the company makes relative to the debts it incurs, or the amount the company spends on its marketing strategies in comparison with operations (Horngren, Harrison & Oliver, 2012). A customer would be interested in the financial statement for them to be able to gage whether the company is profitable and would continue as a going concern. If the financial statement reflects that the co mpany may go under receivership, the customer may get a good picture and strategies on where they will get their products in case the business collapses a\s reflected in the financial statement. ... Customers require that the companies they deal with handle themselves responsively toward the environment and giving back to the society through corporate social responsibility. Therefore, accurate financial statement should contain corporate social responsibility that customers have become increasingly looking for in the company. This is because through financial statement customers would be able to know whether their preferred companies measure the overheads, returns, and their impacts on corporate responsibility initiative (Williams & Williams, 2006). Customer is always interested in knowing the plans of the management. This can be known only through an accurate financial statement that contains the section of executive manager’s discussions and analysis of what had happen in the past and the future prospects. The management analysis is also considered as one way by which customers who does not understand other parts of the financial statement can gain some important inform ation pertaining to company’s plans. Shareholders The shareholders of a company would also be interested in an accurate financial statement so that they can be able to determine whether their investments are being utilized effectively. This would be reflected in the Statement of financial position. Through financial statement, shareholders would be able to know whether the company is profitable and is likely to pay dividends in the near future or not (Horngren, Harrison & Oliver, 2012). Creditors Creditors just like the customers use financial statements in a number of ways. They use the statement of financial position to know the company’s

Wednesday, October 16, 2019

Ethical Business Model Essay Example | Topics and Well Written Essays - 750 words

Ethical Business Model - Essay Example The import of this is that not only is business ethics model an indispensible aspect of organizational management, but it is also imperative of an organization to define and designate its model of business ethics. A Proposal on a Business-Based Ethics Model to Guide Decision Making In the Workplace According to Ashcroft, Dawson and Draper (2007), one of the best business-based ethics models that can be used to guide decision making in the workplace is the organizational or company culture. Organizational or company culture refers to the intangible business environment that leaders and executive managers as major decision makers dispense. In this model, these policy makers use the organization’s culture to perpetuate the mission, objectives and goals on how employees are to approach their work or duties, in the course of helping the organization attain its goals. In this regard, virtues that are to help further positive and stronger organizational culture are to be emphasized, with these virtues being trust, integrity, professional behavior, diligence, leadership and flexibility. It is imperative that the healthcare organization in this instance seek, determine and use the most appropriate way of inculcating these virtues upon the staff. On the part of the executive managers and leaders, there will be a need to weave these very virtues into the healthcare organization’s culture, so as to ensure that employees comprehend and adhere to ethical organizational or business principles (Weber, 2001). The task above can be achieved by employing different approaches. The company can for instance use organizational manuals and informal meetings to teach employees on organizational culture. The merit that consistently characterizes the use of intra-organizational manuals and meetings is the opportunity they give the management to explain the significance of ethical business behavior and to evaluate the gains that have been realized from the steps made. In lin e with this proposal is the need to open up workshops and training programs which will go a long way in helping the personnel understand the essence of business ethics. It is only through this understanding that the personnel can grasp the entire picture on the importance of incorporating organizational ethics into decision-making and work performance. Likewise, it is only when the personnel understand the import of business ethics that the restructuring of organizational can run smoothly, from an intrapersonal volition and without the risk of sabotage. The Anticipated Impact of Putting Company or Organizational Culture into Place to Be In a Healthcare Organization It is a fact that the proposed business ethics model is likely to bring with it, positive values in the organization. One of the most anticipated changes that the organizational/company ethics model will bring about is the shifting of the hospital or the healthcare organization’s from focusing on quantity and mere profit making, to being driven by the dictates of, and cause for patient-based care. This is because, globally, healthcare organizations place patient-satisfaction and the accordance of quality, ethical and patient-friendly care as the center-most point of concern and efforts. Organizational/ company ethics model comes in handy in ensuring that this remains a reality, given that organizational ethics demand the fusing of organizatio

Importance of Maintaining Accurate Financial Statements Research Paper

Importance of Maintaining Accurate Financial Statements - Research Paper Example The paper will explore why accurate financial statements are important for outside business interests Customers Customers are external parties that deal with the company by purchasing its products and services and are therefore interested in the financial statement of a company that needs to be accurate. Customers would be interested in the accurate financial statement for them to be able to know how the company spends its funds and manages its debts. Accurate statement of financial position and statement of comprehensive income will show the customers how the company is performing in terms of the profits the company makes relative to the debts it incurs, or the amount the company spends on its marketing strategies in comparison with operations (Horngren, Harrison & Oliver, 2012). A customer would be interested in the financial statement for them to be able to gage whether the company is profitable and would continue as a going concern. If the financial statement reflects that the co mpany may go under receivership, the customer may get a good picture and strategies on where they will get their products in case the business collapses a\s reflected in the financial statement. ... Customers require that the companies they deal with handle themselves responsively toward the environment and giving back to the society through corporate social responsibility. Therefore, accurate financial statement should contain corporate social responsibility that customers have become increasingly looking for in the company. This is because through financial statement customers would be able to know whether their preferred companies measure the overheads, returns, and their impacts on corporate responsibility initiative (Williams & Williams, 2006). Customer is always interested in knowing the plans of the management. This can be known only through an accurate financial statement that contains the section of executive manager’s discussions and analysis of what had happen in the past and the future prospects. The management analysis is also considered as one way by which customers who does not understand other parts of the financial statement can gain some important inform ation pertaining to company’s plans. Shareholders The shareholders of a company would also be interested in an accurate financial statement so that they can be able to determine whether their investments are being utilized effectively. This would be reflected in the Statement of financial position. Through financial statement, shareholders would be able to know whether the company is profitable and is likely to pay dividends in the near future or not (Horngren, Harrison & Oliver, 2012). Creditors Creditors just like the customers use financial statements in a number of ways. They use the statement of financial position to know the company’s

Tuesday, October 15, 2019

Academic Degree and College Essay Example for Free

Academic Degree and College Essay Is college really worth it? A question many students start to ask as the college cost increases and jobs are tougher to get. When considering college you have to reflect more about what you want out of it rather than what you have to do to complete it. Although getting accepted into a good college is a great start, getting a college degree may appear intimidating in terms of the educational responsibility, tuition, fees, and time commitments involved. However, there are many other ways in which a college degree can be a useful investment; with enhancing the value of your life in several ways. In the future, the education received from college will be very helpful to people in several ways. College is becoming a major decision with adults in America today because people are questioning whether or not if college is actually worth it. People are not doing their research on how a college degree is more beneficial than if you did not earn one. Numerous studies have revealed that a college education can lead to long-term financial returns and increase a student’s success in the future. According to Deanna Mascle â€Å"Individuals with bachelor degrees earn about 60 percent more than those with just a high school diploma, who in turn earn about 40 percent more than high school dropouts†( 2012). Receiving a college degree and bringing what you learned to the real world will benefit you in your pursuit for financial success. If you do not have a mindset that you are going to put your full potential in college. Cooper, argues that there is no reason to waste your time and money. In our society now a college education is no longer a choice or privilege, but rather a necessity or requirement. We are basically raised and accustomed to believe that one needs a higher education in order to succeed in life. The major reason why people go to college is not because they want to, but because they essentially have to. In the article â€Å"College is still worth it†, Anthony Carnevale states, that businesses pay more money to workers with degrees than to those without because employers believe that postsecondary educated workers are more valuable (Carnevale 8). Even though society has began to change that it’s basically a necessity to have a college degree to get a good job its well worth the money in the end. There are a numerous amount of waiters/waitresses, bartenders, plumbers, and so on who have college degrees and are working in jobs that dont require advanced degrees. A cashier, for example, earns $19,000 on average, but with a college degree, earns $29,000 on average. Similarly, plumbers without a degree earn $37,000 on average, but earn $52,000 with a college degree. Nearly all high school seniors are pressured by their guidance counselors and parents to go to college because it is the right thing to do. In Caroline Bird’s essay College is a Waste of Time and Money, she states that students go to college because â€Å"Their mothers wanted them to go. (481) The undergraduate may have different dreams about what he or she desires to do in life, but because they believe that these mentors make out what is best for them, they almost certainly end up doing something that they do not want to do, resulting in being unhappy with their life. Bird makes some good points in her essay, but if children did not get pressured they would have no idea about college, and probably would not even think about going. Bird argues that college is a waste of money because youngsters do not know what they want. No one wants parents, teachers or counselors telling high school students to aim low and skip college. College is expensive we all have established that, but it doesnt have to be. If you have to take out, or plan on taking out more than $50,000 to go to college, you should consider searching for other colleges that will be able to fit your budget. According to Cooper, he has finished college and has a great job. He goes on to talk about how if he never decided to go to college and pay the high tuition that goes along with it. The Public Policy Institute of California concurs and predicts that â€Å"41 percent of jobs in 2025 will require a college degree. † If these counselors and parents did not push these students into looking, and going to college, then the question is who would? Even when applying for a job that will not use your exact degree, just having that degree gives you an advantage over the other applicants who do not possess a degree. The majority of the employers of the company are looking for students with a college degree since employers are looking for students who have the skill to learn new things which is essential in order to work in the corporate world. The degree reassures the employers that a student with a degree can be engaged since completing a degree, that means that he/she can handle the work environment, and also has the skill to settle in to constant change. A degree is said to be more significant than the degree type as such, so as long has one has the ability to learn, then they will have a more prone  chance of getting employed. The majority of college students would feel that college is a waste of money because they do not learn what they want to. Instead they have to take classes that have nothing to do with what they are majoring in, and are only taking these classes to complete the educational requirement to start their actual major. With the increasing costs of college tuition, as well as essentials such as books a college education becomes a burden somewhat more than an investment. Tuition costs continue to rise, and for a lot of struggling Americans, getting an education now means years and years of monthly debt payments. Alexander Thomas Public, two-year college tuition has gone up 7. 3 percent since last year and will no doubt continue to rise (2012). Thomas says â€Å"there are definitely ways to reduce the cost of college, and educating yourself on the federal student loan process in general is extremely useful in the long run†(2012). Although college is expensive, if it is approached the right way, students can get the education they need and desire without getting buried in tons of debt. Americans just need to be smart and do their research when it comes to paying for college. The main reason for attending college is to get a well-paying career, while being happy with that career choice. College prepares you with educational understanding in order to accomplish something in the future. According to Dale Coye the New American College, higher education is necessary for you future. He states that â€Å"In spatial terms, teaching and learning may begin in a classroom, but course work also spills over into the life of the campus and the community. Students engage in experiential learning and co-curricular activities that take abstract ideas and anchor them in real-life problems† (Coye 20). Time and commitment are very important in succeeding with getting a college degree. According to Cooper, if you are planning to have children you should wait until you finish college, as it is a big commitment and time consuming even without children. Parenting students tend to complete four-year degrees at rates far slower than other college students. â€Å"More than half (59 percent) of parents attending college earn less than $10,000 a year† (Sorensen 30). Parents cannot afford to support their children without getting some sort of education. Copper, explains that he probably would not have finished school if he decided to have kids before he graduated. The opposition to get a decent job is increasing; it is near to impossible to achieve a high paying job without at least a bachelors degree. Numerous amounts of jobs that only used to want their employees to have a high school diploma now need some type of college education. College is worth the money, nevertheless, is because it is one of the rare associations that frequently holds people of different cultural and racial backgrounds. This allows one to advance their social and communicative skills because they are exposed to unaccustomed cultures. College helps you to become a responsible adult because for the first time most people are nearly on their own. College helps students get ready for major linked skills. Thus, college helps in achieving skills linked to the business one looks to get into. It helps a student in figuring out how to do their job. It is entirely different from high school; you have to manage your private time and financial state as well. Proceeding with college teaches individuals how to handle their lives. Most college students are managing their college life between studying for their exams and earning money through low paying jobs to maintain their college tuition. In addition to this, they are enjoying the benefits of a good social life, parties and lots of friends. The experience one has in college really helps teenagers turn into adults. Going away to college you have to face situations like having to pay bills, time has to be managed well, and cutoff dates have to be met, just like the real world. College is just not about obtaining a good job, but about gaining knowledge. Sometimes it is good to be an intelligent person instead of being someone who just makes a lot of money. There are quite a few reasons why college is worth it in the end, the tuition and college costs are expensive in the beginning, but it pays off once you are earning the money in the future. Researching colleges and finding out the best option for you will only benefit yourself in the end, making wise choices and deciding if starting a family with your finances without a college education will be worth it in the long run, and doing research for yourself to see what will better benefit you and your family by getting some sort of college education. An education gives people an understanding of what they can do for themselves and how they can make needed changes in their lives. Simply just giving away money would not teach the skills or values that come with receiving an education. This is the value of education: that it makes lasting changes in the lives of those who seek it. Works Cited Bird, Caroline. College is a waste of time and money. The Case Against College (1975): n. pag. Print. Carnevale, Anthony. College is Still Worth it. Inside Higher ED 14 Jan. 2011: 8-10. Print. Cooper, Edward, Veterinarian. Personal Interview. 27 Oct, 2012. Coye, Dale. Ernest Boyer and the New American College. Connecting with the Disconnects 29. 3 (1997): 20. Print. Mascle, Deanna. A College Degree in nearly a necessity. Thinking about college? We can help! : n. pag. College Tidbits. Web. 29 Nov. 2012. http://www. collegetidbits. com/prep4college/A-College-Degree-is-Nearly-a-Necessity. html. Sorensen, Kia. Unmarried Parents in College. Fragile Families 20. 2 (2010): 28-50. Print. Tutiion Breakdown: Is college worth it? HLNtv. com Turner Broadcasting System Inc, 16 Aug. 2012. Web. 19 Nov. 2012.

Monday, October 14, 2019

Miniplates for Osteosynthesis of Middle Facial Fractures

Miniplates for Osteosynthesis of Middle Facial Fractures INTRODUCTION Numerous biomechanical studies illustrate the stability of the rigid fixation for mandibular fractures4-6. However, little research has focused on the maxilla, despite the fact that Le Fort fractures and osteotomies are common clinical presentations. For the treatment of Le Fort maxillary fractures, the primary aims include the restoration of correct midfacial vertical height and anterior projection and restoration of occlusion. Nonetheless, the removal rate of the miniplates and screws were approximately 50% in orthognathic surgery (Le Fort I osteotomy), due predominantly to infection or wound dehiscence7. The other problem is that patients sometimes complain of weak clenching after the operation, therefore questions regarding minimum number of plates and stability following fixation have risen in recent times. Miniplate osteosynthesis, developed by Champy in 19751, is todays standard for the treatment of facial fracture. More recently resorbable plates2 and screws and 3-dimensional miniplating system3, have been introduced for fixation of facial fractures. Many studies have proved the efficacy of three dimensional plating systems in mandible fractures but very little research have been carried out on midface fractures. We studied the efficacy of three dimensional plates in midface fractures and found them efficacious enough to stabilize the bone fragments during osteosynthesis. Three dimensional miniplating system was introduced by Farmand (1992)3. The basic concept of three-dimensional fixation is that a geometrically closed quadrangular plate secured with bone screws creates stability in three dimensions. The three dimensional plates are positioned perpendicular to the fracture line. The screws adapt each part of the plate separately without any tension to the bone. The cross linking provides the stability to the system. Three dimensional miniplates are easy to adjust, requires minimal tissue dissection thus least disturbing the blood supply and because of its design fixation points remain in the vicinity of fracture line. Its low profile design and space between plate holes permits excellent revascularization. The biomechanical and technical advantages of three dimensional miniplate systems over two dimensional miniplate system promoted the current study to evaluate the efficacy of the 3-D titanium miniplates as a viable treatment modality in the osteosynthesis of middle third facial fractures. MATERIAL AND METHOD Subjects for the present study were selected amongst the patients, attending the outpatients department and emergency services of Department of Oral Maxillofacial Surgery, Kothiwal dental college and research centre,Moradabad. Study comprised of thirty patients, with isolated lefort I fracture,20 patients had bilateral fracture and 10 patients had unilateral lefort I fracture . All patients were taken up randomly irrespective of age, sex caste and creed. Patients were diagnosed on the basis of clinical examination and radiographic interpretation. Preoperative evaluation included careful examination of the soft tissues and underlying skeleton. A thorough physical examination was carried out to exclude any other injuries. All selected patients were informed about the experimental nature of the study and the possible complications were explained. Their co-operation was solicited and informed consent was obtained. The patient received prophylactic antibiotic coverage and analgesics at the time of initial presentation. INVESTIGATIONS Radiographs: The following radiographs were used to confirm clinical diagnosis and to assess the exact location of fracture and degree of displacement Occipitomental view and submentovertex view for midface PA – Mandible view OPG view (Orthopantomogram) CT scan as needed Other investigations Routine Blood investigation Urine analysis Urine analysis TREATMENT PLANNING All patients were admitted to the hospital prior surgery. Erich’s arch bar were placed on upper and lower standing teeth to stabilize the fracture segment and to achieve occlusion before plating. ARMAMENTRIUM Basic instrument set for maxillofacial surgery Instrument used for intermaxillary fixation 3-DIMENSIONAL TITANIUM MINIPLATE 1.7 MM SYSTEM PLATES DESIGN: 4 different designs of three-dimensional titanium miniplates were included. 2ц¦2 holed square plate 2 x 2 holed rectangular plates 3 x 2 holed continuous rectangle or double rectangle 42 holed –continuous rectangle plate All the plates had 1.7 mm diameter holes. PROFILE HEIGHT 0.6 mm (low profile plates) SCREWS Non compression, self-tapping, monocortical screws with round head. Diameter : 1.7 mm Length : 5mm, 7mm and 9 mm DRILL BIT: Diameter: 1.2 mm CONVENTIOANAL TITANIUM MINIPLATE 1.7 MM SYSTEM 1ц¦2 holed – straight plate PROFILE HEIGHT 1.0mm SCREWS Non compression, self-tapping, monocortical screws with round head. Diameter : 1.7 mm Length : 5mm, 7mm and 9 mm DRILL BIT: Diameter: 1.2 mm ACCESSORIES Screwdrivers Bone plate holding forceps Bone plate bending forceps Plate cutting pliers OPERATIVE TECHNIQUE FOR THREE DIMENSIONAL MINIPLATES Patients were operated either under general anesthesia (Naso-tracheal intubations) or local anesthesia. Strict asepsis was followed. In this study, the fracture sites were exposed through standard intraoral vestibular incision.(Fig.1), Following reduction of the fragments and temporary maxillomandibular fixation, a suitable 3D plate was selected and bent with a plate bending pliers to conform the proper adaptation of plates to bone surface. The three dimensional titanium miniplates were then positioned in such a way that the horizontal cross-bars were perpendicular to the fracture line and the vertical ones were parallel to it (Fig.2). Holding the plate perpendicular to the reduced fracture, drilling was performed through the hole in the plate strictly perpendicular to the bone surface. The drilling was performed at slow-speed along with copious saline irrigation to prevent damage to the bone by heat. To avoid injury to the dental roots the superior holes were drilled strictly monocortically, and directed into the space between the roots. Later screws of suitable length were selected for fixation of the plate. In each case the upper screws were tightened first, followed by the lower ones. For screw tightening the rotations were executed using the screw-holding screw driver. Maxillomandibular fixation was released and occlusion was checked by moving the lower jaw. The site was closed using 3-0 silk suture material. No maxillomandibular fixation was required in any of the patient. OPERATIVE TECHNIQUE FOR THREE DIMENSIONAL MINIPLATES Operative technique for conventional plate was similar to the one used for three dimensional miniplate.Intraoral vestibular incision was used in all the patients and after fracture reduction either conventional 2 dimensional L shaped plate was fixed at zygomaticomaxillary buttress region and 2 hole with gap miniplate was placed over nasomaxillary buttress region. POSTOPERATIVE MANAGEMENT Postoperative course of medication consisted of injection ceftriaxone 1gm 12 hourly (i.v.), injection metrogyl 100ml 8 hourly (i.v.) and analgesic and multivitamin preparation continued till 5th postoperative day. All patients were put on liquid diet for first 2 weeks. All patients were encouraged to maintained good oral hygiene. Sutures were removed on the 7th postoperative day. All patients were followed up at regular interval that is at 1st week, 3rd week, 6th week and 3 month postoperatively regarding restoration of function, stability of system used and any complication. Assessment of the patients was done under following parameters: Pain Visual Analogue Scale (VAS) (0-10) Swelling present/absent. Occlusion intact/deranged Mobility of fracture segment-present/Absent Infection/wound dehiscence -present/Absent Hardware failure present/Absent STATISTICAL ANALYSIS The following statistical tools were employed for the present study: Mean, Standard Deviation, Student’t’ test, Paired‘t’ test and Chi-square test RESULTS We obtained following results in our study Patients in the 31-40 years of age were the predominant age group presenting with midface fractures (50%). Males were most commonly affected with Lefort I fracture (92.84%). The most common cause of midface fracture was found to be road traffic accident (92.8%). There is significant decrease in pain at 3 WK, 6 WK and 3rd Months from the Baseline (1WK) for both the groups Swelling was present in 15 patients (50%). It decreased significantly at 3W, 6WK, 3 MONTHS, from baseline (1WK)(fig.3) There is significant improvement (75%) in post traumatic Parasthesia of infraorbital nerve following fixation with 3-D plating system.(Fig.4) Occlusion was achieved in all the patients after surgery No sign of infection and hardware failure was present in any patient. DISCUSSION Le Fort I maxillary fractures are among the injuries encountered most frequently in patients who suffer facial trauma and it is common in orthognathic surgery. Fixation of maxillary Le Fort I fractures(/osteotomy) by RIF of the facial skeleton has become an accepted, and even expected, form of treatment. When the teeth of the maxilla and mandible are clenched, anatomic support for the midface is provided through a series of buttresses or struts that distribute masticatory forces from the teeth to skull base.19-21 The vertical struts of the midface are clinically the most important in management of Le Fort I maxillary fractures. The 3 principal vertical buttresses of the maxilla are the nasomaxillary (medial) buttress, zygomaticomaxillary (lateral) buttress, and the pterygomaxillary (posterior) buttress.4 The internal fixation of Le Fort I fractures should use miniplates and screws and be fixed at anterior and lateral buttresses for the ideal internal fixation, whereas the posterior buttress should be without fixation due to the surgical difficulty of the operative approach.4 Surgical treatment of Le Fort I fracture according to the â€Å"ideal internal fixation† produces satisfactory results, but patients sometimes complain of weak clenching after the operation. Very few comparisons of the different maxilla fixation modalities and their behavior have been reported currently. In clinical Le Fort I fracture treatment, restoration of the correct midfacial vertical height and anterior projection and restoration of occlusion are critical. Therefore, questions have arisen regarding the stability and number of plates required of adequate fixation of lefort fractures. The fixation of 2 miniplates on each side as suggested by AO/ASIF, provides adequate stability and conventionally it has been the standard treatment for lefort fractures , Farmand8 in 1992 developed new titanium miniplate system that takes advantage of biogeometry to provide stable fixation and he called it as three dimensional plating system. A geometrically closed quadrangular plates secured with bone screws creates stability in three dimensions. .These plates have low profile design, excellent biocompatibility, and minimal rebound after bending. The present study was carried on patient’s age group 10- 50 years with the mean being 33.14 years. The maximum number of patients were in a age group between 31- 50 years (nearly 50%).This is in accordance with the study of Khateeb T,Abdulla FM(2007)9. There was predominance of males in this study, male is to female ratio being 13:1,and percentage of male patients being 92%. .Motamedi MH (2003)10 observed in a retrospective study on 237 patients, percentage of male patients being 89% and that of female patients being 11%, our study is in accordance with this study. In this study road traffic accident (92%) were found to be the major etiological factor for the fracture of the middle third of the facial skeleton .These findings coincides with the findings of, Iida S, Kogo M 11 who reported road traffic accident to be the most common cause of injury in a retrospective analysis of 1502 patients with facial fractures. In the present study it was observed that among the maxillary fractures, Lefort II fractures( approx78%) were most common, this finding is in accordance with the study Motagemi MH (2003)10 which reported the incidence of Lefort II fractures to be 54.6% among all maxillary fractures in a five year retrospective study on 237 patients . In the present study, post traumatic parasthesia of the infraorbital nerve was present was present in 4 cases (57.14%) (out of the 7 patients with zygomatic complex fractures) which was clinically inferred as compression of nerve by fracture fragments .Anesthesia was relieved in 3(75%) out of 4 patients in a three month follow up period which found to be due to infra orbital nerve relieved from compression by means of reduction of fractured segments in to its correct position. c. Demen et al (1988)12 reported the presence of sensory disturbances of infraorbital nerve in 219 cases (80.2%) out of 273 patients The influence of treatment approach on the recovery of the injured infraorbital nerve is controversial in the literature .Several authors reported that frequency of persistent sensory disturbance is independent of the method of reduction and fixation of fracture. Deman and box (1993)12 state that reduction and fixation are important factors in recovery from sensory disturbances of infraorbital nerve. Taicher (1993)13, observed that there is higher recovery rate of infraorbital nerve with miniplate osteosynthesis than with other method of treatment .We report a (75%) recovery rate of in our study, Our results support these findings .This significantly high recovery rate with 3 D plate can be explained by the fact that fixation with 3 D plate provides better stability to the complex in all the three dimensions of movement? However there is no study in the literature on the recovery of infraorbital nerve after fixation with 3-D plates. In the present study occlusion was achieved in all the patients after surgery. Conventional treatment with maxillomandibular fixation is associated with its well known limitations and disadvantages. Klotch DW(1987)14 studied internal fixation versus conventional therapy in midface fractures and found that a more stable occlusion is achieved with internal fixation .S Anand, Thangavelu (2004)15studied the use of three dimensional plate fixation of fractures and osteotomies and stated that satisfactory occlusion was achieved in all the patients after internal fixation with 3- plates and no patient required any maxillomandibular fixation. Claude Guimond(2005)16 studied the use of 3-D plate for fixation of mandibular factures and reported similar findings in their study. As three dimensional plates provide stability in three dimensions of movement the need for maxillomandibular fixation is greatly diminished or moreover eliminated. Our study is in accordance with these studies. No patient reported for any type of postoperative infection, wound dehiscence during the period of three month follow up. Lia G (1997)17 reported the similar results in his study .He found no post operative complications in 30 treated cases of 3 D titanium bone plating. S Anand, Thangavelu (2004)15 studied the role of 3-dimensional plating system and did not reported any infection in their study .Claude Guimond(2005)16studied the use of 3-D plating in mandibular fractures and reported a significantly low rate of infection as compared with other systems. Farmand(1995)3 studied the use of 3-D plates in fixation of fracture and osteotmies and reported an significantly low rate of post operative infection with 3-D plates. No infection in our cases could be attributed to the preoperative antibiotic therapy in all patients,and proper sterilization technique. In none of the patients plates need to be removed exhibiting there excellent biocompatibility in this short period of study. Farmand(1992)18, in their respective studies on the use of three dimensional plates in oral and maxillofacial region did not report any hardware failure with the use of these plates ,our study is in accordance with these studies. Thus as a result of clinical experience it can be inferred that the use of 3 D plates and screw system in the management of midfacial fractures give good results in term of function ,esthetic and acceptability. However, owing to fewer numbers of cases, no definitive conclusions can be drawn, for this; studies with larger sample size and long term follow up are recommended.