Native Americans and Early American Colonists Essay

Grade school and even beginning level college history classes have taught early American exploration from a largely one sided view of the conflict between early explorers and Native Americans. The traditional image of the Native Americans as the sole victims, is an oversimplification of the conflict that existed between early explorers, settlers and Native Americans. Through the readings from Columbus, Bradford and some selected Native American writings, the traditional view of the Native American victim will be challenged and a broader view of the conflict will be presented. Columbus set out to explore a new land under the Spanish flag to bring riches and fame to Spain and the throne. In his letter to Santangel, Columbus (1493) explained how he hoped to find â€Å"great cities† and â€Å"king[s]† but instead found a primitive people and settlements he described as â€Å"small hamlets† that he viewed quite devolved from the bustling civilizations of Europe (pg. 26). One can clearly see, that Columbus’s hopes of finding rich kingdoms and cultures were dashed; instead his presence was met with resistance from the â€Å"Indians†. This relationship with the natives was described by Baym et. all (2008) as â€Å"disordered and bloody† (pg. 25). These natives were mistreated even though one could argue that they â€Å"threw the first punch† but, as Baym et. all (2008) describes earlier in the chapter, the Natives were not merely victims. They strategically used alliances with explorers and settlers to further their own interests and disputes with warring tribes and peoples. William Bradford (1897) describes quite a different account of his coming to the new world. He was part of a group of â€Å"pilgrims† seeking religious freedom. He likens their arrival to the new world, to the story in Acts were the apostles are met with such aggression from barbarians â€Å"who were readier to fill their sides full of arrows† (pg. 60). Later on in his account, he describes an attack they received from the natives he described as â€Å"enemies† (pg. 64). Later on in his account, Bradford (1897) describes some awful events surrounding early accounts of settler and native interactions in which the Native Americans treated the english as â€Å"worse than slaves† and were sent around and â€Å"ma[d]e sport with† (pg. 70). One last important viewpoint to give credence to is that of the Natives themselves. This account is unique and oftentimes not told. The first story mentioned is that of the freeing of John Smith as a ceremonial act that the natives hoped would earn them respect from the English. This instead had the opposite effect and eventually brought about an attack from the natives which killed over 500 colonists. In a speech from Pontiac (1763) he expresses concern over his people forgetting their heritage and blaming the English for the polluting of his people’s culture and beliefs. He holds the English in complete responsibility and calls for their blood. The traditional view of the natives as the sole victim is an oversimplification of the problems revolving around immigration and cultural diversity. Just from these three personal accounts from the time period we have three very different views of the issue. So, to say that one peoples are the victim is a gross oversimplification and misrepresentation of history. Columbus, C. (1493). Letter to Luis de Santagel Regarding the First Voyage. In Baym, N. (Ed. ). (2008). The Norton Anthology of American Literature (seventh ed., pp. 24-28). New York, NY: W. W. Norton & Company, Inc. Bradford, W. (1897). Of Plymouth Plantation. In Baym, N. (Ed. ). (2008). The Norton Anthology of American Literature (seventh ed. , pp. 57-74). New York, NY: W. W. Norton & Company, Inc. Pontiac (1763). Speech at Detroit. In Baym, N. (Ed. ). (2008). The Norton Anthology of American Literature (seventh ed. , pp. 208-209). New York, NY: W. W. Norton & Company, Inc. Baym, N. (Ed. ). (2008). The Norton Anthology of American Literature (seventh ed. , pp. 1-218). New York, NY: W. W. Norton & Company, Inc.

Asvance Care Planning Essay

Assessment Criteria 1.1. Describe the difference between a care or support plan and an Advance Care Plan Advance care planning (ACP) is a process of discussion between an individual and their care providers irrespective of discipline. According to NHS guidlines the difference between ACP and planning more generally-which sets out how the client’s care and support needs will be met- is that the process of ACP is to make clear a person’s wishes. 1.2. Explain the purpose of advance care planning It usually take place in the context of an anticipated deterioration in the individual’s condition in the future, with attendant loss of capacity to make decisions and/or ability to communicate wishes to others. In that case Advance care planning can ensure that all of those concerned with the patient’s care and well-being kept informed -with the patient’s permission-of any decisions, wishes or preferences which impact upon her care when she has no ability to communicate these any more. 1.3. Identify the national, local and organisational agreed ways of working for advance care planning The main principles are covering the agreed ways of working: The process is voluntary. No pressure should be brought to bear by the professional, the family or any organisation on the individual concerned to take part in ACP ACP must be a patient centred dialogue over a period of time The process of ACP is a reflection of society’s desire to respect personal autonomy. The content of any discussion should be determined by the individual concerned. The individual may not wish to confront future issues; this should be respected All health and social care staff should be open to any discussion which may be instigated by an individual and know how to respond to their questions Health and social care staff should instigate  ACP only if in the context of a professional judgement that leads them to believe it is likely to benefit the care of the individual. The discussion should be introduced sensitively Staff will require the appropriate training to enable them to communicate effectively and to understand the legal and ethical issues involved Staff need to be aware when they have reached the limits of their knowledge and competence and know when and from whom to seek advice Discussion should focus on the views of the individual, although they may wish to invite their carer or another close family member or friend to participate. Some families may have discussed their issues and would welcome an approach to share this discussion Confidentiality should be respected in line with current good practice and professional guidance Health and social care staff should be aware of and give a realistic account of the support, services and choices available in the particular circumstances. This should entail referral to an appropriate colleague or agency when necessary The professional must have adequate knowledge of the benefits, harms and risks associated with treatment to enable the individual to make an informed decision Choice in terms of place of care will influence treatment options, as certain treatments may not be available at home or in a care home, e.g. chemotherapy or intravenous therapy. Individuals may need to be admitted to hospital for symptom management, or may need to be admitted to a hospice or hospital, because support is not available at home ACP requires that the individual has the capacity to understand, discuss options available and agree to what is then planned. Should an individual wish to make a decision to refuse treatment (advance decision) they should be guided by a professional with appropriate knowledge and this should be documented according to the requirements of the MCA 2005 1.4. Explain the legal position of an Advance Care Plan Mental Capacity Act 2005 which came into force in October 2007 along with the supporting Code of Practice. Chapter 9 of the Mental Capacity Act (MCA) 2005 Code of Practice refers specifically to Advance Decisions to Refuse Treatment and will be used as a guide to sections within this document that refer to advance decisions. According to NHS guidelines for individuals with capacity it is their current wishes about their care which needs to be  considered. Under the MCA of 2005, individuals can continue to anticipate future decision making about their care or treatment should they lack capacity. In this context, the outcome of ACP may be the completion of a statement of wishes and preferences or if referring to refusal of specific treatment may lead onto an advance decision to refuse treatment. This is not mandatory or automatic and will depend on the person’s wishes. Alternatively, an individual may decide to appoint a person to represent them by choosing a person (an ‘attorney’) to take decisions on their behalf if they subsequently lose capacity. A statement of wishes and preferences is not legally binding. However, it does have legal standing and must be taken into account when making a judgement in a person’s best interests. Careful account needs to be taken of the relevance of statements of wishes and preferences when making best interest decisions. If an advance decision to refuse treatment has been made it is a legally binding document if that advance decision can be shown to be valid and applicable to the current circumstances. If it relates to life sustaining treatment it must be a written document which is signed and witnessed. 1.5. Explain what is involved in an ‘Advance Decision to Refuse Treatment’ The MCA 2005 provides the statutory framework to enable adults with capacity to document clear instructions about refusal of specific medical procedures should they lack capacity in the future. An advance decision to refuse treatment: Can be made by someone over the age of 18 who has mental capacity Is a decision relating to refusal of specific treatment and may be in specific circumstances Can be written or verbal If an advance decision includes refusal of life sustaining treatment, it must be in writing, signed and witnessed and include the statement ‘even if life is at risk’ Will only come into effect if the individual loses capacity Only comes into effect if the treatment and circumstances are those specifically identified in the advance decision Is legally binding if valid and applicable to the circumstances. 1.6. Explain what is meant by a ‘Do Not Attempt cardiopulmonary resuscitation’ (DNACPR) order In England and Wales, CPR is presumed in the event of a cardiac arrest unless a do not resuscitate order is in place. If they have capacity as defined under the Mental Capacity Act 2005 the patient may decline resuscitation, however any discussion is not in reference to consent to resuscitation and instead should be an explanation. Patients may also specify their wishes and/or devolve their decision-making to a proxy using an advance directive, which are commonly referred to as ‘Living Wills’. Patients and relatives cannot demand treatment (including CPR) which the doctor believes is futile and in this situation, it is their doctor’s duty to act in their ‘best interest’, whether that means continuing or discontinuing treatment, using their clinical judgment. Learning Outcome 2: Understand the process of advance care planning Assessment Criteria 2.1. Explain when advance care planning may be introduced ACP may be instigated by either the individual or a care provider at any time not necessarily in the context of illness progression but may be at one of the following key points in the individual’s life: Life changing event, e.g. the death of spouse or close friend or relative Following a new diagnosis of life limiting condition eg. cancer or motor neurone disease Significant shift in treatment focus e.g. chronic renal failure where options for treatment require review Assessment of the individual’s needs Multiple hospital admissions 2.2. Outline who might be involved in the advance care planning process Advance care planning centres on discussions with a person who has capacity to make decisions about their care and treatment. If the individual wishes, their family, friends and health and social care professionals may be included. It is recommended that with the individual’s agreement that  discussions are documented, regularly reviewed, and communicated to key persons involved in their care. 2.3. Describe the type of information an individual may need to enable them to make informed decisions Statements of wishes and preferences can include personal preferences, such as where one would wish to live, having a shower rather than a bath, or wanting to sleep with the light on. Sometimes people may wish to express their values e.g. that the welfare of their spouse or children is taken into account when decisions are made about their place of care. Sometimes people may have views about treatments they do not wish to receive but do not want to formalise these views as a specific advance decision to refuse treatment. These views should be considered when acting in a person’s best interests but will not be legally binding. A statement of wishes and preferences cannot be made in relation to any act which is illegal e.g. assisted suicide. 2.4. Explain how to use legislation to support decision-making about the capacity of an individual to take part in advance care planning The Mental Capacity Act says: Everyone has the right to make his or her own decisions. Health and care professionals should always assume an individual has the capacity to make a decision themselves, unless it is proved otherwise through a capacity assessment. Individuals must be given help to make a decision themselves. This might include, for example, providing the person with information in a format that is easier for them to understand. Treatment and care provided to someone who lacks capacity should be the least restrictive of their basic rights and freedoms possible, while still providing the required treatment and care. The MCA also allows people to express their preferences for care and treatment in case they lack capacity to make these decisions. It also allows them to appoint a trusted person to make a decision on their behalf should they lack capacity in the future. The MCA sets out a two-stage test of capacity. Does the individual concerned have an impairment of, or a disturbance in the functioning of, their mind or brain, whether as a result of a condition, illness, or external factors such as alcohol or drug use? Does the impairment or disturbance mean the individual is unable to make a specific decision when they need to? Individuals can lack capacity to make some decisions but have capacity to make others, so it is vital to consider whether the individual lacks capacity to make the specific decision. Also, capacity can fluctuate with time – an individual may lack capacity at one point in time, but may be able to make the same decision at a later point in time. Where appropriate, individuals should be allowed the time to make a decision themselves. MCA says a person is unable to make a decision if they cannot: understand the information relevant to the decision retain that information use or weigh up that information as part of the process of making the decision If they aren’t able to do any of the above three things or communicate their decision (by talking, using sign language, or through any other means), the MCA says they will be treated as unable to make the specific decision in question. Before deciding an individual lacks capacity to make a particular decision, appropriate steps must be taken to enable them to make the decision themselves. For example: Does the individual have all the relevant information they need? Have they been given information on any alternatives? Could information be explained or presented in a way that is easier to understand (for example, by using simple language or visual aids)? Have different methods of communication been explored, such as non-verbal  communication? Could anyone else help with communication, such as a family member, carer, or advocate? Are there particular times of day when the individual’s understanding is better? Are there particular locations where the individual may feel more at ease? Could the decision be delayed until a time when the individual might be better able to make the decision? 2.5. Explain how the individual’s capacity to discuss advance care planning may influence their role in the process Example by NHS: Caroline has dementia and lives at home with the support of carers from a domiciliary care agency. Over the last two days, she has become very confused and unable to make decisions about the care she receives. The care worker has suggested that the GP be called. Caroline is adamant that she does not require the GP. It is clear that Caroline is unwell and the care worker, having consulted the family, assesses that Caroline lacks the capacity to make the decision about whether or not to call the doctor. So the care worker calls the GP and records her actions in the care plan. The GP visits Caroline and diagnoses a urinary tract infection. He requests a urine sample for analysis and commences treatment with antibiotics. Within three days, Caroline has regained her capacity, for this decision. 2.6. Explain the meaning of informed consent Informed consent is a process for getting permission before conducting a healthcare intervention on a person. For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision. These terms are explained below: Voluntary – the decision to either consent or not to consent to treatment must be made by the person themselves, and must not be influenced by pressure from medical staff, friends or family. Informed – the person must be given all of the information in terms of what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments and what will happen if treatment does not go ahead. Capacity – the person must be capable  of giving consent, which means they understand the information given to them, and they can use it to make an informed decision. If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected. This still stands even if refusing treatment would result in their death, or the death of their unborn child. If a person does not have the capacity to make a decision about their treatment, the healthcare professionals treating them can go ahead and give treatment if they believe it is in the person’s best interests. However, the clinicians must take reasonable steps to seek advice from the patient’s friends or relatives before making these decisions. 2.7. Explain own role in the advance care planning process Under the MCA, anybody making a decision about the care or treatment of an individual, who has been assessed as lacking the capacity to make that decision for himself, will be required to take any statement of wishes and preferences into account when assessing that person’s best interests. Part of assessing best interests should include making reasonable efforts to find out what a person’s wishes, preferences, values and beliefs might be. This is likely to involve contacting the person’s family or other care providers. They may be able to advise whether any statements of wishes or preferences exists or for help in determining that person’s wishes. This will not always be possible, e.g. if an individual is admitted as an emergency, is unconscious and requires rapid treatment. 2.8. Identify how an Advance Care Plan can change over time Person’s views may change over time. If they wish to make any changes they should let their doctor or nurse know as well as their family and friends. When their Advance Care Plan is completed they are encouraged to keep it with them and share it with everyone involved in their care. What has been written in their Advance Care Plan will always be taken into account when planning their care. However sometimes things can change unexpectedly, such  as their carers (family, friends and neighbours) becoming over tired or ill- these are unforeseen circumstances. 2.9. Outline the principles of record keeping in advance care planning According to NHS guidelines: Healthcare professionals cannot make a record of the discussion without the permission of the individual The individual concerned must check and agree the content of the record Information cannot be shared with anyone, unless the individual concerned has agreed to disclosure. Where the individual refuses to share information with certain individuals the options should be explained to them and the consequences made clear Any record should be subject to review and if necessary, revision and it should be clear when this is planned. Review may be instigated by the individual or care provider, can be part of regular review or may be triggered by a change in circumstances A clear record of who has copies of the document will help facilitate future updating and review Copies in notes should be updated when an individual makes any changes Where an advance decision is recorded, it should follow guidance available in the Code of Practice for the MCA http://www.dca.gov.uk/menincap/legis.htm#codeofpractice and be recorded on a separate document to that used for ACP The professional making the record of an advance decision must be competent to complete the process Where this is part of a professional’s role, competence based training needs to be available and accessed If the individual agrees for their record to be shared, it should be ensured that systems are in place to enable sharing between health and social care professionals involved in the care of the individual, including out of hours providers and ambulance services For an individual who has lost capacity disclosure of a statement will be based on best interests There should be locally agreed policies about where the document is kept. For example, it may be decided that a copy should be given to the individual and a copy placed in the notes 2.10 Describe ci rcumstances when you can share details of the Advance Care Plan The advance care plan is a document that goes into effect only if the  client is incapacitated and unable to speak for herself. This could be the result of disease or severe injury—no matter how old is she. It helps others know what type of medical care she wants. In that case it is really important to make sure that everybody who is involved in her care knows everything about her preferences and wishes-thus the Advance Care Plan’s details should be shared. That could explain her feelings, beliefs and values that govern how she make decisions. They may cover medical and non-medical matters. They are not legally binding but should be used when determining a person’s best interests in the event they lose capacity to make those decisions. Learning Outcome 3: Understand the person centred approach to advance care planning Assessment Criteria 3.1. Describe the factors that an individual might consider when planning their Advance Care Plan The wishes are being expressed during advance care planning are personal and can be about anything to do with the patient future care. They may want to include their priorities and preferences for the future, for example: how they might want any religious or spiritual beliefs to hold to be reflected in their care, the name of a person or people they wish to represent their views at a later time, their choice about where they would prefer, if possible, to be cared for, for example at home, in a hospital, nursing home or hospice their thoughts on different treatments or types of care they might be offered, how they like to do things, for example, preferring a shower instead of a bath or sleeping with the light on, concerns or solutions about practical issues, for example, who will look after their dog should you become ill 3.2. Explain the importance of respecting the values and beliefs that impact on the choices of the individual Sometimes people will want to write down or tell others their wishes and preferences for future treatment and care, or explain their feelings or  values that govern how they make decisions. Statements of wishes and preferences or documented conversations the person has had with their family or other carers may be recorded in the person’s notes. A statement of wishes and preferences can be of various types, for example: A requesting statement reflecting an individual’s aspirations and preferences. This can help health and social care professionals identify how the person would like to be treated without binding them to that course of action if it conflicts with professional judgment A statement of the general beliefs and aspects of life which an individual values. This might provide a biographical portrait of the individual that subsequently aids deciding his/her best interests. Your beliefs and values are what make you a unique individual. They are based upon past experiences as well as present circumstances. Many of them were learned from parents as well as other respected individuals. While some people may have values and beliefs that are deemed to be â€Å"wrong† according to society, unless your values and beliefs cause harm to others, they cannot be considered wrong. While some beliefs and values may change from time to time, they remain your own. 3.3. Identify how the needs of others may need to be taken into account when planning advance care A person assessing an individual’s best interests must:- Not make any judgement using the professional’s view of the individual’s quality of life Consider all relevant circumstances and options without discrimination Not be motivated by a desire to bring about an individual’s death Consult with family partner or representative as to whether the individual previously had expressed any opinions or wishes about their future care e.g. ACP Consult with the clinical team caring for the individual Consider any beliefs or values likely to influence the individual if they had capacity Consider any other factors the individual would consider if they were able to do so Consider the individual’s feelings 3.4. Outline what actions may be appropriate when an individual is unable to or does not wish to participate in advance care planning Many patients with early or slowly progressing disease, and some with advanced disease, will not wish to discuss end-of-life care. However, they should still receive the opportunity to discuss other aspects of their future care. If the patient does not have capacity for making future plans, then the clinical team will need to make choices based on the patient’s best interests as defined in the MCA. 3.5. Explain how individual’s care or support plan may be affected by an Advance Care Plan If an individual wishes, ACP may be an integral part of the care and communication process and of their regular care plan review. The difference between ACP and care planning more generally is that the process of ACP will usually take place in the context of an anticipated deterioration in the individual’s condition in the future, with attendant loss of capacity to make decisions and/or ability to communicate wishes to others.

Diabetes

Motivational Speech Proposal STATEMENT OF THE PROBLEM: According to the Centers for Disease Control and Prevention, in 2005, there were 20. 6 million cases of diabetes among people aged 20 years to 44 years; according to the American Diabetes Association in 2011, there were 25. 6 million cases of diabetes among people aged 20 years to 44 years. GENERAL PURPOSE: To persuade SPECIFIC PURPOSE: To persuade my audience to engage in walking for 30 minutes a day to prevent diabetes. CENTRAL IDEA: My audience should walk for 30 minutes a day because doing so will help them from getting diabetes and other chronic health diseases. Attention Grabber: Isolation, Denial, depression, guilt, anger, embarrassment, and dependence, these are the emotions that are experienced among people with diabetes. Vivian, a 17 year old quiet spoken girl who has gone through these emotions. She began feeling really miserable, throwing up, really thirsty all of the time. One day, after falling into a diabetic coma, she was lying in a hospital bed and the doctors were explaining that her pancreas had stopped functioning and I was no longer producing insulin. This was serious. She was zoned out. She asked herself, â€Å"Diabetes? How could that be possible? And why her? † This could happen to any of us, and we may be the unlucky victim. As college students, we live in a world where everything is convenient, from cars, to fast food, causing us to be more sedentary and unhealthy. It is easy for us to slip into a sedentary lifestyle with no or irregular physical activity. With physical inactivity among threatening our well beings, and precipitating deadly diseases as diabetes, we need a change to better our lives. Problem: According to the Centers for Disease Control and Prevention, in 2005, there were 20. million cases of diabetes among people aged 20 years to 44 years; according to the American Diabetes Association in 2011, there were 25. 6 million cases of diabetes among people aged 20 years to 44 years. A. So what is Diabetes? a. According to American Diabetes Association, diabetes is a disorder of sugar metabolism: It is when high blood glucose level occurs. There are 3 types of diabetes. b. A. Type 1 diabetes, or juvenile diabetes, is when there is no production of insulin-a hormone that guides sugar into cells and help convert it into energy. No insulin means no control of blood sugar. Only 5 percent of all diabetes cases are type 1 and mostly occur in young adults. a. The US Department of Education: Digest of Education Statistics, states that Each fall, 2. 3 million freshmen enroll in institutes of higher education in the U. S. Of these, 7, 700 will have type 1 diabetes, based on an estimated prevalence rate of 1 of every 300. B. Type 2 is when you don’t produce enough insulin, or your insulin is not working properly. Cells have become resistant to the insulin is not very effective. . The ADA describes Type 2 as the most common form of diabetes. In adults, type 2 diabetes, a condition that can be prevented, accounts for 90–95% of all diagnosed case. C. Stress Diabetes: using medication’s especially water pills (diuretics). It can often disappear when the stress is relieved. D. A 2007-2009 national survey data from American Diabetes Association states that for people diagnosed with diabetes aged 20 ye ars or older, 12. 6% of blacks, 11. 8% of Hispanics, 8. 4% of Asian Americans, and 7. 1% of whites. E. Causes of Diabetes? 1. According to Tom and Gena Metcalf, the authors of Diabetes, there are hereditary and environmental factors involved, and lifestyle. a. For type 2 diabetes, there is stronger link to family history than type 1. If both parents have it, there is 50 % of chance of getting it. If one parent has it, the risk is almost 3 times the general population risk. b. Environmental factors are: Dr. James Warram, a lecturer in epidemiology at Harvard School of Public states that one trigger might be cold weather. 2. Also affecting is age, obesity, lack of exercise. F. The Symptoms of diabetes are many factors. 1. Type 1 and 2 diabetes people can have blurred vision, urinary tract infections, blindness, foot ulcers that leads to limb amputations. 2. Symptoms can develop suddenly (over days or weeks), or gradually (over several years). a. Jane 47 year-old is a triple amputee, have undergone operations to remove both her legs and one arm due to Type 1 diabetes. She faces the prospect of losing her remaining arm in the near future because of diabetes. Imagine not having your legs, what a depressing life that would be. Solution: A. First option, you can do nothing about it. 1. Severe consequences can occur with uncontrolled diabetes. . You can get foot ulcers, blindness, leg amputations, and even death. b. According to the National Diabetes Information Clearinghouse, in 2006, about 65,700 lower-limb amputations were performed in people with diabetes.. B. Second option is taking insulin therapy or oral medications. 1. For Type 1 diabetes, injectable insulin is used. 2. According to Doctor Diane Ell iot in Oregon health Science University, There are different types of oral drugs used to manage Type 2 diabetics: 3. Some side effects with metformin are nausea, vomiting, gas, bloating, diarrhea and loss of appetite. 4. The side effects and the cost of such medicine shows that medication might be at an expense physically and mentally to diabetics. a. It can cost a lot of money. The Website Cost Helper, what are people paying explains that for patients without health insurance, diabetes medication costs $200 to $500 or more a month for a multi-drug regimen. C. The third option, an important aspect in managing diabetes that doesn’t cost us a dime is exercise. 1. Hippocrates said â€Å"Walking is man's best medicine. † Walking is one of the easiest and least expensive ways without needing any equipment’s to stay physically fit. There are no side effects for walking. Just good results. 2. According to Linn Goldberg, doctor and author of the Healing power of exercise, walking helps the body becomes more sensitive to insulin’s action, so sugar is more easily removed from bloodstream and blood glucose levels can normalize. 3. Expert from the National institutes of Health all advise 30 minutes or more of moderate to intense walking on most days of the week. You can walk in two 15 minute segments or three 10 minute. You can take a walk on the park, or on your treadmill. a. The cost is only 30 minutes from you day, while the reward outweighs it, saving your life from complications of diabetes. Visualization: D. Here are two stories of diabetics who chose two different paths to manage their diabetes. A. Choosing to walk 30 minutes a day can help you manage diabetes and even combat other diseases. You might know Della Reese, remember her in the TV series â€Å"Touched by an Angel† is America’s best loved celebrities diagnosed with diabetes Type 2. Her activities include walking on a treadmill to manage her diabetes. Now she parks a block away and walk. She knew one thing for sure that â€Å"ignorance and fear would kill you quicker than any disease. Now she is in charge of her diabetes and still living her entertainment life. B. Not walking 30 minutes a days to control your diabetes is a big mistake: Remember Jane, the 47 year old triple amputee who has failed to understand how deadly uncontrolled diabetes was, and now faces the possibility of losing her remaining arm in the future? She says ‘Diabetes is a condition that has to be respected otherwise the implications are horrendous. † Call to Action: So I want to urge you to start walking 30 minutes today, for a better tomorrow. If you walk regularly for 30 minutes a day, it can considerably help you control your diabetes and help you be fit and feel better. After surveying the class, I gathered that most of us would want to choose exercise for preference to prevent and or manage diabetes. Just realize that each mile a sedentary person walks will add 21 minutes to their life and save society 24 cents in medical and other costs according to the Rand Corporation, a well-known California based â€Å"think tank formed to offer research and analysis. So put on some comfortable shoes, and start walking 30 minutes a day. Diabetes Diabetes mellitus (DM) is a set of related diseases in which the body cannot regulate the amount of sugar (specifically, glucose) in the blood. The blood delivers glucose to provide the body with energy to perform all of a person's daily activities. * The liver converts the food a person eats into glucose. The glucose is then released into the bloodstream. * In a healthy person, the blood glucose level is regulated by several hormones, primarliy insulin. Insulin is produced by the pancreas, a small organ between the stomach and liver.The pancreas also makes other important enzymes released directly into the gut that helps digest food. * Insulin allows glucose to move out of the blood into cells throughout the body where it is used for fuel. * People with diabetes either do not produce enough insulin (type 1 diabetes) or cannot use insulin properly (type 2 diabetes), or both (which occurs with several forms of diabetes). * In diabetes, glucose in the blood cannot move efficiently into cells, so blood glucose levels remain high.This not only starves all the cells that need the glucose for fuel, but also harms certain organs and tissues exposed to the high glucose levels. Type 1 diabetes (T1D): The body stops producing insulin or produces too little insulin to regulate blood glucose level. * Type 1 diabetes involves about 10% of all people with diabetes in the United States. * Type 1 diabetes is typically diagnosed during childhood or adolescence. It used to be referred to as juvenile-onset diabetes or insulin-dependent diabetes mellitus. Type 1 diabetes can occur in an older individual due to destruction of the pancreas by alcohol, disease, or removal by surgery. It also results from progressive failure of the pancreatic beta cells, the only cell type that produces significant amounts of insulin. * People with type 1 diabetes require insulin treatment daily to sustain life. Type 2 diabetes (T2D): Although the pancreas still secretes insulin, the body of someone w ith type 2 diabetes is partially or completely unable to use this insulin. This is sometimes referred to as  insulin resistance.The pancreas tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they fail to secrete enough insulin to cope with their higher demands. * At least 90% of adult individuals with diabetes have type 2 diabetes. * Type 2 diabetes is typically diagnosed in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus. These names are no longer used because type 2 diabetes does occur in younger people, and some people with type 2 diabetes require insulin therapy. Type 2 diabetes is usually controlled with  diet,  weight loss,  exercise, and oral medications. However, more than half of all people with type 2 diabetes require insulin to control their blood sugar levels at some point in the course of their illn ess. Gestational diabetes (GDM)  is a form of diabetes that occurs during the second half of  pregnancy. * Although gestational diabetes typically resolves after delivery of the baby, a woman who develop gestational diabetes is more likely than other women to develop type 2 diabetes later in life. Women with gestational diabetes are more likely to have large babies. Metabolic syndrome  (also referred to as syndrome X) is a set of abnormalities in which insulin-resistant diabetes (type 2 diabetes) is almost always present along with  hypertension  (high blood pressure), high fat levels in the blood (increased serum lipids, predominant  elevation of LDL cholesterol, decreased  HDL cholesterol, and  elevated triglycerides),  central obesity, and abnormalities in blood clotting and inflammatory responses.A high rate of  cardiovascular disease  is associated with metabolic syndrome. Prediabetes  is a common condition related to diabetes. In people with prediabetes , the blood sugar level is higher than normal but not yet high enough to be considered diagnostic of diabetes. * Prediabetes increases a person's risk of developing type 2 diabetes,  heart disease, or  stroke. * Prediabetes can typically be reversed (without insulin or medication) with lifestyle changes such as losing a modest amount of weight and increasing physical activity levels.Weight loss can prevent, or at least delay, the onset of type 2 diabetes. * An international expert committee of the American Diabetes Association redefined the criteria for prediabetes, lowering the blood sugar level cut-off point for prediabetes. Approximately 20% more adults are now believed to have this condition and may develop diabetes within 10 years if they do make lifestyle changes such as exercising more and maintaining a healthy weight. About 17 million Americans (6. 2% of adults in North America) are believed to have diabetes.AIt has been estimated that about one third of adults with diab etes do not know they have diabetes. * About 1 million new cases of diabetes is diagnosed occur each year, and diabetes is the direct or indirect cause of at least 200,000 deaths each year. * The incidence of diabetes is increasing rapidly. This increase is due to many factors, but the most significant are the increasing incidence of obesity associated with the prevalence of a sedentary lifestyle. Complications of diabetes Both type 1 and type 2 diabetes ultimately lead to high blood sugar levels, a condition called  hyperglycemia.Over a long period of time, hyperglycemia damages the retina of the eye, the blood vessels of the kidneys, the nerves, and other blood vessels. * Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness. * Damage to the kidneys from diabetes (diabetic nephropathy) is a leading cause of  kidney failure. * Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of foot  wounds  and ulcers, which fr equently lead to  foot and leg amputations. Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastroparesis),  chronic diarrhea, and an inability to control heart rate and blood pressure during postural changes. * Diabetes accelerates  atherosclerosis, (the formation of fatty plaques inside the arteries), which can lead to blockages or a clot (thrombus). Such changes can then lead to  heart attack, stroke, and decreased circulation in the arms and legs (peripheral vascular disease). * Diabetes predisposes people to elevated blood pressure, high levels of cholesterol and  triglycerides.These conditions both independently and together with hyperglycemia, increase the risk of heart disease,  kidney disease, and other blood vessel complications. Diabetes can contribute to a number of acute (short-lived) medical problems. * Many  infections  are associated with diabetes, and infections are frequently more dangerous in someone with diabetes because the body's normal ability to fight infections is impaired. To compound the problem, infections may worsen glucose control, which further delays recovery from infection. Hypoglycemia  or low blood sugar, occurs intermittently in most people with diabetes. It can result from taking too much diabetes medication or insulin (sometimes called an  insulin reaction), missing a meal, exercising more than usual, drinking too much alcohol, or taking certain medications for other conditions. It is very important to recognize hypoglycemia and be prepared to treat it at all times. Headache, feeling dizzy, poor concentration, tremor of the hands, and sweating are common symptoms of hypoglycemia. A person can faint or have a  seizure  if blood sugar level become too low. Diabetic ketoacidosis  (DKA) is a serious condition in which uncontrolled hyperglycemia (usually due to complete lack of insulin or a relative deficiency of insulin) over time creates a buildup of ketones (acidic waste products ) in the blood. High levels of ketones can be very harmful. This typically happens to people with type 1 diabetes who do not have good blood glucose control. Diabetic ketoacidosis can be precipitated by infection,  stress, trauma, missing medications like insulin, or medical emergencies such as a stroke and heart attack. Hyperosmolar hyperglycemic nonketotic syndrome  is a serious condition in which the blood sugar level gets very high. The body tries to get rid of the excess blood sugar by eliminating it in the urine. This increases the amount of urine significantly, and often leads to  dehydration  so severe that it can cause seizures,  coma, and even death. This syndrome typically occurs in people with type 2 diabetes who are not controlling their blood sugar levels, who have become dehydrated, or who have stress, injury, stroke, or are taking certain medications, like  steroids. Next Page: Diabetes Causes Diabetes Diabetes mellitus (DM) is a set of related diseases in which the body cannot regulate the amount of sugar (specifically, glucose) in the blood. The blood delivers glucose to provide the body with energy to perform all of a person's daily activities. * The liver converts the food a person eats into glucose. The glucose is then released into the bloodstream. * In a healthy person, the blood glucose level is regulated by several hormones, primarliy insulin. Insulin is produced by the pancreas, a small organ between the stomach and liver.The pancreas also makes other important enzymes released directly into the gut that helps digest food. * Insulin allows glucose to move out of the blood into cells throughout the body where it is used for fuel. * People with diabetes either do not produce enough insulin (type 1 diabetes) or cannot use insulin properly (type 2 diabetes), or both (which occurs with several forms of diabetes). * In diabetes, glucose in the blood cannot move efficiently into cells, so blood glucose levels remain high.This not only starves all the cells that need the glucose for fuel, but also harms certain organs and tissues exposed to the high glucose levels. Type 1 diabetes (T1D): The body stops producing insulin or produces too little insulin to regulate blood glucose level. * Type 1 diabetes involves about 10% of all people with diabetes in the United States. * Type 1 diabetes is typically diagnosed during childhood or adolescence. It used to be referred to as juvenile-onset diabetes or insulin-dependent diabetes mellitus. Type 1 diabetes can occur in an older individual due to destruction of the pancreas by alcohol, disease, or removal by surgery. It also results from progressive failure of the pancreatic beta cells, the only cell type that produces significant amounts of insulin. * People with type 1 diabetes require insulin treatment daily to sustain life. Type 2 diabetes (T2D): Although the pancreas still secretes insulin, the body of someone w ith type 2 diabetes is partially or completely unable to use this insulin. This is sometimes referred to as  insulin resistance.The pancreas tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they fail to secrete enough insulin to cope with their higher demands. * At least 90% of adult individuals with diabetes have type 2 diabetes. * Type 2 diabetes is typically diagnosed in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus. These names are no longer used because type 2 diabetes does occur in younger people, and some people with type 2 diabetes require insulin therapy. Type 2 diabetes is usually controlled with  diet,  weight loss,  exercise, and oral medications. However, more than half of all people with type 2 diabetes require insulin to control their blood sugar levels at some point in the course of their illn ess. Gestational diabetes (GDM)  is a form of diabetes that occurs during the second half of  pregnancy. * Although gestational diabetes typically resolves after delivery of the baby, a woman who develop gestational diabetes is more likely than other women to develop type 2 diabetes later in life. Women with gestational diabetes are more likely to have large babies. Metabolic syndrome  (also referred to as syndrome X) is a set of abnormalities in which insulin-resistant diabetes (type 2 diabetes) is almost always present along with  hypertension  (high blood pressure), high fat levels in the blood (increased serum lipids, predominant  elevation of LDL cholesterol, decreased  HDL cholesterol, and  elevated triglycerides),  central obesity, and abnormalities in blood clotting and inflammatory responses.A high rate of  cardiovascular disease  is associated with metabolic syndrome. Prediabetes  is a common condition related to diabetes. In people with prediabetes , the blood sugar level is higher than normal but not yet high enough to be considered diagnostic of diabetes. * Prediabetes increases a person's risk of developing type 2 diabetes,  heart disease, or  stroke. * Prediabetes can typically be reversed (without insulin or medication) with lifestyle changes such as losing a modest amount of weight and increasing physical activity levels.Weight loss can prevent, or at least delay, the onset of type 2 diabetes. * An international expert committee of the American Diabetes Association redefined the criteria for prediabetes, lowering the blood sugar level cut-off point for prediabetes. Approximately 20% more adults are now believed to have this condition and may develop diabetes within 10 years if they do make lifestyle changes such as exercising more and maintaining a healthy weight. About 17 million Americans (6. 2% of adults in North America) are believed to have diabetes.AIt has been estimated that about one third of adults with diab etes do not know they have diabetes. * About 1 million new cases of diabetes is diagnosed occur each year, and diabetes is the direct or indirect cause of at least 200,000 deaths each year. * The incidence of diabetes is increasing rapidly. This increase is due to many factors, but the most significant are the increasing incidence of obesity associated with the prevalence of a sedentary lifestyle. Complications of diabetes Both type 1 and type 2 diabetes ultimately lead to high blood sugar levels, a condition called  hyperglycemia.Over a long period of time, hyperglycemia damages the retina of the eye, the blood vessels of the kidneys, the nerves, and other blood vessels. * Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness. * Damage to the kidneys from diabetes (diabetic nephropathy) is a leading cause of  kidney failure. * Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of foot  wounds  and ulcers, which fr equently lead to  foot and leg amputations. Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastroparesis),  chronic diarrhea, and an inability to control heart rate and blood pressure during postural changes. * Diabetes accelerates  atherosclerosis, (the formation of fatty plaques inside the arteries), which can lead to blockages or a clot (thrombus). Such changes can then lead to  heart attack, stroke, and decreased circulation in the arms and legs (peripheral vascular disease). * Diabetes predisposes people to elevated blood pressure, high levels of cholesterol and  triglycerides.These conditions both independently and together with hyperglycemia, increase the risk of heart disease,  kidney disease, and other blood vessel complications. Diabetes can contribute to a number of acute (short-lived) medical problems. * Many  infections  are associated with diabetes, and infections are frequently more dangerous in someone with diabetes because the body's normal ability to fight infections is impaired. To compound the problem, infections may worsen glucose control, which further delays recovery from infection. Hypoglycemia  or low blood sugar, occurs intermittently in most people with diabetes. It can result from taking too much diabetes medication or insulin (sometimes called an  insulin reaction), missing a meal, exercising more than usual, drinking too much alcohol, or taking certain medications for other conditions. It is very important to recognize hypoglycemia and be prepared to treat it at all times. Headache, feeling dizzy, poor concentration, tremor of the hands, and sweating are common symptoms of hypoglycemia. A person can faint or have a  seizure  if blood sugar level become too low. Diabetic ketoacidosis  (DKA) is a serious condition in which uncontrolled hyperglycemia (usually due to complete lack of insulin or a relative deficiency of insulin) over time creates a buildup of ketones (acidic waste products ) in the blood. High levels of ketones can be very harmful. This typically happens to people with type 1 diabetes who do not have good blood glucose control. Diabetic ketoacidosis can be precipitated by infection,  stress, trauma, missing medications like insulin, or medical emergencies such as a stroke and heart attack. Hyperosmolar hyperglycemic nonketotic syndrome  is a serious condition in which the blood sugar level gets very high. The body tries to get rid of the excess blood sugar by eliminating it in the urine. This increases the amount of urine significantly, and often leads to  dehydration  so severe that it can cause seizures,  coma, and even death. This syndrome typically occurs in people with type 2 diabetes who are not controlling their blood sugar levels, who have become dehydrated, or who have stress, injury, stroke, or are taking certain medications, like  steroids. Next Page: Diabetes Causes

Special Interests Essay Example | Topics and Well Written Essays - 1750 words - 2

Special Interests - Essay Example These interest groups lobby the members within legislative bodies so that the work domains are bolstered for the sake of the political parties. They play their role at bringing about those politicians to power who will understand their cause and hence have a sense of empathy for what they are raising their voice for. These interest groups also carry out secret activities so that certain work areas can be targeted. Having said so, these interest groups have the knack of competing within open propaganda areas where such campaigns are an everyday norm. Since the discussion centers on these interest groups, the need is to comprehend the different types of these interest groups. Firstly, there are the economic interest groups which take into account the varied trade unions, the diverse chambers of commerce and industries and a few other religious groups. These interest groups also bring with them some professional associations which include within them skilled workers like doctors, archit ects, lawyers and other professionals who are making their mark. The third type is comprised of the public interest groups which includes individuals who are essentially the friends of the environment and are playing their dire role within the uplifting of the living standards of the people. The fourth and last is a special interest group which is more of a subgroup which forms under the auspices of a larger group and has a much narrowed down interest area. It is a fact that these interest groups attempt to do their best in terms of defending the status quo as well as to sustain the same over a time period. For this reason, these interest groups are held in separate vein from the pressure groups which exist within the fore of any society in this day and age (Wilcox, 2005). Since these interest groups have a particular definition behind their institution, their supporters openly raise their voice every now and then. They believe staunchly in the existence of these interest groups whi ch is an interesting proposition since they represent these interest groups and would go to any limit to tell people to come and join a common cause. For this reason, some people believe that these interest groups are instituted to serve a hidden agenda, which may or may not be true at all times. This is because their mannerisms are quite strange to state the least and hence many opinions do come about by the people within a community or society concern (Cigler, 2011). To quote a couple of examples, some of the more renowned interest groups include the ASH which serves as a legal action arm within the nonsmoking community. It aims to bring or join within different legal actions that concern smoking as well as guaranteeing towards the fact that the voice of the nonsmoker is always heard loud and clear. The nonsmokers’ rights movement is taken care of by ASH in essence. In addition, GLAAD promotes and suggests an equality basis in terms of fair, accurate and inclusive depiction of people as well as events within the different media forms (Pallotta, 2012). The mission behind GLAAD is to do away with homophobia and discrimination basis towards sexual orientation and gender identity. 2. Discuss the relationship between interest groups and political parties. The relationship that exists between interest groups and political parties is a source of inspiration as far as the undertakings of the interest groups

Diabetes Today Essay Example | Topics and Well Written Essays - 4000 words

Diabetes Today - Essay Example Gestational diabetes occurs during pregnancy, which can potentially develop into type 2 diabetes later in life. Diabetes mellitus is characterized by long-term complications involving small and large blood vessels (micro and macroangiopathy) affecting the eyes, kidneys, and nerves. Type 1 diabetes is usually diagnosed in childhood and accounts for 5-10% of diabetes. Type 1 diabetes mellitus is considered to be an autoimmune disease, where there is destruction of the beta cells of the pancreas, which produces insulin. This results in absolute insulin deficiency. Type 2 diabetes is more common than type 1 and accounts for 90%-95% or more of all cases of diabetes. It is characterized by insulin resistance and relative insulin deficiency. Although it usually occurs in adults over the age of 45, it is increasingly being seen in obese individuals of all age groups, including children and adolescents (New York State Department of Health, 2006). Other causes of diabetes include: due to chronic pancreatitis in alcoholics, hormonal abnormalities like pheochromocytoma, acromegaly, and Cushing’s syndrome, steroid hormone administration, endogenous release of glucagon and catecholamines following severe burns, acute myocardial infarction (â€Å"stress hyperglycemia†), diabetes caused by drugs or chemicals, diabetes caused by insulin receptor abnormalities, and diabetes associated with genetic syndromes like lipodystrophies, myotonic dystrophy and ataxia-telangiectasia (Foster,1998.) It has been suggested that modern food processing methods result in glycation end products, oxidized ascorbic acid and lipoic acid, all of which are potential causes of diabetes. High levels of glycation products are also found in infant formula, which also has added ascorbic acid. Adverse immune effects leading to diabetes can result from glycation of a casomorphin released from A1 beta-casein (Elliott, 2006). Since the 1960s, there has been

Assignment Essay Example | Topics and Well Written Essays - 750 words - 16

Assignment - Essay Example According to the law, a drug dealer means a person who ships, transports, or imports or acquires purchases, possess, manufactures or introduces drug substances in that state. According to the law of Iowa, a person becomes a dealer if he or she introduces seven plus grams of a dutiable constituent except marijuana, but comprising a chargeable means, especially a blend of cannabis sativa and other taxable affluences. It also applies when a person gets into possession of forty-two and half or more of refined cannabis sativa, or of a matter consisting of or comprising cannabis sativa. A person in possession of one or more unprocessed marijuana plants becomes subject to the drug-stamp Act. Ten and above prescription components of a taxable matter that is not sold by mass (Department of Iowa Revenue Web). The following rates of tax are imposed on the dealership of marijuana. On every gram of processed marijuana, five dollars is taxed. On every metric gram of any dutiable substance, sold by mass, other than cannabis sativa, two hundred and fifty dollars fee is imposed. Seven hundred and fifty dollars is charged for every unprocessed marijuana plant. Four hundred dollars fee is imposed on every ten-dosage units that are not sold by weight or portions thereof. Tax payment is required upon possession of drugs. Any person dealing with drugs and fits in any of the above categories is required to buy drug tax stamps and affix the stamps on the drugs. To avoid self-incrimination, a person is not required by the law to divulge any personal information. However, there are some penalties imposed on dealers of marijuana. The director assesses tax, interests, and appropriate penalties based on information available. However, the following information is confidential stamp sales and inquiries, assessments, bank levy, and payments. Garnishment and lien can only be exposed to the public if the papers are forwarded to the

Do thr right thing Movie Review Example | Topics and Well Written Essays - 250 words

Do thr right thing - Movie Review Example The cause of disagreement arises when Sal who owns the pizzeria dismisses Buggin a black American young man who protests about the wall of fane at the restaurant. Racial discrimination is evident in Sal’s restaurant when he speaks rudely at Buggin. The wall of fame in this restaurant contains only Italians and no black celebrity is included in the list and photos of fame within the restaurant. Racism intensifies when Mookie asks Vito Sal’s son who is a friend of a black American Mookie about any black celebrity. Vito is ignorant about any black personality despite living in black neighborhood for over 10 years. Sal’s racism continues when he refuses to pay Mookie who has been working for him as a pizza delivery. The way the police officers deal with Buggin and Raheem also indicates racism. The two police officers kill Raheem instead of apprehending him and suing him for inciting a crowd against the Sal. Back at Mookie’s place the care take r of Hector Mookie’s son is Italian and speaks to the son in Italian. Mookie yells at her informing her that he would like his son to speak in English in

Communication discussion Assignment Example | Topics and Well Written Essays - 250 words

Communication discussion - Assignment Example From that point you can be able to customize the way you address him/her. With time get the knowledge and experience on how different people like to be handled so as to create an environment where they feel welcome and hence they can be able to open up. According to Hood, (2013), the biggest barrier to communication is lack of humility. While addressing people of different ages, have empathy and show them that you know exactly how it is to be in their position. The people who are advanced in age are the most tough to deal with as they require a high sense of respect (Sullivan, 2013). Give it to them. Dealing with people of different gender can also be confusing. For instance, a certain patient may not be ready to open up to a nurse of the opposite gender and this may require introducing him/her to another nurse if they are totally uncooperative. Having the knowledge on how to address people is important as seen in the essay. This can determine the difference between a competent nurse and the rest (Bednarz, Stephanie, & Doorenbos, 2010). It is therefore important to observe the points

DISCUSS THE AETIOLOGY AND PATHOLOGY OF RHEUMATOID ARTHRITIS WITH Essay

DISCUSS THE AETIOLOGY AND PATHOLOGY OF RHEUMATOID ARTHRITIS WITH RESPECT TO ITS PRESENTATION IN THE FOOT - Essay Example The disease, which lasts over a long period of time, can cause damage to cartilage, bone, tendons and ligaments (DynoMed.com, 2000). Foot deformities are very common in RA. These deformities may affect patient functional foot, especially hallux rigidus and calcaneal valgus (Bal, et al. 2006). Human foot is more susceptible to arthritis because the human foot contains 33 joints. About 90 percent of RA patients will complain of problems with the midfoot and forefoot while 67 percent will have problems with the hindfoot and ankle. The ankle is usually the last joint to be involved with RA (DynoMed.com, 2000). RA causes inflammation in the lining (synovium) of joints, most often the joints of the feet. The most common symptoms of RA in the foot are pain, swelling, and stiffness. Symptoms usually appear in several joints on both feet. The signs of inflammation can also include a feeling of warmth around affected joints. In some patients, chronic inflammation results in damage to the cartilage and bones in the joint. Serious damage can lead to permanent joint destruction, deformity, and disability (FootPhysicans.com, 2007). With the progress in the disease the feeling of pain in the joint or in the sole or ball of the foot will increase. The joint may be warm and the way the patient walk may be affected. In addition the patient may develop corns or bunions, and the toes can begin to curl and stiffen in positions called claw toe or hammer toe. Corns, or even ulcers, may develop on the foot. Metatarsalgia, a general term for pain in the sole or the ball of the foot, is also very common. This indicates that RA is affecting the metatarsal joints of the toes. Hindfoot and ankle pain often involves the posterior tibial tendon. The ankle itself is usually the last joint in the foot to be involved with RA (DynoMed.com, 2000). As the disease progresses in the foot region, the joint space becomes narrow and bone begins to rub on bone, leading to painful arthritis. Besides, deformities may occur resulting in loosening of the ligaments and capsule lining of the joint. If the housing of the joint or the capsule loosens up considerably, the joints mostly in front of the foot may dislocate. This can cause painful swelling on the bottom of the ball of the foot that can make walking even more terribly uncomfortable. Later the big toe begins to deviate and bunions may form on the inside of the big toe (footandankle.mdmercy.com, N.D.). In cases where the hindfoot (back of the foot) and ankle are affected, the bones may shift position in the joints. This can cause the long arch on the bottom of your foot to collapse (flatfoot), resulting in severe pain and difficulty walking. Because RA affects the entire system, the patient may also feel feverish, tire easily, and lose appetite (AAOS, 2001). AETIOLOGY The exact cause for RA is still unknown, but there are many thoughts about what might contribute to it. A sudden and traumatic injury such as a broken bone, torn ligament, or ankle sprain can cause the injured joint to become arthritic in the future. According to Cotran et al, (1994)"...RA is triggered by exposure of an immuno-genetically susceptible host to an arthritogenic microbial antigen". Heredity, or the genes from the parents, may be a determining factor in who gets rheumatoid arthritis. Roth explains that this "genetic predisposition appears to be related to the

Job Analysis Master Essay Example | Topics and Well Written Essays - 2500 words

Job Analysis Master - Essay Example It is stated, that job analysis is 'a process used to identify the important tasks of a job and the essential competencies an individual should possess to satisfactorily perform the job'. (Clifford, 1994) The purposes of job analysis are multiple, as well as there are multiple methods for conducting it. The aim of the work is to distinguish the main strengths and weaknesses of the job analysis methods existing at present, with trying to identify the most effective among them, if it appears to be possible; it is also necessary to try defining, which methods are mostly applicable in various instances, and should there be made any amendments to the job analysis methods, which are not most often used. The reasons for conducting the present research are the following: 2. It is not yet understood, whether there is the need for the creation of any new methods, with the aim of which it is necessary first to evaluate the strengths and weaknesses of the existing methods. The arguments to follow in the work will be based first of all, on the literary sources used in the present work, which are four and are represented by the peer reviewed journal articles and books on the topic. The arguments will also be based on the discussion of the existing advantages and disadvantages of the methods. The main aims of the answer are to be specified as follows: The conclusion to be reached will be based on the set aims, a... 2. It will be conclude which of the job analysis methods at present appear to be the most effective and display minimum disadvantages; 3. It will be necessary to conclude, whether the already described in literature job analysis methods need more extensive learning; 4. It will be necessary to conclude, whether there is need in creating any new job analysis methods. The conclusion to be reached will be based on the set aims, and will include the answers on the abovementioned questions. I guess, it will be beneficial to make the core of the conclusion related to the most effective job analysis methods among the already described. Analysis Identification and coverage of the main issues The rationale for the job analysis in general lies in the aim of protecting the public 'by assuring that individuals, who work in an occupation or profession are at least minimally competent'. (Gael, 1993) Thus, one of the key issues in discussing job analysis methods is in identifying, which of them appears to be more effective, and is thus the most reliable for ensuring this individual safety mentioned. Another key issue, is that despite the extensive literature sources on the topic, the importance of researching job analysis methods with distinguishing their strengths and weaknesses is not given due importance, and thus this work will be an additional attempt to provide the employer with the analysis of the key methods, making him understand the essential role which job analysis methods play in hiring qualified workers. The main methods of job analysis can be identified as follows: 1. Observation. Levin and Ash (1999) state, that the core issue of any observation in relation to job analysis is

Case Study Boeing Aircraft Company Essay Example | Topics and Well Written Essays - 250 words

Case Study Boeing Aircraft Company - Essay Example change in the market, its management had difficulty co-ordinating activities towards its goals as a result of hierarchical management style; problems that had to be resolved by a willing leadership that is open to new ideas. It was imperative that the management of Boeing takes these into account and comes up with a more effective organisational structure and adapting to a newer organisational culture in order to achieve the company’s objectives. Such change, however, is a worthy risk venture. It is expected that it could be highly resisted by both employees and operational managers. The resistance could emanate from the fear to change (Donnelly et al., 1995). Resistance could also be as a result of fear of losing something valuable or just lack of trust in the management. The large number of employees at Boeing compounds the difficulty of the situation making the change opted by Condit an uphill task. But Condit presents to fore a leadership that can mitigate the upheavals of Boeing by adopting the democratic approach of leadership where he consults his staff. In turn, they feel part and parcel of decision making. This is in contrast with the traditional autocratic style that had been adopted by Shrontz that â€Å"kept every employee at their place.† Thus, with Condit, one foresees a Boeing with a new organizational structure and culture that is embraced by its employees. The present organisational structure and systems adopted by Shrontz were facing a number of issues emerging from the traditional management approach adopted. Condit had the tough task of changing the culture of an organisation in order to enhance its performance and meet stakeholders’ needs. This paper will examine the problems that Boeing was facing and will unveil how an appropriate leadership style can facilitate change. A major issue for Boeing comprised the aggressive environment that the firm was operating in. Boeing was facing tough competition from other well established

Black Boy Essay Example for Free

Black Boy Essay Most African American families in the South were lower class and committed dangerous acts to survive, â€Å"Richard suffered poverty and hunger experiences that later became themes of his work†. He would have to wait a long period of time before food was available for him, â€Å"You’ll have to wait till I get a job to buy food†. The lower class did desperate things to get money â€Å"Richard sneak into saloons and begs for pennies and drinks†. Many African Americans suffered horribly from poverty, â€Å"My mothers’ suffering grew into a symbol, gathering to itself all the poverty, the ignorance, the helplessness, the pain, hunger ridden days and hours†. The Jim Crow South brought many adversities for Blacks and poverty was a major part of that. Poverty not only took away the physical things in their lives, but also it took away from their internal selves as human beings. The things they had in their lives that they were deprived of, did not mean as much to them as losing who they are as a person, â€Å"I would send other words to tell, to march, to fight, to create a sense of the hunger of life that gnaws in us all, to keep alive in our hearts a sense of the inexpressibly human†. Racism in the Jim Crow South was brutal, unnecessary, and in some cases fatal. Racism in the United States South was a major theme, and impacted the life of Richard both in a positive and negative way. The only positive aspect of it was that he and many other African Americans overcame it and helped them become better people. In most cases racism affected lives in a negative way. Most African Americans were both physically and mentally pushed to their limit and caused permanent scars in their lives, â€Å"Having been thrust out of the world because of my race, I had accepted my destiny by not being curious about what shaped it†, The quote by Richard shows the racism was present and unfair, you can still move on and not let it be damaging to your daily lives and emotions. Richard experienced many abusive events resulting from racism, â€Å"He experienced some of the most severe abuses of racial oppression in Mississippi†. African Americans have the theory that White people are dangerous and not to be trusted, â€Å"the Jim Crow South was a system of racial segregation practiced in some states of the US, and it gave whites a reason to treat Blacks as second class citizens†. Richard falls into a category of Black youth who fears the White community and has a hard time interacting with them, â€Å"Richard feels psychological tension around Whites†. The major reason why Richard is a part of the Great Migration and fled North is because of racism. The segregation Blacks had to deal with also took away many educational opportunities, â€Å"No education could alter what the meaning of living, came only when one was struggling†. Racism took away many privileges and rights away from Blacks. Many African Americans in the South moved north for better opportunities, and this vast moment was known as the Great Migration. It was hard for many African Americans to leave the South because that was the only life they knew, â€Å"Nine out of ten African Americans lived in the American South in 1900, by 1930, 3 in 10 lived outside the house†. Richard Wrights’ Black Boy shows how racism destroyed the lives of many African Americans, but for some it did just the opposite, as for Richard it drove him to be the successful writer he is today. Violence affected African American youth in a negative way, and it varied how they let it affect the rest of their lives. Poverty took a major toll on the lives of African Americans during the Jim Crow South system, and affected the majority in an unconstructive way. Racism made a huge impact on the lives of the Blacks because it affected their emotions, physicality, home life, and way of being. For some, racism lead to death or completely ruined their lives, but others took the hardship of racism and went with it in the opposite direction. Richard Wright, once a trouble African American boy, now a flourishing writer.

Performance Management At General Motors (GM)

Performance Management At General Motors (GM) The following assignment explores General Motors Europe in four dimensions as set out by learning outcome spertaining to performance management module. The four learning outcomes (LO) would measure, LO1: Setting GME performance targets to meet strategic objectives. LO2: Agreement on team performance targets and subsequent contribution to meet those objectives. LO3: Monitoring and control process for the goals. LO4: Politics of personal interaction of Sir Leahy. A discussion on his leadership, persuasion and influencing skills. In order to achieve these learning objectives, the author has drawn upon from his practical work experience together with the primary and secondary research through various resources. This article would primarily be divided into two segments within the domain of learning objectives as defined above. The division would be between Performance Management and Performance Measurement. Performance is defined as potential for future successful implementation of actions in order to reach the objectives and targets. The article shows that performance is constructed by the management system and by managers from his own experience of working at GME and taking a more macro view of the organisation. Performance management explains performance measurement and gives it meaning. (Lebas, 1995) Setting performance target to meet strategic objectives General Motors, one of the worlds largest automakers. GME was founded in 1908 by William C. Durant. GM headquarters is in Detroit, GM employs 209,000 people in every major region of the world and does business in more than 120 countries. GM has been the global automotive sales leader since 1931.GM and its strategic business partners produce cars and trucks in 31 countries, and sell and service these vehicles through the following brands: Buick, Cadillac, Chevrolet, GMC, Daewoo, Holden, Isuzu, Jiefang, Opel, Vauxhall, and Wuling. GMs largest national market is China, followed by the United States, Brazil, the United Kingdom, Germany, Canada, and Russia. General Motors Europe acquired operations from General Motors Corporation on July 10, 2009, and references to prior periods in this and other press materials refer to operations of the old General Motors Corporation. GME is running business with revenue of $135.6 billion (GME, 2010a). GME is using different performance management tools . In this assignment score card methodology is discussed that GME is using. Balance Score Card can be used as a short and long term fortheir financial and non financial performance measurement. There are four parts of balance score card; financial perspective, internal business perspective, customers perspective,learning and growth perspective. Balance Score Card is like your cars dash boardwhere there is indicator on as you drive, you can look at the dashboard to obtain real-time information such as how fuel, speed and the distance youve traveled or even anyfaulty system etc.Its known to help companies and implement the changes required to meet their business goals (Pangakar Kirkwood, 2007). The balance score cardenables the companies to develop a more comprehensive view of their operations andto better match all operating and investment activities to long- and short-term strategic objectives (Punniyamoorthy Murali, 2008). Link of each perspective in the Balance Score Card (BCS) High performance work system (HPWS) is also another method to explain the situation in General Motors. Independent work teams, open systems and performance-based pay are known collectively as high-performance work systems (Rouse, 2000). HPWS have also come to be known as high involvement work systems, flexible work systems and high commitment work systems (Aghazadeh Seyedian, 2004) In other words, they are simply work practice that can be deliberately introduced in order to improved organizational performance. The main focus of HPWS is rearranging work so that the employees participate in decisions that affect the everyday operations of an organization. There are three potential factors that can affect high performance work system in General Motors; retrenchment of workers, technology used and layout design. A worker is the key success to any organization. Retrenchment will cause General Motors to lose talented workers subsequently lose competitive edge. To survive in the changing environment, a company must rely on their workers creativity, ingenuity problem solving ability and strong team work. Workers are able to make their own decision on the best way to accomplish their work. The knowledge and skill shared will create a high performance work system. For example, an engineer in General Motors is developing a fuel efficient engine. Engineer A may need assistants from Engineer B, however when GM decided to retrench workers, Engineer A will face difficulty in developing the engine. Performance of employee can be boost through team works. A study by Thompson, Baughan and Motwani indicates that company such as General Motors, Proctor Gamble, Xerox Corporation had huge increase productivity as high as 250 percent and double their profit (1998). The use of technology is another feature in High Performance Work System. All managers in every department of General Motors are able to identify the technology they use in their organization. The application of Human Resource Information System that can store information on workers that can assist managers in deciding which employee is performing and which is not. The use of technology without human operating it is also meaningless. Managers in General Motor can identify whether the qualified workers are able to operate the tools or not. 1.1 The link between team performance and strategic objectives As it is clear from the figure that all the perspectives link eachother. So all the four parts directly effect the strategic objectives of the company. This principle is used at strategic level. 1.1.1 Organisations Strategic Objectives Goals of GME Lead in advanced technologies and quality in creating the worlds best vehicles Give employees more responsibility and authority and then hold them accountable Create positive, lasting relations with customers, dealers, communities, union partners and suppliers to drive our operating success Strategic Objectives of Organisations Financial Growth: Increase the revenues, gross profit and sales. Financial Efficiency: To improve overall productivity. Current Customer: To expand sales to existing customers, To increase customer retention, To increase customer loyalty, To create and use a customer database. New Customer: Introduce existing products into a new market, Anticipate future customer needs through customer feedback. Customer Service: Improve our service approach for new and existing customers. Product/Service/Program Managment: To have all product meet standard of  excellence guideline. Operations Managment: To continually improve internal process to realize  efficiencies, Capitalize on physical facilities (location, capacity, etc.) Improve organizational structure.Redirect or restructure  available resources. Technology Managment: Increase efficiencies through use of wireless or virtual  technology. Communication Management: Improve internal communications. Customer Management: Acquire enhanced CRM data mining capabilities. Marketing Management: To continuously broaden our customer database by  getting new information on customer characteristics  and needs. Develop and implement a promotional plan to drive  increased business. Channel Management: To aggressively strengthen our upstream channels. Improve the distributor and supplier relationships. People: To hire, develop and maintain the right people, in the right place Employ professionals who create success for customers. Training:Develop broad set of skills useful for customer support. To develop the leadership abilities and potential of our team. Strategic Objectives of GME Integrity: We will stand for honesty and trust in everything we do. We will say what we believe and do what we say. Continuous Improvement: We will set ambitious goals, stretch to meet them, and then raise the bar again and again. We believe that everything can be done better, faster and more effectively in a learning environment. Customer Enthusiasm: We will dedicate ourselves to products and services that create enthusiastic customers. No one will be second-guessed for doing the right things for the customer. Teamwork: We will win by thinking and acting together as one General Motors team, focused on global leadership. Our strengths are our highly skilled people and our diversity. Innovation: We will challenge conventional thinking, explore new technology and implement new ideas, regardless of their source, faster than the competition. Individual Respect and Responsibility: We will be respectful of the individuals we work with, and we will take personal responsibility for our actions and the results of our work. Sourse: gm.com 1.1.2 Workforce requirements that are capable of achieving the  organisations objectives General Motors Europe is using the hierarchical approach. In this method each and every employee is controlled by the respective supervisor. And each supervisor gives the performance report of the employee to the top management. In GME every employee is loyal. The company place the right employee to the right job to achieve the objectives of the organisation. There are 209,000 employs of the company. Each and every employee get the proper training for its job which helps the organisation to achieve the objectives with the help of compitent employs. 1.2 Tools and Techniques available to set team performance targets The following important purposes are derived from different resourses including General Motors website,articles,General Motors final reports. The operational performances of GME are reported and viewed on the quarterly at board level and than the summary report is send to the top management. The performance of employs are checked with the help of score card. I gives the daily performance measurement which could be also used for the long term strategic purposes. Daily , weekly and monthly targets are reviewed regularly. An important consideration is to make sure the objectives remain appropriate and robust measures of performance in the company. GME core purpose is to create value for customers to earn their lifetime loyalty. GME,s success depends on customers. The customers who shop with them and the people who work for them. If customers like what the company offer, they are more likely to come back and shop with them again. If the GME team find what the company does rewarding, they are more likely to go that extramile to help their customers. 1.2.1 Processes that deliver outcomes based on organisational goals and aims GME use balanced score card methodology throughout its organisational operations. Every department change the balance score card according to their needs. These performances are measured during team meetings at lower level and is discussed at strategic level. 1.2.2 Appropriate methods for evaluating performance Each and every employee has Personal Development Planning folder. This folder contains all the performance appraisals, the training already given and the future training needs and some departmental performance data. Again the score card helps the company to identify the improvement . 1.2.3 Review capacity and capability of current work force Using the current work force GME has become the largest company and employer in Europe private sector.GME is still expanding by leaps and bounds and earning higher profit than before.The market has enough labour to cater for the recruitment at Europe level. However, for international operations,the recruitment is carried out at local countries. With the current workforce of 209,000 people, the company is more than capable to sustain itself against any future expansion plans. 1.2.4 Plans to meet long term, medium and short term requirements Increase General Motors U.S. market share to 33% Improve customer satisfaction as evidence by points of market share, not fractions GMs Future Hydrogen Power Plans (Mike Floyd, 2010) GM Cuts Unnecessary Spending GM Sales Soar 11.4 Percent In March On Market Shift First Posted: 04/ 1/11 Medical plan and insurance for the employs All of these plans meet the objectives criteria and are in alignment with the growth. 1.2.5 communicate workforce plan GME communicates above mentioned plans through its staff briefings, pamphlets, staff benefits periodical, staffs own website, intranet, films and advertising. The use of flexi hours is very popular in organisation at GME due to the nature of people doing part timer jobs at operational end therefore each department maintains a rota and extra hours available folder through which employees can communicate and leave message for each other along with using staff message boards. The formal training program in GME consists of five components, of which the first three are available through GM University, which is one of the largest corporate educational programs in the world. General Motor has established a learning organization and culture for its employees across the entire enterprise.GM University is designed to align the companys training investment with its business needs, and disseminate best practices and core value. Foundation skill training (i.e. computer software, GM history and business orientation) Functional specific skills and techniques Leadership and professional development On-the-job training in each department In addition, GM supports advanced education and certification through tuition assistance, Cardean e-MBA program, and technical education programs. Tuition Assistance Program: This program regular active salaried employees are eligible for tuition assistance upon date of hire. Graduate Education: Variety of graduate programs are available throughout GM. Checked with the operating unit of interest to you for individual opportunities. On-Site Classwork: Number of educational courses are offered in conjunction with educational institutions throughout the United States. New Hire Mentoring: The GM New Hire (GMNH) is the unique support system for new GM team members. Simply put the GM new hires are paired with our experienced GM team members with the primary objective of professionally transitioning and developing new hires into the GM culture. Providing and enabling to experience professional growth, corporate culture, new ideas and perspectives, while driving for business results. Mentoring is critical as move into the future. The new hires of today, will be our leaders for tomorrow. 1.2.6 Improvements made are in line with the organisations vision and objectives Total worldwide vehicle sales $8.4 million in the year Offering a lease product in certain geographic areas In the year ended December 31, 2010 company worldwide market share was 11.4%. Total of 20,215 distribution outlets throughout the world. Currently offer 19 FlexFuel vehicles for the 2011 model year. Increase the volume of vehicles produced from common global architectures to more than 50% of company total volumes in 2015. Diesel vehicles have become important in the European marketplace, where company encompass 50% of the market share. 1.2.7 Improvements to reduce gap between what customers and  stakeholders want The success of the GME means that the stakeholders at all levels are very happy with the performanceof company. GMEs share is considered to be the most reliable on the market.The gap between customer and stakeholders is substantially reduced by keeping the community and different stakeholders at the heart of scorecard where the progress is checked on recurrent basis. Agreeing Team Performance Targets To Meet  Strategic Objectives This sections aims to look into the team performance targets which match with theultimate strategic gains. 2.1 Required Performance Targets Within Teams Against Current Performance It is the duty of the company to engage with the community and find out about their local shopping preferences. Teams are urged to be polite, helpful and cordial . every company have targets. These targets are compared with the year on year,season on seaon and like for like weekly targets. All the section managers and staff have the access to the relevant information and these targets are reiterated through an internal communication channel. Every single staff working at company has targets. 2.1.1 The type of skills, knowledge, understanding and experience required to undertake current and planned  organisational activities At operational level, there is not much need for high skills required but along with the increment in the hierarchy of the management, the relevant skills are also increased. For example, sectional managers have to be versed in time keeping and management, store managers are more project oriented and have to be more financially aware. GME identify the training needs of its staff. As the company is becoming more technologically oriented, company is investing a lot in the training of systems such as self help check outs monitoring and online reporting. Company employees can manage their own profile these days online and have their personnel related matters sorted through this channel. All this need to be communicated and people are trained through GME Academy. 2.1.2 Systems for collecting and assessing information on the overall performance of theorganisation to identify opportunities for improvement GME relies heavily on digital ways of collecting and assessing information. Although, it does engage with community through local leaflets and local surveys but on strategic level it engages through CSR (corporate social responsibility) initiative. It has found out that it needs to invest ingreener and more fair trade products. Every transaction at GME front end is stored for 5 years,this huge amount of data helps to analyse and compare sales data on the overall performance. 2.2 Encourage individual commitment to team performance in achieving organisational objectives. Staff members are encouraged through motivational techniques such as staff value awards competition, employee of the month and encouragement for every staff to become team members. Such techniques help raise the staff morale ultimate resulting in getting individuals commitment. 2.3 Context of delegation, mentoring and coaching to achieve organisational objectives The concept of mentoring is used at graduate training schemes where graduate recruits get their mentor for a year or so period. Operational staff tend to get more coaching and any limitations in their skills are catered for locally in the staff training room. At grass root level there is not much of delegation involved, more or less the operational teams do the jobs that they are asked to do with avery little chance of job rotation. 3 Monitor activities to improve team performance A strategy implementation to improve team performance process has to be a top to bottom approach. Communication lies at the heart of strategy implementation. If the top management doesnt have the required motivation coupled with strong communication channels then it would behard to monitor any strategic systems and processes. (Mabey 2002). Therefore, GME has adopted various channels for the smooth flow of information and introduced various checks and balances so that the balance score card is measured according to the objectives set. This whole process encompasses the involvement of supervisors, team leaders and other managers during staff appraisals which are conducted twice a year. Employees are encouraged to take part in company development programme which is labelled as personal development planning(PDP). Every employee develops his own objectives. The progress is monitored through PDP folder and staff appraisals. Identification of the work objectives, key dates and support materials are provided by the management and also at their daily and weekly staff meetings so that staff can measure their contribution. The balanced score card is considered to be used for organisational fitness for the purpose and is classified as the in-out approach to controlling strategic performance. Balanced score card helps to strengthen the core competencies of an organisation and enables workforce to sustain the competitive advantage in the market. (Prahalad and Hamel, 1990; Teeceet al., 1997). 3.1 Monitoring team performance Following a resource based review of the adopted balance score card methodology at GME. It encapsulatesthe daily, monthly, quarterly and annual strategic control and the steps through which it iscontrolled and monitored. Balanced score card focuses on alignment and integration of the human activity factor with the operations. It conditions how people work instead of directly trying to influence people (employees and community) what they should achieve. The balanced score card helps to review the objectives and progress through all structures of management and at all levels. GMEs recurring operational issues are discussed at weekly or monthly basis whereas, the strategic issues come up more often at managers meetings on quarterly basis. This is in alignment with the classical view of the balance score card evolution. 3.2 Evaluation of team performance against agreed objectives Team performances are evaluated through 360 feedback, team briefings and by adopting Demings PDC approach. The areas of improvement are defined and are communicated at once throughTeam Exercise. 4 Contribution of influence and persuasion to team dynamics Since the evolution of different management theories, the modern business world uses a mix of all these. Employee motivation through monetary means is still a bigger factor behind better labour output. The contribution of these motivational techniques to influence the team dynamics is measured in this section. 4.1 Methodologies to gain commitment to action GME management uses a combination of Taylorism and Maslow theory of need such that it enriches the job satisfaction by really involving its staff into decision making allowing them to become a part of the organisation and by giving them monetary incentives through bonus and other performance related pay increments. This is a proven methodology to gain GME Staffs commitment in achieving the targets. GME employs over 209,000 and all of them take part in Staff Question Time Sessions which enables the company management to obtain a valuable feedback about the work conditions (Email GME, 2011). This is a 360 degree exercise such that it not only gives feedback to employees but also enables staff to share their experience and opinions to help serve customers better. Staff Training and development is another successful tool that company use to engage with its staff and to enrich their experience of working with them. A good programme such as HPWS (High Performance Work System) is highly eff ective in experienced staff retention. Staff retention and loyalty is a trademark of every successful organisation. 4.2 Impact of individual dynamic on securing commitment to action The impact of the chief executive on securing its staff s commitment to action is distilled at all levels of GMEs organizational structure. For any strategic action has to be channelled through effective top level management. GMEs current boss has earned industry as well as its employees respect by achieving various awards and taking GME,s success to an unprecedented level. Conclusion The above assignment has tried to explore GME within four learning outcomes as specified aboveand has found that due to visionary leadership and innovative performance management measures. The four learning outcomes inspected setting of performance targets through the purpose and balance score card methodology adopted by the company. GME further uses various controlling and monitoring mechanism together with its High Performance Work System to help implement its objectives. Different motivational techniques are used to build up the morale and generate higher labour output by the team members.These teams include enrichment of employees experience through training and development,sharing of success through shares and profits incentives. And eventually, the all important strategic leadership has been discussed. It is argued that without the visionary leadership of management GME would not enjoy the benefits that it is enjoying today. Despite being the leading supermarket, GME continues to expand into more diversified portfolio and the author of this article, having worked in one of the stores, feels confident that the trend would continue in the foreseeable future.