Hip Fracture Treatment in Older Patients

Hip Fracture Treatment in Older Patients1.1 BackgroundHip (neck of femur) dampens are a common, serious and well-defined injury alter mainly one-time(a) people. As global populations age, projections for rose hip break dance numbers over the coming decades will rise. Delays to functioning are associated with increased post-operative complications, prolonged convalescence and distance of stay (LOS), and with increased morbidity and deathrate (Trpeski, Kaftandziev, and Kjaev, 2013). In do-gooder, the cost burden of hip fractures is substantial. The outgrowth of caring for people with hip fractures is complex, long, and involves several diagnostic, therapeutical and administrative activities. These activities occur in AE and orthopaedic departments, operating theatres, and in the community. They involve a range of health professionals and support staff. When this coordination fails, patients may suffer from avoidable delays and suffering. In the united Kingdom (UK), the bed occupancy rove for hip fractures was to a greater extent than 1.5 million days, which represent 20% of the total orthopaedic beds (Compston et al., 2009). The lifetime risk of sustaining a hip fracture in the UK from age 50 is around 11% for women and 3% for men (Van Staa et al., 2001). Many of those who recover suffer a loss in mobility and independence approximately half of those previously independent become partly dependent, while one-third become totally dependent (Myers et al., 1996).1.2 legitimate ProcessWatford full general Hospital (WAT) treat 450 patients for hip fractures every year. Hip fractures are one of the most common complex trauma problems orthopaedic surgeons face. Patients are often earnestly ill, elderly and frail, which can result in poor outcomes.Hip fractures generally result from a fall, patients present at AE where imaging samples are practiced to pretend a diagnosing and offend medication is administered (Appendix A). When possible, patients are moved from the emergency department to a protect.Ideally, patients will call for surgery within 72 hours of arriver at infirmary, put upd they are in a stable condition. A pre-operative assessment is carried out to establish the patients overall health to make sure they are launch for surgery. They also have an anaesthetic assessment. Two main types of anesthesia are used general anaesthetic and spinal or epidural anaesthesia. A aggroup of health wish well professionals will perform the surgery, including an orthopaedic surgeon.The National Hip Fracture Database (NHFD) produce an annual report that includes an analysis of 30-day deathrate grade for hip fracture patients who are over 60 years old within the UK. WAT were alerted by the NHFD that they were an outlier, with 12% mortality over 3 years. In the UK the overall mortality rate within 30 days of hip fracture in 2014 was 7.5% (Johansen, 2016). High mortality rates are a signal to hospitals that they should investigate t o identify and respond fiber issues. soma 1Funnel Plot of Crude and Adjusted Mortality Rates 2014 (Source Johansen, 2016)Effective strategies are needed to reduce the burden on health palm providers and to ameliorate patient quality of life and outcomes aft(prenominal) a hip fracture. Staff at WAT want to develop an action plan to analyse performance and encourage amendment programmes. This included questioning what elements of negociate could have been de exitred better to ensure that racy-quality care is delivered throughout the patients treatment, to improve 30-day mortality rates and operating(a) outcomes for patients.1.3 Perceived Issues with the Current ProcessIn the present study, the incidence and mortality and functional outcomes in hip fracture patients was studied. The relationships between entree and treatment clock, pain dispensement drugs and anaesthesia, and their opinion on the patients length of stay (LOS) in hospital were assessed and the following is sues were foundAdmission time from AE to treatment is highHigh level of opiate usage to manage painRoutine use of general anaesthesia1.4 Value Adding ActivitiesAdmission to surgery times botheration managementDays spent in hospital1.5 ScopeOlder people with hip fractures aged 60 or over are in scope for this project. 1.6 Problem disceptation30-day mortality rates for older hip fracture patients at Watford General Hospital have been 12% for 3 consecutive years, 4.5% higher than the national average (NHFD).1.7 Goal StatementReduce 30-day mortality rates in older hip fracture patients to 8.5% by the end of June 2017.2.1 Process functionFigure 2 Process Map2.2 Process Narrative The person arrives at the AE department by ambulance or car. The triage nurse assesses the patients condition. Patients are classified by severity of injury (red, yellow, or green). Patients presenting with pretend hip fractures are comm that assigned a yellow classification, which indicates an emergency but not of a life-threatening nature. An AE reinstate or nurse checks the patients alert signs, records their pre-fall health condition, and administers pain medication (generally opiates). Subsequently, in consultation with an AE doctor (if available), several basic tests (blood tests) and X-rays (hip and often chest) are ordered and performed. The patient is transferred to the radiology department for x-ray. The AE doctor or nurse then reviews the test results. If a hip fracture is diagnosed, the patient is deemed admissible and an intravenous (IV) drip is started. The patient is transferred to the orthopaedic ward for admission when a bed becomes available. Admission times are currently 13.4 hours.On admittance to the orthopaedic ward an orthopaedic surgeon will review the test results. If the patient is deemed suitable for treatment the medical assessment team will assess if the patient has any existing medical issues that may affect treatment. If exist medical conditions with th e potential to affect treatment are found patients are referred to lenitive care and discharged. If no pre-existing conditions are found patients are assessed by the anaesthesia team. Patients deemed suitable for surgery are placed on the trauma list, surgery generally takes place within 72 hours. Patients deemed unsuitable are referred to palliative care and discharged. Patients go to theatre, they are anesthetised using general anaesthetic and receive surgery. They are subsequently transferred back to the orthopaedic ward for ward-based management. Patients are discharged erst they are mobile.2.3 Identification of Problems, Weaknesses, and Change AreasHigh level of opiate use by AE staff for pain managementAdmission times of 13.4 hoursSurgery wait times of up to 58.6 hoursRoutine use of general anaesthetic in surgery3.1 Key Strategic Elements for ImprovementPatients with hip fractures often require complex and repugn care, this is provided by a number of professionals in severa l departments, crossing a number of service boundaries. These patients are often frail, and their outcomes depend on how in effect their care pathway is managed. Pain management medications, avoidable delays, anaesthesia choices and post-operative care affect functional outcomes and mortality.The key strategic elements towards improving outcomes for older hip fracture patients areReducing morbidity and mortality ratesAchieving better functional outcomes for patientsIncreasing discharge rates to original place of residenceIncreased value from the healthcare budgetThey can be achieved byAltering pain management practicesAltering anaesthetic managementReducing admission and treatment times3.1.1 Pain ManagementDespite recent advances in the care of hip fracture patients, significant morbidity and mortality persists. Some of this is attributable to the pain medication administered in hospital. Opiates are the preferred pain management drug at WAT currently (Appendix A). Opiate use can ca use nausea, constipation, and confusion (delirium) in the older patients (Coruhlu and Pehlivan, 2016).Effective pain management is a primary goal in hip fracture treatment. Research suggests fascia iliaca compartment blocks (FIB) is an alternative for pain management in hip fractures. endovenous opioid therapy is used frequently (Appendix A). However, opioid side effects, such as nausea, vomiting and delirium, are common. Regional analgesic techniques have been shown to provide similar analgesia to opioids. FIB is reported to effectively block cutaneous lateral femoral and femoral nerves in adults (Nie et al., 2015). Studies have suggested superior analgesic effect with pre-operative FIB. They provided superior analgesia to intramuscular morphine in a randomised controlled trial of hip fracture patients (Callear et al., 2016).FIB is a safe and simple technique that can be administered by junior doctors and specialiser nurses with training (Hanna et al., 2014). FIB administered in AE provided significant decreases in pain when compared to opiates. Post block analgesic requirements for patients in the FIB group were minimal. A study conducted by Callear and Shah (2016) concluded that a single dose of FIB given in the pre-operative period significantly reduced the post-operative and total analgesic requirements in the hip fracture patient. Patients also experience lower rates of delirium and were discharged faster. This reduces the cost of providing inpatient hospital beds and improves quality of life for older patients.3.1.2 Anaesthetic ManagementAnaesthetists have an essential role in the preoperative, operative and postoperative management of hip fracture patients. Complications arising from anaesthesia in hip fracture surgery is influenced not only by the type of anaesthetic used, but also by patient comorbidities and the delays between admission and surgery. Approximately 25% of hip fracture patients display at least one episode of cognitive dysfunction duri ng hospitalisation (Heyburn et al., 2012). A systematic review published by SIGN (2009), suggests that the use of spinal anaesthesia may reduce the incidence of postoperative confusion.3.1.3 Time to SurgeryAt present admission times are 13.4 hours (NHFD statistics show the national average is 9.3 hours) and surgery wait times are 58.6 hours. Current guidelines recommend surgery to be carried out within 24 hours of injury (BOA, 2014). Observational studies suggest better functional outcomes, shorter hospital stays, duration of pain, and lower rates of complications and mortality are achieved by performing surgery earlier. Pre-operative delays increase mortality and, in those who survive, prolongs post-operative stay. For every additional 8 h delay to surgery after the initial 48 h, an extra day in hospital results (Colais et al., 2015). Currently WAT fall far short of the ideal to provide optimal care for hip fracture patients.3.1.4 Multidisciplinary ApproachThe management of hip fr actures requires complex, connected care from presentation at AE, through all departments. A study of 116 patients found that dedicated nurse specialists are effective at fast-tracking hip fracture patients to surgery by securing hospital beds, organising care, operating theatre lists and acting as a liaison with all other relevant departments (Larsson and Holgers, 2011).Many published guidelines recommend a multidisciplinary approach to the treatment of hip fractures, in addition to, a good care environment to promote best outcomes. The Scottish Intercollegiate Guidelines Network (SIGN, 2009), the National Institute for Clinical Excellence (NICE, 2013), and the British orthopaedic Association in cooperation with the British Geriatric Society (BOA, 2014), have all produced guidelines supporting a multidisciplinary team approach to deal with hip fractures in older people.Figure 3 Multidisciplinary Team (Source orthopaedics and Trauma)Rieman and Hutichson, (2016) It is recognised t hat a team approach with excellent communication between all the members is essential. The multidisciplinary team looking after hip fracture patients is large (Figure 2), and each role is important in the jigsaw of care.3.1.5 Clinical PathwayClinical pathways should be used to aid the multidisciplinary team. They provide a description of the expected interventions and outcomes throughout the patient journey following a hip fracture. The use of clinical pathways ensures everyone knows the next step in the process and this minimises unnecessary variations in practice (Chudyk et al., 2009). A study of 1193 older hip fracture patients conducted at 6 hospitals in the Limburg trauma region of the Netherlands concluded that the use of a multidisciplinary clinical pathways (MCP) for patients with hip fractures tends to be more effective than usual care (UC). Time to surgery was significantly shorter in the MCP group when compared to the UC group. The mean length of stay was 10 versus 12 day s. In addition, the MCP group had significantly lower rates of postoperative complications (Kalmet et al., 2016).3.2 Proposed StrategyEstablish a designated Hip Fracture Unit within the main orthopaedic unit.Appoint a multi-disciplinary team to be based on the ward comprised ofPhysio /Occupational TherapistOrthopaedic /Orthogeriatric Doctor medical specialist Hip Fracture NurseNursing staffEstablish a Hip Fracture Pathway.Establish a protocol-driven, fast-track admission of patients with hip fractures through AEAE beep specialist hip fracture nurseFIB administered by nurse for pain management and patient centred carePatients are admitted to the hip fracture ward within 6 hoursAppropriate, medically fit patients receive surgery within 24 hoursUse of spinal anaesthesia when appropriateContinuous tracking/live data systems that regularly update patient and logistical data may improve management by identifying patients location, delays in treatment and relevant clinical information.3.3 authorisation Process Improvement Tools3.3.1 Continuous Quality ImprovementContinuous Quality Improvement (CQI) is a quality management tool that encourages all members of the health care team to continuously ask, How are we doing? and Can we do it better? (Edwards et al., 2008). It focuses on proceeds for the patient and the practice by asking questions like, can we do things more efficiently? Can we be more effective? Can we do it faster? CQI uses a structured planning approach to evaluate the current processes and improve those processes to achieve the desired outcomes.Tools commonly used in CQI help team members identify the desired clinical or administrative outcome and the evaluation strategies that change the team to determine if they are achieving that outcome. The team can adjust the CQI plan based on continuous monitoring of progress through an adaptive, real-time feedback tat (NLC, 2013).A CQI approach can help improve patient care. There is a strong link between org anisations with explicit CQI strategies and high performance (Levin, 2016).Figure 4 CQI Framework Model (Adapted from NLC)Structure examines the characteristics of resources, staff and consultants, physical space, and financial resources.Process - the activities, workflows, or tasks carried out to achieve an output/outcome.Output the immediate harbinger to a change in the patients status. Not all outputs are clinical e.g. business or efficiency goals.Outcome the end result of care. Can be change in the patients current and future health status.Feedback Loop represents its cyclical, iterative nature.3.3.2 tiptoe Management flimsy is a process improvement method authentic by Toyota in the 1950s. Lean management principles have been used in manufacturing for many years, however, these principles can be used in healthcare too. According to Womack and Jones, thither are five key lean principles value, value stream, flow, pull, and perfection. Lean drives out waste so that all work adds value from a customer positioning. Lean thinking focuses on how efficiently resources are being used, it looks at each step in the process and asks what value is being produced? Value from a patients perspective can be defined as timeliness of treatment, reduced stress, or better functional outcomes. The NHS defines value as anything that helps treat the patient. Everything else is waste (Jones and Mitchell,2006).Figure 5 Lean Principles severalise customer value in healthcare value is any activity that improves the patients health.Manage the value stream the value stream is the patients journey. Identify process that deliver value to patients.Create Flow align processes to facilitate the smooth flow of patients and informationEstablish Pull provide care on demand and utilising resources effectively.Seek Perfection optimise the process through continued development and adjustment to meet patients needs.Optimal delivery of high-quality care to reduce mortality in hip fract ure patients is an achievable goal. There are numerous opportunities to enhance the quality of care reduced length of stay, reduced institutionalisation, reduced mortality and better functional outcomes for patients. Better quality care minimises treatment delay, promotes recovery and facilitates a speedier discharge. Cost and quality are not in conflict providing high quality hip fracture treatment is a lot cheaper than poor quality treatment. Lean inspired and clinical pathway related process improvement efforts make inconsistent and inefficient practices in health care more visible. The implementation and adherence to evidence based standards will considerably improve the care and management of older patients with hip fractures, this will result in significantly improved outcomes for patients and the healthcare system.5.1 Appendix AReferences BOA (2014) BOA standards for trauma (bOASTs). visible(prenominal) at http//www.boa.ac.uk/publications/boa-standards-trauma-boasts/ (Acce ssed 5 December 2016).Callear, J., Shah, K., Hospital, J.R. and Oxford (2016) Analgesia in hip fractures. Do fascia-iliac blocks make any difference?, BMJ Quality Improvement Reports, 5(1), pp. 210130-4147. doi 10.1136/bmjquality.u210130.w4147.Chudyk, A., Jutai, J., Petrella, R. and Speechley, M. (2009) Systematic review of hip fracture rehabilitation practices in the elderly, Archives of physical medicine and rehabilitation., 90(2), pp. 246-62.Colais, P., Di Martino, M., Fusco, D., Perucci, C.A. and Davoli, M. (2015) The effect of early surgery after hip fracture on 1-year mortality, BMC Geriatrics, 15(1). doi 10.1186/s12877-015-0140-y.Compston, J. (2009) Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK, Maturitas., 62(2), pp. 105-8.Coruhlu, O. and Pehlivan, S. (2016) Worst pills. Available at http//www.worstpills.org/includes/page.cfm?op_id=459 (Accessed 5 December 2016).Edwards, P., Huang, D., Metcalfe, L. and Sainfort, F. (2008) Maximizing your enthronement in EHR. Utilizing EHRs to inform continuous quality improvement., JHIM, 22(1), pp. 7-12.Hanna, L., Gulati, A., Graham, A. and Corporation, H.P. (2014) The role of Fascia Iliaca blocks in hip fractures A prospective case-control study and feasibility assessment of a junior-doctor-delivered service, transnational Scholarly Research Notices, 2014. doi 10.1155/2014/191306.Heyburn, J., Holloway, G., Leaper, E., Parker, M., Ridegway, S., White, S., Wiese, M. and Wilson, i (2012) Management of proximal femoral fractures 2011, Association of Anaesthetists of Great Britain and Ireland, 67(1), pp. 85-98.Jones, D. and Mitchell, A. (2006) Lean thinking for the NHS. Available at http//www.nhsconfed.org//media/Confederation/Files/Publications/Documents/Lean%20thinking%20for%20the%20NHS.pdf (Accessed 11 December 2016).Kalmet, P.S.H., Koc, B.B., Hemmes, B. and ten Broeke, R.H.M. (2016) Effectiveness of a Multidisciplinary Clinical Pathway f or Elderly Patients With Hip Fracture A Multicenter Comparative Cohort Study, Geriatric Orthopaedic Surgery Rehabilitation, 7(2), pp. 81-85.Levin, D. (2016) Using continuous quality improvement to improve patient experience. Available at http//bivarus.com/using-continuous-quality-improvement-improve-patient-experience/ (Accessed 7 December 2016).Myers, A.H., Palmer, M.H., Engel, B.T., Warrenfeltz, D.J. and Parker, J.A. (1996) Mobility in older patients with hip fractures Examining Pre diary of Orthopaedic trauma, Journal of Orthopaedic Trauma, 10(2), pp. 99-107.NICE (2013) Falls in older people Assessing risk and prevention. Available at https//www.nice.org.uk/guidance/cg161 (Accessed 5 December 2016).Nie, H., Yang, Y.-X., Wang, Y., Liu, Y., Zhao, B. and Luan, B. (2015) effectuate of continuous fascia iliaca compartment blocks for postoperative analgesia in patients with hip fracture, 20(4).NLC (2013) Continuous quality improvement (CQI) strategies to optimize your practice Prime r provided by. Available at https//www.healthit.gov/sites/default/files/nlc_continuousqualityimprovementprimer.pdf (Accessed 7 December 2016).Rieman, A.H.K. and Hutichson, J.D. (2016) The multidisciplinary management of hip fractures in older patients. Available at http//www.orthopaedicsandtraumajournal.co.uk/article/S1877-1327(16)30025-2/fulltext (Accessed 5 December 2016).Scottish intercollegiate guidelines network part of NHS quality improvement Scotland SIGN management of hip fracture in older people (2009) Available at http//www.sign.ac.uk/pdf/sign111.pdf (Accessed 5 December 2016).Simunovic, N., Devereaux, P. and Bhandari, M. (2011) Surgery for hip fractures Does running(a) delay affect outcomes?, 45(1).Trpeski, S., Kaftandziev, I. and Kjaev, A. (2013a) Fast-track care for patients with suspected hip fracture. Available at http//www.injuryjournal.com/article/S0020-1383(11)00002-7/fulltext (Accessed 10 December 2016).Trpeski, S., Kaftandziev, I. and Kjaev, A. (2013b) The effec ts of time-to-surgery on mortality in elderly patients following hip fractures, Prilozi (Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki)., 34(2), pp. 115-21.Van Staa, T.P., Dennison, E.M., Leufkens, H. and Cooper, C. (2001) Epidemiology of fractures in England and Wales. Available at http//www.thebonejournal.com/article/S8756-3282(01)00614-7/fulltext (Accessed 5 December 2016).Verhelst, J., Dawson, I., Paul T. P. W. Burgers, Esther M. M. Van Lieshout and Piet A. R. de Rijcke (2013) Implementing a clinical pathway for hip fractures effects on hospital length of stay and complication rates in five hundred and twenty six patients, 38(5).

Female economy

Female economyThe twenty first century has seen the elevated extension of the world economy. As years communicate changes have been inevitable as issues much(prenominal) as the monetary crisis wreak havoc with economies. Following this, enquiryers atomic number 18 focusing their studies on how best to penetrate the live market and emerge unscathed despite the prevalent challenges. It is from this point of view that Sayre and Silverstein (2009) sought to examine the place of women in todays market. In their obligate they explore the quandary facing women and companies due to the latters failure to acknowledge the power women possess. Women are increasingly dominating the worlds market and as drivers of the world economy, they demand attention from product and good companies. Estimated to control almost $20trillion in annual consumer expenditure, they are a neglected consumer group resulting in hefty untapped opportunities. The article bodes that a majority of women touch high ly underserved and sidelined by product companies. This is despite the current and growing stature of women in the society. Women have become quite powerful due to the effect of education, leaders opportunities and career opportunities. It is no longer a world where most women were uneducated currently women dominate half of global students and this enhances their capacities for choice of consumption. Furthermore, most women are pursuance to advance their career opportunities and employment is accompanied by elements of dynamic consumption needs. In the study, it is eminent that women face challenges in managing their ho utilizationholds and finances, having too many demands and the lack of plenty time for themselves. Right here is a loophole for companies to capitalize and serve women with regard to their particularised needs. Sayre and Silverstein (2009) emphasize that companies must learn the strategies of selling to women especially because their dominance is cringe to accr ue large profits. A comprehensive question study requires a concrete research problem. In Sayre and Silverstein (2009), the detectives aimed at understanding how women feel about their melt down and lives and how they were served by businesses. Even though the stated research problem detailed indicated the appropriate form of research methodological analysis to be used it did non indicate the overall subject of the study. Walliman (2006, p.67) argue that hypotheses used in constructing the research problem should emerge from logical deductions from a background research of the topic. However, the article does not use ample background research as no literature review is evident in the study. In addition, while the study is keen to address the feature that women dominate todays market the research problem does not draw a connection to this fact. The research problem guides one into conceptualizing the appropriate form of research methodology and as the article progresses it is e vident that soft methods were most appropriate. The study chose to use qualitative research methods in understanding womens needs and their feelings on the services offered by businesses. Qualitative research is suitable in such studies which seek to understand issues comprehensively and whose qualitative data cannot accomplish the same. As asserted by Ragin (1994, p.83) qualitative research emphasizes on in-depth knowledge and a refined elaboration of images, concepts and overall perceptions. In the study, the qualitative research methods used were the questionnaire and interview methods. All these methods were blade establish with most of the histrions being required to access web services and undertake the interviews. The web stack posted in the consultancy groups website attracted more than 12 000 women from a considerable range of geographies. The survey contained a questionnaire with 120 questions about different aspects of womens lives. Such aspects included homes, care ers, education, relationships, interests and activities among others. This form of survey gives anonymity to participants who then feel uncompromised in reply the questions given. In addition it targets a wide range of participants and thus increases the validity of research results as participants are diverse and unbiased. The web survey was in tandem bicycle with the research goal as the questions addressed the research problem and even heightened the researchs effect through a diversified response.As a qualitative research method, the interview presents a unique form of conversation where the interviewer seeks to understand various items in the participants point of view. Internet interviewing provides for a suitable interviewing technique. With the similar advantage of anonymity, the researcher can seek states from participants through email and other chat services. The study used lucre interviewing in their study of women working in various organizations. Hewson (2003, p.45) observes that net interviewing may limit the researcher from accessing nonverbal information expressed by participants. In a situation where the research clearly embarks on a care of comprehensiveness, this might be a shortfall in the study. Interview conversations need to be highly structured and this prompts researchers to design specific interview questions in redact to guide the process. In any research study, it is expected that various procedures are undertaken as a way of ensuring the comprehensiveness and credibility of the study. At the onset of research preparations are made on how to acquire research participants. While the article underlies the target of the survey to be women, it fails to stipulate protocol for sampling. This liberal web survey received responses from women and the conducted interviews were similarly addressed to women. The articles failure to outline the sampling procedure lives room for speculation and skepticism on the researchs validity and rel iability. Regardless of the sampling misdemeanors, this open form of web survey attracted a sample of participants who fit in with the research outcomes perfectly. Ethical considerations in carrying out research are an integral part of any research study. Its importance is quite pertinent and omitting it may lead to dire consequences. In the article, there are no indications of any honest underpinnings to the study. The web survey does not provide any contractual agreement detailing the object of the research and reasons for research. Whether in the web survey or interviews carried out by the researcher, they are required to make the potential research participant understand their role in the research process. Bell (2005, p.45) argues that it is insufficient when the interviewer just displays the contract and expects the participant to sign it. Seeking consent of the participants is important and the article has no evidence that these measures were taken. In the view of a lack of consent or infringed privacy, researchers are nonresistant to facing legal repercussions which may waylay their research. Moreover, as an interviewer it is crucial to ask questions in a respectful manner which takes into consideration the various characteristics of the participants. Dealing with internet interviews may require one to infer on the appropriate time for the interview and researchers should take any recommendations respectfully. In cases of any shortcomings caused by ineffective ethical considerations, the article should have stated so. Despite this, the web survey allowed participants to engage in the study at their own time and the questions used were in no way inappropriate. Following the study the article chose six archetypes which were observed to be common amongst respondents. It is through these common characteristics that the data collected was analyzed. The data analysis is not clearly detailed as the procedures undertaken in compiling and evaluating the variou s responses are not outlined. The article immediately embarks on presenting the research results and findings. The six archetypes included fast-tracker, military press cooker, relationship focused managing on her own, fulfilled empty nester and making ends meet (Silverstein, 2009, p.49). With reference to each of these aspects, the article expounds on the factors which make women the largest consumers with regard to the products from the specific industries. Using these segments was instrumental in establishing the kind of consumers marketers in companies should aim to target. It is similarly advantageous to understand what consumers are looking for in the market and their specific needs. The separate segments were well presented in a chart describing their income levels, age and stages of life. The article also extensively presents the portion of the population each type of women occupied and the percentage of overall income possessed. The article further indicated the priorities and needs of the women in each segment which gives marketers an idea of the most appropriate consumer goods for them. In the industries which presented the largest opportunities like food, fitness, beauty and apparel, women voiced their views on their experiences with these industries. For instance, women were seen to measure fitness highly but it always tends to take a backseat in their lives. The reason behind this was the fact that most women often prioritized other peoples needs in the beginning their own. Thus, the lack of time provided an opportunity for fitness centers to derive fitness sessions which were less time consuming. On the other hand, the study also included responses on such industries as financial services and healthcare where women felt neglected and underserved. Considering that womens income margins are quite high and they continue to rise, they are required to access effective financial services. Women cited disrespect, stereotyping, poor advice and contrad ictory policies as some of the characteristics of financial institutions. It was clear that these institutions needed to review their approaches and embark on a marketing strategy aimed at keeping women customers happy. The conclusions made in the article are derived from a logical and comprehensive evaluation of the research findings. The article draws from insights on the future outlook of the worlds economy and the effects of the ever growing female workforce. The future of most companies lies at the hand of women as they make up the majority of the worlds consumer spenders. Furthermore, as the research sought to answer the research questions it studies various segments which define women and their consumer needs. As the article concludes that women will continue to experience challenges in such areas, companies must target the specific needs of women. Women are seen to respond to services which encourage love, care and respect which provide a clear picture of what companies sho uld do in order to accrue more sales. The article has in no way illustrated limitations for the research which indicates a subjective form of study. It is crucial to indicate shortcomings of a study and cite areas where more research should be carried out. Nevertheless, the article is indeed quite informative and provides ample insights for marketers and companies dealing with women consumers. ReferencesBell, J. (2005). Doing your Research Project A Guide for First Time Researchers in Educationand Social Science. Berkshire grant University Press.Hewson, C. (2003). Internet Research Methods A Practical Guide for the Social and Behavioral Science. London Sage Publications Ltd.Ragin, C.C. (1994). Constructing Social Research The Unity and Diversity of Method. California pine tree Forge Press. Sayre, K., and Silverstein, M.J. (September, 2009). The Female Economy Harvard Business Review. hbr.orgWalliman, N. (2006). Social Research Methods. London Sage Publications Ltd.

High Schools That Work: Best Practices for CTE Essay example -- Educat

High Schools That Work Best Practices for CTEHigh Schools That Work (HSTW), a school amelioration endeavour of the grey Regional Education Board (SREB), has documented achievement gains by career and technical education (CTE) students at participating sites (Bottoms and Presson 2000). At HSTW sites participating in 1996 and 1998 assessments (Frome 2001), CTE students showed math and science achievement equal to the national average of all high school studentsand exceeded the national average of CTE students in math, science, and reading. One part of the HSTW textile is a set of 10 Key Practices that each participating site implements by developing and carrying out a customized action plan for school modifyment (SREB 1999). Kaufman et al. (2000) apply existing HSTW data to analyze the impact of 6 clusters representing HSTWs 10 Key Practices. They concluded that achievement gains in science, reading, and math were correlated with the proportion of students conflux HSTW compute r program standards and with the amount of time students spent talking to their guidance counselors and teachers about their school program. They also concluded that the proportion of students perceiving their academic and CTE teachers take oning together to improve students math, reading, and indite skills was correlated with achievement gains in those three areas. This Brief provides practical examples of approaches HSTW sites have used to move toward HSTW curriculum standards, provide students with guidance, and allow academic and CTE teachers to work together. HSTW programme StandardsThe curriculum recommended by HSTW (Bottoms and Presson 2000) calls for a challenging program of study with two components. First, an upgraded academic core ... ...Students. Atlanta, GA SREB, 1995. (ED 404 540) Southern Regional Education Board. 1996 slap-up Practices stiff Strategies in Raising the Achievement of Career-Bound High School Students by Replacing the General Track. High Schools T hat Work. Atlanta, GA SREB, 1996. (ED 404 541) Southern Regional Education Board. radical Partnerships and a National Network to Improve High School Education. Atlanta, GA SREB, 1999. <http//www.sreb.org/programs/hstw/background/brochure.asp Southern Regional Education Board. High Schools That Work in Kentucky A build Report. Atlanta, GA SREB, 2000. <http//www.sreb.org/programs/hstw/publications/state_reports/KYstateprofile.pdfWinterburn, P. Learning to Trust. On the Treasure Coast, Tech Prep Proves a Trove for Educators Long Divided. Vocational Education Journal 70, no. 4 (April 1995) 28-29, 44. High Schools That Work Best Practices for CTE Essay example -- EducatHigh Schools That Work Best Practices for CTEHigh Schools That Work (HSTW), a school improvement initiative of the Southern Regional Education Board (SREB), has documented achievement gains by career and technical education (CTE) students at participating sites (Bottoms and Presson 2000). At HSTW sit es participating in 1996 and 1998 assessments (Frome 2001), CTE students showed math and science achievement equal to the national average of all high school studentsand exceeded the national average of CTE students in math, science, and reading. One part of the HSTW framework is a set of 10 Key Practices that each participating site implements by developing and carrying out a customized action plan for school improvement (SREB 1999). Kaufman et al. (2000) used existing HSTW data to analyze the impact of 6 clusters representing HSTWs 10 Key Practices. They concluded that achievement gains in science, reading, and math were correlated with the proportion of students meeting HSTW curriculum standards and with the amount of time students spent talking to their guidance counselors and teachers about their school program. They also concluded that the proportion of students perceiving their academic and CTE teachers working together to improve students math, reading, and writing skills wa s correlated with achievement gains in those three areas. This Brief provides practical examples of approaches HSTW sites have used to move toward HSTW curriculum standards, provide students with guidance, and allow academic and CTE teachers to work together. HSTW Curriculum StandardsThe curriculum recommended by HSTW (Bottoms and Presson 2000) calls for a challenging program of study with two components. First, an upgraded academic core ... ...Students. Atlanta, GA SREB, 1995. (ED 404 540) Southern Regional Education Board. 1996 Outstanding Practices Effective Strategies in Raising the Achievement of Career-Bound High School Students by Replacing the General Track. High Schools That Work. Atlanta, GA SREB, 1996. (ED 404 541) Southern Regional Education Board. New Partnerships and a National Network to Improve High School Education. Atlanta, GA SREB, 1999. <http//www.sreb.org/programs/hstw/background/brochure.asp Southern Regional Education Board. High Schools That Work in Kentuc ky A Progress Report. Atlanta, GA SREB, 2000. <http//www.sreb.org/programs/hstw/publications/state_reports/KYstateprofile.pdfWinterburn, P. Learning to Trust. On the Treasure Coast, Tech Prep Proves a Trove for Educators Long Divided. Vocational Education Journal 70, no. 4 (April 1995) 28-29, 44.

The Salem Witch Trial :: American America History

The Salem Witch TrialThe Salem Witchcraft was a series of undesirable events, which was provide by paranoia and fear. Though several witch trials occurred before the Salem Witch Trial, this was the most well known of all. Many innocent great deal were accused of witchcraft which resulted to 19 men and women that were hanged, 17 innocents that died in unsanitary prisons, and an 80-year old man that was crushed to death by putting stones on top of his stomach until he confesses (movie The Crucible). In some accounts, it was reported that two dogs were stoned to death for cooperating with the Devil. Why did the Salem Witch trial occur? Were these trials appropriate? Or were they truly a Devils work? The Salem Witch Trials might have occurred for a variety of reasons such as peoples ignorance that led to superstitions. It might have also occurred because peoples crave for power, or it might also be because of fear. In the proterozoic years of America, people were mostly unaware of cer tain things. Sickness, for instance, was an important issue for people didnt know how to practise or cure such complex illnesses. The Puritans, during the colonial times, didnt have much information about certain things. They came to believe that certain unexplainable events were done by a powerful source of evil thus brought about superstitions. The infamous Witch Trials done at Salem, Massachusetts, which spread across the continent, was an example of peoples injustice acts in response to superstitions. One of the major cause of the Salem Witchcraft trials was superstition, an irrational belief or practice resulting from ignorance or fear of the unknown (www.encyclopedia.com). A lose of scientific knowledge led many people to be convinced that, witches were responsible to the death of an animal or a livestock John Rogger testified that upon the exist words of Martha Carrier his cattle would be strangely bewitched.(Mather, p55) John Roger believed on superstitions thus he prop osed that Martha was a witch who was killing his cows. It is easy to see how the people of Salem were so vulnerable to the notion of witches taking over their town. Furthermore Tituba, Reverend Parriss slave, practiced ritual dance and black magic in her early years in Africa. She influenced most of the girls in town through her stories. The girls believed on superstitions which overall started the Salem Witch Trials and made it possible for the witch trials to occur for a long duration.

Bertolt Brecht :: Drama

Bertolt Brecht.Brecht was born Augsburg, Germany in 1898. He then attended universityin Munich in 1917. It was while he was at university that he witnessedthe loss Revolution which was the first event to influence him.Brecht wanted what had occurred in Russia to repeat itself in Germanyas he saw all there was to gain from a Revolution. This was the firstinfluence that gave Brecht his voice in social and political issues.In 1918 Brecht was called up for World War 1 as a medical orderly. here(predicate) he witnessed some of the worst medical injuries created by thewar. This experience made him an extreme pacifist. This was the secondmost influential event that took place which in fling caused him to bein opposition to those international opinionated political powers. Hesaw them as being capitalist populations, sending innocent men to bemurdered meaninglessly, for their own efficient profitable gain. Hefelt misery as the human potential completely contradicted its entiremeaning by the fauna actions of humans around the world.Marxism was the influence that gave Brecht hope that there was goodwithin humans although some needed re-awakening. He had seen theRussian Revolution and witnessed the collapse of Germany aft(prenominal) WorldWar 1 and the fall of the Royal Family of Europe. This all influencedBrecht to write his first play Baal in 1918. This raw play andepisodic structure was the young person of Brechts later well-known work,which inhabited a more grotesque quality. His work looks at theincapability one has to have power over the craving and greed in theworld. He uses the element of shock in his plays as he relates to hisyearning for transfigure and fury at his experiences. It was this yearningto bring change via the use of shock that bought us epic theatre.In 1922 Brecht went to Berlin and this experienced gave him theinfluence for all his later work. Here he observed real theatre andthe cabaret, move of theatre he never knew existed. This influencem ade him more culturally aware and gave him the knowledge to develophis work.Aesthetic theatre was influenced by expressionalism, the use of unhomogeneous scenes without any rational order. He discarded Drawing roomcomedy, realism and naturalism. Instead he took influences from EdwinPiscator whom considered theatre as a device for political education.Edwin Piscator used different means in which to convey his politicalmessage. He used news-real, projections and captions to portray thebackground knowledge of the play. He also used long chorus scenes,perceived in traditional Broadway or West- End performances, todemonstrate the significance of the play.

Assimilation “Housing Indigenous Australians in the 1970s” Essay

Since the 1970s the Australian Government started focusing on establishment of houses for natural heap in reserve, remote and very remote areas Indigenous housing programs as. Numbers of housing commission HC has been built under what has called the Housing for Aboriginal pot HFA (1) Consequently, Aboriginal mass started moving from overcrowded private rental homes and government houses to public housing tenants in suburban estates. For many Indigenous Australians, this experience negatively change their obligations to family and community and their conventional pattern of life, because it was based as much on class relations and colonialism view. For this reason, white settlers was justifying the Indigenous people inadequacy participate in social life and / or to assimilate to racist terms, as demonstrating their genetic / biological unsuitability for sophisticated life (2). By another word, white people were represented the problem as social advancement rather than determinant s of better social and wellness circumstances. In all of these forms of policies and acts, the expectations by white settlers was that Aboriginal people did not have adequate culture to be able to participate in normal social life. The standard of the education, childrearing nuclear family life, neighbourly interaction, hygiene and discase housing were the fundamental elements around these housing programs. On the other hand, Aboriginal people were needed to absorb these to be able to leave the poor conditions and to demand citizenship rights (4). This essay will explore the cultural and social and negative impacts of New South Wales Housing Commission (HC) during 1970s, at the end of what is called as the Assimilation era and impacts of ... ...ious Aborigines people in New South Wales found out some important connections between prevalence of those psychiatric disorders and the circumstances in the housing commission. These findings suggest that some conditions involved ad aptation to the normal life circumstances within the whole society and/or accumulative new behaviour increases the vulnerability of illicit drug use and depression. (8) Furthermore, higher levels of at-risk behaviors have been noted among Aboriginal adolescents during the assimilation era. These behaviours include poor physical wellness, risk factor for disability, face a self-assessed health disadvantage, aggressiveness and emotional distress. However, this may bias by the disproportion of socioeconomic factors. By another word, lower socioeconomic level increase the risk of such health outcomes.

America Must Drill for Oil in the Arctic National Wildlife Refuge Essay

America Must Drill for vegetable fossil vegetable oil in the Arctic National Wildlife RefugeOil readinging in the Arctic National Wildlife Refuge is a very controversial topic. On one end you have the people who want to drill for oil to help extinct our economy, and on the other end there are the environmentalists and the Alaskan natives who do not want their land destroyed. Our economy inevitably help oil prices keep rising, gas prices have reached an all time high, and America is depending too much on foreign trade. Drilling for oil in Alaska will solve these problems. There are ways of drilling without disturbing the environment and keeping the animals in their original habitat.The Arctic National Wildlife Refuge (ANWR) is a large piece of land in Alaska. It is an 18 million acre piece of land where the weather reaches only 4 degrees Celsius in the summer and below 20 degrees Celsius in the winters (Urstadt). There is never any sunlight, except for maybe a day the whol e family. It is beautiful land that just happens to be on 5.6 zillion to 16 billion barrels of oil the United States is said to go through over 7 billion barrels of oil a year (Arctic drilling makes sense 1). These days everyone complains about the price of gas, and how it keeps going up. That is the problem the solution would be drilling for oil in that beautiful land. To hear the advocates separate it, drilling for oil in a long off-limits part of Alaska is the solution for record gas and oil prices, increased dependence on oil imports and even the need for U.S. military involvement in the Middle East.(Arctic Drilling Makes Sense 1).By drilling for oil in ANWR, it will help out the economy of the United States greatly. There will be no need to debate the topic of how g... ...Urstadt). It is a secluded part of ANWR, which is why it is a reasoned place to drill. While drilling for oil there are always going to be pipelines everywhere. But today, the oil companies eleva te the pipelines in order to let the animals pass under them. This helps out with the environment and helps to keep the animals in their homes as well.Drilling for oil in Alaska will solve many problems that have occurred the stand up several years in America. Gas prices keep rising in America which is due to a lack of oil and if America keeps getting oil from foreign suppliers, prices will never go down. The United States is the world leader in energy use and gas for cars. This is why drilling for oil is a good idea and will help out with a lot of problems that America has. Drilling for oil in the Arctic National Wildlife Refuge is the do to all Americas questions.