A Research Study On The Blood Pressure Change For Non...

Bosworth, Olsen, Grubber, Powers, and Oddone (2012) conducted a three-arm randomized controlled trial to determine the differences in AAs and Caucasians in two self-management hypertension interventions (N=636; non-whites n=328, and whites n=308). The subjects were randomly placed in the usual care (UC), home BP monitoring (HBPM), a tailored behavioral self-management intervention (TBSMI), and the two groups combined (TBSMI + HBPM). Data collection was done at the initiation of the research, 12 months, and 24 months from the control and intervention groups. BP results on whites at the baseline and intervention groups did not differ, but there was significantly reduction in the systolic BP of 7.5 mm Hg in AAs. This study denotes that a home BP monitoring in combination of nurse-administered telephone behavioral intervention was most effective in BP control in AAs. Similarly, Jackson, et al. (2012) in their research to examine the differences in blood pressure change for non-Hispanic w hite and AAs patients in response to telephone behavioral program delivered by a nurse and medication management intervention. 573 patients (African Americans n=284, and White n = 289) were recruited for this study and randomly placed in one of the three intervention groups. HBPM with remote medication management (HBPM + RMM, n=); HBPM with behavioral management intervention (HBPM + BMI); combined intervention (HBPM + RMM + MMI), and usual care (UC). The result in this study revealed aShow MoreRelated_x000C_Introduction to Statistics and Data Analysis355457 Words   |  1422 PagesStatistical Association’s Joint Committee with the National Council of Teachers of Mathematics on Curriculum in Statistics and Probability for Grades K–12. In addition to her texts in introductory statistics, Roxy is also co-editor of Statistical Case Studies: A Collaboration Between Academe and Industry and a member of the editorial board for Statistics: A Guide to the Unknown, 4th edition. Outside the classroom and the ofï ¬ ce, Roxy likes to travel and spends her spare time reading mystery novels. SheRead MoreEssay Paper84499 Words   |  338 PagesArmy Regulation 600–20 Personnel–General Army Command Policy Rapid Action Revision (RAR) Issue Date: 20 September 2012 Headquarters Department of the Army Washington, DC 18 March 2008 UNCLASSIFIED SUMMARY of CHANGE AR 600–20 Army Command Policy This rapid action revision, dated 20 September 2012-o Updates policy for the administration of unit command climate surveys: adds requirement for personnel equivalent to company level commanders; updates timelines to withinRead MoreHuman Resources Management150900 Words   |  604 Pages To ease employee and managerial anxieties about the changes, GE Fanuc promised that no employees would lose their jobs. Managers and supervisors affected by the elimination of levels were offered promotions, transfers to other jobs in GE Fanuc, or early retirement buyouts. Additionally, employees were promised profit sharing, which has resulted in up to three weeks additional pay in profit sharing bonuses in some years. The test of the change is in the results. GE Fanuc’s revenue is up women employeesRead MoreExploring Corporate Strategy - Case164366 Words   |  658 Pages22/10/2007 11:54 Page 597 CASE STUDIES ECS8C_C01.qxd 22/10/2007 11:54 Page 598 ECS8C_C01.qxd 22/10/2007 11:54 Page 599 Guide to using the case studies The main text of this book includes 87 short illustrations and 15 case examples which have been chosen to enlarge speciï ¬ c issues in the text and/or provide practical examples of how business and public sector organisations are managing strategic issues. The case studies which follow allow the reader to extend

The Is Not Like The Fast Food Workers - 1383 Words

Look at all the people in this world, you have doctors, lawyers, construction workers, fast food workers, and a multitude of other professions. What do all of these professions have in common? All the people that work in these fields, want to go to college. Some are successful like doctors, but some are not like the fast food workers. This brings up a question, what prohibits these people from not going to the college of their choosing? There are two answers to this question, the first is, the individual does not have the grades required to enter the school and second, they cannot afford to go to the school. I would like to focus on the second answer for this proposal. The people with good grades who get into schools on full ride scholarships for academics or if the individual has a parent working at the school do not have to worry about funds. â€Å"Investopedia† is a website that writes about business and finances. They give a definition for student debt, â€Å"money owed on a loan taken out to pay for educational expenses.† With how fast the cost of tuition is increasing each semester student loans are just about the only way for a student to afford to go to college. With the interest rates being ridiculously high, the student cannot afford to pay the loans along with other bills and end up with an insurmountable amount of debt. When an individual goes across the stage to get their diploma, they have a hidden shadow walking right next to them and that shadow is the amount of debtShow MoreRelatedSatisfaction of Customer in Fast Food787 Words   |  4 PagesWhat is fast food and why is it so popular? Fast food refers to food that can be prepared and served quickly. Fast food restaurants usually have a walk up counter or drive-thru window where you order and pick up your food. Fast food restaurants are popular because they serve filling foods that taste good and don t cost a lot of money. However, fast food is usually cheap because it s often made with cheaper ingredients such as high fat meat, refined grains, and added sugar and fats, insteadRead MoreFast Food Should Not Be Served For School Lunch Menu946 Words   |  4 Pagessystem has been serving unhealthy foods to kids (Psyche Pascual).Schools are changing salad bars for ice cream bars and fruit for candy. Your body is not designed for harsh amounts of sodium, fat, and sugar. In the school system, kids should be allowed to only choose healthy alternatives. The community and parents need to change laws to promote healthy nutrition in schools. There are overwhelmingly too many obese children because of school lunch menu. Fast food should not be served in schools becauseRead MoreFast Food Nation by Eric Schlosser: Chapter 3, Behind the Counter, summary/response.1474 Words   |  6 PagesBehind the Co unter. In his book Fast Food Nation, Eric Schlosser shows how the fast food industry has infiltrated every corner of American Society. He tells of the disturbing reality that is American life today; almost every aspect of American life has been franchised or chained. Beginning in California and spreading throughout the entire country, Schlosser gives the history of the fast food industry and the evils and changes that developed with it. In Chapter three, Schlosser begins by describingRead MoreBiography Of Karl Marx s Writing On Class Conflict1335 Words   |  6 PagesStates is looked at as being a part of the elite. Though it may seem like the status may easily be reached, this is not, in fact the case. Karl Marx’s writing on class conflict suggest otherwise. Class conflict is still very relevant in present day’s society and can be seen throughout the levels of class. In today’s society you can see class conflict in the way that working class is under paid such as fast food workers. Fast food workers are coming together and striking for higher pay for the hard workRead More Stigma Within the Fast Food Industry Essay1298 Words   |  6 Pagesat a fast food restaurant, more often than not it is accompanied with a stigma. People tend to believe that those who work in fast food restaurants are not capable of anything better. They assume people working at fast food restaurants are slow and uneducated, or they simply look down upon them because these jobs have become known as dead-end jobs. This so-called dead-end job is what people might describe as low-wage labor that employees have a susceptibility to become trapped in. Fast food employee’sRead MoreComparison of the Jungle and Fast Food Nation1436 Words   |  6 PagesSinclair’s target was the workers who were mistreated in various workplaces, such as the meat packing companies in Chicago, so that they may be treated fairly. 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Therefore the priceRead MoreWith There Being So Many Restaurants Open For These Fast1096 Words   |  5 Pages With there being so many restaurants open for these fast food chains, it s so hard to resist a burger. Many fast food companies give teens a taste of real life by providing a job for them at a restaurant. Because there are so many chains and cheap foods within fast food companies, workers are paid the minimum to work at these occupations. With the increase in business for fast food restaurants, workers are demanding for higher wages. However, if wages were to increase, something elseRead MoreFast Food Industry Essay724 Words   |  3 PagesIt is not a surprise that fast food has become a way of li fe in America. Every day about a quarter of the adult population n United States visits the fast food restaurant. Every month about 90 percent of children aged 3-9 visit McDonalds. According to Schlosser, Americans spent more than $110 billion a year on the fast food. In his book Fast Food Nation Eric Schlosser is not chiefly interested in the consumption of fast food, but his primary objective is to explore manufacturing starting withRead MoreMcdonaldization1720 Words   |  7 PagesMcDonaldization: Bringing Benefits or Disadvantages? Nowadays in every country we see McDonalds. The domination of fast food restaurants has introduced the ideology of McDonaldization. Companies are using the concept of McDonaldization to achieve success in the business world. By implementing the concept of McDonaldization, it has changed the world we see today. The society has become a consumer society, where people are spending more and more money. According to Professor George Ritzer

Theories and Administrative Thought on Modern Day Police Departments Free Essays

Various sociological theories and administrative thought shows that modern police department is a combination of a hierarchical and quasi-military bureaucracy. In accordance to the fundamental rationality of Weber’s theory of bureaucracy, the modern police department is wrought with red tape and other unfortunate side-effects of bureaucratic organizations. On the other hand, as Weber suggested, many large-scale organizations, especially those linked to the government, must be bureaucratic if they are to be most effectively and rationally run. We will write a custom essay sample on Theories and Administrative Thought on Modern Day Police Departments or any similar topic only for you Order Now The modern police department, although it has adopted theories of modern sociologists and administrative thinkers, continues to resemble traditional hierarchical and bureaucratic systems. The modern police department resembles least Fayol’s theories of management, in which red tape detracts from effectiveness and in which horizontal communication is widely practiced. At the same time, many police departments use Fayol’s theories of horizontal communication when seeking accountability and attempting to eliminate corruption within the force. Also in accordance with the theories of Luther Gulick, the theories of Fayol show how within large organizations like police departments, specialization of tasks can lead to effectiveness. Therefore, the modern police department in many ways reflects old-school sociology and administrative theories in that at each rung of the hierarchy, an individual is assigned highly specific tasks and reports to specific individuals in positions of immediate authority. The hierarchy entails that individuals usually report to the person who is ranked immediately above them, similar to a military bureaucracy. The titles and ranks underscore the connections between the modern police department and military organizations. At the same time, police departments are trying to incorporate the more open systems of modern theorists. Based on effective business models, some administrative thought discounts the relevance of bureaucracy and hierarchy in favor of a more democratic operation. Police departments have yet to incorporate such democratic principles within their ranks but at the same time must allow for the inclusion of minorities and minority opinions on the force. How to cite Theories and Administrative Thought on Modern Day Police Departments, Essay examples

sdsaf Essay Example For Students

sdsaf Essay Similarites between Alice Walker and Zora Neale HurstonAlice Walker discovered Zora Neale Hurston when she needed some authentic material on voodoo practiced by blacks in the South in the 1930s. The Revenge of Hannah Kemhuff had so much impact on Walker, she wrote about it repeatedly. The Color Purple has many parallels to Hurstons Their Eyes Were Watching God. Walker highly valued the works of Hurston. Walker says about Hurston:Hurston was exposing not simply an adequate culture but a superior one.Both authors have extremely similar themes, main characters, and attitudes toward women, especially the black women. They also share a common appreciation for language. Common Themes*Uncovering the soul of the black woman*The rise above sexual and racial oppression for relative peace and independence*The breakaway from a suffocating, loveless marriage in search for ones own self.*The unity of women*Salvation leads to powerSimilarities between Celie and Janie*Seen as mules of the world*Unwillingly forced into a marriage involving little compassion and intellect, but involving physical as well as mental abuse*Seeking for control of their lives*Searching for independence in a culture that imposes many limitations*Yearning to create, dream, grow, love, and to be freeAlice Walker even wrote a poem on Janie. Click here to view it. Hurston and Walkers similar attitudes on women and menWOMEN*Searching for their own voice*Formed intimate relationships with each other women to help them survive struggles*In the end, they are very strong and courageousMEN*In most cases, they are very controlling*Instead of treating their marriages as an equal partnership, they smother their wives*Failure to see the beauty of life, including relationships with othersclick here for summary of Walkers Looking for Zora

The Cosmology of Boethius and the Ancient Literature

The Prince and the Pauper Essay Example

The Prince and the Pauper Essay Example The Prince and the Pauper Essay The Prince and the Pauper Essay Essay Topic: The Prince The Taming Of the Shrew The costumes in the play reflected the character and his or her personality, for example Kate wore a wrecked and torn low quality dress and Bianca wore a high quality gold gown. In plays such as The Prince and the Pauper what people wear is very important in this play an example of this is when Lucentio swaps cloths with his servant so no one would know who he was.  I knew what sort of a role a person played. If it was either a rich person or a poor person by what type of cloths they were wearing for example if some one was wearing ripped cloths that were dark in colour and dirty then you know that they are either poor or a servant like Petruchios servant and if someone was wearing a shirt, hat, short trousers, tights and clean shoes with maybe even a sword then straight away you could tell that the person was wealthy and privileged like Hortensio. The orchestra were even in costume and dressed in plain grey robes. I understood the play to a certain extent because I did an abbreviated version of Taming of the Shrew with my drama class in school. Compared to the one I saw in the theatre and the one I did at school it was almost completely different. The school play would have been a lot better if we had seen the play before the production, if we had then maybe the class could have gotten a better understanding of the characters and the main plot of the story, as I think the play we saw could have done this.  Although the theatre production was a lot better, I thought that the character development of Lucentio, Gremio, and Hortensio was a lot more thought out in the one I did with the school and in the theatre production they were a bit characterless and bland. The characters of Kate and Petruchio were a lot better in the theatre they were exciting and competent. My favourite character in the play was Kate, I admire her because it must have really hurt her throat screaming and yelling for most of the play and also that Kates character was the one that in my opinion was more developed, the one that stood out from the other main characters and the best acted. I also liked the way that her character gradually changed through out the play and not many actors can carry it out as well as she did. The change of Kates character was obvious during the play but the actors change wasnt. Generally I believed the choice of cast was very well done  My favourite part of the play I thought was when Petruchio and Kate met for the first time in the play and the actors showed really well that it was love at first sight. It was my favourite part of the play because it was filled with humour, Romance, attraction and physical humour like when Kate is banging her foot against the door shouting to her father to let her back in the house. Although as a whole I thought the audience really enjoyed the performance and I liked the way the director slipped in a few modern jokes but in my opinion I believe that the director could have made the play to suit different types of audience for teenagers and the older type of audience. The director could have done this by maybe shortening the play because I thought the pace of the play was time-consuming and long-winded and some parts of the play were even quite dull. He could have even either changed the language of the play from Shakespearian to modern or changed the costume from old to modern or even both to make the play more appealing to the younger audience.  Overall I enjoyed the performance thurally and it helped me to understand drama to a higher extent.

Dutchtown High School Research Paper Example | Topics and Well Written Essays - 2250 words

Dutchtown High School - Research Paper Example From the discussion it is clear that  Dutchtown High School is located in Geismar, which is an unincorporated area in  Ascension Parish,  Louisiana.  This town has two schools, which are often ranked among the best schools in Louisiana. These are the Dutchtown elementary or Middle School and  Dutchtown High School. The school environment is an attractive scene since the Mississippi river runs across the town.  However, the area where the school is located is vulnerable to hurricanes and the tropical systems since the area is lowly elevated, and has a close location to the coast of southeast Louisiana. The town lies 23 feet above the sea level, which is slightly lower than most areas of United States.This paper discusses that  Geismar in turn is located in Louisiana, a state found in the US, which is found in the southern region. The state of Louisiana is among the most extensive and populous states of the United States. This has contributed greatly in shaping the demogr aphics patterns of Ducthtown High School in that the school boasts of a large population of students and teachers. The average ratio of students to teacher is 25:1, which is actually a moderate ratio. The capitals of Louisiana are found in Baton Rouge whereas the largest city in that state is New Orleans. One interesting political fact is that the state of New Orleans is the only state in the US whereby the three are political subdivisions known as parishes.

Operations Management Principles Research Paper

Operations Management Principles - Research Paper Example According to the study conducted management has always been important to businesses and sustainability of organizations nowadays. All the functions and activities in a group of people must have proper management to ensure the success and that efforts given will not be put to waste. It also allows people to coordinate with one another in working and achieving certain goals. Management can be considered to be a field of study, a class of people, and a process. Management as a field of study means focusing on the principles, functions and techniques in the practice of that profession. Management may pertain to a class or level of people which can be seen in all organizations. They are responsible for practicing the managerial activities while process is the managerial activities itself. The activities involve POSDICON or planning, organizing, staffing, directing, and controlling. Management can be compared to investment as its goal is to maximize the results from the resources used. It focuses on getting the highest possible return from all resources involved in the process. In simple terms, management is concerned with how things are accomplished. It involves the ways on how a group or individuals get the set goals which is said to be both an art and a science. Management is considered as an art when it focuses on the method of doing things. When management is considered as an art, it must be able to apply the skills needed by a person on certain practice and can be enhanced through experience. It requires the manager to use his knowledge, experience and skills in making solutions to existing problems. Ernest Dale even pointed out that management involves more art than science since the managerial abilities is owned by personnel that requires thinking. On the other hand, management is considered as a science when it involves a system which means the discipline is an organized body of knowledge following certain verified principles and outcomes. It should be able to prove results as true in any kinds of situations. It is different from physical sciences which are very specific and exact since management involves people and human behavior is changing and hard to predict making management to be categorized under social sciences (Khandkar, n.d.). Now that management is thoroughly discussed, operations management would be the next to be defined. Operation management concentrates on managing processes to create desired outcomes and products. Product development, production and distribution are under the focus of that discipline or profession. It is also associated with process controls like inventory control and quality control. Purchases must be studied thoroughly as to be exact with the needed amount of products to be made. Processes are also analyzed and studied to ensure their effectiveness. In that discipline, standards and measurements are needed to enhance the performance of the internal processes. The way operations management is observed in a business depends upon the industry in which the organization falls under (McNamara, n.d.). Usually, operations managers perform the following tasks: budget preparations for programs, company programs for the company, inventory control, logistic responsibilities and employee supervision.

Global Internet Advertising Essay Example | Topics and Well Written Essays - 500 words

Global Internet Advertising - Essay Example This paper is going to highlight some of the unanswered questions in the global advertising medium. Although global internet advertising is a good thing to business all over the world there are some areas that need to be further researched. One is that there are privacy concerns on the advertiser’s side and even the potential customers (Tungate, 2013). Business owners when advertising need to prove authenticity of the products or services they are advertising this has caused issues like hackers accessing financial data and employee information via the internet and using it for illegal means (Taylor, 2012). On the customer’s side, some customers have been duped and lied to about keeping their queries or purchases private only for traces to be left that could jeopardize the customer’sreputation and life (St, 2007). This issue needs to be further researched. Secondly, through the research on global internet advertising, there is an issue of Global Internet Access 100% connectivity and when can it be a reality (Hanafizadeh & Behboudi, 2012). It emerged that the whole world knows about the internet and even about internet advertising but not all people have internet access 100% connectivity (Frith& Mueller, 2010). This is either because of high data and broadband prices, lack of data booster in the regions they are situated or partial network coverage (Kogut, 2004). This means that a lot of business will not be reaching the intended target customers while customers will not get the advertisement that could change their daily lives(Krishnamurthy & OConnor, 2006). Further research should be done to establish when 100%comnncevtivty will be a reality especially in developing worlds. A final unanswered question that emerged from the research on global internet advertising was the issue of Advertising & technology (Bidgoli, 2004). To advertise on the internet means that one must be able to use a computer and use their own website or use another

Coffee Shop Business Plan

Coffee Shop Business Plan Java Culture coffee bar is determined to become a daily necessity for local coffee addicts, a place to dream of as you try to escape the daily stresses of life and  just a  comfortable place to meet your friends or to read a book, all in one. With the growing demand for high-quality gourmet coffee and great service, Java Culture will capitalize on its proximity to the University of Oregon campus to build a core group of repeat customers. The company will operate a 2,300 square foot coffee bar within a walking distance from the University of Oregon campus. The owners have secured this location through a three-year lease with an option for extending. The have also provided $140,000 of the required $170,000 start-up funds. The remaining capital will be obtained through  Bank of America commercial loans. The company is expected to grow sales revenue from $584,000 in FY2001 to $706,000 in year three. As Java Culture will strive to maintain a 65% gross profit margin and reasonable operating expenses,  it will see  net profits grow from $100,000 to$125,000 during the same period. 1.1 Objectives: Java Cultures objectives for the first year of  operations are: Become selected as the Best New Coffee Bar in the area by the local restaurant guide. Turn in profits from the first month of operations. Maintain a 65% gross margin. 1.2 Keys to Success: The keys to success will be: Store design that will be both visually attractive to customers, and designed for fast and efficient operations. Employee training to insure the best coffee preparation techniques. Marketing strategies aimed to build a solid base of loyal customers, as well as maximizing the sales of high margin products, such as espresso drinks. 1.3 Mission Java Culture will make its best effort to create a unique place where customers can socialize with each other in a comfortable and relaxing environment while enjoying the best brewed coffee  or espresso and pastries in town. We will be in the business of helping our customers to relieve their daily stresses by providing piece of mind through great ambience, convenient location, friendly customer service, and products of consistently high quality. Java Culture will invest its profits to increase the employee satisfaction while providing stable return to its shareholders. 2.0 Company Summary: Java Culture, an Oregon limited liability company, sells coffee, other beverages and snacks in its 2,300 square feet premium coffee bar located near the University of Oregon campus.   Java Cultures major investors are Arthur Garfield and James Polk who cumulatively own over 70% of the company. The start-up loss of the company is assumed in the amount of $27,680. 2.1 Company Ownership: Java Culture is registered as a Limited Liability Corporation in the state of Oregon. Arthur Garfield owns 51% of the company. His cousin, James Polk, as well as Megan Flannigan and Todd Barkley hold minority stakes in Java Culture, LLC. 2.2 Company Locations and Facilities: Java Culture coffee bar will be located on the ground floor of the commercial building at the corner of West 13th Avenue and Patterson Street in Eugene, OR. The company has secured a one-year lease of the vacant 2,500 square feet premises previously occupied by a hair salon. The lease contract has an option of renewal for three years at a fixed rate that Java Culture will execute depending on the financial strength of its business. The floor plan will include a 200 square feet back office and a 2,300 square feet coffee bar, which will include a seating area with 15 tables, a kitchen, storage area and two bathrooms. The space in the coffee bar will be approximately distributed the following way1,260 square feet (i.e., 55% of the total) for the seating area, 600 square feet (26%) for the production area, and the remaining 440 square feet (19%) for the customer service area. This property is located in a commercial area within a walking distance from the University of Oregon campus on the corner of a major thoroughfare connecting affluent South Eugene neighborhood with the busy downtown commercial area. The commercially zoned premises have the necessary water and electricity hookups and will require only minor remodeling to accommodate the espresso bar,  kitchen and storage area. The coffee bars open and clean interior design with modern wooden decor will convey the quality of the served beverages and snacks, and will be in-line with the establishments positioning as an eclectic place where people can relax and enjoy their cup of coffee. The clear window displays, through which passerby will be able to see customers enjoying their beverages, and outside electric signs will be aimed to grab the attention of the customer traffic. 3.0 Products: Java Culture will offer its customers the best tasting coffee beverages in the area. This will be achieved by using high-quality ingredients and strictly following preparation guidelines. The store layout, menu listings and marketing activities will be focused on maximizing the sales of higher margin espresso drinks. Along with the espresso drinks, brewed coffee and teas, as well as some refreshment beverages, will be sold in the coffee bar. Java Culture will also offer its clients pastries, small salads and sandwiches. For the gourmet clientele that prefers to prepare its coffee at home, Java Culture will also be selling coffee beans. The menu offerings will be supplemented by free books and magazines that customers can read inside the coffee bar. 3.1 Product Description: The menu of the Java Culture coffee bar will be built around espresso-based coffee drinks such as lattes, mochas, cappuccinos, etc. Each of the espresso-based drinks will be offered with whole, skimmed, or soy milk. Each of these coffee beverages is based on a shot of espresso, which is prepared in the espresso machine by forcing heated water through ground coffee at high pressure. Such espresso shots are combined with steamed milk and/or other additives like cocoa, caramel, etc., to prepare the espresso-based beverages. Proper preparation techniques are of paramount importance for such drinks. A minor deviation from the amount of coffee in the shot, the size of the coffee particles, the temperature of milk, etc., can negatively affect the quality of the prepared drink. 3.2 Sales Literature: Two thousand flyers will be distributed in the adjacent neighborhood, on the University campus, at the malls and in the selected office buildings within two weeks prior to the opening of Java Culture. Subsequently, free postcards with Java Culture endorsement will be printed to increase the company visibility among the patrons. 4.0 Market Analysis Summary: U.S. coffee consumption has shown steady growth, with gourmet coffee having the strongest growth. Coffee drinkers in the Pacific Northwest are among the most demanding ones. They favor well-brewed gourmet coffee drinks and demand great service. Eugene, OR, with its liberal and outgoing populace and long rainy winter, has traditionally been a great place for coffee establishments. Java Culture will strive to build a loyal customer base by offering a great tasting coffee in a   relaxing environment of its coffee bar located close to the bustling University of Oregon campus. 4.1 Market Segmentation: Java Culture will focus its marketing activities on reaching the University students and faculty, people working in offices located close to the coffee bar and on sophisticated teenagers. Our market research shows that these are the customer groups that are most likely to buy gourmet coffee products. Since gourmet coffee consumption is universal across different income categories and mostly depends on the level of higher education, proximity to the University of Oregon campus will provide access to the targeted customer audience. The chart and table below outline the total market potential (in number of customers) of gourmet coffee drinkers in Eugene, OR. Java Culture will cater to people who want to get their daily cup of great-tasting coffee in a relaxing atmosphere. Such customers vary in age, although our location close to the University campus means that most of our clientele will be college students and faculty. Our market research shows that these  are discerning customers that gravitate towards better tasting coffee. Furthermore, a lot of college students consider coffee bars to be a convenient studying or meeting location, where they can read or meet with peers without the necessity to pay cover charges. For us, this will provide a unique possibility for building a loyal client base. 4.2.1 Market Needs: General trend toward quality among U.S. consumers definitely plays an important role in the recent growth in gourmet coffee. Additionally, such factors as desire for small indulgencies, for something more exotic and unique, provide a good selling opportunity for coffee bars. 4.3 I Industry Analysis: Coffee consumption has shown a steady 2.5% growth rate in the United States over the last decade. In 1994, total sales of coffee were approximately $7.5 billion with gourmet coffee representing 33% (or $2.5 billion) of that. The retail coffee industry is flourishing in the U.S. Pacific Northwest. The local climate, with a long rainy season, is very conducive for the consumption of hot non-alcoholic beverages. At the same time, hot dry summers drive people into cafes to order iced drinks. Further, coffee has really become a part of the lifestyle in the Pacific Northwest. Its discerning coffee drinkers are in favor of well-prepared, strong coffee-based beverages, which they can consume in a  relaxing environment. 4. 4 Competition and Buying pattern: Competition: According to the 1997 Oregon Food service Statistics (NAICS 72), Eugene had 45 established snack non-alcoholic beverage bars (NAICS 722213) with total sales of $14.2 million. Among other establishments that offer coffee drinks to their customers are most of Eugenes limited- and full-service restaurants. Java Cultures direct competitors will be other coffee bars located near the University of Oregon campus. These include Starbucks, Cafe Roma, The UO Bookstore, and other Food service establishments that offer coffee. Starbucks will definitely be one of the major competitors because of its strong financial position and established marketing and operational practices. However, despite of Starbucks entrenched market position, many customers favor smaller, independent establishments that offer cozy atmosphere and good coffee at affordable prices. Cafe Roma is a good example of such competition. We estimate that Starbucks holds approximately 35% market share in that neighborhood, Cafe Roma appeals to 25% of customers, The UO Bookstore caters to another 10%, with the remaining market share split among other establishments. Java Culture will position itself as a unique coffee bar that not only offers the best tasting coffee and pastries but also provides home-like, cozy and comfortable environment, which established corporate establishments lack. We will cater to customers bodies and minds, which will help us grow our market share in this competitive market. Buying Patterns: The major reason for the customers to return to a specific coffee bar is a great tasting coffee, quick service and pleasant atmosphere. Although, as stated before, coffee consumption is uniform across different income segments, Java Culture will price its product offerings competitively. We strongly believe that selling coffee with a great service in a nice setting will help us build a strong base of loyal clientele. 5.0 Strategy and Implementation Summary: Java Cultures marketing strategy will be focused at getting new customers, retaining the existing customers, getting customers to spend more and come back more often. Establishing a loyal customer base is of a paramount importance since such customer core will not only generate most of the sales but also will provide favorable referrals. 5.1 Competitive Edge: Java Culture will position itself as unique coffee bar where its patrons can not only enjoy a cup of perfectly brewed coffee but also spend their time in an ambient environment. Comfortable sofas and chairs, dimmed light and quiet relaxing music will help the customers to relax from the daily stresses and will differentiate Java Culture from incumbent competitors. 5.2 Sales Strategy: Java Culture baristas will handle the sales transactions. To speed up the customer service, at least two employees will be servicing clientswhile one employee will be preparing the customers order, the other one will be taking care of the sales transaction. All sales data logged on the computerized point-of-sale terminal will be later analyzed for marketing purposes. In order to build up its client base, Java Culture will use banners and fliers, utilize customer referrals and cross-promotions with other businesses in the community. At the same time, customer retention programs will be used to make sure the customers are coming back and spending more at the coffee bar. 5.3 Sales Forecast: Food costs are assumed at 25% for coffee beverages and 50% for retail beans and pastries. Proximity to the University campus will dictate certain sales seasonality with revenues slightly decreasing during the school vacation periods. The chart and table below outline our projected sales forecast for the next three years. 6.0 Management Summary: Java Culture is majority-owned by Arthur Garfield and James Polk. Mr. Garfield holds a Bachelors Degree in Business Administration from the University of ZYX. Hes worked for several years as an independent business consultant. Previously, he owned the ABC Travel Agency, which he profitably sold four years ago. Mr. Garfield has extensive business contacts in Oregon that he will leverage to help his new venture succeed. Mr. Polk has a Bachelors Degree in Psychology from the XYZ State University. For the last five years he has worked as a manager of DEF Ristorante, a successful Italian restaurant in Portland, OR. Under Mr. Polks management, the restaurant has consistently increased sales while maintaining a lower than average level of operating expenses. However, because of the investors other commitments they will not be involved into the daily management decisions at Java Culture. A professional manager ($35,000/yr) will be hired who will oversee all the coffee bar operations. Two full-time baristas ($25,000/yr each) will be in charge of coffee preparation. Four more part-time employees will be hired to fulfill the staffing needs. In the second and third year of operation one more part-time employee will be hired to handle the increased sales volume. 6.1 Management Team: A full-time manager will be hired to oversee the daily operations at Java Culture. The candidate (whos name is withheld due to his current employment commitment) has had three years of managerial experience in the definitely industry in Oregon. This persons responsibilities will include managing the staff, ordering inventory, dealing with suppliers, developing a marketing strategy and perform other daily managerial duties. We believe that our candidate has the right experience for this role. A profit-sharing arrangement for the manager may be considered based on the first year operational results. 6.2 Management Team Gaps: Despite the owners and managers experience in the definitely industry, the company will retain the consulting services of ABC Espresso Services, the consultants who have helped to develop the business idea for Java Culture. This company has over twenty years of experience in the retail coffee industry and has successfully opened dozens of coffee bars across the U.S. Consultants will be primarily used for market research, customer satisfaction surveys and to provide additional input into the evaluation of the new business opportunities. 7.0 Financial Plan: Java Culture will capitalize on the strong demand for high-quality gourmet coffee. The owners have provided the company with sufficient start-up capital. With successful management aimed at establishing and growing a loyal customer base, the company will see its net worth doubling in two years. Java Culture will maintain a healthy 65% gross margin, which combined with reasonable operating expenses, will provide enough cash to finance further growth.

Americans Love Capital Punishment :: Argumentative Persuasive Essays

Americans Love Capital Punishment      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There is one question that has always brought about controversy. Should capital punishment be used as a way of disciplining criminals?   Over the past twenty years, there has been an enormous increase in violent crimes. It seems logical that a person is less likely to commit a given act if by doing so he will suffer swift and certain punishment of a horrible kind.   As most Americans agree, death is the only appropriate punishment for such crimes.      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In ancient times' executions were not uncommon.   Even the Bible teaches capital punishment.   It states, â€Å"Who so sheddeth man's blood, by man shall his blood be shed: for in the image of God made he man† (Bible). In ancient times a set of laws were written which specified many crimes punishable by capital punishment.   These laws were the Code of Hammurabi.   Some of the punishable crimes mentioned included adultery, robbery witchcraft, and murder. During the Middle Ages, the Church assumed the responsibility of administering punishments. During the late 1700's the death penalty steadily grew in acceptance.   Over 200 crimes were punishable by death at the beginning of the 1800's.   There were just as many methods used to execute wrong-doers as there were crimes.   Some of the techniques used included beheading, stoning, drowning, hanging, crucifying, and burying people alive. Also used were many nontraditional forms of execution.   One type of execution utilized elephants to crush the criminal's head on a stone block.      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   As times changed, so did the death penalty.   Laws aimed at abolishing the death penalty began to evolve at the turn of the century.   Even with the changes made, the effectiveness of capital punishment stayed right on track. The crimes punishable by death became more specific, while some were eradicated completely.   For example, there are different types of capital murder that have been specifically defined, but vary from one jurisdiction to another.   These include murder carried out during the commission of another felony, murder of a peace officer, corrections employee, or firefighter engaged in the performance of official duties, murder by an inmate serving a life sentence, and murder for hire (Contract Murder).   Other crimes worthy of death include espionage by a member of the Armed Forces (communication of information to a foreign government), tampering where death results by a witness, and death resulting from aircraft hijacking.   While hangings and firing squads remained in use, many forms of execution were done away with. Methods such as electrocution, lethal gas, and lethal injection soon replaced the annulled ones.   As with almost everything, there were exceptions made.   Some states the prohibited the

Meaning of Education Essay

â€Å"Yep, that’s the last of it† my dad yelled as he slammed the trunk shut. Totes were piled up high and filled with clothes, shoes, and lots of old memories. After getting all settled in my new apartment my family and I said our goodbyes. This next chapter in my life was finally here. I was now a college student entering the real world. We all have our purposes for taking the next step in life and going to college. My purpose for attending college is to take a leap towards creating success and meaning in my life. My family has been a giant influence on attending college. The day my older brother went off to college it was no surprise. It seems that moving on to college was the natural thing to do. For instance, graduating kindergarten and moving to the 1st grade is similar to graduating from high school and moving on to college. It’s just a chapter in life that our parents brought us up expecting to reach and we’ve been taught that it would be the right choice since elementary school. It’s what we grew up knowing we were supposed to do when we got to that point in life. Ultimately, we were taught that this step would lead us to the success to building a more meaningful life. All in all, education is the key to success. Having an education opens many doors to amazing opportunities. Why waste time stuck in a slump when one can go out into the world and be someone, make a difference in this world, and have the pride to say that â€Å"I am successful†. With a college education, the amount of freedom is endless. There are many more careers to choose from and the ability to stand out from others increases your career success. An education helps one develop a more meaningful life, that’s what I want to achieve. I want to make a difference in this world by not only my art but my everyday life. My goals are to one day be very well off financially, enabling me to support my future family and enjoy all the accomplishments and great opportunities life has to offer. Just on a walk to school, I get a glance of the harsh reality by seeing all the unfortunate civilians struggling to survive each day. For instance, an old man and his dog, hungry as can be, asking for money on the corner of the street. This makes me realize that I am very grateful for what I have and that an education is what I must pursue to accomplish my goals and dreams. With all the love and support of my family and friends I have a great positive outlook on a college education. Having moved on to this next step in my life, I already feel as if I’m that much closer to reaching my goals. I can see how proud my family is as they watch me better my life and future. With all my past experiences, I now have a strong mentality to finish with pride and follow all my dreams. Overall, an education is the way to success and the key to many great opportunities.

Effects of Cime essays

Effects of Cime essays Crime affects people in several ways: although law enforcement authorities have made numerous efforts to reduce and prevent crime, it still follows an increasing trend in some communities. Some of the ways crime has affected people are the emotional turmoil that victims of crime go through, the stereotypical labeling of a group or race of people as criminals and how it affects where people choose to live. Crime victims suffer in several ways when crime occurs. Victims of crime suffer emotionally, financially and sometimes physically. In the United States, Americans are known to commit most crimes; but on September 11 2001, people from different countries planned and committed a serious and unforgettable crime against Americans. On that dreadful morning, everything looked and felt like any other day until suddenly a group of evil doers, as President Bush calls them, decided to fly planes fully filled with highly inflammable gas into the world trade center, the Pentagon and a field in Pennsylvania. A perfect example of what crime victims go through is the impact that this attack had on Americans. About 5000 people died due to this senseless act of crime. People with or without immediate family members and friends amongst the dead and injured were emotionally devastated. A sizable amount of job positions were lost in the hospitality business, the airline business and businesses in the immediate vicinity of the crash sites. This criminal act has also resulted in an ongoing war in poverty stricken Afghanistan. Crime also affects peoples opinion and judgment of people from other racial backgrounds. Some people, especially victims of crime tend to label all people from that particular race who committed the crime as potential criminals. This usually occurs when for instance a black person commits a crime and for that reason, any other subsequent crimes are attributed to black people. Whe ...

Writing Within Limitations

Writing Within Limitations Writing Within Limitations Writing Within Limitations By Michael A writer cant do anything he or she wants. Every human being you too is bound by limitations. Our readers are limited because they are human. A skillful writer learns to work with these limitations. Dont overload the emotions of your readers. Escalating the emotional level of your story makes it interesting, you may say, so why not do it unceasingly? If one or two spies add tension to a novel, why not include forty-eight or forty-nine spies? Because the human mind can only handle so much stress (and so many characters). Thats why writers use comic relief. While reading about tragic events, its restful to read a little comedy. Skilled writers give their readers time to breathe before taking away their breath again. Dont stretch the credibility of your readers. When I was a young student, my teacher taught us a big word: verisimilitude, meaning lifelikeness. That is, readers dont mind if a story didnt really happen, but they do mind if it couldnt have really happened. That is, readers demand that characters display the sense and emotions of real people (even if the characters are three-eyed aliens). For example, with a well-written magical fantasy, somehow it becomes easy to believe that people can fly through the air, but hard to believe the hero wouldnt fly through the air to rescue his beloved. Its physically impossible to fly without wings, but its psychologically impossible to love someone without caring about them. I dont think this preference is a choice, but rather an unavoidable part of human psychology, similar to our expectation that pushing an object will move it away from us we couldnt stand a world where the opposite happens. To explain why modern people can accept supernatural s tories, Samuel Taylor Coleridge coined the phrase willing suspension of disbelief. Dont overload the patience of your readers. Wise teachers say, The mind can only absorb what the seat can endure. If a lecture goes on so long that a student becomes physically uncomfortable, he or she will have trouble learning from it. In the same way, you want readers to say about your book, I couldnt put it down, but you should still include chapter breaks stopping places where they can eat and sleep. The cliff-hanger technique of carrying suspense across chapter divisions can get to be too much, especially if the suspense isnt warranted. Then came a knock at the door. Her heart pounded. Could this be her long lost true love? Chapter Six She opened the door. It was the postman, who handed her a cable TV bill. Length is obviously a factor in how patient your readers can be, but that doesnt apply only to your book as a whole. Your reader will become restless with any passage that seems too long to them, such as your description of the setting. He or she will skip ahead, looking for quotation marks and white space. Of course, some of the best-selling books of all time have been long books. They have also been interesting books. I still say, if they cant lift it, they wont read it. Dont forget to research commonly known facts. Some writers keep researching when they should just start writing. But if a fact can easily be checked, make sure its accurate. A recent novel by one of my favorite authors seemed to depend on the premise that Irish people have supernatural powers. Because I live in a country (the United States) where there are more Irish people than in Ireland, I can easily test that premise, so I was disappointed by the book. If she had written about Cornish or Manx people instead, I wouldnt know if she were right or wrong, because I dont know any Cornish or Manx people. When your readers catch you in an obvious error, they can say I personally know that setting or event, but you apparently dont, and they may decide not to read your book. Facts tied to emotions are particularly sensitive. Dont flippantly change the facts behind the founding of my nation or my faith, or I will be annoyed. Dont try to display a superlative. Writers with big ideas can fall into this trap. Its one thing to say that your character is the wisest or funniest person in the history of the world, or the most brilliant or the most intelligent. Its another thing to show your readers an example of exactly what you think that means, which you will as soon as your character opens his mouth. Because at that point, they can instantly decide if they believe you. For example, once your character tells a joke, they will decide for themselves if he is really the funniest person in the world. Heres my example of displaying a superlative: She looked out over the formally-dressed audience, glancing at the head of the Swedish Academy which was now awarding her the Nobel Prize for literature. As everyone in the hall held his or her breath, she unfolded the manuscript of her most famous poem and began to read. If youre writing this, you should draw a veil over the scene right here. Dont actually quote the poem, unless you think you already deserve a Nobel Prize for literature. Can you get away with passing off your own work as an example of a Nobel Prize-winning poem? Ayn Rand, the author of Atlas Shrugged, The Fountainhead and The Virtue of Selfishness, was not afraid of displaying a superlative. In her novel Atlas Shrugged, important people suddenly disappear when they hear John Galts message. We wonder, what could that message be? Well, Rand spends 70 pages telling us, leaving nothing to the imagination. Writers are well advised to show, dont tell. But by this point in Rands life, telling had become more important than showing. So she lost any readers mystified by the question of What is making these important people suddenly disappear? but disappointed by the answer. That is, she lost the readers who couldnt believe what she was now displaying. Good writers know their limits. Once you say something, your readers will use their own judgment to decide whether its believable. They dont need to use their imaginations anymore. And you dont want your readers to stop using their imaginations. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Fiction Writing category, check our popular posts, or choose a related post below:Writing Prompts 101How to Pronounce Mobile5 Erroneously Constructed â€Å"Not Only . . . But Also† Sentences

Gordon rule Research Paper Example | Topics and Well Written Essays - 750 words

Gordon rule - Research Paper Example He is advocating for everyone to have insurance that can afford it and is giving tax credits to anyone who needs it in order to make sure they are covered. The plan seeks to make healthcare more affordable for everyone and not to exclude those people who previously would not have healthcare because of previous health problems (Obama, 2009). According to the Wall Street Journal, there is a shortage of primary care physicians brought on because of the focus on extending healthcare benefits. This has created a space for many general practitioners to go into specialties so that they can be paid more money. The general practitioner used to be the first person to diagnose challenges for people but they are disappearing (The Wall Street Journal, 2008). Part of the challenge in this area is that Medicare and Medicaid will only pay a certain amount of money for doctors visits and primary care. These amounts are often lower than they can receive as specialists. With this in mind, many people who are on Medicaid and Medicare will miss out on the best healthcare in the long run. The program that the government is doing would also give people access to a variety of programs that they may not pay for if they were paying with their own money. According to Tully (2009), this means that the packages that are being proposed would be more expensive than what most people could afford (par. 4). Another issue is that President Obama wants to make insurance mandatory for everyone. To this end, he is making it mandatory for businesses to offer insurance to their employees or to receive a tax up to 8% (Schiff, par. 7). This means that the businesses would have to pay into a government program if they do not have healthcare insurance already covered (The Wall Street Journal, 2009). If someone is self-employed or an independent contractor for a business, they will have to find a way to pay for their own insurance or face a tax that is approximately 2.5% of

Organization strategy Research Paper Example | Topics and Well Written Essays - 1750 words

Organization strategy - Research Paper Example Facts and Problems: Issues on Leadership, Group Dynamics and Motivation At the moment, the leadership structure of the organization is non-functional. The Objectives and goals of the organization have no enforcing authority. Specifically, the human resource department and training and development department need deeper focus. All the workers are discouraged, without morale and have no clear sense of purpose in the organization. The organization functions in a particularly individualistic and divided manner with no sense of accountability whatsoever. This is seen by the fact that workers do not offer quality service and work in a hurry so that they can attend personal issues. Consequences and Analysis of that problem: The leadership gap has led to recklessness within the organization. Workers have no sense of accountability since people are free to do whatever they wish. Some departments are entirely non functional. The human resource management hires unqualified personnel. This has d estroyed the reputation of the organization. The ill motivated workers have no value for their work. Many keep on resigning because there is no reward management system. Those who are left have no valued for their work. This has resulted in the loss of lives, as reflected in the rise in mortality rates in cardiovascular related cases. The organization has not embraced teamwork. People are individualistic and work for their selfish gain. This has caused the organization to be fragmented and to lack a sense of purpose. No department co-works with another. The organization has no collaborations and its goes and objectives are unclear. The main aims To lift the position of the organization so that it can achieve that goals, missions and objectives that have been set. The leadership structure needs to be functional and productive. This includes being the leading organization in service delivery and high quality treatment. This shall entail a relook into the strategies, establishing a vib rant organizational image and a motivated workforce. These goals are achievable. Change is always met by a few barriers which need to be overcome. Every organization has a culture. This culture helps the organization in achieving its goals and targets. Culture is essentially the accepted ways of doing things in a particular organizational set up. The organization has a culture where people are not used to organize systematic and functional group. Therefore, every worker is a stranger to the colleague in terms of professionalism. Workers have accepted underperforming as part of their lives. This is so because there is not accountability within the hospital. This makes it hard to introduce changes. There are extreme barriers to change because the leadership at departmental level in incompetence. This indicates that they are incapable of dissecting or executing any meaningful changes within the departments of the hospital. Under the departmental leaders are ill trained employees who ar e not motivated. Employees who have no morale cannot spearhead or enact change, (Klubeckne & Padget, 2009). Employees follow the direction of their leaders. The departments have no working policies. Unfairness among the departmental heads leads to resentment and dysfunctional departments within the hospital. Employees go for long without training or refresher courses. The department involved with procurement is ill trained. This has caused

Persuasive synthesis Essay Example | Topics and Well Written Essays - 1250 words - 1

Persuasive synthesis - Essay Example They are treated as interesting subjects for study and they are not considered human beings anymore, but rather subjects for research. According to the guidelines set by Papadimos and his colleagues, patient care in the movie, â€Å"Wit† (2001), was partially effectively given because Dr. Kelekian discussed the treatment with the patient and was frank with her about the possible results of the extremely aggressive treatment that was presented. However, the doctors did not discuss with the patient her end-of-life plan. Although with Vivian Bearing’s wit, she was able to read between the lines and understand that the treatment was not working because the cancer cells were just spreading in other parts of the patient’s body, the doctors did not directly discuss things with her. Moreover, it took the courage of a nurse to consult with the patient about the issue of the patient’s dying for her to think about what she would choose the doctors to do in case her h eart stops. Since Dr. Kelekian and his partner were very interested in studying the patient’s case, one cannot help but question their interest in not discussing the patient’s end-of-life plan. Moreover, the doctors failed to recognize dying symptoms such as extreme agony. In one of the doctor’s visit to the patient’s room who was obviously in torment, the physician asked Ms. Bearing if she was in pain and the patient found it ridiculous. Nevertheless, the nurse observed such flaws of the doctors and did her best to provide the patient with the care that she deserved as a human being. Byrne claims that metaphors are also used not only in literature but also in understanding what patients go through. Since not all people go through the same circumstances, not everyone would be able to understand what patients would be going through. However, with the use of metaphors, one could perhaps have a glimpse of the agonies of sicknesses and therefore understand wh at the patient longs for. Henceforth, the caregiver could effectively provide the necessary care and understanding to the patient. On the other hand, metaphor can also be used by doctors to explain the jargons of the medical world to the patient. In the aforementioned movie, Dr. Jason easily used metaphors to explain Ms. Bearing’s health conditions to her and being a literary scholar, the patient was quick to understand the explanation. As a result, there was a point wherein the doctor and the patient had an intellectual sharing about their own professions which gave Bearing new perspectives. Pope Benedict in his speech in 2007 stressed that more palliative care centers are needed to â€Å"provide integral care, offering the sick the human assistance and spiritual accompaniment they need†. Indeed, hospitals should not be just a place where patients are admitted and studied like animals. Rather, they should be treated with all their dignity intact despite the possibilit ies of recovering or dying. In the movie, doctors were careless about the rights of the patient to be treated well because she was not give the care and spiritual assistance a human being needs. This made the patient look back to the times when she was strong and full of health. Like the doctors, she lacked sensitivity to human needs. She was disciplined in her manners and demanded the same from her students. She regretted how she treated other people and wished she would have been a little kinder to them. Eventually, this helped

An Overview of Delta Dental Insurance Essay Example for Free

An Overview of Delta Dental Insurance Essay Abstract This paper provides an overview of Delta Dental one of the most successful health care companies in the United States. As good oral health becomes more essential of Americans’ healthy lifestyle, Delta Dental insurance plans help more than 59.5 million people to be covered on their plans. By describing the outline of Delta Dental’s history and current structure, this article focuses on how Delta Dental insurance has grown and improved access and overall health status. Also, this paper explores strengths and weaknesses (especially with healthcare delivery point of view) as well as makes comparison with other dental insurances companies to reveal that why Delta Dental is better and more successful than others. Finally, the future plans of Delta Dental about how to improve oral care delivery of services to clients and enrollees, as well as how it fared compare to its peer insurance companies are initialed at the end of the paper. Keywords: dental benefits programs, strengths and weaknesses, multiple types, expanding, effective benefits Introduction: Many people in the world may have best access to oral health care, yet millions are unable to get basic dental care. Poor oral hygiene has significant impact on overall personal health. Researches show that poor oral hygiene increases the risk of diabetes, heart disease and poor birth outcome. That’s why nobody can deny the importance of oral health care. According to many statistics insurance companies that play a pivotal role in improving oral health care of the communities, we will focus on the Delta Dental insurance and how growth of the company improved access and overall health status. Delta Dental insurance was established in 1966. Over the years it faces many challenges to expand and increase access of dental care in community. The efforts paid the Delta Dental as widely accepted by community. This paper focuses on challenges Delta Dental had to face to build its pillar in the market. After evolution, Delta Dental insurance exponentially expanded due to its benefits and low primer. Over the years it has made strategies so that many people prefer Delta Dental over other insurances for maximum benefits, which helped improve oral health care. This paper will also highlight some of those strategies. Compare to other dental insurance company, Delta Dental insurance provide wide coverage and offer maximum benefits. This is a unique characteristic of the Delta Dental. We will talk about current structure of the Delta Dental and its future about how to improve oral care delivery of services to clients and enrollees, as well as how it fared compare to its peer insurance companies. Finally, the paper will mention about the future plan of the Delta Dental. History: In order to increase access to oral health care, in 1954, a group of dentists formed a dental service corporation in California, Oregon and Washington. It was lead by Washington Dental Service (WDS), and initiated by providing service to organized labor unions. Later, it expanded its services to all 50 states, the District of Columbia and Puerto Rico. Delta dental is now a fifteen billion dollar a year nationwide group providing dental insurance to 59 million Americans, making it one of the largest non-profits in the country (â€Å"Our Mission History†, n.d.). Washington Dental Service was joined by more local organizations, which then created Delta Dental Plans Association (DDPA) in 1966. Shortly a year after, WDS partnered with the International Association of Machinists, which was the first step into creating a multi-state dental benefits program. There was a growing number of out of state subscribers, and therefore in order to meet their needs WDS worked with other Delta Dental member companies and Blue Cross/Blue Shield Association members, to continue serving its clients. It provided coverage until 1980s this way (â€Å"Our Mission History†, n.d.). The program continued as such until a bid was won by Delta Dental of California being chosen as the dental benefits carrier for the Office of the Civilian Health and Medical Program of the Uniformed Services (OCHAMPUS) program. In order for the administration of this very large account to be centralized, other member companies agreed to share its provider data with Delta Dental of California sharing the administrative income and risk. As a result of this change, the National Provider File (NPF), and the establishment in 1990 of Delta USA — was created, the company responsible for overseeing dentist data and enabling the administration of national business (â€Å"Our Mission History†, n.d.). Currently, there are 39 independent Delta Dental member companies operating in all 50 states, the District of Columbia and Puerto Rico. As one of the largest dental benefits provider DDPA provides coverage to more than 59.5 million people enrolled in more than 97,000 groups. The company was named Dental Care until 1970s and then it officially changed its name to Delta Dental (â€Å"About Us Home†, n.d.). All Delta Dental companies are members, or affiliate of members, of the Delta Dental Plans Association a network of 39 Delta Dental companies throughout the country. Delta Dental companies range from multi-state to single state (â€Å"About Us Home†, n.d.). The multi-state programs consist of the following: * Delta Dental of New Jersey Started in 1969, it provides coverage to over 1.5 million residents of New Jersey and Connecticut (â€Å"Delta Dental of New Jersey†, n.d.). * Delta Dental Plan of Michigan Michigan Dental Service (MDS) was established in 1957, and in 1963 it received its non-profit status. In 1980 MDS expanded to Ohio and Indiana. In early 2006, Delta Dental of Michigan, with its affiliates in Ohio and Indiana, and Tennessee, signed an affiliation agreement under a new nonprofit holding company to strengthen their market positions and increase the number of Americans with dental benefits. In 2009, Delta Dental of Kentucky and Delta Dental of New Mexico affiliated with the family of companies. The newest affiliate, Delta Dental of North Carolina, joined the enterprise in 2010. Currently they cover 8.8 million individuals (â€Å"Delta Dental of Michigan†, n.d.). * Delta Dental of Minnesota It was founded in 1969, and later expanded to North Dakota. It is the largest program in the upper Midwest, serving 7500 Minnesota based on purchasing groups and 3.8 million members nationwide (â€Å"Delta Dental of Minnesota†, n.d.). * Delta Dental of Missouri Delta Dental of Missouri started 50 years ago and has offered dental and vision benefits in the states of Missouri and South Carolina. More than 1,800 companies in Missouri and South Carolina have selected Delta Dental as their dental benefits carrier. The Delta-Vision plan started in 2011 (â€Å"Delta Dental of Missouri†, n.d.). * Dentegra Companies Dentegra is not affiliated with Delta Dental Plans Association. However, this insurance company is authorized by Delta Dental Plans Association to market and underwrites certain national Delta Dental programs. This plan covers 23 million Americans. It serves the states of: Alabama, California, Delaware, District of Columbia, Florida, Georgia, Louisiana, Maryland, Mississippi, Montana, Nevada, New York, Pennsylvania, Puerto Rico, Texas, Utah, Virgin Islands, West Virginia (â€Å"Why do more than†, n.d.). * Hawaii Dental Service Hawaii Dental Service (HDS) is the first and largest nonprofit dental service corporation in Hawaii providing dental benefit plans to more than a half million members. This plan was incorporated on February 15, 1962, and soon 221 licensed dentists became charter members. HDS serves Guam, Hawaii and Northern Mariana Islands (â€Å"Caring, Visionary Dentists From HDS†, n.d.). * Northeast Delta Dental NDD offers the states of Maine, New Hampshire, Vermont, providing quality dental care to millions of residents (â€Å"Northeast Delta Dental†, n.d.). * Oregon Dental Service This plan covers Alaska and Oregon. A research to find affordable dental health by Longshoremens and Warehousemens Union, led them to find Oregon Dental Service in 1955(â€Å"A trailblazer in health†, n.d.). * The single state companies include: Delta Dental of Arizona that started in 1972. Delta Dental of Arkansas, Delta Dental of Colorado began in 1958. Delta Dental of Idaho, Delta Dental of Illinois, Delta Dental of Iowa, Delta Dental of Kansas, Delta Dental of Massachusetts, Delta Dental of Nebraska, Delta Dental of Oklahoma, Delta Dental of Rhode Island, Delta Dental of South Dakota, Washington Dental Service, Delta Dental of Wisconsin, Delta Dental of Wyoming (â€Å"Delta Dental: Members†, n.d.). Delta Dental Plans: Delta Dental offers various plans for individuals, families and enrollees. There are 39 member companies of Delta Dental and each of them provides a variety of dental benefits programs. It also forms contacts with small and large business companies to provide dental insurance coverage for their employees (â€Å"Products and Plans†, n.d.). The various plans offered are the following: 1. Delta Dental Premier ®: This is their traditional fee-for-service plan with largest dentist network with more than four out of five nation’s dentist participating (â€Å"Delta Dental Premier ®Ã¢â‚¬ , n.d., p. 2). It allows patients to get treated by any licensed dentist and also can change dentists at any time without notifying Delta Dental. The main attraction for this plan is that you do not have to pay more than the co-insurance percentage specified by your coverage (â€Å"Delta Dental’s plans†, n.d.). The participating dentists agree to accept pre-negotiated fees and are prohibited from billing more. 2. Delta Dental PPOâ„  : This is a mid-priced fee-for-service plan with the secondary largest dentist network. It has an option to get treated by any dentists and still have lower out-of-pocket costs because the dentists in this network have agreed to do so (â€Å"Delta Dental’s plans†, n.d.). It also has a Delta Dental PPO plus Premier plan which includes all the benefits of Delta Dental PPO and also allows for a patient to see a Delta Dental Premier dentist with benefits of that dentist’s contracted fee (â€Å" Delta Dental PPOâ„   †, n.d.). 3. DeltaCare ® USA: It is a HMO-type prepaid plan with a large network of participating dentists. You must select a dentist from their network for this plan. The main features are there is no annual deductibles, no maximums for covered benefits and set copayments (â€Å"Delta Dental’s plans†, n.d .). 4. Delta Dental Individual and Family: Individual and its family can get the same quality dental benefits as provided by the employers under this plan. Delta Dental offers different plans in different states (â€Å"Delta Dental Individual and Family†, n.d.). 5. Delta Dental Legion ®: It is also known as TRICARE Retiree Dental Program. â€Å"The first and only dental benefits plan created by Congress especially for Uniformed Services retirees and their family members and administered by Delta Dental of California.†(â€Å"TRICARE Retiree Dental Program†, n.d.). 6. Delta Dental Patient Direct ®: It is a dental discount plan for individual, families and groups that do not have dental benefits. The patients choose dentists from the network and pay them directly with the discount price at the time of their treatment. No paper work is required and it is available in the selected markets only (â€Å"Delta Dental Patient Direct ®Ã¢â‚¬ , n.d.). 7. DeltaVision ®: This is vision benefit plan, which is offered in the selected markets only. It includes various pre-negotiated pricing eye-care services, such as professional eye exams, eyewear, contact lenses and laser vision correction (â€Å"DeltaVision ®Ã¢â‚¬ , n.d.). 8. Delta Dental Member Companies: â€Å"They serve nearly one-third of the estimated 173 million Americans with Dental insurance, providing dental insurance coverage to more than 54 million people in more than 93,000 groups across the nation.†(â€Å"Delta Dental Member Companies†, n.d.). There are other plans which are available in few selected populations and states like the American Association of Retired Persons (AARP) Dental Insurance Plan which is exclusively for AARP members and the Costco Group Dental Plan for the Individuals and Families, which is available only in California (â€Å"Delta Dental’s plans, n.d.). Strengths and weaknesses (especially with healthcare delivery point of view): Delta Dental is the largest dental care carrier in the United States, and they provide coverage to more than 59.5 million people enrolled in more than 97,000 groups. The strengths are obviously regarding to the high level access of the dental care. Many years ago, most of people lost their teeth by middle age, but now many Americans have very good oral health because of the various Delta Dental Plans. They may keep their teeth throughout the lifetime. There are some strengths of Delta Dental according to a recent study (â€Å"Delta Dental by the Numbers†, n.d.): * Delta Dental’s nationwide dentist networks offer unprecedented access: * Delta Dental Premier ® offers the largest network of dentists in the country — encompassing more than 142,000 dentists and more than 251,000 office locations. * Delta Dental PPOSM has a national network of more than 83,900 dentists practicing in more than 168,000 locations. * DeltaCare ® USA provides more than 39,800 dentist office locations. * Delta Dentals PPO Plan delivers the industrys best effective discount — averaging 19 percent nationally — resulting in nearly $3 billion in annual savings compared to dentists average charges. * Delta Dental posted approximately $17 billion in premium revenue during fiscal year 2011, our 32nd consecutive year of financial gains. * Delta Dental’s unique cost-control measures and contractual agreements with dentists help to ensure quality care at moderate fees, collectively saving subscribers with group dental coverage more than $9.0 billion in 2011. * In 2011, Delta Dental member companies processed more than 90 million dental claims or approximately 1.7 million every week, with an accuracy rate of 99.7 percent. Delta Dental focuses on the practice sharing, best services, perfo rmance guarantees, brand name recognition and reputation, whereas, it still have weaknesses such as geographic limitations, innovative practices. Through the numbers above, people might think that we have more and more dentists in large networks so that we would get easy access to dental care, but how do these dentists located? Low-income patients still feel hard to get access to meet one dentist regularly due to the inconvenient transportation, difficulties on appointments, and so on. The president and CEO of Delta Dental, Radine (2011) wrote on â€Å"Annual Report 2011†, â€Å"Delta Dental takes pride in being a single-line carrier with unparalleled expertise in dental benefits, our specialty.† Indeed, they against larger, multi-line insurance companies, and they use competitive strategies to survive during the worst of the economic downturn. However, this kind of single-line model can also be a weakness of dental health care, because coordination of dentists needed to reinforce to increase the quality of companies health care performance. Single-line service may hinder such coordination in between the large dentist network, although they meet the needs for restraining the continuous increased costs. As each program have dissimilar strengths and weaknesses and according to Access to Dental Care/Oral Health Care (American Dental Association, 2012), there are still barriers to getting oral health care: * The dental sections in Medicaid and the State Childrens Health Insurance Programs (SCHIP), which are supposed to provide health care to disadvantaged Americans, rarely have enough money budgeted to do so. Federal law requires that Medicaid cover basic dental services. But many state programs fail to deliver care to even half of their eligible children. * Adult dental coverage through public health programs is even worse; many states simply dont provide it. Its not just about the money. Patients covered under public programs still face hurdles, such as transportation to dental appointments and the difficulty of missing work to keep the appointments. Taking care of ourselves is the key to good oral health, and too many Americans lack a basic understanding of how to brush, floss, eat a healthy diet and drink water with fluoride in it. * About one-third of public water systems are not fluoridated, even though that is the single most effective public health measure to protect against tooth decay. And also, people need to treat what form of coverage they require most and make sure the selected plan provides a low price for the needed processes. Comparison of Delta Dental with all other dental insurances: There are many essential things to keep in mind when deciding on a dental insurance plan, such as prices and co-payment options, local dentist availability, actual coverage, whether it meets your needs and more (â€Å"Dental Insurance Review†, n.d.). Delta Dental Insurance ranking at number three after United Concordia and Ameritas Group Dental is one of the top ten insurance plans in the United States (â€Å"2013 Dental Insurance Comparison†, n.d.). As one of the largest dental coverage plans, founded by dentists, it creates dental coverage plans based on current research and designed to keep people their healthiest and most productive (â€Å"Choosing the Right Dental Plan†, n.d.). Delta Dental Insurance pursues their mission by increasing access to benefits, offering the largest national network of dentists, adding innovative new plan features, aggressively working to keep costs down, and supporting p hilanthropic programs that encourage better overall oral health. Delta Dental Insurance plans offer top of the line features and programs to make insurance services more accessible and convenient for its members. Some of the features that Delta Dental Insurance consists are secure and accessible sites for online enrollment, finding dentists and getting information about available plans. It offers Group/Employer plans, which is important as it gives companies information on the cost of getting dental insurance for their employees. This is important as well for families who wish to enroll other members of the family into the insurance plan. Also Delta Dental Insurance offers individual plans, provides up-front cost information for customers and has Better Business Bureau (BBB) accreditation (â€Å"Dental Insurance Review†, n.d.). Better Business Bureau accreditation is definitely a plus, because they provide ratings based on customer service and satisfaction of members. In addition, Delta Dental Insurance offers multiple types of different plans for its consumers. There is Delta Dental Preferred Provider Organization (PPO), DeltaCare ® USA (Health Maintenance Organization (HMO) option), Fee-for-Service (FFS) Plan, and they also used to offer Discount Plans. But the Discounted Plans are no longer offered by Delta Dental since majority of the members prefer PPO, HMO and FFS plans. The Delta Dental PPO plan is offered worldwide, and for that reason it is more accessible even if the customer relocates (â€Å"Choosing between a PPO and HMO†, n.d.). When choosing a PPO dentist, the out of-pocket costs of customers are often lower because PPO dentists have agreed to charge Delta Dental PPO patients reduced fees. The plan also pays enhanced benefits when patients visit a PPO dentist, so they pay only 20 percent of the PPO dentists contracted fee after their deductible for such services as fillings, oral surgery, root canals and treatment of gum disease in addition to other benefit enhancements (â€Å"Types of Dental Plans†, n.d.). Delta Dental PPO does not cover teeth bleaching and other cosmetic procedures (â€Å"University of California†, 2009). The good thing about a PPO plan is that customers have the freedom to choose any licensed dentist, anywhere in the world, each time the member or a family member requires treatment. And there is no referral required for specialty care. On the other hand, DeltaCare ® USA (HMO option) customers must be residents of California to enroll. It provides individuals and their families with inclusive plans and easy referrals to specialists and even has a benefit for teeth bleaching. The plan emphasizes preventive care; so many services are provided at no cost. There is no annual plan maximum for DeltaCare ® USA (â€Å"Types of Dental Plans†, n.d.). As an HMO member, customers are assigned to network dentist that accept the plans and they must be referred specialist by their assigned dentists. Fee-for-service plans, also known as indemnity or traditional plans, typically offer the greatest choice of dentists. It is up to the customer what dentist to choose or procedure they would like to purchase. Like PPO plans, when you visit a network dentist, you typically pay a certain percentage for each service (called coinsurance) and the plan pays the rest. The percentage usually varies by the type of coverage, such as diagnostic and preventive, major services, etc. (â€Å"Types of Dental Plans†, n.d.). However with FFS plan the member might pay a little extra than the PPO plan. And finally, the Discounted Plans are insurance plans that are offered at reduced rates. There is generally no paperwork, annual limits or deductibles, but you must visit a participating dentist to receive the discount. Also, you may be responsible for a greater portion of the treatment cost compare to PPO or HMO plan. The downside of this plan was the fact that there was a possibility of the dentists being changed annually, and new dentists would be assigned to the customers. But on the plus side, the rates that the customers would receive would be unbeatable. Figure 1 shows the continued growth in enrolment throughout the recession. This also proves that Delta Dental is the largest dental carrier in the United States and it has more than 26 million enrollees at present (â€Å"Delta Dental: Annual Report2011†, n.d., p. 10). Figure 1: Shows the increase in the enrollment of Delta Dental plans by the population. The Y-axis shows the number of enrollees in increasing order and the X-axis shows the years starting from 2008-2012. Adapted from: â€Å"Delta Dental: Annual Report 2011.† (n.d., p. 10). Why is Delta Dental better and more successful than other insurances? Delta Dental offers some of the best dental insurance plans in the United States and around the world since 1954 and as the first company exclusively specializing in dental benefits, Delta Dental has been working hard to improve oral health around the world by providing access to the largest network of dentists, great service, top of the line care plans and developing relationships that emphasize prevention and positive oral health care results over the long term (Delta Dental, 2010). Over 56 million enrollees trust Delta Dental Insurance plans with their oral health and the numbers of satisfied members keep growing (â€Å"Why do more than†, n.d.). â€Å"In 2011, the vast majority of surveyed enrollees from our open network plans said they would recommend Delta Dental to a family or friend. That loyalty is also evident in our exceptionally high enrollee retention rate.† (â€Å"Delta Dental 2011 Annual Report†, n.d., p. 11). Figure 2 which is adapted from the â€Å"Delta Dental: Annual Report 2011† (n.d., p. 11) shows the percentage of enrollee satisfaction and enrollee retention in 2011. Figure 2: The percentage of Enrollee satisfaction and Enrollee Retention. 95% of the Enrollees were satisfied with their Delta Dental Plan and 99% of the Enrollees retained their Delta Dental plan. Adapted from: â€Å"Delta Dental: Annual Report 2011† (n.d., p. 11) Future plans: Delta dental has proven itself as one of the good companies in the market but still they are working diligently to make it better. Delta Dental supports projects in conjunction with major universities and other leading research organizations that are designed to advance scientific knowledge and improve health. Among the projects, recently supports are: a study on the potential for dentists to play a greater role in the detection of health conditions such as diabetes; the cost impact of oral cancer; the application of salivary diagnostics to dentistry; and the development of biotechnology to advance health (Carruth, 2012). All these are the major projects of Delta Dental. Delta Dental is trying to identify ways to improve offerings in ways that will reduce costs while still covering the treatment our subscribers need to stay healthy. Delta Dental will focus on expanding their network in remote places and provide oral care. They are planning continue creating dynamic product lines that provide effective benefits to improve oral health–and overall health – while reducing costs. Delta Dental would concentrate on providing good customer service staff as well as an automated phone line for inquiries. Conclusion: Delta Dental has received many awards in improving oral health care. Their current plans are focused on expanding their network and providing good care for the patients. Delta Dental’s strategies are such that not only patients but also dentist and employees are benefitted. They also focus on many researches to improve quality of care. Moreover, their future plans are focus on reducing cost and providing quality of care for patients. They are providing funds for incurable diseases like cancer and other malignancy. References: A trailblazer in health. n.d.). Retrieved from: https://www.odscompanies.com/about/ American Dental Association. (2012). Access to dental care/oral health care. Retrieved from: http://www.ada.org/2574.aspx Carruth, P. (2012). The future of dentistry. Retrieved from: http://www.deltadentalnc.org/deltaDentalNorthCarolina/files/cf/cfd82d85-42e2-47ea-b49d-3d28e5d80bf3.pdf Delta Dental (2010). America’s oral health: The role of dental benefits. Retrieved from: http://www.deltadental.com/TheRoleofDentalBenefits.pdf Delta Dental (n.d.). About us home. Retrieved from: http://www.deltadental.com/Public/AboutDeltaD/AboutDeltaDental.jsp Delta Dental (n.d.) Caring, visionary dentists form HDS. Retrieved from: http://www.deltadentalhi.org/ddpahi/History.jsp?DView=History Delta Dental (n.d.). Choosing the right dental plan for you and your family. Retrieved from: http://www.deltadental.com/WhitePaperChoosingRightDentalPlan.pdf Delta Dental (n.d.). Contact your local member companies. Retrieved form: http://www.deltadental.com/Public/PlanInfo/planAddressStart.jsp Delta Dental (n.d.). DeltaVision ®. Retrieved from: http://www.deltadental.com/Public/Product/vision.jsp?DView=AboutPIVision Delta Dental (n.d.) Delta Dental by the numbers. Retrieved from http://www.deltadental.com/Public/Company/stats2.jsp?DView=AboutDeltaDentalStats Delta Dental (n.d.). Delta Dental individual and family. Retrieved from: http://www.deltadental.com/Public/Subscribers/IndFamCoverage.jsp?DView=SubscriberIndividual Delta Dental (n.d.). Delta Dental of New Jersey. welcome. (n.d.). Retrieved from: http://www.deltadentalnj.com/index.html Delta Dental (n.d.). Delta Dental of Michigan. Retrieved from: http://www.deltadentalmi.com/About/Company-Profile/Our-History.aspx Delta Dental (n.d.). Delta Dental of Minnesota. Retrieved from: http://www.deltadentalmn.org/about.jsp?DView=AboutUs Delta Dental (n.d.) Delta Dental of Missouri. Retrieved from: https://www.deltadentalmo.com/AboutUs/index.asp Delta Dental (n.d.). Delta Dental Patient ® Direct. Retrieved from: http://www.deltadental.com/Public/Product/direct.jsp?DView=AboutPIDirect Delta Dental (n.d.). Delta Dental PPOâ„  . Retrieved from: http://www.deltadental.com/Public/Product/preferred.jsp?DView=AboutPIPreferred Delta Dental (n.d.). Delta Dental Premium ® : Our most valuable network. Retrieved from: http://www.deltadental.com/DeltaDentalPremierBrochure.pdf Delta Dental (n.d.) Delta Dental’s plans. Retrieved from: http://www.deltadentalins.com/individuals/guidance/plans.html Delta Dental (n.d.). Members. Retrieved from: http://www.deltadentalma.com/members/index.asp Delta Dental (n.d.). Northeast Delta Dental. Retrieved from: http://www.nedelta.com/about.aspx Delta Dental (n.d.). Our mission history. Retrieved from: http://www.deltadental.com/Public/Company/mission.jsp Delta Dental (n.d.). Products and plans. Retrieved from http://www.deltadental.com/Public/Product/product.jsp Delta Dental (n.d.) Survey by city of San Jose: Choosing between a PPO and HMO dental plan. Retrieved from: http://hrclassspecs.sanjoseca.gov/humanResources/survey/BenefitsPlan/DentalPl

How the heart functions as a pump

How the heart functions as a pump The objective of this essay is to show how the heart functions as a pump in transporting oxygen to the different parts of the body and how reduction in coronary blood flow can impair the cardiac function. The first part of the essay describes the location, structure, electrical activity within the heart and how the heart transports oxygen throughout the body. The second part describes how reduced coronary blood flow in case of a disease can impair blood flow and its treatment. The heart forms an integral part of the cardiovascular system whose primary function is the maintenance of hemodynamic and homeostatic functions such as maintenance of body temperature, transport of nutrients to the cells, removal of waste materials, transport of oxygen and hormones. [8,1] Heart Location The human heart is like a cone shaped organ composed of four different chambers and is located obliquely across the chest midline with its tip behind the fifth left intercostal space. It weighs on an average between 250-350 grams in adults and is approximately the size of a human fist. [2] An average human heart beats on an average of 75 beats per minute and pumps more than 200 million litres of blood in 80 years. [3]. Although the heart is located in the centre of the chest cavity its beating action is felt on the left side of the chest cavity since the most powerful pumping action of the ventricles of the heart takes place towards the base of the heart which is located in the left side of the chest cavity. [2] The figure below shows the location of the heart in the body. Fig1: Location of the Heart [8] Lecture Physiology and Anatomy- Cardiovascular System Alan Richardson; slide no. 8 The heart is enclosed in a multi-layered sac known as Pericardium which protects the heart by reduction of friction and prevents excessive expansion. Between the different layers of the pericardium (visceral and the parietal layers), the pericardial cavity is present which holds about 5-15 ml of Pericardial Fluid that reduces the friction created due to the movement of the heart. [3] The heart wall consists of three different layers Epicardium (outer layer), Endocardium (inner layer) and Myocardium (middle layer). The 2picardium and the endocardium are both made of simple squamous epithelial cells and a thin areolar tissue layer. However the myocardium is the thickest amongst all the three layers consisting of the heart muscles and its thickness in each chamber of the heart depends upon the amount of force generated by which chamber during the pumping action. [3] The figure below clearly shows the various layers of the heart wall. Fig2: Layers of the Heart wall [9] Structure of the Heart The heart is divided into two different halves depending upon the kind of blood (deoxygenated or oxygenated) received right and left halves. The heart consists of four different chambers with an atria and a ventricle on each side. The atria have relatively thinner walls since they only have to pump the blood to much shorter distances than the ventricles. [4].The atria connect to the ventricles by means of atrioventricular valves (tricuspid in the right half, bicuspid in the left half). The atrioventricular valves are connected to the base of the ventricles by chord like structures known as the chordate tendinae that prevent the valves from swinging in the opposite direction and thus prevent the back flow of blood into the atria from the ventricles. [3,5] The two atria are separated from one another by means of a muscular wall known as the interatrial septum. [3] The atria and the ventricles are separated by means of a fibrous connective tissue known as annulus fibrosis, this helps i n giving a skeleton for attachment of the muscles of the heart and help in providing the site of placement of the heart valves. [4] The ventricles are the lower and the larger chambers of the heart. The two ventricles are separated from one another by means of a thick muscular wall known as the interventricular septum. The right ventricle is connected to the pulmonary artery by means of the pulmonary semilunar valve while the left ventricle is connected to the aorta by means of the aortic valve. [3]. On the surface of the heart the heart chambers grooves are marked by fatty layers containing coronary blood vessels these layers are also known as Sulci.[3] Blood Flow in the Heart The deoxygenated blood from the various parts of the body flows into the heart by the pair of vena cava into the right atria. The blood flowing from the upper part of the body relative to the heart is carried by the superior vena cava while the blood flowing from the lower part of the body relative to the heart is carried by the inferior vena cava. [8] The cardiac muscles empty their deoxygenated blood into the right atria by the coronary sinus. The deoxygenated blood is pumped from the right atria into the right ventricles through the right atrioventricular valves (tricuspid valve) upon atrial sytole and ventricular diastole. The blood in the right ventricles is then pumped into the pulmonary artery through the right semilunar valve (pulmonary valve) to the lungs for oxygenation upon ventricular systole. However, during the ventricular systole the semilunar valves do not open unless the pressure generated in the ventricles due to contraction (systole) is sufficient to push open the valves, such contraction is known as isometric contraction. The pulmonary artery bifurcates into two smaller branches the left and the right pulmonary artery (one for each of the lungs). The pulmonary vein from the lungs brings the oxygenated blood from the lungs into the left atria of the heart which then pumps the blood into the left ventricle through the bicuspid valve (mitral valve) during atrial systole and ventricular diastole. The left ventricle pumps the blood to the different parts of the body through the aorta through the aortic valve during ventricular diastole. The hearts muscles are themselves are supplied by oxygenated blood from the coronary artery branches present on the aortic arch. [3] The figure below shows the various chambers of the heart along with the flow of blood within the heart. Fig3: Blood Flow within the heart [8] Lecture Physiology and Anatomy- Cardiovascular System Alan Richardson, Slide no 12 Blood enters the chambers during the diastole (relaxation) phase and is pumped out during the systole (contraction) phase. As a result, the blood is under a higher pressure in the systolic phase than the diastolic phase. The blood pressure is the pressure exerted by the blood upon the walls of the blood vessels.[5] The blood pressure on the walls of the artery in a healthy individual lies around 80mm Hg for diastole and 120mm Hg for systole. [4] The valves of the heart prevent the back flow of blood and thereby only allow the unidirectional flow of blood. [5] The circulation of deoxygenated blood to the lungs and oxygenated blood back to the heart is known as pulmonary circulation while the circulation of oxygenated blood to all the parts of the body and deoxygenated blood from the various parts of the body into the heart is known as systemic circulation.[5] The entire process is displayed in the figure below. Fig4: Systemic and Pulmonary Circulation [10] Electrical Conduction within the Heart and Heart Beat The cardiac impulse trigger is generated by the group of specialised cells which together form the sino-atrial node (SA node). The SA node is present in the right atrium near the point of attachment of the superior vena cava. The cells in the SA node generate the impulses spontaneously as they are capable of spontaneous depolarisation, hence they are said to possess automaticity. [6] Due to these spontaneous impulses the SA node forms the atrial pacemaker. These electrical impulses are spread throughout the walls of the atrium by means of specialised pathways known as the Bachmanns Bundle, thereby causing the stimulation of the myocardial walls of the atria to contract and push the blood into the ventricles. The wave of electrical excitation travels from the atrial walls via specialised pathways called internodal tracts from the SA node to the Atrioventricular (AV) node. The AV node is also composed of similar autorhythmic cells as the SA node and is capable of pacing the heart in case the SA node fails in pacing and is located in the right side of the interatrial septum. However the pacing of the AV node is slower than the SA node and it thus provides the critical delay in the electrical conduction system, preventing the simultaneous contraction of both the atria and the ventricles. The distal portion of the AV node is known as the Bundle of His which then divides into the two bundle branches for spreading the electrical excitation to the two ventricles. The bundle branches are present along the interventricular septum and end at the tip of the heart by further differentiating into numerous small fibres known as Purkinje fibres. The Purkinje fibres are responsible for depolarising the individual myocardial cells of the ventricles. Thus causing the ventricles to contract and push the blood into the pulmonary artery or the aorta. [3] Blood circulation and Transport of Oxygen The blood vessels and capillaries are the pipes which carry blood throughout the body for metabolic, waste and gaseous transport. The blood vessels include arteries, arterioles, veins and venules. Arteries carry the oxygenated blood away from the heart with the Aorta being the largest artery. Since the artery carry blood in jerks and under high pressure they are surrounded by smooth muscles which prevent it from collapsing. The resistance to blood pressure is controlled by the autonomic nervous system which controls the width of the artery (lumen) through which the blood passes (vasoconstriction and vasodilation). The arteries further divide into smaller divisions known as arterioles which carry blood to smaller parts of the body. The arterioles are also covered with smooth muscles and like the arteries also resist any changes to the blood pressure. The arterioles further differentiate into smaller blood vessels known as capillaries which possess an extremely thin wall so as to allow the exchange of oxygen with the individual cells and carbon-dioxide from the cells. Apart from the exchange of gases the metabolic exchange of nutrients and wastes are also possible at the capilla ries. Several billions of capillaries then join together to form the venules which are smaller blood vessels carrying the deoxygenated blood from the capillaries to the veins. The veins are the formed by the integration of millions of smaller venules and it carries the deoxygenated blood back to the heart. The blood in the veins does not flow under considerable high amounts of pressure and hence the walls of the veins are not as thick as those of the artery. The veins join together to form the two vena cavas. [8] The transfer of oxygen from the blood into the cells at the capillaries is explained by the process of diffusion. Diffusion is the process of movement of particles from their region of higher concentration to a region of lower concentration. Thus in the capillaries the oxygenated blood has a higher concentration of oxygen than that present outside the capillaries in the surrounding cells. At the same time there is higher concentration of carbon-dioxide in the surrounding cells than the oxygenated blood in the capillaries. Hence the oxygen from the blood in the capillaries diffuses out into the surrounding cells while the carbon-dioxide from the surrounding cells diffuses into the capillaries. Thus the oxygenated blood from the lungs passes into the heart which pumps it into the aorta which divides into the arteries which further divides into arterioles and then capillaries. The capillaries then exchange the oxygen with the cells and take carbon-dioxide from the cells and rejoin to form the venules which then form the veins which return the deoxygenated blood back to the heart. Thus the heart acts a pump in the entire cardiovascular system which transports the oxygen to the different parts of the body and carbon-dioxide from the different parts of the body. The figure below shows the overview of the cardiovascular system. Fig5: The Cardiovascular System [11] Reduced Coronary Blood Flow and Coronary Artery Disease The heart needs to perform all the time in the body and can never relax, hence the cardiac muscles have a high demand for oxygen and have very limited capacity for anaerobic respiration. [7] The chest pain which is felt in the patient due to the obstruction of the blood flow in the coronary arteries is known as Angina Pectoris. This deposition of the plaque and lipid layers within the coronary blood vessels thereby causing the hardening and narrowing of the blood vessels is known as Atherosclerosis. Due to the obstruction the cardiac cells are deprived of oxygen and start anaerobic fermentation resulting in the formation of lactic acid. The lactic acid formation in the heart stimulates the pain receptors present in the heart. [3] Depending upon the type of plaque formation in the coronary blood vessel the angina might be termed as stable or unstable. [8] Thus with the reduced coronary blood flow the cardiac output of the heart is severely impaired since the muscles of the heart are deprived of oxygen and nutrients resulting in tissue death or myocardial infarction. Hence the heart is not able to pump properly and thus has a reduced cardiac output. Myocardial Infarction causes severe pain and can even cause death to the patient. [6] The blood flow to the target cells can be increased by vasodilation and thereby allowing more blood to flow through them. This can be done by using organic nitrate medications which release nitric oxide (NO) into the blood stream. Medications known as beta blockers (ÃŽ ²) which also cause of the coronary artery vasodilation can also help in the treatment of the condition in the same manner. Apart from medications surgically also the condition of reduced coronary blood flow can be treated by coronary bypass surgery where the atherosclerotic narrowing of the coronary artery is bypassed by a blood vessel which is grafted from any other part of the patients body. There also is the possibility of performing other angioplasty operations such as balloon angioplasty, etc. [7] The therapeutic goals in treating stable angina are to improve the coronary blood flow to the target cells and reduce the cardiac oxygen demand. While in the treatment of unstable angina steps are taken to prevent the occurrence of myocardial infarction Conclusion The heart acts as a muscular pump which pumps blood throughout the lifecycle beating at an average of 72 beats a minute and pumping 200 million litres of blood in 80 years. [3] The cardiovascular system consists of several different components, the pump (heart), an extensive piping network (blood vessels and capillaries) and finally a working fluid (blood). The heart receives deoxygenated blood from all over the body pumps it to the lungs for oxygenation and receives the oxygenated blood from the lungs and pumps them to the different parts of the body. The piping network includes arteries, arterioles, veins, venules and capillaries. The capillaries are the site of gaseous exchange where the exchange takes place by diffusion. Reduced coronary blood flow impairs the cardiac output by starving the cardiac cells of oxygen and nutrients carried by the blood.