HSA 515 Dealing with Fraud Essay

As the Chief Nursing Officer of the state’s largest Obstetric Health Care Center, this author is responsible for complaints regarding fraudulent behavior in the center. The purpose of this report is to (1) evaluate how the Healthcare Qui tam affects health care organizations, (2) provide four examples of Qui Tam cases that exist in a variety of health care organizations, (3) devise a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals, (4) recommend a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will impact issues of reproduction and birth, and (5) Devise a plan to protect patient information that complies with all necessary laws. Qui Tam (from the Latin phrase â€Å"he who sues on behalf of the king†) is a well-known mechanism used by private individual to assist the government in enforcing specific laws (Ruhnka, Gac, & Boerstler, 2000). The False Claims Act of 1863 is one of the most important examples of the Qui Tam mechanism that was enacted during the Civil War to prosecute war profiteers who were caught overcharging the Union Army (Ruhnka, Gac, & Boerstler, 2000). Showalter (2012) states that the whistle-blower (aka relator) files the suit as a kind of â€Å"private attorney general† on behalf of the government in a qui tam case. Evaluate how the Healthcare Qui tam affects health care organizations. Healthcare qui tam affects health care organizations in many ways. The most popular and inconvenient way is financial losses. If an organization is accused of qui tam, a suit is filed and if the company is found guilty of fraud, they stand to incur a financial loss due to having to repay money to the government. Ruhnka, Gac, & Boerstler (2000) state that intentionally fraudulent activities such as billing for services not provided, billing for services or equipment that is not medically appropriate, or violating clearly stated billing rules are unacceptable and should be prosecuted whenever they occur. Qui tam effect on health care organizations has not been a positive one. Cruise (2003) state that qui tam actions has forced organizations to develop a new cadre of operating guidelines and procedures collectively called â€Å"compliance programs† resulting in organizations having to pay $600 – 700 million per year to a consultant industry to advise them on the intricacies of this new era. Health care organizations have adopted Federal Sentencing Guidelines as a part of their compliance programs due to the laws governing Medicare fraud and abuse (Cruise, 2003). Examples of Qui Tam cases that exist in a variety of health care organizations. Healthcare is on the rise in the United States. Medicare and Medicaid is the largest of the government sponsored healthcare plans and provide health care coverage for as many as 95 million Americans, at an estimated cost in 2012 of more than $900 billion (Raspanti, n.d.). Raspanti (n.d.) state that the primary reason for the rise in healthcare cost has been the large degree of fraud committed against these two major government health care programs. Raspanti (n.d.) state the following are examples of qui tam cases, but not limited to: â€Å"Kickbacks: The federal Anti-Kickback Statute prohibits any offer, payment, solicitation or receipt of money, property or remuneration to induce or reward the referral of patients or healthcare services payable by a government health care program, including Medicare or Medicaid. These improper payments can come in many different forms, including, but not limited to: referral fees; finder’s fees; productivity bonuses; discounted leases; discounted equipment rentals; research grants; speaker’s fees; excessive compensation; and free or discounted travel or entertainment. The  offer, payment, solicitation or receipt of any such monies or remuneration can be a violation of the Federal Anti-Kickback statute, 42 U.S.C.  §1328-7b(b), the Federal False Claims Act, as well as various other federal and state laws and regulations. Ghost Patients: The submission of a claim for health care services, treatments, diagnostic tests, medical devices or pharmaceuticals provided to a patient who either does not exist or who never received the service or item billed for in the claim. Up-Coding Services: Billing of government and private insurance programs is done using a complex series of numerical codes that identify the specific procedure or service being performed. These code sets can include: the American Medical Association’s Current Procedural Terminology (â€Å"CPT†) codes; Evaluation and Management (â€Å"E&M†) codes; Healthcare Common Procedure Coding System (â€Å"HCPCS†) codes; and International Classification of Disease (â€Å"ICD-9†) codes. Government health care programs assign a dollar amount it will pay for each procedure code. Up coding occurs when a health care provider submits of a claim for health care services, treatments, diagnostic tests or items that represent a more serious and more expensive procedure than that which actually was performed. Up coding can be a violation of the Federal False Claims Act. Bundling and Unbundling: In many cases, government health care programs have special reimbursement rates for groups of procedures that are typically performed together, such as laboratory tests. One common type of fraud has been to â€Å"unbundle† these procedures or tests and bill each one separately, which results in greater reimbursement than the group reimbursement rate. Attorneys in the national qui tam whistleblower practice of Pietragallo Gordon Alfano Bosick & Raspanti successfully represented the lead relator in one of the largest cases of â€Å"unbundling† in the history of false claims litigation, United States ex rel. Merena v. Smithkline Beecham Clinical Labs, which resulted in a recovery of $328 million for federal taxpayers. False Certification: When physicians, hospitals and other health care providers submit bills to government health care programs they are required to include a number of important certifications, including that the services were medically necessary, were actually performed, and were performed in accordance with all applicable rules and regulations. Additionally, health care companies such as pharmaceutical companies and pharmacy benefits managers that provide products or services to government  health care programs are required to certify that they are satisfying all obligations under their contracts with the government. One common type of fraud has been to falsify these certifications in order to get a health care claim paid or to obtain additional business† (Raspanti, n.d.). Stanton (2001) acknowledges that in a healthcare facility, with Medicare, each false claim is considered an individual billing whether for a specific medical item or service. Penalties can rise quickly with suspension or delay payment of future claims for a facility if it has been accused of submitting false claims (Stanton, 2001). Devise a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals. In order to avoid health care qui tam, healthcare organizations must stay abreast and compliant with Medicare and Medicaid laws. When a patient enters a facility for illness or an appointment, there are steps to follow. At check-in, the patient gives insurance card and pertinent information to nurse. The nurse enters the information into the system. The patient waits for the doctor to assess the illness to determine the needs of the patient. â€Å"Physician inputs information into the system and system codes the treatment based on Medicare or Medicaid protocols; system confirms and red flags any treatment or medication that is not allowed; patient is discharged and Medicare or Medicaid is billed for services rendered by the hospital, physician, and for medication† (Burnaby, Hass, & O’Reilly, 2011). If for some reason, items billed are questioned or denied, the items are reviewed and resubmitted to Medicare or Medicaid for payment. Recommend a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will impact issues of reproduction and birth. Corporate Integrity Agreements (CIAs) are considered second chances for healthcare organizations. By using CIAs, the organization avoids exclusion from Medicare, Medicaid, or other Federal healthcare programs by establishing and implementing a compliance program per CIA regulations and guidelines (MetricStream, n.d.). Implementing CIAs is challenging and can cause financial strain; however it can â€Å"protect stakeholders and customers from risk, and build brand value† (MetricStream, n.d.) CIAs are implemented  for healthcare organizations to uphold certain standards and to fulfill the organizations’ missions and goals. CIAs are usually proposed due to allegations of fraud or abuse which are found to be true through audits or self-disclosures; and are drawn up for a period of three to five years and can extend up to eight years (MetricStream, n.d.). Ramsey (2002) suggests that a recommended integrity program should include stipulations such as â€Å"designation of a compliance officer and a compliance committee† – to ensure that the needed changes will be made; â€Å"a required code of conduct, mandated compliance policies and procedures† – stating that the organization is committed to complying with the laws; â€Å"training requirements† – to ensure that staff and physicians are knowledgeable and up-to-date on all requirements and processes required by the organization, the government and vendors; â€Å"review and auditing procedures† – to help reduce errors when reporting claims; and a â€Å"confidential disclosure program where employees internally may report possible violations of the law† . Once a CIA is implemented, to deter employees from committing fraud, a stern disciplinary action process should be enforced and followed. Devise a plan to protect patient information that complies with all necessary laws. Protecting patient information is a responsibility of all healthcare organizations and a plan or process must be in place to do so. In any situation, whether in an office, clinic, or in the field, there are important procedures that can be followed to protect a patient’s information and confidentiality (Centers for Disease Control and Prevention, 2012). As a health care worker, you must â€Å"confirm the patient’s identity at first encounter, never discuss the patient’s case with anyone without the patient’s permission, never leave hard copies of forms or records where unauthorized persons may access them, and use only secure routes to send patient information and always mark confidential† (Center for Disease Control and Prevention, 2012). When in healthcare settings â€Å"conduct patient interviews in private rooms, never discuss cases or use patient’s names in public area, and always obtain patient’s permission before distributing his/her information to a staff member or healthcare worker† (Center for Disease Control and Prevention, 2012). Always keep medical records and  computers used in a locked or secure box to prohibit unauthorized persons access. Creation and implementation of a protection and privacy plan can reduce legal actions under the Health Insurance Portability and Accountability Act. Qui Tam cases impact healthcare organizations in various ways to include high penalties if found guilty, payback of monies received, and a negative image for the organization. Medicare and Medicaid fraud cases are the most common qui tam cases. In order to reduce fraud and abuse cases, healthcare organizations must improve their current admission procedure, their corporate integrity program, and their patient information protection system. Reference: Burnaby, P., Hass, S., & O’Reilly, A. (2011). Generic health care hospital: The road to an integrated risk management system. Issues in Accounting Education, 26(2), 305-319. Center for Disease Control and Prevention. (2012). Measures to protect patient confidentiality. Retrieved from http://www.cdc.gov/tb/education/ssmodules/module7/ss7reading4.htm Cruise, P. L. (2003). Deregulating health care ethics education: A curriculum proposal. Global Virtue Ethics Review, 4(3-4). MetricStream. (n.d.). Corporate integrity agreements. Retrieved from http://www.metricstream.com/solution_briefs/corporate-integrity-agreements.htm Ramsey, R. B. (2002). Corporate integrity agreements: Making the best of a tough situation. Healthcare Financial Management, 56(3), 58-62. Raspanti, M. S. (n.d.). Health care fraud and false claims. Retrieved from http://www.falseclaimsact.com Ruhnka, J. C., Gac, E. J., & Boerstler, H. (2000). Qui tam claims: Threat to voluntary compliance programs in health care o rganizations. Journal of Health Politics, Policy and Law, 25(2), 283-308. Showalter, J. S. (2012). The law of healthcare administration (6th ed.). Chicago: Health Administration Press. Stanton, T. H. (2001). Fraud-and-abuse enforcement in Medicare: Finding middle ground. Health Affairs, 20(4), 28-42.

Same Sex Marriage

Same sex marriage is an issue that arises concerns with a lot of people. Some agree, some disagree, and some Just really don't care. I fall under two categories. I disagree, but I really don't care. The reasons being are I stick with God's words. He made Adam and Eve not Adam and Steve or Eve and Ava. God also said Judge not for you'll be Judged. I'm not perfect or anywhere near it, so I definitely don't want to be judged. I was going to write on child hunger, but since I have to deal with this in my life now I decided to provide a written document about this subject.One of my family members is involved in a same sex relationship for the past three years. Although I don't agree I still have love for them. Just recently, theyVe decided that they want to be married. That arises and issue with me because although I don't Judge them; I definitely won't be apart of the wedding and celebration. I couldn't see myself condoning a marriage with the vows of God for a couple of the same sex. I do have standards and I do know how to take a stand. I tried to broaden my thoughts and think about it for a moment, but it still wasn't working for me.So, I decided to do a little research and see what's really going on ith the same sex marriages. As I began to obtain information I was stunned about a lot of things. The facts I found out were surprising to me. I learned that the movement to open civil marriage to same-sex couples achieved its first temporary success in 1993 with the decision of the Hawaii Supreme Court that the restriction of marriage to opposite- sex couples would be presumed unconstitutional unless the state could demonstrate that it furthered a compelling state interest.In response to this decision the state constitution was amended to allow the legislature to preserve that restriction. A similar court decision in Alaska in 1998 led to an even stronger constitutional amendment, itself defining marriage as between one man and one woman. In further reaction to the Hawaii case, the federal Defense of Marriage Act 1996 provided that no state would be required to recognize a same-sex marriage from another state, and also defined marriage for federal-law purposes as opposite-sex. The majority of the states also passed their own â€Å"marriage protection acts. In November 2004, eleven more U. S. states amended their constitutions to prohibit same-sex marriage. In Vermont, after that state's Supreme Court held in 1999 that the state must extend to same- sex couples the same benefits that married couples receive, the legislature in 2000 created the status of â€Å"civil union† to fulfill that mandate. Connecticut adopted a similar civil union law in 2005. In 2001, the Netherlands became the first country to open civil marriage to same- sex couples. Belgium became the second in 2003.In 2002 through 2004, courts in six Canadian provinces held that the opposite-sex definition of marriage was contrary to Canada's Charter of Rights, and in 2005 federal legislation extended same-sex arriage to all of Canada. Same-sex marriage was also legalized in Spain in 2005 , in South Africa in 2006, and in Norway effective in 2009. In November 2003, the Massachusetts Supreme Judicial Court held that excluding same-sex couples from the benefits of civil marriage violated the state constitution, and in February 2004 2004 Massachusetts became the first state in the United States where same-sex marriage per se is legal.In October 2006, the New Jersey Supreme Court held that same-sex couples were entitled to the same rights and benefits enjoyed by opposite-sex couples under the ivil marriage statutes. The Legislature complied with that decision by enacting a civil union act in December 2006. In May 2008, California became the second state to legalize same-sex marriage when the California Supreme Court held that laws restricting marriage to opposite-sex couples were unconstitutional. Connecticut followed suit in October 2008. In California, the Supreme Court decision was apparently overturned by voter initiative in the November 2008 election. Paul Axel- Lute, â€Å"Same-Sex Marriage† (Rutgers-Newark Law Library, Pathfinder Series, Oct. 1996), http://www-rci. utgers. edu/†axellute/ssm. htm, lists articles, statutes, and cases through 1996. ) These things still did not convince me of anything and I decided I still needed more. I wanted to know why did these people of the same sex wanted to get married when it was causing so much controversy and most of the world don't with it. I Just couldn't understand so I went to the library and got a book by the author of William Eskeridge called, Gay Marriage, For Better or For Worse.That title really rocked me because that was the same thing that I was wondering. Is it for the better or for the worse. In his text he stated that the same-sex marriage debate to take account of the new argument against same-sex marriage, to wit: same-sex marriage in Scandinavia has destro yed the institution in those countries, and left children to be raised without married parents. That alone scares me because I was raised with two parents. (Eskridge, William N. , Gay Marriage: For Better or For Worse? What We've Learned from the Evidence. (Oxford Univ.Press, 2006) If marriage between gays becomes the law of the land, married gay couples will be afforded all the legal benefits that apply to heterosexual married couples, including pousal rights to Social Security, Medicare, private pensions, the right to file Joint tax returns, and the right to inherit each other's property. Many gays say it's about time. Others say that allowing gays to wed is wrong and will be harmful. When you ask about the good of marriage, we used to understand that the good of the thing was implied in its nature and its end.And marriage has to be connected and we'll have a chance to pursue this, but marriage has to be connected to that sense of sexuality imprinted in our natures, in the ineffac eable fact that we are born men or women. The purpose or meaning implicit in that sexuality is the notion of begetting, and for compelling reasons, we've found the prospect of begetting finding its most apt reflection in a framework of lawfulness that provides the ground on which parents are committed to the nurturance of their children for the same that they are committed to one another.When children are involved it makes it even more hectic. The children are being taught wrong and that I definitely don't agree with. The more I try to come to terms with this issue I Just can't seem to find enough of vidence that secures my thoughts and heart to condone this kind of thing. I know some people with disagree with me, but we agree to disagree. As time progresses I do indeed believe that eventually their will be more states and same sex laws that I entitled to my opinion.I Just pray for the children and their well-being. Although some only think of themselves they should take a stand bac k and think of their children. Children are our nest generation and raising them to think things are okay when theyre really wrong scares me to death. Let's Just hope that the kids will make better choices than others. Same sex marriage hasn't yet affected my life, but as time goes on I do think it will be a part of my life. Same Sex Marriage Same-sex marriage is a term used for a social or legally recognized marriage amid two people of the same gender. Freeman, M. D. A (1999). The most commonly term used in politics and media is Gay marriage. Some crusaders of the same-sex marriage use the name equal- marriage to emphasis that they are looking for equality and not special rights when it comes to marriage between people of the same sex. There are those people who argue that equating opposite-sex marriage and same-sex marriage will change the entire meaning of marriage and its general traditions (Hull, K. 2006). Moreover they often use the term Homosexual marriage which is regarded to be more stigmatizing than the term gay. There are those people who suggest that the term marriage should be reserved for civil, religious and legal contexts using a standardized concept of civil companionship. This kind of arrangement will reinforce the wall of division between the state and the church by putting a holly institution entirely to the church while placing secular organization under the control of the state. Some opponents and proponents of the same sex-marriage find suggestions of that sort to be unworkable. Whereas there are instances of some societies who recognize same-sex marriages, historical records shows a remarkable diversity of the treatment given to same-sex marriages which range from toleration and sympathy to indifferences and prohibition. Some organizations that are opposed to same-sex marriage often ague that same-sex unions are not marriages (Hull, K. 2006). They also argue that legalizing same-sex marriage will encourage legalization of polygamy and that legalizing same-sex marriage will deny children either a father or a mother while at the same time eroding religious freedoms. A research by American Anthropological Association states no proof has been found to show that people need to maintain marriage between people of the opposite sex and that same-sex marriage can make a greater contribution in stabilizing human societies. To add on, there are crusaders of the same-sex marriage who argue that governments should not play any part in regulating individual relationships. While there are those who insist that by allowing same-sex marriages the governments will be promoting collective benefits to same-sex partners. As stated by Sean Robert Cahill, Sean Cahill (2004) the debate surrounding same-sex marriage includes debate based on different social viewpoints and debate based upon religious convictions, health-related concerns, economic arguments and a variety of other different issues. We can say that the issue of same-sex marriage was meant to be ever since the creation of the universe and people should try and accept it as it is. We should also try and note that we are a people of one race and those we all hold female and male traits inside us, period. There are those people who are reverse-wired than other people and those who are androgynous. This is factual whether it is left-handedness or right-handedness or someone being right brained or left brained, et cetera. It is true that Love through understanding and tolerance is a most important factor to spiritual growth†¦. or else we stumble in fear-based thinking, selfishness and pure and absolute hate (prejudice) against our fellow women and men. Same Sex Marriage In Why Fear Same-Sex Marriages by William Raspberry, the author begins by presenting the side of Gary Bauer, who is against same-sex marriage. He agrees with Bauer that legalizing it will change 4,000 years of Judeo-Christian teaching, however, the greater question is whether it â€Å"launches us on the path to perdition or merely heralds the shedding of another irrational prejudice† (Raspberry, 2001). Raspberry supports same sex marriage so long as these are directed towards forming monogamous and committed unions. It’s the Final Step in Killing Marriage by Maggie Gallagher points out that it’s not wrong to disagree with same-sex marriages. This is in defense of Rev. Fauntroy who is a civil-rights legend but is against same-sex marriages. The author highlights what the gay movement has done as â€Å"harassment tactics, demonizing those who disagree† (Gallagher, 2001). Gallagher ends the essay with a statement on how these ‘tactics’ have even reached her personal email. Committed Couples Would Stabilize Society by Andrew Sullivan supports same-sex marriages. Sullivan points out that based on research during the first six years when gay marriage was made legal, â€Å"the rate of straight marriages rose 10 percent, and the rate of straight divorces decreased by 12 percent† (Sullivan, 2001). Sullivan believes that these types of marriages will strengthen the bonds of heterosexual marriage since ‘marriage’ finally encompasses all citizens. Personally, I would agree that same-sex marriage should be legalized. But it should be kept in mind that marriage is holy, and that the couples should truly be committed to their union. This goes true for gay as well as heterosexual marriage. With the high divorce rates today, I believe this should be the greater concern for society. The focus should be on strengthening marriages, not preventing or discriminating people from entering into marriage. I agree that legalizing gay marriage would â€Å"heal the psychic wounds that scar so many gay people and their families† (Sullivan, 2001). Same Sex Marriage In Why Fear Same-Sex Marriages by William Raspberry, the author begins by presenting the side of Gary Bauer, who is against same-sex marriage. He agrees with Bauer that legalizing it will change 4,000 years of Judeo-Christian teaching, however, the greater question is whether it â€Å"launches us on the path to perdition or merely heralds the shedding of another irrational prejudice† (Raspberry, 2001). Raspberry supports same sex marriage so long as these are directed towards forming monogamous and committed unions. It’s the Final Step in Killing Marriage by Maggie Gallagher points out that it’s not wrong to disagree with same-sex marriages. This is in defense of Rev. Fauntroy who is a civil-rights legend but is against same-sex marriages. The author highlights what the gay movement has done as â€Å"harassment tactics, demonizing those who disagree† (Gallagher, 2001). Gallagher ends the essay with a statement on how these ‘tactics’ have even reached her personal email. Committed Couples Would Stabilize Society by Andrew Sullivan supports same-sex marriages. Sullivan points out that based on research during the first six years when gay marriage was made legal, â€Å"the rate of straight marriages rose 10 percent, and the rate of straight divorces decreased by 12 percent† (Sullivan, 2001). Sullivan believes that these types of marriages will strengthen the bonds of heterosexual marriage since ‘marriage’ finally encompasses all citizens. Personally, I would agree that same-sex marriage should be legalized. But it should be kept in mind that marriage is holy, and that the couples should truly be committed to their union. This goes true for gay as well as heterosexual marriage. With the high divorce rates today, I believe this should be the greater concern for society. The focus should be on strengthening marriages, not preventing or discriminating people from entering into marriage. I agree that legalizing gay marriage would â€Å"heal the psychic wounds that scar so many gay people and their families† (Sullivan, 2001). Same Sex Marriage Same-sex marriage is a term used for a social or legally recognized marriage amid two people of the same gender. Freeman, M. D. A (1999). The most commonly term used in politics and media is Gay marriage. Some crusaders of the same-sex marriage use the name equal- marriage to emphasis that they are looking for equality and not special rights when it comes to marriage between people of the same sex. There are those people who argue that equating opposite-sex marriage and same-sex marriage will change the entire meaning of marriage and its general traditions (Hull, K. 2006). Moreover they often use the term Homosexual marriage which is regarded to be more stigmatizing than the term gay. There are those people who suggest that the term marriage should be reserved for civil, religious and legal contexts using a standardized concept of civil companionship. This kind of arrangement will reinforce the wall of division between the state and the church by putting a holly institution entirely to the church while placing secular organization under the control of the state. Some opponents and proponents of the same sex-marriage find suggestions of that sort to be unworkable. Whereas there are instances of some societies who recognize same-sex marriages, historical records shows a remarkable diversity of the treatment given to same-sex marriages which range from toleration and sympathy to indifferences and prohibition. Some organizations that are opposed to same-sex marriage often ague that same-sex unions are not marriages (Hull, K. 2006). They also argue that legalizing same-sex marriage will encourage legalization of polygamy and that legalizing same-sex marriage will deny children either a father or a mother while at the same time eroding religious freedoms. A research by American Anthropological Association states no proof has been found to show that people need to maintain marriage between people of the opposite sex and that same-sex marriage can make a greater contribution in stabilizing human societies. To add on, there are crusaders of the same-sex marriage who argue that governments should not play any part in regulating individual relationships. While there are those who insist that by allowing same-sex marriages the governments will be promoting collective benefits to same-sex partners. As stated by Sean Robert Cahill, Sean Cahill (2004) the debate surrounding same-sex marriage includes debate based on different social viewpoints and debate based upon religious convictions, health-related concerns, economic arguments and a variety of other different issues. We can say that the issue of same-sex marriage was meant to be ever since the creation of the universe and people should try and accept it as it is. We should also try and note that we are a people of one race and those we all hold female and male traits inside us, period. There are those people who are reverse-wired than other people and those who are androgynous. This is factual whether it is left-handedness or right-handedness or someone being right brained or left brained, et cetera. It is true that Love through understanding and tolerance is a most important factor to spiritual growth†¦. or else we stumble in fear-based thinking, selfishness and pure and absolute hate (prejudice) against our fellow women and men. Same Sex Marriage Same-sex marriage is a term used for a social or legally recognized marriage amid two people of the same gender. Freeman, M. D. A (1999). The most commonly term used in politics and media is Gay marriage. Some crusaders of the same-sex marriage use the name equal- marriage to emphasis that they are looking for equality and not special rights when it comes to marriage between people of the same sex. There are those people who argue that equating opposite-sex marriage and same-sex marriage will change the entire meaning of marriage and its general traditions (Hull, K. 2006). Moreover they often use the term Homosexual marriage which is regarded to be more stigmatizing than the term gay. There are those people who suggest that the term marriage should be reserved for civil, religious and legal contexts using a standardized concept of civil companionship. This kind of arrangement will reinforce the wall of division between the state and the church by putting a holly institution entirely to the church while placing secular organization under the control of the state. Some opponents and proponents of the same sex-marriage find suggestions of that sort to be unworkable. Whereas there are instances of some societies who recognize same-sex marriages, historical records shows a remarkable diversity of the treatment given to same-sex marriages which range from toleration and sympathy to indifferences and prohibition. Some organizations that are opposed to same-sex marriage often ague that same-sex unions are not marriages (Hull, K. 2006). They also argue that legalizing same-sex marriage will encourage legalization of polygamy and that legalizing same-sex marriage will deny children either a father or a mother while at the same time eroding religious freedoms. A research by American Anthropological Association states no proof has been found to show that people need to maintain marriage between people of the opposite sex and that same-sex marriage can make a greater contribution in stabilizing human societies. To add on, there are crusaders of the same-sex marriage who argue that governments should not play any part in regulating individual relationships. While there are those who insist that by allowing same-sex marriages the governments will be promoting collective benefits to same-sex partners. As stated by Sean Robert Cahill, Sean Cahill (2004) the debate surrounding same-sex marriage includes debate based on different social viewpoints and debate based upon religious convictions, health-related concerns, economic arguments and a variety of other different issues. We can say that the issue of same-sex marriage was meant to be ever since the creation of the universe and people should try and accept it as it is. We should also try and note that we are a people of one race and those we all hold female and male traits inside us, period. There are those people who are reverse-wired than other people and those who are androgynous. This is factual whether it is left-handedness or right-handedness or someone being right brained or left brained, et cetera. It is true that Love through understanding and tolerance is a most important factor to spiritual growth†¦. or else we stumble in fear-based thinking, selfishness and pure and absolute hate (prejudice) against our fellow women and men. Same Sex Marriage In Why Fear Same-Sex Marriages by William Raspberry, the author begins by presenting the side of Gary Bauer, who is against same-sex marriage. He agrees with Bauer that legalizing it will change 4,000 years of Judeo-Christian teaching, however, the greater question is whether it â€Å"launches us on the path to perdition or merely heralds the shedding of another irrational prejudice† (Raspberry, 2001). Raspberry supports same sex marriage so long as these are directed towards forming monogamous and committed unions. It’s the Final Step in Killing Marriage by Maggie Gallagher points out that it’s not wrong to disagree with same-sex marriages. This is in defense of Rev. Fauntroy who is a civil-rights legend but is against same-sex marriages. The author highlights what the gay movement has done as â€Å"harassment tactics, demonizing those who disagree† (Gallagher, 2001). Gallagher ends the essay with a statement on how these ‘tactics’ have even reached her personal email. Committed Couples Would Stabilize Society by Andrew Sullivan supports same-sex marriages. Sullivan points out that based on research during the first six years when gay marriage was made legal, â€Å"the rate of straight marriages rose 10 percent, and the rate of straight divorces decreased by 12 percent† (Sullivan, 2001). Sullivan believes that these types of marriages will strengthen the bonds of heterosexual marriage since ‘marriage’ finally encompasses all citizens. Personally, I would agree that same-sex marriage should be legalized. But it should be kept in mind that marriage is holy, and that the couples should truly be committed to their union. This goes true for gay as well as heterosexual marriage. With the high divorce rates today, I believe this should be the greater concern for society. The focus should be on strengthening marriages, not preventing or discriminating people from entering into marriage. I agree that legalizing gay marriage would â€Å"heal the psychic wounds that scar so many gay people and their families† (Sullivan, 2001).

Editing of a Film Essay Example | Topics and Well Written Essays - 500 words

Editing of a Film - Essay Example All the terminologies mentioned above are meant to make the film a big success and that depends upon the way the terminologies are used. Accuracy plays the vital role with the editors who work on these terminologies to edit the movie.For instance, when considering the terminology Crosscut, it actually does the intercutting of shots from two or more scenes. Then the fragments of each scene will be presented to the viewer’s attention alternately. This is in fact meant for parallel action. This option is very much useful to the editors to play between the scenes and edit them in whatever way they wish.At the same time when we consider the terminology called rough cut the editor assembles the film from some selected takes only leaving some specific points alone roughly and arrives at the fair one at the later stage. So in this process, the editors try to bring the original script somehow to a minimal percentage and apply all the other editing terminologies to complete the expected movie according to the original script. After this rough cut concept, the editors may apply the other terminologies like cut, cross cut, dissolve etc. This may be customized according to the editors and each one possesses their own way of working, but at last the ultimate goal is to present the film to the viewers in a proper manner. All the terminologies might not be used for a film, but the required ones alone to present it successfully before the public.Initially, editing was done using a single system that helped the editor to cut the scenes that were not required.

Formal versus Informal Finance Essay Example | Topics and Well Written Essays - 1250 words

Formal versus Informal Finance - Essay Example 18). This discourse delves into the firm financing patterns and growth in China. In the end, the paper finds that very few firms as well as companies rely on formal banks to finance their business, leaving most of them to depend on informal sources to drive up capital for their businesses. Furthermore, the author of this paper discovers that although, few businesses rely on formal sources of finance, such sources are responsible for faster growth of a business company compared to informal sources of finance. Some of the vices identified are corruption. However, there was no evidence to prove that such a vice affected the allocation of credit to firms from the financing institutions. It also did not affect the performance of the business both in the market and in terms of profit making. This paper presents a counter argument on the positive relationship between finance and growth using China’s economy as a case study. Analysis of the Relationship between Finance and growth Econ omists concur on the fact that China has the fastest growing economy in the world. The Chinese economy has gained significance that no other economy can ignore its rate of growth. Pundits believe that the Chinese economy will surpass the size of the US economy by the time we get to the third decade of the current century (Yao & Yueh, 2009, p. 40). Professionally though, its per capita income level will remain very low compared to that of the United States. In some other quarters experts dismiss this predictions as misleading citing various facts. The strength of the China’s economy for instance, appears in its manufacturing sector that is so far challenging manufacturing sectors in advanced economies around the world. This is profound especially in economies that are labor intensive (Angelina, 2008, P. 76). China is also undertaking a top-down approach while entering the high technology industry. This means that the rate at which such an economy accelerates is high and will h it its peak very soon. The growth of technology receives maximum support form high-level research by a large of scientists as well as engineers finishing their undergraduate and postgraduate courses. China is an essential counterexample to findings in various fields among them institutions, law, growth of literature, and finance (Pagano, 1993, p. 619). This is despite the fact that it has very poor financial systems and legal structures. Its economy defies all these to become the fastest growing economy in the world (Patnaik, 2011, p. 33). A lot of information from scholarly articles in the field of law and finance demonstrates that the growth of formal financial institutions relates closely to a faster growth of business organizations in addition to enhancing better allocation of resources (Yu, 1998, p. 79). Literature from these articles also considers the value and input by informal financial systems in the development of economies from developing economies. Informal financing as defined in the scholarly literature entails small, shorter, and unsecured loans. These sources of finance are restricted to the rural areas, households, agricultural financing and contracts, small entrepreneurial engagements, and individuals. The loans target the lower cadre of the market within the developing economies (Hsieh & Klenow, 2009, p. 21). The same appears in the developed economies but takes a different approach. In the US for instance,

Federal Prison Comparison Pape Research Paper Example | Topics and Well Written Essays - 1000 words

Federal Prison Comparison Pape - Research Paper Example Ultimately there are fewer violent offenders in federal prisons than state prisons because a majority of federal crimes are non-violent/commercial crimes. State prisons originate from colonial times, and evolved from the prisons that were established to house criminals who offended the laws against the crown (Clear et al, 2011). Between 1900 and 1970 the prison population in the US was moderate, housing from 90 to 120 prisoners for each 100,000 citizens. However, with more than 35 years of â€Å"steady growth† the prison population is currently five times greater than it was in 1973 representing the largest prison population in the country’s history (Clear et al, 2011, p. 6). There have been many attempts to explain the prions population growth in the US. Gaines and Miller (2011) identified a number of contributing factors. The prions population growth in the US can be attributed to the get tough on crime policies that began in the 1980s. The get tough on crime policies introduced a number of strategies that resulted in mandatory imprisonment. One such strategy in a number of states is the three strikes policy which calls for mandatory incarceration for repeat offenders. Another policy is the longer prison sentencing strategies. With fewer prisoners eligible for parole, the prison population grows because new offenders are introduced into the system and few prisoners are released. Another explanation given for the prison population growth is the fact that there have been more crimes as criminals become more sophisticated and technology aids in the commission of criminal activities (Gaines & Miller, 2011). Security State Prisons State prison systems design their own security systems but they are generally the same among the 50 states. The North Carolina Department of Correction provides an example of the security levels in US state prisons. Prisoners enter the prison system from a county jail for the most part. Upon entering the state prison prison ers are assessed for risks and security risks are balanced against the needs of programs. Newly admitted prisoners are evaluated for security risks and are also subjected to medical and mental health evaluations in the risk assessment process. A number of factors including the crime, social demographics, education, job experience, and criminal history are taken into account (North Carolina Department of Corrections, 2011). Once the prisoner’s evaluation is completed he/she is placed in the appropriate â€Å"custodial level†. The custodial levels are classified as close (maximum), medium, minimum 1, minimum II and minimum III. Close of maximum security is a custodial level where inmates assessed to have the highest security risks are placed. Medium security houses prisoners who are at a lower security risk than prisoners placed in close security. Prisoners who pose a low security risk are placed in minimum III (North Carolina Department of Corrections, 2011). Federal Pr isons The Federal Bureau of Prisons (n.d.) lists four security levels in the federal prison system. The four security systems are minimum security, low security, medium security and high security. Minimum security prisons are also referred to as Federal Prison Camps and have â€Å"dormitory housing, a relatively low staff-to-inmate ratio† and â€Å"limited or no perimeter fencing† (Federal Bureau of Prisons, n.d.). Low security prisons on the other hand have â€Å"double-fenced perimeters†

How do quality management systems impact on revenue in the hospitality Research Paper

How do quality management systems impact on revenue in the hospitality industry - Research Paper Example It has been prophesied time and again by various scholars through various studies what Roberts found in 1996 â€Å"businesses who know and understand customers’ priorities for quality improvements can achieve a threefold increase in profitability† (Dale, 2003).This study has been carried out from the revenue generation context of quality systems implementation for hospitality industry. How the various elements of quality help in achieving the increased profitability needs to be analyzed. It is also important to see whether the concepts that help achieve visible improvements in manufacturing sector also produce profitability improvement worth the effort they involve in the hospitality sector or not. 2. RESEARCH QUESTIONS, AIMS AND OBJECTIVES 2.1. Research questions identified The major questions which this research aims to answer are - What is the impact of implementing quality management systems in hospitality industry? How do these systems impact the revenues? What are the efforts involved in implementing these systems and are the resources required to implement quality systems justified by the value of the revenues generated? 2.2. Research Aims and Research Objectives The aim of this study is to see how quality management systems impact revenue in the hospitality industry. Study objectives are as follows: 1. To study how quality management systems are implemented in hospitality industry – a general study of the companies. 2. To understand how the quality management systems impacted the parameters of financial performance (a study of the various parameters they impact as well as the means of this impact). 3. To measure the impact... This research paper shows that quality management systems have positive impact on revenues of hospitality industry. It has been observed that this has been achieved by improved market share, brand image, ROI and competitive positioning. However, some concerns regarding the impact of these systems on overall performance of the firms have been highlighted. One of the concerns is the sincerity of implementation of quality management systems within the firms. The industry leaders need to understand that they are the main drivers of change which these systems propose to bring about. Hence, a commitment of words or even documented commitment is not sufficient. The leadership team needs to be thoroughly involved in its implementation. They need to have a quality vision to help firms achieve both revenue and cost benefits. Half hearted efforts, especially in the industry of our study, have found to have a negative impact on operational performance. Our literature review has analyzed all the aspects related to the questions set out in the beginning of our study. Hospitality organizations implement quality management systems by applying for certifications like ISO 9000, etc. or by internal process improvement programs. Some companies in this sector were seen to implement Six Sigma methodologies to reap revenue benefits. Most of the successful organizations in this sector have implemented full computerization which helps the management in analyzing revenue versus cost factors.

Strategy implementation Essay Example | Topics and Well Written Essays - 1750 words

Strategy implementation - Essay Example In Andrews’ definition, there appears to be a clear division between strategy formulation and its implementation. It is at the implementation stage that resource allocation becomes crucial. This is in keeping with the classical or planned model of thinking about strategy. In the more recent, process, or resource-based view (RBV) of strategy, when speaking of the competitive advantage of a firm, scholars stress the importance of ‘resources’ and ‘capabilities’ available to it (Amit and Shoemaker 1993). It is commonsensical to argue that the strategy implementation of an enterprise is predicated on the availability (’command’) of resources and capabilities of the firm. Resources are held to be available business-wide, while capabilities are the skills and abilities developed within and specific to the firm. Resources alone therefore, are not in themselves sufficient to gain a ’sustainable competitive advantage’ for a firm. Cap abilities, often in the form of patents, and expertise developed in-house, and not easily replicated by outsiders, are equally, if not more important. It is too simplistic to separate strategy implementation from strategy formulation, since a strategy has to be adaptive and evolving, while keeping at the forefront the ends and goals that need to be met for the business to remain viable. Barney (1991), supported by a number of other researchers, claimed that a firm’s key resources needed optimally to conform to the following criteria.

The Battle for Stirling Bridge Case Study Example | Topics and Well Written Essays - 2250 words

The Battle for Stirling Bridge - Case Study Example Employees are the superior stakeholders of the company. Employees work towards the objective of the company. The skilled metal workers of the Stirling Bridge Company manufacture power tools including the Braveheart tools and other light and heavy industrial machinery and thus they exert their sphere of influence in maximizing the profit. Employees are the superior stakeholders of the company. Employees work towards the objective of the company. The skilled metal workers of the Stirling Bridge Company manufacture power tools including the Braveheart tools and other light and heavy industrial machinery and thus they exert their sphere of influence in maximizing the profit. Customers: Customers play a major role in the development of the organization as they are the consumers of the product produced by the company. The customers influence the company by giving feedback about the quality of the product. Suppliers: Raw materials are the main resources of an organization. Suppliers provide the necessary raw materials and influence the continuous production of the tools. Government: The organization should get the approval of the government before commencing its productions. The concern should abide by the rules and the standard acts imposed by the Government. The Government has full authority to take legal action against the company if any of its activities harm society.   Thus each of the stakeholders exercises their own influence in different areas of interest in the company thereby promulgating the production to a profitable extent.2. How might the actions of Stirling Bridge, with respect to its Braveheart line of tools, be regarded more as a stakeholder approach as opposed to a strict shareholder approach and which of Lantos’ types of Corporate Social Responsibility might be demonstrated by each of the actions taken?

Environmental Scanning Essay Example for Free

Environmental Scanning Essay Everyone in Pakistan well as many sitting thousands of miles away, the business community too is waiting to exhale. And so, all that’s visible in the run up to the precise moment – General Elections 2013 – are lots of breathlessly red faces. Generally, election year produces diametrically opposing reactions within the public and private sectors. While the incumbent seeks to woo fickle voters through last ditch spending (think: poverty alleviation, development projects, etc.), the private sector often buries its head and its wallet in the sand until the storm of unpredictability has passed. Consequently, the business outlook for 2013 will remain depressingly unexciting until the new government settles down. The global recession isn’t going away anytime soon and the IMF recently cut global growth forecasts for 2013 to 3.6%, down from its earlier estimate of 3.9%. Although the Pakistani Government is doing its best to convince anyone who will listen that it is going to manage ‘four’ percent growth in the coming year, nobody is really convinced. The Government doesn’t really have the money to spend. Public revenues – proposed tax amnesty schemes notwithstanding – are low; the fiscal deficit is 8.2% and, to make ends meet, the Government is borrowing heavily from the banking sector. For decent growth, the Government needs a tax-to-GDP ratio in the vicinity of 16%; all it can muster at present is 9.1%. While inflation has finally been brought into the single digit realm, few are deluded enough to imagine it will last. First, global commodity prices (particularly oil) are still heading upwards. Second, with just enough forex reserves left for three months of imports and no bilateral or multilateral donor rushing to save Pakistan from Islamabad, the rupee is poised to come under serious pressure. (In November alone, Pakistan had to repay a staggering $616 million to the IMF.) Third, the Government has the State Bank printing Rs 1.5 billion a day. All inflationary enough on their own, the combined effect of these three will make for a very painful and prolonged hangover . Further, savings are low and the cash flush banks are too busy throwing rupees at the Government to bother with the few businesses that would be willing to invest in Pakistan prior to elections. Simply put, banks would much rather bolster their profits by lending to an insatiable but dependable Government than lend to the brilliant but risky private sector. Significantly, while the  Central Bank has now cut its policy rate by a cumulative 200 basis points since August, its critics are still unhappy with the decision. Their first bone of contention is that the temporarily low inflation numbers do not merit monetary easing and the State Bank is just making it cheaper for the Government to borrow more rather than hauling it up for doing so. Further, they cite data on private sector credit off take that shows that the same actually declined after the deep cut in August (150 basis points) while Government borrowing increased. Businesses, on the other hand, say that interest rates are st ill too high to consider investing. (Foreign investment, of course, requires a climate unavailable in a frontline state in the war against terrorism.) While the specific merits of this allegation can be argued over, the business environment in the country presents a series of uncontroverted and inescapable realities that dilute the impact of the high cost of borrowing. There are obviously those who cry about energy shortages, the unpredictability of supply and the fear that the dollar-rupee exchange rates will cross Rs 100 by June 2013. There are others who moan about the law and order situation and the fact that extortion levels jump up dramatically in the run-up to an election as political parties gather funds for electioneering. But first and foremost is the fact that the entire country is in a state of political flux and the economy is teetering on the brink of a full blown crisis. Typically, investment – be it the setting up of large projects or just the import of new machines for spinning – has a significant gestation period. An investor, who can’t predict whether his deals with the current Government will be honored by the next or what the duty structure will look like by the time his machines come in, is generally wary and prefers to sit on the sidelines until he gets more clarity. Take the example of the energy sector. The long, sizzling summer of 2012 and the frequency of power riots across the country clearly showed that Pakistan has graduated from being energy insecure to an energy crisis state. Throughout this period, the Government and its ministers frequently spoke of the need for more energy related projects, alternative energy and what not at much touted ‘energy conferences’. At various points during the year, the import of energy from even Iran and India were discussed. Clearly, there is significant unmet demand and correspondingly, great returns in the business. Theoretically then, given that energy infrastructure projects take ages to  mobilise, investors should be queuing up to begin these before the summer of 2013. But while a few canny, deep pocketed investors are making ambitious plans, even they are not committing money to these projects just yet. Clearly, the top priority, for even those investors who are mostly immune to political persecution because of their wealth and/or influence, is political stability. This stability, however, refers not only to the political parties that form governments but also the nature of the economic policies they pursue. If an investor raises $200 million to set up an LNG import business, for example, he needs to know what the returns will be and how long the government intends to buy the product for and in the absence of this certainty; no one will cough up the cash. Key External Factors Business, now-a-days is vitally affected by the economic, social, legal, technological and political factors. These factors collectively form business environment. Business environment, as such, is the total of all external forces, which affect the organization and operations of business. The environment of an organization has got internal, operational and general lives managers must be aware of these three environmental levels and their relationship and importance. The term business environment implies those external forces, factors and institutions that are beyond the control of individual business organizations and their management and affect the business enterprise. Business environment influence the functioning of the business system. Thus, business environment may be defined as all those conditions and forces which are external to the business and are beyond the individual business unit, but it operates within it. These forces are customer, creditors, competitors, government, socio-cultural organizations, political parties national and international organizations etc. some of those forces affect the business directly which some others have indirect effect on the business. 5 Key External Factors: * Economic Forces * Social, Cultural, Demographic and Environmental Forces * Political, Governmental and Legal Forces * Technological Forces * Competitive Forces Economic Forces: Economic environment refers to the aggregate of the nature of economic system of the country, the structural anatomy of the economy to economic policies of the government the organization of the capital market, the nature of factor endowment, business cycles, the socio-economic infrastructure etc. The successful businessman visualizes the external factors affecting the business, anticipating the prospective market situations and makes suitable to get the maximum with minimize cost. Social, Cultural, Demographic and Environmental Forces: The social dimension or environment of a nation determines the value system of the society which, in turn affects the functioning of the business. Sociological factors such as costs structure, customs and conventions, cultural heritage, view toward wealth and income and scientific methods, respect for seniority, mobility of labor etc. have far-reaching impact on the business. These factors determine the work culture and mobility of labor, work groups etc. For instance, the nature of goods and services to be produced depends upon the demand of the people which in turn is affected by their attitudes, customs, so as cultural values fashion etc. Socio-cultural environment determines the code of conduct the business should follow. The social groups such as trade unions or consumer forum will intervene if the business follows the unethical practices. Political, Governmental and Legal Forces: The political environment of a country is influenced by the political organizations such as philosophy of political parties, ideology of government or party in power, nature and extent of bureaucracy influence of primary groups etc. political stability in the country, foreign policy, Defense and military policy, image of the country and its leaders in and outside the country. The political environment of the country influences the business to a great extent. Legal environment includes flexibility and adaptability of law and other legal rules governing the business. It may include the exact rulings and decision of the courts. These affect the business and its managers to a great extent. Technological Forces: The business in a country is greatly influenced by the technological development. The technology adopted by the industries determines the type and quality of goods and services to be produced and the type and quality of plant and equipment to be used. Technological environment influences the business in terms of investment in technology, consistent application of technology and the effects of technology on markets. Competitive Forces: * Globalization of corporations, knowledge, products, consumers, and communication. * Growing competition within and across countries, amongst domestic companies, and between domestic and transnational companies. * Link between international trade and international labor standards and parallel efforts to secure labor market flexibility through relaxation of labor laws and standards for stimulating investment, both domestic and foreign * Speedy flow of information, capital, and innovation throughout the world. * Rising expectations of all stakeholders. * Easy access to the best and the least expensive products and services, worldwide. * Rapid pace of change ( £If the rate of change in our organization/society is slower than the rate of change outside the organization/society, we will be led by others.’) * Faster response time (As Smajda of the World Economic Forum avers, the days of big fish eating small fish are over. It is the fast fish which swallows the small fish.’) * Growing socio-economic inequity. Now, we are going to discuss about different sectors which are affected by these key external factors and take opportunities to it but threats are also exists. * Service Sector * Agriculture Sector * Telecom Industry * Cement Industry Service Sector Services sector is largest and fastest growing sector in the world economy, accounting largest share in total output and employment in most developed countries. In case of Pakistan, the shares of services are increasing in all sectors of economy over the period. In fact, the growth rate of services sector is higher than the growth rate of agriculture and industrial sector. The Services sector has registered a growth rate of 4.0 percent during July-March of the fiscal year 2011 12 against 4.4 percent last year. It is dominated by Finance and Insurance at 6.5 percent, Social and Community Services 6.8 percent and Wholesale and Retail Trade 3.6 percent. I. Distributive Services: Transport, Storage and Communications * Railways * Water Transport * Air Transport * Pipeline Transport * Road Transport * Mechanized * Non- Mechanized * Communications * Storage * Water Transport Wholesale, Retail Trade and Hotels and Restaurants * Wholesale and Retail Trade including * Imports * Purchase and Sale Agents and Brokers * Auctioning II. Producer Services: Financial Institution * State Bank of Pakistan * Commercial Bank * Other Financial Intermediaries * Insurance Corporations and Pension Funds III. Social Services: Public Administration and Defense Social Community and Private Services * Education * Medical and Health Services Environmental Scanning: Economic Forces The Services sector contributes 53.8% to Pakistan’s GDP. Its major sub sectors are Finance and Insurance, Transport and Storage, Wholesale and Retail Trade, Public Administration and Defense. Services contribution to our GDP is gradually increasing. During the current period of financial downturn, the services sector has been a major contributor to growth. Pakistan’s GDP grew at the rate of 2.4%in 2010-11. The services sector grew at the rate of 4.1% as against 2.9% last year. The main contributors to this growth are public admin and defense (13.2%) and social services sector (7.1%) A cursory look on the composition of subsectors that contribute most to the services sector shows that retail trade, wholesale trade, research and educational consultancy services, restaurants and hotels, financial, construction, and some business services, such as computer and information technology (IT) services, and professional services, such as engineering, legal and accounting services, IT and related services have been most significant. Banks, DFIs and insurance companies, account for 98 percent of value added in this sector. The finance and insurance sector comprises State Bank of Pakistan, all scheduled (domestic and foreign banks) development financial institutions (DFIs), all insurance (life and general) companies, Modaraba/leasing companies, moneychangers and stock exchange brokers. The financial sub-sector consists of all resident corporations principally engaged in financial intermediations or in auxiliary financial activities related to finance. Social, Cultural and Demographic Forces Demography and lifestyle changes have the major contribution to increase in the growth of consumer demand of services. Pakistan’s consumption data shows that the demand of services is increasing over the time. During the 1985-86 people spent more of their income on goods then services. A number of factors such as income growth, changing demographic profile due to more urbanization, and the socio-economic environment are having its impact on retail scene. Pakistan retail is currently a virgin territory. This is more important in view of the large number of middle class population and available high-disposable income in the age group 25-35 years. Successful Retail Chains like Hyper star, Metro Makro has opened the avenues for the upcoming retailers. In Lahore, large numbers of households do the grocery shopping at Hyper star, Jalal sons, Alfatah, HKB, Metro, Makro and CSD. This shows the changing lifestyle and shopping preferences of the urban population of Pakistan. This retail growth is also supported by the increasing literacy rate in Pakistan; current urban population is more educated than their ancestors and has a better understanding of retailer influences on shopping as the larger retailer give quality assurances to consumers. Political, Governmental and Legal Forces Governments around the globe are gradually coming online using processes in which Information and Communications Technology (ICT) play an active and significant role, beyond simple digitalization, or automation of governance  services, or provision of LANs, since it is ultimately a tool for good governance and human development. The main objectives of e-Governance are to increase transparency of government working, increase and diversify public information and its value, and increase the quality of products and services being currently offered. This helps reduce high transaction costs (in terms of time, efforts and opportunities lost) by timely and relevant access to government information, especially for those who are disadvantaged or marginalized or living in remote rural areas. Services are still identified with line ministries and government departments; there is increasing recognition amongst policymakers for improvements in skill levels in many sectors and for a departure from inward-looking policies. In view of the dramatic changes in the services sector, regulatory and policy issues have continued to gain importance in policy-making circles for the last 15 years. Technological Forces Technology allows businesses to do everything faster. Many processes that once required ledgers, checkbooks and journal notations have now moved onto computer systems. Logging in and out, updating inventory information and communicating can now are happening much more swiftly. Technology moves very quickly, constantly evolving and creating new devices and faster systems. Businesses note these changes and attempt to move with technology, adapting it to their present and future needs. Pakistan has seen an explosive growth in the ICT sector in the last few years with deregulation and ending of the monopolies of the state sector. The number of mobile phones achieved their 2007 target two years earlier, and the recent deregulation of long distance (LDI) wireless local loops (WLL), other sections have served to provide faster, better and wide coverage, all at lower costs. Competitive Forces Of the non-factors input used by the services sectors, 61.1 percent were  purchased from commodity producing sectors, suggesting strong backward linkages of services with commodity producing sectors. Of the total purchases from the commodity sectors, 73.9 percent were purchased from manufacturing sector, followed by 14.6 percent from construction, and 7.7 percent from electricity and gas sectors. The service sectors purchases from agriculture sector account for 3.3 percent of total purchases from commodity sectors. About 76.5 percent of services sector (public administration and defiance, 40.6 percent and transport and communications 35.9 percent) made purchases from the commodity producing sectors respectively. Forward linkages the shares of individual service sectors in total purchases from commodity producing sectors are agriculture 28.1 percent, mining and manufacturing 70.2 percent, electricity and gas distribution 1.0 percent, and construction 0.7 percent. Technology also increases the possibility of crime. A tech-savvy employee can embezzle funds and make it difficult for the company to trace. Hackers can access personal and financial data of customers who trust the company to keep their information safe. Agriculture Sector Agriculture: Agriculture, also called farming or husbandry, is the cultivation of animals, plants, fungi, and other life forms for food, fiber, biofuel and other products used to sustain life. Agriculture was the key development in the rise of sedentary human civilization, whereby farming of domesticated species created food surpluses that nurtured the development of civilization. The study of agriculture is known as agricultural science. Agriculture generally speaking refers to human activities, although it is also observed in certain species of ant and termite. The word agriculture is the English adaptation of Latin agricultÃ… «ra, from ager, a field, and  cultÃ… «ra, cultivation in the strict sense of tillage of the soil. Thus, a literal reading of the word yields tillage of fields. Agriculture Sector in Pakistan: Pakistan has a rich and vast natural resource base, covering various ecological and climatic zones; due to which the country has great potential for producing all types of food produce. Agriculture has an important role in generating economic growth. Agriculture affects the economy in three ways namely, first, it provides food to consumers and fibers for domestic industry; second, it is a source of scarce foreign exchange earnings; and third, it provides a market for industrial goods. Agriculture Sector is a key sector of the economy and accounts for 21 percent of GDP. The supportive policies of the government resulted in a growth of 3.1 percent against 2.4 percent last year. Major Crops registered an accelerating growth of 3.2 percent compared to a negative growth of 0.2 percent last year. The major crops including Cotton, Sugarcane and Rice witnessed growth in production of 18.6 percent, 4.9 percent and 27.7 percent respectively. However, preliminary estimates of wheat production showed a negative growth due to late receding of flood waters in lower Sindh which hampered the timely cultivation of the wheat crop. Livestock has witnessed a marginally higher growth of 4.0 percent against the growth of 3.97 percent last year. Fisheries sector showed a growth of 1.8 percent. Forestry recorded a growth of 0.95 percent as compared to the contraction of 0.40 percent last year. The total geographical area of Pakistan is 79.6 million hectares. About 27percent of the area is currently under cultivation. Of this area, 80 percent is irrigated and Pakistan has one of the highest proportions of irrigated cropped area in the world. Most of Pakistan is classified as arid to semi-arid because rainfall is not sufficient to grow agricultural crops, forest and fruit plants and pastures. About 68 percent of the geographical area has annual rainfall of 250 mm, whereas about 24 percent has annual rainfall of251 to 500 mm. Only 8 percent of the geographical area has annual rainfall exceeding 500 mm. Hence supplemental water is required for profitable agricultural production, either from irrigation or through water harvesting. Agriculture is largely dependent on artificial means of  irrigation. Of the total cultivated area, about 82 percent or around 17.58 million hectares is irrigated, while crop production in the remaining 3.96 million hectares depends mainly upon rainfall. The Irrigation Canal Command Area (CCA) has been grouped into classes on the basis of the nature and severity of its limitations water logging, salinity, sodality and texture. At present about one-fifth of the cultivated land in CCA is affected by water logging and salinity to varying degrees. An additional area of 2.8 million hectares suffers from sodality. Notwithstanding huge investments, the water table was 0 to 1.5 m under 2.2 million hectares of irrigated land, 1.5 to 3 m under6 million hectares and 0to 3 m under 8 million hectares. Thus Pakistan needs to overhaul its entire drainage and reclamation strategy reduces its cost and makes it efficient. Environmental Scanning: Economic Forces Flooding in 2011, affected crops like rice, cotton and sugarcane, although in the current year, 2011-12, they performed well and provided support and continued to support food security objectives this year. The agriculture sector recorded a growth of 3.1 percent in 2011-12. The profitability of agriculture sector during 2011-12, remained high because the farmers received good prices for rice, cotton and sugarcane, which allowed for greater financial resources passed on to the rural economy. During 2011-12, the overall performance of agriculture sector exhibited a growth of 3.1 percent mainly due to positive growth in agriculture related subsectors, except minor crops. Major crops accounted for 31.9 percent of agricultural value added and experienced a growth of 3.2 percent in fiscal year 2011-12 with negative growth of 0.2 percent in 2011. The role of credit is instrumental in the agriculture sector where Pakistani farmers often lack finances necessary for carrying out vital farming activities. This issue, if not addressed, can cause a multitude of problems, ranging from the exploitation of poor farmers at the hands of informal sources of credit, to a slowdown in the adoption of modern farming techniques and inputs, resulting in slow development of this chief sector of our economy. Social, Cultural and Demographic Forces Agriculture generates productive employment opportunities for 45 percent of the country’s labor force and 60 percent of the rural population depends upon this sector for its livelihood. * Established 40 surveillance and 66 rapid response units (RRUs). * Processed 0.4 million samples of blood, tissues and swabs for screening against Avian Influenza * Establishment of the Bio security Laboratory-3 is under process * Disbursed Rs. 23.5 million as compensation to Avian Influenza affected farmers Pakistan is maintaining Avian Influenza (bird flu) free status since June 2008 million tons was from marine production and the remaining came from inland waters. In July-March, 2010-11 the production was estimated to be 937,082 million tons, where 672,652 million tons was marine and the remaining was produced by inland fishery sector. Recognizing the vital role the sector plays in ensuring food security, generating overall economic growth, reducing poverty and the transforming towards industrialization. Political, Legal and Governmental Forces The present government is determined to improve the quality of life of the people and to banish hunger and malnutrition from the country by making agriculture an efficient, productive and profitable sector of the economy. In order to improve governance in the public sector the government took bold steps and brought in the 18th Amendment to the Constitution of 1973. Accordingly, Ministries performing tasks which were provincial subjects were devolved from the Federal level, including the Ministry of Food and agriculture. Two major steps in order to solve the food security issues on a permanent basis; The first step is the establishment of the National Food Security Council representing Federal, Provincial and local level Governments. Secondly, through a Letter of Intent the Ministry, in collaboration with World Food Program, is launching the Zero Hunger Program  worth US $ 1.6 billion to address the food security objective. A total of 290 veterinary clinics have been established providing veterinary services at 70 percent reduced costs to rural farmers at their door steps i.e. 100 percent achievement. Technological Forces The Federal Seed Certification and Registration Department (FSCRD) is engaged in providing seed certification coverage to public and private sector seed companies of the country. It provides seed quality control services through its 28 seed testing laboratories as well as monitoring of seed quality in the market. The activities and achievements of the department during 2011-12 are described below: * During the year 2011-12, forty-five (45) new seed companies were registered, making the total number of registered seed companies in the country 774, which includes four public sector and five multinational companies. * Twenty-two (22) new crop varieties were approved {(5) wheat, (11) cotton, (3) oilseeds, (2) pulses and (1) fodder}. * During 2011-12, different crops offered by the various seed agencies, totaling 502.6 thousand acres, were inspected for certification purposes. * During 2011-12, a total of 13.7 MT of imported seed of various crops and hybrids, with a total value of Rs. 3287.6 million, was tested under the Seed (Truth in Labeling) Rules. 1991 at the port of entries i.e. Lahore and Karachi. * Almost 718 samples of seed and propagating material of various vegetable and fruit crops were tested at the Central Seed Testing Laboratory, Islamabad for detection of fungal and viral disease using latest diagnosis techniques and protocols. The Federal Seed Certification and Registration Department (FSCRD) is engaged in providing seed certification coverage to public and private sector seed companies of the country. It provides seed quality control services through its 28 seed testing laboratories as well as monitoring of seed quality in the market. Competitive Forces Pakistan is member of the Cairns Group (an alliance of 18 countries looking for ambitious outcome in the Market Access areas), G-20 (group for safeguarding interest of developing countries in agriculture negotiations) and the G-33 (group of developing countries and LDCs aiming to get preferential terms in Market Access and Special and Differential treatment). In negotiations on market access, domestic support and export competition, Pakistan’s stance is supportive of the G-20 collective position. Pakistan strongly supports improvement in market access by reducing tariffs, reducing tariff escalation, and eliminating tariff peaks. Pakistan also works closely with the Cairns Group on tropical products issues. Pakistan has entered into Free Trade Agreements (FTA) with China, Malaysia and Sri Lanka and has exchanged a draft FTA with Singapore which includes an investment protection clause. In addition to WTO membership, Pakistan is party to two agreements for regional trade liberalization. The Economic Cooperation Organization (ECO) comprised of Turkey, Iran, Afghanistan, Azerbaijan, Kazakhstan, Kyrgyz, Tajikistan and Turkmenistan; and the South Asian Association for Regional Cooperation (SAARC) with India, Bangladesh, Sri Lanka, Bhutan, Nepal and the Maldives. A Trade and Investment Framework Agreement (TIFA) have been in place between Pakistan and the United States since July 2003. Both countries are now negotiating a Bilateral Investment Treaty (BIT). Telecom Industry Telecommunication: Word Telecommunication has two parts. One is Tele and other is Communication. Communication means conveying or disseminating the information. Word Tele is a Latin word which means far off. Telecommunication is the dissemination of signals to a far palace for the purpose of sharing some message or idea. In ancient time codes, smokes, drums or other components were used for conveying information but now a day telephones, fax, emails etc is used. So now the new definition of Telecommunication states sharing of data over a distance, through electric means. Telecom Sector in the World: In this fastest growing world information flows through the signals and cables in form voice or text. Telecommunication is not just bringing the people together but it is also bringing different economies, cultures and countries together. Now we can see the whole world as a Global Village. Now Telecommunication is an essential part of our lives. With the Expansion of this sector, the world has gained about $3.85 trillion in year 2008. And the service revenues have reached about $2 Trillion and Expected to reach the level of $3 Trillion in 2013. And this revenue is about 3% of the World GDP. The major part of telecom sector is internet and Telephones. Telecom Sector in Pakistan: Pakistan is on the verge of Telecom revolution Pakistan continues to be one of the fastest growing telecom markets in the world. Reforms introduced by successive Pakistani governments over the last decade have dramatically changed the nature of telecommunications in the country. The Pakistani telecom sector has attracted more than $9 billion in foreign investments. During 2007-08, the Pakistani Communication sector alone received $ 1.62 billion in Foreign Direct Investment (FDI) – about 30% of the country’s total foreign direct investment. By March 2009, Pakistan had 91 million mobile subscribers – 25 million more subscribers than reported in the same period 2008. In addition to 3.1 million fixed lines, while as many as 2.4 million are using Wireless Local Loop connections Pakistan is ranked 4th in terms of broadband Internet growth in the world, as the subscriber base of broadband Internet has been increasing rapidly with the total base crossing 170,000 in the country. The rankings are released by Point Topic Global broadband analysis, a global research centre. Pakistan according to PC World was amongst those top five countries with the highest SMS traffic processed with 763 million SMS during 2008-09. In terms of year-on-year growth, Pakistan traffic volume grew by 253 percent compared to last year during the same period. The contribution of telecom sector to the national exchequer increased to Rs 110 billion in the year 2007-08 on account of general sales tax, activation charges and other steps as compared to Rs 100 billion in the year 2006-07.Pakistan telecom industry is handling the telecom companies  which are operating at this time like Mobilink, Ufone, Warid, Telenor, Zong etc†¦

Advertisement Is a Legalised Form of Lying Essay Example for Free

Advertisement Is a Legalised Form of Lying Essay Necessity is the mother of invention is an oft-quoted saying. But now-a-days the reverse of it is more true. In modern business, invention is mother of necessityIn this age of machinery, newthings are produced everyday. Market is created for these things through advertisementBusinessmen advertise their goods in various ways and thus spread a knowledge of their goodsamong the customers. It is through advertisement that people begin to feel a need for even those goods of whichthey had never heard before. Advertisement creates demand. it is the backbone of commerce and Industry. No business can stay in the business world without advertisement. A successful businessman is one who snatches away money from even the most miserly and reluctant customer. Thus, the business world rotates on the pivot of advertisement. As the world is progressing, so the means of advertisement are also increasing. We allknow that big posters are pasted on the walls, and handbills are distributed to advance the sale of goods. Walls are painted and big signboards are displayed on crossings and prominent places toserve this purpose. In a cinema hall, first of all we see the advertisement slides. A major part of thedaily newspapers is full of advertisement. Situations Vacant, Tender Notice, Educational, Lostand Found, Matrimonial, cinema advertisements, and advertisements of so many other commodities are regular features of all newspapers. Radio and Television also are being used asmeans of commercial advertisement. A good advertisement must have certain qualities. First, it should be based on human- psychology. A thing meant for ladies, should be advertised in such a way that they are attractedtowards it. If men are to be customers, then it should appeal to their tastes. Goods for differentincome groups should be advertised, taking into consideration their purchasing power. A motor car is a thing for the rich. Its advertisement must be touch the mentality of the rich. Usha SewingMachine should be advertised in such a way that the family man, with ordinary income, may feelthe economic advantages of the investment of his money on it. Secondly, advertisements should be attractive. This is very essential. People look towardsan advertisement only if it is eye-catching. Good, interesting pictures are very effective form this point of view. We all know about Sanforised cloth. The advertisements to show that quality of the cloth display a man wearing a suit of non-sanforized cloth. He appears funny and uncomfortable ashis suit has gone out of fit by washing. Another man is shown wearing a suit of Sanforised cloth. How smart and active he appears. We immediately learn that Sanforised cloth is best because itdoes not shrink. So a good advertisement must be interesting, attractive and eye-catching. But proper sanctity must be maintained and unnecessary exposure must be avoided. It must also befrequently repeated, otherwise people forget all about the goods advertised. do not like to waste their time on things which do not concern them. So to be successful,advertisement must be brief. Long descriptive stories or certificates of praise about certain thing donot make good advertisement. This is an important point in advertising and a good advertiser mustkeep it in mind. Advertisements are not concerned with the good or bad quality of goods. Even the mostinjurious goods are advertised these days. Advertisements of undesirable drugs and medicines andindecent literature, so common. They simply cheat the public. So we should be careful while purchasing an advertised article. We should use our own mind, instead of blindly following theadvice of the advertisement. In our country, the art of advertising is in its infancy. in progressive countries, likeAmerica, big business concerns have specialists and experts for this purpose. They spend hugeamounts of money on advertisement. But it is not so in our country. Some businessmen consider their products to be very superior. They think advertisement unnecessary. This is undesirable. Toget success in business every big or small business-concern must make effective us of art of advertising goods. To run a business without its aid is not possible in the modern age. â€Å"the advertisement for the body-spray, Impulse. The whole idea of a man absorbed in hisdaily routine being suddenly roused out of it by a whiff of Impulse and then going through a seriesof impulsive actions to compliment the lady wearing it, is romantic and endearing to most women. This combined with the light, tinkling piano accompaniment and soft-focus filming makes theadvertisement an attractive one. Then we have the newspaper and magazine advertisements, invibrant color, interesting graphics and witty slogans. Take a look at most cosmetic advertisementslike Maybelline or Cover girl, where the page is attractively splashed with the newest colors themanufacturer has come up with a pretty, lively girl caught in mid-laughter. Therefore, advertisements today are generally interesting due to the visual and sound effects made possible yadvanced technology in the various mediums of print, sound and film, and a little imagination,especially when rival companies try their best to attract consumers and so try to advertise better. Are they useless? Not necessarily. In many ways advertisements help to keep the cost of most publications low so that we can afford them quite easily. This applies in the case of our dailynewspaper â€Å"The Straits Times†, the Sunday â€Å"Asia Magazine†, the popular â€Å"Readers Digest† andespecially the publication we are all familiar with, our respective school magazines. Theadvertisers pay to advertise and this payment subsidizes publishing cost so that we pay less thanwhat we might otherwise have to pay. Advertisements also help to ease our boredom sometimes. How many times have people been roused out of a bored stupor once they see an interestingadvertisement on a billboard or bus or when lazily flicking through a magazine? Also,advertisements either interesting or otherwise, especially of otherwise, do promote conversationamong friends when they discuss them, how an advertisement is so silly, or another is unusual andimaginative and yet another is introducing an interesting and attractive product which might beworth buying. This then brings us to the last point. Are advertisements misleading? One of their uses is that they inform us as to what is available on the market, but is this informationwholly true? Their main function is to attract buyers so naturally, only certain details regarding a product are highlighted while others are not provided at all. We are made to believe that a productis long-lasting, worthwhile, multi-purpose and bound to give us that happiness we cannot findelsewhere. Perfume advertisements promise to bring the opposite sex falling at one’s feet,dictionary and encyclopedia advertisements promise to give us all the wisdom and knowledge inthe world, cosmetic advertisement for â€Å"Ponderosa Steak Salad Restaurant† promises juicy andtender steak and delicious salad. I have eaten there and found the steak to be of very low quality,for a very high price, but the salad was everything the advertisement led me to believe. conclusion:So in conclusion, I would say that modernAdvertisements are boring, unless and oftenmisleading. †

An Overview Of Peptic Ulcer Disease Health Essay

An Overview Of Peptic Ulcer Disease Health Essay Peptic ulcers are one of the most common gastrointestinal tract disorders. The recent past few decades have witnessed an increase in the rate of peptic ulcers occurrence in our human community (Thompson, 1996). It has evidently been shown from available statistics that an approximated over 10 percent of the human population are extremely at risk of suffering from the disease at some point in their lifetime (Cohen, 2007). Such statistics have also identified that peptic ulcers is more common in men than in women. This is attributed by many to the higher numbers of men engaged in alcohol drinking and cigarette smoking in the society compared to women (NDDIC, 2004). A peptic ulcer is a sore wound or red erosion area on the coating lining of the stomach called (gastric ulcer) or the small intestine called (duodenal ulcer). Duodenal ulcers tend to occur between the ages of 25 75, while gastric ulcers peak between the ages of 55 and 65. Other causes which have been associated with the dis ease include infections by helicobacter pylori. This is a bacterium which is known to attack the gastrointestinal tract thus leading to ulcers. However, it should be noted that genetic factors have also been claimed to cause peptic ulcer. There are many effects of peptic ulcer in the human body. Such include recurrent pains along the gastrointestinal tract, vomiting heartburns poor appetite and weight loss among others (The American College of Gastroenterology, 2009). It should however be realized that with our modern advancements in the medical field the treatment of peptic ulcers is now effective and sufficiently reliable. Such treatments might involve medication, dictated lifestyle, dietary supplements and undergoing surgical operation depending on the severity of the condition. Peptic Ulcer Disease Peptic ulcer disease had a great effect on morbidity and mortality until the last decades of the 20th century, when epidemiological trends started to point to a remarkable fall in its incidence. In addition, two important developments are associated with the decrease in rates of peptic ulcer disease: the discovery of effective and strong acid suppressants, and of Helicobacter pylori. The treatments of peptic ulcer disease have been changed with the discovery of the causes of peptic ulcer (Malfertheiner, P. Chan, F. McColl, K. 2009). Although significant advances in sciences, this disease remains an important medical problem, because the large use of non-steroidal anti-inflammatory drugs (NSAIDs), excessive smoking, increase alcohol consumption, and life style that increase the risk of the disease. Therefore, this explains the reason for choosing this topic in order to promote healthy behavior and improve health outcomes throughout lifespan by giving attention to the preventive measures. This paper is written as a critical analysis and discussion of peptic ulcers disease. It gives a discussion on the causes and effects of peptic ulcers in the human body. Still discussed are the signs and symptoms, diagnosis, treatment and prevention of the disease as well the common types of peptic ulcers that are found in the society. Peptic Ulcers Overview First is a definition of peptic ulcer and its types. An ulcer can be defined as; an area in digestive system where the tissue has been damaged or destroyed by stomach acid and other digestive enzyme. Peptic ulcer disease is a common term for ulcers that occur either in the stomach or upper part of the small intestine. A peptic ulcer is a lesion or open sore in the wall of the gastrointestinal tract. The digestive enzyme which is acidic and is secreted by the stomach cells oxidized the lining of the stomach or upper part of the small intestine (duodenum) causing ulcer. Therefore, eroding can be seen in the mucous membrane which is lining the digestive tract. Moreover, this will lead to cause a gradual breakdown of tissue. This breakdown causes a concerning or burning pain in the upper middle part of the abdomen (Stratemeier, 2009). Even though most of peptic ulcers are small in size, ulcers average between one-quarter and one-half inch in diameter they can cause a significant amount o f symptoms and discomforts. It is to be noted here that the pain caused by peptic ulcers is recurrent and may come and go for a few days or weeks but mainly goes after eating. In addition, there are two different types of peptic ulcers namely; duodenal ulcers and gastric ulcers. Stomach or gastric ulcers is the type of peptic ulcers which mainly affects the stomach while duodenal ulcers affect the upper most part of the small intestine near the stomach. Ulcers can happen at any age, although they are rare in children and teenagers. Duodenal ulcers usually occur twice as common in men more than women. On the other hand, stomach or gastric ulcers usually occur in people older than 60 years and are more common in women (Stratemeier, 2009). It is difficult to estimate exactly how common peptic ulcers are because so many people they will not suffer from any symptoms. However, a study that tested 1,000 adults at random found that four per cent of them had a peptic ulcer (NHS Choices, 2009 ). Causes Second is a discussion on the causes of peptic ulcers. To start with, in the normal lining of the stomach and small intestines there are a protective process from auto digestion by the gastric mucosal barrier, this gastric mucosal barrier will prevent the irritating acids from diffusing back to the underlying tissue. This defensive process can stop working properly, and the lining of the stomach or intestine breaks down for different reasons. Scientific evidence has sufficiently proved that peptic ulcers are caused by the malfunctioning of the stomachs natural lining protection mechanisms against the damage effects of digestive juices (NDDIC, 2004). Such malfunctioning have been claimed to be caused by a number of factors, like is the helicobacter pylorus, a bacterial organism which is the most frequent cause of peptic ulcers. This bacterium mainly eats the protective lining of the gastrointestinal tract. This allows the digestive juice produced by the human body to damage the inner and sensitive part of the stomach or duodenum lining thus causing pain. Just to be stated here is the evidence that though helicobacter pylori is the most common cause of peptic ulcers, there are many people in our population living with the bacteria but do not exhibit signs of the disease (Thompson, 1996). Still clear is that H. pylori is believed to be transmitted through oral to oral contact, so those living in crowed areas increases ones chances of contracting the infection. Another common cause of peptic ulcers is the continuous use of painkiller drugs such as, aspirin, ibuprofen, naproxen or other non-steroidal anti-inflammatory drugs. Scientific evidence has clearly shown that such drugs are highly acidic and thus can easily lead to the wearing out of the digestive system lining (NDDIC, 2004). Still evident is the fact that this type of drugs blocks the flow of prostaglandins in the human body. It should be understood that this is the substance which is responsible for helpin g the flow of blood in the stomach and thus it helps in protecting the stomach from injury. This means that such drugs can compromise the stomach lining protection mechanism of the body and thus risking the occurrence of peptic ulcers in the body (Lanza, Chan, Quigley, 2009). Other causes of peptic ulcers include Zollinger-Ellison syndrome. This is commonly said to be a condition in which the pancreas and duodenum which are responsible for the production of gastric acid have a tumor. Such leads to the excessive production of gastric acid which is responsible for digestion of food in the stomach, a factor which might risk causing ulcers (Dugdale, D. Zieve, D. 2008). In adding together, it has been evidently noted that peptic ulcers are genetic. Therefore, if you have a family history of ulcers or the blood type O, you are more likely to get a duodenal ulcer (Shayne Miller, 2009). Still established is the fact that cigarette smoking and excessive intake of alcohol are not only a ca use of peptic ulcers but also a great threat to the efficient treatment of ulcers. Apart from the many causes of peptic ulcers, are any thing that leads to the direct damage of the digestive wall lining. Such might include physical injury or even radiation therapy. Likewise, a very sick patient who is on a ventilator support is at high risk for a condition called stress ulceration. It is here to be noted that unlike many belief, diet has not been scientifically proven to cause peptic ulcers (Dugdale, D. Zieve, D. 2008). The last and most common factor to peptic ulcers is living in chronic stress or depression (Shayne Miller, 2009). This has been claimed to lead to the excess production of digestive acids thus eating out the stomach lining. Sign and Symptoms Thirdly is a discussion on the signs and symptoms of peptic ulcers. The most common symptom of peptic ulcers is having recurrent abdominal pains which are marked with a burning sensation. Such pains are located in the upper middle part of the abdomen. Also it can be felt like burning or gnawing and it may radiate to the back. It can be aggravated when the stomach is empty, and can worse at night and early morning. Another sign is the constant experiencing of heartburns and indigestion. It is to be noted that though peptic ulcers are more painful when the stomach is empty, such are a leading cause of lack of appetite and vomiting on the individual. Peptic ulcers are also attributed to the sudden loss of body weight in (gastric ulcer) because eating does not relieve the pain and could still worsen it. Yet (duodenal ulcers) will lead to gain weight because the patient eats to relieve pain (Lanza, Chan, Quigley, 2009). Other symptoms of peptic ulcers include the following: discomfort, B loating, and feelings of fullness. Added more symptoms are, feeling of an empty in the stomach, regurgitation (feeling of acid backing up into the throat), and belching. Still to be noted is that peptic ulcers have been closely associated with chest pains and feelings of fatigue. It should however be noted that some symptoms like sudden increase in abdominal pains, vomiting of blood and blood in stool are considered as critical signs of chronic peptic ulcers. All this signs are symbolic of the possibility that ulcers have either broken a blood vessel or perforated the stomach or duodenum walls. Such could also be as a result of the blockage of food from moving from stomach into the duodenum and thus causing vomiting (The American College of Gastroenterology, 2009). Effects of Peptic ulcer Peptic ulcers have many effects in the victims life. The most common is the fact that ulcers in most cases can not be full treated. They are usually recurrent particular to alcohol abusers and smokers. Just to be stated is that the majority of people with chronic ulcers experience considerable pain and sleeplessness; this can have a remarkable and adverse impact on their quality of life (Thompson, 1996). Another effect of peptic ulcers in the body is that they can lead internal bleeding especially when they perforate the stomach lining or break a blood vessel. Peptic ulcers can cause the ultimate obstruction of the gastric outlet, stomach and intestines as well as leading to the inflammation of tissues lining the abdomen. This leads to a serious health complication which might call for a surgical operation or even death (Cohen, 2007). Peptic ulcers if not treated early enough can penetrate into other internal body parts like liver as well as the pancreas and cause severe back pain. I t has also been found out that peptic ulcers can lead to perforation of the wall of the digestive system thus leading to the spilling of digestive system contents into the abdominal cavity. Such are very catastrophic to the patients life as can lead to acute peritonitis (The American College of Gastroenterology, 2009). It should also be noted that peptic ulcer can lead to the swelling of the abdominal wall thus compromising the free flow of food in the digestion system. Lastly, it has been established that peptic ulcers are a great contributing factor in causing peptic cancer. Such could mean a lifetime health complication on the person. This is because even after undergoing surgery operation for treating the problem, it is rarely possible for the individual to fully assume his or her normal lifestyle (NDDIC, 2004). Diagnosis Owing to our modern advancements in technology and medical research, the diagnosis, treatment and prevention of peptic ulcers has been made easier and more reliable. The diagnosis of peptic ulcers mainly involves an interview by the doctor to identify the presence of the many symptoms and signs of the condition. Such include recurrent abdominal pains, vomiting and blood in the patients stool (Cohen, 2007). It should however be noted that for a doctor to qualify a patient to be suffering from peptic ulcer requires for a number of medical tests. The first is the esophagogastroduodenoscopy which involves the insertion of a thin tube attached to a camera through the patients mouth into the digestive system. This helps the doctor to see the presence of sore in the stomach and small intestine walls. It should be noted here that helicobacter pylori is the most common cause of peptic ulcers (NDDIC, 2004). It is due to this reason that the doctor might take a biopsy from the patients stomach walls to test for the presence of the bacterium. Another test which is conducted is the upper G1 test. This involves a series of x-rays on the patients abdomen and is usually conducted after the patient has taken barium (Shayne Miller, 2009). It should be understood that the doctor might also request for a laboratory test of both blood and stool. The stool test seeks to establish the presence of blood in the patients stool while the hemoglobin test checks for anemia. All this tests are conducted as a way of ascertaining the level of the condition which helps in deciding the type of medication to be used. Treatment Treating of peptic ulcers has been greatly improved not only due to our medical advancements but due to the identification of the two major causes of disease among other risk factors. The treatment of peptic ulcers is mainly conducted as a concern for eliminating the underlying causes of the disease. This is because such an approach prevents any further damage and thus reducing chances of reoccurrence of the condition. Therefore, medication is mainly given for eliminating the helicobacter pylori bacteria as well as helping the body overcoming the symptoms of peptic ulcers. Many antacids are available without a prescription, since they are the first drugs suggested to alleviate heartburn and mild digestive disorders. Antacids are not useful to prevent or heal the ulcers; however they are able to assist in the neutralizing stomach acid. When the cause for the ulcer is H. pylori infection, a three-drug course of therapy for two weeks is the standard therapy for curing. This three-drug c ourse of therapy consists of two antibiotics and a proton pump inhibitor (PPI). The most common antibiotics usually used to treat H. pylori infections are amoxicillin, or metronidazone. Proton pumps inhibitor (PPI) therapy (such as omeprazole or lansoprazole) these are drugs that reduce acid secretion by inhibiting the gastric acid pump. Other medications may include one or more of the following: Acid blockers (such as cimetidine or ranitidine) (NDDIC, 2004). However, if a peptic ulcer bleeds severely, an Endoscopy might be needed to stop the bleeding. Otherwise if the bleeding cannot be stopped with an Endoscopy, surgery might be essential. This involves the physical removal of the sores in the stomach or duodenum through endoscopy. A further surgical procedure is vagotomy which is cutting one or more branches of the vagus nerve to reduce hydrochloric acid secretion (Dugdale, D. Zieve, D. 2008). Apart from medication and surgery as ways of treating peptic ulcers, doctors usually a dvice on self-control from risk factors by the patient. These mainly include alcohol abuse and cigarette smoking as well as changes in diets. It has been evidently proved that taking of foods rich in fibers greatly reduces chances of sustaining peptic ulcers Prevention It should be noted that prevention is better than cure. It is therefore mainly advised that people avoid risk factors which can lead to peptic ulcers. In the past, it was broad way to tell people with peptic ulcers to change the way of eating habits by consuming small amount of meals, and frequent amounts of bland foods. Also people can stay away from peptic ulcers by avoiding things that increase stomach acid secretion and break down the stomachs protective barrier. These things include alcohol consumption, cigarette smoking, and non steroidal anti-inflammatory drugs along with aspirin. For preventing H. pylori caused peptic ulcers, people are advised to avoid living in crowded places, avoid contaminated water or food, and stick to strict principles of precautions as well as personal hygiene (NDDIC, 2004). Furthermore some evidence suggests that exercise may help reduce the risk for ulcers in some people. Other than, stress relief programs have not been shown to promote ulcer healin g, but they may have other health benefits (Stratemeier, 2009). In conclusion, it has been evidently established that peptic ulcers is becoming a common disease across the globe. Which can affect quite a lot of people especially Cigarette smokers and alcohol consumers. In addition the main causes of this disease are helicobacter pylori and non-steroidal anti-inflammatory drugs. It has however been clear recognized that there are many risk factor to the disease. Men are more victims to the disease as opposed to women (NDDIC, 2004). Such have been mainly attributed to genetic and hormonal composition of men as well as to the high prone rate of men to risk factors as compared to women. It was also clear that the ulcer caused by numerous reasons, and these reasons leading to several effects such as bleeding, perforation, and obstruction. However, peptic ulcers can be cured and even prevented if the patients are ready to modify their lifestyle and stick to their drug remedy. At last, the need for health educational activities is compulsory to increase the perception and awareness about the disease in the society. References Cohen, S. (2007). Peptic Ulcer Disease. Retrieved December 25, 2009, from http://www.merck.com/mmpe/sec02/ch013/ch013e.html Dugdale, D. Zieve, D. (2008). Peptic Ulcer. Retrieved November 25, 2009. from http://www.healthline.com/adamcontent/peptic-ulcer Lanza, F., Chan, F. Quigley, E. (2009). Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol, 104, 728-738. Malfertheiner, P. Chan, F. McColl, K. (2009) Peptic Ulcer Disease. Retrieved November 25, 2009. from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60938-7/abstract National Digestive Disease Information Clearinghouse. (2004). H. Pylori and Peptic Ulcer. Retrieved November 30, 2009, from http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/hpylori.pdf NHS Choices. (2009). Peptic Ulcer. Retrieved November 25, 2009, from http://www.nhs.uk/conditions/peptic-ulcer/Pages/Introduction.aspx Shayne, P., Miller, W. (2009). Gastritis and Peptic Ulcer Disease. Retrieved December 25, 2009, from http://emedicine.medscape.com/article/776460-overview Stratemeier, M. (2009) Peptic Ulcers. Retrieved November 28, 2009. from http://www.emedicinehealth.com/peptic_ulcers/article_em.htm The American College of Gastroenterology. (2009). Peptic Ulcer Disease. Retrieved November 30, 2009, from http://www.gi.org/patients/gihealth/peptic.asp Thompson, W. (1996). The Ulcer Story: The Authoritative Guide to Ulcers, Dyspepsia, and Heartburn. New York: Plenum.