Knowledge Management - the Knowledge Creating Company Essay

Knowledge Management - the Knowledge Creating Company - Essay Example Another important element of the Japanese perspective on knowledge is how an organization is treated as a living organism. It is not merely a separate legal entity or merely a machine for production wherein people are divided into parts that play specific roles but considered as sentient due to the collective sense of identity and fundamental purpose. According to Nonaka, this makes the area of research, product development, marketing and planning not exclusively the domain of research and development or marketing departments. Rather, each employee contributes something and is a working and functional knowledge worker. The above points were supported by several principles and Nonaka attempted to be as comprehensive as possible, outlining many very important ones. For instance, he cited the idea that innovation would always come from an individual – a manager who has the skill to keep up with the fickleness of the market, a researcher who has the knowledge to develop effective strategies or a cleaner who may have a brilliant idea about effective processes based on his work experiences. So each employee in an organization regardless of his or her position is considered a source of excellent ideas.

Decreasing agitation in demented resident in nursing home Assignment

Decreasing agitation in demented resident in nursing home - Assignment Example Keywords: agitation, dementia, nursing home, nurse leader, evidence based practice Decreasing Agitation in Demented Patients Living in Nursing Home Behavioral and emotional disturbances, particularly agitation, are the major problems commonly observed in impaired elderly people dwelling in nursing homes, particularly those who are suffering of dementia. According to Tariot, Daiello and Ismail (2002, p. 2), behavioral symptoms affect a large population of dementia patients in the United States, where â€Å"as many as 90% of patients with dementia develop significant behavioral disorders at some point.† Based on a clinical research conducted by Bartels, et al. (2003, p. 236), the condition of patients with dementia is â€Å"complicated by mixed agitation and depression accounts for over one-third of complicated dementia†. Compared with other subgroups, elderly patients with dementia which are also experiencing bouts of agitation have the â€Å"highest rate of hospitaliza tion, the greatest number of medical diagnoses, and the greatest medical severity, and they receive the greatest number of psychiatric medications (Bartels, et. al. 2003, p. 234)†. As such, there is a great need to decrease agitation in dementia patients especially in the nursing home settings. Studies on psychiatric disorders recommend that agitation symptoms in patients with dementia should be efficiently treated through proper diagnosis and medication, together with the efficient management of the nurses and caregivers in enhancing the clinical outcomes according to evidence based practices (Salzman, et al., 2008). Cohen-Mansfield, Marx and Rosenthal (1990, p. 3) defined agitation as â€Å"inappropriate verbal, vocal, or motor activity that is not a necessary by-product of the needs or confusion of the agitated individual.† Agitated behavior may be manifested as an appropriate behavior executed with inappropriate rate of recurrence or it may be inappropriate based on social standards for the particular situation, as exemplified by the three syndromes such as aggressive behaviors, physically non-aggressive behaviors, and verbally agitated behaviors. The abusive or aggressive behavior of a patient may be directed towards him or others and are often apparent in the advanced stages of dementia. Physically non-aggressive behaviors are observed as adaptive to nursing home residents during their deteriorated stage of dementia, where their bodies need to be stimulated or undergo physical exercise. Verbally agitated behaviors are regarded as a form of help-seeking behaviors by patients that are experiencing depression and physical diseases (Cohen-Mansfield, Marx and Rosenthal, 1990). In addition, agitation may be brought by various physical and emotional factors like fears, insecurity, frustrations, and false beliefs brought about by impaired hearing, sight, or aphasia, most commonly observed in persons with cognitive impairment (Cohen-Mansfield, Marx a nd Rosenthal, 1990). There are also reports that nursing home staff frequently misapprehends symptoms of cognitive impairment as agitation instead of thoroughly checking if the said behavior stems from other reasons such as pain, hunger, boredom, fatigue, environmental chaos, or consequence of medical issues or medications. Sedatives and atypical antipsychotic drugs are usually administered to patients exhibiting dementia-associated agitation and

The Car Rental Industry In The Us Economics Essay

The Car Rental Industry In The Us Economics Essay The car rental industry is a multi-billion dollar sector of the US economy. The US segment of the industry averages about $18.5 billion in revenue a year. Today, there are approximately 1.9 million rental vehicles that service the US segment of the market. In addition, there are many rental agencies besides the industry leaders that subdivide the total revenue, namely Rent-A-Car, Dollar Thrifty, Budget and Vanguard. The rental car industry is highly consolidated which naturally puts potential new comers at a cost-disadvantage since they face high input costs (since companies in this industry have revenues of billions of dollars), with very low possibilities of economies of scale. Moreover, most of the profit is generated by a few firms including Enterprise, Hertz and Avis. For the fiscal year of 2006, Enterprise generated $7 billion in total revenue. Hertz came in second position with about $3.9 billion and Avis with $2.75 in revenues. During this year, revenues were about $20 billio n, with the top six companies having combined market shares of over 90 percent. Competition in this industry goes beyond nationally, companies are expanding globally, and for example Rent-A-Car is operating in the U.S, Canada, U.K, Ireland and Germany. In the U.S market there is a strong competition between the six largest companies, especially between Enterprise Rent-A-Car and Hertz for the rental facilities in airports. The level of vertical integration in the industry has been reduced in the last decades, by letting these companies more flexibility in the market and leading to higher profit margins. In fact, among the industry players only Hertz is vertically integrated through Ford. The market size of this industry is large so there is high demand for renting, but due to the very strong competition, the profit margin is not so high or attractive, moreover, it is best attained by economies of scale. Competitiveness has risen to such an extent that, according to Business Travel Ne ws, vehicles are being rented until they have accumulated 20,000 to 30,000 miles until they are sent for sale to the used car industry. What is competition like and how strong are the competitive forces? There are many factors that shape the competitive landscape of the car rental industry. Competition is fierce not only because the market is saturated and well guarded by industry leader Enterprise, but competitors operate at a cost disadvantage along with smaller market shares since Enterprise has established a network of dealers over 90 percent the leisure segment. On the corporate segment, on the other hand, competition is very strong at the airports since that segment is under tight supervision by Hertz. Competitively speaking, the rental car industry is a war-zone as most rental agencies including Enterprise, Hertz and Avis among the major players engage in a battle of the fittest. The five competitive forces Competitive Rivalry Among Sellers There are many factors that drive competition within the car rental industry. Over the past few years, broadening fleet sizes and increasing profitability has been the focus of most companies within the car rental industry. Enterprise, Hertz and Avis among the leaders have been growing both in sales and fleet sizes. In addition, competition intensifies as firms are constantly trying to improve their current conditions and offer more to consumers. Hertz, for example, integrates its Never-Lost GPS system within its cars. Enterprise, on the other hand, uses sophisticated yield management software to manage its fleets. The Potential Entry of new Competitors Entering the car rental industry puts new comers at a serious disadvantage. Over the past few years following the economic downturn of 2001, most major rental companies have started increasing their market shares in the vacation sector of the industry as a way of insuring stability and lowering the level of dependency between the airline and the car rental industry. On one hand, this action has ensured the success in the long run of the existing firms; on the other hand it has made it much more difficult for new entrants to join this market. Existing firms such as Enterprise, Hertz and Avis carefully monitor their competitive radars in order to be ready to attack any potential new entrant in the market. Another barrier to entry is created because of the saturation level of the industry. In 2006, Enterprise had a rental location within 15 miles of 90 percent of the US population. Because of the network of dealers Enterprise has established around the nation, it has become relatively s table, and most importantly, less reliant on the airline industry compared to its competitors. The Threat of Substitute There are many substitutes available for the car rental industry. From a technological standpoint, renting a car to go the distance for a meeting is a less attractive alternative as opposed to video conferencing, virtual teams and collaboration software with which a company can immediately setup a meeting with its employees from anywhere around the world at a cheaper cost. In addition, there are other alternatives including taking a cab which is a satisfactory substitute relative to quality and switching cost, but it may not be as attractively priced as a rental car for the course of a day or more. While public transportation is the most cost efficient of the alternatives, it is more costly in terms of the process and time it takes to reach ones destination. Finally, because flying offers convenience, speed and performance, it is a very attracting substitute; however, it becomes an unattractive alternative in terms of price relative to renting a car. On the business segment, car rent al agencies have more protection against substitutes since many companies have implemented travel policies that establish the parameters of when renting a car or using a substitute is the best course of action. Generally, the threat of substitute is reasonably low in the car rental industry since the effects the substitute products have do not pose a significant threat of profit erosion throughout the industry. The Bargaining Power of Buyers An interesting trend that is currently underway throughout the industry is forcing car rental companies to adapt to the needs of corporate travelers. This trend significantly reduces supplier power or the rental firms power and increases corporate buyer power since the business segment is extremely price sensitive, well informed about the industrys price structure, purchase in larger quantities and they use the internet to force lower prices. The Bargaining Power of Suppliers Supplier power is low in the car rental industry. Because of the availability of substitutes and the level of competition, suppliers do not have a great deal of influence in the terms and conditions of supplying the rental cars. Because the rental cars are usually purchased in large quantities, rental car agents have significant influence over the terms of the sale since they possess the ability to play one supplier against another to lower the sales price. Another factor that reduces supplier power is the absence of switching cost. That is, buyers are not affected from purchasing from one supplier over another. What forces are at work to change industry conditions? One of the most important forces in the car renting industry is the use of internet in companies. Internet has made possible instant linking between renting stores in different locations and provides a lower distribution and inventory cost. What is more, improvement in technology and the installation of different tools, including the GPS system in rented cars has made this industry more competitive for customers. The installation of specialized software in the facilities where cars are given for rent, for checking preferences of customers in different regions, gives details about what cars are mostly preferred and how many of them should be in that store, reducing storage costs. Which companies are in Strongest/ Weakest positions? As a moderately concentrated sector, there is a clear hierarchy in the car rental industry. From an economic standpoint, disparities exist from a number of dimensions including revenue, fleet size and the market size each firm holds in the market place. For instance, Enterprise dominates the industry with a fleet size of approximately 600,000 vehicles along with its market size and its level of profitability. Hertz comes in second position with its number of market shares and fleet volume. In addition, Avis ranks third on the map. Avis is among one of the companies that is having issues recovering its revenue margins from prior to the economic downturn. For instance, in 2000 Avis returned revenues of approximately $4.23 billion. Over the course of the next several years following 2000, the revenue of Avis has been significantly lower than that of 2000. As a way of reducing uncertainty most companies are gradually lowering the level of dependency on the airline industry and emerging t he leisure market. This trend may not be in the best interest of Hertz since its business strategy is highly linked to the airports. What strategic moves are rivals likely to make next? Since this industry operates in very narrow profit margins, it is very important to predict what the competitors next moves will be in order to be as prepared as possible. In 2007 there were some developments in this industry which were concerning Rent-A-Cars executives. These developments included a possible merger between Dollar Thrifty Automotive Group and Vanguard Car Rental as well as direct attacks on Enterprises off-airport rental markets and insurance company clients by Hertz, the second rental company in the industry. Avis uses its OnStar and Skynet system to better serve the consumer base and offers free weekend rental if a customer rents a car for five consecutive days. What are the key factors for competitive success? There are many key success factors that drive profitability throughout the car rental industry. Capacity utilization is one of the factors that determine success in the industry. Because rental firms experience loss of revenue when there are either too few or too many cars sitting in their lots, it is very important to efficiently manage the fleets. This success factor represents a big strength for the industry since it lowers if not completely eliminates the possibility of running short on rental cars. Efficient distribution is another factor that keeps the industry profitable. Despite the positive relationship between fleet sizes and the level of profitability, firms are constantly growing their fleet sizes because of the competitive forces that surround the industry. In addition, convenience is one of the crucial attributes by which customers select rental firms. Another key success factor that is common among competing firms is the integration of technology in their business proc esses. Through technology, for instance, the car rental companies create ways to meet consumer demand by adding the convenience of online rental among other alternatives. Furthermore, firms have integrated navigation systems along with roadside assistance to help their customers find the desired location easier and faster. Is the industry attractive or unattractive and why? There are many factors that impact the attractiveness of the car rental industry. Because the industry is moderately concentrated, it puts new market entrants at a disadvantage. What is more, existing companies in the industries can take measures to attack new entrants. Because of the risks associated with entering the industry among other factors, it is not a very attractive sector of the marketplace. From a competitive standpoint, the leisure market is 90 percent saturated because of the active efforts of Enterprise to dominate this sector of the market. On the other hand, the airport terminals are heavily guarded by Hertz. Realistically speaking, entry in the industry offers low profitability relative to the costs and risks associated. For most consumers, the main determining factors of choosing one company over another are price and convenience. Because of this reason, rental firms are forced to offer more to the consumers for less just to remain competitive. Based on the impact of the five forces, the car rental sector is not a very attractive industry to potential new market entrants.

Stepfamilies and Divroce Essay -- essays research papers

â€Å"Money, frequently cited as the biggest source of stress in family life, is often an even more challenging matter for members of stepfamilies† Statistically, in our world today, half of all marriages will end in divorce. About fifty-percent of our population will also live in a stepfamily environment. In other words, more than half of the American families today, are now or eventually will be in involved in one or more stepfamily situations during their life according to the U.S. Census Bureau in 1990. The â€Å"U.S. Bureau decided to discontinue providing estimates of marriage, divorce, and remarriage, except for those that are available from our current census. Thus many of our current estimates were derived from the 1990 census and earlier sources† (Step Family Fact Sheet, 1). Therefore the exact statistics in regards to stepfamilies today may be more or less from the estimated fifty- percent. Stepfamilies nowadays consist of many family members and are very complex. â€Å"Today’s stepfamily consists of you, me, your kids, my kids, our kids, your ex’es, my ex’es, even our ex’es new mates, and all the kin of these various folks. Stepfamilies give a new meaning to the concept of complex family relationships† (Hildebrand, 255). For that reason, the interactions within this family unit can be complicated and uncomfortable. There are many changes, positive and/or negative, that stepfamilies try to adapt to. For instance, adults take on new parenting roles and children take on new roles as well, such as a new stepparent or sibling. The parents and/or children may be required to relocate into a completely different house in a completely new neighborhood or city, which leads to separation issues with their nuclear family. With all these issues at hand it is obvious that this can be very stressful for everyone. Even more, this causes even more str esses, such as money. An ecological factor such as economics can have a huge impact on stepfamilies. This means financial decisions within a stepfamily have more people contributing to economic decisions. In turn, this can lead to more rules, emotions, and financial wishes and requests. When a couple decides to marry, especially for their second, third, or fourth time, it only brings in past experiences into the picture. Both spouses in the stepfamily most likely are in the work force as well. This also leads to the assumption th... ...ely on each other, and all members of a stepfamily adapt to rely on each other. As the entire family is going through change. In conclusion, money is powerful in our society and always has been throughout history. Therefore money has a major impact on families and research show’s that it may even have a larger impact on stepfamilies. References Clark, Janet A., Leigh, Sharon. Financial Decision Making in Stepfamilies. Retrieved from http://www.muextension.missori.edu/xplor/hesguide/ humanrel/gh6603.htm Facts and FAQ’s- Stepfamily Fact Sheet. Retrieved from http://www.saafamilies.org/faqs/index.htm Fletcher, N. Cynthia, (1992). Living in Stepfamilies: Making Financial Decisions. Iowa State University. Hildebrand, Verna (2000). Knowing and Serving Diverse Families (2nd ed.). New Jersey: Upper Saddle River. Klein, David M., White, James M.(1996). Family Theories. Pill, Cynthia J.(1990). Stepfamilies: Redefining the Family. Family Relations, 39, 2, 186-201. Stepfamilies: Meeting Challenges and Building Strengths (1995). Research Review. Retrieved from http://montana.edu/wwwhd/family/ f1195res.html Keri Smith CFD335-Booth Stepfamilies: Economic Factors

Evolution of Medical Practice Essay

1) Great Cases in Bioethics, compiled & edited by Paul A. Lombardo (2005) [available at the law school copy center] 2) Limits: The Role of Law in Bioethical Decisionmaking, by Roger B. Dworkin (Indiana, 1996) & Strangers at the Bedside: A History of How Law and Bioethics Transformed the Practice of Medicine, by David J. Rothman (Harper-Collins, 1991). [These are available for background material.–on reserve at the Law Library & the Center for Bioethics] The field of Bioethics has developed over the past thirty years as a product of several shifts in American cultural consciousness. The pervasive use of rights-based rhetoric borrowed from the civil rights movement contributed to the evolution in the role of physicians as they relate to patients. An ongoing conversation about the impact of law in shaping medical practice also influenced the current complexion of Bioethics as an area of study. A number of legal cases stand as signposts for critical moments in the history of Bioethics. They mark the changing public perception of the intersection of science, medicine, personal values and law. This seminar explores those cases. The first two weeks of the seminar will include a course orientation and exploration of two cases by the instructor. Each week thereafter will feature a presentation on one or more seminal cases, prepared by one or more students. The second hour of the seminar will be a discussion period that focuses on the cultural impact, legal significance and ethical issues raised by the cases. In addition to a class case presentation and involvement in seminar discussions, each law student will be required to complete a research paper building on material presented during the case presentation. Students should be prepared to choose a topic and presentation date at the first seminar meeting. Guidelines for Class Presentations and papers Each student is required to choose a case and make a class presentation that explores the historical, legal, and ethical context of the case. The rest of the students will prepare for the class by reading the case opinion(s). In the first hour, students should: Present the case in its historical setting, budgeting time to entertain questions during or at the end of the hour. The presentation should highlight critical facts of the case, with particular attention to both facts and arguments that have engendered ethical debate. Describe the responses of commentators (ethicists and other) to the case when it was decided; Note the prevailing norms of that period with reference to the ethical and legal issues in the case—this will require a search of the literature of the period; Be prepared to answer the question: Why is this a paradigm case (or set of cases) in the history of bioethics, in other words, why does this case have enduring significance in ethical and legal debate? Students should plan their seminar presentation by meeting with the Professor well in advance of the scheduled presentation date. Resources: A variety of resources may be used, including journal articles from the legal and medical literature, other cases that preceded and followed it, and contemporary media coverage that will explain the social/cultural reaction to the case. Audio visual aids, including video/audio tapes, slides or overheads may be used to elucidate elements of the case. Depending on the time at which the case occurred and the amount of commentary (of various kinds) it may have generated, each student may use different types of resource material, and may choose a different disciplinary perspective from which to present the case. Research for the presentation should range from popular & professional books and articles that elucidate the case and its impact to information found on the Internet. Students will be expected, as part of the class session, to provide other seminar participants with copies of a detailed outline of their presentation. A bibliograpy (1-2 pages) of sources must accompany the materials. The second hour will involve A discussion with assistance from other students and the Professor, to place the case in the current ethical and legal context. What are the contemporary ethical issues with which the case is now associated? What current cases need to be examined in reference to the â€Å"Great Case?† Where does the debate stand today? What is at stake ethically in the debate and what is your position on the issues? Seminar Paper Each student will be required to write a research paper of significant size and substance on a topic that expands on or relates to the case presented in class. The paper will provide an in-depth exploration of issues raised during the class discussion or in conference with the Professor, and will incorporate reference material discovered during research. The paper should be no less than 25 pages, and should demonstrate familiarity with the scholarly literature in the relevant areas.

The Truth of Obama Care

Obama care 1 The Truth of â€Å"Obama Care† American National Government/ POL201 Nicole Emery Instructor: David Williams Obama Care 2The Truth of â€Å"Obama care† Obama Care is the unofficial name for The Patient Protection and Affordable Care Act which was signed into law on March 23, 2010. In a more general sense Obama Care and the Health Care for America Plan or any such name is a reference to the ongoing health care reform under President Obama. (http://obamacarefacts. com/whatis-obamacare. php) The ACA is landmark legislation designed to increase access to health care coverage for millions of Americans. Wizemann,2011) This legislation represents one of the largest and most comprehensive reforms to the American health care system since the enactment of Medicare and Medicaid in 1965. The ACA seeks to extend coverage to roughly 50 million uninsured Americans, slowing down the growth in the cost of health care, and improving the quality of care health care by chan ging the delivery system. ( Some people who oppose the Act are concerned that it gives the Federal government too much control over personal health care decisions and benefits, forcing a complex one-size-fits-all health system onto the states.Some people who are in favor of the Act want lower health care costs overall by making it affordable for more people. The Patient Protection and Affordable Care Act of 2010 significantly changed health care in the U. S. , making insurance available to 32 million more Americans — a total of 95% of the legal population. The Act, is being phased in over four years. By 2014, every citizen will be required to have health insurance, or face a penalty. However, they can choose how to get coverage.If they already have a plan, either through their employers, Medicaid, Medicare, or privately, they can keep it. Those who can't currently get health insurance will have additional options. They can purchase it from a state-based health insurance excha nge (and possibly get subsidy) or they may be eligible under expanded Medicare guidelines. Obama Care 3 The program is originally designed to add to the federal budget $930 billion dollars.The act was designed to offset the budget by lowering payments to hospitals, Increasing Medicare taxes on higher income households, assessing penalties on employers who don't offer, and individuals who don't take, health care insurance, assessing taxes on various health related activities, and reducing overhead by consolidating the higher education loan program with the Pell Grant program. Although there has been tremendous opposition before; during and after its becoming law, the Supreme Court ruled it was constitutional that all U.S. citizens must purchase health care insurance from a private carrier, or pay a penalty, is for the right for congress to impose a tax. Even with our house of representatives trying numerous times to repeal the law and still keeps getting over ruled. The opposition h as been so great that many Americans think the law has already been repealed. I am sure you are asking yourself what does this mean, when does this come to affect and how does this affect you? Here are the changes that happened in 2010.Medicare beneficiaries who fell into the Medicare Part D Prescription Drug â€Å"donut hole† received a $250 rebate. They received a 50% discount on brand name drugs in 2011 and the doughnut hole are eliminated in 2020. Children were allowed to stay on their parents' health insurance until they turn 26. New private plans were required to cover preventive services with no co-payments, and they are exempt from deductibles. Consumers who applied to new plans have access to an external appeals process if coverage is denied. Insurance ompanies were prohibited from dropping coverage if someone got really sick. They couldn't create lifetime coverage limits. They could no longer deny coverage to children with pre-existing conditions. The same will appl y to adults in 2014. Until then, adults with pre-existing conditions who have been denied coverage will get access to temporary health insurance coverage until the exchanges is set up. These are the changes that happened in 2011Medicare-covered preventative services were Obama Care 4 xempted from deductibles and the co-pay was eliminated. Insurance companies must prove they spent at least 80% of the premium payments on medical services, rather than on things like advertising and executive salaries. Those that didn't were required to provide rebates to policyholders. States were funded to require health insurance companies to submit justification for all rate hikes. Funds were expanded to increase the number of doctors and nurses, and more community health centers — enough to double the number of patients they can treat in the next five years.These are future changes to look forward to. Medical expenses must be at least 10% of income before they are deductible for those under 65. Manufacturers and importers of medical devices will pay a 2. 3% excise tax. Federal funds will increase to allow Medicaid to offer free preventive services, and to extend CHIP for an additional two years. The Federal government will fund states to pay primary care physicians 100% of the Medicare fee. Medicare will start a pilot program to encourage hospitals to bundle services before submitting for payment.Additional taxes will be paid by the 1 million people who make more than $200,000 and the 4 million couples filing jointly who make more than $250,000. Specifically, they would pay 3. 8% Medicare taxes on dividends, capital gains, rent and royalties and 2. 35% (up from 1. 45%) Medicare taxes on income. In 2014, the state-run health exchanges will be set up. Medicaid eligibility will be expanded to include those with incomes up to 133% of the Federal poverty line ($29,000 for a family of four). New subsidies will become available for with incomes up to 400% of the poverty leve l ($88,000 for a family of four).Those who don't purchase insurance will be assessed penalties: 2014 – The greater of $95 or 1% of income. 2015 – $325 or 2% of income. 2016 – $695 or 2. 5% of income. Businesses with 50+ workers must pay $2,000 per worker (except for the first 20) if they don’t offer health insurance. Those that do receive a tax credit of 50% of the premium cost. (Donmoyer, 2012 ) Obama Care 5 References: Wizemann, Theresa.Health Literacy Implications for Health Care Reform: Workshop Summary. Washington, DC, USA: National Academies Press, 2011. p 5. http://site. ebrary. com/lib/ashford/Doc? id=10488622;ppg=19 Copyright  © 2011. National Academies Press. All rights reserved. http://obamacarefacts. com/whatis-obamacare. php The Affordable Care Act Turns Two,Lee Goldberg, Sabiha Zainulbhai, http://www. nasi. org/discuss/2012/03/affordable-care-act-turns-two? gclid=CLOuyv-9vrICFURxQgod3TwALA March 2012 HealthReform. gov, Ryan Donmoyer, â₠¬Å"New Health Care Taxes,† Bloomberg, March 22, 2010) Article