Preventing Pet Theft for Cruel Purposes

Forestalling Pet Theft for Cruel Purposes Sorted out pet hoodlums take felines and mutts for two primary purposes-to use as trap in dogfighting and to offer to labs through B vendors. Since pet robbery is illicit, it is hard to evaluate the quantity of creatures included, yet it is accepted to be during the many thousands yearly. How Are Cats and Dogs Stolen? Felines and mutts can be taken from front yards, patios, vehicles, boulevards, or walkways when the gatekeeper goes into a store and leaves the canine tied up outside. Another famous method to take felines and pooches is to answer allowed to a decent home advertisements. The criminal answers the promotion, claiming to need to receive the creature. Afterward, the creature is offered to a lab or utilized as snare in dogfighting. To forestall pet burglary and for different reasons, it is critical to consistently charge a reception expense and to never part with a creature to an outsider for nothing. Despite the fact that the creature was parted with for nothing, getting the creature thusly, under affectations, can be viewed as robbery by trickiness which is a wrongdoing. B Dealers - Selling Animals to Laboratories B Dealers are creature sellers authorized under the Animal Welfare Act (7 U.S.C. Â §2131) to sell pooches and felines industrially, including to research centers. The guidelines received under the AWA can be found at 9 C.F.R. 1.1, where Class B Licensee is characterized as a vendor whose business incorporates the buy or potentially resale of any creature. This term incorporates dealers, and administrators of a sale deal, as such people arrange or organize the buy, deal, or transport of creatures in trade. Class A Licensees are reproducers, while Class C Licensees are exhibitors. B sellers are arbitrary source vendors who don't raise creatures themselves. To forestall extortion and pet burglary, B sellers are permitted to get pooches and felines just from other authorized vendors and from creature pounds or safe houses. Under 9 C.F.R. Â § 2.132, B vendors are not permitted to got creatures by utilization of affectations, distortion, or duplicity. B vendors are required to keep up precise and complete records, remembering records for [h]ow, where from whom, and when the canine or feline was gotten. B sellers frequently work with bunchers who do the real taking in a pet robbery ring. In spite of government guidelines and record-keeping necessities, pet burglary rings normally take creatures in different manners and exchange them to research centers. Records are handily misrepresented, and creatures are regularly shipped across state lines to limit the odds of somebody finding their taken pet. The American Anti-Vivisection Society records B vendors and their Animal Welfare Act infringement. In one famous case, B seller C.C. Baird lost his permit and was fined $262,700, because of an examination by Last Chance for Animals. LCA is the main association in the U.S. bringing issues to light about B sellers. The USDA keeps up a rundown of authorized B sellers, composed by state. Remember that not all B vendors sell taken creatures to research facilities, and most sell creatures as a feature of the legitimate creature exchange. Trap Animals for Dogfighting Felines, hounds andâ even hares can be taken and utilized as lure in dogfighting. In a dogfight, two pooches are assembled in a fenced in area and battle until the very end or until one can not proceed anymore. Crowd individuals wager on the result, and a huge number of dollars can change hands at a solitary dogfight. Dogfighting is unlawful in every one of the 50 states yet is flourishing among both expert dogfighters and rush looking for young people. The lure creatures are utilized to test or train a pooch to be as horrendous and forceful as could be expected under the circumstances. What You Can Do The Pet Safety and Protection Act of 2011, H.R. 2256, would forbid B vendors from selling creatures for use in research. LCA urges everybody to contact their government lawmakers, on the side of the bill. You can look into your delegate on the House of Representatives site, while your congresspersons can be found on the official Senate site. Discover progressively about the bill from the LCA site. To forestall pet robbery, microchip your creatures and never leave your creature unattended outside. This is sound judgment insurance from pet robbery as well as from predators, introduction, and different dangers. You can get familiar with pet burglary and B vendors from Last Chance for Animals, including more approaches to battle pet robbery by B sellers. Pet Theft and Animal Rights From a basic entitlements point of view, pet robbery is a catastrophe, yet utilizing any creature for dogfighting or for vivisection disregards the creatures rights, whether or not the creature was taken or used to be a pet.

Attention Deficit Hyperactivity Disorder :: ADHD Research Papers Health Essays

Consideration Deficit Hyperactivity Disorder  â â â â Consideration Deficit/Hyperactivity Disorder (ADHD) is a neurological cerebrum issue that shows as a constant example of negligence as well as hyperactivity. ADHD is separated into three subtypes: dominatingly preoccupied ADHD, prevalently hyperactive-indiscreet ADHD, and joined sort ADHD. ADHD starts in youth, and has as of late been comprehended, can persevere into adulthood too. While a few youngsters grow out of ADHD, about half to 60% keep on having side effects into adulthood.      Children who have ADHD are regularly handily diverted by sights and sounds in their condition, can't think for significant stretches of time, are eager and hasty, tend to fantasize, and are delayed to finish undertakings. Grown-ups who have ADHD may have less articulated side effects, for example, Inattentiveness, impulsivity or hyperactivity, Impairment in at any rate two of three territories - work, life at home and in social association with peers, and a past filled with youth indications. The specific reason for ADHD isn't known, in spite of the fact that there are numerous hypotheses.      ADHD is extensively characterized and inescapable, and the side effects ascribed to ADHD likely have a wide range of causes. The underlying triggers could incorporate hereditary vulnerabilities, viral or bacterial diseases, mind injury, or wholesome shortages. There has been a flood in elective ways to deal with ADHD, yet these have been vivaciously contested. There is expanding proof that variations in the quality for the dopamine transmitter are identified with the improvement of ADHD. This bodes well, as indicated by other ongoing investigations, individuals with ADHD as a rule have an anomalous high number of dopamine synapses which dispose of the dopamine before the cerebrum can completely utilize it. The energizer drugs used to treat the confusion are for the most part fit for blocking dopamine synapses. The finding of another conceivable reason originated from the perception that offspring of ladies who smoked during pregnancy are bound to be determined to have ADHD. Given that nicotine is known to cause hypoxia (too little oxygen) in the uterus, and that hypoxia causes cerebrum harm, smoking during pregnancy could be a significant contributing component prompting ADHD.

Startup quotes Reid Hoffman from LinkedIn

Startup quotes Reid Hoffman from LinkedIn Reid Hoffman, born on August 5th in 1967, is a famous entrepreneur founded business network platform LinkedIn.Reid is one of the most knowledgeable (Paypal, Linkedin, Greylock Partners) and well-connect entrepreneurs in the Silicon Valley.Startup quotes from Reid Hoffman#1: AN ENTREPRENEUR IS SOMEONE WHO JUMPS OFF A CLIFF AND BUILDS A PLANE ON THE WAY DOWN#2: IF YOU ARE NOT EMBARRASSED BY YOUR FIRST PRODUCT, THEN YOU’VE LAUNCHED TOO LATE.#3: IN REAL ESTATE THE WISDOM SAYS „LOCATION, LOCATION, LOCATION.“ IN CONSUMER INTERNET, THINK „DISTRIBUTION, DISTRIBUTION, DISTRIBUTION.”#4: EVERY INTERNET ENTREPRENEUR SHOULD ANSWER THESE QUESTIONS: HOW DO WE GET TO ONE MILLION USERS? THEN HOW DO WE GET TO 10 MILLION USERS? THEN HOW WILL YOU GET DEEP ENGAGEMENT BY YOUR USERS.#5: EVERYONE IS NOW AN ENTREPRENEUR, WHETHER THEY RECOGNISE IT OR NOT.#6: ONE THING I LEARNED IN 97, WHEN I THOUGHT THE RIGHT TIME TO FOUND A COMPANY WAS DURING A SWING-UP, IS THAT IT‘S MUCH BETTER TO START DURING A N ECONOMIC DOWNTURN. PARTNERSHIPS ARE EASIER; HIRING IS EASIER; AND THE COMPETITION STARTS LATER.

Climate Change The Agricultural Industry And Suffering...

We are on the verge of severe climate change, caused in part by the agricultural industry and suffering animals, but nobody cares. Climate change is upon us caused in part by the agricultural industry. The animal industry continues to wreak havoc on unfortunate livestock who are kept in captivity, and live a life of pain. While finally, we as humans seem to lack the ethic we need to fix our problems, and save not only ourselves, but the animals we share the world with. Earth’s climate is on a downward spiral, and our agricultural industry is a main cause. Climate change is upon us, and it’s happening faster than scientists predicted over a decade ago (Pollan 872). Most People don’t care about climate change; things have gotten worse than what the models have predicted, despite being what the data predicts the outcome will be. Agriculture is a major part of climate change, and it’s already happening today such as droughts, flooding, erratic weather shifting, and longer growing seasons (Lappà © 854). The massive demand on agriculture, and its growth directly contributes to climate change, and our insatiable appetite is to blame. The dilemma with climate change, is that the sum of every little every day choice that we make that affects our environment, because we are 70 percent of the economy that affects the climate (Pollan 872). The only probable solution to our dilemma is to start making better decisions, and to be cons cious of our environment. A key decision we could make toShow MoreRelated Essay on Global Warming: The Effects of Climate Change1410 Words   |  6 PagesClimate change is a long-term alteration in the statistical distribution of weather pattern over periods ranging from decades to millions of years. The world is currently experiencing drastic change in temperature. 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Woman Hollering Creek By Sandra Cisneros - 1587 Words

The book Woman Hollering Creek, by Sandra Cisneros highlights many examples of â€Å"everyday verbal mythology† in the Hispanic culture, literacy and language as sites of conflict build up. The violence in lack of translation, interpretation by translators, culture betrayal and existence of encoded language only familiar to insiders are some of the issues that seems not to appeal to the translators. The sufferings and subordination of both the culture and language by the leading culture is accompanied by other elements that erupt from â€Å"unconscious† of the book’s author to make things work for its conscious signification. The author says that â€Å"[The poem is] Pretty in Spanish. But you ll have to take my word for it. In English it just sounds goofy. (161). this clearly highlights the issue of untranslatability of the discourse subordinated culture to the dominant languages. The untranslatability of the Spanish language, the unpronounceability of Spanish and Amerindian name and the invisibility of silencing of Chicanos are all figured out by Sandra. Spanish operates in the text as a sign of insider status, specifically the bilingual Spanglish which, according to Castillo s poet-narrator, is spoken with an outrag accent splattered with Chicanismos, one could only assume was done with some intention (54). The character, Cleofilas, calls the mixture Spanish po cked with English, the metaphor, perhaps inadvertently, evoking disfigurement and disease (55). Woman Hollering Creek,Show MoreRelatedWoman Hollering Creek By Sandra Cisneros1519 Words   |  7 Pagesideals and their alternative outcomes of the short story â€Å"Woman Hollering Creek† by Sandra Cisneros. In this short story we have the protagonist by the name of Cleà ³filas whose father has agreed to let Juan Pedro Martà ­nez Sà ¡nchez take his daughter for a bride. 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The Differences of Teenagers in the 1940s Compared to Teenagers Today Free Essays

The Differences of Teenagers in the 1940s Compared to Teenagers Today Elizabeth Ann Murphy Keller Regional Gifted Center, Chicago Teacher: Sandra Cap â€Å"Teenager† was not even a word until the late 1940s. Zoot suits, bobby-soxers, soda shops, do not sound familiar. These were all things 1940 teenagers know. We will write a custom essay sample on The Differences of Teenagers in the 1940s Compared to Teenagers Today or any similar topic only for you Order Now A teenager’s life in the 1940s and today is extremely different in the areas of high school life and home life. If you stepped into a classroom in the 1940s, you might see girls making dresses and boys training hard in physical education. At Crane Technical High School, physical education was very important because the principal wanted to keep all of the boys in tiptop shape for war. At Lucy Flower High School for girls, the students studied hat making, laundering, and beauty culture. Also, schools that had sewing classes, had a fashion show at the end of the year where the boys and girls alike would fashion what they had made. According to the Chicago Teen Exhibit at the Chicago Historical Society, the reason these classes are so different from today is â€Å"many poor and immigrant families saw little value in studying subjects like Latin and Botany. Educators knew that young people and their parents would choose school over work only if it served a practical purpose. In response, schools offered vocational and commercial courses from dressmaking to bookkeeping. Growing numbers of young people soon filled technical schools†. Schools taught lessons in family life, hygiene, and health. According to Joel Spring this was because â€Å"What do we do with sixty percent of students who aren’t gaining anything from a college-prep curriculum? We will give them â€Å"life adjustment education†. In 1940, eight out ten boys who graduated from school went to war and more than half of the population of the United States had completed no more than eighth grade. In 1945 fifty-one percent of 17 year olds were high school graduates. Today, more than 13 million teenagers report to public high school classes across the United States. The Scholastics Aptitude Tests (SAT) began in 1941. They were used as a screening device for college admission and originally as an Army intelligence test. The SATs are a major part of today’s teenager’s life. To get into a good college, you eed to do well on the SAT, considering 60% of today’ s jobs require training beyond high school compared to just 20% in the 1940s. Today’s high school students take classes much different than the classes in the 1940s. They take classes such as English, Mathematics, Science (one Biology and one Physical Science), U. S. History, Civics, Economics, Physical Education, Health Education, and E lective, Art or Music or Vocational courses, Career and Technical Education, and a Foreign Language. At Illinois Mathematics and Science Academy (IMSA), an advanced high school, students take math classes such as Mathematics Investigation I to MI IV. They study in-depth mathematics, and some students even work into the Calculus series of mathematics. IMSA has numerous classrooms, an auditorium, and a swimming pool. In the 1940s, St. Michaels High School had a dark room, a gymnasium, a swimming pool, horses (for horse back riding lessons), and a bowling alley. At St. Michaels, on the first floor, there was the gymnasium and the music room, on the second floor the cafeteria, and on the third floor, the library and the chemistry labs. This school is much like today’s high school except the horses. After school, in the 1940s, a teenager might go home, change clothes, and go to work. If your family was poor, you would work very hard after school or you did not even go to school, but worked all day, and all of your earnings would go to your family. There were not a lot of high-paying jobs available in Chicago during the 1940s. Bill Flanagan, a teenage boy during the 1940s, claims â€Å"My first official job, I got when I was 14. I was a bus boy at the restaurant on the South Side. I got $0. 25 an hour. Good money. I got $5 a week. Of course, you could take a girl out on a date for $5. Believe me, $5 was a lot of money. † Eva Kelley, a teenager in the 1940s, was a YMCA locker room attendant for $0. 6 an hour. Yvett Moloney, a young teenager during the late 940s, had a rare job working in a mail order house for $3. 50 a day, and she worked at a telephone company. Other jobs did in the 1940s include working at the YMCA and teaching swimming, working at a pizza place, and working at a warehouse. Anna Tyler, an African-American teenager during the 1940s, worked at the men’s club as a waitress, the office university club, Wiebolt’s as a clerk, and an elevator operator. Jerry Warshaw, a teenager in the 1940s, had numerous jobs: delivery boy at the fish market, a soda jerk, at the Treasury Department, and the post office. His most memorable job was an usher captain. He had 17 men under him and got paid $0. 45 an hour. Today we still have ushers, only they work in performance theaters and at sporting venues. Many teens today work at fast food restaurants and stores such as Jewel Osco and Walgreens. Today, most restaurants and grocery stores let teenagers work there as long as they are 16 or older. Many high school students today volunteer as well as have a job because service hours are required to graduate from high school. Because of World War II, there was rationing and victory gardens on the home front. There were scrap drives, war bond drives, and every sort of stamp for food or shoes. â€Å"The average gasoline ration was three gallons a week; the yearly butter ration twelve pounds per person, 26 percent less than normal; the yearly limit for canned goods thirty-three pounds, thirteen pounds under usual consumption levels; and people could buy only three new pairs of shoes a year†, according to historian Michael Uschan. Compare that to today. Today you can buy almost anything. â€Å"When traditionalists talk about the Family, they mean an employed Father, a stay at home mother, and two school-aged children. This profile only fits 5% of United States families today,† according to historian Letty Pogrebin. During the 1940s, teenagers and there parents were usually very close. Some parents who supported the war effort left there teenagers unattended. This caused â€Å"renewed social alarm about juvenile delinquency. To answer the crisis, social guidance films shown in the classroom presented scenarios meant to shape teen behavior into more acceptable forms†, according to a history of American education. From Zoot suits to baggy pants; from sewing classes to biology; from radios to television, a teenager’s life in the 1940s is very different from today. From Susan Ansell â€Å"High School. Education Week: High School Reform†edweek. org/context/topics;/ issuespage cfm? id+cfm? id+15, (Oct. 4, 2004); Stephen Feinstein â€Å"Decades of the 20th Century: the 1940s, from World War II to Jackie Robinson, Chicago Historical Society, â€Å"Teen Chicago†; Eva Kelle y interview, no date. (www. teenchicago. com); Yvett Mohony interview, (Nov 23, 2002); (www. teenchicago. com), Student Historian’s interview with Meghan Murphy, (Oct. 2, 2004); High School,‘‘ECS IssueSite: High School†, ecs. org/html/issue. asp? issueID=108 (Sept. 5, 2004); High School Curriculum Introduction, www. u46. k12. il. us/high_school_curriculum_introdu. html (Oct. 10, 2004); Sara Mondale and Sara B. Patton, School: The Story of American Public Education; Letty C. Pogrebin, Family politics, Love and Power on an Intimate Frontier; Sammy Skobel interview Nov. 22, 2003. (www. teenchicago. com); Tom Snyder, â€Å"Educational Attainment: Literacy From 1870 to 1979†, www. nces. ed. gov/naal/historicaldata/edattain. asap (Oct. 4, 2004); Michael V. Uschan; A Cultural History of the United States: Through the Decades the 1940s. ] How to cite The Differences of Teenagers in the 1940s Compared to Teenagers Today, Essay examples

Physical Therapy Exercise Tolerance and Quality of Life

Question: Describe about thePhysical Therapy forExercise Tolerance and Quality of Life. Answer: Pulmonary Rehabilitation program in a health clinic setting Pulmonary rehabilitation is also considered as the respiratory rehabilitation. This is considered as an important part of the health maintenance of people who are suffering from the chronic respiratory disease (Jenkins et al., 2010). The Pulmonary Rehabilitation program is found as a broad therapeutic concept. The procedure of pulmonary rehabilitation is approved by American Thoracic Society and European Respiratory Society as a comprehensive, evidence-based and multidisciplinary intervention for patients who are suffering from the chronic respiratory disease (Wong et al., 2010). In this research report the objective or the purpose of the pulmonary rehabilitation program and role of a therapist to enhance the quality service of Pulmonary Rehabilitation Program. Objectives of the Pulmonary Rehabilitation Program The Pulmonary Rehabilitation Program is proved as helpful to improve the quality life of individuals who are suffering from the chronic pulmonary disease (Ringbk et al., 2010). However, there are different objectives, which are helpful to conduct the rehabilitation program successfully. The objectives are as follows- Offering individual with a better understanding of the disease. Helping individuals to develop a method to cope with their disease. Maintaining as well as promoting improvement in physical capabilities of the patients. Helping individual to lead a better lifestyle Decrease the hospitalisation number in a particular community It is recognized an organisation or a clinic can achieve their target, which is helping the patients who are suffering from the severe cardiac disease by fulfilling the objectives stated above (Janssens et al., 2011). However, any patient who is suffering from chest pain does not need to go through a pulmonary rehabilitation program. However, individual who are who are suffering from chronic pulmonary disease, which affected their quality life, as well as functional status, needs to go through a pulmonary rehabilitation program (Ghanem et al., 2010). Several patients can have benefited from the pulmonary rehabilitation program such as chronic obstructive pulmonary disease, cystic fibrosis, bronchiectasis, neuromuscular disease and pulmonary fibrosis. Phases of Pulmonary Rehabilitation Program The Pulmonary rehabilitation program of a clinic has several elements, which are listed as follows but are not limited- Conducting education sessions with the patients who are suffering from chronic cardiac diseases about the breathing techniques, oxygen therapy, respiratory medications, and diseases process as well as exercise techniques (Spruitet al., 2013). Performing exercise in the reconditioning season. Conducting nutrition education session to help the patients to realise which kind of foods is good for their health and lead a quality life. Take session to help the patients to conserve energy. Take individual session with the patients and help them to sort out exercise prescription, program recommendations, and tests. Conducting meeting with the patients to help them understand the test results. Recommending the patients the changes in prescription or exercise routine are necessary, especially changes in overnight oximetry, oxygen therapy, medication changes and ABGs. It is recognised that a pulmonary rehabilitation program may be stretched from six weeks to 10 weeks. The patients who need specialized care can be assisted further by the clinic professionals. Role of a therapist in the Pulmonary Rehabilitation Program in clinical setting In a rehabilitation program, different staffs play a critical role to perform the rehabilitation program successfully. The therapist plays a crucial role to help the patients, who are suffering from cardiac disease. The pulmonary rehabilitation therapist is responsible for the entire rehabilitation program. The person also plays a pivotal role to lead the rehabilitation team. The therapist needs to make coordination between the physiologists, nutritionist as well as the pharmacist (Mainguy et al., 2010). The therapist needs to prepare guideline not only for the patients but also for the nutritionist and exercise tutor. The therapist initially needs to check whether the patients are eligible for the pulmonary rehabilitation program. Then the therapist needs to check the patients present health condition so that he or she can take proper interventions. After that, the therapist should help the patients to learn their current condition. It is important because of the education of the pa tients. The patients need to be educated about their present health status so that they can lead a better life (Yoshimi et al., 2012). The therapist needs them to be educated about the medications, ABGs, overnight oximetry as well as oxygen therapy. It is found that the patients can lead a quality life or a better life with the proper help from their therapist. The therapist also helps the patients to decide, which kind of exercise is helpful for their health. In other words, a therapist takes all the responsibilities of a patient who attend a pulmonary rehabilitation program. Recommendation for the program Although, being a therapist in the clinic where pulmonary rehabilitation program is offered it is important to follow the guideline and help the patients, it is also important to improve the present condition of the clinic and enhance the quality of pulmonary rehabilitation program offered by this clinic. To improve the current state of the pulmonary rehabilitation program in the clinic, several steps can be taken. The pulmonary rehabilitation program offered by this clinic is stretched from six to 10 weeks. However, if a patient seeks special attention, then the clinic can provide an individual appointment for him or her. The clinic can help the patients to find out nearest health care facilities for the patients near their home so that they do not need to travel a longer distance to join in a pulmonary rehabilitation program. The clinic can provide an individual specific guideline to lead their life. The clinic can also check on their patients on a regular basis and summarize the health progress of the patients. Conclusion Offering pulmonary rehabilitation program is not an easy task for a clinic as a clinic does not possess same safety and facilities like a hospital. However, it is possible for them to offer a better life towards the patients who are suffering from chronic cardiac diseases. In this scenario, that key role is played by the therapist, who helps the patients to achieve a better life. References Ghanem, M., ELaal, E. A., Mehany, M., Tolba, K. (2010). Home-based pulmonary rehabilitation program: Effect on exercise tolerance and quality of life in chronic obstructive pulmonary disease patients.Annals of thoracic medicine,5(1), 18. Janssens, T., De Peuter, S., Stans, L., Verleden, G., Troosters, T., Decramer, M., Van den Bergh, O. (2011). Dyspnea perception in COPD: association between anxiety, dyspnea-related fear, and dyspnea in a pulmonary rehabilitation program.CHEST Journal,140(3), 618-625. Jenkins, S., Hill, K., Cecins, N. M. (2010). State of the art: how to set up a pulmonary rehabilitation program.Respirology,15(8), 1157-1173. Mainguy, V., Maltais, F., Saey, D., Gagnon, P., Martel, S., Simon, M., Provencher, S. (2010). Effects of a rehabilitation program on skeletal muscle function in idiopathic pulmonary arterial hypertension.Journal of cardiopulmonary rehabilitation and prevention,30(5), 319-323. Ringbk, T., Martinez, G., Brndum, E., Thgersen, J., Morgan, M., Lange, P. (2010). Shuttle walking test as predictor of survival in chronic obstructive pulmonary disease patients enrolled in a rehabilitation program.Journal of cardiopulmonary rehabilitation and prevention,30(6), 409-414. Spruit, M. A., Singh, S. J., Garvey, C., ZuWallack, R., Nici, L., Rochester, C., ... Pitta, F. (2013). An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation.American journal of respiratory and critical care medicine,188(8), e13-e64. Wong, C. J., Goodridge, D., Marciniuk, D. D., Rennie, D. (2010). Fatigue in patients with COPD participating in a pulmonary rehabilitation program.Int J Chron Obstruct Pulmon Dis,5, 319-326. Yoshimi, K., Ueki, J., Seyama, K., Takizawa, M., Yamaguchi, S., Kitahara, E., ... Fukuchi, Y. (2012). Pulmonary rehabilitation program including respiratory conditioning for chronic obstructive pulmonary disease (COPD): Improved hyperinflation and expiratory flow during tidal breathing.Journal of thoracic disease,4(3), 259-264.

Community General Hospital Essay Example

Community General Hospital Essay Dr Noland Wright, newly appointed manager of Community General Hospital, sighed as he reviewed the hospital’s financial records. He had been given the responsibility of leading the hospital’s next steps, but was perplexed by the financial condition highlighted in the financial statements before him. His training was in medicine, not business, and he had recently taken early retirement. He had been talked into taking Community’s reins by some old friends who live a few miles away from the facility. Community General Hospital had initially begun in 1914 as Whittaker Memorial hospital, a community-run hospital serving the black population of Newport News, Virginia. To meet the needs of an economic expansion of the community largely due to increased commercial activity during World War II, the hospital expanded facilities and scope through federal funding. In the 1940’s the hospital increased its census and gained accreditation by the America College of Surgeons. In the 1950’s and 60’s the hospital enjoyed a bustling business in the segregated health care industry. With the advent of the desegregation movement in the 1960’s, the hospital experienced several threats as black physicians gained the ability to admit patients to the large and better equipped traditionally ‘white’ hospitals in the area. The civic organization that governed the hospital began to be concerned for the hospital’s survival. It was experiencing a falling census, a deteriorating reputation concerning the quality of its health care, and picked up the reputation of being ‘public’ hospital (which it was not). We will write a custom essay sample on Community General Hospital specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Community General Hospital specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Community General Hospital specifically for you FOR ONLY $16.38 $13.9/page Hire Writer While the City of Newport News was willing to help, it was unwilling to acquire full responsibility for the costs of a public hospital. During the 1970’s, the hospital drew on an emergency fund set up by the city. Throughout the 1970’s, the hospital suffered from losses and bad debts. By 1982 the civic board that guided the hospital became inactive. The following year, the last of the segregation practices ended by court order at the large surrounding hospitals. Few patients desired to be admitted to the small, modestly equipped hospital, preferring the larger, modern hospitals they now had access to. The hospitals ended 1983 with a $402,000 budget deficit. Suppliers began demanding cash payment for purchases. Employee layoffs, tightening of admission criteria, and refusal of non-paying patients were some of the steps taken to alleviate the dire financial situation. It was hoped that a new facility, new location and a future change of name to  Community General Hospital would help the hospital to survive. A $15 million bond issue and $1. 5 million in the community pledges the hospital to continue to operate. At the end of 1984 the fund deficit was $749,000. Private healthcare management firms were solicited for help, but these efforts were short-lived. In july 1985, Community General Hospital was dedicated, with a new facility and equipment, and a higher occupancy rate. Between 1979 and 1985, seven different administrators had been in charge of the hospital. Continued losses after 1985, and continued difficulty in retaining continuous management, convinced the hospital’s supporters to seek some solution to the ongoing problems. Political avenues were tried with some success, but did not last. The sale of the hospital to a doctors’ investment group was considered, but the hospital’s supporters ultimately rejected the deal. By 1990 the debt was in excess of $20 million. The ‘board’ of supporters agreed to file for bankruptcy. The Guarantor of the mortgage, the hospital continued to operate as the board sough affiliations with other area hospital. The quality ratings for the hospital continued to suffer. In 1993 the hospital was granted its bankruptcy petition. HUD settled for $4 million, and other creditors were held at bay. Political solutions for Community General’s future were sought, but ultimately, did not help the hospital’s condition. Administrators were hired, but their tenures were short-lived. By mid 1996 the hospital was again running a large fund deficit and was seeking direction in what appeared to be a rather hopeless situation.

Centrosaurus - Facts and Figures

Centrosaurus - Facts and Figures Name: Centrosaurus (Greek for pointed lizard); pronounced SEN-tro-SORE-us Habitat: Woodlands of western North America Historical Period: Late Cretaceous (75 million years ago) Size and Weight: About 20 feet long and three tons Diet: Plants Distinguishing Characteristics: Single, long horn on end of snout; moderate size; large frill over head About Centrosaurus It was probably too dumb to notice the difference, but Centrosaurus was definitely lacking when it came to defensive armament: this ceratopsian possessed only a single long horn on the end of its snout, compared to three for Triceratops (one on its snout and two over its eyes) and five (more or less, depending on how youre counting) for Pentaceratops. Like others of its breed, Centrosaurus horn and large frill probably served dual purposes: the frill as a sexual display and (possibly) a way to dissipate heat, and the horn to head-butt other Centrosaurus adults during mating season and intimidate hungry raptors and tyrannosaurs. Centrosaurus is known by literally thousands of fossil remains, making it one of the worlds best-attested ceratopsians. The first, isolated remains were discovered by Lawrence Lambe in Canadas Alberta province; later, nearby, researchers discovered two vast Centrosaurus bonebeds, containing thousands of individuals of all growth stages (newborns, juveniles, and adults) and extending for hundreds of feet. The most likely explanation is that these herds of migrating Centrosaurus were drowned by flash floods, not an unusual fate for dinosaurs during the late Cretaceous period, or that they simply perished of thirst while gathered around a dry water hole. (Some of these Centrosaurus bonebeds are interlaced with Styracosaurus fossils, a possible hint that this even more ornately decorated ceratopsian was in the process of displacing Centrosaurus 75 million years ago.) Recently, paleontologists announced a pair of new North American ceratopsians that seem to have been closely related to Centrosaurus, Diabloceratops and Medusaceratopsboth of which sported their own unique horn/frill combinations reminiscent of their more famous cousin (hence their classification as centrosaurine rather than chasmosaurine ceratopsians, albeit ones with very Triceratops-like characteristics as well). Given the profusion of ceratopsians discovered in North America over the last few years, it may be the case that the evolutionary relationships of Centrosaurus and its nearly indistinguishable cousins have yet to be fully sorted out.

Questions Coursework Example | Topics and Well Written Essays - 250 words - 1

Questions - Coursework Example The chief executive is also required to remain respectful even if a team player makes a mistake. Mutual respect will further strengthen the team spirit and a collaborative team effort will lead to organizational success. c. A lie may be legitimate deviation if it used temporarily as a tool to find out the truth behind an occurrence, or to persuade a witness to reveal the identification of a criminal or it may be used to investigate and surface the hidden realities otherwise deviant police lie will be considered illegitimate. An exaggerated promise of favoring criminal to let him speak truth is a legal deviant police lie where as a same treatment with an innocent citizen would be illegitimate. The discretionary powers of a prosecutor do not preclude a fair and equitable dispensation of justice because prosecutors are given these discretionary powers to take into account the circumstances under which the crime was

Five year report for the JD sports Coursework Example | Topics and Well Written Essays - 3250 words

Five year report for the JD sports - Coursework Example The company’s business model involves significant reliance on acquisition and organic growth. Cash flow from investing and financing activities properly reflect the strategies adopted. The company has recently broadened its services to Spain, France and Ireland by acquiring fully and partially owned subsidiaries. The business model may be practically supported by 2012 results which show that 67% of cash used in investing activities relate to acquisition of brands. The regular losses in re-measurements, revaluation and impairment of assets raise certain questions on the viability of the company’s depreciation and asset management policies. The exceptional items are seen at almost steady amounts throughout the 5 years period under review. The possible reason for such losses seem to be acquired assets which need to be revalued and losses recognized. The cost controls at JD Sports seem managed and properly monitored. The 2008 growth of cost of sales at 8% was lower than the growth in sales of 12%. This shows, apparently, a strong cost controlling mechanism working at JD Sports. The cost growth of 2009-2023 seems to be in line with the growth in revenue showing a direct relationship between cost and revenue. This further illuminates the tight direct cost control system of JD sports which maintains the levels of earnings and expenses as much as possible. The gross margin growth is relatively steady due to a linear increase in sales and cost of sales. The company’s performance, however, can be appreciated in keeping the costs stable and hence the gross profit. The operating margin in 2011 is 9% as compared to the competitor, Marks & Spencer, at 8.6%. Moreover, the operating margin in 2012 is 7.2% as compared to the Marks & Spencer’s operating margin at 7.5%1. This shows that comparing to the competitor; no significant fluctuations have been observed in the trend. In aggregate, the operating margin before exceptional items seems quite stable and

Role of Metformin for Treatment of Type Ii Diabetes Mellitus

Role of Metformin for Treatment of Type Ii Diabetes Mellitus The role of metformin in the treatment of type II Diabetes Mellitus Introduction: Diabetes mellitus is a sever inherited or acquired disease which occurs when either pancreas does not produce enough insulin, which characterises type I diabetes and it is most commonly diagnosed in children, or the insulin that has been produced does not get used by the body effectively, type II diabetes and therefore patients will have abnormally high level of glucose. Type II diabetes was previously called non-insulin-dependent or adult-onset diabetes (World Health Organisation, WHO website). The latest estimate of the number of diabetics worldwide in 2001 by the World health Organisation (WHO) is 171 million and this figure is likely to be doubled by 2030 (WHO website). A recent study conducted in the UK using the General Practice Research Database (GPRD) illustrate that the mortality rate is twice as high for patients with diabetes type II than those without it (Mulnier et al, 2006). The prevalence of type II diabetes is increasing rapidly both in the UK and worldwide. It has increased by 54% (from 2.8% to 4.3%) and the incidence has increased by 63% over the past decade (Gonzalez, 2009). In most of the cases Type II diabetes is associated with another disorder, obesity, (Krentz et al, 2008). Hence such high increase in the incidence rate for type II diabetes could be due to the increased rate of obesity over past few years as the life style of the population is generally getting poorer and 20% of the population is now obese (UK Obesity Statistics). Understanding and treatment of diabetes has advanced throughout the twentieth century and since insulin has been discovered, many antidiabetic therapies and oral agents such as, Sulphonylureas and Biguanides have been developed to improve glycaemia. Sulphonylurea was the first oral therapy to be discovered for diabetes. It is insulin secretagogues and hence it combats the abnormally high level of blood glucose but it also causes hypoglycaemia and weight gain as it can prolong insulin secretion (Warrell et al, 2006). Biguanides is a class of drugs that are considered antihyperglycemic agents. Metformin is a primary member of this class and it has surpassed sulfonylureas as the most prescribed oral antidiabetic drug in the UK and most parts of the world (Filion, 2009). Metformin is now the most popular treatment for diabetes type II as a study carried out using The Health Improvement database from 1966 to 2005 in the UK shows that only a small number of patients were treated with insul in and its use did not change significantly over the time of study period, in 1966 Sulphonylurea was the most common drug and metformin was relatively less common but by 2005 the use of Sulphonylurea had decreased remarkably and there had been a parallel increase in the use of metformin as a therapy for diabetes (Gonzalez, 2009). In 2006 the American Diabetes Association recommended it as the first drug of choice for patients. In the 15th edition of the Model list of Essential Medicine by WHO, metformin is one of the only two antidebetic oral drug agents (the other is glibenclamide) stated there (WHO, 2007). The other members of biguanides drug class are phenformin and buformin however these two drugs are no longer used in many countries because it carries a very high risk of lactic acidosis. Historical development: In medieval times, French lilac or Goats rue known as Galega officinalis was used as a remedy for intense urination associated with the disease that is now known as diabetes mellitus and the active ingredient in the French lilac that had blood glucose lowering properties was discovered as galegine or isomyleneguanidine, but later on it was discovered that this ingredient was toxic in the plant that caused death of grazing animals (Witters, 2001). In 1918, guanidine was discovered to be blood glucose lowering agent but then it was also found that it is too toxic to be used as a therapy (Foye, 2007). Whilst guanidine itself and some of its other derivatives were considered to be too toxic to be used for diabetes mellitus treatment, the biguanides, two linked guanidine, proved to be safe and effective for the treatment of diabetes (Witters, 2001). In the 1920s, in a search for these guanidine-containing compounds with antidiabetic activities, phenformin, buformin and metformin were discovered. Although they were known to have glucose lowering properties it was not until 1957 when these biguanides were tried on man and introduced clinically in Europe (Gottlieb Auld, 1962, Reitman Schadt, 2007). For the first time in a medical literature by Ungar et al (1957, as cited by Oubre et al 1997) biguanides were described as an efficacious new class of oral drug for the treatment of diabetes. Phenformin which is similar to metformin in structure was very popular in 1960s but in early 1970s it was found to be associated with lactic acidosis and by 1976 clinical studies proved that the hazards of phenformin treatment outweighed its benefits and therefore, phenformin and all the products containing phenformin were withdrawn by the Ministry of Health and buformin was also withdrawn from many countries for the same reason (WHO, 2003). Howe ver, metformin was proved to be safer and did not have same risk of lactic acidosis if appropriately prescribed, and it took another twenty years after a safe and effective use in the Europe until United States Food and Drug Administration (FDA) approved it for use in the United States (Reitman Schadt, 2007). Glucophage the trade name of metformin, formulated by a drug company called Bristol-Myers Squibb, was the first brand to be marketed in the United States (U.S. FDA). Metformin used to be only prescribed for diabetes but then studies published in European journal of clinical investigation 1998 proved that metformin can have a significant effect on reducing weight as well (Paolisso et al, 1998). Meformin has now been used for over 50 years and it has established to be first-line drug of choice for the treatment of diabetes type II, but to get its maximum effect in the anticipation to reduce insulin resistance, weight loss and also to contribute in the improvement of cardiovascular diseases,the American Diabetes Association and the European Association for the Study of Diabetes strongly recommend to use metformin along with lifestyle intervention (Papanas Maltezos, 2009). Mode of Action/ Physiological Effects: Metformin is an antidiabetic oral drug that belongs to a class of drugs called biguanides. It acts by lowering the amount of glucose that liver makes on its own in the body hence it has antihyperglycaemic effects. It was licensed as antihyperglycaemic medication in Europe in 1970s, at that time there was only little known about the mode of action and its physiological effects on body. Despite metformin being in use since 1950s, its cellular mechanism of action is not definite. It primarily acts by inhibiting gluconeogenesis in the liver and hence it reduces the hepatic glucose output; it has also been shown to enhance glucose uptake in the muscles and improve peripheral insulin sensitivity (Ronco et al, 2008). Insulin is a very powerful anabolic hormone and it is involved in the synthesis and storage of glucose, lipid, and amino acid/protein. When blood glucose level rises, insulin is produced by the beta cells of the pancreas. As described by Gropper et al (2008) in their book, it stimulates the uptake of glucose by muscle cells and adipocytes, it also inhibits the gluconeogenesis by the liver to bring about an overall decrease in plasma glucose level. Insulin binds to a specific receptor on the plasma membrane of muscle cells and adipocytes which initiates a cascade of second messenger system that stimulates the tubulovesicle-enclosed GLUT4 glucose transporters to be translocated to the plasma membrane. Insulin also activates the enzyme glycogen synthase and inhibits glycogen phosphorylase and together they help store glucose in the form of glycogen. Hence this way glucose is removed from the blood circulation and is brought to normal level (Gropper et al, 2008). The majority of individuals with type II diabetes are insulin resistant. They have plenty of insulin circulating but their body is not able to respond to it either by having defective or insufficient number of insulin receptors therefore, glucose cannot enter the cells resulting in increased level of plasma glucose. Pancreas continues to produce more insulin in an effort to lower the increased level of glucose and eventually when an individual can no longer produce enough insulin to compensate for the rise, type 2 diabetes develops (Kaufman, 2008). Figure 1shows an overview of antihyoerglycaemic effect of metformin in type II diabetes mellitus. Metformin has various metabolic effects on lowering the hyperglycaemia. It partially acts by improving insulin action and partially by non-directly insulin dependent effects (Krentz Bailey, 2005). Metformin suppresses the hepatic glucose output by decreasing gluconeogenesis, glycogenolysis and fatty acid oxidation and this is the most evident principal blood glucose lowering mechanism and it does so by mainly increasing insulin sensitivity (Krentz Bailey, 2005). In the skeletal muscles metformin increases the insulin mediated glucose uptake and glycogen formation (glycogenesis), it also reduces the fatty acid oxidation. These changes in the muscle cells increase glucose transporters to move to the plasma membrane surface so that glucose can enter the cells (Krentz Bailey, 2005). Another way in which metformin lowers hyperglycaemia is via increasing the anaerobic metabolism of glucose which produces lactate as a by-product and this contributes in lowering the amount of glucose available to move to the serosal side from the lumen, lactate is taken to the liver via portal system (Bailey et al, 2008). Another way in which metformin works independent of insulin action to lower glucose is via increasing the splancchic glucose turn over (Krentz Bailey, 2005). The effect of metformin on skeletal muscles and adipose tissues in improving glucose utilisation in them appears to work through improved binding of insulin to its receptors on the plasma membranes of these cells and therefore, metformin seems to be ineffective without some residual functioning islet cells (Porte et al, 2002). Metformin has no direct effect on insulin secretion in contrast to other antidiabetic drugs such as sulfonylureas, therefore it does not cause hypoglycaemia rather in clinical practice it shows anti-hyperglycaemic actions (Porte et al, 2002). The level of glucose throughout the day changes, it is typically higher after eating and lower in the fasting state. The fasting plasma glucose concentration is measured by the HbA1c test, HbA1c is a glycosylates haemologlibin that is glucose attached with hamemoglobin so the higher the concentration of glucose the higher the level of HbA1c ( Medline Encyclopaedia, 2009). A fasting glucose level lower than 6mmol/l or 7% is normal in non-pregnant individuals and an elevated level shows that either the patient is diabetic or the patient has impaired fasting glucose/impaired glucose tolerance (Bupas health information factsheet, 2008; American diabetes association, 2009). It is important for type II diabetes patients to achieve normal or near-normal glycaemic control with their oral anti hyperglycaemic medications. There are numerous studies that show the effect of metformin decreasing the fasting plasma glucose level. Such as a study by Lozzo (2003), done on type II diabetes patients over 26 weeks with metformin increased the whole-body insulin sensitivity and that was likely to be determined by the reduction in HbA1c and body weight. A similar study done on patients with newly diagnosed Type II diabetes mellitus showed that adding metformin to insulin therapy effectively decreased the HbA1c level from 10.8 to 5.9% and 100% patients achieved an HbA1c less than 7% (Lingvay, 2007). Metformin has also been suggested to work by a biochemical pathway through activation of a protein kinase enzyme 5 adenosine monophosphate-activated protein kinase (AMPK). Its activity is regulated by the depletion in ATP (Adenosin tri-phosphate) and raised level of AMP when energy demand increases, such as in a exercising muscle, thus it is a â€Å"metabolic stress-sensing enzyme† that regulates the energy demand and energy production balance by modulating various metabolic pathways that bring about glucose, protein and fatty acid metabolism homeostasis (Hawley Zierath, 2008). In order for metformin to be effective in the inhibition of the production of glucose, activation of AMPK is required (Zhou, 2001). Kim et al (2008) published a study in 2008 that further described the mechanism of metformin through the activation of AMPK. This study was done on hepatocytes and it showed that through AMPK-dependant pathway metformin increased the gene expression of small heterodimer pa rtner, (SHP), SHP protein represses the transcriptional activity of a number of nuclear reptors including hepatocyte nuclear factor, and that in turn inhibits the expression of the hepatic gluconeogenic genes PEPCK and Glc-6-pase, these are the two enzymes that perform a key role in the homeostatic regulation of blood glucose levels and inhibition of these enzyme gene expression lead to the hepatic glucose production in vivo. Metformin has advantageous effects on atherosclerosis by decreasing Low Density Lipoprotein levels by about 0.26 mmol/L (10 mg/dL), whereas other oral agents appear to have no obvious effects on LDL cholesterol levels (Bolen et al, 2007). Recent prospective and retrospective studies confirm this drug not only being safe for its glucose lowering effects but also indicate its potential anti-atherosclerotic and cardioprotective effects (Scarpello Howlett, 2008). In the UKPD (United Kingdom Prospective Diabetes Study) a randomised trial on obese and overweight patients with initial metformin monotherapy showed a significant reduction in myocardial infarction and diabetes related deaths, it showed 39% decrease in heart attacks and 36% decrease overall mortality rate; metformin was found to be more effective than any other medication with regards to the strokes and overall mortality rate in overweight patients (Krentz Bailey 2005). Kooy et al (2009) investigated whether metformin had sus tained beneficial effects on metabolic control and risk of cardiovascular disease. After a follow-up period of 4.3 years it was found that metformin added to insulin in type II diabetic patients improved body weight, glycaemic control and it reduced the risk of macravascular disease. A 2007 systematic review evaluating antidiabetic agents and outcomes in patients with both diabetes and heart failure showed that metformin is the only antidiabetic agent that is not associated with harm in patients with heart failure and diabetes. In this systematic review and meta-analysis of controlled studies, two of three studies showed association of metformin with reduced all cause mortality and no association with increased hospital admissions. (Eurich et al, 2007) Pharmacokinetics The chemical name of biguanide is  1-(Diaminomethylidene)guanidine (chemical  formula C2H7N5) and it includes compounds that  have biguanide structure. Figure 2 shows the  molecular structure of metformin that has  biguanide structure with two methyl groups  added on the amine group of the first carbon  atom therefore its chemical name being  1,1-dimethylbiguanide and chemical formula  C4H11N5 (Porte et al, 2002). Metformin is taken orally so it has to pass through the digestive system in order to get into the systemic circulation. It is absorbed from the small intestine and does not get metabolised, under fasting conditions the Bioavailability of metformin ranges between 40%-60% (Foye, 2007). From the gastrointestine it gets completely absorbed after 6 hours of oral administration and after absorption it is rapidly distributed and in the plasma it is completely undetectable after 24 hours; the plasma concentration of metformin reaches its peak value within three hours of its oral administration (Papanas maltedoz, 2009). Unlike other biguanides such as phenformin the binding of metformin to plasma protein is negligible and therefore it does not seem to interact with highly plasma protein bound drugs such as sulphonamides and is excreted unchanged (Foye, 2007). Metformin does not get metabolised by the liver and therefore is excreted in the urine from the body as unmetabolised drug through the active tubular excretion and about 30% of an oral dose is excreted through faeces that may be unabsorbed metformin and that retain in the gastrointestinal tract (Porte et al, 2002). It has plasma half life of about 2 to 5 hours in patients with normal renal function but and renal function impairments may lead to retention of metformin in the blood plasma (Foye, 2007). According to Diabetes UK the daily dosage of metformin should be started from 500mg and then gradually increased to a maximum of 2550mg per day but it is entirely individualistic that it depends on the health of individual to consider what dosage is required. Generic metformin is sold in the form of tablets. A slow or extended release preparation of metformin (Glucophage XR ®), introduced in 2004 can act over 24 hours, it has been designed to release metformin slowly over a longer period of time than standard metformin (acts over 8-12 hours) and so its half life is increased to four to eight hours. Timmins et al (2005), in their study on 16 volunteers with 1000mg standard metformin dose twice a day or 2000mg Glucophage XR ® once a day, found out that the pharmacokinetics parameters are similar in Glucophage XR ® to standard metformin, but Glucophage XR ® it is evident to report fewer gastrointestinal side effects than standard metformin so patients who cannot tolerate standard metformin can switch to Glucophage XR ® (Feher et al, 2007). Side effects and contradictions When prescribed appropriately the most common adverse side effects of metformin include a change in taste, nausea or vomiting, abdominal distension or gas, loss of appetite, diarrhea, skin rashes or urticaria, rare – Lactic acidosis (Warrell et al, 2006). These problems are usually mild and occur in the first few weeks for taking the medication but it may discourage the patient from taking the drug, starting the medication in low dosage and increasing it slowly help reduce these side effects (Warrell et al, 2006). In clinical trial done on a total of 286 subjects, 141 were given metformin and the rest were put on placebo. This trial found that 53.2% of subjects who were given Metformin reported diarrhea in comparison with 11.7% for those on placebo, and 25.5% subjects on metformin reported nausea/vomiting compared with 8.3% for those on placebo (Drug Facts and Comparisons, 2005). Compared with any other antidiabetic oral drug metformin is most associated with gastrointestinal distress (Bolen et al, 2007). Phenformin was withdrawn from its theraputical use because of its association with lactic acidosis. Metformin which is similar in structure to phenformin has also been associated with lactic acidosis; however the risk associated with metformin is ten times lower than phenformin (Warrell et al, 2006). A case control analysis on the study population of 50,048 type 2 diabetic subjects using the U.K – based General Practice Research Database found out that the rate of incidence of lactic acidosis per 100,000 person-years is 3.3 cases amongst metformin users (Bodmer et al. 2008). Lactic acid is a by-product of metabolism and it becomes toxic if it is not neutralised fast enough. Lactic acidosis associated with metformin is a very severe and potentially fatal condition that can be avoided easily if the drug is prescribed carefully (Fitzgerald et al, 2009). It arises by the mode of action of metformin, that is the inhibition of hepatic gluconeogensis- a process that consumes lactate, produced by glycolysis, continuously to produce glucose (Warrell et al, 2006). Adopted from Fitzgerald et al. BMJ 2009 In normal conditions during respiration glucose is broken down into two pyruvate molecules in the first step (glycolysis), in the presence of enough oxygen mitochondria oxidises the pyruvate into CO2 and H2O through Kreb cycle by the use of pyruvate dehydrogenase enzyme. But if there is not enough oxygen present, the mitochondria cannot oxidise all of pyruvate so this excess amount of pyruvate is converted into lactate by the lactate dehydrogenase and this lactate is then used in the process of gluconeogenses in the liver. (Fitzgerald et al, 2009; Nicks A, 2009) As shown in figure 3, at site A metformin decreases the activity of pyruvate dehydrogenase and the conversion of pyruvate into CO2 and H2O, therefore at site B it enhancing the anaerobic metabolism even in the presence of enough oxygen and resulting in the increased production of lactate and as metformin inhibits the process of gluconeogenses in the liver, the lactate is not used up and is built up to the toxic extent. Lactic acidosis is the built up of lactate level in the blood (usually >5 mMol/L). (Nicks A, 2009; Fitzgerald et al, 2009) As indicated in figure 3, lactate is excreted 70% by liver, 5% by kidneys therefore liver or renal dysfunctions lead to the retention of lactate and hence to a severe form of lactic acidoses even in the absence of metformin and because metformin is excreted by kidneys if kidneys do not function properly then metformin builds up and hence the severity of lactic acidosis is even greater (Misbin, 2004). The most common contraindications to the use of metformin in people with type II diabetes are renal and liver dysfunctions, congestive heart failure and advanced age, ≠¥ 80 years, and the mortality rate of lactic acidosis is close to 50% (McCormack et al, 2005). But although heart failure has long been known as a contraindication for metformin use a systemic review 2007 showed that metformin is the only anti-diabetic drug that is not associated with any harm in patients withheart failure Eurich et al, 2007). A Medline searched review on the evidence for the use of metformin in the presence of these contradictions concludes that metformin treatment alone does not result in lactic acidosis unless other contributing factors exist as well (Tahrani et al, 2007). However if ingested in toxic doses or in the presence of renal elimination impairment, lactic acidosis does occur (Fitzgerald et al, 2009). The renal function of patients using metfomin should be regularly monitored. It showed be withdrawn if there is any disturbance in the renal function found. Figure 4 shows the current recommendations on contraindications and guidelines for the withdrawal of metformin. Metformin dose should be reviewed if serum creatinine level is greater than 130  µmol/l and a cut-off serum creatinine level above which metformin should be stopped is 150 µmol/l (Fitzgerald et al, 2009). It should be withdrawn during suspected tissue hypoxia that is a condition in which body tissues are deprived of adequate oxygen so cells are forced to respire anaerobically. Patients aged greater than 80 years are at greater risk because they are more likely to have heart problems and kidney or hepatic dysfunctions and patients should be more careful about their alcohol intake while they are on metformin because alcohol can seriously harm liver and that can lead to lactic acidosis (Tahrani et al. BMJ 2007). Metfor min should be withdrawn before any radiographical procedures involving iodinated contrast and should remain discontinued until after three days as this contrast dye may temporarily impair kidney function and cause the retention of metformin indirectly leading to lactic acidosis (Thomsen andMorcos, 2003) â€Å"Review dose of metformin * If serum creatinine is >130  µmol/l or estimated glomerular filtration rate is Stop metformin * If serum creatinine is >150  µmol/l or estimated glomerular filtration rate is Withdraw metformin* * During periods of suspected tissue hypoxia (such as myocardial infarction, sepsis) * For three days after use of contrast medium that contains iodine * Two days before general anaesthesia *Reinstate when renal function stabilises Contraindications * Renal dysfunction * Congestive cardiac failure needing drug treatment * Hypersensitivity to metformin * Acute or chronic metabolic acidosis * Impaired hepatic function Precautions * Age >80 years until renal dysfunction ruled out * Acute myocardial infarction * Radiological studies involving iodinated contrast * Surgical procedures * Alcohol intake † Salpeter et al (2003), in a system review considered 194 studies published between 1, 1959, and March 31, 2002 that evaluated metformin mono therapy or in combination with other treatments for at least one month, in data from these 194 studies there were no fatal or nonfatal lactic acidosis cases found in 36,893 patient-years in the metformin group or in 30,109 patients-years in the nonmetformin or placebo group. It also did not find any difference in lactate levels in metformin therapy and placebo or other non-biguanide therapies. This systemic review concluded that there is no evidence to support association of metformin therapy with increased risk of lactic acidosis or increased lactate level compared with other antihyperglycemic treatments provided that the drugs are prescribed in a suitable dose and all the contraindications are taken into account. Another side effect to the use of metformin is that when it is used in long term it is associated with malabsorption of vitamin B12 (Ting et al, 2006). Combination with other antidiabetic drugs Metformin monotherapy works well with life style interventions in type II diabetic patients but when Type II Diabetes is not controlled with Metformin monotherapy adequately it is often combined with other antidiabetic drugs to maximise its effect. The combination of metformin with rosiglitazone as a single product is known as Avandame, itwas approved by the FDA in October 2002 for the treatment of diabetes and although it has not been appraised by the National Institute for Clinical Excellence (NICE) yet it is often prescribed to patients with type II diabetes who fail to control their glycaemia despite the maximum dose of metformin (Diabetes UK, 2009). The active constituent of Avandamet, metformin and rosiglitazone,have different mechanism of action complementing the action of each other. The tolerability profile of Avandamet is similar to that of metformin, it is more effective in terms of lowering the HbA1c level than metformin or rosiglitazone (Wellington, 2005). Pooled data from two double-blind studies that involved 550 patients randomised to be given metformin with rosiglitazone or placebo patients were divided into obese, overweight or non-overweight. Patients from all groups improved their level of HbA1c and fasting plasma glucose (FPG) to a clinically important extent but the greatest improvement was found in the obese group, these patients improved their glycaemic control, beta cell function and insulin sensitivity with the addition of rosiglitazone to metformin than those who received placebo/metformin (Jones et al, 2003). Metformin can be combined with glyburide which is a member of sulphonylureas and it acts by enhancing insulin release from the cell of pancrease. The combination of these two drugs is proves to be successful in improving the glycaemic control in patients with type II diabetes Studies, such as sixteen week multicenter, randomized, double-blind, 4-arm and parallel clinical trial study (Chien et al, 2007) that involved a total of 100 Chinese patients with type II diabetes and out of which 76 were randomly given metformin 500mg, glyburide 5mg, glyburide/metformin 2.5 mg/500 mg or glyburide/metformin 5.0mg/500mg. After 16 weeks, those who received a combination of both drugs had a greater decrease in both fasting plasma glucose and HbA1c compared with those who received either metformin or glyburide. Insulin therapy alone sometimes fails in patients for the treatment of type II diabetes so metformin can be added to improve the sensitivity of insulin and this combination of two drugs results in superior glycaemic control compared with metformin or insulin alone and it also minimizes the weight gain in insulin therapy ( Wulffele et al, 2002). Continued use of metformin after insulin introduction patients with type II diabetes not only reduce weight and improve glycaemic control but have beneficial effect on cardiovascular outcomes (Kooy, 2009). Addition of pioglitazone to metformin is another combination for the treatment of type II diabetes, this is shown in double-blind, placebo-controlled, clinical trial done by Kaku (2009), compared with metformin monotherapy patients who received pioglitazone plus metformin improved their HbA1C by mean 0.67% and they significantly improved their fasting glucose level and other important markers such as free fatty acids, adiponectin and HDL, that are linked with increased insulin resistance and cardiovascular risks. Metformin can also be combined with other antidiabetic oral agents as a triple therapy for diabetes type II. In a study which was supported by Bristol-Myers Squibb Pharmaceutical Research Institute, 365 patients who were given metformin/glyburide treatment prior to a 24-week double-blind treatment were either assigned to rosiglitazone or placebo while carrying on with metformin, 40% of those patients who received rosiglitazone in addition to metformin/glyburide were able to achieve final HbA1c less than 7.0% and this study concluded that combination of rosiglitazone to metformin/glyburide is â€Å"an effective therapeutic strategy† for those who are unable to control their glycaemia and this treatment is beneficial for lowering HbA1C and fasting plasma glucose levels (Dailey et al, 2004). Who should be treated? Metformin is a very effective antihyperglaecamic drug for patients with diabetes type II and the American Diabetes Association (2006) recommended it as the first drug of choice for patients. Metformin is a preferred treatment for obese diabetics. In most of the cases Type II diabetes is associated with another disorder, obesity (Krentz et al, 2008). Obesity increases the risk of developing type II diabetes and many antidiabetic drugs increase body weight whereas, metformin demonstrates a significant weight loss in type II diabetic patients, Golay (2007) in his review on summarising the effect of metformin on body weight confirms that metformin has been shown to induce weight loss in nondiabetic obese patients, although long term studies on these patients are very rare. Therefore patients with obesity and on the risk of developing diabetes type II should start on metformin. Metformin is also effective with regards to strokes in obese/overweight patients i.e. those on the risk of developing diabetes. UKPD showed a significant reduction in myocardial

The History of Intel

THE HISTORY OF INTEL The microprocessor has changed our lives in so many ways that it is difficult to recall how different things were before its invention. During the 1960’s, computers filled many rooms. Their expensive processing power was available only to a few government labs, research universities, and large corporations. Intel was founded on July 18,1968 by engineers, Gordon Moore, Robert Noyce, Andrew Grove, and Arthur Rock. Rock became Chairman, Moore was President, Noyce was Executive Vice President in charge of product development and worked with Moore on long range planning, and Grove headed manufacturing.The purpose of the new company was to design and manufacture very complex silicon chips using large-scale integration (LSI) technology. Moore and Grove’s vision was to make Intel the leader in developing even more powerful microprocessors and to make Intel-designed chips the industry standard in powering personal computers. Moore and Noyce wanted to seek In tel because they wanted to regain the satisfaction of research and development in a small growing company.Although the production of memory chips was starting to become a commodity business in the late 1960’s, Moore and Noyce believed they could produce chip versions of their own design that would perform more functions at less cost for the customer and thus offer a premium price. Intel’s unique challenge was to make semiconductor memory functional. Semiconductor memory is smaller in size, provides great performance, and reduces energy consumption. This first started when Japanese manufacturer Busicom asked Intel to design a set of chips for a family of high-performance programming calculators.Intel’s engineer, Ted Hoff, rejected the proposal and instead designed a   Single-chip, a logic device that retrieved its application instruction from semiconductor memory. Buying Back the Cash There was a problem with this new chip Busicom owned it. Intel was convinced to repurchase the rights to the product. Intel then offered to return Busicon’s $60,000 investment in exchange for the rights of the product. The Japanese agreed after struggling with the financial troubles. The Microprocessor Hits the Market Intel’s first microprocessor, the 4004, was introduced in 1971.This $200 chip delivered as much computing power as the first electronic computer, the ENIAC. After the 4004, Intel introduced the 8008 microcomputer, which processed eight bits of information at a time. The 4004 and 8008 began to open new markets for Intel products. Today, affordable computing power is available to designers of all types of products, producing creativity and innovation. Turning Point: IBM PC In 1981, Intel microprocessor family had grown to include the 16-bit 8086 and the 8-bit 8088 processors. These two chips created 2,500 winning designs in the year.A product from IBM was one of those designs, which became the first PC. Intel was convinced IBM to ch oose the 8088 as the brains of its first PC. Because of IBM’s intelligent decision, the PC business grew to tens of millions of units every year. In 1982, Intel introduced the 286 chip. It contained 134,000 transistors and provided 3 times the performance of other 16-bit processors during the time. The 286 were the first microprocessor that offered software compatibility with its predecessors. The Microprocessor Machine In 1985, the Intel 386 hit the market.The 386 could perform more than five million instructions every second. Compaq’s DESKPRO 386 was the first PC based on the new microprocessor. In 1989, Intel 486 processor was ready to hit the market. This new chip resulted in 1. 2 million transistors and the first built-in math coprocessor. This chip was faster than the original 4004. In 1993, Intel introduced the Pentium processor, which set new performance standards with up to five times the performance of the Intel 486 processor. The Pentium processor uses 3. 1 million transistors to perform up to 90 MIPS, about 1,500 times the speed of the original 4004.In 1995, Intel’s first processor in the P6 family, the Pentium Pro processor, was introduced. It included 5. 5 million transistors and contained a high-speed memory cache to accelerate performance. The Pentium Pro processor was a popular choice for multiprocessor sewers and high performance workstations. Intel introduced the Pentium II processor in May 1997. It contains 7. 5 million transistors packed into a unique Single Edge Contact Cartridge and delivers high performance. Intel offers Pentium II processors for Mobil PC, carrying new levels of performance and computer capabilities. In April 1998,Intel introduced the Celeron processor. This is the latest Intel processor created to meet the computing needs of Basic PC users. Intel’s recent introduction is the Pentium II Xeon processor. This is the newest addition to Intel’s Pentium II brand. It is Intel’s first microprocessor designed for mid and higher server workstation platforms. The company’s success in memory chips was built from the resources involved in working on projects to design and develop the world’s best microprocessor. INTEL’S STRATEGY Intel's primary business into the mid 1980s was memory chips, which accounted for 70 percent of revenues.In 1985 and 1986, Intel closed eight memory chip plants. They were fighting a never winning battle with the Japanese produces of memory chips. Gordon Moore and Andrew Grove refocused the company on advancing the technology of microprocessors. Intel decided to create a new vision and strategy for the company. Their vision was to make Intel-designed chips the industry standard in powering personal computers. Intel supplies the computing industry with chips, boards, systems, and software. Intel's products are used as â€Å"building blocks† to create advanced computing systems for PC users.Intel's mission is to be th e preeminent building block supplier to the new computing industry worldwide. Intel has several objectives in order to pursue their vision. The objectives include PC and server management advances through new Intel hardware and software products, alliances with other industry leaders, education and development programs, and industry standards efforts. Most importantly, Intel's greatest objective was making the PC an indispensable and persuasive appliance, which would ultimately compete with the TV, VCR, and telephone.Andy Grove crafted a series of strategies in order to reach Intel's objectives: 1. Introduce innovative products quickly. Andy Grove's vision of making the PC tomorrow's information appliance required the company to do more than be a leader in advancing microprocessors. Intel tries to bring innovative products to the market as quickly as possible. In 1995, Intel introduced the new high-end Pentium Pro processor. This came less than three years after the introduction of the Pentium processor, which is now the processor of choice in the mainstream PC market.Together, these products provide computer buyers with a wide spectrum of computing choices. Due to the growing popularity of the Internet, Intel programmers developed a software product called Streaming Media Viewer that software developers could incorporate into their products and allow users to view video as it arrived from the World Wide Web. Also, Intel developed hardware based cryptographic technology that provided increased levels of security for data communicated over the Internet. Intel's strategy of bringing innovative products to the market quickly has proven to be costly.In 1996, Intel spent $500 million on R&D projects to develop products (other than microprocessors). Even though other producers were using joint ventures to build the extremely expensive fabrication plants, Intel chose to go alone. Beyond their primary task of making microprocessors, Intel invests in a range of computi ng and communications applications that support their core business. Intel's supercomputer and network server efforts take advantage of the flexibility and power of Intel architecture, while their flash memory business supports booming communications applications, such as, cellular phones.Intel executives saw the future PCs equipped with new features, such as, digital video, stereo sound, 3-D graphics, fax, and data communications. Intel decided to add these features into its next generation microprocessors. Intel decided to compete with the Taiwanese computer industry. They felt that the Taiwanese were too slow to adapt their products to the latest Intel innovations. By producing motherboards, it would enable Intel engineers to integrate new functions. 2. Promote the Intel brand. Intel invests in education and marketing programs that describe the benefits of genuine Intel technology.In 1990, Intel initiated a marketing program to build the Intel brand and make PC users aware of the benefits of genuine technology and products. Intel asked PC makers to put the Intel logo on their machines. The company also sponsored television and print advertising campaigns stressing that by choosing an Intel-based PC, users got the ultimate in quality, reliability, software computability, and value. The marketing program was a success and had become a prominent element in Intel's strategy ever since.Not only did Intel continue to sustain its dominant market share, but also customer feedback revealed that PC buyers, not just computer techies, really cared about their computer's chip and performance capabilities. Instead of assigning its two new chip generations numbers like 286, 386, and 486 chip generations, Intel named them Pentium and Pentium Pro. This helped Intel build their brand name by allowing PC buyers to become familiarized with their products. Experts believed that Intel was spending over $100 million annually on promoting their name among consumers. . Alliances wi th other industry leaders. The breakup of the old computer industry is what gave Intel its chance and made the mass-produced computer possible. The old computer industry was vertically aligned. Industries used to build their computers from bottom up. Now, these companies purchase products from other industries to build their computers. Because PCs contained components from so many different vendors, Grove believed industry participants in different horizontal specialties had to develop new products in parallel.Intel works with other industry leaders to develop new PC technologies, such as the PCI â€Å"bus†, which has been widely adopted. This technology removes bottlenecks to provide greatly enhanced capabilities. They incorporate their chips into PC building blocks, such as, PC motherboards, to help computer manufacturers bring their products to the market faster. Intel also works closely with software developers to create rich applications, such as, PC video conferencing a nd animated 3D Web sites, that make the most of the power of Intel processors. Also, Intel is working with the U. S.Department of Energy to build the world's fastest computer supercomputers. As Intel introduced new generations of microprocessors, it was beneficial for Microsoft and other developers of operating systems and software to be ready to go to market with new software systems and products that capitalized on the speed of Intel's new processors. Andy Grove and Bill Gates began meeting in the 1980s to explore how their organizations can share information. Intel believes that if computers work better, do more, and are easier to use, more PCs will be sold and more Intel processors will be needed.As with any other strategy, it is necessary to evaluate performance and initiate adjustments in vision, long term direction, objectives, strategy, or implementation in the occurrence of changing conditions, new ideas, and new opportunities. For example, in 1994, a mathematics professor found a flaw in how Intel's new Pentium chip did division in certain situations. The media got a hold of this and there was negative publicity about Intel floating around. Intel explained to its consumers that the chances of this happening were minute. Intel admitted the flaw, but Andy Grove felt that it shouldn't concern nyone except the most demanding scientists. Intel wanted to stand behind there â€Å"Intel Inside† campaign, so they had to reevaluate their strategy. Within days of the incident, Intel offered all owners of Pentium based computers a free replacement of their Pentium chip and took a $475 million write off to cover the costs. Even though it was considered a disaster, only a few owners took a replacement chip. Intel focuses on being a best-cost provider. Their strategic target is the value conscious buyer. They want to give customers more value for their money.Intel's product line carries good-to-excellent attributes, several to many upscale features at low co st to the PC buyer. Overall, their focused strategies have kept them on the right track. However, Intel continues to attract competition, both from makers of software-compatible microprocessors and from makers of alternative-architecture chips. SWOT ANALYSIS To provide a good overview of Intel’s business position and whether it is healthy or unhealthy, a SWOT analysis was conducted. This analysis will show if there is a good fit between Intel’s resource capability and its external situation.STRENGTHS Intel is one of the most profitable companies in the world. It is a leader in its industry with over 80 percent of the world’s 250 million personal computers powered by Intel microprocessors and over 90 percent of all new PCs currently being assembled with â€Å"Intel Inside†. Intel is a recognized market leader with an attractive customer base and a good reputation of creating an advanced quality product. Some of Intel’s strengths are its financial co ndition, brand-name image, good management skills and technical expertise. Financial ConditionOne of Intel’s major strengths is the ability to fund for research & development. The company has a high degree of profitability, cash flows from depreciation, and low dividend payout. Therefore, Intel can provide the financial resources and use their financial strength to fund the capital requirements associated with refurbishing existing plants and building new ones. Intel’s strategy to maintain a leader status in the industry and to accommodate expected demand is necessary for them to stay ahead of competitors by producing more advanced products and building new plants or refurbishing existing plants.In recent years, Intel has built a new fabrication plant about every 9 months and announced that its goal is to reduce that to every 6 months. Also, for the past 6 years, it has led the semiconductor industry in new capital investments. Brand Name Image In 1990, Intel initiated a marketing program to build the Intel brand and show PC users the benefits of Intel technology and products. The reason for the program was to increase sales of the Intel brand and lower sales of AMD’s cloned microprocessors. Their marketing strategy was to ask PC makers to put a distinctive â€Å"Intel Inside† sticker on their machines.They also sponsored television and print advertising campaigns promoting that an Intel-based PC provided customers with ultimate quality, reliability, software compatibility, and value. This was a major success and created a good brand name image for Intel. Management Skills and Technical Expertise Talented and skilled individuals from the beginning managed Intel. They had the expertise to manage Intel by choosing the right individuals that had the technological know-how to bring it to the top. Intel’s skill and expertise proved to be a strength back in 1985 when Intel’s primary business was the memory chip.Japanese comp etitors started producing and marketing their memory chips at lower costs than Intel. However, Intel had the skills and expertise to abandon the memory chip business and put their full energies into a secondary microprocessor business. They wanted to become leaders of the industry and they proved that they knew what needed to be done to accomplish their vision. WEAKNESSES Diversity Intel is one of the most successful companies and it is hard to find a weakness in such an established firm. Intel is known for its strengths, competencies, and capabilities. However, one of Intel’s weaknesses is the focus on primarily microprocessors.The diversification of companies into other industries allows them to be less risky in case a rival developed a better product. For example, Microsoft is expanding into the Internet business to become more diversified. America Online and Netscape are merging to enhance their core business. Intel could become even more successful if it were to diversif y into other industries. The company can be in grave danger if another firm was to rise to the top with the manufacturing of microprocessors or if technology promoted a more efficient product than the microprocessor. Leadership After GrovesAndrew Groves has been the backbone of Intel for many years. Under Grove, Intel was very aggressive in protecting its technology. He is a hands-on manager whose high level of involvement and attention to detail inspired and intimidated subordinates. A big part of Intel’s success is Groves’ leadership style, competitive ability, and innovative mind set. Eventually, Groves will retire and the question will be what will happen to Intel? Will Groves’ successor lead Intel to remain on top. Andrew Groves has proved to be an excellent leader, but the leadership after him is questionable. OPPORTUNITIESMarket opportunity is a big factor for shaping Intel’s strategy. Intel is equipped with the right resources and has the capabili ty to pursue many opportunities that exist. The company’s innovation has helped build alliances to expand the firm’s market coverage and competitive capability. Intel also has the ability to grow rapidly because of strong increases in market demand. Innovation Andrew Groves has a vision of the PC as tomorrow’s information appliance. He wants to have televisions, VCRs, game players, cable boxes, and telephones to be pushed to the background and bring PCs to be in the spotlight.Groves does not want to just lead in advancing the microprocessor, he wants to fully utilize the capability of the microprocessor and introduce a number of PC-based communications products to meet the broad range of consumer needs. Some of the products that Intel has available are chip products used for keyboards, printers, copiers, and fax machines. These chip products are used to enhance cellular phones, pagers, digital cameras, and personal digital assistants. Intel is also manufacturing universal Serial Bus- single type of connector to attach printers, modems, CD-ROM drives, and other peripherals.Other innovative products include Intercast plug-in cards, a ProShare line of conferencing products,   And an I960 RP processor. Intel has a software lab in Shanghai developing multimedia and 3-D content in Chinese. They have created software to help popularize long-distance telephone calls on the Internet and a hardware-based cryptographic technology that provides levels of security for data communicated over the Internet. Intel is introducing new products and technologies on a weekly, sometimes daily, basis. They are gradually increasing their R&D budget to look for valuable ways to broaden their product line.Their reputation for innovation is among the best in the U. S. In fact, Intel was ranked third for its innovation in 1997. Strategic Alliances Alliances expand the firm’s market coverage and competitive capabilities. It is essential that Intel develop a cl ose relationship with other PC component producers, manufacturers, software developers, cable TV companies, media and telecommunications companies, and entertainment companies. Before the mid-1980s the structure of the old computer industry was aligned vertically, in which each company sold their products based on their own proprietary technology.They designed and built their computers themselves. Buyers had to commit to the whole package of one manufacturer. Since then, the computer industry is growing horizontally. Each product depends on another product. This is why it is important to collaborate with others. Products within each horizontal specialty should be compatible with other specialty products to make a powerful PC or other PC-based product. Growth Intel has the ability to grow rapidly because of strong increases in market demand. The process of making PCs has changed with that of the past. Only a few PC makers produced the components inside of the PCs.Therefore, the deman d for Intel’s products increased. Intel had the ability to grow rapidly because it responded quickly to market demand and had the capital and expertise to develop advanced powerful products faster than competitors. THREATS Looking at Intel’s external environment, there are some factors that create a threat to the company. Some of the threats Intel is facing are competition, slowdowns in market growth, and the bargaining power of consumers. Competition In 1997, Advanced Micro Devices (AMD) and Cyrix were the two major competitors that challenged Intel by cloning Intel’s microprocessors and marketing them at lower prices.This created a major threat to Intel’s market share. A third competitor was developed by the partnership among Motorola, IBM, and Apple Computer. They were producing and marketing Power PC chips for Apple’s line of PCs and certain IBM PCs. For example, the Power PC offered a reduced instruction-set computing (RISC) processor which ha d a simpler instruction set and higher computing speeds than Intel’s chips. This was an attractive feature for the end user, which also threatened Intel’s market share. The competitors mentioned above are just three of the major companies that are a threat to Intel.There is also the possibility of other companies making a technological breakthrough by developing a more powerful and cheaper product that will outlive Intel. For such reasons, Intel has to be innovative and ready for any possible external threat. Slowdown in Market Growth Intel is always planning ahead of things. They refurbish or build plants two years before the new product ever is produced. This could be considered an advantage or disadvantage. It is an advantage to Intel because they are constantly developing technologically advanced and more powerful products, which allows them to compete and be a leader of the industry.However, the major disadvantage is the possibility of the PC market slowing down. Intel could be hurt tremendously if the market growth slows down because they have already planned ahead and invested a lot of capital into the plants. Bargaining Power of the Consumer Cost pressures are also a threat to Intel. Consumers are demanding lower prices on products or higher quality for the prices they are paying. If a consumer can get the same product at a lower price from competitors, it can be a major threat to the company.Intel can influence bargaining power of the consumer by making sure the prices are low based on cost efficiency and the quality is maintained. The SWOT analysis provided the opportunity to view the company’s overall position. An evaluation of Intel’s strengths, weaknesses, opportunities, and threats support the fact that above all Intel has established a healthy position in the industry. TESTS OF A WINNING STRATEGY Test 1: Goodness of Fit The goodness of fit test determines if a company’s strategy is suitable for its internal and external situation in order to obtain market success.Intel is a member of the technology sector and in the semiconductor industry. Firms involved with technology must deal with the quick obsolescence that is inherent when dealing with computers. An example of this is Moore’s Law coined after Gordon Moore, Intel’s founder, who truthfully stated that â€Å"the power and complexity of silicon chips would double every year with proportionate decreases in cost†. This external environmental situation causes two problems for companies in the industry. One problem is that a company must constantly innovate to stay on top and secondly, the company will need capital in order to create new technology.Does Intel’s strategy adequately deal with the constant change that is prevalent in its business environment? The Intel’s strategy is to cannibalize its own products. In other words Intel strives to make its own products obsolete. A Company’s profits and market position can be severely undermined if another company offers a faster chip with more capabilities. Intel is able to do this because of its internal situation. Intel has vast amounts of capital, â€Å"†¦a ‘war chest’ of about $10 billion†. This is useful when the average plant costs will be about $2. 5 billion dollars around the year 2000.Test 2: Competitive Advantage Test The competitive advantage test ascertains if a company’s strategy leads it to have a sustainable competitive advantage over its rivals. The competitive advantages that Intel has are its brand image and research prowess. Intel’s brand name is a competitive advantage because it helps keep the sale of silicon chip clones from rivals down so that these companies do not erode Intel’s profitability and market share. If a company had a clone of equal performance, it would be easier for consumers to switch over if not for the power of brand name and awareness that keeps customers loyal.The strategy that Intel has is to increase the awareness and preference for its products. Research prowess is a competitive advantage for Intel. It has large amounts of capital compared to its competitors. For example, next year Intel will spend $3 billion on research and development, â€Å"which is more than AMD generated in sales in 1998†. Intel continues to produce innovative products faster than its rivals do in order to receive the lion’s share of profits so as to keep itself able to acquire the capital to produce these innovations. Test 3: Performance TestThe performance test ascertains if the company’s strategy is helping the company become profitable and help obtain long-term market position. Located in the Appendix are several profitability ratios for Intel from 1983 until 1998. In Appendix A-E are graphs representing this data? In Appendix F are the actual numerical data. After 1986 is when Intel changed its strategy to what it is pres ently. The data used to compute these ratios was from the Intel case in Strickland and Thompson’s Strategic Management 10th Edition. The 1997 and 1998 were compiled from data obtained from Intel’s homepage located at http://www. ntel. com. Appendix A shows the gross profit margin. The gross profit margin has, since 1986, been steadily increasing and since 1990, has remained above fifty percent. This profitability ratio shows the amount of money that remains after making a product that is available for the company to utilize. This shows that the company is strong in this aspect. Operating profit margin is shown in Appendix B. This shows the profit of the company prior to interest payments and taxes taken out. The ratio was negative for the years 1985 and 1986. After 1986, the operating profit margin has been strong reaching a peak of 39. 4% in 1997. Appendix C displays the net profit margin, which is the profit the company realizes. After posting a loss in 1986, the net profit margin of Intel has steadily improved and strengthened. Since 1990, Intel has been positing profits higher than fifteen percent. It reached a profit peak in 1997 with a net profit margin of 27. 7%. Intel has at the present time has a dominant 75. 7 % market share. This is a dominant position since its next closest rival, Advanced Micro Devices (AMD), has merely fifteen and one-half percent of the market share. Its other competitor Cyrix has only 5. 6%.This data is represented in pie chart form in Appendix G. The data has shown that Intel’s strategy has successfully completed all of the tests and is thus a winning strategy. Its present strategy is allowing it to respond to the business environment and maintain its competitive advantages while raking in profits. Andy Grove’s Performance as CEO It is imperative to acknowledge Gordon Moore, his mentor, before discussing the performance of Andy Grove. Gordon helped to set the Intel culture as being one of low bureau cracy and set the standard of holding one-on-one meetings with his subordinates in order to help the flow of information.Moore has is own ‘law’ which stated that the power and complexity of the chip would double every eighteen months with proportional decreases in costs. This helped Intel from the onset set its sights on innovation and being a leader. Appendix F shows the numerical numbers for the return on stockholders’ equity (ROE) and return on assets (ROA). Appendix D and E show their values graphically. These ratios are used to gauge how effective management is. Andy Grove became President in 1979 and was given more total control in 1987 when Gordon Moore served only as chairman.To adequately ascertain how well Andy Grove has been as CEO, an examination of the following these ratios are necessary. The ROE since 1987 has been strong with most years above twenty-percent as displayed in Appendix D. The highest value being in 1997 with 35. 99%. This ratio is put into perspective when one compares the ROE with that of the industry. The ROE-to-Industry ratio taken from Daily Stocks website which is 131. 4%. The ROA since 1987 has also been steadily increasing into the teens and lower twenty’s. The ROA-to-Industry for Intel is large 140. 4% from Daily Stocks website.This analysis shows that Andy Grove has done a superb job at Intel. Other factors concerning Andy Grove speak well of his performance as the CEO of Intel. His views have permeated into the corporate culture of Intel and have helped it become the dominant force in its industry. The strategy-making style that Grove uses is that of a master strategist. The master strategist exerts strong influence over the strategy of the company. Andy Grove’s own view, which is his ‘law’, of â€Å"only the paranoid survive† has helped keep Intel on its toes and looking ahead to what is happening.This is shown by the fact that Intel builds factories years before they are needed in order to stay on top of the market. Andy Grove’s leadership has helped Intel not fall into the pitfall of becoming stagnated by its own success. The shortcoming that Andy Grove has in being a manager is he is too good. As stated in the SWOT analysis, Andy Grove’s permanent retirement from Intel could set the company floundering unless the company finds someone as well qualified and with an analogous approach to management style. INDUSTRY ANALYSIS The U. S. icroprocessor industry comprises of more than 100 companies that design, manufacture, and market semiconductors to original equipment manufacturers and personal computer end users. The following information is a profile of the dominant economic characteristics of the microprocessor industry. Market Size: $300-$350 billion worldwide consumption. Scope of Competitive Rivalry: Global. Market Growth Rate: 15-20 percent annually. Stage in Life Cycle: Rapid growth and takeoff. Number of Companies in Industry : About 174 companies. Customers: 80 million microprocessors for use in PCs and network servers.Degree of Vertical Integration: Mixed; forward and backward integration. Ease of Entry/Exit: High entry barriers in the form of capital requirements. Technology/Innovation: Rapid technological changes microprocessor production. Product Characteristics: Highly standardized. Scale Economies: Companies can realize economies of scale. Learning and Experience Effects: Strong. Capacity Utilization: Manufacturing efficiency is higher when capacity is increased. Industry Profitability: Above par. 1995 Industry Usage 1997 Industry Usage Error! Not a valid embedded object.The two pie charts above display the industry usage in 1995 and 1997. As shown, the computer sector is the main user of the microprocessor. Within two years, the computer sector increased its usage by 11% and is expected to continue increasing over the next several years. Computers are the main focus in the microprocessor industry , which is why many rivals are competing for market share in that sector. THE FIVE FORCES MODEL OF COMPETITION Rivalry among competing manufacturers in this industry is a strong force of competition. It is focused on such factors as performance features, new product innovation, quality, and brand image.New product innovation plays a major role in the microprocessor industry because it determines the intensity of rivalry among competing firms. Companies are trying to gain better market position and competitive advantage. Threat of potential entry is a weak force due to the fact that it is hard for a newcomer to break into the market. Moreover, economic factors put a potential entrant at a great disadvantage because of the learning and experience curve effects. The existing microprocessor companies have advantageous positions in the industry from the experience they have gained from being in the industry longer than new entrants have.Leaders of the industry, like Intel, have verticall y integrated their manufacturing to make products at low efficient costs that entrants would not be able to compete and be exposed to fierce competition. Other entry barriers are economies of scale, brand preferences and resource requirements. Competition from substitutes is a weak force because there are no substitutes in the industry. The microprocessor is needed to manufacture many types of equipment, such as, TV sets, VCR’s, cameras, wristwatches, kitchen appliances, mobile phones, and stereo equipment.There is no other product that can be used in place of the microprocessor. Power of suppliers is moderate. Some companies rely on suppliers to supply a component more cheaply than industry members can make themselves. This can increase their leveraging power. However, suppliers also tend to have less leverage to bargain over price and other terms of a sale because the industry they are supplying is a major customer. A microprocessor company usually orders in large quantitie s, which in turn decreases suppliers leverage. Also, major companies are integrating backwards to self-manufacture the component.Backward integration allows companies to negotiate favorable terms with suppliers. Power of customers is a strong force in the industry primarily because buyers are large and purchase much of the industry’s output. Purchasing in large quantities gives a buyer enough leverage to obtain price concessions and other favorable terms. For instance, PC makers have a substantial bargaining leverage when deciding to use Intel’s chips in their computers. International Competitiveness Due to fierce international competition, the microelectronics industry has become highly globalized. To compete effectively, U. S. icroelectronics suppliers must sell to all domestic and foreign markets. The profit margins for certain products are so slim that only through international sales can a supplier generate profits adequate to remain in business. Survival in this highly international industry requires microelectronics manufacturers to be first to market with leading-edge products that focus on high-end technology. Only those suppliers who introduce the breakthrough products can maintain profit margins that will support research, development, and the purchase of new equipment for manufacturing the next generation product. COMPETITOR ANALYSISIntel's rivals: Advanced Micro Devices, Cyrix Corporation, Motorola, IBM, Apple Computer, and the Power PC are favorably positioned, but not in the same leading position as Intel. Intel dominates the computer industry. Intel works closely with alliances to introduce many innovative products that give them a leading edge over their rivals. Intel’s products are distinguished from their competitors, which make it difficult to clone. In 1997, Intel's two biggest competitors were Advanced Micro Devices (AMD) and Cyrix, both of which made â€Å"Intel-clone† microprocessors and marketed them at pric es below those charged by Intel.A partnership among Motorola, IBM, and Apple Computer to produce and market Power PC chips for Apple's line of PCs and for certain IBM PCs represented a third competitor. Sun Microsystems was a fourth competitor, producing and marketing a microprocessor line that competed against Intel chips in a limited number of computing applications. These competitors can possibly take some of the market share away from Intel. Therefore, Intel needs to maintain market dominance by continuing to make a high quality microprocessor with process technology improvements.These factors will help Intel stay ahead of their competitors. Advanced Micro Devices (AMD) had carved out a niche providing less expensive microprocessors than Intel's mainstream offerings. AMD, confident that NexGen had strong technology despite its low sales, promptly scrapped its own design for a chip to compete with Intel's Pentium Pro in favor of a design (subsequently named K6) that NexGen had un der development. Whereas previous generations of AMD chips had been clones of Intel's designs, AMD and NexGen engineers had designed the K5 and K6 from scratch.AMD hoped that its K6 chip would be an attractive alternative to Intel's higher-priced Pentium Pro chip. AMD was planning to introduce 180, 200and 233 MHz versions of its K6 chip during 1997 and a 300 MHz version was the plans for 1998. AMD expected that 5 of the top 10 PC manufacturers would be using the K6 in some of their models during 1997; analysts projected that AMD could sell up to 5 million K6 chips in 1997. The K6 was expected to sell for about 25% less than Intel's Pentium   Pro chips. IBM and Compaq announced in 1997 that they would use AMD's K6 processors in their low-end machines.During the first three weeks of September, nearly half of all the desktop computers sold through retailers used the AMD K6 microprocessor, according to market researcher PC Data Inc. That is a dramatic improvement from last year when 9 2% of those same machines had Intel chips inside. Today, only 43% of retail PCs sold use Intel. Industry analysts expected Cyrix to be more successful in marketing its M2 against Intel's MMX Pentium in the price-sensitive home computer and notebook segments. The stigma of a non-Intel chip posed a high barrier for Cyrix to hurdle in, penetrating the high-end desktop and notebook segments.Motorola, Apple, and IBM initiated a partnership in 1991 to develop the Power PC chip as an alternative to Intel chips. After production delays and disagreements over design, IBM and Apple finally agreed to a common design in 1995. The Power PC along with Sun Microsystems' UltraSPARC chip was a reduced instruction-set computing (RISC) processor, whereas, Intel, AMD, and Cyrix chips were complex instruction-set computing (CISC) processors. Chips incorporating RISC designs used simpler instruction sets to achieve higher computing speeds than CISC processors. Also, RISC designs had better floating-point performance.KEY SUCCESS FACTORS Technology-Related KSFs Intel has many key success factors that helped it prosper in the market place. Intel has product innovation capability and the funds available to invest in research and development. Intel's reputation for innovation was among the best of any U. S. company, it ranked third on innovation among all U. S. companies. Besides investing in R&D, Intel had to gut and refurbish its existing fabrication plants every three years to produce the new chips and sometimes build a new plant to accommodate the expected   demand.Year after year, building new plants became very expensive because they used exotic tools and equipment to etch finer and finer lines on a silicon chip. Finer etching also required more labor and production time. Intel estimated that each succeeding generation of microprocessors required more than twice the capital and manufacturing capacity for production. Intel intended to be among the handful of chip producers that c ould afford to build top-of-the-line chip fabrication plants. Manufacturing-Related KSFs Intel has the flexibility to manufacture a range of models and sizes.Besides the products already in the market, it has additional products in various stages of development. For instance, Intel has a segmented brand including the Celeron, Pentium II, and Merced chip which is expected to be available in 2000. Distribution-Related KSFs Intel works closely and distributes to PC component producers, PC manufacturers, software developers, cable TV companies, media and telecommunications companies, entertainment companies, and information-communications appliance for both the home and the workplace.Intel is involved with Microsoft, Pointcast, America Online, IBM, Cisco Systems, and others to develop and promote Internet software. Marketing-Related KSFs To diminish the sales of clones of Intel microprocessors marketed by AMD, Cyrix, and others, Intel initiated a marketing program in 1990 to build the I ntel brand and make PC users aware of the benefits of genuine Intel technology and products. Intel asked PC makers to put a distinctive â€Å"Intel Inside† sticker on their machines. Manufacturers who used Intel microprocessors in their PCs also used the logo on their packaging and in their ads and brochures.The company also sponsored many television and print advertising campaigns to promote the Intel’s brand name image. Skills-Related KSFs Intel has the ability to develop innovative products and product improvements. Also, it has the ability to get newly conceived products past the R&D phase and out into the market very quickly. They are always ahead of their competitors and always find new ways to improve their product. Intel’s team consists of many experienced employees using top of the line technologies. Organizational CapabilityIntel has the ability to respond quickly to shifting market conditions and customer needs because of its many years of experience and the ability to invest in R&D. Andy Grove’s management style also plays a major role in organizational capability. His concern for the flow of information helped instill Intel’s corporate culture and allows every employee to contribute to the company. INDUSTRY PROSPECTS AND OVERALL ATTRACTIVENESS The factors that make the industry attractive are the large use of computers at home, work, libraries, coffee shops, and bookstores. Computers allow easy access to Internet, e-mail, and research.PC’s use up-to-date technology, which makes life easier and daily tasks simpler. The fastest growth was expected to occur in Asia outside Japan, where use of PCs was still relatively limited and where the market potential was largely untapped. The Chinese market was the largest in the Asia-Pacific region (with projected growth of 25-35 percent annually over the next several years), followed in order by Korea and Japan. Also, PC sales in Europe were expected to grow 8% annuall y. The profit outlook seems favorable because a computer at home or work will be a necessity.The factors’ making the industry unattractive was that Intel was producing new products too quick for the market to catch up. New developments were occurring at such a fast and furious pace that the end result was unpredictable. There was a lot of competition going on. The Internet was central to most of the forthcoming developments in information technology. This is the reason why Intel is mainly focused on the computer sector. As Andy Grove put it, â€Å"The Internet is like a 20-foot tidal wave coming thousands of miles across the Pacific, and we are in kayaks. It’s†¦ gaining momentum, and its going to lift you and drop you.It affects everybody†¦the computer industry, telecommunications, the media, chipmakers, and the software world. † FUTURE PROSPECTS Their commitment to R&D creates future generations of products and the manufacturing processes they use to make them, while their capital expenditures ensure the availability of state-of-the-art factories that allow them to deliver high-volume, high-performance microprocessors efficiently. Looking into the future, they will continue to manufacture quality microprocessors that will live up to the Intel name and strive towards perfecting their existing ones.