All of the psychoanalyst Essay

Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that  their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the  childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that  their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the  childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that  their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the  childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that  their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the  childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial. Psychoanalytic – Freud- Psychoanalytical theory was formulated by Freud based on how the human mind functions. He believed that there were factors outside of the individual person’s awareness (unconscious thoughts, feelings and experiences) that influence their emotions, behaviour and actions, and that their past experiences, and their future. The Psychoanalytical Theory highlights the importance of the unconscious mental processes and childhood development issues as they relate to childish impulses, childish wishes, juvenile desires and the anxiety of reality. The Psychoanalytical Theory is also based on the idea that a person’s personality is formed throughout the childhood years, that children go through certain stages at certain points of their childhood and depending on how well the child copes with each of these stages, their adult personality will be affected. This influences current practise as Freud’s observations into the link between our unconscious actions and our mind are still seen as beneficial.

Option and Major Studios

FIN 4414 – Financial Management – Spring 2009 â€Å"Arundel† Case Assignment Due: March 23, 2009 Case: â€Å"Arundel Partners: The Sequel Project,† HBS, Case # 9-292-140, Revised 12/92. Main Question: Is $2million per movie a fair price? Why or why not? Additional Questions 1. Provide a brief overview of the proposed venture. Clearly describe the relevant time line. 2. Why do the proponents of this venture believe that Arundel Partners can make money buying movie sequel rights? Why do they propose buying a portfolio of rights rather than negotiating the purchase price on a film-by-film basis? Why do they propose to purchase the sequel rights at t=0 (before the first film is released) rather than at t=1? 3. Assuming a discount rate of 12% (risk free rate of 6% and a risk premium of 6%) calculate the NPV for all the sequels. Use the expected negative costs and the expected revenues given in Table 7. 4. Using the â€Å"decision-tree† approach, calculate the per-movie value of the sequel rights to the entire portfolio of 99 movies released in 1989 by the six major studios. . Assume that a maximum of ten sequels can be made in any given year. Using the same decision-tree approach, what would you estimate to be the per-movie value of the sequel rights to the entire portfolio of 99 movies released in 1989 by the six major studios? 6. Using the Black-Scholes approach, calculate the per-movie value of the sequel rights to the entire portfolio of 99 movies released in 1989 by the six major studios. Assume once again that there is no maximum to the number of sequels that can be made in a given year). You must provide details of how you estimated the inputs to the B-S formula. a. Asset value b. Exercise price c. Volatility of asset returns d. Time to maturity e. Risk-free rate HINT: Note that the time to maturity of the options is when uncertainty is resolved not necessarily when the sequel is made. The asset value is what you will get if you exercised the option to make the sequel. Again use average values for all the sequels. Similarly use the average value of the cost to make the sequels for the exercise price. Estimating standard deviation is a little trickier. Note that you do not have past information on returns to each sequel to estimate volatility for a sequel. However, you have information on a portfolio of sequels and you know the returns to these sequels and you could use these to estimate a standard deviation based on a cross-section of returns (DO NOT USE PRICE LEVELS). Also the standard deviation should be based on all 99 sequels – that is it should be based on the entire distribution. 7. Carry out a sensitivity analysis of the value of the option to the values of the underlying asset, exercise price, and volatility. 8. What problems or disagreements would you expect Arundel and a major studio to encounter in the course of a relationship like the one described in the case? What contractual terms and provisions should Arundel insist on?

Counselor’s failure to connect with client

â€Å"There is also some current there, you feel hurt because, in some ways you’re saying to me that you can’t love her as full as you really love her, you can’t show her. † The counselor failed to connect with the client when the client is told thatâ€Å"there is always going to be a conflict. † The client was in the course of sharing her thoughts to which the counselor mutters the word â€Å"anytime† thrice. The client seems to be distracted by the constant response of â€Å"anytime† to which she simply said â€Å"okay†. Then the counselor proceeds with periodic interruptions and said â€Å"conflict in you so the relationship with the daughter can be as full as it can.† The client wanted to state something but the therapist continues to elaborate on what she thinks the client wants to say. Another part that the counselor did not connect to the client is when counselor stated to add reinforcement schedules, or intellectu al, other intellectual strategies to start where the client is the strongest. The client replied by asking if her tears will control of the reinforcement schedules, or intellectual strategies which were ignored by the counselor. The counselor continues to advise the client to â€Å"build her heart to your head and not from your head to your heart, that’s a personalized view.† It is clear that the session is not client-centered towards the end of the conversation. The client spoke in soft voice saying â€Å"yeah yeah. † While the counselor continues to elaborate her piece of advice by saying â€Å"It would make sense and it would be an area of strength there† and â€Å"it makes sense. And it’s just that I had it in the wrong† without acknowledging the client’s question. The counselor also finished the client’s sentence when he or she said the word â€Å"order† indicating that the counselor did not let the patient say what she needs to say.It failed to promote understanding given the need for the client to reiterate what she heard from the counselor to confirm mutual understanding. Overview of the session The session was about the dilemma of the client on teaching her daughter to sleep in her separate bed. The mother reinforces this behavior but easily succumbs to the cries of her daughter to let her sleep beside her mother. The mother wants to teach her daughter how to be independent enough to sleep alone. There was a significant progress of this reinforcement when the daughter is promised to have rewards during birthdays and Christmas.The mother has frustrations on how she surrenders and let her daughter have her own way. In addition to, the mother has trouble sleeping when her daughter cries until she is transferred to her mother’s bed. The main issue of the client is that she feels angry with herself more than she feels angry toward her daughter. The client thinks that she is the one to bl ame for allowing her daughter to get some leeway thus allowing herself to be weak to stand by her own rules. A non-evaluative overview of what happens in the sessionThe session allowed the client to express her trouble and feelings with regards to reinforcing her daughter to sleep in her own bed. The client opened up her problem at the first half of the session while the counselor rendered her opinions and suggestions on how to view the disciplinary actions applied to the client’s daughter as well as how to approach the issue by taking â€Å"small, increment† steps. How did you feel while reading about the session? (no more than half a page) While the reading the session, it struck me how important it is to share burdens or worries.Issues such as parenting or reinforcing good behavior of children can be a battle of emotions and will. Thus, a parent can be torn between following her mother’s instincts to let her child have her or his desires but at the same time should be a disciplinarian. After all, the role of parents is to rear their children to be responsible and productive individuals. I also realized that the conflict between being too lenient and strict when it comes to parenting is often a battle of emotions for most mothers.Motherly love often gets in the way on instilling discipline on the child as pity gets the better of a mother upon seeing her child showing signs of distress such as crying, throwing tantrums, or helplessness. Lastly, there is a need for making appropriate responses during counseling. The responses made should be oriented in a manner to further explore a client’s feelings by expressing acknowledgment, accepting by letting the client talk, exploring with additional questions, and validating the client’s responses by asking the client to further elaborate her or his thoughts.My opinion of this counseling session Based on what I read, the counseling session has its good and bad points. Counseling is c onsidered a good therapy for clients who need to talk their problems out. Thus, the client in one way or another expressed her pent up anger and frustrations. The counselor was able to listen and give suggestions to the client and her problem. Counseling skills that the counselor attempt to use and list some examples using your transcript.The counseling skills employed by the counselor are verbal attending behavior include things such as your tone of voice, rate of speech, sighs, and uhms. The classic â€Å"uhum† is a verbal sign of interest that encourages a client to keep talking. What do you see as the counselor’s main strengths or good qualities? The main strength of the counselors is having the ability to form interpretations and use of empathetic comments. The counselor expressed his or her own interpretations when the client narrates her struggles on reinforcing her daughter and the need to sleep in her bed.The act of nodding your head or being silent while the client is talking serves as a powerful message to encourage the client to express his or her feelings. This therapeutic form of communication can only be used on specific instances thus should not be used all the time since it shows disinterest. The counselor made empathetic comments such as â€Å"so, but, but you’re still left with a, holding your breath. † and you’re really testing your own patience with the three days, four days, two weeks, then back. † Thus it validates clients’ reactions as acceptable, normal, or understandable.

Proposal Essay Example | Topics and Well Written Essays - 2000 words - 1

Proposal - Essay Example The proposed comprises of preliminary literature review as well that will be beneficial in creating fundamental framework before carrying out the research. Lastly, the research proposal includes methodology section that specifies selection of secondary, as well as primary research methodology that will be very effective in efficient acquisition of data. INTRODUCTION The focus on forming valuable associations with clients is not a fresh approach within the field of business. The growing competition in addition to lessening customer loyalty have created the need for applying innovative tools to facilitate businesses to do well in the competition and win customers’ loyalty by offering more modified products. Fast development within ‘information systems applications’ that allow business-client communication along with the boom of ‘internet technology’ have given companies with additional potential to manage increasing understanding obtained by clients alo ng with the varying nature of their requirements for particular products (Finnegan & Willcocks, p. 94, 2007). Whereas, the mainstream of companies attempt to apply CRM systems, they come across the upsetting reality of the large percentage of collapse within their CRM implementations. As a reply to the need of dealing with the issue of the high failure ratio of CRM ventures, various researchers have created a range of frameworks for CRM implementation. In this regard, the proposed research is an attempt to analyze different factors related to the process of CRM implementation. Research Objectives Before carrying out research, it is very imperative that the researcher ensures clarified understanding of aims and objectives, as it is an observation that vague objectives often result in unproductive outcomes, and thus, the research proposal will now include aims and objectives of the proposed research: Identify and examine various internal and external factors that play a determining ro le in ensuring success of CRM implementation Inspect the level of impact of identified factors in banking institutions in Saudi Arabia Investigate the impact of identified CRM implementation factors in the case study of a two banking organizations in Saudi Arabia Recommend strategies that may ensure successful implementation of CRM in banking institutions and organizations globally, and particularly, in the corporate society of Saudi Arabia Research Statement In this regard, the researcher will focus on the following research statement to fulfill the aims and objectives of the research: â€Å"To identify and investigate the implementation of CRM in Saudi Arabia, and evaluate different factors that ensures successful ERM implementation† LITERATURE REVIEW There is a common recognition among researchers about the classification of CRM constituents. CRM involves three key constituents, which are information technology, individuals, and business traditions. The involvement of ever y part differs in accordance with the level of CRM implementation. Technology means computing potential that let a business to gather, arrange, save, and utilize records regarding its customer. Technology is the facilitator for CRM systems to successfully attain their goals of collecting, categorizing, and saving important information on

Compare and contrast the approaches to the learning and teaching in Essay

Compare and contrast the approaches to the learning and teaching in the early years utilised by Montessori with the EYFS - Essay Example She came to believe that with special educational treatment, their condition could be improved. Inspired by this new idea of pedagogy, she devoted herself to the teaching of defective children. Gradually, she began to realise that the methods she was using had nothing in them peculiarly limited to the instruction of the retarded. On the contrary, they contained educational principles more rational than those generally in use. She says, â€Å"This feeling, so deep as to be of the nature of an intuition, became my controlling idea. I became convinced that similar methods applied to normal children would develop and set free their personality in a marvellous and superior way.† Thus developed the Montessori Method, the educational system devised by Madame Montessori and which has undergone a process of birth, death and re-birth. In the last few years, innumerable books, magazines and newspaper articles have appeared in many parts of the world, singing the praises of Madame Montess ori. As a matter of fsct, a whole ‘Montessori Mystique’ has come into being. New theories have developed leading to new methods for pre-school education in different parts of the world. However, they are either adaptations of the Montessori Method, or deviations in some respect, yet, rooted somewhere in the Montessori Method. One such scheme operating in U.K. is the Early Years Foundation Stage (EYFS). Theory and principles: Montessori was not a theoretician in the true sense. Montessori education is based on an empirical experiment with children in concrete life situations. Madame Montessori was so struck by what she observed that she never felt the need to build up an abstract theoretical system. More important to her were not the theories but the child itself and the revelations of its spontaneous behaviour which touched her so profoundly that she devoted the rest of her life to provide him such conditions

Learning By Doing and Using Instructional Technologies Research Paper - 1

Learning By Doing and Using Instructional Technologies - Research Paper Example Making use of technologies, students are able to access a wide range of virtual environments. This paper focuses on the process of learning by doing and using instructional technologies. The paper will explore the theories of learning and teaching relative to instructional technologies. Introduction of microcomputers and internet has greatly influenced teaching and learning. Technology motivates students to learn since it encourages use of hands-on-technology activities making learners more autonomous. Appropriate use of technology in teaching motivates students since encourages creative methods of learning and enables students to remain attentive. Use of technology for teaching affects the learning process in different ways. The instructional methods are affected since teacher or educators act more like facilitators (Hung, 2001; Candace, Sheri, & Lane, 2011). Several theories relate the theories of learning to use of technology in teaching. Educational theories embrace any phenomena that contribute to education in either philosophical or general approach. Instructional theories deal with aspects pertaining to instructions. The four main models of learning which include social constructivism, cognivitism, behaviorism, and constructivism form the framework of learning and teaching. The learning theories are distinct from the instructional approaches. Behaviorism and cognitivist models showed that the manner in which instructions are given determines the ease of learning. This is because the mind acts as an information processor. It is thus important to use technology base instruction approaches to encourage learners to reason (Bot, Gossiaux, Rauch, & Tabious, 2005). Constructivism and social constructivism models focus on influence of interactions on learning or assimilation and accommodation of knowledge. People tend to interpret ideas depending on how they perceived them. Use of technology to provide

Clinical biochemistry Essay Example | Topics and Well Written Essays - 750 words

Clinical biochemistry - Essay Example ncerned with the whole disease range, and it mainly relies on detection of changes in the various components such as proteins, electrolytes and enzymes in blood serum and the other body fluids (Varcoe 2001). Clinical biochemistry also relies on the laboratory tests carried out on samples of patients’ body fluids. Obesity is an illness that results when the body accumulates excess fats to levels that cause a great deal of effects on the health of the person. This occurs when the body mass index of the person is above 30kg/m2. Obesity is mainly caused by excessive intake of carbohydrates and fats and lack of physical exercise of the body, and in some cases it is genetic while in others, it may result from endocrine disorders and medical complications. Obesity is a major threat to the lives of persons since most people do not realize that they have the condition until it is in its late severe stages. However, obesity can be treated or managed by dieting and doing physical exercises. Other models of managing obesity are the use of medical drugs that many people have opted to use. However, with the advancement and growth in the technological industry; and its wide application in almost every field, in the world, the medical discipline is no exception. The development of equipment that are used in treatment and management of various medical conditions has been a great boost in the fight towards a healthy society. The health of individuals is very critical, and thus the development of the field of clinical biochemistry has really advanced that fight. The incorporation of this advanced technology in the fight against obesity is clearly a great boost to helping the obese patient. The application of the clinical biochemistry technology in dealing with the obese patient is very wide. Biochemical analysis contribute in management of the obese patient since through the various tests carried out on samples of the patient’s blood; the condition is detected. Some of the

Individual Employment Law Case Study Example | Topics and Well Written Essays - 1750 words

Individual Employment Law - Case Study Example Several matters need to be taken into consideration regarding your current situation with filing an injunction against Brett your sales and marketing director. Employment law protects Brett as well as you so I advise you to carefully pursue the issue. Fraser Younson was quoted in the September 2 issue of Lawyers Weekly Magazine in an article about the rise in claims by employees against their firms, a relatively new issue in the British legal profession. Unfair or wrongful dismissal claims occur when firms to do follow the correct procedure made mandatory in legislation on October 1, 2004. "In some firms in particular, partners need to understand that they need to coach employees on an on-going basis, not just mention their shortcomings at appraisals," (Younsun) The major issue you have at hand is a no compete contract where the contract was an oral agreement. An oral agreement is legal and binding as long as consideration was present. In the case of consideration and your verbal agreement with Brett consideration was present but there are other matters at hand that must be taken into consideration. One of them is the time factor. As the agreement between Brett and yourself was never formally written up a date and the time limit on the agreement are difficult to determine at this time. The proof of the time is difficult to prove at this point. McDermott was recommended in Legal 500 Eur... egration following the acquisitions of two German companies, a varied and challenging mandate which required negotiations with trade unions and group works council on a mass redundancy program, and the establishment of a European works council." (Anthony) Essentially you had a no compete oral contract with Brett. Legal for such a contract should read: (a) Company Information. The Company will make available to the Independent Contractor certain Confidential Information of the Company, previously non-disclosed to him or her, which will enable him or her to optimize the performance of his or her duties to the Company. In exchange, the Independent Contractor agrees to use such Confidential Information solely for the Company's benefit. Notwithstanding the preceding sentence, the Independent Contractor agrees that upon the expiration or termination of the Agreement, the Company shall have no obligation to provide or otherwise make available to the Independent Contractor any of its Confidential Information. "Confidential Information" means any Company proprietary information, technical data, trade secrets or know-how, including, but not limited to, research, product plans, products, services, customer lists and customers (including, but not limited to, customers of the Company on whom the Independent Contractor called or with whom her o r she became acquainted during the term of the contract), markets, software, developments, inventions, processes, formulas, technology, designs, drawings, engineering, hardware configuration information, marketing, finances or other business information disclosed to the Independent Contractor by the Company either directly or indirectly in writing, orally or by drawings or observation of parts or equipment. Confidential Information

Fiction analysis Essay Example | Topics and Well Written Essays - 1000 words

Fiction analysis - Essay Example Because the grandmother recognizes him, the entire family is taken back into the woods and killed with the exception of the grandmother, who is allowed to talk with the Misfit until the rest of the family is dead and then is killed there at the side of the road. A few more superficial comparisons can be made in that the main character of each story is a woman, each woman must face the death of her son and both women die by the end of the story for reasons they have little or no control over. However, there are deeper similarities between these two stories that emerge when one takes a closer look. These similarities include being written in the realist tradition, featuring men who suddenly realize their own common connections and both having a gothic element. One of the most glaring similarities between these two stories is that they are both written in the realist tradition. The realist tradition in American literature focused on the concept that people were just people, not submerge d divinities as the transcendentalists claimed or helpless victims of fate as the naturalists claimed. "These American realists believed that humanity's freedom of choice was limited by the power of outside forces" (Penrose). In other words, realism acknowledges individuals have their own power to make choices, but that they are also forced to work within boundaries established by external events. In Chopin's story, this is seen as Desiree finds herself trapped in a situation in which her beloved husband can no longer stand the sight of her because of the obviously mixed blood seen in their baby - a condition she cannot control. However, her fate is determined by her individual choice to "not take the broad, beaten road which led to the far-off plantation of Valmonde ... She disappeared among the reeds and willows that grew thick along the banks of the deep, sluggish bayou; and she did not come back again" (Chopin). It is also found in O'Connor's story as the grandmother is unable t o determine where she will go for a family vacation, but has the option of going along with the family or continuing to bid for a trip to Tennessee instead of Florida. In each case, there are limiting outside forces, but it is still the individual's choice that leads them to their fate. Both stories also have a strong gothic element. Some of the common elements of Gothic literature are emotional terror, some form of crumbling architecture, death and madness occurring among the characters, a sense of pervading darkness and plenty of secrets and hereditary curses (Hume 282). Desiree's home is dark enough to give Madame Volmonde shivers with its deeply sloping roof, "steep and black like a cowl," and the "big, solemn oaks" whose "thick-leaved, far-reaching branches shadowed it like a pall" (Chopin), giving a strong instance of foreshadowing in the symbolism used within this description. The nearby marshes, the stubble of the fields that cut Desiree's feet on the November evening that s he disappears, and the prevailing gloom of the harshly treated slaves all function to create a gothic environment. This is further enhanced by the mental anguish of the lady as she perceives

Organisational change management Essay Example | Topics and Well Written Essays - 3000 words - 2

Organisational change management - Essay Example The positive energy approach will help to build the organisations on the strengths (Cooperrider and Whitney, 2001; Cooperrider, et al., 2008). The first step in this process is identifying and describing the problems which are needed to be solved. The approach can be described in five steps: (Source: The Eye Health Summit, 2013) Definition Definition is the first phase of the Appreciative Inquiry process. It is the phase where the organisations try to find out the underlying issues of the current business process, which require immediate attention of the management. In this phase, the management makes a flow map of those factors which are creating problems in the present business process and require external enquiry. In today’s business environment, the importance of organisational change management has been one of the most widely investigated areas. The organisational change management has gained attraction to a great extent from the researchers all around the world. Accordin g to Harigopal (2006), the organisational change is an essential process associated with the growth and expansion of a particular business. It is considered to be a complex process because a change which was successful for one organisation might not be so for other organisations. Thus, it becomes necessary to check that the change is congruent to dynamism, complexity and finally the uniqueness of the respective organization. The changes taking place in the political, economic and social environment also has an effect on the individuals and the organizations. Even if the change has been a constant process but its rapidity and swiftness have always been different. It is because of this reason that the external environmental changes have forced the organizations to make certain changes in their operational systems. We find a large number of companies implementing various strategic changes for coping up with the existing challenges. In case of strategic change, the companies restructure their business or marketing plans in a wider context. The main intention of performing strategic changes in an organization is for achieving the organizational goals and harmonizing the organizational activities along with the business environment. Organizational change management is one of the most crucial activities of an organization (Chen, et al., 2013). According to Jones (2004), there are two reasons responsible for the changes in the organizations. One is the response to the changes in the external environment. Another reason is the response of the companies to a specific crisis situation. The organizational change also becomes evident when various companies undergo any change in their executive power (Haveman, Russo and Meyer, 2001). The present study deals with the investigation of the problems in D2, which is an automobile components manufacturer. The company is facing a large number of problems associated with the cost of operations. The economic downturn has resulted in the worsening of the scenario in the company. D2 had to struggle for surviving in the market. The company planned for formulation of new strategies in order to achieve the economies of scale. The new strategy which has been taken into consideration is yet to be conveyed to the employees and only the senior managers are informed about the strategy

Technical Writing Essay Example | Topics and Well Written Essays - 1000 words

Technical Writing - Essay Example Constructing the charts using the computers is much easier than constructing it manually. However, although the constructing the charts by computers is easier, the guidelines for constructing the charts both manually and by using computers are similar. The pie charts must always be numbered as figure 1 or figure 2 and so on. However, if the visual (chart) is one, the numbers are excluded. The charts must also have a title and each segment or sector must be labelled concisely and clearly. In addition, arrows or lines should be used if necessary to link the labels to the segments (Picket, Laster and Staples, 2001). The chart below is an example of a pie chart. The chart is prepared by computer software graphic. It represents the total expenses of a student in Linfield College per term. These are estimates of his expenses for one of the terms in the 2011-2012 year of study (Linfield College, 2011). College Expenses per Term Item Amount($) Percentages (%) Accommodation 2,490 8.987547374 Personal expenses 1,100 3.970402454 Telephone/Internet 550 1.985201227 Food 3,000 10.82837033 Laundry/Personal Hygiene 430 1.552066414 Clothing/Entertainment 1,000 3.609456777 Transportation (local) 375 1.353546291 Tuition 16,050 57.93178127 Books and Supplies 700 2.526619744 Board (Standard) 2,010 7.255008121 Total 27,705 100 Question 5.12 Bar charts Bar charts are also referred to column charts or bar graphs. Just as the pie charts, bar graphs are also simple and very useful visuals because they permit easy comparison of proportions or amounts. Bar charts are composed of one or more vertical or horizontal bars that are equal in width and length. Bar charts can either be column charts or bar charts. Column charts are those with vertical bars whereas bar charts are those with horizontal bars. The bars, whether vertical or horizontal, are usually separated so as to improve their appearance and readability (Picket, Laster and Staples, 2001) . In representing multiple data in bar chart s, multiple bars with different colours, shading or cross-hatching may be used to show different divisions. Bars charts can also be designed manually or by computer graphic software. Preparation using the computer is easier provided one has the knowledge of using the software. Like a pie chart, a bar chart must also have a title and the bars together with the axes must be well labelled. The charts must also be numbered as figure 1 or figure 2 and so on if they are more than one (Picket, Laster and Staples, 2001). The figure below is an example of a bar chart. The bar chart is a column chart representing the annual retirement plan of Gomez. The retirement plan is paid by Roy Gomez who earns an annual salary of $ 50,000, Comal County and the state. Gomez’ Annual Retirement Plan Payer Amount ($) Gomez 2500 Comal County 2000 State 1000 Total 5500 Question 5.3 Estimated Preparation Time for IRS Form 1040A Visuals are images that relay information. Although written language is the most common mode of communication used in the workplace, images such as charts, graphs and tables are also required to support the information passed by written language. However, the visual language used must be suitable to the intended persons and purpose regardless of the subject matter. Therefore, since the response of the audience to visual information is

Formative and Summative Assessment Essay Example for Free

Formative and Summative Assessment Essay On the basis of only one factor we cannot take a life long decision in our life. For instance, individuals who are considering purchasing a house look at the house’s age, state, position, style, characteristics, and edifice, as well as the worth of nearby homes. Doctors detecting an illness apply multiple evaluations: the patient’s medical history, lab experiments, answers to questions about how the patient experiences, and so on. The question arises that why do education representatives and practitioners at times choose to make vital decisions based on only one pointer? Here, the concept of multiple measures comes into play. By the term ‘multiple measures’ we mean that one indicator to make decision about groups such as class, team, educational institutions, etc. Individuals who understand, use, and converse review results have a specialized liability to employ multiple sources and sorts of relevant information about individuals or programs whenever likely in making educational judgments. In any kind of educational backdrop, decisions should not be taken on the basis of one single indicator. If the overall scores and situations are taken into consideration, then the decision making procedure seems to be better. If our major concern is to make out for certain whether an educational institution has arrived at a goal on a particular accomplishment construct (an attribute one is trying to assess), then we might feel like to apply a compensatory approach joining multiple measures of that construct. If false negatives are a major concern—for example, if rigorous outcomes are in position for failing to meet a standard—then we would like to apply complementary multiple measures so that an educational institution can pass by fulfilling the standard on any one assessment. However, if we are persuaded that each of several assessments is crucial to quality, we would perhaps want to apply a conjunctive approach in which an educational institution must pass all assessments. This is what Brookhart’s reading is trying to articulate (Brookhart, 2009). According to McMillan, each decision taken about the learners and the educational institutions should be based on something. The educators make use of their knowledge, logical reasoning, experience and convention to come to any decision. Evaluation of learners is difficult since effectual decision making is based to some extent on the capability of educators to comprehend their learners and to match performances with precise evaluations (McMillan, 2000, p. 3). The teachers need to understand the learners what they are capable of, what are their problems and how they can cope with that problems, then only the educators can come to any decision and make assessments. Assessments start with the recognition of specific purpose for gathering and interpreting the information. Once the rationale has been identified, accurate techniques for collecting and synthesizing the information can be recognized. What works well for one rationale might not work out for another rationale. The nature of assessment technique should follow from the projected rationale (McMillan, 2000, p. 4). Similar kinds of views have been found in both the arguments placed by Brookhart and McMillan. Thus, the arguments placed by both the proponents have solid ground. Therefore, it is important to use multiple measures in today’s classrooms to assess children’s academic performance. Youngsters deserve assessment that demonstrates them their strengths as well as their requirements and that directs their educators to devise instruction that will best assist them develop as readers. Formative assessment and summative assessment share a general aim of evaluating learner knowledge. The main distinction between the two is the rationale for which the assessment is carried out. Formative assessment is proposed to notify and direct alterations to teaching on an enduring basis. Summative assessment is proposed to keep an eye on development and assess the overall achievement of both learners and instructional programs on a continuing basis (Formative and Summative Assessment, n. d. , p. 5). Summative assessments are aimed purposely for execution with uninterrupted progress-examining systems. These systems would permit educators to track learners all through a school year and, preferably, over a total educational career, from nursery through high school (Formative and Summative Assessment, n. d. , p. 8). The summative assessment can be related to the propositions placed by Brookhart and McMillan. By making use of all the assessment records of any learner, the educators can easily come to any decision of evaluating a student’s performance at the end of any academic year. According to Dylan William, he wanted to find out if using evaluation to support learning, rather than just to assess its results, can improve learners’ accomplishment, even when such accomplishment is evaluated in the form of state-authorized examinations. In assessing 250 studies from around the globe, issued between 1987 and 1998, he had observed that a focus by educators on evaluation for learning, in preference to assessment of learning, produced a considerable increase in learners’ accomplishment. Since the studies also divulged that day-to-day classroom evaluation was comparatively rare, he felt that substantial improvements would be caused by supporting educators in developing this feature of their practice. The studies did not tell, however, how this could be attained and whether such achievements would be continued over an unlimited period of time. Each educator will have to find a method of integrating the assessment designs into their own practice, and effectual formative assessment will look very dissimilar in different classrooms. It will, however, have some distinctive characteristics. Learners will be considering more often than they are seeking to remember something, they will think that by working hard, they get intellectual, they will appreciate what they are working in the direction of, and will know how they are advancing. References: 1. Brookhart, S. M. (Nov. 2009). â€Å"The Many Meanings of Multiple Measures†. Educational leadership. Multiple Measures. Vol. 67, No. 3. Available at: http://www. ascd. org/publications/educational-leadership/nov09/vol67/num03/The-Many-Meanings-of-? Multiple-Measures?. aspx (Accessed on July 15, 2010). 2. McMillan, J. H. (2000). Essential assessment concepts for teachers and administrators. California: Corwin Press. 3. â€Å"Formative and Summative Assessment† (n. d. ). Glencoe/McGraw-Hill. Interactive Educational Systems Design, Inc. Available at: http://www. readingnavigator. com/mkt/assets/formative_and_summative_assessment. pdf (Accessed on July 15, 2010).

Literature Review on Breast Cancer Research

Literature Review on Breast Cancer Research Aashiyana Vadsariya Introduction    Evaluation is a process of reviewing of any programme, project or policy, its design and results. The main objective of doing evaluation is to measure the effectiveness of the programme or policy, its impact and sustainability. Evaluation helps to solve the problem as well as to build the knowledge and it enhances the decision making process and thus evaluation is an important part of quality improvement (The Health Foundation, 2015). There are different types of evaluation such as formative evaluation, outcome evaluation, process evaluation, impact evaluation and economic evaluation which can be conducted to ensure programme activities. Moreover, vigorous evaluation provides not only about intervention that is worked but it also describes why and how that allows an individual to discover new interventions in healthcare settings. Additionally, it involves ethical approval, collection and analysis of data (Centre for Disease Control and Prevention, 2015). Background of the study According to Ministry of Health (2015), Breast cancer is the third most common cancer in New Zealand. It causes more than 600 deaths every year. Breast cancer is most common over the age of 50 and risk of developing breast cancer increases as age increases. Approximate 80% of women are over 50 years of age who died because of breast cancer. There are 8 cases diagnosed with breast cancer every day, out of them 1 will be Maori and pacific women who are at higher risk of dying from breast cancer. Maori women are more likely to develop breast cancer about 33% than non-Maori women (The New Zealand Breast Cancer Foundation, 2013). National Breast Cancer Foundation describes certain risk factors which increases the chance of developing cancer such as age, gender, positive family history, personal health history and genetic factors. Ministry of Health have started the programme called Breast Cancer Screen Aotearoa to fight against breast cancer by providing free breast screening to the women aged 45-69 years of age. The main objective of this programme is to reduce number of deaths from breast cancer by providing them regular screening (National Screening Unit, 2014). This paper will critically evaluate five (5) research papers of breast cancer that were published worldwide focusing on their significance, methodology and quality and will analyse the four (4) audit and evaluation processes and approaches such as outcome, process, impact, economic evaluation from the evaluated breast cancer research papers. Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis. This study evaluated the breast cancer early detection programme in Basque country in relation to cost effectiveness and budget impact from 1996 to 2011. The researcher has used population level and single cohort analysis methodology. Annual costs were taken into consideration for budget impact analysis. The results of this study showed that total cost of breast cancer screening program was 1,127 million euros and 6.7 million QALYs over the lifetime of the target population, bringing about a pickup of 8,666 QALYs for an extra cost of 36.4 million euros (Arrospide, Rue Van Ravesteyn et al., 2016). The researcher has finally summed up that the breast screening programme ran in Basque country was cost effective and as per determined budget impact. This study contributes to measure cost effectiveness of this breast cancer screening programme and evaluate its budget in order to decide the future of this programme. A review of breast cancer awareness among women in India: Cancer literate or awareness deficit? This study was conducted to assess the level of awareness about risk factors leads to breast cancer in Indian women and healthcare professionals through literature review. The researcher used bibliographic databases such as MEDLINE, SCOPUS, Cochrane database of systematic reviews and Cumulative Index to Nursing and Allied Health. The findings of the research suggested that total 7066 number of women between ages of 15-70 years reflected different level of awareness on risk factors such as family history (13-58%), obesity (11-50%) and reproductive history around 1-88% (Gupta, Shridhar Dhillon, 2015). Low cancer literacy on risk factors of breast cancer among Indian women and healthcare professional noted during research process irrespective of their socio-economic status and education was (Gupta, Shridhar Dhillon, 2015). This study contributes to aware the nation about programmes and to improve the cancer literacy rate in India by engaging various stakeholders of society and health system. National Breast Cancer Screening Programme, Singapore: Evaluation of participation and performance indicators. The researcher evaluated participation rates and performance indicators in the National Breast Cancer screening programme in Singapore during this study. This study involved the use of retrospective evaluation approach by using the BSS system and the Singapore Cancer Registry data on women aged 40-69 screened in period of 2002-2009. The results showed that participation rate was more than 10% since 2005 and performance indicators (such as screen detection rates, small tumour detection rates, recall rates, accuracy and interval cancer rates were improved from 2002-2006 to 2007-2009 (Loy, Molinar Chow, 2015). This study indicated that there is room for improvement in participation rate in breast cancer screening in Singapore by providing screening packages, reducing screening cost and targeting underserved populations. This study contributes to improve the participation rate of breast cancer screening programme for the effectiveness of the BreastScreen Singapore by providing training opportunities to the healthcare professionals. Impact of mammographic screening on ethnic and socioeconomic inequities in breast cancer stage at diagnosis and survival in New Zealand: a cohort study. This study was conducted to determine the impact of differences in rates of mammographic screening on inequities in cancer stage at diagnosis and survival between Maori and Pakeha women. The researcher used Waikato Breast Cancer Register and the National Screening Database to compare the data for diagnosis and survival between screen detected and non screen detected breast cancer by socio-economic status and ethnicity. The results indicated that there were lower rate of screen detected cancer in Maori women and also they had lower 10 year breast cancer survival rate as compared to Pakeha women (46.5% vs. 73.2%) (Seneviratne, Campbell Scott, et al., 2015). The study determined that lower rate of screening detected breast cancer was the important reason for lower rate of survival for Maori women in comparison to European women. This study contributes to assess the screening rates, to improve the survival for Maori women and to reduce inequity for the breast cancer survival among Maori and New Zealand European women. An ongoing case-control study to evaluate the NHS breast screening programme This research was carried out to evaluate the national breast screening programme in England. This study estimated the effects of the national breast screening programme in regards to breast cancer incidence, mortality and over-diagnosis of breast cancer. The researcher has used quantitative methodology and retrospective case control study to describe the policy on mammographic screening. The findings suggested that there is decrease in incidence by screening, excess risk of disease in screened ages from 47-54 years and potential deficit in risk seen between the ages of 65-69 years up to 15 years of screening (Massat, Sasieni Parmar et al., 2013). This research concluded that case control evaluation strategy relates the clinical endpoints to the screening history. This study contributes to measure the effectiveness of the national breast screening programme in England, benefits on mortality from and on incidence of invasive primary breast cancer and harms from over-diagnosis. Audit and Evaluation processes Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis. Economic evaluation is one of the most important forms of evaluation which measures the expenditure and their consequences and also describes about allocation of the resources (Cunningham, 2000). In this research, the researcher has used economic evaluation to measure cost effectiveness of the breast cancer screening programme in the Basque Country from 1996 to 2011. This study was mainly based on budget impact analysis and retrospective cost effectiveness evaluation to determine what resources are being used in programme and their costs as compare to outcomes (Arrospide, Rue Van Ravesteyn et al., 2016). Economic evaluation in this research took a step back and looked objectively in context to appropriate role and use of cost effective analysis in order to determine the outcome of the breast cancer screening programme. This research revealed that the breast screening programme was found to be cost effective within determined budget impact (Arrospide, Rue Van Ravesteyn et al., 2016). A review of breast cancer awareness among women in India: Cancer literate or awareness deficit? Outcome evaluation identifies the effects of the programme in target populations by reviewing effectiveness of programme (Centre of Disease Control and Prevention, 2015).The researcher used outcome evaluation to determine awareness levels of risk factors for breast cancer among women and healthcare professional in India. This outcome evaluation was undertaken through a structured literature review by using bibliographic databases journals (Gupta, Shridhar Dhillon, 2015). The main purpose of this outcome evaluation in this study was to assess the cancer literacy among women in India because of the rising incidence and mortality rates from breast cancer. Furthermore, the researcher concluded that there was a low literacy rate among Indian women regarding risk factors that causes breast cancer through this evaluation study (Gupta, Shridhar Dhillon, 2015). National Breast Cancer Screening Programme, Singapore: Evaluation of participation and performance indicators. Process evaluation was conducted to assess how this breast screening programme is being implemented whereas outcome evaluation was conducted to measure the outcome and effectiveness of this programme (NYS Health Foundation, 2016). The researcher used outcome and process evaluation to evaluate the participation rates and performance indicators in the National Breast Cancer Screening programme in Singapore. Data was collected on women aged 40-69 screened during period of 2002-2009 from the BreastScreen Singapore and Singapore Cancer Registry (Loy, Molinar Chow, 2015). Process and outcome evaluation was helpful to determine the rate of participation and performance indicators, to measure the quality of the programme delivered and to assess the effectiveness of the breast screen Singapore programme. This evaluation allows researcher to examine the performance of this Breast Screen Singapore programme and to recommend further changes if required. Impact of mammographic screening on ethnic and socioeconomic inequities in breast cancer stage at diagnosis and survival in New Zealand: a cohort study. Impact evaluation measures whether the programme is effective in achieving its goal or not. Generally, it identifies long term effects and changes in outcome based on cause and effect analysis (Collins, 2017). The researcher utilised impact evaluation to determine the impact of mammographic screening on ethnic and socio economic inequities in breast cancer stage at diagnosis and survival between Maori and European women. The researcher collected data by using National Screening Database and Waikato Breast cancer Register (Seneviratne, Campbell Scott, et al., 2015). Impact evaluation was carried out to measure the impact of screening programme on ethnic and socio economic inequities for breast cancer survival rate which can be useful for government to take necessary actions and to form policies in healthcare settings to reduce inequalities in health. An ongoing case-control study to evaluate the NHS breast screening programme Process evaluation determines the effectiveness of the programme and how well the programme is working (Community Interventions for Health, 2017). The researcher used process and impact evaluation to evaluate the national breast screening programme in England. Impact evaluation was helpful to identify the impact of breast cancer screening on breast cancer incidence and mortality. Data was gathered by traditional retrospective case control study of deaths and incidences cases of breast cancer in England within 2 years of period during this ongoing evaluation (Massat, Sasieni Parmar et al., 2013). The main purpose of impact evaluation is to see that breast cancer screening programme is working effectively and is doing well than harm. Process evaluation can help to ensure that the breast screening programme continues to deliver the predicted health benefits and potentially improve the programme by assessing the good and bad practices. Evaluative Model The (CIPP) model The CIPP evaluation model is developed by Stufflebeam in 1983 which provides comprehensive framework for the evaluation of the programmes. The CIPP model consists of four components which are context, Input, Process and product evaluation. The CIPP model mainly focuses on improvement of the programme rather than justifying about the programme. The main purpose of this CIPP model is to offer critical and rational basis for the programme decision making by applying different aspects of this evaluation model according to the needs of decision makers and programme activities based on the planning and implementation for the continuous improvement of the programme (Kellaghan Stufflebeam, 2003). The context, input and process evaluation approach are based on formative evaluation whereas product approach is useful for summative evaluation study. The four elements of the evaluation model must be taken into consideration otherwise it could reduce the effectiveness of the project. The context evaluation study can be conducted when a new programme is being planned which helps to identify the program goals and objectives by assessing needs whereas the input evaluation study can be conducted during resource allocation to assess the feasibility or the cost effectiveness of the alternate approaches. It provides systematic approach to programme design and helps the evaluators and experts to develop the programme which is most likely to work better (Frye Hemmer, 2012). Source: Adapted from Stufflebeams CIPP Evaluation Model (1983). Retrieved from http://arcmit01.uncw.edu/jonesi/Evaluation.html The process evaluation helps the evaluators and stakeholders to assess the implementation of the programme and to interpret the outcomes of the programme through document review, observation and participant interview. On the other hand, the product evaluation is similar to outcome evaluation which focuses on assessing the outcomes of the programme including positive or negative, short term or long term outcomes. In general, the CIPP model provides information about improvement of the programme, interpretation of the programme outcomes and information for accountability. However, careful planning is needed while applying this model. This model is useful for retrospective evaluation of a completed programme (Kellaghan Stufflebeam, 2003). This evaluation model can contribute to measure the effectiveness of the breast cancer screening programme run by Ministry of Health in New Zealand. The four elements of the model can be used to improve the programme by identifying the non-compliance of women for the breast screening programme. Auditing and evaluating the breast cancer screening programme helps to know the barriers and promote the awareness regarding breast cancer to provide beast quality care services to the New Zealanders. Furthermore, staying healthier is one of priorities of the Ministry of health. It can be achieved through evaluating the programme and implementing a change accordingly if needed. Conclusion Evaluation research is an essential tool to evaluate the effectiveness of the programme or to know how well the programme is working. Evaluation research helps managers and stakeholders of the organisation to improve the performance of the organisation and to provide the quality care health services. Staff and clients can be encouraged to provide useful feedback about the programme which helps in decision making and policy formation about the programme and thus improving the services provided by organisation. References Arrospide, A., Rue, M., Van Ravesteyn, N. T., Comas, M., Soto-Gordoa, M., Sarriugarte, G., Mar, J. (2016). Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis. BMC Cancer, 16(1). doi:10.1186/s12885-016- 2386-y Centre for Disease Control and Prevention. (2015). Types of evaluation. Retrieved from https://www.cdc.gov/std/Program/pupestd/Types%20of%20Evaluation.pdf Collins, K.B. (2017). What is Impact Evaluation. Retrieved from http://programs.online.american.edu/online-graduate-certificates/project- monitoring/resource/what-is-impact-evaluation Community Interventions for Health. (2017). Process Evaluation. Retrieved from http://www.oxha.org/cih_manual/index.php/process-evaluation Cunningham, S.J. (2000). Economics: Economic evaluation of healthcare is it important to us? Retrieved from http://www.nature.com/bdj/journal/v188/n5/full/4800444a.html Frye, A. W., Hemmer, P. A. (2012). Program evaluation models and related theories: AMEE Guide No. 67. Medical Teacher, 34(5), e288-e299. doi:10.3109/0142159x.2012.66863 Gupta, A., Shridhar, K., Dhillon, P. (2015). A review of breast cancer awareness among women in India: Cancer literate or awareness deficit? European Journal of Cancer, 51(14), 2058-2066. doi:10.1016/j.ejca.2015.07.008 Kellaghan, T., Stufflebeam, D. L. (2003). International handbook of educational evaluation. Dordrecht: Kluwer Academic Publishers. Retrieved from http://link.springer.com/chapter/10.1007%2F978-94-010-0309-4_4 Loy, E. Y., Molinar, D., Chow, K. Y., Fock, C. (2015). National Breast Cancer Screening Programme, Singapore: Evaluation of participation and performance indicators. Journal of Medical Screening, 22(4), 194-200. doi:10.1177/0969141315589644 Massat, N. J., Sasieni, P. D., Parmar, D., Duffy, S. W. (2013). An ongoing case- control study to evaluate the NHS breast screening programme. BMC Cancer, 13(1). doi:10.1186/1471-2407-13-596 Ministry of Health. (2015). Breast Cancer. Retrieved from http://www.health.govt.nz/your-health/conditions-and-treatments/diseases- and-illnesses/breast-cancer National Screening Unit. (2014). BreastScreen Aotearoa. Retrieved from https://www.nsu.govt.nz/breastscreen-aotearoa/about-breast-screening- programme NYS Health Foundation. (2016). Process Evaluation. Retrieved from http://nyshealthfoundation.org/our-grantees/grantee-resources/process- evaluation Seneviratne, S., Campbell, I., Scott, N., Shirley, R., Lawrenson, R. (2015). Impact of mammographic screening on ethnic and socioeconomic inequities in breast cancer stage at diagnosis and survival in New Zealand: a cohort study. BMC Public Health, 15(1). doi:10.1186/s12889-015-1383-4 The Health Foundation. (2015). Evaluation: what to consider. Retrieved from http://www.health.org.uk/sites/health/files/EvaluationWhatToConsider.pdf The New Zealand Breast Cancer Foundation. (2013). New Zealand Breast Cancer Facts. Retrieved from http://nzbcf.org.nz/BREASTCANCER/Overview/BreastCancerinNZ/Fastfacts.a spx

Aravind Eye Hospital, India: Mission and Vision

Aravind Eye Hospital, India: Mission and Vision Aravind Eye Hospital:Â  Improving Lives One Eye at a Time A Brief Introduction Imagine having the world as you know it cease to exist, the things you once saw be erased, and having no hope to gain control of your life. This is how life for many people in India once was, and how it still is for some even today. A cataract, a curable infliction of the eye, has attacked men and women of every age, sparing no one, not even a child. They build up in size over time, and leave many blind. Once struck, the individual in question can no longer work, and has no way to take care of themselves, making them entirely dependent on their family for support. Living in an already impoverished area, blindness has dire consequences, resulting in many cases of premature death. There is a simple procedure that can reverse the effects of cataracts and return sight to the user. However, this surgery is too costly for some to afford. In India, a country with an extremely high poverty rate, cataracts had become a major problem for the inhabitants. Cataracts have left millions to suffer with an unnecessary disability, but one man came about to challenge its hold on the people of India. Dr. Govindappa Venkataswamy revolutionized the medical field of eye care, and built a health institution that would allow everyone afflicted to get the help they needed, despite their ability to pay. This case analysis examines that institution, how it came into existence, how it operates, its creator, and the general background of the country of origination. Poverty and Healthcare in India Poverty is one of the biggest social issues in India. According to the Indian government, of its nearly 1 billion inhabitants, an estimated 260.3 million are below the poverty line. More than 75% of these poor people reside in impoverished villages (Azad, 2008). The causes of rural poverty include inadequate and ineffective implementation of anti-poverty programs, and the unavailability of irrigational facilities. The poor irrigation systems result in crop-failure and low agricultural productivity, forcing farmers into a debt-trap. Economic development since independence has been lopsided. There has been an increase in unemployment rates that have forced many people into a state of poverty, and the population continues to grow at an alarming rate (Economy, 2009). Overpopulation of an already scarce job field has kept many individuals trapped by poverty. India has a Universal Health Care System operated by the government, like many other industrialized countries. The governmental hospitals offer health care to the masses at the tax-payers expense. The Indian government set up the health care system to help people who are below the poverty line, but many people have problems using the hospitals. One reason for this is the fact that there are an extremely low number of medical practitioners available for the people. Another reason is that most public hospitals are inefficient, and provide poor quality medical services to their patients. Quality could be better, but public hospitals generally only provide basic treatment, and have lower quality equipment to perform with. Inefficiency in the system is caused by the imbalance between medical providers and the needy population. For example, although India requires more than 74,000 hospitals to satisfy demand, it just has about 37,000 health care centers (Liberty, 2009). Due to the impoverished peoples lack of resources, they cannot afford to go to a private eye hospital to get their cataracts removed. And because of the limited availability and help from government hospitals, and their inability to perform eye surgery, most individuals are left with no choice but to remain blind. This in turn adds to the increasing rate of unemployment, as it is difficult for a blind person to get or maintain a job. And that leads to having even more people below the poverty line, as it is not only the individual in question, but their entire family as well. If there was a place they could go to be treated, it would help stop the cycle of poverty, and give them a fighting chance to live. Enter the Vision, Aravind Eye Hospital Aravind Eye Hospital has risen from its humble beginnings to promote eye health not only in India, but also throughout the world. Doctor Govindappa Venkataswamy, along with his sister and brother-in-law, started Aravind in 1976 (Maurice, 2001). This eye hospital was first opened in a rented house that contained only ten beds. The three founders were the only doctors at Aravind when it first opened. Since then it has grown little by little each year. This hospital has grown into a five-story building that is located in Madurai, in the southern Indian state of Tamil Nadu. This particular hospital now contains 1,900 beds. As of 2001, approximately 1.5 million blind people have left this one hospital with their sight completely restored. In addition to this, Aravind Eye Hospital has now expanded into a total of five hospitals throughout India (Maurice, 2001). The Aravind franchise includes a hospital created specifically to help restore sight to children (Maurice, 2001). The Internationa l Institute for Community Ophthalmology, which is a part of Aravind Eye Hospital, trains eye care workers from low-income countries. There is a medical research foundation as well as an eye bank that handles about 900 corneas a year that are associated with Aravind. Aurolab is a manufacturing facility that makes lenses, pharmaceuticals, and surgery supplies for Aravind (Maurice, 2001). Aravind Eye Hospital later branched out and opened Aurolab, despite disagreements from the Indian government, because imported intraocular lenses, IOLs, were too expensive for low-income patients to afford (Shah, 2004). Aurolab makes approximately 700,000 IOLs each year (Maurice, 2001). These IOLs are then sold, not only to Aravind but to eye care facilities in over eighty countries, for a price that is ten times less expensive than the same quality of IOLs used in western countries (Maurice, 2001). Aurolab also manufactures spectacles, sutures, and medications along with the IOLs, to sell to the hosp itals for reduced costs (Chang, 2004). The Aravind group worked with approximately 1.3 million patients in 2000 (Maurice, 2001). This is about 85-90% more than most other hospitals in India. Also, Aravind holds mobile eye camps throughout the year to raise eye care awareness in India (Maurice, 2001). These eye camps screen villagers on a Sunday, then bus the patients into Aravind in the evening (Chang, 2004). The surgeries are then performed on Monday. There are usually 300-400 cases on Mondays, with the record being 500 cases (Chang, 2004). Most eye surgeons in the world perform less than 350 surgeries each year. At Aravind, the average number of surgeries per doctor is 2000 per year. Aravind looks to multiply its benefits by hiring and training local doctors and surgeons. Even though Aravind pays slightly more than the government hospitals, seven to ten doctors leave each year. The reason is, since Aravind is nonprofit organization, it is unable to compete pay wise with private practice institutions (Maurice, 2001). The Path to Aravind As previously mentioned, Aravind was founded by Govindappa Venkataswamy, who is commonly known as Dr. V (Maurice, 2001). Dr. V does not view his job as work, but rather as something that he is excited to be able to do. According to Dr. V, if there is something you can do, you should do it. Dr. V was born in 1918 and died at the age of 87 on July 7, 2006 (Govindappa, 2009). He received a Bachelors of Arts in chemistry from American College in Madurai in 1938. Then, in 1944, he received a doctor of medicine from Stanley Medical College in Madras. Finally in his education he received a doctor of ophthalmology from the Government Ophthalmic Hospital in Madras in 1951. From 1976 until his death in 2006, Dr. V was the chairman of Aravind Eye Hospital. In 1956 he was named the head of the Department of Ophthalmology at the Government Madurai Medical College. At the same time, he was an eye surgeon at the Government Erksine Hospital. He held both of these positions for twenty years until his forced retirement from the government hospital in 1976 (Govindappa, 2009). Dr. V was partly influenced in the creation of Aravind by his mentor, the philosopher and mystic Sri Aurobindo, whom Dr. V was a disciple of for fifty years (Maurice, 2001). When Dr. V was asked about the influence of his mentor into Aravind, he made the following statement: You do your best in your job and higher ideas come to you, and then you try to realize those ideas too (Maurice, 2001). Dr. V was also motivated from his work at the government hospital (Shah, 2004). The government asked him to have four camps a year while he still worked with the government hospital in 1961. This also proved to be a part of his opportunity identification. He saw the number of patients attending rise each time the camp was held (Shah, 2004). The fact that eighteen million people are blind by curable cataracts worldwide is another part of Dr. Vs opportunity identification (Chang, 2004). This number is growing at an alarmi ng, nearly epidemic rate. Blindness causes reduced life expectancy, and productivity is lost for both for the blind as well as for those that care for them (Chang, 2004). Dr. Govindappa Venkataswamy: A True Social Entrepreneur Dr. V had entrepreneurial quality, which is one of the four categories used to evaluate Ashoka nominees (Bornstein, 2004). People with entrepreneurial quality seek to change an entire field, not just get something done locally. People with this trait not only want to express their ideas, but they want to go out and be a part of solving the problems by executing their ideas (Bornstein, 2004). Dr. V has shown entrepreneurial quality through his work at standardizing the procedures for cataract surgery because this allowed the change to spread throughout the field, not just at his hospitals in India. Another way he has shown entrepreneurial quality is through the training that Aravind does for doctors in other countries. Finally, the fact that Dr. V did over 100,000 eye surgeries successfully himself shows that he was willing to be a part in executing his idea (Govindappa, 2009). The Six Qualities of Social Entrepreneurship Dr. V has also demonstrated the six qualities of a successful social entrepreneur as laid out by David Bornstein (2004). These six qualities are as follows: the willingness to self-correct, the willingness to share credit, the willingness to break free from established structures, the willingness to cross disciplinary boundaries, the willingness to work quietly, and a strong ethical impetus (Bornstein, 2004). Dr. V asked for help from business schools to on how to keep doctors from falling back into complacency at their own hospitals after completing training with Aravind (Shah, 2004). This shows his willingness to share credit because he publicly sought their help. It also shows his willingness to self-correct because when he saw the problem of doctors becoming complacent, even after receiving Aravinds training, he took active measures to fix the problem. He also shared credit with the other doctors that work with him, acknowledging the fact that Aravind could never have become such a success without the hard work put forth by everyone involved. And as mentioned earlier, the government was against the creation of Aurolab (Shah, 2004). By creating the facility anyway, Dr. V demonstrated his willingness to break free from established structures. Dr. V was able to cross disciplinary fields from medical and into manufacturing when he opened Aurolab. Also, by working privately at creating Aurolab and making it affordable, Dr. V demonstrated his ability to work quietly (Shah, 2004). Dr. V has repeatedly demonstrated his strong ethical impetus. During an interview Dr. V said that the focus of Aravind was on honesty and respecting the patients (Shah, 2004). Also, he said he tries to choose compassion over cost. This is exemplified when they spend more than the fixed charge for a patient because they do not charge the extra cost to the patient. R.D. Thularsiraj, the executive director of Aravind, says that Dr. V instituted a system of values into the hospital that has the effect of guiding their work to wanting to help others and away from focusing too much on money (Maurice, 2001). Finally, Dr. V has capacity building programs that basically work to instill integrity and quality into new hospitals (Shah, 2004). Structuring Sustainability, the Core of Aravind Dr. V wanted to reach those who had not been reached before, and help the poverty stricken individuals, who without his help, would not be able to see. He removed barriers, promoted community involvement, and had a growing market model for healthcare. Even after his death, his dream is still living on. Aravind continues to explore new approaches to the primary eye care market, and continuously seeks new innovations to help the population. When opening the first hospital in Madurai, in Tamil Nadu, his sister and her husband, both eye surgeons, joined Dr. V in his efforts. To cut costs, all three doctors took significant pay cuts since bankers would not finance a clinic that, regardless of ability to pay, gives eye care to the rich and poor. Dr. V even mortgaged his house to get the necessary finances to start the hospital. Within a year, all the efforts paid off and the hospital quadrupled in size. There are now five Aravind Eye Hospitals, and all are self sustaining, thanks to a blueprint copying system that has allowed for easier knowledge transfusion throughout the hospital chain. Dr. V took the unusual step of asking even poor patients to pay whenever they could, believing that the volume of paying business, which amounts to approximately 30% of clients, would sustain the rest (Aravind, 2007). Two thirds of patients receive the free outpatient services, while paying patients receiving additional amenities, such as private rooms for extended recovery, and hot meals. The profit made from every one paying customer covers the costs of two patients that cannot pay. Aravind is famous for its fee structure. The consultations are free for poor patients while others pay 50 Rs (their currency, approximately $1 US). Impoverished patients can be expected to pay as little as nothing, or up to 250 Rs, which is as much as they can spare. A subsidized rate is 750 Rs (approximately $15 US). The regular patient fee, which is aimed for middle income patients, is 3,500-6,000 Rs. For a Phaco surgery, the rate is 6,500-12,000 Rs (Saravana,2002). This is a need based transparent financial system, and it is this kind of trust and care Aravind has built that attracts paying patients. The lower than market cost for even the paying patients, at least 25% lower, attracts them also. The Business Model of Aravind Aravind Eye Hospital operates with a business model unlike that of any other business in the health care industry, bearing striking similarities to the fast food industry instead. Dr. V. was impressed with how a chain like McDonalds could offer the same quality product no matter where you went, and still get it to you quickly (Health, 2007). He became adamant about the fact that a hospital could be run under the same principle, and trained his employees to treat large amounts of people without sacrificing quality. Today, Aravinds network of hospitals has the distinction of being the most productive eye care organization in the world in terms of surgical volume and the number of patients treated. The success of Aravinds business model is dependent on numbers, as it is the high-volume of low cost procedures that offsets the costs associated with delivering such a high quality service. In order to reach more patients, Aravind Eye Hospital advertises its services heavily, and is benefite d by the positive word of mouth that has quickly spread about them. They have also implemented technology that allows his staff to serve people that are not able to come to the hospital; they do this by video conferencing, instant messaging, online patient questionnaires, and through the use of web cams. One example of how they have used technology to help their business can be seen through the internet kiosks the place in remote villages. Here, they have women trained to take pictures of the patients eyes using a webcam, then they send the images to the Doctor along with the filled out patient questionnaire. The doctor then receives the file via e-mail almost instantaneously, and is able to interact with the patient through an online chat program. This is made possible because of collaboration with the University of Berkeley Information Technology center, with a low cost Wi-Fi connection. This provides access to the patient, and a remarkable cost reduction. This also allows the sta ff to provide consultations with people who would otherwise not be able to make it to the hospital, and makes it easier for the team to transfer information between each other (Aravind, 2007). What Makes Aravind Different A core part of Aravinds model is to never turn away a patient due to economic reasons. In fact, it has even been recorded that Dr. V once accepted a chicken as payment for surgery. The goal of Aravind is to help as many people as they can, not to make a profit. Their business model is formatted in a way that provides a level of self-sustainability that allows them to use all income towards expanding their processes, improving their work, and keeping services free to those who need them. Dr. V set up this model believing that people will pay when they can, even if its months after their surgery. Aravinds business model originally focused on just eye surgery and care, but after time it expanded into manufacturing in order to create low cost lenses. This change in the model was necessary because importing the lenses from the West was too expensive, and in order to comply with their vision of providing eye care to the disadvantaged, they needed to come up with a way to lower costs. Anoth er way they have put into their system to help them reach more clients is by using a two tiered pricing structure. Wealthy people are expected to contribute more, and for every one paid surgery, Aravind can afford to do many free surgeries. And because Aravind is the best eye hospital in the region, wealthy people choose to go there. In order to maintain maximum levels of efficiency and resource usage, the hospital staff performs just their specific specialization, and the surgery procedures themselves are standardized. And to make sure that all who want to go to Aravind are able to, the clinic provides buses that pick people up in the morning, and then drive them back to their communities after the day is over (Shah, 2009). Before the patients are brought to the hospital, they must go through an eye screening at their local community, using one of the internet kiosks as mentioned earlier. They are then evaluated, and transported to the hospital if it appears that surgery or a live consultation will be necessary. This process is promoted, organized, and financially backed by local business leaders. In keeping staffing cost low, Aravind recruits locally. The majority of the staff is from local villages. Being trained and having grown up in the same community as they will be working, they share the dream of the hospital. And since local wages expectations and cost of living are low, the hospital can pay these individuals less than individuals coming from out of the country. The medical staff is also trained, not only for a job, but a prestigious life long career. For each surgeon, the hospital has four highly trained paramedics for support. Aravind Eye Hospitals ophthalmologists are linked with video conferencing with their Vision Centers technicians for each patient. Expanding their business model, Aravind ventured into lens production. They now have a factory that can produce parts at low-cost prices. Compared to the $200 for imported lenses, they produce these for about $5 at their home factory (Dan, 2008). Now, because of outside funding they export their products to over 80 countries. Their method to production lens was branched out to produce other products such as blades, instruments, sutures, and pharmaceuticals. They can produce these products for fractions of what the western world can, and make a handsome profit. This also cuts costs on buying them from somewhere else. The income gained from the paying patients contributes to approximately 20% of the budget. The other income comes from the production of manufactured products and the provision of training and consultations. In order to retain a sustainable operation Aravind is constantly looking to improve. Since they adopted many technologies earlier than other hospitals they are remain ing high in breakthrough technology. They utilize their technology to communicate easier with fellow staff members, patients, partners, and other hospitals across the globe. Aravind has regular reviews of their system, and follows up on executive decisions to ensure they stick to their intended model. But they are always looking for new ways to better themselves, and to grow. Scalability of the Aravind Model The Aravind System has a great approach to overcoming obstacles in the cataract surgery industry. The main characteristic of the Aravind model is that they provide quality care at prices that everyone can afford. They are self sustaining, yet still able to provide their services to the poor and rich alike. Their business model stresses a maximum use of all resources. This is all achieved by their high volume quality, and a well structured system. The Aravind model can be replicated in countries with inexpensive labor. For example, the model would work well in Asia or underprivileged areas in Africa. Their model will work well if you have a large population with a social need, and if you can find doctors who are willing to operate many times daily. Also, to be financially stable there must be enough revenue to cover the free services from the paying ones. The cost of the service cannot be too high. In order for the need-based service to work, there must be incentives to paying. The people at Aravind pay because they want to have a bed in a private room with air conditioning, or the other amenities that they offer. Aravind eliminated non-beneficial activities and wait time. By having standardized protocols of clinical procedures, activities, and administrative measures, it cuts down on the error count and makes procedures more efficient. The surgeons do not do tasks such as preparing patients, taking measurements, or diagnostic s testing, this is all done by trained assistants. Letting the surgeons focus on just the surgical procedure itself. It cuts down on transition time between surgeries. The state of the art technology requires surgeons to exhibit less energy, and allows them to operate more times per day. Since surgeons average 1700 more surgeries than the national average, there are many benefits to being an Aravind surgeon. Surgeons here do not only want to make a difference in the lives of the people, but by performing many more surgeries than they would otherwise, they are also bettering themselves. Aravind has reached over 200 hospitals through their consultancy process, and they hope to reach many more in the near future. The Aravind model makes scalability in developing nations limitless through their fee system, management techniques, high aspirations, and quality of care. From the David Bornsteins book example of blueprint copying, Aravind wants to be used as an example. They want their techniques, management protocols, and philosophies to be copied by others, as well as they have in making their hospitals across India. Just as the Grameen Banks idea of Micro-credit has spread to numerous lending programs, Aravinds basic model, a 250-bed hospital was adopted in Mumbai, Kolkata and Nepal hospitals. Also, the Indian government is adopting Aravinds medical protocol doctrine for their training centers around the country. Aravinds goal is to be an example of efficient management and inexpensive care to patients, since any ophthalmologist can provide eye care, but can only sustai n affordability to the masses as long as it is managed properly. This is their new focus called Managed Eye Hospitals. In the long term, according to their website, they want to affect a larger population, by exceeding 100 eye care hospitals spreading to other parts of the world. They want to be an example for other health care hospitals to become more efficient, and to grow and thrive. Aravinds ultimate goal is to join together with others to help eliminate treatable blindness entirely by the year 2020 (Aravind, 2009). A Bittersweet Critique It is hard to critique a social business, as we try to negate or justify the flaws in the system by contrasting it with the good it does for the public. However, a company, no matter how well intentioned, cannot grow to its full potential if not given the criticism necessary to improve their system. In this section, we will first explain the flaws we found within Aravind and how we believe they might negatively affect the company in the future. Then we will explain some of the great benefits or pros of Aravind, and how we believe they will perform in the future. The Bad The business model of Aravind, although scalable, is very reliant upon having a strong client base. In particular, it needs a constant influx of paying customers to negate the costs incurred by offering their services for free or for extremely reduced prices. The location of new ventures is also a factor of success for the model to work, as their structure involves hiring local residents to work in the hospitals. If the quality of workers is diminished in the area attempted, then the Aravind system will not run as efficiently or effectively as intended. Also, it would cost them more to bring in employees from outside the area, which would raise the overall cost level, and reduce their ability to offer their services to the impoverished people of the area. Another flaw in the Aravind system is the high turnover rate they must deal with. Doctors come from all over the globe to train in these hospitals, as they perform more surgeries in a day than they would otherwise perform in a few m onths time. But since Aravind is trying to operate on as small a cost budget as possible, they cannot afford to pay their staff rates that are high enough to compete with private practice firms. One final flaw we saw when examining Aravind, was the fact that they make staff members work even when they are sick. Although this is done to keep production up, it also makes room for errors, and contagion. The dedication seen by the employees is admirable, but when sick, you should not be performing any service in the medical field. The Good Aravind has greatly enlarged the social impact they have on society by not only providing a necessary service to meet one of their healthcare needs, but also by creating jobs and hiring locally. This is seen both with Aravind hospitals and with their manufacturing plant, Aurolab. Aravind could easily outsource to get employees and resources, but instead they choose to continue helping the social sector in their respective areas. And even though Aravind Eye Hospitals treat more patients than any other eye care facility in the world, they continue to advertise their service across the country in order to find and serve more individuals. They are actively seeking out their target market instead of waiting for them to come to them. Eye camps, kiosks, and bus runs have been created by the Aravind system to get them closer to their market, and physically bring their clients in. Their use of technology allows them to consult and share their practices with hospitals worldwide, and increases productivity among staff members, and allows them to reach the population that cannot make it into the hospitals. Aravind Eye Hospitals have created an efficient and effective service that best serves the social sector, and provides much needed help to the economically disadvantaged and blind population. And because Aravind is renowned worldwide for its innovation in the field, technical excellence, and operational efficiency, it attracts new ophthalmologists to the system. Once these new surgeons get trained in the Aravind way, it betters the surgeon himself because of the massive amount of surgeries he will complete, and it also extends the Aravind practice into even more hospitals across the globe. We believe that Aravind is doing an excellent job so far, and has a very sustainable model. They have been critical in their decision making thus far, and we feel confident that they will only become stronger as time goes by. This will hit a cap at some point though, as Aravind gets closer to reaching its vision of curing all the worlds treatable blindness, their market will start to decline. Once demand sinks low enough, the current model used by Aravind will become useless, and they will need to undergo some major revisions to their model. Overall though, it really is an excellent business model, and is doing a great deal of good for the people of India. Work Citations Azad India Foundation: http://www.azadindia.org/social-issues/poverty-in-india.html Economy Watch: http://www.economywatch.com/indianeconomy/poverty-in-india.html Reason For Liberty: http://www.reasonforliberty.com/current-affairs/indian-health-care-an-overview.html Bornstein, David. How to Change the World: Social Entrepreneurs and the Power of New Ideas. New York, NY: Oxford University Press, Inc., 2004. Print. Chang, David F. Three programs offer hope. (Cover story). Ophthalmology Times 34.9 (2009): 1-43. Health Source: Nursing/Academic Edition. EBSCO. Web. 27 Oct. 2009. Govindappa Venkataswamy, MD (deceased). ASCRS: The American Society of Cataract and Refractive Surgery. 2009. ASCRS. Web. 17 Nov. 2009. Maurice, J. Restoring sight to the millionsthe Aravind way. Bulletin of the World Health Organization 79.3 (2001): 270. CINAHL. EBSCO. Web. 27 Oct. 2009. Shah, Janat, and L. S. Murty. Compassionate, High Quality Health Care at Low Cost: The Aravind Model. IIMB Management Review 16.3 (2004): 31-43. Business Source Complete. EBSCO. Web. 4 Nov. 2009. Aravind Eye Hospitals: http://74.125.93.132/search?q=cache:-V-GZ0L9JZMJ:www.aravind.org/tribute/A%2520Man%2520Who%2520Saved%25202.4%2520Million%2520Eyes.pdf+aravind+eye+hospital+business+modelcd=7hl=enct=clnkgl=us Health Scribe Media: http://health.scribemedia.org/2007/01/03/aravind-eye-clinic/ Saravanan, S., Organisational Capacity Builting- A Model Developed by Aravind Eye Care System http://laico.org, retrieved on 11-29-2009, http://laico.org/v2020resource/files/capacity_build.pdf. Dan, Sorin A.,ARAVIND EYE HOSPITAL:Assignment Public Managementhttp://www.people.umass.edu, retrieved on 11-27-2009. http://www.people.umass.edu/sdan/projectspapers/Aravind.pdf. Last opened 11/29/2009.