Lung Cancer: Symptoms, Treatment and Literature

Lung Cancer: Symptoms, Treatment and Literature Introduction According to Cancer research UK lung cancer is a rapid and uncontrol proliferation of cells that may start in trachea, bronchioles or pulmonary tissue (Cancerresearchuk.org, 2017). It is broadly classified into Non-Small Cellular lung cancer (NSCLC) type and small cellular lung cancer (SCLC). Additionally, NSCLC is further subdivided into the squamous cell, adenocarcinoma, large cell carcinoma and undifferentiated NSCLC (Travis et al., 2015). Clinically both types are presented with similar symptoms (prolong cough, thoracically lymph node enlargement), and typical X-ray image (shadows with define outline). However, a specialized distinction can be done with the help of biopsy and genotypic analysis (Hoffman, Mauer and Vokes, 2000). Current literature analysis will focus on epidemiological features, clinical features, and available treatment options, as well as highlight gaps in the lung cancer understanding. According to Cancer Research UKs statistical data, lung cancer accounts for 13% of all causes in the UK. In addition, 22% of all cancer death is attributed to lung cancer, with 23% of all male cancers and 21% female. Additional examination shows that SCLC accounts for 12% of all lung cancers and NSCLC for 87%, with adenocarcinoma as a most common type (Cancer Research UK, 2017). Major cause of lung cancer is the tobacco consumption. The US statistics supports this notion, indicating that 90% of all lung cancer death in men and 80% of cases in women are caused by tobacco consumption (Szklo, 2001). Apart from environmental factors, there are individual genetic and epigenetic traits, which will alter lung cancer susceptibility. For example, according to meta-analysis data, having causes of lung cancer in family attributes to 1.7 fold increase in cancer development, with an additional increase if two or more relatives were affected (Lissowska et al., 2010). Studies identified DNA methylation markers, in cell cycle regulatory and repair genes. Specifically, significant changes in methylation patterns occurred in   BNC1, MSX1, CCNA1,p16, LOX genes in comparison to non-malignant cells (Licchesi et al., 2008). There are multiple classifications which allow identifying a lung cancer stage. However, the current essay will focus on two mainstream classifications by American Joint Community of Cancer (AJCC) (Goldstraw and Crowley, 2006) and Veterans Administration Lung Study Group (VALSG) (Zelen, 1973) which are based on clinical and pathological examination. SCLC According to International Association of Lung cancer, the TNM classification is recommended for classification of patients with SCLC. Current 7h edition of the AJCC manual identifies three major criterias: T (TX-T4) local cancer spread; N (NX-N3) metastatic involvement of lymph nodes; M (M0-M1)- presence or absence of metastasis (classification check online). With grouping, SCLC causes into four stages (Table 1)( (Egner, 2010). However, TNM classification is not widely used in clinical practice, in comparison to VALSG classification (Zelen, 1973. Which divides SCLC into limited stage (encapsulated) and extensive stage ( local spread of tumor).   Adaptation of the TNF was supported by a study involved 8000 patients worldwide, which pointed out limitations of VALSG. (Shepherd et al., 2007). Allowing to conclude that stratification of patients based on tumor encapsulation only does not accurately represent the patients prognostic outcomes. Overall, SCLC has a poor prognosis with su rvival rates up to 4 months without treatment (Foster et al., 2009). A major prognostic factor per TNM is the local disease spread, with metastasis as a critical factor for stage rectification. Thus, median survival for treated patients with Stage I-III disease progression is around 15-20 month with around 20% chance for 2 years survival. On the other hand, Stage IV of the disease is attributed to 8-13-month survival and only 5% survival up to 2 years (Lally et al., 2007). NSCLC Staging of NSCLC is fully regulated by the AJCC classification and divided into four stages. It has similar principles of TNM division mentioned above, with some prognostic adaptations (Egner, 2010). Specifically, variations within tumor size (T), are associated with decreased survival rates, for instance, primary tumor with diameter 2cm (53%), 3 cm (47%), 5cm (43%), more than 7cm (26%) (Rami-Porta et al., 2007). Lymphatic nodule involvement is a debatable topic due to a large degree of variability in classifications, but TNM staging attributes to worsening of the disease outcome (Rusch et al., 2009). Lastly, metastatic involvement is considered as the Stage 4 of the disease with average 8-month survival rate (Postmus et al., 2007). However, in addition to AJCC classification, it is important to take into account patient related factors such as gender, comorbidity, and age; environmental factors like nutrition and quality of treatment (Gospodarowicz and OSullivan, 2003). Last stateme nts are not strictly limited to NSCLC as similar variables may cause changes in SCLC patients. Treatment for SCLC Standard of care for the extensive stage of the disease during the SCLC will be chemotherapy treatment. Usually, first line treatment will include six cycles of etoposide with cisplatin or carboplatin. Meta-analysis data on this topic is controversial, with no specific recommendations given by the authors about any of the benefits of the treatment (Galetta et al., 2000; Mascaux et al., 2000). A possible explanation was based on the toxicity of cisplatin or inconsistency in patient number in the control arm of the trials (Amarasena et al., 2015). In addition, second set of meta-analysis data, six drug trials with 1476 patients in total, identified irinotecan and platinum as a viable combination for treatment of Stage IV of the SCLC (Jiang et al., 2010). Indicating the lesser amount of off-target effects ( less anemia, thrombocytopenia), and increase in overall survival rates. Thus, patients who are falling into the first line treatment regimen should result in overall response rate mo re than 20 %, and maintain therapy-related mortality as low as 5%. Knowing the limits of chemotherapy, the second line of drugs for SCLC is in development. Possible target therapies include: inhibitors of cell proliferative signaling pathways ( c-Kit, Src, EGFR, m-TOR etc.); angiogenesis ( VEGFR, VEGF); promoters of apoptosis ( Bcl-2, HDAC); immunotherapy and vaccines (CD56, p53); multidrug resistance (P-glycoprotein, MDR-1). It is important to indicate that most of the second line treatments are at the stage of development and majority of them does not show significant results.   For instance, Imatinib did not show any significant response from patients in phase II trial as single drug moderate dose (600 mg daily) or high dose (400mgx2 day) therapy (Johnson et al., 2003) Similar apoptosis regulators with specific Bcl-2 regulates, like Oblimersen, did not show significant results in a clinical trial against a placebo group, despite promising data in the pre-clinical validation (Rudin et al., 2008). Better outcomes can be seen in angiogenesis studies with bevacizumab, monoclonal antibody for VEGF-A receptor, maintenance therapy, phase II clinical trials, with combination with chemotherapy, showed 80% response rate, with 58 % chance of two years progressive free survival (Patton et al., 2006). Treatment for the NSCLC Despite the mainstream therapy with platinum compounds as first line drugs, and signaling pathway, immunotherapy drugs as a second line therapy. Additional surgical intervention can be applied on initial stages of cancer. The main surgical procedure which is implemented in cancer treatment is the lung resection under the video-assisted thoracoscopic access (VATS lung resection). However, results are controversial with the improvement of 5 years survival outcome in 21 studies on one hand, and 1.6-time increase in post-surgical complications in 13 000 patients in the US (Gopaldas et al., 2010). Nonetheless, chemotherapy is the standard of care for stages III and IV. Multiple landmark trials have shaped the treatment plan for the first choice. Starting with the JMDB trial which included administration of pemetrexed with cisplatin or gemcitabine with cisplatin, with overall response rate(ORR) of 30.6% and 28.2% in order (Scagliotti et al., 2009). In addition, both combinations have similar 10.3-month survival rate. Second, ECOG 4599, for nonsquamous carcinomas with the administration of carboplatin/paclitaxel with bevacizumab and carboplatin/paclitaxel alone (Sandler et al., 2006). Study indicate ORR of 15% and 35 % for double combination vs single, with 12.3 months and 10.3-month survival, in the same order. Lastly, the study of IPASS compared carboplatin/paclitaxel against gefitinib with ORR 32% vs 43% in order (Mok et al., 2009). With progression-free survival index of 5.8 and 5.7 months for combination and single therapy. The addition of drugs altering signalling pathways was a promising approach. However, like SCLC trial, most of the NSCLC were not significant. With the exception of angiogenesis inhibition by bevacizumab, listed for first line therapy above, a monoclonal antibody for vascular endothelial growth factor (VEGF). Evidence of a large randomized trial supports the significant improvement in ORR (Wheatley-Price and Shepherd, 2008) Second line therapy for the NSCLC includes docetaxel, pemetrexed (nonsquamous cancers), and tyrosine kinase pathway inhibitors erlotinib and gefitinib. In detail, the trial of JMEL examines pemetrexsed and docetaxel, with 9.1% and 8.8% ORR in order, and median survival of both drugs of 8.1 months (Scagliotti et al., 2009). Next drug trial, INTEREST, compared gefitinib and docetaxel , with ORR of 9.1% and 7.6% respectively, and median survival 8.3 and 7.9 month for each drug, same order (Kim et al., 2008). Lastly, clinical trial of BR.21 compared Erlotinib with the placebo group, with ORR of 9% and 6.7-month survival for the TKI (Shepherd et al., 2005). The addition of TKI was verified with a large cohort of patients in the randomized trial, with the exceptional activity of the gefitinib in EGFR mutations (Douillard et al., 2010). Overall NSCLC treatment options are oriented on chemotherapeutic approach with platinum compounds with the addition of EGFR specific TKIs. Gaps in general lung cancer There several potential areas of improvement in current treatment and patient management strategies. Critical gaps in the lung cancer can be seen in delayed patient referrals, administration of first line treatment, undertreatment of old age patients, under-utilisation of palliative care, lack of psychosocial support for patients. The current essay will address first two topics in greater details. One of the major gaps in the lung cancer field is the delay in the patients referral to the specialized help. (Yurdakul et al., 2015) According to UK guidelines people with possible symptoms of lung cancer should be referred to the specialists not later than 2 weeks after first GP visit (Nice.org.uk, 2017). Unfortunately, that is not always the cause and some patients will not see the specialist at all during the disease progression. For instance, it is estimated that 11% of lung patients in Australia will not be able to reach specialized care due to the socioeconomic background or old age (Vinod et al., 2010). Additional studies identified more factors contributing to patients late referral, like 23% of UK lung cancer patients will be diagnosed only in the emergency department even though they have had multiple visits to GP and presented typical pulmonary symptoms (Barrett and Hamilton, 2008). Next area of improvement is the underutilization of potential curative (surgical,chemotherapy) treatments in lung cancer (Blinman et al., 2010). For instance, Netherland study group identified that more patients receive surgical treatment in the active teaching and high-class hospitals than distant (Wouters et al., 2010). On the other hand, Australian group has identified no difference in curative surgical operations between rural and central areas (Jiwa et al., 2010). Raising the question of countries treatment protocols and the need for standardization on the multi-national scale. In continuation, international guidelines for successful chemotherapy utilization are 73% for NSCLC and 93% for SCLC where each patient received at least one course of treatment (Jacob et al., 2010). However, combined data (NSCLC+SCLC) from the UK has dramatic differences , such as 21% for South East England and 20% for South East Scotland, so as the USA with 45% and Australia 30% (Jacob et al., 2010). Differences in numbers are attributed to variation in clinical judgments by a doctor, patient preferences and hospital preferences (Blinman et al., 2010). Thus, it is possible to assume that some patients do not receive any treatment. Statistical studies support this statement indicating that 19% of USA, 33% of Australian, 37% Scotland and 50% of Ireland patients does not get any treatment for lung cancer, even though some cases had a potential curative outcome. Lastly, from the perspective of novel medicinal treatment for pulmonary, it is vital to indicate difficulties associated with potential laboratory and clinical results. The general trend is observed with an adaptation of drugs from CML, breast cancer and colorectal cancers to the needs of lung cancer. However, most of the clinical trial are terminated due to the high toxicity of the drugs (Rudin et al., 2008) or absence of ORR (Johnson et al., 2003). Thus, based on available treatment options further development of monoclonal antibodies or glycoengineering of human-like antibodies seems a promising direction (Patton et al., 2006). In addition, implementation of EGFR related TKIs, erlotinib and gefitinib, seems a good research avenue, with a focus on mutational aspects in EGFR signaling pathway (Douillard et al., 2010; Shepherd et al., 2005). Case Analysis: Freedom of Speech Law Case Analysis: Freedom of Speech Law Case Analysis Research Project: Discuss in detail the basis of any challenges to Section. B and evaluate the Big Bad Bruces fans chances for success. Introduction Freedom of speech, association, political freedom and freedom of public places is common in most states and as such, many cases regarding these freedoms is common. According to the first amendment in the US Bill of Rights, the people have the right to assemble and to free speech. The Supreme Court has therefore provided a list of public places and spaces that expressive activities of right to speech and right to assembly can take place(Henry, 2009). Enthusiastic fans of Big Bad Bruce are planning a gathering at the Baltimore airport to welcome the rock star home and to show support for his candidacy. The Department of transportation in Maryland state owns and controls the Baltimore airportdenies this group of fans permission to gather citing Section B ofairports regulations that make it unlawful for any gathering that exceeds 30 people at any given time at the airport unless for travelling purposes.This paper discusses in details the basis of all challenges to Section B citing laws r egarding public gatherings in airports in Baltimore, Maryland and the United States. This paper also explores the success chances of Big Bad Bruces fans regarding their permission to hold their welcome-home gathering for the rock star. This paper begins with a case brief that gives a condensed and concise summary of the airport opinion and the legal rule of law that applies to the case. The paper then provides the case background including discussions of previously decided related cases using the actual court opinions of other legal cases and laws. The next section analyses the current and future implications of the case this section will discuss how the case is likely to affect current and future events and business laws using court opinions of other legal cases and publications. Also included in this case analysis research project is my personal opinion of the case. This will be based on legal rationale, principles, resources and other cases. The final section of this research paper will be the summary/conclusion of this case based on legal principles and facts. This paper examines how the Section B can be challenged based on the Federal laws and if the rock star’s fans have chances for success in the laws uit. Case brief This case analysis research paper is about Big Bad Bruce and his fans. The rock star is returning home to announce his running for a political office and 200 enthusiastic fans of Big Bad Bruce are planning a gathering at the Baltimore airport to welcome the rock star home and to show support for his candidacy. The enthusiastic fans of Big Bad Brucewere denied permission to gather at the Baltimore airport to welcome the rock star home and express their support for his candidacy. The gathering would involve 200 fans as well as a speech on political views by Bid Bad Bruce to the fans that will take 15 minutes. The Baltimore airport denied them permission for the gathering citing Section B of the airport regulations that technicallymake it unlawful for more than 30 people to gather anywhere in the airport unless they are gathering for travel related issues. According to the airport authorities, such a prohibition is intended to make the airport free of congestion and ensure that activiti es go uninterrupted (Maryland State Archives 2013). Following this decision, the fans are challenging Section B and want to gather at the airport in support of the rock star and welcome him home. The issues that arise in this case include whether Section B follows the First Amendment clause on regulations of the freedoms of speech, which includes political freedoms and freedom of association. Another issue that arises is whether Section B violates the First amendment. Case background Section B of Baltimore airport regulations prohibits any form of gathering of more than 30 people at the airport unless the gathering is travel related. In this case, several issues arise if the lawsuit goes to court. According to the first amendment of the US constitution, all fans that are US citizens have the freedom to speech including freedom of association and political freedoms. This means that the US government as well as the state governments should and must adhere to this first amendment. However, the said governments may and can dictate time, place and other restrictions on the protected speech through the 14th amendment of the constitution. The welcome gathering and political speech that the fans of Big Bad Bruce want to hold is of this nature. Saying so, the Department of Transportation in the stateregulates a public forum with reasonable time, space and other restrictions leaving an open end for communication regarding important government interests. Section B is however neutral as it is not specific to speech and so the rock star fans have the chance to challenge it as an overboard rule that allows no room for their speech related activity. Section B prohibits gathering outside the terminals and this makes the law unduly overboard as it restricts any form of gathering above 30 people anywhere in the airport. Some parts of the airport might be considered public forums but airports are generally held as not to be public forums even though they are property of the public. A similar case would be that of International Society for Krishna Consciousness (ISCON) v. Lee. In this case, the New York and New Jersey port authorities had put in place a regulation prohibiting solicitation of funds and distribution of literature at air port terminals. The ISCON alleged violation of the first amendment by the regulation(Stone, 1987). On this basis, all public gatherings in the airport can be banned by the concerned authority, which is the Department of Transportation in Maryland, of which it can prohibit the use of the ground for any speech related activity. This will happen if the Section B’s purpose is to ease congestion and promote smooth running of airport activities. There is no provision that enables a person to determine what conduct or activity is precisely prohibited. In this situation, the regulation is overboard as it forbids more conduct than what is considered necessary to achieve the main purpose of the regulation. A similar case would be that of Hague vs. CIO whereby a city official was allowed by an ordinance to decide whether an organization seeking to hold a gathering in public places in the city could do so. In this case, if the city official decided that the meeting would be a risk disturbance, then the request would have been rejected. The law in contention was also vague and overboard (Stone, 1987). Analysis of Current Implications of Case This case is challenging Section B in order to obtain access to the airport for the welcome-home gathering. It is also challenging the use of Section B as a means of contradicting the first amendment that guarantees freedom of speech including freedom of association and political freedom. The State of Marylands Department of Transportation denied the groups of fans permission to have a public gathering at the airport. If the court upholds this decision, it is going to affect current issues and business laws in different ways. First of all, the first amendment prohibits the US government and the states government from forbidding assembly and speech by imposing putting restraints. In The Hague v. CIO case, the Supreme Court upheld the freedom to assemble by siding with the CIO with its intended activity of peaceably distributing literature and organizing labor meetings .The Supreme Court therefore ruled in the CIO favor showing that the city ordinance violated the First Amendment. The government may limit speech or assembly only when the speech or assembly has a compelling interest like presenting a potential harm to the general public(Van William, 2003). Section B tends to violate this law as it prohibits public gathering of the rock star fans as well as his intended public speech. A regulation that limits space, time and manner of assembly or speech may be allowed in some instances mostly in security instances. In the case of Big Bad Bruce’s fans, Section B clearly violated the First Amendment act by prohibiting public gathering anywhere in the airport. Even though airports are not considered public spaces, they are still spaces that the public own. Since the purpose of this law is mainly to decongest the airport and enable smooth running of activities and operations, the fans had the right to assemble as long as they did not cause congestion or interfere with smooth operations of the airport(Van William, 2003). Analysis of Future Implications of Case Since its adoption, the First amendment with its fundamental freedoms of speech, religion, press, assembly and petition have been intensely debated. The US courts have interpreted these freedoms in various landmark cases hence setting the standards for these freedoms. The cases involving ISCON v. Lee, Hague v. CIO and now Big Bad Bruce’s Fans v. Baltimore Airport involve state and public office regulations that violate the First Amendment. However, airports are not considered public spaces even though the public owns and uses the airports. This case involving Big Bad Bruce raises a question on what public organizations the First Amendment applies. According to the US constitution, the First Amendment applies to all government levels including public offices and spaces. Even though courts cases have managed to limit the freedoms to assembly and speech in some instances, the First Amendment protects the citizens. Until another amendment or clause is added by the congress, the freedoms of speech and right to peaceably assemble still stand and the state will and shall protect these freedoms. The government may still limit assembly or speech based on the purpose or content of which standard it is difficult to meet. The public should note that the First Amendment does not specifically require the US and states governments to respond to petitions by citizens on the violation of the First Amendment (Emerson, 1963). Personal Opinion of Case It is clear that the First Amendment guarantees all US citizens the freedom of speech, association and political freedom. The first challenge on Section B would therefore be based on that the law is broad and vague. There is no provision that enables a person to determine what conduct or activity is precisely prohibited. In this situation, the regulation is overboard as it forbids more conduct than what is considered necessary to achieve the main purpose of the regulation. The purpose of â€Å"avoiding congestion at the airport† and â€Å"ensuring smooth airport operations† can therefore,be achieved with less restrictive means of enforcing a regulation(Garvey Schauer, 1996). The amendment also imposes restrictions regarding time, space or other manner of restrictions on the freedom of speech and requires that the right to association or assemble is done in a peaceful manner. The restrictions will however depend on whether the restriction restricts assembly or speech in a public or non-public forum. If the airport is a public space because the public owns and uses the place, then the government can have a restriction for the interest of the government and only if it allows alternative open cannel for communication. In this case, Section B is quite ambiguous and vague and so it is not clear if the purpose is to protect the interest of the government, which is a neutral content. In addition, it appears to restrict all forms of gatherings of more than 30 people unless the gathering is travel related. If the court rules that the restriction serves a neutral purpose, it should then specify if it is to promote an interest of the government. As it is stated in t he regulation, Section B seems to be putting up restrictions more than it is necessary to enable smooth operations of the airport; the neutral purpose is unlikely to be found. If the court also finds Section B to be tailored for the interest of the government, the court should also state whether an alternative open line of communication was provided for. Section B states that there should be no form of gathering â€Å"anywhere† in the airport including concourse, gates, parking lots and grassy knolls so it does not seem to promote a significant interest. Section B should therefore not be held as a valid regulation for a public office since it does not show any narrowly tailored interest and leaves no open channel for alternative communication(Henry, 2009). Summary/Conclusion of Case In conclusion, the First Amendment protects the freedoms of association and assembly in the US including Maryland State that houses Baltimore airport. The 200 fans of Big Bad Bruce that are planning to gather for the welcome home gathering and the intended speech of 15 minutes by Big Bad Bruce on political views are protected by this amendment. However, the amendment applies to all levels of government and public spaces. The amendment also provides for a regulation clause limiting the time, space and other restrictions on the speech and association freedoms. However, the regulation should serve a neutral content like government interest and should allow an open channel for communication. Several issues arise in the case that require jurisdiction of the court. As seen in other cases of this nature, the court and the Supreme Court can deliberate on petitions by the public regarding violations of the First amendment. The court will have to make a ruling based on whether the First Amendm ent is violated, if the regulation serves a narrowed interest and/or if Section B regulation leaves an alternative channel for communication. This case analysis research paperdiscusses how the Section B rule can be challenged based on the law and the chances for success if the rock star’s fans file a lawsuit. References Emerson, T. (1963). Toward a General Theory of the First Amendment.  YaleLaw Journal, Vol.  72, no. 5.pp 877-956 Garvey, J. Schauer, F. (1996). The First Amendment: A Reader. St.Paul,  Minn: West Pub.  Co. Henry, C. (2009). Freedom of Speech and Press: Exceptions to the First Amendment.  Legislative  Attorney. Congressional Research Service. Maryland State Archives (2013). Department Of Transportation. Maryland. Stone, G. (1987). The Burger Court and the Political Process: Whose First Amendment?  Harvard  Journal of Law Public Policy, Vol. 10 Van, A. William, W. (2003). Reconciling What the First Amendment Forbids with What The  Copyright Clause Permits: A Summary Explanation and Review. Law and Contemporary Law Problems, Vol 66, No. 225

How Sainsburys Has Used Performance Management to Increase their Qualit

How Sainsburys Has Used Performance Management to Increase their Quality of Service   Ã‚  Ã‚  Ã‚  Ã‚  This report will show how Sainsburys have used performance management to increase their ability to provide a quality service and gain a competitive advantage, it will also show how systems have been implemented to achieve this and what Sainsburys have changed in recent years to achieve the competitive advantage it was looking for, The main area Sainsburys have changed is there Supply chain which had a cost gap of around  £60 million. It will also look at how the operations functions carried out by Sainsburys can be linked in with other areas of the business like Finance, Human Resource Management and Marketing. The main contents of this report will be based on the theory about performance management; it will start with a section explaining what the theory is and how it is generally applied in business. It will also contain my own experiences and insight into how operations have had an effect from my own viewpoint. It will have a conclusion on how I believe my ex periences of operations management has helped me and or hindered Sainsburys. There will also be a report conclusion showing how I think Sainsburys operations strategies have evolved over time. Theory   Ã‚  Ã‚  Ã‚  Ã‚  This section will be looking at the theory which will be applied to Sainsburys and how it can be applied in this way. The main theories I will be looking at will be Capacity management, Open Systems, Quality Management, Performance Management and how Socio-technical Systems can be implemented into Sainsburys business. Capacity Management The meaning of capacity itself is being the ability to produce work in a given time, must be measured in the unit of work. There are three main types of Capacity management when looked at through operations. These are †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Potential Capacity The capacity that can be made available to influence the planning of senior management (e.g. in helping them to make decisions about overall business growth, investment etc). This is essentially a long-term decision that does not influence day-to-day production management †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Immediate Capacity The amount of production capacity that can be made available in the short-term. This is the maximum potential capacity - assuming that it is used productively †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Effective Capacity An important concept. Not all produc... ...y chain transformation, â€Å"the biggest project of its kind in Europe and one of the largest in the world†, was still out. A newspaper commentary summarized the concerns: â€Å"The UK’s number two is meeting turnaround targets set by Sir Peter Davis, CEO, two years ago. But the complexity of Sainsbury’s regimen means its healthy overall financial appearance could disguise selective bingeing. Growth has still lagged behind that of market leader Tesco, and Tesco has a lower investment as a percentage of sales. Sainsbury is recovering from a disastrous patch in the late 1990s. It is on target to achieve the  £700 million of cost savings promised by 2004, and margins seem to be creeping slowly towards its targeted 5.5%. But it can hide behind its cost savings while it buys time to demonstrate that improvements in the brand and supply chain will have a sustainable impact on its competitive position. They might. But investors need stronger sales momentum to give them comfort, especially as the market becomes more difficult and competitors such as ASDA continue to outperform. Until Sainsbury’s shows it is building up muscle - not just shedding fat - fitter rival Tesco deserves its 15% premium.† How Sainsburys Has Used Performance Management to Increase their Qualit How Sainsburys Has Used Performance Management to Increase their Quality of Service   Ã‚  Ã‚  Ã‚  Ã‚  This report will show how Sainsburys have used performance management to increase their ability to provide a quality service and gain a competitive advantage, it will also show how systems have been implemented to achieve this and what Sainsburys have changed in recent years to achieve the competitive advantage it was looking for, The main area Sainsburys have changed is there Supply chain which had a cost gap of around  £60 million. It will also look at how the operations functions carried out by Sainsburys can be linked in with other areas of the business like Finance, Human Resource Management and Marketing. The main contents of this report will be based on the theory about performance management; it will start with a section explaining what the theory is and how it is generally applied in business. It will also contain my own experiences and insight into how operations have had an effect from my own viewpoint. It will have a conclusion on how I believe my ex periences of operations management has helped me and or hindered Sainsburys. There will also be a report conclusion showing how I think Sainsburys operations strategies have evolved over time. Theory   Ã‚  Ã‚  Ã‚  Ã‚  This section will be looking at the theory which will be applied to Sainsburys and how it can be applied in this way. The main theories I will be looking at will be Capacity management, Open Systems, Quality Management, Performance Management and how Socio-technical Systems can be implemented into Sainsburys business. Capacity Management The meaning of capacity itself is being the ability to produce work in a given time, must be measured in the unit of work. There are three main types of Capacity management when looked at through operations. These are †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Potential Capacity The capacity that can be made available to influence the planning of senior management (e.g. in helping them to make decisions about overall business growth, investment etc). This is essentially a long-term decision that does not influence day-to-day production management †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Immediate Capacity The amount of production capacity that can be made available in the short-term. This is the maximum potential capacity - assuming that it is used productively †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Effective Capacity An important concept. Not all produc... ...y chain transformation, â€Å"the biggest project of its kind in Europe and one of the largest in the world†, was still out. A newspaper commentary summarized the concerns: â€Å"The UK’s number two is meeting turnaround targets set by Sir Peter Davis, CEO, two years ago. But the complexity of Sainsbury’s regimen means its healthy overall financial appearance could disguise selective bingeing. Growth has still lagged behind that of market leader Tesco, and Tesco has a lower investment as a percentage of sales. Sainsbury is recovering from a disastrous patch in the late 1990s. It is on target to achieve the  £700 million of cost savings promised by 2004, and margins seem to be creeping slowly towards its targeted 5.5%. But it can hide behind its cost savings while it buys time to demonstrate that improvements in the brand and supply chain will have a sustainable impact on its competitive position. They might. But investors need stronger sales momentum to give them comfort, especially as the market becomes more difficult and competitors such as ASDA continue to outperform. Until Sainsbury’s shows it is building up muscle - not just shedding fat - fitter rival Tesco deserves its 15% premium.†

Organzational Behavior

Clarification is the first step towards understanding dynamics of conflict within the work place. Exploring the various types of conflict should be used as a precursor to approach the differences between constructive and destructive conflict. Understanding how organizations can enhance employee strengths under varying conditions is reinforced through good communication skills in the conflict management process. Communication emphasizes the need for self-understanding and self-management for the conflict resolution process to work.The techniques of Indirect Conflict Management and Direct Conflict Management help in dealing with specific problems such as hostile individuals, personality conflicts, etc. are best used as a guide and should not be taken literal as each individual presents varying issues. Destructive conflict works as a disadvantage to employees, groups and organizations. Destructive conflict affects group efforts needed for team building, and creates hostility resulting i n a hostile environment. Constructive conflict is a beneficial factor for some organizations in which groups address issues and make decisions to provide an opportunities for improvement.Conflict-management appropriately models professional standards so that every employee may effectively progress in a professional manner appropriate for the workplace. Indirect conflict management approaches share the common quality of avoiding direct dealings with personalities. They include reduced interdependence, appeals to common goals, hierarchical referral, and alterations in the use of mythology and scripts (Schermerhorn, Hunt, & Osborn, 2008, p. 349). Reduced Interdependence creates a systematic approach by eliminating conflict by separating groups in which require interaction.By spreading or reducing contact with one another resolution is believed to be resolved. As an alternative to reduced interdependence another indirect approach is assigning a liaison to facilitate activities among gro ups to smooth the process creating conflict. Conflict is given a common perspective by directing the attention towards a focus of appealing to common goals as opposed to conflict. Hierarchy referral is used to provide employees with alternatives to conflict when the appropriate steps or conflict resolution is unattainable.Providing a smoke screen, Altering scripts and Myths is utilized when resolution has been unattainable. Approaching common goals indirect conflict management uses a system of individuals in ranking positions above one another. This strategy uses a chain of command for resolutions lacking the interpersonal relationship needed for team building. However, the organizational dynamics of indirect conflict can be useful when there is no direct conflict, and the plans recommended by a primary leader require guidance.Direct conflict management utilizes five methods of managing conflict smoothing or accommodation, collaboration and problem solving, compromise, avoidance, an d competition and authoritative command. â€Å"The five approaches to conflict management are described from the perspective of their relative emphasis on cooperativeness and assertiveness in the relationship† (Schermerhorn, Hunt, & Osborn, 2008, p. 349). Maintaining working relationships, direct conflict identifies the underlying issues first proceeded by utilizing systematic actions agreeable for all parties.Smoothing requires a mediator in which allows all parties to address the issues experienced and identify the dynamics of the conflict. Accommodating gives the power to ease conflict by obliging and exploring possibilities of resolution. Smoothing and accommodating prepares and facilitates the methods of Collaboration and Problem Solving seeks true satisfaction of everyone's concerns by working through differences, finding and solving problems so that everyone gains results. (Schermerhorn, Hunt, ; Osborn, 2008).Compromise is an essential effort in which requires an agree ment of resolution without it the likelihood of conflict is possible. In a win-lose conflict some employees may still not be satisfied with the mediation in which one party submits to the compromise to avoid further conflict. â€Å"Avoidance may be used when an issue is trivial, when more important issues are pressing, or when people need to cool down temporarily and regain perspective† (Schermerhorn, Hunt, ; Osborn, 2008, p. 351).All contributing information should be considered in mediation whereas some issues are personality conflicts in which do not apply to issues work related. Placing the conflicting ideas into perspective is advisable at best so long as it does not pose further immediate conflict. â€Å"Competition and Authoritative Command is working against the wishes of the other party, fighting to dominate in win-lose competition, and/or forcing things to a favorable conclusion through the exercise of authority† (Schermerhorn, Hunt, ; Osborn, 2008, p. 49). A uthoritative command is best utilized when immediate action is needed to firmly establish direction in conflict resolution. Understanding the mutual purpose of an organization is beneficial for teambuilding and management. Direct strategies incorporate team building to identify organizations success in business and working relationships. Firmly established leadership abilities are essential to mediate direct conflict.

India and Pakistan Essays

India and Pakistan Essays India and Pakistan Essay India and Pakistan Essay It was in the year 1947 that both India and Pakistan were granted independence on the midnight of August 14-15 but Pakistan celebrates its independence on August 14 and India on August 15. Ironic but interestingly, Pakistan first independence day was celebrated as August 15 and later on it became August 14.Another reason was that British Viceroy Mountbatten, who chose August 15 symbolizing the surrender of Japan to Allies two years ago as the date, preferred to transfer power to Pakistan on August 14 so he could attend the ceremony in Karachi and be in New Delhi the next day to oversee India’s birth as an independent nation. Since the power of transfer took place on the midnight of 14 and 15 August, the Indian Independence Act 1947 clearly stated that 15 August was the birthday of both Pakistan and India. As from the fifteenth day of August, nineteen hundred and forty-seven, two independent Dominions shall be set up in India, to be known respectively as India and Pakistan, the act stated. Even Mohammad Jinnah, who became the first governor general of Pakistan, declared August 15 as the independence day of Pakistan in his opening speech. Jinnah in his first broadcast to the nation said: August 15 is the birthday of the independent and sovereign state of Pakistan.It marks the fulfilment of the destiny of the Muslim nation which made great sacrifices in the past few years to have its homeland. So, Pakistan celebrated its first birthday on 15 August but in subsequent years 14 August was marked as the independence day. Even the first commemorative postage stamp of the country that was released a year later stated 15 August 1947 as the independence day of Pakistan. But in 1948, Pakistan decided to celebrate its Independence Day on August 14, a day before India’s Indepndence Day due to 27 Ramadan that fell on August 14, 1947.

Withstanding the Challenge of Transnational Network in the System of Education

Withstanding the Challenge of Transnational Network in the System of Education Introduction: Back to Where It All Started In the course of the past few decades, people have been trying to make the distance between states and cultures as less noticeable as possible; an obvious result of globalization, the given phenomenon has also touched upon the specifics of the British education. In the 7th Chapter of the book by Tim Dunne, Milya Kurki Steve Smith, the former argues against Bulls’ opinion that â€Å"there is no escape from values.†1Advertising We will write a custom essay sample on Withstanding the Challenge of Transnational Network in the System of Education specifically for you for only $16.05 $11/page Learn More Claiming that shared values are the only thing which the modern world should strive for for the sake of science development, Dune does not take into account that the integration which is currently taking place between the English schools and the schools from the rest of the world is a natural process which i s bound to bring to fruitful results. Escape from Values as a Possible Threat: There Is a Reason to Shatter the Existing Rules According to Dunn, the idea that â€Å"Values will inform the selection of topics to Be studied, and the writings and statements of academics will in turn have an impact on the political process†2 is absolutely insane. Hence, Dunn explained, comes the weakest point of Bull’s argument, for the values within certain fields are completely independent and cannot impact one another. However, when rethinking the idea which Bull offered, one can possibly argue that there can be a grain of truth in Bull’s speculations. What Holds the Values Together: Stronger Than They Might Seem However, when it comes to taking a more critical look at Bull’s theory and Dunn’s counterarguments, one must admit that the relations between the world politics and science seem way too far-fetched. Indeed, as Dunn emphasizes, â€Å"the enforcement of hum an rights principles risked undermining international order†3 does not have anything to do with reality. As a matter of fact, Bull makes rather bold statement claiming that the human rights reinforcement can affect the international order negatively, which Dunn points out in his analysis. Thus, with the help of Dunn’s argument, one can see clearly that national order is far stronger than it may seem and that sharing scientific data worldwide will not harm it in any possible way. A Danger or an Opportunity? English School Needs Reorganization According to Dunn, the idea of shared knowledge does not imply any political context and presupposes rather building stronger cultural and scholarly ties between the countries of the world than crashing the traditional values of the English school.Advertising Looking for essay on international relations? Let's see if we can help you! Get your first paper with 15% OFF Learn More Dunn makes it obvious that Bull ’s theory need serious reconsideration, for it is rather out of date from the modern world and its constant changes: â€Å"In our globalized world, the dynamics of governance outstrip these traditional English school categories.†4 Conclusion: The Established Values as the Three Pillars of Education: English School and Changes Therefore, it is obvious that the idea of values exchange as something that can lead to serious political conflicts is less than implausible; to be more exact, it is straight ridiculous. With the help of shared facts, information and knowledge, people will be able to provide a variety of innovations, which would be hardly possible if shared knowledge was considered inappropriate. Bibliography Dunne, Tim. â€Å"The English School.† In International Relations Theories: Discipline and  Diversity, edited by Tim Dunne, Milya Kurki Steve Smith, 135-155. Oxford, UK: Oxford University Press, 2007. Footnotes 1. Tim Dunne, â€Å"The English Schoo l† in International Relations Theories: Discipline and Diversity, edited by Tim Dunne, Milya Kurki Steve Smith (Oxford, UK: Oxford University Press, 2007), 139. 2 Tim Dunne, â€Å"The English School† in International Relations Theories: Discipline and Diversity, edited by Tim Dunne, Milya Kurki Steve Smith (Oxford, UK: Oxford University Press, 2007), 139. 3Tim Dunne, â€Å"The English School† in International Relations Theories: Discipline and Diversity, edited by Tim Dunne, Milya Kurki Steve Smith (Oxford, UK: Oxford University Press, 2007), 146. 4 Tim Dunne, â€Å"The English School† in International Relations Theories: Discipline and Diversity, edited by Tim Dunne, Milya Kurki Steve Smith (Oxford, UK: Oxford University Press, 2007), 147.Advertising We will write a custom essay sample on Withstanding the Challenge of Transnational Network in the System of Education specifically for you for only $16.05 $11/page Learn More

Cathedral by Raymond Carver Research Paper Example | Topics and Well Written Essays - 750 words

Cathedral by Raymond Carver - Research Paper Example Until the narrator realizes his own incapability to perceive, with Robert’s guidance, what a cathedral really is, he cannot understand about how the blind man, Robert, sustains an intimate relationship with his wife Beulah (also with the narrator’s wife). He further is blindfolded by outward appearance of things. Referring to Bub’s obsession with outer appearance, Teresa Alutto comments, â€Å"The narrator’s preoccupation with physical appearance is evident. Therefore, it is not surprising that he cannot understand Robert’s marriage, which was entirely based on the emotional and intellectual aspects of a relationship.† (2) Bub cannot understand that beauty or appreciation of beauty plays a very little role in a successful relationship. Neither can he delve deep into his wife’s mind to grow mutual understanding. The narrator, Bub expresses his confusion regarding Robert’s successful relationship with Beulah as following: â€Å"I found myself thinking what a pitiful life this woman must have led. Imagine a woman who could never see herself as she was seen in the eyes of her loved one†¦go on day after day and never receives the smallest compliment from her beloved.† (193) Bub is also aware of Robert’s closeness with the narrator’s wife. The irony of the narrator’s capability to see is that he neither tries to understand what he sees. He shows no effort to understand and explain his wife’s exasperation with him. He simply describes the mystery of Robert’s relationship with his wife in a disinterested manner. Robert takes it for granted that physical blindness is a type of obstacle in the way of close relationship. Therefore he wonders at the blind man’s ability to grow intimacy with others. In the second paragraph he comments on his wife’s disinterestedness in him, as following: â€Å"My wife finally took her eyes off the blind man and looked at me. I had the feeling she didnt like what she saw†

Writing profile on foster parent Essay Example | Topics and Well Written Essays - 500 words

Writing profile on foster parent - Essay Example In the statistics provided by the Children Uniting Nations, citing the source of information from the Adoption and Foster Care Analysis and Reporting System (AFCARS), it was disclosed that â€Å"more than 463,000 children live in foster care. In California, which has the largest foster care population than any other state, the number of foster youth has tripled in the last 20 years† (par. 1). Locating competent and highly qualified foster parents who could genuinely meet and support varied needs of children in need is therefore challenging. As one tried to locate potential foster parents, it was convenient to go directly to one of the established foster homes in Southern California and interview professional members of the organization’s team with regards to parents who signified intentions to become foster or adoptive parents. The Southern California Foster Family and Adoption Agency (SCFFAA) has been serving the needs of homeless children since 1994. It was deemed com mitted to â€Å"helping abused, abandoned and neglected children find secure, stable and nurturing homes. The agency provides for the well-being of children in its care and helps them become independent and successful adults† (Southern California Foster Family and Adoption Agency 1).