Americas Medicare And Medicaid Healthcare Health And Social Care Essay

Health attention costs in the United States exceed 14 per centum of the entire gross domestic merchandise, far more than in any other state. In the twelvemonth 1992 overall costs were approximately $ 838 billion or over $ 3,000 per individual. Equally good as there were about 6,066 infirmaries with 1.14 million beds in the twelvemonth 1992 in the United States. Hospital attention dominates entire wellness attention disbursement in United States.After decennaries of induction long term attention in America is undergoing enormous alteration in response to increasing Medicare and Medicaid expenditures. As the response to the lifting province and federal outgos in America community based wellness attention options are promoted for long term attention over institutional attention. Despite the fact that persons with really serious and relentless psychiatric upsets are over represented in the population of long term attention and consequences into disproportional sum of psychiatric wellness attention cost, every bit good as there is an alarming deficit of attending to the services for the aged individuals with the persistent and serious mental unwellness. About 2 per centum of individuals aged 55 or above in America are enduring from terrible and relentless psychiatric upset and it is assumed to duplicate in following three coming decennaries. Since the current strategy of long term psychiatric attention for the aged individuals with this upset is missing and service proviso is extensively driven by reimbursement policies, community based attention and managed attention is likely to hold profound consequence on this population. The grounds to twenty-four hours provinces that these proposals can cut down the demand of hospital resources but there remains concern about cost effectivity of community attention compared with infirmary attention.However the wellness policy issues of America is been debated in conformity with community based wellness attention for aged persons and the hereafter challenges of supplying psychiatric wellness services to aged population.Although, small attending has been highlighted on the plausible impact of managed attention on the concatenation of aged individuals with relentless and serious psychiatric upsets who have the most demanding long term attention demands. Service NEEDS: Aged persons with serious and relentless psychiatric upsets are denoted in this survey as individuals age 65 and over with perennial or late-onset terrible psychiatric upset with residuary damage. As by and large defined, terrible and repetitive psychiatric upsets includes diagnosings such as delusional upset, schizophrenic disorder, bipolar upset, and recurrent major depression.Elderly grownups who evolve these upsets in early maturity frequently have unequal societal support systems and lesser fiscal resources than those with late-onset unwellness, but both of them portion many similar clinical characteristics and the common demand for long-run mental wellness attention services. However, latest psychiatric wellness services for aged individuals are mostly disconnected and underutilized and do non adequately turn to their long-run mental wellness demands. Overall, deinstitutionalization has left infinite figure of aged individuals with reduced entree to mental wellness attention in both community and institutional long-run attention scenes.Larger proportion of aged grownups with terrible and relentless mental unwellness who stays in the community receive small support from the mental wellness system except for medicine despite continued demand, and those without household attention are at higher hazard of being institutionalized.These factors highlights the pressing demand to specify and advance place and community based options. LONG TERM CARE REFORM: The sudden shrinkage and closing of province infirmaries over the past few decennaries has resulted in â€Å" trans-institutionalization † into attention places of many dependent aged individuals with terrible and relentless psychiatric unwellness. Eighty-nine per centum of all institutionalized these aged individuals reside in attention places. However, assorted tendencies suggest that establishments will play a diminishing function in future systems of long-run mental wellness attention compared with community-based scenes. First, the bulk of older grownups with mental unwellness resides in the community and favour to stay at that place ( Bartels SJ, Levine KJ, Miles KM, et Al, unpublished manuscript, 1999 ) . The more recent cohort of aging individuals with terrible psychiatric unwellness had spent most of their lives in the community instead than institutional scenes. Therefore trans-institutionalization from long-run province infirmary units to care places will go a vanis hing phenomenon. Equally good as the 2nd tendency suggests the diminishing function for establishments is the execution of nursing place reforms under the federal Omnibus Budget Reconciliation Act of 1987 ( Public Law 100-203 ) , with the purpose of cut downing the use of nursing places for long-run mental wellness attention. This reform ‘s were practiced in response to increased psychiatric admittances to care places after closings of province infirmaries. Last, the lifting outgos for nursing place attention are exciting sudden reforms in policy and reimbursement. They include authorizations by provinces to curtail Medicaid outgos by forestalling the nursing place bed supply and cutting Medicaid reimbursement rates. As the wellness attention system transportations to suit the increasing figure of patients necessitating chronic attention, forthcoming anticipation suggest the greatest success in services will be in home- and community-based scenes.Sudden alterations in the funding and construction of long-run and managed attention are progressing quickly across the provinces, with a practical deficit of attending to the lifting Numberss of aged grownups with serious and relentless mental unwellness who will hold of import service demands. Financing OF MEDICARE AND MEDICAID: Soon, most of the psychiatric wellness and long-term-care services for aged individuals are financed through fee-for-service Medicare and Medicaid. Medicare is the federally financed wellness insurance plan, supplying insurance for persons age 65 and above and handicapped persons under age 65. Medicare is composed of two parts: portion 1covers inmate infirmary attention, 60 yearss of skilled nursing place attention, and place wellness and hospice attention. Separate 2 provides reimbursement for outpatient infirmary services and doctors. Among the major limitations in Medicare coverage of the psychiatric wellness services are a needed 50 per centum copayment for psychotherapeutics services, deficit of general outpatient prescription drug coverage, restricts on inpatient psychiatric yearss, and limited or no coverage of important services such as residential attention, reprieve attention and grownup twenty-four hours attention and place wellness attention. Home wellness attention is an of import permutation to institution-based attention. However, merely acute portion of unwellness instead than long-run attention is cover by Medicare. Psychiatric upsets, including dementedness, constitute merely 2.8 per centum of primary diagnosings for place wellness attention. It is likely that place wellness attention for psychiatric upsets will go barely available in future coming old ages as Medicare reform consequences in cutbacks under the Balanced Budget Act of 1997. After passage of these reforms, 14 per centum of U.S. place wellness attention bureaus, a sum of 1,355 bureaus, closed in 1998. However, less than 3 per centum of the entire budget of Medicare is spent on mental wellness, with half less than these outgos ( about 1.5 % ) – traveling to psychiatric wellness services for the aged population. Acute hospitalizations consequences to the huge bulk of these outgos. Medicaid is the main insurance company for long-run attention in nursing places and the of import beginning of reimbursement for state-funded services for handicapped persons, including persons with serious and consistent mental unwellness. Since Medicaid is a combined federal and province plan, with provinces paying up to 50 per centum of the cost, provinces have of import discretion in make up one's minding the eligibility standards and sorts of mental wellness services covered. For case, although legion provinces offer coverage of prescription drugs, most have restrictions in the sort of copayments, limited refills, or other restrictions.States may besides implement restrictions on mental wellness attention, including anterior mandate and restriction on the figure of visits to suppliers. Medicaid reimbursement rates average 20 to 30 per centum beneath bing market rates.Restricting the sum and range of services and paying for psychiatric attention at lesser rates than for medical attention create barriers to adequate psychiatric attention for aged patients. In short, the argument between the federal and province authoritiess over the costs of Medicaid, every bit good as the restrictions in Medicare coverage, leave many spreads in insurance coverage for aged grownups.These spreads result in a disintegrated intervention system and critical load in out-of-pocket costs. In add-on, briskly increasing Medicare and Medicaid outgos are ensuing in the impulse to develop schemes that contain costs. The blend of spreads in coverage and service and intensifying costs under a fee-for-service reimbursement construction has resulted in an eruption of managed attention enterprises in America. CARVED-IN AND CARVED-OUT MENTAL HEALTH SERVICES: The statement over the finest manner to pull off fiscal hazard and to transport mental wellness services in managed attention has resulted in a scope of theoretical accounts that may be loosely classified into two general classs. In some managed attention establishment, mental wellness attention is straight merged into the bundle of general wellness services that are covered and provided, or carved in. In others it is supported through a contract with a separate forte mental wellness establishment that provides services and accepts the hazard, or carved out. CARVED-IN Agreements: Patron of carved-in mental wellness services argue that this form of attention better integrates both physical and mental wellness attention, reduces barriers to mental wellness attention due to stigma, and is more apt to bring forth cost beginnings and overall nest eggs in usual wellness attention expenditures. These characteristics are specifically of import because aged individuals normally have co morbid medical conditions and take multiple medicines that may impact mental upsets ; they typically avoid forte psychiatric wellness scenes and incur important wellness attention disbursals related to psychiatric symptoms. By and large, carved-in agreements promotes communicating and coaction between medical and psychiatric suppliers suppressing arbitrary differentiations about medical versus psychiatric causes of symptoms and functional issues.Carved-in agreements may be advantageous for the many aged individuals with similar sort of upsets who receive the greater part of their mental wellness attention from primary attention suppliers. Despite the fact that, carved-in agreements are assumed to supply fiscal inducements for incorporate medical and psychiatric wellness services, functional integrating is far from guaranteed. Unfortunately, mental wellness forte services for aged persons tend to be a low precedence in managed wellness attention organisations in comparing with surgical and medical forte services. Mental wellness carve-in agreements may besides be economically hazardous. First, if mental wellness net incomes are carved in as portion of a net income bundle, grounds from private-sector wellness programs reveals that without administered para, insurance companies will offer differential coverage of mental wellness attention.In add-on, if remunerators or suppliers contest for enrollees, a healthy inducement will be to forestall those expected to hold higher costs from psychiatric jobs, such as aged persons with serious and consistent unwellness. Finally, process of seting payments to counterbalance for the increased fiscal hazard of supplying attention to more badly sick enrollees under a capitated payment, known as hazard accommodation, are rather hard to use for psychiatric wellness attention. For case, unless reliable hazard accommodation schemes are developed for complex populations such as aged person with mental unwellness, the capableness for significant losingss is likely to perpetuate the present deficiency of enthusiasm and services for this bad group among managed attention organisations. CARVED-OUT Agreements: In comparing, advocates of carved-out agreements for mental wellness services for aged persons argue that stray systems of funding and services are likely to be superior for individuals with particular mental wellness services. Specifically, they advocate that carved-out mental wellness organisations have advanced proficient cognition, a broader array of services, specialised accomplishments, greater Numberss and assortments of mental wellness suppliers with experience handling terrible mental conditions, and committedness and willingness to supply services to bad populations. In add-on, advocates argue that mental wellness carve-out organisations allows economic systems of graduated table in supplying the comprehensive array of rehabilitative and community support mental wellness services necessary to care for elderly terrible mentally sick individuals in the community. At last, an inducement exists to reinvest nest eggs from any decrease in inmate service usage into advanced outpatient options. Although appropriate surveies are missing, plans utilizing carved-out services for younger persons have by and large reported important cost nest eggs and favourable results. Unfortunately, informations are missing on results and costs for aged individuals with serious mental unwellness in mental wellness carve-outs. From a clinical mentality, the downside of a carve-out agreement is an increased hazard for unfavourable results due to atomization of medical and mental wellness attention services. The possible for these inauspicious results is significantly pronounced for aged individuals, who are frequently taking multiple medicines and who have complex medical upsets. Unsuccessful communicating or deficit of coaction between mental wellness and medical suppliers places the aged individuals at peculiar hazard of medicine, misdiagnosis, interaction, inaccurate premises about medical versus psychiatric causes of symptoms, and ambiguity about whose duty it is to vouch that appropriate community-based services are provided. From a fiscal mentality, foremost and most important, mental wellness carve-out organisations predicts the hazard of supplying services for a specific given population at a set negotiated fee. Downward pressures to incorporate or cut down costs may take into a one-sided decrease in the proportion of the overall wellness attention dollar allocated for mental wellness services. Second, a fiscal inducement exists for medical suppliers to switch and delegate duty for co-morbid conditions to mental wellness suppliers and frailty versa. For case, since the allotments for medical and psychiatric services are fixed and dispersed, it may be in the fiscal attractive force of a medical supplier organisation to inaccurately tie in the cause of a complex medical-psychiatric job to mental unwellness, which would take into unequal attention and switch the cost load to the mental wellness supplier organisation. A 3rd exposure of carve-out agreements is the hardship that they pose in finding the benefits or cost nest eggs of mental wellness services. Increased usage of mental wellness services may look to be more dearly-won in a carve-out agreement. At last, the physical and mental co-morbidity found in aged grownups with serious and relentless mental unwellness may cut down any awaited fiscal advantages of carved-out services. If the mental wellness supplier can non every bit pull off services and costs related with the combination of medical and mental wellness upsets, anticipated nest eggs may non happen. INNOVATIVE PATTERNOF MANAGED LONG TERM CARE: The demand of keeping intensifying outgos of long-run attention while supplying home- and community-based options to institutional attention has been the focal point of s experiments in long-run attention reform, including societal HMOs, the Program for All-Inclusive Care of the Elderly ( PACE ) , and state-managed long-term-care presentations. Initially initiated as a four-site long term attention presentation undertaking in the mid-1980s, societal HMOs are determined to intermix ague attention and long-run attention within a managed attention model. The implicit in plan is to supply both ague and chronic attention net income under a individual organisation at fiscal hazard, based on a postpaid capitation payment pooled from different beginnings including Medicare, Medicaid, and copayments. In comparing, PACE largely pay attending on persons who meet eligibility standards for nursing place attention and suspects high hazard under capitation for all long-term-care services, financed by monthly capitated payments from Medicare and Medicaid. Elite characteristics of the PACE plan include a multidisciplinary squad attack, service proviso in a separate grownup twenty-four hours wellness centre, chronic attention without caps on long-term-care outgos, and everyday one-year wellness showing and preventative attention. These theoretical account plans involves many elements that might be adapted to the demands of aged individuals with rigorous and grim mental unwellness to better future long-run attention for this population, including instance direction and multidisciplinary squads. Imaginative state-initiated managed long-term-care presentations include plans for people dually entitled for Medicaid and Medicare, who are among the premier users of acute and long-run wellness services. This group includes old individuals with serious and consistent mental unwellness. At present, multistate proposals are being constructed to unite Medicaid and Medicare resources under a capitated program that provides a full scope of services, including community-based and institutional ague and long-run attention. These enterprises have the possible to supply comprehensive long-run medical and mental wellness attention through public insurance to a population with high rates of chronic mental and wellness upsets. However, with few exclusions, presently planned proposals do non have mental wellness attention as a nucleus constituent or supplier of services. An alternate system of managed attention with the prospective to supply wide-ranging services is exemplified by a single-payer national wellness attention system. However, statistics from national comparings are assorted. Single-payer wellness attention systems in other states are more likely to function persons with lower incomes and more terrible mental unwellness than in the U.S. , but overall entree to specialty mental wellness services is no better and frequently involves longer waiting periods. Deduction FOR THE FUTURE: How will elder individuals necessitating long-run mental wellness attention menu in an epoch of managed attention? Existing issues reviewed here suggest that there is cause for dismay ; at the same clip, new attacks to funding services hold promise if they are suitably developed and harnessed. However, this sum-up of the literature suggests several specific instructions and steering rules for future theoretical accounts. Integration of mental wellness and medical services: Optimal services for older individuals with terrible and changeless mental unwellness require a close association of primary medical attention and mental wellness services. The high prevalence of medical and cognitive comorbidity in this group necessitates a clinical attack that recognizes the complex mixture of medical and psychiatric upsets and the value of a collaborative medical-psychiatric attack. A array of attacks to incorporating medical and mental wellness attention have been described, but run intoing the demands of persons with serious and changeless mental unwellness is particularly debatable. Promising theoretical accounts of incorporate attention consist of location of medical and mental wellness suppliers at the same site, multidisciplinary medical-psychiatric intervention squads, proviso of primary attention in mental wellness clinics, proviso of specialised mental wellness services in primary attention clinics, and cross-trained medical-psychiatric suppliers. The cardinal clinical topic here is the formation of a collaborative attention theoretical account across medical and mental wellness suppliers, of whether the services are financially incorporate ( carved in ) or separate ( carved out ) . For illustration, the literature describes booming theoretical accounts of community-based mental wellness services that include a primary wellness attention supplier as an built-in portion of a mental wellness outreach squad for senior grownups with terrible and relentless mental unwellness ( Levine KJ, Bartels SJ, unpublished manuscript, 1999 ) and the development of an associated primary attention medical clinic specifically for persons with terrible and changeless mental unwellness. Integration of specialised services and community-based attention Rising systems of community-based long-run attention across the provinces promise to supply many indispensable supports and services indispensable to keep frail aged individuals with several medical upsets in place scenes. These theoretical accounts of home- and community-based long-run attention offer advanced attacks to supplying medical and societal services to elder individuals, yet by and large do non include specialised services for long-run mental wellness attention of individuals with serious and continual mental unwellness. To undertake these demands, such plans will necessitate to spouse with specialised geropsychiatric and community support services. Although empirical informations are missing, a restricted descriptive literature suggests that theoretical account plans must hold specific clinical constituents to successfully keep senior grownups with terrible and continual mental unwellness in the community. These constituents consist of intensive instance direction, general medical attention, 24-hour crisis engagement, home-based mental wellness attention, residential and household support services, caregiver preparation, multidisciplinary squads, active instance determination and outreach, and psychosocial rehabilitation ( Levine KJ, Bartels SJ, unpublished manuscript, 1999 ) . Descriptions of results for these plans suggest that with sufficient supports, the bulk of senior individuals with terrible and continual mental unwellness can be maintained in the community at lower cost than in establishments and with equal or enhanced quality of life. Blended funding and seting for unwellness badness The greatest challenge to run intoing the long-term-care demands of the increasing Numberss of aging individuals with terrible mental unwellness will be fiscal. Predictions of the bankruptcy of the Medicare trust fund and current projections for Medicaid expenditures require advanced and resourceful usage of these and other fiscal resources. Meeting the complex long-run medical and mental wellness attention demands of senior individuals with terrible and continual mental unwellness under fee-for-service support will necessitate originative pooling of resources, including Medicare, Medicaid, and funding for aging services under federal and province block grant plans, every bit good as private insurance and limited personal financess. However, even with these steps, in the deficiency of singular reforms in the funding of wellness and long-run attention for senior individuals, financess may be deficient. Capitated attention agreements may be necessary to incorporate costs and to promote usage of the most cost-efficient services. A major aspiration of financing long-run attention will be the reallocation of outgos to back up the development of home- and community-based options. The most striving theoretical accounts of forming and funding services for open populations of senior individuals provide integrated services under a individual system responsible for both acute and long-run attention. PACE, societal HMOs, and province proposals for senior individuals who are dually suited for Medicare and Medicaid blend these beginnings of support to make systems of acute and long-run attention. All of these attacks portion the common purpose of redeploying financess from current dearly-won nursing place attention and hospital-based attention to supported community options. The end of such plans is to intermix these fiscal resources under capitation with an accent on back uping the least restrictive and least dearly-won long-term-care services. Managed attention plans functioning senior individuals with terrible and changeless mental unwellness will necessitate to integrate hazard accommodation schemes that account for the significant costs associated with combined hazards of older age, long-run mental disablement, and medical comorbidity. For case, current reforms under the 1997 Balanced Budget Act include programs to finally associate Medicare capitation rates to wellness position through risk-adjusted payments. Guaranting answerability, protagonism, and results At last, it is of import to admit that senior individuals with terrible and changeless mental unwellness typify the most complex, susceptible, resource-poor, and bad long-term-care patients. Service organisations that presume the fiscal hazard for ague and long-run psychiatric and medical attention will necessitate to be suitably reimbursed and held responsible for quality of attention. In the absence of mechanisms to finance these services, adjust for hazard, and step results, managed attention agreements will be in struggle with the ends of supplying high-quality attention for senior individuals with terrible and continual mental unwellness. Decision: We have no simple replies to the inquiry of how to outdo organize, finance, and present mental wellness and long-term-care services to elder individuals with terrible and continual mental unwellness. The integrated funding and organisation of services promised in germinating theoretical accounts of managed long-run attention offer the possible to eliminate atomization and inefficiencies and to make a much-needed continuum of medical, mental wellness, and societal support services. Yet bing theoretical accounts fail to supply the specialised mental wellness services that are critical for functioning this population in the community.REFRENCES:1 } Jonas & A ; Kovner ‘s Health Care Delivery in the United StatesA edited by Anthony Kovner, PhD, Steven Jonas, James Knickman, PhD. 2 } Hand book of Health Economics by Anthony J.Culyer and Joseph P.New house. 3 } The Economicss of Health and Health attention by Folland Goodman Stano. 4 } The Economic and Budget Outlook: Fiscal Old ages 1998-2007. Washington, DC, Congressional Budget Office, 1997. 5 } Bartels SJ, Miles KM, Levine K, et Al: Bettering psychiatric attention of the older patient, in Clinical Practice Improvement Methodology: Effective Evaluation and Management of Health Care Delivery.Edited by Horn SD. New York, Faulkner & A ; Gray, 1997. 6 } Kane RL: Managed attention as a vehicle for presenting more effectual chronic attention for olderpersons. Journal of the American Geriatric Society 46:1034-1039, 1998. 7 } Frank R, McGuire T, Newhouse J: Hazard contracts in managed mental wellness care.Health Affairs 14 ( 3 ) :50-64, 1995. 8 } Bartels SJ, Colenda CC: Mental wellness services for Alzheimer ‘s disease: current tendencies in reimbursement, public policy, and the hereafter under managed care.AmericanJournal of Geriatric Psychiatry. 9 } Jencks S, Goldman H: Deductions of research for psychiatric prospective payment.Medical Care 25:542-551, 1987. 10 } Miller R, Luft H: Does managed attention leadto better or worse quality of attention? Health Affairs 16 ( 5 ) :7-25, 1997. 11 } Wells KB: Cost containment and mental wellness results: experiences from US surveies. British Journal of Psychiatry 166 ( suppl 27 ) :43-51, 1995. 12 } Felker B, Yazel J, Short D, et Al: Mortalityand medical comorbidity among psychiatricpatients: a reappraisal. Psychiatric Services 47:1356-1362, 1996. 13 } Sturm R, Wells KB: How can care for depression become more cost-efficient? JAMA 273:51-58, 1995.

Hilary Kuykendall Ya Liang Essay

1. How did Turner get himself into this predicament? What is going on for Cardullo? Many reasons contribute to the situation Turner’s currently in, first of all being his abrupt decision of taking the job. The job offer by MLI is very appealing, though, Turner isn’t thinking thoroughly about whether or not he is capable of doing industrial marketing,which is different from what he really likes and is expert in. Making a pros/cons list like the chart below is a great way to evaluate if you will be successful in a new position [4]. The risk is even higher as MLI is struggling financially and still in the transition of a merger.The unstable environment has left him little time to adapt to the new job though time is promised by Cardullo. So this is not a wise career choice in the first place. Secondly, Turner is trusted with too many responsibilities too early in his job. Turner doesn’t really know how to cope with the situation because it’s quite different from what he had in Wolf River. He really needs time to absorb all the information and get an understanding of both internal and external circumstances. Now he has no choice but to make quick calls based on a superficial observation, as well as instincts and past experience which could prove to be very wrong and dangerous. The same is true with the full autonomy over pricing. Turner never has a safe chance to prove his worth before being handed so many responsibilities, so once he fails, he will lose it all. Thirdly, things going on with Cardullo is making it worse. From the case, Cardullo can be described as being extremely judgemental and strongly opinionated. He abruptly sees people as either competent or incompetent and has, from what Turner sees, undermined the value of Kelly, a dependable sales veteran. His attitude also intensifies problems. Cardullo believes in the very opposite of â€Å" praise in public, censure in private†. The public rebuttals are making business issues  personal, and Turner is not comfortable with it. The upper management should be at least seemingly united and resolve issues in private, especially during the unstable period, otherwise some employees would take advantage of it and act on their own interest, such as Julie Chin. She is now teaming up with Cardullo against Turner and worsening the relationship. Generally, the soured relationship between Turner and his boss truly results from the lack of communication. Cardullo is spending too much time at San Diego Office and lacks patience of affairs in MLI. Cardullo’s undermining Turner’s performance irrespective of external environment change and his accusing of Turner’s team leaking sensitive information are jeopardizing mutual trust. His meek response towards Turner’s generator plan and his questioning Turner’s decision making ability concerning the bulb sales are melting Turner’s loyalty and enthusiasm. 2. What did Pat Cardullo and Jamie Turner each initially bring to the situation at MLI that would seem to ensure success? Failure? Pat Cardullo and Jamie Turner come from different company cultural background and have different management style. Jamie Turner has a good educational background and rich experience in marketing. He’s intelligent, dynamic and willing to accept challenges, which is exactly what MLI needs during the special time. Compared with Cardullo, he is more appealing to subordinates from MLI, who are really having a hard time coping with their new boss. Moreover, Turner is afraid of being seen as a job flopper and really enjoys his living in Chicago, so he could be a stable and loyal employee for quite a long time. Cardullo, on the other side, is very analytical and determinant. During their first meeting, Cardullo has demonstrated qualities of empathetic, receptive and cooperative. He is open ­minded and pretty good at being the charming boss. If, during their later cooperation as colleagues, Cardullo can remain as supportive and open ­minded as he appears in the beginning, they’ll make it a wonderful working relationship. However, things become more complicated when Turner is really worki ng for Cardullo. Cardullo is showing more of his other side as being impulsive and obstinate, which Turner is not prepared for. Turner’s position of â€Å"being afraid of losing the job and be seen as job ­flopper† lead him to suppress his feelings and try to be compliant, but  it only makes things worse. He doesn’t actively seek solutions to better their communication in the very beginning. Moreover, he is so confident about his position and â€Å"promising future† in MLI, and pays less attention in dealing with co ­workers, such as Julie Chin. Julie Chin later plays a key role in worsening the relationship between Cardullo and Turner. Secondly, Turner’s past experience is not strong enough to make him a â€Å"competent person† as what Cardullo expect. He is new in industry marketing, and lacks experience in cross ­functional collaboration. Also, he has little successful experience operating during financial shocks (think of the example of Turner’s leaving Lambowland.com). In addition, Cardullo’s position in San Diego office is really taking too much of his time and energy. These all almost ensure a unsuccessful result. 3. What were key choice points where either of them could have done things differently? Many opportunities arose for Cardullo to turn around the deteriorating situation with Turner. When he first brought Turner into the office for the second interview, Cardullo could have  introduced him to other members of the team and encouraged individual conversations with them. Giving a candidate the chance to learn what it is actually like to work in a certain office is part of a Realistic Job Preview, defined by Organizational Behavior as â€Å"giving job applicants a balance of positive and negative infor mation about the job and work context† [1]. This RJP is essential for both candidate and employer because it ensures both parties know what to expect before an actual offer is made thus reducing turnover. The CPA Journal found that â€Å"a firm with an initial turnover rate of 50%, using RJPs should result in a turnover rate of 38%, a decrease of 12%† [2]. If Turner was given the chance to speak to someone like Tim Kelly before he accepted the position, he might have rethought what working for Cardullo would be like in the long ­run. Another key point when Cardullo could have avoided the issues with Turner is when Cardullo gave Turner control over both pricing and sales long before they had originally discussed. Not only did he give Turner control over pricing, but the fact that Cardullo wanted to retain control over large orders was never discussed again. If he had proceeded as originally planned and waited until Turner had a better grasp of the business and understood what was  expected, the break ­even sale of halogen bulbs might have been avoided. As for Turner, his problems with Controller Chin began when he recruited one of her star performers for a project management position, even when she strongly resisted. Snagging someone’s top worker is a quick way to earn their resentment and even distrust. On top of poaching Bill Cook from Chin, Turner also undermined her power as controller when he took his cash ­flow concerns to Cardullo. Turner failed to recognize these two instances as subtle insults to Chin, so he was not prepared for her resulting reaction. Chin’s resentment manifested itself when she went straight to Cardullo to tell on Turner for the halogen bulb incident. His over ­the ­top reaction to her email strained their relationship to the breaking point. If Turner had not alienated Chin from the beginning of his time at MLI, he could have used her as a powerful ally in his dealings with the president. From day one, Turner knew Cardullo believed â€Å"control and marketing are the most important f unctions,† and to get the controller on his team would have been quite the coup. A major key point when Turner could have saved his working relationship with Cardullo was when Cardullo stated that he spent half of each week in each location, despite the CEOs suggestion otherwise. Turner should have seen this confession either as a red flag that working under Cardullo would not be as it seemed and remove his suit for the position, or as an opportunity to inquire further into the situation of Cardullo as president of two divisions. The information that Cardullo was in fact going against the wishes of the CEO would be a warning flag to most candidates, yet Turner did nothing after hearing of the situation. Finally, Turner’s approval of the break ­even sale of the halogen bulbs ruined any hope of earning Cardullo’s trust. When first discussing Turner taking over pricing, Cardullo stated he wanted to retain control over large orders. This stipulation was forgotten when Turner took over much sooner than expected. Whether he forgot the caveat or chose to ignore it, the large order of halogen bulbs was not Turner’s to dispose of. Even if the original transaction did not upset  Cardullo, hearing about the order after the fact from Chin would make anyone feel out of the loop and lied to. Turner should have either approached Cardullo before the sale ever took place, or shortly after to update the  president of the goings ­on of the division. 4. How, if at all, should Turner approach Cardullo at the end of the case? At this point in the situation, Turner’s options for salvaging his relationship with Cardullo seem minimal. Anytime Tuner has approached Cardullo with a relevant concern, Turner usually leaves still as frustrated and angry as ever. On the plane to San Diego the two discussed concerns in a frank and honest manner, but Cardullo dropped the suggestions within a few days after returning and left Turner feeling like their progress was disingenuine. In one last effort before Alan Oliver arrives, we suggest Turner sit down with Cardullo and clarify both of their roles as specifically as possibl e. Many issues stem from Turner stepping on Cardullo’s toes because he does not understand the boundaries of his new role, a typical case of role ambiguity. Even if it means conceding some power back to Cardullo, it would be helpful to both parties. The lack of constraint has left Turner feeling overwhelmed and kept him from settling in at MLI. It has also affected Cardullo to the point where he feels his power as president at MLI has been usurped. He even was heard to exclaim, â€Å"Remember that I’m still the president of this division.† As seen in Exhibit 1 below, role ambiguity is caused when something, either internal or external, has kept the receiver from fully understanding the role expectations of the sender. Another strategy is to admit that efforts to work together with no outside intervention have not been successful, and to enlist the guidance of the CEO. Even without the added formal credibility Oliver brings as head of the company, in many situations a third party can help facilitate the reconciling of parties. The added perspective can keep the airing of issues from becoming too personal, and there is a witness for the agreed solution and plan to reach it. According to the U.S. Online Training on OSCE, they can even do something as simple as â€Å"provide a party with reactions as to the acceptability of its proposals†. In addition to airing all issues, this would present a good opportunity for all three men to address the problems that have arisen from Cardullo splitting his two presidential roles. Each position demands his full time and attention and the different locations  make this impossible. From the beginning, Turner noticed he knew more about the details of MLI’s operations than Cardullo. A successful president is one that knows his or her operations inside and out, something impossible to achieve if you are gone for half of the week. Overall, Turner and Cardullo are not incompatible. We believe they could successfully work together if the underlying issues are addressed and boundaries clarified. References McShane, S., & Vonn Glinow, M. A. (2012). Organizational Behavior. New York: McGraw ­Hill/Irwin. [2] CPA, P. R., & Roth, P. Reduce Turnover With Realistic Job Previews. The CPA Journal. [3] McMillan, A. (n.d.). Group Dynamics. Reference for Business. Retrieved April 1, 2014, from http://www.referenceforbusiness.com/management/Gr ­Int/Group ­Dynamics.html [4] Gallison, D. (n.d.). An Effective Tool for Making Decisions. Career Transition: The Inside Job. Retrieved April 1, 2014, from http://ccppblog.wordpress.com/2013/08/20/an ­effective ­tool ­for ­making ­decisions/ [5] Third party roles in conflict situations. (n.d.). U.S. Online Training on OSCE. Retrieved April 1, 2014, from http://react.usip.org/pub/m3/p23.html

Research approach in the social world Essay Example | Topics and Well Written Essays - 2500 words

Research approach in the social world - Essay Example s, many researches were conducted regarding teenage pregnancy (Colleta, 1981; Barth and Schinke, 1984; Crockenberg, 1987; Whitehead, 1994; Kelly, 1997; Cater and Coleman, 2006). According to Teenage Pregnancy Associates (2011: 1), despite the case that the teenage pregnancy rate in United Kingdom decreased about 18 percent since 1998, England still had the highest rate accumulating a total of 35,966 conceptions under 18 years old in 2009. It is the case that the society in which we live in highly discriminates and stigmatises teenage pregnancy. There are different ‘imaginative measures’ to make teenage motherhood look nasty, disagreeable and immoral, thus ‘uglifying’ teenage pregnancy (Whitehead, 1994: 55 – 81). Girls who have been pregnant at an early age are labelled as sluts, ho, promiscuous, ignorant, incompetent, irresponsible, and so on (Kelly, 1997: 165 – 180). In this case, these young girls are stigmatized for being young moms. However, this concern is not just personal but also with the trend, the society is also alarmed. Different institutions like government, economy, education, church, and most specially, the institution of the family have been upset with the numbers young mothers. Basically, the reason that has pushed me to investigate this research topic regarding teenage pregnancy is because of how our society views these pregnant teens as well as the teenage moms. Thus, the necessity to conduct an exploratory study of the experienced and circumstances contributing to the crisis of teenage pregnancy can be backed – up by the current situation of our society in relation to the issues on teenage pregnancy. However, in this study, instead of looking from the perspective of society, this will examine the perspective of the young moms. The question of who will be the beneficiaries of this academic endeavor is not only the pregnant teens and teenage moms but the society as a whole because as the stories of these girls are told through this

Financial Management Principles (Dell inc.) Essay

Financial Management Principles (Dell inc.) - Essay Example Why had Dell made it to the top spot According to writer Abrhm Lustgarten "Dell's peers see it as brilliantly managed brand - but no innovator in raw computing" (Dell Tops Fortune's List, 2005). Though Dell slightly fell down to the 8th position in the 2006 Fortune magazine's America's Most Admired Companies List (Fortune America's Most Admired Companies 2006), still it leads the computer manufacturers in this prestigious list. Thanks to the exemplary entrepreneurial and leadership trait of Michael Dell, Dell, Inc. has maintained its position as the industry leader in computer manufacturing. In terms of its financial status, as illustrated on Table 1 below, Dell is in good shape. In terms of profitability, the industry leader performs extremely well. Having a return on equity (ROE) of 86.5%, Dell enables its investors to yield $.856 in every dollar they invested on its stocks within a year. Together with 15.5% return on asset (ROA) and gross margin that accounts for 18.2% of the entire revenue, the figures under the Profitability Ratios section of the Financial Ratios of the company (Table 1), exhibits the company's efficient cost management.

Assignment Example | Topics and Well Written Essays - 1000 words - 19

Assignment Example Iron catalyses L-DOPA to generate a genuine free radical which forms covalent bonds. These compounds then make good means to bond antifouling polymers. 6. If you want to break the amide (peptide) bonds that marine life use to attach themselves to ship, one should put a minimum of hydrophobic coating on to minimize the adhesive strength of the bonds. This process is called amide hydrolysis. 8. Fluid Flow in most non-biological applications falls into non-biological applications fall into either the laminar flow region for gas phase flows or the turbulent region for liquid phase flows. For biological flows, one is often in the molecula flow regime. 11. 1 (a) Artificial Kidney: Polyhydroxyethylmethacrylate (PHEMA) which is a cross-linked hydrogel. It is not absorbed by the body, capable of withstanding heat sterilization without damage, has resistance to degradation and it contains water content similar to living tissue. (b) Blood Vessels: Nitinol, a shape memory alloys is used as an artificial blood vessel like coronary artery. The memory alloy has the capability of being deformed and going back to its original shape when pressure is released. The materials should be non-corrosive, have resistance to blood platelet, be durable and non-toxic. (c) Contact Lenses: Polyhydroxyethylmethacrylate (PHEMA) is also used in the production of contact lenses. It is selected since it can be organized into any shape or form; it can withstand degradation and can’t be absorbed by the body. (d) Artificial Heart: Polyethylene terephthalate (Knitted Dacron) and Polytetrafluoroethylene (PTFE) as vascular graft are in common use for creation of artificial heart components. Materials should exhibit resistance to platelet and blood clotting, it should have biomechanical strength and durability, non-toxicity and biocompatibility. (e) Hip & Knee replacement: Materials used for hip & knee replacement are metallic biomaterials divided into 3 groups

Hong Kong Market Essay Example | Topics and Well Written Essays - 2250 words

Hong Kong Market - Essay Example The paper tells that market research is understood to be a scientific process concerned with gathering and processing critical information, which can be used in marketing management decisions. Due to this, marketing research is considered a critical part of a marketing intelligence system that in most cases functions to improve management decisions using timely, relevant, and accurate information. Marketing research has become popular in many organizations due to perceived benefits the process is seen to generate. For instance, smart organizations have been able to achieve and sustain their competitive advantage by using market information in the most creative manner. Moreover, organizations that adequately satisfy the needs of their consumers have done so by intelligently and creatively using appropriate market research information. Therefore, at this point it can be stated that market research is critical in the modern world especially in the age of globalization and increased cons umerism. Consumers in Hong Kong, just like consumers in other societies are likely to exhibit varied behaviors with regard to consumption. Although consumption is an aspect that is synonymous with all societies, numerous evidences have shown that societies across cultures differ in terms of consumption behavior, consumption pattern, and the overall consumption culture. This is to say, consumption behaviors exhibited by consumers in Hong Kong are likely to differ to behaviors exhibited by consumers in other regions. ... erous evidences have shown that societies across cultures differ in terms of consumption behavior, consumption pattern, and the overall consumption culture (Hoyer and Macinnis, 2009). This is to say, consumption behaviors exhibited by consumers in Hong Kong are likely to differ to behaviors exhibited by consumers in other regions. Therefore, the discovery makes it virtually impossible to generalize consumer behavior across cultures. As a result, introducing a new flavor of soft drink in Hong Kong market will require the company to undertake a detailed market research that aims to identify specific consumer behaviors that are likely to influence or impact the marketing process. Accurate intelligence information about how consumers in Hong Kong consumer products in terms of beliefs, values, demographic factors, socio-economic aspects, cultural issues, lifestyles, and many more (Hoyer and Macinnis 2009). This is critically important since such information will help the management team o f the company to initiate appropriate strategies of marketing for the new product to succeed in the new market. Marketing Research Design In order to successfully carry out market research, the researchers have to develop and implement the most appropriate research design techniques. Consequently, the usefulness of research project is likely to be realized when there is evidence of quality of research design, coupled with appropriate data collection and analysis process based on the design. Research design in marketing research involves identifying the best research methods that are appropriate in obtaining the required data (Churchill and Lacobucci, 2009). As a result, validity and reliability of data to be collected, which is critical in research process depends a lot on the type of

Roles you play Essay Example | Topics and Well Written Essays - 500 words

Roles you play - Essay Example The first task consisted in eliciting support from the members of the community through their becoming members of this group. A few of us, including myself, were given the task of persuading as many community members as possible to become members, and involve themselves in the activities of planning, implementing, and monitoring of the community development activities. Thus, my first group task was that of INITIATOR-CONTRIBUTOR. This role was assumed by me, because of the motivation and energy that I had for the objectives of the group, and my ability for persuasive communication. This role was effective in drawing many members to the group. It was not long before a majority of the members of the community had become members of the group, and the forming phase was over. We next had to get down to the storming phase or the phase in which the agenda of group activities would be decided. At this stage my role in the group changed to that of an ELABORATOR. This role was assumed by me as I had the capacity to listen and understand the opinions of the members of the group, and put it to the group clearly, for better understanding in the group. This role was effective in ensuring that every member had a proper voice in the setting of the agenda for the group activities. Having sorted out the agenda, we next moved on to assigning tasks and roles for the members of the group. This was the most disruptive phase encountered thus far. In this phase I played the role of a GATEKEEPER-EXPEDITER. Every member needed to know the opinions of others, and also have a say in the assigning of roles and tasks, for an amicable way in going about the assigning and acceptance of roles and tasks. I assumed this role because of my listening and communication skills, persuasive nature, and high energy levels. This role of mine ensured that communication between members was maintained during the disharmonious periods, so that tasks and roles

Absenteeism within the Work Place Essay Example | Topics and Well Written Essays - 2000 words

Absenteeism within the Work Place - Essay Example Researchers as well as practitioners are also performing their part to find a remedy that can at least reduce employee absenteeism and thereby improve the productivity and savings in cost. It is known commonly that absenteeism results in cost and productivity problems, puts extra burden on other employees, and ultimately affects adversely customer satisfaction and the country's economy. It has been observed through many studies that lack of absenteeism results in better quality, lower costs, and greater productivity (Hazzard, 1990). Absenteeism is pervasive in all organization irrespective of size, type and nature. However, it is higher in manufacturing organizations. Research supports both reward and punitive mechanism of destructing absenteeism and helping organizations meet its demand to various stakeholders. The present study is an attempt to suggest some solutions to this mounting problem of workers absenteeism. The study basically aims to assess the reasons of absenteeism among the selected sample respondents from industrial background. It also attempts to understand the impact of unauthorized absenteeism on productivity and cost of production and ultimately on profit. The study takes a descriptive as well as explorative approach where in attempt is made by the researcher to describe the various factors responsible for employee absenteeism and to explore the relationship between variables.... It also covers studies and publications on remedial measures of absenteeism adopted by employers and those suggested by researchers and practitioners. As already mentioned, absenteeism is a universal phenomenon. However, it is mostly seen in the manufacturing/industrial sectors. It has been observed that employee absenteeism is higher in manufacturing organisations than in any other areas (Hazzard, 1990). It has also been understood that it is higher in union settings than in nonunion settings. Another significant study concludes that absenteeism is more common among women than men as women are more sensitive to family needs (Dunn and Youngblood, 1986). Another interesting finding is that absenteeism is high among unmarried than among married workers. The reason for the same observed is that married employees find more financial pressure than single employees and as such there is less chance of employees taking unscheduled leaves (Drago and Wooden, 1992). The studies undertaken so far to explore the reasons for/ factors responsible for employee absenteeism vary one to another. However, one common conclusion among studies across industries and countries is that employee unscheduled absenteeism should be restricted and given due importance as it will serious repercussions on productivity and profitability. Steers and Rhodes (1984) claim that employee attendance is determined by two factors, basically, (a) employee's motivation to attend, and (b) the employee's ability to attend. The first factor is concerned with the organizational factors that stimulate employees to attend for the work. These factors include cordial working

How did the Constitution impact the development of American freedom Essay

How did the Constitution impact the development of American freedom - Essay Example The foremost reason for the proposal of the amendment of the articles was to ensure a harmonious operation of the states1 under an active central government. It was mainly to achieve union of the states given that it was not operational in most other states. The proposal for amendment, however, was not feasible. Many states were uncomfortable with the articles and cited possibilities of failure to materialize and function in such states. Since achieving a consensus among the thirteen states was a great challenge, the necessity for a new document led to the drafting of the constitution. Drafted in 1787 and ratified in 1788, the constitution became operational in 1789. The constitution would create a powerful central government as required by proponents of its drafting. The drafted constitution would turn out to form an efficient government that endured successful operation of the confederation. Some of the thirteen states greatly supported the necessity to change the articles that wer e the foundations of the initial government. According to the provisions of the articles, there were thirteen elected delegates. That formed the national congress. The basis of most decisions was on the conformity of majority delegates in the national congress since the state had single representative and vote. Advocates of reforms of the articles cited reasons as loose confederacy of the different states. The articles granted limited authority to the central government, over the states. States were too powerful under the articles. The

Play Therapy for Children with Sensory Processing Disorder(SPD) Essay

Play Therapy for Children with Sensory Processing Disorder(SPD) - Essay Example tional senses, the touch,  hearing, taste, sight and smell; as well as two additional senses, the vestibular and the proprioceptive senses, which tell us what position our body is in (Ayres, 25th edition, page 38). Carol Stock has defined this condition as "inefficient neurological processing of information received through the senses, causing problems with learning, development, and behavior"(The Out-of –Sync Child, 1998). Other common terminologies used for this condition are Sensory Processing Disorder (SPD), Dysfunction of Sensory Integration (DSI) and Sensory Integrative  Disorder (SID). The term Sensory Integration Dysfunction, was coined by Dr. A. Jean Ayres, a researcher and pioneer in the field of occupational therapy (Miller, Sensory Processing Disorder Foundation). Sensory systems are means of perceiving the external world. They are essential for maintaining arousal, forming body image and regulating movement. Sensory inputs are necessary for brain function and contribute to development. Thus, those children in whom sensory inputs are not integrated or processed normally, experience real-life situations in a different manner when compared to normal children (Ayres, 25th edition, pages 13-22) . Many children with SPD have normal intelligence (â€Å"How is SPD treated?†, Sensory Processing Disorder Foundation), but the way they perceive sensory information is different from the normal children. This does not mean they are blind or deaf. The blind and deaf children do not perceive the specific senses at all. There is defect in the visual or auditory pathways. Whereas, in a child with SPD, these pathways are normal, the perception is also present, but the perception is abnormal. The children are either hyposensitive or hypersensitive to outside stimuli. For example, a child who is hyposensitive to touch will constantly be crashing into things seeking extra stimulation, while a hypersensitive child will avoid being touched or will not touching things when

Ancient Egypts Effect on Modern Society Essay Example for Free

Ancient Egypts Effect on Modern Society Essay The museum has always been a place for all different types of people from the public to go and appreciate art and feel reconnected with the past. People may go to the museum for these reasons or a variety of others. But for whatever reasons they choose to go to the museum it always has an influence on that person’s relationship between them and the history they viewed. Specifically speaking the museum has a big influence on the public and Ancient Egypt. The museum is already a place of history and mystery and Ancient Egypt is one of the most mysterious ancient cultures. With so little known about these ancient people it only makes sense that the museum would be a good place to strengthen that feeling of mystery. Ever since the modern discovery of Ancient Egypt the public have been fascinated by the mystery left behind by these ancient people. The modern public is always interested in learning about Egypt. Weather that be from books to movies or trips to the museum the general public uses a variety of methods to learn about the Ancient Egyptians culture. Stereotypically speaking when most people talk of Egypt they think of mummies. Most people one speaks to have generally the same depiction of what Egypt is in their heads. So a lot of times people don’t really know the truth about Ancient Egypt. And that is where the museum comes into play. The museum has always been found as a viable source of accurate information regarding history. So in today’s media rich society most people who are really curious about learning about Egypt would rather visit the museum rather than pick up a book on Egyptology and read it. The museum is a good place to start for people to go and observe visually what is left of Ancient Egypt. And these exhibits help to construct an idea of what this Ancient civilization was truly like compared to the entertainment industries depiction of it. This act of going to the museum to fulfill ones curiosity on the subject is just one way the museum helps strengthen the bond between the public and Ancient Egypt. Another way the museum helps strengthen the relationship between the public and Ancient Egypt is by giving them an escape from reality. Most people get fed up with the normal day in and day out of adult life and are always looking for something new exciting and mysterious. Ancient Egypt is something that is tantalizing for people to learn and talk about because so little is known and so much can be speculated. So the museum helps give this bored person a chance to view what is left of Ancient Egypt and to escape from their reality and escape to this mysterious world. This strengthens the relationship between Ancient Egypt and the public because people desire that mystery and they can get it by viewing the mystery of Ancient Egypt at the museum. One more way the museum strengthens this relationship is by adding more to the mystery. Meaning the museum shows the public a depiction of the past but no definitive answers, if anything I found you leave the Ancient Egyptian exhibit with more questions than answers. This quest for answers strengthens the relationship because the public is searching for an element of mystery and find it in Ancient Egypt, but every time they get more of a taste they get more unanswered questions. This causes more of a desire to learn and explore and it all begins with the museum giving just a taste of the mystery surrounding Ancient Egypt. Following this drive for knowledge on Ancient Egypt the museum also helps strengthen the physical relationship between the public and Ancient Egypt. Ancient antiquities are one of the most sought after items for just aesthetic position. People will go out of their way to bring back a piece of history with them that they can hold in their hands. Weather that be through artifact relics or souvenirs somebody is always trying to take a piece of history with them. They might be doing this for a variety of reasons. They may just want something interesting on a shelf to start a discussion where they can gloat about their recent trip to Egypt. Or they may want to have it because it makes them feel closer to the ancient times and the mystery of it all. But for whatever reason people always want to have some sort of item that relates them to the history or journey. The museum does this by providing them with a large varieties, the person who wants to fulfill that desire of owning a souvenir or relic, to choose from. You can buy almost anything Ancient Egypt related at the gift shop in a museum. From Lego pens to imitation artifacts, the museum is a great place to fill a need to buy a souvenir. Also what better time would it be to buy something Egyptian than right after viewing an exhibit of the real artifacts. So by being able to create a need for a physical relic and then fulfill it the museum is a perfect place to strengthen the bond between the public and Ancient Egypt. So the museum as it seams is a very powerful place when it comes to strengthening the bond between the public and Ancient Egypt. Weather the museum is providing just a simple craving of curiosity or to providing the perfect place to shop for a relic you can take home with you, it has been a great place to strengthen the bond between the public and Ancient Egypt. This place of mystery, knowledge and unanswered question will hopefully be around for a long time to fulfill the publics desire to know more and become closer with Ancient Egypt.

A Study On Power Of Media

A Study On Power Of Media Gods great gift to humanity is communication. Freedom of speech is a right of every individual who have expressed their thoughts, because of their free will desires, and aspirations through the mass media (Russell, Norman and Heckler, 2004). Communicating liberally with other affirms the self-esteem and merit of each and every member of society. Freedom of phrase is vital in the achievement and growth of knowledge. Communication brings ahead a variety of ideas and information. People nowadays are well-versed and more open-minded thanks to flourishing press freedom and rising mass media here and in many parts of the world (KRCMAR and Kean, 2005). All points of view are represented in the souk of ideas and culture benefits from question about their worth. In addition, this is how media influences culture as it leaves a large shock on the individuals (Potts, Richard, Dedmon and Halford, 1996). As it has an innate power to hold and influence the total person. It leaves a sensible and lasting impact on equally the conscious and subconscious. While media informs and educates, it also corrupts and exploits, leading it to adjoin to the moral disgrace of society (Russell, Norman and Heckler, 2004). Medias function in society is to update, educate, and amuse. It tells the truth and provides optimistic motivation that can build up descriptions and reputations the right way. Therefore, media has contributed deeply in ways that both enlighten and supplement society, but in additional ways have deteriorated and perplexed it. It is not a shock to learn, then, that media is the most powerful source of information, and nothing else in todays world influences public insight as heavily (Salzman, Philip 1993). Media in the Philippine is simply a sign, an outgrowth, and a mirror of society as a whole. In spite of everything, media has been thought to have such a great authority over people. But, rather than performing its work in society, media has strayed, having a more harmful than constructive implication. It destroys descriptions and reputations, covers up the truth, stimulates negatively, and imparts the wrong messages (Anderson, Eugene, Fornell, and Lehmann, 1994). Moreover, people practice a freedom of the press that becomes a flood of contradictory information and opinion. It confuses even as it is thought to inform, it assails the sanity even as it is thought to cleanse them, it entertains more than it enlightens, it gossips more than it informs (Salzman and Philip, 1993). Media has become ethically and ingeniously bankrupt. Media shows no ethics and morals and the substance is packed with no other topic but aggression and sex. As a result, media mirrors society by reflecting it as a society with little ethics, with offense, sex, and pornography. It contributes to the nationwide breakdown and the moral disgrace of society. It has dishonored and broken the freedom of the press (Miller, 1995). Media teaches by means of sensations and descriptions that leave a superior effect on the youth. People become victims of medias misuse as they are being inclined for the bad. Because of the influences that shape the subconscious, all forms of media should be taken more significantly so as to prevent harmful effects (Potts, Richard, Dedmon and Halford, 1996). 1.2 Modern Media The medias main impact is psychological and intellectual. Media and entertainment companies form public opinion and assist in framing the terms of public discussion. The media is what we interpret, listen to and observe. In equivalent, through its close affiliation with advertisers, the media also exerts a great influence on the decisions we put together, the products we buy, and the kind of questions we put when we make our daily choices (Gerbner, 1990). The long view of the past proves medias power by presentation that the medium itself, in the extended run, is more influential than the messages it carries, because the medium determines what can be communicated and how we imagine about that communication (Potts, Richard, Dedmon and Halford, 1996). Television, radio stations, newspapers, magazines, and internet sites are mainly owned by profit-making businesses. 1.3 Changing Media Values, Study of Pakistan Media is one of the significant organs in forming national identities. For the last ten years media in subcontinent is conquered by India. To begin with the domination was in the form of movies but once the advent of satellite television they have altered the lives of people of subcontinent (Malhotra, Iqbal 2000). Following the liberalization of Indian media Indian satellite channels principally entertainment channels were launched swiftly. This all started in 90s, at that time rest of the countries of South Asia together with Pakistan, Bangladesh, Nepal, and Sri Lanka etc were far behind India. Through that era they all were relying on national televisions. Television programming was going to full circle now. It started of with Doordarshan. Then comes satellite television. From local content it becomes more national (Sonwalkar. Prasun, 2001). Public of these countries were not having any right of entry to moderate media like Zee TV or Star TV Asia. Indian entrepreneurs just took benefit of this fact and launched plethora of satellite channels one by one. In 1999 Pakistani government allowed private television and radio channels to be aired from the soil of Pakistan, until this time Pakistani audience were used to Indian entertainment. Pakistani government tried to vanish Indian satellite channels from the TV lounges of regular Pakistani family in the course of imposing bar on Indian satellite channels, but they were unsuccessful (Gholam Khiabany, 2003). In this age of Globalization the majority of the regions are affected by commercialization and uneven stream of Information. The worst victims of Globalization are developing countries those are victims of uneven stream of information from urban countries. In South Asia case is totally different, this region is dominated by India, which itself still comes in the category of emergent country. The thought of writing this text is to write something about non-western world (Sardar, Ziauddin 1993). India is improving in media industry, this is not only influencing Indian society but also its influence stretched to its neighbors, Pakistan Bangladesh, Nepal and even Sri Lanka is reliant on their media (David and Crawley, 2001). Language and ethnicity played important function in the growth of Indian Media industry, Urdu language bind India and Pakistan. Everyone in Pakistan understands Urdu, and there is no visible difference in Hindi and Urdu. Elites of Pakistan, Bangladesh, Nepal and Sri Lanka always speak about cultural imperialism of India. Pakistani government tried to stop this influence by banning Indian channels in Pakistan, but Pakistani people are now more inclined to Indian media. Zee TV, Sony and Star Plus (Indian Satellite Channels) have penetrated in the upper middle class Pakistani homes as never before (Sonwalkar. Prasun, 2001). According to UNESCO India is the lowest importer of Television programs, only 8 percent of the programming showed on television in 1990 was imported from abroad. Indian satellite channels dispersed from the control room of cable operator to the subscriber home, not only shows film and television dramas but also showed political and supplementary events to grip advertising (David and Crawley, 2001). The soap opera culture which was in fact western idea was ideally adopted by Star Plus. In nineties while Indian media liberalized from the control of Door Darshan, and star network began there satellite channels, then primarily star network laid the foundation of westernized form of entertainment. Like Stars Channel V, Zees Music Asia channel is a booming indigenized adaptation of Western models such as MTV and Channel V (Mowlana Hamid, 1996). Going on in step with the liberalization of the market, television has brought about a liberalization of culture inside India over the past decade. This has meant, on one hand, admission to sources of news and entertainment not controlled by government but, on the other hand, exposure to a tele-visual culture at odds with conventional norms and morals (Gholam Khiabany, 2003). Yet as it may have been Western programs such as The Bold and the Beautiful that led this cultural invasion, the resulting competition for audiences has clearly been won by those channels that have developed programs based on Indian accepted culture, mainly film and film music, and have normally been able to indigenize the worldwide forms of commercial television. Indian satellite television networks particularly Star Plus have cached the overseas formats and tried with the Hindi versions. Kyon kai saas bhi kabhi bahu thi(Indian satellite channel Star Plus famous soap opera) is most prominent soap opera in South Asia (John Ellis, 2000). In South Asia soap opera culture was introduced by Zee TV, in 1992 Tara (Zee TV Soap opera) was first and praised by community all across South Asia. Before soap opera Pakistani Dramas were very famous, but due to soap opera traditions the whole television drama creation industry is on the edge of fall down. Even Pakistani satellite channels are replication same format. This is the sequence of globalization, Indian media engaged western structure of entertainment and they experimented (Butcher, 2003). Indian television programs and films are integral part of Pakistani society. Over the years through videos and TV, there has been an recognition of Indians as similar people, so it would be very hard to get rid of Indian videos and TV programs from Pakistani society. The accessibility of international television channels by means of satellite at the start of the 1990s forced the liberalization of a television market formerly held as a national monopoly by the state broadcaster Doordarshan. There remain important technical boundaries on the degree to which television can give out as the stage on which new convergent information services can be delivered (Banerjee, 2002). As language and region increasingly dominate media content and viewership, concept of Imperialism and hegemony acquires new meanings in localized settings. Language and traditions played important role in the development of Indian Media industry, Urdu language bind India and Pakistan. Everybody in Pakistan understands Urdu, and there is no visible dissimilarity in Hindi and Urdu. Elites of Pakistan, Bangladesh, Nepal and Sri Lanka at all times talk about cultural imperialism of India. Pakistani government tried to prevent this persuade by banning Indian channels in Pakistan, but Pakistani people are now more inclined to Indian media (Butcher, 2003). Zee TV, Sony and Star Plus (Indian Satellite Channels) have penetrated in the upper middle class Pakistani homes as never before. The coming of Satellites television has posed peculiar problems for the official custodians of Pakistani culture because it has breached the ideological boundaries of the state in a much more intensive way then ever before (David Page and William Crawley, 2001). 1.4 Importance of this research: Media industry (drama/soaps) in Pakistan is at it growing stage and due to the reason it lacks many important resources in terms of capital and infrastructure it gets dependant on the copy art and starts taking influences from the neighboring countries. Such research would be able to highlight different aspects of the industry and the weakness that are the causes of the failure to capture the audience. Similarly how these weaknesses can be tempered and taken care of. Efforts can be put on those areas for improvement. This research will benefit the producers that are produce dramas/soaps, the production companies and the TV channels involved in this area. Pakistani industry has a lot of talent in terms of the human resource but they are not being utilized at the potential. By highlighting the issues and their remedies one can easily understand how to improve the quality of the product. 1.5 Theoretical Framework and Research Question The reason to conduct this research was to study and understand the correlation between the connectedness with the program while watching any TV program. This research will try to identify the existence of any sort of relation between the viewership and the connectedness of an individual with the program. In order to prove such relationship the frequency of viewership will be questioned and level of connectedness with the program will be analyzed. In this research five variables have been taken into consideration for studying the relationship between connectedness and the viewership of the program as proposed by (Russell, Norman and Heckler, 2004): Escape Modeling Aspiration Imitation Fashion The current media situation in Pakistan Entertainment sector is that producers of the dramas/soaps have an understanding of what the viewer wants to see. This comes from the high involvement of Pakistani viewer in the Indian dramas/soaps. Due to this producers are producing content that is in turn a copy of the Indian dramas/soaps. If we see this from the perspective of a viewer there is lesser viewership of Pakistani entertainment channels as compared to Indian channels, then why is the producer producing such content? There is a gap in the understanding of the viewer and the producer of the dramas/soaps in Pakistan. We can study this by studying the television viewing and the factors that are influencing the viewer to watch on program more than the other. Connectedness is a newly developed construct of audience viewing behavior, and it proposed to be one of the important antecedents of audience satisfaction with positive relationships. We will find out if the viewer is willing to watch any other content on the Pakistani channel and can relate to it. In order to analyze the correlation between the connectedness and the frequency of viewership following Hypotheses are being proposed: Frequency of viewing a particular program has no relationship with the time spent in watching television. Frequency of viewing a particular program has no relation with the connectedness of the program Connection with the favorite particular program has no relationship with the number of hours an individual spends in front of a TV. 2.0 LITERATURE REVIEW 2.1 Television viewership Robinson in a studies concluded that television seems to have a superior influence on the structure of daily life than any other novelty in this century (Gabriel Weimann, Hans-Bernd Brosius and Mallory, 1992). Television has altered the daily life of more people in this century then any other medium or discovery. In a US poll, 68 percent stated that watching television was their main resource of enjoyment (Gabriel Weimann, Hans-Bernd Brosius and Mallory, 1992). Children are watching television as a firm routine around the age of two and a half and a typical mature or child watching an average of two to three hours per day more time that they utilize on any other activity except working and sleeping. No wonder that this influential medium has become one of the principles of modern culture (Jeanette K. Chan, Marcia Ellis, and Auria Styles, 2005). Moreover, adults are thought to obtain their images of actual and ideal truth and it also interacts with the childrens developing perceptions of reality, both on a communal and individual level (Jennifer M, Lawrie 1998). The last decade had witnessed noteworthy changes in the media system of many societies. The development of the cable television , undeviating broad casting satellites, teletext and additional broadcast television joined existing competitors for audience attention time, money and pleasure.( Lin, Carolyn A. 1993). Watching television is today more than ever a significant attribute of the modern life, capturing a major slice of our spare time. This has led quite a few scholars of mass communication to draw their attention towards television-its content, construction, usage as well as outcomes and control. 2.2 Media globalization: An Indian perspective It is not an understatement to say that the 1990s have been moderately vital to the conversion of Indian media networks and industries. Considering the fact, that the Indian media for a long time was principally restricted national wide . Indian cinema had active regional division networks in Africa, the USSR, South East Asia, and the Middle East, but here the cultural broadcast of the Hindi film greatly outweighed any severe economic returns in comparison to Hollywood, or what was to approach in the 1990s. Television only advanced after the 1980s, with a huge state network that crossed the country boundries. The 1980s were no doubt important as cassette culture changed the music industry and outweighed the iron grip of international music forms that had conquered the old LP record business. As Peter Manuels work shows, cassette culture drew new markets, created new artists and music forms, and enormously expanded the market (Ravi Sundaram, 2005). Thus the media bang of the 1990s, generally going under globalization, was not without a background, but was obvious by a mixture of both media forms and temporal stepping up. Within a few years India experienced satellite cable television advancing from just a a few to a total of 80 channels, and the increase of other media in the shape of cassettes, CDs, VCDs, MP3s, and DVDs. Media ownership was enormously varied. New empires came up from satellite television, going into circulation, and later on into film production. For the most part television circulation remained extremely erratic; cable was largely retailed by minor independent group of actors in the neighborhoods. By the late 1990s, multi-service providers came forward, pushed by large television networks contributing franchises to local troupes, but this only enlarged difference at the local level between competitors. Mostly, cable distribution stays in the informal zone and a source of disagreement over intellectual possess ions. In the music sector, a huge new production network now exists in the informal subdivision, producing a range of remixes, religious, crossovers and versions of registered film music. The larger companies have tremendously profited by lowered costs of manufacture and the capability of the small company to immediately respond to musical tastes and produce new artistes. Film music, once a leading part of the market (80%) has witnessed its share slipping slowly, at any tempo piracy makes market control impossible (Ravi Sundaram, 2005). In the case of Bombay, the picture remains unclear with the industry moving from crisis to crisis. Most of the expression seems to be against piracy as a reason for losses, but the quality of wordings has been declining, a constant objection in the industry. This situation has led to a small opening for new medium-budget productions with new actors and directors. Concisely, we can differentiate the media in India from the 1990s whose relationship can at best be described as permeable. At one level are the new media enteritis: the business owners of satellite television channels, large software industries located in the techno-cities of Bangalore and Hyderabad, and the advertising companies in Bombay. The great software companies have been the most gainful in the stock market, and operate in real time with Western companies, and hire thousands of programmers. The second level is the huge and vibrant informal and often illegal media zone of urban India, which has, practically, retailed the new cultural group to the group of citizens. This includes the thousands of small cable television networks, millions of publicly operated phone booths in neighborhoods, street music sellers, pirate and non-copyright media producers, and public internet entrà ©e points (Sonwalkar. Prasun, 2001). In India especially Delhi, a considerable part of the media experience of the 1990s emerged from networks that were part of this society of the copy, a world that I have called pirate modernity. Pirate modern culture transformed production and movement of commodities using the ill-legal media copy as a major form for producing and reproducing products in the city. In Delhi the media copy exists in a balanced relationship with all other objects and industries: clothes, cosmetics, medicine, household goods, and also car and machine parts. As is clear, copy ethnics pits piracy right into a global social disagreement on definitions of property (Ninan, 2004). Media and film research in India has now given way to chronological and modern studies, as well as digital networks and the upcoming industrial form of the media itself. Research is at an initial stage, but given the seriousness of the task and an extensive list of issues, some thrilling interventions should be predictable in the next few years (Ravi Sundaram, 2005). An efflorescence of the media in India during the 1990s, mostly in television has changed the south Asian media. After the innovation of the overseas channels declined in the early 1990s, Indian channels strengthened their position, experienced highest viewers rating and enforced foreign channels to significantly adopt local programming. The late 1990s supplemented a new aspect with region/language-specific channels. Besides, Indian media products are gradually being viewed as cultural imperialism within South Asia similar to as the western products were during 1960s-70s. Indias media power and effervescence appears to pose some tests to the trope of media imperialism (Prasun Sonwalkar, 2001). The concept of media-scape as battle ground is often suggested in economic terms, but this can well de broadened to politics as well, as the situation in South Asia. For example, cream of Pakistan, Nepal Bangladesh and Sri Lanka not normally speak of Indian cultural imperialism. Zee TV and Sony have entered into the upper middle class Pakistani homes as never before (Amit Baruah, 2000). As Pakistans information minister, Javed Jabbar, put in I am worried about the pressure of Indian satellite television on our people (Sanjaya Baru, 2000). Foreign channels like Star TV were first to affect in the early 1990s, but its initial uneasiness of a cultural invasion appeared lost as their viewership declined when local channels like Zee came up. In 1992 viewers switched to channels with programs that closer to their culture. This is obvious from the program-based viewer-ship examples across eight major Indian cities. This however, this let down most foreign channels to make a good ranking. Many viewers seemed to decline Indian channels like Doordarshan, Zee TV or Sony (Prasun Sonwalkar, 2001). This has enforced major overseas channels like Star TV to initiate Hindi language programming. According to, Patrick Cross (BBC worlds managing director), additional programs in Hindi were going to be introduced. This was the first time that BBC World was going to broadcast in aregional language anywhere in the world (Anjan Mitra, 2000). According to Peter Mukerjea (CEO, Star India), they had to get into regional language programs in India and speak the tongue that the Indians were at ease in (Anjan Mitra, 2000). Furthermore, Star TV reintroduced their programming by moving popular English-language soaps like Santa Barbara, Baywatch and Bold and the Beautiful to Star world to make way for Hindi shows (Prasun Sonwalkar, 2001). Doordarshan had dominated the market before 1991, but the growing attractiveness of satellite channels has affected its returns even though it sustained its vast viewership (Hasan Suroor, 2000). In 1992, the Indians were alarmed that a cultural invasion could take place, but it was an out-vasion which occured. Sony and Zee are viewed in some African countries, in the Middle East, the UK and Europe, and Star Plus is streaming across Asia. Each one of them represented what is relevant to Indians (Iqbal Malhotra, 2000). Not only the entertainment channels but also the Indian news channels receive normal response in the newsroom from many spectators and politicians in Nepal, Pakistan, Bangladesh, the Philippines, etc. who regularly call up newsrooms to comment on news stories which are live or offer suggestions for coverage (Prasun Sonwalkar, 2001). In conclusion is can be said that, the western communication of cultural/media imperialism comes in for a dispute even as national continues to be a key determinant in the cultural scene thats permits new language and regional force to appear within and across nation states due to new media and trends in communications technology (Prasun Sonwalkar, 2001). 2.3 Soap Operas and Gossip Soap operas are extremely accepted cultural forms, attracting more than 10 million viewers daily, the majority of which are females. From the economic point of view, they produce significant profits for the network (Hasan Suroor, 2000). Regardless of their abilities to draw large number of audiences and to produce large profits, soap operas have long been seen as an object of disrespect. One of the criticisms leveled at soap operas is that they are slow-paced. Soap operas are multifaceted, with large characters and plot lines which build up slowly over large periods of time. Viewers tend to get emotionally involved to the characters in a soap opera (Hasan Suroor, 2000). Viewers themselves penetrate vicariously into the imaginary soap opera community. There are many long-term audiences, some of whom have been watching soap operas for as long as 35 years. Soap operas are planned around a cylindrical cycle of the real world in which viewers live. The lives of characters run corresponding to the lives of viewers in time. Thus it is the time not plot which comes to control the description process (Hasan Suroor, 2000). The organization of time and the durability of certain characters, allows the viewers to turn into very familiar with the characters histories, well ahead of the time-frame of any one episode. These histories are reactivated in the minds of long-time viewers in scenes where the characters talk about the implications of a particular occasion or action. Scenes filled with gossip are in fact essential to how events on soap operas are interpreted by audiences (Hasan Suroor, 2000). Gossip among characters and a soap opera to give the viewers a running commentary on the action, providing information and details about the latest facts of the plots. It helps bind together various plots and characters so that the audiences can interpret how an action will affect other characters not directly involved in the plot, giving a certain plot line a depth (Hasan Suroor, 2000). The intensity of this model complexity is evident at a soap opera wedding, funeral, and other traditional events, allowing audiences to revive memorial events of their own minds. Viewers of soap operas tend to talk about its characters as if they were real people and also have a tendency to get personal about them (Hasan Suroor, 2000). The wider fame of soap operas extends discussion ahead of the television and into the categories through which people live through the dialogue they excite in the media. In these ways, we see that the idle talk (gossip) in and generated by soap operas has a superior impact on our lives then previously envisioned (Hasan Suroor, 2000). Americans watch a lot of television; a study conducted in 1978 indicates that for a U.S. household, he television set is on an average of six hours and eleven minutes daily. At the same time as TV Audience program preferences are rationally well documented, the base for these preference lies in what the viewer is offered. Thus, an understanding of the quantitative rate and the qualitative content of what programs are available (the menu) is a qualification to a more complete understanding and conceptualization of what the audience prefers. Clearly, prime time is vital to the network. The program lineups assembled for this time period have been manufactured and designed to attract most viewership. Although less commercials minutes per hour are permitted in prime time, the actual dollars per second are much more expensive during these hours than any other times due to large number of audiences (Mazzarella, 2003). For the network programmer, critical attention must be given to the calculated succession of the shows during the prime time. Successful television programming involves far more than simply arriving at come capricious sequence of program product. Of course, networks want to collect large, static audience for their prime time line-ups. There is also a desire to constantly increase ones own audience size. 2.4 Television Audience Satisfaction To help increase the efficiency of television broadcasting and advertising, studies have been conducted on audience viewing manners by investigating the background and consequences of audience satisfaction of television programs. Consumer satisfaction has long been recognized as a vital concept as well as an significant goal of all business activities (Anderson, Fornell, and Lehmann, 1994). High consumer satisfaction has many paybacks for the firm, such as amplified consumer loyalty, enhanced firm reputation, condensed price elasticity, etc. comprehension of its importance has resulted in a proliferation of research on consumer contentment over the past few decades (Anton, 1997). Considering television programs as products, media researchers study audience liking and satisfaction from the marketing perspective. The audience activity constructs as an dominant factor in the gratification-seeking course and examines the viewing motives, activities, and satisfaction of adolescents (Lin, 1993). In addition to studying audience satisfaction from the viewpoint of viewers behavior, it is no doubt that TV programs presentation should play a role in audience satisfaction. Rather than studying the performance at product level, Gardial et al. (1994) point out that consumers are more likely to eevaluate of their post-purchase practice of satisfaction at an attribute level. An attribute-based approach enables researchers to conceptualize usually practical phenomena, such as consumers experiencing assorted feelings toward a product or service. An attribute-level approach to satisfaction affords managers a superior level of specificity and analytical usefulness compared with the product level or overall approach. The link between products attribute-level presentation and overall satisfaction has been considered by many marketing researchers (Mittal, Ross, and Baldasare, 1998; Oliva, Oliver, and Bearden, 1995). When adopting such a concept on an audience satisfaction study, we can say that a TV programs performance at quality level is one of the significant antecedents of audience satisfaction. When examining the theoretical and logical significance of the link between attribute-level performance and overall satisfaction, it is vital to recognize that the relationship could be asymmetric according to the well-known prospect theory (Kahneman and Tversky, 1979), which postulates that peoples judgments show loss aversion. Psychologically, a one-unit loss is weighted more than an equal amount of gain. On the basis of this theory, we propose: Connectedness is a recently developed construct of audience viewing behavior, and it is projected to be one of the important antecedents of audience satisfaction with optimistic relationship. Study confirms the legitimacy of connectedness and supports it as an antecedent of audience satisfaction. 2.5 Behavioral measures of television audience appreciation Study on audience reactions to television programs dates back to the 1960s. A variety of private research firms and public broadcasters

Laser Hair Removal: Strategies, Types and Uses

Laser Hair Removal: Strategies, Types and Uses Test patch: [10, 19] A test patch is performed by many physicians before performing the actual fist sitting of the procedure. A test patch is usually done on two or three different spots using different parameters. This helps in physician’s evaluation of the ideal treatment parameters and pain threshold for an individual case and also gives an idea to the patient about the procedure and the associated discomfort. This helps in reassuring the patient about the procedure. The patient is called after 72-96 hrs to assess the development of any delayed adverse effects and if there is no adverse sequel, the procedure can be started immediately. The energy density that is required in the first sitting is the one that caused a perifollicuar erythema and edema in the test spot.[ 30] However, a test patch may not always be feasible and is as such not recommended in all cases. It may be considered important in difficult to treat areas and in patients who are apprehensive. Laser safety It is paramount to observe safety precautions in all cases. This includes laser safety precautions and personnel safety precautions. These have been listed in box 3 Box3: Laser Safety Guidelines [19] Treatment Protocol [19,21] Pat should be asked to wash the treatment area with soap and water to remove any grease, dust or make up. Pre treatment photograph should be taken. The area to be lased should be marked with a white skin marking pencil. [Figure 38.8] Topical anaesthesia or ice cubes can be used to make the patient more comfortable during the procedure especially, if the patient is apprehensive or experienced pain during the test patch. The hair on the treatment area should be trimmed to the skin with the help of an electric trimmer or shaved with a disposable laser just prior to the procedure. The residual hair growth should not be more than 1mm -3mm. If the hair is stuck on the skin surface after shaving, these can be removed with the help of a micropore tape. The exact parameters to be used should be determined based on the test patch result or on basis of the skin and hair type of the patient. Prior to starting the procedure, it is important to recheck the parameters fed in to the system. Make a f inal check on the safety measures prior to starting the procedure as mentioned in box 3. It is especially important to confirm that all personnel in the treatment zone are wearing safety goggles. The patient should be informed before firing the laser. The hand piece should be kept perpendicular to the skin surface with firm but gentle pressure and there should be complete contact of the hand piece with skin. In case of areas such the mandibular edge, where complete contact in not possible the skin should be pulled towards the flat surface, e.g. cheek, to effect a complete contact. The pressure should be enough to reduce the capillary blood flow and push the hair follicles towards the skin surface. All areas should be treated in a single sitting. The complete area should be covered by proper placing of the handpeice with not more than 10% overlap of the treatment area. Care should be taken that the same area is not lased more than once which can lead to development of adverse effects . Care should also be taken to lase the entire treatment area and not leave behind untreated spots . This can lead to development of patchy hair growth. A treatment grid may be used to prevent these errors. Adequate cooling during the procedures can be achieved by using cool air sources or immediate application of ice packs on the treated area by an assistant. The recent equipments come equipped with cryosprays or precooled sapphire tips for intraprocedure cooling. Development of dusky discolouration or blister formation indicates incorrect parameters and these should be immediately rectified or the procedure should be stopped. Certain difficult to treat areas require special care. These are mentioned in box 4. After completing the procedure the patient should be asked to apply ice packs to reduce pain and edema. At the end of procedure a sunblock cream is applied on the treated area. The procedure details should be immediately noted and this should include the patient details and s kin and hair type, procedure details including date/ time, photograph record, fluence, pulse width and cooling method used and lastly the record of any untoward incident should be noted. Post procedure care at home should be explained and this should include avoidance of heat or hot water bags on the area for at least 24-48 hours, using mild soap and pat drying the treated area and in case if there is a blister formation or any other adverse effect, patient should be advised to apply an antibiotic ointment and inform the treating physician. Box 4: Laser hair removal in difficult to treat areas Adverse effects with Laser hair removal [30] Most complications are mild and transient such as pain erythema and edema. Sometimes superficial thermal burns may be seen. [Figure 38.9 and 38.10] These are generally caused due to wrong parameter settings, physician error during procedures, lack of adequate safety measures and inadequate sun protection by the patient. Table 6 lists the complications during a laser hair removal procedure and its management. Apart from these certain uncommon adverse effects are possible which the clinician should be aware of. Paradoxical hair growth is seen in 0.6% to 10% of patients treated as per data available from different studies. [30]. The possible etiology is the stimulation of vellus hair to form terminal hairs by the low fluences in the areas near to the treatment zones. Another theory is the synchronisation of the hair growth cycle to form terminal anagen hair from the dormant hair follicles. [ 57] Darker skin types [III-VI skin types] and patients with Hirsutism seem to be more prone to d evelop paradoxical hair growth. Continued laser treatment of the affected area is the treatment for the paradoxical hair growth. Persistent severe urticaria has been reported in a number of patients after laser epilation. Some authors believe it to be due to the delayed hypersensitivity reaction to the ruptured hair follicular antigen. [58]. Nd: YAG Laser treatment of axillary hair has been reported to cause persistent hyperhidrosis. This is possibly due to the stimulatory effect of laser on the hair follicle. [59]. Premature hair greying and ingrowing hair are some other complications reported. [30] Table 6: complications and its management during laser removal What’s New in Laser Hair removal? Newer devices are focussing on faster treatments with better patient experience. Devices with pneumatic skin flattening (PSF) help in reducing pain by working on the ‘gate theory’ of pain reduction. This theory states that on stimulation of the non-nociceptive nerves, signal transmission of pain is reduced. The device suction in the skin that has to be treated and this suction pressure on the skin stimulates the tactile nerve endings that reduces pain sensation transmission. This also helps in bringing the target chromophore closer to the laser window and reduces capillary flow which helps in optimising the treatment as has been explained above [illustration 38.4]. [30] SHRâ„ ¢ technology is another improvement that uses low fluence with rapidly delivered pulses (5-10Hz) and higher average energy. This necessitates the use of multiple passes to build the necessary energy but is faster and has a better patient experience. Another development for performing rapid treatm ents is computer controlled laser scanner mirrors. These help in automatically placing the laser beam in a perfect non-sequential pattern over a larger skin area. [60]. The technology helps in treating larger areas of various sizes by automatically addressing the issues of correct beam placement. Miscellaneous pearls in laser hair removal procedure The procedure of laser hair removal can be optimised by matching the patient and his correct parameters. Table 7 describes the ideal parameters for various skin and hair types Table 7: Laser parameters based on skin and hair characteristics As the hair structure changes from thick terminal hair to thin vellus hair, the laser parameters need to be changed to a smaller spot size. Hence a different laser may be needed as the therapy proceeds. Concurrent use of multiple laser wavelengths could have a synergistic effect and this needs to be probed further. Treatment grids are very helpful to prevent skip areas especially when a large area needs to be lased. Some patients may not respond to the therapy. In these cases, changing the wavelength may be helpful. Conclusion Laser hair removal remains one of the most commonly availed laser populations. The results post therapy are very gratifying. The learning curve with lasers for hair removal is not as steep as with some other indications. It is important not to be very aggressive, since that can lead to adverse effects. Newer technologies minimize pain and the treatment duration time. Home hair removal systems may prove to be a an essential aid in every house hold in the near future especially since the price are reducing and the newer technologies have made these equipments significantly effective. It is important to keep a standard operating protocol and following it diligently to reduce iatrogenic complications. Summary Hair has a lot of aesthetic value irrespective of age and gender. There is a decreased quality of life in hirsute patients. The laser equipments work in the wavelength range of 600-1100nm. Lasers act through the principle of selective photothermolysis and target the melanin but hair reduction occurs by the transfer of heat to the stem cells which are located in the bulge and the hair papillae. This works on the extended theory of selective photothermolysis. The parameters that have to be monitored for optimal therapy are the wavelength, fluence and the pulse width. Multiple equipments are available for hair reduction such as diode, alexandrite, Long pulse Nd YAG and IPL Home use laser hair removal devices are now available but are expensive at present. The commonest indication for hair removal is hypertrichosis in a female, however multiple other indications can be corrected by laser hair removal. Patient assessment includes detailed history and examination. An informed consent shoul d be taken prior to the procedure. The actual procedure is nearly the same with all machines with few subtle differences. Most adverse effects are iatrogenic and following a strict protocol helps in ameliorating these complications. Newer technologies are making the procedure faster and pain free.