The attempt to manage population change Essay Example for Free

The attempt to manage population change Essay Thailand had a massive population problem where in 1970 it had a large youthful population and an ageing population which can create a lot of problems for the economy and country in the future so Thailand had various schemes in order to fix this, these being split into social, economic and political solution. The main way to decrease population is to increase the amount of contraceptives used and available by the public so socially condoms became available anyway for example the cinema or festivals even traffic jams, this would mean that more people would have access to condoms and ultimately have less children. Although condoms became the main feature of the campaign, the Thai government also supported Mechais efforts by making a wide range of contraceptives available to the public too for example the pill. Thailand was one of the first countries to use intravenous contraceptive DPMA and is one of the largest users. This was a successful as most Thais were open to accepting new ideas so were rooting for this new campaign, these contraceptive methods were spread to rural areas too so all of Thailand benefited from this. This also created free and readily available sterilisation which promoted the use of birth control, PDA offer free vasectomies at festivals on the kings birthday too. This success was due to the large egalitarian relationship between men and women, it is also higher than most developed countries in the world and this promoted family planning because of the contraceptive use which was available for both genders, also the advances and improvements in healthcare for mothers and children had a large role to play in the success of the scheme. Schools and university schemes helped to also teach the younger population about contraceptives and family planning to insure that they use contraceptives in the future, this plan was reinforced by the fact that 90% had a high literacy rate which means that the educational opportunities are the same and they are taught the importance of family planning and contraceptive use. They also use things like condoms and cabbages to break down barriers in conversations regarding this subject. Thailands population is largely made up of  Buddhists, around 95% of the population are Buddhist. Family planning in the Buddhist scriptures are also a reason why this scheme has been successful, for example it says many children make you poor telling the population to increase their use of contraceptives to economically benefit which brings me to my next point. The economy plays a large role in the task to bring down the birth rate and decrease the ageing population. PDA offers loans linked to contraception use and preference was given to applicants who were practising family planning. Loans were based on character, credit worthiness and the type of project. Interest rates were substantially lower than traditional moneylenders in poor rural communities. This encouraged couples to family plan in order to obtain more money and increase their standard of living leading to the use of contraceptives and healthcare and larger loans were given to those who used more successful methods of contraception. PDA provided loans to build rain water catchment jars for drinking water set up rice banks, pig banks and buffalo banks. The PDA provided loans to build rain water catchment jars for drinking water so No money was involved just a loan in the form of the animal which would benefit those who live in rural areas and farm or cant afford to buy meat, this also encourages the use of family planning and contraceptive use. Lastly they recognised the effect that it can have on tourism if HIV/AIDS spreads and becomes a high rate, so the economic schemes were successful due to the growth in urban population and also the high rates of urban and industrial growth. I feel that the political changes created the biggest impact on the attempt on population change and was able to successfully do so, in 1971 family planning was made a national goal so was recognised by the whole of Thailand, Mechai Viravaidya launched the PDA which is an Investment in combatting Aids and poor international reputation for sex tourism which lead to a 20x increase investment which reduced from 2% in 1990 to 1.2% 2015. There is also a backup of 100% government enforcement campaign in sex establishments. These schemes were schemes were successful due to the creative drive, imagination marketing from the genius of Mechai Viravaidya in addition the PDA worked closely with the government. In conclusion I feel that the attempt to manage population change has been a success as in 2010 the birth rate has decreased dramatically and these schemes have been recognised globally which shows that there methods to manage the change in population to be very effective and successful for the reasons I have explained.

Marketing mix and customer loyalty

Marketing mix and customer loyalty This chapter will discuss the findings of this study as outlined in the previous chapter and conclusions drawn. We will start this chapter by summarizing the whole study. Next, we will discuss the results in light of previous studies conducted by other researchers. Subsequently, we will identify the theoretical and managerial implications of the study. Lastly, we will present limitations of the study and directions for future research. The chapter ends with the conclusion of the study. The main objective of this study was to examine the relationships between the marketing mix used by the company and the relationship quality a company had with their customers and their loyalty. In addition, these relationships were tested under a supply shortage situation, to see whether the supply shortage situation would moderate the relationships between the marketing mix and the relationship quality with customer loyalty. Based on the literature review, four dimensions were identified for relationship quality, namely service quality, trust, satisfaction and commitment. The four dimensions for the marketing mix were product, price, place and promotion. For customer loyalty, four dimensions were also identified, repurchase, increase in repurchase volume, recommend and refusal to switch. A total of four hypotheses were developed in this study to match the objectives of the research. They are as follows: Customers perception of the marketing mix is positively related to customer loyalty. Customers perception of the relationship quality is positively related to customer loyalty. Customers perceived environment uncertainty moderates the relationship between marketing mix and customer loyalty. Customers perceived environment uncertainty moderates the relationship between relationship quality and customer loyalty. The data for this survey was gathered from construction companies registered with the Construction Industry Development Board (CIDB) of Malaysia. A questionnaire was mailed to the construction companies based on their CIDB ranking and geographical location, thus ensuring that a representative sample was obtained. A total of 800 questionnaires were sent out and 179 were duly returned, giving this study a response rate of 22.4%. To ensure the goodness of measures, factor analysis and reliability test were conducted to test the data collected. Factor analysis was used to test the validity of the measures and the results showed that the extracted factors fit the conceptualized variables. Cronbachs alpha was used to test the reliability of the variable and the results showed that all variables had a sufficient level of reliability. Bivariate correlation analysis were conducted to determine the inter correlations amongst the independent variables and dependent variable. Regression analysis was used to test the hypothesis and sub-hypothesis. The study found that 3 of the hypothesis were partially accepted whereas the last hypothesis was rejected. 5.2 Discussions The aim of our study was to ascertain whether a supplier in the construction industry should focus on their companys marketing mix (cognitive component) or should they instead focus more on the relationship quality (affective component) they have with their customers, to ensure that their customers stay loyal to them. Further more, these relationships were also tested under a supply shortage situation, to see whether the relationships between the independent and dependent variables would change, providing us with valuable information for future use. This is because the supply shortage situation periodically happens in Malaysia and subsequently impacts the development of Malaysia as well. Similar research was done by Cater and Cater (2009) and De Rutyer and Semejin (2002) in which emotional motivation was the affective component and rational motivation was the cognitive component. Both researches found that both the affective and cognitive component positively influences customer loyalty. However, the affective component seems to be much stronger than the cognitive component in their findings. Our first hypothesis result seems to mirror those of other studies. van Riel et al (2005), Yoo et al (2000) and Kim and Hyun (2010) have established the effects of the marketing mix on brand equity. They found that companies investing in the marketing mix, product, price, place and promotion, would create brand awareness and a positive brand image. In this way, brand equity would be created, and when brand equity exists, brand loyalty follows. For this study, we replaced brand equity with the suppliers equity and brand loyalty with the customers loyalty. The results show that the companys marketing mix has a positive relationship on customer loyalty. The RÂ ² value indicates that 29% of the variation in customer loyalty can be explained by the variation in the marketing mix. The study found that buyers in construction companies placed great emphasis on the product, price and promotion, but not the place. This is slightly different from results obtained from van riel et al (2005), Yoo et al (2000) and Kim and Hyun (2010). In the aforementioned studies, results indicated that all the 4Ps had significant impact on customer loyalty for their respective industries which were the chemical and retail industry respectively. As this study was conducted in the construction industry, we were dealing with industrial products like cement, steel bars, sand, bricks, which are very expensive and represent a large amount in the cost of a building. Therefore, price would definitely be a very important consideration when purchasing. The product range that a supplier can provide is also important in maintaining their loyalty because a supplier who carries a wide range of products will mean that buyers need not source for other suppliers to fulfil their needs. Therefore this result is consistent with our literature review finding that says product and price play an important part in maintaining customer loyalty. Promotions have also been found to be significant in maintaining customer loyalty. Frequent advertisements seem to keep the supplier in the forefront of the buyers mind, thus increasing both their behavioural and attitudinal loyalty. With the current competitive situation that exists in the construction industry with many suppliers in the market and not many buyers, suppliers need to maintain their existing customers by offering discounts and volume rebates. These types of sales promotions are closely related to the dimension of price, thus a very effective method to maintain customer loyalty. This is similar to what has been postulated by Yoo et al (2000) Place (channel of distribution), was found to not positively affect customer loyalty. This is contradicting with other findings previously highlighted in the literature review. Probably this dimension of the marketing mix does not have an impact on customer loyalty because buyers of construction companies do their purchasing virtually via the internet, through the telephone or via facsimiles. Buyers do not need to physically go to the buyers office to place their orders, thus distribution intensity (the number of branches the supplier have all over Malaysia) would not be important to buyers. Also once they place their order with a supplier, the goods can be shipped anywhere in Malaysia as specified in the order. A buyer in Kuala Lumpur can place an order with a supplier in Ipoh for goods to be delivered to Johor Baharu. This is unlike the retail market in which distribution intensity (the number of stores available) helps to promote loyalty because it makes it easier for the consumer to acquire their goods. Our second hypothesis explores the relationship between relationship quality and customer loyalty. Numerous researches have been conducted on this in the B2B as well as B2C contexts. The rational is that when the quality is good, the relationship is successful, thus, leading to customer loyalty. In general, similar results were found in this study, in which we found that buyers in construction companies viewed the relationship quality they had with their supplier as important in maintaining their loyalty to them. The RÂ ² value indicates that 33% of the variation in customer loyalty can be explained by the variation in relationship quality. However, they did not view service quality as an important dimension in relationship quality for maintaining their loyalty to the supplier. Even though past researchers like Caceres and Paparoidamis (2007),Rauyruen and Miller (2006), Hewett et al (2002), Hennig-Thurau and Klee (1997), Storbacka et al (1994), Dorsch et al (1998) and Crosby et al (1990) has advocated that service quality will have an impact on customer loyalty, findings in this study indicate otherwise. This could be caused by the gender and cultural profiles of our respondents as well as the context of the study, which was the construction industry. According to Donthu and Yoo (1998) and Furrer, Shaw and Sudharshan (2000), cultural influences will have an impact on service expectations. All the previous researches mentioned earlier were done in the Western cultural context. Customers in different cultures or countries will have different levels of service expectations because cultures differ in their patterns of behaviour and attitudes. Donthu and Yoo (1998) and Furrer et al (2000) used Hofstedes typology of culture to investigate cultural differences on service expectations. They found that customers in high power distance countries, like Malaysia, were more likely to accept very low levels of service quality or overlook it totally. They would accept or tolerate poor service delivery because of the service providers expertise. For seemingly poor services, the customers of high power distance countries would find excuses for the service providers instead. Thus, in this study, buyers in construction firms in Malaysia do not view service quality as an important dimension in maintaining their loyalty to their supplier as opposed to their Western counterparts. Donthu and Yoo (1998) and Furrer et al (2000) also found that customers in feminine countries like Malaysia which focused on values such as interdependence and relationships did not expect every service encounter to be perfect and would sacrifice the service quality for more important values to them like long term relationships. As 69.3% of our respondents were from the Chinese race, the Confucian dynamic of long term orientation would come into play. The Chinese are more prone to saving face, respect for others and traditions. They do not like to complain and bring shame to others. Thus, in line with this thinking, our findings indicate that trust, commitment and satisfaction are important in maintaining customer loyalty in this study. Also being a very collectivistic country, Malaysian buyers in construction firms would always be looking at how they can preserve harmony in their relationship with the supplier and not rock the boat by complaining behaviour on the service quality provided. They would be willing to overlook the lack or poor service provided by the supplier. Due to this fact, they do not view service quality as being able to maintain their loyalty to the supplier. Gender also plays a role in service quality perceptions and customer loyalty. According to Gocek, Kursun and Beceren (2007) in a research on the role of gender in service quality perceptions in the textile industry, they found that males gave less importance to perceive service quality received compared to females. Males were less bothered about how service quality could enhance their overall satisfaction levels towards their supplier, and ultimately on their loyalty. Thus, in our study, 57.5% of the respondents were males as compared to only 41.9 % females. Therefore based on this, our findings indicated that service quality was not an important dimension in ensuring their loyalty. In line with other research in the literature review, the accepted dimensions of relationship quality like satisfaction, trust and commitment were found to positively affect customer loyalty. Hesket et al (1994), Storbacka et al (1994), Hennig-Thurau and Klee (1997)and Lam et al (2004) posits that when the customer is satisfied, it will impact on the relationship strength and longevity and ultimately on the customers profitability and serve as the key to an organizations success and long term competitiveness. Chaudhuri and Holbrook, 2001 linked trust to loyalty through performance whereas Sirdeshmukh et al (2002) linked trust to loyalty through value creation. Buyers need to feel that they can trust their suppliers and these can be exhibited by frontline employees (trustworthy behaviour) and management practices (trustworthy practices). Most researchers identify commitment among exchange partners as key to achieving customer loyalty. Morgan and Hunt, 1994, Dick and Basu, 1994 and Oliver, 1999, all agree that relationship commitment is similar to loyalty because of the consequences exhibited like positive word of mouth, rebuy or repurchase a product/service consistently and refusal to switch. Our third hypothesis was also partially accepted, in which the supply shortage situation moderates the relationship between the marketing mix and customer loyalty. In other words, the supply shortage situation affects how the suppliers marketing mix is perceived by the buyers, and this would affect their loyalty. As postulated by Wagner and Gopalakrishna (2001) and Kotler (1974), suppliers in the construction industry should be making intelligent adjustments to the marketing mix to focus on the opportunities presented by the supply shortage situation. Price still remains the most important component of the marketing mix, especially for buyers in construction companies because the procurement of building materials represents a large amount of the building cost. Therefore, suppliers must resist the urge to raise prices as shortage conditions on the grounds of supplier opportunism because by doing so, they will loose their customers instead. Suppliers must also ensure that they do not cut down on production or product lines because of a shortage in the mistaken belief that it would not affect their customers loyalty. Even though there is a shortage supply situation in the construction industry, this does not mean that certain essential building materials are not required by the contractor during that time. In fact, the whole range of building materials from the structural, intermediate to the final stages in the construction process is required, regardless of whether there is a supply shortage for certain materials or not. Therefore, it is important for suppliers to be cognizant of this fact, and ensure that they carry a wide range of product solutions for their customers needs, even though during a supply shortage situation. The place (channel of distribution) also becomes important during a supply shortage situation in maintaining customer loyalty. This is because during a supply shortage situation, buyers will try to reduce their risk of being unable to obtain their supply. Therefore, a rational buyer will maintain their loyalty with a supplier that has intensity of distribution (having many branches all over Malaysia) to ensure that they will be able to get their supply of building materials. A contractor based in Kuala Lumpur, might very well have jobs all over Malaysia, thus by buying from a supplier that has many branches all over Malaysia, this will ensure better coordination in deliveries to various job sites all over Malaysia due to the fact that there would be personnel from the supplier stationed in the relevant geographical area. The buyer would feel more comfortable and confident, thus enhancing their loyalty to the supplier. Our study indicates that promotion becomes less important during a supply shortage situation. This could be because in a shortage situation, products are able to sell themselves. Suppliers need not have promotions and advertisements to maintain their presence in the mind of their customers during a shortage. Their buyers are very much aware of their suppliers and their importance during a time of shortage Our final hypothesis was rejected, indicating that the supply shortage situation does not affect the relationship between relationship quality and customer loyalty. In other words, the supply shortage situation has no affect on how the buyer views their relationship quality and their loyalty with the supplier. This is contradictory to findings in the literature review which posits that a supply shortage situation is perceived as a risk. Thus, buyers will try to engage in risk reducing activities such as looking for other suppliers, thus making them less loyal to their existing supplier. However, our findings can be answered by a research done by Wood (2008) in the B2B context for wireless telecommunications. He found that when the buyer was very satisfied with his relationship (indication of good relationship quality) it would instead reduce the inclination of the buyer to search for new alternatives, thus positively influencing the buyers intention to remain with the supplier even during a supply shortage situation. This positive satisfaction with the relationship will instead negatively influence the buyers perception of other available suppliers in the market, thus ensuring the buyers loyalty to his/her existing supplier. 5.2.1. Major results of the study Based on the explanation and discussion above, a summary of the major results are presented as follows: The marketing mix element of price presented by a company has a positive affect on their customers loyalty The marketing mix element of product presented by a company has a positive affect on their customers loyalty The marketing mix element of promotion presented by a company has a positive affect on their customers loyalty The marketing mix element of place presented by a company does not have a positive affect on their customers loyalty The relationship quality element of service quality does not have a positive effect on customer loyalty The relationship quality element of trust has a positive affect on customer loyalty The relationship quality element of satisfaction has a positive affect on customer loyalty The relationship quality element of commitment has a positive affect on customer loyalty The relationship quality has a stronger affect on customer loyalty than the marketing mix The supply shortage situation affects how customers view the marketing mix presented by the company and this would affect their loyalty. The supply shortage situation does not affect how customers view their relationship quality with a company, thus not affecting their loyalty. 5.3 Implications of the study Based on the research findings, several implications related to the theoretical and practical aspects of management will be discussed. 5.3.1 Theoretical implications The theory of cognitive-affective-conative-behavior was used in this study to explain the formation of customer loyalty. This theory suggests that customers loyalty is influenced by both cognitive and affective components. The cognitive components reflect that customers will make conscious evaluations based on information or knowledge such as the price or quality. (Oliver, 1999, Sawmong and Omar, 2004). Cognitive components in this study are represented by the 4Ps, namely product, price, place and promotion. (van Riel et al, 2005,Yoo et al, 2000, Kim and Hyun, 2010) The affective components reflect the fact that customers emotions or feelings are likely to play an important role in their behaviour. (Oliver, 1999) The affective components in this study are represented by relationship quality. (Hewett et al, 2002, Rauyruen and Miller, 2006, Caceres and Paparoidamis, 2007) The conative-behaviour is accompanied by the desire to an intended action. (Oliver, 1999) It can be exhibited through various ways through the customers behaviour; most commonly cited are repeat patronage (behavioural loyalty) and positive word of mouth (attitudinal loyalty). The findings in this research is consistent with the postulated theory. Both cognitive and affective components have an effect on customer loyalty. In this study, the RÂ ² for marketing mix was 29% and for relationship quality is was 33%. This indicates that the relationship quality has a strong affect on customer loyalty than the marketing mix. Research by Cater and Cater (2009) and De Rutyer and Semejin (2002) support this statement. In these researches, the affective component was found to be stronger than the cognitive component. Customers therefore seem to value the emotional we like more than the rational we benefit. Cater and Cater (2009) surmises that because of this findings, customers are not as rational as they should be, or much more likely, that rational benefits are perceived as minor in their decision making. In this case, the heart rules the head in the making of decision of continued loyalty. 5.3.2 Managerial implications From this study, we can draw several managerial implications as follows: The marketing mix presented by a company plays an important role in influencing their customers loyalty. Therefore, managers should not neglect the elements of price, product and promotion in their marketing strategies. Price is a very important consideration in purchasing in the construction industry as building materials are very expensive and make up a large amount of the construction cost. All buyers in construction companies would be very price sensitive due to this fact. Managers must ensure that they price their products competitively, according to the going rate. Pricing too high will have a negative affect unlike consumer goods which provide an impression of quality. ( Yoo et al, 2000) Managers should also pay attention to promotions to keep their company in the forefront of their customers mind. With the current competitive situation that exists in the construction industry with many suppliers in the market and not many buyers, suppliers need to maintain their existing customers by offering discounts and volume rebates. These types of sales promotions are closely related to the dimension of price, thus a very effective method to maintain customer loyalty. This is also similar to what has been postulated by Yoo et al (2000). Lastly, managers should make sure that their companies carry a wide range of products as this will ensure that their customers need not source for other suppliers to fulfil their orders. The relationship quality that a company has with their customer is also important in maintaining their customers loyalty. Managers should pay attention to their companys relationship management strategies and ensure that their customers are satisfied, trust and committed to the relationship they have with the company. Managers should focus on frontline employees especially sales personnel to ensure that they exhibit trustworthy behaviour. Management must ensure that they are ethical and honest in their dealings with customers, thus fostering a climate of trust. (Sirdeshmukh, 2002). To cultivate commitment, managers should place more emphasis on activities that produce strong positive feelings of affiliation and camaraderie between their company and customers. (Kumar et al, 1994). In general, satisfaction is a persons feeling of pleasure or disappointment resulting from comparing a products perceived performance in relations to his or her expectations. (Storbacka et al, 1994) Thus, ma nagers should focus on product and service quality and put in the effort to creating a high perception of these elements to ensure that their customers are not disappointed, but delighted instead. Supply shortages periodically occur in the construction industry. Thus, managers need to know how to manage their customer loyalty during such times. This study shows that the supply shortage situation affects how customers view the marketing mix presented by the company and this would affect their loyalty. Therefore, managers should be making intelligent adjustments to the marketing mix to focus on the opportunities presented by the period of uncertainty (shortage). By recognizing the changing environment, organizations can still retain their customers and enhance their profitability. (Kotler, 1974, Wayne and Gopalakrishna, 2001). As product, price and place have been found to affect customers loyalty during a supply shortage situation, managers should focus on these three elements. This means that they should not simply increase prices, reduce product lines and cut down on channels of distribution. Instead, managers should ensure that they price competitively, ensure that they carr y enough product lines and not shut down any branches/cut down on sales personnel during a shortage situation. As promotions was found to not affect customer loyalty during a supply shortage situation, managers can then save some spending and cut down on their sales promotion and advertising budgets. The supply shortage situation does not affect how customers view their relationship quality with a company, thus it does not affect their loyalty. However, this does not mean that managers should neglect the quality of the relationship they have with their customers. Managers should continue to do what they have been doing during normal periods. Ensure that your customers are satisfied and happy with the existing relationship they have by continually meeting their requirements and delighting them always. Overall, in a normal situation, to maintain their customers loyalty, a company should pay more attention to the relationship quality because it has been found to have a stronger affect. However, this does not mean that managers can neglect the marketing mix, because it has also been found to have an affect on customer loyalty. Therefore, prudent managers should pay attention to both cognitive and affective components to maintain their customers loyalty. However, when a supply shortage situation occurs, managers who focus on their marketing mix can reap substantial gains in their customers loyalty as opposed to the relationship quality. For managers, this provides them with valuable information on which aspect to focus on to advance their customers loyalty. Therefore, they can formulate strategic plans that suit the existing situation. 5.4 Limitations of the study The results should be interpreted in light of the limitations of the study. They are as follows: The sample surveyed. Our population for the study comprised of all organizations registered with the Construction Industry Development Board (CIDB) of Malaysia. There are many more contractors which are not registered with the CIDB. Therefore, the results should be carefully considered as being representative of the construction industry as not all organizations in the construction industry were sampled. It should be noted that 62% of the respondents were private limited corporations which were locally owned. As such, smaller contractors might not have enough representation in this study. This study was conducted in the construction industry, thus it may limit the generalization to other industries and business to business settings. The study is based on perceptions. As such, the inherent limitations of perception studies are acknowledged. The respondents responses represent what they consider to be facts rather than what the facts actually are. Another limitation might be that the data was collected via a self administered questionnaire. There is concern in the study that customer do not always perform as they say they will and might not answer truthfully for a variety of personal or organizational reasons. The study asked for the questionnaire to be answered by someone in the organization who has done purchasing and experienced a supply shortage situation before. It should be noted that there is room for bias as we cannot ascertain that the respondent that answered the questionnaire fulfils that criteria. Due to the time constraints, a cross sectional study was conducted. As such, changes in the variables under study over time, especially the dimensions of relationship quality and customer loyalty may limit the possibility to infer causation. 5.5 Directions for future research While this study advances the knowledge of customer loyalty in the construction industry, it also provides additional opportunities for future research. Future researches should consider having more or different marketing mix dimensions instead of using the 4Ps. This might lead to different findings for customer loyalty. The same applies for relationship quality, in which different dimensions are used instead of the generally accepted ones of trust, satisfaction and commitment. Future research can also enhance this study by having a larger sample that covers all organizations in the construction industry, irregardless of whether they are registered with CIDB. Hardware companies are also involved in the construction industry by supplying building materials to contractors. They also frequently encounter supply shortage situations, thus, for future research, they can also be considered. Because nothing is manipulated in this study, it is difficult to make causal inferences from the data. Perceived marketing mix and the relationship quality could be illusive reflections, distinct from the actual efforts put in by the company. To investigate more thoroughly the causal impact of each independent variable towards loyalty, future researchers could design and conduct experiments manipulating the levels of the independent and the moderating variables. 5.6 Conclusion The main objective of this study was to examine the relationships between the marketing mix used by the company and the relationship quality a company had with their customers and their loyalty in the construction industry. In addition, these relationships were tested under a supply shortage situation, to see whether the supply shortage situation would moderate the relationships between the marketing mix and the relationship quality with customer loyalty. Overall, this study has provided some empirical evidence that a companys marketing mix and the relationship quality with their customers has positive impact on their customers loyalty. The marketing mix components had varying degrees of significant relationships to customer loyalty. Product, price and promotion were found to have positive relationships with customer loyalty. Place was found not to have an affect on customer loyalty. The relationship quality components also had varying degrees of significant relationships to customer loyalty. Trust, satisfaction and commitment were found to have positive relationships with customer loyalty. However, service quality was found not to have any affect on customer loyalty. Overall, relationship quality was found to have a stronger affect on customer loyalty in the construction industry. Perhaps the main contribution of this study is the evidence that the significance of cognitive and affective components in customer loyalty changes during a perceived environment uncertainty. Cognitive components become more important to customer during a supply shortage situation than affective components. Cater and Cater (2009) theme of rational we benefit rules against the emotional

Alzheimer’s Disease Case Study

Alzheimer’s Disease Case Study B. Trimble Case Study M. T. an 86-year-old Asian male is brought into the geriatric clinic by his daughter because he is becoming more forgetful. The daughter explains that the patient often does not even recognize his own grandson. When asked, however, the patient denies memory impairment. The daughter states that her father has been having trouble for almost four years now. She said she did not realize how much her father had changed until she watched a home video of her father with his grandson from six years ago. â€Å"His personality has even seemed to have changed, said the daughter. M.T. is no longer able to take care of his house and household chores and is sometimes slow to respond to questions. Past Medical History Peptic Ulcer Disease (PUD) with the last occurrence three years ago. Social History Retired sanitation worker times fifteen years. Lives with his daughter since his wife died five years ago. Previous cigarette smoker quit fifteen years ago. Denies ethyl alcohol (ETOH), and intravenous drug abuse. Family History Father died in combat in Korea Mother died at age 92, unknown cause Medications and allergies NKDA Prevacid 30 mg orally once daily Mylanta 30 ml orally as needed for stomach upset Aspirin EC 81 mg orally once daily Tylenol 325 mg orally as needed for headache Physical Examination General – patient is a thin, pleasant man, with working memory in no acute distress. Vital signs – BP 145/78 , pulse 80 RR 17 , WT 70 kg , Ht 6’2† BMI 19.8 HEENT- Pupils PERLA Ears with cerumen Neck no bruit no JVD Cardiovascular – Normal sinus rhythm, S1 S2, negative for S3/S4, resp RRR Neuro – Aox1 (Oriented to person only), CN – XII – XII intact, reflex normal Abdomen – positive bowel sounds, non-tender, non-distended External – WNL, no clubbing, cyanosis, or edema Laboratory Tests Albumin – (3.6-5 g/dL) 3.6g/dL total protein – (6.3-8.2g/dL) 6.8g/dL Alk Phos – (38-126U/L) 41U/L ALT – (7-58 U/L) 21 U/L AST – (7-58 U/L) 21 U/L bilirubin – (0.2-1.3ug/dL) 0.3ug/dL BUN – (8-25mg/dL) 11mg/dL HgB – (13.2-15.2 g/dL) 13.5g/dL SCr- (0.5-1.4mg/dL) 0.7mg/dL Hct (40-52%) 39% Na+ (134- 146 mEq/dL) 136 mEq/dL Plts – (140-450 mm3) 300,000/mm2 Cl-(98-107mEq/dL) 103 mEq/dL WBC – (4.1-10.9mm3) 8700/mm2 Bicarb – (22-26 mEq/dL) 24 mEq/dL ESR – ( Glucose – (65-110mg/dL) 101mg/dL B12 – (223-1132 pg. /ml) 452pg/ml Ca- (8.9-10.4 mEq/dL) 8.5 mEq/dL folate – (3.6-20ng/dL) 6.4ng/dL Mag – (1.6-2.4mEq/dL)1.9 mEq/dLFTI – (4-11) 6.3 Phos (2.5-4.5 mg/dL) 3.3 mg/dLT3 – (75-220ng/dL) 101ng/dL Cholesterol- (T4 – (4-11mEq/dL) 6.1 mEq/dL TSH – (0.35-6.2 microU/uL) 2.0 micro Unit/uLRPR – non-reactive Radiology Testing CT scan impression mild cortical atrophy Diagnosis Dementia (senile dementia) is a syndrome rather than a distinct disease entity. It is usually progressive and irreversible. It is characterized by a general decline in cognitive abilities that may include losses of memory, abstract reasoning, judgment, and impulse control, as well as changes in personality. It is usually subtle in onset and often progresses slowly until symptoms are very obvious and profoundly devastating. The three most common dementias are Alzheimer’s disease, multi-infarct dementia, and a mixed Alzheimer’s disease and multi-infarct dementia (Cayton, Graham, Warner, 2004). Alzheimer’s disease is sometimes called primary degenerative dementia or senile dementia of the Alzheimer’s type. It accounts for at least 80 percent of all the dementias suffered by the elderly (Whalley, Lawrence, Breitner, 2009). It is a progressive, irreversible, degenerative neurologic disease of unknown origin that begins insidiously. The highest incidence is among persons 65 years and older with increasing incidence after age 70. The life expectancy following the diagnosis varies from six to twenty years (Whalley, Lawrence, Breitner, 2009). The etiology of the disease is unknown, but there are specific neuropathologic and biochemical changes. These include neurofibrillary tangles and senile or neuritic plaques. This neuronal damage occurs primarily in the cerebral cortex and results in decreased brain size. These changes are found to a lesser extent in normal brain tissue of older adults. Cells principally affected by this disease are the ones that use the neurotransmitter acetylcholine. Biochemically, the enzyme active in producing acetylcholine is decreased. Acetylcholine is specifically involved in memory processing (Whalley, Lawrence, Breitner, 2009). Clinical manifestation Symptoms of Alzheimer’s disease are highly variable. Early in the disease, forgetfulness and subtle memory loss occur, but the victim has adequate cognitive function to hide the loss. Social skills and behavior patterns remain intact; problems are difficult to detect on casual observation (Cayton, Graham, Warner, 2004). With further progression of the disease there is an inability to conceal the deficits. Forgetfulness is manifested in many daily actions. The victim may lose his way in a familiar environment. He may repeat the same stories because he forgets that he told them. Reasoning and reality orientation by caregivers increase the patient’s anxiety without increasing function, because this is also forgotten (Cayton, Graham, Warner, 2004). Conversations become difficult because the victim forgets what he was about to say or may not be able to remember words. Ability to formulate concepts and think abstractly disappears (Cayton, Graham, Warner, 2004). The person can interpret a proverb only in concrete terms. The victim is often unable to appreciate the consequences of his actions and will therefore exhibit impulsive behavior. He will have difficulty with everyday activities such as working simple appliances and handling money (Cayton, Graham, Warner, 2004). Personality changes are usually negative. The patient may become depressed, suspicious, paranoid, hostile, and even combative (Whalley, Lawrence, Breitner, 2009). Progression of the disease intensifies the symptoms. Speaking skills deteriorate to nonsense syllables; agitation and physical activity increase. A voracious appetite often develops because of the high activity level. The patient may wander at night for hours. Eventually he will need help in all areas of personal care including toileting and eating; dysphagia occurs and incontinence develops. The terminal stage may last for months (Cayton, Graham, Warner, 2004). Treatment Treatment for dementia of the Alzheimer’s type will be Aricept 5 mg once daily at bedtime. After four weeks symptoms will be reviewed, and titration to ten mg once daily may be initiated, depending upon results. Maximum dosage of 23 mg daily if needed after three months of 10-mg treatments (Katzung, Mastes, Trevor, 2012). Follow up in office in four weeks. Discontinued use of Prevacid, as the medication is implicated in low platelet, WBC, HgB and Hct, calcium, and B12 levels (Brunton, Chabner, Knollman, 2011). Follow-up blood work in four weeks, should include CBC with differential, CMP, liver panel, weight, and blood pressure. Patient is borderline hypertensive and increase in fluid volume may correct this issue. Patient should be encouraged to change diet to a high-protein diet with adequate hydration. If platelet count and WBC count continue to be below normal a hematology consult will be discussed. Referral to Alzheimer’s support group will be given to the daughter. References Brunton, L., Chabner, B., Knollman, B. (2011). Goodman Gilmans: The pharmacological basis of therapeutics (12 ed.). McGraw-Hill. Cayton, H., Graham, N., Warner, J. (2004). Dementia: Alzheimers and other dementias: At your fingertips guide (2 ed.). London: Class. Katzung, B., Mastes, S., Trevor, A. (2012). Basic clinical pharmacology (12 ed.). McGraw-Hill. Whalley, L., Lawrence, J., Breitner, J. (2009). Dementia (2 ed.). Health Press.

Sidetracked Movies :: essays research papers fc

Movies have been around for as long as I can remember. They may come in many forms or video types, such as film on a reel, beta, VHS, DVDs and many more. Every successful movie tells a certain story, whether it be original, based on a true story, or based on a book. Whatever the case, the scripts are usually original and closely follow the plot they are based on, if there is one. More recently, unfortunately, movies based on novels are being made closer to the ideas of the screenwriter instead of those of the novel. It is in my opinion that these types of movies should reflect the original works of the authors more closely. One of my personal favourite pieces of literature is the Harry Potter series, written by J.K. Rowling. Naturally, when I heard about the movies being made I was just as excited as any other fan, and I was at the cinema on opening night. I believe Chris Columbus did an awesome job with the movie, keeping the plot moving, introducing the characters, and still including a large majority of the plot in only three hours. The second movie, I thought was even better because everyone knew all the characters already so he could just jump right in with the plot. However, this past couple of years the cast worked with a new director, Alfonso Cuarà ³n, who took the film in a new and possibly worse direction. Not only did Cuarà ³n change the plot around, for example Harry receiving the Firebolt after his encounter with Sirius Black though in the book he received it long before this encounter, but he changed many other things as well. Some of these other changes include the setting, the uniforms , and the characters from J.K. Rowling’s original novels, and from Chris Columbus’ works. Some of the main examples from the third Harry Potter movie include Professor Flitwick, who is described in the book as having â€Å"greying hair.† This is portrayed in the first two movies, however in the third movie Professor Flitwick is portrayed as a small man with a black mushroom cut and a black handlebar moustache. Another point about the third movie that I am very eager to uncover is the origin of the â€Å"maggot heads.† The heads were never mentioned in the third book or any other book for that matter; and were completely made up by the director or screenwriter, possibly to add comedy.

Woodstock 1969 Essay -- essays research papers

Woodstock ‘69 Many large concerts occurred throughout America in the summer of 1969, but none were as well known and symbolic as Woodstock. Its message was clear; three days of Peace and Music. Its impact on America’s culture and society as well as its youth will not be forgotten for many years to come.   Ã‚  Ã‚  Ã‚  Ã‚  Four men named Michael Lang, Artie Kornfield, John Roberts, and Joel Rosenman originally established Woodstock. The men’s initial idea for the festival was to promote the idea of a new recording studio in Bethel, New York, which is where the event actually took place. (Jacksonville.net) Because of the extensive amount of rain that fell before and during Woodstock, the site was changed twice and ended up on Max Yasgur’s farm. (Bethelwoodstockmuseum.com) This resulted in the loss of preparation time. The stage had not been entirely put up and the sound system was dangerously assembled. There were many other problems that occurred as a result of the mud produced during the rain. Most of the gates and fences were not put up which allowed many people to enter the festival for free.(Jacksonville.net) The mud also created a major cleanup project after the festival ended.   Ã‚  Ã‚  Ã‚  Ã‚  Woodstock gathered an unexpectedly large attendance. Only 50,000 to 100,000 people were expected to arrive at the site. These numbers seemed small compared to the 400,000 to 500,000 people who converged on the area on August 15, 16, and 17 of 1969. (Webster’s) Many expected singers and bands could not arrive due to traffic backed up for miles along all the roads leading to the area. It was said that nearly one million people could have attended the concert if it had lasted longer. (Visi.com) Many recognized musicians preformed at the concert such as Janis Joplin, Jimi Hendrix, Creedence Clearwater Revival, The Who, Jefferson Airplane, and many others. (Home.columbus.rr.com) Truly by the first day, as the musicians looked out upon the vast crowd, they must have known that Woodstock was not going to be just another concert that would be forgotten. On the outside, Woodstock could just be considered another concert for the youth of the time to hear their favorite music, but it can be seen that it was much more than that. Although the music was a large part of the festival, there would be no reason for it to be remembered this long if that w... ...stock fans that made the trip to all three festivals bearing the â€Å"Woodstock† name. It seemed that the other men and women that made up the rest of the audience were nearly all there to get drunk and destroy anything they could get their hands on. By the end of the concert, nearly all of the stage and equipment was destroyed. Women were raped and all souvenirs such as shirts and posters were stolen. (MTV Woodstock Uncensored) The acts displayed at Woodstock 99’ could be summed up in two words: destructive force. It went beyond misguided violence to such a point as to bring down some of the original Woodstock’s glory. Unfortunately now when people think of Woodstock they will also think of the destruction that occurred during its latest attempt at recreation. Despite people’s desire to bring back the feeling of the original Woodstock, all that can remain is its effect on the people who experienced it and the affect on the culture they lived in. The concert was necessary to have because it eased tension in a time of history that was full of war and prejudices. Its stories will be told, some good, some bad, but the desire that people feel to experience it firsthand will never be lost.

Institutional Racism and Racial Discrimination in the U.S. Health Care System Essay

Institutional racism and racial discrimination in the U.S. health care system has been part of a long continuum dating back over 400 years. After hundreds of years of active discrimination, efforts were made to admit minorities into the â€Å"mainstream† health system but these efforts were flawed. Colin Gordon in his book Dead on Arrival portrays a very strong stance towards this issue when he states, â€Å"The American welfare state has always been, at root, a Jim Crow welfare state – disdainful of citizenship claims of racial minorities, deferential to a southern-controlled Congress, and leery of the racial implications of universal social programs† (172). It is evident that throughout the history of U.S. health care that race has shaped health provisions in a number of ways, most noticeably in private and public health care institutions. Gordon throughout his books discusses the ways in which institutional racism, specifically in the field of healthcare, has manifested itself throughout history. One of the most prominent manifestations of institutional racism in the healthcare field comes to light when examining past (and sometimes present) policies regarding admission (to healthcare facilities) and discrimination of minorities. It is evident when observing the adoption, administration, and implementation of these policies in the past that they were purposefully constructed to be exclusive of minority citizens (specifically African Americans and Latinos). Gordon gives an example of such policies in 1939 under the Social Security reforms. In the formative years of the New Deal southerners in Congress pushed for and won for the exclusion of agricultural and domestic labor from coverage under the National Recovery, Agricultural Adjustment, Social Security, National Labor Relations, and Fair Labor Standards act, this affectively excluded 90 percent of the southern black workforce (185). The implications of this act of agricultural exclusion are most clearly evident in the South and Southwest—regions whose economies were dominated by agriculture, who agriculture systems were peculiarly labor intensive, and whose agricultural labor markets were organized around low wages, tenancy, harsh legal controls, and violence. Gordon argues that segregation  persisted in medicine and hospitals longer than in any other public institution or facility partly due to the fact that Southern Congressmen pushed for local control of any federal expenditure; and later on this pushed Southern and Southwestern leaders into a partnership with doctors, employers, and insurers to keep racial minorities excluded from the health system. Southern interests led to a push for job-based private insurance, locally administered subsidies for hospital construction, and penurious charitable programs for those left behind, â€Å"southerners persistently worked to exclude African Americans from coverage, tap into federal funds without sacrificing local practices, and ensure that charity programs remained under local control† (174). Employment-based benefits, initially developed as a surrogate for national policy, was successful in leaving behind the majority of African Americans and Latinos due to the fact that they were grossly underrepresented in the unionized industrial economy, and in part because benefits such as these did not extend to casual or domestic or agricultural workers. Private health benefits came to be looked upon by many Americans as a â€Å"wage of white-ness† (176). Federal agencies, both out of practical and political necessity, consistently surrendered control over federal funds and standards over to state and local administration, â€Å"states set their own standards for care and eligibility and controlled the pace and scope of federal matching funds. Local political and medical authorities wielded considerable informal power and discretion† (187). In 1948 the Brookings Institution published a book-length assault on health reform. The conclusion of this publication was that higher black mortality rates are â€Å"predominately the result of economic, cultural and social differences† although, the research for this publication based cost estimates off of the ordinary expenditures of white families and confined comparative mortality rates to the white population, this led to them to conclude that the United States was among one of the most healthful nations in the world (188). Seconding this conclusion and also asserting that higher rates of non-white mortality were due to such things as poor sanitation, housing, education, and the lack of ordinary individual and community common sense was the AMA. The partnership between these two organizations is evident. At the root of the hospital issue in the South was not only professional and patient segregation but also the way in which it was countenanced by federal efforts  to address the region’s dearth of facilities. What is shown here is the long-standing political strategy to try and appease reformers by granting federal funds but to simultaneously placate opponents by relinquishing control to local or private interests; federal aid to hospitals both in 1940 and under the 1946 Hill-Burton Act â€Å"avoided any commitment to maintenance: once built, hospitals would reflect local control and local custom† (193). This however did nothing to prevent segregation seeing as in order to be considered nondiscriminatory a hospital was only required to grant equal access to the portion of the hospital that was built with federal funds. Perhaps the most compelling public health issue during the formative years of the American welfare state was the dismal status of rural services. In places in the South and Southwest and the nation’s inner cities basic services such as a hospital, public health clinic, and a doctor accepting Medicaid patients did not even exist. Gordon offers the example in Mississippi in 1948, there were only five general hospital beds for every 100,000 blacks in the state—at a time when four beds for every 1,000 citizens was considered adequate (175). It is evident that health care in the twentieth century has been shaped by a myriad of â€Å"direct and indirect discrimination, strong southern interests and local administration, the uneasy intersection of public and private (job-based) benefits, and the sharp political distinctions routinely drawn between contributory and charitable programs† (209). According to the U.S. Commission on Civil Rights, â€Å"Despite the existence of civil rights legislation equal treatment and equal access are not a reality for racial/ethnic minorities and women in the current climate of the health care industry. Many barriers limit both the quality of health care and utilization for these groups, including †¦ discrimination.† Importance of Health Care Access to comprehensive, quality health care services is important for the achievement of health equity and for increasing the quality of a healthy life for everyone. Access to health services entails the timely utilization of personal health services in an effort to achieve the best possible health outcomes. The utilization of and access to health care has many substantial impacts on a person’s life. A person’s overall physical, social and mental health statuses are all impacted by the ability to be examined and treated by a medical professional. Health care also plays a significant role in the prevention of disease and disability, the detection and treatment of health conditions and a person’s quality of life. A structured healthcare system assists in providing a foundation for a healthy lifestyle for both individuals and their families. Without access to healthcare, minor health issues have the potential to escalate either permanently affecting living standards or worse resulting in death. The health care sector also has an impact on the local economy. Health care facilities such as hospitals and nursing homes provide jobs and income to people in the community. As these employees spend their income in the community, a ripple spreads throughout the economy, creating additional jobs and income in other economic sectors. Also, providing healthcare may also be a business incentive to companies. Healthy employees can mean a healthier, happier, more productive workplace. A company’s decision to invest in and offer health care to their employees not only filters back into the economy but also may help them to recruit and retain quality employees, improve employee satisfaction, and reduce absenteeism due to sickness. Business that offer health insurance as part of their employee benefits package are probably better able to attract more qualified applicants than those who don’t. Also, offering health insurance coverage is a way of keeping operating costs low, because employees are generally more apt to take a position at a lower salary when health insurance benefits are provided. This is because it generally costs more for someone to obtain an individual or family health insurance policy than to get employer-sponsored coverage, making the difference of a lower salary negotiable. Businesses offering health insurance can deduct their portion of the contribution toward their employee plan as a business expense and get a tax advantage. If the business is incorporated, the business owner’s insurance and the coverage paid for employees are deductible. Access to health care services and insurance plays a vital role in individual and families lives along side society as a whole.

Nike Internal Factors

Nike Corporation today is the largest sports apparel and footwear brand in the world. Thousands of people wear Nike gear not only to the playing field but also so social gathering and other casual events. Nike is one of the pioneers to take sportswear from the playing field to public domain. It not only made wearing sports wear popular and turned it into fashion wear but also simultaneously captured the serious performance wear market. The growth of the company over the years has been attributed to its brand building efforts and creative marketing. When it first enter into the industry the market was dominated with German products and others products even those made in America were considered inferior to the products from the European giants like Adidas and Puma. To overcome this they collaborated with Japanese partners who can provide similar quality at cheaper prices. After nearly eight years of selling through importing, Blue Ribbon Sports the company that evolved into Nike was formed. The name ‘NIKE’ was taken from Greek goddess of victory and Swoosh was adopted as brand logo. (Nike, 2007) Strengths of Nike Nike Business Model The Nike business model has little changed over the last four decades. The company was founded with the belief that it can provide customers products at competitive prices by getting them manufactured in Japan and selling them over in United States. Over the years the destinations have changed but the philosophy remained intact. As the income level in Japan increased it shifted it manufacturing units in Taiwan and Korea. After the boom in Korean and Taiwanese economy it shifted its base in other emerging economies like Indonesia, Thailand, Vietnam and China to leverage the cost of production difference. This has resulted in reducing the costs significantly and the company is enabled to deliver maximum value to its customers. Strong Marketing Abilities All this time Nike managed the product design, marketing, sales and distribution system which made it one of the first company in the world to focus on the core competitive advantage and outsource the rest. Strong Supply Chain Management This strategy not only enabled Nike to focus on its strengths of marketing and designing but also able to leverage the specialization of the vendors supplying the goods. For example Shoes were manufactured cost effectively in Taiwan and Japan while clothing is manufactured in labor inexpensive countries like Indonesia, Vietnam and Thailand. Recently with increasing operations and established brand the company has changed focused on streamlining operations, efficient demand forecasting and supply chain management. Celebrity Advertising with Cutting Edge Products On the marketing front the company spend big amount on building the brand since the mid eighties. The success of Nike advertising can be attributed to its repeated success of picking up the next superstar in world or sports like Michael Jordan, Tiger Woods in past or Sharapova and Michelle Wie at present. Efficient Retail Management and Brand Management Starting from the running shoes, today the company has turned into a lifestyle brand. Today it not only sells shoes and sports gear but casual clothing, bags, fashion accessories etc (Holmes, 2004). The number of stock keeping Units (SKU) becomes large if one considers that these accessories and gears are developed according to various sports following like cycling, aquatic, skateboarding, outdoor activities, football, baseball, soccer, golf and tennis. Merchandise Mix To enter into various price points with diluting the brand Nike has bought various brands like Exter, Starter, Team Starter, Asphalt, Cole Haan shoes, Converse, Hurley skateboard gear, Bauer etc. Weakness Issues with Sweatshops This dead fish focus on leveraging low labor cost in South East Asian economies to deliver competitive products has often landed Nike in various sorts of troubles from human right groups and labor unions back home, most blaming the company for exploiting children and workers in inhumane conditions. Numbers of these groups blamed it for bringing in and supporting the sweatshop culture in these economies and the company once famous for innovative designs and creative products soon became poster child of anti-globalization worldwide. Noting this Phil Night in said in annual meeting – â€Å"The Nike product has become synonymous with slave wages, forced overtime, and arbitrary abuse†. Since then Nike has taken number of steps to cut this malaise in the system and develop respectable human and working standards for its third party vendors. Fall in the Sports shoes market due to changing trends Over the last few years there is continuous decline in sports shoes sale because of trend of non sports shoes with jeans. This has resulted in increasing discount and low realization. Nike has to sort out this aspect of their business along with the rest of sporting gear. Conclusion Over the years Nike has moved from manufacturing to purely a R&D and marketing company. Today Nike headquarters only looks after the designing, market trends and marketing of the products while outsourcing all others. This may have resulted in cutting the cost but it has also increased the dangers like sweatshops and blemish to the brand equity of the company. Nike (2007) Nike official Website 2007. Retrieved on 20th March from www.nikebiz.com