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Assistant Practitioner Providing Support For A Diabetes Patient

Share this: Facebook Twitter Reddit LinkedIn WhatsApp The following paper will reflect on an experience as a trainee assistant practitioner which involved the care and support of a patient with type 1 diabetes. For this reflection I will use Bill as a pseudonym name for my patient as The Nursing and Midwifery Council (2010) states that. “The common law of confidentiality reflects that people have a right to expect that information given to a nurse or midwife is only used for the purpose for which it was given and will not be disclosed without permission. This covers situations where information is disclosed directly to the nurse or midwife and also to information that the nurse or midwife obtains from others”. For this assignment Gibb’s Reflective Cycle (1988) will be utilised as I feel comfortable with this model. Gibbs (1998) refers to the experience as an incident which involves exploring good and bad feelings, however Johns (1995) suggests that the fundamental purpose of reflective practice is to enable the practitioner to interpret an experience in order to learn from it. Type 1 diabetes is a lifelong condition in which the body cannot control the amount of glucose in the blood. This is because the body cannot produce the natural hormone insulin. Diabetes is a common, lifelong condition and as Zimmet et al (2001) identify that in developed countries one person in thirty may be affected and it is likely that by 2025 there will be three hundred million people with diabetes worldwide, this is mainly the result of more sedentary lifestyles and increased obesity. In 2006 Diabetes UK estimated that there were more than two million people with diagnosed diabetes and up to one million who are still undiagnosed (Diabetes UK 2006). A holistic approach to this long term condition is essential as it can come with so many complications. Complications may arise from inadequate management and treatment of the condition, which can adversely affect the quality of life and have financial implications for patients and the National Health Service (DH2001). There are two types of diabetes. In type 1 diabetes there is no production of insulin by the beta (ß) cells of the pancreas. In type 2 diabetes, which accounts for over 80 per cent of all cases of diabetes, insulin is produced by the ß cells and is released into the bloodstream, but it subsequently fails to act properly at the sites of glucose uptake, which are skeletal muscle, liver and adipose tissue (Donnelley and Garber 1999, Reginato and Lazar 1999). As a trainee assistant practitioner I was asked by the district sister to visit Bill to do a blood test which had been requested by the general practitioner as Bill is housebound and unable to attend a blood clinic. The blood test was to check his full blood count and HbA1c which had not been done for almost a year. Bill is seventy four years of age, lives alone and has lived with diabetes for many years. Bills wife passed away a year ago and has one son who lives many miles away so sees him very little; he does however have a neighbour who pops in to check on him now and again. Bill administers his own insulin in the mornings and checks his blood sugar levels daily before giving his insulin. My first impressions of Bill were that he looked frail and quite pale but having not met him before this may have been the norm for him. Whilst taking the blood sample I began chatting to Bill and he started to tell me that he had several episodes of feeling unwell recently and on that morning he had felt particularly unwell. I asked him to explain why he felt unwell and what symptoms he was experiencing. He explained the symptoms included shaking in his hands, feeling lightheaded and a fuzzy headache. As a trainee assistant practitioner I felt it necessary to explore what was wrong with Bill even further. First of all I began taking some basic clinical observations, his blood pressure was 140/90, pulse 80 and regular which were both within normal limits. He appeared pale and clammy so I checked his blood glucose level which was 3.2mmols; Bill was suffering from hypoglycaemia. Blood glucose levels are normally maintained within relatively narrow limits at about 5-7mmol/l (Williams and Pickup 2004). My immediate concern was to ensure Bills blood glucose levels did not drop any further and the priority was to take short term action and increase his blood sugar to prevent it becoming any worse. Bill had no glucose tablets or glucogen so with his consent I looked in his fridge and cupboards to find something that would increase his blood sugars quickly. All that was in his fridge was a carton of milk a few slices of bread and some jam, I promptly gave him a drink of milk and made a jam sandwich. I felt it was my responsibility to sit with Bill until his blood glucose returned to acceptable levels and he had recovered from this episode of hypoglycaemia. I took Bills blood glucose levels every ten minutes until it returned to a safe and acceptable level. Bills blood sugar was now 5.2mmols and he was feeling brighter I checked to see if he ever recorded his blood glucose levels or kept a record of administration of his insulin but there was nothing. I asked him about his diet he said he hadn’t been feeling up to eating much, I asked who did his shopping which he informed me his neighbour gets his milk and bread and a few other little bits when he needed them. I was aware that the lack of food in the house was probably the cause of Bill suffering from hypoglycaemic attacks. Hypoglycaemia occurs when the blood glucose level falls below 4mmol/L and is a common side effect of insulin therapy. Causes of hypoglycaemia include missed or late meals, not eating enough, taking too much insulin, exercise and excessive alcohol. National Health Services Choices (2009) state that hypoglycaemia should be treated with fast-acting carbohydrate, for example, 3-6 glucose tablets, 150ml fizzy drink or 50-100ml Lucozade, and followed up with a longer-acting carbohydrate, for example, biscuits or a sandwich. Glucose gels, for example, GlucoGel are useful to raise blood glucose levels and blood glucose should be recorded five to ten minutes after treatment. After ensuring that Bill’s hypoglycaemic attack had subsided and he was feeling better I made him a cup of tea and left him another sandwich that he could have at lunchtime. My initial feelings were of concern for Bills safety in the future and as a trainee assistant practitioner I knew that it was my responsibility to see my mentor immediately to discuss the situation. I was satisfied that I had taken the time to find out what was wrong with Bill and that he had recovered from his hypoglycaemic attack which I may not have taken time to do in my previous role. From the years of working in the community nursing setting experience I was fully aware that other mutli-displinary agencies may need to be involved in the care of Bill. I returned to the office and fed back to my mentor and later that day we returned to Bill and a full assessment was undertaken, it came to light that Bill had been struggling for some time with his diabetes, personal care and shopping and housework. It was decided by my mentor that for the interim period until care and support for Bill could be implemented that the district nursing team would administer his insulin that way his blood glucose levels could be regularly recorded and ensure that he has eaten something. He was also referred to the community diabetic nurse for a review of his insulin regime. Dietary management of type 1 and type 2 diabetes Nutritional therapy is an integral part of effective management of diabetes and has a vital role in helping people with diabetes to achieve and maintain optimal glycaemia control (Delahunt 1998, UKPDS 1990).I visited the general practitioner surgery and obtained some patient information on diabetes care and diet and took them to Bill, with the supervision of my mentor I sat with him and read through them. Once a care package was in place the carers would be informed of what foods Bill should and should not have and they would help with meal preparation. The British Diabetic Association (1999) suggest that ideally dietary information should be delivered by a diabetes specialist dietician, however in the case of Bill awaiting an appointment to see the dietician would have taken time and the information was needed on a more urgent basis. McGough (2003) suggest that structured patient education plays an important role in enabling people with diabetes to manage their diabetes on a day-to-day basis and a greater emphasis should be on the benefits of regular physical activity and weight management. More flexibility in the proportion of monounsaturated fat and carbohydrate in dietary intake and sucrose should no longer be restricted to a specific amount. For Bill initially it was essential that he was provided with regular meals and snacks at least three times daily to prevent any further hypoglycaemic attacks. An urgent referral was sent to members of the multi-disciplinary team and a meeting was arranged the following day with a social services. Referrals were also sent to the community diabetic nurse, dietician and foot health services. On assessment with my mentor she identified that Bill had not been washing properly and had not cut his toe nails for some time, Bill was also experiencing pain in his legs and feet. Bill was likely to be experiencing diabetic peripheral neuropathy, and I completed a pain assessment chart with him. Hill (2009) identifies that painful neuropathy affects the feet, typically causing burning or stabbing pain, which is particularly apparent at night. This was a mirror of what Bill described his pain as and we reassured him that his pain control would be discussed with his general practitioner as at present Bill took no analgesia at all and there was none in the house. The general practitioner prescribed paracetamol 1000mg four times daily initially as he felt that the pain may improve once more control had been gained again with his diabetic control. I returned to assess Bills pain control several days after commencing paracetamol and it had improved, he was still experiencing slight discomfort but felt that he would like to continue on this regime as he did not want anything stronger at the present time. It was agreed with Bill that this would be reviewed again the following week. A joint visit was done with the diabetic nurse, my mentor and myself and it was identified that Bills technique of giving his own insulin was poor due to poor dexterity in his hands and he was unable to turn his insulin pen properly or read the digits on the pen clearly. It was unclear how long Bill had been trying to manage in this way but Bill would certainly need long term care with his insulin from the district nursing team. The diabetic nurse identified that Bills eyesight was particularly poor and that he had not had his eyes checked for several years. Diabetic retinopathy is a major cause of blindness and many patients do not have any symptoms of the damage occurring in the retina until the complications have become advanced. NICE (2008) recommend annual screening for all patients with diabetes and that a record of the retina is made by digital imaging for year on year comparison to identify the development and progression of retinopathy. The general practitioner was informed that Bill had not had his eyes checked and he agreed that he would refer him for retinopathy screening. As a trainee assistant practitioner I have learnt valuable knowledge in the management and care of patients with diabetes, from Bill requiring a routine blood test he has become a complex patient with multiple problems related to his diabetes. Due to the word limitations of the essay all areas of complications relating to diabetes could not be covered but through researching and reading around the topic I am aware of other complications such as nephropathy, cardiovascular, cerebrovascular and peripheral vascular disease. I have continued as an assistant trainee practitioner to visit Bill and monitor his progress with my mentor. His blood glucose levels have improved and are maintained controlled between 6-9mmols. Bill has needed some psychological support as he is used to seeing few people and all of a sudden his life has changed and he has several members of the multidisciplinary team visiting and reviewing him regularly. Overall I feel a sense of satisfaction that from a routine blood test and utilising a more advanced role all of this relating to Bill has been identified and his health and care are much more improved. Share this: Facebook Twitter Reddit LinkedIn WhatsApp

Turbocharger Technology Vs CRDI In Diesel Engine Engineering Essay

A turbocharger is a gas compressor that is used for forced-induction of an internal combustion engine. A form of supercharger, the turbocharger increases the density of air entering the engine to create more power. A turbocharger has the compressor powered by a turbine, driven by the engine’s own exhaust gases, rather than direct mechanical drive as with many other superchargers. OPERATING PRINCIPLE A turbocharger is a small radial fan pump driven by the energy of the exhaust gases of an engine. A turbocharger consists of a turbine and a compressor on a shared shaft. The turbine converts exhaust heat and pressure to rotational force, which is in turn used to drive the compressor. The compressor draws in ambient air and pumps it in to the intake manifold at increased pressure, resulting in a greater mass of air entering the cylinders on each intake stroke. The objective of a turbocharger is the same as a supercharger; to improve the engine’s volumetric efficiency by solving one of its cardinal limitations. A naturally aspirated automobile engine uses only the downward stroke of a piston to create an area of low pressure in order to draw air into the cylinder through the intake valves. Because the pressure in the atmosphere is no more than 1 atm (approximately 14.7 psi), there ultimately will be a limit to the pressure difference across the intake valves and thus the amount of airflow entering the combustion chamber. Because the turbocharger increases the pressure at the point where air is entering the cylinder, a greater mass of air (oxygen) will be forced in as the inlet manifold pressure increases. The additional air flow makes it possible to maintain the combustion chamber pressure and fuel/air load even at high engine revolution speeds, increasing the power and torque output of the engine. Because the pressure in the cylinder must not go too high to avoid detonation and physical damage, the intake pressure must be controlled by venting excess gas. The control function is performed by a wastegate, which routes some of the exhaust flow away from the turbine. This regulates air pressure in the intake manifold. COMPONENTS The turbocharger has four main components. The turbine (almost always a radial turbine) and impeller/compressor wheels are each contained within their own folded conical housing on opposite sides of the third component, the centre housing/hub rotating assembly (CHRA). The housings fitted around the compressor impeller and turbine collect and direct the gas flow through the wheels as they spin. The size and shape can dictate some performance characteristics of the overall turbocharger. Often the same basic turbocharger assembly will be available from the manufacturer with multiple housing choices for the turbine and sometimes the compressor cover as well. This allows the designer of the engine system to tailor the compromises between performance, response, and efficiency to application or preference. Twin-scroll designs have two valve-operated exhaust gas inlets, a smaller sharper angled one for quick response and a larger less angled one for peak performance. The turbine and impeller wheel sizes also dictate the amount of air or exhaust that can be flowed through the system, and the relative efficiency at which they operate. Generally, the larger the turbine wheel and compressor wheel, the larger the flow capacity. Measurements and shapes can vary, as well as curvature and number of blades on the wheels. Variable geometry turbochargers are further developments of these ideas. The centre hub rotating assembly (CHRA) houses the shaft which connects the compressor impeller and turbine. It also must contain a bearing system to suspend the shaft, allowing it to rotate at very high speed with minimal friction. For instance, in automotive applications the CHRA typically uses a thrust bearing or ball bearing lubricated by a constant supply of pressurized engine oil. The CHRA may also be considered “water cooled” by having an entry and exit point for engine coolant to be cycled. Water cooled models allow engine coolant to be used to keep the lubricating oil cooler, avoiding possible oil coking from the extreme heat found in the turbine. The development of air-foil bearings has removed this risk. PRESSURE INCREASE In the automotive world, boost refers to the increase in pressure that is generated by the turbocharger in the intake manifold that exceeds normal atmospheric pressure. Atmospheric pressure is approximately 14.7 psi or 1.0 bar, and anything above this level is considered to be boost. The level of boost may be shown on a pressure gauge, usually in bar, psi or possibly kPa. This is representative of the extra air pressure that is achieved over what would be achieved without the forced induction. Manifold pressure should not be confused with the volume of air that a turbo can flow. In contrast, the instruments on aircraft engines measure absolute pressure in millimetres or inches of mercury. Absolute pressure is the amount of pressure above a total vacuum. The ICAO standard atmospheric pressure is 29.92 in of mercury (101.325 kPa) at sea level. Most modern aviation turbochargers are not designed to increase manifold pressures above this level, as aircraft engines are commonly air-cooled and excessive pressures increase the risk of overheating, pre-ignition, and detonation. Instead, the turbo is only designed to hold a pressure in the intake manifold equal to sea-level pressure as the altitude increases and air pressure drops. This is called turbo-normalizing. Boost pressure is limited to keep the entire engine system, including the turbo, inside its thermal and mechanical design operating range. The speed and thus the output pressure of the turbo is controlled by the wastegate, a bypass which shunts the gases from the cylinders around the turbine directly to the exhaust pipe. The maximum possible boost depends on the fuel’s octane rating and the inherent tendency of any particular engine towards detonation. Premium gasoline or racing gasoline can be used to prevent detonation within reasonable limits. Ethanol, methanol, liquefied petroleum gas (LPG), compressed natural gas (CNG) and diesel fuels allow higher boost than gasoline, because of these fuels’ combustion characteristics. To obtain more power from higher boost levels and maintain reliability, many engine components have to be replaced or upgraded such as the fuel pump, fuel injectors, pistons, valves, head-gasket, and head bolts. CHARGE COOLING Compressing air in the turbocharger increases its temperature, which can cause a number of problems. Excessive charge air temperature can lead to detonation, which is extremely destructive to engines. When a turbocharger is installed on an engine, it is common practice to fit the engine with an intercooler, a type of heat exchanger which gives up heat energy in the charge to the ambient air. In cases where an intercooler is not a desirable solution, it is common practice to introduce extra fuel into the charge for the sole purpose of cooling. The extra fuel is not burned. Instead, it absorbs and carries away heat when it changes phase from liquid to vapor. The evaporated fuel holds this heat until it is released in the exhaust stream. This thermodynamic property allows manufacturers to achieve good power output by using extra fuel at the expense of economy and emissions. Over time a Charge Air Cooler (CAC) can leak loosing boost pressure, and reducing fuel economy. It is common practice to test a CAC during routine service, particularily in trucking where a leaking CAC can result in a 20% reduction in fuel economy. CRDi CRDi stands for Common Rail Direct Injection meaning, direct injection of the fuel into the cylinders of a diesel engine via a single, common line, called the common rail which is connected to all the fuel injectors. Whereas ordinary diesel direct fuel-injection systems have to build up pressures a new for each and every injection cycle, the new common rail (line) engines maintain constant pressure regardless of the injection sequence. This pressure then remains permanently available throughout the fuel line. The engine’s electronic timing regulates injection pressure according to engine speed and load. The electronic control unit (ECU) modifies injection pressure precisely and as needed, based on data obtained from sensors on the cam and crankshafts. In other words, compression and injection occur independently of each other. This technique allows fuel to be injected as needed, saving fuel and lowering emissions. Common rail direct fuel injection is a modern variant of direct fuel injection system for petrol and diesel engines. On diesel engines, it features a high-pressure (over 1,000 bar/15,000 psi) fuel rail feeding individual solenoid valves, as opposed to low-pressure fuel pump feeding unit injectors (Pumpe Düse or pump nozzles). Third-generation common rail diesels now feature piezoelectric injectors for increased precision, with fuel pressures up to 1,800 bar/26,000 psi. In gasoline engines, it is utilised in gasoline direct injection engine technology. PRINCIPLES Solenoid or piezoelectric valves make possible fine electronic control over the fuel injection time and quantity, and the higher pressure that the common rail technology makes available provides better fuel atomisation. In order to lower engine noise the engine’s electronic control unit can inject a small amount of diesel just before the main injection event (“pilot” injection), thus reducing its explosiveness and vibration, as well as optimising injection timing and quantity for variations in fuel quality, cold starting, and so on. Some advanced common rail fuel systems perform as many as five injections per stroke. Common rail engines require no heating up time and produce lower engine noise and emissions than older systems. Diesel engines have historically used various forms of fuel injection. Two common types include the unit injection system and the distributor/inline pump systems. While these older systems provided accurate fuel quantity and injection timing control they were limited by several factors: They were cam driven and injection pressure was proportional to engine speed. This typically meant that the highest injection pressure could only be achieved at the highest engine speed and the maximum achievable injection pressure decreased as engine speed decreased. This relationship is true with all pumps, even those used on common rail systems; with the unit or distributor systems, however, the injection pressure is tied to the instantaneous pressure of a single pumping event with no accumulator and thus the relationship is more prominent and troublesome. They were limited on the number of and timing of injection events that could be commanded during a single combustion event. While multiple injection events are possible with these older systems, it is much more difficult and costly to achieve. For the typical distributor/inline system the start of injection occurred at a pre-determined pressure (often referred to as: pop pressure) and ended at a pre-determined pressure. This characteristic results from “dummy” injectors in the cylinder head which opened and closed at pressures determined by the spring preload applied to the plunger in the injector. Once the pressure in the injector reached a pre-determined level, the plunger would lift and injection would start. In common rail systems a high pressure pump stores a reservoir of fuel at high pressure – up to and above 2,000 bars (29,000 psi). The term “common rail” refers to the fact that all of the fuel injectors are supplied by a common fuel rail which is nothing more than a pressure accumulator where the fuel is stored at high pressure. This accumulator supplies multiple fuel injectors with high pressure fuel. This simplifies the purpose of the high pressure pump in that it only has to maintain a commanded pressure at a target (either mechanically or electronically controlled). The fuel injectors are typically ECU-controlled. When the fuel injectors are electrically activated a hydraulic valve (consisting of a nozzle and plunger) is mechanically or hydraulically opened and fuel is sprayed into the cylinders at the desired pressure. Since the fuel pressure energy is stored remotely and the injectors are electrically actuated the injection pressure at the start and end of injection is very near the pressure in the accumulator (rail), thus producing a square injection rate. If the accumulator, pump, and plumbing are sized properly, the injection pressure and rate will be the same for each of the multiple injection events. Most of the people who used to be called “gearheads” will at least be familiar with the term CRDI and how it applies to engines for cars and trucks. The letters stand for common rail direct injection, which is a fairly recent design for diesel engines that may also be suitable for passenger automobiles. Though originally intended for commercial use, this design is now in wide use around the globe. The method is chosen by more and more manufacturers and by individual users because it is fuel efficient as other diesel technologies were. However, CRDI has also provided a tremendous boost in diesel-engine performance. The improvement is mainly due to the common-rail design, which has tubes that connect all the injectors. These injectors are based on the direct-injection concept, as was the case in the past. But the common-rail design was quite a step forward. Fuel in the common tube or “rail” is under a set amount of pressure which causes the fuel to be “atomized” or broken down to its smallest particles. This allows the fuel to combine with the air much more efficiently. With proper direct injection, fuel use is highly efficient, with much less waste fuel escaping the system unused. The newest electronic technology has also allowed CRDi engines to better control the amount of fuel used, the pressure within the system and the timing of both the injection of fuel and the electronic charge applied to make the fuel burn. Injectors in the common rail direct injection engine have controls on the injector heads that allow slight variances in the amount of fuel put into the cylinders. As is the case with almost all automobiles, trucks and motorized equipment today, a “computer” or electronic “brain” controls the various factors, including amount of fuel, timing of injection, timing of the charge and the pressure within the tubes or common rails. According to those who have used this technology in both test and commercial applications, the CRDI method greatly reduces engine and vehicle vibration, allows the engine and vehicle to run more quietly and reduces the cost of operation significantly. For the most part, traditional, classic carburetion engines have been replaced by such methods as MPFI or multi-point fuel injection designs for gasoline engines and CRDI or common rail direct injection for diesel engines. MPFI was first developed some years ago in response to the call for more fuel-efficient engines. The need for better emission standards made MPFI popular, since it allowed for better gas mileage in automobiles. CRDI for diesel vehicles has improved performance by as much as 25 percent, according to some studies. This gives the vehicle more power and makes the technology more attractive for passenger vehicles. These engines run much more smoothly, with efficiency greatly enhanced by higher pressure possible in the common-rail or tube design. While the CRDI engine is a little more expensive than previous technologies, the savings in fuel cost can help recoup the initial expensive over time. HOW THE CRDi ENGINE WORKS DISADVANTAGES In cold weather, high speed diesel engines that are pre-chambered can be difficult to start because the mass of the cylinder block and cylinder head absorb the heat of compression, preventing ignition due to the higher surface-to-volume ratio. Pre-chambered engines therefore make use of small electric heaters inside the pre-chambers called glowplugs. These engines also generally have a higher compression ratio of 19:1 to 21:1. Low speed and compressed air started larger and intermediate speed diesels do not have glowplugs and compression ratios are around 16:1. Some engines use resistive grid heaters in the intake manifold to warm the inlet air until the engine reaches operating temperature. Engine block heaters (electric resistive heaters in the engine block) connected to the utility grid are often used when an engine is turned off for extended periods (more than an hour) in cold weather to reduce start-up time and engine wear. In the past, a wider variety of cold-start methods were used. Some engines, such as Detroit Diesel engines and Lister-Petter engines, used a system to introduce small amounts of ether into the inlet manifold to start combustion. Saab-Scania marine engines, Field Marshall tractors (among others) used slow-burning solid-fuel ‘cigarettes’ which were fitted into the cylinder head as a primitive glow plug. Lucas developed the Thermostart, where an electrical heating element was combined with a small fuel valve in the inlet manifold. Diesel fuel slowly dripped from the valve onto the hot element and ignited. The flame heated the inlet manifold and when the engine was cranked, the flame was drawn into the cylinders to start combustion. International Harvester developed a tractor in the 1930s that had a 7-litre 4-cylinder engine which started as a gasoline engine then ran on diesel after warming up. The cylinder head had valves which opened for a portion of the compression stroke to reduce the effective compression ratio, and a magneto produced the spark. An automatic ratchet system automatically disengaged the ignition system and closed the valves once the engine had run for 30 seconds. The operator then switched off the petrol fuel system and opened the throttle on the diesel injection system. Recent direct-injection systems are advanced to the extent that pre-chambers systems are not needed by using a common rail fuel system with electronic fuel injection.

Leadership Project: Formal Leadership

online dissertation writing Leadership Project: Formal Leadership. Paper details BMAL 700 Leadership Project: Formal Leadership Assignment Instructions Over the last two (2) weeks, you have read four (4) new chapters in the course text (pages 132 – 221). Each chapter reveals to the reader both history and God’s hand in it. The chapters tell of both formal leadership (those in a position of power based on organizational structure) and informal leadership (those who have power based on their ability to demonstrate influence without being in a formal organizational structure). In this assignment, the student is required to write an APA formatted 900 word paper that expands on a theme from one of the chapters. Why was this information so important that Merida included it in the text? How is this theme relevant today? Why is this theme important to you in your current or future leadership endeavors? Support your research with five (5) scholarly sources. Limit your literature search to the last five (5) years and select only sources that are full text – PDF. As part of this project, prepare an annotated bibliography. The bibliography will be structured as follows: APA formatted reference (minimum 100 words per reference) followed by summary of key points, evaluation of the quality of the publication, evaluation of the quality of the author(s), where this fits into the assignment, and the library database in which you found the article. A traditional APA reference page and the annotated bibliography will be turned in with the associated paper. Leadership Project: Formal Leadership

American Military Opioid Medications and Healthcare System Paper

American Military Opioid Medications and Healthcare System Paper.

Complete a research essay on the government and healthcare. Remember this is being written for the president to read. The U.S. healthcare system has been a controversial topic for decades. Here are the aspects and questions to address for this essay:
Identify a current issue being debated about the American healthcare system.
Explain two competing solutions to this problem.
Evaluate which one is preferable.
Address the responsibilities of each level of government, which are federal, state, and local. (Most of the essay will be about the federal government).
Address the responsibilities of each of the three branches of the federal government.
500 word minimum and 600 word maximum length, not including references listed at the end or footnotes if used.
Incorporation of concepts and terms from the required readings.
Inclusion of facts from a recent news article about the topic/solution.
Correct spelling, grammar, and formatting, whether it’s APA, MLA, or Chicago/Turabian.
American Military Opioid Medications and Healthcare System Paper

Marketing mix for Levis Brand Makeover

The target market for the Levi’s image makeover is the young generation. However, Levi’s is now promoting ‘Curve ID’, but it is not enough to beat up premium jeans because ‘curve id’ is a just guide line for customer when they are to buy Levi’s Jeans being confused what will fit them right. Levi’s need to offer an optimized assortment of their Jeans products to their customers. Offering of the best mix of the products is essential to the long-term success and for customer satisfaction. The Product assortment optimization needs the strategic inventory decisions and the product selection. The best product assortment strategies should maximize the profits, minimize risk and increase the overall sales. They should include a kind of the mixture for the Jeans products basing on their respective life cycles in your store. If it offers a strong mix of the products basing on the product life, customers will be satisfied and develop the desire to make repeat purchases of the established product and there are higher chances for them to piqué their interests with the new options. Introduction of new products will increase the amount of time that the customers tend to increase the frequency of routine checks into their stores. Price Levi’s jeans are quite affordable, to have a better approach to its new line, they will have to increase their price to a margin that will be competing with the premium jeans. But not as high as price of premium jeans. It has to be reasonable. The customer recognition of Levi’s jeans price is not high therefore, It is not a good idea to challenge its price recognition, otherwise it rather lose customers who belong to the Y-generation with that is known to be very volatile. As a result its new line would have a narrow range of $100 to $200. Later on, Levi’s Jeans will involve the techniques such as the temporary discounts, coupons, the cash refunds, rebates or the buy-one-get-one offers which are the common pricing strategies that are used to drive the sales. C. Place Levi’s jeans should first create the demand for its products. Then get those products into the consumers’ hands. Planning of its product distribution strategy needs to be done during the product development stage. The placement of the products is very important because the methods employed in the distribution of the products impacts on the actual retail price of the products. Levi’s has worldwide stores as well as online stores. They have been reaching customers greatly. I don’t think they need a critical strategy for place, but they should not concentrate on its wholesale store and should not have its products showing up on discount stores like Wal-Mart or target. This company should use the exclusive distribution strategy to establish the image of its jeans over the premium jeans brand. By use of a limited number of the distribution channels, the partners will be enabled to create an image of exclusivity. Levi’s jeans should also consider the parallel distribution opportunities and Set up the market research opportunities in order to find out the customer preferences for the mode of receiving the products. D. Promotions Levi’s will use both direct and indirect advertisements. The celebrity marketing can also be used as a form of indirect marketing, since the y-generation is a fashion sensitive group, they can be easily influenced by the celebrities’ preferences. Trendy celebrity association with the brands of Levi’s Jeans wears, young people will get the pretty fashionable jeans unconsciously. And Levi’s street post ads as direct marketing would better have just picture image with its logo. No slogan no title. No more ‘go back to original’ slogan. It is not working for the young. They just like something simple. Just one image picture that bring unique and trendy image of Levi’s well is just enough. The Levi’s jeans should determine goals of your promotion to establish the best promotional activities. Your promotional strategies could target a specific demographic or reach millions of people. Therefore Levi’s Jeans will use Advertising as the means of product promotion. Direct mails, the televisions, and the magazines. Other options may include; the in-store displays, use of billboards, newspapers, the online display advertisements, and the electronic email advertisements. The Levi’s Jeans will develop advertisements that define clear benefits to consumer if they purchase its products, and at the same time reinforce its brand image and reputation through the Internet. E. People. Brand communication helps to bridge the gap in the perception that the target audiences have on the brand. Effective product communication of the Levi’s Jeans will give competitive advantages which will targets the receptive Y-generation customers with the marketing message. Product communication strategy is then a very important component of the marketing plan. The best product communication strategies will help to improve the chances of delivering the message to the targeted customers therefore increasing the sales. Levi’s Jeans will use multiple methods of communicating with its customers, through the e-mail newsletters, the magazine advertisements, postcards, the billboards, in-store displays, and good product packaging F. New Tactics Through Internet Marketing Strategy; the company will explore the strategies and new tactics that can be used on the Internet to enhance and support the Levi’s Jeans and the business overall marketing objectives. It will conduct banner promotions; generate the targeted online traffic, positioning its contents, and the overall brand awareness.

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