Critically examine British government policies directed towards Essay

Basically look at British government arrangements coordinated towards prostitution - Essay Example The issue of prostitution in the UK is frequently something other than the development of the sex business; it is necessarily identified with the expansion of exchange in the city and the wrongdoings related with it. In February 2003, 31 cops in Glasgow captured ladies in an enemy of prostitution clampdown went more than 48 hours because of their incitement by the irate occupants. In this activity, no men were captured. A greater part of the ladies occupied with the demonstration of road prostitution are either rocks addicts or are on heroin or both. The majority of the prostitution in the UK occurs in the outside city and the indoor scene is little. Ladies that are occupied with the road prostitution are presented to sexual or physical savagery in the unbalanced levels. Prostitution is one of the main sources of dubious passings and death of ladies in the UK. Acknowledgment of the lap moving among the VIPs and the organizations just as communicating of the lap moving in the TV programs gives proof to its relative achievement. Standardization has put accentuation upon the perspectives that were progressively worthy like little houses of ill-repute and escort organizations. Guideline can be comprehended as a shelter plan that comprises various methodologies and systems, that incorporate yet are not restricted to a receptive annoyance reaction with the inhabitant clampdowns upon clients and particularly ladies, and a visually impaired eye approach in which rules casual resilience. â€Å"The legitimate guideline of prostitution in the UK was set out in the Sexual Offenses Act 1956, which mirrored the discoveries of the Wolfenden Committee examination concerning prostitution and homosexuality that occurred around that time† (politics.co.uk, 2012). Prostitution in the Wolfenden Committee was treated as an ethical issue as was apparent from the Act’s text. This turned into the premise of the mainstream banters between Herbert Hart and Lord Devlin. Before the year's over 2003, the Home Office pronounced its arrangements to modify

Quality Assurance in Clinical Bacteriology Assignment

Quality Assurance in Clinical Bacteriology - Assignment Example From begin to end, the full creation line must be appropriately observed and to be set up with alternate courses of action. To accomplish Total Quality Management, a Quality Systemâ€defined as the authoritative structure and assets expected to execute quality prerequisites (Kumari and Bhatia, 2003, p. 20)â€must be built up. The organizationl the board and structure, the referential (quality) norms, documentation, appraisal (observing and assessment) and preparing are all piece of Quality Systems. Legitimate designation of obligations and proper appropriation of outstanding task at hand will give equalization to the frameworks just as make a steady establishment for the work process. Gauges for quality estimation are additionally basic in guaranteeing the consistency as well as in the confirmation of giving quality yield constantly. Legitimate documentation and evaluation of the work process normally characterizes the degree of progress the framework will have the option to accomplish. Exhaustive assessment of the entire procedure may reveal escape clauses, shortcomings and potential wellsprings of b lunders of the creation line. Recognizing these blemishes is the first step in quite a while arrangement. From now on, preparing of the work power and countinous update of conventions must be actualized for the entire gathering to improve. Beside Quality System, Quality Audit is additionally significant for the improvement of the research facility. As clarified by Kumari and Bhatia (2003), Quality Audits are set up to confirm the viability of the acivities of the research facility. This is to test whether the actualized activities do explain or potentially achieve its assigned objective. A different group, either another gathering inside the research facility (inner reviews) or a gathering not inside the lab (outside reviews), typically handle these worries to accomplish a fair view and judgment. Improvement is anything but a one-advance thing. It is continous. It is essential for the framework to more than once plan, do (execute), check and act

Burgess and Martin Dehydrating Reagents

Burgess and Martin Dehydrating Reagents A comprehension of artificially helpful getting dried out reagents for the decrease of hydroxyl gatherings, different practical gathering interconversions and other artificially valuable tasks. Oday Alrifai Parchedness of alcohols has been an artificially helpful technique so as to accomplish olefins in significant returns through the treatment of auxiliary, tertiary and homoallylic alcohols. Martin sulfurane and Burgess getting dried out reagents have been helpful due to their gentle and particular properties on liquor containing species. [1] Both reagents have made a critical commitment in modern and scholarly applications, helping in the amalgamation of characteristic items and medications. The Burgess Reagent, known as Methyl-N-(triethylammoniumsulphonyl)carbamate (Figure 1), is an intriguing reagent helping developments of 5-membered heterocycles, at first got from the non-cyclic forerunner by dehydrative treatment. [1] It was first found by Edward Meredith Burgess in 1968, yet was not given a lot of consideration until Peter Wipf proposed the possibility of heterocyclic arrangement. Further research on this reagent, for example, the planning of isocyanides and nitrile oxides from formamides and nitroalkanes, separately, have been examined. [1] Figure 1. Structure of Methyl-N-(triethylammoniumsulphonyl)carbamate, otherwise called Burgess’s drying out reagent. [1] Like the Burgess reagent, Martin reagent (or Martin sulfurane) is another drying out reagent having high reactivity to permit the creation of alkenes, with diphenyl sulfoxide and a liquor as minor items, happening quick (roughly 60 minutes) and at beneath room temperatures. [2] It was James C. Martin who found this steady, dampness delicate sulfurane, otherwise called bis(î ±,î ±-bis[trifluoromethyl]benzyloxy)diphenyl sulfur (Figure 2), in 1971. [2][3] Similar to the Burgess reagent, the robotic activity might be comparative, by means of E1 and additionally E2 (or cis) end, all together for the treatment of auxiliary and essential alcohols, separately. [3] Also comparative, cyclic heteroatoms have been progressively great in blend, due to carbenium particle revamp, through alcoholic lack of hydration. [3] Figure 2. Structure of bis(î ±,î ±-bis[trifluoromethyl]benzyloxy)diphenyl sulfur, otherwise called Martin’s sulfurane or Martin’s getting dried out reagent. [10] Planning of the Burgess reagent requires the consolidation of two economically accessible synthetic concoctions, chlorosulfonyl isocyanate (CSI) and trieethylamine (TEA), and stops in two stages. Figure 3 outlines the treatment of CSI with anhydrous methanol and dry benzene at temperatures running from 25-30Â °C, for around half-hour. This genuinely brisk response gives great yields (88-92%) of methyl (chlorosulfonyl) carbamate (MCC) which exists as white precious stones when separated and washed with hexanes. The produced MCC is then treated with an answer of TEA in anhydrous benzene, at temperatures running from 10-15Â °C, throughout 60 minutes. The created salt, Methyl-N-(triethylammoniumsulphonyl)carbamate, encourages into vapid needles (84-86% yield). [1] Figure 3. Planning of the inward salt (Burgess reagent) from two financially accessible mixes, trieethylamine and chlorosulfonyl isocyanate. An uncommon kind of disposal response is accepted to happen during the period the Burgess reagent is operational. The concurrent end of two vicinal substituents, shaping an alkene structure from an alkane, is the course of an intramolecular (Ei) system or a syn disposal. The unthinking activity taken by the Burgess reagent, delineated in Figure 4, will initially create a sulfamate ester by the assault of the sulfonyl bunch just as the fast relocation of the TEA gathering, by oxygen’s solitary pair in methanol (pka=15.5). [1][4] By warming the sulfamate ester, pyrolysis is started, the ÃŽ ±-carbon is ionized and bears a particle that quickly moves the ÃŽ ²-hydrogen from the cationic to the anionic state. [1] Figure 4. Instrument delineating treatment of Burgess reagent with ethanol, permitting the extraction of the ÃŽ ²-hydrogen and development of the olefin. When all is said in done, the extraction of the proton and the ejection of the leaving gathering will create the normal olefin, appeared in Figure 5. The creation of the olefin relies upon the geometry of the atom, in this way the hydrogen must be available in the syn adaptation to the leaving gathering (TEA) all together for the response to continue. Furthermore, the leaving bunch has nucleophilic properties that will permit the proton to be removed promptly in low extremity solvents. It additionally should bear various proton acceptor destinations to allow positive proton catch. [1] It is conceivable anyway that the cis disposal not be seen due to carbonium particle dependability, which is settled by substituents, and additionally an increasingly steady arrangement by methods for improvement. [1] Figure 5. Case of a syn disposal, where the proton adjoining the carbon bearing the reagent is evacuated and the deuterium stays a substituent with the olefin development. Relating to Figure 5, the sort of liquor gathering (auxiliary, tertiary and homoallylic), the design and the earth are the fundamental factors that influence the procedure of the response. The lack of hydration of an auxiliary or tertiary liquor, in an aprotic dissolvable, adheres to Saytzef’s rule to shape an all the more thermodynamically stable alkene, versus the dynamic item. Oppositely, essential alcohols (Figure 5i) won't yield the normal olefins; rather carbamates by means of a SN2 pathway as they are vigorously increasingly great. Steric block is another significant factor while treating with the Burgess Reagent.[1] Such a model remains constant in essential sulfamate esters where intramolecular adjustment happens when temperatures increment because of the limitations on bimolecular dislodging (Figure 5ii). Contingent upon the states of the response, for example, dissolvable extremity and temperature, allylic alcohols can either experience disposal or SN1 revision (Fig ure 5iii), with increasingly ideal methodologies of SN1 responses giving more noteworthy than 90% yields. The equivalent is material for tertiary alcohols where they can be exposed to modification despite the fact that, under typical conditions, experience lack of hydration. [1] Figure 6. Models showing I) essential alcohols won't experience olefin arrangement, rather delivering a carbamate by means of SN2, ii) sterically ruined mixes can continue with the development of a thermodynamic item (Saytzef’s rule) and iii) allylic liquor parchedness through end or SN1. [1] Useful gathering interconversions (FGI) can help in numerous valuable blends to structure adaptable mixes. With the help of Burgess’s reagent, significant returns have been gotten through the change of formamides to isocyanides, nitrile oxides from nitroalkanes and nitriles from essential amides, for instance. To animate the development of nitriles from essential amides, the Burgess reagent is frequently utilized rather than different reagents. [1] The issue emerges when specific reagents interact with certain utilitarian gatherings, requiring securing gatherings or option multi-step amalgamations to complete the creation. Burgess reagent is utilized because of its chemoselective properties and its capacity to shape the halfway in a fast(er) way. Because of this speedy response, the item is actively progressively preferred. [1] Figure 7 outlines the interconversion of an amide to permit the Burgess reagent to continue with dehydrative exercises, in this way yielding isocyanide with reworking. Figure 7. To permit drying out of the liquor, an amide experiences interconversion to permit the Burgess reagent to continue, shaping isocyanide. Knowing the condition the liquor bunch is in and how its arrangement can be modified, the union of normal items in industry, by utilization of this reagent, has been of incredible manufactured worth. For instance, dihydrooxazoles are significant heterocyclic-containing intermediates utilized in the amalgamation of numerous organically dynamic normal items. At first, these mixes have required a broad multi-step amalgamation for their planning and past endeavors to cyclize have given low item yields (25%) and a plenitude of recouped beginning material. [5] Wipf and Miller researched increasingly proficient conventions that would acquire better yields of the ÃŽ ²-sulfonate subsidiaries (Figure 8) of threonine and serine by means of a progressively specific intramolecular replacement. Treating the hydroxyl amino corrosive forerunners, threonine and serine, with the reagent permitted the creation of dihydrooxazoles as a result of their high reactivity to invigorate intramolecular cyclizat ion. [5] Unlike different reagents evacuating hydroxyl substituents, Burgess reagent permits stereospecific creation of dihydrooxazoles without the arrangement of minor items like azirdine or ÃŽ ²-lactam. [5] Figure 8. Development of the olefin, through parchedness, and continuing with intramolecular cyclization to shape the 5-membered ring. A paper by Rigby et al. examined phenanthridone alkaloids beginning from the narciclasine family and their enemy of tumor properties. The union of (+)- lycoricidine included the utilization of the Burgess reagent so as to specifically deprotect the hydroxyl gathering and to advance cis disposal. [1][6] When dried out into an olefin, the compound can show antimitotic movement, which thusly can inspire cytotoxic exercises associated with the restraint of plant development and guideline, for instance. [7] Chida et al. detailed that manufactured (+)- lycoricidine showed solid cytotoxic action against P-388 lymphocytic leukemia, proposing stereochemistry was a dependable and a significant segment for the raised cytotoxicity. [7] Other artificially helpful instances of items that are of worth are restorative medications, for example, Efrotomycin, which is another class of

Understanding The Principles Of Developing Postive Relationships Free Essays

1. 1:1 Why successful correspondence is significant We are bound to convey data to each other in the event that we have positive connections. Guardians and different grown-ups who come into the school are bound to give gainful help if correspondence is solid and viable †this, thusly, benefits students. We will compose a custom article test on Understanding The Principles Of Developing Postive Relationships or on the other hand any comparable theme just for you Request Now It is additionally significant for understudies that we model powerful relational abilities. This implies checking what we are stating some of the time in snapshots of stress or fervor, with the goal that they can comprehend what our desires are in school. On the off chance that we request that students carry on with a certain goal in mind when imparting and afterward neglect to do so ourselves, they will think that its harder to comprehend the limits of what is worthy. Compelling correspondence and positive connections don't occur by some coincidence. You should consider the manner in which you identify with others and the messages this conveys. In circumstances where correspondence separates, mistaken assumptions can prompt terrible inclination. 1. 1:2 The standards of relationship building The standards of relationship working with childrenâ and grown-ups in any setting are that on the off chance that others are agreeable in our organization, they will be bound to impart adequately. Where individuals don't get along or are dubious of each other, they are probably going to stay away from each other at every possible opportunity. Positive connections are not something which ought to be left_ to possibility and it is critical to consider the manners by which we can create them. We manufacture associations with others in school every day in various ways. In spite of the fact that you may do a portion of these without fundamentally thinkingâ about it, it merits taking effort to consider whether you do the entirety of the accompanying. ? Compelling correspondence †this is the key territory for creating associations with others and furthermore covers various types of correspondence (see beneath). ? Indicating regard †so as to create positive associations with others, it is critical to be affable and deferential, and to tune in to their perspectives. Grown-ups and students with whom you work may likewise be from various societies and have various convictions or qualities from your own. Youâ should guarantee that you recognize and regard the perspectives on others consistently and set aside some effort to recollect names and favored types of address. ? Being circumspect †set aside the effort to think about the places of others. You might be working with a kid or grown-up who is feeling the squeeze at a given time and need to comprehend why they may have carried on or responded with a particular goal in mind or abnormal. ? Recollecting issues which are close to home to them †it will consistently assist with building constructive connections in the event that you enquire a_er specific aspectsâ of another person’s life †for instance, on the off chance that you realize that a partner is worried about their kid getting into a specific auxiliary school, or on the off chance that you know that it is a child’s birthday. ? Setting aside some effort to tune in to others †ensure that you set aside some effort to tune in to others, specifically on the off chance that they are requesting exhortation or help, or on the off chance that they have to trust in you. You ought to consistently show that you are keen on what they need to state and react fittingly. ? Being sure about key focuses †when you have discussions with others in which you are givingâ them data, you ought to consistently guarantee that they are clear what you have said toward the finish of the conversation. This is on the grounds that it very well may be anything but difficult to be diverted from the central matter of the discussion. When conversing with kids, consistently request that they rehash back to you what they have to do. ? Keeping up a comical inclination †in spite of the fact that the idea of our work in school is significant, we ought to likewise once in a while set aside effort to see the interesting side of vario us circumstances. Chuckling can be a decent icebreaker and is likewise an incredible method of unwinding and easing pressure. The most effective method to refer to Understanding The Principles Of Developing Postive Relationships, Papers

Error logging sentence corrections Essay Example | Topics and Well Written Essays - 250 words

Mistake logging sentence adjustments - Essay Example Lady shields the result of her delicacy and dedication for her kids and others, and the penances of ladies in life’s occasions, in which we as a whole take an interest. The support of ladies in playing out their job as moms in the public arena consistently shows up transcendently as identified with their youngsters. Working indefatigably for them to have the best and she is constantly worried about what befalls them. The essential factor in making a family bond is the mother, since she adds to the arrangement of her child’s enthusiastic and social turn of events. Her youngsters are increasing the greater part of the personal conduct standards from their mom. My days pass by more rapidly with the assistance of my family and with my job of being a pen at-home mother. These obligations are things that I love, yet in addition a requesting work. As a mother, I should give care to my youngsters, assume liability for my family and love them all simultaneously. I set up my fami ly through fondness, love persistence, delicate tuning in, reassuring and consolation. I additionally need to attempt to douse relational clashes in the family by looking out for every part with genuine delicacy. The home ought to be all around thought about and the training of kids is fundamental for the correct working of the family and society. This is each of the a piece of a mother‘s dedication to her kids.

To What Extent Does The Provision Of Interpreters In Public Services

To What Extent Does The Provision Of Interpreters In Public Services To What Extent Does The Provision Of Interpreters In Public Services In Britain Act As A Barrier To â€" Essay Example > @2011IntroductionInterpreters are translators of speech or spoken language with the aim of getting rid of the communication barriers between the communicators and none communicators of a certain language. This is effective in cases where foreigners are involved. They may not be conversant with the language as well operations of organization or nation hence the need for someone to guide and explain everything to them. Interpreters are trained depending on the areas of specialization. There are many sectors of public services in Britain which requires some professional interpreters to ensure that all the members of the public can access the services, for example, hospitals, solicitors, police and social services. These interpreters however have some negative impacts on the members of the public that they serve. The study below considers ways through which the provision of interpreters of public services in Britain acts as a barrier to integration of minority speakers. Interpreters o f public services in BritainMostly the work of the interpreters entails face to face communication as the professional interprets things to the clients. This is done through the context of arrival interviews or casework interviews whereby the interested individual is expected to book in advance. Both cases require provision of simultaneous translation of information or activities. With the advancement in technology, everything is turning to be online as people struggle to make things easier. Telephone interpreting is becoming very common in Britain especially in legal, health and local government (Great Britain. Parliament. House of Commons, 2004). The interpreters are required to have knowledge of all the languages used in the local communities as well as those that are internationally accepted like English. However some of the languages especially those used by people in the most marginalized areas are overlooked. The official language like English is the common used and accepte d especially in the professional fields like medicine and schools thus the minority speakers may not have equal opportunities to access the services because of the communication barrier. The public institutions make the languages used by the majority of the people the sole medium of public communication the minority language speakers feel isolated and not recognized in the society where they belong. The speakers of some of the minority languages personally complain when they object to the monolingual policy in reference to their own interests either as individuals or as a group. The less educated are the most affected because they may not be bale to access the information or services offered in the public institutions due to the communication barrier. The main complain is that the monolingual policies do not recognize the legitimate interests that they have in the struggle to accommodate their language. They also join hands to express their impersonal complains concerning the isola tion of the entire group. It is the interest of each member of the social group to have their cultural activities maintained like the indigenous language (Ostarhild, 2002). Provision of the interpreters in the public services shows that the state is encouraging monolingualism in which English is the language which is likely to be favored since it is considered as the national language in Britain. Instead of supporting and encouraging the locals to use their languages they discourage them by using English in most of the public offices even those located in the interior parts thus creating communication barriers between the locals and the professionals. There are some sensitive issues like in the health sector which the individuals may not be comfortable with the involvement of the third party as the interpreter since they are a bit confidential. Therefore, the affected ends up not accessing the required health services because of the fear of sharing their personal information to mo re people. The senior politicians are so keen on ensuring that the immigrants learn the majority languages so as to easily communicate to most of the people. This ends up stigmatizing the languages of the minority speakers because they are also forced to neglect their original languages and adapt those used by the major societies. The commitment of the government of the state to the process of monolingualism is reflected by designating only English language to be official and demanding all the workers to learn and consider using this language. Mostly these leaders prefer privileging their own languages for the material benefits of their social groups if identified as the major and superior groups in the state thus have some benefits over the other groups in the competition for the resources and other opportunities (Roda, 2000).

The Best Day of My Life Essay

Best Day of my Life The best day of my life was when I found out that I was not god. This might of course need some explanation on my part, but once you understand what I mean, you would get my drift. I grew up as a child with a lot of self-confidence. I was alone most of the time as I was living away from my parents with my grandfather. Despite being a small kid, I have been self-reliant in many things. I hardly went to others seeking for any kind of help. I tried to manage everything on my own. This was good in a way, but I also carried a lot of undue pressure, as I began to handle things on my own. In a way, I was the god of my life and I ran it the way I wanted. Although this made me look confident on the outside, I knew my own weaknesses and I was always a little insecure on the inside. I put on a brave front, but I was always afraid that I could come across a situation that I could not handle. The pressure was constantly on and I had a lingering fear of uncertainty. I never knew how I could get rid of my fear and regain stability in my life. That is when I realized that I was not made to be a god of my life, but that I was a creation of God, who was the Supreme Being. The day I realized that, the load on my shoulders fell away and I was free to be who I was. That day was the best day of my life.

IRVING Surname Meaning and Family History

The Irving surname generally  originated as a geographical surname, indicating someone who was from Irving, the name of a historic parish in Dumfriesshire, Scotland, or from Irvine in Strathclyde, Scotland.   It may also be a variant of Irvine, a habitational surname for someone from Irvine in Ayrshire, which is named for the  river Irvine that originates in Ayrshire and flows through Dumfriesshire, from the Welsh ir, yr,  meaning green or fresh, and afon, meaning water.   Surname Origin: Scottish, English Alternate Surname Spellings: IRVINE, IRVIN, IRWIN, IRWINE, URVINE, ERWIN, ERWINE, ERVING Where in the World is the IRVING Surname Found? While it originated in Scotland, the Irving surname is now most prevalent in the United States, according to surname distribution data from Forebears. However, it is more common, based on percentage of population, in Jamaica, followed by Micronesia, Isle of Man, Scotland, New Zealand, Taiwan and England. Within Scotland, Irving is still most common in Dumfriesshire, where it originated, ranking as the 3rd most popular surname in that area at the time of the 1881 census. The Irving surname is also popular in the Cumbria and Northumberland counties of England, according to  WorldNames PublicProfiler, followed by the Dumfries and Galloway council district in Scotland. It is also more common in Canada than in the United States, especially in Nova Scotia.   Famous People with the Last Name IRVING Sir Henry Irving -  British stage actor during the Victorian eraT. B. (Thomas Ballantyne) Irving  - publisher of the first American English translation of the QuranThomas Irving - Union navy sailor during the U.S. Civil War; recipient of the Medal of Honor for helping to rescue his grounded shipEdward Irving - Scottish clergymanWashington Irving - American author  best known for his short stories Rip Van Winkle (1819) and The Legend of Sleepy Hollow (1820). Genealogy Resources for the Surname IRVING Clan IrwinLearn about the history of this ancient Scottish border clan, plus upcoming events and tours. Clan Irwin Surname DNA StudyTradition recorded in the 17th century claims that the Irvines or Irvings of Eskdale and Bonshaw (in Dumfriesshire, in the Scottish Borders),  Castle Irvine (in Co.  Fermanagh,  in Ulster), Drum and Marr (in Aberdeenshire), Mearns (Kincardineshire), Orkney and Perthshire were all descended from a single ancestor, who was also the progenitor of the kings of Scotland from 1034 to 1286.  This study, with over 400 members, aims to use Y-DNA testing to sort out the various family branches. Most Common Scottish Surnames and their MeaningsCampbell, Stewart, Wilson, Reid, MacDonald... Are you one of the millions of  individuals of  Scottish ancestry sporting one of these top common last names from Scotland?   Irving Family Crest - Its Not What You ThinkContrary to what you may hear, there is no such thing as an Irving  family crest or coat of arms for the Irving surname.  Coats of arms are granted to individuals, not families, and may rightfully be used only by the uninterrupted male line descendants of the person to whom the coat of arms was originally granted. FamilySearch - IRVING GenealogyExplore over 400,000 historical records and lineage-linked family trees posted for the Irving surname and its variations on the free FamilySearch website, hosted by the Church of Jesus Christ of Latter-day Saints. IRVING Surname Family Mailing ListsRootsWeb hosts several free mailing lists for researchers of the Vanderbilt surname. DistantCousin.com - IRVING Genealogy Family HistoryExplore free databases and genealogy links for the last name Irving. The Irving Genealogy and Family Tree PageBrowse genealogy records and links to genealogical and historical records for individuals with the popular last name Irving from the website of Genealogy Today. ----------------------- References: Surname Meanings Origins Cottle, Basil.  Penguin Dictionary of Surnames. Baltimore, MD: Penguin Books, 1967. Dorward, David.  Scottish Surnames. Collins Celtic (Pocket edition), 1998. Fucilla, Joseph.  Our Italian Surnames. Genealogical Publishing Company, 2003. Hanks, Patrick and Flavia Hodges.  A Dictionary of Surnames. Oxford University Press, 1989. Hanks, Patrick.  Dictionary of American Family Names. Oxford University Press, 2003. Reaney, P.H.  A Dictionary of English Surnames. Oxford University Press, 1997. Smith, Elsdon C.  American Surnames. Genealogical Publishing Company, 1997. Back toGlossary of Surname Meanings Origins

Analysis Of Laura Palmer By Bastille / Running Away...

â€Å"Laura Palmer† by Bastille// Running Away From Pencey Prep The song â€Å"Laura Palmer† by Bastille reminds me of the scene in Catcher in the Rye where Holden ran away from Pencey Prep, thoroughly finished with the â€Å"morons† there. Pencey, the last school Holden attended, was full of phonies according to Holden. Although he did not like the people at Pencey, the school provided a generally stable environment for Holden. After Holden ran away from Pencey, he had three days to kill before the start of the Christmas break when he would have to face his parents. His parents would know â€Å"something was up† if Holden returned home early instead of at the start of the holiday. In these few days, Holden was denied the relative level of stability and comfort he enjoyed at Pencey Prep and was forced to face the hard reality of the outside world. As I picture Holden in this situation, I can visualize the song â€Å"Laura Palmer† through the lyric s â€Å"You ran into the night from all you had.† Thus, as in the song, Holden unknowingly left a good situation for one that was worse. This scene was significant to the story line launched Holden into a particularly self-destructive journey. The lyrics â€Å"Walking out into the dark† directly apply to Holden. If Pencey was the known and where Holden was going was the unknown, Holden was walking out from the light into the dark, as in the song. 2. â€Å"I Wanna Dance With Somebody† by Whitney Houston// Lavender Room â€Å"I Wanna Dance With Somebody† by

Looking at Othello as a Tragic Hero Essay example

Looking at Othello as a Tragic Hero Killing myself, to die upon a kiss. Othellos death brings a sense of justice to the play, one of the main forms and conventions of a tragedy. But if Othello is a tragedy then Othello must be a tragic hero. Traditionally a tragedy follows the downfall of an individual who is usually high up in society (such as a king). This downfall is triggered by a fatal flaw in the tragic heros character. During the play the audience must have many different feelings towards the hero, from respect to anger and maybe even pity. These may also turn to terror, as people close to the hero are hurt. Fate is seen to be predetermined and ensures that justice is seen to†¦show more content†¦Their use of racial comments such as Thick-lips and Old black ram imply that a black man is not a common sight especially of such a high rank. These racist images of Othello do not provide very good pictures for the readers and almost turn us against him. However in the next scene a very different version of Othello is shown. Othello is seen to be Hotly called for by the duke leading us to believe that he is a very important person. He commands respect from noble men like Montano and the Duke, suggesting that Othello is a noble man. Shakespeare then continues to build Othello up. We are shown how many people care for and respect the moor, for example when Othello is sailing to Cyprus Montano, Cassio and Desdemona are all concerned for his safety during the storm. When Cassio reaches the shore he begs the heavens to Give him defence against the elements implying his wish for Othello to arrive safely. This shows that many people look up to him and respect him. From this we can see that Othello is an honourable and respected man. He can sort out problems quickly and efficiently and he is confident that his services to Venice shall out-tongue his complaints. He believes that the Duke will be on his side because of his rank, so it does not matter what Brabantio has to say. If Othello is a tragic heroShow MoreRelatedOthello : An Aristotelian Tragedy And Tragic Hero1604 Words   |  7 PagesOthello, an Aristotelian Tragedy and Tragic Hero When reading a story, specifically a tragedy, what stands out? Tragedy often enables its audience to reflect on personal values that might be in conflict with civil ideas, on the claims of minorities that it neglected or excluded from public life, on its on irrational prejudices toward the foreign of the unknown (Kennedy Gioia, 2103, p. 857). Readers feel sympathy for the characters, especially the tragic hero. Othello, the Moor of Venice isRead MoreOthello is Not a Tragic Hero Essay1481 Words   |  6 PagesOthello has been described as one of William Shakespeare’s most popular plays because the play focuses on its themes of good and evil, military, politics, love and marriage, religion, racial prejudice, gender conflict, and sexuality; but the controversy and debate surrounding Othello is â€Å"Why is Othello a qualification for a tragedy?† Most readers are aware of the many famous deaths or acts of death within the Shakespearean plays. And when the main characters die in Shakespeare’s plays, indeedRead MoreOthello, By William Shakespeare Essay1203 Words   |  5 PagesDramatic play entitled Othello is an unusual story full of jealousy, dark misunderstandings, lies, and regrets. Following Aristotle s definition of a true tragedy, where does the tale of Othello fall? Is Othello too dramatic too be considered a tragedy or does it barely fall along the lines of tragic? Shakespeare s innovation with poetry and dramatic plays have been recognized by critics and playgoers throughout the centuries (Lee,1899). The Bard s play entitled Othello, is among some of the mostRead MoreThe Tragedy Of Othello By William Shakespeare1141 Words   |  5 Pages2 Hr 16 December 2014 Othello Essay The Tragedy of Othello The renowned play of Othello was written by William Shakespeare in the 17th century. The drama follows the life of Othello, a well-respected and admired Venetian general, and the lie he gets tangled up in. Othello is deceived by his â€Å"trustworthy† friend, Iago, who confidently convinces Othello that his honest wife, Desdemona, committed infidelity upon him with his honorable lieutenant, Cassio. At the start, Othello doesn’t quite believe IagoRead MoreTragic Hero in Othello by William Shakespeare1306 Words   |  6 Pagesprojecting. The entire play of Othello conveys a motion that of a Shakespearean Tragedy. 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Comparison of the Matrix and the Allegory of the Cave Essay

Composition I 3 October 2012 The Matrix and the Allegory of the Cave What if one were living through life completely bound and facing a reality that doesnt even exist? The prisoners in Platos Allegory of the Cave are blind from true reality as well as the people in the movie The Matrix. They are given false images and they accept what their senses are telling them. They believe what they are experiencing is not all that really exists. Plato, the ancient Greek philosopher wrote The Allegory of the Cave, to explain the process of enlightenment and what true reality may be. In the movie The Matrix, Neo (the main character) was born into a world of illusions called the Matrix. Neo’s true reality is being controlled by the†¦show more content†¦In The Matrix the puppet-handlers and the machines spawned from a singular consciousness called A.I. (artificial intelligence). In both The Matrix and Allegory of the Cave, the puppeteers have created artificial surroundings as a way to control and operate the information the prisoners receive. Plato also stated that eventually one of the more intellectual prisoners would break free from the cave and into the outside world. The one prisoner that Plato refers to reflects Neo in The Matrix when he is being released from his pod that the machines have created. Once the prisoner of the cave has broken free he can now look all around him and see the objects as they really are. While in the movie The Matrix, Neo is using is own eyes for the first time and sees that he is actually living in a human factory. In Platos Allegory of the Cave, he states that the freed prisoner would be shocked and not used to the outside world. The prisoner would try to think that what he saw and experienced before was truer than what is he sees now. 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Medical Home Practice-Based Care Coordination Free Essays

string(176) " perception of barriers to care coordination in the medical home includes: time, reimbursement, lack of physicians, lack of skill/training, and limited cultural effectiveness\." Medical Home Practice-Based Care Coordination: A Workbook By: Jeanne W. McAllister Elizabeth Presler W. Carl Cooley Center for Medical Home Improvement (CMHI) Crotched Mountain Foundation Rehabilitation Center; Greenfield, New Hampshire Beyond the Medical Home: Cultivating Communities of Support for Children/Youth with Special Health Care Needs Funded by: H02MC02613-01-00 United States Maternal and Child Health Bureau, Integrated Services for CSHCN, HRSA June 2007 Workbook Contents This workbook includes the tools and supports needed for a primary care practice to develop their capacity to offer a pediatric care coordination service; particularly for children with special health care needs. We will write a custom essay sample on Medical Home Practice-Based Care Coordination or any similar topic only for you Order Now The health care team, determined to develop such an explicit service, makes an assessment of current care coordination practice and frames their improvement efforts to achieve proactive comprehensive practice-based care coordination. Tools included in this resource are: a definition of care coordination in the medical home, a care coordination position description, a framework for care coordination services including structures and processes, strategies for the protection of devoted staff time, and a logical sequence of care coordination improvement ideas offered in the context of the Model for Improvement (Langley, 1996). Each tool can be used as is or it can be customized in a manner which best fits your practice environment and the strategic plans your organization holds for medical home improvement activities. Table of Contents Medical Home Practice Based Care Coordination Medical Home Care Coordination A Definition A Vision Is It Medical Home Care Coordination? A Checklist Medical Home (Practice Based) Care Coordination – Position Description – A Worksheet A Medical Home (MH) Care Coordination Framework – Framework – Worksheet Time Protection Tips Strategies †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 3 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦5 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 6 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦7 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦9 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 10 †¦Ã¢ € ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 11 Care Coordination Development: The Model for Improvement †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦12 Care Coordination Aim Statement †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦13 Care Coordination Outcomes †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦14 Plan Do Study Act (PDSA) Worksheet Examples †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦15 1) Care Coordination Role/System †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦16 2) Care Coordination – Needs Assessment †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦18 3) Comprehensive Care Planning †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦20 Medical Summary, Action Emergency Plans 4) Transition to Adult Care Services †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦22 5) Community Outreach Resources †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦24 Appendices A. Websites and References †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦.. 26 2 Medical Home – Practice-Based Care Coordination This workbook is designed to support practice-based quality improvement teams in their efforts to build comprehensive primary care â€Å"medical homes†. The focus is specifically upon the professional role development for the provision of practice-based care coordination. The ideal care scenario is one where the staff within the medical home is proactively prepared to support the central care giving role of families. The role of care coordination discussed within this workbook is one designed in the service of children/youth with special health care needs (CYSHCN). It is acknowledged that care coordinators in different environments will apply their skills and efforts toward the care of all children as well as adults with special needs or chronic health conditions; you should find the structures and processes offered within suitably applicable. Workbook Goals and Objectives: Goal: To put forth a practice-based medical home care coordination framework from which practices can select and suitably customize. Contents include a medical home care coordination checklist, definition, position description, model framework with structures and processes, and strategies for effective and successful care coordination development and implementation. Objectives: 1) Define practice-based care coordination for children with special health care needs in a medical home ) Select and appropriately modify a position description that fits each unique medical home improvement team environment 3) Use a care coordination model framework to fit the role well within each practice environment 4) Draw from a list of time protection and resource allocation strategies those with the best fit for the practice environment and related improvements 5) Develop tests of change (PDSA – plan, do, study, act) for the incremental development of a comprehens ive care coordination service model to include: care services, assessment of needs, care planning, transition support, and community outreach with resource linkages. It is established in the literature that the medical home is meant to be a centralizing resource for children and families, particularly for CYSHCN (AAP Medical Home Advisory Committee, 2002) Evidence is building that care coordination is essential to a medical home (Antonelli, 2004). It has been suggested that you cannot be a strong medical home without the capacity to link families with a designated care coordinator; this is the ideal. The policy statement issued by the American Academy of Pediatrics on Care Coordination (CC) describes CC as complex, time consuming, even frustrating but as key to effective management of complex issues in a medical home; and states that a designated care coordinator is necessary to facilitate optimal outcomes and prevent confusion. Care coordination takes resources and time. Practices need to be reimbursed for this labor intensive role (AAP Committee on Children with Disabilities, 1999). Horst, Werner, and Werner (2000) state that in all types of systems, care coordination is an essential element to ensure quality and continuity of care for CSHCN and their families. In a 10 point strategy to 3 achieve transformational change within health care for all, issued by the Commonwealth Fund, care coordination is cited as one of ten key components to organize care and information around the patient (Davis, K. 2005). Ideal care coordination provides timely access to services, continuity of care, family support, strengths-based rather than deficit-based thinking and advocacy. This is very time consuming, whether accomplished by parents or by parent professional partnerships (Presler, 1998). At the front lines of care, in the medical home Antonelli (2004) states that without the ability to support care coordination at the level of the medical home, barriers to achieve the Healthy People 2010 objectives remain. In the Future of Children (2005) the author claims that care coordination requires (at the very least) adequate personnel and time and is often limited in primary care by lack of the very time and resources necessary. This is substantiated by the AAP Periodic Survey of Fellows #44, (2000), by a national Family Voices Survey (2000) with parents reporting their physicians have the skill for coordination but are difficult to access and have minimal time available for care coordination activity/implementation. Similarly a survey of state Title V Directors and their perception of barriers to care coordination in the medical home includes: time, reimbursement, lack of physicians, lack of skill/training, and limited cultural effectiveness. You read "Medical Home Practice-Based Care Coordination" in category "Papers" Successful medical homes result when partnerships with families offer fully implemented practice-based care coordination. Proactive care coordination and care planning are fundamentally essential for improved care quality, access to services and resources, health and function of children and youth, and quality of life as well as improved systems of care. No medical home will achieve optimal comprehensive, coordinated and compassionate care without dedicated time and resources to develop, implement, and evaluate a complement of care coordination activities. Such an investment is favorable in terms of cost and benefit for children/youth and families, primary care practices and their broader health care systems. In summary, care coordination: Is accomplished everyday by families with and for their children and youth, but Support is desirable, feasible and beneficial coming from the medical home Requires critical funding and protected time Requires tested tools and strategies (some are included in this workbook, others have been developed and continue to evolve) Is a defining characteristic (element) of a fully implemented and comprehensive medical home Medical Home Care Coordination – A Definition The literature offers several definitions of care coordination but most have been written for application across varied health care environments such as hospitals, specialty based centers, community home health agencies. Few definitions focus exclusively on the distinctions found within the primary care medical home for the role of pract ice-based care coordinator. The focus of the Center for Medical Home Improvement is on the primary care practice with the provision of team-based care coordination, delivered from the centralizing resource of a primary care medical home with physician leadership and by experienced nurses, social workers, and/or comparable professionals. Care Coordination Practice-based care coordination within the medical home is a direct, family/youth-centered, team oriented, outcomes focused process designed to: Facilitate the provision of comprehensive health promotion and chronic condition care; Ensure a locus of ongoing, proactive, planned care activities; Build and use effective communication strategies among family, the medical home, schools, specialists, and community professionals and community connections; and Help improve, measure, monitor and sustain quality outcomes (clinical, functional, satisfaction and cost (McAllister, et al, 2007) A Vision for Practice Based Care Coordination Children, youth, and families have seamless access to their team, enhanced by they availability of a designated care coordinator who facilitates a team approach to family-centered care coordination services. (McAllister, et al, 2007) 5 CC CHECKLIST Is It Medical Home Care Coordination? Checklist – how are you doing? What elements are in place, which require some additional attention? NO / PARTIALLY/ YES 1) Families know who their care coordinator is and how to access him or her (or their backup)? ) Values of family-centeredness are known to the medical home team and drive the development and provision of care coordination? 3) A medical home care coordination position description is established; roles/activities are clearly articulated and care coordination training and education is available? 4) Administrative leadership helps to develop/support a care coordination service system; protected time allows for CC role development? 5) C YSHCN identification and assessment of child/family needs/unmet needs are completed; care planning is a core CC/medical home response? ) Education and counseling are offered as an essential part of medical home care coordination? 7) Care coordination includes comprehensive resource information, referrals, and cross agency/organization communication? 8) Child/family advocacy is a part of care coordination 9) Families are asked for feedback about their experiences with health services/care coordination? 10) Medical home system improvements are implemented simultaneously with the development of care coordination (care coordinator contributes to this quality improvement process)? 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 1 2 2 3 3 1 2 3 1 2 3 Total score: _________/ out of 30. Notes: 6 Medical Home (Practice Based) Care Coordination – Position Description The care coordinator works within the context of a primary care medical home, from a team approach, and in continuous partnership wi th families and physicians to promote: timely access to needed care, comprehension and continuity of care, and the enhancement of child and family well being. Care Coordination Qualifications: The care coordinator shall have: Bachelor’s preparation as a nurse, social worker, or the equivalent with appropriate past experience in health care Three years relevant experience, or the equivalent, in community based pediatrics or primary care, particularly in the care and service of vulnerable populations such as children/youth with special health care needs (CYSHCN) Essential leadership, advocacy, communication, education and counseling, and resource research skills Core philosophy or values consistent with a family-centered approach to care Culturally effective capabilities demonstrating a sensitivity and responsiveness to varying cultural characteristics and beliefs Medical Home Care Coordination Responsibilities The care coordinator will: 1) Demonstrate and apply knowledge of the philosophy/ principles of comprehensive, community based, family-centered, developmentally appropriate, culturally sensitive care coordination services 2) Fac ilitate family access to medical home providers, staff and resources 3) Assist with or promote the identification of patients in the practice with special health care needs (such as CYSHCN); add to registry and use to plan and monitor care 4) Assess child/patient and family needs and unmet needs, strengths and assets 5) Initiate family contacts; create ongoing processes for families to determine and request the level of care coordination support they desire for their child/youth or family member at any given point in time 6) Build care relationships among family and team; support the primary care-giving role of the family 7) Develop care plan with family/youth/team (emergency plan, medical summary and action plan as appropriate) 8) Carry out care plans, evaluate effectiveness, monitor in a timely way and effect changes as needed; use age appropriate transition timetables for interventions within care plans 9) Serve as the contact point, advocate and informational resource for family and community partners / payers 10) Research, find, and link resources, services and supports with/for the family 11) Educate, ounsel, and support; provide developmentally appropriate anticipatory guidance; in a crisis, intervene or facilitate referrals appropriately 12) Cultivate and support primary care subspecialty co-management with timely communication, inquiry, follow up and integration of information into the care plan 13) Coordinate inter-organizationally among family, medical home, and involved agencies; facilitate â€Å"wrap around† meetings or team conferences and attend community/school meetings with family as needed and prudent; offer outreach to the community related to the population of CYSHCN 14) Serve as a medical home quality improvement team member; help to measure quality and to identify, test, refine and implement practice improvements 15) Coordinate efforts to gain family/youth feedback regarding their experiences of health care (focus groups, surveys, other means); participate in interventions which address family/youth articulated needs 7 Position Description Worksheet Medical Home (Practice Based) Care Coordination Position Description Responsibilities Worksheet – Customize for Your Practice Care Coordination in a Medical Home – The Care Coordinator will: 1) Demonstrate and apply knowledge of the philosophy/ principles of 2) 3) comprehensive, community based, family-centered, developmentally appropriate, culturally sensitive care coordination services Facilitate family access to medical home providers, staff and resources Assist with or promote the identification of those with special health care needs (such as CYSHCN); add them to the registry and use it to plan and monitor care Assess child/patient and family needs/unmet needs, strengths and assets Initiate family contacts; create ongoing processes for families to determine and request the level of care coordination support they desire for their child, youth or family member at any given point in time Build care relationships among family and team; support the primary care giving r ole of the family Develop care plan with family/youth/team (emergency plan, medical summary and action plan as appropriate) Carry out care plans, evaluate effectiveness, monitor in a timely way and make changes as needed; use age appropriate transition imetables for interventions within care plans Serve as contact point, advocate and informational resource for family and community partners/payers Research find, and link resources, services and supports with/for the family Educate, counsel, and support; provide developmentally appropriate anticipatory guidance; in a crisis, intervene or facilitate referrals appropriately Cultivate and support primary care subspecialty co-management with timely communication, inquiry, follow-up and integration of information into the care plan Coordinate interorganizationally among family, the medical home, and involved agencies; facilitate â€Å"wrap around† meetings or team conferences and attend community/school meetings with family as need ed and prudent; offer outreach to the community related to the population of CYSHCN Serve as a medical home quality improvement team member; help to measure quality and to identify, test, refine and implement practice improvements Coordinate efforts to gain family feedback regarding their experience with health care(focus groups, surveys, other means); participate in interventions that address family/youth articulated needs Accept Reject 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) *** Add additional key responsibilities here (use additional paper): 8 A Medical Home (MH), Team Based, Care Coordination (CC) Framework Fundamental Tools Structures Medical Home Interventions Access to Medical Home, Health Care and Other Resources Identify and register the CYSHCN opulation Establish with families effective means for medical home/office access Provide accessible office contract for family and community agencies Catalog resources to link families to appropriate educational, information and re ferral sources Promote and â€Å"market† practice-based care coordination to families and others (e. g. brochures, posters, outreach efforts) Establish alliances with community partners Facilitate practice family linkages with agencies (e. g. family support, schools, early intervention, home care, day care agencies offering respite, housing, transportation) Align transition support activities with schools other groups Collaborate to improve systems of care for CYSHCN (families, payers, provides, and agencies) Community Connections Fundamental Processes Proactive Care Planning Medical Home Interventions Help to maintain health and wellness prevent secondary disease complications Maximize outcomes (e. g. lleviation of the burden of illness, effective communication across organizations, enrollment in needed services, and school attendance/success) Listen, counsel, educate, foster family skill building Screen for unmet family needs Develop written care plans; implement, moni tor and update regularly Plan for future transition needs; incorporate into plan of care Facilitate subspecialty referrals, communication help family integrate recommendations of specialists Link family, staff to educational/financial resources †¢ †¢ †¢ †¢ Establish alliances with community partners Facilitate practice family linkages with agencies (e. g. family support, schools, early intervention, home care, day care agencies offering respite, housing, transportation) Align transition support activities with schools other groups Collaborate with families, payers, providers and community agencies to improve systems of care for CYSHCN Improving and Sustaining Quality 9 Framework Worksheet A Medical Home (MH) Care Coordination Framework – WORKSHEET Fundamental Structures Access to Medical Home, Health Care and Other Resources Who? How? Medical Home Interventions Identify and register the CYSHCN population Establish with families effective means for medical home/office access Provide accessible office contract for family and community agencies Catalog resources to link families to appropriate educational, information and referral sources Promote and â€Å"market† practice-based care coordination to families and others (e. g. brochures, posters, outreach efforts) Establish alliances with community partners Facilitate practice family linkages with agencies (e. g. family support, schools, early intervention, home care, day care agencies offering respite, housing, transportation) Align transition support activities with schools other groups Collaborate to improve systems of care for CYSHCN (families, payers, provides, and agencies) Community Connections Fundamental Processes Proactive Care Planning Medical Home Interventions Help to maintain health and wellness prevent secondary disease complications Maximize outcomes (e. g. alleviation of the burden of illness, effective communication across organizations, enrollment in needed services, and school attendance/success) Listen, counsel, educate, foster family skill building Screen for unmet family needs Develop written care plans; implement, monitor and update regularly Plan for future transition needs; incorporate into plan of care Facilitate subspecialty referrals, communication help family integrate recommendations of specialists Link family, staff to educational/financial resources †¢ †¢ †¢ †¢ Establish alliances with community partners Facilitate practice family linkages with agencies (e. g. amily support, schools, early intervention, home care, day care agencies offering respite, housing, transportation) Align transition support activities with schools other groups Collaborate with families, payers, providers and community agencies to improve systems of care for CYSHCN Who? How? Improving and Sustaining Quality 10 Time Protection Tips Strategies The statement (on page 4) that no medical home will achieve optimal comprehensive, coordinated and compassionate care without dedicated time and resources to develop, implement, and evaluate a complement of care coordination activities warrants a few tips about how to achieve such dedicated time. Ideas for the successful implementation of practice based care coordination include administratively supported techniques and the resulting implemented care coordination (systematic) processes. Consider the following suggestions for time protection and use them to craft your own strategic approaches. Administrative Strategies for Achieving Some â€Å"Think† and Implementation Time Personnel – proactively allocate a block of dedicated time. This includes the number of hours, days and time blocks or hours and how those hours will be prepared for, spent and accounted for. (This can be done as a trial or test of change) You may need a private place, an office, or even a â€Å"my care coordination development hat is on today† sign! Clear activities – Use the position description and the CC framework on page 9 to select the focus and logical progression of this role development and how time will be spent Determine how you will document and/or account for this time Team based care coordination – determine how you will allow for the development of care coordinator – family partnership. Could there be a designated clinic time for specific group of CYSHCN, or a special condition focused approach with a care coordination protocol? Some practices have held what is referred to as a DIGMA (drop in group medical appointments) for a group of families with children with similar conditions. A DIGMA can take on many forms such as family education, community resource connections, or even time for care coordination introduction and development with the opportunity to meet, greet and complete care plans. Approaches Helpful to Building Time into Your System Use your population identification system to determine who needs care coordination Use the development of your CC role to establish systematized screening assessments and resulting care planning and monitoring Hold medical home related staff meetings; offer education regarding CYSHCN and gain buy-in and staff understanding for the value of providing care coordination Engage families who can educate staff about the complexity of their child’s needs Create a reporting line to senior leaders from the Care Coordinator so that CC development is built into their role expectation Develop the capacity for care coordination â€Å"rounds† by discussing direct CC efforts around individual children and youth with staff; gaining the input of colleagues will help you with staff education and their buy in to the medical home and practice-based care coordination approach; all will then learn about complex health and community based n eeds and resources Maximizing Reimbursement for Care Coordination: Ensuring affordability and sustainability by: Developing smart legitimate up-coding; Tracking CC data (service/outcome) to negotiate new payment opportunities Prepare for the use of new codes (care plan oversight) Become aware of and access Title V supports 11 Care Coordination Development: 1) The Model for Improvement 2) Care Coordination Aim Statement 3) Plan Do Study Act (PDSA) cycles or â€Å"tests of change† Model for Improvement Questions 1) What are we trying to accomplish? Medical Home Improvement Responses Medical Home – Care Coordination 2) How will we know that a change is an improvement? Measures – Medical Home Index, Medical Home Family Index Survey, Other 3) What changes can we make that will result in an improvement? Good ideas – ready for use (e. g. CC definition, job description, framework activities, PDSA examples 12 2) Care Coordination Aim Statement A good aim statement includes the following elements: Population – CYSHCN Timeframe – by when Intent – what/why Stretch goals – e. g. identify 100% CSHCN Example: Overarching Aim – Care Coordination Between Learning Session 2 and spring of 2006 we will customize and use a model of medical home care coordination for children/youth with special health care needs so that a position description and framework of activities are explicit, with time protected and accounted for and ~ 75% (goal) of children, youth and families report that they: Know who their care coordinator is Know they are receiving care coordination Participate in decisions about the level of care coordination needed Are satisfied with their access to care, care coordination, and resources (most of the time) For Veterans – Advanced Care Coordination Aim Goals Youth and families report that: A transition timetable is shared among family, practice and community professionals They have coordinated support getting their child’s needs met within the community and from sub-specialists 13 Thinking Through Some Measurement Ideas – For Practice-Based Care Coordination – PDSA Cycles Care Coordination Outcomes Family satisfaction decrease in worry and frustration (CMHI survey tools) increased sense of partnership with professionals (CMHI survey tools) improved satisfaction with team communication (CMHI survey tools) Staff satisfaction improved communication and coordination of care improved efficiency of care elevated challenge and professional role Improved child/youth outcomes Decrease in ER visits, hospitalizations, school absences (family, plan report) Increase in access to needed resources (CMHI survey tools) Enhanced self-management skills (CMHI survey tools) Improved systems outcomes decreased duplication decreased fragmentation improved communication and coordination (CMHI Medical Home Index) 14 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 15 CMHI Plan-Do-Study-Act (PDSA) Worksheet PDSA Example Team: #1 Care Coordination Role/System Aim: Use from page 13 or create own PLAN: Objective: (Including details (who, what, where, when) We will develop and test a clearly defined system of care coordination (CC) services using strategies that fit our practice environment. This will include the use of a: 1) clear CC definition, 2) CC position description and 3) CC framework with an outline of activities. CC role, contact and access information will be explicit for families. {Our test of change will include dedicated time for the CC to share plans with staff and implement CC PDSA cycles (see examples in following pages). We will feed back lessons learned to our Medical Home Improvement team for guidance and direction. What additional information will you need to take action? Knowledge of and securing the availability of senior leader support with designation of one (or more) staff members to provide CC leadership What do you predict will happen? There will be false starts with â€Å"tyranny of the urgent† keeping us from our task; our will, ideas and execution will overcome this in the end. How will you know your change is an improvement? Staff/families begin to ask for care coordination / CC activities (e. g. care plan); selected outcome measures improve (see page 14) DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 16 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 17 CMHI Plan-Do-Study-Act Worksheet PDSA Example Team: #2 Care Coordination Needs Assessment Aim: Use from page 13 or create own PLAN: Objective: (Including details (who, what, where, when) With MH lead physician review pending CYSHCN visits; select 3 CYSHCN who will benefit from an assessment for care coordination. By â€Å"a week from next Tuesday† complete an assessment (e. g. parent/youth screening tool in appendices behind page 26) either before the office visit or by pre-visit phone call. Begin care planning process with child/youth and family What additional information will you need to take action? Listing of pending CYSHCN visits from the CYSHCN list or â€Å"registry† What do you predict will happen? Some false starts finding the right CYSHCN and with timing; we will succeed if persistent over slightly longer time span How will you know your change is an improvement? Follow up with 3 families in 2 weeks to determine if pre-visit assessment and follow-up planning are helpful and what needs to be added/improved; review value with lead physician as well. DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 18 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 19 CMHI Plan-Do-Study-Act Worksheet PDSA Example #3 Comprehensive Care Planning Team: Aim: Use from page 13 or create own PLAN: Objective: (Including details (who, what, where, when) 1) Develop/choose care plan medical summary and use with 5 identified CYSHCN/week. 2) Add an emergency plan if warranted. ) Study provider and family feedback and integrate to improve the plan and the process for plan use. Create immediate action plan for how to meet resource, educational and other needs of CYSHCN/patient and family 4) Use lessons learned to share, engage, educate and spread medical home to staff. What additional information will you need to take action? Sample care plans to choose from using team priorities; identified CYSHCN with pending visit to initiate plan with. Also identify educational needs of staff /families. What do you predict will happen? Will start slow, 1-2 per week and pick up speed to reach 5. Value will result in better preservation of care coordinator time to complete plans, thus increased use of CC and team process. Ultimately, we may schedule comprehensive care planning â€Å"rounds† with team/staff; review 3-5 CYSHCN/patients who are receiving this care coordination. Use rounds to review successes, challenges, needs of child/family with staff and address questions. How will you know your change is an improvement? Review with families for benefit, follow up in 4-6 weeks; review also with staff DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 20 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 21 CMHI Plan-Do-Study-Act Worksheet PDSA Example #4 Transition to Adult Care Services; Up-coding to maximize reimbursement Team: Aim: Use from page 13 or create own PLAN: Objective: Have MD Care Coordinator jointly see (2) YSHCN family for transition visit; use a transition assessment (timetable) checklist to guide the visit and align activities with community partners. Bill for visit – document nature of complexity Details (who, what, where, when) CC Schedules 2 YSHCN for transition care plan visit next week, with family permission informs/communicates with key community partners about assets needs. Codes for â€Å"99214† for 60 minute visit with established patient and document extent and complexity of the visit What additional information will we need to take action? – Extract from list of CYSHCN youth over 14 due for visit; communicate with family and learn community partners – Clarify with senior leaders ability to track reimbursement results for these visits What do we predict will happen? (E. g. May take time to match YSHCN with open slots; will need to follow up with payers for denials and use documentation to justify activities). How will you know your change is an improvement? Review with family staff; community partners. Select other ongoing measures (p14) DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 22 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 23 CMHI Plan-Do-Study-Act Worksheet PDSA Example #5 Community Outreach / Resources Team: Aim: Use from page 13 or create own PLAN: Objective: (Including details (who, what, where, when) Plan for care continuity across the: medical home, school, and community agencies with 4 families and children/youth over the next four weeks. Use a selected communication strategy (fax back, email, NCR paper, electronic forum, other) to centralize key information with strengths, goals, care plans, access information, and releases fostering cross organizational communication; the CC performs as a â€Å"hub of the wheel function† in these activities. What additional information will you need to take action? Identification of children/youth and families in need of transition and/or community-based coordination; identification of key community partners; consensus on communication strategy What do you predict will happen? Territorial barriers will crop up and family will need to be front and central to the process. How will you know your change is an improvement? Review with family and agencies whether there has been improved care communication, also consider other systematized outcome measures (see page 14). DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 24 PDSA Worksheet PDSA Team: Aim: CMHI Plan-Do-Study-Act Worksheet PLAN: Objective: (Including details (who, what, where, when) What additional information will you need to take action? What do you predict will happen? How will you know your change is an improvement? DO: Was the plan carried out? What was observed that was not part of the plan? STUDY: What happened? Is this what you predicted? What new knowledge was gained? ACT: As a result, list next actions: Are there organizational forces that will help or hinder efforts? Objectives for next test of change: 25 Appendices A. Key Websites for Care Coordination Tools 1) Center for Medical Home Improvement (CMHI): www. medicalhomeimprovement. org 2) National Center for Medical Home Initiatives (AAP) www. medicalhomeinfo. org 3) Utah Medical Home Portal www. medhomeportal. org References 1) McAllister, J. W. , Cooley, W. C, Presler, E. Practice-Based Care Coordination: A Medical Home Essential. Pediatrics, Volume 120, Number 3, September 2007, e1e11. 2) American Academy of Pediatrics, Medical Home Initiatives for Children with Special Health Care Needs Project Advisory Committee. The medical home. Pediatrics, 2002; 110:184-186. 3) American Academy of Pediatrics, Committee on Children with Disabilities. Care Coordination: Integrating Health and Related Systems of Care for Children with Special Health Care Needs, Pediatrics, 1999, Vol. 104:978-981. 4) American Academy of Pediatrics, Division of Health Policy Research. Periodic Survey of Fellows #44. Health Services for Children with and without Special Needs: The Medical Home Concept Executive Summary. Elk Grove Village, Illinois: American Academy of Pediatrics; 2000. Available at: www. aap. org/research/ps44aexs. htm. Accessed April, 2005. 5) Antonelli, R. , Antonelli, D. , Providing a Medical Home: The Cost of Care Coordination: Services in a Community-Based, General Pediatric Practice. Pediatrics (Supplement) 2004; Vol. 113: 1522-1528 6) Cooley, W. C. and McAllister, J. W. Building Medical Homes: Improvement Strategies in Primary Care for Children with Special Health Care Needs. Pediatrics (Supplement) 2004; 113: 1499-1506. ) Davis, K. , Transformation Change: A Ten Point Strategy to Achieve Better Health Care for All. The Commonwealth Fund. Accessed at www. cmwf. org April 13, 2005. 8) Family Voices. What Do Families Say About Health Care for Children with Special Health Care Needs in California: Your Voice Counts. Boston, MA: Family Voices at the Federation for Children with Special Health Care Needs; 2000. 9) Future of Children, Health Insurance for Children; Care of children with Special Health Care Needs. Key Indicators of Program Quality. Available at www. futureofchildren. org/information2827/Accessed April 13, 2005. 10) Horst, , Werner, R. , Werner, C. 2000) Case management for children and families Journal of Child and Family Nursing, 3, 5-14. 11) Langley, G. J. , et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Jossey-Bass, San Francisco, 1996. 12) Lindeke, L. L. , Leonard, B. J. , Presler, B, Garwick, A, Family-centered Care Coordination for Children with Special Health Care Needs across Settings. Journal of Pediatric Health Care, Vol. 16, No. 6, November/December, 2002, 290-297 ** 13) Presler, B. (1998, March/April) Care Coordination for Children with Special Health Care Needs. Orthopedic Nursing, (Supplement), 45-51. 26 CMHI Center for Medical Home Improvement (CMHI ) Crotched Mountain Foundation Greenfield, New Hampshire 2007 27 How to cite Medical Home Practice-Based Care Coordination, Papers

What are the key issues deciding to purchase for zara internally and externally free essay sample

Speed and responsiveness to Market, Zara has changed the way clothing industry works where deigning, production and delivery to the retailers requires period of six months. The design and distribution cycle of the company takes just 10-15days in the whole process. Zara’s speed to market in product development exceeds the capabilities of its competitors. This in itself provides additional value to stakeholders, customers, and stores in producing quality clothing at affordable prices. The proximity of their manufacturing and operational processes allows Zara to maintain the flexibility necessary to design and produce over 12000 new items annually. This capability allows Zara to achieve their strategy of expedited response to consumer demand. The process of obtaining market information and relaying it to design and production teams expedites product development by shortening the throughput time of their products from design to store. Dependability Due to Zara’s ownership and control of production, they ensure timely delivery and service. We will write a custom essay sample on What are the key issues deciding to purchase for zara internally and externally or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Although most of their stores run out of stock, signifying that they have low dependability in terms of product availability, another perspective of dependability in terms of keeping to date with fashion is achieved. Quality Zara brand has been said to be ‘synonymous with the cutting edge of fashion at affordable prices. ’ (123helpme. com, 2008) Another Quality advantage is the added sense of quality to the product as the tags would be labelled with â€Å"made in Europe† rather than â€Å"made in China† due to Zara’s trade-off between Low labour costs in Asia and operational efficiency. Flexibility: Designers (of average age 26) draw the design sketches then discuss it with market specials and planning procurement staff illustrating a flexibility of ideas generation and on the other hand the huge number of designs reflects the ability to meet almost all the fashion requirements by customers of all ages (up to 55). This adaptive model rather than traditional merchandising is very different from its competitors. Many competitors rely on a small elite design team that plans both design and production needs well in advance. Stores have little autonomy in deciding which products to display or put on sale because Headquarters plans accordingly and ships quantities as forecasted. Zara owned many of the fabric dying, processing and cutting equipment that provided Zara added control and flexibility to adopt new trends on demand. The added flexibility helped Zara on two fronts: shorter lead times and fewer inventories. (OPPapers. com, 2009) Cost: Zara produces most of its products in Europe. Compared to their competitors, they outsource very little to Asia [6] . Though the cost of production in Spain is 17-20% more expensive than Asia, Zara does have a competitive advantage over its competitors in regards to operations. Though there is a cost advantage in their approach in regards to labour, the lack of flexibility in changing orders based on current trends hinders their operational efficiencies. Inventory costs are higher for competitors because orders are placed for a whole season well in advance and then held in distribution facilities until periodic shipment to stores. Lower inventory cost is a key sustainable advantage as it enables Zara to manufacture and sell its products at cheaper prices. A case study analysis of Zaras Operations Strategy Zara is the largest division and flagship brand of the Spanish retail group Inditex [1] . It sells up-to-the-minute ‘fashionability’ at low prices, in stores that are clearly focused on one particular market. (Slack, Chambers, Betts, Johnson, 2006) The first store opened by accident in 1975 due to a large pyjamas order cancellation. This typically can be said to be an emergent strategy as the Zara store today was not an intended strategy. [2] As described in a case study of Zara’s supply chain, the company is vertically integrated, controlling most of the processes in its supply chain. On the average, 50% of its products are manufactured in Spain, 26% in the rest of Europe and 24% in Asian countries. Zara outsources products of high labour intensive processes but maintains in-house capital intensive processes, protecting knowledge and know-how. It takes less than two weeks for a skirt to get from Zaras design team in Spain to a Zara stores in any part of the globe, as much as 12 times faster than the competition. And with shorter lead times, Zara can ship fewer pieces, in a greater variety of styles, more often and they can more easily cancel lines that dont sell as well, avoiding inventory backlogs. (Upadhyay, 2009) Zara’s quick response capacity is made possible by the fact that it controls the 3 main stages of its operations that define the competitive edge of the company: design, manufacturing and distribution. This strategy is embraced to focus on the operations which can enhance cost efficiency while boosting service delivery and value proposition. As a fashion imitator, Zara ‘s priority was to focus its attention on understanding the dynamic fashion trends, aligning these changes to meet its customers’ wants rather than on promoting predicted seasons trends via fashion shows and similar channels of influence, which the fashion industry traditionally used. Other production activities are completed via a network of about 500 subcontractors in close proximity to Zara’s operations at La Coruna. Mr. Ortega the CEO of the Inditex, the parent company of Zara, once said that the secret to retail success is to have five fingers touching the factory and five touching the customer. (Slack Lewis, Operations Strategy, 2008) This paper uses the models and frameworks of the Operations Strategy module to describe analyze how Zara’s operations strategy led to a sustainable competitive advantage in the global apparel industry. 2 Introduction Zara is the flagship brand of the Spanish retail group, Inditex SA, one of the super-heated performers in a soft retail market in recent years. The first Zara shop opened its doors in 1975 in La Coruna, GaliciaSpain, the city that saw the Groups early beginnings and which is now home of its central offices. Its stores can now be found in the most important shopping districts of more than 400 cities in Europe, the Americas, Asia and Africa. With year-on-year sales increasing at around 25% over the last 5 years, it has become one of the world’s fastest growing retailers. As of late last year, Zara had 350 shops in Europe, 18 in the Middle East, 52 in the Americas and five in Asia. With roughly 40% of Inditex shops, Zara brings in about 80% of the groups revenue.(Zara founder makes a mint, 2001) As retailers like Marks Spencer and Gap join retailers in reporting falling profits, what makes a Spanish retailer to announce profit and Growth and assume this post as forthcoming leader in the fashion retail industry? What Ortega, the founder of Inditex, saw that others didn’t see? What is Zara Business Model? What is Z ara strategy? What are the factors behind the success of Zara? How scalable its model is? What are the challenges? How Zara would cope with the challenging environment of fashion retail business faced nowadays by the leaders in this industry? Amancio Oretga thought that customer would regard clothes as perishable commodity – no different from yogurt or bread- to be consumed rather than stored in closets, and has gone about building a retail business that provides â€Å"freshly baked clothes â€Å". By Focusing on apparel as product for consumption Zara compete on speed. This business is all about reducing response time. In fashion stock is like food it goes bad quickly. So, Zara concentrates on three winning formulas: Offering fashionable variety with limited supply at affordable price (cost) with a quick response to market.(Devangshu Dutta 2002) 3- Zara Vertical integrated Supply Chain An efficient supply chain is becoming more and more key success factor for companies. Henry Ford assembly line was the event of mass industrial production. Is supply chain management the new differentiation for companies? According to McMillan and Mullen (Operations Management Vol-2, 2002), â€Å"the purpose of SCM is to integrat e all tasks associated with the bi-directional flow of materials, information and finance into organized, coherent, managed processes in order to provide end-to-end management and control. †