Feudalism and Court Services Vassals

Feudalism began in France around A. D. 900 and spread. The feudal hierarchy was an arrangement of rank resembling a pyramid. At the top of the pyramid was the king. In the feudal relationship the king was the suzerain, or lord, of a group of dukes and counts who were his vassals. Each of these vassals was in turn lord to lesser vassals, who had even less important vassals. At the bottom of the pyramid were the knights, who had no vassals. Lord and vassal owed certain obligations to each other. The vassal pledged to perform certain services for his lord, and in return the lord granted him a fief, or fee. A fief was anything that was considered useful or valuable. Usually, a fief was a piece of land, jurisdiction over the peasants who lived on the land, and ownership of the goods they produced. All fiefs were technically owned by the king, but a vassal held, in effect, all the rights of ownership of the fief as long as he performed the services required by his lord. The entire kingdom was divided into fiefs, except for the land held by the king personally. Feudal tenure was hereditary. When a vassal died, his heir did homage for his fief and swore an oath of fealty to his lord, promising to be faithful and render service. In the ceremony of investiture, the lord handed his vassal some symbol—such as a sword or a clod of earth—in token of title, and promised to defend the vassal's fief. If a vassal died leaving a minor heir, the lord usually became the guardian of the fief and managed it. If the heir was an unmarried daughter, the lord could select a husband for her because only a male could perform the services of the fief. Feudal services were the services that a vassal owed his lord varied. Military or Knight Service: A vassal was expected to serve his lord in war. Usually he served 40 days a year at his own expense if engaged in an offensive action against his lord's enemy. In a defensive action the term of service was unlimited. A knight was expected to furnish only his horse and armor, but great vassals had to supply hundreds of knights and men-at-arms. With Court Services vassals had to serve, when summoned, in the lord's court. They were called upon to give the lord advice. They also met in assembly to settle disputes between vassals. This was the origin of the principle of trial by a jury of peers, or equals. Vassals were also summoned for ceremonial occasions, such as investitures. Financial Obligations included: A relief, or gift, to the lord when the fief passed to an heir. It amounted usually to a year's income. Aids, payments made by vassals when their lord needed additional resources. A common aid was to help ransom the lord when he was taken prisoner in war. Other aids were given when the lord's eldest daughter was married and when his eldest son became a knight. They were obligated to entertain the lord when he paid a visit. During feudal warfare a powerful vassal who did not fulfill his obligations could usually withstand his lord's wrath if he owned a strong castle, since medieval castles were almost impossible to overrun. Forty days' service—the usual limit for knights in the attacking force—left insufficient time for siege operations. Private warfare between nobles who were neither lord nor vassal to each other was common in France, since the king could not control the vassals of his vassals. The church sought to limit strife by forbidding warfare on certain days of the week and during church festivals. Chivalry developed as a code of conduct for knights. Feudalism came to an end as the kings increased their power and forced the lesser landowners to obey their orders. Feudalism was introduced in England in 1066 following the Battle of Hastings and the Norman Conquest. The Normans, led by William the Conqueror who was crowned King William I of England were responsible for introducing feudalism to England. Feudalism was based on the exchange of land for military service. William the Conqueror claimed all the land in England and divide the land between himself (about 20%), the church (about 25%) and the remainder of English land was given to Norman soldiers and nobles (barons). Following the Norman Conquest William the Conqueror ordered a full survey of England which was called the Doomsday Book. It gave the new King of England full details of the land, the people and how much taxes and dues would be paid to the Normans. Under the Feudal system the vassals who were awarded land swore an Oath of Fealty to their lord and provided fully equipped soldiers under the Feudal Levy. Medieval Serfs were peasants who worked his lord's land and paid him certain dues in return for the use of land, the possession (not the ownership) of which was heritable. When the land changed owners during the time of feudalism the peasants were obliged to work for the new owners – the Normans. The decline of feudalism in England occurred due to many events including the Black Death, changes from a land-based economy to a money based economy and the establishment of Centralized government. Feudalism began in 410 AD with the fall of Rome. Feudalism in Germany was different from that of France and England. The old Germanic tribes which plagued the Roman emperors emerged again after Charlemagne's successors lost power. Four stem duchies eventually emerged as the most powerful in Germany: Saxony, Franconia, Swabia, and Bavaria. One strong duke, Otto of Saxony (936-973) tried to establish lordship over the other dukes. He invaded Italy, starting a long tradition of German interference in that peninsula, and made himself King of Italy. He was then crowned emperor by the pope himself (962). The strong points were; l) fragmentation of political power; 2) public power in private hands; and 3) armed forces secured through private contracts. Feudalism is, therefore, a method of government, and a way of securing the forces necessary to preserve that method of government. It is also an extreme form of decentralization. There many centers of power. Power does not reside at a center, or at the top, even though there a pyramidal structure in theory, with the emperor at the top and the simple knight at the bottom. The weak points were weak central power and realizing that a strong defense relied on a single leader. Napoleon was a leader during that time. Feudalism in Germany ended in the 15th century at about the same time England's Feudalism ended, as well as the rest of Europe's feudalism.

Developmental History Case Study Essay

Child’s Name: Rita G.Lapid Date of Interview: November 7 2007 Date of Birth: June, 20 2003 Age of child: 4 Address: 136 Bellemont St. Greenville, Manila Phone: n/a (private purposes) School: New Jerusalem School (NJS) Grade: Pre-school, Kinder-1 Teacher: Female, Mrs. Rosia Lewer Referral Information: Why are you seeking help for this child? She has delayed language development. Who referred you to our services? NJS School Pediatrician, Ms. Emelita Zobel What kind of services are you seeking? I am seeking psychological consultation for my daughter about her delayed speech problem. PRIMARY CAREGIVER/PARENT INFORMATION Father Name: Rino S. Lapid Address (if different from mother): 136 Bellemont St. Greenville, Manila Phone: n/a Employment: Civil Engineer Length of Employment: 10 years Occupation: Engineer Highest Grade Level: College Degree, MA, PhD Stepfather: n/a Primary Language: Tagalog Secondary Language: English Mother Name: Magdalene G. Lapid Address: 136 Bellemont St. Greenville, Manila Phone: n/a Employment: none Length of Employment: n/a Occupation: Housewife Highest Grade Level: College Degree Stepmother: n/a Primary Language: Tagalog Secondary Language: English Primary Caregiver With what adults does this child live? The child resides together with her parents How long in the current living situation? The child has started this state since birth. Name of Caregiver: Magdalene G. Lapid Relationship to Child: Mother Address:136 Bellemont St. Greenville, Manila Age: 31 Home Phone: n/a Work Phone: n/a Occupation: Housewife Employer: n/a How long with present employer: n/a Highest grade Completed: College degree Primary Language: Tagalog Secondary Language: English FAMILY HISTORY Please list all brothers and sisters, and any other children living with the family Age Sex Relationship to this child living at home? Rita G. Lapid ———–Female—————–4 yrs old——————- Only child CHILD CARE If primary caregiver works outside the home, please provide the following information. Who cares for this child when caregivers are gone? The caregiver is basically the child’s mother who is a housewife. If in case the mother is gone, the father or the housemaid takes care of the child. How many hours per day is this child in a child-care setting? 5 hours per day, 4 days a week How many different people care for this child? Usually the mother takes care of the child; however, if the mother is not available, the father or housemaid assumes the role. PREGNANCY Planned pregnancy? Yes Pregnancy under doctor’s care: Yes Number of previous miscarriages: n/a Check any of the following complications that occurred during the pregnancy ______Difficulty in conception ______Toxemia _______ Abnormal weight gain ______Measles Check Excessive vomiting _______German measles Check Excessive swelling Check Emotional problems Check Vaginal bleeding ______Flu ________Anemia Check High blood pressure Rh-incompatibility: n/a Maternal injury: Describe: n/a Hospitalization during pregnancy: Reason: For consultations and routine check-up purposes X-rays during pregnancy: n/a Medications used during pregnancy: n/a Alcohol used during pregnancy: no Cigarettes during pregnancy: no Other drugs used during pregnancy: n/a Paracetamol——————————–500mg————————- As needed BIRTH At this child’s birth, what was the mother’s age? 27 yrs old Fathers Age?28 yrs old Mother’s age at birth of FIRST child? 27 yrs old Was this child born in the hospital? Yes If No, where? n/a Length of pregnancy: 9 months and 5 days Birth Weight: not remembered by mother Length of Labor: n/a Apgar Score: n/a Child’s condition at birth: normal and stable Mother’s condition at birth: normal and stable Check any of the following complications that occurred during birth: ______Forceps used ______Breech Birth ______Labor Induced Check Caesarean Delivery Other Delivery Complications: n/a Incubator: No How long? n/a Jaundiced: No Bilirubin Lights? No If Yes, How Long? n/a Breathing Problems right after birth: n/a Supplemental Oxygen: No If yes, how long? n/a Was anesthesia used during delivery? Yes If yes, what kind? n/a DEVELOPMENT At what age did this child first do the following? Please indicate year/month of age. Turn Over: 4 mos. Walk down Stairs: 1- 1 and 5 mos. yr. old Sit Alone: not observed Show interest in or attraction to sound: not observed Crawl: 9 months Understand first words: 2 yrs old Sand Alone: 2 yrs old Speak first words: 3 yrs old, (da-da, ma-ma) Walk Alone: 2 yrs old Speak in sentences: n/a Walk up Stairs: 2 yrs old Was this child breast-fed? No When weaned? n/a Was this child bottle-fed? Yes When weaned? n/a When was this child toilet trained? 2 yrs old Days: vary Nights: vary Did bed wetting occur after toilet training? Yes If yes, until what age? 3 yrs. old Did bed-soling occur after toilet training? No Has this child experienced any of the following problems? If yes, please describe. Walking difficulty: No Unclear Speech: Yes My daughter’s speech is somewhat delayed. She only speaks the words ma-ma or da-da, but she still cannot forms any phrase.   In addition, she started speaking these words very late. Sleep Problem: No Feeding Problem: No Underweight Problem: No Eating Problem: No Overweight Problem: No Colic: No Difficulty learning to Ride a Bike: Yes My daughter is having a hard time riding her bicycle. She seems to play with it but not like any other kids. She just stairs on it, touches it and every time we place her on the bike, she gets disappointed. It is a bit weird to have a behavior like that. Difficulty Learning to Skip: Yes I have not seen her skipping ever since. I don’t know why. She only plays with her dolls and seems to be introvert in terms of her behavior. Difficulty Learning to Throw and Catch: Yes She does not play throw and catch. If a ball for example is thrown to her, she just looks at it and dodges it. During this child’s first four (4) years, were any special problems noted in the following areas? If yes, please describe. Eating: No Motor skills: Yes She moves less frequently and does not show any active participation in school, other children or even inside the house. She just plays with her dolls, which seems to be her only world. Sleeping too much: No Temper tantrums: No Excessive crying: No Sleeping too little: No Failure to thrive: No Separating from parents: No Which hand does this child used for writing or drawing? Right Eating? Right Has this child been forced to change writing hand? No MEDICAL HISTORY Childhood Illnesses/Injuries Please check the illnesses this child has had and indicate age, year and month Measles: No  Ã‚  Ã‚  Ã‚  Ã‚   Rheumatic fever: No German measles: No Diphtheria: No Mumps: No Meningitis: No Chicken pox: No Encephalitis: No Tuberculosis: No Anemia: No Whooping Cough: No Fever above 1040: No Scarlet Fever: No Broken bone: No Head injury: No Sustained high fever: No Coma or any loss of consciousness: No Illness/Operations Has this child ever been on any medication for six months or more? No Please indicate whether this child currently has any of the following problems. Respiratory Cardiovascular Gastrointestinal ______Frequent colds  ­Ã‚ ­Ã‚ ­Ã‚ ­_______Shortness of breath _______Excessive vomiting ____Chronic cough ___Dizziness with physical exertion _____Frequent diarrhea ________Asthma ________Activity limited due to heart _______Constipation ______ Hay fever ________Condition ______Stomach pain ______Sinus condition ______Heart murmur Genitourinary Musculosketetal Neurological Check Urination in pants/bed _______Muscle pain ______Seizures/convulsions ______Pain while urinating ________Clumsy walk Check Speech defects ______ Excessive urination Check Poor posture _______Bites nails ______Strong odor to urine _______ Other muscle problems _____Sucks thumb ______Tics/twitches______ Bangs head Check Rocks back and forth Allergies Skin ________Allergy to medicine 0Frequent rashes ________Allergy to Food 0Bruises easily ________Bowel movements in other allergies _____ Sores _____ Pants/bed _____Severe acne _____ Itchy skin (Eczema) Speech Hearing Vision ______Stuttering ______ Ear infections ______ Vision problems Check Unclear speech ______ Hearing problems ______ Glasses/contacts Delayed speech Other speech problems _______Ear tubes Date of most recent speech exam: August 20, 2007 Date of most recent hearing exam: n/a Date of most recent vision exam: n/a MEDICAL CARE Child’s Physician: Emilta Zobel How often does child see doctor? My daughter is having her check-up twice every 6 months since last year. Is this child currently on medication? No Has this child ever been physically or sexually abused or neglected? No Has this child ever had psychological counseling or therapy? No Has this child ever had a neurological exam? No Has this child ever had a psychological or psychiatric exam? No Developmental Analysis   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Starting out with the brief background, the client is the only child of the couple with one housemaid living together in the capital city of Manila. The child, having the primary concern of language development delays, has been recommended by the school pediatrician for a psychological consultation. The primary breadwinner of the family is the father who is actually a civil engineer, while the mother resides solely in the house as the housewife. The care of the child is distributed among the three individuals in the house; however, the primary care is given by the mother herself. The child is studying in a private school, NJS, in a kinder-1 preschool level.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In the initial statement mentioned by the mother, the child is said to be having delayed speech problem; however, other fields of child development are normal in the case of the child. Upon assessment of care delivery, it has been concluded that the child receives specific parental attention of the mother in the child’s earliest years. The care of the child is subjected to three important personas with housemaid as the last option of care facilitator. In such case, we can conclude that the care needed by the child is adequately provided by appropriate significant individuals. There have been no conception anomalies noted in the assessment phase; hence, clinical or congenital contributors are most likely negative in terms of child condition effect. However, the mother has had excessive swelling, emotional problems due to personal reasons, slight vaginal bleeding noted and occurrence of high blood pressure. Some of these signs and symptoms are most commonly associated with pre-eclamptic effect (Erickson, 2005 p.23), although the mother has not indicated any possible diagnosis of pre-eclampsia during pregnancy.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Language development can be affected by drug intake during period of pregnancy especially during times of critical brain development particularly during the 1st quarter of the pregnancy (Johnson & Eviritt, 2000 p.216); however, the only medicine that has been noted is Paracetamol, which apparently is not anymore significant since the intake is only during times of fever. In addition, the pregnancy has not suffered any significant medical difficulties aside from the following mentioned.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Analyzing now the developmental features of the child, the speech developmental delays are the evident features of the child. The child has spoken her first words at the age of 3 yrs old, which is supposed to be less than one year old. Moreover, the child has not spoken any complete phrase, but only baby-talk words, da-da or ma-ma. The mother mentioned that the child speaks less frequently, which is contrary to the normal language development of a child that is, supposedly, speaking more than 2000 words at the age of one (Philipps & Guilherme, 2004 p.12). During the assessment of the cues that might participate in the relationship of such effect, other behavioral alterations are observed. The child manifests inappropriate introvert behaviors that are usually found in some delayed psychological and/ or mental impaired condition. The child is having difficulties riding bicycle as well as skipping; however, the problem, basically, is not due to motor impairments but rather due to substantial cognitive and psychological in the essence. Other associated problems are not evident in the child, especially physical in origin. Another manifesting deviation on the child’s behavior is primarily related on her social character. The child enters school with other kids; however, as stated by the mother, the child possesses an isolative behavior that tends to remove her attention towards mingling with other kinds. Instead, the child focuses imaginative play in an object, particularly her doll. If we analyzed the given statement in terms of part records, the child has never had any negative experiences in the past, such as trauma, rape or accident, which may have caused this certain behavior. The client has never had any physical impairment or a disease that may have contributes to this psychological manifestations. Moreover, the child is not into medication, treatment procedures or psychological supervision that aims to take hold of the situation. In fact, this is the first time that the child is having her psychological assessment; however, she has had initial check-ups that resulted to referral for psychological examination. In addition to the client’s assessment, she also possesses poor postural features noted on her back, and urination in bed, although this has been alleviated just recently through trainings. Moreover, the client has manifested enigmatic behavior such as rocking back and forth with less perception on her environment. Discussing now possible disorder pathology, the case of the patient has wide range of possibilities in terms of disorder development. The following two conditions are the closest; however, still requires further validation and assessment of the client features. The first is the possibility of Asperser’s Syndrome progression, which is primarily evident due to her poor social capacity, delayed language progression and imaginative play with enigmatic behavioral flaws. Second, is language development delay, which involves the primary concern of the patient that is speech delay. In the analysis of possible Asperger’s syndrome development, the patient involves the primary signs of the condition such as the impairments in language, social participations and imaginative play. However, the only validated impairment is the speech delay. Other impairments are resulted by the parental observation, which apparently, still requires further assessment on the child. The child may exhibit these behaviors as due to situational causation, which happens to be unfamiliar with the parents, or a behavioral altering family situation that displaces the normal behavior of the child. This may be difficult to diagnose as of now since, the case of the child does not support the major and specific behaviors associated with the condition. Although if the child progresses in this type of developmental pattern, she may acquire maladaptive behavior such as introversion, social self-degradation, self-infliction, and worst of all, further progression towards Asperger’s condition. In terms of language development delay, the child maybe be evidently having such developmental deficit; however, other symptoms are contradicting the statement, since behavioral isolation is not present if the case is solely language development problem. However, the possibility is still there that the child is just experiencing this development lag, and with further trainings, can help improve language development. The following implications are based on critical interpretation and analysis of the gathered data from the psychological assessment history taking. It does not, however, conclude that the client possess the featured conditions. Although, this are the possibilities that may incur to the child if behavioral patterns progress. References Erickson, T. (2005). Pediatric Toxicology: Diagnosis and Management of the Poisoned Child. McGraw-Hill Professional. Johnson, M., & Eviritt, M. J. (2000). Essentials in Reproduction. Blackwell Publishing. Philipps, A. M., & Guilherme, M. (2004). Critical Pedagogy: Political Approaches to Language and Intercultural Development. Multilingual Matters.

Operations management and productivity slp Assignment

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Tales of a Childhood Pyromaniac - Essay Example . My grandmother was a careful lady. As far as I know she had never been in a traffic accident, gone through a divorce, or suffered from identity theft. She was just as careful when we were burning leaves. She would make me wait until the wind was absolutely still. I would sit by the pile watching the weather and waiting for the calm of late afternoon. When the wind would stop I'd go get my grandmother and she would always ask, "Is it as still as a sinner in church". She would get her old silver lighter and head out to the backyard. Grandma always let me light the first leaves. She would break out an antique Zippo lighter and hand it to me. I would struggle with it as I lit one corner of the pile. The sparks would fly like fireworks, the wick would ignite, and the leaves would succumb to the flames. Lighter fluid would seep from the lighter and leave my hands smelling like a used car part. With the scent of the fluid filling my head I would hand the lighter back to my grandmother and she would finish lighting the pile. The flames roared as my grandmother made sure I kept a safe distance. Even from afar, the heat would embrace my young face. I would imagine that the fire was a distant sun and I was a distant planet. Here, in my own world, I could find the warmth and comfort of a familiar face and a familiar place.

DQ1 e-activity and DQ2 Competitive Advantage Essay

DQ1 e-activity and DQ2 Competitive Advantage - Essay Example of buyers had an effect on an industry’s competitive pricing and consumer’s demand for better services, which affects the strategy of a firm (Porters, 2008b, 14). In this case, firms in the industry where customers have bargaining power experienced instances whereby consumers pressed for price reductions. Finally, the rivalry influenced the profitability of firms in an industry depending on the intensity of the rivalry and the basis of a firm’s rivalry (Porters, 2008b, 18). The online auction industry experiences robust growth due to the ongoing global internet and technological innovations although Yahoo, Amazon, and eBay are the most dominant firms in the industry (Bajari & Hortaà §su, 2004, p. 459). Nevertheless, the availability of online auction software in the industry, coupled with the low costs of establishing start-ups and cheap hosting services available, pose a threat of new entrants into the industry. In effect, the fact that the cost of start-ups in the industry is cheap makes the bargaining power of suppliers low in the online auction industry. On the other hand, buyers in the industry hold high stakes in a company’s profitability and success due to the bidding platform that the industry provided (Pinker, Seidmann, & Vakrat, 2003, p. 1457). In this case, buyers will control a firm’s strategy in the online auction industry since they have an option of buying the same commodities online from other dealers at a price of their choice. On the other hand, rivalry amongst firms in the industry results from the bidding platform offered, which brings intense rivalry (Stafford & Stern, 2002, p. 135). Finally, other resellers and auctioneers that are not internet based pose the substitutes’ threat in the online auction industry. Stafford, M. R., & Stern, B. (2002). Consumer Bidding Behavior on Internet Auction Sites. International Journal of Electronic Commerce, 7(1), 135-150. Retrieved from http://www.jstor.org/stable/27751048 Small businesses

Apollo 13 Essay Example for Free

Apollo 13 Essay For those not old enough to have lived through it, a story of shooting for a landing on the moon, suffering an explosion on the spacecraft on the way to the moon, not landing on the moon, and then narrowly making it home to Earth is the story of Apollo 13. When facing issues, conflicts, and the attainment of goals, having the resources of a fully functional manager and team are irreplaceable. A manager that has clear goals and strategies in place is more likely to succeed even when faced with the greatest types of adversity. Every employee of NASA should know about the tragic event of Apollo 13. The background of the team began with the completion between the U. S. and Russia and their space exploration programs. What started out as a routine trip to the moon and back soon became one of the biggest crises NASA had ever experienced. From understanding the plight of the spacecraft, to knowing what needed to be done, to creating a CO2 converter out of materials only available on the spacecraft, the flight is a clear lesson on how to manage a team in a crisis. In many projects, it always comes back to a stressful situation, where quick decisions must be made which have a major impact on the achievement of the task at hand. Many managers often ask for advice on how to handle such situations in order to be a good leader and achieve maximum results. In order to be an effective manager and to be able to influence other and exercise high degrees of control, some rules should be followed. I will give a few examples of how Gene Kranz managed to promote teamwork and to achieve the best possible solutions despite unprecedented problems, lack or resources and time pressure. One must remain optimistic and believe in themselves and the team to achieve a set goal. Without personal convictions managers will not be able to motivate the team to developed new solutions, continue to working and foster collaboration. Gene demonstrated principled management and a leadership in demanding the best from his team while respecting their efforts no matter the outcome. One great thing about Gene’s management was that is set a standard of excellence. With statements like â€Å"I don’t care about what anything was meant to do, I care about what it can do. This set in motion self-management by various supporting teams. This shows us important lessons that we can apply to other environments. Make sure to clearly identify roles and responsibilities of each and every team member. Communication is also a key in managing a team effectively. In the movie one of the team members unplugs his TV and takes his phone off the hook which cost everyone value time and inpu t in solving this crisis. Managers should make sure they can get in touch with employees. Create a policy if you must. An over authoritarian style of management with a top down principal is sometimes inappropriate. Managers often give instructions, tasks and fiat without asking the employee for their opinion. In contrast managers with a cooperative democratic style of management involve employees in decision making. Decisions are taken after detailed discussion in working groups. Information should be forwarded to a great extent through all communication channels. Gene Kranz was drawing at the board and listened to his team and their suggestions. And they all discussed the suggestions together. Without this democratic management style of Gene Kranz, the team would not have been as successful. Another issue is to work the problem correctly. Defining the problem is the hardest part of problem solving. As a manager it is important to define and communicate the problems which must be solved. Otherwise, no team will be able to find suitable solutions. Gene Kranz identified all the problems and formed special teams to address them. He made it clear to the teams which objects could be used. Only the objects that were available to the astronauts could be used. He wasted no time in complaining about what objects were not available or missing to solve the problem. He was action oriented and emphasized problem solving. It is also important to be a visible manager or leader. A good manager shoulders responsibility and conveys to all team members that they will work through the problem. Another trait of an effective manager is respect for others. Too often in today’s corporate environment, we don’t respect the judgment of those actually doing the work. Moreover, a crisis is not a time for accusations. The primary objective should be to handle the situation together and make the best of it. Gene Kranz did not ask at any time after the explosion, how such an explosion could have happened. Neither the astronauts nor Mission Control would have benefitted from the discussion of guilt, creative problem solving was much more important. In spite of all the negative talk, Gene told them failure was not an option, and they did not fail. Building trust must be combined with effective communication. Its benefit was evident in the film through the obstacles the team overcame. As a team grows together through strong management, their level of trust to achieve a collective goal, individuality becomes less important and the team’s objective is placed in the forefront. Action orientation becomes second nature, and feedback is open and honest. Combined, these improve the overall success and functionality of the manager, employee relationship. Finally, nobody wants to experience crisis such as the one in Apollo 13, however there will always be unpredictable problems and managers will have to challenge the situations. An effective manager should place themselves in Gene Kranz’s place for internalizing his way of leading a team. In addition, difficult situations that happen in the past should be analyzed for developing suggestions for managers to learn how to act in prospective situations. Every crisis is unique and demands an individual solution but for learning how to find the best solution, act right as a manager and motivate your team. Being successful and solving problems in a creative way is just but one aspect of being an effective manager and leader for your team.

Ibandronate vs. Alendronate for Osteoporosis

Ibandronate vs. Alendronate for Osteoporosis Cost-Effectiveness of Ibandronate vs. Alendronate used in treatment of osteoporosis, in a specialized clinic in Tirana. Dr. Mirela Miraà §i1; Msc.Arlinda Demeti2; Prof.as Zamira Ylli3; Prof.Mira Zià §ishti3; Prof.As Suela Kellià §i1 Faculty of Pharmacy, University of Medicine, Tirana. Bioparafarmacia Franceze Neostyle Clinic Abstract: Osteoporosis is â€Å"a systemic skeletal disease with a high prevalence. Biphosphonates are medicaments which are chosen for their efficacy in reducing fracture incidence, increasing bone density and improving bone microarchitecture. The aim of the study is to evaluate the effectiveness of the drugs (ibandronate and alendronate) used in osteoporosis treatment, in post-menopausal women over the age of 50 years at a specialized clinic in Tirana; to calculate the annual cost of treatment of osteoporosis and to perform a cost effectiveness analyze. Methods: Retrospective. The patients were all female, in menopause or post menopause, with T-score -1 to -6, treated with alendronate or ibandronate. The effectiveness is calculated as the average percentage of change in bone mineral density (av. % of change in BMD) of year 2011 vs. 2010 baseline. The annual cost of the treatment of osteoporosis according to the protocols and the cost of the examination with DXA scan (dual x-ray absorptiometry) were calculated. Finally a comparison of the cost-effectiveness was performed. Conclusion:  Patients with osteoporosis treated with Ibandronate, at our clinic in Tirana, have an average change from baseline higher compared with patients treated with Alendronate, with statistically significant difference between them (Man Whitney U = 66.0, p The annual cost of the disease when treated with ibandronate is 1.3 times higher than the annual cost of treatment with alendronate. Ibandronate is more cost effective than all other alendronate . Introduction: Osteoporosis is â€Å"a systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fractures† (1) The World Health Organization defines osteoporosis as â€Å"bone density 2.5 standard deviations (SDs) below the mean for young white adult women at lumbar spine, femoral neck or forearm†. (2) Osteoporosis leads to nearly 9million fractures each year worldwide and over 300,000patients with fragility fractures are registered in UK hospitals each year (British Orthopaedic Association, 2007).(3) Osteoporoza, à «shtà « njà « sà «mundje me njà « prevalencà « tà « lartà « edhe nà « Shqipà «ri (7.28% e popullatà «s dhe 9.6% tek femrat)4, e njà «jtà « me atà « tà « hasur pà «r astmà «n apo sà «mundjet e zemrà «s; †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. Direct medical costs due to fragility fractures in UK healthcare economy were estimated at  £1.8billion in 2000, with the potential to increase to  £2.2billion by 2025 and the major part of these costs were related to hip fracture care. (5) The annual cost of osteoporosis and fractures in the US elderly was estimated at $16 billion(6) Osteoporosis is diagnosed by a T-score, which is the number of standard deviation (SD) that patient’s bone mineral density (BMD), measured using dualX-ray absorptiometry, differs from the mean BMD of 30-years old premenopausal women. Patients with T-score of between -1 and -2.5 SD are said to have osteoporosis.7,8 Biphosphonates are medicaments which are chosen for their efficacy in reducing fracture incidence, increasing bone density and improving bone microarchitecture.9-15 Top of Form Methods: Retrospective. The patients were all female, in menopause or post menopause, 50 years old or elder, with T-score -1 to -6, diagnosed for the 1rst time in 2010 (the 1rst BMD measurement), who have received treatment (alendronate or ibandronate) for 12 months and in 2011 have performed a 2nd BMD measurement. The effectiveness is calculated as the average percentage of change in bone mineral density (av.% of change in BMD) of year 2011 vs. 2010 baseline. It was calculated the annual cost of the treatment of osteoporosis according to the protocols: with once monthly 150 mg oral ibandronate plus supplements (calcium, vitamine D) and once weekly 70 mg alendronate (4 times per month) plus supplements (calcium, vitamine D). There are also included other direct costs such as the examination with DXA scan (dual x-ray absorptiometry) to determine the diagnosis and the medical visits. Finally a comparison of the cost-effectiveness will be performed. Statistical Analysis Data were analyzed with SPSS 20 statistical package. It is used the non-parametric Man Whitney U test to compare the continuous variables, Fisher Exact test was used to compare proportions between variables and the the Odds Ratio OR for assessing the association between variables. Point estimations are accompanied with interval estimation by 95 % CI. For continuous variables is presented the average, the standard deviation and the minimum and maximum values. The level of statistical significance is defined at ÃŽ ± ≠¤ 005. Statistical tests are two-sided.duhet te shihet gjuha e perdorur, a qendron ne anglisht? Results of the study In our study were included 70 patients who fulfill the inclusion criteria. 24 patients were treated with once monthly 150 mg oral ibandronate and 46 patients with once weekly 70 mg alendronate.There were not case of fracture among our patients. Table 1 compares the frequency of pathologies (osteopenia and osteoporosis) in two groups of patients treated with alendronat or ibandronat. Osteoporosis Osteopenia Ibandronate 14 10 Alendronate 18 28 OR= 1.3 95%CI 0.5 4.2 p=0.4 Your contribution will be used to improve translation quality and may be shown to users anonymously Contribute Close Thank you for your submission. Number of patients treated with alendronate is 1.3 times higher than the number of patients treated with ibandronate in the case of osteoporosis. (OR = 1.3, 95% CI 0.5-4.2, p = 0.4). Chart 1 Calculation of efficiency We have to calculate the average percentage of change of BMD (2011) to baseline (2010): Table2. In the group of Alandronate (N=46) we have found this data: Osteoporosis n=18 Osteopeni n= 28 M (SD) min max M (SD) min max Mann-Whitney U p T Score 2010 -3.2 (0.7) -4.6 -2.5 -1.9 (0.4) -2.4 -1.1 507.0 T Score 2011 -3.1 (0.8) -4.7 -2.2 -1.8 (0.6) -2.4 -1.1 515.5 Age, yrs 61.2 (8.0) 51.0 – 79.0 59.1 (7.8) 51.0 – 81.0 223.5 0.3 Height, m 1.5 (0.05) 1.4 – 1.6 1.5 (0.07) 1.4 – 1.7 304.5 0.3 Weight, kg 58.8 (8.3) 46.0 – 73.0 68.6 (11.1) 51.0 – 95.0 376.5 0.01 *Age-Group, yrs n (%) n (%) OR (95% CI) 50 -59 yrs 8 (17) 19 (41) 60 -69 yrs 7 (15.2) 6 (13.0) 1.6 0.4 – 6.7 0.4 >70 yrs 3 (7) 3 (7) 2.8 0.4 – 25.2 0.3 *Fisher exact test p=0.3 There are 46 patients treated with alendronate. 18 ( 39.1 %) (95% ; CI 29.7 52.1) of them suffer from osteoporosis and 28 ( 60.9 % ) (95 % CI 47.8 74.2) from osteopenia, with no statistically significant difference between them, p = 0.9 Grupmosha 60 – 69 vjeà § ka 1.6 herà « mà « tepà «r gjasa qà « tà « vuajnà « nga Osteoporoza sesa grupmosha 50-59 vjeà §, por pa ndryshim sinjifikant ndà «rmjet tyre (OR=1.6; 95%CI 0.4–6.7; p=0.4) Grupmosha >70 vjeà § ka 2.8 herà « mà « tepà «r gjasa qà « tà « vuajnà « nga osteoporoza sesa grupmosha 50-59 vjeà §, por pa ndryshim sinjifikant ndà «rmjet tyre (OR=2.8; 95%CI 0.4–25.2; p=0.3) Pacientet me Osteopeni kanà « peshà « mesatare mà « tà « lartà « krahasuar me pacientà «t me Osteoporozà «, me ndryshim statistikisht tà « rà «ndà «sishà «m ndà «rmjet tyre (Man Whitney U=376.5, p=0.01) Pacientà «t me Osteoporozà « kanà « tà « njà «jtà «n gjatà «si mesatare me pacientà «t me Osteopeni, pa ndryshim statistikisht tà « rà «ndesishà «m ndà «rmjet tyre (Man Whitney U=304.5, p=0.3). The change from baseline for Alendronate group The change from baseline is calculated: Table 3 Osteoporosis n=18 Osteopenia n= 28 M (SD) min max M (SD) min max Mann-Whitney U p The change from baseline 2.1 (4.5) -7.6 – 13.9 1.7 (6.2) -23 – 11.1 316.0 0.2 Patients with osteopenia have an average change from baseline higher compared with patients with osteoporosis, no statistically significant difference between them (Man Whitney U = 316.0, p = 0.2). Table 4. In the group of Ibandronate (N = 24) we have find this data: Osteoporosis n=14 Osteopeni n= 10 M (SD) min max M (SD) min max Mann-Whitney U p T Score 2010 -3.7 (0.7) -5.0 -2.7 -1.8 (0.3) -2.2 -1.4 140.0 T Score 2011 -3.2 (0.8) -4.4 -1.7 -1.5 (0.4) -2.1 -1.0 134.5 Age yrs 64.3 (7.3) 53.0 77.0 59.1 (5.0) 53.0 – 68.0 39.5 0.07 Height (m) 1.5 (0.05) 1.4 – 1.6 1.5 (0.06) 1.4 – 1.6 71.0 0.9 Weight 66.2 (10.9) 47.0 – 84.0 70.7 (7.1) 65.0 – 82.0 90.5 0.2 *Age-group, yrs n (%) n (%) OR (95% CI) 50 -59 yrs 3 (12.5) 6 (25.0) 60 -69 yrs 8 (33.3) 4 (16.7) 3.7 0.6 – 27.8 0.2 >70 yrs 3 (12.5) 0 13 0.5 – 33.0 0.03 *Fisher exact test p There are 24 patients treated with Ibandronate. 14 (58.3%), (95% CI 33.2-76.5) of them suffer from osteoporosis and 10 (43.7%), (95% CI 23.4-61.7) of osteopenia, no statistically significant difference between them, p = 0.9. Pacientà «t me Osteoporozà « kanà « njà « moshà « mesatare mà « tà « lartà « krahasuar me pacientà «t me Osteopeni, por pa ndryshim statistikisht tà « rà «ndà «sishà «m ndà «rmjet tyre (Man Whitney U=39.5, p=0.07). Pacientà «t me Osteoporozà « kanà « tà « njejtà «n gjatà «si mesatare me pacientet me Osteopeni, pa ndryshim statistikisht tà « rà «ndà «sishà «m ndermjet tyre (Man Whitney U=71.0, p=0.9) Grupmosha 60 – 69 vjeà § ka 3.7 herà « mà « tepà «r gjasa qà « tà « vuajà « nga Osteoporoza sesa grupmosha 50-59 vjeà §, por pa ndryshim sinjifikant ndà «rmjet tyre (OR=3.7; 95%CI 0.6–27.8; p=0.2). Grupmosha >70 vjeà § ka 13 herà « mà « tepà «r gjasa qà « tà « vuajà « nga osteoporoza sesa grupmosha 50-59 vjeà § me ndryshim sinjifikant ndà «rmjet tyre (OR=13; 95%CI 0.5–33.0; p=0.03). Pacientà «t me Osteopeni kanà « peshà « mesatare mà « tà « lartà « krahasuar me pacientà «t me Osteoporozà «, por pa ndryshim statistikisht tà « rà «ndà «sishà «m ndà «rmjet tyre (Man Whitney U=90.5, p=0.2) The change from baseline for Ibandronate group (N=24) The change from baseline is calculated: Table5 Osteoporosis n=14 Osteopenia n= 10 M (SD) min max M (SD) min max Mann-Whitney U p The change from baseline 7.3 (6.1) -0.5 – 17.3 3.3 (2.2) -1.3 – 6.3 43.0 0.1 Patients with osteoporosis have an average change from baseline higher compared with patients with osteopenia, no statistically significant difference between them (Man Whitney U = 43.0, p = 0.1) Comparison of change from baseline for patients with osteoporosis referring the two drugs. Table 6. Alendronate n=18 Ibandronate n= 14 M (SD) min max M (SD) min max Mann-Whitney U p The change from baseline 2.1 (4.5) -7.6 – 13.9 7.3 (6.1) -0.5 – 17.3 66.0 Chart 2. The change from baseline for patients with osteoporosis Pacientà «t me Osteoporozà « tà « mjekuar me medikamentin Ibandronat kanà « njà « ndryshim mesatar nga baseline mà « tà « lartà « krahasuar me pacientet e mjekuar me Alendronat, me ndryshim statistikisht tà « rà «ndesishà «m ndà «rmjet tyre (Man Whitney U=66.0, p Table 7. Percentages of the average change of BMD from baseline Total Osteoporosis Ostopenia Alendronate 1.83564848 2.081694 1.677476 Ibandronate 5.635355 7.27025 3.346503 Chart 3. Nga figura rezulton se efikasiteti i medikamentit ibandronat (5.6) à «shtà « dukshà «m mà « i lartà « se efikasiteti i medikamentit alendronat (1.8). Efikasiteti i medikamentit ibandronat tek pacientà «t me osteoporozà « (7.3) à «shtà « dukshà «m mà « i lartà « se efikasiteti i medikamentit alendronat (2.1). Efikasiteti i medikamentit ibandronat tek pacientà «t me osteoponi (3.3) à «shtà « mà « i lartà « se efikasiteti i medikamentit alendronat (1.7). Cost analysis We consider only direct costs such as: DXA scanner examinations, medical visits and medications costs (drugs and the supplements), according to a well-defined treatment protocol. In Albania, there is only one kind of ibandronate (only one brand) 150 mg / once a month, while there are lots of alendronate (different brands) 70 mg / 4 times per month, which we have called A1,A2,A3, A4,A5. We have calculated the costs of the only ibandronate and the costs of five types of alendronate, including the alendronate produced by a pharmaceuticals firm in the country, which has the lowest price in the market. In both cases the basic treatment is associated with calcium and vitamin D. Table 8 Annual Cost of treatment and cost of examination Nr Currency Quantity Cost Month Annual Costs 1 Diagnostics skaner DXA Lek1 1 4,000 4,000 Medical examination 1 1,000 1,000 2 Type of Alendronat 70mg A1 lek 4 3,410 12 40,920 A2 lek 4 2,093 12 25,116 A3 lek 4 3,301 12 39,612 A4 lek 4 4,102 12 49,224 A.5 (Albanian Product) lek 4 1,200 12 14,400 3 Ibandronat 150 mg lek 1 4,873 12 58,476 4 Calcium Carbonat 1000 mg + Colecalciferol 880 UI lek 30 1,019 12 12,228 Table 9 Cost of illness according the type of medications Type of Alendronat 1+2+4 Annual costs A1 lek 58,148 A2 lek 42,344 A3 lek 56,840 A4 lek 66,452 A5 lek 31,628 Type of Ibandronat 1+3+4 Annual costs I1 lek 75,704 The annual cost of the disease when treated with ibandronate is 2.4 times higher than the annual cost of treatment with alendronate the alendronate produced by a pharmaceuticals firm in the country, which has the lowest price in the market, respectivly 537[1] euro versus 226 euro per patient in alendronate group. Having all the annual costs and the efficiency for each drug, we can compare: Table 10 Name (Changes by baseline in %) Efficiency of alendronate 1.83565 Efficiency of ibandronate 5.63536 Table11 Type of treatment C/E Alendronate A1 31,677 A2 23,068 A3 30,965 A4 36,201 A5 17,230 Ibandronate 13,434 The analyse of cost per efficiency unit (Table 10) shows that in the case of ibandronate the value obtained is 13.434 units and in alendronate A1 case is 31.677 units. Discussion of results Patients with osteoporosis treated with Ibandronate, at our clinic in Tirana, have an average change from baseline higher compared with patients treated with Alendronate, with statistically significant difference between them (Man Whitney U = 66.0, p 16 The annual cost of the disease when treated with ibandronate is 1.3 times higher than the annual cost of treatment with alendronate A1 and 2.4 times higher than the annual cost of treatment with the alendronate produced by a pharmaceuticals firm in the country, which has the lowest price in the market. So as claimed, the cost for effectiveness unit is lower (about 2.3 times) in the case of ibandronate compared to alendronate A1. Well ibandronate results the most cost- effective. Ibandronate turns more cost effective than all other alendronate including the alendronate produced by a pharmaceuticals firm in the country, which has the lowest price in the market Literature Christiansen, C. (1993). Consensus development conference: diagnosis, prophylaxis,and treatment of osteoporosis. Am J Med 94:646–50. Kanis, J.A. (1994). Assessment of Fracture Risk and its Application to Screening forPostmenopausal Osteoporosis. Report of a WHO Study Group. Geneva: World HealthOrganization. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis International 17: 1726–33. Dorina Ruco,(Dhjetor 2011): Osteoporoza nà « qytetin e Tiranà «s British Orthopaedic Association (2007).The care of patients with fragility fracture. Burge RT, Worley D, Johansen A, et al. The cost of osteoporotic fractures in the UK: projections for 2000–2020. Journal of Medical Economics 4: 51–52. Blume SW,Curtis JR Osteoporos Int.2011 Jun;22(6):1835-44. doi: 10.1007/s00198-010-1419-7. Epub 2010 Dec 17. Medical costs of osteoporosis in the elderly Medicare population. BMJ Group. Annual zoledronic acid for osteoporosis. Drug Ther Bull. 2008 Dec;46(12):93-6. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002;359:1761e7. Delmas PD. Treatment of postmenopausal osteoporosis. Lancet 2002;359:2018e26. Hochberg MC, Ross PD, Black D, et al. Larger increases in bone mineral density during alendronate therapy are associated with a lower risk of new vertebral fractures in women with postmenopausal osteoporosis.Fracture Intervention Trial Research Group. Arthritis Rheum 1999;42:1246e54. Hochberg MC, Greenspan S, Wasnich RD, et al. Changes in bone density and turnover explain the reductions in incidence of nonvertebral fractures that occur during treatment with antiresorptive agents. J Clin Endocrinol Metab 2002;87:1586e92. Epstein S. The roles of bone mineral density, bone turnover, and other properties in reducing fracture risk during antiresorptive therapy. Mayo Clin Proc 2005;80:379e88. McClung MR, Wasnich RD, Recker R, et al. Oral daily ibandronateprevents bone loss in early postmenopausal women with osteoporosis.J Bone Miner Res 2004;19:11e8. Rosen CJ. Postmenopausal osteoporosis. N Engl J Med 2005;353: Miller PD,Epstein S,Sedarati F,Reginster JY Once-monthly oral ibandronate compared with weekly oral alendronate in postmenopausal osteoporosis: results from the head-to-head MOTION study. http://www.ncbi.nlm.nih.gov/pubmed/18042311

Naturalism and Symbolism in the Poem Design by Robert Frost Essay

Naturalism and Symbolism in the Poem "Design" by Robert Frost The poem "Design" by Robert Frost is a sonnet written about man's relationship with nature. Frost deliberately uses the form of a sonnet, using the octave for a discussion and the sextet for questioning the fact that there is a force that controls our existence. There are natural characters and some degrees of irony also that give this poem a naturalistic feel. Frost uses the style of a sonnet in "Design" to present a philosophical problem - who controls our destiny. The octave is a single, smooth flowing sentence full of description. We are introduced to three things the narrator happened upon one day. There is a scene of contradictory pictures. The color of the white heal--all, the white spider, and the white moth all suggest purity and innocence. These are the, as the speaker describes them, "characters of death and blight." The octave has a lighter tone than the sextet. Even thought the tone is lighter there still seems to be a tension and seriousness that flows evenly to the sextet, which seems to bring chills to the reader's spine. The sextet is a series of questions that reveals a blend of emotions. The sextet brings about an unexpected change in tone. The poet is no longer observing, but questioning. The first question sounds like he is questioning something that doesn't fit in. The next question brings about a harsher image. The last question is the revelation into the speaker's torment. In the sextet, where the issues are raised, they should be solved in the following octet. They are not. Frost poses three unanswerable questions. The speaker seems reluctant to asks these questions and face them openl... ...ting there. It may be considered fate. The fate of the moth lay in the spider eating it. It was born to fly near that white flower and feed the spider. There is also a third reason that could be addressed. Naturally, a white moth would be attracted to a white flower as camouflage from predators. The white spider would use the flower as concealment from prey. There is a design at work but not a "design of darkness." It is simply an order of nature. It can be attributed to survival of the fittest. The final verse however calls to doubt not just evidence of natural darkness but the entire epistomogical basis of the poem. Is there someone or something controlling us or are we so small that is doesn't really matter in the grand scheme of things. "If design govern a thing so small" questions the result and method of the rest of the poem.

Television and Media - Censorship of TV Violence Not Necessary Essay

Censorship of TV Violence Not Necessary    Censorship of televised media often begins as a result of the concern many adults show over what their children watch. Children begin watching television at an early age, and they are usually lifetime viewers by the time they are two to three years old. There is usually a steady increase in the amount of television watched during a persons' childhood. This is followed by a decline during adolescence. What is more of a concern to the American people, however, is the amount of violence depicted on the television screen. The addition of cable TV also adds a whole new dimension to the problem. Children who watch a lot of TV are less aroused by violent scenes, less bothered by violence in general, and less likely to find anything wrong with it ( Comstock 521). A study by George Gerbner, Ph.D., at the University of Pennsylvania, enlightens this subject. His research shows that TV programs made for children typically contain over 20 acts of violence per hour. 'Children who watch the vio lent shows, even 'just funny' cartoons, were more likely to hit out at their playmates, argue, disobey class rules, leave tasks unfinished, and were less willing to wait for things than those who watched the nonviolent programs,' says Aletha Huston, Ph.D., now at the University of Kansas.      Ã‚  Ã‚   Even though many studies have been conducted on the effects of TV violence on youngsters many scientists doubt that a connection exists between these two topics. Most simply say that there is just not enough evidence available to make a definite conclusion. In the end it is up to the parents of children to make the ultimate decision of what should or should not be watched. There are several things parents ... ...rograms of historical significance, such as Schindler's List, further lessons its value.      Ã‚  Ã‚   Overall it can be said that violence is indeed prevalent on television in today's society. Some may argue that this violence is harmful to our children and must be ended, while others view the media as a form of free speech. Either way it is up to the individual to make the decision on whether a program should or should not be watched. The TV can simple be turned off or the channel changed if the program is not to a person's liking. The government should not have to do this regulation for us.    Works Cited Comstock, G. (1994). The effects of television violence on antisocial behavior: A meta-analysis. Communication Research, 21 (4), 516-546. Palmer, E.L. (1988). Television and America's children: A crisis of neglect. New York: Oxford University Press.

Jean Watson’s Theory of Caring Essay -- Philosophy Nursing Caring Wats

Jean Watson’s Theory of Caring Since its establishment as a profession more than a century ago, Nursing has been a source for numerous debates related to its course, methods and development of nursing knowledge. Many nursing definitions and theories have evolved over time. Furthermore it is in a constant process of being redefined. The purpose of this paper is an overview of Jean Watson’s Theory of Caring. This theory can be taken into account as one of the most philosophicaly complicated of existent nursing theories. The Theory of Human Caring, which also has been reffered to as the Theory of Transpersonal Caring, is middle – range explanatory theory. (Fawccett, 2000) The central point of which is on the human component of caring and actual encounter between the client and the caregiver. Jean Watson has stated that her work was motivated by her search of a new meaning to the world of nursing and patient care. â€Å" I felt a dissonnance between nursing’s (meta) paradigm of caring-healing and health, and medicines’s (meta) paradigm of diagnosis and treatment, and concentration on disease and pathology†. (Watson, 1997,p.49) Jean Watson’s theory was first published in 1979. Later Watson explained that this work was an attempt to solve some conceptual and empirical problems, with no intention to create a theory. This theory was expanded and formalized in her next book in 1985. Since then, Watson continued to refine her ideas through various publications. At his time, the major conceptual elements of the theory are ten Clinical Caritas Processes (originally Carative factors), Transpersonal Caring Relationship, Caring Moment/Occasion and Caring Consciousness. According to Watson’s theory, the human care process is performed through a Transpersonal Caring Relationship guided by the Carative factors, which are based on humanistic – altruistic value system. The Theory of Human Caring was initialy based on data about variety of aspects of caring, collected through open – ended quistionnaire. The purpose of this research was to evaluate different points of view, expressed by both the clients and registered nurses. In addition to this data, Watson’s theory uses broadly recognized work from other disciplines. Specific philosophers cited by Watson, as sources are Rogers, Whitehead, Gadow, Yalom etc. Furthermore, she also recognises the contribution of the east... ...d evaluation of contemporary nursing knowledge: Nursing models and theories. Philadelphia: F.A. Davis. Geissler, E.M (1998). Cultural assessments. St. Lois: Mosby. Marriner–Tomey, A. (1994). Nursing theorist and their work. (3rd ed.) St. Lois: Mosby. McCance,T.V.,McKenna, H. P., & Boore, J. R. P. (1999). Caring: Theoretical perspectives of relevance to nursing. Journal of Advanced Nursing,30, 1388 – 1395. Piccinato, J. M & Rosenbaum, J. N. (1997). Caregiver hardiness explored within Watson’s theory of human caring in nursing. Journal of Gerontological Nursing, 23(10), 32 – 39. Strickland, D. (1996). Applying Watson’s theory for caring among elders. Journal of Gerontological Nursing, 23(1), 32 – 40. Watson, J. (1979). Nursing: The philosophy and science of caring. Little Brown, Boston. Watson, J. (1985). Nursing: Human Science and Human. Norwalk; CT: Appleton – Century – Crofts. Watson, J. (1997). The theory of human caring. Retrospective and prospective. Nursing Science Quarterly. 10(1), 49-52. Weeks, S. K (1995). What are the educational needs of prospective Family Caregivers of newly disabled adults? Rehabilitation Nursing, 20(5), 256 – 60, 272.

Blue Nile Case Study

Blue Nile Case Study Cristeen McPherson Student Number 326914 BUSA 506 Dr Terry Power November 11, 2012 1) The competitive forces confronting Blue Nile and other online retail jewellers are medium or weak in strength, with the exception of the strong rivalry between sellers. The potential for new entrants to the jewellery market is relatively low due to the high costs of inventory, the lack of differentiation of product and the brand recognition held by the industry leaders. Good substitute products for a quality diamonds are not readily available.There are synthetic gemstones, cubic zirconium and other jewellery options, but the general consumer does not see these as a true substitute for real diamonds. Supplier bargaining power is a mixture of strong and weak factors leaving this force with a medium impact on the industry. The diamond supply industry is more concentrated than the retailers but is having new entrants emerging. Like the Canadian diamond producers Ekati in 1998, Diavi k in 2003, Jericho in 2006 and Snap Lake-4 in 2007 making Canada now the third largest diamond producer in the world. 1] Two factors contributing to a stronger supplier power are that products are critical to the retailers’ success and there is a lack of good substitute products. In contrast, the commodity trading or buying process for diamonds contributes to a weaker supplier power as retailers have easy ability and low costs to switch suppliers. Industry members are also now integrating backwards into the supply of the product, Diavik mine is a joint venture between Rio Tinto and Harry Winston Diamond Corporation and the De Beers Group owns the Snap Lake-4 mine. [2] Buyer bargaining power is moderately strong due to: Low costs of switching between retailers ? Lack of differentiation of product between retailers – differentiation is more on quality provided than the style or presentation of the product ? Large and diverse consumer base ? Buyers ability to be well info rmed on product; information on quality, prices and costs is growing due to internet accessibility ? Buyers are price sensitive The strongest force is the rivalry between the competing retail sellers. Factors affecting competing rivalry: ? Buyer demand is growing slowly – jewellery market is mature, with a broad range of consumers ?Buyer demand had fallen off in recent years due to recession – many sellers found themselves with slow moving inventory ? Buyer costs to switch brands is low – the buyer has no costs to switch to another online retailer, it’s just a mouse click ? Products are weakly differentiated – diamonds and jewellery are similar offerings between the sellers ? High fixed or storage costs – the bricks and mortar (b&m) retailers and many of the online retailers have high inventory costs, which when not turning incur carrying costs (interest etc) negatively impacting cash flow and earnings ?High exit costs – the high inve ntory costs make it difficult to liquidate quickly ? Competitors are numerous – and diverse in their value proposition, with low value, high volume retailers like Walmart as well as high end prestigious retailers like Tiffany & Co. 2) Some key success factors that will affect the online jewellery retailers in the near future: Fine jewellery buyers are looking for a retailer that offers quality product at a competitive price. Retailers must rely on their brand recognition with consumers; they need to build awareness of their product offerings as well as their customer service.Retailers must prove they are reputable, reliable and trustworthy. Online retailers have to express this through capturing their online audience with an easy to navigate website, appealing to their emotional response and showing other consumers satisfaction and confidence with past purchases. Jewellery retailers must be able to provide exceptional customer service and support. Major purchases of jewellery items, especially a diamond engagement ring, are very emotional to the purchaser. Customer service that acknowledges the significance of the purchase and guides the purchaser hrough the transaction will be a necessity for success and gaining consumer loyalty. With the high costs of inventory, retailers need to manage costs of inventory and operations, keeping costs in line with sales and managing cash flow is a key capability for success. A successful retailer is able to match inventory purchases with their consumer sales at a similar rate, maintaining inventory turnover and cash flow through the business. Not updating and maintaining their awareness and a high level of market knowledge will put a retailer at a significant competitive disadvantage.If they are not recognizing the market trends, striving to achieve some product differentiation and preparing to meet customer needs and wants, they will fall behind and lose customer loyalty, sales and market share. 3) Blue Nile is emplo ying a best-cost provider strategy as their competitive approach in the online jewellery business. Their aim is to create competitive advantage by offering a quality product at a competitive price. Blue Nile is able to do this through their supplier agreements where the diamonds and other gems are not actually purchased by Blue Nile until they have a consumer order for that particular product.This limits Blue Nile’s exposure on inventory costs and the risk of non-selling product. Blue Nile also relies on strict control of their operating costs; expenses for employees, facilities and technology are continuously reviewed to ensure their efficiency and that low costs are maintained. These two components combine to allow Blue Nile to offer comparable quality jewellery at substantially lower prices than their competitors. 4) Blue Nile has a very deep and keen knowledge of their customer and market.This enables them to tailor their website to their customers’ needs, offer su perior service and educational aspects for the consumer, effectively establishing trust with their consumers. This knowledge also gave them the ability to strike very good supply agreements with multiple providers for the quality product they sell online. Many of the diamonds and other jewellery are only available via Blue Nile because of their exclusive supply contracts. In order to remain competitive, Blue Nile must be diligent in maintaining and updating their market knowledge.The ability to accurately predict market trends and proactively alter business strategy is vital to ongoing success. For instance, many of the online retailers are currently relying on their educational information to garner the customers trust and loyalty. With every retailer working to increase the knowledge of the consumer, this strategy will lose effectiveness over time as the consumer becomes more knowledgeable. The ease of switching retailers is very high and Blue Nile must be ready to offer another c ompelling reason to remain loyal.Blue Nile must also be aware of any changes in their suppliers and the diamond market, if new diamond suppliers reach similar supply agreements with any of Blue Nile’s competitors, they may lose their supply chain advantage and risk significant increases in inventory costs. 5) SWOT Analysis – Blue Nile – Table 1 [pic] Although Blue Nile has many company strengths that propel their current success, the many competitors in the online and b&m jewellery industry have many of the same strengths.Blue Nile needs to improve and expand their marketing campaign and strengthen their brand recognition. They also need to develop a program to offer more product differentiation. One suggestion to incorporate both these needs might be to develop a strategic alliance with a well-known jewellery designer and offer custom design service online using the designer name and reputation. 6) Blue Nile posted exceptional double-digit sales growth over the six years 2002-2007, the recession of 2008 interrupted their growth trend actualizing a 7. % loss on sales year over year. They have since achieved moderate sales increases ranging from 2. 3% to 10. 18%. Blue Nile shows a steady gross margin averaging about 21. 7% over the last ten years. They also show very steady levels of selling, general and administrative expenses that have a slight increase each year most likely due to inflation of salaries and input costs. Consequently, their EBT margin is also very healthy, averaging 7. 0% earnings return on sales. Blue Nile has large cash reserves and very little long-term iabilities, their liquidity ratios are very healthy. Their current ratio averages 1. 5:1 over the last ten years. With their cost control and supply chain management, Blue Nile has very positive results for the performance/efficiency ratios. Their cash conversion is excellent due to the payables terms of supplier agreements; they have a positive cash float of about 40 da ys from the collection of sales revenue to the payment for goods. 7) Weighted Competitive Strength Assessment – Table 2 Blue Nile does have enough strength to remain competitive against its rivals.Their main rival based on pricing, quality and market knowledge is JamesAllen. com. Blue Nile is the strongest in terms of cost control and inventory control/supply chain management. Currently Blue Nile does have a sustainable competitive advantage over its rivals. Their product offerings are very similar, as are their websites and customer service policies, but Blue Nile’s cost control is far superior giving the advantage of greater efficiency and lower costs as compared to the other online retailers. ) In order to develop a more sustainable competitive advantage; Blue Nile will need to use their market knowledge to develop a stronger marketing plan to drive their brand recognition, product differentiation and develop greater customer loyalty. Blue Nile also needs to address the future erosion of market share due to the growing strength of competitors, and the potential of the loss on exclusivity from their product suppliers. 9) Recommendations: [pic] The components of the marketing plan and the strategic alliance with a jewellery designer fit together very well and should be quite easy and quick for Blue Nile to develop and execute.The value that would be seen via the increased brand recognition, customer loyalty and product differentiation would increase their competitive strength and be sustainable for the near future. Blue Nile’s current geographic expansion has shown success, continued expansion will need to be founded on research into the jewellery customs of target locations, to use the website’s appeal to the emotional purchase of jewellery. Low costs of online expansion are advantageous, while care must be taken to ensure language and culture are respected.Selective expansion will help to retain competitive advantage for the medi um range future and grow market share internationally. With their keen market knowledge, Blue Nile is positioned to take advantage of the weaker competitors in their market and secure market share growth for the mid range future via acquisitions. The potential to acquire a competitor would take longer to evaluate completely but is still a viable option to gain large portions of market share and increased sales.Blue Nile does have positive cash flow, good cash reserves and available credit facility to use to accomplish the acquisition. While the strategic alliance with a diamond producer/mine would secure long-term guarantees of the supply of quality, exclusive product at very competitive costs, the timeline to complete such a project is lengthy. The cost could also be prohibitive to Blue Nile at this point in time. The potential for long-term sustainable competitive advantage is most beneficial with this strategy and Blue Nile should not rule this option out as a future long-term go al.Bibliography: CBC News, ‘Canada’s Diamond Rush’, http://www. cbc. ca/news/background/diamonds/, Last Updated September 20, 2007, accessed November 9, 2012 Case 9, ‘Blue Nile Inc. in 2010†¦. ’ Thompson, Arthur A. , Strickland, A. J. & Gamble, John E. (2012). Crafting & Executing Strategy: The Quest for Competitive Advantage: Concepts and Cases(18th ed. ). New York: McGraw-Hill Irwin Power, Terrance P. (2008). Power’s Case Study Analysis and Writers’ Handbook. Toronto: Nelson. Appendices: Current Strategic Group Map High | | | |Price/Quality | | | |Low |Few Locations |Geographic Coverage |Many Locations | Market Share Chart for Top 20 Jewellery Retailers [pic] Financial Information Growth Profitability and Financial Ratios for Blue Nile, Inc. | | | | | | | | |Financials | | | | Ratios downloaded November 9, 2012 | | | | | | | | | | | ———————– [1] CBC News, ‘Canadaâ₠¬â„¢s Diamond Rush’, http://www. cbc. ca/news/background/diamonds/, Last Updated September 20, 2007, accessed November 9, 2012 [2] Ibid ———————– WalmartSterling Jewelers Zale Corporation Costco, Target Blue Nile QVC, Sears, JC Penney, Fred Meyer Jewelry TV, HSN Macy’s East & West, Neiman Marcus Cartier Tiffany & Co. Walmart, 4. 83% Sterling, 4. 17% Zales, 2. 83% Tiffany & Co, 2. 50% QVC, 2. 33% Sears, 1. 50% JCPenney, 1. 50% Finlay Fine Jewelry, 1. 50% Macy's East, 1. 00% Neiman Marcus, 1. 00% Costco, 0. 83% Target, 0. 83% Fred Meyer Jewelers, 0. 67% Helzberg Diamond, 0. 67% Jewelry Television, 0. 67% Macy's West, 0. 67% Tourneau, 0. 67% Cartier, 0. 50% Blue Nile, 0. 50% HSN, 0. 50%

Night World : Secret Vampire Chapter 3

All Poppy could think of was the pretty bald girl inthe gift shop. Cancer. â€Å"But-but they can do something about it, can'tthey?† she said, and even to her own ears her voice sounded very young. â€Å"I mean-if they had to, theycould take my pancreasout†¦.† â€Å"Oh, sweetheart, of course. â€Å"Poppy's mother took Poppy in her arms. â€Å"I promise you; if there's some thing wrong, we'll do anything and everything to fix it. I'd go to the ends of the earth to make you well. You knowthat. And at this point we aren't even sure that there issomething wrong. Dr. Franklin said that it's extremely rare for teenagers to get a tumor in the pancreas. Extremely rare. So let's not worry about things until we have to.† Poppy felt herself relax; the pit was covered again. But somewhere near her core she still felt cold. â€Å"I haveto call James.† Her mother nodded. â€Å"Just make it quick.† Poppy kept her fingers crossed as she dialedJames's apartment. Please be there, please be there, she thought. And for once, he was. He answered laconically, but as soon as he heard her voice, he said, â€Å"What's wrong?† â€Å"Nothing-well, everything. Maybe.† Poppy heardherself give a wild sort of laugh. It wasn't exactly alaugh. â€Å"What happened?† James said sharply. â€Å"Did youhave a fight with Cliff?† â€Å"No. Cliff's at the office. And I'm going into thehospital.† â€Å"Why?† â€Å"They think I might have cancer.† It was a tremendous relief to say it, a sort of emo tional release. Poppy laughed again. Silence on the other end of the line. â€Å"Hello?† â€Å"I'm here,† James said. Then he said, â€Å"I'm coming over.† â€Å"No, there's no point. I've got to leave in a minute.† She waited for him to say that he'd come and see her in the hospital, but he didn't. â€Å"James, would you do something for me? Wouldyou find out whatever you can about cancer in the pancreas? Just in case.† â€Å"Is that what they think you have?† â€Å"They don't know for sure. They're giving me some tests. I just hope they don't have to use any needles.† Another laugh, but inside she was reeling. She wished James would say something comforting.†I'll see what I can find on the Net.† His voice was unemotional, almost expressionless. â€Å"And then you can tell me later-they'll probablylet you call me at the hospital.† â€Å"Yeah.† â€Å"Okay, I have to go. My mom's waitin†Ã¢â‚¬ Take care of yourself.† Poppy hung up, feeling empty. Her mother wasstanding in the doorway.†Come on, Poppet. Let's go.† James sat very still, looking at the phone withoutseeing it. She was scared, and he couldn't help her. He'dnever been very good at inspirational small talk. It wasn't, he thought grimly, in his nature. To give comfort you had to have a comfortableview of the world. And James had seen too much of the world to have any illusions. He could deal with cold facts, though. Pushingaside a pile of assorted clutter, he turned on his lap top and dialed up the Internet. Within minutes he was using Gopher to search theNational Cancer Institute's CancerNet. The first file he found was listed as â€Å"Pancreatic cancer-Patient.†He scanned it. Stuff about what the pancreas did,stages of thedisease, treatments.Nothingtoo gruesome. Thenhewentinto â€Å"PancreaticcancerPhysician–a file meant for doctors. The first lineheld him paralyzed. Cancer of the exocrine pancreas is rarely curable. His eyes skimmed down the lines. Overall survival rate †¦ metastasis †¦ poor response to chemotherapy, ra diation therapy and surgery †¦ pain †¦ Pain. Poppy was brave, but facing constant painwould crush anyone. Especially when the outlook for the future was so bleak. He looked at the top of the article again. Overallsurvival rate less than three percent. If the cancer had spread, less than one percent. There must be more information. James wentsearching again and came up with several articles from newspapers and medical journals. They wereeven worse than the NCI file. The overwhelming majority of patients will die, and dieswiftly, experts say†¦. Pancreatic cancer is usually inoperable, rapid, and debilitatingly painful†¦. The averagesurvival if the cancer has spread can be three weeks tothree months†¦. Three weeks to three months. James stared at the laptop's screen. His chest andthroat felt tight; his vision was blurry. He tried to control it, telling himself that nothing was certain yet. Poppy was being tested, that didn't mean she had cancer. But the words rang hollow in his mind. He had known for some time that something was wrong with Poppy. Something was-disturbed-inside her.He'd sensed that the rhythms of her body wereslightly off; he could tell she was losing sleep. Andthe pain-he always knew when the pain was there.He just hadn't realized how serious it was. Poppy knows, too, he thought. Deep down, she knows that something very bad is going on, or she wouldn't have asked me to find this out. But whatdoes she expect me to do, walk in and tell her she's going to die in a few months? And am I supposed to stand around and watch it? His lips pulled back from his teeth slightly. Not anice smile, more of a savage grimace. He'd seen a lot of death in seventeen years. He knew the stages ofdying, knew the difference between the moment breathing stopped and the moment the brain turnedoff; knew the unmistakable ghostlike pallor of a freshcorpse. The way the eyeballs flattened out about five minutes after expiration. Now, that was a detail most people weren't familiar with. Five minutes after you die, your eyes go flat and filmy gray. And then your body starts to shrink. You actually get smaller. Poppy was so small already. He'd always been afraid of hurting her. She lookedso fragile, and he could hurt somebody much stronger if he wasn't careful. That was one reason hekept a certain distance between them. One reason. Not the main one. The other was something he couldn't put intowords, not even to himself. It brought him right up to the edge of the forbidden. To face rules that had been ingrained in him since birth. None of the Night People could fall in love with ahuman. The sentence for breaking the law was death. It didn't matter. He knew what he hadto do now.Where he had to go. Cold and precise, James loggedoff the Net. Hestood, picked up his sunglasses, slid them into place. Went out into the merciless June sunlight, slamminghis apartment door behind him. Poppy looked around the hospital room unhappily.There was nothing so awful about it, except that it was too cold, but †¦it was a hospital. That was thetruth behind thepretty pink-and-blue curtains and the dosed-circuit TV and the dinner menu decoratedwith cartoon characters. It was a place you didn't come unless you were Pretty Darn Sick. Oh, come on, she told herself. Cheerup a little.What happened to the power of Poppytive thinking? Where's Poppyanna when you need her? Where'sMary Poppy-ins? God, I'm even making myself gag, she thought. But she found herselfsmilingfaintly, with selfdeprecating humor if nothing else. And the nurses were nice here, and the bed wasextremely cool.Ithad a remote control on theside that bent it intoevery imaginable position. Her mother came in while shewas playing with it. â€Å"I got hold of Cliff; he'll be herelater. Meanwhile,I think you'd better change so you're ready for the tests.† Poppy looked at the blue-and-white striped seersucker hospital robe and felt a painful spasm that seemed to reach from her stomach to her back. And something in the deepest part of her said Please, not yet. I'll never be ready. James pulled his Integra into a parking space on Ferry Street near Stoneham. It wasn't a nice part of town. Tourists visiting Los Angeles avoided this area. The building was sagging and decrepit. Severalstores were vacant, with cardboard taped over broken windows. Graffiti covered the peeling paint on thecinder-block walls. Even the smog seemed to hang thicker here. Theair itself seemed yellow and cloying. Like a poisonous miasma, it darkened the brightest day and made everything look unreal and ominous. James walked around to the back of the building.There, among the freight entrances of the stores in front, was one door unmarked by graffiti. The signabove it had no words. Just a picture of a blackflower. A black iris. James knocked. The door opened two inches, anda skinny kid in a wrinkled T-shirt peered out with beady eyes. â€Å"It's me, Ulf,† James said, resisting the temptationto kick the door in. Werewolves, he thought. Why do they have to be so territorial? World. I don't want to break any laws. I just wanther well.† The slanted blue eyes were searching his face. â€Å"Areyou sure you haven't broken the laws already?† And when James looked determined not to understand this, she added in a lowered voice, â€Å"Are you sure you're not in love with her?† James made himself meet the probing gaze directly. He spoke softly and dangerously. â€Å"Don't say that unless you want a fight.† Gisele looked away. She played with her ring. Thecandle flame dwindled and died. â€Å"James, I've known you for a long time,† she saidwithout looking up. â€Å"I don't want to get you in trouble. I believe you when you say you haven't brokenany laws–but I think we'd both better forget this conversation. Just walk out now and I'll pretend itnever happened.† â€Å"And the spell?† â€Å"There's no such thing. And if there was, Iwouldn't help you. Just go.† James went.There was one other possibility that he couldthink of. He drove to Brentwood, to an area thatwas as different from the last as a diamond is fromcoal. He parked in a covered carport by a quaint adobe building with a fountain. Red and purplebougainvillaea climbed up the walls to the Spanishtile on the roof. Walking through an archway into a courtyard, hecame to an office with gold letters on the door. Jasper R. Rasmussen, Ph.D. His father was a psychologist. Before he could reach for the handle, the dooropened and a woman came out. She was like mostof his father's clients, forty-something, obviously rich, wearing a designer jogging suit and high-heeled sandals. She looked a little dazed and dreamy, and therewere two small, rapidly healing puncture wounds on her neck. James went into the office. There was a waitingroom, but no receptionist. Strains of Mozart came from the inner office. James knocked on the door. â€Å"Dad?† The door opened to reveal a handsome man withdark hair. He was wearing a perfectly tailored gray suit and a shirt with French cuffs. He had an aura of power and purpose. But not of warmth. He said, â€Å"What is it, James?† in the same voice he used for his clients: thoughtful, deliberate, confident. â€Å"Do you have a minute?† His father glanced at his Rolex. â€Å"As a matter offact, my next patient won't be here for half an hour.† â€Å"There's something I need to talk about.† His father looked at him keenly, then gestured to an overstuffed chair. James eased into it, but found himself pulling forward to sit on the edge. â€Å"What's on your mind?† James searched for the right words. Everything depended on whether he could make his father under stand. But what were the right words? At last hesettled for bluntness. â€Å"It's Poppy. She's been sick for a while, and nowthey think she has cancer.† Dr. Rasmussen looked surprised. â€Å"I'm sorry to hearthat.† But there was no sorrow in his voice. â€Å"And it's a bad cancer. It's incredibly painful andjust about one hundred percent incurable.† â€Å"That's a pity.† Again there was nothing but mildsurprise in his father's voice. And suddenly James knew where that came from. It wasn't surprise thatPoppy was sick; it was surprise that James had made a trip just to tell him this. â€Å"Dad, if she's got this cancer, she's dying. Doesn'tthat mean anything to you?† Dr. Rasmussen steepled his fingers and stared intothe ruddy gloss of his mahoganydesk. He spoke slowly and steadily. â€Å"James, we've been through this before. You know that your mother and I are worried about you getting too dose to Poppy. Too . . . attached †¦to her.† James felt a surge of cold rage. â€Å"Like I got tooattached to Miss Emma?† His father didn't blink. â€Å"Something like that.† James fought the pictures that wanted to form inhis mind. He couldn't think about Miss Emma now; he needed to be detached. That was the only way to convince his father. â€Å"Dad, what I'm trying to say is that I've knownPoppy just about all my life. She's useful to me.† â€Å"How? Not in the obvious way. You've never fedon her, have you?† James swallowed, feeling nauseated. Feed onPoppy? Use her like that? Even the thought of it made him sick. â€Å"Dad, she's my friend,† he said, abandoning anypretense of objectivity. â€Å"I can't just watch her suffer. I can't. I have to do something about it.† His father's face cleared. â€Å"I see.† James felt dizzy with astonished relief. â€Å"Youunderstand?† â€Å"James, at times one can't help a certain feeling of . . .compassion for humans. In general, I wouldn't encourage it-but you have known Poppya long while. You feel pity for her suffering. If youwant to make that suffering shorter, then, yes, Iunderstand.† The relief crashed down around James. He stared at his father for a few seconds, then said softly, â€Å"Mercy killing? I thought the Elders had put a banon deaths in this area.† â€Å"Just be reasonably discreet about it. As long as itseems to be natural, we'll all look the other way. There won't be any reason to call in the Elders.† There was a metallic taste in James's mouth. Hestood and laughed shortly. â€Å"Thanks, Dad. You've really helped a lot.† His father didn't seem to hear the sarcasm. â€Å"Gladto do it, James. By the way, how are things at the apartments?† â€Å"Fine,† James said emptily. â€Å"And at school?† â€Å"School's over, Dad,† James said, and let himselfout. In the courtyard he leaned against an adobe walland stared at the splashing water of the fountain. He was out of options. Out of hope. The laws ofthe Night World said so. If Poppy had the disease, she would die from it.