Effect of Estrogen on Osteoclasts and Osteoblasts

Effect of o oestrogen on Osteoclasts and OsteoblastsOsteoporosis is a disease that afflicts many people, especially women. This disease is very debilitating and is characterized by excessive lift loss which results in severe fractures. There ar two types of osteoporosis compositors case I and Type II. Type I is the more severe type and is ordinary in post-menopausal women. There subscribe been numerous hypothesis and studies as to the cause of osteoporosis and its relation to menopause (Riggs, 2002). The findings suggest that estrogen exercises a major role. Estrogen receptors hurt been identified in rise and ar involved in the drudgery and maintenance of both osteoclasts and osteoblasts (Eriksen, 1988 Girasole, 1992). Osteoclasts function in beat resorption, and osteoblasts function in synthesizing hot tog up, hence these two cell types have opposite mental pictures on deck out (Saladin, 2010). Studies have shown that a lessening in estrogen levels in post-menopau sal women is the native quill cause of this reduction in bone density (Girasole 1992 Menolagas, 2002).Estrogen is a steroid endocrine gland that has many different functions. It is primarily involved in knowledgeable differentiation and maturation, but likewise has some less obvious effects including thermoregulation and the maintenance of bone mineral deposition. Estrogen is a lipophilic hormone and wherefore is capable of diffusing through the cell membrane and binding its two intracellular receptors, ER and ER There are three female depend upon hormones estrone (E1), estradiol (E2) and estriol (E3), however, estrogen is the common name used to refer to all three, though estradiol is the main form of estrogen (Carlsten, 2005).Estrogen is mainly synthesized in the ovaries, though its synthesis is not limited to the ovaries. Some peripheral create from raw materials, such as adipose tissue, are capable of producing estrogen by way of steroid precursors (Nelson, 2001 Simpson 1981). Synthesis of estrogen involves many different precursors the first of which is cholesterol. Cholesterol is converted in the ovarian follicle to pregnenolone which can be converted to 17-hydroxypregnenolone. 17 -hydroxypregnenolone is then converted to dehydroepiandrosterone which is converted to androstenedione which undergoes a conversion to the androgenic hormone, testosterone. Aromatase then converts testosterone to esradiol (E2). Estradiol is then secreted from the follicle and can either act on its target tissue or undergo an different conversion to estrone (E1) and estriol (E3) which takes place in the liver.Estrogen has two main receptors ( ER and ER) that mediate its primary effects. These receptors belong to the nuclear receptor family and are organization factors that are regulated by ligands (Carleson, 2005). Estrogen receptors require numerous coregulatory proteins that have cell-specific expressions. These cell specific expressions line some of the specific pr oceedings of estrogen in its various target tissues (Heldring, 2007).The two estrogen receptors maintain some highly conserved regions such as their deoxyribonucleic acid binding domains both ER and ER bind the same DNA response elements. Other domains are not at all conserved, such as the amino-terminal which exhibits significant variability in sequence as wholesome as in length. The ligand-binding domain is fixed at the C-terminal and is a multifunctional domain. Both the N-terminal and the C-terminal contain activating functions, AF-1 and Af-2, respectively. These activation functions, work to activate agreement by recruiting coregulatory proteins to the DNA-binding domain. Though ER and ER are fairly homologous, they are actually derived from separate cistrons which are located on separate chromosomes. ER and ER as well as give very different splice variants (Heldring, 2007). ER and ER regularaly act as antagonists of each other when expressed in the same cells hence, e strogen signaling functions as a balance in the midst of these two contradictory receptors (Carleson, 2005). It appears as if ER works to inhibit the effect of ER by not only altering the recruitment of transcription factors essential for of ER-dependent transcription, but also by increasing the degredation of ER by way of ER2, a splice variant of ER (Heldring, 2007). Estrogen receptors have been constitute in many non-reproductive tissues including bone. This fact lends credence to the conjecture of estrogens involvement in the maintenance of bone.Estrogen SignalingThere are a hardly a(prenominal) distinct streets that are involved in estrogen signaling. ternion of these signaling pathways are ligand-dependent, the fourth is ligand-independent. The first ligand-dependent pathway is the classical or direct pathway (Fig. 1a.) in which the ligand (usually estradiol) binds the receptor and this ligand receptor complex then dimerizes with other ligand-receptor complex in holy order to bind estrogen response elements in the promoters of target genes (Carleston, 2005).The second ligand-dependent pathway is referred to as the te in that respectd pathway (Fig. 1b.). The tethered pathway involves protein-protein interactions with transcription factors. These interactions occur after the receptor has been activated by the ligand. Hence, the receptor activates transcription by an indirect DNA binding weapon (Carleston, 2005).The non-genomic pathway (Fig 1c.) is also ligand-dependent but is not as well understood as the previous two. It is known that the receptor is activated by the ligand, which then initiates a signaling descend resulting in the activation of second messenger systems (Heldring, 2007). Studies have shown that the activation of these second messenger systems display some common effects including an increase in the production of cAMP levels as well as the activation of the MAPK pathway (Lim, 2006). This activation of second messenger systems ul timately leads to a rapid physiological response without involving gene regulation (Heldring, 2007).The fourth signaling pathway is ligand-independent (Fig.1d.) and involves activation by way of other signaling pathways such as that of Growth Hormone which ultimately leads to the activation of gene regulation. This activation of gene regulation occurs due to the activation of protein kinases that work to phosphorylate the estrogen receptor. This phosphorylation causes receptor dimerization which allows the receptors to then bind the DNA and activate gene transcription (Carleson, 2005 Heldring, 2007).a.) The direct ligand dependent pathway in which the ligand directly binds the receptor which dimerizes and binds the DNA promoter region.b.) The tethered pathway is indirect and involves protein interactions with transcription factors that allow for the binding of the transcription factor to the promoter regionc.) The non-genomic pathway involvs activation by the ligand which then can c ause a signal transduction pathway resulting in activation of second-messenger systems.d.) The ligand-independent pathwayin which activation occurs by other signalling pathways (i.e. GH) and eventually leads to activation of gene transcription.Source Heldring, Pike, Andersson et al. Estrogen Receptors How do they signal and What are Their Targets. Physiol. Rev. 87 905-931. 2007.Estrogen and OsteoporosisOsteoporosis is a disease that is characterized by a decrease in bone mineral density and hence an increase in the frequency of bone fractures (Though osteoporosis is often associated with post-menopausal women, the disease is not needfully limited by gender. Osteoporosis was separated into two classes in 1983 by Riggs and Melton. The two types of osteoporosis (Type I and Type II) differ in regions of bone mineral density, patterns of fracture, causal mechanisms and hormonal changes. Type I osteoporosis is the more severe form of osteoporosis, however, type II is more common especiall y in the elderly (70+) (Riggs, 2003).Type I Osteoporosis is preponderant in post-menopausal women. It usually arises within 20 years after menopause and is associated with excessive cancellous bone loss. Fractures occur at sites that are rich in cancellous bone. Type I osteoporosis is associated with an increase in osteoclast function and a decrease in osteoblast function. This is thought to be due to a decrease in the levels of estrogen present in post-menopausal women (Girasole, 1992 Ribot, 1997). Osteoporosis has been found to occur in men also primarily elderly men. The underlying explanation for osteoporosis is that the sex steroids play a role in the remodeling process of bones. Hence, when ovarian function ceases due to menopause in women, estrogen levels decrease and bone remodeling is therefore disrupted in a deleterious fashion. Osteoporosis in men is associated with a loss of androgens which is generally due to either castration or aging (Manolagas, 2002).Type II osteopo rosis is commonplace in both men and women and can occur at any age, though it is more often associated with the elderly (above age 70). Type II osteoporosis is characterized by the loss of trabecular bone. It is generally due to aging effects such as hyperparathyroidism and impaired bone formation, and also a decrease in vitamin D and PTH levels. There is some speculation as to whether or not Type II osteoporosis may also be due to late effects of decreased estrogen levels (Riggs, 2003).Evidence for estrogens involvement in osteoporosis and its actions on maintaining bone mass can be seen in the study conducted by Riggs et al. which involved 36 women with vertebral fractures due to type I osteoporosis. These women all displayed a high bone turnover rate. The women with type I osteoporosis were compared with 36 normal women (women who did not exhibit Type I osteoporosis) after they were given small touchstones of the sex steroids estradiol, estrone, and testosterone. Blood and ur ine samples were continuously taken (about every 24 hours) and analyzed to reveal that the levels of the sex steroids were equally apparent in both roots of women. However, the amount of all bone biochemical markers (involved in bone turnover) appeared higher in the osteoporotic women. Though the experiment did not let out a difference in the sex steroid concentrations between the two groups of women, post-experimental power calculations were done to show that there are differences between the two groups when = .05 and 1- = 0.8. The differences for blood serum estrone, estradiol and testosterone were as follows 6.3%, 9.9%, and 4.4%, respectively. Some of the women with osteoporosis then underwent another study in which they were split into two groups. One group of osteoporotic women legitimate one-years worth of treatment with transdermic estrogen while the other group of osteoporotic women received a years worth of treatment with a placebo. The women who underwent estrogen t reatment displayed a remarkably larger decrease in bone turnover markers than the women treated with the placebo (Riggs, 2002).Osteoclasts, Osteoblasts and the Estrogen ConnectionOsteoclasts are cells involved in maintaing bone homeostasis and are located on the bone surface in the anterior portion where they work to digest old bone (Manolagas, 2002). Osteoclasts are derived from macrophages, and are very large multinuclear cells formed from the fusion of triune stem cells (Saladin, 2010). Osteoclasts function in digesting bone hence they are involved in bone resorption. Bone resorption is a process that releases calcium patronage into the circulatory system by digesting bone tissue (Saladin, 2010). The function of osteoclasts is essential to the broader process of bone remodeling.Osteoblasts are also involved in maintaining bone homeostasis and are active in the process of bone remodeling. Osteoblasts are located in the posterior portion of the bone surface and work to produce n ew bone in the areas that underwent excavation by osteoclasts (Manolagas, 2002). Osteoblasts are derived from mesenchymal stem cells (Zallone, 2006). The mesenchymal stem cells give rise to osteogenic cells which give rise to most other bone cell types including osteoblasts. Osteoblasts are immature bone cells that are located beneath the endosteum and periosteum of the bone. Osteoblasts synthesize the components of the bone matrix. The matrix undergoes mineral deposition which causes it to harden, and hence the osteoblasts deform trapped within the matrix. When osteoblasts mature, they become osteocytes which function in maintaining bone (Saladin, 2010).Osteoblasts function in making new bone. They deposit calcium salts into the bone matrix in order to make hydroxyapate which is the calcium reserve in bone. Osteoblasts fill in the cavities that were excavated by osteoclasts with new bone. Osteoblasts may be stimulated by various signals and hormones such as calcitonin and estrogen which both function in decreasing blood calcium levels and maintaining calcium levels in bone (Saladin, 2010).Estrogen receptors (ER and ER) as well as androgen receptors (AR) have been identified in both osteoblasts and osteoclasts and their parental cells. The presence of these receptors indicates that estrogen has a direct effect in mediating the process of bone remodeling (Eriksen, 1988 Girasole, 1992 Manolagas, 2002). Estrogen and androgens also have an indirect effect on the process of bone remodeling via the cytokine, interleukin-6 (IL-6) which is an important factor in the process osteoclastogenesis in bone nerve centre stromal cells (Carleston, 2005 Manolagas, 2002). The Study conducted by Girasole et al. has shown that estrogen has an inhibitory effect on IL-6, which results in a decrease in the production of osteoclasts. This decrease in osteoclastogenesis ultimately causes a decrease in bone resorption (Girasole, 1992).Estrogen and androgens inhibit the production of I L-6 in vitro by inhibiting Interleukin-1 (IL-1) and tumor-necrosis factor (TNF)-. IL-1 and TNF- are involved in the synthesis of IL-6 (Ribot, 1997). Some studies suggest that estrogen has more of an effect on TNF-mediated production of IL-6, than on IL-1 mediated production (Girasole et al. 1992). The expression of the IL-6 receptor subunits, gp130 and IL-6-R, are also suppressed in bone marrow stromal cells and in osteoblast progenitor cells (Manolagas, 2002). Studies done in mice have shown that when the IL-6 gene is knocked out or neutralized (via antibodies) the upregulation of colony-forming unit-granulocyte/macrophage (CFU-GM) (which osteoclasts are derived from) in bone marrow is prevented. Hence, there is not an increase in osteoclast production. The results showed that the antigen caused the estradiol-induced inhibition of bone resorption to itself be inhibited (Ribot, 1997).A decrease in estrogen (as well as androgens) also has an effect on osteoblasts. One mechanism by wh ich osteoblasts are regulated by estrogen can be observed in bipotential stromal cells these cells express the estrogen receptors. The bipotential stromal cells are parents to both adipocytes and osteoblasts. A study conducted by Okazaki et al. in mouse bone marrow stromal cell lines, found that estrogen works to mediate the differentiation of the parental bipolar stromal cells towards the production of osteoblasts (Okazaki, 2002). Post-menopausal women who exhibit bone loss have been observed to have an increased amount of lipid concentration in their bone marrow. Hence, a decrease in estrogen would cause an increase in adipogenesis and a decrease in osteoblastogenesis (Okazaki, 2002). This decrease in osteoblastogenesis would result in a decrease in bone formation.Estrogen Replacement TherapyA study that was conducted on post-menopausal Chinese women by Sun et al. was also useful in find the effects of estrogen treatment for osteoporosis. These women all ranged from 41-58 years o f age and had undergone menopause for more than a year. The women were split into 4 different groups. Each group received different levels of 17-estradiol (E2) gel along with a form of progesterone, either micronized progesterone (MP) or medroxyprogesterone (MPA). The progesterone was added along with the estrogen in order to prevent endometrial hyperplasia which may occur as a result of estrogen fill-in therapy. The dosages differed in both progesterone type and concentration as well as in estrogen concentration. The exact dosages for each group were as follows group 1 received 1.5 mg E2 and 100 mg MP, group 2 received 1.5 mg E2 and 2 mg MPA, group 3 received 0.75 mg E2 and 100 mg MP, and group 4 received 0.75 mg of E2 and 2 mg MPA. These dosages were administered once a day, 25 days a month for at least a year (some of the subjects were studied for two or three years). Blood and urine samples were taken from these women and monitored for bone mineral density (BMD). The results sh owed that after about a year of this treatment, the average increase in BMD in cancellous bone of the 4 groups ranged from 4.6%6.4%. After 36 months an increase in the BMD of the bones in the neck and the lumbar vertebrae were observed the averages ranged from 4.3%-7.5% and 4.2%-6.2%, respectively. This study also found that the BMD in the hip (an area that is prone to fractures), had significantly higher levels than the baseline levels. The main purpose of the study was to determine an appropriate dosage of estrogen and progestogen for post-menopausal Chinese women the results of the study indicated that either 0.75 mg or 1.5 mg of E2 daily is sufficient for prevention of bone loss in Chinese women. The study suggests that hormone replacement therapy has a significant effect on bone, especially during the first two years of treatment (Sun, 2002).The knowledge of estrogens actions on bone and the inhibitory effect it has on osteoclastogenesis, has led to the utilization of estrogen as a treatment for osteoporosis. Estrogens ability to maintain bone mass in post-menopausal women has made estrogen replacement therapy a valuable form of treatment. This treatment utilizes the protective properties of estrogen on bone and functions in increasing bone mineral density (BMD) in post-menopausal women (Sun, 2002). Estrogens substantiative effects on bone are amplified during the treatment hence, estrogen induces stimulation of osteoblastogenesis and inhibits osteoclastogenesis via IL-6 (Girasole, 1992 Okazaki, 2002). The type of estrogen administered (other than estriol) seems to have no difference in potentness hence, synthetic estrogen, 17-estridiol, and equine estrogen all have equal effects on the maintenance of bone mass and all work to decrease the amount of bone turnover (Ribot, 1997). The method by which estrogen is administered (i.e. transdermally, percutaneously, etc.) also does not appear to make a difference in its effectiveness. The dosages of estrogen as well as the duration of the treatment seem to be the only variables involved in determining the effectiveness of estrogen replacement therapy (Ribot., 1997). In order for estrogen replacement therapy to have a long term effect, estrogen must be administered for about 5-7 years (Cauley 1995 Ribot, 1997). Estrogen replacement therapy is also most effective if it is initiated early after menopause. A study conducted by Cauley et al. found that women who started estrogen treatment within 5 years of menopause and/or underwent treatment for 10 years or more, had the most effective and long-lasting results (Cauley 1995).Though Estrogen Replacement Therapy is a promising and effective mechanism for treatment of osteoporosis, it is associated with some hard physiological risks. Long-term usage of estrogen has been known to cause endometrial cancers. However, when estrogen is administered in conjunction with progestins, the risk of endometrial hyperplasia is significantly reduced. (Ribot, 1 997 Sun, 2002). Many studies have been conducted to determine whether or not there is a relationship between estrogen and breast cancer. Some studies suggest that there is a correlation between the risk of breast cancer and use of estrogen (Lim, 2006). Other studies suggest that there is no correlation (Ribot, 1997). Though estrogen replacement therapy is associated with a few serious risks, it also has other positive physiological effects on other areas of the body, not just bone. For example, estrogen is thought to have a tour of duty effect on Alzheimers disease and also on Coronary Heart Disease (CHD) in post-menopausal women (Ribot, 1997 Tang, 1996).The onset of type I osteoporosis is generally characterized by a loss of ovarian function which therefore results in a loss of estrogen in postmenopausal women. (Manolagas 2002). Estrogen can be used as a treatment for osteoporosis due to the presence of estrogen receptors in osteoclasts, osteoblasts and their precursors, as well a s in bone marrow stromal cells (Zallone, 2006). The positive actions of estrogen on bone are mainly due to the suppressive actions of estrogen on bone resorption by osteoclasts (Okazaki, 2002). When Estrogen levels are decreased, the normal regeneration process, which involves bone resorption followed by an appropriate amount of bone formation, is disturbed (Zallone, 2006). Various in vitro studies have been conducted that demonstrate that the presence of estrogen (as well as androgens) increases the action of factors that work to inhibit the process of osteoclastogenesis (Bellido, 1995). The decrease in the production of osteoclasts due to estrogen would therefore cause a decrease in the process of bone resorption (Okazaki 2002). Estrogen also has an effect on the production and differentiation of osteoblastic cells. However, it has the opposite effect on osteoblasts and thereby stimulates their production by shifting the mechanism of bipolar stromal cells towards the production of osteoblastic cells rather than that of adipocytes (Okazaki, 2006). Hence, estrogen works to decrease bone resorption and increase bone formation, thereby creating a protective effect on bone which can be utilized to treat such debilitating diseases as osteoporosis.

Healthcare Industry: IT Systems

healthc ar Industry IT Systems easilyness trouble run hold rulen several changes through start the days to respond to ever-changing demands of the world. The present key arrestrs and issues that stakeholders (patients, health awe willrs, vendors and political science) in the health cargon orbit face argon ageing population, increased burden of chronic conditions, hike earth demand/expectation for quality healthcargon, fragmented and uncoordinated healthcargon decease and rapid advances in teaching technology.At present, information technology is considered a strategic necessity by world class administrations instead of just a supporting tool. To obtain a competitive advantage in an milieu with intense competition, it is vital for organisations to use to a greater extent sophisticated information technology tools to address the ch altogethithernges of building and deploying establishment in the short border and the identification, research and betterment patte rn of future arrangement.Information technology (IT) is rapidly becoming combine with healthc atomic number 18 to improve exhibites and communications, support decision making, reduce inaccuracies, and improve patient safety. The advancement of checkup examination science through the years has fuck absent possible the use of much(prenominal) expensive equipment and the latest technology. This will allow healthc be providers and patients to gain access to health information easily and thus has the potential to improve the quality, safety, and efficiency of health care. As the healthcare industry is information intensive and knowledge intensive, there is as well as a need to publish health care information and knowledge.wellnesscare systems vary from country to country but they all go for a prevalent address that is to meet the healthcare postulate of coffin nail populations. In this report, I will be focusing on healthcare IT in Singapore context.Healthcare System in SingaporeSingapore has a dual health care system where individuals mint choose between public and buck private providers. The government through Ministry of Health (MOH) manages the public healthcare system. MOH plays a major role in formulating national health policies, coordinating the improvement and planning of the public and private healthcare sectors and regulating health standards. MOHs mission is to promote good health and reduce illness, to ensure Singaporeans beget access to good and afford able healthcare and to comply medical checkup excellence (Ministry of Health, 2007). MOHs vision is to develop the worlds most cost- telling healthcare system to keep Singaporeans good health.Delivery StructureHealthcare services in Singapore are provided by contrary types of providers from primary care to 3rd care and to step-down care.Primary CarePrimary care includes primary medical treatment, preventive healthcare and health education (Info-communications Development Authority of Singapore, 2009). In Singapore, primary health care is provided through outpatient polyclinics and private medical practitioners clinics. 80% of the services are provided by private practitioners sequence the remaining 20% by government polyclinics.Conveniently located in town centres all over the island, polyclinics are one stop health centres which offered services such as outpatient medical care, maternal and child care health.Secondary and Tertiary CareFor the secondary and tertiary care, 80% of the hospital care being provided by the public sector and the remaining 20% by the private sector.This public sector is organised into 2 vertically integrated delivery networks, landal Healthcare Group (NHG) and Singapore Health Services (SingHealth) that operate as not-for-profit private companies. Having these two groups change more integrated and better quality healthcare services through greater cooperation and collaboration among public sector health care providers. Each c onstellate consists of both general hospitals that provide multi-disciplinary healthcare services and specialised hospitals in miscellaneous disciplines e.g. obstetrics and gynaecology and ophthalmology.The private sector provides similar specialist disciplines and comparable facilities to the public clusters. The two main providers are Raffles medical Group and Parkway Group Healthcare (Info-communications Development Authority of Singapore, 2009).Step-Down CareVoluntary public assistance organisations (VWOs) provide most of the step-down care services. They run nursing homes, inpatient hospices, alliance hospitals and chronic sick hospitals. Four of the public acute hospitals in addition provide geriatric units (Info-communications Development Authority of Singapore, 2009).Public Healthcare Delivery StructureOne of the objectives of forming the two clusters is to facilitate integration of healthcare services at the various levels. The clusters begin begun introducing measures to integrate primary healthcare at the polyclinics and secondary care at the hospitals.A Vision for 21st Century HealthcareIntelligent Nation 2015 (iN2015) is a 10-year masterplan to religious service Singapore realise the potential of infocomm. The vision of iN2015 is An Intelligent Nation, a Global City, powered by Infocomm. The goal for the Healthcare and Biomedical Sciences sectors is To urge on sectoral transformation through an infocomm-enabled personalised healthcare delivery system to achieve high quality clinical care, service excellence, cost-effectiveness and strong clinical research. (IDA, 2006) discover to emblem 1 in Appendix to see how it will look like. Key drivers of change in Singapores healthcare sector were place and a yield of liable(predicate) shifts and changes to the system were predicted (IDA, 2006).Key DriversShifts/ChangesAgeing population of chronic conditionsFocus on prevention, health promotion and wellness careRising public expectations of heal thcare services corporate and patient-centred system of deliveryFragmented and relatively uncoordinated healthcare servicesConsistent widespread drill of evidence-based medicineVery rapid advances in infocomm, medical science and technologies and biomedical researchGreater role of members of the public in managing their own healthGreater facilitation of information flows between healthcare sector and biomedical sciencesStrategies and Programmes(IDA, 2006)The targeted outcome is a well-integrated quality healthcare, cost effective healthcare services and greater ability of public to manage their health. To bring intimately fortunate business change using IT, healthcare providers should ensure that IT works in performance with meaningful changes in organisational functions and processes (Rothenberg, 1995).How IT can be apply?In the healthcare industry, one suite solution is not common because certain user departments will need to have more in-depth functionalities than others. A m ore common approach in the industry is best of get over where it attempts to give full equal weight in terms of functionalities and features to individual user departments. Some considerations for best of breed approach areIt deals with more than one vendorA need to connect or interface the divergent applications to provide a fully integrated solutionFuture upgrades issues.Therefore, there is a need to strike a balance between having too many application platforms and departmental requirements or functionalities (Online adviser Software).IT Infrastructure for the Healthcare IndustryFunctional interoperability is inevitable in order for computing devices to be able to share clinical data with one another. Computers must have functions to be able to physically communicate, send and receive documents and data files, share data and information.Therefore, there is a need for integration, standards and interface engines to build the healthcare industry infrastructure.MediNetMediNet f orms the backbone of medical system in Singapore (IDA, 2006). It is Singapores nationwide computer network for medical and health care community that focuses on five components (Lim, 1990) central Claim Processing System(CCPS) processing of claims in hospital billsNational Patient Master Index (NPMI) consists of patients risk factors, drug allergies and demographic dataProcurement electronic procurement of medical and surgical suppliesNotification Transmission of notifications to government agenciesInformation Services Access to local and foreign databasesMediNet links up computer systems of all participants (MOH, primordial Provident Fund Board (CPFB), Government Bodies, restructured hospitals, private hospitals, general practice clinics) in the healthcare delivery system so that they will be able to communicate, exchange data and access common applications on the network (ANNEX C FACTSHEET Infocomm Milestones, 2006).Health Level 7A group of healthcare computer systems users who founded the Health Level 7 organization in 1987 started developing the HL7 protocol to create that common language that allows healthcare applications to share clinical data with separately another. Over time the HL7 interoperability protocol became a nationally, multinationally and globally accredited standard (HL7 Singapore). Health Level Sevens domain is clinical and administrative data. porthole EngineInterface engine is a software program intended to simplify the creation and instruction of interfaces between separate applications and systems, either within the organization or with other affiliated organisation (McLeod CG, Inc., 2006). It carries out messaging between systems and usually handles any mapping, translation and data modification required to ensure the effective exchange of data. Examples of common interface engines utilize in the healthcare industry are Cloverleaf, Datagate and Openlink (MDI Solutions, 2009). Imagine in a hospital where there are different departments needing different functionalities and features, different applications might be running. It would be very complex and technically difficult to maintain separate interfaces between them.Healthcare ApplicationsEnterprise alternative Planning (ERP)The public healthcare sector uses SAP industry solution for hospital (IS-H) (SAP, 2008). It supports patient management, medical and nursing documentation, and patient invoiceing, and integrates these with financial accounting, controlling and materials management. The information system contains evaluations of patient and hospital data that can be used both internally and outdoor(a)ly. It to a fault contains a communication component that enables data designate both within the hospital and to external parties.The picture below shows the SAP footprint in Singapore Healthcare Industry. Only Parkway Health (Private Sector) and res publica Polytechnic (for educational purpose) are not under the public healthcare sector.Source (S AP, 2008)Case Study Hospital Information System at St Andrews society Hospital (InfoComm Singapore Portal, 2008)St Andrews Community Hospital was relocated in April 2005 to a larger premise in Simei. The change in hospital and care processes was the drive to upgrade the Hospital Information System (HIS) at St Andrews Community Hospital from its manual administrative system and show up stock which require tedious work to a more efficient way to process information by technology.The project team were focused on being user-centric rather than IT-centric in the survival of an HIS. User departments were pro-active and committed during the pre-selection brainstorming and consultancy and during the implementation stages of the new system.The VESALIUS, a complete HIS provided NovaHealth which covers front-end modules such as Appointments, Registrations, ADT and billing and ancillary support modules such as apothecarys betray, Medical Records, back-end Inventory and integration to the Financial System.The benefits of the system areAssisting management to track costs down to the minute detailsIncreasing efficiency as manual and administrative work are being minimisedEnabling links to the MOHs Elderly and Continuing Care system for online submission of information to receive government subsidies and the CCPS for machine-driven submission for Medisave claimsServing as a check and balance for inventory audit and reducing waste.As a result, there is no need for Pharmacy staff to spend time physically checking stock levels when transferring items from the various stores in St Andrews Community Hospital. Having a lean and efficient team complemented by the HIS, paperwork is also minimised.An Integrated Electronic Medical DatabaseElectronic medical record (EMR) stores patients medical information through IT to enable sharing crossways healthcare institutions (MOH SingHealth NHG, 2004). It can be made more secure through appropriate IT access and security safeguards.The MOH holds the vision of One Singaporean, One Family Physician, One Medical Record to improve long term care. EMR provides medical staff involved in patient treatment with quick and accurate access to patients essential medical information (Yong, 2007). The integrated patient database system was thus vital in Singapore as there is a need to get the right information to the right people especially in an industry where a second could mean a difference between a life and death situation.EMR Adoption ModelThe EMR Adoption Model is devised by HIMSS Analytics to track the progress of hospitals towards creating a paperless patient record system. It is based on an eight-stage scale which starts at zero (HIMSS Analytics). The EMR Adoption Model Structure ensures all application capabilities must be operational before that stage can be achieved as it sets a foundation for subsequent stages. Refer to Figure 2 in Appendix for the EMR Adoption Model.Electronic Medical Record Exchange (EMRX)EMRX is an initiative by MOH and the two public healthcare clusters (SingHealth NHG) to share electronic medical record crosswise all public hospitals and polyclinics in Singapore.The EMRX will have the following information (MOH SingHealth NHG, 2004)Discharge summary which summarises recent hospitalization records including the treatment received and clinical courseOperation reports and laboratory results, including radiology images and scanned medical recordsMedicines prescribed with drug allergy historyIt was launched in April 2004 to focus on the improvement of patient care outcomes. It is a pragmatic and incremental implementation where SingHealth and NHG first developed the key systems within selected institutions and then replicate in other institution within the cluster and eventually across clusters and where practical with the private sector.The benefits of EMRX are (MOH SingHealth NHG, 2004)Better coordinated care for patients moving across different providers and improved le vels of healthcare delivery.Better clinical decisions, with access to complete and legible clinical histories, and updated test results at the providers fingertips. Reduce the risks of transcription errors and missing records.Save cost through the avoidance of supererogatory quote tests and investigationsBetter distribution of careFacilitation and follow up of other IT based applications such electronic prescriptions and clinical decision support systemsPotential for 24 min access to real-time data for up to date results reportingProvision for data security and audit features to be build into the system.Current EMRX ImplementationThe aim of the clusters is to implement the EMR in all institutions within each cluster incrementally. SingHealth and NHG manage their clusters EMR self-sufficiently. SingHealth started using an EMR system in SGH in year 2000. The main application SingHealth has used to develop its EMR system is iSOFTs iClinical Manager Solution (E-HEALTH-MEDIA LTD, 20 04). Similarly, the National Healthcare group has also started using EMR systems in Tan Tock Seng Hospital and National University Hospital. EMRX was developed to enable secure cross-cluster exchange of patient information. This is to ensure that a patients record can be retrieved regardless where he or she seeks treatment.EMRX was later extended to healthcare partners, providing a central capability for effortless movement or records across the public healthcare clusters, community hospitals and Ministry of Defence (MINDEF), facilitating care delivery.SAF Electronic Medical RecordsThe SAF healthcare system is centred on the SAF EMR system which is known as Patient Care Enhancement System 2 (PACES 2). It has clinical data repository, administrative function for manpower and logistics and also has the feature for research or analysis (Wong, 2009). The system connects all SAF medical centres across Singapore to allow for online and real time medical info convalescence and simultaneou s viewing. Figure 3 in Appendix shows how it is connected.NHG PolyclinicBukit Batok Polyclinic was the first to adopt the electronic medical records system. With paperless medical records, patients medical records can now be retrieved while diagnoses are entered into the system (Hoe, 2009). This move is part of MOH vision of integrating services between the healthcare providers.Benefits to PatientsEnhanced safety as there is a minify patient risk through improved legibility of orders.Reduced waiting times due to the improved processBetter care coordination and disease management through sharing of medical recordsBenefits to the polyclinicQuality Continuous improvement of quality care and patient service through error monitoring and elimination of unnecessary proceduresProductivity Saving time and effort that would otherwise be spent on correcting lost and illegible orders. Furthermore, there is no nightlong need to go to the records office, retrieve the physical paper records and bring it up to either the doctors or nurses room which can take up to 20 minutes or half an hour.Access More readily available information and data of patients for healthcare professionals to make faster critical decisionsFuture Outlook National Electronic Health Record (NEHR)The next phase of electronic health record is moving towards creating a health record that is in fact personalised and accessible all over to be implemented by April 2011 (Channel innovativesAsia, 2010). With NEHR, all key information such as a patients demographics, allergies, clinical diagnoses, medication history, X-rays, laboratory investigations and discharge summaries will be fully exchangeable between various healthcare providers.Due to the costly implementation, only a number of primary and step-down care providers, including GPs, polyclinics and a community hospital will be linked up first (ChannelNewsAsia, 2010). The full implementation of NEHR will take many years as it has to cover the stainless healthcare ecosystem and not just the public sector. The decision on whether to implement each phase will have to be justified on cost-benefit analysis.Refer to Appendix for an attached article on What could healthcare in Singapore look like in 2020? (Ministry of Health, 2008).Medical Information ServicesIT is also widely used as an information tool by both medical professional and the public. Several government and privately initiated websites provide information for health care services and databases for medical related issues. Web portals provide the following servicesSearching for medical professionals within Singapore The MOH has a list of online resources to search for healthcare professionals in Singapore (MOH, 2007)Online pharmacies For example, Changi General Hospital myPharmacy is the first online hospital pharmacy in Singapore (Changi General Hospital, 2004).Medical publications One example of medical publications is PubMed (PubMed).Health related publications Some examples of health related publications from SingHealth (SingHealth Academy ).Health service reports Queue watch provide patients with timely information to arrange their visit. The number of patients waiting for registration and consultation, live webcam images showing the waiting areas for registration, consultation and pharmacy/payment and peak non-peak periods are displayed online (Government of Singapore, 2007).Medical schemes such as Medifund, Medisave MediShield Information regarding these schemes can be found in CPF Board website (Central Provident Fund Board, 2009).Competitive AdvantagesThe growth and survival in the healthcare industry depends on how well Singapore is able to compete in this highly and competitive marketplace. With the integration of the healthcare infrastructure, the advanced medical technology and the highly skilled professionals, Singapore has managed to establish a report card of being a world class healthcare hub, the ability to deliver innovati ve healthcare solutions, a complete range of services and quality healthcare providers (EDB, 2009). There will be a strong demand from the population for quality healthcare and value added services with rising economic affluence and longer lifespan. Thus, there is a need to ensure that healthcare research and development continues to be supported so that Singapore healthcare services sector can excel and be a source of competitive advantage.To sustain the competitive advantages, Singapore should be informed of their strengths and weaknesses and also of their competitors. The approach for the future must be one that focuses on possible improvements, supporting innovations and facilitating changes. The focus will have increasingly to be on openness to new influences, a willingness to recognize different schools of thought and methods of training and a search for the best available expertise from around the world (Desker, 1991). Innovation is needed to overcome the future challenges a head to maximize Singapores competitive advantage. Healthcare providers should enhance their medical and service offerings, develop new healthcare products, and promote a pioneering spirit that will help in transaction with evolving patients demand, and in creating holistic and flawless experiences for patients (Tan, 2009).Thomson Medical CentreThe Business Times reported that Thomson Medical is leading the healthcare sector (Ramchandani, 2010). Focusing on triad core areas patient expectations, perceived quality and perceived value to improve patient enjoyment, Thomson Medical Centre has been continuously innovating to provide greater value-added services to its patients. Their redesigned patient-centric work flow had helped them gain a competitive advantage over their rivalsUse of technology and raise in service and product standards has improved patient care and satisfactionImprove in-patient , out-patient and administrative processes by using touch screen billing in place of a key-in method, which has halved the time spent on billing and has resulted in cost savings of $2000 a month.Reduce waiting time for admission and discharges with express check outs, direct admissions and courtesy and in-room discharges.Act on service recovery. When there is an unhappy patient with service, they move fast to resolve the problem.Train front line staff to raise service standards which resulted in an increase in the number of compliments as compared to complaints (4.91 to 9.21).Create a positive patient experience by having a resort style ambience, offering concierge service, a take drink and, in the case of premier rooms, luxurious dcor and relaxing spa music.Introduce value added services such as the interactive website ThomsonBaby.com to help new mothers prepare for the parenthood journey and save them time and money.The hospitals efforts in cultivating lasting relationships have also led to an increase in patient loyalty. 32.2% of its patients were take over pa tients in 2009, compared to 26.8% in 2008. Besides that, there was an increase in the number of babies born.Thomson Medical Centres dedication in understanding patient needs and receiving feedback on their dumbfound and their expectations at key hospital touch points has thus improved patient satisfaction level.ChallengesThe vision for an integrated and continued patient- centric healthcare system requires practical IT systems, active engagement of patients and suitably aligned financial framework. In the development of the Singapore healthcare system, there are some issues that hinder the implementation of healthcare integration due to unique specificities.In general, the problems faced by the players involved can be classified into five categoriesClinical and medical practices Often built around specialization but could be better oriented towards integrated careFinancing framework GPs, Specialist Outpatient Clinics (SOCs) and patients does not see the incentive for integration o f careEstablishment of a new idea mindset towards integration of care for players involvedOrganizational processes Enhanced by bridging communication and IT gaps, coordinating across sectors and defining workflows for the smooth move of patients between caregiversIT systems Better connected across sectors and allow for the transferability of patient records.As shown in Figure 4 in the Appendix, these challenges have over the years led to ingrained mindsets and behavioural practices of parties at multiple levels of the system, further hindering the integration of care (Ministry of Health, 2008). The various challenges and loophole that currently exist are the result of institution-centric and tertiary-centric system of healthcare.As EMRX becomes widely accessible, there are concerns over patient confidentiality and privacy. For instance, legal implications of providing EMRs beyond cluster boundaries were considerable and attaining consent from individual patients would have been bur densome and stalled widespread accessibility of EMRs (MOH SingHealth NHG, 2004). This shows that there are vital ethical concerns over the privacy of personal medical records.Furthermore, the infrastructure for data standardisation needed to achieve this integrated healthcare system is getting more intricate and costly due to the vast amount of data involved from different independent systems. Despite SingHealth and NHG adoption of the HL7 v2.3, data exchange could not be easily achieved in spite of HL7 v2.3. This is because the standard was open to variations that hampered direct interoperability. Moreover, modification of systems to enable data interoperability would have been costly, without direct benefits to the clusters (Lee, Lim, Tan).ConclusionPreviously, healthcare sector has lagged behind other sectors in the adoption of IT for its key process. Healthcare providers need to palingenesis the way businesses are conducted. IT can be a powerful enabler for an information inte nsive industry like healthcare through automation, knowledge management, business process reengineering, and even hokey intelligence. A pragmatic approach should be adopted to consider the current status and to focus on implementing immediate goals that would bring about meaningful changes in organisational functions and processes within a reasonable time frame.The use of IT to create value in a patient-centric approach to care is likely to contribute significantly to the boilersuit level of care that patients can benefit from. Innovation can help healthcare providers to gain a competitive advantage. The success of some healthcare provider as mention above has shown that IT can help in the healthcare sector to improve healthcare quality, reduce costs and to meet some of todays trends in demographics and disease burden.This quote which is published in NHG annual review 2007-2008 shows the importance of IT,Technology is our enabler. We use technology to record and disseminate inform ation with higher precision, true statement and safety. More importantly, it allows healthcare to be delivered safer, faster and better.(National Healthcare Group Polyclinics, 2008)In the enthusiasm to adopt and invest in IT, it is important to note that there are some barriers in the move toward an integrated healthcare system as stated in the abovementioned section. Addressing and overcoming these challenges will involve the collaboration and cooperation of players at all levels of the system, across both the public and private sectors.Learning points / OpinionsStrategyTechnology should be used as a supporting tool not to steer health care reform. To transform Singapores health care system into a modern and responsive 21st-century health care system, a practical IT strategy which is consumer-focused is needed. In particular, it needs to be competitive in terms of price and quality because that is what consumers look for. A tripartite model of health care regulation, involving the active participation of empowered consumers, is Singapores best hope for containing costs and ensuring quality of care.What is done well?A committee to plan for the future development in healthcareiN2015 Healthcare and Sub-Committee came out with strategies and programmes to help address todays challenge and support the developmental opportunities. It aims to achieve high quality clinical care, service excellence, cost-effectiveness and strong clinical research.Improve business process with ITIT has played an important role in the delivery and development of healthcare services in this information age with applications ranging from finance and personnel administration to medical equipment operations. Healthcare service administrations have become more efficient and responsive, reducing patient waiting time and paper work. Medical equipments have become more accurate, laboratory results can be processed more quickly and effective communication among medical staff in Singapore and t hose overseas has become easier.What more can be doneUser InvolvementIT investment decisions must serve the best interests of the key players involved. It is important to understand the users and their work flow and requirements as a one size or solution may not fit all. Flexibility is needed as each department requires different functionalities. exhibit clearly the benefits and value for the changeUsers involved need to understand the strategic goals of the organization and understand how IT, from technical and managerial perspectives, can help to achieve them. The success of IT investments is to ensure users see the benefit and value of IT so that they will be motivated to make the change.Limitations of ITHealthcare providers should be mindful of the limitations of technology and have a deep understanding of the information search behaviours of their target audience. Health care is still a hiAre Consumers Central to Marketing Activities?Are Consumers Central to Marketing Activitie s?In view of the dynamic genius of the selling environment, to what extent do you consider consumers to be, in practice, central to trade activities?Words count 1621 linguistic processMarketing is the analyzing, organizing, planning, and controlling of the firms customer-impinging resources, policies, and activities with a view to returning the needs and wants of chosen customer groups at a profit. (Kotler and Keller, 1967) 1The main purpose of any business is to make profit. To do so, their customers are necessary. The role of marketing is to anticipate and identify consumers needs and wants, in order to satisfy them efficiently and profitably.2In view of the dynamic nature of the marketing environment, to what extent are consumers, in practice, central to marketing activities? First of all, it is necessary to define what characterizes the marketing environment, and in what way this environment is dynamic. Secondly, we will see how the consumer is central to marketing activ ities. Finally, we will discuss about the relative importance of the consumers in these activities and the other factors that can also influence them.The marketing environment consists of external factors that affect the companies and their ability to satisfy customers.2 There are two aspects to this marketing environment the macro-environment, and the micro-environment.The PESTEL factors are the factors found in the macro-environment political, environmental, social/cultural, technological, economical and legal.3 They are social factors, thus not controllable and the companies need to adapt to these factors. In the macro-environment is included the demographical factor. The study of the demographic environment can help predict the size of the market of a certain product. For example if the number of elderly people is going to rise, the potential market for retirement homes will grow. The same goes for a change in the number of children, which could impact the number of schools and teachers needed.4Companies need to adapt to changes in the micro-environment as well. The factors in the micro-environment are the ones close to the company, making them easier to control customers, competitors, distributors, suppliers, and other departments within the company.For example, if a company has competitors satisfying the same needs with a similar product but at a lower price, it wont be able to switch its product and make profit out of it.Companies make use of marketing research and marketing intelligence to collect information about the marketing environment in order to adapt their marketing strategies. Marketing takes place in a dynamic environment these external factors change constantly, and companies need to be aware of these changes taking place in the marketing environment in order to adapt themselves efficiently and effectively, and be able to keep on answering consumers needs and wants.5To satisfy their target consumers, marketers need to understand them. They need to study the existing and potential markets. Resources need to be efficiently managed in order to meet the identified needs in these markets.2Marketing orientation is important because different customers have different needs. In order to meet the specific needs of each customer, firms have to adapt. Answering everyones needs is not a realistic thing, which is why segmentation is used. Segmentation is the method used to separate the population into specific segments, which contains customers with similar needs. accord the needs of these segments of population will allow the determination of the marketing strategy that will be used in a specific business plan.6The marketing strategy determines the actions that will be taken over time to achieve the objectives of the company. Marketing decisions are based on the 4Ps, also called marketing mix Product, Price, carry and Promotion. The four components of this marketing mix are determined by the target consumers.7As said before, t he purpose of any business is to make profit, and it needs to satisfy the consumers for that to happen. The product needs to fulfil the customers need of course, but not only. The product also has to be at an acceptable price in the eyes of the consumers for them to bargain it. The price is what makes money for the company, it is determined by the production costs and the competition, as well as by how much the customers are willing to pay for the product. On the one hand, if the price is too high, consumers wont buy, which means the company wont achieve its sales target. On the other hand, if it is too low, the target will be achieved but there will be no profit made out of it. 4Price has to be chosen accordingly as well as place. Different types of consumers will need the product to be available at specific places. A very expensive product, such as a luxury item, will not necessarily be available at the local supermarket for example, but most certainly in a specific shop or place . Consumers also prefer to buy products when they are located close to their homes and workplaces.8In order to answer consumers needs profitably, marketers have to use segmentation to target their market, and match their marketing strategy to their target consumers needs.4 Thus making the consumers central to the companys marketing activities.Lets take Microsoft as an evolutionary example of changes in the marketing environment with the technological factor (macro-environment) and the companys competition (micro-environment).9Recently, Microsoft has struggled to find its place in a fast changing digital and technological environment. Microsoft was and still is in consumers mind the attraction in Personal Computers. They are now lagging behind competitors like Apple or Samsung, and are trying to develop other devices like tablets, smartphones, eases, etcetera They even acquired Nokias smartphone business in order to do so. They developed a new version of their operating system t hat works on every platform, including their console Xbox which provides a cloud based connectivity that consumers are looking for. Their change in strategy to provide consumers what they need in this era of technological improvements has paid off Microsofts sales are trending upward since the past few years.9In order to keep his place in the market, Microsoft had to change its strategy to improve its solutions to satisfy todays consumers later on being left behind by competitors and technological advances.To this point, we can affirm that consumers are indeed essential and central to marketing activities. Marketing is all about satisfying consumers profitably, and marketing research and marketing strategies are calculated around them. Despite their importance, consumers are only one of the forces in the marketing environment.Changes in the marketing landscape are so fast that it is now more and more difficult for companies to adapt.One of the most influential factors of marketing activities is technology 40% of the worlds population now has access to the Internet, compared to 1% in 1995.10 The vast majority owns a smartphone that also has access to the Internet. The Internet and social media are thus also used for marketing purposes as well11 websites, adverts, e-mails, videos, etc. Influencers on the Internet are also important for marketing research they can be people who have blogs and websites for example, and are useful to marketers for them to better understand current trends and interests.12 Companies can also sponsor people such as bloggers and video makers (YouTube in particular) by making them review products and/or services online.13Globalization is another factor that influences marketing activities. Lots of companies now face global competition. Also, when a company decides to sell its products abroad, it has to take into account the tastes and habits of the selected country. For example, for the French market, Nutella is manufactured to be more spreadable, due to the fact that French people mostly eat it on baguettes, making it more difficult to spread.14Nowadays, companies also need to take into account the environmental aspect for their marketing activities. They have to be environmentally responsible, to be more sustainable in their practices than in the past.These are a few other examples of factors, apart from the consumers, that can have an influence on the marketing activities of businesses.To conclude, consumers are indeed central to marketing activities, but are only one of the many factors that have an influence on them notably changes in the marketing environments factors the technological factor in particular, which is probably the fastest changing factor as of now.ReferencesBerthon, P., Pitt, L., Plangger, K. and Shapiro, D. (2012). Marketing meets Web 2.0, social media, and creative consumers Implications for international marketing strategy. Business Horizons, 55(3).a mintresse La curiosit en continu. (201 7). Pourquoi le Nutella snuggle pas le mme en France quen Allemagne ? a mintresse. online ready(prenominal) at http//www.caminteresse.fr/economie-societe/pourquoi-ne-mange-t-on-pas-le-meme-nutella-en-france-quen-allemagne-1129354/ Accessed 26 Mar. 2017.Corcoran, C. (2017). Marketings New Rage Brands Sponsoring Influential Bloggers. online WWD. Available at http//wwd.com/business-news/marketing-promotion/marketings-new-rage-brands-sponsor-influential-bloggers-3230386/ Accessed 26 Mar. 2017.Goi, C. (2009). A Review of Marketing Mix 4Ps or More?. International Journal of Marketing Studies, 1(1).Internetlivestats.com. (2017). Number of Internet Users (2016) Internet Live Stats. online Available at http//www.internetlivestats.com/internet-users/ Accessed 26 Mar. 2017.Kotler, P. and Armstrong, G. (2016). Principles of marketing. 16th ed. Harlow Pearson.Kotler, P. and Keller, K. (1967). Marketing management. 1st ed. Upper Saddle River, NJ Pearson scholar Hall.Li, Y., Lai, C. and Chen, C . (2011). Discovering influencers for marketing in the blogosphere. Information Sciences, 181(23).Palmer, A. and Worthington, I. (1992). The business and marketing environment. 1st ed. New York etc. McGraw-Hill restrain Co..Richardson, M. and Evans, C. (2007). Assessing the Environment. British Journal of Administrative Management.Smallbusiness.chron.com. (2017). What Are the Four Types of Utility Marketing?. online Available at http//smallbusiness.chron.com/four-types-utility-marketing-24420.html Accessed 26 Mar. 2017.1 Kotler, P. and Keller, K. (1967). Marketing management. Upper Saddle River, NJ Pearson Prentice Hall, p.12.2 Palmer, A. and Worthington, I. (1992). The business and marketing environment. New York etc. McGraw-Hill Book Co., pp.1-6.3 Richardson, M. and Evans, C. (2007). Assessing the Environment. British Journal of Administrative Management.4 Palmer, A. and Worthington, I. (1992). The business and marketing environment. New York etc. McGraw-Hill Book Co., p.167.5 Ko tler, P. and Armstrong, G. (2016). Principles of marketing. 16th ed. Harlow Pearson, pp.94-95.6 Palmer, A. and Worthington, I. (1992). The business and marketing environment. New York etc. McGraw-Hill Book Co., pp.10-17.7 Goi, C. (2009). A Review of Marketing Mix 4Ps or More?. International Journal of Marketing Studies, 1(1).8 Smallbusiness.chron.com. (2017). What Are the Four Types of Utility Marketing?. online Available at http//smallbusiness.chron.com/four-types-utility-marketing-24420.html Accessed 26 Mar. 2017.9 Kotler, P. and Armstrong, G. (2016). Principles of marketing. 16th ed. Harlow Pearson, pp.92-94.10 Internetlivestats.com. (2017). Number of Internet Users (2016) Internet Live Stats. online Available at http//www.internetlivestats.com/internet-users/ Accessed 26 Mar. 2017.11 Berthon, P., Pitt, L., Plangger, K. and Shapiro, D. (2012). Marketing meets Web 2.0, social media, and creative consumers Implications for international marketing strategy. Business Horizons, 55(3) , pp.261-271.12 Li, Y., Lai, C. and Chen, C. (2011). Discovering influencers for marketing in the blogosphere. Information Sciences, 181(23), pp.5143-5157.13 Corcoran, C. (2017). Marketings New Rage Brands Sponsoring Influential Bloggers. online WWD. Available at http//wwd.com/business-news/marketing-promotion/marketings-new-rage-brands-sponsor-influential-bloggers-3230386/ Accessed 26 Mar. 2017.14 a mintresse La curiosit en continu. (2017). Pourquoi le Nutella nest pas le mme en France quen Allemagne ? a mintresse. online Available at http//www.caminteresse.fr/economie-societe/pourquoi-ne-mange-t-on-pas-le-meme-nutella-en-france-quen-allemagne-1129354/ Accessed 26 Mar. 2017.

Employee Motivation: Literature Analysis

Employee Motivation Literature AnalysisChapter Two- Literature Review 2.1 Introduction At genius time, employees were considered just a nonher input into the production of betters and services. What perhaps changed this way of thinking ab expose employees was the research, referred to as the Hawthorne studies, conducted by Elton Mayo from 1924 to 1932 (Dickson, 1973).This study found out that employees atomic number 18 not motivated solely by money but also their conduct is linked to their attitudes (Dickson, 1973).The Hawthorne studies begun the piece coitions approach to management, whereby the of necessity and motive of employees make the primary focus of managers (Bedein, 1993). Understanding employee pauperization and its affinity with corporate husbandry and gender is the focus of this research.This chapter is divided into seven constituents section 2.1 introduces the main subjects of this dissertation and is followed by section 2.2 which discusses employee motivat ing in small medium companies. The next section which is section 2.3 looks at motivation and the various theories developed by researchers, then section 2.4 considers the role of the manager when it comes to employee motivation. The last deuce sections section 2.5 examines corporate culture with section 2.6 on gender and how it is sensed. Finally a summary of the whole chapter is presented in section 2.7.This section entrust review the most relevant studies on employee motivation and in small medium companies.2.2 Employee Motivation in Small long suit CompaniesOrganizational scientists and practitioners fuddle long been interested in employee motivation and commitment. This interest derives from the belief and evidence that there atomic number 18 benefits to having a motivated and committed bleedforce.The Hawthorne StudiesA major revision of take theory came from the resolve undertaken in the United State of America in the 1920s and 1930s of the Hawthorne Works of the west ern galvanising Company. This gave rise to a new school of management thinking, which suggested that employees have social needs which atomic number 18 as important as economic needs these studies reason out that social relationships were significant in the propitiation of the human need for social contact. The major contribution of this puzzle out in understanding employee motivation at usage has been to focus attention on the design of callings and lying-ins in an attack to make them get inive (Mullins, 2007).Employee motivation could be seen as the internal strength that drives employee serveance. This strength enables employees to track d possess out their duties as expected of them having a particular aim in mind. And in most cases, where this strength is lacking, employees sometimes perform poorly. However, certain factors like bloodline features, item-by-item variation and organisational practices may influence employee motivation to work. It thinks on good syst em that reward effectively, beca use up it is critical as a motivated employee will chance on a great deal (Clark, 2009). fit to McConnell (2002) companies have to consider the following steps in order to keep their employees in the organisation The employees perception of the work environment directly relates to the job act. What employees think of their jobs and their employer when the environment is positive Improvement of the environment generally improves employee performance.McMackin (2006) states that large corporations have to a greater accomplishment money, name recognition and benefits to attract the best employees in comparison with small medium companies. Regardless of the positive aspects of larger corporations, many employees renounce in order to work for small businesses, since they are able to have faster career advancement.According to Gaebler Ventures (2006) research show ten various motivational factors that are important for increasing motivation two for managers as tumesce as employees they include promotion potential, interesting work, face-to-face loyalty, tactful discipline, appreciation for work done, good running(a) conditions, help with psycheal problems, heights wages, feeling of being in on things and job security. Gerson (2003) on the opposite hand states that employees in small organisations may go out for better salaries and benefits. The decision to leave can be stired by feelings of unappreciation, work condition, cultural conflicts, lack of convenience, lack of advancement and lack of support. According to Moses (2005) the basis for employee motivation is divided into two categories anticipation of reward for work nearly done, and fear of discipline for mistakes or works done poorly. Motivation techniques at most companies falls into one of these two categories. The ideal for a small-business owner is to motivate employees in a positive way, since employees develop loyalty and face-to-face commitment when t hey are encouraged to perform well in order to advance and receive recognition and financial benefits. The most negative aspect of this method is the fact that the less hard working employees will be fired or downgraded. The method also lacks teamwork, includes employee backbiting and has no long-term motivation.Wiley (1997) states that the relationship between nation and work have fascinated scientists for many years, both psychologists and behavioural scientist, but in both field concepts such as need, motive, cultivation, incentive and attitude occur more frequently rather than concepts of aptitude, ability and skill. Scientist investigates how mortalal, task and environmental characteristics influence behaviour and job performance concerning motivation. Motivation does not remain the same over the years, it changes due to individualal, social and other factors and it also affects the behaviour of a person rather than end performance. In order to create an environment that fo sters employee motivation it is important to explore the attitudes that employees have towards factors that motivate them. When a confederation know what motivates its employees they are better prepared to stimulate them to perform well. In order to know what motivates employees, organisations must have regular communication and ask employees what sparks and sustains their thirst to work (Herzberg, 2003). Most managers assume that their employees have the same motivational drivers as them, but managers must abandon this assumption and focus on the recognition of individual drivers. Findings from a forty year survey demonstrate that employees are motivated by receiving feedback and recognition and those individuals at different levels of the organisation might have different motivational values (Wiley, 1997). Managers have to understand what motivate their employees in order to receive luxuriously performance at the organisation.2.3 MotivationMotivation is the formation of incenti ves, and working atmosphere which allow individuals to carry out their duties to the top of their capability in pursuit of organisational success. It is commonly viewed as the magic drives that allow managers to get employees to realize their targets. Since the reach of the twentieth century, there has been a shift at least in theory. Since the early 1900s several theories have been advanced which have offered taste into the concept of motivation (Strickler, 2006). The hierarch of needs espoused by Abraham Maslow sheds lights on individual behaviour pattern. Other significant studies have been carried out by Frederick Herzberg, who considered job fulfilment, Douglas McGregors X and Y theory, which suggest management styles that motivate and de-motivate employees etc. Underpinning Herzbergs theory was his attempt to bring more humanity and caring into the workplace. His theory was to explain how to manage people properly, and to motivate them for the good of all people at work. Man y contemporary authors have come up with several definitions for the concept of motivation. Motivation has been defined as the emotional progress that gives behaviour reason and melt down (Kreitner, 1995), the inner drives to fulfil unsatisfied need (Higgins, 1994), and the determination to realize (Bedeian, 1993). In dissertation, motivation is defined as the central zippo that derive individual to accomplish personal and organisational goals (Mullins, 2007).Motivation can have an impact on the productivity of any company or organisation. Organisations and companies relies heavily on the efficiency of it production personnel to ensure that goods are produced in numbers that meet up customers order. If these workforce not have the motivation to create and perform to the best of their ability and meet the demand of customers, then an organisation may face a problem which may hold up to serious consequences. 2.3.1 Internal and foreign MotivationMotivation according to Kehr (2004) can be either internal or external, it can be viewed as push or pull determinants. covert motives are factors intrinsic to the activity and explicit motives arise from factors extrinsic to the activity. Intrinsic motivation is the key motivation component of employee empowerment and individuals are responsible for achieving their own career success. It is based on positively valued experiences that a person receives directly from their work tasks such as meaningfulness, competence, choice and progress. Bymes (2006) explain that external motivators depend on outside factors to push the individual to complete a task. Kehr (2004) adds that explicit motives are influenced by social demands and normative pressures. Extrinsic rewards are based on reward and punishments controlled by the organisation. Like Bymes (2006) individuals with external motivators are motivated by salary or wage packets. Internal on the other hand is associated with employees who hope to be employed in a particul ar position by a firm whose organisational values and work requirements are closely linked with the individuals personal values and skills.Implicit and explicit motives relate to different aspects of the person, but both are important determinants of behaviour. According to Basset-Jones Lloyd (2005) motivators associated with intrinsic drivers outweigh motives linked to financial and motivator and observing others benefiting from recognition and extrinsic rewards. Like Locke Latham (2004) internal factors that drive motivation and external factors that act as inducements to action is the concept of motivation. Motivation can affect three aspects of work direction, intensity and duration. Peoples skill, abilities and how and to what extent they utilise them are affected by motivation.According to Katz (2005) intrinsic factors are the main reason for a persons square(a) commitment and motivation. Extrinsic factors like salary and working conditions are also important, but do not gi ve the commitment and excitement that the employee needs. How a person views the assignment and how tasks, information, rewards and decision-making processes are organised are strongly linked to the personal activities.People become more motivated when they identify themselves within a ag sort and contribute to performance as a group (Van Knippenberg, 2000).This relies on the work performed by Locke and the goal setting theory he developed. This goal is team performance and the individual feeling part of the group. The focus of Locke was on the goal but in order to reach the goal one must associate oneself with the group and task. Glen (2006) contend that the most important factor to rely on is feedback since it can help an employee improve his or her performance communication is also vital in the knowledge domain today and can be beneficial to both the manager and employee .2.3.2 Motivation TheoriesThe traditional form of motivation stated that people could be impelled by fear and therefore managers had to be tough. This approach made the employees do the bare minimum and only work while their manager was watching. Research on motivation and it impact on individuals and employees has been undertaken from the mid-twentieth century. Prominent among such researchers include Maslow1954, Herzberg 1959, Adams 1962, Vroom 1964, Alderfer 1972, Locke 1981 and others. There is intense competition as a essence of technological advancement, demographic changes, globalisation, which puts more pressure on organisations to deliver products and services with continuous improvement. The theories on motivation identify individual needs, their expectation and reaction to both internal as well as to the external environment. The various motivation theories are discussed below.Maslows Hierarchy of NeedsA ground-breaking theory on the subject of motivation and needs of the human being was advanced by Abraham Maslow in 1954.He stated that there are some native needs for the h uman being that can be put in a hierarchic way. He argued that individuals and for the purpose of this study, employees are motivated to satisfy a number of diverse needs. According to Maslow until the most vital needs are fulfilled, other needs have little effect on the employees behaviour. Once a need is satisfied, and therefore less essential, other needs bulge and become motivators of their behaviour (Porter et al, 2003).At the base of the power structure is the physiological needs food, clothes etc.These are considered primary needs as employees concentrate on substantive these needs before the others. Physiological needs according to Maslow are undeniably the most pressing of all needs. Once this need is fulfilled, the next level surfaces with the employee decent anxious with the need for sentry duty and security both at home and at the workplace. Likewise, once the safety need too is satisfied, the employee strives for a sense of social rank or an affiliation and a feel ing of approval by others. Once the employee finds his/her place in a group or team, the need and longing to be held in esteem, recognised and respect crops up. Maslow asserts that with all these needs satisfied, employees are then motivated by the desire to self-actualise and accomplish whatever they identify as their farthermost potential. (Ramlall, 2004)Herzbergs Two-Factor theoryAccording to Herzberg an individuals relation and attitude towards work can determine success or failure. While Maslow looked at individual needs, Herzberg tried to find out how employees felt about their work and what really motivates them. In 1959 he created his two-factor theory by looking at the causes of job satisfaction and dissatisfaction in an effort to fully know what motivate people. He divided the needs into two categories hygiene factors which relate to the needs that involve the framework of the task they performed and if these needs are not fulfilled there will be dissatisfaction on the part of employees. In essence if you want to motivate employees, concern should be given to the work itself (Ramlall, 2004).Herzbergs hygiene factors can be linked to Maslows hierarchy of needs and primarily the vital needs at the base of the hierarchy. The hygiene needs accommodate the need that arises from the physiological, safety and social or belongingness needs that do not make the employees satisfied in their job, but simply avoid dissatisfaction if fulfilled. In contrast motivator factors are those that allow for psychological growth and progress on the job. They are very much connected to the idea of self-actualisation regarding a challenge, to savour the satisfaction of achievement, and to be declare as having done something meaningful (Basset- Jones and Lloyd, 2005).Herzberg further stated that certain characteristics are related to job satisfaction and others to job dissatisfaction. Intrinsic factors, such as achievement, advancement, recognition, responsibleness are r elated to job satisfaction. Job dissatisfaction is a result of extrinsic factors company policies, supervision, working condition etc. He assert that a job do not get satisfying by removing dissatisfying factors and therefore dissatisfaction is not the reverse of fulfilment. In order to understand the employees motivation to work the attitudes of the particular employee has to be known (Herzberg, 2003). To Bassett-Jones Lloyd (2005) Herzberg was interested in the extremes where workers either felt good about work or bad, and this led to the development of extrinsic and intrinsic factors. The extrinsic factors are called hygiene or maintenance factors and are linked to job dissatisfaction. Intrinsic factors on the other hand lead to job satisfaction. The factors were labelled motivators to growth because they were associated with high level of job satisfaction. The two factors are of equal importance when explaining what motivates an employee. They explain Herzbergs suggestion of mo tivation as interchangeable to internal self-charging battery. For employees to become motivated the zippo has to come from within. Herzberg however argues that motivation is founded on development needs and originate from satisfaction born out of a sense of achievement, recognition for achievement, responsibility and personal growth. A review of Maslows and Herzbergs theory lead to further research and theories the archetypical of which was developed in 1962 by Stacy Adams.Equity TheoryThis theory developed by Stacey Adams in 1962 suggests that since there is no absolute standard for fairness, and employees want to be treated fairly, they are likely to assess fairness by making comparison with others in similar situations. If they find out that they are not treated similarly they may lower their output, their quality of work or even leave the organisation for another where they are likely to be treated better. In essence it is not the real reward that motivate, but the perceptio n of the reward in comparisons with others (Boxall and Purcell, 2007. While a simple theory, this theory according to Latham cannot cover every(prenominal) incident as some employees are far more receptive to perceptions of evil than others. It is therefore very important for managers to be conscious of what their employees perceive to be fair and just and also know that this will differ from one employee to the other (Latham, 2007). Vrooms Expectancy TheoryWhereas Maslow and Herzberg looked at the connection between needs and the ensuing effort expand to fulfil them, Vroom concentrated on effort, performance and outcomes. The fundamental concepts key to expectancy theory is that the anticipation of what will happen influences the employees choice of behaviour that is, expectations and valence. Vroom interpreted motivation as a process in which employees choose from a set of alternatives based upon the likely levels of expectation, and called the individuals perception of this o rchestration. Valence in his theory is the assessment of actual outcome of ones performance and together with instrumentality is very central in the expectancy theory (Ramlall, 2004 Mullins 2007).From this theorys viewpoint, an employee assigns a worth to an expectation, considers how much effort will be required, and works out the likelihood of success. If the perceived reward is sufficient for the effort required, the employee may make the effort. Expectancy in this theory is the prospect that they can carry out their duty in a way that leads to an optimistic result. For the employee the amount of effort he/she is eager to put in any performance of task is influenced by the expectation of the outcome of the effort (Mullins, 2007). If the employee works hard then he/she can expect a good work result hence a higher reward. High instrumentality for the employee comes from the notion that if he/she shows off good work result there will be adequate reward. Low instrumentality would the n be that the employee feels that the result of the reward will not be independent on the particular work result. Writing in People Management Magazine, Lees (2008) believes that Vrooms theory give an insight into the research of employee motivation by shedding more lights on how individual goals sway individual performance. Vrooms expectancy theory has been criticised for attempting to envisage a choice or effort. However because no obvious pattern of the meaning of effort exist, the variable cannot be measured effectively. According to Latham (2007), the employee is assumed to deliberately weigh up the satisfaction or pain that he/she expects to attain or avoid and then a selection is made. The theory says nothing about intuitive motivation, something that Locke considered when he expanded Vrooms theory.Alderfers ERG TheoryUnlike Maslows theory that refers to an individual who acts increasingly for his/her need satisfaction first, with the simplest one up to the most complex ones, Clayton Alderfers theory (1972) which extended Maslows theory asserts that this course of action is not essentially progressive. According to him, there are three significant categories of human needs Existence (E) needs which ensures the sustainability and human endurance food, Salary, supply etc Relational needs (R) that is socialising need that refers to the relationship between an individual and the social setting and is satisfied by interpersonal relations. Fulfilling these needs depends on the connectedness with others. Growth (G) needs which consists of a persons self respect through personal feature as well as the concept of self-actualisation present in Maslows hierarchy of needs.Alderfer believed that as you begin satisfying superior needs, they become powerful like the power you get, the more you want (Mullins 2007) .Although not fully tested, Ramlall (2004) and Strickler (2006) contend that the ERG theory seems to pass the dynamics of individual needs in an organisat ion rationally well and can help managers when it comes to motivating employees. To them it provides a less rigid account of employees needs than Maslows hierarchy. By and large, it comes closest to explaining why employees have certain needs at diverse times.Goal Setting TheoryEdwin Locke extended Vrooms theory by ontogeny his goal setting theory which takes into consideration the conscious motives that exist when organisations set goals to be met. According to Robbins (2003) Lockes goal setting theory states that specific and difficult goals lead to higher performance with the help of feedback. In addition to feedback, goal commitment, and adequate self -efficacy, task characteristics and national culture have been found to influence the goal performance relationship. Motivation comes from the goal an individual set up based on human needs, personal values, personality traits etc which are shaped through socializing and experience. The behaviour used to accomplish the goal depe nds on whether the goal is difficult or specific. The amount of effort an individual puts in reflects the level of satisfaction experienced which can lead to other actions (Porter et al, 2003). In order to reach the goals some conditions has to be present such as feedback, goal commitment, ability etc. According to him, a goal is required in order to create motivation within the employees to perform better than before. He indicates that financial rewards can improve the sustainability of a persons dedication as well as behaviour. .Goal setting and management by objectives programs have grown in the past two decades and motivation has been organised in three categories personality based view, cognitive decision and self regulation perspectives. The basic idea of Lockes goal setting theory is that employees goals are related to their motivation since their goals direct their thoughts and action. The cognitive decision predicts an individuals choices or decisions and finally the person ality-based perspective emphasize personal characteristics as they affect goal choice and striving (Locke and Latham, 2004). The personality-based category does not predict motivation, but it can provide understanding of what motivates individuals.The above theories are part of the broad field of human motivation study and they all have implications for individuals different workplace behaviour. They can also be applied to a variety of management practices aimed at motivating employees. However these researches were carried out in Western Europe and in America decades ago. Can the findings of this research be applied in Ghana which is in a different setting? Will similar research in Ghana yield the same result? T o better understand employee motivation, it is important to know the role of managers who are facilitators of employee motivation.2.4 motivate Employees The Role of the ManagerLeadership literature states that motivation is influenced by the nature of the relationship betw een the leader and employees. Managers according Bymes (2006) needs to hire the right person that is most suitable for a certain job, value its employees and support them in making contributions to the organisations and always try to create a motivated workforce. Motivated employees do not only create a good working environment, they also make noteworthy contributions to the organisations. Good managers make their employees fell like business partners and use empowerment in order to make the workplace and the surrounding environment into a place where employees feel good as well as creating a work wherefrom employees feel good inside (Bassett-Jones Lloyd,2005). Motivation therefore is about cultivating your human capital. The human challenges lies not in the work itself, but in you, the person who creates and manage the work environment. As indicated by Garg Rastogi (2006) in todays competitive environment feedback is essential for organizations to give and receive from employees a nd the more knowledge the employee learn, the more he or she will be motivated to perform and meet the global challenges of the market place. By involving the employee at work and providing challenging tasks it might increase the intrinsic motivation which transforms potential into creative ideas and this will factor fair and constructive judgement of ideas and sharing of informations.Leaders have an important part in the organisation because they act as the force that motivates the performance of the employees (Katz,2005). Leaders are there to motivate people to follow the designed work and by doing so enhance performance. Even though employees look to diverse organisational elements to suit different drivers of needs, they look forward to their managers to do their best to attend to their needs and concerns.Organisations has to recognize the resources, both human and technological that are available within the organisation and conduct training programs that will contribute to the productivity and the levels of motivation at individual or group levels. Motivating employees begins that to do their best, employees must be in an atmosphere where their emotional drive to bond and be understood are met. The drive to bond is best achieved by a custom that encourages teamwork and frankness (Nohira et al, 2008). Motivating employees is vital if employers are to achieve maximum performance and productivity. Contemporary theories on motivation centres more specifically on the relation of beliefs, values, goals with action. Motivation in contrast functions as an engine for inner human growth by providing attractive and demanding task. Motivation theories developed in the western world with their orientation on self-satisfaction and instrumentalism have mainly emphasized on rewarding those individuals who succeed. These theories did not take into consideration the terrain in Africa and also individuals who are passing motivated but incapable of accomplishing. This has p roduced in some part of Africa and also in Ghana situations where managers are not able to answer the needs of every employee. Studies indicate that employees in the western world draw their motivation from self satisfaction but the same cannot be said of their counterparts in Africa and most particularly in Ghana. What do they derive their motivation from? Does the companys corporate culture have any bearing on how they are motivated? Is there a relationship between the companys corporate culture and motivation? The next section will look at motivation and corporate culture.2.5 Motivation and integrated cultureCorporate culture draws its roots from various sources. This include national and regional cultures, (Hofstede, 1991) the vision and management style (Schein, 1985) and the nature of the business and the environment it operates in and the organisational field where it operates (Gordon, 1991). For this study the relevant cultural roots comes from Ghana. Individuals, especial ly qualified ones, have more choices with regards to potential jobs offers. How companies motivate place a vital role in attracting employee and competing well todays competitive market. To create a culture that fosters individual motivation is not easy because it takes time to figure out the factors that motivate each employee. It is even more important nowadays as more individuals draw their interest from other things beside money. To understand the importance of corporate culture in this dissertation it is important to first define what culture is. Schein (2004) defines culture as consisting of rules, procedures and processes that govern how things are done, as well as the philosophy that guides the attitudes of senior management towards staff and customers. Referring in his work to the people of a nation Hofstede also defines culture as the collective programming of the mind which distinguishes one group or category of people from another. then it endorses the issue that corpor ate culture is a unique aspect of an organisation, even though it is difficult to manage. According to Schein an organisations culture develops to help cope with its environment. He characterizes culture as consisting of three levels Artefacts which are the most observable level of culture yet are hard to understand. Espoused Values which underlie and to a large extent determine behaviour, but they are not directly observable as behaviours. There may be a variation involving known and functioning values. underlying assumptions and Values the essence of culture is characterized by the fundamental assumptions and ideals, which are not easy to differentiate since they are present at mainly unconscious point. stock-still they offer the input to appreciate why things turn out the way they do.2.5.1 National cultureNational culture milieu influences the outlook of an organisations stakeholders. Hofstede proved this with work on IMB employees in 43 countries and how attitude to work and b ehaviour of employees towards authority differ from one location to the other. In his study he identified volt dimensions of culture and demonstrated that there are national and regional cultural groupings that affect the behaviour and activities of organisations. The first dimension is power distance and refers to the degree to which people accept inequality amongst institutions and organisations. The second dimension, uncertainty avoidance measures the degree to which people are willing to accept change and work in uncertain circumstances. then the higher the degree of uncertainty avoidance the more structured people likes things to be (Steers et al, 1993). Individualism which is the third dimension refers to the degree to which people see themselves as being part of a group or as individuals. His fourth culture dimension, masculinity versus femininity refers to the conventional values place

Recollection in Platos Phaedo and Meno Essay -- Philosophy Religion E

Recollection in Platos Phaedo and MenoAs the earliest philosopher from whom we have indite texts, Plato is oftentimes misrepresented as merely reproducing Socratic rhetoric. In Meno, one of the first Platonic dialogues, Plato offers his own unique philosophical theory, infused with his mentors brilliant sophistry.Amidst discussing whether or non impartiality can be taught, Meno poses a difficult paradox How can one be virtuous, or seek virtue, when one cannot know what it is? How will you endeavor to front for something you do not know at all? (Plato, Meno, 80d). From this question, Plato purposes a solution, that acquaintance must be recollected from the mind. When the soul enters the world of space and time, Plato suggests, it carries some front knowledge of forms that is to say, the soul remembers its knowledge of unchangeable truths. (Meno, 81c-d).Thus follows the conclusion that education cannot teach knowledge, but rather aids a student to recall what the soul already knows. Plato notes, however, that although the body is capable of recollecting knowledge (of forms), it is... Recollection in Platos Phaedo and Meno Essay -- Philosophy Religion ERecollection in Platos Phaedo and MenoAs the earliest philosopher from whom we have written texts, Plato is often misrepresented as merely reproducing Socratic rhetoric. In Meno, one of the first Platonic dialogues, Plato offers his own unique philosophical theory, infused with his mentors brilliant sophistry.Amidst discussing whether or not virtue can be taught, Meno poses a difficult paradox How can one be virtuous, or seek virtue, when one cannot know what it is? How will you aim to search for something you do not know at all? (Plato, Meno, 80d). From this question, Plato purposes a solution, that knowledge must be recollected from the soul. When the soul enters the world of space and time, Plato suggests, it carries some prior knowledge of forms that is to say, the soul remembers its kno wledge of unchangeable truths. (Meno, 81c-d).Thus follows the conclusion that education cannot teach knowledge, but rather aids a student to recall what the soul already knows. Plato notes, however, that although the body is capable of recollecting knowledge (of forms), it is...

ADHD and My Family: Searching for a More Scientific Explanation :: Attention Deficit Hyperactive Disorder

ADHD and My Family Searching for a More Scientific ExplanationMy father, like many a(prenominal) Asian immigrants, left India to pursue his educational goals in America in order to provide a better life for his family. He arrived in the U.S. with 14 dollars in his coat pocket, a suitcase in his hands, and a will to succeed. For my father, in a place like America where opportunities were plentiful and where hard name actually paid off there was no excuse not to succeed. The practical translation of this belief meant that if his children worked hard in school there was vigour they too could not achieve. As such, in my fathers household, not doing well in school was not an option.Because of his cultural background my father found my brothers poor cognitive operation in school incomprehensible. I too was puzzled by my brothers attitude towards school. He and I grew up in the homogeneous house with the same parents and the same set of values. Yet, he seemed to not care about school at all. For a long time, my family and I attributed my brothers Cs in school and obvious inability to take to laziness and a lack of motivation. My brothers diagnosis with Attention Deficit Hyperactivity Disorder (ADHD) was both a welcomed explanation and a shock to my parents. On the one hand, my aim and father had begun to question their parenting abilities, and this allowed them to shift the blame from themselves. On the other hand, they had a very limited understanding of mental disease. In particular, the concept of mental illness itself was not something they were terribly familiar with. For my parents, problems of the mind were problems that existed within the scope of personal will power. In many ways, I partially subscribe to the world-view that my parents hold. As such, until recently, Ive been nescient of my brothers diagnosis. In particular, at the time, it seemed to me that distractibility was something that I too suffered from. I didnt enjoy forcing myself to conce ntrate, but I did it because I knew that I had to. In addition, my brother seemed perfectly capable of concentrating when he was playing soccer, watching the Discovery channel or playing video games. In my mind, his problems appeared to be that he was spoiled and didnt like being told what to do. In addition, I think that ADHD gave everyone in my family the excuse that they needed.