Global in and global out in regard of food industry in Japan Research Paper

Global in and global out in regard of food industry in Japan - Research Paper Example Japanese Food The Tokyo Metropolitan Central Wholesale Market generally known as Tsukiji Market is considered to be one of the biggest wholesale fish markets around the globe. The market is situated in Tsukiji city of Tokyo and is determined to be a major attraction for many foreign visitors because of its large variety of fish and seafood7,8. The contribution of Tsukiji Market for spreading Japanese food culture globally is considered to be noteworthy. Not only the market provides a wide variety of fish to the nation but it is also a global provider of various fishes to some of the most renowned restaurant chain businesses and hotels around the globe. A few of the most well-known Japanese cuisines that have gained considerable amount of likings globally include Sushi, a food item that consists of cooked vinegared rice with a combination of other ingredients such as raw food or other sea foods and meat occasionally, Tempura, dish prepared of sea foods or vegetables that is battered a nd deep fried along with ramen; a type of white noodles served with meat and fish and often flavored with soy sauce or miso9. According to many critics, it has been stated that the main reason behind the rapid globalization and adaption of Japanese culture and practices worldwide is the result of its manga and animations series that are being telecast in various regions of the world. However, it has been viewed that it is not only the Japanese culture that is establishing its trends in other nations however the culture of different nations including their food habits are being invaded in Japan as well. For instance, in a research conducted by Kamei, M., Ki, M., Kawagoshi, M., and Kawai, N. (2001) it was viewed that 24 out of 100 lunch boxes in Japan contained food items such as hamburgers,... The aspect of globalization is considered to be a vital constitute in today’s society. It has been viewed that the advent of globalization has not only changed the way one does business but has also brought drastic alterations in the cultural and religious facets associated with an individual. One such crucial facet is the change in the food habits of people. Japan which is regarded as one of the most renowned countries in the world, specially for their food habit that help the people to live long, has been facing rapid challenges due to globalization of the food industry. This has not only resulted in changing the food habits of an individual but has motivated other nations to invent new food items following their steps that are affecting the health aspects of the civilians in the nation. With reference to the above discussion, it can be viewed that the way in which modern food industry has motivated people to adopt food items as their daily supplementary provider that are le ss healthy. However, if proper steps are taken by the government to promote the difference in the ingredients amid western and Japanese products along with highlighting the disadvantages of consuming some unhealthy food items then the issue can be mitigated to a great extent. Thus, it can be concluded that practices such as campaigns and government programs to create awareness would not only stop people to adapt such food habits but would also facilitate people to return to their traditional eating habits and culinary methods by reducing the risk of nutrition related diseases to a great extent.

Managing Waste Products from Dairy Factories in Greece Dissertation

Managing Waste Products from Dairy Factories in Greece - Dissertation Example Nutrients and proteins can also be extracted from wastewater for various business purposes. The question is what technology is effective in the treatment of dairy wastewater. Wastewater management, which includes treatment, is part of an effective environmental management system (EMS) which dairy factories should implement immediately at the start of the operation. In countries such as Greece, EMS implementation is not uncommon. This is so because, in the countryside where wastewater usually flows to rivers and adjoining bodies of water, wastewater has to be treated first before it has to be discharged. Environmental impact created by businesses, organizations and dairy factories has to be minimized in order to deliver sustainability for the next generation. An Environmental Management System is a way of addressing the impact on the environment by issuing guidance to organizations, businesses, and governments which maintain or regulate establishments that produce wastewater. An EMS a nswers the environmental compliance regulations and other relevant activities for environmental best practice. An EMS aims for sustainable development in the community, and minimize waste and hazardous materials. It is a set of rules and requirements that set up a policy for environmental promotion and can be effectively implemented through the guidelines set by ISO 14001. The International Standards Organization states that businesses should implement an EMS which carries out its environmental objectives in accordance with the legal and other significant requirements of the organization and the laws of the land. Wastewater treatment, to include reuse and recycle, is a best practice in line with ISO compliance. (Edwards, 2004) There are a number of methodologies in wastewater treatment that have been implemented by the dairy industry, but some problems in the methods have to be identified. This paper, therefore, will provide an in-depth analysis of some of the methods and technologi es available, along with a business model that can be created out of these methods. 1.1 Objectives The objectives of this paper are: 1.1.1 To analyse how Greek dairy factories, conduct wastewater treatment and reduce wastewater generation that leads to minimization of effluent-treatment costs, and how to extract proteins and nutrients from wastewater; 1.1.2 To analyse the business side of the treated wastewater, taking into consideration the business model that can be created from the nutrients and proteins extracted and separated from the wastewater; 1.1.3 To provide an in-depth analysis of the methods and technologies available so that clear recommendations can be provided. 2. Literature Review There has to be a holistic view of the various ways of waste production, including collection and treatment and subsequent disposal of wastewater. The treatment to be implemented would depend on what type of wastewater is produced by the dairy factory or pond. Wastewater comes from milk, bu tter, yogurt, ice cream and other varieties which may be composed of desserts. Initial planning of wastewater treatment plant includes the following aspects: 1.) The various data and information gathered from the field surveys should be put together, inputted into a database, and carefully studied; 2.) What type of wastewater collection and system will be implemented?

A Study On Australian Globalization Economics Essay

A Study On Australian Globalization Economics Essay The effects of Globalization are manifold, affecting various aspects of the world economy to bring about overall financial betterment. The impact of Globalization exerts intense influence on the financial condition as well as the industrial sector of a particular nation. Globalization creates markets based on industrial productions across the world. This in turn, widens the access to a diverse variety of foreign commodities for consumption of the customers, owing to the marketing strategies undertaken by different corporations. Economywatch.com states that In the world economic arena, Globalization facilitates the formation of a common worldwide market, on the basis of the liberal exchange of both cash and kinds. Globalisation has largely benefited the Australian economy. As Australia has an abundance of natural resources that our whole population cannot use, the extra surplus is sold to other countries that have a demand for the resources, giving us a world market of over 6.5 billion people. Skwirk.com states that Australia As a country with a stable government and substantial revenue, globalisation, in many ways, has been positive. Australia has not fallen into the cycle of debt that many developing nations have suffered, nor have we been adversely affected by bad investments. Australias strong economy has therefore been strengthened during the globalization time. An international trade theory can be seen as a measure to address problems in a country which has high unemployment, inflation or a weak macro economy. One international trade theory is known as mercantilism, and this theory suggests that a government can improve its economic well-being for the country by increasing exports and reducing imports. Two of the other main trade theories are known as absolute advantage and comparative advantage. If a country has an absolute advantage over its trading partners, it is able to produce more of a good or service with the same amount of resources or the same amount of a good or service with fewer resources, whereas a country that has a comparative advantage in the production of a good or service, produces it at a lower opportunity cost than its trading partners. According to Ahsan Kaleem, The theory of comparative costs argues that it is better for a country that is inefficient at producing a good or service to specialise in the production of th at good it is least inefficient at, compared with producing other goods. Another important trade theory known as the factor endowment theory, strongly supplements the theory of comparative advantage by bringing consideration to the endowment and cost of factors of production. The theory states that countries with a big labour force will focus on labour intensive goods, and countries with more capital will focus on producing goods that are capital intensive. Economywatch.com states that The benefits of international trade have been the major drivers of growth for the last half of the 20th century and nations with strong international trade have become prosperous and have the power to control the world economy. There are a few more important benefits of international trade, one of which is the fact that it enhances the domestic competitiveness and takes advantage of international trade technology. An increase in sales and profit can be made through international trade and an extend sales potential of the existing products is created. In an international trade market, the ability to maintain cost competitiveness in a domestic market is achievable and the potential to expand a business is enhanced. There is a reduce in dependence on existing markets within the global trade scene and a stabilisation of seasonal market fluctuations can also be achieved. A government may choose to intervene in international trade largely based on the fact of wanting to change the allocation of resources and achieve what they perceive to be an improvement in economic and social welfare. Geoff Riley states that all governments of every political persuasion intervene in the economy to influence the allocation of scarce resources among competing users. The main reasons for policy intervention are to correct for market failure, to achieve a more equitable distribution of income and wealth and to improve the performance of the economy. There are many ways in which intervention can take place; these include government legislation and regulation, the direct state provision of goods and services, the fiscal policy intervention and an intervention designed to close the information gap. Regulation can be used to introduce fresh competition into a market whereas the state funding can be used to provide goods and services and public goods directly to the population. The fiscal policy can be used to alter the level of demand for different products and also the pattern of demand within the economy. Market failure often results from consumers suffering from a lack of information about the costs and benefits of the products available in the market. Through government action, and increase in information to help consumers and producers value the true cost and benefit of a good or service can be found. The global trade system can have a variety of different implications if it is not conducted in the correct manner. International trade may discourage the growth of domestic industries and excessive exports may cause quick depletion of natural resources of a country. Global trade may create economic dependence which may threaten political independence and in the case of intense competition, exports may lead to rivalry among nations. Also, Soumya Singh believes that too much dependence on imports may undermine the economy of a country and developed countries may economically exploit the underdeveloped countries that are dependent on international trade for their economic development. The globalisation of markets and the development of the global economy have had a definite impact on both the international and Australian economies. There are many benefits to be gained through international trade; however, if it is not conducted in the correct manner, there could also be many implications. Through the various trade theories and government intervention, the most effective way for each country to be involved within the international trade market can be utilised, and as a result, can boost the global economy and support the idea of globalisation. Sources: Kaleem, A, 2005, International Trade Theories [online]. Available from: http://bizeco.blogspot.com.au/2005/06/international-trade-theories.html [September 2012] Economywatch.com, 2010, Benefits of International Trade [online]. Available from: http://www.economywatch.com/international-trade/benefit.html [September 2012] Economywatch.com, 2010, Effects of Globalization [online]. Available from: http://www.economywatch.com/economics-theory/globalization/effects.html [September 2012] Riley, G, 2006, Government Intervention in the Market [online]. Available from: http://tutor2u.net/economics/revision-notes/as-marketfailure-government-intervention-2.html [September 2012] Singh, S, 2012, What are the Disadvantages of Foreign Trade? [online]. Available from: http://www.preservearticles.com/2012022923900/what-are-the-disadvantages-of-foreign-trade.html [September 2012] skwirk.com, 2012, Globalisation in Australia [online]. Available from: http://www.skwirk.com/p-c_s-57_u-507_t-1374_c-5292/globalisation-in-australia/qld/sose-geography/the-global-citizen-ecology-and-economy/globalisation [September 2012]

Capital Punishment :: essays research papers

Capital Punishment is the ultimate denial of human rights. There are strong indications that rather than deterring violence, it increases people’s tolerance of and tendency toward violence. Though capital punishment does not deter capital crimes it does constitute a uniquely cruel and degrading punishment. It’s imposition forever deprives a potentially innocent individual the benefits of new evidence or a new law that might warrant the reversal of a conviction or the setting aside of a death sentence. In addition, the cost of executing a person in the U.S. is far higher than the cost of imprisoning him or her for life. States wishing to condemn cruel and inhuman acts of killing do not serve their purpose by repeating the act of killing. The average homicide rate in the 13 states without the death penalty is lower than the average homicide rate in the 37 states where it is legal. Between 1972 and 1990, the homicide rate in Michigan which has no death penalty, was generally as low or lower than the neighboring state of Indiana, which restored the death penalty in 1973. The U.S. Bowers- Pierce study analyzing executions between 1907 and 1963 concluded, that an average of two additional homicides were committed in the month after an execution; they also noted a â€Å"brutalizing† effect on society resulting from executions. According to FBI statistics the murder rate in some states which use the death penalty is twice that of some states which do not use the death penalty. Between 1976 and 1985, almost twice as many law enforcement officers were killed in death penalty states as were killed in states that don’t use the death penalty. The death penalty has not proven its worth to society; study after study has shown! that it fails to deter crime, no credible body of evidence contradicts them. Capital punishment is pre- meditated killing and, like all killing, involves a cruel and violent assault on the human body. If administering 100 volts of electricity to the most sensitive parts of a man’s body is rightly condemned as torture, how does a state condone the administration of 2,000 volts to a human body in order to cause death? At a 1990 Florida execution, a malfunction of the electric chair equipment caused flames to leap six inches above the prisoner’s head each time the current was turned on. In 1992, a prisoner in Oklahoma had a violent reaction to the drugs used in the lethal injection.

Diabetes mellitus

Diabetes mellitus is a group of metabolic diseases characterized by elevated levels of glucose in the blood or hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Normally a certain amount of glucose circulates in the blood. The major sources of this glucose are absorption of ingested food in the gastrointestinal tract and formation of glucose by the liver from food substances (Kozier et. l, 2002). Client’s name is Mr. Harvey, 48 years old and has three children and he is newly diagnosed having Type 1 Diabetes. He is a college undergraduate and has experienced working in a restaurant as chief cook until now where in he works for 6 hours. He is also a small businessman and is greatly affected by the economic condition as of the present.He only earns enough for his kids since he is a single parent; he earns about 350 dollars a day including his earnings in his small business. These factors aforementioned greatly influence to his ability to access the necessary healthcare that he should have. Yes, he has a job but his earnings is not enough for him to be thoroughly be checked by healthcare professionals, and also because he has three kids which are all studying as well.As a single parent, it is his job also to look after his children and this means all his extra time will be devoted to them and he will not be able to attend to his own needs and other self- care practices needed for his condition. Although he can do some modification in his diet still he cannot manage to consistent all throughout because he still has a lot of things to attend to, but nevertheless as a college undergraduate he has some basic knowledge about the condition he has which is Type 1 Diabetes.Although he has a job and a business of his own it still does not erase the fact that he is a single parent of three kids, maybe he can buy some medicine for his condition but it will not be continuous because he will tend to prioritize other things. Prognosis of his condition would be poor because he cannot focus on the treatments that he should be getting to alleviate his condition; Diabetes is such a silent killer especially when complications arise. Lastly, diabetes can be fatal. Diabetes Mellitus Diabetes Mellitus (DM) is a common and potentially serious, chronic metabolic condition which is characterized predominantly by hyperglycemia and other manifestations. Diabetes can be a devastating condition with long lasting hazardous consequences since due to its chronicity it affects almost all the major organs of the body including the eyes, the kidneys, the nerves, heart and blood vessels (Jennifer, 1998).There are two main types of Diabetes Mellitus viz. Type 1 Diabetes Mellitus (also termed as Insulin Dependent Diabetes Mellitus or IDDM and juvenile Diabetes Mellitus) and Type 2 Diabetes Mellitus (also known as Non-Insulin Dependent Diabetes Mellitus or NIDDM and adult-onset Diabetes Mellitus) (Jennifer, 1998). Type 1 DM is more common as compared to type 2 DM in younger age groups and accounts for almost two-thirds of the cases of diabetes diagnosed amongst individuals less than 19 years of age (Levitsky & Misra, 2008).Epidemiology of DM – The magnitude of the problemI n the United States, Diabetes Mellitus is the fourth leading cause of death and accounts to 178,000 deaths per year (Do I Have Diabetes?, 1998). Individuals with DM have been shown to have a 5-10 years shorter lifespan as compared to their normal counterparts (Lipsky & Sharp, 2004). Moreover, DM also contributes to significant morbidity and remains amongst the leading cause of blindness in adults in the 20-74 years age group. Similarly, it also remains as one of the most common causes of non-traumatic lower-limb amputation and end-stage renal disease (ESRD) (Votey & Peters, Diabetes Mellitus, Type 1 – A Review, 2007).It was estimated that about 7% of the U.S population (20.8 million individuals) were inflicted with this condition in the year 2005. Amongst these, 14.6 million were diagnosed as having DM while the rest were undiagnosed. Moreover, an additional 54 million people were shown to have pre-diabetes’ (defined below) (Votey & Peters, Diabetes Mellitus, Type 1 â €“ A Review, 2007). It is alarming to note that over the past decades, the incidence of DM has been increasing and it was observed that the percentage of adults in the U.S diagnosed with DM increased by 49% (from 4.9 to 7.3%) during the period 1990-2000 (Lipsky & Sharp, 2004).Diabetes Mellitus is also important from an economic and public health perspective as well since it leads to both direct and indirect costs of health care. The magnitude of the problem can be judged by the fact that in the year 2002, the per-capita healthcare cost for diabetic individuals was $13,243 as opposed to $2560 for non-diabetics (Votey & Peters, Diabetes Mellitus, Type 2 – A Review, 2009).Type 1 and Type 2 DM – A comparisonAs discussed above, there are two main types of Diabetes mellitus – type 1 DM and type 2 DM – which differ in etiologies and pathogenesis. DM was classified into two major subtypes viz. IDDM and NIDDM in 1979 by the National Diabetes Data Group and thi s classification was later endorsed by WHO (Jennifer, 1998). However, this classification had certain limitations and therefore the recent guidelines classify DM into four main groups viz. type 1 DM, type 2 DM, â€Å"other specific types† and gestational diabetes (Jennifer, 1998).According to the recent guidelines, the diagnosis of DM requires two fasting plasma glucose levels of 126 mg per dL (7.0 mmol per L) or greater. Moreover, if after a glucose load of 75 g a patient has two two-hour postprandial plasma glucose (2hrPPG) readings of 200 mg per dL (11.1 mmol per L) or higher or two random blood sugar levels of 200 mg per dL (11.1 mmol per L) or higher, he/she can be diagnosed as being diabetic.It is preferable to use the fasting plasma glucose level, due to its better reproducibility and easier administration, however, in clinical practice, a combination of any two abnormal test results can be employed (Jennifer, 1998). In addition to full blown DM, the American Diabetes Association has defined another category, pre-diabetes. This is a state in which ‘the blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes’ (Votey & Peters, Diabetes Mellitus, Type 1 – A Review, 2007).Type 1 DM is a metabolic disorder resulting from the autoimmune destruction of the pancreatic beta cells located in the Islets of Langerhans which results in a progressive disability to secrete insulin (Votey & Peters, Diabetes Mellitus, Type 1 – A Review, 2007). Type 1 DM can present at any age the most common presentation being in childhood but one-fourth of cases are diagnosed in adults. (Levitsky & Misra, 2008). This late presentation of type 1 diabetes mellitus has been termed as latent autoimmune diabetes of the adult (LADA). Studies have suggested that type 1 DM occurs in individuals who are genetically predisposed to developing this disease and its onset may be triggered by certain environment agents such as viru ses and toxins (Votey & Peters, Diabetes Mellitus, Type 1 – A Review, 2007).Once the onset is triggered, there is progressive destruction of the beta cells and a subsequent decrease in insulin production. However, during this period the individual is asymptomatic and euglycemic (Eisenbarth & McCulloch, 2009). Overt hyperglycemia is manifested when more than 80-90% of the beta cells have been destroyed (Votey & Peters, Diabetes Mellitus, Type 1 – A Review, 2007). Recently, a newer subtype of type 1 DM has been identified which is characterized by a non-immune mediated destruction of pancreatic islet cells and has been termed as Type 1B DM (Eisenbarth & McCulloch, 2009).It is a well established fact that type 1 DM is genetically determined. Several genes have been implicated to play a role in the pathophysiology of type 1 DM including polymorphisms in HLA-DQalpha, HLA-DQbeta, HLA-DR, preproinsulin, the PTPN22 gene, CTLA-4, interferon-induced helicase, IL2 receptor (CD25) , a lectin-like gene (KIA0035), ERBB3e, and an undefined gene at 12q (Eisenbarth & McCulloch, 2009).In individuals with type 1 DM, genetic markers are present since birth. However, it has been elucidated that immune markers develop after the onset of the autoimmune process of beta cell destruction and metabolic derangements can be identified once a significant proportion of beta cells have been destroyed but before the occurrence of symptoms (Eisenbarth & McCulloch, 2009).The immune markers which have been identified for type 1 DM include antibodies to the islet cell (IA2) and to insulin (IAA). Moreover, autoantibodies to islet–glutamate decarboxylase (GAD) including anti-GAD65 have been found in patients with type 1 DM and are of particular importance in adults with this disease since these antibodies are clinically detectable and can be used to aid in the detection and diagnosis of type 1 DM in adults (Votey & Peters, Diabetes Mellitus, Type 1 – A Review, 2007).Type 2 DM is relatively far more common than Type 1 DM, especially amongst adults accounts for almost 80-90% of all the cases of DM in various regions of the world (Gerich, 1998). Over the past few decades, epidemiologic studies have identified an alarming increase has been observed in the cases of Type 2 DM to an extent that type 2 DM is now being regarded as an epidemic. In a study conducted in a Japanese population comprising of children of school going age, type 2 DM was found to be seven times more common as compared to type 1 DM and a 30-fold increase in its incidence was noticed over the last two decades (Rosenbloom, 1999).Type 2 DM typically affects individuals aged greater than 40 years but more recently it has been observed to be occurring more frequently in younger age groups and has been found in individuals who are as young as two years of age and have a positive family history of this disorder. There are various factors which have led to an increase in the incidence of type 2 DM in younger age groups. These include increasing incidence of obesity and a sedentary lifestyle amongst children and an increase in the life expectancy, with more individuals surviving past the age of 65 years (Votey & Peters, Diabetes Mellitus, Type 2 – A Review, 2007).The etiology of Type 2 DM is a multifactorial and it arises from a complex interplay of both genetic and environmental influences. The inheritance of this disorder does not follow the simple Mandelian patterns. Infact, this disorder has a polygenic inheritance requiring multiple gene polymorphisms (Gerich, 1998). Lipsky describes the genetic-environmental interaction which is implicated in the development of type 2 DM as â€Å"A good analogy is that although genetics loads the gun, environment pulls the trigger (Lipsky, 2004).†Several genes have been implicated in the causation of type 2 DM. Amongst these the three most consistently identified genes include TCF7L2, KCNJ11, and PPARG (Lyssenko, 2008 ). However, more recently, a number of novel genes which increase an individual’s susceptibility to type 2 DM have been identified including CDKAL1, IGF2BP2, the locus on chromosome 9 close to CDKN2A/CDKN2B, FTO, HHEX, SLC30A8, WFS1, JAZF1, CDC123/CAMK1D, TSPAN8/LGR5, THADA, ADAMTS9, and NOTCH2 (Lyssenko, 2008).The pathogenesis of Type 2 DM is different from type 1 DM in that it results from both an impairment in insulin sensitivity and insulin secretion as opposed to Type 1 DM which results solely from impaired insulin secretion (Gerich, 2009). Individuals with type 2 DM have end-organ or peripheral resistance to insulin and additionally a defect in the production of insulin and recent data suggests that both must co-exist for causing manifestations of type 2 DM. Several risk factors have been identified which increase a person’s susceptibility to developing type 2 AM.These include a positive family history of DM, and increase in the Body Mass Index (BMI), impaired or elevated Liver Function Tests (LFTs), comorbid conditions such as current smoking status and hypertension, decreased measures of insulin secretion and action, Hispanic, Native American, African American, Asian American, or Pacific Islander descent , a history of GDM or of delivering a baby with a birth weight of >9 lb and Polycystic ovarian syndrome (Lyssenko, 2008 and Votey & Peters, Diabetes Mellitus, Type 2 – A Review, 2007).Amongst other risk factors, obesity is one of the most consistently identified and the strongest risk factor for the development of type 2 DM. Moreover, studies have shown that intraabdominal obesity is of particular significance in causing insulin resistance (Gerich, 2009). Most of these risk factors are modifiable and current public health strategies focus on targeting these modifiable risk factors in addition to pharmacologic intervention for the control of type 2 DM.The complications of DM are numerous and diverse and include increased susceptibil ity to infections, microvascular complications including nephropathy, neuropathy and retinopathy which can lead to subsequent end-organ failure and macrovascular complications, which include stroke and coronary artery disease (Diabetes Mellitus, Type 2 – A Review, 2007).In conclusion, DM is a common disorder and affects a large proportion of the population globally. There are two main types of DM viz. type1 and type 2 and both differ in etiology and pathogenesis. DM can lead to several manifestations and complications and hence is a major public health concern. Although extensive research has been conducted in order to identify the underlying etiology of both types of DM, there is a pressing need to explore the arena of prevention measures for this disorder and devise strategies to control the increasing incidence of Type 2 DM in the younger age groups.ReferencesDo I Have Diabetes? (1998, October 15). Retrieved April 20, 2009, from American Family Physician: http://www.aafp.o rg/afp/AFPprinter/981015ap/981015b.htmlEisenbarth, G. S., & McCulloch, D. K. (2009, February 11). Pathogenesis of type 1 diabetes mellitus. Retrieved April 20, 2009, from Uptodate online: http://www.uptodate.com/patients/content/topic.do?topicKey=~JYHFR94z4VP3LY&selectedTitle=4~150&source=search_resultGerich, John E. (1998) The Genetic Basis of Type 2 Diabetes Mellitus: Impaired Insulin Secretion versus Impaired Insulin Sensitivity. Endocrine Reviews 19(4): 491–503Jennifer, M. (1998). Diagnosis and Classification of Diabetes Mellitus: New Criteria. American Famil Physician .Levitsky, L. L., & Misra, M. (2008, November 18). Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents. Retrieved April 20, 2009, from Uptodate Online: http://www.uptodate.com/patients/content/topic.do?topicKey=~0babJ4CniXpnXAf&selectedTitle=12~150&source=search_resultLipsky, M. S., & Sharp, L. K. (2004). Preventive Therapy for Diabetes: Lifestyle Changes and th e Primary Care Physician. American Family Physician .Lyssenko Valeria et al. (2008) Clinical Risk Factors, DNA Variants, and the Development of Type 2 Diabetes. The New England Journal of Medicine 359; 21Rosenbloom, Arlan L. and Joe Jenny R. (1999). Emerging epidemic of Type 2 Diabetes Mellitus in Youth. Diabetes Care 22:345–354Votey, S. R., & Peters, A. L. (2007, October 2). Diabetes Mellitus, Type 1 – A Review. Retrieved April 2, 2009, from emedicine: http://emedicine.medscape.com/article/766036-overviewVotey, S. R., & Peters, A. L. (2009, February 2). Diabetes Mellitus, Type 2 – A Review. Retrieved April 20, 2009, from emedicine: http://emedicine.medscape.com/article/766143-overview

Brain And Behavior

I believe that human emotion is determined by the â€Å"hard wiring† of the brain. One good example is the criminal intent of particular individuals. It is actually interesting to know that anthropological research data shows that violence is an inherent conduct among the primate species (Walker, 2001). In society, criminal violence is a common occurrence and legislators have suggested that the behavior of criminals be analyzed in order to identify any psychological patterns that are consistent among these particular types of individuals.In the past few decades, neurobiologists have proposed that an individual’s condition, which encompasses empathy, morality and free will, is holistically influenced by the frequency of stimulation and assembly of the neurons of an individual. Such notion is contradictory to the concept of Cartesian dualism, which states that the brain and the mind are two independent entities that coordinate with each other.To date, the accumulation of research reports from the field of neuroscience is gradually affecting the concepts and effectivity of the justice system because of the shifting in the concept of human behavior and response to different stimuli. Neuroscience has influenced our current understanding of the multiple factors that govern violent behavior among criminals. The 19th century classic report of Phineas Gage regarding the anti-social behavior that emerged after massive damage of the prefrontal cortex of his brain from a railroad accident is now considered as the birth of the field of forensic neurology (Harlow, 1848).Today, computerized imaging of his fractured skull has shown that the autonomic and social nerve systems are the specific damages that were affected, thus resulting in a totally different individual. Such observation, together with research results gathered from war veterans, has led to the conclusion that violent criminal behavior is caused by injuries to the frontal lobe of the brain. It has t hen been proposed that injury to the prefrontal cortex of the brain causes a condition that has been coined as acquired sociopathy or pseudopsychopath (Blair and Cipolotti, 2000).It is interesting to know that there is an 11% reduction in the size of the grey matter of the prefrontal cortex among patients diagnosed with anti-social personality disorder (APD) (Raine et al. , 2000). A related observation has also been observed between intelligence and alterations in the grey matter of the prefrontal cortex. The temporal lobe of the brain has also been determined to influence an individual’s emotional response and aggression, wherein lesions in the amygdale of the temporal lobe result in an individual’s failure to recognize fear and sadness among the faces of other people (van Elst et al. , 2001).The connection between the decreased expression of the monoamine oxidase A enzyme and reactive violence has already been established (Caspi et al. , 2002). Monoamine oxidase A is responsible for the catabolism of monoamines such as serotonin (5-HT). The working hypothesis currently accepted is that the prefrontal-amygdala connection is altered, resulting in a dysfunctional aggressive and violent behavior, resulting in criminality in particular individuals. The self-control theory as proposed by Gottfredson and Hirschi (1990) couples an argument regarding the driving force behind criminality and the features of a criminal act.Gottfredson and Hirschi contend that crime is similar to other out of control and unlawful actions such as alcoholism and smoking because it generates in an individual a temporary yet immediate feeling of gratification. This kind of action is created by a condition that is characterized by low self-control. The authors claim that the condition of having poor self-control is an innate condition that is set in place during the early childhood at around 7 or 8 years of age. In relation to the mechanism behind criminality, the authors expla in that crime is a straightforward action to results in gratification in an individual.Such perception of crime is associated with a number of implications to the general theory of crime. Firstly, the general theory of crime presents that crime is an uncomplicated action that does not need any strategic preparation or intricate knowledge. Secondly, the general theory of crime is related to a number of elements that are included in the theory of routine activities because just like other uncontrolled acts, crimes are not planned and it is easy for individuals with low self-esteem to be easily motivated to commit such acts.In addition, criminality is strongly influenced by external factors such as the scarcity of easy targets as well as the presence of associates that are capable of helping or even performing a criminal act. The theory of crime by Gottfredson and Hirschi regarding the early age of 7 or 8 also entails that the longitudinal analysis of crime is not necessary and that ag e-correlated theories of crime are confusing. The general theory of crime of Gottfredson and Hirschi also considers the fundamental argument regarding age and the unlawful act.It is actually different from what is presented at general courses in criminology regarding the analysis of age-crime correlations and social factors that are related to crime. A distinction of the general theory of crime of Gottfredson and Hirschi is that the age-crime linkage is very different through time, location and culture that the age-crime correlation is irrelevant of any social explanation. Their general theory of crime also describes that criminals continue to perform unlawful acts of crime even during marriage and eventually end up as unmarried criminals.The same thing goes with offenders who are currently employed—these individuals generally continue on as offenders and the only difference after some time is that they lose their jobs. The general theory of crime of Gottfredson and Hirschi t hus presents an argument against the connection of crime with marriage and employment thus showing that a criminal is incompetent in maintaining a relationship in a marriage or a commitment to work because he is commonly known as person of very low command of his control.Their presentation of the force behind criminality is thus focused on self-control and the authors point out that most investigations regarding criminality do not include this concept. References Blair RJ and Cipolotti L (2000): Impaired social response reversal. A case of ‘acquired sociopathy’. Brain 123:1122–1141. Caspi A, McClay J, Moffi tt TE, Mill J and Martin J (2002): Role of genotype in the cycle of violence in maltreated children. Science 297:851–854. Gottfredson MR and Hirschi T (1990): A General Theory of Crime. In: Jacoby JE (ed. ): Classics of criminology, 3rd ed.Illinois: Waveland Press, Inc. Harlow J (1848): Passage of an iron bar through the head. Boston Med Surg J 13:389â €“393. Raine A, Lencz T, Bihrle S, LaCasse L and Colletti P (2000) Reduced prefrontal gray matter volume and reduced autonomic activity in antisocial personality disorder. Arch Gen Psychiatry 57:119–127. van Elst LT, Trimble MR, Ebert D, van Elst LT (2001) Dual brain pathology in patients with affective aggressive episodes. Arch Gen Psychiatry 58:1187–1188. Walker PL (2001): A bioarchaeological perspective on the history of violence. Annu Rev Anthropol 30: 573–596.

Free Essays on Gender Reflection Paper On Friends

GRP #3 - Friendship I was raised to be a girly girl. I didn’t climb trees, I didn’t fight boys, I never learned to ride a bicycle because I got driven everywhere I wanted to go. Frankly, I was basically scared of boys through about eighth grade. I was afraid of the smallest iota of a possibility of rejection. This meant that most of the energy that would have gone towards actually pursing the boys I had crushes on was spent on psychoanalyzing my friends. Between the ages of 5 and thirteen I probably had a total of 2 male friends outside of my church. However, despite this severe lack of cross gender relationships I had my first â€Å"boyfriend† at seven years old! Strangely, this new development was encouraged by my teachers, while the idea of having a boy as friend would classify me as a tomboy or de-sex him as a male. Because of these complications I never felt very compelled to engage in a friendship with a male. However, in High school my life began to make a change, my friends (whom I had not seen since elementary school) had progressed to cross-gendered relationships – opening my eyes to a whole other spectrum of friendship possibilities. I suddenly realized that I actually had more in common with the opposite sex that I believed. In fact over the years I have found that guys have replaced some of my closest girlfriends. As I reflect on the effect of my social network on my friendships I have mixed emotions – although I appreciate the distinct femininity that has been instilled in me I wish that I had had the experience of growing up with more male friends. I would like to believe I might not have been so emotionally stunted when it came to boys. Although I see the disadvantages of my upbringing the likelihood is that I won’t stray far from it. And will sadly, pass this setback to my children until one of us gains the audacity to end the emotionally destructive circle.... Free Essays on Gender Reflection Paper On Friends Free Essays on Gender Reflection Paper On Friends GRP #3 - Friendship I was raised to be a girly girl. I didn’t climb trees, I didn’t fight boys, I never learned to ride a bicycle because I got driven everywhere I wanted to go. Frankly, I was basically scared of boys through about eighth grade. I was afraid of the smallest iota of a possibility of rejection. This meant that most of the energy that would have gone towards actually pursing the boys I had crushes on was spent on psychoanalyzing my friends. Between the ages of 5 and thirteen I probably had a total of 2 male friends outside of my church. However, despite this severe lack of cross gender relationships I had my first â€Å"boyfriend† at seven years old! Strangely, this new development was encouraged by my teachers, while the idea of having a boy as friend would classify me as a tomboy or de-sex him as a male. Because of these complications I never felt very compelled to engage in a friendship with a male. However, in High school my life began to make a change, my friends (whom I had not seen since elementary school) had progressed to cross-gendered relationships – opening my eyes to a whole other spectrum of friendship possibilities. I suddenly realized that I actually had more in common with the opposite sex that I believed. In fact over the years I have found that guys have replaced some of my closest girlfriends. As I reflect on the effect of my social network on my friendships I have mixed emotions – although I appreciate the distinct femininity that has been instilled in me I wish that I had had the experience of growing up with more male friends. I would like to believe I might not have been so emotionally stunted when it came to boys. Although I see the disadvantages of my upbringing the likelihood is that I won’t stray far from it. And will sadly, pass this setback to my children until one of us gains the audacity to end the emotionally destructive circle....

Coke Financial Structure Essays

Coke Financial Structure Essays Coke Financial Structure Essay Coke Financial Structure Essay [pic] Andrea R. Hart GB550: Financial Management August 24, 2011 The Abstract The topic of this research paper will be about the capital structure of Coca Cola, This paper serves as a comparison of debt and equity. It will help determine the true value of the company while also determining what their free cash flow is and the risk level for the organization. The question that this research will try to answer is if the 125 year old company is financially ready for another 125 years. The company needs to remain liquid and keep its operating costs low during times of inflation. The methodology that will be used will be multiple financial ratios to determine how the organization is operating and compare to times of exponential increases in profits. My expected findings will be that Coca Cola will have a minimal amount of free cash flow. There would be enough to remain liquid but also to remain flexible in starting new product lines or new investments. Coca Cola already operates in over 200 countries and should seek to expand advertising efforts in recently adopted countries. I anticipate that the company has endured over 125 years of economical, political and social upheavals. I hope to conclude that although there could be unpredicted unprecedented environmental events that Coca Cola will be able to continue operate. Table of Contents A preview of capital structure issues†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦4 Business and financial risks related to capital structure†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 5 Modigliani and Miller’s [MM] capital structure theory †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 6 Criticisms of the MM model and assumptions†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦6 Capital structure evidence and implications†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã ¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦7 Estimating the firm’s optimal capital structure†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 References†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦9 A preview of capital structure issues Capital structures of companies are based on the amount of debt and equity a company holds. When a company begins to increase their debt the company becomes more of a risk to investors because the company now has a higher chance that it may not be able to repay its debts. Although if there is more debt an organization taxes can be reduced because the organization is able to take out what it must pay as interest to investors and holders from being taxed. The higher cost of capital translates into a lower fair value estimate, and vice versa; furthermore, seemingly small changes in cost of capital can make a significant difference in a stocks fair value (Kathman, 2002). The giant beverage maker, that’s in a fairly stable environment does not have very much debt. The company in the non-alcoholic beverage industry, Coca Cola’s cost of equity of 8. 6% when the industry average is 11. 67% and is a large influence on the WACC of 8. 4%. Although the company incurs an 8. 6 % cost on the equity the company has averaged a return on equity for the past five years of 30. %. A Company with a high weighted average cost of capital could be considered a risky company or a company in a risky industry that mainly uses equity for funding. Coca Cola’s debt to equity ratio is 23% however the total debt to equity has been on average for the past five years at 51% showing that the company uses only half debt to finance growth within the company which is accurate for a company that is not quite so capital intensive. Although the company finds itself in a well established industry, it must still make investments and use 51% of debt to finance the new growth. WACC and Free Cash Flows impact a company’s value. FCF is what would come back to a company after the investment was made to enhance the company. FCF can determine if it is worth to take on an investment. Coca Cola’s current Free Cash Flow is -546. 8 (COCA COLA CO (NYSE:KO ), 2011). Business and financial risks related to capital structure There are many factors that could play into the financial risk of Coca Cola. The company itself, affiliates, subsidiaries, licensed distributers and bottlers are a risk factor to Coca Cola. Bottlers generate a significant portion of Coke’s net operating revenues by selling concentrates and syrups to independent bottling partners. In 2009, approximately 79 percent of our worldwide unit case volume was produced and distributed by bottling partners in which the Company did not have a controlling interest (ITEM 1A. RISK FACTORS, 2010). The company also operates internationally which is additional business and financial risk to the company. International economies and political environments become a risk to an American investor when considering purchasing securities. Some business risk of the company includes the availability in Coca Cola’s special ingredient of extracted coca leaf, the sustainment of a network that spans 200 countries, health concerns that cause a reduction in market demands. For the company to ensure that it has enough cash flows must be able to have the infrastructure to handle the large amount of demands. Being that Coca Cola is an international company it has opened its doors to many more financial risks. Risks with their international counterparts include fluctuations in foreign currency and exchange rates effecting financial results (ITEM 1A. RISK FACTORS, 2010). If interest rates rise or new tax laws are set it would negatively impact net income. Increase in costsdue to shortages of supplies or materials to produce products or changes in accounting standards can all affect the risks of the company. Coca Cola monitors exposure to financial market risks using several objective measurement systems, including value-at-risk models. Value-at-risk calculations use a historical simulation model to estimate potential future losses in the fair value of our derivatives and other financial instruments that could occur as a result of adverse movements in foreign currency and interest rates (ITEM 7A. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK, 2011). Modigliani and Miller’s [MM] capital structure theory The underlying and basic assumption of the Modigliani and Miller Capital Structure Theory is that there is no major difference if a company were to fund its operations with the use of debt or using equity. The 1958 Modigliani-Miller Theorem was initially designed to show that the corporations capital structure decisions are not value increasing or decreasing; it has, however, become apparent that the theorem is far more general (MacMinn, 2011). The theory rests on assumptions that there are no brokers or bankruptcy costs, no taxes and that investors can borrow at the same rate as the corporations and that EBIT is not affected by the use of debt. In 1991 Miller explained that the theory any gain from using more of what might seem to be cheaper debt is offset by the higher cost of now riskier equity and given a fixed amount of total capital, the allocation of capital between debt and equity is irrelevant because the weighted average of the two costs of capital to the firm is the same for all possible combinations of the two (Villamil, 2010). Criticisms of the MM model and assumptions The same assumptions that the Modigliani and Miller Capital Structure Theory is based on have been criticized. While the three Modigliani and Miller propositions make good sense and have become widely known there has been disagreement. Capital Structures that are designed to enhance value, the majority of the value is from the decisions that are made by financial managers. The value in the company is from the strategy that makes and it is the duty of the financial manager to make sure that the capital structure supports the strategy that the company is trying to pursue. Further, Coca Cola, initial strategy was to sell Ice cold Coca Cola’s to its customers. The company was able to successfully change its strategy to only produce the syrup, the process was able to be broken down and both are able to reap values and benefits. By leaving capital structures to be independently determined by the bottlers and distributors, the structure of Coca Cola Holland and Coca Cola Japan to be different. Other theories have been created in spite of the MM model such as the Trade-Off Theory which takes into consideration the costs of bankruptcy. Capital structure evidence and implications Because of the low debt that Coca Cola has it also carries a low rate for taxes. In the last 5 years, half of Coke’s worldwide investments include almost $20 billion dollars in capital expenditures and acquisitions in the U. S. In addition, each year, we invest over $10 billion dollars in our supply chain in the U. S. including $208 million dollars that was spent this past year on supplies (Kent, 2010). In 2010, The Coca Cola Company acquired Coca Cola Enterprises (CCE) assets and liabilities. Coca Cola by purchasing CCE, Coke will have a $100 million net pre-tax income benefit, however after adjusting to the impact of the full value of the stand alone debt Coke will have acquired a $200 million interest expense reduction. However Coke stands to benefit from the overall transaction with a pre tax benefit in 2011 of an estimated $300 million (Investors Information, 2010). CCE is still set to acquire bottlers in Germany, Sweden and Norway as part of the deal. With Coke becoming a producer and now a larger owner in bottling, this has changed the capital structure of the company. Estimating the firm’s optimal capital structure During the acquisition of Coca Cola Enterprises (CCE) assets and liabilities, Coca Cola’s shares decreased while CCE increased. With this transaction, we are converting passive capital into active capital, giving us direct control over our investment in North America to accelerate growth and drive long-term profitability Coke said, with the transactions that are expected to generate operational cost savings of approximately $350 million over four years for Coca-Cola and will add to earnings by 2012 (Gelsi Spain, 2010). The current estimate of Coke’s cost of debt is 7% as well as the WACC. (Coca Cola (KO) Stock Research, Equity Ratings, News Analysis , 2911). If this amount were to increase it is possible that it could also increase the risk to investors. Coke’s beta has been reported at . 59 and for the non-alcoholic beverage industry is average. With their current capital structure Coke has had a steady 6% in revenue growth. The company also recently acquired CCE their debts, liabilities as well as CCE’s acquisitions which is why Coke’s shares declined by 3. % (Gelsi Spain, 2010). These changes were brought about due to economical conditions and felt the need to take over more operations. Although this acquisition effected their shares in the short term, the company has estimated that this change will save the company almost $350 million in operational costs in four years and will begin generating income by 2012. References Coca Cola (KO) Stock Research, Equity Rating s, News Analysis . (2911). Retrieved August 23, 2011, from ValueInvesting 2. 0: wikiwealth. com/research:ko COCA COLA CO (NYSE:KO ). (2011, August). Retrieved August 23, 2011, from Forbes. Com: http://finapps. forbes. com/finapps/jsp/finance/compinfo/Ratios. jsp? tkr=KO Ehrhardt, M. C. , Brigham, E. F. (2009). Financial Management: Theory and Practice. Mason: South-Western. Freeland, K. , Gabruk, B. , Laidlaw, K. , Levine, J. , Michaels, M. , Schramm, G. (1998, May 4). The Beverage Industry: This One’s on the House! Retrieved August 23, 2011, from Stern NYU. Edu: http://people. stern. nyu. edu/adamodar/pdfiles/cfprojs/beverage. df Gelsi, S. , Spain, W. (2010, Feb 25). Coca-Cola buying CCE North American bottling business. Retrieved Aug 23, 2011, from The Wall Street Journal: MarketWatch: marketwatch. com/story/coca-cola-buying-north-american-unit-of-cce-2010-02-25 Hines, J. J. (2007, March). Capital Structure with Risky Foreign Investment. Retrieved August 11, 2011, from Harvard Business School: people. hbs. edu/ffoley/riskycap. pdf Investors Information. (2010, Dec 14). Retrie ved Aug 23, 2011, from The Coca Cola Company: ttp://www. thecoca-colacompany. com/investors/pdfs/modeling_2010. pdf ITEM 1A. RISK FACTORS. (2010). Retrieved August 23, 2011, from The Coca Cola Company. Com: thecoca-colacompany. com/investors/pdfs/10-K_2009/04_Coca-Cola_Item1A-1B. pdf ITEM 7A. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK. (2011). Retrieved August 23, 2011, from The Coca Cola Company. Com: thecoca-colacompany. com/investors/pdfs/10-K_2006/Coca-Cola_10-K_Item_07a. pdf Kale, J. R. , Noe, T. H. , Ramirez, G. G. (Dec. , 1991). The Effect of Business Risk on Corporate Capital Structure: Theory and Evidence. The Journal of Finance , 1693-1715. Kathman, D. (2002, December 20). Why Discount Rates Matter. Retrieved August 23, 2011, from MorningStarNews. Com: http://news. morningstar. com/articlenet/article. aspx? id=84699_QSBPA=Y Kent, M. (2010, May 19). Enhancing our National Competitiveness. Retrieved August 23, 2011, from The Coca Cola Company: thecoca-colacompany. com/dynamic/leadershipviewpoints/2010/05/enhancing-our-national-competitiveness-is-not-an-option. html MacMinn, R. (2011). Theorems in Corporate Finance . Retrieved August 23, 2011, from MacMinn. ORG: http://macminn. org/Fin374/theorems/theorems. html The Coca Cola Company. (2011). Financial Statements. Retrieved August 9, 2011, from The Coca Cola Company. Com: thecoca-colacompany. com/investors/financial_statements. html Villamil, A. P. (2010, March 10). The Modigliani-Miller Theorem. Retrieved August 9, 2011, from Econometrics at the University of Illinois: econ. uiuc. edu/~avillami/course-files/PalgraveRev_ModiglianiMiller_

Application of Sensory for the Maintenance of Health for the Elderly

Disorders of smell and taste are often diagnostic dilemmas that most times present themselves in elderly people(Croy, Nordin, & Hummel, 2014). The lack of knowledge and insight of these impairment conditions are common and can result in life threatening situations especially among the aged. In addition, poor appetite   is a challenge faced by elderly people living both at home or in nursing care homes. Poor appetite can result in nutritional deficiencies and weight loss and is linked to poor health outcomes and mortality. By gaining an understanding on what causes reduced appetite and its link to sensory impairment, clinical staff and nurses can quickly identify elderly patients that have an impaired appetite. Several strategies can be utilized in promoting appetite and increasing intake of food (Pilgrim, Robinson, &Save, 2015). When the human tongue receives taste signals, a number of neural pathways are activated. However, these pathways don't require for food to be in the mouth for them to be activated; the sound of rattling dishes, or an image of food can cause the stomach to rumble. The sense of vision provides a critical sense with regard to food perception, driving preferences and raising expectations. Humans discriminate unconsciously, between foods that are low and high in calories, by just looking at the said food. Looking at images of food that are low or high calorie provokes different responses with varying intensities in the brain(Toepel, Ohla, & Hudry, 2014). The study by Toepel et al.,( 2104) tested subjects where they were shown images of high calorie foods such as pastry, pizza, salmon, and lamb chops which were alternated with images of low calorie foods such as pasta/tomato sauce, yoghurt, watermelon, and beans. For every image observed, a weak electric current was attached to the tongues of the participants which stimulated the state function of the brain without any real taste being mimicked. This produced a metallic taste and sensation hence, the a food cue was initiated by the   images and neutralized by the metallic stimulation. The results from the EEG measurements showed that looking at high calorie images stimulated pleasant and strong sensations as opposed to the low calorie food images. The high calorie images evoked neural activity which was stronger in some parts of the brain such as frontal operculum and the bilateral insula in comparison to images of lower calories. Any taste pleasantness changes activated the medial orbitofrontal cortex. Shape also affects taste as was studied by Gal in a research that analyzed consumer behaviour against marketing. In the study, the participants first sorted geometric figures after which they were shown a piece of cheese that had pointed corners rather than the usual round ones. The subjects described the taste of the cheese as being sharper (Bakalar, 2014). However, understanding the brain's mechanism that connects between gustatory and visual senses is still a relatively new In addition to visual and shape, odour too plays a significant role. Volatile molecules are released when a person chews food which then travel to the receptors at the back of the mouth that lines the nasal passages. The receptors are what enable a person to identify the different sensations' combinations which result in flavour- knowing what one is consuming. When a person eats sour or sweet strawberry, the mouth is able to detect this even while the nose is held tight (Stevenson, 2012). Hearing too plays a part in what people eat. If for example one hears the crunch of potato crisps, one imagines the crisps to be fresher. Taste can also be affected by sound as was demonstrate by a study where participants were asked to bite into crisps and rate their freshness and crispiness. The researcher played a crunching sound once the subject took a bite and which systematically changed the perceptions by the subjects where the subjects stated the crisps were crispier and fresher compared to when there was no aural cue (Spence,2015). Temperature also is a factor that determines one's perception of taste. For example, warming ice cream increases the perceived flavour. Sensitivity to temperature is regulated by the taste buds' molecular processes that are responsible for the different tastes (Amerine, Pangborn, & Roessler, 2013).   Increasing food temperature to 15-35 degrees Celsius enhances one's sweetness neural response. In approximately half of the population, cooling or heating the tongue causes taste sensations in that, cooling the tongue increases the salty or sour tasting sensations while increasing the temperature increases the taste sensation of sweetness.   Smell when compared against taste, is more complex as human receptors for taste are fewer than receptors for smell. The five taste receptors are umami, bitter, salty, sour, and sweet. There are various ways of mixing both smell and taste leading to a broad array of flavours that a person perceives and which bear little subjective resemblance to the aforementioned tastes. There is a neurological link between taste and smell that is unique to the two senses. When one sees and hears something simultaneously, two different neurological pathways are used while this is not the case with tasting and smelling. For example, when one pops a jellybean in the mouth while holding the nose tight, one can still sense the jelly beans' sweetness but will not perceive the flavour. Once a person releases the nose, the flavour becomes identifiable. The flavour thus comes from the nose even when one tastes the sweetness of the beans (Society for Neuroscience, 2015). There is a distinction between smelling via the nose and via the back of the throat, while there is a neurological distinction in the tasting. Arrival of the retronasal and orthonasal odours is via the same route however, when they arrive simultaneously as taste, integration of taste and odour occurs which creates the perception of flavour. Flavour is only perceived through the simultaneous arrival of odour and taste to the anterior insula. Hence, it is concluded that the overlapping of the distinct smell and taste pathways occurs in the anterior insula. When molecules bind in the tongue receptors, then the sense of taste can be perceived which proceeds to send signals to various parts of the brain to eventually meet at the anterior insula (Yin, Hewson, Linforth et al., 2017). Further, a person is able to differentiate the experience with food through touching the food. This is more so, with regard to true fats (an example is the creamy taste of ice-cream and butter). There are specific neurons in the brain's orbitofrontal cortex that respond to fats texture in the mouth such as fat rich foods including chocolate and ice cream as well as similarly oily non food substances such as silicone oil and mineral oil. In addition, the taste of soda is influenced greatly by feel where a flat soda tastes different from a carbonated one (Drewnoski & Almiron, 2010).  Ã‚   The proportion of elderly is escalating fast in the world. It is estimated that by 2025, there wil be 1.12 billion people aged 60 and above with most having some level of sensory loss including smell and taste perception (Coreira, Lopez, &Wroblewsski et al., 2016). Laboratory and clinical studies have shown a decline in smell and taste functioning among persons aged 60 years and above which increases in severity in those aged 70 years and above. Dysfunction of smell and taste is caused by ageing and some specific disease conditions such as Alzheimer's and cancer, surgical and pharmacological intervention, environmental and radiation exposure. The chemosensory deficits may result in alteration in food choices and consumption and subsequently worsen any existing medical conditions, compromise immunity and nutritional status, change food choices and result in decrease in weight (Doty & Kamath, 2014).   As has been discussed earlier, vision, smell, and taste are involved in food enjoyment. When these senses are impaired due to ageing, they result in a reduction in appetite among the elderly. Appetite is stimulated by the smell of food while the taste of food promotes its enjoyment and stimulates the appetite further even after eating. Most elderly people have taste and smell senses that are impaired and which hinders their appetite to a great extent (Nieuwenhuizen et al., 2010). Having a good vision helps in stimulating one's appetite (Spence, Okajima, & Cheok et al., 2015). As one ages, the vision reduces with 1 in 5 persons aged 75 years and above and 1 in every 2 persons aged 90 years and above having loss of vision (RNIB, 2014). The body composition of an individual is what determines his/her energy requirements and more so, the fat free mass (the component s of the body that are exclusive of fat for example organs, bones, and muscles), and their physical activity levels.   As people age, they lose the fat free mass with a 1% rate of skeletal muscle loss among those aged 70 years and above. With most being physically inactive. Therefore the energy requirements among the elderly are low which is a contributory factor to appetite loss. This varies among individuals, which is reflective of the body composition differences as well as physical activity differences (Milanovi?, Panteli?, & Trajkovi? et al., 2013). As people become older, the sense of smell deteriorates with declining olfactory functioning (Doty & Kamath, 2014;Smoliner, Fischedick, &Sieber et al., 2013).  In addition to losing the sense of smell, people lose the ability to differentiate smells with more than 75% of persons aged 80 and above experiencing acute olfactory impairment with increased continuous decline after 70 years (Doty et al., 2014). Of persons aged between 80-97 years, 62.5% had olfactory impairment(Schubert, Cruickshanks, &Klein et al., 2011). However, taste impairment is more common than olfactory impairment (Malaty & Malty, 2013) Gustatory dysfunction is also linked to ageing, however, most often, what is thought to be taste impairment is in fact an olfactory impairment. Besides smell impairment, taste impairment is caused by prior infection of upper respiratory area, drug use, head injury, as well as idiopathic causes (Fomazieri, Borges, & Bezerra, et al., 2014; Bromley & Doty, 2014; Roper, 2013).  Problems with chewing caused by loss of teeth and dentures can interfere with sense of taste along with decreased production of saliva. Decreased senses of tastes and smell causes suppression of appetite which results in loss of weight, impaired immunity, malnutrition, and medical conditions deteriorations (Phillips, Caroll, & Drayson et al., 2015; Jacobson, Green, & Murphy,2010).  Problems with nutrition form a significant sequeale from disorders of taste and smell.  Elderly persons need two-three times more salt concentration in tomato soup before they are able to detect it (Ahmed & Haboubi, 2010).  The tendency for the elderly to take in higher concentrations of sugar and salt can exacerbate already hazardous medical conditions they may be experiencing. A decrease or distortion in the sense of smell results in a decrease in life quality or even disability(Smeets, Veldhuizen, & Galle, 2009). Further, such medical conditions can result in a high level of depression and anxiety in the person. Anxiety resulting from inability to enjoy the taste of food and fear that the taste impairment could be as a result of a n unknown condition. In addition, there is also heightened depression among persons with anosmia (Hummel, T., Landis, B. N., & Hà ¼ttenbrink,, 2011).   Classification of chemosensory dysfunction is as follows: ageusia (loss in sense of taste), hypogeusia (decrease in taste sensitivity), dysgeusia (normal taste distortion), anosmia (loss in of the sense of smell), hyposmia (decrease in smell sensitivity) and dysomia (normal smell distortion). Persons with hypogeusia often need tastants in higher concentrations in order to detect the same; their threshold for detecting and recognizing tastants is elevated above the normal controls. These group of persons also have less intense suprathreshold concentrations. Persons with dysgeusi experience taste distortion such as metallic/bitter taste sides that are not often linked to the foods they are consuming. Analogous impairments in perceptions of smell are often reported in persons with dysosmia and hyposmia. The chemosensory deficits that the elderly experience are irreversible. However, there are several sensory interventions that can be applied such as odour and taste intensification to compensate for perceptual loss that is age related. One such method is addition of monosodium glutamate (MSG) in food during and after its preparation to enhance its taste and smell as well as enhance its palatability. When a person presents with taste and smell disorders, they will first need reassurance and counselling that they are not suffering from an infection or malignant disease. Once diagnosis of diminished smell is done, the management goal will entail injury prevention that is related to the condition. Gas detection visual stimulating devices are ideal for a person that use gas stoves as such a person will be incapable of smelling a gas leak. Neighbours and relatives will need to be involved in assisting such a person as he/she may be unable to detect spoiled food which can cause food poisoning if consumed. MSG is the glutamic acid sodium salt that poses the unique umami taste quality. The term umami is Japanese with no English translation , and is used for describing the MSG taste as well as the taste of certain broths and fish. The umami taste is similar to the protein taste. Different tests have shown that umami does not fall in any of the categories of bitter, salty, sour, and sweet. MSG is used in making commercial mixtures that contain specific 5†²-ribonucleotides such as IMP (inosine-5†²-monophosphate) and GMP (guanosine-5†²-monophosphate). MSG together with these compounds have synergistic and potent effects, including a significant decrease in the threshold levels of MSG. A person with a taste disorder will need flavoring enhancements added to his/her food. Flavors are a combination of odorant molecules which are blended or extracted from natural product or can be synthesized from natural products through   mass spectrographic and chromatographic analysis. Flavor enhancers modify or enhance the food's original aroma or taste but lack their individual aroma or taste. For example, simulated beef flavour can be used as an addition to beef or beef soup to increase the beef sensation. There is a difference in flavour enhancement from the more common taste and odour sensation enhancers such as salt, herbs, and spices. Herbs and spices add diverse flavours as opposed to intensifying the food's existing chemosensory properties. Flavours are not spices hence they do not cause any stomach or mouth irritations. The main component in flavour enhancements is salt but also, MSG is used often. Flavour enhancement added in food for the sick and elderly can improve the palatability of food and also its acceptance, slow or reverse decline in functionality, increase counts of lymphocytes, and improve the overall quality of life. It also potentially makes up for anorexia (Islam, Fagundo, & Arcelus, 2015).One study revealed that enhancement of flavour for the elderly living in a retirement home resulted in an enhanced immune status as witnessed in levels of B and T cell counts and also an improved strength in grip (Islam et al., 2015). In addition, odour and taste stimulation among the elderly has been shown to improve with an increased salivary IgA rate (Philips et al., 2015) Several factors contribute to impaired appetite among the elderly and these are often linked to the psychological and physical alterations that come with ageing. Poor appetite is significant as it increases the likelihood of a person becoming nutritionally deficient and even losing weight. Weight loss is particularly difficult to regain in elderly patients and along with nutritional deficiency, they are both associated with mortality and poor health outcomes. The nurse is in a position to quickly identify patients that have impaired appetite and can commence on interventions to help the elderly patients to enhance their appetite and increase food intake by utilizing different strategies as discussed in this paper. These strategies include flavoring food with sauces, spices, and herbs, improving the ambience of food, ensuring the patient has company while eating, serving meals that the patient has shown preference for and during regular times when the patient eats. Amplification of fo od taste and flavor using MSG can improve the palatability of the food and its acceptance as well. It can also increase the immunity and salivary flow in a patient as well as minimize oral complaints among the elderly and the sick. Flavor molecules compensate for losses in chemosensory abilities by interacting with receptors in the mouth. MSG adds taste without enhancing other tastes.   It may also be helpful to increase the patient's physical activity. Finally, the use of oral nutritional supplements may be necessitated in supporting elderly patients with acute illness and who have very low appetite. Ahmed, T., & Haboubi, N. (2010). Assessment and management of nutrition in older people and its importance to health.  Clinical Interventions in Aging,  5, 207–216. Amerine, M. A., Pangborn, R. M., & Roessler, E. B. (2013).  Principles of sensory evaluation of food. Elsevier. Bakalar, N. (2012). Sensory science: partners in flavour.  Nature,  486(7403), S4-S5. Bromley, S.M. & Doty, R.L.   (2014)Clinical disorders affecting taste: an update.   Chapter 39 in R.L. Doty (Ed),  Handbook of Olfaction and Gustation  (3rd Edition).   New York: Wiley-Liss, 2014, in press. Correia, C., Lopez, K. J., Wroblewski, K. E., Huisingh?Scheetz, M., Kern, D. W., Chen, R. C., ... & Pinto, J. M. (2016). Global sensory impairment in older adults in the United States.  Journal of the American Geriatrics Society,  64(2), 306-313. Croy, I., Nordin, S., & Hummel, T. (2014). Olfactory disorders and quality of life—an updated review.  Chemical senses,  39(3), 185-194. Doty, R. L., & Kamath, V. (2014). The influences of age on olfaction: a review.  Applied Olfactory Cognition,  5, 213-232. Drewnowski A, Almiron-Roig E.(2010) Human Perceptions and Preferences for Fat-Rich Foods. In: Montmayeur JP, le Coutre J, editors. Fat Detection: Taste, Texture, and Post Ingestive Effects. Boca Raton (FL): CRC Press/Taylor & Francis; 2010. Chapter 11.  Available from: https://www.ncbi.nlm.nih.gov/books/NBK53528/ Fornazieri, M. A., Borges, B. B. P., Bezerra, T. F. P., de Rezende Pinna, F., & Voegels, R. L. (2014). Main causes and diagnostic evaluation in patients with primary complaint of olfactory disturbances.  Brazilian journal of otorhinolaryngology,  80(3), 202-207. Hummel, T., Landis, B. N., & Hà ¼ttenbrink, K.-B. (2011). Smell and taste disorders.  GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery,  10, Doc04. https://doi.org/10.3205/cto000077 Islam, M. A., Fagundo, A. B., Arcelus, J., Agà ¼era, Z., Jimà ©nez-Murcia, S., Fernà ¡ndez-Real, J. M., †¦ Fernandez-Aranda, F. (2015). Olfaction in eating disorders and abnormal eating behavior: a systematic review.  Frontiers in Psychology,  6, 1431. https://doi.org/10.3389/fpsyg.2015.01431 Jacobson, A., Green, E., & Murphy, C. (2010). Age-Related Functional Changes in Gustatory and Reward Processing Regions: An fMRI Study.  NeuroImage,  53(2), 602–610. https://doi.org/10.1016/j.neuroimage.2010.05.012 Malaty, J., & Malaty, I. A. (2013). Smell and taste disorders in primary care.  Am Fam Physician,  88(12), 852-859. Milanovi?, Z., Panteli?, S., Trajkovi?, N., SporiÃ… ¡, G., Kosti?, R., & James, N. (2013). Age-related decrease in physical activity and functional fitness among elderly men and women.  Clinical Interventions in Aging,  8, 549–556. https://doi.org/10.2147/CIA.S44112 Nieuwenhuizen W, Weenen H, Rigby P, et al. (2010). Older adults and patients in need of nutritional support: review of current treatment options and factors influencing nutritional intake.  Clinical Nutrition.29:160–169. Phillips, A. C., Carroll, D., Drayson, M. T., & Der, G. (2015). Salivary immunoglobulin a secretion rate is negatively associated with cancer mortality: The West of Scotland Twenty-07 Study.  PloS one,  10(12), e0145083. Pilgrim, A., Robinson, S., Sayer, A. A., & Roberts, H. (2015). An overview of appetite decline in older people.  Nursing Older People,  27(5), 29–35. https://doi.org/10.7748/nop.27.5.29.e697 RNIB (2014). Key Information and Statistics.  (Retrieved on 7th May, 2017). Available:https://www.rnib.org.uk/knowledge-and-research-hub/key-information-and-statistics. Roper, S. D. (2013). Taste buds as peripheral chemosensory processors.  Seminars in Cell & Developmental Biology,  24(1), 71–79. https://doi.org/10.1016/j.semcdb.2012.12.002 Schubert, C. R., Cruickshanks, K. J., Klein, B. E., Klein, R., & Nondahl, D. M. (2011). Olfactory impairment in older adults: 5-year incidence and risk factors.  The Laryngoscope,  121(4), 873–878. https://doi.org/10.1002/lary.2146 Smeets, M. A., Veldhuizen, M. G., Galle, S., Gouweloos, J., de Haan, A. M. J., Vernooij, J., ... & Kroeze, J. H. (2009). Sense of smell disorder and health-related quality of life.  Rehabilitation Psychology,  54(4), 404. Smoliner, C., Fischedick, A., Sieber, C. C., & Wirth, R. (2013). Olfactory function and malnutrition in geriatric patients.  The Journals of Gerontology Series A: Biological Sciences and Medical Sciences,  68(12), 1582-1588. Society for Neuroscience (2015). Making sense of scents: smell and the brain. (Retrieved on 7th May, 2017). https://www.brainfacts.org/sensing-thinking-behaving/senses-and-perception/articles/2015/making-sense-of-scents-smell-and-the-brain/ Spence, C. (2015). Eating with our ears: assessing the importance of the sounds of consumption on our perception and enjoyment of multisensory flavour experiences.  Flavour,  4(1), 3. Spence, C., Okajima, K., Cheok, A. D., Petit, O., & Michel, C. (2015). Eating with our eyes: From visual hunger to digital satiation.  Brain Cogn. Stevenson, R. J. (2012). The role of attention in flavour perception.  Flavour,  1(1), 2. Toepel, U., Ohla, K., Hudry, J., le Coutre, J., & Murray, M. M. (2014). Verbal labels selectively bias brain responses to high-energy foods.  NeuroImage,  87, 154-163. Yin, W., Hewson, L., Linforth, R., Taylor, M., & Fisk, I. D. (2017). Effects of aroma and taste, independently or in combination, on appetite sensation and subsequent food intake.  Appetite.

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The Ineffective Approach in Medicare Reimbursement Essay

The Ineffective Approach in Medicare Reimbursement - Essay Example On the other hand, the support on setting the Medicare reimbursement is that, there is no one general approach in which the most effective amount will be arrived at. In addition, the set guidelines and rules for Medicare reimbursement lack a proper structure making the approach more challenging to the practitioners. Nevertheless, the failure to involve the health practitioners, especially advanced nursing practitioners in management, effectively makes the approach ineffective. Therefore, their involvement is crucial to ensure an approach that suits the needs of all the stakeholders and making it responsive to the needs of both the patients and the healthcare providers. In addition, government intervention by creating proper legal guidelines is crucial to ensure that the approach meets the required needs. Keywords: reimbursement, Medicare, Medicaid The ineffective approach in Medicare Reimbursement Introduction Wong (1999) noted that, the Balanced Budget Act of 1997 provided the reimb ursement of APNs for the services they provided in any given setting at a fraction of the physicians fee. Nevertheless, a long process requiring meeting specific guidelines and documentation makes the process of reimbursing APNs hectic and confusing. In this case, the new era of providing medical care should be devoid of the factors that do not in any way help in simplifying the process of reimbursement. Background Reinhardt (2003) identifies the Medicare reimbursement system in the country as a large one and much more centralized than in other countries. Moreover, the inflexible nature of the system does not offer any assistance but only helps make the issue much more complex for advanced practice nurses in management. In this case, this makes the system fail to respond to the local markets conditions, patients’ requirements, and more significantly to nursing care providers’ needs and requirements. Moreover, the unresponsive nature of Medicare is made worse by the rul es and guidelines that groups of actors manipulate easily to meet their specific needs. Cohen and Spector (1996) noted that, the annual threat in a considerable cut in Medicare reimbursements often lead to speculation that hospitals will have a limit on the number of Medicare patients they admitted and treated. In effect, advanced nurses in charge of management faced a dilemma whether to admit these patients due to the cut in Medicare considering that the reimbursement formula to determine how much payment a hospital gets is determined by a particular number of cost-related factors and in particular the geographical location and inflationary rates. Position It is my position, as a nurse with advanced preparation in management, that the current Medicare reimbursement system is complex in its effort to offering quality care to the country’s population. In this case, the structure, rules, and guidelines on the reimbursement policy fails to capture the opinions of nursing practit ioners on how best to structure the reimbursement policy. On the other hand, the structure of obtaining the reimbursement amount in terms of cost-related measures such as geographical location and inflation makes the policy on reimbursement appear unfair to some states and nurses practitioners while others benefit. In fact, this makes the policy more complex and puts management at an awkward position in terms of implementation of their policies.

Discussion 5 Assignment Example | Topics and Well Written Essays - 500 words - 1

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The Ineffective Approach in Medicare Reimbursement Essay

The Ineffective Approach in Medicare Reimbursement - Essay Example On the other hand, the support on setting the Medicare reimbursement is that, there is no one general approach in which the most effective amount will be arrived at. In addition, the set guidelines and rules for Medicare reimbursement lack a proper structure making the approach more challenging to the practitioners. Nevertheless, the failure to involve the health practitioners, especially advanced nursing practitioners in management, effectively makes the approach ineffective. Therefore, their involvement is crucial to ensure an approach that suits the needs of all the stakeholders and making it responsive to the needs of both the patients and the healthcare providers. In addition, government intervention by creating proper legal guidelines is crucial to ensure that the approach meets the required needs. Keywords: reimbursement, Medicare, Medicaid The ineffective approach in Medicare Reimbursement Introduction Wong (1999) noted that, the Balanced Budget Act of 1997 provided the reimb ursement of APNs for the services they provided in any given setting at a fraction of the physicians fee. Nevertheless, a long process requiring meeting specific guidelines and documentation makes the process of reimbursing APNs hectic and confusing. In this case, the new era of providing medical care should be devoid of the factors that do not in any way help in simplifying the process of reimbursement. Background Reinhardt (2003) identifies the Medicare reimbursement system in the country as a large one and much more centralized than in other countries. Moreover, the inflexible nature of the system does not offer any assistance but only helps make the issue much more complex for advanced practice nurses in management. In this case, this makes the system fail to respond to the local markets conditions, patients’ requirements, and more significantly to nursing care providers’ needs and requirements. Moreover, the unresponsive nature of Medicare is made worse by the rul es and guidelines that groups of actors manipulate easily to meet their specific needs. Cohen and Spector (1996) noted that, the annual threat in a considerable cut in Medicare reimbursements often lead to speculation that hospitals will have a limit on the number of Medicare patients they admitted and treated. In effect, advanced nurses in charge of management faced a dilemma whether to admit these patients due to the cut in Medicare considering that the reimbursement formula to determine how much payment a hospital gets is determined by a particular number of cost-related factors and in particular the geographical location and inflationary rates. Position It is my position, as a nurse with advanced preparation in management, that the current Medicare reimbursement system is complex in its effort to offering quality care to the country’s population. In this case, the structure, rules, and guidelines on the reimbursement policy fails to capture the opinions of nursing practit ioners on how best to structure the reimbursement policy. On the other hand, the structure of obtaining the reimbursement amount in terms of cost-related measures such as geographical location and inflation makes the policy on reimbursement appear unfair to some states and nurses practitioners while others benefit. In fact, this makes the policy more complex and puts management at an awkward position in terms of implementation of their policies.