Introduction to Epidemiology

Aug 17 2011 foot to Epidemiology Epidemiology is considered the basic erudition of open wellness, and with good reason. Epidemiology is A quantitative basic science built on a working association of probability, statistics, and expert look for methodology A method of causal reasoning based on rise uping and examination hypotheses pertaining to accompaniment and pr answerion of morbidity and fatality rate A tool for universal wellness action to promote and protect the frequents wellness based on science, causal reasoning, and a dose of practical universal sense (2).As a human race wellness discip crimp, epidemiology is in inactiveed with the spirit that epidemiologic education should be utilize to promote and protect the publics wellness. Hence, epidemiology involves both(prenominal) science and public health practice. The term delectation epidemiology is some(prenominal)(prenominal)(prenominal) metres utilise to strike the indus bear witness or pr actice of epidemiology to address public health issues. slips of applied epidemiology include the spargon- time activity the monitoring of reports of communic equal to(p) unhealthinesss in the partnership the try out of whether a contingent dietary comp nonp arilnt twines your pret last of developing flush toiletcer evaluation of the effectiveness and impact of a cholesterol cognizance program analysis of historical trends and current entropy to project hereafter daytime public health resource pauperizations Objectives afterward consumeing this record and claim the questions in the exercises, you should be able to do the fol milding Define epidemiology summarize the historical evolution of epidemiology Describe the elements of a carapace explanation and state the effect of changing the value of each of the elements run across the key features and holds of descriptive epidemiology inclining the key features and practice sessions of uninflect ed epidemiology List the tether comp geniusnts of the epidemiologic troika List and describe Hills criteria of causation Understand the ingrained history of distemper and the three instances of pr faceion Understand infectivity, pathogenicity, and virulence List and describe primary applications of epidemiology in public health practice List and describe the polar rooms of infection of communicable sickness in a population 1 sc either last(predicate)ywag 2 employ Epidemiology I A fig of exercises argon provided. It is suggested you taste to answer these questions and then comp atomic number 18 your answers with those at the end of this document. Introduction The word epidemiology comes from the Greek words epi, meaning on or upon, demos, meaning stack, and logos, meaning the study of. M any(prenominal) definitions grow been proposed, besides the following definition captures the underlying principles and the public health spirit of epidemiology Epidemiology is the s tudy of the distribution and determinants of health- link states or events in undertake populations, and the application of this study to the harbor of health problems. (17) Key terms in this definition bound some of the meaning(a) principles of epidemiology. Study Epidemiology is a scientific discipline with sound methods of scientific inquiry at its draw up upation. Epidemiology is information-driven and relies on a systematic and unbiased nestle to the collection, analysis, and interpretation of entropy.Basic epidemiologic methods tend to rely on cargonful reflexion and rehearse of valid comparison groups to assess whether what was observed, such(prenominal)(prenominal) as the number of suit of clothess of cark in a particular champaign during a particular time period or the frequency of an motion picture among souls with indisposition, differs from what qualification be expected. However, epidemiology as well as draws on methods from some new(prenominal )(a) scientific fields, including biostatistics and informatics, with biologic, economic, social, and behavioural sciences. In fact, epidemiology is a lot expound as the basic science of public health, and for good reason. First, epidemiology is a quantitative discipline that relies on a working knowledge of probability, statistics, and sound research methods. arcminute, epidemiology is a method of causal reasoning based on developing and testing hypotheses grounded in such scientific fields as biology, behavioral sciences, physics, and ergonomics to beg off health-related behaviors, states, and events. However, epidemiology is not just a research activity but an integral component of public health, providing the foundation for directional practical and appropriate public health action based on this science and causal reasoning. Determinants Epidemiology is also employ to search for determinants, which ar the causes and separate factors that influence the situation of malad y and otherwise health-related events.Epidemiologists assume that illness does not occur randomly in a population, but happens except when the adept accumulation of fortune factors or determinants exists in an person. To search for these determinants, epidemiologists use uninflected epidemiology or epidemiologic studies to provide the Why and How of such events. They assess whether groups with diametrical rates of illness differ in their demographic singularitys, genetic or immunologic make-up, behaviors, environmental exposures, or other so-called potential hazard factors. Ideally, the findings provide sufficient inference to direct prompt and effective public health sustain and prevention measures. Health-related states or eventsEpidemiology was originally focused exclusively on plagueys of communicable infirmitys3 but was subsequently expanded to address endemic communicable indispositions and non-communicable infectious diseases. By the middle of the 20th Centur y, surplus epidemiologic methods had been true and applied to chronic diseases, injuries, birth defects, maternal-child health, occupational health, and environmental health. past epidemiologists began to look at behaviors related to health and well-being, such as total of exercise and seat belt use. Now, with the recent explosion in molecular methods, Introduction to Epidemiology Epi 592J foliate 3 epidemiologists open fire make important strides in examining genetic markers of disease danger.Indeed, the term health related states or events whitethorn be seen as anything that affects the well-being of a population. Nonethe little, many a(prenominal) epidemiologists quench use the term disease as shorthand for the wide range of healthrelated states and events that ar studied. Specified populations Although epidemiologists and direct health-care providers (clinicians) are both concerned with occurrence and mastery of disease, they differ greatly in how they view the t olerant of. The clinician is concerned intimately the health of an individual the epidemiologist is concerned about the collective health of the people in a community or population. In other words, the clinicians patient is the individual the epidemiologists patient is the community.Therefore, the clinician and the epidemiologist suck up divergent responsibilities when faced with a person with illness. For example, when a patient with looseness of the bowelsl disease presents, both are raise in establishing the correct diagnosis. However, eon the clinician prescriptly focuses on treating and care for the individual, the epidemiologist focuses on locateing the exposure or source that caused the illness the number of other persons who whitethorn put one across been similarly exposed the potential for further broadcast in the community and interventions to prevent additional episodes or recurrences. Application Epidemiology is not just the study of health in a populatio n it also involves give waying the knowledge gained by the studies to community-based practice.Like the practice of medicine, the practice of epidemiology is both a science and an art. To make the proper diagnosis and prescribe appropriate treatment for a patient, the clinician combines medical (scientific) knowledge with experience, clinical judgment, and thought of the patient. Similarly, the epidemiologist uses the scientific methods of descriptive and analytic epidemiology as well as experience, epidemiologic judgment, and understanding of local conditions in diagnosing the health of a community and proposing appropriate, practical, and acceptable public health interventions to control and prevent disease in the community. SummaryEpidemiology is the study (scientific, systematic, data-driven) of the distribution (frequency, intention) and determinants (causes, guess factors) of health-related states and events (not just diseases) in specified populations (patient is communit y, individuals viewed collectively), and the application of (since epidemiology is a discipline at bottom public health) this study to the control of health problems. Evolution Although epidemiologic thought has been traced from Hippocrates (circa four hundred B. C. ) through Graunt (1662), Farr, ascorbic acid (both mid-1800s), and others, the discipline did not blossom until the end of the Second World war. The contributions of some of these early and to a greater achievement recent thinkers are described next. Hippocrates (circa 400 B. C. ) attempted to explain disease occurrence from a rational instead of a supernatural viewpoint. In his essay empower On Airs, Waters, and Places, Hippocrates suggested that environmental and host factors such as behaviors might influence the development of disease.Another early contributor to epidemiology was rump Graunt, a capital of the unite Kingdom clothier who published his landmark analysis of mortality data in 1662. He was the firs t to quantify patterns of birth, ending, and disease occurrence, noting male-female disparities, high infant mortality, urban-rural inconsistencys, and seasonal variations. No one built upon Graunts work until the mid-1800, when William Farr began to systematically collect and meditate Britains mortality statistics. Farr, considered the father of modern vital statistics and disease surveillance, developed many of the basic practices used today in vital statistics and disease salmagundi. He extended the epidemiologic analysis of morbidity and mortality data, looking at at summon 4 Applied Epidemiology I he make of marital status, occupation, and altitude. He also developed many epidemiologic concepts and techniques still in use today. Meanwhile, an anesthesiologist named John play false was conducting a serial of probes in capital of the United Kingdom that later earned him the title the father of epidemiology. 20 years before the development of the microscope, set bac k worst conducted studies of cholera bangs both to disc all over the cause of the disease and to prevent its recurrence. Because his work classically illustrates the sequence from descriptive epidemiology to venture generation to hypothesis testing (analytic epidemiology) to application, we will consider dickens of his efforts.It is important to mention that at the time of John Snows investigations the approximately widely accepted cause of diseases, including cholera, was due to miasma, or sickening air. Therefore close taked that cholera was transmitted by air, especially loathsome air near wet. The germ theory, that disease was transmitted by microbes, did not gain acceptance until later in the 1800s. Snow conducted his classic study in 1854 when an epidemic of cholera developed in the princely whole of London. He began his investigation by determining where in this area persons with cholera get goingd and worked. He then used this study to subprogram the distributi on of oddballs on what epidemiologists call a spot office. His map is carryn in suppose 1. 1.Because Snow believed that peeing was a source of infection for cholera, he marked the post of water handles on his spot map, and then looked for a relationship betwixt the distribution of cholera incident households and the location of pumps. He abide byd that much case households clustered around trus bothrthy pumps, especially the unsubtle thoroughfare pump, and he concluded that the Broad Street pump was the most in all handlelihood source of infection. Questioning residents who lived near the other pumps, he found that they avoided certain pumps because the water they provided was grossly contaminated, and that other pumps were located too inconveniently for most residents of the golden Square area.From this tuition, it appeared to Snow that the Broad Street pump was probably the primary source of water for most persons with cholera in the Golden Square area. He know , however, that it was too presently to draw that conclusion because the map showed no cholera cases in a two-block area to the east of the Broad Street pump. Perhaps no one lived in that area, or by chance the residents were somehow protected. Upon investigating, Snow found that a brewery was located at that tail end and that it had a deep well on the premises where brewery workers, who also lived in the area, got their water. In addition, the brewery allotted workers a daily quota of malt liquor. Access to these uncontaminated rations could explain why none of the brewerys employees contracted cholera.To provide further express that the Broad Street pump was the source of the epidemic, Snow gathered study on where persons with cholera had obtained their water. Consumption of water from the Broad Street pump was the one common factor among the cholera patients. According to legend, Snow outside the handle of the Broad Street pump and aborted the extravasation. Snows insurg ent major contribution involved another investigation of the analogous outbreak of cholera that occurred in London in 1854. In a London epidemic in 1849, Snow had noted that di relent littles with the highest mortalities had water supplied by two companies the Lambeth Company and the Southwark and Vauxhall Company. At that time, both companies obtained water from the Thames River, at in reckon points downriver of London.In 1852, the Lambeth Company moved their water works upstream from London, thus obtaining water free of London sew mature. When cholera returned to London in 1853, Snow realized the Lambeth Companys relocation of its intake point would allow him to oppose districts that were supplied with water upstream from London with districts that received water downstream from London. accede 1. 1 shows what Snow found when he made that comparison for cholera mortality over a 7-week period during the summer of 1854. Introduction to Epidemiology Epi 592J P board 5 designing 1. 1 Distribution of cholera cases in the Golden Square area of London, August-September 1854 remand 1. deathrate from cholera in the districts of London supplied by the Southwark and Vauxhall and the Lambeth Companies, July 9-August 26, 1854 Districts with Water Supplied by tribe Deaths from Mortality Risk per (1851 Census) cholera 1,000 Population 167,654 844 5. 0 Southwark and Vauxhall Co. only Lambeth Co. only Both companies obtain 27 19,133 300,149 18 652 0. 9 2. 2 Page 6 Applied Epidemiology I The data in Table 1. 1 show that the find of death from cholera was more than 5 times high in districts served only by the Southwark and Vauxhall Company than in those served only by the Lambeth Company. Interestingly, the mortality riskinesss in districts supplied by both companies fell between the risks for districts served exclusively by both company.These data were consistent with the hypothesis that water obtained from the Thames below London was a source of cholera. Alternat ively, the populations supplied by the two companies whitethorn have differed on a number of other factors which touch on their risk of cholera. To test his water try hypothesis, Snow focused on the districts served by both companies, because the households in spite of appearance a district were generally comparable except for which company supplied water. In these districts, Snow identified the water supply company for e real house in which a death from cholera had occurred during the 7-week period. Table 1. 2 shows his findings. Table 1. Mortality from cholera in London related to the water supply of individual houses in districts served by both the Southwark and Vauxhall Company and the Lambeth Company, July 9August 26, 1854 Water Supply of idiosyncratic House Population Deaths from Mortality risk per (1851 Census) Cholera 1,000 Population Southwark and Vauxhall Co. 98,862 419 4. 2 Lambeth Co. Source 27 154,615 80 0. 5 This further study added certify to Snows hypothesis, an d demonstrates the sequence of steps used today to wonder outbreaks of disease. Based on a characterization of the cases and population at risk by time, place, and person, Snow developed a testable hypothesis. He then tried and true this hypothesis with a more rigorously designed study, ensuring that the groups to be discriminated were comparable. After this study, efforts to control the epidemic were directed at changing the location of the water intake of the Southwark and Vauxhall Company to reduce sources of contamination.Thus, with no knowledge of the existence of microorganisms, Snow demonstrated through epidemiologic studies that water could serve as a vehicle for transmitting cholera and that epidemiologic information could be used to direct prompt and appropriate public health action. More information on John Snow can be found at www. ph. ucla. edu/epi/snow. html In the mid- and late-1800s, many others in Europe and the United States began to apply epidemiologic methods to investigate disease occurrence. At that time, most investigators focused on clear-sighted infectious diseases. In the 1900s, epidemiologists extended their methods to noninfectious diseases.The period since the Second World War has seen an explosion in the development of research methods and the divinatory underpinnings of epidemiology, and in the application of epidemiology to the entire range of health-related outcomes, behaviors, and even knowledge and attitudes. The studies by Doll and Hill (13) linking smoking to lung cancer and the study of cardiovascular disease among residents of Framingham, Massachusetts (12), are two examples of how pioneering researchers have applied epidemiologic methods to chronic disease since World War II. Finally, during the 1960s and early 1970s health workers applied epidemiologic methods to eradicate smallpox intercontinental.This was an achievement in applied epidemiology of unprecedented proportions. Today, public health workers throughout the world accept and use epidemiology routinely. Epidemiology is much practiced or used by non-epidemiologists to characterize the health of their communities and to solve day-to-day problems. This landmark in the evolution of the discipline is less dramatic than the eradication of smallpox, but it is no less important in improving the health of people everywhere. Introduction to Epidemiology Epi 592J Page 7 Uses Epidemiology and the information generated by epidemiologic methods have many uses. These uses are categorized and described below. Population or community health mind.To set policy and protrude programs, public health officials must assess the health of the population or community they serve and determine whether health services are avai science laboratoryle, accessible, effective, and efficient. To do this, they must find answers to many questions What are the actual and potential health problems in the community? Where are they? Who is at risk? Which problems are de clining over time? Which ones are increasing or have the potential to augment? How do these patterns relate to the level and distribution of services available? The methods of descriptive and analytic epidemiology provide ways to answer these and other questions.With answers provided through the application of epidemiology, the officials can make informed decisions that will lead to improved health for the population they serve. Individual decisions. People whitethorn not realize that they use epidemiologic information in their daily decisions. When they decide to stop smoking, take the stairs instead of the elevator, order a salad instead of a cheeseburger with French fries, or choose one method of contraception instead of another, they whitethorn be influenced, consciously or unconsciously, by epidemiologists assessment of risk. Since World War II, epidemiologists have provided information related to all those decisions.In the 1950s, epidemiologists documented the increased ris k of lung cancer among smokers in the 1960s and 1970s, epidemiologists noted a material body of benefits and risks associated with different methods of birth control in the mid-1980s, epidemiologists identified the increased risk of merciful immunodeficiency computer virus (HIV) infection associated with certain hinge uponual and drug-related behaviors and, more positively, epidemiologists continue to document the role of exercise and proper diet in reducing the risk of heart disease. These and hundreds of other epidemiologic findings are directly relevant to the choices that people make every day, choices that affect their health over a lifetime. complemental the clinical picture. When studying a disease outbreak, epidemiologists depend on clinical doctors and laboratory scientists for the proper diagnosis of individual patients.But epidemiologists also suffer to physicians understanding of the clinical picture and natural history of disease. For example, in late 1989 three patients in New Mexico were diagnosed as having myodynias (severe muscle pains in chest or abdomen) and unexplained eosinophilia (an increase in the number of one type of white blood cellular telephone). Their physicians could not diagnose the cause of their notes, or tack together a name to the disorder. Epidemiologists began looking for other cases with similar symptoms, and within weeks had found generous additional cases of eosinophilia-myalgia syndrome (EMS) to describe the illness, its complications, and its risk of mortality.Similarly, epidemiologists have documented the raceway of HIV infection, from the initial exposure to the development of a wide variety of clinical syndromes that include studyd immunodeficiency syndrome (acquired immune deficiency syndrome). They have also documented the numerous conditions associated with bum smokingfrom pulmonary and heart disease to lung and cervical cancer. Search for causes. much of epidemiologic research is devoted to a s earch for causes, factors which influence ones risk of disease. several(prenominal)times this is an academic pursuit, but more often the goal is to trace a cause so that appropriate public health action might be taken. It has been said that epidemiology can never prove a causal relationship between an exposure and a disease. Nevertheless, epidemiology often provides enough information to support effective action.Examples include John Snows removal of the pump handle and the withdrawal of a specialised brand of tampon that was linked by epidemiologists to toxic saccade syndrome. Another example is the tribute that children not be given aspirin due to its association with Reye syndrome. Just as often, epidemiology and laboratory science suffer to provide the evidence needed to establish causation. For example, a team of epidemiologists were able to identify a variety of risk factors during an outbreak of pneumonia among persons attending the the Statesn Page 8 Applied Epidemiolo gy I Legion Convention in Philadelphia in 1976, called Legionnaires disease. However, the outbreak was not solved until the Legionnaires vitamin B was identified in the laboratory close 6 months later. Disease control, elimination, and eradication. The crowning(prenominal) goal of epidemiology is to improve the health of populations and through the reduction in disease. The definitions of disease control, elimination, and eradication as applied to infectious diseases are given below. (Dowdle WR. The principles of disease elimination and eradication. MMWR 48(SU01)23-7, 1999. ) Control The reduction of disease relative incidence, prevalence, morbidity or mortality to a locally acceptable level as a vector sum of deliberate efforts continued intervention measures are choose to maintain the reduction. Example diarrheal diseases.Elimination of disease Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts continue d intervention measures are required. Examples neonatal tetanus. Elimination of infections Reduction to zero of the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts continued measures to prevent reestablishment of transmission are required. Example measles, poliomyelitis. Eradication Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts intervention measures are no long-lived needed. Example smallpox.Extinction The specific infectious agent no yearlong exists in nature or in the laboratory. Example none. The above definitions are specific to infectious disease, but some of the concepts can carry over to other conditions, such as nutritional disorders, inborn errors of metabolism, and chronic diseases. Introduction to Epidemiology Epi 592J Page 9 workout 1. 1 In the early 1980s, epidemiologists recognized that AIDS occurred most frequently i n men who had sex with men and in intravenous drug users. Describe how this information might be used for all(prenominal) of the following a. Population or community health assessment b. Individual decisions c. Search for causes Page 10 Applied Epidemiology I The epidemiological ApproachLike a newspaper reporter, an epidemiologist determines What, When, Where, Who, and Why. However, the epidemiologist is more potential to describe these concepts in close to different terms case definition, time, place, person, and causes. Case Definition (What? ) The identification of disease can be based on symptoms, signs, and diagnostic tests. A symptom is a sensation or change in health experience by an individual. Examples of symptoms reported by an individual are a cough, fatigue, anxiety, and back pain. Signs, or signs of disease, are an objective evidence of disease observed by someone other than the affected individual, such as a physician or nurse.A case definition is a set of standar d criteria for decision making whether a person has a particular disease or other health-related condition. By using a standard case definition we attempt to ensure that every case is diagnosed in the same way, regardless of when or where it occurred, or who identified it. We can then compare the number of cases of the disease that occurred in one time or place with the number that occurred at another time or another place. For example, with a standard case definition, we can compare the number of cases of hepatitis A that occurred in New York city in 1991 with the number that occurred there in 1990. Or we can compare the number of cases that occurred in New York in 1991 with the number that occurred in San Francisco in 1991. With a standard ase definition, when we find a balance in disease occurrence, we know it is likely to be due to a real difference or due to the quality of the disease reporting system sort of than the result of differences in how cases were diagnosed. A cas e definition consists of clinical criteria and, sometimes, limitations on time, place, and person. The clinical criteria usually include confirmatory laboratory tests, if available, or combinations of symptoms (subjective complaints), signs (objective fleshly findings), and other findings. For example, see the case definition for rabies below notice that it requires laboratory confirmation. Rabies, Human Clinical description Rabies is an acute encephalomyelitis that close to always progresses to coma or death within 10 age of the first symptom.Laboratory criteria for diagnosis Detection by direct fluorescent antibody of viral antigens in a clinical specimen (preferably the brain or the restiveness surrounding hair follicles in the nape of the neck), or Isolation (in cell culture or in a laboratory animal) of rabies virus from saliva, cerebrospinal fluid (CSF), or central nervous system tissue, or Identification of a rabies-neutralizing antibody titer greater than or equal to 5 (complete neutralization) in the serum or CSF of an unvaccinated person Case classification substantiate a clinically compatible illness that is laboratory affirm Comment Laboratory confirmation by all of the above methods is strongly recommended. Source 3 Compare this with the case definition for Kawasaki syndrome provided in purpose 1. 3 on page 12. Kawasaki syndrome is a childhood illness with febricity and rash that has no known cause and no specifically typical laboratory findings. nonice that its case definition is based on the presence of feverishness, at least four of phoebe bird specified clinical findings, and the lack of a more reasonable explanation. A case definition may have several sets of criteria, de unfinished on the certainty of the diagnosis. For example, during an outbreak of measles, we might screen a person with a fever and rash as having a Introduction to Epidemiology Epi 592J Page 11 odd, probable, or confirmed case of measles, depending on what additional evidence of measles was present. In other situations, we may temporarily classify a case as suspect or probable until laboratory results are available. When we receive the laboratory report, we then reclassify the case as both confirmed or not a case, depending on the lab results.In the midst of a large outbreak of a disease caused by a known agent, we may permanently classify some cases as suspect or probable, because it is unnecessary and wasteful to run laboratory tests on every individual with a consistent clinical picture and a history of exposure (e. g. , chickenpox). Case definitions may also vary harmonize to the purpose for classifying the occurrences of a disease. For example, health officials need to know as soon as possible if anyone has symptoms of plague or foodborne botulism so that they can let planning what actions to take. For such rare but potentially severe diseases, where it is important to identify every possible case, health officials use a sensi tive, or loose case definition.On the other hand, investigators of the causes of a disease outbreak insufficiency to be certain that any person include in the investigation really had the disease. The investigator will prefer a specific or strict case definition. For instance, in an outbreak of Salmonella agona, the investigators would be more likely to identify the source of the infection if they included only persons who were confirmed to have been infected with that organism, rather than including anyone with acute diarrhea, because some persons may have had diarrhea from a different cause. In this setting, a disadvantage of a strict case definition is an underestimate of the total number of cases. Exercise 1. 2In the case definition for an apparent outbreak of trichinosis, investigators used the following classifications Clinical criteria affirm case signs and symptoms plus laboratory confirmation Probable case acute onset of at least three of the following four features myalg ia, fever, seventh cranial nerve edema, or eosinophil count greater than 500/mm3 Possible case acute onset of two of the above four features plus a physician diagnosis of trichinosis Suspect case unexplained eosinophilia Not a case failure to fulfill the criteria for a confirmed, probable, possible, or suspect case Time tone-beginning after October 26, 1991 Place Metropolitan capital of Georgia Person Any Assign the appropriate classification to each of the persons included in the line listing below. (All were residents of Atlanta with acute onset of symptoms in November. ) Page 12 Applied Epidemiology I ID 1 2 3 4 5 Last name Abels Baker Corey Dale Ring myalgia yes yes yes yes yes fever yes yes yes no no facial edema no yes no no no eosinophil count 495 pending 1,100 2,050 600 Physician diagnosis trichinosis trichinosis ? trichinosis EMS ? trichinosis Lab confirm yes pending pending pending not done Classification __________ __________ __________ __________ __________Exercise 1 . 3 The following is the official case definition for Kawasaki syndrome that is recommended by CDC Kawasaki Syndrome Clinical case definition A febrile illness of greater than or equal to 5 days duration, with at least four of the five following animal(prenominal) findings and no other more reasonable explanation for the observed clinical findings Bilateral conjunctival injection Oral changes (erythema of lips or oropharynx, strawberry tongue, or fissuring of the lips) Peripheral extremity changes (edema, erythema, or generalized or periungual desquamation) Rash cervical lymphadenopathy (at least one lymph node greater than or equal to 1. cm in diameter) Laboratory criteria for diagnosis None Case classification Confirmed a case that meets the clinical case definition Comment If fever disappears after intravenous gamma globulin therapy is started, fever may be of less than 5 days duration, and the clinical case definition may still be met. Source 3 Discuss the pros and cons o f this case definition for the purposes listed below. (For a brief description of Kawasaki syndrome, see Benensons Control of Communicable Diseases in Man). a. Diagnosing and treating individual patients b. Tracking the occurrence of the disease for public health records c. Doing research to identify the cause of the disease Introduction to Epidemiology Epi 592J Page 13 Numbers and RisksA basic task of a health department is numeration cases in order to measure and describe morbidity. When physicians diagnose a case of a reportable disease they are suppose to report the case to their local health department. For most reportable conditions, these reports are legally required to contain information on time (when the case occurred), place (where the patient lived), and person (the age, race, and sex of the patient). The health department combines all reports and summarizes the information by time, place, and person. From these summaries, the health department determines the extent an d patterns of disease occurrence in the area, and attempts to identify clusters or outbreaks of disease.A simple count of cases, however, does not provide all the information a health department needs. To compare the occurrence of a disease at different locations, during different times, or in different subgroups, a health department converts the case counts into risks, which relates the number of cases to the size of the population. Risks are profitable in many ways. With risks, the health department can identify groups in the community with an elevated risk of disease. These so-called high-risk groups can be further assessed and targeted for special intervention the groups can be studied to identify risk factors that are related to the occurrence of disease.Individuals can use knowledge of these risk factors to guide their decisions about behaviors that influence health. Descriptive Epidemiology In descriptive epidemiology, we organize and summarize data according to time, place, and person. These three characteristics are sometimes called the epidemiologic variables. Compiling and analyzing data by time, place, and person is desirable for several reasons. First, the investigator becomes intimately familiar with the data and with the extent of the public health problem being investigated. Second, this provides a detailed description of the health of a population that is easily communicated. Third, such analysis identifies the populations at superior risk of acquiring a particular disease.This information provides important clues to the causes of the disease, and these clues can be turned into testable hypotheses. Time (When? ) Disease risks usually change over time. Some of these changes occur regularly and can be predicted. For example, the seasonal increase of grippe cases with the onset of cold weather is a pattern that is familiar to everyone. By knowing when flu outbreaks will occur, health departments can time their influenza vaccination campaigns e ffectively. Other diseases may make unpredictable changes in occurrence. By examining events that precede a disease increase or decrease, we may identify causes and appropriate actions to control or prevent further occurrence of the disease.We usually show time data as a graph ( simulacrum 1. 3). We put the number or risk of cases or deaths on the vertical, y-axis we put the time periods along the plain, x-axis. We often indicate on a graph when events occurred that we believe are related to the particular health problem described in the graph. For example, we may indicate the period of exposure or the date control measures were implemented. Such a graph provides a simple visual motion-picture show of the relative size of a problem, its past trend and potential future course, as well as how other events may have affected the problem. Studying such a graph often gives us insights into what may have caused the problem.Depending on what event we are describing, we may be provoke in a period of years or decades, or we may limit the period to hours, days, weeks, or months when the number of cases reported is greater than normal (an epidemic period). For some conditionsfor many chronic diseases, for examplewe are interested in long-term changes in the number of cases or risk of the condition. For other conditions, we may find it more revealing to look at the occurrence of the condition by season, month, day of the Page 14 Applied Epidemiology I week, or even time of day. For a newly recognized problem, we need to assess the occurrence of the problem over time in a variety of ways until we discover the most appropriate and revealing time period to use. Some of the common types of time-related graphs are further described below. blase (long-term) trends.Graphing the annual cases or risk of a disease over a period of years shows long-term or secular trends in the occurrence of the disease. We commonly use these trends to suggest or predict the future incidence of a disease. We also use them in some instances to evaluate programs or policy decisions, or to suggest what caused an increase or decrease in the occurrence of a disease, particularly if the graph indicates when related events took place, as render in predict 1. 3 (note the scale of the y-axis). embark 1. 3 Malaria by year, United States, 1930-1990 Works Progress Administration Malaria Control Drainage course of study Relapses from Overseas Cases 1000 Reported Cases per 100,000 Population 100Relapses from Korean Veterans Returning Vietnam Veterans 10 Foreign Immigration 1 0. 1 0. 01 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 Source 9 yr Seasonality. By graphing the occurrence of a disease by week or month over the course of a year or more we can show its seasonal pattern, if any. Some diseases are known to have characteristic seasonal distributions for example, as mentioned earlier, the number of reported cases of influenza typically increases in winter. Sea sonal patterns may suggest hypotheses about how the infection is transmitted, which behavioral factors increase risk, and other possible contributors to the disease or condition.The seasonal pattern of an unknown disease is shown in Figure 1. 4. What factors might contribute to its seasonal pattern? From only the single years data in Figure 1. 4, it is difficult to conclude whether the peak in June represents a characteristic seasonal pattern that would be repeated yearly, or whether it is simply an epidemic that occurred in the spring and summer of that particular year. You would need more than one years data before you could conclude that the pattern shown there represents the seasonal variation in this disease. Introduction to Epidemiology Epi 592J Page 15 Figure 1. 4 Cases of an unknown disease by month of onset 450 400 350 300 Cases 50 200 150 100 50 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Source 14 calendar month of Onset Day of week and time of day. Displaying data by days of the week or time of day may also be informative. Analysis at these shorter time periods is especially important for conditions that are potentially related to occupational or environmental exposures, which may occur at regularly scheduled musical intervals. In Figure 1. 5, farm tractor fatalities are displayed by days of the week. Does this analysis at shorter time periods suggest any hypothesis? In Figure 1. 5 the number of farm tractor fatalities on Sundays is about half the number on the other days. We can only suppose why this is.One reasonable hypothesis is that farmers spend fewer hours on their tractors on Sundays than on the other days. Figure 1. 5 Fatalities associated with farm tractor injuries by day of death, Georgia, 1971-1981 Source 15 Page 16 Applied Epidemiology I pick up the pattern of fatalities associated with farm tractor injuries by hour in Figure 1. 6. How might you explain the morning peak at 1100 AM, the dip at noon, and the afternoon peak at 40 0 PM? Figure 1. 6 Fatalities associated with farm tractor injuries by time of day, Georgia, 1971-1981 Source 15 Epidemic period. To show the time course of a disease outbreak or epidemic, we use a graph called an epidemic curve.As with the other graphs you have seen in this section, we place the number of cases on the vertical axis and time on the horizontal axis. For time, we use either the time of onset of symptoms or the date of diagnosis. For very acute diseases with short brooding periods (i. e. , time period between exposure and onset of symptoms is short), we may show time as the hour of onset. For diseases with longer incubation periods, we might show time in 1-day, 2-day, 3-day, 1-week, or other appropriate intervals. Figure 1. 7 shows an epidemic curve that uses a 3-day interval for a foodborne disease outbreak. Notice how the cases are stacked in bordering columns. By convention, we use this format, called a histogram, for epidemic curves.The shape and other features of an epidemic curve can suggest hypotheses about the time and source of exposure, the mode of transmission, and the causative agent. Figure 1. 7 Date of onset of illness in patients with culture-confirmed Yersinia enterocolitica infections, Atlanta, November 1, 1988-January 10, 1989 8 7 6 Thanksgiving Christmas New Years Cases 5 4 3 2 1 0 1 4 7 10 13 16 19 22 25 28 1 4 7 10 13 16 19 22 25 28 1 4 7 10 November December January Source 18 Date of Onset Introduction to Epidemiology Epi 592J Page 17 Place (Where? ) We describe a health event by place to gain insight into the geographical extent of the problem. For place, we may use place of residence, birthplace, employment, school district, hospital unit, etc. , epending on which may be related to the occurrence of the health event. Similarly, we may use large or small geographic units country, state, county, census tract, street address, map coordinates, or some other geographical designation. Sometimes, we may find it helpful to prov e data according to place categories such as urban or rural, domestic or foreign, and institutional or noninstitutional. Not all analyses by place will be equally informative. For example, examine the data shown in Table 1. 3. Where were the malaria cases diagnosed? What place does the table break the data down by? Would it have been more or less reusable to analyze the data according to the state of residence of the cases?We believe that it provides more useful information to show the data in Table 1. 3 by where the infection was acquired than it would have to show where the case-patients lived. By analyzing the malaria cases by place of acquisition, we can see where most of the malaria cases acquired their disease. Table 1. 3 Malaria cases by distribution of plasmodium species and area of acquisition, United States, 1989 Species Area of Acquisition Vivax Falciparum Other fit Africa 52 382 64 498 Asia 207 44 29 280 Central America & Caribbean 107 14 9 130 North America 131 3 13 147 (United States) (5) (0) (0) (5) South America 10 1 2 13 Oceania 19 2 5 26 Unknown 6 2 0 8 Total 532 448 122 1,102 Source 6By analyzing data by place, we can also get an opinion of where the agent that causes a disease normally lives and multiplies, what may carry or transmit it, and how it spreads. When we find that the occurrence of a disease is associated with a place, we can infer that factors that increase the risk of the disease are present either in the persons living there (host factors) or in the environment, or both. For example, diseases that are passed from one person to another tend to spread more quickly in urban areas than in rural ones, mainly because the greater herd in urban areas provides more opportunities for susceptible people to come into rival with someone who is infected.On the other hand, diseases that are passed from animals to humans often occur in greater numbers in rural and suburban areas because people in those areas are more likely to come into contact with disease-carrying animals, ticks, and the like. For example, perhaps Lyme disease has become more common because people have moved to overgrown areas where they come into contact with infected deer ticks. Although we can show data by place in a tableas Table 1. 3 doesit is often better to show it pictorially in a map. On a map, we can use different shadings, color, or line patterns to indicate how a disease or health event has different numbers or risks of occurrence in different areas, as in Figure 1. 8. Page 18 Applied Epidemiology I Figure 1. 8 AIDS cases per 100,000 population, United States, July 1991-June 1992 Source 4For a rare disease or outbreak, we often find it useful to prepare a spot map, like Snows map of the Golden Square of London (Figure 1. 1), in which we mark with a dot or an X the relation of each case to a place that is potentially relevant to the health event being investigatedsuch as where each case lived or worked. We may also label other sites on a spot map, such as where we believe cases may have been exposed, to show the orientation of cases within the area mapped. Figure 1. 9 is a spot map for an outbreak of mumps that occurred among employees of the Chicago futures exchanges. Study the location of each case in relation to other cases and to the profession pits. The four numbered areas delineated with tough lines are the trading pits.Does the location of cases on the spot map lead you to any hypothesis about the source of infection? Figure 1. 9 epidemic parotitis cases in trading pits of exchange A, Chicago, Illinois, August 18-December 25, 1987 1 3 2 4 Key Pit areas are numbered and delineated by heavy lines. Individual trading pits within pit areas are outlined by light lines. Affected person (N= 43) Desk areas Source CDC, unpublished data, 1988 Introduction to Epidemiology Epi 592J Page 19 You probably observed that the cases occurred primarily among those working in trading pits 3 and 4. This clustering of illn ess within trading pits provides indirect evidence that the mumps was transmitted person-to person. Person (Who? ) In descriptive epidemiology, when we organize or analyze data by person there are several person categories available to us. We may use inherent characteristics of people (for example, age, race, sex), their acquired characteristics (immune or marital status), their activities (occupation, leisure activities, use of medications/tobacco/drugs), or the conditions under which they live (socioeconomic status, access to medical care). These categories usually determine, to a large degree, who is at greatest risk of experiencing certain undesirable health conditions, such as befitting infected with a particular disease organism. We may show person-related characteristics in either tables or graphs.In analyzing data by person, we often must try a number of different categories before we find which are the most useful and enlightening. long time and sex are most critical we a lmost always analyze data according to these. Depending on the health event we are studying, we may or may not break the data down by other attributes. Often we analyze data by more than one characteristic simultaneously for example, we may look at age and sex simultaneously to see if the sexes differ in how they develop a condition that increases with agesuch as with heart disease. Age. Age is probably the single most important person attribute, because almost every health-related event or state varies with age.A number of factors that also vary with age are behind this association cleverness, opportunity for exposure, latency or incubation period of the disease, and physiologic response (which affects, among other things, disease development). When we analyze data by age, we try to use age groups that are narrow enough to detect any agerelated patterns that may be present in the data. In an initial breakdown by age, we commonly use 5-year age intervals 0 to 4 years, 5 to 9, 10 to 14, and so on. Larger intervals, such as 0 to 19 years, 20 to 39, etc. , may conceal variations related to age which we need to know to identify the true ages at greatest risk.Sometimes, even 5-year age groups can hide important differences, especially in children less than five years of age. Take time to examine Figure 1. 10, for example, before you read ahead. What does the information in this figure suggest health regimen should do to reduce the number of cases of whooping cough? Where should health authorities focus their efforts? You probably said that health authorities should focus on immunizing infants against whooping cough during the first year of life. Now, examine Figure 1. 11. This figure shows the same data but they are presented in the usual 5-year intervals. Based on Figure 1. 11 where would you have suggested that health authorities focus their efforts?Would this recommendation have been as effective and efficient in reducing cases of whooping cough? You probably said that health authorities should immunize infants and children before the age of 5. That recommendation would be effective, but it would not be efficient. You would be immunizing more children than actually necessary and wasting resources. Sex. In general, males have higher risks of illness and death than females do for a wide range of diseases. For some diseases, this sex-related difference is because of genetic, hormonal, anatomic, or other inherent differences between the sexes. These inherent differences affect their susceptibility or physiologic responses.For example, premenopausal women have a lower risk of heart disease than men of the same age. This difference is attributed to higher oestrogen levels in women. On the other hand, the sex-related differences in the occurrence of many diseases reflect differences in opportunity or levels of exposure. For example, Figure 1. 12 shows that hand/radiocarpal joint disorders occur almost twice as often in females than in males. Wh at are some sex-related differences that would cause a higher level of this disorder in females? Page 20 Applied Epidemiology I Figure 1. 10 Pertussis (whooping cough) incidence by age group, United States, 1989 Source 9 Figure 1. 11 Pertussis (whooping cough) incidence by age group, United States, 1989 Source 9 Figure 1. 2 Prevalence of hand/radiocarpal joint cumulative trauma disorder by sex, Newspaper Company A, 1990 Source NIOSH, unpublished data, 1991 Introduction to Epidemiology Epi 592J Page 21 You may have attributed the higher level of disorders in females to their higher level of exposure to occupational activities that require repetitive hand/ wrist joint motion such as write or keyboard entry. With occupationally-related illness, we usually find that sex differences reflect the number of workers in those occupations. You may also have attributed the higher level of disorders in females to anatomical reference differences perhaps womens wrists are more susceptible to ha nd/wrist disorders. Ethnic and racial groups.In examining epidemiologic data, we are interested in any group of people who have lived together long enough to acquire common characteristics, either biologically or socially. Several terms are commonly used to identify such groups race, nationality, religion, or local reproductive or social groups, such as tribes and other geographically or socially isolated groups. Differences that we observe in racial, ethnic, or other groups may reflect differences in their susceptibility or in their exposure, or they may reflect differences in other factors that bear more directly on the risk of disease, such as socioeconomic status and access to health care. In Figure 1. 13, the risks of suicide for five groups of people are displayed. Figure 1. 3 Suicide death rates for persons 15 to 24 years of age according to race/ethnicity, United States, 1988 Source 22 all the way this graph displays a range of suicide death rates for the five groups of pe ople. These data provide direction for prevention programs and for future studies to explain the differences. socioeconomic status. Socioeconomic status is difficult to quantify. It is made up of many variables such as occupation, family income, educational achievement, living conditions, and social standing. The variables that are easiest to measure may not reflect the overall concept. Nevertheless, we commonly use occupation, family income, and educational achievement, while recognizing that these do not measure socioeconomic status precisely.The frequency of many adverse health conditions increases with decreasing socioeconomic status. For example, tuberculosis is more common among persons in lower socioeconomic strata. Infant mortality and time muddled from work due to disability are both associated with lower income. These patterns may reflect more harmful exposures, lower resistance, and less access to health care. Or they may in part Page 22 Applied Epidemiology I reflect an interdependent relationship which is impossible to untangledoes low socioeconomic status contribute to disability or does disability contribute to lower socioeconomic status? Some adverse health conditions are more frequent among persons of higher socioeconomic status.These conditions include breast cancer, Kawasaki syndrome, and lawn tennis elbow. Again, differences in exposure account for at least some of the differences in the frequency of these conditions. Exercise 1. 4 The following series of tables (Exercise 1. 4, Tables 1-4) show person information about cases of the unknown disease described in Figure 1. 4 on page 15. Look again at Figure 1. 4, study the information in the four exercise tables and then describe in words how the disease outbreak is distributed by time and person. Exercise 1. 4, Table 1 Incidence of the disease by age and sex in 24 villages surveyed for one year Males Females Age Group Population* Cases Risk per Population* Cases Risk per (years) 1,000 1,0 00

Ralph Lauren Branding

In voice of the case need exit describe the CUBE (Customer-Based-Brand-Equity) del for Ralph Lauren grades. Second section will adjudicate the theatrical role of blot association in the fraternitys conquest. The third section fixed Ralph Laurels set extension decision to rugger and the last section will be good words for the companies regarding stewardship of their brand in the future. 3 Section 1 1 . 1. Identity of Ralph Lauren brand Brand Salience The Ralph Lauren brand has been chiefly victorious in defining a exact niche pigeonholing of customers, offering a brand knowledge that is casual yet classic.It has modify a whole brand experience encompassing creation, display, retail, customer expediency of process and ad resources. Ralph Lauren has been winning in extending from luxury garments to selling Jeans, bed linen paper and even labeled paint. The brands atomic number 18 updated and transmitted across cultures Ralph Laurels trade with countersign is face up nearly the world. The varied products include iodin of the worlds few widely recognized families of consumer brands. For example the Polo brand draws on themes that have been explained as clownish ho utilise clout, cottages and castles and Bridgehead Revisited (Ellwood, 2002).These all advise a con work outation of product character that is backward- expressioning and nostalgic. They similarly propose a form of uppercases life style future to e aspiration. A digit of brand names and logos of Ralph Lauren Corp.. Advises a leisure activity of the upper classes, yet it ass been presented as obtainable to a wider audience. It is seem as more(prenominal) approachable than the natural Seville tailor yet purports to offer similar brand values. One of the strengths of the system is that the unlike symbols and logos argon all easy to recognize and to rejoin in addition it is easy for the customers to match the diametrical sings to the right labels.Thought their brand beau teousness with its brand extension / brand trenching advertising strategy, they amplified aw arness and profitability form offering more than Just whiz product category (Ralph Lauren briny weapon, 2010). 4 1. 2. Meaning Brand Performance The Primary characteristics of Ralph Lauren brands are contemplateing spunky feeling products in all categories to the customers. The organic law is offering products for divers(prenominal) age, sexuality and social groups. Ralph Laurels brand hears are reflecting an upper-class society. Every customer bottomland identify it self with the specific brand.Every make is built on individual(a) foundation and style, and it is appealing o the right target market. The makeup is strong organized with success in different expressions of service to a fault they offering warranty (up to 10 years) for the products. The organizational Is global organelles. Ra VPN Lauren NAS seek to secure ten legal right to use images of polo players as billet o f its trade dress, ad prevent to Ameri hindquarters Polo Club from doing so. The country of birth for Lauren is USA and it is reflected in some brands (RL with the US flag).The products of the organization are available in different sizes, colors, shapes and materials (Ralph Lauren Weapon online store, 2010). The prices are different for apiece brand From the very expensive Purple Collection to the more inexpensive Polo Jeans and RL. each label provides a full range of products and line extensions (Seafarer, 2005). Brand tomography The visual roleplayation of Ralph Lauren is an intelligent, people of good social standing physically fit handsome young person with timeless style. Ralph Lauren uses images of the upper-class society, cavalry riding, sailing, and exclusive hobbies to connote that massage about his clothes via the proximity of the two images (Ellwood, 2002). Ralph Lauren products appeal to different age groups, starts room teens to retirees (16 to 55 years olds) millennial teens now wear Junior-sized versions of the DENY and Ralph Lauren garb that adults wear (Quart, 2004). Man and women with different material stipulation and income levels are wearing the products all over the world. The brands are present with social events such(prenominal)(prenominal) in sport tournaments.The imagery characteristics comprise a feeling of an exclusive life standard the brand mediated an attitude of nobility, luxurious, elegance and classic style. The realm of the imaginary, of imagery and inwardness is the American Wild West for Ralph Laurels RL brand (Figure 1). The organizations have peculiar designs the clients can recognize the Ralph Lauren elements which are reflected in the products (Figure 2). 1. 3. Response 5 Consumer Judgments Ralph Lauren is one of the worlds premier brands, generally recognized and associated with respective(a) designs, luxury and quality.The brand quality is well organized it is used high-end qualities for their designs, fabrics and products. The strength of the organization is their well hustling service based on ability of products, customer services, locations, and so forth (Ralph Lauren Weapon about, 2010) The troupe is a market leader in the creation, marketing and striation of tri thoe lifestyle products in four categories apparel, home, accessories and fragrances are not fewer than 10 brand ranges within the Ralph Lauren organization (Annual Report, 2010).Consumer Feeling The brand likeability well structure thought all product areas. The brands rugger and Polo reflect a rollicking image to the customers and sport is connected with fun. Sport events hosted by the participation they are linked with amusing and leisure. The brand stores are constructed on a sore nimbus with friendly stuff which is important for the general view. The brands of the corporation represent a good feeling to the clients, he different logos and advancement of the goods reflects confidence, warmth, trustines s, self-respect and high quality.Ralph Lauren products mediated a comfortable feeling when clients use or wear the products (Seafarer, 2005). 1 4 Relationship Consumer Brand ringing The brand is successful in transmitting a picture of verity to their consumers, on the different side the consumers reacting with the same result, they capturing the image of faithfulness and they cultivate some kind of relationship to the specific brands. The brand reflects a status of healthiness and upper-class standard, some clients want to show there live-status through the RL rodents.Ralph Laurels customers are general loyal, they trust in the quality, service and the designs. Ralph Lauren website and the RL cartridge holder informs the clients for new products 6 and lifestyles, the company send out quality magazines and catalogues to the registered brand-loyal customers, for informations around the organization (Awoken, 2007). Enthusiasts of the brand have the option to subscribe the e-mail service to get the newest releases and informations all around Ralph Lauren on the weapon to get a direct connection to the brands, and they have also the choice to ion fan clubs such as in face-book, twitter etcThe Ralph Lauren organization is uploading important informations about the company for shareholders, press, customers, general viewing, investors and so on (Ralph Lauren investor, 2010) Section 2 Ralph Laurels success in brand association can be analyses in different heydays (Figure 3). The diverse brand logos are reflecting a specific image to the customers. Lauren brands can be al situated in dissimilar price classes, the customers can reason the prices, styles, and exquisite thought the specific logos.Every label responds to the right target market. by means of the imagery of the signs, clients can identify which the sportive and which the elegant products are. Ralph Laurels country of origin is the USA Laurels cooperation is established in 1968 as Polos Fashion. The close to of the products are reflecting the Americans demeanor of life, RL logo is decorated with the US flag, it is a sign of liberty for the US consumers. Ralph stores are global present the flagship of the R.Lauren stores is located in Madison Avenue in New York (Vindictiveness, 2010), private organizations are offering their products Store in stores Harrows (Harrows, 2010) The company is offering different rodents on their weapon (Awoken, 2007) RL goods can be found on private websites and retailers as well (my-wardrobe, 2010). The cooperation has the rights of 25 lucrative licensing (Answers, 2010), the company is offering those license in selection products through co-branding Ralph Lauren has built his shape, fragrance and home furnishings (Rotation, 2006) the company is also providing jewelry accessories. (Ralph Lauren product, 2010) By defining the diverse fashion brands, it can be articulate that they 7 are capturing different lifestyles for the various target market , the brand Polo is eased on traditional style Polo, offering styles that were refined, a flux of English classic and traditional American, and conveyed the image of landed gentry to a society that had little use for class (Answers, 2010) where Rugby can be defined as sportive Ana Purple Aloe Is more elegant Ana exults etcRa VPN Laurels characters though licensing reflected in the diverse brand logos such as POLO, the organization owns the licensing rights for the polo player design that means the logo is in particular certified for use by the company (Parr, 2007). Polo shall have the sole eight to determine which trademark shall be used in connection with each particular Licensed Product (Finland, 2010). Ralph Lauren is the spokesperson for the organization he is also the face of the brand.He is born in the street of the Bronx, the story of him is like a myth from a storybook form no one to one of the renowned designers in the world. He is present in TV, events, catwalks, fash ion-shows & gossip columns (Girding, 2008). Though diverse sponsorships are the organization present in events, for example fashion shows with aft(prenominal) parties and charity events Foundation o support higher education a ND p roger m s w h I c h p rove did he It h ca ere n m deed IAC I lay- u n d e RSI e r Veda communities (electrotherapist, 2010).Events for advertising plays a big role for the company, the newest gig is the AD cinema advert (Amassable, 2010). Ralph Lauren is highly distinguished with alternative awards and reviews CAFE (Council of Fashion Designers of America) for the categories in fashion design and best in business (CAFE, 2010) and they earned an award from the NOR for the best retailer The National retail Federation has selected US fashion firm Polo Ralph Lauren for its Gold Medal face in retail. Oust-style, 2009) and so on The well know companies success is reflected in there brands, awards and products.Section 3 Ralph Laurels brand extension decision to Rugby is excellent, because the company is capturing a new field for their brand association. The Rugby brand dialogue to the young generations, for the sportive committed target audience also known as the Gene-Y generation Young people were not wearing Polo, and in fact the label has taken on hippies for teens and young women in light of fashions current preppy mood. The young market from what we know buys the knit shirts, except with Rugby, ere dressing them head-to-toe in shirts, sport coats, evenings.Its affordable and authentic, the designer said (Lockwood, 2004). The latest objective is to capture the growing college market with a novel just trade concept for the brand. Ralph is now one step forward against the competitors, the organization is capturing products for every individual customer. The look of Rugby fashion stand for the college bookman from an earlier period The Rugby line represents a nostalgic look at the Ivy League experience and the ideals of a collegiat e picture (Hancock, 2009).Models with tattoos ND piercing are used for fashion picture-shoots it is Rugby way to be apparent for the Gene-Y customers. The advertising strategies for the brand are build on a successful way thought Technological factors such as a active device application Ralph 8 Lauren launched a mobile app with its Fall 2008 collection and is now selling all kinds of products with this mobile technology (Blanch, 2009). The hollo app Make you own Rugby is offered to clients for free download, to design their own shirts, choosing shapes, colors and uploading pictures.Every one with the app can create an individual rugby close. It was a victorious way to attract the already exist and new customers (l I ones, 2 I en organizational Is attracting ten consumers Walt n Levers events new store openings, fashion shows, leisure activities, competitions, parties etc. All informations for events can be filtered out from Rugby weapon (Rugby Style Blob, 2010). The Rugby Cafe i s a place where rugby clients can meet and to become acquainted with each other, it is a set where consumers can order food and drinks in a comfortable atmosphere (Rugby Our Stores, 2010).Purchase prices for Rugby articles are more reasonable in the market the Rugby store offers a repay lifestyle collection at more affordable price points than Laurels Blue Label ( provided available at Ralph Lauren stores) and minatory Label and Collection (sold at select department and specialty stores as well as Ralph Lauren stores. ) Rugby will be around 40 percent less expensive than Blue Label in some product categories (Lockwood ,2004) Rugby by Ralph Lauren is a triumphant way which attracts the younger generation with the attractive, casual, sportive and leisure oriented, historic based designs and products.My first recommendation for the stewardship of Ralph Lauren cooperation future is, o produce their all products in the USA, because it would be reflect more quality do from Americans t o Americans it can be a catchword of advertising for the US market, for every other countries, it can be made from Americans for the World. The second recommendation is to be more different than the competitors, M. mathematical (2007) sad it before Differentiation, the art of standing out from the competition. It can be everything, for example a space in Ralph Laurels website, where customers can design and buy their own Lauren sweatshirt, NIKKEI is offering this with shoes already to their clients (Nikkei, 2010) The third advice for the organization is to advertise more in the East of the globe (East and Far East). The different brands are already known in the US and Europe but not really in the East countries like Turkey, Iran, China etc , only 1 or 2 brands (POLO, Ralph Lauren) are popular there, but what is with the other brands (chaps, purple label ) they are not really recognized and present in those countries.There is a powerful target market for the Ralph Lauren cooperation , with effective advertising strategies, the company can be successful in adding clients for their products, the result can be more sales, profit, high turnover, customers, reputation and so on. My fourth aim will be, the advice to work with other famous 9 persons together, it can be popular designers, celebrities, politicians etc , the company can make features in the designs with those persons, it can be for example Ralph Lauren winter collection designed by Marc Jacobs or Beams intense design on Lauren shirtsThose features can attract more customers to buy Ralph Lauren products and it will be a good social advertising for the organization. The last point of y recommendations will be that the company can produce their products ecological responsive. They can use for the manufacture of Ralph Lauren products environmental friendly materials colors, fabrics / garments, recyclable goods etc. A big organization like R. Lauren can reduce the blow emissions significantly and that wou ld be a positive respond from the clients.

Pope Leo XIII-Rerum Novarum Essay

Encyclical is a earn from a Christian leader, relegateicularly the pope, which is intended for general distribution among church buildinges. The tern originally applied to around of the garner written by Saint Paul and early church writers called Apostolic Fathers that were sent to many churches. After the time of the Apostolic Fathers, bishops wrote encyclicals to the churches in their c are. In modern times, encyclical has come to mean a letter written by the pope to roman Catholic churches throughout the world.These letters overhear intercommunicate such topics as church doctrines, church discipline, reliable mixer and moral issues, peace, the rights of workers, and the plight of people living under oppression. pope affectionate lion 12I With the election to papacy by Leo XII in 1878 comes a new age in the history of the Roman Catholic perform. His reign was the second longest in papal history. just Pius IX served longer. Leo wrote many encyclicals. One of the most (prenominal) famous was Rerum Novarum which he wrote in May 15, 1891. The aforementi mavind encyclical upheld the rights of labor. pontiff Leo thirteen sought to convince liberal administrations that it is possible for the church and the state to fuck in harmony. During his papacy, particularly intense anti-church feelings were expressed by Italy, France, and Germany. The pope was no-hit in reducing the liberal administrations limitations against the church. However he was a visitation in Italy and France. If truth be told, in 1880, new anti-church laws were submitted by the cut politics. Such laws eliminated the church from several other areas of French lifestyle, prohibited phantasmal education in academic institutions, and banished religious orders from the country.On the other hand, in Italy, oppositions against the church were expressed by both the g everywherenment and its citizens. The pope started a new policy of maintaining an open communication between the church gov ernment and the daily life of the Catholics. To achieve this end, he authored several writings addressed to the Catholic community. His pronouncements covered different subjects ranging from the relationship between the state and the work sieve, theology and church decrees, Bible teachings, and philosophy. Rerum Novarum was his most important statement on tender questions.Leo was open to new forms of government, but he static remained suspicious of democracy. In a letter to United States Catholics in 1895, he warned against seeing the American separation of church and state as an precedent for all nations. In 1899, he addressed another letter to the American church condemning Americanism, a movement that had many followers in France and Italy. It was an adaptation of such American plans as religious liberty and the ingest to adjust the presentation of Catholic teachings to modern ideas and practices.Leo was born in Carpineto, Italy, near Rome. His given and family trope was Giocchino Vincenzo Pecci. Rerum Novarum The expansion of factories and industry in the ordinal century created a class of wealthy owners, a class of industrial workers, and a host of new social problems. The socialists proposed that the state should take over the factories from closed-door ownership. In this official papal statement, pope Leo thirteen sought a middle ground, recognizing the oppression workers could suffer but rejecting the abolition of private property as a solution.In the Catholic tradition, Pope Leo XIII thinks of a job primarily as a way to support ones family, not as a calling in itself and this may be a more possible approach to factory work. Rerum Novarum is conservative on issues of the fathers bespeak in the family, but it was and is radical on issues of labor and capital. Rerum Novarum is the magna carta of Catholic social endeavor. Subtitled as On Capital and Labor, this encyclical expressed the Roman Catholic Churchs response to the labor tensions an d social instability which have emerged in the advent of industrialization and ultimately marked the beginning of socialism.The Pope articulated that the function of the state is to maintain social referee by upholding the rights of the citizens, while the church must make a stand on social concerns to demonstrate proper social principles as well as to guarantee class harmony. Leo XIII reiterated the churchs antique teaching concerning the central value of the rights to private property, but acknowledged, in one of the most popular passages of the encyclical that moral considerations must temper the apologize operation of market forces.Even while Rerum Novarum adheres to position of the conventional teaching regarding the duties and rights of property and the employee-employer relationship, it employs the ancient teachings particularly to current conditions. Describing the plight of the working class as an introduction, the encyclical then disputes the false Socialist philosophie s and protects the right of private ownership. The real solution, as prescribed by the pope may be obtained through the combined action between the employee, the employer, the state, and the church.The church as it should be is concerned in the social matter beca exercise of its moral and religious outlooks. The state, on its part has both the duty and right to interfere in the name of individual and social welfare and justice. Moreover, the workers and their employers should coordinate in separate and joint relations for their common protection. All of these were laid out with substantial expand to address the main issues and interactions of social and industrial life. Further identifying the Catholic Church with labor, while vehemently criticizing socialism, Pope Leo XIII released the first of the social encyclicals.In 1891, eight years after the death of Karl Marx, Pope Leo XIII begins this encyclical by describing the industrialization in terms logical with socialist analysi s. In describing this process of industrialization, Pope Leo XIII distinctly sympathizes with the plight of the common laborers who must sell their labor in exchange for less than a just wage to owners of the means of exertion who are not equally compelled to enter this contractual relationship. He recognizes that workers must unite and organize if they are to restore the power imbalances between laborers and the owners of the means of production.He clearly rejects a socialist revolution instead, he calls for reforms that would mitigate the detrimental effects of the free market. He argues that socialism is misguided for at least two reasons. First, he states that the socialist cure, eliminating private property, is unjust for those owners of the means of production who have acquired their property through legitimate means. Second, workers would actually be worse off, he argues, if in the name of justice they lost their freedom to use the fruits of their labor as they pleased.P erhaps, no other proclamation on social concerns reached a wide audience or enjoyed broad influence. Rerum Novarum inspired an capacious Catholic social writings, as many non-Catholics regarded it as one of the most sensible and explicit pronouncements ever made concerning the issue in question. At times dismissed as vague, this encyclical is as precise as any text could be written for a number of nations in varying levels of industrial progress. Even while Rerum Novarum had formed a part of the established Catholic teachings for several years now in no way had it ever been expressed with distinct articulation and authority.Over the years, manhood has come towards a realization of how hard it is to describe the complete requirements of justice in terms of wages, a continuously growing number of persons delve to the message sent by the pope as the most booming and valuable principle of industrial justice that has ever been expressed in recorded history. The significance of Rerum N ovarum lies in its clear depiction of the troubles confronting the urban unequal during the 19th century. Also, this encyclical was remarkable for its condemning open capitalism.One of the solutions it recommended were the insertion of trade unions as well as the introduction of collective bargaining, in general as a substitute to state intervention. It also acknowledged that the abject deserves to be considered when addressing social concerns. Such consideration is stressed by the concept of preferential option for the poor which is a contemporary Catholic principle. paragons special preference for the poor was initially expressed in Pope Leos Rerum Novarum.

Listening Skills

Effective chat dramatically distinguishes humans from other forms of life. It allows us to organize and work together in groups and develop a civilize society. In fact, without communication, there stinkpot be no social organization. overly being important in todays changing business environment, effective communication is vital for mortalal satisfaction and supremacy. Through communication, hatful ar up to(p) to clarify their concepts and ideas. It enables us to at a lower place stick up, persuade, and work with other race. In many commissions, our success in soulfulnessal and corporal life is based on our magnate to communicate effectively.After having laid so much importance on communication, we must(prenominal)(prenominal) withal understand that communication is never one way. Communication in simple terms can be defined as the mould of sharing by which messages produce responses (Munter, 1987). It is always a two way process with a sender sending a message and a receiver providing a feedback of its reception. The success of an effective communication therefore rests on the receiver who is at the listening end.A research proves that Communication is 85 portion listening and 15 percent remonstrateing (Pierce and Palmer, 2006). Not denying the significance of effectively putting across your message, listening to others is equally important and surprisingly difficult skill. We have to be an effective tender when we are spiritstorming ideas with others, assemblage data, talking on the telephone, resolving conflicts, at bleeding lectures and even while conversing with our kids. We must remember that the person who is talking can sense whether attender is engrossed or non.So, how to improve our listening skills? Various researchers have given heterogeneous techniques to be an effective listener. There is however consensus on first removing the inner and international shutdgets which whitethorn be affecting our concentration. A ma jor cozy block stems from our ability to sound off so much faster than a speaker can possibly talk. People on average talk at about 125 words per split second but our brain can process information at more than 600 words per minute (Munter, 1987).With so much extra time available in our brain, we tend to wander to completely unrelated affairs. A nonher important indispensable block to listening is emotional. Its hard to resist jumping to conclusions, defending our own position, contesting new ideas, and indulging into a thought process of preparing our own response. The external blocks on the other hand can be your uncomfortable seat, distractions caused by various sounds, a glance at papers in our turn over/desk or even some pleasant smell of perfume or food coming from nearby. Of all the external blocks, time is probably the well-nigh important. Removing all such blocks is the first maltreat to effective listening.The second step in developing listening skills is adopting a capable posture or how we look when we are listening. A trade good listener needs to stand or sit with an open posture that is facing the other person and looking alert. On the other hand closed or battleful postures like guardianship the arms crossed, turning away, bowing shoulders or keeping hands on hips do not give a overconfident feedback to the person who is talking. Similarly nervous gestures such as cleaning fingernails, beat with fingers or keeping hands on or near the hint tend to make the speaker system feel uncomfortable.Another prognosis of improving the nonverbal signs of listening is the facial expression. A good listener needs to distract a deadpan and stony face. Instead, look beted raising and sonorous of middlebrows, occasionally smiling or nodding can help puddle rapprt. Perhaps the most important signal of attentive listening is maintaining the eye contact. Staring should be suspended however constantly looking away is as well as interpreted as lack of interest. The appropriate distance between the talker and listener also indicates the level of interest and involvement. The distance may be appropriate for conversational listening. Altogether, the importance thing to keep in judgement about nonverbal signals of listening is how they make the speaker feel (Knapp, 1980).We can not fake good listening by merely adopting a suitable posture and maintaining an eye contact. high-priced listening must be sincere. The third step of improving listening skills is therefore embedded in controlling our feelings and thoughts (Knapp, 1980). Controlling our feelings is often difficult. We tend to interrupt or disagree before the person speaking is finished. To improve our listening skills, we need to be patient and give the speaker time. A good listener should avoid interrupting and do not block communication by arguing, criticizing or fit angry too soon.To control your feelings, you must avoid prejudging either the topic or the spea ker. Moreso, do not be overly affected by the initial impressions the topic or the speaker make on you. The lift out way to control our feelings is to empathize with the talker that is by putting ourselves in his or her shoes. Besides controlling the feelings, a good listener should think objectively and analytically. A good way of analyzing is to take notes mentally, write good deal key words, mentally summarize what the talker has said so uttermost and weigh the evidence. Besides listening to the speakers content, a good listener will always analyze the speakers feelings so as to evaluate the motivation/intention behind his or her talk. take care not only to what the speaker is avering, but how she or he says it. Be aware, in other words, of the speakers voice, volume, facial expression, and body language. Sometimes, people say one thing but a good listener can hear that they really mean something else.The last step to effective listening is what to say. Obviously, most of th e time you are listening you are not saying anything. Humans by nature prefer talking to listening. A good listener should however learn to tolerate silence. Instead of feeling unconfortable with silence, think of it as a chance to let other person be heard. Although the most important listening skill is to listen and appease silent, however a good listener might have to say few things to encourage the other person to talk.Asking for clarifications, rephrasing/restating ideas for confirmation and petition few questions when given an opportunity to speak are few techniques not only to enhance own receptivity but are also indicative of the listeners interest and involvement in the talk. For promote the speaker to talk, use small phrases such as I see, Uh-huh, and Go on. These phrases are not considered as interruptions rather these help to portray your interest in what the speaker is saying (Barker & Watson, 2000).To conclude, listening skills are important not only for a successfu l career, but are very utile for becoming good students, parents, and friends. Its importance is much more highlighted in the corporate world which relies on good leadership and as it is pointed out that Good leaders build teams by being willing to hire people better than themselves, staying secure in their own roles and by listening (Maxell, 2006). The quadruplet step approach to effective listening discussed in this paper is not a final word on such an important aspect of human life but it gives a guideline for developing this skill in a methodological manner.In nut shell, to be an effective listener we need to first remove or minimize various internal and external blocks to listening, concentrate on how we look by adopting a suitable gesture, feel, analyze the content and intentions of the speaker and should know what to say at what time. We must remember that if we will not listen to people around us, under us or in our homes, they will take their ideas or problems elsewhere s ubordinates may feel discontended if they are not properly heard colleagues and friends may even stop sharing their feelings with you customers may take their business elsewhere, and at homes you will never get to know your children.ReferencesBarker, Larry & Watson, Kittie. (2000). Listen Up How To alter Relationships, Reduce Stress. NY St. Martins Press.Knapp, K. (1980). Essentials of Nonverbal Communication. New York Holt, Rinehart & Winston.Maxwell, J. (2006). The 360-Degree Leader. Business book review library, 23 (11), 1-11.Munter, Mary. (1987). Business Communications Strategy and Skill. Eaglewood Cliffs, New Jersey Prentice-Hall, Inc.Pierce, E., & Palmer, L. (2006). 24 Things Experts are Dying to Tell You. Redbook, 206 (6), 102-111.

Describe the Process Consultation Essay

Describe the deal consultation. Discuss when it should be used and how it applies to brass instrument development. Process consultation (PC) is a oecumenical frame impart for carrying step to the fore helping races. It is oriented to helping managers, employees, and groups esteem and improve act upones, such as communication, interpersonal relations, decision making and depute performance. Schein argues that effective advisers and managers should be goodness helpers, aiding others in getting things d single and in achieving the goals they have ascertain. Thus, PC is more a philosophy than a set of techniques aimed at performing this helping relationship.The philosophy ensures that those who argon receiving the help testify their problems, gain the skills and goodise to constitute them, and solve them themselves. Thus, it is an begin to helping lot and groups help themselves. Schein defines process consultation as the creation of a relationship that permits the client to perceive, understand, and act on the process events that occur in (her/his) inherent and external environment in order to improve the situation as defined by the client. The process consultant does not offer expert help in the form of solutions to problems, as in the doctor-patient model.Rather, the process consultant break downs to develop relationships, fall outs groups and people in action, helps them diagnose the way they atomic number 18 carrying out tasks, and helps them learn how to be more effective. In the OD literature, group create is not clearly variantiated from process consultation. This confusion exists because nearly team building includes process consultationhelping the group diagnose and understand its own internal processes. However, process consultation is a more ordinary approach to helping relationships than is team building. Team building focuses explicitly on helping groups perform asks and solve problems more effectively. Process consultation, o n the other hand, is concerned with establishing effective helping relationships in brass sections. It is seen as place to effective management and consultation and fucking be applied to some(prenominal) helping relationship, from subordinate development to interpersonal relationships to group development. Thus, team building consists of process consultation plus other, more task-oriented interventions (Cummings & ampereere Worley, 2009, p. 253). Describe the linchpin success requirements for a microcosm group intervention. A microcosm group onsists of a polished number of indivi forkeds who reflect the issue being addressed. For example, a microcosm group sedate of fel mortified members representing a spectrum of ethnic backgrounds, cultures, and races can be created to address diversity issues in the organization. This group, assisted by OD practitioners, can create programs and processes targeted at special problems. In addition to addressing diversity problems, microco sm groups have been used to carry out organization diagnoses, solve communications problems, integrate devil cultures, smooth the flip to a new structure, and address dysfunctional political processes.Microcosm groups work through and through parallel processes, which are the unconscious sorts that take place in individuals when two or more groups interact. After groups interact, members often find that their characteristic patterns of roles and interactions change to reflect the roles and dynamics of the group with whom they were relating. Put simply, groups seem to infect and force infected by the other groups. The following example given by Alderfer helps to clarify how parallel processes work. An organizational diagnosis team had charge its members to all(prenominal) of five plane sections in a gloomy manufacturing company.Members of the team had interviewed each department head and several department members, and had observed department meetings. The team was preparing to observe their first meeting of department heads and was trying to anticipate the groups behavior. At first they seemed to have no rational basis for predicting the pass along groups behavior because they had no data from direct observation. They persistent to role-play the group meeting they had never seen. Diagnostic team members behaved as they thinking the department heads would, and the result was uncanny.Team members found that they easily became engaged with one another in the simulated department-head meeting emotional bringment occurred rapidly for all participants. When the team actually was able to observe a department-head meeting, they were astonished at how well-nigh the simulated meeting had approximated the actual session. Thus, if a small and representative group can intimately understand and solve a complex organizational problem for themselves they are in a good position to recommended action to address the problem in the larger outline (Cummings & W orley, 2009, p. 279).Discuss why the ground substance structure is the best and close to negotiable organization structure. Some OD practitioners have focused on maximizing the strengths and minimizing the weaknesses of both the functional and the self-contained-unit structures, and this effort has resulted in the matrix organization. intercellular substance organizational formulas originally evolved in the aerospace industry where changing client demands and expert conditions caused managers to focus on lateral relationships between functions to develop a flexible and adaptable system of resources and procedures, and to achieve a series of project objectives.intercellular substance organizations now are used widely in manufacturing, service, and nonprofit, governmental, and professional organizations. both matrix organization contains leash unique and critical roles the top manager, who heads and balances the dual chains of command, the matrix bosses (functional, product, o r area), who share subordinates and the two-boss managers, who report to two different matrix bosses. Each of these roles has its own unique requirements. In a matrix organization, each project manager reports directly to the vice president and the general manager.Since each project represents a potential profit centre, the might and part used by the project manager come directly from the general manager. Matrix organizations, like all organization structures, have both advantages and disadvantages. On the positive side, this structure allows multiple orientations. Specialized, functional fellowship can be applied to all projects. New products or projects can be apply quickly by using people flexibly and by mournful between product and functional orientations as circumstances demand.Matrix organizations can maintain consistency among departments and projects by requiring communication among managers. For many people, matrix structures are motivating and exciting. On the negativ e side, these organizations can be difficult to manage. To tool and maintain them requires heavy managerial costs and support. When people are assigned to more than one department, there may be role equivocalness and conflict, and overall performance may be sacrificed if there are power conflicts between functional departments and project structures.To make matrix organizations work, organization members accept interpersonal and conflict management skills. People can get befuddled about how the matrix works, and that can lead to chaos and inefficiencies (Cummings & Worley, 2009, p. 319). What is the TQM approach to employee involvement and how does it differ from other approaches? Discuss Demings influence on this approach. Total quality management (TQM) is the most recent and, along with high-involvement organizations the most comprehensive approach to employee involvement.Also known as Continuous process improvement and continuous quality, TQM grew out of a manufacturing em phasis on quality control and represents a long- term effort to orient all of an organizations activities around the concept of quality. Quality is achieved when organizational processes reliably upraise products and services that meet or exceed customer expectations. standardised high-involvement designs, TQM increases workers knowledge and skills through extensive training, provides relevant information to employees, pushes decision-making power downwards in the organization and ties rewards to performance.When implemented successfully. TQM also is aligned closely with a wholes overall business strategy and attempts to change the entire organization toward continuous quality improvement. TQM is a philosophy and a set of directional principles for continuous improvement based on customer satisfaction, teamwork, and empowerment of individuals. TQM applies man resources and analytical tools to focus on meeting or exceeding customers current and future needs. There are a series of planned improvements that will ultimately influence the quality and productivity of the organization.Like high-involvement designs, TQM increases workers knowledge and skills through extensive training, provides relevant information to employees, pushes decision-making power downward in the organization and ties rewards to performance. When implemented successfully TQM also is aligned closely with a firms overall business strategy and attempts to change the entire organization toward continuous quality improvement. (Cummings amp Worley, 2009, p. 359). Discuss the motivational approach to melodic line design. What are the key dimensions that lead to high work quality and internal motivation?The motivational approach to work design views the effectiveness of organizational activities primarily as a function of member needs and satisfaction, and seeks to improve employee performance and satisfaction by enriching jobs. The motivational method provides people with opportunities for autonomy, responsibility, closure (that is, doing a complete job), and performance feedback. Enriched jobs are usual in the United States at such companies as ATampT Universal Card, TRW, Dayton Hudson, and GTE. The motivational approach usually is associated with the inquiry of Herzberg and of Hackman and Oldham.Herzbergs two-factor theory of motivation proposed that certain attri barelyes of work, such as opportunities for advancement and recognition, which he called motivators, help increase job satisfaction. Other attributes that Herzberg called hygiene factors, such as company policies, working conditions, pay, and supervision, do not produce satisfaction but rather prevent dissatisfaction all important(p) contributors because only satisfied workers are move to produce. Successful job enrichment experiments at AT&T, Texas Instruments, and Imperial chemical Industries helped to popularize job enrichment in the 1960s.Although Herzbergs motivational factors sound appealing, increase doubt has been cast on the underlying theory. Motivation and hygiene factors are difficult to put into operation and measure, and that makes implementation and evaluation of the theory difficult. Furthermore, important worker characteristics that can affect whether people will respond favourably to job enrichment were not included in his theory. Finally, Herzbergs failure to involve employees in the job enrichment process itself does not suit most OD practitioners today.Consequently, a second, well- investigateed approach to job enrichment has been favored. It focuses on the attributes of the work itself and has resulted in a more scientifically acceptable theory of job enrichment than Herzbergs model. The research of Hackman and Oldham represents this more recent trend in job enrichment. Considerable research has been devoted to defining and understanding core job dimensions. Figure 50 summarizes the Hackman and Oldham model of job design. Five core dimensions of work aff ect three critical psychological states, which in turn produce personal and job outcomes.These outcomes include high internal work motivation, high-quality work performance, satisfaction with the work, and low absenteeism and turnover. The five core job dimensionsskill variety, task identity, task significance, autonomy, and feedback from the work itselfare described below and associated with the critical psychological states that they create (Cummings amp Worley, 2009, p. 377). References Cummings, T. G. , amp Worley, C. G. (2011). Organization development amp change (11th ed. ). Australia Mason, OH South-Western/Cengage Learning.

Night World : Daughters of Darkness Chapter 9

Mary-Lynnettes hearing had g ane funny. Sheheard kestrels words like a character remembering aphrase In a naughty movie. Kill them, protrude them, kill them. go over laughed In a real(prenominal) strange way.This is press release to be really rotten for him, MaryLynnette thought, curiously dispassionate. I mean, if wewere going apart tolive through this, which were not, it would be really rotten for him. He was al effectuate afraidoflady friends, and sort of pessimistic ab start life in general wherefore dont we all sit down? rowan tree give tongue to with astifled sigh. Weve got to figure this out. crossbreed threw bet on his head and gave an former(a)wise shortbark of a laugh.Why not? he verbalise. Lets all sit down, wherefore not?Theyre fast as whippets, Mary-Lynnette thought.If we give-up the ghost now, theyll catch us. however If we sit, and they consider comfortable, and I distract them-or hitthem with somethingSitl she ordered retick briskly. rowan tree and Kest rel moved away from the cervid and sit. taxicabs overlyd with her detainment on her hips for a moment, indeed sat,too.Sitting, Mark was still acting punch-drunk. Hewaved the great mullein almost. You girls aresomethingelse.You girls are really-Were vampires, wear off said sharply.Yeah. Mark laughed quietly to himself. Yeah, he said again.Mary-Lynnette took the flash easy away from him. She wanted control of it. And it was heavy plastic andmetal. It was a weapon.And while one layer of her mind was thinkingShine the light in their eyesat and the rightmoment andthenhit oneof them another part was thinkingShemeans theyrepeoplewhothinktheyre vampirespeoplewiththat supernatural disease that makes them anemic and one final part was sayingYou qualification as strong exhibitittheyrereal.Mary-Lynnettes world view had been knocked rightout of the ballpark.Dont you justhate that, Mark was saying. You meet a girl and she check overms pretty nice and you class all your friends and then before you hit the sack it she turnsout to be avampire.Dont you just hate it whenthat happens?Oh. God, hes hysterical, Mary-Lynnette realized. She grabbed his shoulder and hissed in his ear, Get agrip, now.,I dont see what the point is in talking to them,rowan tree, Kestrel was saying. You crawl in what we relieve oneself todo.And Rowan was rubbing her forehead. I was thinkingwe strength influence them, she said in anundertone.You know why that wont work. Kestrels fathom was loopy and flat.Why? fornicatress said sharply.They followed us for a reason, Rowan saidtiredly. She nodded toward the hole. So theyvebeen suspicious for a while-for how prospicient? She looked at Mary-Lynnette.I saw you dig the hole Tuesday night, MaryLynnette said. She nodded toward the hole. Is thatyour aunt in there?There was a brief silence and Rowan looked selfconscious. then she inclined her head slightly.Gracefully.Oh, hell, Mark said. His eyes were shut and his head was bankroll on his neck. Oh, hell. Theyvegot Mrs. B. in a bag.Two days, Rowan said to hack writer. Theyve surmise for two whole days. And we cant removememories that are interlaced with other things for that spacious. Wed neer know if we got them all.Well, we could just takeeverything for the last two days, bore said.Kestrel snorted. And take hold two more(prenominal) people wandering around with lost clip?Mary-Lynnettes mind went click. Todd Akers andVic Kimble, she said. You did something to givethem amnesia.I knew there had to be a connection.Theres no other choice for us, Kestrel said quietly to Rowan. And you know it as well as Ido.Shes not being malicious, Mary-Lynnette realized. except practical. If a lioness or a wolf or a falcon couldtalk, it would say the same thing. We have to either kill or die its as simple as that.Despite herself, Mary-Lynnette matt-up something like fascination-and respect.Mark had his eyes open now. And Rowan was looking for sad, so sad. Its awful, her expression said, butsomebody here is going to have to get damage.Rowan bowed her head, then lifted it to face MaryLynnette directly. Their eyes met, held. After amoment Rowans face changed slightly and she nodded.Mary-Lynnette knew that in that instant they werecommunicating without words. Each recognizing theother as an alpha female who was voluntary to fightand die for her kin.Meaning they were both big sisters.Yes, somebodys going to get hurt, Mary-Lynnette thought. You queer myfamily,I fight back.She knew Rowan understood. Rowan was going to really hate killing her.No, a voice said passionately, and MaryLynnette realized it was weary. And the next second dull was on her feet, give clenched, words erupting like a steam steam boiler exploding. No, youcantkillMark. I wontletyou.Rowan said, Jade, I know this is hard-Kestrel said, Jade, dont be a wimp-Jade was trembling, body tensed like a cat ready to fight. Her voice was louder than either of them.You just cant do itl I think -Ithink- Jade-I thinkhes my soulmateDead silence.Then Rowan groaned. Oh, dearKestrel said, Oh,sure.They were both looking at Jade. Focused on her. Mary-Lynnette thought, now.She swung the flashlight viciously at Kestrel, absentminded to take her out first, betting that Rowan would staybehind if Kestrel were hurt. But the swing never connected, Mark threw himself in front of her, slamminginto her arm.Dont hurt JadeThen everything was just a mad tangle. Arms, legs,grasping hitchhikes, kicking feet. Jade and Mark bothyelling for it to stop. Mary-Lynnette matt-up the flashlight wrenched out of her hand. She make up long hair, gothold of it, yanked. Someone kicked her, and pain blossomed in her ribs.Then she felt herself being dragged backward Mark was holding her, pulling her away from thefight.Jade was lying on top of Kestrel and clutching at Rowan.Everybody was panting. Mark was or so crying.We just cant do this, he said. This is terrible.This is all wrong.Meanwhile Jade was snarling, Hes my sou lmate,okay? okay? I cant do anything with himdeadHes not your soulmate, idiot, Kestrel said in a somewhat muffled voice. She was facedown on thecarpet of needles. When youre soulmates, it hits you like lightning, and you know thats the one personin the world you were meant to be with. Youdontthink youre soulmates you just know its your micklewhether you like it or not.Somewhere, deep in Mary-Lynnettes brain, something stirred in alarm. But she had more urgentthingsto worry about.Mark, get out of here, she said schnorchellessly. ?Run?Mark didnt even ease his grip. Why do we have to be enemies?Mark, theyre killers .You cant justify that. They killed their own aunt.Three faces off-key toward her, startled. A one-half-fullmoon had risen above the trees, and Mary-Lynnettecould see them clearly.We didnot Jade said indignantly.What made you think that? Rowan asked.Mary-Lynnette felt her tattle hang open. Be causeyou buried her, for Gods sakelYes, but we found her dead. person staked h er, Kestrel said, brushingpine needles out of her roaring hair. Probably a vampire hunter. I dont suppose youd know anythingabout that.Mark gulped. Staked her-with a stake?Well, with a picket from the fence, Kestrel said. She was already dead? Mary-Lynnette saidtoRowan. But then why on earth did you bury herin the backyard?It would have been contumelious to leave her in the cellar.But why didnt you have her taken to a cemetery?Rowan looked dismayed.Jade said, Um, you havent seen Aunt Opal.Shes not looking so good, Kestrel said. Kind ofhard and stiff. You might say mummified.Its what happens to us, Rowan said almostapologetically.Mary-Lynnette slumped back against Mark, trying to get her new world view into place. Everything waswhirling.So you were just trying to hide her. But you did do something to Todd Akers and VicKim-Theyattackedus, Jade interrupted. They were thinking very bad things and they pinched ourarms.They-? Mary-Lynnette sat up suddenly. entirely at one time she un derstood. Oh, my God. Those jerksWhy hadnt she thought of that? Todd and Vielast year there bad been rumors about them saltation somegirl from Westgrove. So theyd tried it on these girls, and Mary-Lynnette gasped and then snorted with half inhaled laughter. Oh, no. Oh, I hope you got themgoodWe just bit them a little, Rowan said.I wish Id been there tosee it.She was laughing. Rowan was smiling. Kestrel was grin barbarically. And suddenly Mary-Lynnetteknew that they werent going to fight anymore.Everybody took a deep breath and sat back and looked at one another.They do look different from chemical formula humans, Mary-Lynnette thought, staring at them in the moonlight. Itsso obvious once you know.They wereinhumanly beautiful, of course. Rowanwith her soft chestnut hair and sweet face Kestrelwithher feral sleekness and golden eyes Jade with her delicate features and her hair like starshine. LiketheThree Graces, solitary(prenominal) when fiercer.Okay, Rowan said softly. We seem t o have asituation here. Now weve got to figuresomethingout.We wont tell on you, Mark said. He and Jadewere gazing at from each one other.Weve got Romeo and Juliet on our hands here is what weve got, Mary-Lynnette said toRowan.But Kestrel was speaking to Rowan, too. No outletwhatthey promise, how do we know we can believe them?Rowan considered, eyes roving around the clearing. Then she let out a long breath and nodded.Theres only one way, she said. Blood-tie.Kestrels eyebrowsflew up. Oh, really?What is it? Mary-Lynnette asked.A blood-tie? Rowan looked helpless. Well, its a chemical attraction ceremony, you know. WhenMary-Lynnette just looked at her, she went on It makes our families related. Its like, one of ourancestors did it with a family of witches.Witches, Mary-Lynnette thought. Oh gosh. Sowitches are real, too. I wonder how many other thingsare real that I dont know about?Vampires dont usually get along with witches, Rowan was saying. And HunterRedfern-thats ourancestor-had a real blood feud going with themback in the sixteen hundreds.But then he couldnt have kids, Jade said gleefully. And he needed a witch to help or thewholeRedfern familywould end with him. So he had to apologize and do a kinship ceremony. And thenhe had all daughters.Ha ha.Mary-Lynnette blinked. Ha ha?So, you see, were part witch. All the Redfern are, Rowan was explaining in her gentle teachingvoice.Our father used to say thats why were so disobedient, Jade said. Because its in our genes .Because in witchfamilies, womenare in charge.Mary-Lynnette began to like witches. Ha ha, shesaid. Mark gave her a skittish sideways look.The point is that we could do a ceremony like that now, Rowan said. It would make us familyforever. We couldnt betray each other.No problem, Mark said, still looking at Jade.Fine with me,Jade said, and gave him a quick, fierce smile.But Mary-Lynnette was thinking. It was a serious thing Rowan was talking about. You couldnt dosomething like this on a whim. It was wo rse than adopting a puppy it was more like getting married. Itwas a lifetimeresponsibility. And even if these girls didnt kill humans, they killed animals. With their teeth.But so did people. And not always for food. Wasit worse to drink deer blood than to make baby cowsinto boots?Besides, strange as it seemed, she felt dose to the three sisters already. In the last couple of arcsecondsshedestablished more of a relationship with Rowanthan she ever had with any girl at school. spell andrespect had turned into a weird kind of instinctive trust.And besidethat, what other real choice was there? Mary-Lynnette looked at mark, and then atRowan.She nodded slowly.Okay.Rowan turned to Kestrel.So Im supposed to decide, am I? Kestrel said.We cant do it without you, Rowan said. Youknow that.Kestrel looked away. Her golden eyes were narrowed. In the moonlight her visibility was absolutelyperfect against the darkness of trees. It would mean we could never go rest home again. Make ourselves kint o vermin? Thats what theydsay.Whos vermin? Mark said, jolted out of his communion with Jade.Nobody answered. Jade said, with odd dignity, Icant go home, anyway. Im in sock with an Outsider.And Im going to tell him about the Night World. SoIm dead no matter what. Mark was opening hismouth-to protest that Jade shouldnt take such arisk forhim,Mary-Lynnette thought-when Jade addedabsently, And so is he, of course.Mark shut his mouth.Rowan said Kestrel, weve come too far to go back.Kestrel stared at the forest for another minute orso. Then suddenly she turned back to the others,laughing. There was something wild in her eyes.All right, lets go the whole way, she said. Tell them everything. Break every rule. We might aswell.Mary-Lynnette felt a twinge. She hoped she wasntgoing to regret this. But what she said was Just howdo we do this-ceremony?Exchange blood. Ive never done it before, but its simple.It might be a little bit strange, though, Jade said because youll be a little bit vampire safterward.A little bit what? Mary-Lynnette said, her voice rising in spite of her.Just a little bit. Jade was measuring out tiny bitsof air between her index finger and thumb. Adrop.Kestrel cast a look skyward. Itll go away in a few days, she said heavily, which was whatMaryLynnette wanted to know.As long as you dont get yourself bitten by a vampire again in the meanwhile, Rowan added.Otherwise, its perfectly safe. Honestly.Mary-Lynnette and Mark exchanged glances. Not to discuss things, theyd gone(p) beyond that now. Justto brace themselves. Then Mary-Lynnette took a deep breath and flicked a bit of fern off her knee.Okay, she said, feeling lightheaded but determined. Were ready.