Saturday, August 31, 2019

Business Research Essay

In today’s society we have found that the best way to find what works for individuals and businesses alike is done through business research. This is not always done in ethical manners though. Some companies tend to ask questions that are inappropriate while others changed the information they have been given to make their product look more appealing. This paper will focus on skewing the research results in the service of selling the drug Neurontin. Neurontin is a brand name for the drug gabapentin and it is manufactured by Pfizer and Parke-Davis (Ramirez de Arellano, 2009). The drug has been approved by the FDA to use in treating neurological conditions such as epilepsy. There have been a large number of off-label uses added to the list that have not been approved by the FDA which has increased the company’s sales. In 2004, Pfizer was found guilty in urging physicians to prescribe Neurontin to patients for off-label uses such as treatment of migraines, bipolar disorder, insomnia, and hot-flashes (Ramirez de Arellano, 2009). This act was an illegal one that cost the company millions of dollars in fines and penalties. That was not the last of the case on Neurontin. Since so many people had used Neurontin for various treatments not approved by the FDA, a large number of companies decided to show an interest in getting some of the off-label uses approved. In order to do this the companies began conducting research to see if the drug really worked for the ailments. If it did indeed work, it could be approved through the FDA. This would in turn help the company make more money selling Neurontin. After the legal case was started in 2004 it opened another door that provided information showing strategies that Pfizer and Parke-Davis used to offset the publication of unfavorable findings. In 2008 reports were released to the public that showed Pfizer and Parke-Davis had delayed reports if no evidence was found in the efficacy of the drug, reinterpreting negative data, and fusing negative data with positive studies to cancel the results, and some researchers saw their work being rewritten by the company’s own medical write to make it sound better than the graph showed it (Ramirez de Arellano, 2009). During the studies done on Neurontin 20 clinical trials were identified and only 12 of those reported in publications, in which 8 of those published trials had different primary outcomes reported than was in the original research protocol (Ramirez de Arellano, 2009). These differences included changing the primary outcome, not distinguishing between the primary and the secondary outcomes, and not reporting all of the primary outcomes. There was 21 primary outcomes for the research and out of those 21 protocols there was 6 not reported and 4 were put as secondary outcomes instead of primary. The changes made in the published reports were done to make Neurontin look favorable for the unapproved indications. In the Neurontin situation of skewing the research done for the medication, affects the people that use the drug along with others that take any medication. It makes the doctors look as if they do not know what they are doing when they prescribe the medication and leaves individuals in an untrusting state to try something new to treat their ailments. It also makes the scientists that develop the drug look bad. Another thing this does is undermines individuals’ trust in published studies and the entire decision-making process. The organization is affected by this unethical behavior in many ways as well. First off the company was faced with a hefty criminal fine for coaxing the doctors to prescribe the drug to the public for off-label purposes. Secondly the company lost accreditation with the public for skewing the research being done to make the drug more appealing in what it could treat. Skewing the research affected society by losing the trust of individuals when it was made public that the research published had been tainted. It is hard to trust again when you find out the information you are being give is all but the truth. Unethical business research could be avoided if companies that do business research would publish all of the truth without changing any of it or doctoring it up to look better than it really is. If the punishment for using unethical business research were harsher it may deter companies from using unethical practices to conduct their business research. Companies that continue to be found guilty of using unethical business research should be humiliated to the point nobody would want to do business with them, forcing them to close their doors. In conclusion it can be noted that the most important part of finding the right treatments today in medicine is through clinical research data and that data has to be 100% undistorted to know whether or not the treatment is one that will do good or one that will do harm. This goes for any type of business research and should be followed with all companies.

Friday, August 30, 2019

Fractures of the Distal Tibia: Minimally Invasive Plate Osteosynthesis

Injury, Int. J. Care Injured (2004) 35, 615—620 Fractures of the distal tibia: minimally invasive plate osteosynthesis D. J. Redfern*, S. U. Syed, S. J. M. Davies Department of Orthopaedics, Frimley Park Hospital NHS Trust, Surrey, UK Accepted 9 September 2003 KEYWORDS Minimally invasive plate osteosynthesis; Plate ? xation; Fracture; Tibia; Metaphysis Summary Unstable fractures of the distal tibia that are not suitable for intramedullary nailing are commonly treated by open reduction and internal ? ation and/or external ? xation, or treated non-operatively. Treatment of these injuries using minimally invasive plate osteosynthesis (MIPO) techniques may minimise soft tissue injury and damage to the vascular integrity of the fracture fragments. We report the results of 20 patients treated by MIPO for closed fractures of the distal tibia. Their mean age was 38. 3 years (range: 17—71 years). Fractures were classi? ed according to the AO system, and intra-articular extension s according to Ruedi and ? Allgower. The mean time to full weight-bearing was 12 weeks (range: 8—20 weeks) and to union was 23 weeks (range: 18—29 weeks), without need for further surgery. There was one malunion, no deep infections and no failures of ? xation. MIPO is an effective treatment for closed, unstable fractures of the distal tibia, avoiding the complications associated with more traditional methods of internal ? xation and/or external ? xation. ? 2003 Elsevier Ltd. All rights reserved. Introduction Unstable fractures of the distal tibia with or without intra-articular fracture extension can present a management dilemma. Traditionally, there have been a variety of methods of management described and high rates of associated complications reported. Non-operative treatment can be technically demanding and may be associated with joint stiffness in up to 40% of cases as well as shortening and rotational malunion in over 30% of cases. 14,20 Traditional operative treatment of such injuries is also *Corresponding author. Present address: 16 By? eld Road, Isleworth, Middlesex TW7 7AF, UK. Tel. : ? 44-(0)20-8847-1370; fax: ? 44-(0)20-8847-1370. E-mail address: david. j. [email  protected] com (D. J. Redfern). associated with a high incidence of complications. Intramedullary nailing remains the gold standard for treatment of most diaphyseal fractures of the tibia. However, although some authors have described good results with intramedullary nailing in the treatment of distal peri-articular tibial fractures, it is generally considered unsuitable for such injuries, due to technical dif? culty and design limitations. 17,20 Traditional open reduction and internal ? ation of such injuries results in extensive soft tissue dissection and periosteal injury and may be associated with high rates of infection, delayed union, and non-union. 5,11,13,18,19,22 Similarly, external ? xation of distal tibial fractures may also be associated with a high incidence of complications, with pin infection and loosening in up to 50% of cases and malunion rates of up to 45%. 20 Minimally invasive plate osteosynthesis (MIPO) may offer biological 002 0–1383/$ — see front matter ? 2003 Elsevier Ltd. All rights reserved. oi:10. 1016/j. injury. 2003. 09. 005 616 D. J. Redfern et al. advantages. MIPO involves minimal soft tissue dissection with preservation of the vascular integrity of the fracture as well as preserving osteogenic fracture haematoma. 3 MIPO techniques have been used successfully in the treatment of distal femoral fractures. 9,10,23 Experience of the application of these techniques to fractures of the distal tibia is less extensive and opinion regarding optimal technique differs. Some authors advocate temporary external ? xation prior to de? itive MIPO and routine ? xation of associated ? bula fractures. 7 Others advocate a more selective approach to the role of external ? xation and ? bular ? xation. 2 Purpose We report our experience with minimally invasive plate osteosynthesis in the treatment of closed, unstable fractures of the distal tibia that are unsuitable for intramedullary nailing. Patients a nd methods We undertook a review of patients treated by MIPO for unstable fractures of the distal tibia in our hospital, between 1998 and 2001. Twenty-two patients were identi? d, of whom 20 had followTable 1 Patient Detailed patient data Age (years) 71 46 20 32 27 26 34 23 26 26 50 59 27 39 54 67 25 24 67 46 Mechanism of injury Fall Fall Football Motorcycle RTA Twisted Motorcycle RTA Rugby injury Rugby injury Football injury Motorcycle RTA Fall Fall Fall Fall Fell from wheelchair Fall Motorcycle RTA Motorcycle RTA Fall Fall Fracture classi? cation AO/R&A 42-A2 42-B1 42-A2 42-A2 42-B1 42-C1 42-B1/grade 42-A1/grade 42-B1 42-B2 42-A1 43-A3/grade 42-A1 42-A1 42-B1 42-A1 43-B1 42-A1 43-B1/grade 43-B1/grade up available. Their mean age was 38. 3 years (range: 17—71 years). There were 18 males and 4 females. The mechanism of injury was: fall (12); motorcycle accident (6); rugby/football injury (4) (see Table 1). Fractures were classi? ed according to the AO system12 and distal intra-articular fracture extension classi? ed according to Ruedi and Allgower18 ? ? (Table 1). All 20 fractures involved the distal onethird of the tibia and in 5 cases the fracture clearly extended distally in to the ankle joint (Ruedi and ? Allgower grade I in 3 cases and grade II in 2 cases). It ? is important to note that although 16/20 of the fractures were classi? d according to the AO system as 42 (diaphyseal), this is somewhat misleading as the ‘essence’ of these fractures was metaphyseal. Within the strict AO system12 de? nition of a metaphyseal fracture of the distal tibia (43), the centre of the fracture must lie within a square of sides equal to the widest metaphyseal distance, and the centre of many of our fractures lay just outside of the ‘metaphys eal square’ (Fig. 1a). The fracture pattern was however predominantly long oblique or long spiral and as such extended well into the distal metaphysis ? extension into the joint (Fig. 1). Indications for use of MIPO technique These included distal diaphyseal, or metaphyseal fractures of the tibia that were considered unsuitable Time to callus (weeks) 8 7 8 8 8 8 10 10 8 8 11 8 12 12 8 8 10 8 10 10 Time to FWB (weeks) 12 13 12 14 8 20 12 12 10 17 9 14 13 12 N/A 12 10 13 10 12 Time to union (weeks) 26 24 20 22 20 20 24 18 28 29 24 26 24 20 24 20 20 22 24 20 Complications 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 I I II I II — Metalwork discomfort — — — — Super? cial infection Metalwork discomfort Metalwork discomfort — — Malunion CRPS (type 1) — — — — — — — R&A: Ruedi and Allgower. ? Fractures of distal tibia 617 Figure 1 (a) AP and lateral radiographs of the distal tibia for case 8 (42-A1, R&A grade 1). (b) AP radiograph (case 8) at 10 weeks post-operatively showing callus formation (A); AP radiograph (case 8) at 18 weeks showing radiological union (B). for intram edullary nailing due to the distal nature of the fracture and/or intra-articular or peri-articular fracture extensions. gical evidence of callus. All patients were followedup for a minimum of 12 months. Operative technique Management protocol Initially, patients were managed in a plaster splint with elevation until de? itive ? xation could be undertaken. Surgery was undertaken on the next available theatre list and only delayed if soft tissue swelling or anaesthetic concerns dictated that this was necessary. Intravenous antibiotics were given at induction of anaesthesia and two doses following surgery. Post-operatively, patients were not routinely splinted unless deemed unlikely to comply with a partial weight-bearing regime. The majority of patients were encouraged to partial weight-bear on the limb (10—15 kg) from the ? rst post-operative day. Early active and passive knee and ankle motion was encouraged. In the majority of cases, patients were discharged from hospital 24 h following surgery. Clinical and radiological review took place at 6—8 weeks to assess for evidence of callus formation. Patients were allowed to proceed to full weight-bearing on the basis of clinical and radiological evaluation but not before there was radioloSurgery was performed with the patient supine on a radiolucent table. Routine preparation and draping of the injured limb was performed. Both indirect and direct techniques of fracture reduction were used depending upon the nature and pattern of the fracture. Reduction techniques employed included the use of manual traction, the AO femoral distracter, the AO articulated fracture distractor, and direct reduction with fracture reduction forceps across the fracture (via two stab incisions). A 2 cm incision was made proximal and distal to the fracture on the medial border of the tibia. An extraperiosteal, subcutaneous tunnel could then be fashioned between these two incisions using blunt dissection. A pre-measured and pre-contoured narrow 4. 5 mm DCP was then positioned in this extra-periosteal subcutaneous tunnel (Fig. 2). Accurate plate contouring and positioning was con? med by ? uoroscopy. The length of plate selected is important and should be as long as is reasonably possible given the particular fracture pattern. As the length of plate is 618 D. J. Redfern et al. Figure 2 Pre-contoured plate insertion with fracture reduction maintained by direct technique. increased, the strength of the ? xation construct is also increased. 21 A cortic al screw (4. 5 mm) was then inserted through a screw hole at one end of the plate via the incisions already made for plate insertion. At this stage, axial fracture alignment was con? rmed before inserting any further screws. Subsequent screws were inserted close to either side of the fracture via stab incisions. Further screws may be used depending upon the characteristics of the fracture. If possible, a lag screw was also inserted across the fracture (via the plate) in order to further reduce the fracture gap and add to the rigidity of the ? xation. However, because the technique employs a bridge plating principle, interfragmentary lag screws were not felt to be obligatory. It is not necessary to place screws through all of the remaining holes in the plate as this does not further increase the strength or rigidity of the ? ation construct4,21 but does require further skin incisions, providing more potential portals of entry for infection (Fig. 1b). The ? bula was not ? xed unless necessary for accurate reconstruction of length such as encountered with some severely comminuted fractures. With fractures extending into the ankle joint, careful attention was paid to restoration of the articular surface cont inuity and 3. 5 mm cortical screws inserted through stab incisions or formal open exposure as required. In only one case was it deemed necessary to ? x the ? ula in order to accurately reconstruct length before proceeding to minimally invasive plating of the tibia. The mean hospital stay was 6 days (range: 2—31 days). The mean time to radiological evidence of callus formation was 9 weeks (range: 7—12 weeks). Sixty percent of patients achieved radiological callus by 8 weeks and all by 3 months (Table 1 and Fig. 2). The mean time to full weight-bearing was 12 weeks (range: 8—20 weeks) and the mean time to union was 23 weeks (range: 18—29 weeks). There were no non-unions and one malunion in whom there was >58 of varus angulation. There were no cases of failure of ? xation. Three soldiers have subsequently had their metalwork removed due to discomfort during training, and have reported no further symptoms. One patient required exchange of a distal screw that was too long and was impinging upon the distal tibia—? bula joint. A further patient developed type I complex regional pain syndrome (CRPS). He required guanethidine blocks to control his pain. There were no deep infections (one super? cial infection which resolved on oral antibiotics). Sixteen of the 20 patients were employed at the time of their injury. Six patients were soldiers. All patients in this study have subsequently returned to their pre-injury occupations/level of activity. Discussion Results Of the 20 patients presented, 12 were operated upon within 24 h of the injury, and 16 within 72 h of the injury. Surgery was delayed in the remaining four patients due to: transfer from another hospital (1); swelling at the site of injury (1); medical problems (1); and for further imaging (1). The surgery was performed by, or supervised by, one of six consultant orthopaedic surgeons in the department. Favourable results have been described using minimally invasive plate osteosynthesis techniques for ? xation of distal femoral fractures. 9,10,23 Cadaveric and animal studies have emphasised the importance of minimising the degree of soft tissue damage in the region of long bone fractures. 3,16,24 Recently, Borrelli et al. 1 have demonstrated that the distal metaphyseal region of the tibia has a relatively rich extraosseous blood supply, provided primarily by Fractures of distal tibia 619 branches of the anterior tibial and posterior tibial arteries. They also demonstrated that open plating in this region produces signi? cantly greater disruption of this extraosseous blood supply than minimally invasive plate application. Helfet et al. 7 described their experience with MIPO in 20 closed pilon fractures and advocated routine use of external ? xation acutely, followed by de? nitive ? xation 5—7 days later once the swelling has subsided. They also advocated the routine ? xation of associated ? bula fractures. They splinted the limb post-operatively but allowed toe-touch weight-bearing (20 lb) from the ? rst post-operative day. Their patients achieved full weight-bearing at an average of 10. 7 weeks (range: 8—16 weeks). Malunion occurred in 20% of cases although all patients had a good functional outcome and none required any further surgery. Collinge et al. 2 have reported their experience using MIPO in 17 tibial shaft fractures. Twelve cases had open injuries and ? ve of these required bone grafting at a later stage such that they suggested that this should be considered at an early stage in such injuries. The ? ve patients with closed injuries had complete union after the index procedure with no cases of malunion or infection. These closed injuries all achieved a good functional outcome. They routinely splinted the limb post-operatively with weightbearing commenced at approximately 12 weeks. In this series, we con? rm that good results can be obtained with this technique in the treatment of closed tibial fractures with intra-articular or periarticular fracture extensions, which are not suitable for intramedullary nailing. However, intramedullary nailing still remains the treatment of choice for most uncomplicated diaphyseal fractures of the tibia. We would not advocate the routine use of external ? ation in the acute management of such injuries, except in some open injuries with extensive soft tissue damage. Early de? nitive surgery negates the need for any form of temporary ? xation other than a POP back-slab for closed fractures. This avoids the added risk of complications arising from the use of such devices. It is our experience that ? xation of the ? bula is not necessary except to aid in reconstructi on of length when there is extensive comminution of the tibial fracture. In the current series (and those of Collinge et al. 2 and Koury et al. ), a 4. 5 mm DCP has been used with satisfactory results. However, this is a relatively bulky implant and lower pro? le plate designs might be expected to result in a lower incidence of postoperative metalwork discomfort along this subcutaneous medial aspect of the tibia, especially in the region of the medial malleolus. This in turn may reduce the need for subsequent implant removal. Other recent developments in plate design include pre-contoured and locking plates (e. g. LCP system, Synthes), which may offer signi? cant advantages. The ‘internal ? ator’ design of locking plates has the advantage that screw insertion does not draw the bony fragments to the plate (as occurs with traditional non-locking plates) and hence, the precise contouring of the plate is less important in achieving accurate fracture reduction. 6,15 For the same reason, the footprint of the locking plates should also be signi? cantly smaller than traditional non-locking plates, hence preserving periosteal blood supply to the fracture. 6 In the majority of cases, we have found it possible to safely mobilise patients, partial weightbearing (10—15 kg), from the ? st post-operative day without external splintage of the limb. This also allows early mobilisation of the knee, ankle and subtalar joints. Conclusion Whilst intramedullary nailing still remains the treatment of choice for most uncomplicated diaphyseal fractures of the tibia, minimally invasive plate osteosynthesis offers a reliable and reproducible technique in the treatment of closed unstable fractures of the distal tibia with intra-articular or periarticular fracture extensions. This technique may avoid the signi? ant complications encountered with more commonly used techniques of internal ? xation and external ? xation in such injuries. References 1. Borrelli J, Prickett W, Song E, Becker D, Ricci W. Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study. J Orthop Trauma 2002;16:691—5. 2. Collinge C, Sanders R, DiPasquale T. Treatment of complex tibial periarticular fractures using percutaneous techniques. Clin Orthop 2000;375:69—77. 3. Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury 1997;28:S-A7—S-A12. 4. Field RJ, Tornkvist H, Hearn TC, et al. The in? uence of ? screw omission on construct stiffness and bone surface strain in the application of bone plates to cadaveric bone. Injury 1999;30:591—8. 5. Fisher WD, Hambledon DL. Problems and pitfalls of compression ? xation of long bone fractures: a review of results and complications. Injury 1978;10:99—107. 6. Frigg R. Locking compression plate (LCP). An osteosynthesis plate based on the dynamic compression plate and point contact ? xator (PC-Fix). Injury 2001;32:S-B63—6. 7. Helfet DL, Shonnard PY, Levine D, Borrelli J. Minimally invasive plate osteosynthesis of distal fractures of the tibia. Injury 1997;28:S-A42—8. 620 D. J. Redfern et al. 8. Koury A, Liebergall M, London E, Mosheiff R. Percutaneus plating of distal tibial fractures. Foot Ankle Int 2002;23: 818—24. 9. Krettek C, Schandelmaier P, Miclau T, Tscherne H. Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures. Injury 1997;28:S-A20—30. 10. Krettek C, Schandelmaier P, Miclau T, Bertram R, Holmes W, Tscherne H. Transarticular joint reconstruction and indirect plate osteosynthesis for complex distal supracondylar femoral fractures. Injury 1997;28:S-A31—41. 11. McFerran MA, Smith SW, Boulas HJ, Schwartz HS. Complications encountered in the treatment of pilon fractures. J Orthop Trauma 1992;6:273—85. 12. Muller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classi? cation of fractures of long bones. Berlin: Springer-Verlag; 1990. 13. Olerud S, Karlstrom G. Tibial fractures treated by AO compression osteosynthesis. Acta Orthop Scand Suppl 1972; 1:1—104. 14. Oni OO, Stafford H, Gergg PJ. A study of diaphyseal fracture repair using tissue isolation techniques. Injury 1992;23: 467—70. 15. Perren SM. Editorial. Injury 2002;33:S-A-VI—S-A-VII. 16. Rhinelander F. The normal microcirculation of diaphyseal cortex and its response to fracture. J Bone Joint Surg Am 1968;50A:784—800. 17. Robinson CM, McLaughlan GJ, Mclean IP, Court-Brown CM. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classi? ation and treatment by locked intramedullary nailing. J Bone Joint Surg Br 1995;77B:781—7. 18. Ruedi T, Allgower M. Fractures of the lower end of the tibia ? ? into the ankle joint. Injury 1969;1:92. 19. Ruedi T, Allgower M. The operative treatment of intra? ? articular fractures of the lower end of the tibia. Clin Orthop 1979;138:105—10. 20. Russell TA. Fractures of the tibia and ? bula. In: Rockwood CA, Green DP, Buckolz RW, Heckman JD, editors. Fractures in adults. 4th ed. Philadelphia: Lippincott; 1996. p. 2139— 57. 21. Sanders R, Haidukewych GJ, Milne T, et al. Minimal versus maximal plate ? xation techniques of the ulna: the biomechanical effect of number of screws and plate length. J Orthop Trauma 2002;16:166—71. 22. Tornetta III P, Weiner L, Bergman M, et al. Pilon fractures: treatment with combined internal and external ? xation. J Orthop Trauma 1993;7:489—96. 23. Wenda K, Runkel M, Degreif J, Rudig L. Minimally invasive plate ? xation in femoral shaft fractures. Injury 1997;28:SA13—9. 24. Whiteside L, Lesker PA. The effects of periosteal and subperiosteal dissection. J Bone Joint Surg Am 1978;60A: 26—30.

Thursday, August 29, 2019

Answering Questions Research Paper Example | Topics and Well Written Essays - 500 words - 6

Answering Questions - Research Paper Example more, Swift also rose to a respected position in society, in league with Irish noblemen who maintained wealth, rental estates and worked with business leaders to promote commerce. During this period, many Irish landlords did not adequately maintain their rental properties and also used their resources to promote exportation of products rather than allocating them for domestic consumption. These noblemen were often criticized by the poor and disadvantaged for these behaviors due to the suffering it imposed. Swift, rather than flatly risking his position of respect in the community, chose to use irony to get his point across without angering nobleman landlords with direct accusations and statements. By adding humor to his rather harsh and critical essay, he could gain favor and keep his position of brotherhood with other well-to-do Irish and British citizens. Swift’s determination that the best course of action for curing the plight of the destitute was to use children as food for the impoverished, suggesting they be fattened like cattle to provide greater sustenance. The ironic approach to providing literary criticism was to shock audiences after they began to empathize with the situation of the impoverished. Much of this was due to Swift’s personality in which he labeled himself a person who served interests of human liberty and could not be imitated. These were direct self-observations on Swift’s self-written epitaph, therefore he wanted to use irony to distinguish himself from other satirists and authors as one who was innovative in approach and that would leave a lasting legacy on culture and society. Moreover, during this time period there were growing tensions between Ireland and the British Empire during a period where Britain was using its military might to consume regions and make them part of the Empire. Many of the aforementioned noblemen were loyal to the British throne and worked with ambassadors of the Crown to promote trade and business

Wednesday, August 28, 2019

Identify the GAAP used to create the financial plan, and provide one Assignment

Identify the GAAP used to create the financial plan, and provide one recommendation for Patton-Fuller Community Hospital based on their 2009 budget statement for improving - Assignment Example A financial plan is a succession of steps or objectives set by businesses or individuals to describe a progressive or cumulative attainment of a certain financial accomplishment (Lucy, 1999). These financial objectives and forecast are aimed at improving the financial position of the individual or organization through acquisition of new assets or elimination of debt. Various GAAP are instrumental in the preparation of GAAP. Principle of continuity- The principle of continuity assumes that the business or financial activities of an individual are continuous (Hirschey, 2009). This principle eliminates complexities that may be associated with discontinuity. Principle of periodicity- The principle of periodicity allows each accounting entry to be split according to periods. The principle also allows accountants to utilize the cyclic nature of business occurrences. Patton – Fuller community hospital has continuously provided quality medical services to people living in Kelsey and the immediate environment since 1975 (Apollo Group, 2006). To maintain its standards of operation, the hospital needs to have an economically viable financial plan. According to the 2009 budget plan, there is lack of consistency and continuity of the financial projections of the hospital. To maintain its position, the hospital needs to balance its organization and institutional roles. Financial accountants assume that a business will remain in operation within the forthcoming business period, when preparing its financial statements. On the other hand, the financial statements should indicate whether the business is likely to close down. In the 2009 financial budget, Patton – Fuller Hospital’s auditor did not evaluate the sustainability of the business in the near future. In this case, the auditor did not evaluate the hospitals

Tuesday, August 27, 2019

Bear Stearns & Co Essay Example | Topics and Well Written Essays - 750 words

Bear Stearns & Co - Essay Example gh development rate of new franchisees and their new organization possessed saves, all the unneeded "hit" tapes from their current saves either could gainfully sold to new franchisees for stocking their saves with a base stock, or be utilized to stock the s organizations new stores. Blockbusters administration Pointed out that amortization of goodwill in excess of 40 years is worthy under proper accounting rules (GAAP). Blockbuster ought to be realized that adjusting lapses happen and depending how the loan specialist collects these blunders, the mixed installment (central + investment) may change marginally a few months to keep these mistakes from collecting; or, the gathered slips are balanced for at the end of every year, or at the last advance payment (Penman, 2009). There are a couple of pivotal focuses important when selling a home with an amortized credit. Primarily, there is significant dissimilar portion of the regularly scheduled installments at the investment, particularly amid the initial 18 years of a 40-year contract. 2. The impact on the Blockbusters 1988 earnings per share if 5-year amortization were applied to this goodwill will decrease keeping in mind that terms governing loan amortization is based on the mark of 40 years. In the case underneath, installment 1 apportions around 80-90% of the aggregate payment towards interest and just $67.09 (or 10-20%) at the Principal equalization. The careful rate distributed towards installment of the key relies on upon the investment rate. Not until payment 257 or 21 years into the credit does the installment assignment towards chief and investment level out and in this manner tip most of the regularly scheduled installment to Principal equalization pay down, and I think it is appropriate on this ground. In addition, the level of mortgage monthly payment will be high. 3. The earnings per share if the Video superstore purchases were not included in the 1988 revenues would have been much low keeping in

Monday, August 26, 2019

Trans Global Holidays Niche Product - Yoga and Facial Yoga Excursions Essay

Trans Global Holidays Niche Product - Yoga and Facial Yoga Excursions - Essay Example Yoga Excursions focuses on health and well-being of its diverse clientele. Green (2008) suggests that yoga exercises improve focus and mental attention, creating the catalyst for improved moods and concentration. In a world where consumer activities create stressful life situations, Trans Global believes that Yoga Excursions maintains the ability to capture the attention of the wealthier consumer demographic and the upscale business-oriented consumer audience. The tour begins with a full day at the Yoga Excursions spa for body waxing, massage or any other variety of personal grooming and care required by the tourist. This period of the company tour is designed to facilitate the initial sensations of freedom and personal indulgence, an emotional sensation triggered by the upscale salon and social environment provided by Trans Global. The yoga sessions are aggressive, led by a senior professional in the field of yoga and contortionist training, designed to act as a positive motivator and facilitate interpersonal relationships with the tour’s attendees. Facial yoga, according to Stinchfield (2007) involves the manipulation of facial muscles, utilizing various facial-toning techniques to develop perceptions of personal youth and beauty. According to Boone & Kurtz (2006), more and more middle-aged women are turning toward non-surgical beauty enhancements as a means to avoid long-term surgical complications, thus Trans Global believes th at facial yoga maintains a rather new-age alternative to recapturing youth and beauty. The entire tour ends with a final group dinner in which the clients are allowed to share their unique yoga experiences and receive their appropriate Trans Global awards for excellence in yoga and creative facial yoga exercises.

Sunday, August 25, 2019

HRM Innovation and Change Essay Example | Topics and Well Written Essays - 500 words - 3

HRM Innovation and Change - Essay Example ctive team work combined with strategic performance metrics like using internal and external benchmarking are important tools to evaluate performance outcome. The continuous learning environment provides the workers with a wider scope for professional growth in the area of core competencies and making them responsible for advocating and nurturing a high standard of ethics and quality work. The measurement of change vis-Ã  -vis performance, innovation and customer satisfaction are few of the critical success factors that have significant impact on the market positioning of the organization. The empowered workforce that thrives on shared learning and collective goals greatly facilitates improved performance. TQM and benchmarking promote quality assurance at various levels of business processes through measures that drastically reduce the percentage of error within the production and become cost effective. Thus, organizations continuously make effort to identify factors and issues that would help meet the challenges with efficiency and unmatched proficiency. The organizational change can broadly be defined as the ability of management to identify and incorporate the factors that increase output and improve the performance outcome of the organization. Through focused approach, the companies develop dynamic business strategies to identify the critical factors of change and meet the challenges with creative inputs through collective vision and shared goals. The strategy involves simultaneous inputs from various different departments so as to measure, analyze, improve and control the production of new products and services. Hence, the companies through regular surveys, feedback processes and R&D activities are able to identify the opportunities for new products. Evaluation and implementation of performance metrics gives a competitive edge to

Saturday, August 24, 2019

Press Release assignment Research Paper Example | Topics and Well Written Essays - 250 words

Press Release assignment - Research Paper Example The next step would be to ensure that the information contained in the press release is true, accurate and has been certified by the company in question. The next step would be to ensure that the news headlines should be catchy to the audience. They want something that they can relate to and that can get their attention. The body copy should be written and it should be written as it should appear in the news story. There should also be clear communication that states out the six major things that would make the reader know everything they need. These five major things would include; what, when, who, where, why and also how (Gorton, 2007). It should be applicable to the audience and clean. Such an announcement of such information should be enhanced across the social society through the use of social networking sites and also other sites that may have a huge fan base. The press release needs to be able to spread the news across another spectrum and this will ensure that the message is passed onto the intended target. In an effort to ensure that it keeps its customer base and attracts more customers, J.C. Penney has offered discounts to those who bring in reusable bags. Some may call this a hoax, but the reality of the matter is that reusable bags brought in will earn the individual a discount. Call it earning money the simple

Performance, Planning and Decision-Making Essay - 1

Performance, Planning and Decision-Making - Essay Example The context will enumerate the advantages that can be experienced by an organization by selecting an appropriate leadership style. At the same time, the context of the essay will explain some inherent problems associated with one single type of leadership. At the end the researcher will state that authentic leadership approach is the best method to govern a concern in the current dynamic world. The entire context of the essay will include several empirical examples for making the analysis more robust. The essay will focus on the importance of choosing appropriate leadership style for successful organizational performance. It will critically analyze for and against the statement concerned. The analysis will be done with the help of theoretical and empirical analysis tools. The state of business complexity has significantly increased in the current era. At this juncture, business firms actively seek productive ways by which they would be able to achieve competitive edges in business (Casson and Wadeson, 2012). Efficiency of factor resources is crucially required for long-term growth of a company. However, growth and productivity of all resources can be stimulated by a leader or an entrepreneur. Many researchers observe leadership as an important causal factor affecting performance of an organization. However, there exist very few studies that show the exact ways that allow leadership to affect performance, culture and climate of a business organization. There are various researches conducted on leadership relating to human services in organizations, but little investigation has been conducted on appropriate practice of leadership in the similar context. It is believed by some researchers that an organization is able to effectively prepare growth plans in business only after determining an appropriate leadership style. This is because through leadership, management system of