Geomorphology Lab 3 Report Example | Topics and Well Written Essays - 500 words

Geomorphology 3 - Lab Report Example Further, a model for predicting age can be succinctly tested based on weathering degree. The class split into three groups and recorded the varying degrees of weathering for different tombstones at the Murray Cemetry. The characteristics of the 20 tombstones were recorded by each group. The characteristics recorded for each tombstone include height, width, length, name, thickness at bottom and thickness at top, texture, lithology, tilt and visual weathering class. The data obtained were entered into an excel spreadsheet as shown in the result section. As shown in the above the graph, with the help of a best fit line, there is a general trend observed between weathering class and age. A positive gradient indicates that there is a positive relationship between the two and as the age increases so does the weathering class of tombstone increases. As shown in the graph, there is a general trend between weathering class and height of the tombstone. The equation gives a positive gradient, showing that as the height increases there is a positive effect on the weathering class. The weathering class increases with increase in height. A line of best fit, as shown in the graph, indicates that there is a considerable relationship between weathering class and length. The graph shows that an increase observed in length leads to an increase in weathering class. The positive gradient shows that there is a positive relationship between the two. The results obtained were able to support the initially listed hypotheses. For age, there was observed consistency in its relationship with weathering class as shown in the graph. Hence, from the methodology used, the hypothesis â€Å"The degree of tombstone weathering is related to tombstone age† is sufficiently supported because there was observed consistency with a positive gradient. The results supported hypothesis two which stated that â€Å"The degree of tombstone weathering relies on the height of the tombstone† given

Project Management Unit 7 - Assignment Essay Example | Topics and Well Written Essays - 500 words

Project Management Unit 7 - Assignment - Essay Example In the transportation stage, he will need information on the status of the transportation of the machines. The freighters will give this information. They will use phones and emails to communicate between them. The vendor will also communicate to the company on his progress on acquiring the machines the company requires for the installation of the system. This will be done by use of emails and personal communication with the head of the installation project with back up documents in hard copy. The engineers will need to keep in touch with the technicians in London and Baumholder. They will require information on the progress on the installations the technicians make on an hourly basis. The engineers and technicians will use teleconferencing to communicate. This will enable the engineers to communicate on small details that would not be possible with other methods of communication. They will also require the feedbacks from the testers on a daily basis during the testing stage. The engineers will provide questioners to the testers to complete. This will be done online through the use of electronic mails and phone calls. The engineers should also report on the progress of the installments to the company management through presentations and reports. They should make updates to the implementation team on a weekly basis to give the company enough time to address any emerging issue. The engineers should make the updates in hardcopy as well as in person with the head of the company’s department in charge. They will require instructions from the engineers. The technicians will also provide a detailed report on the system they assemble. The report should include all the information necessary to addressing future breakdowns or changes in the system. The report should be in hard copy, and they should deliver it to the company’s data department for storage. The department shall ensure that the purchases the vendor makes are in line with the specifications the

Application of the Neuman Systems Essay Example for Free

Application of the Neuman Systems Essay With concerns of our day to day living we do not have enough time and budget to be choosy of the type of food or the nutritional value of it, what we think of nowadays is just to have something to satisfy our hunger without considering the nutrients that our body needs each day. When we hear diet nowadays often we see it as losing weight by means of controlling food intake, but the truth is diet could also mean eating nutritious foods to supplement our body’s needs of nutrients and the type of foods that we are going to consume. As statistics report show that in the United States as many as 20% of hospitalized patients are hypokalemic; however, hypokalemia is clinically significant in only about 4-5% of these patients. Severe hypokalemia is relatively uncommon. Up to 14% of outpatients who undergo laboratory testing are found to be mildly hypokalemic .Approximately 80% of patients who are receiving diuretics become hypokalemic. Sex Incidence is equal in males and females. The researcher chose hypokalemia as a topic for a case study in acute adult diseases for the reason that hypokalemia is a fatal disease that is often neglected by the people in the sense that people does not know what the disease is all about. The researcher believes that through studying the whole course of illness, insights and new information can be obtained in dealing with hypokalemia which could help students, nurses and any researcher who would endeavor in the study of hypokalemia Theoretical Framework The researcher aimed to utilize Neuman Systems Model in a client with hypokalemia. This theory holistically developed to meet or complement for the client’s needs the researcher wants to verify and to validate the theory by using it on an acute condition called hypokalemia. The unique focus of the Neuman Systems Model is the wellness of the client/client system in relation to environmental stress and reactions to stress (Fawcett,1995). In relation to its wholistic approach According to the Neuman Systems Model and systemic perspective in general, health and wellness is defined as the coordination or the degree of system stability, that is, the condition in which all parts and subparts (variables) are in balance or harmony with the whole of the client/client system (Neuman,2002) Betty Neuman’s Systems Model is based on concepts related to stress and reaction to stress. The Neuman Systems Model includes the physiological, psychological, sociocultural, developmental, and spiritual variables at all levels of the system (Neuman, 2002). The physiological variable deals with mental relationships and processes. The sociocultural variable deals with those functions of the system that involve social and cultural interactions and expectations. The developmental variable deals with developmental processes and needs that vary as the system matures. The spiritual variable deals with the system’s beliefs and their influence and is, according to Neuman, the least understood despite its importance (Frisch, 2006). Basic Structure consists of common client survival factors, as well as unique individual characteristics. It represents the basic system energy resources (Neuman, 2002). Client/client system a composite of variables (physiological, psychological, sociocultural, developmental, and spiritual), each of which is a subpart of all parts, forms the whole of the client. The client as a system is composed of a core or basic structure of survival factors and surrounding protective concentric rings. The concentric rings are composed of similar factors, yet serve varied and different purposes in either retention, attainment, or maintenance of system stability and integrity or combination of these. The client is considered an open system in total interface with the environment. The client is viewed as a system, and the term can used interchangeably with the client/client system (Neuman, 2002). Content the variables of a person in interaction with the internal and external environment comprise the whole client system (Neuman, 2002) Degree of reaction the degree of reaction is the amount of system instability resulting from stressor invasion of the normal lines of defense. Environment is defined as â€Å"all factors affecting and affected by the system† and is â€Å"all internal and external factors or influences surrounding the identified client or client system†. Neuman has identified three relevant environments. The internal environment â€Å" consists of all forces or interactive influences internal to or contained solely within the boundaries of the defined client/client system†. The external environment â€Å" consists of all forces or interactive influences external to or existing outside the defined client/client system† and is interpersonal and extrapersonal in nature(Neuman, 2002). Feedback the process within which matter, energy, and information, as system output, provide feedback for corrective action to change, enhance or stabilize the system. Flexible lines of defense is a protective buffer for the client’s normal or a stable state. Ideally, it prevents invasion of stressors and keeps the client system free from stressor reactions or symptomatology (Fawcett, 1995). Goal the system goal is stability for the purpose of client survival and optimal wellness. Health a continuum of wellness to illness, dynamic in nature, that is constantly subject to change. Optimal wellness or stability indicates that total system needs are being met. A reduced state of wellness is the result of unmet needs. The client is in a dynamic state either wellness or illness, in varying degrees, at any point in time. Input/Output the matter, energy, and information exchanged between client and environment that is entering or leaving the system at any point in time. Lines of resistance contain certain known and unknown internal and external resource factors that support the client’s basic structure and normal defense line thus protecting system integrity. An example is the body’s mobilization of white blood cells or activation of immune system mechanisms. Effectiveness of the lines of resistance in reversing the reaction to stressors allows the system to reconstitute; ineffectiveness leads to energy depletion (Neuman, 2002). Normal line of defense is the solid boundary line that encircles the broken internal lines of resistance. This line represents what the client has become, the state to which the client has evolved over time, or the usual wellness level. The normal defense line is a standard against any deviancy from the usual wellness state can be determined (Neuman, 2002). Prevention as intervention typology or modes for nursing action and determinants for entry of both client and nurse into the health care system. Primary prevention: before a reaction to stressors occurs. Secondary prevention: treatment of symptoms following a reaction to stressors Tertiary prevention: maintenance of optimal wellness following treatment. Reconstitution represents the return and maintenance of system stability, following treatment of stressor reaction, which may result in higher or lower level of wellness than previously. Stability a state of balance or harmony requiring energy exchanges as the client adequately copes with stressors to retain, attain, or maintain an optimal level of health, thus preserving system integrity. Stressors are environmental factors, intra-, inter-, extrapersonal factor in nature that have potential for disrupting system stability. A stress is any phenomenon that might penetrate both the flexible and normal lines of defense, resulting in either positive or negative outcome (Neuman, 2002). Intrapersonal stressors are within the internal environment of the client/client system and include such forces as conditioned and autoimmune responses. Interpersonal stressors are in the external environment. They occur at the boundary between the client/client system and the proximal external environment an include such forces as role expectations and communication patterns. Extrapersonal stressors also are in the external environment. They occur at the boundary of the client/client system and the distal external environment and include such forces as financial concerns or social policies (Fawcett, 1995). Wellness/Illness wellness is the condition in which all system parts and subparts are in harmony with the whole system of the client. Wholeness is based on interrelationships of variables, which determine the amount of resistance an individual has to any stressor. Illness indicates disharmony among the parts and subparts of the client system. Wholistic a system is considered wholistic when any parts or subparts can be organized into an interrelating whole. Wholistic organization is one of keeping parts whole or stable in their intimate relationships; individuals are viewed as wholes whose component parts are in dynamic interdependent interaction. Research Design The researcher in this study utilized the case study method. The case study design involves an intensive exploration of a single unit of study, such as a person, very small number of subjects, family, group, community, or institution ( Burns Grove, 2003). Research locale The study was conducted in Cebu City Medical Center located at N. Bacalso Avenue,Cebu City. Cebu City Medical Center (CCMC) is a 300 bed capacity government hospital that caters all residents of Cebu City. The client was admitted at the stroke ward, third floor which accommodates clients with physical complaints, classified under Internal Medicine (IM) as cardiovascular problems. It is a 10 bed capacity ward which caters patients admitted with cardiovascular problems. Research Instrument The researcher utilized Gordons functional health pattern as a research instrument which is categorized in 11 domains namely health perception management pattern which explains of what the client perceives in her condition, nutritional-metabolic pattern explains for the diet of the client and regarding food groups and the number of servings per day, elimination pattern pertains to urinary and bowel patterns, exercise- activity pattern points out to the activities of daily living of the client which also includes exercise, sleep-rest pattern defines the number of hours the client sleeps or on what time of the day the client takes his rest/ either its continuous or disturbed, cognitive perceptual pattern refers to the level of cognitive maturation of the client, self-perception pattern means on how the client perceives or sees herself, role-relationship pattern explains the role of the client in her family and society, sexuality-sexual functioning this domain explains if the client is sexually active or not and the number and age gap of the children the client has, coping-stress management pattern means on how the client would react to stress and what would the client do to resolve it , and values-belief system identifies the belief or religion of the client and their religious practices. Data gathering procedure A transmittal letter was sent to the chief nurse of cebu city medical center. The researcher chose a client which had an acute condition to be interviewed, prior to the interview the researcher explained to the client the purpose and the goals of the interview, wherein the client agreed with her full consent and understanding. The researcher conducted a chart review of the client followed by doing a physical assessment and did an interview utilizing Gordon’s Health pattern tool. Chapter 2 Results and Discussion This chapter presents an appraisal utilizing the Neuman Systems Model in assessing and dealing with clients with hypokalemia. Situational Appraisal The client is a 38-year old female, which currently resides at baranggay ylaya talamban Cebu City. She was born on march 10, 1975, she is a Roman Catholic by faith and is the youngest amongst two daughters of the second family her father had, and is now an orphan and a widow. She perceives her current condition as a payment for her sins, the client’s sister said that the client had times where she had epilepsy and sometimes with seizures but it disappeared later in time .She is currently unemployed and only works as an extra even though she had an unstable source of income she still managed to eat 3 times daily but with limitation of food intake vegetable is the main food source that they can afford and is only in a single food group drinks water depending on her needs or if she is thirsty. Elimination pattern is on a daily basis or depending upon the urge. Her daily activity includes waking up, sleeping, and goes to work which is considered as sedentary. Sleep and rest patterns are altered she sleeps 6-9 hours daily but is interrupted she wakes up at night and has difficulties in falling back to sleep. The client was a third year high school level but it was not a hindrance to her to find a job. The client views herself as helpless and hopeless at some times due to her illness. She was the youngest daughter she sought all the attention of her parents but she did not rely on them she worked hard to be employed and she found a job as a factory worker her elder sister was had a child and which she also loved as her own, and later was married. She was married but never had a child but she acted as a mother to her sister’s son, in her current state she has no partner in life and is not sexually active for her living a single life free of obligations is fine, following by the loss of both her parents she was on depressed and drowned herself in her work just to get over following her loss, it was also aggravated when her husband died in an accident which she had the hard time to accept and was depressed which made her let go of her job, the most depressed moment of her life where she resorted to the use of prohibited drugs happened when her nephew died it was the most painful loss for her because she treated her nephew as her own son. The only family member that is left with her is her elder sister all of her siblings on her father’s first family is not close to them. The client believed that her present condition is a punishment to her since she forgot her obligations in the church and thought being a creditor is a sin and she is paying for it. Theory-Based Assessment Physiological loss of system stability demonstrated in muscle weakness as seen in difficulty in breathing and inability to ambulate Psychological loss of system stability demonstrated in feelings of uselessness and helplessness Sociocultural loss of system stability seen in lack of financial support upon hospitalization and relative support Developmental loss of system stability seen in unemployment, dependence, and a decrease in competency in current age bracket. Spiritual loss of system stability in feelings of uselessness Psychopathophysiology The first is deficient intake. Poor potassium intake alone is an uncommon cause of hypokalemia but occasionally can be seen in very elderly individuals unable to cook for themselves or unable to chew or swallow well. Over time, such individuals can accumulate a significant potassium deficit. Another clinical situation where hypokalemia may occur due to poor intake is in patients receiving total parenteral nutrition (TPN), where potassium supplementation may be inadequate for a prolonged period of time. The second is increased excretion. Increased excretion of potassium, especially coupled with poor intake, is the most common cause of hypokalemia. The most common mechanisms leading to increased renal potassium losses include enhanced sodium delivery to the collecting duct, as with diuretics; mineralocorticoid excess, as with primary or secondary hyperaldosteronism; or increased urine flow, as with an osmotic diuresis. Gastrointestinal losses, most commonly from diarrhea, also are common causes of hypokalemia. Vomiting is a common cause of hypokalemia, but the pathogenesis of the hypokalemia is complex. Gastric fluid itself contains little potassium, approximately 10 mEq/L. However, vomiting produces volume depletion and metabolic alkalosis. These 2 processes are accompanied by increased renal potassium excretion. Volume depletion leads to secondary hyperaldosteronism, which, in turn, leads to enhanced cortical collecting tubule secretion of potassium in response to enhanced sodium reabsorption. Metabolic alkalosis also increases collecting tubule potassium secretion due to the decreased availability of hydrogen ions for secretion in response to sodium reabsorption. The third is due to a shift from extracellular to intracellular space. This pathogenetic mechanism also often accompanies increased excretion, leading to a potentiation of the hypokalemic effect of excessive loss. Intracellular shifts of potassium often are episodic and frequently are self-limited, for example, with acute insulin therapy for hyperglycemia. Regardless of the cause, hypokalemia produces similar signs and symptoms. Because potassium is overwhelmingly an intracellular cation and because a variety of factors can regulate the actual serum potassium concentration, an individual can incur very substantial potassium losses without exhibiting frank hypokalemia. Conversely, hypokalemia does not always reflect a true deficit in total body potassium stores. Variance from wellness| Nursing intervention| Reconstitution| Weak extremitiesSubjective cues: â€Å"dili nako malihok ako mga tiil† as verbalized by the client.Objective cues: * Client lying on bed * Foot plantar flexed. * Weak muscle strength and low muscle tone on extremities.Difficulty in breathingSubjective cues: â€Å" usahay mag lisod ko ug ginhawa† as verbalized by the clientObjective cues: * Enlarged chest cavity. * Use of accessory muscles in breathing * Fast deep breaths * Presence of nasal prongs at the bedside.Risks for muscle atrophy and foot droppingSubjective cues: mura ug ning gamay akong mga bati-is† as verbalized by the client.Objective cues: * Client is lying on bed * Foot plantar flexed * Immobility of the lower extremities * No presence of foot board * No ROM exercises done.| * Promote ROM exercises to prevent muscle atrophy on the affected limb * Provide foot board to support the foot and avoid plantarflexion which causes foot drop. * Encourage the client to eat a balanced diet paired with bananas for potassium replacement * Administer medications as prescribed * Monitor the client for any complications * Position the client on semi-fowlers position. * Instruct client to do abdominal breathing or pursed lip breathing. * Monitor for signs of hypoxia * Administer oxygen prn as prescribed. * Promote ROM exercises. * Provide foot board. * Encourage the S.O. to do sponge bathing to promote circulation. * Encourage the client to move the and exercise the toes of the feet.| Goal: demonstrated techniques and lifestyle changes to meet physiologic needs.Reconstitution: lines of resistance building.Goal: promoted techniques and exercises to meet physiologic needsReconstitution: lines of resistance buildingGoal: promoted techniques and exercises to prevent the occurrence of physiologic problemsReconstitution: lines of resistance building and strengthening the flexible lines of defense. Response of the client on the Interventions Provided The client was able to see through herself on identifying and prioritizing the problems through based on her judgment and of the researcher’s appraisal of her identified stressor the client was able to recuperate in the treatment, the client was able to come up with solutions on the problems that were most attainable and most important to her which is attaining the optimum level of functioning. The client was able to gain a boosted self-esteem and a positive outlook in life, reconstitution of her lines of defense and strengthening each lines is in progress, through positive feedback the client was able to see through it all that the physiological body is not just the only factor in healing but it should comprise the mind, the spirit, the society, and development to achieve a wholistic and faster recovery from illness. Conclusion and Recommendations Conclusions The Neuman Systems Model was effective, efficient in providing a wholistic nursing care to the client with hypokalemia. The assessment made was thorough and was based on the what the client and the care provider perceives thereby giving a collaborative and specific hint as to what the problem is wherein effective solutions can be brought up. Though the system is quite complicated and challenging at some times, it just needs practice in implementing the model to be able to familiarize it. The research concluded that the Neuman Systems Model is an effective tool which can enhance the nurses critical and analytical thinking by the data gathered based on the client’s initial response and the nurses judgment thereby minimizing the occurrence of an error in identifying problems and providing nursing care. Recommendations Based on the findings, observations and the conclusion utilizing the Neuman Systems Model is effective and wholistic enough in the approach of a client with hypokalemia. The following are the researchers suggestions and recommendations 1 nurse practitioners should do a thorough assessment on their clients not only by identifying the main problems but also by assessing the person as a whole it could be done through the use of the Neuman Systems assessment and evaluation tool. 2 Interventions differ from client to client others may vary but there is no such thing as a uniformed intervention thereby it is necessary for the nurse to assess for the needs of the client. Bibliography Burns and Grove (2003) Understanding Nursing research 3rd edition W. B. Saunders, Elsevier Company Fawcett, Jacqueline (1995) Analysis and Evaluation of Conceptual Models of Nursing 3rd ed. F.A. Davis Company Frisch N., Frisch L. (2006) Psychiatric Mental Health Nursing 3rd ed. Thomson Delmar Learning Company Karch, Amy (2008) Lippincotts Nursing Drug Guide: Wolters Kluwer Lippincott Williams Wilkins Company Medical-Surgical Nursing Made Incredible Easy (2004). Lippincott Williams Wilkins Company Springhouse Neuman, Betty and Fawcett, Jacqueline 2002 The Neuman Systems Model 4th edition Prentice Hall Company

Effects of Adverse Perinatal Outcomes (APO)

Effects of Adverse Perinatal Outcomes (APO) Specific Aims Adverse perinatal outcomes (APO) include infants birth defects, maternal pregnant and obstetric complications. Birth defects, including major congenital malformation (MCM) and minor anomaly (MA), become the leading causes of infant morbidity, mortality, and years of potential life lost in the United States.1 Low birth weight (LBW), abnormal condition of new born (ACNB), preterm birth, and Developmental Delay or Disability (DDD) are also birth anomalies that impacts the infants health.2-5 The association of in utero exposure to teratogenic medications with infant birth defects and other anomalies has been widely investigated.6,7 The literature has shown that taking antiepileptic drugs (AEDs) poses an increased risk of having child with congenital malformations in women with epilepsy.79 The most common MCMs caused by in utero exposure to AEDs are orofacial clefts, cardiac abnormalities, neural tube defects, urologic defects, and skeletal abnormalities.80 In utero exposure to valproate, the most teratogenic AED, was associated with elevated risk of impaired cognitive function for children at 3 years of age, and reduced cognitive abilities for children at 6 years old.98,101 However, study results for many medications, such as antidepressants, opioids, antipsychotics, and antibiotics, are inconsistent for fetal safety.[1*-8*] The limited data source and rare incidence of birth defects, ACNBs, and other anomalies restrain the study power, and makes some studies inconclusiv e.8-10 Our long term goal is to determine the association between teratogenic effects of medications that mothers exposed during pregnancy and infants birth defects. The major objective of this study is to build a linked database in Rhode Island (RI) to facilitate the subsequent research on teratogenic effects of medication in RI population. The birth defects and birth certificates data from the Department of Health (DoH) and pharmacy claims from the Medicaid program offer an essential resource to investigate these aims. The availability of hospital diagnoses and birth records offers a significant advantage for investigating birth defects with corresponding clinical conditions in large population with a longitudinal approach. Our team is well suited to conduct this research given extensive expertise in contemporary pharmacoepidemiology, many years of experience on drug safety research, prior drug utilization and birth defects study with the linked data from another state, and clinical expertise from obstetric and gynecologic physicians. Our specific aims are to generate a linked data and investigate the medication utilization and assess the corresponding birth defects with the following efforts: Aim 1: To build a linked database that includes mothers medications prescribed during pregnancy and subsequent adverse perinatal outcomes. We hypothesize that the data from two state departments can be internally linked using identifiers. Mothers medication prescriptions will be extracted from Medicaid claims provided by the RI Executive Office of Health Human Services (EOHHS). The adverse perinatal outcomes include: MCMs, MAs, abnormal conditions of new born, fetal death, and low birth weight, and maternal adverse pregnancy and obstetrical complications. All of these outcomes will be obtained from birth certificates, institutional and professional claims that are collected and managed by RI Department of Health (DoH). These two parts of data will be linked by the deterministic or probabilistic linking strategy using mothers medical record number, name, and date of born. We will apply for IRB approval with a waiver of informed consent by RI DoH, EOHHS, Brown, and URI. Aim 2: To characterize the patterns of medication use in women during pregnancy. We hypothesize that medication use in women during pregnancy changes in recent years. Many medications, such as AEDs, statin, or angiotensin converting enzyme (ACE), have been classified as teratogens and categorized as D or X by the Food and Drug Administration (FDA). However, studies have found that these teratogenic drugs still have been prescribed to pregnant women.5-7 Some medications with contradictive results reported from the literature may have increased use in pregnant women. We will examine the prescribing patterns of these medications in pregnant women with varied age, race, comorbidities, co-medications, as well as medication types and doses. The utilization pattern will be delineated in secular trends and mapped geographically, as will facility, provider, and state-level variations. Aim 3: To assess infants birth defects and birth anomalies using advanced statistical model. We will identify all corresponding birth defects, including MCM, MA, LBW, ACNB, DDD, preterm birth, and fetal death and compare the birth defect rates in mothers with varied demographic characteristics and medication exposure. Previous studies have suggested that the LVM can be used to combine four specific birth defects together to create a severity index.16-18 We hypothesize that this LVM can be improved and optimized to combine any number of components with a proper weight on severity and frequency to evaluate the overall health status of infants. B. Significance and Innovation Birth defects occur in 3 5% of children born in the United States and account for 20% of all infant deaths.1,2 During 2010-2012, RI DoH identified 1,390 newborns with at least one birth defect.3 The rate of birth defects in RI increased by 14.2% from 2008 to 2012.3 It was reported that 2-3% of birth defects are due to teratogen-induced malformations, which refer to malformations resulting from environmental or in utero exposure to teratogens.4 In the United States, about 3 million people currently live with teratogen-induced malformations.4 The FDA defined the pregnancy category to enforce the labeling of drugs with respect to their effects on pregnant women. Some medications, such as AEDs, statin, or ACEs, have been classified in FDA pregnant category D or X due to their teratogenic effects. Previous studies reported a two- to three-fold increase in the malformation rate among infants with in utero exposure to AEDs.21,22,81,82 The incidence rates in infants with in utero exposure to AEDs were 3.1% to 9.0% for MCMs, 37% for one MA, and 11% for two MAs.21,80-83 The risk of malformations for infants with in utero exposure to valproate is 7.3-fold higher than that of non-exposed, and 4-fold higher than those exposed to all other AEDs.7 Some widely used medications, such as antidepressants, opioids, antipsychotics, and antibiotics, tend to have increased utilization in pregnant women while the results from teratogenic studies are controversial and inclusive.[1*-8*] It is difficult to distinguish between the real non-inferior results and power deficiency owing to rare outcomes. It has led to an urgent need to determine the fetal safety of these medications and prevent teratogenic medications prescribing to pregnant women. However, the limited data source and rare incidence of birth defect outcomes impact the study power, and makes studies inconclusive.8-10 Traditional claims data (data from Medicaid or private health plans) is not suitable for birth defect research as it only contains medical information for either mother or infant, not both. Birth certificates or birth defects data doesnt include mothers medication information. As such, to investigate utilization patterns and teratogenic effects of medications, we need to link mothers pharmacy claims with infants birth defects assessments. The linkage should be conducted in a secure data server with patients identifiers. The main goal of this proposed one-year pilot study is to collaborate with the RI EOHHS and RI DOH and generate a linked statewide dataset that includes mothers pharmacy claims and infants birth defect outcomes. This linked dataset will facilitate the researchers in Brown and URI to conduct studies regarding drug-induced birth defects in RI and provide a potential for combining RI linked data with the linked data from other states to conducting drug teratogenic studies in large population. Innovation This proposed study will generate a linked data with combining Medicaid pharmacy claims from the RI EOHHS and birth certificates and birth defects from the RI DOH. This would make RI become the fourth state that possesses the linked mother-infant data in the United States, besides California, Texas, and Florida. Our approach will provide a large linked dataset to facilitate the researchers from URI and Brown to conduct drug-induced birth defects studies. This linked dataset will provide a potential for future drug teratogenic research in large population with combining the RI linked data with the linked data from other states. Our approach will employ state of the art, innovative pharmacoepidemiologic study designs and statistical models, to improve the study power and efficiency. A latent variable model will be employed in this study to combine all birth defects outcomes into a continuous severity score to assess the overall infants morbidity and mortality. C. Approach Data Sources This study is based on a statewide, retrospective 11-year data sources: RI birth certificates and birth defects from January 1, 2006 to December 31, 2016. In Rhode Island, birth certificates are collected in the hospital within 24 to 48 hours after the baby birth. The RI DoH collects and manages birth certificate data for all infants born in RI. Birth dates and places for infants, and demographic characteristics for infants, mothers, and fathers are all recorded in birth certificates. The RI Birth Defects dataset consists of birth defects registry data prepared and maintained by RI DoH. Infant birth defects, including MCMs and MAs, were identified 0-365 days after live birth from hospital inpatient and outpatient claims. This study includes infants who were born in RI between January 01, 2006 and December 31, 2016. Medication information will be provided by the RI EOHHS. The data is comprised of eligibility, medical, and pharmacy claims for services from inpatient hospitals, outpatient clinics, emergency rooms, and pharmacies from January 01 2005 to December 31 2016. Brief demographics for enrolled members are included in Medicaid claims data, such as age, gender, race, residency, etc. Medicaid claims data do not include claims for managed care or Medicare enrollees. We excluded patients with dual eligibility, and thus restricted the drug exposure cohort to pregnant women who were only in the fee-for-service or primary care case management program. Each data source will be cleaned first, and then linked with other corresponding datasets using a multi-step linkage approach in which three methods of linkage are applied in sequence Deterministic, Fuzzy Matching, and Probabilistic.156 Records will be first matched deterministically, based on exact matches of unique combinations of personal identifiers including Social Security Numbers, Date of Birth, and Mothers Names (used for the linkage of BVS to Medicaid only). Records that cannot be exactly matched due to missing or poor data quality will be linked using Fuzzy Matching.156,157 Fuzzy Matching allows at least one occurrence of Social Security Number digit transpositions, name misspelling, or day or month errors in birth date fields.157 Remaining unmatched records will be linked using probabilistic techniques, based on statistical weighting of combinations of personal identifiers. Probabilistic linkage involved a two-step process. 1) Deterministic matching from the first merging step empirically derived weights to the non-missing fields based on successful linkages. 2) After the unlinked data matched with several records by weights, the matches with the highest statistical probability (indicating by high weights) will be chosen. The record remained unmatched when no high weights could be obtained. Study Cohort This study includes female Rhode Island Medicaid enrollees who were older than 15 years of age, delivered a live singleton infant between January 01, 2006 and December 31, 2016, and are enrolled in the Medicaid program as identified by pregnancy status. The study cohort of mother-infant pairs will be generated by linking the Rhode Island Medicaid claims data and Rhode Island Birth defects data using strategies described above. Many women joined the Medicaid program after becoming pregnant. We excluded the women who were enrolled in Medicaid program after a positive pregnant test. More exclusion criteria for maternal-infant pair include: mothers with less than 6 months of Medicaid eligibility before pregnancy; mothers who lost Medicaid eligibility during pregnancy; mothers with dual enrollment with Medicare, HMO, or other private health plans; mothers giving multiple births; mothers with diabetes mellitus (ICD-9-CM: 249.x, 250.x, 790.29, or used of any antidiabetics during baseline), hypertension (ICD-9-CM: 401.x, 416.x, 796.2, , 997.91, 459.3, or used of any antihypertensive drugs during baseline), or HIV pre-pregnancy (ICD-9-CM: 042, 079.53, V08, V01.79, 795.71, or used of any antiretroviral drugs); Infants who were twins, triplets, quadruplets or more; outliers involving infants with birth weight less than 350 g or above 6000 g; mothers or infants missing critical information, such as infants birth weigh t, mothers demographic information, or perinatal medical information. Only less than 1% of infants are missing birth weight records in the birth certificate, these will be excluded from the study.20 Overall Study Design This is a retrospective cohort study based on linked mothers Medicaid claims and state birth registry data. The infants birth date will be the study index date. The drug exposure window will be defined as the subsequent 9-month pregnancy period after the first day of mothers last menstrual date. We will use a 6-month baseline period prior to the first date of mothers last menstrual date to obtain the baseline demographic and clinical information. Birth defect outcomes will be detected 0-365 days after the live birth. The entire study period lasts from January 01 2005 to December 31 2016. Drug Exposure Pharmacy claims in Medicaid have been approved as an accurate source for the assessment of drug exposure in observational studies.158 Mothers medication exposure during pregnancy will be obtained from Medicaid pharmacy claims using NDC codes for filled prescription medications, and the number of days for which the medication is supplied.160 The birth anomalies are associated with exposure during entire pregnancy, MCM relates to the teratogen exposure during the first trimester, and MA and LBW associates with the maternal medication exposure at the third trimester.161 Maternal medication exposure during entire pregnancy period can affect the occurrence of varied birth defects. The exposure window, thus, will be established as a period of 14 days prior to the first day of the mothers last menstrual period (LMP) to the date when infant is born. The drug exposure will be defined as any one dose of study medications dispensed during the exposure window, including which the medication is d ispensed before the exposure window but its supply days cover at least 1 day of the exposure window. Adding 14 days prior to the pregnancy is to include the conception period and the residual effects of medications. Sensitivity study will be conducted to examine the different definitions of medication exposure windows. The mothers LMP will be obtained from birth certificates. If the dates are not available in birth certificates (about 13% of LMP in birth certificates are missing), then this information will be imputed from clinical estimates.163-165 The literature suggests that LMP from birth certificates and clinical estimates agrees within 2 weeks.166 Outcome Assessment In this study, we will identify all individual adverse infant outcomes: birth defects (involving MCM and MA), ACNB, LBW, DDD, and preterm birth from the DoH birth defects data. MCM is defined as an abnormality of an essential anatomic structure that is present at birth and interferes significantly with function and/or requires major intervention.38,39 MCM includes heart malformations, urological defects, oro-facial defects, neural tube defects, and skeletal abnormalities, etc..38,40,41 Drug-induced MCMs mostly occur between the third and eighth week of gestation.44 Any impairment before three weeks is more likely to result in fatality. The fetus becomes less sensitive to teratogenic effects after the eighth week, when the organs have developed. 2-1 delineates the time window of exposure to teratogens and associated MCMs and MAs.44 MA, also called minor congenital malformations, is the abnormal morphologic feature that does not cause serious medical or cosmetic consequences45. Identification of MA can be difficult due to the definition and the easy-variable occurrence area.46 Approximately 70% of MAs occur on the face or hands.46 The prevalence of MA is less than 4% in the general population, and varies by race, ethnicity, and gender.45,46 In healthy newborns, about 15% to 20% have one MA, 0.8% have two MAs, and 0.5% have three or more MAs.46 MA mostly occurs after the eighth week of gestation, which is so-called fetal period.44 The use of teratogens during this period may induce MAs by disturbing the growth of tissues or organs.44 ACNB includes seven medical conditions for new born infants. Infants birth weight less than 2500g, 1500g, and 1000g are categorized respectively as low birth weight (LBW), very low birth weight (VLBW), and extremely low birth weight (ELBW). Infants with low birth weight are likely to be born before 37 weeks of pregnancy. In 2009, 8.16% of live born infants showed low birth weight.50 The high risk of infant mortality and morbidity associated with low birth weight has been documented.51 Although this positive association has been ameliorated over time with improved perinatal technology and intensive care, low birth weight and prematurity still have been identified as risk factors predisposing to cardiovascular dysfunction, lung disorder, hypertension, type 2 diabetes, renal diseases, autism, and developmental delay.52-56 MCM, MA, DDD, and fetal death will be collected from birth to the first 365 days of life using the ICD-9 CM code (740-759.9, 315, 768.0, 768.1) from inpatient and outpatient claims. ACNB and preterm birth will be identified from Rhode Island birth certificatedata, and one year follow ups in infant hospital discharge data. Infant birth weight is accurately recorded in the birth certificate.19 It was noted in previous studies that these birth defects outcomes are highly related to each other.59,70-75 MCM, MA, VLBW, and ELBW relate to significant morbidity, mortality, and childhood disability or serious pregnancy or obstetric complications. 58,70-75 About 6-42% of evolving cognitive dysfunction, 9-26% of neurosensory disabilities, 1-15% of blindness, and 0-9% of deafness occurred in infants born with VLBW and ELBW.71 A significantly higher risk of DDD was found in infants born with MCM (prevalence rate: 8.3, 95%CI: 7.6-9.0).72 A 44% 86% of mortality rate occurs in infants with ELBW (500-750g).73 Moreover, infants with 1, 2, or 3 MAs had a risk rate of corresponding MCMs at 3%, 10%, or 20%, respectively.46 Some risk factors, such as infant gender, maternal age, race, social-economic status, BMI, smoking, alcohol use, nulliparity, comorbidity, and comedication during pregnancy are risk factors for all of these outcomes.75-78 Latent Variable Model Liu and Roth developed an LVM to incorporate four important BD outcomes into a single measurement, the infant morbidity index, to describe an infants overall tendency to BD.13 We will apply this model to combine all birth defects outcomes defined in this study into a continuous index of overall adverse perinatal outcome (APO) in this study. The combined outcome will be evaluated in terms of validity and reliability to ensure the appropriate use of this new methodology. MCM, MA, ACNB, Fetal Death, and DDD will be categorized as a binary variable, and assumed Bernoulli distributed.21 Four levels of LBW will be modeled as a multinomial variable since the four birth weight categories are mutually exclusive and each has its own probability. The summation of the individual probabilities of birth defects outcomes equals one. The unobserved index score will be assumed log-normally distributed. Based upon the assumption of local independence, responses of individual component outcomes are independent given the latent variable.22,23 Thus, the overall probabilities of component outcomes conditional on the latent variable are equal to the products of conditional probability for each individual component outcome.21 Based on the local independence and Bayes rule, the joint distribution for component outcomes can be expressed as an integral of product of multinomial variable for conditional distribution of each component outcome and marginal distribution of latent variable.22-24 Marginal distribution of the latent variable is described as log normal. Given the observed outcomes, we can obtain the posterior distribution of the latent severity score. Furthermore, we assume that the conditional distribution of each categorical observed outcome is nonlinear function of the latent variable.13 The conditional distribution of observed outcome and the latent variable will be linked by two parameters in the non-linear function.The probability of any specific observed outcome equals to 0 when the value of the latent variable equals to 0 because the latent variable accounts for all variation of the observed component outcomes and the relationship among these component outcomes.13 In the non-linear function, the probability of an infant having an individual birth defect outcome is assumed zero if the latent variable is zero, and every normal level (no birth defect or normal weight) will be treated as a reference. The latent variable positively associates with observed outcomes. The larger the latent variable, the higher the probability of the observed outcome.13 Latent Trait Model will be conducted using SAS Proc IML. The proportion of each outcome combination will be calculated. Then each parameter will be estimated using the iteration function for EGNLS starting from iteration 0 with initialized value until the stepping coefficient is less than 10-9. The final results are the estimates of all parameters. The estimate of latent variable will be obtained by entering the computed parameters into posterior function.13 Sensitivity Studies In order to examine the proper definition of exposure window, sensitive studies will be conducted with the exposure window defined as the period of 3, 7, 21, or 30 days prior to the first day of the mothers LMP to the infants birth date. D. Timeline Table. Study Timeline of the Study. Time Period Study Progress Before 07/01/2017 Obtain IRB approval from URI, Brown, RI DoH, and RI EOHHS. Complete DUA with RI DoH and RI EOHHS. 07/01/2017 08/01/2017 Complete data linkage for specific aim 1 08/01/2017 10/01/2017 Complete data cleaning, manipulating, variable editing, and analyses for demographic and clinical characteristics 10/01/2017 01/31/2018 Complete specific aim 2 02/01/2018 02/28/2018 Submit an abstract to the annual meeting of International Society of Pharmacoepidemiology (ISPE) 03/01/2018 06/30/2018 Complete specific aim 3 and submit a journal article

Hallucinogens :: essays research papers fc

Hallucinogens or psychedelics are mind-altering drugs, which affect the mind’s perceptions, causing bizarre, unpredictable behavior, and severe, sensory disturbances that may place users at risk of serious injuries or death. Hallucinogens powerfully affect the brain, distorting the way our five senses work and changes our impressions of time and space. People who use these drugs a lot may have a hard time concentrating, communicating, or telling the difference between reality and illusion. Hallucinogens cause people to experience - you guessed it - hallucinations, imagined experiences that seem real. The word "hallucinate" comes from Latin words meaning, "to wander in the mind." Your brain controls all of your perceptions; the way you see, hear, smell, taste, and feel. Chemical messengers transmit information from nerve cell to nerve cell in the body and the brain. Your nerve cells are called neurons, and their chemical messengers are called neurotransmitters. Chemicals like hallucinogens can disrupt this communication system, and the results are changes in the way you sense the world around you. There's still a lot that scientists don't know about the effects of Hallucinogens on the brain though. Some hallucinogens occur naturally in trees, vines, seeds, fungi and leaves. Others are made in laboratories by mixing different chemical substances. LSD or acid is one of the most common, well-known hallucinogens. Psilocin or Psilocybin mushrooms, Mescaline or Peyote, MDMA, Bufotenine, Morning Glory seeds, Jimson weed, PCP and DMT are less common psychedelics with effects similar to LSD. PCP and Ketamine are drugs with hallucinogenic properties. Some drugs, such as cannabis, can cause hallucinogen-like effects when used in high doses or in certain ways. Using hallucinogens is often called tripping. In its pure form LSD is a white, odorless powder. This pure form is very strong, so LSD is usually mixed with other things to make the dose large enough to take. LSD comes in the form as liquids, tablets, capsules or squares of gelatin or blotting paper. LSD use can have many effects. These may include sleeplessness, trembling, and raised heart rate, and blood pressure. LSD users may feel several emotions at once (including extreme terror), and their senses may seem to get crossed, giving the feeling of hearing colors and seeing sounds. Even a tiny speck of LSD can trigger these effects. Many LSD users have flashbacks; sudden repetitions of their LSD experiences, days or months after they stop using the drug.

Speech on Powerful Nature of Books :: essays research papers

I'd like all of you to raise your hand if you have read a book. You may be wondering what I am doing, but I wanted to show you something. I wanted to show you how many people have read books. These people don?t always fit into one category. They may be young, they may be old, rich, poor, and even education levels differ. Books range in topics from sports to science fiction to western. At one point or another in our lives, we were probably captivated by the words or picture on the sleek pages. If that is the case for you, then you, my friend have experienced the immense power of books. You all know that books can give hope to a hopeless soul, and they can give one wisdom and intelligence. Maybe you have been feeling down, and in your angry state, for some reason or another decided to pick up a book. While tearing through the pages, you may have seen a glimmer of hope. Gary Paulsen, the well published author shared an experience when books gave him hope. He was a young kid, 10 years old, and just transferred from the Philippines to a public school in Washington D.C., He dropped his coat off in the in-room coat room, and was so frightened that he simply could not move. The teacher noticed this and went back into the room with him. She brought a book with a horse on the cover and let him turn the pages. This enabled him to interact with the book. When the teacher felt he was ready, she asked him if he wanted to come out. He agreed, and she held is hand as he was led into the classroom, to his seat. Paulsen?s story was just one of many stories of how books instilled hope in someone. Books gave Paulsen an escape from his drunken, screaming parents, gave him a plac e where he could be free from school bullies. Whether a book makes you go from a rage, to just a little sad, or from sad to happy, books can give one person hope. Books can do more than provide hope. Books, as you would expect, can give someone intelligence and wisdom. While, Paulsen was a young thirteen year old living in the a Minnesota town, he was selling newspapers to drunks, trying to scrounge up some extra cash to buy nicer clothes to fit in with the popular kids in school.

Levi’s Swot Analysis

TABLE OF CONTENTS 1. EXECUTIVE SUMMARY—————————————————————- 2. CURRENT SITUATION—————————————————————— 2-1-Strategic Posture 2. 2. Current Performance 3. CORPORATE GOVERNANCE——————————————————– 3-1-Board of Directors 3-2-Top Management 4. EXTERNAL ENVIRONMENT ANALYSIS—————————————— 4-1-Societal Environment 4-2-Task Environment 5. INTERNAL ENVIRONMENT ANALYSIS————————————— — 5-1-Corporate Structure -2-Corporate Culture 5-3-Corporate Resources 6. ANALYSIS OF STRATEGIC FACTORS —————————————— 7. STRATEGIC ALTERNATIVES AND RECOMMENDED STRATEGY — 7-1-Review of Mission and Objective 7-2-Strategic Alternatives and Recommended Strategy 8. CONCLUSION—————————————————————————- BIBLIOGRAPHY————————————————————————- 1. EXECUTIVE SUMMARY 2. CURRENT SITUATION Levi Strauss & Co. s a privately held American clothing company known worldwide for its Levi's brand of denim jeans. The core Levi's was founded in 1873 in San Fr ancisco, specializing in riveted denim jeans and different lines of casual and street fashion. Levi Strauss received a U. S. Patent to make the first riveted men's work pants out of denim: the first blue jeans. The company briefly experimented (in the 1970s) with a public stock listing, but remains owned and controlled by descendants and relatives of Levi Strauss' four nephews. Levi Strauss & Co. s a worldwide corporation organized into three geographic divisions: Levi Strauss Americas (LSA), based in the San Francisco headquarters; Levi Strauss Europe, Middle East and Africa, based in Brussels; and Asia Pacific Division, based in Singapore. The company employs a staff of approximately 11. 400 people worldwide. 2. 1 STRATEGIC POSTURE Vision and Core Values Levi’s believes that business can drive profits through principles, and that core values as a company and as individuals give the company a competitive advantage. Empathy — walking in other people’s shoes Empathy begins with paying close attention to the world around. Levi’s listens and responds to the needs of customers, employees and other stakeholders. Originality — being authentic and innovative The pioneering spirit that started in 1873 with the very first pair of blue jeans still permeates all aspects of the business. Through innovative products and practices, the company breaks the mold. Integrity — doing the right thing Integrity means doing right by the employees, brands, company and society as a whole. Ethical conduct and social responsibility characterize company’s way of doing business. Courage — standing up for believes It takes courage to be great. Courage is the willingness to tell the truth and to challenge hierarchy, accepted practice and conventional wisdom. It means standing by Levi’s convictions and acting on beliefs. Levi’s is the embodiment of the energy and events of time, inspiring people from all walks of life with a pioneering spirit. Generations have worn Levi’s jeans, turning them into a symbol of freedom and self-expression in he face of adversity, challenge and social change. Customers forged a new territory called the American West. They fought in wars for peace. They instigated counterculture revolutions. They tore down the Berlin Wall. Reverent, irreverent — they took a stand. 2. 2. CURRENT PERFORMANCE For its first 100 years, Levi Strauss & Company was a private company. Relatives of founder Levi Strauss owned nearly all the stock, and company employees owned most of the remaining shares. In 1971, the company went public to finance growth and diversification. However, in 1985, the company again went private, which it remains today. In September 2004, Levi Strauss announced plans to sell its Dockers casual-clothing brand to Vestar Capital Partners (a private equity fund) and an apparel industry executive for about $800 million. Selling the Dockers brand would have allowed the company to reduce its heavy debt and refocus attention on turning around the Levi brand. However, the company soon changed its mind and chose instead to reinvest in and revitalize the popular Dockers brand. Recently the company produces only for men under Dockers brand. Its products are sold in more than 110 countries worldwide through a combination of chain retailers, department stores, online sites, and franchised and company-owned stores. As of August 28, 2011, the company operated 499 stores within 31 countries. Levi Strauss & Co. ’s reported fiscal 2010 net revenues were $4. 4 billion. Regional net revenues for the quarter were as follows: The reported net revenues increase in Europe was due to currency; net revenues were down on a constant-currency basis. Gains from the expansion of the company-operated retail network and the continued success of the Levi’s Curve ID collection for women were more than offset by declines in the wholesale business. Revenue growth in Asia Pacific, primarily driven by the Levi’s brand and continued expansion of the company’s brand-dedicated retail network in China and India, offset the revenue decline in Japan. Cash Flow and Balance Sheet As of August 28, 2011, cash and cash equivalents were approximately $231 million, and $337 million was available under the company’s revolving credit facility. Cash provided by operating activities during the nine-month period in 2011 was $17 million, compared with $96 million for the same period in 2010; the decline reflected higher inventories, due primarily to the increased cost of cotton, increased selling, general and administration expenses and increased pension plan contributions. Net debt was $1. 75 billion as compared to $1. 6 billion at the end of 2010. 3. CORPORATE GOVERNANCE 3. 1Board of Directors Fernando Aguirre, a director since July 2010, is currently Chairman of the Board, President and Chief Executive Officer of Chiquita Brands International, Inc. a position he has held since 2004. From 2002 to 2004, Mr. Aguirre served as President, Special Projects for The Procter & Gamble Company (P&G), a manufacturer and distributor of consumer products. From 1980 to 2002, he served P&G in various capacities, including in an executive capacity with P&G's Global Snacks and U. S. Food Products business. Mr. Aguirre is also a director of C oca-Cola Enterprises, Inc. Chip Bergh, a director since September 2011, is the President and Chief Executive Officer. He joined the company in September 2011. Prior to joining Levi Strauss & Co. , Mr. Bergh was Group President, Global Male Grooming, for The Proctor & Gamble Company (P), a manufacturer and distributor of consumer products. During his 28-year career at P, he served in a number of leadership positions. Mr. Bergh previously served on the Board of Directors for VF Corporation and on the Economic Board, Singapore, and was a member or the US-ASEAN Business Council, Singapore. Vanessa J. Castagna, a director since 2007, led Mervyns LLC department stores as its executive chairwoman of the board from 2005 until early 2007. Prior to Mervyns LLC, Ms. Castagna served as chairman and hief executive officer of JC Penney Stores, Catalog and Internet from 2002 through 2004. She joined JC Penney in 1999 as chief operating officer, and was both president and Chief Operating Officer of JC Penney Stores, Catalog and Internet in 2001. Ms. Castagna is currently a director of SpeedFC and Carter’s Inc. Robert A. Eckert, a director since May 2010, is currently Chairman of the Board and Chief Executive Officer of Mattel, Inc. , a position he has held since May 2000. He previously worked for Kraft Foods, Inc. for 23 years, most recently as President and Chief Executive Officer from October 1997 until May 2000. From 1995 to 1997, Mr. Eckert was Group Vice President of Kraft Foods, Inc. and from 1993 to 1995, Mr. Eckert was President of the Oscar Mayer foods division of Kraft Foods, Inc. Robert D. Haas, a director since 1980, was named Chairman Emeritus in February 2008. He served as Chairman of the Board from 1989 until February 2008. Mr. Haas joined Levi’s in 1973 and served in a variety of marketing, planning and operating positions including serving as our Chief Executive Officer from 1984 to 1999. Peter E. Haas Jr. , a director since 1985, is a director or trustee of each of the Levi Strauss Foundation, Red Tab Foundation, Joanne and Peter Haas Jr. Fund, Walter and Elise Haas Fund and the Novato Youth Center Honorary Board. Mr. Haas was one of the managers from 1972 to 1989. He was Director of Product Integrity of The Jeans Company, one of the former operating units, from 1984 to 1989. He served as Director of Materials Management for Levi Strauss USA in 1982 and Vice President and General Manager in the Menswear Division in 1980. Leon J. Level, a director since 2005, is a former Chief Financial Officer and director of Computer Sciences Corporation, a leading global information technology services company. Mr. Level held ascending and varied financial management and executive positions at Computer Sciences Corporation from 1989 to 2006 and previously at Unisys Corporation (Corporate Vice President, Treasurer and Chairman of Unisys Finance Corporation), Burroughs Corporation (Vice President, Treasurer), The Bendix Corporation (Executive Director and Assistant Corporate Controller) and Deloitte, Haskins & Sells (now Deloitte & Touche). Mr. Level is also currently a director of UTi Worldwide Inc. Stephen C. Neal, a director since 2007, became Chairman of the Board in September 2011. Mr. Neal is currently the chairman of the law firm Cooley LLP. He was also chief executive officer of the firm until January 1, 2008. In addition to his extensive experience as a trial lawyer on a broad range of corporate issues, Mr. Neal has represented and advised numerous boards of directors, special committees of boards and individual directors on corporate governance and other legal matters. Prior to joining Cooley LLP in 1995 and becoming CEO in 2001, Mr. Neal was a partner of the law firm Kirkland & Ellis. Patricia Salas Pineda, a director since 1991, is currently Group Vice President, National Philanthropy and the Toyota USA Foundation for Toyota Motor North America, Inc. an affiliate of one of the world’s largest automotive firms. Ms. Pineda joined Toyota Motor North America, Inc. in September 2004 as Group Vice President of Corporate Communications and General Counsel. Prior to that, Ms. Pineda was Vice President of Legal, Human Resources and Government Relations and Corporate Secretary of New United Motor Manufacturing, Inc. wi th which she was associated since 1984. She is currently a director of the Congressional Hispanic Caucus Institute and a mem ber of the board of advisors of Catalyst. 3. 2 Top Management in Turkey Hakan Atalay is the general manager of Levi’s Turkey since 2008. He graduated from Textile Engineering Department from Istanbul Technical University and he also has a graduate degree from the Management Department of Marmara University. He has a 16 years of experience in retail, sales and product management in local and multinational companies like Mexx Turkey, Network and Unitim. Lately he was the country sales director of Nike Turkey. He is now responsible for the management of Levi’s and Dockers brand operations and for the development of strategic vision of those brands in Turkey. Kayhan Ongun is the sales director of Levi’s Turkey since 2010. He graduated from Management Engineering Department from Istanbul Technical University and he has a Management of Business Administration degree from Rowan University. He worked at various sales positions in Michelin and Nike Turkey. Lately he was Football Sales Manager in Nike Turkey. Korhan Oz is the finance manager of Levi’s Turkey. Korhan Oz is a graduate of Istanbul University Department of Economics. He has in particular substantial experience in finance. He worked as Country Financial Controller at Ernst Audit, Intergen and Nokia and then worked as Executive Vice President for Financial Affairs at Krea Group. Orhan Ors is the Information Technology Director of Levi’s Turkey. He has been working for Levi’s for 22 years. Ozan Duman is the Human Resources Director of Levi’s Turkey since 2011. Lately, he was HR Manager of Kimberly Clark Turkey. Ipek Bekiroglu is the Marketing Manager of Levi’s Turkey since 2006. Lately, she was working as a Brand Manager in Carslberg Turkey. 4. EXTERNAL ENVIRONMENT ANALYSIS: OPPORTUNITIES AND THREATS 4. SOCIETAL ENVIRONMENT Socio-cultural Turkey has the youngest population in Europe with 31M under 25 and the population growth rate is 1. 35%. Life style changes heavily affect trends in casual apparel design and market. Being thin and skinny creates a trend in the market where skinny and tight jeans dominate the market. Economic There is a shortage in cotton supply in the world combined with high cotton prices due to several important factors: First, global stocks of cotton were drawn down sharply as less cotton was grown and shipped through the global supply chain due to competition from other crops. Second, climate changes and bad weather undermined global cotton production. Thirdly, government actions further aggravated the situation where India, one of the world’s largest cotton producers, slapped export quotas on raw cotton. And finally, demand for textiles and apparel rose. Retail landscape is evolving with the opening of many new malls and locations. In addition street store rents are increasing, so brands are investing on shopping malls in primary and secondary cities. In line with this development, traditional outlet stores on the highway breakpoints have been converted to outlet malls. Extended seasonal sale months, attractive promotions are offered throughout the year. There is high investment cost on one hand; as the average shop size is growing, rents are getting higher. On the other hand however, shopping malls have made significant discounts in their rents or currency rates have been fixed due to global crisis. Technological E-commerce is getting more popular with private shopping concept. (Trend-Yol, Markafoni and Limango are the main players in Turkish Market. ) Social media has a narrow effect right now but it is increasingly becoming a part of ompanies’ marketing strategies. Political legal There is continuous financial instability in Turkey that strongly affects the spending power of Turkish people. Income difference between regions is dramatic in Turkey which affects the spending power. However, lower income classes’ and regions’ spending is increasing. Environmental standards and regulations against hazardous jeans production are in creasingly applied by many countries and companies (The blue dust that stems while sanding jeans is a heavy irritant to the lungs). In the European Union, the Registration, Evaluation, Authorization and Restriction of Chemicals (REACH) regulations enacted 1 June 2007 require clothing manufacturers and importers to identify and quantify the chemicals used in their products. These regulations may even require manufacturers to inform consumers about potentially hazardous chemicals that may be present in their products. Actual end products are governed by stipulations of the European Equipment and Product Safety Act, which regulates the use of heavy metals, carcinogenic dyes, and other toxics used in textile manufacture. Additional consumer protection is offered by the European Union’s Oko-Tex Standard 100, a testing and certification program established in 1992. The standard gives the textile and clothing industry uniform guidance for the potential harm of substances in raw materials as well as finished products, and every stage in between—these include regulated substances as well as substances that are believed to be harmful to health but are not yet regulated (such as pesticides). The standard also governs elements such as colorfastness and pH value. Along with these standards, Levi Strauss and Co. Turkey does not produce jeans with sanding. 4. 2TASK ENVIRONMENT Rivalry among existing firms There is a heavy weight of local players in Turkish casual apparel market. Local retailers like Mavi, LC Waikiki, Colin’s, LTB (Little Big) have their own denim production facilities so that they can sell with reasonable prices. This fact that the competitors have low entry prices makes â€Å"price† the main differentiator. International and local brands are investing in key cities and key locations. (Zara, Mango, Adidas, Nike, Mavi, Colin’s). In addition, local competition is investing on O stores which are bigger than 200 sqm. Mavi was acquired by Turkven (private equity fund) with 35% share in 2008. The company has aggressive revenue targets and invests heavily in ATL communication. The company is focusing on head to toe look and as a result of this approach, their women and tops share increased. Colin’s is re-vamping the brand identity launched a new logo. The company focuses on O (owner and operator) model. In accordance with this approach, they re-fit O stores in major shopping malls. Lee is losing ground, they have no presence in stand alone stores, and they focus on department stores. LTB is re-fitting their O stores in premium shopping malls. Diesel has not been aggressive in communication for a long period. Jack & Jones is entering department stores. Grey market is an important factor that has a huge impact in the competition. The high number of grey market producers impacts the competition between the existing firms as especially the local denim producers try to differentiate themselves by price. Threat of new entrance New brands entered the market (H- 5 stores in 5 months) whereas local brands have elevated their retail environment to attract the young consumer. A will be opening their first store in Turkey in 2012. EFAS TABLE External FactorsWeightRatingWeighted ScoreComment SROpportunities O1Turkey’s young population 0. 103. 00. 3 O2E-commerce and social media; new distribution channel0. 053. 00. 15 O3Malls; increasing number of shopping malls0. 105. 00. 5 O4Seasonal sale months extension, attractive promotions0. 04. 00. 4 O5Life style changes; new products0. 104. 00. 4 O6Environmental standards and regulations0. 052. 00. 1 Threats T1Financial instability0. 105. 00. 5 T2Grey market0. 103. 00. 3 T3High operational costs (O)0. 104. 00. 4 T4Marketing investments of the local brands0. 054. 00. 2 T5Increasing number of new competitors0. 053. 00. 15 T6Low cotton supply and high cotton prices0. 105. 00. 5 Total1. 003. 9 5. INTERNAL ENVIRONMENT ANALYSIS: STRENGTHS AND WEAKN ESSES 5. 1CORPORATE STRUCTURE The worldwide leadership team, which includes the CEO and ten executives, sets the company’s overall direction and is responsible for all major strategic, financial and operational decisions. Many of the senior-most leaders have risen through the company ranks over the past two or three decades. But to maintain the lead in the fast-changing fashion industry Levi’s leadership team also includes executives who bring leading-edge expertise and new ideas from other consumer companies and other industries. Levi Strauss Co. as a corporation has operations divided under three main regions: Asia Pacific, Europe and America. The company has headquarters in Singapore, Brussels and San Francisco. Every region is under the management of a Vice President. Country General Managers are directly reporting to their respective Regional Vice Presidents. In Turkey, human resources, information technology and finance departments are directly reporting to their respective region and they are indirectly reporting to Turkish General Manager. However, sales and marketing departments are directly reporting to Turkish General Manager and they are indirectly reporting to their respective region. Retail Operations and Sales Manager and Wholesale Sales Manager are directly reporting to Sales Director. Retail Operations and Sales Manager manages four District Managers and Wholesale Sales Manager manages three Account Managers in Turkey. 5. 2CORPORATE CULTURE Levi Strauss & Company as a multinational company embodies its vision that has four main values at the core: empathy – walking in other’s shoes; originality – being authentic and innovative; integrity – doing the right thing; and courage – standing up for what they believe. In addition to guiding the strategic decisions and actions, the company’s values also guide its social responsibility in various ways – through the grants provided by the Levi Strauss Foundation, through the support provided to communities in which it has a business presence, through its employee community-involvement program, and through its ethical code of conduct for its business partners. The company’s strategic move to outsourcing has presented its own challenges because of Levi Strauss’ strong commitment to socially responsible business practices. In 1991, Levi Strauss became the first multinational company to establish a comprehensive ethical code of conduct for its alliance partners in manufacturing and finishing. This code, titled the Global Sourcing and Operating Guidelines, establishes business practices such as fair employment, worker health and safety, and environmental standards. The company remains committed to ensuring compliance with its â€Å"Code of Conduct† at all facilities and works onsite with its contractors to develop responsible business practices and continuous improvement. Trained inspectors closely audit and monitor the contractors and if it is determined that a business partner is not complying with the terms, Levi Strauss requires that the partner implements a corrective action plan within a specified time period. If a contractor fails to take corrective actions, the business relationship is terminated. By nature, the company is externally focused and determined to stay that way. This means constantly scanning developments that affect the business, and acting on that information to surprise their customers. The above are part of Levi Strauss’ global corporate citizenship culture. To make these to also diffuse to Turkish Levis’ employees working environment, the top management team is making radical moves. 5. 3CORPORATE RESOURCES STRENGTHS Levi Strauss and Co. is a member of Better Cotton Initiative. Better Cotton is a different way to grow cotton that decreases the negative environmental impacts and has the potential to improve the livelihood of the 300 million people involved in cotton farming worldwide. At its heart, the Better Cotton Initiative aims to make all cotton grown around the world more sustainable by reducing water and chemical use (including pesticides and fertilizers), protecting the health of the soil and promoting important labor standards including bans on child labor. The Better Cotton Initiative also focuses on training and empowering farmers to improve their long term financial profitability. This is a conscious effort made by all partners of the Better Cotton Initiative to help prevent prices for Better Cotton from rising dramatically in the short term. This is an advantage on behalf of Levi? s Turkey as the competitors in Turkish market are not involved in this initiative. Levi’s always had been described as a fashion innovator, as the company created the jeans market. The company continues to recognize the importance of the right products to its future success. One of Levi Strauss’s critical strategic goals is to â€Å"innovate and lead from the core,† and it continues to introduce product innovations. For instance, since 2001, the Advanced Innovation Team for the Dockers line has introduced several groundbreaking product innovations. For instance, in 2004 and 2005, the team developed three new and exclusive product innovations. The first was the Never-Iron Cotton that dramatically minimizes wrinkling. Another was the Thermal Adapt Khaki pants that adjust to body temperature. And the third was Dockers Shirts with Perspiration Guard, a special finish that wicks away moisture from the body and eliminates the appearance of perspiration marks. This is a strength that differentiates Levi? s from its competitors. In addition to this, the company recently decided to make a tradeoff and it stopped producing for women under Dockers brand. This is another wise strategic move on behalf of the company. And furthermore- in line with the above tradeoff- Levi’s was one of the first companies to tap into the mass customization trend by offering made-to-order jeans. In 1999, the company announced that it would begin offering customized versions of its classic denims to fit every woman’s body type, but this move was not successful at that time. In 2011, the company re-launched the same project under the name of â€Å"Curve ID† for women and now it proved to be a great success to regenerate growth on women? s product line. This is another important advantage that makes the brand stronger than the other brands. Youth panel- as a method of consumer-driven brand innovation- is a qualitative consumer panel focused on the consumer typologies that the company believes exercise greatest influence on the dynamics of change within the casual apparel market. The panel has been built up in most fashion significant European cities and comprises between 50 and 100 of the most fashion-forward youth. It is convened twice a year to fit into the line development calendar. This tool is strength for Levi? as it provides the best indication the business has of how much momentum a particular trend has in it, and so serves to guide both general businesses forecasting as well as specific product life cycle management. Every second quarter the brand and design teams dedicate a day to working with the insights coming out of the panel. It helps set the strategic agenda and also enables some very effective and immediate trouble- shooting. WEAKNESSES One of the company’s most valuable assets is its Levi’s brand. However, that venerable Levi’s brand had lost much of its popularity. Although Levi Strauss has one of the best-known names in the world, its market power has declined. An annual ranking of global brands with the most impact showed Levi’s ranked at number 32 in 2001, number 34 in 2002, and number 56 in 2003, and rebounding to number 44 in 2004. The products that baby boomers in the 1960s defined as hip and anti-establishment were now perceived as non-trendy and dull. In the brutally competitive apparel market, that type of image, particularly with younger consumers, has proven to be a disadvantage. As a way to span the consumer market, the company launched several new brands in USA and several other countries. But the same product strategy is not applied in Turkey and the product range is not diversified to cover all customer segments as far as price competition is considered. The company chose to stick with low-tech, in-store posters and other promotions; rather than mass media coverage – television and print ads which the biggest competitors in Turkey extensively use. The company doesn’t invest on brand image and use localized advertisement. But the competitors are using constant brand communications strategy including celebrities, outdoor events. IFAS TABLE Internal FactorsWeightRatingWeighted ScoreComment SRStrengths S1High brand awareness 0. 155. 00. 75 S2Member of Better Cotton Initiative0. 053. 00. 15 S3Advance innovation competence0. 154. 00. 60 S4Profit growth0. 103. 00. 30 S5Product category fragmentation (Curve id-women; Dockers- men)0. 104. 00. 40 Weaknesses W1Inflexible pricing strategy 0. 155. 00. 75 W2Misuse of marketing communications budget0. 154. 00. 60 W3Brand image deterioration 0. 155. 00. 75 Total1. 004. 30 6. ANALYSIS of STRATEGIC FACTORS A. SITUATIONAL ANALYSIS SWOT- SFAS TABLE SRInternal FactorsWeightRatingWeighted ScoreComment S1High brand awareness (global reach and scale)0. 05. 00. 50 S3Advance innovation competence0. 105. 00. 50 S5Product category fragmentation (Curve id-women; Dockers- men)0. 053. 00. 15 S6Financial strength0. 054. 00. 20 W1Inflexible pricing strategy 0. 054. 00. 20 W2Misuse of marketing communications budget0. 053. 00. 15 W3Brand image deterioration 0. 105. 00. 50 O1Turkey’s young population 0. 055. 00. 25 O3Malls; increasing number o f shopping malls0. 104. 00. 40 O4Seasonal sale months extension, attractive promotions0. 054. 00. 20 O5Life style changes; new products0. 053. 00. 15 T2Financial instability0. 055. 00. 25 T3Grey market0. 053. 00. 5 T4High operational costs (O)0. 104. 00. 40 T5Marketing investments of the local brands0. 054. 00. 20 T6Increasing number of new competitors0. 053. 00. 15 Total1. 03. 70 7. STRATEGIC ALTERNATIVES and RECOMMENDED STRATEGY 7. 1 Review of Mission and Objective 7. 2 Strategic Alternatives and Recommended Strategy TOWS MATRIX Internal FactorsStrengths S1. High brand awareness (global reach and scale) S2. Member of Better Cotton Initiative S3. Advance innovation competence S4. Profit growth S6. Financial strengthWeaknesses W1. Inflexible pricing strategy W2. Misuse of marketing communications budget W3. Brand image deterioration External Factors Opportunities O2. E-commerce and social media; new distribution channel O3. Malls; increasing number of shopping malls O4. Seasonal sale months extension, attractive promotions O5. Life style changes; new products1. Levis can continue to growth with new openings in different malls 2. Through high brand awareness, easy to take place in social media and cooperate with e-commerce websites as new distribution channels 3. Levis can adapt its products for different preferences1. New online campaigns to improve the brand image Threats T2. Grey market T5. Increasing number of new competitors T6. Low cotton supply and high cotton prices1. Developing new production technologies in order to use the raw materials effectively 2. Support social responsibility initiatives worldwide 1. Assessment of local competitors in order to redesign the marketing campaigns Recommended Strategy Functional strategy, marketing strategy; positioning should be made according to the target audience. Through social media and online campaigns Levis can improve its brand image and can reach Turkey’s young population. After several researches, it has been found out that the potential age group for both men and women is 14-25 in Turkish casual apparel market. However, it must also be taken into consideration that it is the 18-35 age group that consumes more and that women are the ones who increase the overall sales in general. The private shopping companies are growing very fast in Turkey. Levis can use e-commerce websites as new distribution channels to improve the brand penetration among 24-35 years old, worker segment. Levis is using its global marketing communications campaigns in Turkey, as they are. The company does not try to assess its competitor’s strategies or to adapt the tone of the messages according to local needs and preferences. However the local competitors are really aggressive in communication. Levis has to redesign its communication campaigns and reallocate its marketing budget. 8. CONCLUSION BIBLIOGRAPHY 1)http://www. levistrauss. com/ 2)Company’s 2012 plan 3)Company’s distribution strategy 4)Inspiring the organization to act: a business in denial, International Journal of Market Research Vol. 44 Quarter 2, 2002, the Market Research Society 5)Denim Pazar? nda Marka Konumland? rmalar? n? n Karsilastirilmasi,