Wild horses

During first years of ass's a new generation was blossomed all over the world. Apparently, this Juvenile posture was trying to brake all the rules from their previous generations. Freedom, liberty and peace were part of manifesto expressed by millions of young people demanding social revolution under one common flag: Rock and Roll. By middle of decade, different rock styles were played all over America: folk, surf, collides, chicane, southeast, bruit among many others.Perhaps for first time In the story the music meant more than chords and scales, It became an expression canvas for all up coming generations. Rolling Stones is one of my favorite band, they were very interested to dig into find the roots of the rock and roll music: Delta blues. Mica Eager and Keith Richards did several trips to Chicago to learn the old school blues with musicians like muddy water or chuck berry. Once they finally dominated the basic tune they could fusion it with the Bruit rock creating the base for th eir up coming albums and influencing numerous new bands in England and the rest of the world.Wild horses theme is written by Mica and Keith on 1971. It has an acoustic and melancholy melody. The words are easy to follow and they have metaphoric and idiomatic expressions: Wild Horses: if you say that wild horses couldn't make you do something, you mean nothing could persuade you to do it Wild horses couldn't drag me to a party tonight. Dragged something away: push or pull something from a place. In my opinion, the lyrics make reference to a break up and all the process to leave all memories behind.

Apple Strategy Management Essay

Formerly known as Apple Computer, Apple Inc. has effectively became a successful company in a competitive consumer electronics industry. The firm managed to outsell others by being innovative and differentiating its products through superior service standards and high quality products. To ensure standards are met, Apple outsourced its manufacturing to a reliable third party electronics manufacturing company, Foxconn Technology. In recent years, the smartphone industry is moving towards commoditization. This resulted in intense competition where constant innovation is required to withstand its business marketability. Apple’s strategic capabilities such as having tailored hardware/software systems has enabled the corporation to position itself in term of value, rarity, inimitability and non-substitution. However, to continue gaining its market share as the best smartphone, the corporation might need to review its business suitability, so as to maintain its market leadership in t he industry. This strategic analysis and evaluation report will hence review Apple’s performance and sustainability through using business level strategies before strategic recommendations are decided upon. In order for Apple to continually retain its market position, the corporation might need to consider its business suitability such as its strategic direction. Through market development, the company can increase its presence in new market segments. There is a need to look into its R&D (Research & Development), so that new products with unique features can progressively developed. Table of Contents Introduction (300words) 372 Background Information Apple Inc. is a technological company that had achieved great success in designing, producing and selling its wide range of products categories including Mac, IPad, IPod and IPhone, which brings innovations in computers, media tablet, Portable music players and mobile phones respectively. In addition, Apple also offers a variety of related software, applications, services, networking solutions, peripherals and third-party digital content which represent a revolutionary era for innovation and differentiation of Apple. (reuters). Although touch screens in mobile devices are not new, Apple managed to be the first to achieve mass market adoption for that technology by creating and launching the first IPhone series in January 2007. The IPhone was so much ahead of its time that it virtually created a new category in the market leaving everyone else playing catch up (Elliot, 2012). The Apple’s target market includes teenagers, college and university students, business people, young children and kids and adults. As of September 29, 2012, it had 412 retail stores in 14 countries around the world. (Financial Report 2012) At the same time, Apple had an extensive 72,800 regular employees and an additional 3,300 temporary employees or contractors worldwide (Apple 3 year PnL). Financial Performance According to the financial report, the company recorded total net revenue of $156,508 million during the fiscal year 2012, which shows an increase of 63% over fiscal year 2011. In which net profit accounted for $41,733 million, a 61% increase over fiscal year 2011 (Apple 3 year PnL). As observed from the report, Apple’s gross profit margin had rise from 40.5% to 43.9% in the past 2 years. This is mainly the result of effective implementation of cost-leadership and differentiation strategy over the years. (Find source). Culture The firm’s pervious CEO, Steve Job (from 1997 – 2011) had created a culture in which vision are understood and is live by their employees. He believes that communicating the vision to the employee is almost as important as coming out with new products (Elliot. Jay, 2012). This culture was kept alive even when Tim Cook took over as CEO (from 2011 – current) which essentially kept all Apple’s employees on the same page and enact the vision with true passion (Elliot. Jay, 2012) which is key to strategic management (Find that book) Macro Environment Analysis (700words) 803 PESTEL Analysis PESTEL analysis will be used to understand Apple’s external environment and gain an insight of Apple’s future business potential, market situation and operations directions. There are six elements in the PESTEL analysis; Political, Economical, Social, Technological, Environmental and Legal (Find source). Considering developments, trends, indicative incidents at the global levels, we identify that Social, Technological and Legal element of the PESTEL analysis pose a much significant impact on Apple’s mobile phone SBU as compared to the rest. Social Apple’s social environment is one of key contributor for its success today and will continue to lead it into greater height in future (wei kang, 2013). It’s ‘think different’ slogan is the unique combination of simplicity, creativity and luxury image into the product that reflects the user’s individual identity and the desire to be different (Schneiders, 2011). Apple’s pervious CEO Steve Job always had a sense of what consumer really wanted and adjusted the company’s products line to meet their wants. In other words he tells them what they should love (VERGANTI, 2010). This is a phenomenon known as the cult marketing in which people do not know their wants until cult marketers present it to them (RAGAS & BUENO, 2005). In simple terms, Cult marketing is actually a tool used in strategy to strengthen customer loyalty (Schneiders, 2011). This element has significant positive impact as it allows Apple to have the strongest customer loyalty in the world and achieve the highest repurchase rate in the electronic field (MacNN, 2006). This effect can be seem worldwide whenever Apple launch their new product, Apple’s fans would camp for days in front of the store only to get one of its newest innovation. This shows that Apple’s users really love Apple unlike most others (NUSSBAUM, 2005). In addition, due to the technology development, Apple’s Products such as the IPhone are no longer being viewed as luxuries but real necessities goods (source). To succeed in the long run, Apple should follow and abide to its guiding principle; ‘don’t follow your customers; Lead them’ which implies that consumer need to be shown a superior alternative which Apple distinguishes itself and provide these alternatives (MacVarish, 2009). Technological The market for mobile phone and other electronic products that Apple offers puts them in a hyper competition environment driven by the fast pace of technological changes. Companies like Apple which manufacture such products will have to continually invest substantial amount of money on research and development (R&D) to produce better performance, new feature and better design products to counter the short life cycle and frequent introduction of new products in the market (source). According to MacVarish, one of Apple’s guiding principle for their innovation strategy was ‘Be your own toughest Critic’. In which, Apple aims to offer new product lines that replaces older products making their them obsolete and thus preventing competitor from doing so. With this principle to beat itself, Apple managed to beat its competitors too (MacVarish, 2009). Ultimately this enable Apple to lead the market as it did in the launching of the different generation of IPhone especially IPhone 5 which become the world’s best-selling Smartphone worldwide during the 4th quarter of 2012 (Maisto, 2013). As a result, Apple’s R&D expense increases exponentially from $1.782 billion in 2010 to $3.381 billion in 2012 (Apple 3 year PnL). Due to their research intensive nature to keep innovation ahead of competitors, Apple becomes less cost-effective in saturated markets and is exposed to greater risk if it’s R&D does not come through (source). Legal The intellectual property war has long being used as tool in technology and management strategy by companies such as Apple to gain strategic advantage against their competitors. Apple alone has filled as many as 250,000 patents for the IPhone and other Smartphone covering the design and functionality of these products (Cusumano, 2008). Apple had lawsuits all around the world with its competitors such as Samsung, Motorola and Nokia both suing and being sued over violation of each other’s patents (source). One such case is the lawsuit in the U.S between the Apple and one of its top smart phone competitor; Samsung in which the jury awarded Apple $1.05 billion in damage and ordered some of Samsung’s Smartphone products off shelf in parts of the US (source). This verdict allows the IPhone to gain distinctive advantage in the US market and at the same time helped Apple in advertising and broadcast IPhone originality. In addition the amount of damage awarded to Apple could be counted as revenue which eventually increases the profit margin significantly for of Apple that quarter. In conclusion, while most lawsuits Apple filed comes with little success, any court decisions that verdict in favor of Apple’s patents will likely allow IPhone to remain distinctive in the market (Cusumano, 2008). Industry (Competitive) Analysis 815 Michael Porter’s 5-forces model Apple’s competitive position and its attractiveness in the smart-phone market can be explained in analyzing the Porter’s 5-Forces framework (Porter, 1980). Using the competitive forces, it would identify the competitiveness and its ability to position itself with diversification. It will show its sustainability and profitability of its iPhone series. Threat of Potential Entry/Barriers to entry – LOW The smart-phone industry is saturated and poses strong barriers to potential entrants who are keen to enter the market. Presently, there are a few well-established competitors that have a large market share and economies of scale which limits new entrants from entering. Its strong brand presence and consumer loyalty is a hindrance to potential entrants (Bostic, 2013). New entrants require a large amount of capital investment, so as to compete against the market leaders. Due to large economies of scale, it is nearly impossible for this new entrants to enter and gain substantial market share. Sometimes, there is a need for new entrant to innovate such as creating distinctive features or software to compete. But this usually brought about by lack of resources as investing in ample resources does not come cheap. Legal terms such as patents and trademarks serves as a barrier to new entrants. New entrants also face barriers such as legal terms. These are usually patents or trademarks that the dominants players have. This market leaders such as Apple Inc have patents on its designs of iPhones including software such as iTunes. This prevents any infringements from new entrants to copy similar ideas. After all, Apple is still a dominant player in the smart-phone market and competing against Apple really requires a new entrant high start-up costs. Reference: Bostic, K, (2013), â€Å"Study finds 20% of Apple iPhone users switched away from Android in past year†, Apple Insider Porter, M, (1980), â€Å"Competitive Strategy: Techniques for analyzing industries and competitors†, Free Press, Simon & Schuster Adult Publishing Group Rivalry between competitors – HIGH The smart-phone market is very well-developed and there is a high degree of concentration. It is controlled by a few large competitors which are Apple’s strong rivalry. This are dominant smart-phone players such as Samsung, LG and HTC Mobile which has high capital investments. Smart-phones have become a commodities item that any person will require. As such, dominant players have been placing an emphasis on competitive pricing. This will enable them to gain an edge over competitors. These competitors are generally of comparable size with Apple in its operations. Due to stiff rivalry, Apple will differentiate itself in terms of design features and functionalities. Its competitors have also aggressively seek a leadership position in the smart-phone market by constantly innovating and seeking new changes. The result of technology advancement has also caused an increased competition to seek change in the industry. This in turn results in rivalry among smart-phone players to stream line its products and constantly refreshed its gadgets to meet the demand, so as to stay in competition. (Apple Inc Report, 2009). References: Apple Inc. SEC 2009 Form 10-K Filing Page 16 Threat of substitutes – MODERATE It may seems that Apple has a variety of substitutes in the market, but the nature of Apple’s products sets itself apart from competitors. Although it may seem that Apple has an extensive array of substitutes in the market, but its proprietary nature of products sets itself apart from competitors. Presently, its threat of substitutes of its smart-phones (e.g: iPhone5) are still moderate. But competitors are already riding on its successes by constantly innovating and substitutes it with a similar product in the market. In general, Apple sources its parts from various suppliers, thus keeping itself unique in the smart-phone market. As such, Apple still have to constantly stay innovative and price conscious so as to effectively positioned itself against other competitors with a strong branding and following. As such, its differentiation strategy can effectively diversified itself from others. Bargaining Power (buyers) – LOW There are many smart-phone brands in the market that is a substitute to Apple’s iPhones, but the bargaining power by buyers remain low. The main fact is that Apple’s focuses on differentiating its products from its competitors. Its unique designs, features and cult marketing are testimony to its loyalty by buyers. Its niche market in the smart-phone industry also makes buyers less sensitive on product pricing. Customers or loyal fans of Apple are still willing to pay regardless of the price. Although major retailers or businesses have some relative power to bargaining due to its bulk volume, individual buyers still have no control especially on their product pricing. Apple’s lack of third party options also means that buyers have less options for other product. Bargaining Power (Suppliers) – LOW Apple relies on a variety of suppliers in its manufacture for smartphones. Usually, it is not limited to just one single supplier for various components in the assembly of its smartphones. As such, this leaves Apple’s suppliers with less bargaining power over prices. This enables Apple to successfully create a competitive advantage over its competitors in the market (Apple Annual Report, 2012). Due to its bulk quantities of components, Apple Inc can have a leverage over suppliers through negotiating better terms and pricing. This allows Apple to have a lower cost structure and ensures a higher profit margin as compared to its competitors. Apple’s Strategic Capabilities 684 Analysis Apple’s integrated system of hardware and software has enabled the firm to successfully market and develop to be their most valuable strategic resources (Dhaliwal, 2009). It was their former CEO, Steve Jobs that pulled Apple’s back to the growth stage. Apple’s talented team of software engineers, programmers and designers are the firm’s key resources in innovating. This enables Apple to utilize their knowledge to successfully create a tailored hardware and software system which serve as its key capabilities. Its integration in its key capabilities has allowed Apple to create a competitive advantage and sustainability in the market (â€Å"Electronic Industry Citizenship Coalition,† 2009). Resource/Capability| Value| Rare| Imitate| Non-substitution| Relationships with OEMs| √| | √| | Retail locations| √| √| √| | Tailored Hardware/Software Systems| √| √| √| √| Figure 1: VRIN Table Applying VRIN, The VRIN model, a four key criteria resource-based view, examines if Apple Inc. uses its strategic resources to create a competitive advantage. Relationships with OEMs Apple holds good relations with its OEM business partners in China. It includes companies such as Foxconn and Hon Hai Precision Industry. This close relationships that the firm maintains with its partners assures that the outputs produced are superior and of high quality. This allows Apple to be ahead of other smart-phone manufacturers who prefers not to outsource production. Value: Its strong relationships maintained with its business partners allow Apple to take advantage of opportunities by Foxconn, such as cheap manufacturing costs. This ensures that the firm can provide a sustained value in its products and thus reducing any threats (Barney, 1991). Inimitability: Competitors can still imitate by following Apple’s strategy of finding an OEM partner. But what sets Apple apart from the rest, is its ability to maintain its development of software, which others has problems imitating despite having an OEM partner. The intention of Apple Inc. is to integrate multiple functions into developing an Apple product. This will ensure Apple’s users get the most value when they purchase the final product. Apple Inc. ability of combining all 5 aspects of key strategic resources/capabilities into one, allows the firm to be ahead of competitors due to its sustained value and its success in taking opportunities and reducing threats. (Barney, 1991). Retail Locations The introduction of Apple’s retail stores provide the corporation with a physical presence and convenience to its customers. It allows Apple to create a store image by providing an attractive store front and superior customer service. This key resource serves as an important value to Apple which is a relative rarity in the industry. Value: Its strategic locations of its retail stores worldwide provide consumers with the ability to reach its products easily. This gives Apple a competitive advantage against competitors. Rarity: Apple’s strategy in positioning its store and differentiating its products ensures that the firm is in a leadership position. Its unique factors of its strategic retail location are a rarity to the organization. Talented software development teams Apple has a capable team of software developers. This are often carefully chosen by the corporation and serves as Apple’s most talented programmers. They assist Apple with introducing important products. But often developers of this caliber are not rare in the IT industry, neither are they tough to imitate. Hence other smart-phone manufacturers such as Samsung Mobile can also train or hire strong caliber of developers too. Industrial Design Capability Industrial design capability is one of Apple Inc. strategic resource that serves as a function of its innovation ability. Its capability of its innovative design teams are valuable to the corporation. Its innovative design teams also have strong teamwork which forms one of Apple Inc. strategic resource too. This enables Apple to indeed be very valuable, rare among its competitors and also its difficulty in imitation. Tailored Hardware/Software Systems Apple Inc. competitive advantages among competitors are having a tailored hardware and software systems. It is one of Apple’s most important abilities as it is only specifically designed and built in its integrated products. Its ‘closed system’ styles also form its specialty as most competitors relied on third party software. One example would be Samsung Mobile adopting the Google’s Android market. Its capability of combining its own design, software development, hardware programmers ensures its competitive advantage. Value: The benefits of having its own hardware and software ensure that the firm provides value to its consumers. Rarity: The rarity of having a dynamic team of talented staff allows the firm to develop specialized hardware and software which are unique to the company. This are important factors which identifies Apple’s power in the industry. Inimitability: Apple’s inimitability in most of its strategic capabilities allows the firm to be of a competitive advantage than its competitors. In particular, its tailored software, iOs app store was developed ahead of its competitor, Samsung mobile who adopted the Google Play store. Though Apple has a talented team of software developers, this is still inimitable as competitors can train and develop staff. In general, Apple’s strong strategic capabilities still prevent competitors from intimidating. Non-substitution: In general, Apple’s products are substitutable with alternative products. The reason that sets apart from its competitors is its brand identity and its tailored hardware and software. This development serves as a unique factor which no third-party can substitute. Sustainability as Competitive Advantage To successfully sustain Apple’s continued performance and competitive advantage, its management may consider seeking exclusive partnerships or arrangements with its OEM partners to bring costs down and probably reaching out to more countries with expansion of Apple’s stores. These strategies will allow Apple to continually lead the market with its dominance and market share. Value The intention of Apple Inc. is to integrate multiple functions into developing an Apple product. This will ensure Apple’s users get the most value when they purchase the final product. Apple Inc. ability of combining all 5 aspects of key strategic resources/capabilities into one, allows the firm to be ahead of competitors due to its sustained value and its success in taking opportunities and reducing threats. (Barney, 1991). Rare In the smart-phone industry, there are many brands that compete directly with Apple iPhones. But what stands out against competitors is Apple’s ability to position and differentiate its products. Its innovativeness in industrial design, specialized hardware/software and its strategic retail location allows Apple to gain its uniqueness in the market. This assures Apple Inc. as a successful organisation due to its brand identity and superior quality.Inimitate Apple’s inimitability in most of its strategic capabilities allows the firm to be of a competitive advantage than its competitors. In particular, its tailored software, iOs app store was developed ahead of its competitor, Samsung mobile who adopted the Google Play store. Though Apple has a talented team of software developers, this is still inimitable as competitors can train and develop staff. In general, Apple’s strong strategic capabilities still prevent competitors from inimitating. Non-substitution Generally, Apple’s products are substitutable with alternative products. The only reason that sets apart from its competitors are its brand identity and ability to keep hold of Apple’s fans. Its talented teams of software developers and tailored hardware/software are an uniqueness to Apple and no third-party can be substituted. Business Strategy 781 Strategy Statement An analysis shows that there is a strategy shift in Apple for its smart Phone business as the company had a change in leadership since 2012. Apple’s current goal is to give its consumer the best product experience by offering superior high and low-middle end products that are user friendly, innovative in design and feature, integrate seamlessly and excellence sales and post-sale support experience for consumers (forbes). Generic Competitive Strategy Apple’s is pursuing a hybrid combination of product differentiation and cost leadership strategy. With the combination of the 2 strategy, Apple managed to achieve high profit margin where it produces its smart phone cheaply and selling them at a premium price. Competitive scope (broad target) Under Tim cook’s (CEO of Apple from 2012- current) lead, Apple started to explore new territory by building on the success of its current smart phone business unit and expanding it into emerging markets. This strategy is seen to be put into action with the announcement of the IPhone 5s and IPhone 5c (a watered-down version of the IPhone series) launch (Apple main website). With the dual launch of the IPhone 5s and IPhone 5c, Apple managed to position its product in both the premium and non-premium category respectively that offers 2 price points. The IPhone 5s will continue to address their current market while the IPhone 5c will catered to more price sensitive customer base especially from the emerging market. Competitive Advantage (Lower cost and Differentiation) Given that Apple will be having a dual IPhone launch with almost the same design, features and running on the same operating system (ISO 7), it will achieve economies of scope where cost factors such as advertising and research and development will be shared. In addition, the 2 IPhone caters to different market segment, allowing Apple to have a larger addressable market where economies of scales can be achieved by driving supplier’s cost down with the promise of increase order quantity. These factors will help Apple deliver cost leadership in the smart phone industry. However despite the increasing effort in research and development to bring about innovation and to differentiate their smart phone, Apple failed to produce sufficient uniqueness and dimension that is valued by their consumer. In fact, Apple is replicating its previous IPhone model with minimum introduction of ‘game-changing’ features. The company’s reduce pace of innovation can be inferred fro m its latest launched flagship IPhone, the IPhone 5s which retains the dimensions and design of its pervious flagship; Phone 5 with little addition to its feature and performance (yahoo news). Value Chain Apple.inc has been able to perfect the chain of activities in innovation. Apple starts from its new ideas of product design through R&D with its strategy capability and extensive funding. Then manufacturers it and finally markets it wholeheartedly. The process of transforming inputs into outputs compromises a number of primary and support activities† (Hill and Jones, 2001, p.133). Each value is considered to be a source of competitive advantage. Value chain analysis is a powerful tool for managers to identify the key activities within the firm which form the value chain for that organisation, and have the potential of a sustainable competitive advantage for accompany. Therein, competitive advantage of an organisation lies in its ability to perform crucial activities along the value chain better than its competitors Technology Development Buying and R&D Inbound Logistics Most components are generally available from multiple sources; a number of components are currently obtained from single or limited sources. Hardware products are manufactured by outsourcing partner primary in Asia e.g. Foxconn. Delegate raw materials acquisition – Apple works with its OEM partners to delegate the raw materials acquisition process but provides some supervision for quality control purpose. Automated receiving systems – Apple has implemented sophisticated automated receiving systems to speed up the receiving process and reduce facility footprint and storage space requirement That is a concern for suppliers. Apple’s smartphone margins are the highest in the industry. But as those margins come under pressure, Apple will push suppliers to cut costs. Flat-panel televisions followed a similar pattern, with margins for screens eventually falling to near break-even levels, says Alberto Moel, an analyst at Bernstein Research.( http://online.wsj.com/article/SB10001424127887323610704578625540722848194.html) Outbound Logistics Apple used variety of direct and indirect distribution channel, such as retail stores,online stores and direct sales force, 3 Rd party cellular network carriers, wholesalers, retailers and value added resellers. Apple continue to expand and improve its distribution capacities by expanding the number of its own retail stores worldwide in order to ensure a high quality buying experience for its product. Economical packing – Apple employed teams of design and engineering experts who develop product packaging that’s slim and light yet protective. Efficient packaging design not only reduces materials and waste, it also helps reduce the emissions produced during transportation. Marketing & Sales http://www.docstoc.com/docs/121102555/Apple-Computer-Value-Chain http://www.reuters.com/article/2012/04/30/us-honhai-idUSBRE83T08K20120430 References used: Dhaliwal, A. (2009). â€Å"Apple’s Q4 results beat analysts? Estimates; quarterly profit rises to $1.67 billion.† Top News, retrieved on September 14, 2010 from: http://topnews.us/content/27794-apple-s-q4-results-beat-analysts-estimates-quarterly-profit-rises-167-billion â€Å"Electronic Industry Citizenship Coalition.† (2009). Electronic Industry Code of Conduct. retrieved on September 14, 2010 from: http://www.eicc.info/PDF/EICC%20Code%20of%20Conduct%20English.pdf Barney J, (1991), â€Å"Firm resources and sustained competitive advantage†, Journal of Management, vol. 17, no1, p99-125 Identifying the strategy Generic Competitive Strategy Apple is pursuing a broad differentiation strategy. Apple differentiates by offering high-quality, exceptional design, and personalized service. The scope of their strategy is broad targeting customers ranging from unsophisticated beginner users to specials needs power-users. 1) Cost-leadership 2) Differentiation Business Suitability Apple Inc. is concerned with which strategic directions and methods suggested addressed the issues the corporation faced (Johnson & Scholes, 2008). It assists in determining the business suitability of strategic choices which relates to the strategic position. To test on Apple’s suitability on its proposed business strategies, the Porter’s value chain model is chosen to consider the internal factors of the organization. Strategic Directions Market Penetration Presently, Apple’s infrastructure is very well established and developed. But the corporation should still continue in its infrastructure developments, so as to achieve back its high market share in the smartphone industry. Its market penetration business strategy relies heavily on its primary activities such as inbound logistics, outbound logistics; and sales and marketing. To continue moving towards the market penetration direction, its support activities do play apart. The technology development will then be in a position to assist the support to the proposed strategy. Product Development Apple may need to consider a strategic drift to gain a competitive advantage in its business strategy. The product development strategy gets its assistance from support activities such as developing new products to meet customer demands. To increase its firm performance and market share, Apple is introducing new features such as finger sensor on its new iPhone5s and also colored version of its iPhone5c (Apple.com). This new features or product development somehow serves a determining factor whether Apple will achieve its business strategy or affects its corporate performance. Market Development At present, the firm is adopting the market development strategy. It assists Apple in venturing into new market segments. Thus, there is the importance to focus especially on the primary activities of inbound and outbound logistics, sales and marketing. Apple is still able to rely on its OEM partners for resources especially in manufacturing, which serves as Apple’s key competency. To move ahead, Apple might need to enter or develop new market, such as in developing markets which it has zero presence. With its strong alliance partner, such as Foxconn, Apple is able to utilize its logistics part and its strong sales and marketing to open up new market. Hence, these three suggested business strategies are suitable to evaluate the value chain, and Apple can carry any of these strategies ahead. Apple will need to consider which strategy will achieve its overall business objectives to sustain itself in the market. Conclusion Reference List 1) http://in.reuters.com/finance/stocks/companyProfile?symbol=AAPL.O (reuters) 2) http://files.shareholder.com/downloads/AAPL/2634031917x0x444195/E7A8FE5F-8835-46AB-ACC2-6FA28DFB546D/Three_Yr_Financial_History.pdf (Apple 3 year PnL) 3) Porter. ME, (2008), ‘The Five Competitive Forces that Sharpe Strategy’, Harvard Business Review, vol. 86, no. 1, pp. 78-93, Business Source Complete, (online) Available at: EBSCOhost database [Accessed:15 sept 2013] (Porter, 2008) 4) MacVarish, B. (2009, August 13). Guiding Principles of Apple Innovation.brucemacvarish.com. Retrieved January 29, 2010, from http://www.brucemacvarish.com/2009/08/guiding-principles-of-innovation-at-apple1-dont-follow-your-customers-lead-themapple-tends-to-place-less-emphasis-on-evide.html (MacVarish, 2009) 5) Cusumano, M 2008, ‘Technology Strategy and Management: The Puzzle of Apple’, Communications Of The ACM, 51, 9, pp. 22-24, Business Source Complete, EBSCOhost, viewed 16 July 2013. (Cusumano, 2008) 6) http://www.forbes.com/sites/mobiledia/2012/02/19/nuts-apples-ceo-reveals-future-strategy-google-to-expand-into-hardware/ (forbes) 7) (http://sg.news.yahoo.com/photos/apple-unveils-iphone-5s-iphone-5c-slideshow/five-colors-iphone-5c-cases-photo-181338126.html) (yahoo news) 8)

Pros and cons of horse racing Essay

Horse racing is an adrenaline filled sport for all the participants. It is a short lived, action packed, joy ride. The sport has increased in popularity over the past several years, due to the need for a rush, and is continuing to rise. Due to this massive influx in size the amount of money the business is contributing to the government is large. The business has also had to hire a multitude of people to help carry out the job of keeping the business as orderly as possible. The enlargement of the horse racing industry has also made the stakes for money in the winning a much bigger deal for owners which means they will do most anything to win. This includes the use of illegal drugs on the horses and many other forms of cheating. When the prize money raises so does the need for as many winning horses as possible for horse owners in the industry. The need for horses has led to an intense amount of over breeding of thoroughbreds. The amount of money contributed to the United States gover nment by the horse racing industry is an incredible amount. On average the sport produces 38.8 billion dollars, of which a whopping $1.88 billion is paid in annual taxes. That amount of money just goes to the United States. Around the world, countries make on average 40.2 billion. For instance, in Europe, horse racing is a widely known event and is tradition to participate in. they make on average about 45.3 billion United States dollars in the horse racing industry. Then, when talking into account supplies and employees, they produce around 101.6 billion us dollars. Governments around the globe benefit highly from the industry and horse racing being banned could have a drastic effect on entire populations from lack of money. Horse racing being banned could also cost millions of people around the globe their jobs and businesses. According to a recent labor poll over 4.6 million people are involved in the horse industry in some way, either as owners, employees, service providers or v olunteers. This includes 2 million horse owners, of which 238,000 are involved in breeding. When it comes to competing such as the jockeys and handlers, 481,000 people are involved. When looking at the amount of people involved in other activities such as grooms, veterinarians, and care takers, 1.1 million involved. 119,000 service providers and 702,000 employees, full- and part-time and 2 million family members and volunteers. That means that 1 out of every 63 Americans is involved with horses. Many of these jobs are held by lower-income families. This could be disastrous when taking into account  all the people who depend on the money they make from this business. Banning the horse racing industry could affect the local areas around them badly. The results of the one study done by students at the University of Louisville show that the horse business is a highly diverse industry that supports a wide variety of activities in all regions of the country. It combines the primarily rural activities of breeding, training, maintaining and riding horses with the more urban activities of operating racetracks, off-track betting parlors, horse shows and public sales. Usually when people go to watch a race they want to get dinner or spend their newly eared money in the expertly placed, over priced restaurants and shops. These strip mall shops gain money and business from these enthused shoppers. If there is no race track, these shops and small businesses could have a plummet in sales and be shut down for lack of ability to pay. Additionally, the volume of consumers that are driven to the racetracks each year create a need for additional medical care, education for children and families of track staff, as well as the local universities. Having the race tracks removed could lower business income for hospitals and schools as well as universities. The United States alone produces 3 billion from horse racing and tourism. Over 67 percent of activity as well as gambling money come from tourists going and paying at the race track. As a source of entertainment as well as having food venues and shopping areas round the premises of the track, it is an ideal hot spot for tourists to spend their money; whether it be on food, gambling, or shopping. The revenues made my gamblers who are not local to the area is 785 million dollars. Gambling is exciting as well as engaging for the participants. For those who enjoy taking risks, the propensity for risk associated with gambling may be both simulating and challenging. Also, gambling on horse racing allows the participant to challenge themselves with predicting the potential wins and losses. Gamblers from out of the country are obviously a large part of the income on the race track. Banning racing could make the area of choice loose business all around from not having the interest of tourists any longer. When it comes to betting on horses in horse racing, bettors rely on the accuracy of the statistics on the horses. The statistics allow the bettors to know which horses to bet and wager on. Cheating, such as the latest scandal called ‘doping’, can affect the reliability if those statistics. Doping and other forms of cheating using  drugs can harm the jockeys and horses in the long run. A few of the top drugs used in horse racing are cocaine, blcarbs, anabolic steroids, blue magic and heroine. Drugs such as heroine and anabolic steroids are typically injected into the lungs of the horse or the heart as to keep them from feeling pain and to slow down the rapid rate at which they would usually work to keep them from tiring. This can cause break downs on the track because of the lack of oxygen entering the blood stream at such a high rate of physical activity. Drugs such as cocaine blcarbs, and blue magic are usually pumped into the blood stream on added into the grain. Wha t the purpose of these are is to give the horses an energy boost that is un natural and these can also cause break downs on the track because of the amount of stress the horse is putting its body under without being aware until it is too late. The form of cheating of which is in drugs is considered cruel to the horse. Another form of cheating in the racing industry is toe grabs. A toe grab is a raised rim on the toe area of a horseshoe; its purpose is to help the horse â€Å"dig in† to the track and reduce sliding much like football cleats. However, there are increased stresses on the limbs from this stronger grip on the ground and quicker â€Å"stops† of the feet when they land while normally the foot slides forward just a bit on the ground before stopping, but toe grabs arrest this slide. It’s also been suggested that toe grabs add stress to the limb by raising the toe relative to the heel. Toe grabs on front feet have been associated with increased incidence of catastrophic injury in horse racing. Horses involved in racing are being over bred and this is causing weakening in the breed and mass slaughter of those horses that do not make the cuts. While over-breeding in the racing industry is the derivation of availability, inbreeding, and drugs are inescapably interconnected with the callous and brutal practice of slaughter as is the insatiable demand for horse meat for human consumption principally in European and Asian cultures. Inbreeding and drugs have weakened the modern Thoroughbred while the horse meat industry remains a lucrative multi-million dollar enterprise. More than 100,000 unwanted horses are born in the U.S. per year. Roughly 83,000 of those horses are slaughtered every year just in the United States because of improper breeding. A recent study was done and it showed that if 1,000 horses are bred for racing, only 300 will make it to training. Of that 300, only  roughly 75 horses will make it to racing. Only about 4 horses will make it to live their second race . Most horses that are not used for racing are sold to meat and glue factories. Only 12% of horses are properly retired and either sold to a family for other riding uses it retired to the pasture. This unnecessary breeding has caused weak bones in the thoroughbreds and diseases passed down in blood lines. The weakening of the breed has aroused a lot of controversy over whether or not horse racing should continue due to this issue. In the end there are both pros and cons to whether or not horse racing should be banned. Horse racing contributes an incredible amount of money worldwide and produces multiple job opportunities as well as business in local shops. It also brings in tourism to the track and surrounding areas which can help great deal of money also. Horse racing also has a large issue with cheating that can harm both the jockey and the horse against their will. The use of illegal drugs and product on the race horses’ pre race can significantly alter the horses performance whether for the good or the bad and in the long run, harm the horse terribly. Also over breeding has become a widely known issue across the globe and is causing a mass amount of horses to be sent to slaughter. Over breeding has also caused a decline in the stability of the breed. Horse racing both helps and harms.

Challenges of Incorporate Gen Y into the Workplace Essay

Challenges of Incorporate Gen Y into the Workplace - Essay Example Despite this, it is evident that the same generation counterbalances these negative traits by working well with specific managers aiming at meeting the corporate visions and values in addition to portraying their hard work to their employer in exchange for not only immediate reward, but also recognition (Alexander & Sysko, 2013). Alexander and Sysko claim that Millenials regard technology as their â€Å"sixth sense†. Thus, it is evident that this generation must incorporate technology into every aspect of their life. It is their extensive use of the technology that distinguishes them from other generations (Alexander & Sysko, 2013). Alexander and Sysko (2013) claim that the incorporation of the Millenial employees with other generations is often associated with confrontation from the Millenial employees. The Millenial employees often have ambiguous attitudes as well as conflicting behaviors (Alexander & Sysko, 2013). Millenials also carry their unique attitude and behavior to institutions. In tandem with this assertion, Alexander and Sysko (2013) argue that many Millenials portray not only a lack of drive and motivation, but also accountability in academia. They claim that the majority of the Millenials have the mindset of just showing up. Additionally, Alexander and Sysko (2013) claim that Millenials have an alarming attitude; being there to be entertained. The most disturbing element of the Millenials, however, is their lack of concern for the accuracy as well as the validity of the sources they use in carrying out their research. In other words, Millenials often portray unoriginality in everything they do (A lexander & Sysko, 2013). It is as a result of these qualities that it becomes very hard to mix Generation Y with other generations in a working environment. The attitude and behavior portrayed by the Millenials is as a result of their mindset. According to Alexander and

List of countries for Obscure Country Project Research Paper - 1

List of countries for Obscure Country Project - Research Paper Example It has some great geographical sites spread all over the region which might prove to be of interest to the tourists. The Northern areas of Pakistan consist of mountains with snow which range over from 1000 to more than 8000 metres. There are a total 14 over 8000 metre peaks in the world and 4 of these peaks are located within Pakistan. These peaks are K-2, Broad Peak, Gasherbum and Nanga Parbat. Moreover the northern regions also have the widespread glaciers which are usually found in the Polar regions of the world (PTDC 2011; CIA 2011). The state of Pakistan is divided into five provinces namely Punjab, Sindh, Balochistan and North West Frontier Province. The climate of Pakistan is not of concern to people as it is mostly hot in the regions of Sindh, Balochistan and Punjab. Because of the desert conditions in Sindh and Balochistan the temperature is dry and arid. On the other hand the northern region of north West Frontier Province is cold on the peaks. But here also it can be said that the climate is suitable for people visiting the country. Catastrophes which have to be feared in the region of Pakistan are related to the seismic plates. Earthquakes and floods are common in certain regions. A major flood hit Pakistan in the months of July and August in 2010. Other than that the country does not face from any other problem of catastrophes with the weather (CIA 2011; PTDC 2011). Points of Tourism Pakistan has different spots for tourism and these relate to different adventures. The mountainous areas pertain to these different spots. The Karakoram, Silk Route, and other glaciers are sights which are worth seeing because of their natural significance. The beauty of these regions can be witnessed in the natural resources found in these regions. Moreover the country has different parks, rivers, forests and plains which are worth seeing. All these sites have their own significance as they relate to something important in Pakistan. Birds of different species can be f ound in the forests and blind dolphins can be found in the Arabian Sea which are famous all over the world for their beauty. Ayubia National Park is one of the most famous parks in Pakistan and is worth a visit. The religions practiced in the region of Pakistan are also worth a visit by the ones who are interested in religious tourism. Forts can also be found in different cities of Pakistan which clearly shows the importance of historical tourism in Pakistan. Similarly the remains of old civilizations of Gandhara can also be found in this region (PTDC 2011). Goods, Services and Native Plants and Animals The goods and services in country relate to different methods. People belonging to lower class are seen to be working in industries and agriculture. Textile industries are the most useful for the country as they help the country to increase their exports. Moreover the agricultural industry is booming within the country as many of the people feed their family on it in Pakistan (CIA 20 11). Alpine, coniferous and subalpine trees are found in the northern regions of Pakistan. Shisham is a type of tree found in the Salt Ranges of Pakistan and scrub plants along with dwarf palm are found in the province of Balochistan. Thorn trees are found in the hotter regions of Pakistan as they can survive a higher temperature. Mangrove forests are also

First aid and personal safety Essay Example | Topics and Well Written Essays - 500 words

First aid and personal safety - Essay Example The following are the objectives set by the American Red Cross; Recognizing and handling an emergency, checking the scene of accident for safety and the victims for consciousness, how and when to remove a victim from a scene that is dangerous, how to do an interaction with emergency medical services and the time they should be called, learn how and why it’s important to use basic precautions so as to avoid disease transmission risk while and after provision of care, how to make a prioritization and care serious life-threatening sudden illnesses and injuries, how to identify a victim who is conscious for both life and non-life threatening situations, how to care and recognize for victims who fall ill suddenly, how to identify and take care of various kinds of wounds, which include bleeding and burns, how to identify and take care of a victim injured by cold or heat-related emergency, how to perform simple precautions so as to minimize the risk of transmitting disease, how to ch eck external bleeding and finally how to identify and take care of bone, joint and muscle injuries, which includes injuries to such parts as the neck, head and back. There are three different and separate types of first aid kits; for the car or truck, travel purposes and for your home or business. For a First Aid kit to be effective it should always be stocked in regard to the localized needs. For instance, the First Aid to be used along the coast is completely different from that likely to be used inland.

Elderly Receive Free Bus Rides Essay Example | Topics and Well Written Essays - 750 words

Elderly Receive Free Bus Rides - Essay Example Elderly Receive Free Bus Rides These programs are either in operation or are going to become operational soon, the question here to be asked is why seniors throughout the world should have access to such discounts. Several policy makers have time and again given importance to the question and due to various reasons such policies related to free travelling for seniors have been created. Body Studies conducted in different areas and locations show that seniors live longer and healthy if their activity level is high, and in order to increase the quality of life of seniors it should be the first priority of policy makers to give seniors access to free transportation so they can easily move from one place to another and increase their activity level (Nussbaum 122). During the period of 2006, seniors living in the region of England were offered free of cost travelling as soon as the rush hours of weekdays used to end and throughout the weekends (BBC News 20120. This policy is under scrutiny and policy makers are thinkin g of ending the policy. According to a study conducted by Sophie Coronini-Cronberg on the senior citizens of the England, showed that people who had access to free bus passes participated highly in traveling from one end to another through means of walking, public transportation and cycling (U.K. Government Online 2012). The research further suggested that the free ride passes did not only benefit the poor in the community, it even benefited the rich within the community. The research results even showed that those individuals who were car owners participated less in active traveling activities. Active travelling has been associated with better health and exercise, people mostly around the world hate exercising or they do not get enough time to exercise. But if the use of public transport, especially busses increase they will start walking from their homes to buss stands and such travelling activities will assist them in complying with the exercises they have been recommended by phy sicians. According to a research conducted in Britain, when adults participate in active travelling such as travelling from their homes and offices to bus stands, they are able to fulfill certain portion of their recommended exercises (AlphaGalileo 2012). According to Santos those senior citizen that take part in active travelling and physical activities end up with better quality of life, have better mental fitness and are able to participate in economic activities which helps the government in keeping their expenses low as seniors work and do not require government aid (Fleischer 2002). Seniors that are mentally fit easily find jobs due to their experience, this helps them in becoming dependant on their families and their families do not have to think of them as burden. Death rate of senior citizens have even been linked with physical activity, studies show that those senior individuals who participate in physical activities are at a 12% lesser risk of loosing their lives as soon as they cross the age of 60 (Harbert 23). Before policy makers decide to cancel free bus trips and travelling for senior citizens, they should look at the costs associated with doing so. Medical expenses are on a rise, seniors need great amount of medical attention as at their age they experience various health diseases and if free bus rides

Local Partnerships in Community Empowerment Essay

Local Partnerships in Community Empowerment - Essay Example It is actually a fuzzy spectrum of activities. People may engage at different depths, in different parts of the spectrum, at various times in their life. The easier it becomes for people to become involved, and, crucially, to disengage at personal need, the more likely they are to feel able to act. It is this principle which operates behind local partnerships - to enable the person to become engaged and become empowered without having too much burden to bear. Local partnerships have been established particularly in the United Kingdom and in Poland which is the focus of this study. In this paper, I will be determining whether local partnerships are effective in empowering the community. I will be looking at how the Local Strategic Partnership (LSP) of the United Kingdom and the Local Initiatives Program (LIP) of Poland have fared in the years of its implementation. In the end, I will be arriving at some conclusions about whether local partnerships deserve a place in public governance. In the UK, community involvement has been integrated in public governance. It finds expression in the so called Local Strategic Partnerships (LSP) which is non-statutory, multi-agency partnerships that match local authority boundaries. LSP's bring together at a local level the different parts of the public, private, community and voluntary sectors allowing different initiatives and services to support one another so that they can work together more effectively. (ODPM, 2004, 2006) Lack of joint working at local level has been one of the key reasons why there has been little progress in delivering sustainable economic, social and physical regeneration, or improved public services, that meet the needs of local communities. Ideally, a combination of organisations and the community working co-operatively as part of an LSP will have a far greater chance of success. To achieve these improvements, the Government, local authorities and other service providers must work co-operatively, change the ways they work, reallocate resources and 'bend' their mainstream programmes to tackle issues that really matter to local people.(Orton, 2004) LSPs have the aim of bringing about widening involvement in governance. LSPs are a long way from uniform institutions. Their history, composition and working arrangements vary enormously. The 'board' of an LSP may include anything from 12 people to more than 60. Board members may be nominated by sub-groups or partner organisations, or invited by the board, or recruited through public appointment processes, or elected by community forums. I LSPs were introduced by the Government as a means of improving inclusion in the development of priorities for service provision on a local level as well as in its continuing governance. In its 2002 report 'We Can Work it Out' the Local Government Association said that LSP's have been established to support localities in their attempts to work together more coherently in the pursuit of community wellbeing and good governance by providing a single strategic focus within a locality. (Local government Association) Hillary Armstrong wrote in the DETR Local Strategic Partnerships Consultation Document of October 2000: We do not want to start

Citizenship Curriculum Guidelines Changed the Methods of Teaching Essay

Citizenship Curriculum Guidelines Changed the Methods of Teaching Citizenship in English Secondary Schools - Essay Example As the report declares the active elements of teaching Citizenship usually engage pupils that are more difficult and if these elements were introduced into other mainstream lessons they could contribute to pupils engaging with learning, leading to less exclusion, less negative incidents improved attendance and improved classroom behaviour. The text of the current literature in Wright’s Teaching citizenship in the Secondary School supports student teachers, NQTs and practitioners in implementing the Citizenship Order in secondary schools - to be introduced in September 2002. This paper stresses that other changes in curriculum plans include providing further support for teachers. Recent efforts have been put forth to provide support for teachers in developing levels of religious and theological literacy, both of individual pupils and the society as a whole. It suggests tasks, activities and further reading designed to enhance the experiences of teachers. Resources are a factor that have been addressed in curriculum guidelines in the past and are a concern for the future. Tudor’s book is founded on the new curriculum for citizenship and the issues that arise from these changes. The book provides practitioners in secondary schools with the essential tools needed to teach citizenship. Tudor provides an overview of the citizenship order and gives guidance on how to fulfill its three main elements: social and moral responsibility, community involvement, and political literacy.

Value for health care managers Essay Example | Topics and Well Written Essays - 1250 words

Value for health care managers - Essay Example In this gradual endeavor, healthcare managers may help a medical personnel carry out vital tasks efficiently in treating a patient by examining the set of necessities that matter to the working personnel who seeks to fulfil them to acquire a motivational tool for enhancing performance. It may be a tedious work to come to know and evaluate the concerns of each individual working in a medical firm. There are need-based theories of motivation, however, which a healthcare manager may look into and for which to invest some time to assist him in determining which would be most fitting and valuable at targeting to motivate a particular group or individual in the company. Maslow’s Hierarchy of Needs, the ERG theory of Clayton Alderfer, the Two-Factor theory of Frederick Herzberg, and D. McClelland’s Acquired Needs theory are the four need-based theories of motivation which to some extent attempt to demonstrate grounds for human needs and wants (Carpenter, Bauer, & Erdogan, 2009 ). Majority of these and related theories according to the specific needs of a man bring across the significance of having certain needs come to be satisfied prior to shifting focus on other priorities that are less relevant in the sense that they bear no direct impact upon motivation. By his Hierarchy of Needs, Abraham Maslow proposed ranking of human needs with the use of pyramid representation where the basic of all is the state of ‘physiology’. Maslow points out that only by satisfying such primary requirement through sufficient food, air, and water can the person proceed to deal with supplicating the need for safety which is on the next level since needs come in the order of importance and human desires attached with the needs, particularly those yet to be satisfied, affect human behavior (Cuizon, 2009). Using the pyramid model, Maslow further levels up safety to social need after which esteem is accounted for in order that self-actualization on the top-most level can be sustained by a character initially developed by self-worth. The hierarchy presents a systematic manner of assessing where a laborer stands within circumstances which allow him to display appropriate potentials where, in doing so, the process may inevitably reflect what he lacks or yearns for. Moreover, application of Maslow’s theory could bring out in each subject the type of response through which a behavior is delivered or that which suggests how the person feels about the situation in relation to himself and the people around him. Consequently, his strengths and weaknesses are also revealed in the course of communicating to others his set of attributes and principles which depict them. For instance, an employee who is trying to feed her esteem may be appreciative of a boss who receives an equal or higher degree of acclaim may rather find it unsuitable or awkward if she occurs to be at the stage of trying to be socially content, knowing that individual rewards would probably keep her further apart from the rest of the circle which she desires to be part of (Carpenter, et al., 2009). Considering the ability of a competent healthcare manager to execute

University of Phoenix and I Essay Example for Free

University of Phoenix and I Essay It is clear to me how University of Phoenix’ convenient and efficient educational program designed for working professionals, has helped me grow. I see tremendous change and development in myself. I have not only matured personally and professionally, but have also grown to believe in orderly goals and motives with respect to my existence. My life has been organized and I see greater potential for my progress. The outlook of the entire university, dedicated to the success of its students, may be viewed now in who I am as compared to who I was before joining the BS of Information Technology program. When I started the program at University of Phoenix, my professional attitude was unseasoned. I was an unsure person, someone who had not matured. My humble and uninformed self did not allow me to think much of my career. I had briefly dreamt of becoming a graphic designer. However, I had wrongly imagined that I would not go too far. My mind was set at thinking that I might have to do with unsuitable jobs. What else are high school graduates supposed to do? I did not aspire to be great or hold lofty goals for my career. My goals were in fact, not many. I only desired to keep myself employed. My knowledge base was limited. I was raw. To that end, I am absolutely honest to claim that I knew little or nothing about the things I have learned at the University of Phoenix. Knowledge has been added on to my life at a rapid pace with this great program. Before this, life could seem sluggish to me as an unaware person. At work, I did not consider myself a professional. I did not even present myself as such. I was simply working; holding a job because one has to do that in this uncertain world. I would describe my writing skills before the program as ranging from bad to good. This is one of the areas where I have experienced drastic change. Besides, I now have extremely different views about myself and my career. My verbal communication skills before the program may also be described as varying from bad to good. With less confidence, the way I presented myself was obviously poor. I did not grasp at the time that professionally, one must appear assertive and proficient to get the work done. At present, I like to view myself as a thorough professional. My critical thinking skills before the program were good. All the same, my â€Å"Critical Thinking† (PHL/251) general education course worked wonders to polish my skills. It was for this reason that I had chosen the course. I believe that my decision was absolutely correct. After all, critical thinking is crucial in both personal and professional life. My interpersonal skills were always excellent, according to my opinion. This is because I believe in people, trust them, and wish to know more about them in order to be of assistance to them. I chose the general education course called â€Å"U. S. History to 1865† (HIS/110) because I was deeply interested in understanding the mechanics of human relationships, as well as the causes and effects of human decisions. Learning about U. S. history was essential, seeing that the people I share my space with do also share the same history. Hence, I believed unconsciously that I would be able to improve myself in my relations with others if I studied human history. Once again, my decision to opt for this general education course was correct, seeing that I now deal even more effectively in my personal and professional relationships. The most important core courses with respect to my employment were â€Å"Critical Thinking: Strategies in Decision Making† (MGT/350) and â€Å"Project Planning and Implementation† (CMGT/410). I opted for these courses because I believe that professionals who know the functions of management are always more successful than the rest. Furthermore, these courses helped me to assimilate my ideas about team projects as well as leadership. I further believe that all professionals must be armed with knowledge of management, even if this knowledge is specialized in terms of Information Technology. What is more, decision makers, project planners and implementers must always bear in mind the people connected with the decisions and projects. Indeed, this idea connected with my love for people and interest in human relations. Moreover, I now connect better with the people at my workplace, and truly understand more about the mechanics of decision making and project planning as well as implementation. One of the terminal objectives of my program was, of course, for me to mature into a successful individual in my professional life. Even at my current organization – General Mills, where I presently work as a Network Engineer – development and innovation are priorities as well as major targets. Hence, both the University of Phoenix and General Mills have contributed to my current upsurge or growth. But the job without the education at University of Phoenix would definitely not be as good as it is at present. At this time, however, my job is a huge part of who I am and who I want to be. The program at University of Phoenix has really been a great source of inspiration for me. Employment may have helped me go on living. But the education here has helped me to live life fully, to enjoy my work and to be proper in all respects. It has shown me the way to live life in a way that is better, not just to live as I may have heard others living. Life does not just drag on anymore. It is full of enthusiasm and anticipation for a bright present and future. I am applying the tools that I have learned through the University of Phoenix, and there is hope to use them in better ways to achieve higher goals. I am eager to learn even more of that which would help me along. Learning should be a life-long process so that one’s intellectual powers do not rust. Before the program, it was as though I, as a resource, was underutilized. Now I feel fully functional. Just as General Mills thrives on research and development, I see myself flourishing with an increase in my knowledge base and the utilization of my mental resources to their fullest capacity. The Information Technology skills learned by me through the program at University of Phoenix are incomparable to anything I have ever been taught. I feel more grown-up now because of what this program has done for me. I have been shown much of my potential. It seems that I have learned a lot and there is excitement in me now to know more. Life does not seem like dreary employment anymore. I enjoy my personal and professional life much more now that I have been a part of the University of Phoenix. As far as my ethical outlook is concerned, I see no change between the past and the present, and I do not see it changing either. My values have not changed. My self-esteem has increased because the way I see myself has changed. Whereas I may have been covered by darkness in my mind, I now see myself in the light, capable of doing much, maintaining goals, and wanting to do all that is good. I certainly have become advanced in my professional attitude. With regards to my personal attitude, I even walk more confidently now and that has a serious affect upon my professionalism too. At work, I have to be responsible, knowing and showing that I can make it right and to the top. It is as though I have been cultivated and I know what I am doing now. My career views have changed so much that whereas I had seen myself doing basic jobs and not going too far in my professional life before I joined University of Phoenix, now I feel confident and able to be the leader at work. I feel that the axiom ‘the sky is the limit’ is working in my life now. Earlier I may have thought that it is impossible to have such an attitude unless one’s performance was really marvelous. But this program has been about trying to do one’s best and fulfilling one’s potential. It has made me open my eyes and view the world out there full of possibilities for a bright human being wanting to do more and wanting to do what is excellent. I feel capable of reaching the top of my company now. Furthermore, now that I have had a glimpse of my highest potential, I also feel self-assured and competent enough to be at the top of another organization, if not my present company. A part of this newly found confidence in me is a result of observation. Even so, the knowledge that has been imparted to me with the wonderful Information Technology program takes most of the credit for my motivation today. Resonant with my new goals is the fact that my knowledge base has grown impressively. I now know not only that which is taught at undergraduate level in my field, but I am also seen by others as a better professional. My professional sense is increasing, signaling that I must continue trying to do better. I do not see the way down now. What is more, I am now able to hold professional presentations and meetings with high level professionals at General Mills. I am also more interested in my work at present. Over the next five years, my professional and personal attitudes may become more refined. I hope to become more mature and confident. I now understand how learning more can make one grow. I do not only want to continue learning, but I also want to continue growing until I can become a self-actualized individual. I wish to develop my ability to move to higher levels in my career through greater productivity. My goal is to be my best and also to be the very best in others’ opinion. I would like to attend a graduate program. I have so greatly and positively been influenced by the undergraduate program at University of Phoenix that I hunger for more of education. I understand to an extent how much it can do for me. Before the program, I did not think much of education besides the fact that it is necessary to a certain level. But because I have been working and noticing the changes that education brings into my professional life, I long to gather more knowledge. Education is directly related to success. I love the changes higher education has brought to my life and I welcome this fantastic transformation on an ongoing basis. Thinking is the basis of our actions, and if the undergraduate program at University of Phoenix could do so much for my life and attitudes, I cannot yet imagine where a graduate program might put me with regards to my professional position. I need more guidance for the future though, to be specific about what I would really do. I see the possibilities laid open before me, but which way do I really go? Many ways seem important. Perhaps I would settle for an MBA. In any case, I would have liked the University of Phoenix to better assist me in getting to the right place at the right time in future. To get a clearer sense of my educational goal at present, I may have to go for education counseling. I would like to recommend at this point that the University of Phoenix should incorporate an extensive education counseling program for its students. Over the next five years, I wish to grow to have more business sense. This may happen through higher education and additional years of experience at work. In point of fact, I would like to improve in all spheres of my life, and in the areas of my being that are good now, I would like to keep a balance whereby I do not drift to the low side of things. With my new outlook, I feel ready to take responsibility to add value to the world, even if it is solely by way of doing my job well and showing others that honesty, hard work and learning can go a long way. I feel worthwhile now and am prepared to continue struggling through life with zeal. When life gets slothful, I know what I must do to change that and to be promoted learn. I must continue learning.

Bed Wetting in School Children Essay Example for Free

Bed Wetting in School Children Essay Bedwetting (also referred to as nocturnal enuresis) is the involuntary passing of urine during sleep after the age at which bladder control usually occurs. It can be an embarrassing, frustrating and distressing problem that affects millions of children. It is more common than most parents think. Many children are dry at night by the time they reach the age of 5 but others take longer to become dry. When children still wet the bed when they are 6 or older, parents usually start to become concerned that their child may have some kind of physical or emotional problem. Some decide not to stress about it and give it time; others will seek medical advice, take their child to counselling or use alternative therapies. Once children go to Primary School and become aware that other kids of their age are dry at night they become embarrassed about it. Some children avoid going to sleepovers and school camps because of the fear of other kids discovering their problem. Teenagers are usually even more distressed by the bedwetting and many worry the problem will never go away. It often has a significant impact on their self-esteem. I decided to choose Bowen Therapy for Bedwetting as the subject for my Research Project because I have always had a passion for working with children. As a mother of two daughters and having dealt with toilet training issues I have experienced how upsetting and frustrating bedwetting can be for a child and their family. As Bowen Therapy is a wonderful holistic technique to promote physical and emotional balance, it is an ideal way to help children gain control of this problem. This research task explores the different causes and methods of treatment of nocturnal enuresis. It also outlines the anatomy of the urinary system and the nerves and muscles involved in micturition to gain a better understanding of how Bowen Therapy addresses this condition. I evaluated the effectiveness of Bowen Therapy on nocturnal enuresis in combination with dietary modifications as recommended by Mr. Bowen. The therapeutic value of omega-3 fatty acids is also mentioned (which have been proven to be effective in treating nocturnal enuresis) and the benefits of Neuro-Developmental reflex integration exercises.

The Levels Are Core Product Benefits Marketing Essay

The Levels Are Core Product Benefits Marketing Essay BMW has the image of a premium car manufacturer who is know for its well driving cars with a sportier performance than their competition, prime example of this is the fact that BMW only produces rear-wheel drive and four-wheel drive cars. Their premium image comes from the fact that they produce high-quality and relatively high prices automobiles. Even though their prices are relatively high the perceived value level is still at a sufficient level because of the balance with high quality. One of the core product benefits would be technology. For example EfficientDynamics which manages to lower fuel consumption without really compromising the performance BMW is known for, through means such as lightweight construction, a start-stop function, brake energy regeneration and tires with less roll resistance just to name a few. BMW has won many awards for innovation for measures such as these so their technology is at a high and innovative level. Product Attributes BMW was founded in 1916 and its first car went on sale in 1929, a well known and old brand known for its innovation is one of the strengths BMW can build on. Not only in the automobile branch but also known for its aircraft engines and motorcycles. Design, especially under Christopher Bangle recent design has been an important factor, loved by some hated by others the new design direction Bangle took was a hot topic in automobile discussions. What cannot be denied is that BMWs have a distinctive design with some elements that have been in its cars for decades. For example the characteristic grille, first introduced in 1933 and still in use on every car model BMW manufactures. Another part of design is that BMW designs all its products with recycling in mind, Design for Recycling makes sure that the right materials are used and recycling is easier because it is being accounted for at a design stage. BMW has a programme called BMW Individual in which such as the name states a customer can customise its car to great extent. Options such as exclusive paint, leather colours and types and more extensive audio/video possibilities are all part of this programme, all to satisfy the customer to the greatest extent. Support Services The normal delivery of an automobile consists of having it made ready by your dealer and having it delivered to your home. With BMW it is possible to pick it up at the factory it was produced at and have a tour there for example and visit the BMW museum, it is even possible for American customers to make use of this programme and BMW will even take care of the shipping afterwards. An exclusive offering which turns a simple delivery into a whole experience. BMW offers a long 12 year warranty on the body of the car, 3 years on the paintwork and 2 years on the rest with no maximum amount of kilometres used. Furthermore there are programmes that allow you to extend the warranty beyond this time for a premium. Every consumer has access to the BMW group Service Center which can be phoned 24/7 and is free of charge. BMW also offers BMW Financial Services, which is a lease and financing company. They offer lease agreements but also insurance, not only on cars but they even offer home or travel insurance. To summarize BMW produces high quality products which have a few characteristics they are well known for. There are many factors in which BMW has a great product strategy but the most notable factors would be driving quality, BMWs offer a high degree of performance in its cars. Also one very important factor is its technology, most notably EfficientDynamics through which BMW manages to lower fuel consumption and emissions without compromising the quality driving it is known for. There is also the design which characterises its cars as typical BMW and last but not least the high level of support services. Miscellaneous One of the biggest issues global society is facing is global warming, this is especially important in the automotive industry as their products play a (large) part in this issue. Car manufacturers face a bit of a paradox, their product is inherently harmful to the environment yet at the same time they try to be as environmentally conscious as possible. BMW not only tries to be environmentally conscious in their products they also strive to be this in their organisation. As stated on their website all BMW Group employees are guided by the ICCs Business Charter for Sustainable Development. Managers are stimulated to implement environmental guidelines and convey this message onto their employees. Just some examples are reducing the amount of paperwork that goes with every car as it goes down the production-line in the factory to reduce the amount of paper used. Turning off unused factory equipment in the weekends. Grouping the production of same coloured cars together so that the painting equipment has to be cleaned and sterilized less often. BMW Group acknowledges its responsibilities and commits to apply latest the technologies in order to enhance safety and lower fuel consumption and noise and exhaust emissions. As stated previously BMW applies Design for Recycling in which at the design stage there is already being accounted for optimizing the recycling process. BMW also is developing alternative fuel technologies such as BMW CleanEnergy which allows for the use of liquid hydrogen as a fuel. Furthermore BMW Group suppliers are required to adhere to the standards which BMW applies to its organisation and products. It is through technologies such as BMW Efficient Dynamics that the consumer is actually experiencing a lower fuel consumption and lower emissions. All of this achieved through lightweight construction, energy management and modern technology. For example in the Netherlands BMW has 129 models which have a green label, greener labels in turn allow for lower costs for the car. To summarize, although BMWs product is harmful to the environment they try to minimize this through the use of company-wide policies and design philosophy to ensure environmentally conscious production and technology to minimize fuel consumption and emissions. Sources Essentials of Global Marketing Svend Hollensen http://www.bmw.com/com/en/insights/overview.html http://www.bmw-warranty.co.uk/Pages/Information.aspx?page=Products/Comparison.htm http://www.bmwusa.com/Standard/Content/Owner/BMWUltimateService/Warranty.aspx http://www.bmw.co.uk/bmwuk/about/corp/environment http://www.bmwusfactory.com/Environment.aspx?id=282

Cesare Lombroso :: criminology

Cesare Lombroso was an Italian university professor and criminologist, born in Nov. 6, 1835, in Verona, who became worldwide renowned for his studies and theories in the field of characterology, or the relation between mental and physical characteristics. Lombroso tried to relate certain physical characteristics, such as jaw size, to criminal psychopathology, or the innate tendency of individuals toward sociopathy and criminal behavior. As such, Lombroso's approach is a direct descendant of phrenology, created by the German physician Franz Joseph Gall in the beginning of the nineteenth century, and closely related to other fields of characterology, such as craniology and physiognomy. His theory has been scientically discredited, but Lombroso had the merit of bringing up the importance of the scientific studies of the criminal mind, a field which became known as criminal anthropology. Lombroso studied at the universities of Padua, Vienna, and Paris, and was later (1862-1876) a professor of psychiatry at the University of Pavia and of forensic medicine and hygiene (1876), psychiatry (1896) and criminal anthropology (1906) at the University of Turin. He was also the director of a mental asylum in Pesaro, Italy. Lombroso's main idea was partly inspired by the evolutionary and genetical studies at the end of the nineteenth century, and proposed that certain criminals had physical evidence of an "atavistic" (reappearance of characteristics which were present only in distant ascendants) or hereditary sort, reminiscent of earlier, more primitive stages of human evolution. These anomalies, named as stigmata by Lombroso, could be expressed in terms of abnormal forms or dimensions of the skull and jaw, assymmetries in the face, etc, but also of other parts of the body. These associations were later shown to be highly inconsistent or plainly inexistent, and theories based on the environmental causation of criminality became dominant.

History of the Sound Card :: essays research papers

History of the Sound Card: How it Came About The very first sound card every manufactured was a Sound Blaster card. Far West was the manufacturer of the first Sound Blaster sound card. Let’s step back a little in time to take a look back at when sound cards haven’t even yet existed. â€Å"Computers were never designed to handle sound.† Before sound cards were invented, the only sounds you would hear from a computer would be the beeps that would tell you if something was wrong with the computer. That’s all! No sounds would accompany any games, you couldn’t play music at all, nothing! Computer programmers wanted to use the beeps for games they created, and so they would program the beeps into their games. However, it would be â€Å"awful music as an accompaniment to games like Space Invaders†. Far West came up with the solution, thus the invention of the first Sound Blaster sound card. It still wasn’t good quality music, but it was a big step up from just the beeps. â€Å"It could record real audio and play it back, something of a quantum leap. It also had a MIDI interface, still common on sound cards today, which could control synthesizers, samplers and other electronic music equipment†. The first sound card was of 8 bit 11 kHz audio quality, similar to an AM radio. There are two parts to the â€Å"complicated piece of electronics†, the sound card. ADC and DAC were they. ADC is the analog-to-digital converter and DAC being the opposite (digital-to-analog converter). ADC took an analog signal from a device and converts it to digital signals for the computer to use, as DAC did the exact opposite, taking a digital signal and converting it to analog. However, in the future, there will be no use of ADC and DAC since â€Å"both speakers and microphones will be able to directly record and playback digital signals directly†. An example of ADC would be a sound through the microphone being recorded into the computer. A CD player is an example of a device that uses DAC.   Ã‚  Ã‚  Ã‚  Ã‚  Digital audio has its advantages. One would be that â€Å"no matter how many times it is copied it remains identical†. It does not degrade analogue sources. An example of an analogue source is vinyl. A leap up to 16 bit 44.1 kHz was a major development. This is the quality of a CD. This became a problem for the ISA bus.

Disney :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  Final Copy   Ã‚  Ã‚  Ã‚  Ã‚  If a girl was going to search for her Prince Charming, the first place she should look is in the world of animation. Animation has probably been around since the beginning of time. Although, the artwork that originally resembled animation was only one or two cels, animation today is made up of hundreds or thousands of cels.   Ã‚  Ã‚  Ã‚  Ã‚  The early animated movies were black and white, did not have a plot, and were mostly a series of little gags. Then came ... COLOR. To make an animated movie popular, color was needed to give it style. Walt Disney and his technicians created color to make the movies more enjoyable for the viewers.   Ã‚  Ã‚  Ã‚  Ã‚  What was the first Disney Movie to come out? It was Snow White and the Seven Dwarfs. To make this movie Disney ran into a slight problem. Sure, it was easy to animate animals, but humans? To solve the problem, they filmed live actors doing exactly what the characters would do. This would work, but there was still a problem with the size of objects and losing things in the foreground when the camera zoomed. The solution ... a multiplane camera. In this camera, instead of many layers of artwork, there would be two, the foreground and the background. This made zooming in and out easier.   Ã‚  Ã‚  Ã‚  Ã‚  In the 1940's there were four classical Disney feature animated movies to come out: Pinocchio, Dumbo, Fantasia, and, Bambi. Little did Walt Disney know that the five movies that he made would be the base for many more Disney movies. In the movie Pinocchio for example, a toy maker creates a puppet and when he makes a wish upon a star.....the puppet turns into a real boy. Dumbo was the next movie to come about from Disney. Dumbo is a movie that teaches, you can do anything if you put your mind to it. Now Fantasia on the other hand is a totally different kind of movie. It's a cartoon musical. Bambi was the next movie to come out. To some it might be called a tragedy. But to others it might be called a happy and joyful movie. It teaches you to fend for yourself.   Ã‚  Ã‚  Ã‚  Ã‚  After World War II Disney came out with a few more feature animated movies such as: Cinderalla, Peter Pan, Lady and the Tramp, and Sleeping Beauty. One thing that Snow White, Cinderalla, and Sleeping Beauty all have in common is that they are all stories about princesses who live happily ever after with their prince.

Cognitive Impairment And Alzheimers Disease Health And Social Care Essay

Apathy is one of the commonest symptoms in Alzheimers disease and is associated with frontal lobe disfunction. Apathy is associated with high health professional load and has several negative effects.Purposes:The primary purpose of this survey is to analyze an association between apathy and frontal lobe disfunction in patients with memory jobs. We besides aimed to look into the association between apathy badness and health professional load along with the relationship between apathy and practiceMethods:This was a retrospective cross sectional survey. We selected 162 back-to-back patients diagnosed with Alzheimer ‘s dementedness and Amnestic Mild Cognitive Impairment who had comprehensive battery of neuropsychological trials and a behavior evaluation graduated table of involvement for this survey recorded in the database. Correlation between apathy with and without depression were tested against frontal lobe trial including Trail doing A, Trial doing B, Letter Fluency, Ideationa l Fluency, Category eloquence, Abstract Thinking and Executive working subtest of CAMGOG-R. Similarly correlativity analysis was besides done to look into association between apathy and caregiver load every bit good as practice.Consequences:Statistically important relationship were found between apathy and executive map tonss, conceptional eloquence tonss, abstract thought and class eloquence tonss. Relationship between apathy and health professional load were extremely important. Further bomber analysis, found apathy to be significantly associated with health professional load in both AD and aMCI patients.DecisionsApathy is associated with frontal lobe disfunction particularly impaired executive map and conceptional eloquence even when controlled for depression. It is extremely associated with health professional load both in AD & A ; aMCI.Hence early acknowledgment and direction of apathy is of import bettering the forecast of patients with AD & A ; aMCI.Table OF CONTENTSABSTRACT 3Chapter 1: Overview OF APATHY 5- 18Chapter 2: Introduction 19 – 20Chapter 3: AIMS & A ; OBJECTIVES 21Chapter 4: Methodology 21 – 28Chapter 5: RESULTS 28- 40Chapter 6: DISCUSSION & A ; CONCLUSIONS 40 – 44REFERENCES 45 -48APPENDIX A: Clinical RESEARCH PROTOCOLAPPENDIX B: ETHIC APPROVAL LETTERAPPENDIX C: NHS R & A ; D APPROVAL LETTEROVERVIEW OF APATHYDefinitionApathy is derived from the Grecian term apatheia intending deficiency of poignancy, or passions, and is normally referred as absence of feeling, emotions, involvement, or concern. ( Marin, 1990 ) Marin was the first to gestate apathy at both symptomatological and syndromal degrees and defined apathy as â€Å" deficiency of motive non attributable to decrease degree of consciousness, cognitive damage, or emotional hurt † ( Marin, 1990 ) .Motivation is a psychological construct and therefore it hard to quantify and measure up it.Hence to do it more clinically qualifiable and quantifiable, Apathy was proposed as a behavioral alteration from the person ‘s baseline and measured as a decrease in spontaneous and purposeful activity. ( Levy and Dubois, 2006 ) . A Starkstein and co-workers have developed a set of diagnostic standards for apathyA these standards specify the undermentioned as nucleus characteristics of apathy: lessened motive, inaugural and involvement, and blunting of emotions ( Starkstein and Leentjens, 2008 ) . In malice of assorted definitions of apathy being proposed, confusion continue to reign sing the nosological place of apathy.Nevertheless progressively apathy is being recognised as an of import constituent of neuropsychiatric research and that ‘s why dependable instance description and designation is necessary, to help communicating, research and intervention. This led to the development of consensus diagnostic standards for apathy in Alzheimer ‘s disease and other neuropsychiatric upsets ( Robert et al. , 2009 ) .DIAGNOSTIC CRITERIAThe revised consensus standards for apathy follow the same general construction as the standards proposed by Starkstein et Al in 2001 ( Robert et al. , 2009 ) . For a diagnosing of Apathy the patient should carry through the standards A, B, C and DStandards ALoss of or diminished motive in comparing to the patient ‘s old degree of operation and which is non consistent with his age or civilization. These alterations in motive may be reported by the patient himself or by the observations of others.Criteria BPresence of at least one symptom in at least two of the three following spheres for a period of at least four hebdomads and present most of the clipDomain B1: Loss of, or diminished, purposive behavior as evidenced by at least one of the followers: Loss of self-initiated behavior ( for illustration: starting conversation, making basic undertakings of daily life, seeking societal activities, pass oning picks ) Loss of environment-stimulated behavior ( for illustration: responding to conversation, take parting in societal activities )Domain B2: Loss of, or diminished, purposive cognitive activity as evidenced by at least one of the followers: Loss of self-generated thoughts and wonder for modus operandi and new events ( i.e. , disputing undertakings, recent intelligence, societal chances, personal/family and societal personal businesss ) . Loss of environment-stimulated thoughts and wonder for modus operandi and new events ( i.e. , in the individuals abode, vicinity or community )Domain B3: Loss of, or diminished, emotion as evidenced by at least one of the followers: Loss of self-generated emotion, observed or self-reported ( for illustration, subjective feeling of weak or absent emotions, or observation by others of a dulled affect ) Loss of emotional reactivity to positive or negative stimulations or events ( for illustration, observer-reports of unchanging affect, or of small emotional reaction to exciting events, personal loss, serious unwellness, emotional-laden intelligence )Criteria CThese symptoms ( A-B ) cause clinically important damage in personal, societal, occupational, or other of import countries of operation.Criteria DThe symptoms ( A-B ) are non entirely explained or due to physical disablements ( e.g. sightlessness and loss of hearing ) , to drive disablements, to decrease degree of consciousness or to the direct physiological effects of a substance ( e.g. drug of maltreatment, a medicine ) .PrevalenceApathy is an of import and often happening symptom in a assortment of neuropsychiatric upsets. Dementia and schizophrenic disorders are among the common causes of apathy ( ref ) . The prevalence for apathy in Alzheimer ‘s disease ranged between 32.1 % ( Holthoff et al. , 2005 ) and 93.2 % ( Sr ikanth et al. , 2005 ) . Point prevalence for apathy in Alzheimer ‘s disease ranged from 32.1 % 19A to 58.7 % ( Aharon-Peretz et al. , 2000, Holthoff et al. , 2005 ) . Table 1: Prevalence of Apathy Across Disorders ( Ishii et al. , 2009 )DisordersPrevalenceMild Cognitive Impairment 14.7 % a?’39.8 % Parkinson ‘s disease 17.0 % a?’45.7 % Progressive supranuclear paralysis 22 % a?’91 % Huntington ‘s disease 59 % a?’82 % Corticobasal devolution 40 % A Frontotemporal dementedness 89 % a?’100 % Dementia with Lewy organic structure 52 % Multiple induration 20 % a?’31 % Stroke 15.2 % a?’42 % Vascular dementedness 22.6 % a?’93.6 % Traumatic encephalon hurt 20 % a?’70 % Amyotrophic sidelong induration 55.6 % Hiv 12 % Cardiovascular disease 29 %CONDITIONS ASSOCIATED WITH APATHYApathy can be a symptom in a figure of neurological or psychiatric syndromes. Neurological Disorders include Traumatic encephalon hurt, Stroke affecting the frontal-subcortical circuit, Alzheimer ‘s disease ( AD ) , Dementia with Lewy organic structure ( DLB ) , Creutzfeldt-Jakob disease, Frontotemporal dementedness ( FTD ) , HIV dementedness, Parkinson ‘s disease ( PD ) , Progressive supranuclear paralysis, Anoxic brain disorder, Cerebral tumor, Chronic subdural haematoma, Huntington ‘s disease, Limbic phrenitis, Multiple induration, Bingwanger ‘s encephalopathy, Wernicke-Korsakoff syndrome, Kluver Bucy syndrome, Hydrocephalus, Delirium Psychiatric Disorders such as Depression, Schizophrenia, Psychoses and Adjustment upset Psychotropic drugs: . Dopamine adversaries are by and large associated with lessened motive, whilst agonists can increase it. Cannabis dependance, pep pill and cocaine backdown have all been implicated as a causative factor. An amotivational, or apathy, syndrome has been reported in a figure of patients having selective 5-hydroxytryptamines reuptake inhibitor ( SSRI ) intervention over the last decennary. This inauspicious consequence has been noted to be dose-dependent and reversible, but is frequently unrecognised ( Garland and Baerg, 2001 ) . Medical Disorders such as Apathetic thyrotoxicosis, Drug intoxications/withdrawal, Hypothyroidism, Lyme disease, Pseudoparahypothyroidism, Chronic weariness syndrome, Testosterone lack, Vitamin B12 lack, Other enfeebling conditions ( eg, malignance, CCF, nephritic or hepatic failure ) .IS APATHY AND DEPRESSION THE SAME?Apathy has frequently been treated as a portion of depression and it can frequently be diagnostically disputing to distinguish between the two due to frequent carbon monoxide morbidities and a considerable convergence in cardinal symptoms. However they are different concepts and it is of import to distinguish them because of predictive and intervention deductions. Apathy can besides ensue from the intervention for depression. There are theoretical concern that serotonergic re-uptake inhibitors ( SSRIs ) may impact the counterweight of 5-hydroxytryptamine and Dopastat, which can take to apathy, and SSRI-induced apathy has been progressively reported.Table 2: Differences and convergences in the clinical symptoms of apathy and depression ( table adapted from Landes et al. , 2005 )Apathy SymptomsDepressive SymptomsShared SymptomsLack of emotional response Indifference Diminished motive Lack of productiveness Poor Persistence Low societal & amp ; occupational battle Person is by and large satisfied Low temper Feelingss of guilt, Suicidal ideations Insomnia Reduced appetency Pessimism Self-criticism Hopelessness Worthlessness Loss of involvement Psychomotor deceleration Fatigue/hypersomnia Lack of penetrationEffectss of ApathyApathy has important negative effects and therefore early designation and diagnose is critical. In Alzheimer ‘s Disease ( AD ) patients, apathy is associated with hapless penetration into cognitive and behavioral alterations ( Derouesne et al. , 1999 ) along with greater cognitive every bit good as functional diminution ( Holtta et al. , 2012 ) . Apathetic patients are frequently misperceived as lazy by the household taking to increasing resentfulness. Apathy may impact patient perceptual experience of quality of life ( Gerritsen et al. , 2005 ) and is significantly associated with activities of day-to-day life ( ADLs ) damage ensuing in increased patient and health professional distress.. It is besides significantly associated with older age and a higher incidence of depression and craze ( Holtta et al. , 2012 ) . Apathy has been shown to be associated with frontal lobe disfunction particularly executive map in dementedness ( Ready et al. , 2003 ) and these frontal lobe maps are indispensable to a individual ‘s ability to transport out mundane planning and determination devising along with health-promoting behaviors, such as medicine direction, dietetic and lifestyle alterations, self-monitoring of responses, and follow-up with wellness attention professionals ( Kuo and Lipsitz, 2004 ) . Apathy affects the quality and degree of familiarity in a relationship and hence enjoyment of each other ‘s company. This leads to impairment of the relationship, increased health professional load and an increased the hazard of institutionalisation ( Spruytte et al. , 2001 ) ( de Vugt et al. , 2003 ) . Apathy besides has of import diagnostic and intervention deductions.It may forestall patients from seeking an early formal appraisal and may interfere with attachment to pharmacologic intervention for memory loss and engagement in compensatory schemes, such as keeping an accurate and up-to-date memory notebook ( Ready et al. , 2003 ) . Apathy may hold important predictive value.Apathy has been described to increase the hazard of patterned advance from MCI to dementia. In nursing place patients with Alzheimer ‘s dementedness, apathy has been associated with physical damage, dependence, hapless nutritionary position and significantly increased 2-year mortality rates ( Holtta et al. , 2012 ) .PATHO-PHYSIOLOGY OF APATHYApathy has been shown to be associated with a break of the frontal-subcortical neural circuit. Assorted surveies have concluded that the neural circuit that originates from the anterior cingulate cerebral mantle, so proceeds to the ventral striate body, globus pallidus, and thalamus, with a concluding cringle back to the anterior cingulate cerebral mantle is related to apathy ( Bonelli and Cummings, 2007 ) .Autopsy surveies have shown that neurofibrillary tangles load were significantly higher in the anterior cingulate cerebral mantle in apathy ( Marshall et al. , 2006 ) .Similarly structural magne tic resonance imagination ( MRI ) surveies have shown that apathy badness correlated with wasting of bilateral anterior cingulate and left auxiliary motor country ( Apostolova et al. , 2007 ) .Studies with Single photon emanation imaging have besides shown that apathetic AD patients had significantly decreased perfusion in the anterior cingulate, the inferior and median convolution frontalis and the orbito frontal convolution ( Robert et al. , 2006 )FigureA 1.A Behavioural and cognitive alterations associated with break of specific frontal-subcortical circuits ( Ball et al. , 2010 ) .Dopamine is the principle neurotransmitter of purposive behaviour, modulating motive, rousing, motor response, and sensorimotor integrating. There is a strong relationship between D2 receptor stimulation and anterior cingulated cortex metamorphosis. The anterior cingulate cerebral mantle appears to be of importance in motive and wages ( Devinsky et al. , 1995 ) and receives exceptionally heavy dopaminer gic ( DA ) excitation originating from ventral tegmental country ( VTA ) nerve cells ( Williams and Goldman-Rakic, 1998 ) . Cholinergic and serotonergic tracts besides play a neuromodulatory function in the motivational circuitry. Acetylcholine ( ACh ) and DA systems appear to organize striatal wages map in a feed-forward, complementary mode ( Williams and Adinoff, 2008, Zhou et al. , 2003 ) . Serotonin is chiefly an repressive neurotransmitter can straight impact frontal lobe activities and they can indirectly modulate frontal lobe activity by suppressing the release of Dopastat ( Daw et al. , 2002 ) . Positron Emission Tomography surveies have important decreases of 5-HT2AA receptor densitiesA in the frontal lobe in patients with apathy ( Franceschi et al. , 2005 ) .ASSESSMENT OF APATHYThere are assorted graduated tables available to determine and quantify apathy. A recent literature reappraisal has identified around 14 graduated tables of which seven were full apathy graduated ta bles and eight were apathy subscales embedded in larger graduated tables ( Clarke et al. , 2011 ) . The most widely used graduated table were the Apathy Evaluation Scale AES ) and the Neuropsychiatric Inventory ( NPI ) .Neuropsychiatric Inventory ( NPI )The NPI is a graduated table that assesses and quantifies neurobehavioral perturbations in dementedness patients and besides quantify health professional hurt caused by such behaviors ( Clarke et al. , 2011, Cummings et al. , 1994 ) . The NPI has an apathy subscale, which consists of a general screen point rated on a yes-versus-no footing. If the symptom is found to be present, seven extra apathy inquiries are administered and scored on a yes-versus-no footing. The overall frequence ( rated as 1-4 ) and badness ( rated as 1-3 ) of apathy is so rated. Tonss on the NPI apathy subscale scope from 0 to 12 with higher tonss bespeaking more terrible apathy ( Cummings et al. , 1994 ) . The NPI, and therefore the NPI-apathy subscale, is depe ndable, widely used, and has been validated in many different scenes.Apathy rating graduated table ( AES )The AES is an Eighteen-item graduated table capturing symptomatology over last 4 hebdomads. This scale buttockss and quantifies the affectional, behavioural, and cognitive spheres of apathy. It specifically assesses apathy and discriminates it from depression. Each point can be rated on the 4 point likert Scale. It takes around 10-20 min to be completed by a trained interviewer. This trial has a good interrater dependability and is widely usedPOTENTIAL TREATMENT OPTIONS FOR APATHYNonpharmacologic Treatment of ApathyThere are many non pharmacological intercessions that have anecdotal and qualitative grounds of effectivity in the apathy but merely a few of them has quality research confirmation in footings of effectivity ( Brodaty and Burns, 2011 ) . Open-label surveies have shown that multisensory behavior therapy and music therapy have positive consequence in cut downing apathy and could hike the consequence of anti dementedness drugs ( Ferrero-Arias et al. , 2011, Staal et al. , 2007 ) . Cognitive stimulation therapy that provides activities affecting cognitive processing, within a societal context, with an accent on enjoyment has been shown to be effectual in cut downing apathy in early Alzheimer ‘s Disease ( Buettner et al. , 2011 ) . Treatment of apathy requires multidisciplinary attack along with health professional psycho instruction about the pathological nature of apathetic province. The health professionals should besides be encouraged to present new beginnings of pleasances, involvements and stimulation along with increasing chance for socialization. It is besides of import that the patient ‘s general medical conditions are assertively treated and centripetal shortages corrected along with environmental alterations such as usage of adaptative devices such as wheelchair, seeable Clocks, calendars and equal lighting to increase the reward potency of the environment and thereby enhance motive. Although there is presently lack of research grounds, it is possible the other non pharmacological intercessions such as originative activities, cookery, Montessori methods, and behavioural elements, frequently separately tailored, exercising, multisensory stimulation, favored therapy, and particular attention unit s have the possible to cut down apathy ( Brodaty and Burns, 2011 ) .Pharmacologic Treatment of ApathyAcetylcholinesterase InhibitorsAChIs are chiefly used for handling cognitive symptoms in dementedness but recent surveies have shown positive effects on noncognitive symptoms such as apathy, depression, anxiousness, and purposeless motor behaviours. Consequences from randomized controlled tests have shown that AChIs including donepezil, galantamine and rivastigmine are clearly good in the intervention of apathy. There is no clear indicant that any one AChI is superior.NDMA Receptor AntagonistMemantine is a specificA N-methyl-D-aspartate receptor adversary and is the lone drug approved for handling terrible AD.A It appears to work by modulating the activity of glutamate, leting a controlled sum of Ca to flux into nerve cells ( enabling information processing, storage, and retrievalA 98 ) protecting nerve cells against glutamatergic excitotoxicity and, potentially, holding a neuroprote ctive consequence by cut downing toxic Ca inflow. There is grounds from randomized, double-blind, placebo-controlled tests, which indicated important betterments in apathy degrees for patients treated with MemantineMajor tranquilizersTypical Consequences from Randomized, double-blind, placebo-controlled test in nondepressed inmates with dementedness found no alteration in apathy degrees Atypical Surveies look intoing the effects of untypical major tranquilizers on apathy have reported important betterments in symptomsA farther 12-week open-label survey 130 of risperidone in 135 patients with AD showed increasing and important betterment in apathy. An RCT of 652 nursing place occupants with terrible AD reported betterment in apathy for occupants treated with olanzapine 5 mg/day but non with 1, 2.5, or 7.5 mg/day, and there was no accommodation for multiple comparingsAntidepressantsBupropion is aA dopamineA andA norepinephrine re-uptake inhibitorA and releaser. It is approximately twice as potent an inhibitor of Dopastat re-uptake than of norepinephrine reuptake.A Besides reuptake suppression of Dopastat and noradrenaline, bupropion besides causes the release of Dopastat and noradrenaline. Hence theoretically should profit apathy but there have been no good quality tests with Bupropion. There is grounds signifier clinical instance series that bupropion may profit apathy ( Corc oran et al. , 2004 ) Assorted tests of antidepressants in the interventions of apathy have mostly been negative, supplying extra support that depression and apathy are different concepts. There is good quality grounds from assorted randomised controlled trails that antidepressants do no alteration in apathy degrees. Interestingly apathy syndrome has been reported in a figure of patients having selective 5-hydroxytryptamines reuptake inhibitor ( SSRI ) intervention over the last decennary and hence SSRI must be used with cautiousnesss clinicians need to be proactive in supervising for this inauspicious consequence ( Barnhart et al. , 2004 )PsychostimulantsEvidence from instance studies and little open-label surveies in non demented populations suggests that psychostimulants such as dextroamphetamine and Ritalin may be effectual in the intervention of apathy.Results from a recent double-blind, randomized, placebo-controlled crossing over test of Ritalin for the intervention of apathy suggest modest benefit s in a subset of AD patients, but that tolerability may be a concern in this population ( Herrmann et al. , 2008 ) .A There are instance studies that have reported that Modai ¬?nil may profit apathy syndrome in the older patients and is more tolerable ( Camargos and Quintas, 2011 )Dopaminergic agentsThere are merely few surveies on the effectivity of dopaminergic agents as a intervention for apathy and such surveies have been chiefly focussed on Parkinson ‘s disease and station shot conditions.Bromocriptine, aA Dopastat agonist, in case-series studiesA have been found to be effectual in cut downing apathy symptoms in shot and hypoxic encephalon hurt patients ( Barrett, 1991, Debette et al. , 2002, Krishnamoorthy and Craufurd, 2011 ) . There is nevertheless no good quality research grounds of their effectivity in handling apathy in Alzheimer ‘s disease ( van Reekum et al. , 2005 ) .Amantadine is aA N-methyl-D-aspartic acid receptor adversary, which may indirectly height en dopaminergic transmittal and confer neuroprotective effects, similar to its parallel, memantine has been shown to be effectual in bettering executive map and apathy symptoms in chronic encephalon hurt, dementedness and Parkinson ‘s disease ( Drayton et al. , 2004, Wu and Garmel, 2005 ) . Levodopa/carbidopa besides appears to better motive in assorted neurological and psychiatric upsets harmonizing to instance surveies of patients ( Bakheit et al. , 2011, Drubach et al. , 1995 ) Pramipexole, another Dopastat agonist with D3-preferring receptor adhering profile, is used in the early-stage Parkinson ‘s disease ( PD ) .A meta-analysis of placebo-controlled surveies have shown good consequence on temper and motivational symptoms in PD patients ( Leentjens et al. , 2009 ) . Similarly Ropinirole, Dopastat D2/D3 receptor agonist been reported to better apathy and temper in patients with Parkinson disease ( Czernecki et al. , 2008 )IntroductionApathy is a neurobehavioral syndrome which is defined as quantitative decrease of voluntary, purposive behavior ( Levy and Dubois, 2006 ) .It extremely prevailing across a big assortment of neurological, psychiatric, and medical conditions and is the most common neuropsychiatric symptom of Alzheimer ‘s disease with an mean point prevalence of 60 % in outpatients with Alzheimers Disease. ( Clarke et al. , 2011, Robert et al. , 2004 ) Apathy is a major hazard factor for transition to dementia in MCI topics and follow up surveies have shown that rates of transition to dementia in MCI with apathetic symptoms were up to 60 % as compared to 24 % for MCI without apathy and depression ( Vicini Chilovi et al. , 2009 ) . Apathy was thought to be upset of sub cortical encephalon construction but interestingly it appears to be really commoner in cortical encephalon upsets with averaged point prevalence of about 60 % as compared to 40 % in upsets of sub cortical constructions ( van Reekum et al. , 2005 ) . The frontal lobes play an of import function in back uping higher-level cognitive map, dwelling of executive accomplishments and working memory. Executive maps are higher-order cognitive procedures that orchestrate simple thoughts, motions and actions into complex purposive behaviors. They include be aftering, induction, coincident information processing, ordinance, judgement, abstraction, and job resolution. Damage of executive working consequences in disinhibition, concrete thought, perseveration, deficiency of enterprise, apathy, and loss of cognitive i ¬Ã¢â‚¬Å¡exibility ( Tsoi et al. , 2008a ) . A significant organic structure of grounds suggests that apathy typically occur following harm to prefrontal cortical-striatal circuits in the encephalon, and are seen in many neurological and psychiatric upsets, including all of the common signifiers of dementedness: Alzheimer disease ( AD ) , vascular dementedness ( VaD ) , and Frontotemporal dementedness. ( Craig et al. , 1996 ) .Studies have shown that Apathy in AD patients was associated with more terrible hypoperfusion in frontal parts on functional imagination ( Craig et al. , 1996 ) . A few surveies have tried to look into the relationship between apathy in dementedness and frontal lobe disfunction. Apathy in AD has been shown to be significantly associated with hapless public presentation on executive map trials, such as the Trail-Making Test and the Stroop colour intervention trial ( McPherson et al. , 2002 ) . Executive disfunction, particularly shortages impacting verbal eloquence and conceptional eloquence, was a important forecaster of apathy in dementedness ( Tsoi et al. , 2008a ) . There has been really small literature about relationship between practice and apathy in Alzheimer ‘s disease. It is known that frontal systems behavioral jobs are associated with higher health professional load after commanding for dementedness badness and health professional depression. There has been conflicting studies about part of apathy towards caregiver burden. Few surveies have shown that apathy was associated with greater grade of health professional load ( Chow et al. , 2009 ) ( Leroi et al. , 2012 ) while another survey showed that it was the behaviors associated with executive disfunction and disinhibition that were prognostic of load and apathy was considered less troublesome to health professionals ( Davis and Tremont, 2007 )AIMS & A ; OBJECTIVES:The primary purpose of this survey is to analyze the association between apathy with or without depression and frontal lobe disfunction in patients with memory jobs. The secondary purpose is to look into association between apathy badness and the health professional load In add-on, this survey will look into the association between apathy and practice in AD and MCI as there are presently limited surveies that have looked into association between them.DESIGN/ METHODOLOGY:Ethical motives Approval: A The survey was approved by The National ResearchA EthicsA Service ( NRES ) Committee for East of England, King College London every bit good as the NEPFT NHS R & A ; D officePutingThe survey was done at the West Essex Neurocognitive Clinic which is third referral Centre and is based at three locations viz. St Margaret ‘s Hospital, Epping, Princess Alexandra Hospital, Harlow and Rectory Lane Health Centre, Loughton. The catchment country serves population of aged people of greater London and Essex, UK. The Clinic provides a specialised, multidisciplinary, hospital-based appraisal for people with cognitive jobs Majority of the patient ‘s referred are those with mild cognitive damages or patients hard to name due to combination of medical, neurolog ical, societal and neuropsychological factors. The clinic is focused on research and preparation and is involved in assorted imagination, cognitive and intervention surveies, every bit good as encephalon contribution programme. Referral standards are based on a history of cognitive damage, which is likely to be caused by degenerative alterations of the encephalon with the MMSE mark of at least 20/30, complex presentations due to interplay of varying degrees medical, neurological and neuropsychological factors and hard to name instances. Patients must be aged in surplus of 40 old ages ( reflecting appropriate referral of people with possible immature onset dementedness ) and must be able to give informed consent. The appraisal is done by a trained and experient clinician along with a psychologist/assistant psychologist. Assessment encompasses a assortment of trials aimed at set uping diagnosing and badness of unwellness. The appraisals of involvement for this survey includes A standard psychiatric interview Behavioural Pathology in Alzheimer ‘s Disease Scale ( BEHAVE-AD ) sum 75 where higher mark indicates more disturbed behavior ; Apathy/Indifference sub-scale ( NPI ) total/12 – higher mark indicates greater apathy ; Hospital Anxiety and Depression Scale ( HADS ) -total on each scale/21 -score of 7 or less indicates no important symptoms, mark of 8 – 10 indicates mild symptoms, mark of 11 + indicates moderate symptoms ; Instrumental Activities of Daily Living Scale ( IADL ) total/31 -higher tonss indicates increased dependence upon the source or ‘carer ‘ ; Clinical Dementia Rating ( CDR ) total/5 -higher mark indicates more badly affected cognitive and occupational/social operation ; Screen for Caregiver Burden ( SCB ) total/100 – higher mark indicates client is perceived to be a greater load by the source or ‘carer ‘ ; Neuropsychometric Assessment is done by the Psychologist/Assistant psychologist. The battery of neuropsychometric trials done of involvement to this survey includes: Estimated pre-morbid rational operation ( National Adult Reading Test – NART ) , Cambridge Cognitive Examination-Revised ( CAMCOG-R ) Trail doing A & A ; Trial devising B Letter Fluency, Category eloquence, Ideational Fluency Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual logical thinking ) Subjects: This was a retrospective Cross-sectional survey. The survey population comprised 160 back-to-back patients with newly-diagnosed Alzheimer ‘s disease and amnestic-MCI, All the patients at the clip of their initial neurocognitive clinic appraisal had a thorough neurological and psychiatric scrutiny by a trained and experiences clinician along with extended neuropsychometric appraisal by a psychologist. Health professionals and next-of-kin were besides interviewed.At the clip of the appraisal all patients had capacity to give an informed consent to undergo the appraisal. Their capacity was assessed by a member of clinical squad familiar with, and trained in usage of the Mental Capacity Act. In add-on, patients have either agreed or disagreed to hold their informations entered into unafraid database maintained by North Essex Mental Health Partnership NHS Trust, for the intent of supplying wellness attention and set abouting medical research and statistical analysis. Eligibility standards: All patients diagnosed with Alzheimer ‘s disease and amnesic Mild Cognitive Impairment who had the undermentioned probes recorded on database: NPI apathy mark, frontal lobe map trial i.e Trail doing A, Trial doing B, Letter Fluency, Ideational Fluency, Category eloquence, Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual logical thinking, CAMCOG-R, age, gender, HAD Depression mark, Care giver load and Praxis. All these patients would be eligible to take a portion in the survey. Inclusion standards: Eligible patients who gave an informed consent to hold their informations entered into unafraid database maintained by North Essex Mental Health Partnership NHS Trust, for the intent of supplying wellness attention and set abouting medical research and statistical analysis. This is considered to be patients presumed wants. Exclusion standards: Patients who did non consent to hold their informations entered into unafraid database maintained by North Essex Mental Health Partnership NHS Trust, for the intent of supplying wellness attention and set abouting medical research and statistical analysis. This is considered to be patients presumed wants. Patients whose depression scores on HAD were more than 8 were besides excluded.MeasuresApathy will be measured as the apathy sub-score on the NPI. The NPI was developed to measure and quantify neurobehavioral perturbations in dementedness patients and to quantify health professional hurt caused by such behaviours. The NPI has an apathy subscale, which consists of a general screen point rated on a yes-versus-no footing. If the symptom is found to be present, seven extra apathy inquiries are administered and scored on a yes-versus-no footing. The overall frequence ( rated as 1-4 ) and badness ( rated as 1-3 ) of apathy is so rated. Tonss on the NPI apathy subscale scope from 0 to 12 with higher tonss bespeaking more terrible apathy. The NPI, and therefore the NPI-apathy subscale, is widely used and has been validated in many different samples such as ambulatory patients with dementedness, outpatients with AD, multicultural samples, and nursing place occupants. Cognitive damage will be measured by the mark on Cambridge Cognitive Examination-Revised ( CAMCOG-R ) . This neuropsychological battery steps cognitive shortage in a figure of cognitive spheres – mark & lt ; 80/105 suggests the presence of a dementedness, mark of 80-90/105 is fringy. Frontal Lobe disfunction will be measured by the tonss obtained from the undermentioned frontal lobe map trial i.e. Trail doing A, Trial doing B, Letter Fluency, Ideational Fluency, Category eloquence, Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual logical thinking ) . The Trail Making Tests ( TMTs ) are popular neuropsychological instruments used either entirely as a showing instrument for observing neurological disease and neuropsychological damage or as portion of a larger battery of trials. The trials are believed to mensurate the cognitive spheres of treating velocity, sequencing, mental flexibleness and visual-motor accomplishments Part A is by and large presumed to be a trial of ocular hunt and motor velocity accomplishments, whereas portion B is considered besides to be a trial of higher degree cognitive accomplishments such as mental flexibleness. TMT-A requires chiefly visuoperceptual abilities, TMT-B chiefly reflects working memory and secondarily task-switching ability, while B-A minimizes visuoperceptual and working memory demands, supplying a comparatively pure index of executive control abilities.Average DeficientDrag A 29 seconds 78 seconds Trail B 75 seconds 273 seconds Letter Fluency undertakings require coevals of words get downing with specific letters within a limited clip it has been. Letters F, A, and S ( FAS ) version of the The Controlled Oral Word Association Test is used in this survey. The trial disposal takes about five proceedingss. The mark is the amount of all admissible words for the three letters ( Loonstra et al. , 2001 ) . Category Fluency undertaking require persons to bring forth examples of specific semantic classs such as the names of animate beings or fruits. CF trial is a really speedy ( normally taking 1 min ) , easy to administrate trial that proved to be utile in the diagnosing of mild AD. The most common version involves the semantic class of animate beings. Surveies have shown that tonss below 15 in the CF ( animals/min ) had a sensitiveness of 88 % and a specificity of 96 % , in distinguishing AD patients from normal controls, bespeaking that a 1-minute trial can be helpful to clinicians to place persons in the early phases of the disease ( Caning et al. , 2004 ) . Category Fluency and Letter Fluency require frontally mediated executive retrieval mechanisms. Both besides require entree to phonological/lexical shops. But, merely class eloquence besides requires entree to more widely distributed semantic shops as the topic searches for examples suiting the mark class ( Cerhan et al. , 2002 ) .Datas AnalysisDependent variable is Apathy mark. Independent variables are CAMCOG-R tonss, tonss of the undermentioned frontal lobe testsTrail doing A, Trial doing B, Letter Fluency, Ideational Fluency, Category eloquence, Abstract Thinking, Executive working subtest of CAMGOG-R ( eloquence + Similarities+ Ideational eloquence + Visual concluding ) every bit good as tonss of health professional load and practice. All these variables will be analysed as uninterrupted informations. The consequences will be graphed to look into if the distribution is about normal and the spread secret plan used to measure the one-dimensionality of the association. Correlation analysis, measured as a correlativity coefficient R, will be used to look into for the presence, the strength and way of a relationship between these variables. Cut-off point of 0.4 will be considered to be important. Depending on the one-dimensionality one of the two correlativity coefficients will be calculated. Ranked correlativity will be used in the statistical analysis if the relationship between the two variables in non-linear. Rank correlativity coefficients, such as Spearman ‘s rank correlativity coefficient measures the extent to which, as one variable additions, the other variable tends to increase, without necessitating that addition to be represented by a additive relationship. If, as the one variable addition, the other lessenings, the rank correlativity coefficients will be negative. If the two variables appear to hold additive relationship Spearman correlativity coefficient will be calculated. The closer the coefficient is to either a?’1 or 1, the stronger the correlativity between the variables. Correlation Negative Positive Small a?’0.3 to a?’0.1 0.1 to 0.3 Medium a?’0.5 to a?’0.3 0.3 to 0.5 Large a?’1.0 to a?’0.5 0.5 to 1.0 If the variables are independent so the correlativity is 0. However, the antonym is non true because the correlativity coefficient detects merely additive dependences between two variables.Power computationStatisticalA powerA analysesA wasA doneA byA usingA G*PowerA 3.1 ( Faul et al. , 2009 ) TypeA IA error=0.05A TypeA IA error=0.01A TypeA IA error=0.001 Power=80 % A 34A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 56A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 84 Power=90 % A 47A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 72A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 106 Power=99 % A 85A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 117A A A A A A A A A A A A A A A A A A A A A A A A A A A 159 ThisA indicatesA thatA inA orderA toA determineA aA correlationA ofA magnitudeA 0.4A atA P & lt ; 0.05A atA aA powerA levelA ofA 80 % , A thisA studyA needsA aA minimumA ofA 34A participants.AConsequenceOne hundred and 60 patients with AD or amnesic MCI who met the above-described standards were enrolled in the survey. Of these 68 patients had a diagnosing of Alzheimer ‘s disease and 92 had a diagnosing of amnesic MCI. The demographic information of the topics are summarized in Table 1. No statistically important differences in age, instruction, gender, premorbid intelligence, or old ages in instruction consequences were observed between the two groups. However as expected, there was statistically important difference in footings of the IADL, CAMCOG-R, CDR & A ; MMSETable 1: Demographic and clinical featuresAverage AD ( SD )Average MCI ( SD )P valueNIADL10.34 ( 5.52 ) 8.11 ( 3.42 ) & lt ; .001 160CAMCOG-R76.8 ( 12.66 ) 86.98 ( 8.71 ) & lt ; .001 156MMSE22.19 ( 5.13 ) 25.81 ( 2.55 ) & lt ; .001 158NART105.33 ( 10.00 ) 106.26 ( 12.23 ) .319 124CDR0.82 ( 0.41 ) 0.55 ( 0.17 ) & lt ; .001 159Age74.37 ( 8.61 ) 73.37 ( 8.70 ) .339 160Old ages Ed.11.14 ( 2.91 ) 11.16 ( 2.60 ) .655 154AdMCIChi SquareP valuePercent female51.5 47.8 0.21 .65Percentage with intoxicant history63.2 65.9 1.47 .69Percentage with smoking history42.6 50.0 2.33 .31 The frequence distribution box secret plan suggested that NPI apathy bomber graduated tables are non usually distributed. We did normalcy trials to find whether apathy informations set is well-modelled by a normal distribution or non. We used the Shapiro-Wilk trial as our numerical agencies of measuring normalcy and found that the apathy informations significantly deviate from a normal distribution. Shapiro-Wilk Statistic df NPI Apathy sub graduated table .624 160 As our information ‘s were non parametric, utilizing the Spearman rho correlativity coefficient, correlativities between variables for whole group and subgroups was generated. The Spearman rho correlativity was repeated with depressive subgroups removed. All trials were one-tailed since hypotheses were directional. The exclusion to this was the trial look intoing the relationship between gender and apathy. These hypotheses were non-directional and therefore two-tailed trials were used.Executive map markAbstract believing markCaregiver loadCAMCOG-R markLetter FluencyClass EloquenceTrail Making Test A ( seconds ) Trail Making Test B ( seconds )Conceptional eloquence markPractice Correlation Coefficient-.222**-.180*.477**-.136*-.071-.166*.009 .010-.213**-.102 Sig. ( 1-tailed ).003.012.000.045.189.019.456 . 464.004.103 Nitrogen157157145156155157152 84156156ConsequencesTable 1: Correlations between variables for whole group and subgroupsCorrelations between variables for whole group and subgroups with depression removed.Executive map markAbstract believing markCaregiver loadCAMCOG-R markLetter Fluency Class Eloquence Trail Making Test A ( seconds ) Trail Making Test B ( seconds )Conceptional eloquence markPractice Correlation Coefficient-.169*-.125 .475** -.067 -.041 -.123 -.052 .089-.186*.019 Sig. ( 1-tailed ).027.077 .000 .223 .321 .080 .279 .229.017.417 Nitrogen131131 121 131 130 131 127 72130131Relationship between apathy and executive mapIn the combined sample ( AD and A-MCI ) , informations on executive map was available for 157 patients. In these patients, NPI apathy mark was significantly related to executive operation ( rs = -.222, P = .003 ) .When the group of patients with depressive symptoms were removed, the NPI apathy mark still remained significantly related to executive operation ( n=131, rs =-.169, p=.027 )Relationship between apathy and trail devising trialsIn the combined sample ( AD and A-MCI ) , informations on trail doing trial A was available for 152 patients. In these patients, NPI apathy mark was non significantly related to drag doing tonss ( rs = .009, P = .456 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to drag doing A tonss ( n=127, R -.052, p=.279 ) In the combined sample ( AD and A-MCI ) , informations on trail doing trial B was available for 84 patients. In these patients, NPI apathy mark was non significantly related to drag doing tonss ( rs = .010, P = .464 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to drag doing B tonss ( n=72, R.089, p=.229 )Relationship between apathy and verbal eloquenceIn the combined sample ( AD and A-MCI ) , informations on missive eloquence ( FAS ) was available for 150 patients. In these patients, NPI apathy mark was non significantly related to eloquence ( rs = -.047, P = .284 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to eloquence tonss ( n=130, R -.041, p=.321 )Relationship between apathy and class eloquenceIn the combined sample ( AD and A-MCI ) , informations on class eloquence ( animate beings ) was available for 157 patients. In thes e patients, NPI apathy mark was significantly related to category eloquence ( rs = -.166* , P = .019 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to category eloquence ( n=131, rs -.123, p=.080 )Relationship between apathy and conceptional eloquenceIn the combined sample ( AD and A-MCI ) , informations on conceptional eloquence was available for 156 patients. In these patients, NPI apathy mark was significantly related to conceptional eloquence ( rs = -.213** , P = .004 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained significantly related to on conceptional eloquence ( n=130, rs -.186* , p=.017 ) .Relationship between apathy and cognitive mapIn the combined sample ( AD and A-MCI ) , informations on CAMCOG-R was available for 156 patients. In these patients, NPI apathy mark was significantly related to cognitive operation ( rs = -.136* , P = .045 ) . When the group of patients with depressive symptoms were removed, the NPI apathy mark remained significantly related to on conceptional eloquence ( n=131, rs -.067, p=.223 )Relationship between apathy and abstract thoughtIn the combined sample ( AD and A-MCI ) , informations on abstract thought was available for 152 patients. In these patients, NPI apathy mark was significantly related to abstract thought ( rs = -.180, P = .013 ) .Relationship between apathy and health professional load.In the combined sample ( AD and A-MCI ) , informations on health professional load was available for 145 patients. In these patients, NPI apathy mark was significantly related to caregiver load ( rs = .477** , P = .000 ) . NPI apathy mark remained significantly related to caregiver burden even when the depressive subgroup of patient was removed ( n=121, rs =.475** , P = .000 ) . The correlativity between apathy and caregiver load were so tested in Alzheimer ‘s disease and amnesic MCI individually and in both subgroups NPI apathy mark was significantly related to caregiver loadNonparametric Correlations: NPI Apathy and Caregiver Burden in AD & A ; aMCIaMCIAdNPI Apathy sub graduated table Correlation Coefficient .458** .480** Sig. ( 1-tailed ) .000 .000 Nitrogen 68 53 A arrested development analysis was carried out to understand the relationship between a health professional load and MMSE, Depression Scores, Apathy, Behave -AD Scores, executive map mark, IADL.Arrested development Analysis CoefficientsaModel Unstandardized Coefficients Standardized Coefficients T Bacillus Std. Mistake BetaNPI Apathy sub graduated table1.130.240.3944.703IADL.360.167.1812.155Behave -AD mark .303 .211 .113 1.438 HADS-depression mark .016 .212 .006 .074 Executive map mark -.113 .200 -.047 -.566 MMSE mark .024 .193 .010 .125 a. Dependent Variable: Mark for ‘caregiver load ‘ questionnaire at baseline It is clear from the multiple arrested development analysis that merely NPI apathy tonss and IADL were significantly related to caregiver load. However the other variables which included Behave AD tonss, HADS depression tonss, Executive map tonss and MMSE were non significantly related to the health professional load tonssModel SummaryModel Roentgen R Square Adjusted R Square Std. Mistake of the Estimate Change Statisticss R Square Change F Change df1 df2 1 .542a .293 .288 7.668 .293 59.353 1 143 2 .592b .350 .341 7.377 .057 12.488 1 142 a. Forecasters: ( Constant ) , NPI Apathy sub graduated table b. Forecasters: ( Constant ) , NPI Apathy bomber graduated table, IADL at baseline ANOVAc Model Sum of Squares df Mean Square F 1 Arrested development 3489.675 1 3489.675 59.353 Residual 8407.663 143 58.795 Entire 11897.338 144 2 Arrested development 4169.290 2 2084.645 38.305 Residual 7728.048 142 54.423 Entire 11897.338 144 a. Forecasters: ( Constant ) , NPI Apathy sub graduated table b. Forecasters: ( Constant ) , NPI Apathy bomber graduated table, IADL at baseline c. Dependent Variable: Mark for ‘caregiver load ‘ questionnaire at baseline Further sub analysis suggests that NPI apathy contributes to about 29 % of the health professional load and IADL contributes to around 5 % of the health professional loadRelationship between apathy and practiceIn the combined sample ( AD and A-MCI ) , informations on executive map was available for 156 patients. In these patients, NPI apathy mark was non significantly related to praxis ( rs = -.102, P = .103 ) .When the group of patients with depressive symptoms were removed, the NPI apathy mark still remained non significantly related to praxis ( n=131, rs =.019, p=.417 )Relationship between apathy and genderMann-Whitney TrialRanksgenderNitrogenMean RankNPI Apathy sub graduated table male 81 85.38 female 79 75.50 Entire 160Test StatisticsaNPI Apathy sub graduated tableMann-Whitney U 2804.500 Wilcoxon W 5964.500 Omega -1.621 Asymp. Sig. ( 2-tailed ) .105 a. Grouping Variable: gender From the above saloon graph, with mistake bars, it appears that males have higher apathy tonss as compared to females. We used the Mann-Whitney U trial to look into if the relationship of apathy with gender is statistically important. However this did non accomplish statistically significance ( U = 2804.500, P = 0.105 )DiscussionApathy is one of the commonest symptoms in Alzheimer ‘s disease. Evidence from assorted clinical, radiological and neuropathological surveies suggests that apathy in Alzheimer ‘s disease is frontally mediated and has important negative deduction. Our survey is a realistic survey with moderate power affecting both Alzheimer Disease and Amnestic-MCI. This is the first survey as per our cognition in which the relationship of apathy with and without depression in a combined sample of AD & A ; aMCI were tested against a scope of frontal lobe map trials which included executive map mark, abstract believing mark, Category Fluency, missive Fluency, conceptional eloquence mark and test doing A & A ; B trials. Few surveies have at the same time investigated the relation of apathy with such a big scope of frontal lobe map trials.Relationship between apathy and executive mapWe found statistically important tie ining between apathy and executive map with and without depression corroborating findings from other surveies ( McPherson et al. , 2002 ) . Deficits in frontal lobe map were significantly worse when symptoms of apathy were combined with depression corroborating the determination from a Nipponese survey with a smaller figure of pati ents ( Nakaaki et al. , 2008 ) .This determination has of import clinical significance because hapless tonss in executive map influence memory abilities by forestalling people to use compensatory schemes that can assist them retrieve information and maintain functional abilities. It is besides associated with greater neuropsychiatric perturbations particularly a greater grade of agitated and disinhibited behaviors ( Chen et al. , 1998 ) . Assorted surveies have shown that impaired executive map is associated with increased pace variableness ensuing in higher incidence falls in patient with AD ( Allali et al. , 2010 ) . In Amnestic MCI, executive map damages is associated with early functional diminution in older grownups ( McGough et al. , 2011 ) . Badness of functional damage is good recognized forecasters of institutionalization ( Rozzini et al. , 2006 ) .Relationship between apathy and conceptional eloquenceSuccessful completion of Ideational eloquence undertakings require speede d productiveness every bit good as the accomplishments of self-monitoring, working memory, scheme coevals, and divergent thought ( Vannorsdall et al. , 2012 ) . We found statistically important tie ining between apathy and conceptional eloquence with and without depression.This is similar to the determination from another survey where Ideational Fluency was found to be significantly associated with apathy ( Tsoi et al. , 2008b )Relationship between apathy and Category FluencyWe found that NPI apathy mark was significantly related to category eloquence but when patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to category eloquence. There are conflicting consequences about the relationship between apathy and class eloquence. One survey ( n=72 ) found no important relationship ( McPherson et al. , 2002 ) but another more recent survey ( n=42 ) found statistically important relationship ( Tsoi et al. , 2008b ) .Relationship between ap athy and abstract thoughtWe found that NPI apathy mark was significantly related to abstract believing but when patients with depressive symptoms were removed, the NPI apathy mark remained nonsignificantly related to abstract believingRelationship between apathy and cognitive mapSimilar to consequences from other surveies, NPI apathy mark was significantly related to cognitive working proposing that apathy was related to poorer cognitive map.However when the group of patients with depressive symptoms were removed, the NPI apathy did non stay score significantly related to cognitive map.Relationship between apathy and missive EloquenceNo statistically important relationship was found. This is consistent with current literature grounds ( McPherson et al. , 2002 )Relationship between apathy and test doing A & A ; B trialsNo statistically important relationship was found between apathy and both TMT- A & A ; TMT-B in our survey. However another survey had found a statistically important relationship between TMB trial and apathy tonss in Alzheimer ‘s dementedness ( McPherson et al. , 2002 ) In drumhead among the frontal lobe trial we found that statistically important relationship between apathy and executive map tonss, conceptional eloquence tonss, abstract thought and class eloquence tonss. When the groups were reanalysed after taking patients with depressive symptoms, the relation between apathy and abstract thought every bit good as category eloquence became non important.We think that this may be do the power of the survey has reduced when the depressive subgroups were removed.The 2nd possible ground is that apathy and depression portion many common symptoms and therefore the patients we removed utilizing a rigorous diagnostic standards of HAD depression standards were truly patients with apathy.Relationship between apathy and health professional loadIn our survey, series of explorative Spearman rho correlativity confirmed the important relationship between apathy and health professional load with and without depression. We did farther bomber analysis and found apa thy to be significantly related to caregiver load in both AD and aMCI patients. Our survey is the first as per our cognition that confirms that apathy is significantly related to caregiver load in amnestic MCI reverse to the popular belief. The relation of apathy to caregiver load was confirmed by other surveies ( Chow et al. , 2009, Leroi et al. , 2012 ) nevertheless another survey showed that it was the behaviors associated with executive disfunction and disinhibition that were most prognostic of load instead than apathy itself ( Davis and Tremont, 2007 ) . However we did a arrested development analysis and found that apathy approximately accounted for 30 % of health professional load but found no important relationship with behave AD tonss, HADS depression tonss, Executive map tonss and MMSE tonss We besides found a higher incidence of apathy in females as compared to males but farther statistical testing showed no important relationship. In our sample NPI apathy mark was significantly related to cognitive operation as confirmed by other surveies but when patients with depressive symptoms were removed the relationship with cognitive damage was nonsignificant. Our survey has few restrictions.First of all this was a retrospective cross sectional survey and so has its drawbacks, nevertheless it realistic, cross-sectional survey. Another possible job is that the subjective nature of the information ‘s nevertheless the information ‘s were collected as a portion of comprehensive neurocognitive appraisal in a third Centre by trained and experient clinicians. Prospective surveies would hold been better but would hold needed extended resources and clip. The sample size was moderate and consisted of assorted sample of Alzheimer ‘s disease and Amnestic MCI, nevertheless it was reasonably powered and amnesic MCI is considered as prodromic Alzheimer ‘s disease. We had used merely one graduated table for mensurating apathy.The NPI Apathy subscale is a portion of NPI devised to buttockss and quantifies neurobehavioral perturbations in dementedness and non specifically developed to mensurate apathy.AEP would hold been a better pic k as it is specifically developed to mensurate apathy, nevertheless the trial would necessitate preparation and would take a well longer period which would non hold been practical in a normal clinic scene This survey has shown high association of apathy with health professional load both in AD & A ; aMCI and given our anterior cognition of the significantly inauspicious effect, we would go on screen actively for apathy and utilize more specific apathy graduated table along with the NPI graduated table in future