High School and Extracurricular School Food Essay

This brief addresses â€Å"open† or â€Å"off † campus policies that allow high school students to go off campus to purchase and eat food during their lunch periods. The brief highlights issues related to open campus policies and complements the separate Legal Notes: Open Campus Lunch, which highlights some of the legal issues related to off campus lunch and the creation of effective policy addressing this matter. OPEN CAMPUS LUNCH POLICY DECISIONMAKERS Copies of Legal Notes: Open Campus Lunch, Mapping School Food, and other related materials are available on the Public Health Advocacy Institute website at: www.phaionline. org/schoolfood. For more on Potter Boxes, please review Mapping School Food. A quick primer, Potter Boxes at a Glance, is also provided near the end of this brief. This issue brief and the legal notes will help you craft your own Potter Box—a decision-making matrix—that provides a legal and social framework and helps identify key legal access points directed towards reaching your policy goal. This brief defines an open or off campus policy as one that allows select or all students to leave campus during the lunch period to purchase or consume food and beverages. Therefore, a school with a â€Å"modified† policy that only allows certain students who meet specified requirements to go off campus is considered to have an open campus policy. This brief defines a closed campus policy as one that does not allow any students to leave campus during lunch or any other time during the school day. The focus of this brief is on high schools, although research and data that extend to elementary and middle school students were evaluated in preparation of this brief. Open and closed campus policies can be set at the state level by a state board of education or by the state’s education code. Typically, policies are set at the district level by the school district board. The district can create base guidelines establishing an open campus, but it can additionally allow the principal at each school the authority to make provisions or decide under certain circumstances whether or not to allow off campus privileges. In California, for instance, the Stockton Unified School District board policy makes detailed provisions for open campuses but gives the school principal the power to completely close campus if there are specific reasons to do so. In addition to board members, the superintendent is a key decision-maker because he or she must implement the board’s policies. Off campus policies can also be set at the school level by the principal. See legal notes, School Structure, Power, and Responsibility: From State Laws to High School Handbooks, for additional information. Open campus lunch laws and policies do not exist in a vacuum. Policy goals, community support, and specific situational facts must be taken into consideration or the law or policy can be rendered useless, harmful, or ignored. OPEN AND CLOSED CAMPUSES BY THE NUMBERS High schools tend to have unhealthier school food environments than elementary schools. Open and closed school campus policies have the potential to affect students’ health, safety, and security, as well as to influence the school environment itself in these 1 Open Campus Lunch Off the Map: Extracurricular School Food areas. The 2006 School Health Policies and Programs Study showed that nationwide 71. 1 percent of high school districts and 73. 1 percent of high schools had a closed campus policy where students could not leave campus during lunch or at any other time during the school day (compared with 65. 9 and 73. 4 percent, respectively, in 2000). This is similar to a finding of about 25 percent of high schools having open campuses obtained in spring 2005 by the third School Nutrition Dietary Assessment Study (SNDA-III). Percentages can vary by state and study. A 2003 survey of California high schools found that 46 percent had open campuses, the same as it found in its 2000 survey. We conducted a small, informal survey with people who provided input for Mapping School Food and who impact the school food environment in Arkansas, California, Massachusetts, and Mississippi. We also reviewed notes from interviews conducted in 2007 in preparation for Mapping School Food. The results of the survey are anecdotal evidence to enhance this brief and cannot be generalized. A little under one fifth of those surveyed stated that the school or district they worked with had an open campus policy. Some did not have open campuses because they worked primarily with younger students not yet in high school. There is a strong link between a student’s dietary behavior and his or her risk of becoming overweight. Students should eat less low-nutrient, energy-dense foods and beverages and more fruits, vegetables, and low- or no-fat milk. A study of Minnesota secondary school students found a strong link between frequency of eating fast food and â€Å"poorer food choices,† resulting in more fatty and sugary foods—and less fruits, vegetables, and milk—consumed. Most of those we surveyed felt that food and beverages obtained through concession stands, fundraisers, school stores, and off campus lunch periods were unhealthy, and over half believed that students would purchase healthier foods if they were available. They thought that most of their students who bought food and beverages near campus did so at chain fast food establishments and minimarts with prepared foods. Depending on what is offered in the cafeteria and school, closing the campus for lunch could eliminate the fast food option and help strengthen good food choices. Foods subsidized by federal programs must comply with certain nutrition regulations and generally are called program foods, while all other school food generally can be considered non-program or competitive foods. For more information, see Mapping School Food, particularly Appendix: Federal School Meal Programs and its Legal Practitioner’s Point. The United States Department of Agriculture’s SNDA-III found that students who participated in  the National School Lunch Program (NSLP) were more likely to consume fruits, vegetables, and milk. Correspondingly, non-participants were more likely to consume snacks, desserts, and beverages like sodas during the lunch period. Policy changes that restricted non-program foods, meaning food obtained through school stores, snack bars, and a la carte options, resulted in a reduction of sugar-sweetened beverages consumed by middle and high school youth. Closed high school campuses also were linked to an increase in eating vegetables. However, these initial analyses from the dataset collected during the 2004–2005 scholastic year must be taken into consideration with one finding of no strong association between school food policies and high school students’ obesity risk. Continued research into this rich data set is necessary to clarify and further inform these analyses. Policymakers should explore if closing campuses for lunch will improve healthier choices and eating habits. The 2003 California High School Fast Food â€Å"The food environment surrounding schools could easily negate school food policies and health education in the classroom, especially in high schools with an open campus policy that allows students to leave campus during their lunch break. † STURM (2008) STUDENT HEALTH, NUTRITION, EATING PATTERNS, AND SCHOOL FOOD The school environment is an important sphere in the development of dietary behavior. Policymakers should craft school food laws or rules that encourage healthier options while restricting unhealthier options. They also should assess open campus lunch policies because these policies can affect policy goals regarding the school food environment. 2 Open Campus Lunch Off the Map: Extracurricular School Food Survey found indications that schools with an open campus lunch policy reported less participation in the NSLP compared to schools with closed campus policies. The SNDA-III reported that 14 percent of high school students who were interviewed about what they ate on a certain day reported that they did not participate in the NSLP because they went off campus to eat lunch. Thus, there is the possibility that closed campus policies could encourage increased NSLP participation and healthier eating habits. Open and closed campus lunch policies must be examined further in the context of their relationship to school food and student health. There is also a perception issue that demands attention. Regarding open campus lunch policies, one Massachusetts Food Service Director commented, â€Å"It sends the message that school food is not as good as fast food and also there are a great deal of safety issues involved with leaving and returning. † Some students may perceive a certain stigma with regard to cafeteria food—particularly program foods—which must be corrected. CLUSTERING OF FAST FOOD ESTABLISHMENTS, RACIAL AND SOCIOECONOMIC DISPARITIES food or other establishments clustering around the school should evaluated. School policy must also consider student subgroups that could be disparately impacted by the clustering of fast food establishments and/or the adverse health effects of overweight. Studies show that fast food restaurants cluster within easy walking distance around schools. A recent study of middle and high schools in California found a direct relationship between fast food establishments being near those schools and the students being overweight. It also found that students within walking distance of fast food restaurants were significantly less likely to say they had eaten fruits or vegetables and more likely to have consumed soda. The study did find a larger association of overweight being associated with fast food proximity for Black students which it did not find with other racial and ethnic minority student populations. It also found the same increased association for students in urban schools. Overweight is a health indicator displaying significant disparities amongst racial and ethnic minority youth, as certain groups have higher risks of obesity and resultant health problems compared with others. Studies also have indicated that low-income and racial minority students can tend to live in communities with less safe streets, poorer facilities, and/or greater access to low-nutrient, energy-dense foods and less access to healthy foods. One study examined high and middle schools and their proximity to restaurants, convenience stores, snack stores, and liquor stores. Observing racial and socioeconomic variances, it found that Hispanic students are more likely to go to schools within close Open campus and other school policies should aid student development in all areas including nutrition and health. Fast food availability around schools encourages consumption of low-nutrient, energydense food and could influence students’ developing decision-making skills and habits regarding nutrition. When crafting school policy, the significance of fast â€Å"While it is important to respect adolescents’ increasing autonomy and decisionmaking skills, research clearly shows that food availability is one of the strongest correlates of food choices in adolescents. † NEUMARK – SZTAINER ET AL . (2005) In study results published in 2005, over a thousand, mostly suburban, high school students were surveyed across twenty high schools in a region in Minnesota. At least six of the high schools had an open campus policy. The study found that students on an open campus were â€Å"significantly more likely† to get their lunches from fast food establishments and convenience stores. It also found that students in upper grade levels purchased lunch from convenience stores or fast food restaurants with greater frequency than students in lower grade levels. The study concluded that school food policies that limit access to low-nutrient, energy-dense foods and beverages are linked with students purchasing these types of food and beverages less frequently. 3 Open Campus Lunch Off the Map: Extracurricular School Food walking distance of those types of establishments. That particular study did not find such strong associations among other racial groups, except with regard to liquor stores. Another study published in early 2009 found that fast food restaurants in New York were concentrated in commercial areas and in predominantly Black communities in both low-income and more affluent areas. More data and studies are needed to clarify the relationship between different establishments’ proximity to schools and student eating patterns—and how racial, ethnic, socioeconomic, and other factors are related to fast food establishment clustering, overweight, and health risks. Still, these factors newly have been considered in local land use law, and they should be considered when crafting current school policy. In Los Angeles, an ordinance recently passed that puts a one year moratorium on building new fast food establishments in areas of South Los Angeles, which have large Latino and Black communities. The ordinance was significantly motivated by the city council’s concerns about how the proliferation of fast food restaurants escalate socioeconomic problems in low-income neighborhoods—and this proliferation’s impact on food security and children’s health and nutrition. Hopefully, the moratorium will provide time for more permanent regulatory controls to be put in place. See legal notes, Legal Interventions—Holistic Considerations, for additional information. LOCAL BUSINESSES AND ENVIRONMENT go off campus for lunch, said that local businesses donate money to the school, and a closed campus policy would likely cause the loss of those donations. However, in our informal survey, the few people that did work with schools that received donations from local businesses that sell food or beverages did not feel that those donations were a necessary part of the school’s overall budget. When constructing your Potter Box, the facts of the situation will clarify specific concerns, such as local establishments’ reliance on youths’ lunch money and whether these businesses donate or contribute to the high school(s) to an extent that it could impact policy decisions. Local businesses therefore can be attuned to the school’s schedule and policies. â€Å"We always know when kids aren’t going to be in school,† a pizza manager told a newspaper. â€Å"When kids are home from school they’re ordering pizzas, so we schedule another driver. † Local businesses also may contribute to the schools in non-monetary ways like monitoring and reporting student behavior. Antioch Unified School District in California is starting a â€Å"We Tip† program where local businesses are encouraged to report truancy. Improved average daily attendance results in more monetary support from the government. Programs like â€Å"We Tip† have to be measured against closed campus policies to see which is—or if both applied together are—more effective and beneficial to the school. Most of those we surveyed who had experience with off campus policies felt that such policies were popular with local businesses and students and, conversely, not popular at all with cafeteria staff and food service directors. They also thought their location and community could not accommodate an open campus lunch policy. The outflow of students during the lunch period may cause problems or potential hazards in the local area. Residents may be worried about students bringing large groups of their peers and congregating in homes or complexes. Schools in rural areas may not have businesses nearby. Off campus lunch can be viewed as a valuable revenue stream for local businesses. One â€Å"highly profitable† fast food location up for sale advertised in 2007 as a factor in its value that it is located next to â€Å"a high school which allows off campus lunch time to their students. † These businesses may in turn make donations or otherwise support the school. The school’s perception of the value of these local business donations could conflict with instituting healthier school food initiatives. A principal from Modoc County, California, who estimated that 80 percent of students 4 Open Campus Lunch. Off the Map: Extracurricular School Food SAFETY ISSUES, TIME, AND CAR ACCIDENTS Safety issues also factor into determining open and closed campus policy. One Californian who works in nutritional education emphasized that safety issues were concerns â€Å"especially at the high school where there is an open campus. † Newspapers report incidents like fighting, fatal car accidents, mugging, substance abuse and arrest, and sexual assault as occurring off campus during lunch periods. Although these incident rates may be relatively small, each incident can have a significant impact on the school and its students. Time is a considerable factor in evaluating a policy’s safety and feasibility. The lunch period may be too short for students to reasonably go off campus for lunch. An overwhelming number of those we surveyed thought that there was not enough time for students to go off campus, buy and eat lunch, and return on time. Some of those surveyed reported having as little as twenty minutes allotted for lunch, and a student article, discussed below in Student Input and Support, averaged a 37 minute high school lunch period. Schools with open campus policies should monitor whether or not the policy affects afternoon tardiness or truancy. Also, time issues may encourage unhealthier eating off campus. One Virginia public high school has an â€Å"Off-Site Lunch Contract Senior Privilege Form† as part of its off campus lunch driver permit. The contract stresses that this is a privilege, limited to seniors and extended lunch days. It requires students not to travel alone, sets area restrictions, and states, â€Å"There is plenty of variety in fast food establishments within the boundaries provided. Students should choose establishments that can serve within five to ten minutes of your arrival. You should allow at minimum 15 minutes of driving/parking time. † In granting the privilege to go off campus for lunch, the school policy seems to encourage students to eat fast food in order for the policy to operate smoothly and for students to return on time. Traffic accidents are a major concern for many high schools. Student drivers add to lunchtime traffic congestion, and students driving to pick up lunch may rush back to class. A study of three North Carolina counties over four years found that there was a â€Å"significantly higher† rate of risk for car accidents during open campus lunch periods compared to any other time of the day and compared to a county with closed campus lunch. There were also more passengers in the cars during lunch period accidents. Safety concerns and student fatalities during lunch periods have resulted in the proposal of two New York State assembly bills designed to regulate off campus policy. Student injuries and death that occurred while the students were off campus during the lunch period also have resulted in lawsuits being brought against school districts and officials. See legal notes, Open Campus Lunch Tort Concerns and School Structure, Power, and Responsibility: From State Laws to High School Handbooks, for more information. CAFETERIA AND CAMPUS CONCERNS— ADEQUATE TIME, FACILITIES, SUPERVISION, AND BUDGET Closing an open campus may give high schools the ability to refocus school food issues like cafeteria breakfast, lunch, vendors, and water fountains. One Arkansas School District Nurse commented, â€Å"My districts do not want anything on campus that competes with the federal lunch program. † A closed campus could assist in a comprehensive approach to improving school food and offering healthy food choices on campus. What are the practical considerations when closing an open campus? About half of those surveyed who had experience with open campus lunch policies thought their school or district, as it stood, could provide lunch to all its students. A few specifically suggested that schools would need to improve food options in cafeterias, extend the lunch periods, and expand and renovate facilities for food preparation. A school or district deciding to close a campus for lunch needs to ensure the necessary resources are in place before the policy is implemented. 5 Open Campus Lunch Off the Map: Extracurricular School Food. The high school or district needs to determine whether the cafeteria and campus can adequately handle a closed campus. For example: What kinds of burden will the additional students who used to go off campus for lunch put on the cafeteria? Factors include: Time. Adequate time to eat lunch is a concern in the cafeteria just as much as it is off campus. One California food services staff exclaimed, â€Å"30 minutes to serve 3,000! † Some cafeterias have to stagger their lunch periods, with students eating lunch anywhere from 10:30 a. m. to 2:00 p. m. The 2006 School Health Policies and Programs Study found students on average have 22. 8 minutes to eat lunch once seated. It also found an increase in school districts that required a â€Å"minimum seating time† for eating lunch once seated. Facilities. This includes cafeteria space, kitchen and food production capacity, etc. The school might want to consider renovations that would help accommodate more and even healthier food options or improve the flow of students getting their food. Facilities also include fences and other structures that may be necessary to control a closed campus. A California principal anticipated, â€Å"All 1,200 students eat at the same time and it would be a nightmare to serve all of these students with the current setup. † A California Nutrition Educationalist stated, â€Å"Closing the campus at the high school has been discussed numerous times in the past with the results always being that it would be too difficult to close campus and we are lacking in facilities to accommodate the students. † Supervision. School officials have a duty to supervise the students on campus. When deciding whether to close a campus, it should be deter-mined whether there are enough resources and staff to adequately supervise the students during the lunch period. Also, can students leaving and entering the campus be adequately supervised? Budget. Foreseeable costs incurred by staff or facilities changes need to be supported by already overextended school budgets. Among the school food decision-makers we informally surveyed, the top two concerns to their district or school were the school budget and the school food budget. This could be a potential barrier to closing a campus. However, closing a school’s campus could be seen as an investment in student health, safety, and perhaps monetary return. Most of those we surveyed with open campus lunch policy experience thought that a closed campus would increase cafeteria profit, and none of them thought it would decrease profit. Specific research may be needed for an advocate to determine whether and by how much a closed campus policy could increase cafeteria revenues. Potential impact on student health should also be evaluated. For example: How will closing campus affect students’ eating patterns both on campus and outside of school? What are the choices on a closed campus and how healthy are they? What changes can be made to offer a variety of healthier, appealing food choices? One high school in Missouri was able to close its campus after it moved into a newly built structure that could accommodate serving food to all the students and staff. Yet closing a campus for lunch does not necessarily keep fast food away, as the food services supervisor contemplated using vendors such as Pizza Hut and Quiznos—in part because â€Å"it helps out the community merchants. † â€Å"Our food service program operates in the black now, whereas it never did before,† said Kevin Ivers, Bridgman’s superintendent, noting that the high school had added a second lunch period to reduce lines, and overhauled the menu to introduce quesadillas, yogurt, salads and fruit. â€Å"That enables us to put more money into the classrooms. † NEW YORK TIMES ( MAY 2008) A 2008 New York Times article noted that school districts in New York and nationwide were instituting closed campus lunch policies due to car accident-related deaths, injury, and truancy. The Times also anecdotally interviewed specific high schools where closing campuses for lunch had improved attendance for post-lunch classes, increased cafeteria sales by in some cases over 10 percent and 22 percent, and turned a food service program operating at a loss into a profitable one. However it also cited concerns that closed campus lunch policies were part of a trend in restricting youths and hindering their decision-making experiences. 6 Open Campus Lunch Off the Map: Extracurricular School Food STUDENT INPUT AND SUPPORT. Student input and support are critical to a successful closed campus lunch policy. School lunch is a popular topic for high school students. LA Youth, an online student journal that reaches half a million Los Angeles County youth, published an informal survey a few years ago where student reporters found out â€Å"What’s for Lunch? † in their high schools. Examining twenty four public and private high schools in Southern California, it found that lunch on average lasts thirtyseven minutes. About two thirds of schools had vendors in cafeterias or push carts, and most schools had open campus policies for seniors. Only about four schools had a fully closed campus. The survey also noted types of vendors (Subway, Pizza Hut, and Dominos being the most common), cafeteria menus (Mexican food and sandwiches being popular), and cafeteria food prices. Many students may balk at a closed campus policy, seeing it as restricting their freedom and taking away a reward for good grades, attendance, or other open campus policy requirements. A Californian nursing manager described the toughest obstacles to changing open campus policy as the â€Å"objections of community stores and restaurants and student protests. † Students may be more likely to advocate for open campus policies. After two high school students approached the School Committee, a Massachusetts high school started an off campus pilot program open to only seniors in good standing. At the time, key issues or concerns with the program were safety, student initiative/input, incentives for students to improve grades and behavior, monetary impact on school food, student nutrition, â€Å"rewarding children with junk food,† and potentially teaching responsibility and time management. While the pilot program and these issues were being discussed in 2004, the high school currently allows seniors who meet certain requirements off campus lunch privileges. Other students have opened up online forums such as MySpace message boards to discuss and protest their school’s attempts to close their campus for lunch. An advocate seeking to change a high school or district’s off campus lunch policy may consider surveying or interviewing students to find out what is important to them so as to determine potential sources of student support. These tools also could be useful in  finding what influences students’ food and beverage choices—such as cost, certain tastes, convenience— in order to make healthy choices in school food more appealing. Another LA Youth article discussed a student having informal weekly potlucks with friends that focused on â€Å"food adventure† and not on eating healthier foods. This could nonetheless spark ideas and discussions about using similar methods to promote healthier eating programs and deciding what types of equipment could be helpful, such as microwaves and secured refrigerators. Other student newspapers have covered open campus policies. One student reporter, who found that fifteen out of twenty students surveyed ate daily at Jack in the Box, Wendy’s, or McDonald’s, recommended that her high school â€Å"ban off-campus lunch, and improve the food in our school cafeteria. † Most of those we surveyed were involved with schools that had nutrition education programs. Perhaps encouraging student-led nutritional education projects to supplement or strengthen existing nutrition education programs could lead to some innovative ideas, positive results, and student support for policies like closed campus lunch. LACK OF ENFORCEMENT AND LEADERSHIP The number one obstacle to implementing the type of food program desired by those surveyed was lack of enforcement of school food policies. The next two obstacles were lack of resources and time constraints in the budget’s timeline. One person surveyed recommended to â€Å"put in policies a way of enforcing any regulations that are mandated. † Another who worked in food service in California suggested â€Å"tougher penalties. † A community health nurse specialist in Arkansas pointed to the relationship between leadership and enforcement: â€Å"Leadership in schools has to enforce the school’s policies or the policy is ineffective. † A food service director in Massachusetts stated, â€Å"Lack of funding has resulted in lack of good leadership for the district. Policies on safety, wellness, etc. , have taken a back seat to teacher loss and budget cuts. With our school budget in a deficit and no town support for an over-ride, my personal feeling is we will keep losing students to school choice and private schools. † For legal analysis on building enforcement and accountability into school policy, see legal notes, Enforcement Issues and Possible Enforcement Mechanisms. 7 Open Campus Lunch Off the Map: Extracurricular School Food. OTHER POLICY CHANGE CONCERNS Sources describe open campus lunch for students as a â€Å"privilege. † Policymakers and advocates should stress that off campus lunch is not a right or requirement. If the policy has academic achievement, attendance, and/or other requirements, this policy is also characterized as a reward for students. Advocates may want to consider suggesting alternate rewards. While wellness policies generally do not address off campus lunch policies, perhaps the two should be integrated in order to frame the off campus issue as one of student health. One superintendent told a newspaper that it was â€Å"hard for one campus to have one rule and another campus to have another. ‘We don’t want advantages or disadvantages to going one way or the other. ’† Students also have stated that it was unfair if their campus was closed and neighboring high school students could go off campus for lunch. Perhaps consider a comprehensive district ban. Tradition or culture may be obstacles to changing the policy. As a food service director from Massachusetts noted, â€Å"Change is never easy. We do not have off campus lunch. However, I worked in a school that did previously and it was very difficult to change even though it was discussed every year! † YOUR NEXT STEPS To help you with your next steps, this issue brief provides factors that will help you construct your own Potter Box about off campus lunch policy. Hopefully, this brief, the accompanying legal piece, and Mapping School Food will provide you with a strong foundation upon which to construct policy that fulfills your own goals. A blank Potter Box for you to fill out is provided on page 12 of Mapping School Food, or you can make your own. You may also want to consult the Model Decision-Maker Potter Box on page 13 and the other filled-in Potter Boxes in Mapping School Food. POTTER BOXES AT A GLANCE BOX 2 Values and Tools BOX 1 Excerpts from Mapping School Food: The Potter Box is a four-part square that can help you make informed decisions. While the Potter Box cannot make a decision for you, it can help clarify your options and why you would choose one option over another. We have adapted the Potter Box to help you clarify the interactions between the many factors that affect school food decisions and critique the different factors that affect your own decision making. This modified version of the Potter Box can†¦help you understand the law and to identify key decision-makers. It also demonstrates how the law plays out in real-world situations and the assumptions and concerns that various decision-makers bring to bear on school food policy. Facts List all the facts known about the situation or problem. List the factors that drive your school food decisions. What are the elements that you need to consider when making decisions? What tools do you typically use? How are the solutions to the problem evaluated?

African American Essay Essay

African American literature is captivating, powerful, spiritual, and emotional. The recurring theme is slavery but there are others such as inequality among sexes and races, injustice, resentment, and the strong belief in religion. These pieces of literature have been told by the individuals who went through the experience of slavery such as Frederick Douglass and others, like Jamaica Kincaid who have a passion for writing. The writers who experienced slavery themselves had differing views of their experience and relationship with their master. These pieces of literature share the pain, strength, heartache and will to go that each of these individuals experienced. The first reading is, To My Old Master, by Jourdan Anderson. This piece of literature is Anderson’s response to a letter he has received from his old master. It is a compelling story about how terrible and bad the Whites treated the African Americans. The master want’s Anderson and his family to come back and work for him. He reminds the master about how poorly they were treated while working for him. Anderson states, â€Å"Although you shot at me twice before I left you, I did not want to hear of your being hurt, and am glad you are still living. † (1865, p. 15). Anderson tells the master that he is making money and his family is living and doing well. He even expresses that his children are receiving an education now. It is very apparent to the reader that Anderson’s wife does not want to return and work for the master. â€Å"Mandy says she would be afraid to go back without some proof that you were disposed to treat us justly and kindly; and we have concluded to test your sincerity by asking you to send us our wages for the time we served you. † (1865, p. 16). Anderson remembers how horribly the woman and girls were treated, and he will never allow his daughters to go through that experience. â€Å"I would stay here and starve- and die, if it come to that- than to have my girls brought to shame by the violence and wickedness of their young masters. † (1865, p. 16) The end of the story the reader still feels Anderson’s resentment and bitterness toward the master. The next story and the one piece I enjoyed the most is, â€Å"White Folks Treated Us Good† by Marriah Hines. Hines states, â€Å"My white people treated us decent. † (p. 32). She goes onto further explain how her master feed, dressed, and kept them well. Hines explains how terrible master’s treated other slaves. â€Å"Some unfortunate individuals practically have nothing to eat. Why, the way their owners treated them was disgraceful treated them like felines and canines† (Hines, p. 32). Hines sounds fortunate and lucky to have worked for her master. The master gave the slaves Sunday off to rest and even allowed them to attend Church. Unlike other slaves Hines was never raped, beaten, or treated in a physical horrible way. The compelling part of this piece occured when the slaves were allowed to leave; most of them choose to stay. â€Å"Most of us stayed right there and raised our own crops. † (p. 34). Hines knew of her freedom but believed in her loyalty to her master and his family. The master provided her with assistance and support. A rare occurrence to read an African American piece of literature that speaks of a master in a positive and respectful manner. This master was a different man of his time. He did not take advantage of his slaves or treat them in a horrendous manner. This master used his slaves to care and run his property but treated them with respect and dignity, they deserved. Hines went onto, marry Benjamin F. Hines and give birth to five children. The last piece of literature is, â€Å"If We Must Die† by Claude McKay. This poem is about how horribly and disgusting Whites treated African Americans. It is written about the race riots in 1919. It describes the strength of the African Americans standing up to the Whites even if it ultimately meant dying. McKay states, â€Å"Like men we’ll face the murderous, cowardly pack, pressed to the wall, dying but fighting back! † (p. 378). This poem exemplifies the bravery and the will to fight for what is right otherwise these people would have been beaten and killed for the rest of their lives. There will always be a presence of racism in the world and specifically in the United States of America. Still today African Americans are treated equally as Whites. Although we as a country have come a very long way there is still work to be done. The more we educate people the less we will experience ignorance. The hate and the idea of inferiority will slow diminish if people become educated. I can end proudly stating that I am married to a Black man and we have two beautiful daughters, and I give an enormous amount of respect to those who fought for what was right. References Anderson, J. (1865). To my old master. In I. Reed (Ed. ), African American Literature. Abrief introduction and anthology (pp. 15-16). New York: The Longman LiteraryMosaic Series. [serial online]. December 2005;36(4):299-323. Available from:Academic Search Complete, Ipswich, MA. Accessed May 23, 2011. Hines, M. (n. d. ). My white folks treated us good. In I. Reed (Ed. ), African Americanliterature. A brief introduction and anthology (pp. 21-25). New York: TheLongman Literary Mosaic Series. [serial online]. December 2005;36(4):299-323. Available from: Academic Search Complete, Ipswich, MA. Accessed May 21,2011. McKay, C. (n. d. ). If we must die. In I. Reed (Ed. ), African American literature. Abriefintroduction and anthology (pp. 378). New York: The Longman LiterarySeries[serial online]. December 2005;36(4):299-323. Available from: AcademicSearchComplete, Ipswich, MA. Accessed Dec, 2011.

The Article Summaries and Reaction Paper Management of Computers Essay

The Article Summaries and Reaction Paper Management of Computers - Essay Example Proper management of computers in the classroom and lab are so significant in the learning process of the students and so to the security and life of the computer system itself. The Net Support School or NSS, offers a comprehensive and proper management in the use of computers in classroom and computer lab. Their main objective is how to manage the use of computer, printers, and the devices more effectively. Teachers should act as administrator to control the user privileges of the students, they can also log-in and log-off remotely to student's computers through his unit. They can also monitor the screen of every student simultaneously as to observe what the students are doing. During the discussions, monitors or screens of the student's computers should be blank, keyboard and mouse must be locked to gain their focus and attentions. Considering that computer printing is important, teachers should also control the page limit of every student. Computers are subjective to malwares, spywares and other form of viruses, thus teacher or laboratory in-charge should not allow copying of files from USB devices and CDROMS to the hard drives or hard disk. The capabili ty to transfer files or handouts to selected computers and even to all units is also an advantage with regard to time management. In summarizing the proper management of computers, teachers can control various computer privileges such as; application and internet metering and control, teacher security, internet safe search, printer control and device control (Intel.com). Like the Net Support School, Intel Education Initiative also explained how to manage the computer use effectively, because they know that allocating more time for students in using the computer is so important. They are also taking into consideration about the subject matter, like, having a focus on discrete activities, where work activities are well-defined by the teachers to let the students do a desirable project immediately. They believed that computers must not be used in internet research during work activities for it is just a waste of time, since it could be assigned as homework to students. Creating a checklist for a task and a timeline respectively will help students to be more productive and efficient toward their work. It is also important that proper and appropriate use of computer must be implemented, and whatever inappropriate action will result in losing and deactivation of students' computer access and privilege as a form of their punishment. The computer classroom m ust be made available before school time, during break time, and after school time especially for students who don't have computers at home (Netsupportschool.com). In relation to my own professional thinking, both of the two articles were implementing better practice in proper management of computers in classroom and computer lab. I agree that the teachers should also be the administrator at the same time in terms of giving user access and privilege. Aside from the teaching procedures and guidelines, being a good administrator will also result to harmonious and smooth sailing learning for students. I also agree that during the discussions and defining of task, the monitor, mouse and keyboard should be disabled to let the students listen attentively. In addition to their principles of management, I would like to encourage that the classroom and com

Addiction in Pregnancy to Prescription Drugs Essay

Addiction in Pregnancy to Prescription Drugs - Essay Example Another form of abuse is taking the medicine while still using alcohol and other narcotic drugs. Moreover, abuse of the drugs can be in the form of taking medicine without consent of a medical profession in order to relieve pain. Availability of the drugs makes it easy for most people to access them. This paper illustrates some of the common issues related to addiction of prescription drugs among pregnant women. Introduction Most pregnant women expose themselves into the dangers of abusing of prescription drugs. This abuse tends to cause many health risks to both the mother and the infant. After taking the prescription drugs for sometime without following the regulations ordered by the provider, most of the pregnant women find themselves becoming addicts. Through biological research work, there is enough evidence that everything a pregnant woman eats or drinks have the potential of reaching to the infant. Moreover, the substance ingested may have various effects, either positive or n egative on the infant. Any drug that a pregnant woman may take eventually crosses and reaches the infant. This gives a clear indication that addiction to prescription drugs harms the unborn baby. Provide a brief overview regarding the substance. Prescription drugs are of many kinds depending on their nature of use. Some of the commonly types include Opiods. Most of the drugs under Opiods are prescribed to treat various discomforts that come up because of pain (Schmid et al., 2010). Another common abused one includes the CNS depressants. These types of drugs are commonly prescribed to a patient with aim of reducing anxiety. Moreover, patients with sleeping disorders may take these drugs to improve their sleeping patterns. Examples of these drugs include mephobarbital and pentobarbital (Hanson, Venturelli & Fleckenstein, 2011). The use of all of the above prescription drugs and many more others not mentioned tends to be risky to the unborn child when taken against the instructions. Wh at is the nursing care considerations associated with the use of the substance during pregnancy? If a pregnant woman is taking prescription drugs, she should inform her health care provider. This helps the medical professional to offer necessary medication at the right time. A woman ought to provide her history on the drugs abuse and state the type of drugs she has been using while in pregnancy or before. This will assist the nurse in providing the best advice about how to stop the addiction and live healthily for her benefit and that of the unborn child. Moreover, nursing care considers universal screening of the drugs as the option to determine how they may have affected the woman and the infant in order to provide the recommended medication (Cazacu, et al., 2011). Another consideration that nurses tend to make is checking the level at which the prescribed drugs may have affected the infant. In some cases, it is not advisable for an addicted woman to stop taking the drugs immediat ely. Stopping the drugs at once may lead to a higher chance of causing death to the infant. Therefore, it is advisable for the women to seek medical advice from medical professionals in order for the situation to be addressed carefully. Another nursing care consideration entails that the woman should be ready to undergo various laboratory check-ups in order to determine the level of the effects on both the woman and the infant. What are the nursing care considerations specifically during the second trimester related to this substance? Exposure to prescription drugs

Assignment Example | Topics and Well Written Essays - 500 words - 71

Assignment Example Other researchers have noted that the successful completion of a course requires online participation. (Nagel, L., Blignaut, A.S., and Cronjà ©, J.C., 2007) The purpose of the study is to know 1) how online participation affected learning and successful course completion, and 2) how the participation influenced the learning community. (Nagel et. al, 2007) The researchers observed students of an 8-week web-based distance learning course which was part of the curriculum for the students’ Masters degree. (Nagel et. al, 2007) Using specialized computer software such as the ATLAS.tiTM and the WebCT Campus edition student tracking tool, the students’ performance and activities online were tracked and analyzed. The findings revealed that active learning participation not only led to a successfully completed course but also a satisfied experience by the learning community. The failure of some students to get a good grade was attributed to, among others, connection problems. Responses showed that accessibility to the online course material was difficult for several learners because of unreliable Internet service, computer issues and financial constraints. Curiously, results also showed that some students had poor Internet connection but relayed this to their facilitator through text messages or phone calls. Thus, they were able to work out deadlines to successfully complete the course. Few postings and comments on discussion boards directly affected student performance as well. The results revealed that those students who just signed in without collaborating with the community members or those who did not put up a significant number of posts or replies ended up with unsatisfactory grades or dropped the course. Low online visibility and participation which encompass a number of students’ roles (Nagel et. al, 2007) resulted to

Service Activity Summary Report ( for Human Service Class) Essay

Service Activity Summary Report ( for Human Service Class) - Essay Example They prefer to do some routine things by themselves. I guess this is an element of pride and soon started to get involved when my help was necessary, or when they asked for it. There is a senior citizen that shared the pain of losing his wife and facing the rest of his life alone. From his story, I gathered that he was very lonely and the center offered him the chance to meet people closer to his age as well as people to talk to. There are times when is suspected that living family members had abandoned their elderly when they became too much of a burden. The disturbing thing is that they do not admit this. They claim that at the present times, all people are too busy to carry unwanted baggage. I learned that senior citizens have an element of pride and deserve to be treated in a manner where they feel dignified because sometimes, their dignity is all that they have left. I also learned about the value of social services in the community. There are many things that I took for granted and this activity enlightened me. I also learned that eventually, everybody would grow old and hence lose their productive ability (Midlam, 2004). It is best to make use of all the energy that comes with youth because I will miss it when I become a senior citizen. Their stories clearly show that some are satisfied with their achievements. I hope I can tell similar stories when I am their age. In addition, I have also come to appreciate the benefits of having a retirement benefit. I am likely to be very compassionate about the affairs of the elderly. In addition, I will make an effort to visit and take care of my own grandparents because I have realized that it is really lonely when a person is no longer able to work. The world is becoming busier, and sometimes an occupation is the sole reason to live for the senior citizens (Midlam, 2004). I will also ensure that I volunteer at these

Denial Of Service Essay Example | Topics and Well Written Essays - 500 words

Denial Of Service - Essay Example Denial of service attacks is common in businesses and organizational websites. Perpetrators of these attacks target services or sites that are hosted by high profile servers. These include credit card payment systems, banks and root name servers. The article on denial of service attacks that will be used is Dave Neal’s â€Å"Denial of Service Attacks Exploits White House Press Machine†. This article was published in The Inquirer on November 12, 2014. According to this article, attackers used the White House press release machine as a way of gaining network trust. The White House made this discovery when it updated its internet report with a caution that attackers are exploiting the facility’s press release machine. These attackers are using content emanating from the White House to gain network trust. They are using DNS reflection attacks to exploit the press machine. Attackers who target the network at the White House are designing large DNS text records in order to increase amplification, and magnify their attacks. These attackers create their own text records to amplify the responses as required (Neal, 2014). This helps them to direct traffic to targeted sites. The targeted traffic, which is amplified overwhelms the targeted site and makes it unable to respond to requests. In this case, the attacks saturate the target network or machine with amplified external communication requests. These requests come in large number s in order to prevent the machine from responding to legitimate traffic. They also cause the network or machine to respond slowly to legitimate traffic. Denial of service attacks eventually lead to server overload. This technique is effective because the text records have the ability to achieve the largest possible response. The attacks that were observed lasted for 5 hours and created a bandwidth load that peaked at 4.3Gbps (Neal, 2014). The text record technique has been extensively used to target entertainment

What is Education Policy Policymaking, Policy Implementation, the Essay

What is Education Policy Policymaking, Policy Implementation, the State, Ideology and Interest Groups - Essay Example While this articulation of the experiences learners are expected to undergo is quite vital to learning, it would not pay without a proper educational policy making and implementation by all stakeholders in the education sector (Ball, 2009a). The role of education policy in the realization of academic and professional growth for learners cannot thus be overemphasised. In its general sense, an education policy refers to the various systemic and structural arrangements by which the expected experiences and outcomes in an educational system can be achieved (Ball, 2009a). Importantly, these arrangements must maximize the attainment of these outcomes for students. However, in most cases, the policy structures and arrangements designed and implemented do not translate into the expected learning experience and outcomes. Unfortunately, the pressure piled upon schools, colleges, universities and their administrators, managers and teachers by stakeholders such as government authorities, school boards and parents for improved performance and experiences are partly responsible for the failed educational policies (Ball, 2009b). As a result of this kind of pressure, school managers and administrators end up having incoherent and mixed up policies that are not only hard to design but also to implement to fruition. Hence, instead of supporting learning institutions to achieve what is expected of them by the government and parents, schools end up failing due to excessive pressure and interest from the many stakeholders in the education system. Research has shown that there is not a single system of education and educational policy that would be best for all the stakeholders, including learners, teachers, parents, local communities, school boards and the regulatory bodies such as the central government. In education, just like other social issues, policies depend on various aspects of life in the target population (Les, 2006). In other words, education policy solutions are more based on case-to-case scenario instead of universal standards. Hence, discrepancies on education standards must be addressed based on th e immediate situation, which obviously has its complex and intertwined social, cultural and economic issues. Nonetheless, solving educational policy issues in whatever setting is never a complex task; all stakeholders are expected to do is to step aside and let education policy experts to design, develop, implement, evaluate, monitor, and reform education policy. These experts are also expected to incorporate the input of all educational stakeholders in executing their mandate. State and local skills and knowledge, educators, communities, parents are some of the stakeholders who must be involved in these exercises to design educational systems that function to achieve the expected experiences and objectives. This paper explores the concept of education policy with regards to policy making, implementation, ideology and interest groups or stakeholders. The Ideology and the Making of Education Policy Many an education policy is based on a market-based education system and reforms chara cterised by programs and strategies that promote choices and ready solutions to social, economic, political and cultural problems (Hanushek & Woessmann, 2008). However, some oppose this ideology for education, arguing that such an approach misperceives the function and objectives of education. In addition, the market-based approach to education is considered to weaken and threaten the democratic philosophies of education. However, both ideologies have been shown to have strengths and weakness and each jurisdiction may weight its options before adopting the ideology on which to base their

Cold war Essay Example | Topics and Well Written Essays - 500 words

Cold war - Essay Example The domestic influence of the Cold War brought to their prominent leadership anti-communist presidents such as Truman, Kennedy, and Nixon who not only waged political and cultural battle with the Soviet Union, but also fought with the latter in the endeavor to achieve greater favor for the American economy. Though the nature of Cold War bore domestic consequences upon local affairs, political battles between the Soviet Union and the United States were mostly staged on an international level. By the time ‘Sputnik’ took off, most schools functioned as fighting grounds in allowing intellectual ideas to flourish over ideological conflicts of the 50s and this incident drew education to a sense of drastic reformation that appeared to radicalize certain schools of thoughts in various levels. Democratic enthusiasts would normally stress that acquisition of good scholastic foundation was beyond primary necessity, being an accountability and contribution to gaining victory over th e communists so that state and federal sovereignties expressed support through generous funding of academic institutions. Fields of maths and sciences had been able to receive more than sufficient financial assistance with adequate books and facilities.

Language and vocabulary Essay Example for Free

Language and vocabulary Essay Language can be defined as a means of communication through spoken sounds, written symbols, or hand and body gestures. Subject to this simple definition language is neither human nor animal exclusive, meaning that all living creatures use some form of language to communicate. Humans have created the most advanced system of language. Human language has advanced to include listening, speaking, reading, writing, viewing and visual representation. These components are known as the six language arts and while they are individual components they are as well interdependent. What you learn about one affects what and how you learn about the others. Listening is the foundation for speaking, reading and writing. Listening is how we interpret sounds that we hear and what those sounds mean. In the beginning listening is merely receptive. Our brain receives sounds and begins to catalog those sounds. Listening is both an auditory and a visual skill and begins at birth. Children of normal hearing begin by creating mimicking sounds those sounds then become words. Visual listening is often most specifically noted in young children with a hearing impairment and is referred to as sign language. Sign language is not just for the hearing impaired. Parents/caregivers use hand gestures to increase the meaning of a word or to add value or impact to a word. An example of this is seen when a mother shakes her head or finger at a child as she says â€Å"no†. In the classroom children will generally begin a regular routine of listening. Students learn by example and repetition. Teachers explain what is needed, demonstrate the desired task or skill, and repeat. Students will gain good listening skills as they learn their class routine, listen to stories and instruction. Students gain an understanding of the task, and interpret what they have heard. As an understanding has been obtained they evaluate for an appropriate response. Speaking or the act of making a meaningful word comes later than does listening. Speaking is commonly referred to as an expressive skill and must be learned. A child begins to form words somewhere between ten and eighteen months of age. The first word of a child is often momma or dada. The child repeats the sounds or utterances heard from the adults around him. Speech does not actually occur until the spoken word is deliberate and meant to communicate. By the time a child reaches  kindergarten he has likely gained a 2000 – 3000 word vocabulary. While this number may seem excessive Dr. Mary E. Dahlgren states that a beginning kindergartener should have a 6000 word vocabulary for optimum grade and class performance (Dahlgren, 2008). In the classroom a student’s vocabulary size was an effective predictor of reading comprehension. Children with a restricted or limited vocabulary also had declining comprehension scores in the third grade. The elementary teacher can promote speaking by allowing the student the opportunity to speak and by listening to the student completely. Discussing a recently read book, or open discussions are ways in which a teacher can aid a student’s speech development. Reading is the interpretation of written symbols and involves the visual perception of those symbols. Reading connects the meaning of symbols with the words that has been spoken or heard. Kindergarten students build reading skills as they progress from letter recognition to early phonics. They begin to learn the beginning and ending sounds of common or high frequency words. As their vocabulary increases students begin to use words in context. In the classroom reading should be encouraged, should be intentional, and should be fun. Students who learn to read well achieve more and enjoy the learning process more fully. Active readers make for active listeners and intentional speakers and this is when comprehension of the text is experienced. During early reading development children learn by lessons designed around phonemic awareness. Usually this can be seen as student interaction with rhyming games, sing-a-longs, and listening games. As these games become familiar the teacher will integrate visual aids such as letter cards, word flash cards, independent reading time, and writing assignments. All of these early reading techniques aid in the development of early reading skills. Writing like speaking is expressive. This is where the students begin to place their own thoughts into print. This is the most magical of all six language arts experiences. Writing incorporates prior knowledge of reading, speaking and listening. Children begin to exhibit early writing as they experiment with crayons, chalk, and markers. They make scribbles and later form letter-like forms as toddlers. As the child is building his early listening and reading skill they are as well building the early writing skills through pre-phonemic spelling and copying techniques. Some children utilize invented spelling and finally conventional spelling techniques. Writing as it evolves  over time allows for communication on a broad level through time and space that may not have been possible otherwise. In the classroom writing is a means to relay a lesson, message, or concept. Students should be encouraged to write or draw in the best way they know how to. Students should be comfortable making mistakes as this leads to new discoveries and personal satisfaction. Viewing is an important component of literacy and language development. Viewing is extremely broad and is not limited to children’s books. In fact viewing should be stated as any visual content including TV, print ads, multi-media, and even computer software. Students must learn how to comprehend and integrate visual knowledge in the same way that they must learn to comprehend written, spoken, heard and read information (Roe Ross, 2013). As students begin to build on their foundation skills in reading and writing, they are also beginning to use critical thinking skills. This is where children begin to understand that people view things differently. It is important that students learn how to gain important and relevant content from what they see. Students learn to comprehend the message, evaluate the message, and determine the validity of the message. This is an on-going process that follows from infancy through adulthood. Students in the classroom should be taught how to use specific comprehension strategies and to critically analyze the content in everything that they view. Visually Representing is a way of communicating through visual images. It was common practice for the art teacher to have us cut up a magazine and to create a collage of our favorite things. We never thought of this as visual representation, it was just art class. In fact while not always part of the language arts standards it has been used and in practice for many years. In the classroom we make dioramas, models, graphs and maps all of which are visual representations of an idea or concept. Visual representation requires a unique set of strategies such as organization, data collection, and audience identification in order to convey a message. It appears to be impossible at this point to separate the six components of language arts thus far; as one builds on the other, knowledge or insight is gained, it is clear we must have each in order to process the other. Works Cited Dahlgren, D. M. (2008). Oral Language and vocabulary development Kindergarten First Grade. Nashville: Reading First National Conference. Retrieved from http://www2.ed.gov/programs/readingfirst/2008conferences/language.pdf Roe, B., Ross, E. (2013). The Language Arts. Education.com.

Healthcare Industry: IT Systems

Healthcare Industry: IT Systems Healthcare services have seen several changes throughout the years to respond to changing demands of the population. The present key drivers and issues that stakeholders (patients, healthcare providers, vendors and government) in the healthcare sector face are ageing population, increased burden of chronic conditions, rising public demand/expectation for quality healthcare, fragmented and uncoordinated healthcare services and rapid advances in information technology. At present, information technology is considered a strategic necessity by world class organizations instead of just a supporting tool. To obtain a competitive advantage in an environment with intense competition, it is vital for organisations to use more sophisticated information technology tools to address the challenges of building and deploying system in the short term and the identification, research and design of future system. Information technology (IT) is rapidly becoming integrated with healthcare to improve processes and communications, support decision making, reduce inaccuracies, and improve patient safety. The advancement of medical science through the years has made possible the use of more expensive equipment and the latest technology. This will allow healthcare providers and patients to gain access to health information easily and thus has the potential to improve the quality, safety, and efficiency of health care. As the healthcare industry is information intensive and knowledge intensive, there is also a need to publish health care information and knowledge. Healthcare systems vary from country to country but they all have a common aim that is to meet the healthcare needs of target populations. In this report, I will be focusing on healthcare IT in Singapore context. Healthcare System in Singapore Singapore has a dual health care system where individuals can choose between public and private providers. The government through Ministry of Health (MOH) manages the public healthcare system. MOH plays a major role in formulating national health policies, coordinating the improvement and planning of the public and private healthcare sectors and regulating health standards. MOHs mission is to promote good health and reduce illness, to ensure Singaporeans have access to good and affordable healthcare and to pursue medical excellence (Ministry of Health, 2007). MOHs vision is to develop the worlds most cost-effective healthcare system to keep Singaporeans good health. Delivery Structure Healthcare services in Singapore are provided by different types of providers from primary care to tertiary care and to step-down care. Primary Care Primary care includes primary medical treatment, preventive healthcare and health education (Info-communications Development Authority of Singapore, 2009). In Singapore, primary health care is provided through outpatient polyclinics and private medical practitioners clinics. 80% of the services are provided by private practitioners while the remaining 20% by government polyclinics. Conveniently located in town centres all over the island, polyclinics are one stop health centres which offered services such as outpatient medical care, maternal and child care health. Secondary and Tertiary Care For the secondary and tertiary care, 80% of the hospital care being provided by the public sector and the remaining 20% by the private sector. This public sector is organised into two vertically integrated delivery networks, National Healthcare Group (NHG) and Singapore Health Services (SingHealth) that operate as not-for-profit private companies. Having these two groups enable more integrated and better quality healthcare services through greater cooperation and collaboration among public sector health care providers. Each cluster consists of both general hospitals that provide multi-disciplinary healthcare services and specialised hospitals in various disciplines e.g. obstetrics and gynaecology and ophthalmology. The private sector provides similar specialist disciplines and comparable facilities to the public clusters. The two main providers are Raffles Medical Group and Parkway Group Healthcare (Info-communications Development Authority of Singapore, 2009). Step-Down Care Voluntary welfare organisations (VWOs) provide most of the step-down care services. They run nursing homes, inpatient hospices, community hospitals and chronic sick hospitals. Four of the public acute hospitals also provide geriatric units (Info-communications Development Authority of Singapore, 2009). Public Healthcare Delivery Structure One of the objectives of forming the two clusters is to facilitate integration of healthcare services at the various levels. The clusters have begun introducing measures to integrate primary healthcare at the polyclinics and secondary care at the hospitals. A Vision for 21st Century Healthcare Intelligent Nation 2015 (iN2015) is a 10-year masterplan to help Singapore realise the potential of infocomm. The vision of iN2015 is An Intelligent Nation, a Global City, powered by Infocomm. The goal for the Healthcare and Biomedical Sciences sectors is To accelerate sectoral transformation through an infocomm-enabled personalised healthcare delivery system to achieve high quality clinical care, service excellence, cost-effectiveness and strong clinical research. (IDA, 2006) Refer to Figure 1 in Appendix to see how it will look like. Key drivers of change in Singapores healthcare sector were identified and a number of likely shifts and changes to the system were predicted (IDA, 2006). Key Drivers Shifts/Changes Ageing population of chronic conditions Focus on prevention, health promotion and wellness care Rising public expectations of healthcare services Integrated and patient-centred system of delivery Fragmented and relatively uncoordinated healthcare services Consistent widespread application of evidence-based medicine Very rapid advances in infocomm, medical science and technologies and biomedical research Greater role of members of the public in managing their own health Greater facilitation of data flows between healthcare sector and biomedical sciences Strategies and Programmes (IDA, 2006) The targeted outcome is a well-integrated quality healthcare, cost effective healthcare services and greater ability of public to manage their health. To bring about successful business change using IT, healthcare providers should ensure that IT works in performance with meaningful changes in organisational functions and processes (Rothenberg, 1995). How IT can be used? In the healthcare industry, one suite solution is not common because certain user departments will need to have more in-depth functionalities than others. A more common approach in the industry is best of breed where it attempts to give full equal weight in terms of functionalities and features to individual user departments. Some considerations for best of breed approach are: It deals with more than one vendor A need to connect or interface the different applications to provide a fully integrated solution Future upgrades issues. Therefore, there is a need to strike a balance between having too many application platforms and departmental requirements or functionalities (Online Consultant Software). IT Infrastructure for the Healthcare Industry Functional interoperability is needed in order for computers to be able to share clinical data with one another. Computers must have functions to be able to physically communicate, send and receive documents and data files, share data and information. Therefore, there is a need for integration, standards and interface engines to build the healthcare industry infrastructure. MediNet MediNet forms the backbone of medical system in Singapore (IDA, 2006). It is Singapores nationwide computer network for medical and health care community that focuses on five components (Lim, 1990): Central Claim Processing System(CCPS) processing of claims in hospital bills National Patient Master Index (NPMI) consists of patients risk factors, drug allergies and demographic data Procurement Electronic procurement of medical and surgical supplies Notification Transmission of notifications to government agencies Information Services Access to local and foreign databases MediNet links up computer systems of all participants (MOH, Central Provident Fund Board (CPFB), Government Bodies, restructured hospitals, private hospitals, general practice clinics) in the healthcare delivery system so that they will be able to communicate, exchange data and access common applications on the network (ANNEX C: FACTSHEET: Infocomm Milestones, 2006). Health Level 7 A group of healthcare computer systems users who founded the Health Level 7 organization in 1987 started developing the HL7 protocol to create that common language that allows healthcare applications to share clinical data with each another. Over time the HL7 interoperability protocol became a nationally, internationally and globally accredited standard (HL7 Singapore). Health Level Sevens domain is clinical and administrative data. Interface Engine Interface engine is a software program intended to simplify the creation and management of interfaces between separate applications and systems, either within the organization or with other affiliated organisation (McLeod CG, Inc., 2006). It carries out messaging between systems and usually handles any mapping, translation and data modification required to ensure the effective exchange of data. Examples of common interface engines used in the healthcare industry are Cloverleaf, Datagate and Openlink (MDI Solutions, 2009). Imagine in a hospital where there are different departments needing different functionalities and features, different applications might be running. It would be very complex and technically difficult to maintain separate interfaces between them. Healthcare Applications Enterprise Resource Planning (ERP) The public healthcare sector uses SAP industry solution for hospital (IS-H) (SAP, 2008). It supports patient management, medical and nursing documentation, and patient accounting, and integrates these with financial accounting, controlling and materials management. The information system contains evaluations of patient and hospital data that can be used both internally and externally. It also contains a communication component that enables data transfer both within the hospital and to external parties. The picture below shows the SAP footprint in Singapore Healthcare Industry. Only Parkway Health (Private Sector) and Republic Polytechnic (for educational purpose) are not under the public healthcare sector. Source: (SAP, 2008) Case Study: Hospital Information System at St Andrews Community Hospital (InfoComm Singapore Portal, 2008) St Andrews Community Hospital was relocated in April 2005 to a larger premise in Simei. The change in hospital and care processes was the drive to upgrade the Hospital Information System (HIS) at St Andrews Community Hospital from its manual administrative system and record stock which require tedious work to a more efficient way to process information by technology. The project team were focused on being user-centric rather than IT-centric in the choice of an HIS. User departments were pro-active and committed during the pre-selection brainstorming and consultancy and during the implementation stages of the new system. The VESALIUS, a complete HIS provided NovaHealth which covers front-end modules such as Appointments, Registrations, ADT and billing and ancillary support modules such as Pharmacy, Medical Records, back-end Inventory and integration to the Financial System. The benefits of the system are: Assisting management to track costs down to the minute details Increasing efficiency as manual and administrative work are being minimised Enabling links to the MOHs Elderly and Continuing Care system for online submission of information to receive government subsidies; and the CCPS for automated submission for Medisave claims Serving as a check and balance for inventory audit and reducing waste. As a result, there is no need for Pharmacy staff to spend time physically checking stock levels when transferring items from the various stores in St Andrews Community Hospital. Having a lean and efficient team complemented by the HIS, paperwork is also minimised. An Integrated Electronic Medical Database Electronic medical record (EMR) stores patients medical information through IT to enable sharing across healthcare institutions (MOH; SingHealth; NHG, 2004). It can be made more secure through appropriate IT access and security safeguards. The MOH holds the vision of One Singaporean, One Family Physician, One Medical Record to improve long term care. EMR provides medical staff involved in patient treatment with quick and accurate access to patients essential medical information (Yong, 2007). The integrated patient database system was thus vital in Singapore as there is a need to get the right information to the right people especially in an industry where a second could mean a difference between a life and death situation. EMR Adoption Model The EMR Adoption Model is devised by HIMSS Analytics to track the progress of hospitals towards creating a paperless patient record system. It is based on an eight-stage scale which starts at zero (HIMSS Analytics). The EMR Adoption Model Structure ensures all application capabilities must be operational before that stage can be achieved as it sets a foundation for subsequent stages. Refer to Figure 2 in Appendix for the EMR Adoption Model. Electronic Medical Record Exchange (EMRX) EMRX is an initiative by MOH and the two public healthcare clusters (SingHealth NHG) to share electronic medical record across all public hospitals and polyclinics in Singapore. The EMRX will have the following information (MOH; SingHealth; NHG, 2004): Discharge summary which summarises recent hospitalization records including the treatment received and clinical course; Operation reports and laboratory results, including radiology images and scanned medical records Medicines prescribed with drug allergy history It was launched in April 2004 to focus on the improvement of patient care outcomes. It is a pragmatic and incremental implementation where SingHealth and NHG first developed the key systems within selected institutions and then replicate in other institution within the cluster and eventually across clusters and where practical with the private sector. The benefits of EMRX are (MOH; SingHealth; NHG, 2004): Better coordinated care for patients moving across different providers and improved levels of healthcare delivery. Better clinical decisions, with access to complete and legible clinical histories, and updated test results at the providers fingertips. Reduce the risks of transcription errors and missing records. Save cost through the avoidance of unnecessary repeat tests and investigations Better distribution of care Facilitation and follow up of other IT based applications such electronic prescriptions and clinical decision support systems Potential for 24 hour access to real-time data for up to date results reporting Provision for data security and audit features to be built into the system. Current EMRX Implementation The aim of the clusters is to implement the EMR in all institutions within each cluster incrementally. SingHealth and NHG manage their clusters EMR independently. SingHealth started using an EMR system in SGH in year 2000. The main application SingHealth has used to develop its EMR system is iSOFTs iClinical Manager Solution (E-HEALTH-MEDIA LTD, 2004). Similarly, the National Healthcare group has also started using EMR systems in Tan Tock Seng Hospital and National University Hospital. EMRX was developed to enable secure cross-cluster exchange of patient information. This is to ensure that a patients record can be retrieved regardless where he or she seeks treatment. EMRX was later extended to healthcare partners, providing a central capability for effortless movement or records across the public healthcare clusters, community hospitals and Ministry of Defence (MINDEF), facilitating care delivery. SAF Electronic Medical Records The SAF healthcare system is centred on the SAF EMR system which is known as Patient Care Enhancement System 2 (PACES 2). It has clinical data repository, administrative function for manpower and logistics and also has the feature for research or analysis (Wong, 2009). The system connects all SAF medical centres across Singapore to allow for online and real time medical info retrieval and simultaneous viewing. Figure 3 in Appendix shows how it is connected. NHG Polyclinic Bukit Batok Polyclinic was the first to adopt the electronic medical records system. With paperless medical records, patients medical records can now be retrieved while diagnoses are entered into the system (Hoe, 2009). This move is part of MOH vision of integrating services between the healthcare providers. Benefits to Patients: Enhanced safety as there is a reduced patient risk through improved legibility of orders. Reduced waiting times due to the improved process Better care coordination and disease management through sharing of medical records Benefits to the polyclinic: Quality: Continuous improvement of quality care and patient service through error monitoring and elimination of unnecessary procedures Productivity: Saving time and effort that would otherwise be spent on correcting lost and illegible orders. Furthermore, there is no longer need to go to the records office, retrieve the physical paper records and bring it up to either the doctors or nurses room which can take up to 20 minutes or half an hour. Access: More readily available information and data of patients for healthcare professionals to make faster critical decisions Future Outlook National Electronic Health Record (NEHR) The next phase of electronic health record is moving towards creating a health record that is in fact personalised and accessible everywhere to be implemented by April 2011 (ChannelNewsAsia, 2010). With NEHR, all key information such as a patients demographics, allergies, clinical diagnoses, medication history, X-rays, laboratory investigations and discharge summaries will be fully exchangeable between various healthcare providers. Due to the costly implementation, only a number of primary and step-down care providers, including GPs, polyclinics and a community hospital will be linked up first (ChannelNewsAsia, 2010). The full implementation of NEHR will take many years as it has to cover the entire healthcare ecosystem and not just the public sector. The decision on whether to implement each phase will have to be justified on cost-benefit analysis. Refer to Appendix for an attached article on What could healthcare in Singapore look like in 2020? (Ministry of Health, 2008). Medical Information Services IT is also widely used as an information tool by both medical professional and the public. Several government and privately initiated websites provide information for health care services and databases for medical related issues. Web portals provide the following services: Searching for medical professionals within Singapore The MOH has a list of online resources to search for healthcare professionals in Singapore (MOH, 2007) Online pharmacies For example, Changi General Hospital myPharmacy is the first online hospital pharmacy in Singapore (Changi General Hospital, 2004). Medical publications One example of medical publications is PubMed (PubMed). Health related publications Some examples of health related publications from SingHealth (SingHealth Academy ). Health service reports Queue watch provide patients with timely information to arrange their visit. The number of patients waiting for registration and consultation, live webcam images showing the waiting areas for registration, consultation and pharmacy/payment and peak non-peak periods are displayed online (Government of Singapore, 2007). Medical schemes such as Medifund, Medisave MediShield Information regarding these schemes can be found in CPF Board website (Central Provident Fund Board, 2009). Competitive Advantages The growth and survival in the healthcare industry depends on how well Singapore is able to compete in this highly and competitive market. With the integration of the healthcare infrastructure, the advanced medical technology and the highly skilled professionals, Singapore has managed to establish a reputation of being a world class healthcare hub, the ability to deliver innovative healthcare solutions, a complete range of services and quality healthcare providers (EDB, 2009). There will be a strong demand from the population for quality healthcare and value added services with rising economic affluence and longer lifespan. Thus, there is a need to ensure that healthcare research and development continues to be supported so that Singapore healthcare services sector can excel and be a source of competitive advantage. To sustain the competitive advantages, Singapore should be aware of their strengths and weaknesses and also of their competitors. The approach for the future must be one that focuses on possible improvements, supporting innovations and facilitating changes. The focus will have increasingly to be on openness to new influences, a willingness to recognize different schools of thought and methods of training and a search for the best available expertise from around the world (Desker, 1991). Innovation is needed to overcome the future challenges ahead to maximise Singapores competitive advantage. Healthcare providers should enhance their medical and service offerings, develop new healthcare products, and promote a pioneering spirit that will help in dealing with evolving patients needs, and in creating holistic and flawless experiences for patients (Tan, 2009). Thomson Medical Centre The Business Times reported that Thomson Medical is leading the healthcare sector (Ramchandani, 2010). Focusing on three core areas patient expectations, perceived quality and perceived value to improve patient satisfaction, Thomson Medical Centre has been continuously innovating to provide greater value-added services to its patients. Their redesigned patient-centric workflow had helped them gain a competitive advantage over their rivals: Use of technology and raise in service and product standards has improved patient care and satisfaction Improve in-patient , out-patient and administrative processes by using touch screen billing in place of a key-in method, which has halved the time spent on billing and has resulted in cost savings of $2000 a month. Reduce waiting time for admission and discharges with express check outs, direct admissions and courtesy and in-room discharges. Act on service recovery. When there is an unhappy patient with service, they move fast to resolve the problem. Train front line staff to raise service standards which resulted in an increase in the number of compliments as compared to complaints (4.9:1 to 9.2:1). Create a positive patient experience by having a resort style ambience, offering concierge service, a welcome drink and, in the case of premier rooms, luxurious dà ©cor and relaxing spa music. Introduce value added services such as the interactive website ThomsonBaby.com to help new mothers prepare for the parenthood journey and save them time and money. The hospitals efforts in cultivating lasting relationships have also led to an increase in patient loyalty. 32.2% of its patients were repeat patients in 2009, compared to 26.8% in 2008. Besides that, there was an increase in the number of babies born. Thomson Medical Centres dedication in understanding patient needs and receiving feedback on their stay and their expectations at key hospital touch points has thus improved patient satisfaction level. Challenges The vision for an integrated and continued patient- centric healthcare system requires interoperable IT systems, active engagement of patients and suitably aligned financial framework. In the development of the Singapore healthcare system, there are some issues that hinder the implementation of healthcare integration due to unique specificities. In general, the problems faced by the players involved can be classified into five categories: Clinical and medical practices: Often built around specialization but could be better oriented towards integrated care Financing framework: GPs, Specialist Outpatient Clinics (SOCs) and patients does not see the incentive for integration of care Establishment of a new idea mindset towards integration of care for players involved Organizational processes: Enhanced by bridging communication and IT gaps, coordinating across sectors and defining workflows for the smooth move of patients between caregivers IT systems: Better connected across sectors and allow for the transferability of patient records. As shown in Figure 4 in the Appendix, these challenges have over the years led to ingrained mindsets and behavioural practices of parties at multiple levels of the system, further hindering the integration of care (Ministry of Health, 2008). The various challenges and loophole that currently exist are the result of institution-centric and tertiary-centric system of healthcare. As EMRX becomes widely accessible, there are concerns over patient confidentiality and privacy. For instance, legal implications of providing EMRs beyond cluster boundaries were considerable and attaining consent from individual patients would have been burdensome and stalled widespread accessibility of EMRs (MOH; SingHealth; NHG, 2004). This shows that there are vital ethical concerns over the privacy of personal medical records. Furthermore, the infrastructure for data standardisation needed to achieve this integrated healthcare system is getting more intricate and costly due to the vast amount of data involved from different independent systems. Despite SingHealth and NHG adoption of the HL7 v2.3, data exchange could not be easily achieved in spite of HL7 v2.3. This is because the standard was open to variations that hampered direct interoperability. Moreover, modification of systems to enable data interoperability would have been costly, without direct benefits to the clusters (Lee, Lim, Tan). Conclusion Previously, healthcare sector has lagged behind other sectors in the adoption of IT for its key process. Healthcare providers need to review the way businesses are conducted. IT can be a powerful enabler for an information intensive industry like healthcare through automation, knowledge management, business process reengineering, and even artificial intelligence. A pragmatic approach should be adopted to consider the current status and to focus on implementing immediate goals that would bring about meaningful changes in organisational functions and processes within a reasonable time frame. The use of IT to create value in a patient-centric approach to care is likely to contribute significantly to the overall level of care that patients can benefit from. Innovation can help healthcare providers to gain a competitive advantage. The success of some healthcare provider as mention above has shown that IT can help in the healthcare sector to improve healthcare quality, reduce costs and to meet some of todays trends in demographics and disease burden. This quote which is published in NHG annual review 2007-2008 shows the importance of IT, Technology is our enabler. We use technology to record and disseminate information with higher precision, accuracy and safety. More importantly, it allows healthcare to be delivered safer, faster and better. (National Healthcare Group Polyclinics, 2008) In the enthusiasm to adopt and invest in IT, it is important to note that there are some barriers in the move toward an integrated healthcare system as stated in the abovementioned section. Addressing and overcoming these challenges will involve the collaboration and cooperation of players at all levels of the system, across both the public and private sectors. Learning points / Opinions Strategy Technology should be used as a supporting tool not to steer health care reform. To transform Singapores health care system into a modern and responsive 21st-century health care system, a practical IT strategy which is consumer-focused is needed. In particular, it needs to be competitive in terms of price and quality because that is what consumers look for. A tripartite model of health care regulation, involving the active participation of empowered consumers, is Singapores best hope for containing costs and ensuring quality of care. What is done well? A committee to plan for the future development in healthcare iN2015 Healthcare and Sub-Committee came out with strategies and programmes to help address todays challenge and support the developmental opportunities. It aims to achieve high quality clinical care, service excellence, cost-effectiveness and strong clinical research. Improve business process with IT IT has played an important role in the delivery and development of healthcare services in this information age with applications ranging from finance and personnel administration to medical equipment operations. Healthcare service administrations have become more efficient and responsive, reducing patient waiting time and paper work. Medical equipments have become more accurate, laboratory results can be processed more quickly and effective communication among medical staff in Singapore and those overseas has become easier. What more can be done User Involvement IT investment decisions must serve the best interests of the key players involved. It is important to understand the users and their work flow and requirements as a one size or solution may not fit all. Flexibility is needed as each department requires different functionalities. Express clearly the benefits and value for the change Users involved need to understand the strategic goals of the organization and understand how IT, from technical and managerial perspectives, can help to achieve them. The success of IT investments is to ensure users see the benefit and value of IT so that they will be motivated to make the change. Limitations of IT Healthcare providers should be mindful of the limitations of technology and have a deep understanding of the information search behaviours of their target audience. Health care is still a hi Are Consumers Central to Marketing Activities? Are Consumers Central to Marketing Activities? In view of the dynamic nature of the marketing environment, to what extent do you consider consumers to be, in practice, central to marketing activities? Words count: 1621 words Marketing is the analyzing, organizing, planning, and controlling of the firms customer-impinging resources, policies, and activities with a view to satisfying the needs and wants of chosen customer groups at a profit. (Kotler and Keller, 1967) [1] The main purpose of any business is to make profit. To do so, their customers are necessary. The role of marketing is to anticipate and identify consumers needs and wants, in order to satisfy them efficiently and profitably.2 In view of the dynamic nature of the marketing environment, to what extent are consumers, in practice, central to marketing activities? First of all, it is necessary to define what characterizes the marketing environment, and in what way this environment is dynamic. Secondly, we will see how the consumer is central to marketing activities. Finally, we will discuss about the relative importance of the consumers in these activities and the other factors that can also influence them. The marketing environment consists of external factors that affect the companies and their ability to satisfy customers.[2] There are two aspects to this marketing environment: the macro-environment, and the micro-environment. The PESTEL factors are the factors found in the macro-environment: political, environmental, social/cultural, technological, economical and legal.[3] They are societal factors, thus not controllable; and the companies need to adapt to these factors. In the macro-environment is included the demographical factor. The study of the demographic environment can help predict the size of the market of a certain product. For example if the number of elderly people is going to rise, the potential market for retirement homes will grow. The same goes for a change in the number of children, which could impact the number of schools and teachers needed.[4] Companies need to adapt to changes in the micro-environment as well. The factors in the micro-environment are the ones close to the company, making them easier to control: customers, competitors, distributors, suppliers, and other departments within the company.For example, if a company has competitors satisfying the same needs with a similar product but at a lower price, it wont be able to sell its product and make profit out of it. Companies make use of marketing research and marketing intelligence to collect information about the marketing environment in order to adapt their marketing strategies. Marketing takes place in a dynamic environment: these external factors change constantly, and companies need to be aware of these changes taking place in the marketing environment in order to adapt themselves efficiently and effectively, and be able to keep on answering consumers needs and wants.[5] To satisfy their target consumers, marketers need to understand them. They need to study the existing and potential markets. Resources need to be efficiently managed in order to meet the identified needs in these markets.2 Marketing orientation is important because different customers have different needs. In order to meet the specific needs of each customer, firms have to adapt. Answering everyones needs is not a realistic thing, which is why segmentation is used. Segmentation is the method used to separate the population into specific segments, which contains customers with similar needs. Understanding the needs of these segments of population will allow the determination of the marketing strategy that will be used in a specific business plan.[6] The marketing strategy determines the actions that will be taken over time to achieve the objectives of the company. Marketing decisions are based on the 4Ps, also called marketing mix: Product, Price, Place and Promotion. The four components of this marketing mix are determined by the target consumers.[7] As said before, the purpose of any business is to make profit, and it needs to satisfy the consumers for that to happen. The product needs to fulfil the customers need of course, but not only. The product also has to be at an acceptable price in the eyes of the consumers for them to buy it. The price is what makes money for the company, it is determined by the production costs and the competition, as well as by how much the customers are willing to pay for the product. On the one hand, if the price is too high, consumers wont buy, which means the company wont achieve its sales target. On the other hand, if it is too low, the target will be achieved but there will be no profit made out of it. 4 Price has to be chosen accordingly as well as place. Different types of consumers will need the product to be available at specific places. A very expensive product, such as a luxury item, will not necessarily be available at the local supermarket for example, but most certainly in a specific shop or place. Consumers also prefer to buy products when they are located close to their homes and workplaces.[8] In order to answer consumers needs profitably, marketers have to use segmentation to target their market, and match their marketing strategy to their target consumers needs.4 Thus making the consumers central to the companys marketing activities. Lets take Microsoft as an evolutionary example of changes in the marketing environment with the technological factor (macro-environment) and the companys competition (micro-environment).9 Recently, Microsoft has struggled to find its place in a fast changing digital and technological environment. Microsoft was and still is in consumers mind the leader in Personal Computers. They are now lagging behind competitors like Apple or Samsung, and are trying to develop other devices like tablets, smartphones, consoles, etc. They even acquired Nokias smartphone business in order to do so. They developed a new version of their operating system that works on every platform, including their console Xbox; which provides a cloud based connectivity that consumers are looking for. Their change in strategy to provide consumers what they need in this era of technological improvements has paid off: Microsofts sales are trending upward since the past few years.[9] In order to keep his place in the market, Microsoft had to change its strategy to improve its solutions to satisfy todays consumers after being left behind by competitors and technological advances. To this point, we can affirm that consumers are indeed essential and central to marketing activities. Marketing is all about satisfying consumers profitably, and marketing research and marketing strategies are calculated around them. Despite their importance, consumers are only one of the forces in the marketing environment. Changes in the marketing landscape are so fast that it is now more and more difficult for companies to adapt. One of the most influential factors of marketing activities is technology: 40% of the worlds population now has access to the Internet, compared to 1% in 1995.[10] The vast majority owns a smartphone that also has access to the Internet. The Internet and social media are thus also used for marketing purposes as well[11]: websites, adverts, e-mails, videos, etc. Influencers on the Internet are also important for marketing research; they can be people who have blogs and websites for example, and are useful to marketers for them to better understand current trends and interests.[12] Companies can also sponsor people such as bloggers and video makers (YouTube in particular) by making them review products and/or services online.[13] Globalization is another factor that influences marketing activities. Lots of companies now face global competition. Also, when a company decides to sell its products abroad, it has to take into account the tastes and habits of the selected country. For example, for the French market, Nutella is manufactured to be more spreadable, due to the fact that French people mostly eat it on baguettes, making it more difficult to spread.[14] Nowadays, companies also need to take into account the environmental aspect for their marketing activities. They have to be environmentally responsible, to be more sustainable in their practices than in the past. These are a few other examples of factors, apart from the consumers, that can have an influence on the marketing activities of businesses. To conclude, consumers are indeed central to marketing activities, but are only one of the many factors that have an influence on them: notably changes in the marketing environments factors; the technological factor in particular, which is probably the fastest changing factor as of now. References Berthon, P., Pitt, L., Plangger, K. and Shapiro, D. (2012). Marketing meets Web 2.0, social media, and creative consumers: Implications for international marketing strategy. Business Horizons, 55(3). Ça mintà ©resse La curiosità © en continu. (2017). Pourquoi le Nutella nest pas le mà ªme en France quen Allemagne ? Ça mintà ©resse. [online] Available at: http://www.caminteresse.fr/economie-societe/pourquoi-ne-mange-t-on-pas-le-meme-nutella-en-france-quen-allemagne-1129354/ [Accessed 26 Mar. 2017]. Corcoran, C. (2017). Marketings New Rage: Brands Sponsoring Influential Bloggers. [online] WWD. Available at: http://wwd.com/business-news/marketing-promotion/marketings-new-rage-brands-sponsor-influential-bloggers-3230386/ [Accessed 26 Mar. 2017]. Goi, C. (2009). A Review of Marketing Mix: 4Ps or More?. International Journal of Marketing Studies, 1(1). Internetlivestats.com. (2017). Number of Internet Users (2016) Internet Live Stats. [online] Available at: http://www.internetlivestats.com/internet-users/ [Accessed 26 Mar. 2017]. Kotler, P. and Armstrong, G. (2016). Principles of marketing. 16th ed. Harlow: Pearson. Kotler, P. and Keller, K. (1967). Marketing management. 1st ed. Upper Saddle River, NJ: Pearson Prentice Hall. Li, Y., Lai, C. and Chen, C. (2011). Discovering influencers for marketing in the blogosphere. Information Sciences, 181(23). Palmer, A. and Worthington, I. (1992). The business and marketing environment. 1st ed. New York [etc.]: McGraw-Hill Book Co.. Richardson, M. and Evans, C. (2007). Assessing the Environment. British Journal of Administrative Management. Smallbusiness.chron.com. (2017). What Are the Four Types of Utility Marketing?. [online] Available at: http://smallbusiness.chron.com/four-types-utility-marketing-24420.html [Accessed 26 Mar. 2017]. [1] Kotler, P. and Keller, K. (1967). Marketing management. Upper Saddle River, NJ: Pearson Prentice Hall, p.12. [2] Palmer, A. and Worthington, I. (1992). The business and marketing environment. New York [etc.]: McGraw-Hill Book Co., pp.1-6. [3] Richardson, M. and Evans, C. (2007). Assessing the Environment. British Journal of Administrative Management. [4] Palmer, A. and Worthington, I. (1992). The business and marketing environment. New York [etc.]: McGraw-Hill Book Co., p.167. [5] Kotler, P. and Armstrong, G. (2016). Principles of marketing. 16th ed. Harlow: Pearson, pp.94-95. [6] Palmer, A. and Worthington, I. (1992). The business and marketing environment. New York [etc.]: McGraw-Hill Book Co., pp.10-17. [7] Goi, C. (2009). A Review of Marketing Mix: 4Ps or More?. International Journal of Marketing Studies, 1(1). [8] Smallbusiness.chron.com. (2017). What Are the Four Types of Utility Marketing?. [online] Available at: http://smallbusiness.chron.com/four-types-utility-marketing-24420.html [Accessed 26 Mar. 2017]. [9] Kotler, P. and Armstrong, G. (2016). Principles of marketing. 16th ed. Harlow: Pearson, pp.92-94. [10] Internetlivestats.com. (2017). Number of Internet Users (2016) Internet Live Stats. [online] Available at: http://www.internetlivestats.com/internet-users/ [Accessed 26 Mar. 2017]. [11] Berthon, P., Pitt, L., Plangger, K. and Shapiro, D. (2012). Marketing meets Web 2.0, social media, and creative consumers: Implications for international marketing strategy. Business Horizons, 55(3), pp.261-271. [12] Li, Y., Lai, C. and Chen, C. (2011). Discovering influencers for marketing in the blogosphere. Information Sciences, 181(23), pp.5143-5157. [13] Corcoran, C. (2017). Marketings New Rage: Brands Sponsoring Influential Bloggers. [online] WWD. Available at: http://wwd.com/business-news/marketing-promotion/marketings-new-rage-brands-sponsor-influential-bloggers-3230386/ [Accessed 26 Mar. 2017]. [14] Ça mintà ©resse La curiosità © en continu. (2017). Pourquoi le Nutella nest pas le mà ªme en France quen Allemagne ? Ça mintà ©resse. [online] Available at: http://www.caminteresse.fr/economie-societe/pourquoi-ne-mange-t-on-pas-le-meme-nutella-en-france-quen-allemagne-1129354/ [Accessed 26 Mar. 2017].