Development of In Vitro Fertilization Essay

Robert G. Edwards was born on September 27, 1925 in Batley, Yorkshire, UK. Before he got into the medical field, he served in World War II before studying biology at the University of Wales in Bangor and Edinburgh University in Scotland. There, he received a PhD in 1955 with a thesis on embryonal development in mice. In 1958, he became a staff scientist at the National Institute for Medical Research in London and initiated his research on the human fertilization process. Five years later, he began his academic career in the reproductive physiology department was spent in Cambridge, UK, where he and gynecologist, Patrick Steptoe started the world’s first In Vitro Fertilization centre, the Bourn Hall Clinic. Edwards was the research director for the clinic for several years and had also edited many leading scientific journals on fertilization. He currently teaches at the University of Cambridge. As early as the 1950s, Edwards envisioned that In Vitro Fertilization could be a very useful treatment for infertility. He worked in steps – from systematically determining his goal, discovering principles for human fertilization, and succeeding in accomplishing fertilization of human egg cells in test tubes, or cell culture dishes. First of all, infertility, a medical and psychological problem, affects 10% of all couples in the world. This causes lifelong psychological trauma for these couples and the fact that medicines have limited opportunities to help them, there is little hope for them to conceive. In Vitro Fertilization (IVF) is an established therapy when sperm and egg cannot meet inside the body. After previous research had shown that egg cells from rabbits could be fertilized in test tubes when sperm was added, giving rise to offspring, Edwards decided to investigate further if similar methods could be used for humans. In experimental studies conducted together with several different co-workers, he made a great deal of encouraging discoveries. Findings proved how human eggs mature, how different hormones regulate their maturation, and the time in which eggs are susceptible to the sperm. In 1969, his efforts met with success when a human egg was fertilized in a test tube. In spite of his success, the fertilized egg did not develop more than a single cell division. He suspected that eggs had matures in the ovaries before they were removed for IVF would work better, and looked for different ways to obtain eggs in a safer way. While Steptoe used the laparoscope to remove eggs from the ovaries, Edwards put the eggs in cell culture and added sperm. Embryos started to from after the egg cells divided several times. Though the studies were promising, the Medical Research Council did not fund a continuation of the project. However, a private donation allowed the work to continue. By analyzing the patients’ hormone levels, they could determine the best time point for success. In 1977, Lesley and John Brown arrived at the clinic after nine years of trying to have a baby. IVF treatment was carried out and once the fertilized egg had developed into an embryo with eight cells, it was returned to Lesley Brown and on July 25, 1978, a healthy baby girl named Louise was born through C-section after a full-term pregnancy. It was then that IVF moved from a vision to reality and a new era in medicine begun. Gynecologists and cell biologists from different countries trained at the Bourn Hall Clinic and the original methods of IVF were refined. By 1986, a thousand children had been born after IVF in the world. To this day, IVF is an established therapy throughout the world and has undergone several improvements, including single sperm being microinjected directly into the egg cell in the culture dish. IVF is safe – 20-30% of fertilized eggs lead to the birth of a child. With most procedures and attempts, there are risks of complications, such as premature birth, but they are very rare. As of 2010, approximately four million individuals have been born thanks to IVF. Louise Brown and many other IVF children have even given birth themselves, adding to the success and safety of this therapy. A new field of medicine had emerged, with Edwards heading the process. â€Å"His contributions represent a milestone in the development of modern medicine. †

Promote childrens behaviour Essay

Unit 304 Promote children and young people’s positive behaviour The role of a school is multi-faceted. It exists not only to educate, but to guide children’s development into well-adjusted, independent, and successful adults. In order to offer support and time to a class in its entirety, pupil behaviour needs to be managed effectively. Boundaries and rules need to be set for children and a consistent approach applied by all staff. Documented policies and procedures enable all to have a clear understanding of expectations and common goals. There are, however, behavioural or discipline problems that need to be referred to others and all need to be aware of when the situation needs additional assistance and where to obtain this. All staff, from teaching to support staff and lunchtime supervisors, within my setting have sight of the behaviour policy and are expected to adhere to the principles and strategies contained within it. This ensures that all know what is expected f rom them and children can respond positively. I believe that children respond well to having clear, consistent, boundaries and guidelines. When met with unclear, or differing rules, they will attempt to test or push the boundaries as they do not have the security of knowing where they stand. This is likely to be most evident with older students. When all staff follow the correct procedures and fairly apply boundaries, the children know what is acceptable and what is not. If children are aware of the scale of rewards and sanctions and the order in which they are applied, it should not matter, who is speaking to them about their behaviour. As a volunteer within the school, I have the same status and authority as contracted teaching staff with regard to behaviour management. I am fortunate to have the full support of the class teacher and this reinforces my confidence in dealing with inappropriate behaviour. The children can see that there is a â€Å"team† approach to behaviour management and that they will be treated in the same manner, regardless of who is with them at the time. . The school works collaboratively with parents by supplying each with a copy of the school promises at the start of the academic year. These are signed by the teacher and the children. The aim of the school is to reward good behaviour in order to develop an ethos of kindness and co-operation. This is certainly  true within the class in which I volunteer; however, I am aware that some days can be a battle against poor behaviour and it is a challenge to find positive behaviour to praise, but absolutely essential. A child may become accustomed to only getting attention for bad behaviour, which may serve only to reinforce his actions; especially if it is the only attention that they receive. The guidelines for the area of school in which I volunteer indicate that a child sit in the â€Å"thinking chair,† when they have behaved inappropriately, followed by moving their name if the behaviour continues. Further occurrences would mean the class teacher speaking to the parents. I recently told a child not to swing his p.e bag from his neck and discussed with him the potential dangers of doing so. He continued to display the actions that I had asked him not to and so I used the thinking chair. Further occurrences would have involved moving Julie Gibson10/11/2013 his name and continuing with the set behaviour procedure. Before returning to join the rest of the class, we discussed why he had been on the chair and the potential injuries he could have sustained. In this instance the class teacher also spoke to his parents because of the dangerous nature of his actions and spoke to the whole class about the incident, to reinforce the dangers. The following week, I observed the child warn another, not to put their cord around their neck as â€Å"it could hurt.† I praised the child for his actions and explained how much I valued his support. I knew that this particular child liked to be praised in front of his peers and so at a convenient moment, I stopped the class and explained to them that I was awarding him a team point for sensible behaviour in class. The pride and boost to his self-esteem was clear to see. Applying the same rules and boundaries helps children feel equal, valued and respected. Fairly applied boundaries can also help children become more independent and co-operative. It is important for all pupils to be recognised and rewarded for positive behaviour. As previously stated, children who are more often given attention for poor behaviour, require positive behaviour to be recognised and rewarded when positive behaviour is displayed. When children attempt to gain attention through undesirable behaviour, it is often better to ignore it if possible and give attention to those behaving  well. Research and studies developed by B.F Skinner in the 1940’s, suggest that behaviour that gives them recognition or praise is more likely to be repeated. In order to maintain a balance, children need six positive responses for every negative. If possible, negative behaviour should be ignored and diversion techniques used, to prevent the undesirable behaviour. Boundaries help children feel safe and avoid confusion. By rewarding good behaviour, children experience a boost to their self-esteem, which, ideally creates a self-perpetuating response of good behaviour. Good behaviour creates a positive environment for learning and should maximise performance in the classroom. There is no value in consistently applying rewards and sanctions, if I do not role model the actions that I am actively promoting. Children will take their lead from me and if I am not behaving responsibly or appropriately, they will not take me seriously. I ensure that interactions that I may have with other adults, or children are respectful and give a clear indication of the correct way to behave. If I make a mistake, I ensure that I apologise and show my actions to rectify as I am aware that negative actions observed will have a resulting, negative influence upon the actions of the children within my class. When giving instructions and guidelines on required behaviour to the class, I use a positive tone and discuss the benefits with the class e.g â€Å"why is it better to walk in class.?† Children are likely to give responses regarding tripping and hurting themselves. By using this tactic, the children are setting boundaries collaboratively. When they do not act in the way agreed, they are breaking their own rules, not Julie Gibson10/11/2013  simply ones enforced by me. When they do behave appropriately, I can highlight this and give praise and recognition. These may be by way of stickers and team points or recommending for a superstar certificate, to be awarded at the end of the week. Whilst all staff should feel confident in dealing fairly and consistently with inappropriate behaviour, there will always be occasions when others need to be involved. If it becomes clear that a situation is getting out of hand and there is possible danger to the staff member, or pupil, assistance should be requested from another staff member. A pupil may begin to behave in an unpredictable way that makes the  staff member uncomfortable. Referral to the SENCO may be required if a child with additional needs has a behavioural problem requiring specialist assistance and additional strategies for use within the classroom. If staff have a problem with a particular child that is proving increasingly difficult to resolve, assistance from senior staff, or the head teacher can be sought. They can assist in referrals to the local authority behaviour unit and educational psychologists, who will make assessments and offer advice, help and support. Clearly when situations concerning behaviour reach a point where external agencies become involved, parents should be fully aware of difficulties and their cooperation sought to enable a combined approach from all sides. Consistency is key when dealing with behavioural issues. If all staff support each other to deal in a fair manner, applying rules and boundaries equally, children feel safe in the knowledge that rewards and sanctions with be the same, regardless of who is dealing with their behaviour. By actively promoting positive aspects of behaviour and role modelling requirements, children are more likely to repeat appropriate behaviour. When poor behaviour creates a situation where staff or pupils may be endangered, help from others should be sought. Behaviour can be managed when all collaborate to support children to work within boundaries and help them to feel confident in their surroundings. .

Memoir Research Paper Example | Topics and Well Written Essays - 750 words

Memoir - Research Paper Example Life did not exactly go as I planned it, but deep inside of me I believed that the perfect guy was out there for me. I looked after my daughter all by myself for a few more years. Times were tough, but I always had my daughter to look after. Her beautiful smile was like a sign telling me that I should not give up. Then back in 2011 I met a man who seemed to be perfect in more ways than one. He came from an upstanding family and held a well-paying job. Because of a tough time financially that I was in, I quickly fell for him because I saw him as a means to help me and my daughter live a better life. During the courting stage, which only lasted a few short months, I felt like a princess. My then-boyfriend would randomly turn up at my work with flowers and chocolates, and many of my workmates commented how lovely we were together. I tended to agree, but I did not see it coming when he proposed to me just a few short weeks later. Although I was naturally a cautious person, I felt a sense of joy that I had finally found someone who I could grow old with. My dream was live side-by-side with my husband until we were both very old. Unfortunately, things took a turn for the worse not long after we were married. The day of the wedding provided lots of sunshine, with many flowers marking the occasion in a way that I could only have dreamed of. I was a little nervous, as every young woman should be, but I could not say that I was totally in love at that time. It seemed like that was just the next step to take. My daughter was growing up, and I did not want to have to raise her alone. It was my utmost desire to have a loving partner to be with, not so much for myself but for the sake of my daughter too. For the first few months of my marriage not a lot seemed to change. My husband had received a promotion at work, so he was doing longer hours than before. Because my daughter had just started going to school, I had many more responsibilities on my plate. It would have been n ice to get some help from my new husband, but he did not seem to care about my situation. Whenever he would come home from work he always seemed to be in an agitated state. I knew that his work gave him a lot of stress, but this was no reason to take it out on me. I had never seen my husband get violent when we were still dating, so this was a new experience for me. The alarm bells should have been ringing for me back then, but I was still holding onto my dream of living happily ever after with my prince charming. After more than a year of marriage, I was beginning to see less and less of my husband. His job required him to travel frequently, so he was not around the house on a daily basis. Whenever he was home, he seemed to be a different person than the one I first married. I carried on for a few more months before I could take it no longer. In January of 2013, I asked my husband to move out as I wanted a divorce. Surprisingly he was not too upset with this request, and he complie d with it almost immediately. I wanted to move on from him as soon as possible, so we got a quick divorce through the help of an experienced lawyer. Although I am now a divorced woman, I still have hope that my true prince charming is out there for me. Times have been tough lately, but I always wish for a better future. Right now

Nursing case study Example | Topics and Well Written Essays - 750 words - 2

Nursing - Case Study Example I would ensure that I educate the patient on how to respond to certain occurrences. This would help the patient to overcome serious instances that lead to heart attacks such as shortness of breath. I would also consider assessing the nutrition that the family is providing to the patient. Here, I would ensure that the patient is taking the appropriate diet especially one that would strengthen their body so as to improve blood pumping capabilities. Therapeutic exercises are also important in these cases (Icahn School of Medicine at Mount Sinai, 2014). Therefore, as a professional, I would ensure that Mr. P undertakes exercises on a daily basis to further help in strengthening his body. These may help in eliminating the labored breaths that he experiences frequently. With regard to the despondence that Mr. P has developed, I would begin counseling sessions for him to change his perspectives on life, as this would be paramount to restoring his health. As for a treatment plan, I would recommend a disease management program. This is because currently, there is no known cure that can eliminate cardiomyopathy. However, it can be maintained and the symptoms can be suppressed to help the individual to lead a better life than how the situation would be if no treatment were offered. The disease management program would involve strategies that would help in relieving the existing complicating factors, stop the progression of the disease, and control the symptoms. When these aspects are addressed, the overall health for Mr. P would improve significantly. I would also recommend Mr. P to take specific medications to improve his situation. These include the medication that can reduce the exertion of his heart muscles, ease on the symptoms, and improve the ability for his heart to pump blood (The Johns Hopkins University, 2014). In as much as Mr. P would like to get out of the house, I would advise his wife to use caution with

IOM Essay Example | Topics and Well Written Essays - 2000 words

IOM - Essay Example her, this report will highlight some ways Redgate can attain best results by improving the culture of organization and methods of motivation of employees. Redgate Software has been selected for this analysis report because it is a highly advanced and state of the art technology company in the world it was founded in 1999 in England by Neil Davidson and Simon Galbraith. It is based (headquarters) in Cambridge, England and its motto is â€Å"ingeniously simple tools†. At the end of 2012, the number of employees of Red Gate Software was 290. Red Gate Software was named after Via Porta Rossa (Red Gate Street) situated in Florence (Italy). The name of this place was selected because Neil Davidson was used to live in that street. In 2010, Redgate Software acquired HyperBac from Quest Software. Simple Talk is a famous online technical journal of Redgate and it provides support to MS .NET and MS SQL Server developers. There are a lot of products of Redgate Software. The main objectives of this report are to shed light on the importance of motivation skills and culture of organization to get best results. Moreover, another objective of this report is to study the motivation style and culture of Redgate in detail. Then in the end of the report we would like to relate the theory with practice by combining the important of motivation skills and culture of an organization with the motivation skills and culture of Redgate. It is important to discuss the importance of motivation and culture for an organization before we discuss the problems related to motivation and culture in Redgate. In analysis part we will discuss motivation and culture in general and then we will discuss the motivation and culture related problems at Redgate. Motivation is a very important tool for a manager or supervisor. Motivation is necessary to get best results from employees. Motivation is a important to make sure the right way to address an issue is adopted. Motivation can be defined as a

Financial accounting Assignment Example | Topics and Well Written Essays - 1250 words

Financial accounting - Assignment Example This is regardless on the time when the cash is actually received. In a sale proceed, the revenue is recognized when the ownership of a good or a commodity has been transferred to the buyer together with the associated risks. The amount of the proceeds has to be reliably measurable in terms of revenue. Similarly, the costs associated with the transaction should also be measurable in a reliable way. Finally, there has to be a probability that the economic benefits related to the transaction will flow or will be realised by the organization. The same criteria apply for services rendered. In case of dividends, the revenue should be recognized once the right for payment has been established (IFRS, Pg. 2). In accounting, it is important to distinguish between the terms income, revenue and gains since it will facilitate accurate and clear preparation of the financial statement (Agtarap-San, Pg. 5). Income is defined as the savings opportunity that a business entity gains within a given tim e and it is measured in monetary terms (Weitzman, Pg. 2). Revenue on the other hand is the income that a business entity realises from its usual operations such as the sale of goods and services (ACCA, Para 5). Finally, gains refer to the increase in shareholder’s equity as a result of a transaction other than the daily operations. These are transactions which are non- recurring, for instance sale of a fixed asset (Weltman, Pg. 70). Case Study; Ibi Ryan Plc According To IAS 18, revenue should be recognized when earned. As such, the sale of Electrical goods on 30th March should be included in the revenue for the period ended 31st March 2013. This is because it was earned within the period despite the fact that the delivery was delayed to the following period. A total of ?50, 000 should be included in the financial statements. The revenue generated from the sale proceeds of good sold to Witney Ltd should not be included in the revenue of the period ended 31st March since Ibi Ry an retained ownership of the goods. According to IAS 18, revenue is only recognized when ownership has been transferred. In addition, the announcement that the creditor would receive 50p for every 1? owed did not guarantee future economic benefits since Whitney Ltd did not state it conclusively. It stated that it is â€Å"likely† meaning there was no guarantee and hence this should not also be recognized in the revenue of that period. The total amount of ?600, 000 owing to Ibi Ryan from Witney Ltd as at 31st March 2013 could not be recognized as revenue for the period due to the fact that ownership of goods worth that amount was not yet transferred. The cost price should also not be charged to the period’s revenue. When Ibi Ryan entered a contract with PC4U, it was certain that the amount of the contract will be realised by the company in the future upon delivery of the laptops. However, in the contract, it was agreed that Ibi Ryan would provide support services for a period up to December 31st, 2015. The support services were to cost ?240, 000 each year. It was certain that these costs were to b incurred. The costs were also reliably measured. The profits to be realised from the support services were to be 25% of ?240, 000 which is equal to ?60 000. Similarly, the company was certain to get this revenue though in the future. Therefore, the revenue that would be included in the period ended

The recent Supreme Court decision allowing large corporations to run Essay

The recent Supreme Court decision allowing large corporations to run their own political ads - Essay Example However, just before the crucial 2010 midterm congressional election period, this law was partly upended by the United States Supreme Court. In the case of Citizens United versus Federal Election Commission, the Supreme Court, by a 5-4 votes, ruled that corporations and unions were constitutionally allowed to spend as much money as they can on campaign ads supporting particular candidates (Francia 16). However, the corporations were still prohibited from donating money directly to campaigns. Ever since its ruling, the court’s decision to allow large corporations run their own ads has received mixed reactions among politicians, scholars, lawyers and the rest of the citizens. Whereas some people have been in favor of the ruling, others have strongly contested the decision, terming it a threat to democracy (Carney 2). Those against the ruling argue that the decision favors republicans, threatens democracy and allows for election interference by the corporations, as they can now r un their own ads in support of a specific candidate (Kosterlitz 5). However, this is just fear of unknown. For as much as the ruling might have negative implications on the federal elections, these arguments are not true and, as far as I am concerned, the decision will not have drastic effects on the politics of the United States of America, especially the elections. Therefore, to arrive at the conclusion that the ruling will not threaten the democracy of this nation but actually help it, this paper will make several observations. First, the argument that the court’s ruling greatly favors republicans is not true because, as opposed to the previous years, nowadays most large corporations hedge their bets and give donations to both parties. In fact, they give donations to whoever is in power, or possibly going to be (Carney 2). This explains why the Obama campaigns were able to do so well. All the funds used in the campaign did not only come from individuals, a huge portion cam e from large corporation, that is, their PACs. Therefore, the ruling will not favor republicans, but it will favor the most promising or prominent party. Secondly, the claim that large corporations will greatly dominate or interfere with the politics of the country is perplexing (Carney 2). For quite a long time even before the ruling, large corporations, such as New York Times, The Washington Post, USA Today and The Wall Street Journal, among others, have had the ability to further their political needs. Under the political action committees (PACs), they have been given the permission to support and donate to political parties or candidates. Moreover, most unions or corporate lobbyist PACs have been running ads about various issues or in support of various candidates. Therefore, it a fact that this ruling will not change the politics or the election of the country, but it will just eliminate the middleman, PACs (Carney 2). Finally, the ruling is good for small businesses because it could promote free market competition. Previously, before the court’s ruling, small businesses could not compete effectively with the large corporations because they had no PACs and lacked money to give to powerful lobbyists, who had PACs, to act on their behalf. Large corporations, such as Wal-Mart, had great influence on political issues of the country and, thus, received favors from the political divine, leaving the small firms to deteriorate further and go out of business. However, with the ruling, the small firms

The Role Of Technology In Education Essay Example | Topics and Well Written Essays - 750 words

The Role Of Technology In Education - Essay Example Nagel said, â€Å"Technology is woefully inadequate in most classrooms despite the progress schools have made in bringing computers and the Internet to students and staff, and these groups need still greater access if technology is to become a reliable tool for teaching and learning.† A lack of technology use by teachers to communicate instructional activities in the classroom is evident. Teachers fail to use technology due to inadequate training or staff development activities provided to teachers. Educators reported inadequate resources in the area of education technology support, including inadequate professional development or training. Education administrators reported that after teachers attended professional development activities and training for technology support or integration, only 61percent felt prepared to make effective use of educational technology for instruction.Despite the disparities in schools that use technology and those that do not, teachers remain chal lenged with the efforts of using various technologies in instruction, and using various assessment strategies using technology in the classroom. For whatever reasons, teachers use far less technology than is expected to result in minimal technology exposure for students in public schools, which causes a halt and a fall in students’ academic success. For the high percentage of minority students without access to the Internet or a computer except at school, this is a serious concern that requires immediate investigation. Teachers are doing a grave disservice to these students. The relations among and between students and teachers is devalued without the use of technology intertwined with the curriculum. School communities are suffocating in our society due to the lack of technological support required to assist with students’ academic success. Recommendations As the world continues to embrace the ever-changing technological aspects of society, the methods used to teach students must also change.

Cockpit display visual Research Paper Example | Topics and Well Written Essays - 1000 words

Cockpit display visual - Research Paper Example The cockpit will inform them the positions to be in order to avoid any encounter (Weber, 2011). However, proper information has to be fed to the pilots for them to make accurate decisions. Cockpit visual display systems rely solely on highly reliable and accurate mathematical algorithms that correctly tell the cockpit the right air path that the pilot should maintain in order to avoid collisions. Despite the many lives that the cockpit has already and is still saving, the problem lies with the vision of the pilots. Does the lighting system of the cockpit affect the eyes of the pilots? The human visual sense has so many limitations that make it had to adapt to the complex environment in the air. The three dimensional movements and high speeds present in the air are too demanding for the human eye. Furthermore, the human vision is prone to illusions especially at night or when there is poor lighting. Since the human eyes cannot be relied upon to safely navigate through the air, the best substitute is automatically the cockpit. However, the cockpit system should not be a hazard to the pilots because as the eyes’ performance keeps waning, the higher the risks of accidents occurring (Aviationknowledge, 2012). The human eye has two color receptors: Rods and Cones. The cones are found at the center of the Retina while the rods are found at the periphery of the retina. Cones are responsible for photopic vision used when there is light while Rods are responsible for Scotopic vision used in darkness or when there is poor illumination. During the post World War II era, all aircrafts utilized the red light for the cockpit lighting since it did not degrade adaption of the eye to darkness (American Optometric Association, 2011). Nowadays, cockpits are made up of white light that is poor at preserving visual sensitivity for viewing. White light cockpits are being used today because they do not distort the true color of objects. Furthermore, red lighting

Outline and evaluate behavioural therapies to treat mental disorders Essay Example for Free

Outline and evaluate behavioural therapies to treat mental disorders Essay Because of the nature of the behavioural model which measure specific behaviours in precise terms such as how many times a negative behaviour is performed, improvements can be accurately measured. Which in turn means therapies effectiveness can also be measured. The classical conditioning therapies have been proved to be effective by Wolpe who found an 80-90% success rate with these therapies. Barlow and Lehmen also found a success rate of 77% following treatment. However medication can interfere with systematic desensitization because medication suppresses anxiety. Operant conditioning is also based on scientific principals proven to be effective by Azrin who examined female patients in a mental hospital who were incapable of doing everyday tasks. Using token economies, positive behaviour in these women increased. However studies looking at children and students by Lepper and Deci also found that rewarding intrinsic interests actually reduces behaviour. A strength of the classical conditioning therapies is that the patients have a high level of control. In token economies however patients have very little control over their therapies. This raises ethical issues as informed consent is not achieved for token economies, instead they are enforced with or without the patients consent. Token economies are also open to abuse and can be deemed as a form of social control. Classical conditioning therapies also raise ethical issues in terms of putting their patients at risk of emotional harm. Other problems with classical conditioning therapies include the fact that some patients may not have a vivid enough imagination for flooding, and social desensitization may be difficult to arrange and control, whereas token economies are practical as they can be done anywhere. A problem with token economies though, is that changes are due to external rewards and not an innate desire to change and so if the rewards are removed the positive behaviour may cease. Finally debate will also continue whether the treatments provided by the behavioural model only treat the symptoms and not the causes, and if only the symptoms are treated, does it matter?

Rheumatoid Arthritis Treatment Methods

Rheumatoid Arthritis Treatment Methods INTRODUCTION Autoimmunity is the inability of an organism in recognizing its own parts as  self, which triggers an abnormal immune response against its own cells or tissues. Due to such a response, autoimmune diseases occur. Autoimmune diseases are broadly divided into the following: Systemic autoimmune diseases: The symptoms and damage occurs throughout the body, i.e the antigen is not tissue-specific. Localized autoimmune diseases: The damage is localized, i.e., the antigen is tissue specific. Rheumatoid arthritis (RA) is a chronic  inflammatory, systemic autoimmune disorderthat may affect many tissues and organs, but mainly attacks the flexible (synovial) joints. 75% of the reported cases of RA occur in women, especially at age: 30 and 40 years and between 50 and 60 years (Bach, 1982). It can be a disabling and  painful  condition, which can lead to consequential loss of mobility and function if not treated adequately. But it is still unclear whether T-cells primarily respond to a microbial antigen, or a self-constituent antigen (Chiniet al., 2002). Lesions developed in RA appear to be involved in both cell-mediated and humoral responses. Prior research work focused on identifying the cells present in the affected synovium, and has been concluded that CD4+ T lymphocytes, active B lymphocytes, and plasma cells, combined with well-formed lymphoid follicles having germinal centers (in more serious cases), are present in the synovium of the patients (Abbas et al., 1994). Major cells present in the synovial filtrate of patients are T-cells, and a partial therapeutic effect was observed due to depletion of T-cells in these patients (Berneret al., 2000). Present understanding of RA conveys that TH1 cells which are specific for a particular antigen (which hasn’t been identified yet) are present in the joints of the patients. Pathogenesis and symptoms Fig1.1: Release of cytokines due to T-cell activation causing an inflamed synovium and pannus. Cytokines released in the synovium are Interleukin(IL)-1, IL-8, Interferon-gamma (INF-gamma), and Tumour Necrosis Factor-alpha(TNF-alpha). But the clinically important ones are IL-1 and TNF-alpha. These cytokines stimulate increase in collaginases, IL-6, chemokines, nitric oxide and Cyclo-oxigenase-2(COX-2) production. The combined action of these and a few others like IL-2 and IL-4 lead to the pathogenesis of the disease. Other than antigens, RA also involves antibodies- this is most likely due to formation of immune complexes. The auto-antibodies produced are called ‘rheumatoid factors’ and are specific to the Fc region of IgG. This rheumatoid factor is an IgM antibody and hence the immune complex consists of IgG-IgM which cause the damage (Janeway et al., 2001). Symptoms include stiffness, pain, swelling, and erythema, joints become tender, swollen, and warm. As it progresses, multiple joints would be affected (polyarthritis). The clinical manifestations are collection of polymorphonuclear leukocytes and macrophages at the inflamed region, cartilage damage, and, destruction of the joint Synovitis (inflammation of the synovium) can lead to  tethering  of tissue, lack of movement and erosion of the surface leading to deformity and loss of function. Systemic complexities are damage to various other organs like lungs, myocardia, pericardia pleura, eyes, and Central Nervous System as a result of inflammatory reactions (fig-1.1). Many agents are now available to treat RA, and many of them are monoclonal antibodies. Several new monoclonal antibodies are currently under development and hopefully will be available as other alternatives The focus of this paper is to state the latest therapeutic monoclonal antibodies being used for RA treatment, to state their merits and demerits and whether they are better than normal drugs/medication. Monoclonal antibodies with different mechanisms of action and route of administration are discussed and whether they pose as good therapeutic agents with an acceptable safety profile. 2. REVIEW OF LITERATURE 2.1  Treatment of Rhematoid Arthritis Some of the treatments for RA are: Anti-TNF-alphaTreatments Medications Therapeutic monoclonal antibody treatment Earlier it was believed that if one cytokine signal cascade was blocked then another cytokine would takeover. It was hypothesized that IL-1 caused the cartilage and bone damage.Through a study(at Kennedy Institute of Rheumatology), it was found that IL-1 bioactivity had stopped due to TNF-alpha blocking. This led to the development of anti-TNF-alpha treatments like- cyotokine antibodies and soluble-receptor antagonists (Feldmann et al., 1999). There are mainly four types of medications being used- Disease-modifying anti-rheumatic drugs (DMARDs), Non-steroidal anti-inflammatory drugs (NSAIDs), immuno-suppressants, and corticosteroids (glucocorticoids).(Rang et al.,1995). DMARDs include pencillamines (Cuprimine ®, Depen ®), gold compounds (Myochrysine ®, Ridaura ®) and chloroquine (Plaquenil ®). Although their mechanism of action is not properly understood, they have a very significant effect on RA patients. NSAIDs like asprin, ibuprofen (Advil  ®), ketoprofen (Orudis ®), naproxen (Naprosyn ®), etc.. have a variety of effects like anti-inflammatory, anti-pyretic, and analgesic effects.Immuno-suppressants like cyclosporine and cytotoxic agents like azathioprine suppress both humoral and cell-mediated immunity. Corticosteroids like prednisone, hydrocortisone, etc., have immunosuppressive and anti-inflammatory effects (Rang et al.,1995). 2.1.1 Therapeutic monoclonal antibodies: Each B-cell synthesizes only one kind of antibody and every organism has various populations of B-cells which secrete various antibodies specific to various antigens being recognized. But in order to turn this function into a helpful tool, we need huge amounts of a same antibody. So we need to culture a B-cell population originating from the same ancestral B-cell and hence obtaining the same kind of antibodies.Such a population of cells are called ‘monoclonal’ and the antibodies are‘monoclonal antibodies’(mAbs).Such monoclonal antibodies used for various therapeutic purposes are referred to as ‘therapeutic monoclonal antibodies’. If a specific antibody of a B-lymphocyte is needed, that B-cell should be secreted in an organism. So the antigen for which the antibody is needed is injected into a mouse and it secretes the B-cell antibodies against the antigen. Such B-cells are isolated from the spleen and fused with myeloma cells (using Poly Ethylene glycol, or electroporation), forming hybridomas. To selectively isolate the hybridoma cells, they are grown in HAT(Hypoxanthine AminopterinThyamidine) medium. (Fig 2.1.1) The cancer cells are HGPRT- and the B-cells are HGPRT+(HGPRT is an enzyme Hypoxanthine-guanine phosphoribosyltransferase which helps in the synthesis of nucleotides from hypoxanthine). Therefore, all the unfused myeloma cells die in the HAT medium and all the unfused B-cells can’t divide for long and only the hybridoma cells survive indefinitely. It is from these cells that the antigen-specific antibodies are labelled and isolated using radioactivity or immunofluorescence. Fig 2.1.1- A summary of the process of monoclonal antibody production. Types Till date there are four types of therapeutic mAbs- Murine Chimeric Humanized Human Murine antibodies (suffix omab)refer tomAbs made from any mammal of the family muridae (like mouse, rat). These mAbs were produced using hybridoma technology and were analogous to murine antibodies. But these were not a success because immune complexes formed due to which they only had a short half-life in vivo and caused cytotoxicity resulting in allergies and anaphylactic shocks .Hence these were replaced by chimeric and humanizedmAbs.Chimeric mAbs (suffix ximab) has variable regions of murine and constant region of humans fused together (they are 65% human). This decreases immunogenicity. Humanized antibodies (suffix –zumab) are made by grafting murine hyper-variable region onto the amino acid region of the human Abs (they are 85% human). However, these antibodies lacked the specificity of their parent murine mAbsso, affinity was increased by introducing mutations in the CDR (complementarity determining region). Phage display libraries or transgenic mice are use to produce human mAbs (suffix –umab). In this the murine genome is injected with the human immunoglobulin genes due to which it becomes transgenic. This mouse is injected with the desired antigen to yield the subsequent mAbs(Hudson PJ, Souriau C., 2003). 2.1.1.1 Monoclonal Antibodies Directed Against TNF-ÃŽ ± TNF-ÃŽ ± is a key mediator of the inflammation-induced joint damage that is a hallmark of this disease. Monoclonal antibodies to TNF bind soluble and transmembrane TNF, thereby down-regulating TNF-induced immune responses including adhesion molecule expression, cytokine production, matrix metalloproteinase production, neutrophil activities, dendritic cell function and osteoclast differentiaion. (Blumi S, Jet al.,2012) Monoclonal antibodies to TNF, except for certolizumab have the ability to lyse TNF-expressing cells in the presence of complement. (Kukar M, et al.,2009). Currently there are four mAbs approved for the treatment of RA Infliximab This is a chimeric IgG1 mAb and has human constant region with murine variable regions.(Perdriger A., 2009). This is best used with methotextrate(MTX) and is available only in the intravenus form. In 2001, it was approved by the FDA in combination with MTX to treat moderate to severe RA. Effectiveness and improvement in the disease compared to placebo was shown in multiple, randomized trials(Elliott MJ, et al., 1993) ,( Lipsky PE, et al., 2000), (MainiRN, et al., 2004). It was proven to be effective in early stages of the disease (et al., 2004).Given that influximab is comprised of a significant proportion of murine protein it was anticipated that patients would develop antichimeric antibodies that could impair the efficacy and increase the risk of infusion reactions. The combination of infliximab and MTX results in a substantial reduction in antichimeric antibody and increased serum infliximab levels.. Adalimumab Adalimumab is a human recombinant IgG1 mAb that has no murine component and is produced by phage display technology. It was FDA/EMA approved in, or soon after, 2002 for the treatment of moderate-to-severe RA as monotherapy or in combination with disease-modifying antirheumatic drugs (DMARDs). It is available in the subcutaneous form at a dose of 40 mg every 2 weeks. Despite adalimumab being a fully human antibody, anti-adalimumab antibodies have been detected in a significant number of patients(Vincent FB, Morland EF, Murphy Ket al.2013). Adalimumab responses and long-term sustainability may be reduced by anti-adalimumab antibodies, but adalimumab generally has good sustainability similar to that of etanercept and generally better than infliximab. Golimumab Golimumab is a fully human IgG1 anti-TNF-ÃŽ ± antibody that was generated and affinity matured in an in vivo system. It is very similar in structure to infliximab without the mouse protein. It was approved by the FDA/EMA in or soon after 2009 for the treatment of moderate-to-severe RA in combination with MTX(Kremer J, et al,2010). Certolizumab Certolizumabpegol is a humanized Fab fragment (Fc free) fused to a 40-kd polyethylene glycol (PEG) moiety. It was FDA/EMA approved in 2009 for the treatment of moderate-to-severe RA as monotherapy or in combination with MTX. It is available in the subcutaneous form at a dose of 400 mg at 0, 2 and 4 weeks, then every 2 weeks or 400 mg every 4 weeks. 2.1.1.2 Antibodies against B Cells B cells are critical to the pathogenesis of RA. Mature B cells may evolve into antibody producing plasma cells. Although the precise role of B-cell-producing autoantibodies in RA remains unclear, B cell and plasma cell infiltration into synovium has consistently been found.In addition to their role as precursors to antibody producing plasma cells, B cells may function as antigen-presenting cells and may also produce inflammatory cytokines and co-stimulatory molecules important for T-cell function.(TngYKO,et al., 2007). Rituximab As rituximab is a B-cell-depleting agent, chimeric/IgG1 monoclonal antibody which binds to the CD20 cell surface marker found on several maturation stages of B lymphocytes. It gained FDA/EMA approval in 2006 for the treatment of moderate-to-severe RA in combination with MTX in patients with inadequate response to anti-TNF. Rituximab is given via the intravenous route at a dose of 1000 mg for two doses 2 weeks apart for each cycle. The first study evaluated rituximab in RA was reported by Edwardset al., 2004.Four treatment groups consisting of MTX monotherapy, rituximab monotherapy, rituximab plus cyclophosphamide and rituximab plus MTX were compared, and all rituximab groups had a better ACR20 response compared with MTX monotherapy, with a comparable safety profile. 2.1.1.3 Antibodies That Interfere With IL-6 Function IL-6 is a cytokine produced by immunologically important cells that has an important role in T-cell activation and immunoglobulin secretion.It also stimulates synovial fibroblast differentiation and osteoclast activation.Dysregulation of IL-6 is also, in part, responsible for many of the generalized systemic effects of RA, including anemia of chronic disease as well as the acute phase reactants seen in this disease(Tanaka.Tet al. , 2010). Tocilizumab Previously called MRA, tocilizumab is a humanized/IgG1 mAb directed against IL-6 receptor in its soluble and transmembrane form. It was approved by the FDA/EMA in early 2010, or slightly before, for the treatment of moderate-to-severe RA in patients with an inadequate response to DMARDs and/or anti-TNF. A subcutaneous form of tocilizumab is currently under study. It is also indicated in patients with anemia of chronic disease since it dramatically increases hemoglobin as a consequence of reduction in hepcidin – the protein that inhibits iron utilization in RA. 2.1.1.4 Antibodies That Interfere With IL-1 Function IL-1 is produced by many cell types in response to myriad inflammatory stimuli and mediates multiple immunologic and inflammatory pathways. In patients with RA, the levels of naturally produced IL-1 receptor antagonist in the synovium is thought to be insufficient to counteract the increased levels of IL-1 produced in this disease (Arend WP., 2002) Anakinra Anakinra is the recombinant form of a human receptor antagonist (IL-1ra), and was approved by the FDA/EMA in, or slightly after, 2002 at a daily dose of 100 mg subcutaneously for moderate-to-severe RA that has been unresponsive to initial disease DMARD therapy. It has been studied in RA in several trials. (Fleischmann RM.et al,  2003) 2.1.1.5 Safety Infections Infections are the most common adverse event associated with the use of all biologics. Infection risks with anakinra and tocilizumab are probably similar to the TNF inhibitors, with rituximab perhaps having slightly less risk.Infection risk may be higher with the use of increased doses of infliximab and anakinra.Respiratory tract infections are most commonly reported. The risk of granulomatous infections, such as tuberculosis, is also increased in patients using monoclonal antibody TNF inhibitors. Malignancies The use of TNF inhibitors in patients with RA has not been associated with an increased risk of solid cancers, with the exception of cutaneous malignancies.. Malignancies have been reported with anakinra, tocilizumab and rituximab, but the risk does not seem higher than predicted in RA patients.(Ding T et al., 2010)Longer-term follow-up is required to more clearly understand the risk of malignancies with these drugs. Demyelinating diseases Symptoms of demyelinating neurologic dysfunction have been associated with TNF inhibitors. Resolution of these symptoms with drug withdrawal is common. TNF inhibitors should be withdrawn immediately if neurologic symptoms occur with use, and probably should be avoided in patients with pre-existing demylelinating symptoms(Ding T, Ledinghamet al., 2010).   3. DISCUSSION AND CONCLUSION 3.1 Drugs vs mAbs Just as monoclonal antibodies have various side effects the medication used for RA also have various complications There have been many news reports about how pain-killing drugs known as COX-2 blockers increase heart attack and stroke risks. Additional studies suggested that older non- steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen could also elevate heart risks.One of the culprits: methotrexate. It’s the most commonly prescribed disease-modifying anti-rheumatic drug, orDMARD, for rheumatoid arthritis. It’s also responsible for hair loss in about 1 to 3 percent of people. The hair loss happens because methotrexate is doing what it’s supposed to do – stop cells from growing, including cells causing inflammation and, unfortunately, hair follicles. Folic acid, which is commonly prescribed with methotrexate to mitigate some of its side effects, is a synthetic form of folate, a B-complex vitamin. It can help keep hair healthy, but it has not been fou nd to promote hair growth.Generally as a drug-related side effect, the hair loss is not drastic and the hair does not fall out in patches. And it usually grows back once the patients stop taking the drug.So as of now, most of thesuccesful treatments for RA using monoclonal antibodies are in combination with methotrexate. 3.2 Conclusion and future prospects Monoclonal antibodies with different mechanisms of action and route of administration are highly effective therapeutic agents in the treatment of RA with an acceptable safety profile. Choosing the appropriate treatment is a complex decision that is affected by clinical data, physician and patient preference, and payers. Almost undoubtedly, these types of agents will continue to be important agents in the rheumatologists armamentarium. How to use these agents more selectively, particularly regarding which agents are best for which patients, hopefully will be better established in the future with new biomarkers. Prediction as to what agent to use in the right patient at the right time is clearly a research priority. Monoclonal antibodies as new agents are expensive, and the cost/benefit analysis justifying their use is also critical to practitioners. . Many aspects regarding the efficacy and safety of the supposedly cheaper biologics need to be evaluated before they are available for w idespread use, but their availability and the emergence of new agents in the future may substantially change the RA treatment landscape. Although current therapies can reduce the signs and symptoms of RA for many patients, the quest for a cure (or a more complete blockade of the structural damage) in RA is still ongoing and will need treatment approaches, which are not exclusively confined to blocking a particular cytokine, receptor, or auto-reactive B or T cell involved in disease progression. To this end exciting treatment alternatives and drug targets are on the horizon that may become available to patients in the future.

Education In The Media A Look At October Sky :: essays research papers

"How about I believe in the unlucky ones? If I don't I'd probably go crazy."(Laura Dern, October Sky) This could arguably be the most important line in the entire movie, in my opinion. This teacher recognizes the potential in every student, not only the ones with visible ability. This, I would hope, would be the goal of every teacher. Teachers have the greatest gift in the world - - the ability to help shape a student's life. Recognized and appreciated he or she can use that to present a world of opportunities to those who may not have had any. This was true in "October Sky"; the "Rocket Boys" were from a small failing mining community, where little expectations were placed on them and even less opportunities were available. When Dern's character was accused of giving the boys false hopes she held her grounds and continued to support the boys. This to me is an example of a great teacher, one who will continue to do what he or she thinks is right regardless of whether it earns her the disapproval of the rest of the staff. The movie "October Sky" gives a very positive representation of a teacher. She is a role model, a friend, a source of information, a defender, and a fighter. She is portrayed as compassionate, understanding, and very beneficial in keeping the students directed toward their goals. This would seem to say that teachers need these qualities in order to fully relate to their students. A teacher can not only be there for informational needs, but must also stand behind her students and be prepared to defend their rights to discover themselves. Education In The Media A Look At October Sky :: essays research papers "How about I believe in the unlucky ones? If I don't I'd probably go crazy."(Laura Dern, October Sky) This could arguably be the most important line in the entire movie, in my opinion. This teacher recognizes the potential in every student, not only the ones with visible ability. This, I would hope, would be the goal of every teacher. Teachers have the greatest gift in the world - - the ability to help shape a student's life. Recognized and appreciated he or she can use that to present a world of opportunities to those who may not have had any. This was true in "October Sky"; the "Rocket Boys" were from a small failing mining community, where little expectations were placed on them and even less opportunities were available. When Dern's character was accused of giving the boys false hopes she held her grounds and continued to support the boys. This to me is an example of a great teacher, one who will continue to do what he or she thinks is right regardless of whether it earns her the disapproval of the rest of the staff. The movie "October Sky" gives a very positive representation of a teacher. She is a role model, a friend, a source of information, a defender, and a fighter. She is portrayed as compassionate, understanding, and very beneficial in keeping the students directed toward their goals. This would seem to say that teachers need these qualities in order to fully relate to their students. A teacher can not only be there for informational needs, but must also stand behind her students and be prepared to defend their rights to discover themselves.

Common People in John Steinbeck’s The Grapes of Wrath and Of Mice and Men :: comparison compare contrast essays

Common People in John Steinbeck’s The Grapes of Wrath and Of Mice and Men John Steinbeck’s novels The Grapes of Wrath and Of Mice and Men reveal and confront the struggles of common individuals in their day-to-day lives. The Grapes of Wrath creates a greater verisimilitude than Of Mice and Men as it illustrates the lives of Oklahoma farmers driven west during the Dustbowl of the late 1930’s. Of Mice and Men deals with a more personal account of two poor men and the tragic ending of their relationship. Steinbeck expresses his concern for multiple social issues in both The Grapes of Wrath and Of Mice and Men. Tightly-knit relationships appear prominently in both books and provide the majority of the conflicts that occur. The decency of common people is written about to a great extent in The Grapes of Wrath and is also prevalent through numerous examples in Of Mice and Men. As in all effective writing that bares the soul of the author, each novel reveals Steinbeck’s core beliefs. In Of Mice and Men, Steinbeck uses the relationship between George and Lenny to express the decency of common people. Lenny is mentally disabled and George is his companion because Lenny is too incompetent to live on his own. Throughout the book, it becomes increasingly apparent that Lenny is incapable of interacting appropriately with people (other than George) without unknowingly causing some sort of trouble. Even George is sometimes overcome with the hassles of taking care of Lenny. ‘â€Å"God, you’re a lot of trouble,’ George said. ‘I could get along so easy so nice if I didn’t have you on my tail. I could live so easy and maybe have a girl†Ã¢â‚¬â„¢ (7). Yet, George looks beyond the ways in which Lenny irritates and inconveniences him and realizes that Lenny is as human as he is. He believes that regardless of Lenny’s disability, he should be treated as respectfully as anyone else. Contrary to his earlier remarks, George has great affinity for Lenny. George understands that Lenny necessitates a watchful-eye, and he is willing to be that caretaker. Ultimately, if George did not love and care about Lenny, he would have most likely abandoned him. However, George’s fundamental decency did not allow him to do this. In The Grapes of Wrath, the overall struggle of the Okies, while on their mass exodus to California, is Steinbeck’s platform to examine human beings’ innate goodwill.

Management :: essays research papers

Level of planning paper In 2000, the Primeco Wireless submerged, and emerged as Verizon Wireless; the need for speed was gaining momentum. Verizon Wireless Online DSL, digital subscriber’s line, is the number one telecommunication industry appearing in the FORTUNE Magazine; it has listed as the most Admired Company. Hay Group Fortune Magazine. The founder of Verizon Company is Darby Checketts; he was a man with a vision. This fast speed company under the CEO, Chairman, leadership of Ivan Seidenberg, has grown into an internet king. There are over 208,000 employees at the Verizon Online DSL Wireless Company, with an upward of $13 billion dollars a year in technology, it has 2.7 million shareowners and services billions of customers in communities all over America and the World. At least a 100 million people are connected by Verizon network everyday, whether at home, at work or on the go. Women Warriors has discovered in their research the highlights, accomplishments, and opportunities of Verizon to improve their customers lives in six areas that make up Verizon approach to corporate responsibility:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ethic and Governance   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Service and Innovation   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Empowering Employees   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Promoting Community’s Growth   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Protecting the Environment   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Partnering with Communities Strengths & Weaknesses Strengths and weaknesses are essentially internal to the organization and relate to matters concerning resources, programs, and organization in key areas. Strengths & Weaknesses are internal to the business and Opportunities & Threats are external. Verizon Communications Inc is one of the world's leading providers of communications services. With a diverse work force of more than 208,000, Verizon has four business units. Domestic Telecom serves customers based in 29 states with wireline telecommunications services, including broadband, nationwide long-distance and other services. Verizon Wireless owns and operates the nation's most reliable wireless network, serving 42.1 million voice and data customers across the United States. Information Services operates directory-publishing businesses and provides electronic commerce services. International includes wire line and wireless operations and investments, primarily in the Americas and Europe. Strategic Planning Process Strategy is define as the continuous, iterative planning process, which focuses on Keeping an organization competitive in its environment (Miller & Dess, 1997). Strategic planning is complex, laborious, and time consuming. Accordingly, an organization must allocate resources and time to the strategic planning process. ( Strengths Verizon strengths are its resources and capabilities that can be use as a basis for a competitive advantage. Verizon business strategy is to archive a sustainable competitive advantage such as. Cost advantage Differentiation advantage Verizon is able to deliver the same benefits as the other communication companies, but a lower cost, (cost advantage) or deliver benefits that exceed the competing products (differentiation advantage). Management :: essays research papers Level of planning paper In 2000, the Primeco Wireless submerged, and emerged as Verizon Wireless; the need for speed was gaining momentum. Verizon Wireless Online DSL, digital subscriber’s line, is the number one telecommunication industry appearing in the FORTUNE Magazine; it has listed as the most Admired Company. Hay Group Fortune Magazine. The founder of Verizon Company is Darby Checketts; he was a man with a vision. This fast speed company under the CEO, Chairman, leadership of Ivan Seidenberg, has grown into an internet king. There are over 208,000 employees at the Verizon Online DSL Wireless Company, with an upward of $13 billion dollars a year in technology, it has 2.7 million shareowners and services billions of customers in communities all over America and the World. At least a 100 million people are connected by Verizon network everyday, whether at home, at work or on the go. Women Warriors has discovered in their research the highlights, accomplishments, and opportunities of Verizon to improve their customers lives in six areas that make up Verizon approach to corporate responsibility:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ethic and Governance   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Service and Innovation   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Empowering Employees   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Promoting Community’s Growth   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Protecting the Environment   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Partnering with Communities Strengths & Weaknesses Strengths and weaknesses are essentially internal to the organization and relate to matters concerning resources, programs, and organization in key areas. Strengths & Weaknesses are internal to the business and Opportunities & Threats are external. Verizon Communications Inc is one of the world's leading providers of communications services. With a diverse work force of more than 208,000, Verizon has four business units. Domestic Telecom serves customers based in 29 states with wireline telecommunications services, including broadband, nationwide long-distance and other services. Verizon Wireless owns and operates the nation's most reliable wireless network, serving 42.1 million voice and data customers across the United States. Information Services operates directory-publishing businesses and provides electronic commerce services. International includes wire line and wireless operations and investments, primarily in the Americas and Europe. Strategic Planning Process Strategy is define as the continuous, iterative planning process, which focuses on Keeping an organization competitive in its environment (Miller & Dess, 1997). Strategic planning is complex, laborious, and time consuming. Accordingly, an organization must allocate resources and time to the strategic planning process. ( Strengths Verizon strengths are its resources and capabilities that can be use as a basis for a competitive advantage. Verizon business strategy is to archive a sustainable competitive advantage such as. Cost advantage Differentiation advantage Verizon is able to deliver the same benefits as the other communication companies, but a lower cost, (cost advantage) or deliver benefits that exceed the competing products (differentiation advantage).

The Pentium Flaw

Back in June, 1994 the Pentium Flaw was noticed by Intel testers, who had discovered a division error on the Pentium chip. Intel managers didn’t see this as a major problem so they kept this from anyone outside their corporation. The nature of this issue was a mathematical problem in their Floating Point Unit (FPU), or the math coprocessor. The Pentium chip was having glitches in calculating large divisions. It wasn’t until October 19th, when Dr. Thomas R.  Nicely had revealed the malfunction of the (FPU) trying to do certain calculations. Dr. Nicely was a mathematics teacher at Lynchburg College in Virginia.After running several test on the 486 and Pentium he had pin pointed the error to the Pentium chip. Dr. Nicely contacted Intel and they had confirmed the error, but said they had no reports till then. Intel handled the situation very poorly; they would not return contact to Dr. Nicely, forcing him to write a letter on the internet about the flaw.Even then Intel co ntinued to consider the problem as minor. The internet was getting loads of articles on the flaw and people were making a joke out of Intel. By not letting the industry know about the Pentium glitch, Intel showed their selves to be untrustworthy to the costumer. There are so many different ways Intel could have handled their mistake. They chose to rather send a measly email of apology from the President of Intel with the wrong address. This infuriated costumers saying it was a fake.In the Pentium problem (Janeba, 1995) wrote: Intel's policy, when it first publicly admitted the problem around November 28 of 1994, was to replace Pentium chips only for those who could explain their need of high accuracy in complex calculations. Intel tried to fix the problem still as a minor error and kept delaying the proper fix. By Intel postponing the fix on the (FPU) cost them even more money than what it would have, if they’d answer back right away with an honorable fix. This goes to show y ou learn from your mistakes.Eventually in late December Intel declared they would replace all flawed chips upon request. Now Intel has employees who keep up on newsgroups on the internet to see what people are saying about Intel; and they now conduct a better follow up with unsatisfied costumers. I believe Intel did handle this publicity very incorrectly. For being a well-known corporation they didn’t act like it. When they first got word of Dr. Nicely and his discovery on the flaw, Intel should’ve immediately contacted the professor with any apology and offered to replace the bad one.If this procedure would have been done the professor would have been happy, and never have written what he did. Then customers possibly wouldn’t have known of the flaw. In my opinion of the question, what would happen today if this same problem occurred? I don’t think Intel would take the same route they did back then. Intel is a well-established corporation and I believe th ey would act faithfully with great hast, to solve the problem. I think they have a greater appreciation of their customers now, since this whole Pentium Flaw hit the fan. The Pentium Flaw Back in June, 1994 the Pentium Flaw was noticed by Intel testers, who had discovered a division error on the Pentium chip. Intel managers didn’t see this as a major problem so they kept this from anyone outside their corporation. The nature of this issue was a mathematical problem in their Floating Point Unit (FPU), or the math coprocessor. The Pentium chip was having glitches in calculating large divisions. It wasn’t until October 19th, when Dr. Thomas R.Nicely had revealed the malfunction of the (FPU) trying to do certain calculations. Dr. Nicely was a mathematics teacher at Lynchburg College in Virginia. After running several test on the 486 and Pentium he had pin pointed the error to the Pentium chip. Dr. Nicely contacted Intel and they had confirmed the error, but said they had no reports till then. Intel handled the situation very poorly; they would not return contact to Dr. Nicely, forcing him to write a letter on the internet about the flaw.Even then Intel conti nued to consider the problem as minor. The internet was getting loads of articles on the flaw and people were making a joke out of Intel. By not letting the industry know about the Pentium glitch, Intel showed their selves to be untrustworthy to the costumer. There are so many different ways Intel could have handled their mistake. They chose to rather send a measly email of apology from the President of Intel with the wrong address. This infuriated costumers saying it was a fake.In the Pentium problem (Janeba, 1995) wrote: Intel's policy, when it first publicly admitted the problem around November 28 of 1994, was to replace Pentium chips only for those who could explain their need of high accuracy in complex calculations. Intel tried to fix the problem still as a minor error and kept delaying the proper fix. By Intel postponing the fix on the (FPU) cost them even more money than what it would have, if they’d answer back right away with an honorable fix. This goes to show you learn from your mistakes.Eventually in late December Intel declared they would replace all flawed chips upon request. Now Intel has employees who keep up on newsgroups on the internet to see what people are saying about Intel; and they now conduct a better follow up with unsatisfied costumers. I believe Intel did handle this publicity very incorrectly. For being a well-known corporation they didn’t act like it. When they first got word of Dr. Nicely and his discovery on the flaw, Intel should’ve immediately contacted the professor with any apology and offered to replace the bad one.If this procedure would have been done the professor would have been happy, and never have written what he did. Then customers possibly wouldn’t have known of the flaw. In my opinion of the question, what would happen today if this same problem occurred? I don’t think Intel would take the same route they did back then. Intel is a well-established corporation and I believe they would act faithfully with great hast, to solve the problem. I think they have a greater appreciation of their customers now, since this whole Pentium Flaw hit the fan.

Creating Customer Value: General Concept Questions

Chapter 5: Creating Customer Value, Satisfaction, and Loyalty GENERAL CONCEPT QUESTIONS Multiple Choice 1. ________ are adept at building customer relationships, not just products; they are skilled in market engineering, not just product engineering. a. Profit-centered companies b. Customer-centered companies c. Production-centered companies d. Sales-centered companies e. Promotion-centered companies Answer: bPage: 119Difficulty: EasyAACSB: Reflective Thinking 2. The opening vignette on Ritz-Carlton shows that successful marketers are the ones that fully ________. a. understand promotional strategy b. diversify their product line . divorce themselves from a production mentality d. satisfy their customers profitably e. understand the sales concept Answer: dPage: 120Difficulty: Medium AACSB: Reflective Thinking 3. In the modern customer-oriented organizational chart, which of the following is considered to be at the top of the organizational pyramid? a. Sales b. The president c. Front-line people d. Customers e. Middle management Answer: dPage: 121Difficulty: Medium 4. ________ is the difference between the prospective customer’s evaluation of all the benefits and all the costs of an offering and the perceived alternatives. a. Perceived usefulness . Failure avoidance rate c. Report rating d. Customer-perceived value e. Competitors’ market share rate Answer: dPage: 121Difficulty: Medium AACSB: Analytic Skills 5. Total customer benefit is the perceived monetary value of the bundle of economic, functional, and ________ benefits customers expect from a given market offering. a. psychological b. intangible c. realized d. fabricated e. advertised Answer: aPage: 121Difficulty: HardAACSB: Analytic Skills 6. The bundle of costs customers expect to incur in evaluating, obtaining, using, and disposing of the given market offering is called the ________. a. rganizational expense ratio b. shopper’s fatigue c. total customer cost d. analysis paralysis e. comparison shopping to comparison buying ratio Answer: cPage: 121Difficulty: MediumAACSB: Analytic Skills 7. In applying a customer’s perceived value to a decision, a seller who is at a disadvantage with respect to customer-perceived value has two alternatives: to increase total customer benefit or ________. a. increase a cash-back bonus b. decrease total customer cost c. lose the sale to the competitor d. advertise more frequently e. offer an extended warranty Answer: bPage: 123Difficulty: MediumAACSB: Analytic Skills 8. The final step of customer value analysis is to ________. a. identify the major attributes and benefits that customers value b. assess the company’s and competitors’ performances on the different customer values against their rated importance c. examine how customers in a specific segment rate the company’s performance against a specific major competitor on an individual attribute or benefit basis d. monitor customer values over time e. assess the quantitative importance of the different attributes and benefits Answer: dPage: 122Difficulty: Medium 9.The ________ consists of the whole cluster of benefits the company promises to deliver; it is more than the core positioning of the offering. a. customer promise b. mission statement c. corporate pledge d. corporate-perceived value e. value proposition Answer: ePage: 123Difficulty: MediumAACSB: Analytic Skills 10. A company’s ________ includes all the experiences the customer will have on the way to obtaining and using the offering. a. value proposition b. value delivery system c. customer-value analysis d. total customer benefit e. total customer cost Answer: bPage: 123Difficulty: EasyAACSB: Analytic Skills 11. Total customer satisfaction is measured based on the relationship of ________. a. anticipated and real performance b. perceived performance and expectation c. advertised outcomes and real outcomes d. past experience and present experience e. customer attitude and salesperson’s attitude Answer: bPage: 124Difficulty: HardAACSB: Reflective Thinking 12. The ultimate goal of the customer-centered firm is ________. a. high customer satisfaction b. high profits c. low costs d. maximum stakeholder satisfaction e. none of the above Answer: ePages: 124–125Difficulty: HardAACSB: Reflective Thinking 13.Buyers form their expectations from all of the following EXCEPT ________. a. past buying experience b. friends and associates advice c. marketers’ information d. competitors’ information e. governmental newsletters Answer: ePage: 125Difficulty: EasyAACSB: Analytic Skills 14. A customer’s decision to be loyal or to defect is the sum of many small encounters with the company. In order for all these small encounters to add up to customer loyalty, many companies, such as Joie de Vivre Hospitality, strive to create ________. a. a reward program b. a comprehensive customer database c. a branded customer experience . strong word-of-mouth promotions e. a top-notch advertising campaign Answer: cPage: 125Difficulty: HardAACSB: Reflective Thinking 15. One key to customer retention is ________. It would be wise for a company to measure this factor frequently. a. heavy promotion b. deep discounts for intermediaries c. to have an ethics officer d. customer satisfaction e. to have customers on the board of directors Answer: dPage: 125Difficulty: MediumAACSB: Reflective Thinking 16. ________ can track customer satisfaction directly and also gauge consumers’ willingness to recommend the company and brand to others. . Periodic surveys b. Mystery shoppers c. Customer loss rates d. Customer focus statements e. All of the above Answer: aPage: 126Difficulty: Medium AACSB: Analytic Skills 17. Studies of customer dissatisfaction show that customers are dissatisfied with their purchases about 25% of the time, but only about ________ complain. a. 1% b. 5% c. 10% d. 15% e. 20% Answer: bPage: 128Difficulty: Hard 18. Of customers who register a complaint, ________. a. the majority will do business with the company again because they are unwilling to dedicate the effort required to find another vendor b. one will do business with the company again c. customers whose complaints are satisfactorily resolved spread more word of mouth than those who continue to be dissatisfied d. the speed of resolution has no impact on the likelihood of repeat business e. between approximately half and three-quarters will do business with the company again if their complaint is resolved Answer: ePage: 129Difficulty: Hard 19. ________ is the totality of features and characteristics of a product or service that bear on its ability to satisfy stated or implied needs. a. Performance b. Value c. Quality d. Customer retention e. Ð ¡ustomer loyalty Answer: cPage: 129Difficulty: EasyAACSB: Analytic Skills20. Total quality is the key to value creation and customer satisfaction. A marketing manager has several roles to play in a quality-centered company, including ________. a. participating in cross-functional team building b. correctly identifying customers’ needs and requirements c. ensuring costs are adequately controlled during order fulfillment d. setting expectations both internally and externally e. working closely with the sales team to create a dynamic sales message Answer: bPage: 130Difficulty: HardAACSB: Analytic Skills21. The 20–80 rule reflects the idea that ________. a. the top 20% of customers often generate 80% of the company’s profits b. the top 20% of customers are highl y satisfied and 80% of customers will recommend the company to a friend c. 20% of customers are unprofitable, and 80% make up a company’s profits d. 20% of the company’s profits are generated by the top 80% of customers e. any new product offering will be accepted by 20% of the customers immediately, but 80% of the customers will be up for grabs throughout the product’s life cycle Answer: aPage: 130Difficulty: HardAACSB: Analytic Skills22. Most companies have learned that the ________ are often the most profitable because of service expectations and their willingness to pay almost full price. a. large-size customers b. midsize customers c. small-size customers d. niche customers e. target market customers Answer: bPage: 130Difficulty: Medium23. A(n) ________ customer is a person, household, or company that over time yields a revenue stream that exceeds by an acceptable amount the company’s cost stream of attracting, selling, and servicing that customer. a . profitable b. semiprofitable c. unprofitable d. niche e. target Answer: aPages: 130–131Difficulty: EasyAACSB: Analytic Skills24. Customer profitability analysis (CPA) is best conducted with the tools of an accounting technique called ________. a. input-output analysis b. factor analysis c. revenue-based costing (RBC) d. activity-based costing (ABC) e. future date costing (FDC) Answer: dPage: 131Difficulty: MediumAACSB: Reflective Thinking25. ________ describes the net present value of the stream of future profits expected over the customer’s lifetime purchases. a. Activity-based costing b. Customer profitability analysis c. Customer value analysis . Customer-perceived value e. Customer lifetime value Answer: ePage: 132Difficulty: Medium AACSB: Analytic Skills26. The aim of customer relationship management (CRM) is to produce high customer ________. a. value b. loyalty c. profitability d. satisfaction e. equity Answer: bPage: 133Difficulty: Medium27. A customer touch point in the airline industry would include an item such as ________. a. reservations b. mechanics’ ability to service the airplanes c. ease of access to the airport d. the value of air travel versus surface transportation e. competency of a travel agent Answer: aPage: 133Difficulty: MediumAACSB: Reflective Thinking28. Customer relationship management enables companies to provide excellent real-time customer service through the effective use of _______. a. reports from mystery shoppers b. survey data from customers who have defected c. market research into overall consumption trends d. individual account information e. demographic trend data Answer: dPage: 135Difficulty: HardAACSB: Reflective Thinking29. All of the following would be among the Peppers and Rogers’s four-step framework for one-to-one marketing that can be adapted to CRM marketing EXCEPT ________. . customizing products, services, and messages to each customer b. interacting with individual customers to l earn their needs c. always offering the lowest price d. differentiating customers in terms of their needs and value to the company e. identifying your prospects and customers Answer: cPage: 135Difficulty: HardAACSB: Analytic Skills30. Winning companies improve the value of their customer base by excelling at each of the following strategies EXCEPT ________. a. retaining all customers regardless of profitability b. reducing the rate of customer defection c. ncreasing the longevity of the customer relationship d. making low-profit customers more profitable or terminating them e. focusing disproportionate efforts on high-value customers Answer: aPage: 136Difficulty: MediumAACSB: Reflective Thinking31. Harley-Davidson sells more than motorcycles and accessories. Its dealerships also sell branded clothing and licensed goods. This expansion of dealership sales offerings is an attempt to increase the value of the customer base by ________. a. reducing the rate of customer defection b. incr easing the longevity of the customer relationship . enhancing the growth potential of each customer through cross-selling d. making low-profit customers more profitable e. terminating low-profit customers Answer: cPage: 136Difficulty: Medium AACSB: Reflective Thinking32. Although actual costs vary from business to business depending on the complexity of the sales process, the most expensive customer acquisition method based on cost per solicitation is ________. a. personal selling b. direct mail c. telemarketing d. banner advertisements e. e-mail Answer: aPage: 137Difficulty: MediumAACSB: Analytic Skills33.Another term for high customer ________ is customer churn. a. retention b. defection c. value d. perception e. belief Answer: bPage: 137Difficulty: EasyAACSB: Analytic Skills34. People with the motivation, ability, and opportunity to make a purchase are known as ________. a. potentials b. advocates c. members d. prospects e. partners Answer: dPage: 137Difficulty: Medium AACSB: Ana lytic Skills35. Customers who enthusiastically recommend the company and its products and services to others are known as ________. a. potentials b. advocates c. members d. prospects e. partners Answer: bPage: 137Difficulty: Medium AACSB: Analytic Skills36. Satisfied customers constitute the company’s ________. a. customer relationship capital b. customer churn c. prospects d. high-value customers e. customer touch points Answer: aPage: 138Difficulty: Medium37. Acquiring new customers can cost ________ times more than satisfying and retaining current customers. a. two b. three c. five d. seven e. 10 Answer: cPage: 138Difficulty: Hard38. All of the following are methods to form strong customer bonds EXCEPT ________. a. creating superior products, services, and experiences for the target market b. aking it easy for customers to reach the appropriate company personnel and express their needs, perceptions, and complaints c. organizing and making accessible a database of informati on on individual customer needs, preferences, contacts, purchase frequency, and satisfaction d. running award programs recognizing outstanding employees e. concentrating the planning and management of the customer satisfaction and retention process within the marketing department Answer: ePage: 138Difficulty: HardAACSB: Reflective Thinking39. When companies provide rewards to customers who buy frequently and in ubstantial amounts, this is referred to as ________. a. benefit programs b. frequency programs c. satisfaction programs d. loyalty programs e. quality programs Answer: bPage: 139Difficulty: EasyAACSB: Analytic Skills40. Typically, ________ gains the most benefit from introducing a frequency program. a. the first company to introduce a frequency program in an industry b. the fast follower, who is second to introduce a frequency program in an industry, c. the industry sales leader d. the niche player in the industry e. the low-cost leader in the industry Answer: aPage: 140Diffi culty: MediumAACSB: Reflective Thinking41. All of the following are CRM imperatives EXCEPT ________. a. acquiring the right customer b. crafting the right value proposition c. instituting the best processes d. motivating employees e. learning to make profits through marginal customers Answer: ePage: 141Difficulty: HardAACSB: Analytic Skills42. CRM technology can help motivate employees by ________. a. analyzing customer revenue and cost data to identify current and future high-value customers b. better targeting the company’s direct marketing efforts c. racking customer-service satisfaction levels d. aligning employee incentives and metrics e. developing new pricing models Answer: dPage: 141Difficulty: Hard AACSB: Reflective Thinking43. According to Stanford’s business guru Jeffery Pfeffer, â€Å"the best companies build cultures in which frontline people ________. † a. can refer serious problems to senior management b. have strictly limited freedom to deviate f rom standard operating procedures c. are also consumers of the company’s products d. are empowered to do what’s needed to take care of the customer e. ive in the communities they serve Answer: dPage: 142Difficulty: Medium AACSB: Reflective Thinking44. An organized collection of comprehensive information about individual customers or prospects that is current, accessible, and actionable for such marketing purposes as lead generation, lead qualification, sale of a product or service, or maintenance of customer relationships is called ________. a. a customer database b. a customer mail list c. target market segments d. customer segments e. relationship markets Answer: aPages: 142–143Difficulty: MediumAACSB: Analytic Skills45.The process of building, maintaining, and using customer databases and other databases for the purpose of contacting, transacting, and building customer relationships is called ________. a. data warehousing b. datamining c. database marketing d . custom marketing e. electronic marketing Answer: cPage: 143Difficulty: EasyAACSB: Analytic Skills46. A _____________ is simply a set of names, addresses, and telephone numbers. a. customer database b. customer mailing list c. call-waiting list d. psychographic list e. demographic list Answer: bPage: 143Difficulty: Easy47. A customer database should contain all of the following EXCEPT ________. a. customer’s past purchases b. demographics c. psychographics d. mediagraphics e. an assessment of competitive strengths and weaknesses Answer: ePage: 143Difficulty: MediumAACSB: Reflective Skills48. A ________ would contain such items as past volumes, prices, profits, buyer, status of current contacts, and an assessment of competitive strengths and weaknesses. a. customer mailing list b. contact list c. customer database d. business database e. general corporate database Answer: dPage: 143Difficulty: EasyAACSB: Analytic Skills49. Savvy companies are capturing information every time a customer comes into contact with any of its departments. As a marketing manager all of the following would be available customer touch points for your consideration EXCEPT ________. a. a customer purchase b. an online query c. a mail-in rebate card d. an ad run on a national television network e. a customer-requested service call Answer: dPage: 143Difficulty: Medium50. Using his company’s ________ lets a telemarketer respond to customer inquiries more effectively because he or she can see a total picture of the customer relationship. a. data warehouse b. call back list c. call rejection list d. corporate database e. Better Business Bureau contacts Answer: aPage: 143Difficulty: Medium51. Through ________, marketing statisticians can extract useful information about individuals, trends, and segments from the mass of data. a. data accumulation b. target market information supplied by the government c. datamining d. data management e. data marketing Answer: cPage: 143Difficulty : MediumAACSB: Analytic Skills52. ________ involves the use of sophisticated statistical and mathematical techniques such as cluster analysis, automatic interaction detection, predictive modeling, and neural networking. a. Data management b. Data marketing c. Target market analysis d. Data accumulation e. Datamining Answer: ePage: 143Difficulty: MediumAACSB: Analytic Skills53. In general, companies can use their databases in all of the following ways EXCEPT ________. a. to predict competitive strategies and plans b. to identify prospects c. to decide which customers should receive a particular offer d. to deepen customer loyalty e. to avoid serious customer mistakes Answer: aPages: 143–145Difficulty: MediumAACSB: Analytic Skills54. Susan Lefferts’ company advertises widely. Ms. Lefferts uses business reply cards attached to her company’s magazine ads to build her company’s database. In which of the following ways would Ms. Lefferts most likely use the dat abase? a. To deepen customer loyalty b. To reactivate customer purchases c. To avoid serious customer mistakes d. To determine if up-selling is appropriate e. To identify prospects Answer: ePage: 143Difficulty: HardAACSB: Reflective Thinking55. Phil Langston has just ordered a number of expensive executive gifts that he will be sending as an appreciation token to a select few customers from his client database. In which of the following ways is Mr. Langston most likely using his database? a. To identify prospects b. To decide which customers should receive a new sales offer c. To deepen customer loyalty . To avoid serious customer mistakes e. To beat the competition to a sale Answer: cPage: 145Difficulty: MediumAACSB: Reflective Thinking56. Royal Caribbean uses its ________ to offer spur-of-the-moment cruise packages to fill all the berths on its ships. It focuses on retired people and single people because they are more able to make quick commitments. a. advertising b. database c. mail catalogs d. public relations department e. radio advertising Answer: bPage: 145Difficulty: Easy57. Which of the following is considered to be one of the four problems that can deter a firm from using CRM (customer relationship marketing)? . Competitors can often hack into CRM systems. b. Building and maintaining a customer database requires a large investment. c. It is very difficult to find and train database employees. d. Long-term results of such systems are still unproven. e. Focusing too much on databases separates a company from its customers. Answer: bPage: 145Difficulty: MediumAACSB: Reflective Thinking58. Building a database would not be worthwhile for a company in all of the following cases EXCEPT ________. a. where the product is a one-in-a-lifetime purchase b. where customers show little loyalty to a brand c. here the company already has an above average relationship with its customers d. where the unit sale is very small e. where the cost of gathering the informati on is too high Answer: cPages: 145–146Difficulty: Hard59. All of the following are examples of the perils of CRM EXCEPT ________. a. implementing CRM before creating a customer strategy b. the enormous cost that might eventually drain significant profits from the organization c. rolling out CRM before changing the organization to match d. assuming more CRM technology is better e. stalking, not wooing, customers Answer: bPage: 146Difficulty: Medium60.Marketers from which of the following are most likely to use database marketing? a. An airline b. A candy bar manufacturer c. A grand piano maker d. A toothpaste manufacturer e. None of the above would use database marketing. Answer: aPage: 146Difficulty: Medium AACSB: Reflective Thinking True/False61. Managers who believe the customer is the company’s only true â€Å"profit center† consider the traditional organization chart to be obsolete. Answer: TruePage: 120Difficulty: Easy62. The modern customer-oriented organi zation chart places top management at the top of the pyramid as long as they can think like consumers. Answer: FalsePage: 120Difficulty: Medium AACSB: Reflective Thinking63. There are two determinates of customer-perceived value: total customer benefit and total customer cost. Answer: TruePage: 121Difficulty: Medium AACSB: Analytic Skills64. Customer-perceived value is the perceived monetary value of all the purchases a customer makes on an annual basis. Answer: FalsePage: 121Difficulty: Medium AACSB: Analytic Skills65. Consumers tend to be value maximizes—they estimate which offer will deliver the most perceived value and act on it. Answer: TruePage: 121Difficulty: Easy AACSB: Analytic Skills66. At the heart of a good value delivery system is a set of core business processes that help to deliver distinctive customer value. Answer: TruePage: 123Difficulty: Hard AACSB: Analytic Skills67. Professional buyers and purchasing agents operate under various constraints and occasional ly make choices that give more weight to their personal benefit than to the company’s benefit. Answer: TruePage: 123Difficulty: Medium AACSB: Reflective Thinking68. The value proposition is stated in the price of a product and readily recognized by the average consumer. Answer: FalsePage: 123Difficulty: Medium AACSB: Analytic Skills69. The value delivery system includes all the experiences the customer will have on the way to obtaining and using the offering. Answer: TruePage: 123Difficulty: Medium AACSB: Analytic Skills70. For a consumer to be delighted with a product or service he or she must perceive that performance exceeds expectations. Answer: TruePage: 124Difficulty: Easy AACSB: Analytic Skills71. The ultimate goal of the customer-centered firm is to create high customer satisfaction. Answer: FalsePage: 124Difficulty: Hard AACSB: Reflective Thinking72.One key to customer retention is customer satisfaction. Answer: TruePage: 125Difficulty: Easy73. Consumers’ expe ctations result exclusively from past buying experiences. Answer: FalsePage: 125Difficulty: Medium74. A highly satisfied customer generally stays loyal longer, pays less attention to competing brands, and is less sensitive to price. Answer: TruePage: 125Difficulty: Medium75. Price perception is the totality of features and characteristics of a product or service that bear on its ability to satisfy stated or implied needs. Answer: FalsePage: 129Difficulty: Medium AACSB: Analytic Skills76. Conformance quality and performance quality is essentially the same thing in a marketing sense. Answer: FalsePage: 129Difficulty: Medium AACSB: Analytic Skills77. Two products with very different performance qualities can have the same conformance quality if both products deliver their respective promised quality. Answer: TruePage: 129Difficulty: Hard AACSB: Analytic Skills78. Marketers have found that pricing plays the most essential role in defining and delivering high-quality goods and services t o target customers. Answer: FalsePage: 130Difficulty: Easy AACSB: Reflective Thinking79.The midsize customers for most organizations receive good service, pay nearly full price for the products and services they purchase, and are often the most profitable. Answer: TruePage: 130Difficulty: Medium AACSB: Reflective Thinking80. A profitable customer is a person, household, or company that over time yields a revenue stream that exceeds by an acceptable amount the company’s cost stream of attracting, selling, and servicing the customer. Answer: TruePages: 130–131Difficulty: Medium AACSB: Analytic Skills81. The best thing a company can do in the face of company mistakes is to discourage the customer from complaining. Answer: FalsePage: 129Difficulty: Easy AACSB: Reflective Thinking82. Quality is the key to value creation and customer satisfaction. Answer: TruePage: 130Difficulty: Medium83. The least profitable 10% to 20% of customers can reduce profits by 50% to 200% per acc ount. Answer: TruePage: 130Difficulty: Medium AACSB: Analytic Skills84. Most companies measure customer satisfaction and individual customer profitability. Answer: FalsePage: 131Difficulty: Medium85. Unprofitable customers who defect to a competitor should be encouraged to do so. Answer: TruePage: 131Difficulty: Medium AACSB: Reflective Thinking86. Customer profitability analysis (CPA) is best conducted with the tools of an accounting technique called activity-based costing (ABC). Answer: TruePage: 131Difficulty: Medium87. According to customer profitability analysis (CPA), platinum customers spend the most money with the organization, thereby making them valuable. Answer: FalsePage: 131Difficulty: Hard AACSB: Analytic Skills88. Customer lifetime value (CLV) describes the net present value of the stream of future profits expected over the customer’s lifetime purchases. Answer: TruePage: 132Difficulty: Medium AACSB: Analytic Skills89. A good illustration of a personal touch in the hotel business would be if the hotel employees (e. g. , registration, maid service, et cetera) call a guest by his or her name. Answer: TruePage: 133Difficulty: Easy AACSB: Reflective Thinking90. A customer touch point is the time when the customer makes a purchase. Answer: FalsePage: 133Difficulty: Medium AACSB: Analytic Skills91. The aim of customer relationship management is to keep the costs of meeting and tracking consumers as low as possible. Answer: FalsePage: 133Difficulty: Medium AACSB: Reflective Thinking92.All companies should practice one-to-one marketing. Answer: FalsePage: 135Difficulty: Medium93. A key driver of shareholder value is the aggregate value of the customer base. Answer: TruePage: 136Difficulty: Medium94. Customer churn is how rapidly a store can move customers through its checkout facility or process. Answer: FalsePage: 137Difficulty: Medium95. The average company loses 25% of its customers each year. Answer: FalsePage: 138Difficulty: HardAACSB: Analy tic Skills96. A customer database is simply a listing of a customer’s name, address, and phone number for credit reference.Answer: FalsePages: 142–143Difficulty: Easy97. It’s often easier to reattract ex-customers (because the company knows their names and histories) than to find new ones. Answer: TruePage: 142Difficulty: Medium AACSB: Reflective Thinking98. Cluster analysis is a good example of a statistical technique that might be employed in datamining. Answer: TruePage: 143Difficulty: MediumAACSB: Analytic Skills99. It always costs less to serve loyal customers than to attract new ones. Answer: FalsePage: 146Difficulty: Medium AACSB: Analytic Skills100.Database marketing is most frequently used by business marketers and service providers (hotels, banks, airlines, and insurance, credit card, and telephone companies) that normally and easily collect a lot of customer data. Answer: TruePage: 146Difficulty: Medium Essay101. Compare and contrast the traditional o rganization chart for an organization against the modern customer-oriented organization chart. Suggested Answer: For a visual comparison, see Figure 5. 1. With respect to a written description, students should note that the modern customer-oriented organization chart is inverted (see the traditional model [e. g. top management—middle management—frontline people—customers]). Customers are at the top, followed by frontline people, then middle management, and, lastly, top management. Students might also provide some discussion on why the inversion is beneficial. Pages: 120–121Difficulty: Medium AACSB: Analytic Skills102. Provide a customer-centered definition of the term quality. Suggested Answer: Quality is the totality of features and characteristics of a product or service that bear on the ability to satisfy stated or implied needs. This is clearly a customer-centered definition. Page: 129Difficulty: Easy AACSB: Reflective Thinking103.Differentiate betwee n performance quality and conformance quality. Give an example of two products that have different performance quality but are of equal conformance quality. Suggested Answer: Performance quality is the quality of the product’s attributes. Conformance quality is the extent to which the product delivers the performance quality promised to consumers. A Lexus provides higher performance quality than a Hyundai: The Lexus rides smoother, goes faster, and lasts longer. Yet both would deliver the same conformance quality if both delivered their respective promised quality. Page: 129Difficulty: Hard AACSB: Analytic Skills104. The case for maximizing long-term customer profitability is captured in the concept of customer lifetime value. How is customer lifetime value calculated? Suggested Answer: Customer lifetime value describes the net present value of the stream of future profits expected over the customer’s lifetime purchases. The company must subtract from its expected reve nues the expected costs of attracting, selling, and servicing the account for that customer, applying the appropriate discount rate (depending on cost of capital and risk attitudes). Page: 132Difficulty: Hard AACSB: Analytic Skills105.Peppers and Rogers outline a four-step framework for one-to-one marketing that can be adapted to CRM marketing. What are those four steps? Suggested Answer: The four steps are: (1) Identify your prospects and customers; (2) differentiate customers in terms of their needs and their value to your company; (3) interact with individual customers to improve your knowledge about their individual needs and to build stronger relationships; and (4) customize products, services, and messages to each customer. Page: 135Difficulty: Hard AACSB: Analytic Skills106. A key driver of shareholder value is the aggregate value of the customer base. Identify the five strategies employed by winning companies to improve the value of their customer base. Suggested Answer: Win ning companies improve the value of their customer base by excelling at the following five strategies: (1) reducing the rate of customer defection; (2) increasing the longevity of the customer relationship; (3) enhancing the growth potential of each customer through â€Å"share-of-wallet,† cross-selling, and up-selling; (4) making low-profit customers more profitable or terminating them; and (5) focusing disproportionate effort on high-value customers. Page: 136Difficulty: Hard AACSB: Reflective Thinking107. Today, companies are increasingly concerned about customer defection. There are three main steps a company can take to reduce the defection rate. Characterize those three steps. Suggested Answer: The three steps are: (1) The company must define and measure its retention rate; (2) the company must distinguish the causes of customer attrition and identify those that can be managed better; and (3) the company must compare the lost profit equal to the customer lifetime value from a lost customer to the costs to reduce the defection rate. Page: 137Difficulty: Hard AACSB: Analytic Skills108. Discuss the concepts of a data warehouse and datamining. Suggested Answer: Data are collected by the company’s contact center and organized into a data warehouse. Company personnel can capture, query, and analyze the data. Inferences can be drawn about an individual customer’s needs and responses. Through datamining, marketing statisticians can extract useful information about individuals, trends, and segments from the mass of data. Datamining involves the use of sophisticated statistical and mathematical techniques. Page: 143Difficulty: Medium AACSB: Analytic Skills109.Assume that a marketing manager of a small company is in the process of implementing the use of a database to assist his or her company in its marketing efforts. Considering the information found in the text, list five ways that the marketing manager might be able to use the database for marketing efforts. Suggested Answer: Five ways to use a database for marketing efforts include: (1) to identify prospects; (2) to decide which customers should receive a particular offer; (3) to deepen customer loyalty; (4) to reactivate customer purchases; and (5) to avoid serious customer mistakes. Pages: 143–-145Difficulty: Medium AACSB: Reflective Thinking110. Describe four situations or cases when building a customer database would not be worthwhile for a company. Suggested Answer: Four situations or cases when building a customer database would not be worthwhile for a company would be: (1) where the product is a once-in-a-lifetime purchase; (2) where customers show little loyalty to a brand; (3) where the unit sale is very small; and (4) where the cost of gathering information is too high. Pages: 145–146Difficulty: Medium AACSB: Reflective ThinkingAPPLICATION QUESTIONS Multiple Choice111. John Chambers, CEO of Cisco Systems, said, â€Å"Make your customer the ce nter of your culture. † Customer-centered companies are adept at building customer relationships, not just producing products; they are skilled in ________, not just product engineering. a. service engineering b. market engineering c. cultural engineering d. innovation engineering e. management engineering Answer: bPage: 119Difficulty: Medium112. Immediately below the customers in a modern customer-oriented organization chart, we would expect to find the ________ of an organization. . top management b. marketing department c. middle management d. frontline people e. service department Answer: dPage: 121Difficulty: Easy AACSB: Analytic Skills113. All of the following are considered to be customer costs EXCEPT ________. a. financial cost of acquiring the product b. financial cost of disposing of the product c. time spent acquiring the product d. the risk of social stigma associated with acquiring the product e. All of the above are considered to be customer costs. Answer: ePage: 121Difficulty: Medium AACSB: Reflective Thinking114.When a consumer considers a product or service, he or she will choose whichever product or service delivers the highest ________. a. customer-perceived value b. customer-perceived cost c. consumer discount d. consumer relationship e. consumer synergy Answer: aPage: 121Difficulty: Medium AACSB: Analytic Skills115. Buyers do not always make logical or rational decisions. They might purchase the most expensive and least quality item for example. Which of the following would be another good example of this behavior? a. The buyer is not seen by the seller as being very intelligent. b. The buyer might be under orders to buy at the lowest price. . The buyer might be underage. d. The buyer might be under pressure to resist sales messages. e. The buyer refuses to listen to or read any advertising. Answer: bPage: 123Difficulty: Medium AACSB: Reflective Thinking116. If a company were to focus its marketing efforts on all the experiences the customer will have on the way to obtaining and using the offering, it would be focusing its marketing efforts on the customer’s ________. a. perception system b. cost versus benefit system c. demand d. psychological system e. value delivery system Answer: ePage: 123Difficulty: Medium AACSB: Analytic Skills117. _______ is defined as â€Å"a deeply held commitment to rebuy or repatronize a preferred product or service in the future despite situational influences and marketing efforts having the potential to cause switching behavior. † a. Customer satisfaction b. Customer value c. Loyalty d. Customer profitability e. Quality Answer: cPage: 123Difficulty: Medium AACSB: Analytic Skills118. Whether the buyer is satisfied after purchase depends on the offer’s performance in relation to the ________. a. buyer’s reactions b. buyer’s expectations c. seller’s delivery d. seller’s expectations e. both the buyer’s and seller’s demand s Answer: bPage: 124Difficulty: Medium AACSB: Analytic Skills119. Buyers form expectations in all of the following ways EXCEPT ________. a. from past buying experience b. from friends’ and associates’ advice c. from marketers’ information d. from competitors’ information e. from inherited traits Answer: ePage: 125Difficulty: Easy AACSB: Analytic Skills120. Field Grocery is considering using _________ to pose as customers and report on strong and weak points in customer service at Field Grocery stores. a. intelligence agents b. covert operatives c. mystery shoppers d. market mavens e. opinion leaders Answer: cPage: 126Difficulty: Easy121. 3M makes it easy for dialog to occur with its customers. 3M claims that over two-thirds of its product-improvement ideas come from listening to ________. a. customer suggestions b. entrepreneurial product ideas c. customer complaints d. media feedback e. customer reactions to competitive products Answer: cPage: 129Difficu lty: Medium AACSB: Analytic Skills122. According to GE’s former chairman, John F. Welch Jr. , â€Å"________ is our best assurance of customer allegiance, our strongest defense against foreign competition, and the only path to sustained growth and earnings. † a. Quality b. Customer satisfaction c. True value d. Sustainable enterprise e. Motivation Answer: aPage: 129Difficulty: Hard AACSB: Analytic Skills123. With respect to customer profitability analysis, ________ customers are the most likely dropped as customers because of poor profitability. a. granite b. wood c. iron d. plastic e. lead Answer: ePage: 131Difficulty: Medium124. Jim is a residential construction contractor. Although one particular realtor provides Jim with a large volume of work, the realtor frequently demands discounts for sending him customers. This realtor is best described as a(n) ________ customer. a. latinum b. gold c. lead d. iron e. ivory Answer: dPage: 131Difficulty: Medium AACSB: Reflective Thinking125. Harrah’s has used effective ________ to almost double its share of customers’ gaming budgets by targeting offers to specific customer segments. a. customer relationship management b. customer lifetime value c. customer profitability analysis d. customer satisfaction analysis e. customer-value delivery Answer: aPage: 135Difficulty: Medium AACSB: Analytic Skills126. Many banks and phone companies now charge fees for once-free services to ensure minimum customer revenue levels. This is an example of ________. . reducing the rate of customer defection b. making low-profit customers more profitable c. enhancing the growth potential for each customer through cross-selling d. increasing the longevity of the customer relationship e. focusing disproportionate effort on high-value customers Answer: bPage: 136Difficulty: Medium AACSB: Reflective Thinking127. When Bob found out his friend was thinking about buying a new car, he strongly recommended that his friend lo ok into the newest line of Ford sedans. Bob is best characterized as a(n) ________ for Ford. a. first-time customer b. member c. partner d. advocate e. rospect Answer: dPage: 137Difficulty: Medium AACSB: Reflective Thinking128. Carol is currently considering buying a Motorola cell phone offered by her service provider in conjunction with a two-year service contract. Carol is best characterized as a(n) ________ for Motorola. a. first-time customer b. member c. partner d. advocate e. prospect Answer: ePage: 137Difficulty: Medium AACSB: Reflective Thinking129. Southwest Airlines offers a Rapid Rewards program, an example of a ________ that allows customers to count flights they have taken toward free future flights. a. value proposition b. value delivery system c. lub membership program d. one-to-one marketing program e. customer churn Answer: cPage: 140Difficulty: Easy AACSB: Analytic Skills130. The skillful use of database marketing and ________ has made catalog house Fingerhut one o f the nation’s largest direct-mail marketers. a. everyday low prices b. expanded home delivery options c. relationship building d. competitor’s mistakes e. retailer alliances Answer: cPage: 145Difficulty: Hard AACSB: Analytic Skills Short Answer131. What do modern managers believe is their company’s only true â€Å"profit center†? Suggested Answer: Managers believe the customer is their only true profit center. Page: 120Difficulty: Easy AACSB: Analytic Skills132. Customer-perceived value is based on two components. What are those components? Suggested Answer: The two components of customer-perceived value are total customer value and total customer cost. Page: 121Difficulty: Medium AACSB: Analytic Skills133. What is the definition for customer-perceived value (CPV)? Suggested Answer: Customer-perceived value (CPV) is the difference between prospective customer’s evaluation of all the benefits and all the costs of an offering and the perceived alter natives. Page: 121Difficulty: Medium AACSB: Analytic Skills134. Using European automobile giant Volvo as your illustration, create a value proposition for the company. Suggested Answer: Students may have several answers; however, any value proposition must be built on their stated positioning objective of â€Å"safety. † Other benefits that might be worked into a value proposition could be a long-lasting car, good service, and a long warranty period. Basically, the value proposition is a statement about the total experience customers will gain from the company’s market offering and from their relationship with the supplier. Page: 123Difficulty: Medium AACSB: Reflective Thinking135. How do customers determine their level of satisfaction with a product? Suggested Answer: In general, satisfaction is a person’s feelings of pleasure or disappointment that result from comparing a product’s perceived performance to the customer’s expectations. Page: 124Di fficulty: Easy AACSB: Reflective Thinking136. Give an example of a â€Å"branded customer experience. † Suggested Answer: Students may have several answers. One example from the book is that of Joie de Vivre Hospitality Inc, which operates a chain of boutique hotels, restaurants, and resorts in the San Francisco area. The boutique concept enables hotels to offer personal touches, such as vitamins in place of chocolates on pillows. Page: 125Difficulty: Hard AACSB: Reflective Thinking137. Companies need to be especially concerned today with their customer satisfaction level. Why? Suggested Answer: Companies need to be especially concerned today with their customer satisfaction level because the Internet provides a tool for consumers to quickly spread bad word of mouth to the rest of the world. Page: 126Difficulty: Easy AACSB: Reflective Thinking138. Identify three ways companies with customer complaints can recover customer goodwill. Suggested Answer: Five methods are identifie d in the text. Students should present three of the following: (1) Set up a 24/7 toll-free â€Å"hotline† to receive and act on customer complaints; (2) contact the complaining customer as quickly as possible; (3) accept responsibility for the customer’s disappointment; (4) use customer-service people who are empathic; and (5) resolve the complaint swiftly and to the customer’s satisfaction. Page: 129Difficulty: Medium AACSB: Analytic Skills139.Define the term quality. Suggested Answer: Quality is the totality of features and characteristics of a product or service that bear on its ability to satisfy stated or implied needs. Page: 129Difficulty: Easy AACSB: Analytic Skills140. What are the three ways that customer profitability can be assessed? Suggested Answer: Customer profitability can be assessed individually, by market segment, or by channel. Page: 131Difficulty: Medium AACSB: Analytic Skills141. What are the four classifications (tiers) of customers in cus tomer profitability analysis using activity-based costing? Suggested Answer: The tiers would be platinum customers (most profitable), gold customers (profitable), iron customers (low profitability but desirable), and lead customers (unprofitable and undesirable). Page: 131Difficulty: Hard AACSB: Analytic Skills142. What is a customer touch point? Suggested Answer: A customer touch point is any occasion on which a customer encounters the brand and product—from actual experience to personal or mass communications to casual observation. Page: 133Difficulty: Medium AACSB: Analytic Skills143. One-to-one marketing is not for every company. For whom does this style of marketing work best? Suggested Answer: One-to-one marketing works best for companies that normally collect a great deal of individual customer information, carry a lot of products that can be cross-sold, carry products that need periodic replacement or upgrading, and sell products of high value. Page: 135Difficulty: Ha rd AACSB: Reflective Thinking144. A 5% reduction in the customer defection rate can increase profits by 25% to 85%, depending on the industry. Explain how this is so. Suggested Answer: Acquiring new customers can cost five times more than satisfying existing customers. Customer profit rate also tends to increase over the life of the retained customer due to increased purchases, referrals, and price premiums and reduced operating costs to service. Page: 138Difficulty: Medium AACSB: Reflective Thinking145. Explain how a company frequency program might work. Suggested Answer: Frequency programs are designed to provide rewards to customers who buy frequently and in substantial amounts. Frequency programs acknowledge the validity of the 20–80 rule. Page: 139Difficulty: Medium AACSB: Analytic Skills146. Describe the process of database marketing. Suggested Answer: Database marketing is the process of building, maintaining, and using customer databases and other databases (products, suppliers, resellers) for the purpose of contacting, transacting, and building customer relationships. Page: 143Difficulty: Medium AACSB: Analytic Skills147. How do companies use their databases to identify prospects?Suggested Answer: Many companies generate sales leads by advertising their product or service. The ads generally contain a response feature, such as a business reply card or a toll-free phone number, and the company builds its database from customer responses. It sorts through the database to identify the best prospects, then contacts them by mail, phone, or personal call to convert them into customers. Page: 143Difficulty: Medium AACSB: Reflective Thinking148. Give an illustration of how a company can use a customer database to reactivate customer purchases. Suggested Answer: Companies can install automatic mailing programs that send out birthday or anniversary cards, Christmas shopping reminders, or off-season promotions. Other illustrations by students should be in a similar vein. Page: 145Difficulty: Medium AACSB: Reflective Thinking149. One of the main problems that can prevent a firm from effectively using CRM is that some of the assumptions behind CRM may not always hold true. Give an example of one of these assumptions that might not always hold true. Suggested Answer: It may not actually cost less to serve more loyal customers. Page: 146Difficulty: Medium AACSB: Analytic Skills150. According to information provided in the text, what are the four main perils of CRM? Suggested Answer: The four main perils are: (1) implementing CRM before creating a customer strategy; (2) rolling out CRM before changing the organization to match; (3) assuming more CRM technology is better; and (4) stalking, not wooing, customers. Page: 146Difficulty: Hard AACSB: Analytic Skills