Burger King Profile free essay sample

Burger King appeals to a broad spectrum of consumers because it offers customers quick service of fast food at affordable prices. Burger King’s slogan is â€Å"Have it your way†, which means allowing consumers to make better tasting hamburgers according to their preference. What’s more, one of Burger King’s business strategies is focusing on BK ® brand equities and optimizing its menu, which reflected the company’s core value of â€Å"customer focus, operational perfection and care for the highest quality services and dishes†. Other strategies applied by Burger King include expanding worldwide development, driving corporate-level GA efficiencies, and focusing on cash flow generation and debt paydown by tying a portion of managements incentive compensation to profitability and free cash flow generation. Revenue Recognition Burger King’s revenues and their recognition methods are as follows: (1)Retail sales at Company restaurants are recognized at the point of sale and royalties from franchisees are based on a percentage of retail sales reported by franchisees. We will write a custom essay sample on Burger King Profile or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Royalties are recognized when collectability is reasonably assured. (2) Franchise revenues. Initial franchise fees are recognized when the related restaurant begins operations. Renewal franchise fees are recognized upon receipt of the non-refundable fee and execution of a new franchise agreement. (3) Property revenues, including rental income from operating lease rentals and earned income on direct financing leases on property leased or subleased to franchisees, are recognized when collectability is reasonably assured. Franchise Restaurant Leases Burger King typically does not own the land or the building associated with its franchise restaurants and its standard franchise agreement does not contain a lease component. For properties that it leases from third-party landlords and subleases to franchisees, leases generally provide for fixed rental payments and may provide for contingent rental payments based on a restaurants annual gross sales. The franchisee is obligated to pay all costs and expenses, including all real property taxes and assessments, repairs and maintenance and insurance. Advertising and Promotion Costs Company restaurants generally make 4% to 5% of monthly gross sales to company managed advertising fund, franchisees make this contribution into a franchisee managed advertising fund. Advertising contributions are used to pay for expenses relating to marketing, advertising and promotion, including market research, production, advertising costs, sales promotions and other support functions. In addition to the required national advertising fund, U. S. ranchisees may choose to participate in certain local advertising campaigns on their own expenses Burger King does not list their inventory in the balance sheet because of the low quantity of inventories. This indicates a high inventory turnover, which is a feature of fast food industry. On November 5, 2010, Burger King’s Board of Directors approved a change in fiscal year end from June 30 to December 31. The change became effective at the end of the quarter ended December 31, 2010. The financials Burger King plans to improve its average restaurant sales and return on capital by applying a more efficient cost-effective remodel solution. Recently, it has implemented a global restructuring plan by reducing work force throughout its organization. In the United States, approximately 375 corporate and field positions were eliminated. In addition, approximately 250 corporate and field positions were eliminated in Canada, Latin America, and Asia Pacific area. At the same time, Burger King is seeking geographical expansion of its restaurant network. Its development strategy centers on ensuring that franchisees in each of its markets have the resources and incentives to grow. In addition, it has invested in joint ventures with franchisees to drive development in Taiwan and Northern China, and it expects to continue to use this investment vehicle as one of the strategies to increase its global presence.

protective features of the constitution essays

protective features of the constitution essays The United States democratic system includes certain features that are intended to protect against the abuse of the power by the government and public officials. Some protective features include: judicial review, impeachment process, freedom of expression, protection against unreasonable searches, equal protection under the law, and the rights of the accused. One important protective feature is judicial review. Judicial review is the power of the courts to review laws and determine whether or not they are unconstitutional. The Judiciary Act of 1789 stated that all citizens of the United States are separate but equal, referring to segregation. Blacks were supposed to be treated equally and fairly, without discrimination just as whites were, but they were to have separate facilities, schools, etc. In the case of Marbury v. Madison, on John Quincy Adams last night in office, he appointed 82 new Federalist Justices. These "midnight judges" as they were called represented a threat to incoming President Thomas Jerreson, a Democrat-Republican. Jefferson feared Federalist interpretation of the law for the next 20 years, a fear that ended up coming to fruition. Among these midnight judges was one William Marbury. Jefferson ordered his Secretary of State, John Madison, not to deliver the official documents granting Marbury his position. Bec ause of the Judiciary Act of 1801, Marbury appealed directly to the Supreme Court asking for a "writ of mandamus" or an order to act. Chief Justice John Mashall recognized he would be correct in ordering Madison to deliver the papers but feared weakening the image of the Court if President Jefferson refused to comply. Instead Marshall ruled that the Judiciary Act of 1801, which Marbury had used to submit his claim directly to the Court wa s unconstitional, and it was. In this way the Court was able to rule a law unconstitutional and therefore created the important precedent...

Kinesiology-- Essential nutrients Essay Example | Topics and Well Written Essays - 1000 words

Kinesiology-- Essential nutrients - Essay Example Each vitamin has different functions in the body. Vitamin B helps in releasing energy from ingested food. There are also required in the synthesis of RNA and DNA. Vitamin C is mostly important in the development of bones, teeth and gums. Vitamin D is also used in bone development. Vitamin E functions as an antioxidant. Vitamin K enables blood clotting. Water forms about 60% of our body weight. It enables the maintenance of body temperature, blood pressure and blood volume. In addition, it provides moisture for moth, eyes and nose tissues. Helps to avoid constipation, enables muscle functions and lubricates joints. Fibers and indigested forms of carbohydrates. They enable normal bowel movements and decrease the risks of constipation, colon cancer and hemorrhoids. They increase the excretion of cholesterol thus minimizing risks of heart disease and obesity. Vitamins are classified as either fat-soluble or water-soluble vitamins. Water soluble vitamins are not stored in the body. After they are ingested they have the ability to dissolve in water. They are then taken in the blood stream. The body is able to incorporate the amount it requires at the time and the excess is excreted in urine. Water soluble vitamins are all vitamins B and Vitamin C. they can be obtained from grains, vegetables and fruits. Fat soluble vitamins are vitamins that are stored in the body. After ingestion they are dissolved in fat. After ingestion the body uses the required vitamins and the rest is stored and used when required in future. The excess is excreted as stool. The main sources of fat soluble vitamins are oily fish, liver, animal fats, butter, vegetable oil and dairy products. In the body, 45% to 65% of the total calories are carbohydrates. A daily caloric level should be maintained should be maintained at a daily concentration of 1800 calories. This translated to 202-292 grams of carbohydrates daily. A high fat intake is classified to be above 35%

Embracing Globalization while Maintaining Identity Essay

Embracing Globalization while Maintaining Identity - Essay Example As the paper discusses while globalization is not the answer to all the world’s problems, a negative attitude towards it is one that is capable of breeding suspicion and misunderstanding between different cultures and nations. Also, economically speaking, globalization can be far more complicated than merely showing tolerance and acceptance towards other cultures. This essay will first illustrate some of the negative attitudes toward globalization. Next, globalization as it relates to education in Israel will be discussed. Through these examples one can likely see that many people are afraid that globalization will weaken their particular nation and take away from their common identities. In response to these fears, the paper will suggest that it is indeed possible to maintain one’s identity while at the same time accepting globalization. One instance of a negative view towards globalization is â€Å"anti-soccer† Americans as described in the work of Franklin Foer. According to Foer, globalization has actually failed some of its expectations, both economically and culturally, given that a majority of the world’s nations remain poor, and that some cultures actually fear that â€Å"globalized culture† will eventually erode their own unique cultural identities. In order to illustrate the failures of globalization, particularly in its failure to promote the homogenization of culture (and even attracted the reversion to old cultural identities and hostility to other cultures), Foer uses the ever famous worldwide sport of soccer.  

Develop a new idea for existing company Term Paper

Develop a new idea for existing company - Term Paper Example Until only recently the brand went through expansion and introduced the Skin care product range which now included lotion, cleansers, towelettes, make-up removers etc. Smooth and Soft face wash will be the solitary face wash related product offering in the company’s portfolio of products. However, given ample time and growth, the company plans on expanding its line of face wash with more special purpose face washes instead of a one-for-all product. We’ll use penetration pricing for Our Soft and Smooth face wash will cost $3.25. Another added advantage that we’ll get is that it will complement our cream range as people who use face wash and care for their skin will also make lotion and cream purchases hence this strategy will benefit us in the longer run. We’ll use advertising in Magazines and place ads which clearly highlight features of the new product and its lower price with similar benefits to the competitors. This would create a pull in the market. The promotion and publicity activities plan include a first time customers’ discount of 30% if purchased in the soft launch activity zone. The product will be showcased at prominent malls in the metropolis along with banners, decoration, flash mob, gift hampers and other awareness-creating activities. Sales promotion will be initially used which will include offers like giving small sample tubes & bottles in a package with the already well established cream and lotion range. Discounts will not be offered as the product is already lowered price to competitors while providing quality. If prices will be lowered than this then customers will doubt the quality, An indirect distribution channel will be used as we have to reach to masses and also our products are Shopping products which are usually sold by retailers at stores and shops as compared to specialty goods require direct

Studying the role of leadership management

Studying the role of leadership management According to Bennis and Nanus (1985, p. 20), leadership is referred as the most studied and least understood topic of any in the social sciences. There are more than 100 definitions of leadership having been identified in literature (Rost, 1991), and Stogdill (1974) even suggests that the definitions of leadership are as many as people who have ever tried to define it. However, there is neither any unanimously accepted definition of leadership, nor any consensus on the best way to train leaders (Bolden, 2004). Gallie (1955, cited in Grint, 2004, p. 1) defines leadership as, Leadership appears to be, like power, an essentially contested concept', whereas Bennis and Nanus (1985, p. 20) describes leadership as the abominable snowman, whose footprints are everywhere but who is nowhere to be seen. To summarise, the meaning of leadership is complex and includes many dimensions and it addresses many other key business/corporate, organisational, socio-cultural and personal processes. In mode rn days, it is generally popularised among commentators that charisma, inspiration, trust and consensus have been increasingly associated with leadership, but the author tends to advise they are necessary conditions for successful leadership in most situations, and there are circumstances, where other determinants are needed. Various Schools of Thoughts about Modern-day Leadership In 21st century the concepts of leadership and its definition are becoming more diversified according to various schools of thoughts. Peters (1993, p.19), explains the modern-day leadership as, Crucial to the revolution now under way so crucial that we believe the words managing and management should be discarded. Drucker (1992, p.119), having a similar point as Peters, identifies modern-day leadership as, Mundane, unromantic and boring. Its essence is performance, though Bolden (2004) is not in the favour of differentiating the details of the leadership from the management. What is more, as noted in the Jack Welchs example, General Electric Company progresses many folds in few years and the basis of this success is a candid, lucid and set guideline for a linear and prolific organization (Slater, 2003). Last but not least, Peter Scholtes (1998) leadership concentrates on systems thinking, and his opinions include leading by objectives, merit pay, performance appraisals, motivation, etc. According to Collinson (2005), followership is the essence of leadership, which means that modern-day leadership styles should be according to the personality and characteristics of the followers. The author understands from these different views that in the 21st century leadership styles, there is no one monotonous leading style in the organizations. Charisma in Modern-day Leadership Charisma is an advantage that promotes modern-day leadership performances, but it is not essential (Carpenter, 2002). Max Weber (1947) firstly defines that charisma differing leaders from ordinary people refers to special gifted magnetic charm and appeal; it gives leaders the capacity to do extraordinary things, and in particular it gives the leader exceptional powers of influence to followers. Scholars further suggest that charismatic leaders often serve as a strong role model for values that they desire others to adopt, show competence in every aspect of leadership so others trust his or her decisions, articulate clear goals and strong values, communicate high expectations for followers and show confidence in their abilities to meet those expectations (Conger, 1989; House, 1977; Shamir et al., 1993). Charismatic leaders are having deep impact on followers value, attitude and behavior, and it is suggested charisma is an important leadership attribute that motivates followers (Ilies et al., 2006). Leaders with charismatic personalities can get things done through attracting the subordinates to achieve the organisational goals more effectively, as people feel encouraged to be more devoted to their work, as a result of their admiration and respect to their leaders (Mortensen, 2008). Bill Clinton and Steve Jobs are both typical charismatic leaders. With overwhelming personal charm and vision, they successfully create their era. However, Ciulla (2004) suggests that basis of the leadership is ethics like earned trust not the charm. Tyler (2008) also advises people are lead because of their trust to the leaders, not charisma. Furthermore, it is generally agreed that leadership is ability and a skill which could be learnt over time and with the experience and maturity (Mumford et al., 2000); leaders are made not born, and charisma could be developed (Adair, 2005). Yet, Howell and Shamir (2005) also figure out that characteristics of followers sometimes determine the e fficiency of charismatic leadership. There is no denying of the importance of charisma for the leaders in the present-day leadership styles. Charisma is the capability to project the vision and thoughts regarding what the future prospects will hold upon others to bring a positive transform or change. In the light of this discussion, author understands that charisma is increasingly associated with modern-day leadership, and with the concern of other factors like the element of trust and follower, leadership in the modern-day organisations becomes more effective. The Inspirational Approach in Modern-day Leadership Inspirational leaders could positively motivate and influence people to get the best out of themselves, and accordingly pursue a far better performance of the organization (Wilson, 2010). Wilson and Rice (2004) also state that inspirational leaders are able to encourage, grow, and build up confidence of followers, through which modern organizations could benefit higher performance, even facing adversity. Robbins et al. (2010) suggest that charismatic leadership is the most common style of inspirational approach to leadership. The most striking element of the charismatic leadership is the ability to inspire astonishing performance from the followers and the team. It is also revealed that inspiration is a tactic to influence others and is associated with the research conducted by Yukl and Falbe (1990). The concept is that the leader makes a request or proposal that arouses enthusiasm by appealing to peoples values, ideals and aspirations or by increasing their confidence that they can do it. However, leaders are starting to inspire and motivate followers to perform, once trust is built up (Zeffane, 2010). Scholars claims that there are factors stimulating inspira tion, like a vision, which tells followers what they are expected to achieve and which they could always hold on (Scott, 2010). Other factors include involvement of everyone (Bilchik, 2001; Wilson, 2010), and the courage to admit personal weakness (Goffee and Jones, 2000) and so forth. Yukl and Falbe (1990) also conclude that leaders are most likely to use inspirational appeal and pressure when trying to influence subordinates, rather than their boss, or colleagues. In short, people are inspired to enthusiastically perform as well as they could, and ultimately succeed in achieving better organisational performance. Consensus and Modern-day Leadership With more and more emphasis on democracy, modern-day leadership is being increasingly associated with the consensus element in the decision making in the business organizations. Early experiments and research of Lewin et al. (1939) indicates that people are performing better, if they have been involved in the decision-making process. They also suggest leadership style to a large degree determine the performance of the group and they have categorized leadership into three styles: authoritarian, democratic and laissez faire leadership, among which democratic leadership is generally regarded as the more effective style. Consensus plays a very important role in democratic leadership, as members are encouraged to participate in the decision-making process and involved in the final decision and the agreement (Knight et al., 1999). Hence, with the support to the decision, people are better motivated and likely to perform better that they have been expected to (Brilhart and Galanes, 1989). M oreover, consensus in leadership stimulates team cohesiveness, with which members cooperate more with each other (Sanders and Schyns, 2006). It is also stated effective strategic leaders understand the necessity to involve team members in consensus decision making (Brilhart and Galanes, 1989). Besides, Felfe and Heinitz (2010) conclude that consensus not only largely predicts members commitments and their satisfaction, but also enhance organisational performance and leadership. Yet, Frisch (2008) argues a team cant make effective decisions if its members dont trust one another or if they fail to listen to one another. Therefore, before adopting consensus decision-making process, it is important that trust has been built up among members. It should not be neglected the decision-making ability of members in consensus process, as well as the fact that there are times authoritarian leaders work more effectively, especially facing risks and opportunities, as at least authoritarian leader ship is far less time-consuming (Lewin et al., 1939), and not everyone has the ability to tell and seize opportunities. Steve Jobs to some degree is an authoritarian leader, as no matter what other say and do, he insists that Apple should do its software and hardware all by itself even in such an open world day, as they know themselves best. It appears that Steve Jobs and his way is the path to the success of Apple. It would still appear consensus in modern-day leadership helps to sustain decisions, and to succeed a strategic leader needs to build the consensus. Trust Element in Modern-day Leadership As previously discussed, trust is shown as the basis of no matter charismatic, consensus or inspirational leadership. The importance of trust in modern organizations is widely recognized (Clegg et al., 2002), and it is increasingly important for leaders to arouse trust and faith to motivate the followers in modern organizations (Robbins et al., 2010). Martin (1998) defines trust leadership as, Leadership that is born and kept alive by the follower trust is trust leadership. According to him, followers attitudes are created by the leaders in the modern-day organisations. This allows the followers to trust the leader and trust is at the root of the leadership. Leadership is meant very little without the trust and vice versa. George Washington, Abraham Lincoln, Martin Luther King Jr. are some of the examples from the recent history who have innate abilities to influence the followers by appealing to their values and earning the trust. These values include trust, respect, equality and freedom and are present in the modern-day followers, too. The values practiced in the past can be duplicated and practiced today and applied to the workplaces (Martin, 1998). Attitudes determine responses, so effective leaders understand that employees attitudes are very important in achieving goals of the company. To build the trust, leaders influence employees by tapping into their values and thus a positive behavior and attitude is encouraged in both the leader and the follower. Thus, as Matthews (2010) suggests that trust is the basis to heighten and achieve productivity and profitability in modern-day businesses in addition to aligning the organisational values with the employees values. Vadell (2008) also describes the trust as the leading concept in the organisational commitment, which could be exemplified by his research about United States Air Force Officers commitment and intention to leave the military. On the other hand, leaders trust in subordinates benefits themselves in delegating power to subordinates (Leana, 1986), by which subordinates would be further motivated. Likewise, Greenberg (2009) indicates innovation more than often comes from taking risks, while trust is key determinant to inspire people to take risks; for example, Google employees are trusted to have one day a week to do whatever interests them, which gives birth to innovations like Gmail. The author understands that in the modern-day organisations and leadership styles, mutual trust between leaders and subordinates helps develop the commitment among the followers and this commitment element establish the truthfulness of the charismatic leadership style. Increasing Association of Charisma, Trust, Inspiration and Consensus with the Modern-day Leadership Theories Literature reveals charisma, trust, inspiration and consensus are all important factors of transformational leadership, which elevate followers well-being (Gillespie and Mann, 2004; Khatri, 2005; Nielsen and Munir, 2009; Liu et al., 2010; Felfe and Heinitz, 2010). Bass (1985) suggests that transformational leadership theory results into growth and empowerment of the followers, and Howell (1988) believes transformational leadership style develops dependency among the followers on the leader. This means that followers motivation, self respect and esteem all are dependent on the positive feedback and recognition from the leader. Richard Branson could well exemplify modern-day transformational leadership. In Virgin empire the individual personality of Branson is stamped all through the organization, and his values and goals derive and infuse every corner of the corporation. Charismatic transformational leaders like Branson are capable to achieve their impact by the creation of followers who personally identify with this style as well as with the work group they are with (Yukl, 1989). Conger and Kanungo (1998) suggest that the personal attachment and identification with the leaders is because of leaders charismatic style and approach and is based on referent power. Similarly, Shamir et al. (1993) suggest that role model behaviour is one main method with which leaders influence the followers. The older leadership styles such as contingency models of Fiedler (1967), Vroom and Yetton (1973) and Yukl (1989) have main focus on the identification of the leadership styles which predicts effective results depending on situational contingencies. But these theories could not advise for a continuous changing environment and circumstances. One of concepts recognised by most scholars as accurately reflecting what it is to be a leader is leadership is a trait (Rost, 1991). Stogdill (1974) studied some leadership qualities in traits that appeared more often than others, like sense of responsibility, self-confidence and emphasis on task competition. However, Shaw (1976) and Fraser (1978) identifies that leaders usually attain above average scores for the traits like motivation, ability and sociability. Rost (1991) suggests that according to the trait theory people are either born or not born with the leadership qualities that help them succeed in the leading roles. Inherited qualities for example the personality and cognitive ability are basis of the effective leadership. Author feels that sometimes traits are built or developed within the leaders. Richard Branson was not very sociable in his school life, but he has made himself the face of Virgin Group by participating in the shocking promotional and publicity stunts to g ain attention. Therefore, personality and traits are core part of modern-day leadership, but accordance to needs and wants of the business become the more rife drivers of the behavior. Modern-day leadership styles are more associated with the mix of charisma and trust to inspire the followers. Influence of Cultural Differences on Modern-day Leadership In modern days, more and more researches are focused on leaders/leadership in the context of globalization, that is global leaders/leadership (Mendenhall et al., 2008). It is also indicated despite of being a good leader in home country, one of the biggest challenges facing modern global leaders is how to lead people cross-culturally (Thomas, 2008; Deresky, 2011), as one leadership style may be effective in one culture, but fails in another (Scandura and Dorfman, 2004). DeGrosky (2011) reveals that leadership theory and practice have a great impact and are influenced by the differences among the cultures. However, the basic or fundamental principles of the leadership are same in all cultures even if leaders execute those functions in diverse ways from culture to culture. People influence others through leadership. Peoples values, attitudes, beliefs and behaviours vary largely by culture (Hofstede, 1998; Walumbwa et al., 2007; Thomas, 2008), so efficiency of leadership influence diffe rs by cultures, too. In some cultures, people could be influenced successfully by applying coherent persuasion teamwork and consultation, while other cultures may be influenced successfully by using general approaches like socialising, gifting and exerting pressure (DeGrosky, 2011). For example, as Americans have an individualistic cultural style (Hofstede, 1983), in this cultural context, leadership looks more at individual leaders and personality traits, style, behavior, as well as charisma, and it is encouraged to highlight individual success; While in China, with a highly collectivism context, it is more reasonable to praise a team/group, instead of individuals. The case of the Floundering Expatriate also indicates that different leadership style is required by different cultural context. In modern-day leadership, peoples views of effectual leadership change from customary and individualistic toward collective and collaborative styles. The Global Leadership and Organisational Be havior Effectiveness project in 2004 indentifies there are universally accepted leadership characteristics worldwide. Positive leader attributes include trustworthiness, justice, confidence, honesty and so forth, while loner, non-cooperation, ruthlessness and asociality etc. are negative attributes (House et al., 2004). Conclusion Concept of modern-day leadership differs from one school of thought to other like modern-day leadership styles include simple linear, visionary, pure arts and science, systems thinking and military style, etc. However, in modern-day leadership there is no single leading style among the leaders and in the organisations. Type of the organization and followers characteristics also play an important role in deciding for the leadership style now. But the key point is that modern-day leadership is increasingly associated with charisma, inspiration, trust and consensus, as well as other determinants like followers characteristics and cultural differences. However, charisma is criticised in a positive as well as in a negative manner by different school of thoughts. When charismatic leadership style is based on the core values like paying respect and attention to the ideas of subordinates, then this brings a positive synergism for the impact of charismatic leadership style in the success of t he business processes and operations. Trust between leaders and the followers is the basis for success of charismatic leadership style. Strategic leaders and policy makers with inspirational abilities and consensus development attitudes can develop trust between them and the followers/employees. In short, charisma, inspiration and trust are linked with each other and collectively help develop commitment among the followers. 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Hard Hits in Womens Tennis Industry Causes a Racket Essays -- Explora

Hard Hits in Women's Tennis Industry Causes a Racket From sunrise to sunset, I constantly hit fuzzy balls over the net. At age eight, my plan was to be a professional women's tennis player, so I figured that I needed to start training now. Wanting to be just like Martina Hingis, I loved to watch how she could hit the ball with such pace and accuracy. Some of the best women athletes drive themselves to participate in this grueling sport, and, although tennis was once not the most popular sport, I still wanted to be one of these women. Throughout history, women competing in sports has been debated, and women were once excluded from sports entirely. Luckily, I was not born in this era. Within the last century, women have made complicated advances towards being created equal in sports. Broer discusses how women were once degraded from playing sports since the physical activity was considered unlady-like and masculine, but times are changing. When women tried to participate in athletic competitions, they were labeled as inferiors to the men and were thought to be unfeminine. The reason for this was the difference in upbringing of men and women. Men were taught to show evidence of physical strength and control; while on the other hand, women were expected to develop physical attributes and domestic abilities (201-223). Women broke through these stereotypical thoughts of being homemakers during the second part of feminism. This was precisely when doors began to open, and playing courts were allowing the shift in sports. Women's tennis was gaining national and global attention. The combination of elegance and athleticism in tennis was thought to be perfect for women. Women were only allowed to play in mixed gender tournaments.... ...ky.com. 2002 Aug 1. 2004 March 17. <http://www.twincities.com/mld/kentucky/sports/other_sports/3775992.htm>. Smith, Lisa. Nike is a Goddess: the History of Women in Sports. New York: Atlantic Monthly Pr., 1998: 135-149 "Special Report: Women and Minorities in Tennis". Tennis Industry. 1997 March/April. 14 March 2004. <http://www.tennisindustry.com/mar_apr1997/news.html#Women1>. Tennis Channel Quotes. 10 March 2004. 10 March 2004. <http://www.thetennischannel.tv/quotes.php>. "The Tennis Channel". Lexisnexis. 8 Jan. 2004. 15 March 2004. <https://web.lexisnexis.com/universe/document?_m=bd9aacf99e3b88fe751f9ce1a8f28998&_docnum=1&wchp=dGLbVtzzSkVA&_md5=4194a3fcba6e3f0903bb26231282f86c>. "Two-handed or One-handed Backhand?" United States High School Tennis Association. 17 March 2004. <http://www.ushstca.org/HSTMAG/202twohand.htm>.

The Effect Of Manual Therapy Health And Social Care Essay

The shoulder encroachment syndrome is one of the most common causes of hurting and disfunction in the jocks shoulder. Primary shoulder encroachment syndrome can happen in anyone who repeatedly or forcefully uses the upper appendage in an elevated place. The patho-mechanics of this syndrome implicate activities that repetitively place the arm in over caput places. Majority of jocks who manifest this status take part in baseball, swimming, cricket and tennis, but it is by no agencies confined to these athleticss. Repeated compaction of the subacromial contents causes micro-pockets of harm which finally summate as the activity is persisted with. Capsular stringency appears to be a common mechanical job in primary impingement syndrome. The resulting inflammatory reaction involves vascular congestion and hydrops into the sinew or Bursa which farther reduces the infinite beneath the coraco-acromial arch. This consequences in hurting that interferes with normal biomechanics of the shoulder by doing musculus encroachment and compensatory motions or positions. The importance of its acknowledgment is that encroachment is frequently a progressive status that, if recognized and treated early, can hold a more favourable result. Delay in acknowledgment and intervention can let secondary alterations to happen, with attendant restrictions in intervention options and functional results.1.2 THE MagnitudeThe magnitude of the job is attested by the fact that 30 to 60 per centum of competitory swimmers and 25 per centum of base ball hurlers and tennis participants incur this malady at some point during their callings. Recognition of the syndrome and early non-operative intercession are indispensable for a successful declaration and the return of jocks to their accustomed degree of public presentation. Most jocks start take parting in athleticss when they are comparatively immature, by adolescence many would hold experienced the symptoms normally known as â€Å" bursitis † , â€Å" cuffitis † , or â€Å" supraspinatus syndrome † . Impingement syndrome is by far the most common soft tissue hurt of the shoulder for which an jock seeks intervention.1.3 Mechanical FactorCapsular stringency appears to be a common mechanical job in primary impingement syndrome. The buttocks, anterior and inferior part of the capsule has been reported to be involved in this. Athletes or persons who avoid painful overhead activity or who are subjected to gesture instabilities as a consequence of their athleticss can develop capsular stringency which restricts joint mobility and prevent opposite way humeral caput semivowel taking to an earlier oncoming or greater grade of subacromial compaction and painful or limited map, peculiarly in elevated planes of motion.1.4 OVERUSE INJURIES: AN OUTLINEOveruse hurts in jocks are more common than traumatic and post surgical hurts to shoulder. The joint by structural default via medias on stableness for the interest of mobility. This poses a complex interaction of laxness, rotator cuff hurt ( Tensile tendonitis ) and impingement hurts ( Compression tendonitis ) taking to syndrome doing functional restriction. The etiology once more is attributed to patho-mechanics and can be classified into primary and secondary causes.Primary CAUSESPrimary encroachment i? ¶ Increased subacromial burden i? ¶ Acromial morphology ( A hooked acromial process, presence of an osacromiale or osteophyte, and/or calcific sedimentations in the subacromial infinite make patients more predisposed for primary encroachment. ) i? ¶ Acromioclaviculararthrosis ( inferior osteophytes ) i? ¶ Coracoacromial ligament hypertrophy i? ¶ Coracoid encroachment i? ¶ Subacromialbursal thickener and fibrosis i? ¶ Prominent humeral greater tubercle i? ¶ Trauma ( direct macrotrauma or insistent microtrauma ) i? ¶ Overhead activity ( athletic and nonathletic )Secondary CAUSESSecondary encroachment i? ¶ Rotator turnup overload/soft tissue instability i? ¶ Eccentric musculus overload i? ¶ Glenohumeral laxity/instability i? ¶ Long caput of the biceps tendon laxity/weakness i? ¶ Glenoid labral lesions i? ¶ Muscle instability i? ¶ Scapular dyskinesia i? ¶ Posterior capsular stringency i? ¶ Trapezius palsy1.5 NEED FOR THE STUDYThe usage of manual therapy as a portion of comprehensive rehabilitation attention is still non really popular and there are merely few surveies done in this peculiar country and needs more nonsubjective findings. It is this dearth my survey aims to bridge.1.6 SIGNIFICANCE OF THE STUDYThe specific hypotheses were that patients diagnosed with primary shoulder encroachment syndrome, treated with manual joint mobilisation combined with hot battalions, active scope of gesture, physiologic stretching, musculus strengthening exercisings, soft tissue mobilisation and patient instruction would see less hurting strength upon subacromial compaction testing and Greater active scope of gesture. My survey aims to sketch the benefits of integrating Manual therapy technique into intervention governments.1.7 OBJECTIVE OF THE STUDYThe aim of the survey is to measure the consequence of manual therapy ( Mulligan, Maitland ) as a constituent of comprehensive i ntervention for primary shoulder encroachment syndrome in athletic shoulder.1.8 HYPOTHESISThe void hypothesis for the survey is stated as follows:â€Å" There is no important difference in cut downing hurting and bettering scope of gesture and map on utilizing manual therapy techniques in overhead jocks with primary shoulder encroachment syndrome †2. LITERATURE REVIEWi Lo YP, Hsu YC and Chan KM conducted a survey in 372 participants and found that 163 individuals ( 43.8 % ) had shoulder jobs and 109 participants ( 29 % ) had shoulder hurting. The prevalence of shoulder hurting ranked highest among volley ball participants ( N= 28 ) followed by swimmers ( N= 22 ) , badminton, hoops and tennis ( Br.J.Sports Med, sep 1990 ) i Fluerst Ml has stated impingement syndrome to be one among the 10 most common athleticss hurts and impute it to unstable design of the joint. He suggests exercising to rotator turnup beef uping to keep the shoulder in topographic point and forestalling disruptions ( American Health Oct 1994 ) . i Fu FH, Harner CD and Klein AH classifies encroachment into 2 classs Primary and Secondary. Primary being caused by nonathletic hurts of supraspinatus sinew while secondary is caused by athletic hurts due to unstable forms of motion ( nerve-racking and end scopes ) . This they concluded will enable better clinical attacks. ( Clin. Orthop Aug 1991 ) . i Brox JL, Staff PH, Ljunggren AE & A ; Brevik JL used Neer shoulder mark and found that surgery and supervised exercising plan decidedly had an improved rotary motion when compared to placebo intervention. ( BMJ Oct 1993 ) . i Blevins FT has suggested categorization of rotator cuff hurt and disfunction based on etiology as primary encroachment, primary tensile overload and secondary encroachment and tensile overload ensuing from glenohumeral instability. Arthoscopic scrutiny shows anterior capsular laxness ( positive â€Å" thrust through mark † ) every bit good as superior posterior labral and cuff hurt typical of internal encroachment. If rehabilitation entirely is non successful a capsulolabral fix followed by rehabilitation may let the jock to return to their old degree of competition. Athletes with acute episodes of macrotrauma to the shoulder ensuing in turnup pathology normally presents with hurting, limited active lift and a positive â€Å" shrug-sign † . Arthroscopy and debridement of thickened, inflamed or scarred subacromial Bursa with cuff fix or debridement as indicated is normally successful in those who do non react to a rehabilitation plan. ( Sports Med.1997 ) . i Masala S et al. , in their survey on â€Å" Impingement syndrome of shoulder † have proved that CT and MRI are more dependable and accurate diagnostic methods. CT scan is sensitive to even cold-shoulder bony alterations and MRI detects tendon, Bursa and rotator turnup alterations. However they suggest obviously X raies to be performed as a first process. ( Radiol. Med Jan 1995 ) . This thought of MRI being sensitive to name encroachment has besides been confirmed by Rossi F ( Eur.J.Radiol. May 1998 ) . However, Holder J has concluded that distinction between tendinopathy and partial cryings might be hard utilizing MRI imagination. ( Radiologe Dec 1996 ) . i Corso G has emphasized the usage of impingement alleviation trial as an adjunctive process to traditional appraisal of shoulder encroachment Syndrome. This purportedly helps in insulating the primary tissue lesion. Such that conservative direction could be addressed to that specific construction ( J.ortho. Phys Ther, Nov 1995 ) . i Brossmann J and co-workers from the veterans disposal medical centre of California have stated that MR imagination of different shoulder places may assist uncover the pathogenesis of shoulder encroachment Syndrome. ( AJR Am. J Roentgenol. Dec 1996 ) . i Deutsch A, Altcheck DW et al. , have shown that patients with phase II and phase III encroachment had a larger scapulothoracic constituent than the normal shoulder during abduction motion. The superior migration of humeral caput is likely the consequence of turnup failure, either partial or complete. i Douglas E. Conroy and Karen W Hayes in their article on â€Å" Impingement syndrome in the athlete shoulder † have once and for all stated that the topics having joint mobilisation and comprehensive intervention would hold improved mobility and map compared to similar patients having comprehensive intervention entirely. Mobilization decreased 24-hour hurting and hurting with subacromial compaction trial in patients with primary impingement Syndrome. ( J Orthop Sports Phys. Ther. Mar 1998 ) . i Hawkins RJ and Hobeika PE in their article on â€Å" Impingement syndrome in the athlete shoulder † have once and for all stated that the impingement syndrome may slop over at any clip to affect the next biceps tendon, subacromical Bursa and acromio-claviular articulation and as a continuum, with the transition of clip, may eventuate in devolution and partial, even complete thickness, rotator turnup cryings subsequently in life. They besides recommend careful warm-up exercisings, occasional remainder by avoiding piquing motion and local modes of ice, ultrasound and transcutantaneous stimulation along with pharmacotherapy. They besides province surgical decompression and unequivocal acromioplasty could be performed. ( Cl. Sports. Med. Jul 1983 ) . i Bak K and Magnusson SP have emphasized that internal rotary motion might be much more affected than the external rotary motion which might do superior migration of humeral caput. They besides province that scope of gesture in shoulder demand non correlate with the happening of shoulder hurting. ( Am. J. Sport Med, Jul 1997 ) . i Homes CF and associates of University of Arkansas have concluded that intensive patient instruction, place plan, curative exercisings and specific manual mobilisation has better patient conformity and lesser abnormalcies on nonsubjective scrutiny after 1 year. ( J.Orthop. Sports. Phys. Ther. Dec 1997 ) . i McCann PD and Bigliani LU in their article on â€Å" Shoulder hurting in tennis participants † has emphasized rotator turnup and scapular musculus strengthening and surgical stabilisation of the capsulo-labral composite for patients who fail rehabilitation plan. Prevention of hurt in tennis participants seem to depend upon flexibleness, strength and synchronism among the gleno-humeral and scapular musculuss. ( Sports Med. Jan 1994 ) . i Carpenter JE et al. , in their article in MDX wellness digest have found out that there is an addition in threshold for motion proprioception by 73 % . This lessening in proprioceptive esthesis might play a critical function in diminishing athletic public presentation and in weariness related disfunction. Thought it is still dubious if developing improves the perceptual experience, this is an of import determination that has farfetched deductions in the intervention of shoulder impingement syndrome as weariness might be rather common with the lessening vascularity and injury to the construction of rotator turnup. ( Am. J. Sports Med Mar 1998 ) . i Scheib JS from university of Tennessee Medical Center has stated that overexploitation sydromes mandate remainder and control of redness through drugs and physical modes. He prescribed a gradual patterned advance of beef uping plan and any return of symptoms should be adequately and quickly appraised and treated. He emphasized that proper conservative intervention entirely prevents patterned advance of impingement syndromes. ( Rheum. Dis. Clin. North.Am Nov 1990 ) . i Morrrison DS and co-workers have shown that non operative intervention of shoulder encroachment syndrome resulted in important betterments. In their survey of 413 patients 67 % had a good recovery while 28 % had to travel for arthroscopic processs. Further age, gender and attendant tenderness of acromio-clavicular articulation did non impact the result significantly. ( J.Bone and Joint Surg. Am. May 1997 ) . i Brewer BJ has documented a structural alteration of the greater tubercle and progressive devolution of all elements of the sinewy constructions that is age related with progressive ( 1 ) osteitis of the greater tubercle, cystic devolution, and abnormality of the cortical border ; ( 2 ) degenerative sulcus between the greater tubercle and the articular surface ; ( 3 ) break of the unity of the fond regard of the sinew to the bone by Sharpey ‘s fibres ; ( 4 ) loss of cellularity, loss of staining quality, and atomization of the sinew ; ( 5 ) decline of the vascularity of the sinew ; and ( 6 ) dimmunition of fibrocartiage. ( Am J Sports Med, Mar-Apr 1979 ) . i Kinger A et al. , stated that volleyball participants have a different muscular and capsular form at the playing shoulder compared to the opposite shoulder. Their playing shoulder is depressed, the scapular lateralized, the dorsal musculuss and the buttocks and inferior portion of the shoulder capsule shortened. These differences were of more significance in volleyball participants with shoulder hurting than in volleyball participants without shoulder hurting. Muscular balance of the shoulder girdle is really of import in this athletics. It is hence imperative to include equal stretching and muscular preparation plan for the bar, every bit good as for therapy, of shoulder hurting in volleyball participants. ( Br J Sports Med, Sep 1996 ) . i Jobe FW, Kvitne RS, Giangarra CE in their article â€Å" shoulder hurting in the overhand or throwing athlete- the relationship of anterior instability and rotator turnup encroachment † , shoulder hurting in the overhand or throwing athlete can frequently be traced to the stabilising mechanisms of the glenohumeral articulation. i Flatow EL and associates of Orthopaedic Research Laboratoty, New York Orthopaedic Hospital, on the biomechanics of humerus with acromial process provinces that contact starts at the anterolateral border of the acromial process at 0 grades of lift, it shifts medially with arm lift. On the humeral surface, contact displacements from proximal to distal on the supraspinatus sinew with arm lift. When external rotary motion is decreased, distal and posterior displacement in contact is noted. Acromial bottom and rotator turnup sinews are in closest propinquity between 60 grades and 120 grades of lift ; contact was systematically more marked for type III acromial processs. Mean acromiohumeral interval was 11.1 millimeter at 0 grades of lift and decreased to 5.7 millimeters at 90 grades, when greater tubercle was closest to the acromial process. Contact centres on the supraspinatus interpolation, proposing altered jaunt of the greater tubercle may ab initio damage this rotator turnup part. Conditionss restricting external rotary motion or lift may besides increase rotator cuff compaction. Marked addition in contact with Type III acromial processs supports the function of anterior acromioplasty when clinically indicated, normally in older patients with primary encroachment. ( Am J Sports Med, Nov-Dec 1994 ) . i Hawkins RJ, Abrams JS in â€Å" Impingement syndrome in the absence of rotator turnup tear ( stages 1 and 2 ) † lay accent on prophylaxis in bad populations, such as hurlers and swimmers. Once symptoms occur, the bulk can be successfully managed with nonoperative steps. Prolonged failure of conservative attention prior to rotator turnup tear requires surgical decompression with predictable success in most. ( Orthop clin North Am, Jul 1994 ) . i Hjelm R, Draper C, Spencer S supported the construct that capsular ligament non merely supply restraint, but are specifically oriented to steer and focus on the humeral caput on the glenoid during shoulder motions. Glenohumeral ligament length inadequacy can be the primary cause of shoulder hurting, runing from frozen shoulder to impingement like symptoms.Proper capsular ligament length can be restored with manual techniques. All patients with shoulder hurting should hold capsular ligament appraisal to guarantee proper glenohumeral mechanics. ( J Orthop Sports Phys Ther, Mar 1996 ) . i Frogameni AD, Woodworth P in their survey on â€Å" Non- operative intervention of subacromial impingement syndrome † performed a retrospective survey of 616 patients and have shown that non-operative intervention of subacromial impingement syndrome resulted in important improvement.Overall,413 patients had a satisfactory consequence while others had to travel for arthroscopic processs. Besides, shoulder laterality, gender and attendant tenderness of the acromioclavicular articulation did non impact the consequence significantly. ( Arthroscopy ; 16 ( 1 ) :35-40 ) . i Pink MM et Al in their article â€Å" Arthroscopic findings in the overhand throwing jock: grounds for posterior internal encroachment of the rotator turnup † supported the construct of encroachment of the posterior turnup bottom with the posterosuperior glenoid rim in the overhand throwing athlete with shoulderpain. ( J Shoulder Elbow Surg ; 8 ( 2 ) :102-111 ) . i Gjengedal E et Al in their survey on â€Å" Arthroscopic surgery versus supervised exercisings in patients with rotator turnup disease ( phase II encroachment syndrome ) : a prospective, randomized controlled survey in 125 patients with a two-and-half twelvemonth followup † found that the success rate was higher for patients randomized to surgery ( 26 of 38 ) and exercises ( 27 of 44 ) compared with the placebo group ( 7 of 28 ) . ( Clin J Sport Med 2003 May ; 13 ( 3 ) :176-182. ) i Claude HC, Pierre Freemont in their article â€Å" Curative exercising and orthopaedic manual therapy for impingement syndrome: a systematic reappraisal † suggested that curative exercising or manual therapy benefited more when compared with other interventions such as acromioplasty, placebo or no intercession. Surveies were included if ( 1 ) they were a randomized controlled test ; ( 2 ) they were related to impingement syndrome, rotator turnup tendonitis or bursitis ; ( 3 ) one of the interventions included curative exercising or manual therapy. ( J Orthop Sports Phys Ther.1998 Jul ; 28 ( 1 ) :3-14. i Greenbaum BS, Einhorn A in their article â€Å" Shoulder encroachment † has stated that impingement rehabilitation focuses on beef uping the humeral caput depressors while disregarding the deltoid and supraspinatus musculuss. Later intervention includes specific retraining of scapular reconciliation musculuss. The concluding stage of intervention includes beef uping the premier humeral movers in places that avoid farther emphasis to the injured rotator turnup sinews and last of all specifically beef uping the supraspinatus musculus. ( Orthop Clin North Am.1997 Jan ; 28 ( 1 ) :69-78. i Roberts et Al ( 2002 ) used MRI to place and mensurate the alterations in anatomic constructions in the subacromial infinite as the arm was moved from complete remainder to 160 grade of forward flexure during the Hawkin ‘s and Neer encroachment tactics. They concluded that a clinically positive Hawkin ‘s mark is consistent with external shoulder encroachment. i Andy Finn in his article â€Å" Shoulder impingement physical therapy to halt the hurting and retrieve fast † has once and for all stated that shoulder encroachment upset can be resolved efficaciously with a professional plan of rehabilitation which is based on specific exercisings for the rotator turnup can cut down recovery times from months to hebdomads, cut downing hurting, redness and the demand for medical specialties, of course. i MacDonald et al. , compared the diagnostic truth of the Neer and Hawkin ‘s impingement mark to arthroscopic findings and stated that both trials were similar for happening rotator turnup disease but the Hawkin ‘s mark was more sensitive for subacromial bursitis. They concluded that when both the trials are negative there is a high degree of anticipation that rotator turnup tendinopathy, rupturing or bursitis can be ruled out. i Aimie F.Kachingwe et al. , found that MWM in combination with a supervised exercising plan resulted in a higher per centum of alteration ( but non statistically important ) from pre- to post-treatment in diminishing hurting and bettering map compared to the supervised exercising merely and command groups. i Pappas GP et Al. , in their article â€Å" In vivo anatomy of the Neer and Hawkins sign places for shoulder encroachment † has stated that the Neer and Hawkins impingement marks are normally used to name subacromial pathology. It was found that the Hawkins place resulted in significantly greater subacromial infinite narrowing and subacromial rotator turnup contact than the Neer place though both the manoeuvres significantly decreased the distance from the supraspinatus interpolation into the acromial process and posterior glenoid and from the subscapularis interpolation to the anterior glenoid. The intraarticular contact of the supraspinatus with the posterosuperior glenoid was observed in all topics in both places, which they stated that internal encroachment may play a function in the Neer and Hawkins marks. ( J Shoulder Elbow Surg 2006 Jan-Feb ; 15 ( 1 ) :40-49 ) . i Valadie et al. , in a survey described that there is consistent contact between the soft tissues and the coraco-acromial ligament and between the articular surface of the rotator turnup and the anterior superior glenoid during the Hawkin ‘s and Kennedy test.Edelson and Teitz reported contact between the lesser tubercle and antero-superior glenoid in the Hawkin ‘s and Kennedy test place. i MacDermid JC et al. , in their article â€Å" The shoulder Pain and Disability Index demonstrates factor, concept and longitudinal cogency † concluded that the SPADI is a valid step to measure hurting and disablement in community-based patients describing shoulder hurting due to musculoskeletal pathology. The SPADI is a self-report questionnaire to mensurate the hurting and disablement associated with shoulder pathology.Based on their survey the internal consistences of the SPADI subscales were high. ( BMC Musculoskeletal Disorders 2006,7:12 do1:10.1186/1471-2474-7-12 )3. MATERIALS AND METHODOLOGYThis survey is designed to affect Manual therapy as a constituent of comprehensive intervention for primary shoulder encroachment in athletic shoulder. The survey was carried out for one twelvemonth.3.1 STUDY DESIGNThe survey is conducted in the format of experimental pre trial, station trial survey design.3.2 STUDY SettingThis survey is conducted on jocks of Coimbatore athleticss n ine, when they had come to Sri Ramakrishna infirmary for shoulder hurting intervention. Informed consent was obtained from all the topics to transport out my thesis work after anterior referral from the physician in-charge.3.3 SamplingRandom trying A sum of 20 jocks with primary shoulder encroachment were divided into 2 groups of 10 each. Group A 10 jocks: – Mulligan mobilisation combined with Stretching and Strengthening exercisings. Group B 10 jocks: – Maitland mobilisation combined with Stretching and Strengthening exercisings.3.4 CRITERIA FOR SAMPLE SELECTIONEligibilityAge eligibility for survey: 18 Old ages to 35 Old ages Genders eligibility for survey: Male Accepts Healthy Volunteers: NoStandardsInclusion Standardsi Reproduction of symptoms with impingement trial: either Hawkins-Kennedy or Neer trial. i Pain about the superolateral shoulder part. i Pain during active shoulder lift at or above 60o. i Active scope of gesture shortage in humeral lift. i Limited functional motion forms in elevated places. i Positive clinical marks bespeaking subacromial encroachment symptoms ( SIS ) : hurting worsening with overhead activity ; a painful discharge, etc.Exclusion Standardsi History of capsular, ligament, sinew and labrum hurts. i Any recent surgeries carried out in and around shoulder articulation. i Traumatic shoulder disruption within the past 3 months. i Previous rehabilitation for this episode of shoulder hurting i Severe devolution bony or ligament alterations. i Primary shoulder blade thoracic disfunction. i Reproduction of shoulder hurting with active or inactive cervical gesture. i Systemic inflammatory joint disease. i Unstable break of humerus, shoulder blade and collarbone. i Any neurovascular co-morbidities of the involved upper appendage. i Any pathology around the shoulder like Periarthritis, Calcified tendonitis, Frozen shoulder, AC arthritis etc. i Global loss of inactive shoulder ROM, declarative mood of adhesive capsulitis.3.5 MAIN STUDYProcedure Athletes were indiscriminately assigned to two groups harmonizing to the block randomisation method Group 1- Mulligan mobilisation combined with Stretching and beef uping exercisings. Group 2- Maitland mobilisation combined with Stretching and beef uping exercisings. Block randomisation was used to guarantee that an equal figure of jocks were assigned to each intervention group and informed of their intervention protocol. Pre and post-treatment appraisal measurings were taken, the initial appraisal session occurred on the first twenty-four hours of the hebdomad of the physician scrutiny. The consequence of intervention was assessed based on the undermentioned dependent variables: –1. Pain-free active ROM measured with a standard goniometer for flexure and scaption.Pain-free shoulder fexion and scaption active ROM was measured with a cosmopolitan goniometer harmonizing to a standard process. Scaption was measured in standing by alining the goniometer axis over the coracoid procedure, the stationary arm analogue to the thorax and the traveling arm midplane of the humerus with the median epicondyle as a usher. Standardized goniometric measurings of glenohumeral gesture have been shown to hold good intrarater dependability and cogency.2. Measurement of shoulder map assessed with the shoulder hurting and disablement index ( SPADI ) .The numerically- scaly SPADI, a 13-item self-administered instrument mensurating shoulder functional and hurting position, has been shown to hold good test-retest dependability, reactivity, and/or cogency. The SPADI used in this survey was modified to ease capable apprehension by including equal-distanced hashed lines marked 0-10, with nothing labeled no pain/no functional restrictions and 10 labeled worst pain/unable to execute. If a topic chose to tag between the hashed lines, the inquiry was scored to the nearest 0.25.3. Hawkins- Kennedy trialThe Hawkins-Kennedy trial is performed by positioning the arm passively at 90A ° of shoulder fexion followed by the healer forcibly internally revolving the arm-a manoeuvre that besides directs the critical zone against the coracoacromial ligament. The sensitiveness of this manoeuvre has besides been found to be good.4. Neer trialThe Neer encroachment trial, conducted by inactive forward lift and internal rotary motion of the humerus with the shoulder blade stabilized, is deemed positive if the patient studies hurting, normally above 120A ° of shoulder lift when the critical zone of the rotator turnup sinew is compressed against the subacromial arch. The Neer trial has been found to hold fair to good sensitiveness for finding the presence of shoulder encroachment. All topics in the intervention groups ( Groups 1-2 ) received physical therapy for one hr each for three times per a hebdomad for four hebdomads harmonizing to the undermentioned protocols, and each session ended with topics having a cold battalion for 10-15 proceedingss to diminish possible redness and delayed musculus tenderness. Participants were instructed to execute a place exercising plan one time a twenty-four hours, Participants were besides educated in the etiology of shoulder encroachment syndrome and the importance of proper position, and they were instructed to modify overhead activities. Participants in Group 1, the exercising plus MWM group received the standard exercising protocol as per showed in Appendix ( No.5 ) plus glenohumeral joint MWM technique as described by Mulligan. This technique involved the healer using a sustained posterior accoutrement semivowel to the glenohumeral articulation while the topic at the same time actively flexed the shoulder to the unpainful end point and applied a soft overpressure force utilizing the contralateral arm ( Figure 3 ) in Appendix ( No.4 ) . Entire abolishment of hurting during the technique was compulsory ; if the patient started to see hurting during active gesture ; the healer would look into different force planes and/or classs of force until unpainful gesture was restored. This process was repeated for a sum of 3 sets of 10 repeats every bit long as unpainful gesture was sustained ; if hurting commenced during any repeat of any set, the technique was terminated. Participants in Group 2, the exercising plus mobilisation group received the standard exercising protocol as per showed in Appendix ( No.5 ) with add-on of glenohumeral joint mobilisation techniques as described by Maitland. Anterior, posterior, inferior semivowels, or long-axis distraction grade I-IV joint mobilisations were applied consequently ( Figure 2 ) in Appendix ( No.4 ) . For state of affairss where there was responsiveness within the capsular ROM, grade I-II mobilisations were applied. For state of affairss where there was no responsiveness but capsular hypomobility, grade III-IV accessary gestures were applied. Each mobilisation was applied for 30 seconds at a rate of about one mobilisation every 1 to 2 seconds, followed by a 30-second remainder. The 30-second mobilisation and resting Sessionss were repeated 2 extra times for a sum of 3 sets of 30- 2nd mobilisations.3.6 Materials USEDi Treatment sofa i Orthopedic Evaluation Chart. i Shoulder Pain And Disability Index ( SPADI ) i Goniometer. i Handheld weightsA ( Dumbbells ) . i Flexible gum elastic tube, a bungee cord, or a big gum elastic set.3.7 TREATMENT DURATIONGroup A: – Mulligan mobilisation combined with Stretching and beef uping exercisings for one hr each for three times per hebdomad. Group B: – Maitland mobilisation combined with Stretching and beef uping exercisings for one hr each for three times per hebdomad.3.8 DurationDuration of survey is 12 months. Treatment Duration is 4weeks/ alternate days/one hr a twenty-four hours.3.9 OUTCOME MEASURESi Pain and Shoulder disablement were assessed utilizing Shoulder Pain and Disability Index ( SPADI ) . i Active Range of Motion ( AROM ) : Flexure and Scaption were assessed utilizing Goniometer.3.10 Statistical AnalysisTwo tailed, Independent't ‘ trial was used to compare between groups on all descriptive and dependent variables. This will define the significance of betterment between the two groups. The t-test was calculated utilizing the expression: T = S = n1= figure of jocks in first sample group. n2= figure of jocks in 2nd sample group. x1= average difference of first sample group. x2= average difference of 2nd sample group. s = combined standard divergence.4. DATA ANALYSIS AND INTERPRETATIONThe survey was conducted in two groupsGROUP 1Athletes were treated with Mulligan mobilisation combined with Stretching and Strengthening exercisings.GROUP 2Athletes were treated with Maitland mobilisation combined with Stretching and Strengthening exercisings. Pre -test and station -test values were taken and the result was evaluated by utilizing the undermentioned tools Goniometer ( Active Range of Motion ) Shoulder hurting and disablement index ( SPADI ) The independent't ‘ trial was used for statistical analysisTable No. 4.1RANGE OF MOTION OF FLEXION, ABDUCTION FORGROUP I ( Mulligan Mobilization )S.NO. Flexure Abduction Pretest Post trial Pretest Post trial 1 133 167 80 174 2 128 155 92 150 3 120 166 87 164 4 136 169 90 173 5 138 167 79 175 6 123 154 77 164 7 127 154 90 170 8 134 164 95 170 9 120 165 87 166 10 117 158 93 170RANGE OF MOTION OF FLEXION – Group I( Mulligan Mobilization )RANGE OF MOTION OF ABDUCTION – Group I( Mulligan Mobilization )Table No. 4.2RANGE OF MOTION OF FLEXION, ABDUCTION FORGROUP II ( Maitland Mobilization )S.NO. Flexure Abduction Pretest Post trial Pretest Post trial 1 132 152 94 140 2 136 145 83 150 3 142 140 87 144 4 130 142 90 146 5 135 153 75 157 6 117 137 86 137 7 132 150 98 145 8 123 147 90 146 9 130 148 96 139 10 127 139 80 137RANGE OF MOTION OF FLEXION – GROUP II( Maitland Mobilization )RANGE OF MOTION OF ABDUCTION – GROUP II( Maitland Mobilization )Table No. 4.3SPADI PAIN, DIABILITY, TOTAL SCORE – Group I ( Mulligan Mobilization )S.NO. Pain Disability Entire Mark Pre trial Post trial Pre trial Post trial Pre trial Post trial 1 45 10 56 16 101 26 2 40 10 48 24 88 34 3 35 5 56 16 91 21 4 40 10 40 8 80 18 5 45 15 48 8 93 23 6 30 5 56 8 86 13 7 45 10 40 24 85 34 8 40 15 40 24 80 39 9 35 10 48 16 83 26 10 40 15 32 8 72 23SPADI PAIN – Group I ( Mulligan Mobilization )SPADI DIABILITY – Group I ( Mulligan Mobilization )SPADI PAIN, DIABILITY, TOTAL SCORE – Group I ( Mulligan Mobilization )Table No. 4.4SPADI PAIN, DIABILITY, TOTAL SCORE – GROUP II ( Maitland Mobilization )S.NO. Pain Disability Entire Mark Pre trial Post trial Pre trial Post trial Pre trial Post trial 1 40 15 40 24 80 39 2 30 10 56 8 86 18 3 45 10 32 8 77 18 4 40 15 48 16 88 31 5 35 5 40 24 75 29 6 40 5 32 16 72 21 7 30 10 56 16 86 26 8 40 15 48 24 88 39 9 45 10 40 8 85 18 10 35 20 56 24 91 44SPADI PAIN GROUP II ( Maitland Mobilization )SPADI DIABILITY – GROUP II ( Maitland Mobilization )SPADI PAIN, DIABILITY, TOTAL SCORE – GROUP II ( Maitland Mobilization )Table 4.5Summary OF DATA ANALYSIS FOR TWO GROUPS OF PRIMARY SHOULDER IMPINGEMENT SYNDROME S.No. Group Parameter Mean Sd. ‘t ‘ value 1. Group I Flexure Read-only memory 34.3 6.79 6.21 Group II 15.3 6.16 Group I Abduction ROM 80.6 10.17 4.93 Group II 56.2 10.83 2. Group I SPADI Pain 29 3.74 0.975 Group II 26.5 6.73 3. Group I SPADI DISABILITY 31.2 10.4 0.65 Group II 28 10.28 4. Group I Entire SPADI SCORE 60.2 10.97 1.223 Group II 54.5 8.65MEAN IMPROVEMENT BETWEEN RANGE OF MOTION OF FLEXION – Group I AND GROUP IIMEAN IMPROVEMENT BETWEEN RANGE OF MOTION OF ABDUCTION – Group I AND GROUP IIMEAN IMPROVEMENT BETWEEN PAIN-GROUP I AND GROUP IIMEAN IMPROVEMENT BETWEEN DISABILITY– Group I AND GROUP IIMEAN DIFFERENCE OF SPADI TOTAL SCORE –GROUP I AND GROUP II5. DiscussionThis survey shows the effectivity of Manual therapy as a constituent of comprehensive intervention for primary shoulder encroachment syndrome in athletic shoulder. The information analysis shows that there has been important decrease in hurting, addition in ROM and functional ability of shoulder articulation, in values of group 1 and group 2. Pain and shoulder disablement is measured by SPADI, the entire SPADI shows that average betterment of group 1 is 60.2 and group 2 is 54.5 with standard divergence of 10.97 and 8.65 severally. The independent ‘t ‘ value calculated for SPADI is 1.223 at 18 grade of freedom. This deliberate ‘t ‘ value is less than the table value of 2.101 at 0.05 degree of significance. Hence, we accept the void hypothesis. Therefore, there is no important difference in cut downing hurting and bettering map on utilizing Manual therapy technique in over caput jocks with primary shoulder encroachment syndrome. Sing hurting, the average betterment of group 1 is 29 and group 2 is 26.5 with standard divergence of 3.74 and 6.73 severally and for disablement the average betterment of group 1 is 31.2 and group 2 is 28 with standard divergence of 10.4 and 10.28 severally. For hurting the independent ‘t ‘ value is 0.975 and for disablement is 0.65. Since the values are less tha n the table values of 2.101 at 0.05 degree of significance we are accepting the void hypothesis. ROM is measured by goniometer, it shows that average betterment of flexure in group 1 is 34.3 and group 2 is 15.3 with standard divergence of 6.79 and 6.165 and for abduction the average betterment in group 1 is 80.6 and group 2 is 56.2 with standard divergence of 10.17 and 10.83. The ‘t ‘ value calculated for flexure is 6.21 and for abduction is 4.93. Since both the values are more than the table value of 2.101 at 0.05 degree of significance, we reject the void hypothesis. Therefore, there is a important difference in bettering ROM of flexure and abduction on utilizing Manual therapy technique in over caput jocks with primary shoulder encroachment syndrome. Statistical analysis showed that, The group 1 who underwent Mulligan mobilisation combined with Stretching and beef uping exercisings has more consistent betterment than the other group in increasing ROM. There was no important difference between the groups on cut downing hurting and bettering disablement.RestrictionThe continuance of the survey could non be extended for more than 12 months due to clip restraint. This survey did non include the jocks in phase 3 primary shoulder encroachment syndromes therefore the consequences of this survey can non be generalized to all patients with assorted phases of primary shoulder encroachment syndrome.6. DecisionIn this survey the effectivity of Manual therapy as a constituent of comprehensive intervention for primary shoulder encroachment syndrome in athletic shoulder, shows that Mulligan mobilisation combined with Stretching and Strengthening exercisings is effectual in increasing mobility. However, athletes improved significantly with all the two intervention schemes. From this survey it is suggested that Manual therapy techniques ( Mulligan and Maitland ) can be efficaciously used as a constituent of comprehensive intervention plan.6.1 RecommendationSince it is a clip edge survey, a survey with a big sample size and long term follow up can be done in hereafter. Surveies can be compared with other use techniques. Surveies can be carried out in bilateral primary shoulder encroachment syndrome.

Free Essays on Christopher Columbus

Christopher Columbus (1451-1506) Christopher Columbus was an outstanding navigator and organizer of expeditions. He achieved fame by sailing west across the Atlantic Ocean in search of a sea route to Asia. He did not accomplish this goal. Instead, he encountered islands in the Caribbean Sea. At that time, the people of Europe and the Americas did not know of each other's existence. During his four voyages westward-between 1492 and 1504-Columbus explored what are now the West Indies and the coasts of Central and South America. Columbus was not the first European to reach the Western Hemisphere. The Norse(also called the Vikings) had settled for a time on the coast of North America about A.D. 1000. That contact did not last, and most Europeans of the 1400's did not know it had taken place. Columbus' voyages led to enduring links between the Eastern and Western hemispheres. The World of Columbus When Columbus was born in 1451, Europe was struggling against the growing power of the Ottoman Turks, who had conquered much of southeastern Europe. In 1453, the Ottomans took control of Constantinople (now Istanbul, Turkey), a major center of trade between Europe and Asia. The ottomans made Constantinople the capital of their empire, cutting off easy European access to Asian goods. The only alternative to a difficult, dangerous land journey was a sea route-either around Africa or westward across the Atlantic. The desire for a sea route to Asia started a remarkable wave of European exploration, even though Europe had limited resources. European explorers combined the seafaring skill of the Italians with the resources of the Portuguese and the Spanish. Europe constantly improved its ships and navigational aids, as well as its arms for trading and a desire to preach Christianity worldwide. Early Years Boyhood. The exact date of Christopher Columbus' birth is not known. He was born sometime between August... Free Essays on Christopher Columbus Free Essays on Christopher Columbus Christopher Columbus is often described as â€Å"one of the greatest mariners in history, a visionary genius, a mystic, a national hero, a failed administrator, a naà ¯ve entrepreneur, and a ruthless and greedy imperialist†. Throughout history, his story has been referred to in all situations, some were good and some were bad. But all who teach and hear the story agree that without him, the world would be different. There were many different ways Christopher Columbus’ voyages were viewed. His voyages expressed the general political, social, and scientific outlook of the fifteenth century in many ways. Through every thing he had the determination and strength to get through even when he had no support. From the political outlook, not many â€Å"high up† people believed in what Christopher Columbus was setting out to accomplish. He had tried unsuccessfully to enlist support for his project. He presented his intentions to many different people to ask for support. Through a combination of good luck and persuasiveness, he finally was offered help from Catholic monarchs, Queen Isabel and King Fernando, who agreed to back him up. They agreed to Columbus’s demands on the condition that he would be successful on his first voyage. He was to be rewarded with â€Å"being knighted, appointed Admiral of the Ocean Sea, made the viceroy of any new lands, and awarded ten percent of any new wealth. He took his three ships, the Santa Maria, the Nina, and the Pinta. After the voyage of 1492, the widely published reports made Columbus famous. Political support was no longer hard to come by, and he earned the title of â€Å"Admiral of the Ocean Sea† and further royal patro nage. Not only did the political outlook change, so did the social outlook. Before Christopher Columbus set sail, his fellow mariners thought he was wasting his time with mere dreams and idealistic fantasies. After receiving support from Queen Isabel and King Fernando, he se... Free Essays on Christopher Columbus Christopher Columbus (1451-1506) Christopher Columbus was an outstanding navigator and organizer of expeditions. He achieved fame by sailing west across the Atlantic Ocean in search of a sea route to Asia. He did not accomplish this goal. Instead, he encountered islands in the Caribbean Sea. At that time, the people of Europe and the Americas did not know of each other's existence. During his four voyages westward-between 1492 and 1504-Columbus explored what are now the West Indies and the coasts of Central and South America. Columbus was not the first European to reach the Western Hemisphere. The Norse(also called the Vikings) had settled for a time on the coast of North America about A.D. 1000. That contact did not last, and most Europeans of the 1400's did not know it had taken place. Columbus' voyages led to enduring links between the Eastern and Western hemispheres. The World of Columbus When Columbus was born in 1451, Europe was struggling against the growing power of the Ottoman Turks, who had conquered much of southeastern Europe. In 1453, the Ottomans took control of Constantinople (now Istanbul, Turkey), a major center of trade between Europe and Asia. The ottomans made Constantinople the capital of their empire, cutting off easy European access to Asian goods. The only alternative to a difficult, dangerous land journey was a sea route-either around Africa or westward across the Atlantic. The desire for a sea route to Asia started a remarkable wave of European exploration, even though Europe had limited resources. European explorers combined the seafaring skill of the Italians with the resources of the Portuguese and the Spanish. Europe constantly improved its ships and navigational aids, as well as its arms for trading and a desire to preach Christianity worldwide. Early Years Boyhood. The exact date of Christopher Columbus' birth is not known. He was born sometime between August...

The New Career Path for Headmasters - Then and Now

The New Career Path for Headmasters - Then and Now The route to the headmasters office has changed. Once upon a time, the headmaster, often referred to as the head of a school, was almost certainly somebody with teaching and administrative experience. Better yet, he or she was an alumnus or an alumna - an old boy or an old girl, well connected and respected within the community. However, in an increasingly competitive marketplace with higher expectations placed on schools, the profile of the head of school is changing. To be sure, its a gradual change. But its a change nonetheless, and its occurring because the challenges facing a head of school these days require experiences and skill sets not usually found in a person who is first and foremost an educator. The Way It Used to Be For years, the way to the top of the private school organization chart was through the hallowed halls of academe. You graduated from college with a degree in your subject. You were engaged as a teacher, coached your team sport, kept your nose clean, married acceptably, raised some children of your own, became dean of students, and after 15 or 20 years you were in the running for head of school. Most of the time that worked just fine. You knew the drill, understood the clientele, accepted the curriculum, made a few changes, tweaked the faculty appointments ever so slightly, steered clear of controversy, and magically, there you were: receiving a nice check and being put out to pasture after 20 years or so as head of school. The Way It Is Now Life got complicated in 90s, however. Years ago, it used to be that the head could run his school simply by looking out his office window and observing what was going on. A periodic look in at the faculty lounge and an occasional meeting with alumni and parents to raise some money - it all was pretty straightforward. Even a bit dull. Not any more. The head of a private school in the new millennium has to have the executive ability of Fortune 1000 executive, the diplomatic skills of Ban Ki-moon and the vision of Bill Gates. S/he has to deal with substance abuse. S/he has to be politically correct. His graduates have to get into the right colleges. He has to raise millions for this project and that. He has to sort through legal issues which would numb the mind of a Philadelphia lawyer. He needs the diplomatic skills of an ambassador to deal with parents. His technology infrastructure costs a fortune and doesnt seem to have improved teaching at all. On top of all this, his admissions department now has to compete for students with several other schools which years ago could hardly be considered the competition if they existed at all. CEO vs Educator Many people first acknowledged this shift in  the summer of 2002, when Mayor Michael R. Bloomberg of New York City surprised the masses by  appointing a lawyer/executive with no formal educational administrative training as Chancellor of the New York City schools. As CEO of the Bertelsmann, Inc. media conglomerate, Joel I. Klein brought vast business experience to that most complicated of assignments. His appointment served as a wake up call to the educational establishment as a whole that new and imaginative approaches to school administration are needed. This was only the first step in what soon became a rapidly changing environment.   Private schools shifted from viewing themselves solely as academic institutions to operating under dual roles: schools and businesses. The academic side of operations continues to grow and flourish with the changing times, often faster than the business side of these elite institutions. However, heads have begun to acknowledge the need for augmented admission offices to recruit students, development offices to raise money to support school operations, and business offices to better manage the daily financial needs of schools and their communities. The need for strong marketing and communications has also become apparent, and continues to grow rapidly, with schools employing large offices of skilled professionals working to develop new target audience.   The new heads role isnt to simply ensure that everything plugs along in terms of day to day tasks. But rather, the new head is responsible for leading a powerful group of professionals who are working to ensure that the school thrives in difficult and at times, downright volatile market conditions. While the head isnt expected to know how to do everything, he or she is expected to provide clear and concise goals and strategic vision.   The biggest, and often hardest change for many to swallow is the need to  see families as customers and not only as parents of students with malleable minds which need solid training, nurturing and direction for success in later life.  Ã‚   Characteristics to Look for Choosing the right head is critical part of moving your school successfully through changing circumstances and financial tough times. Given the large number of constituencies within a school community you will need to find a strategic leader and consensus builder. A good head listens well. S/he understands the widely differing needs of parents, faculty and students, yet demands the partnership and cooperation of all three groups to accomplish his educational goals. S/he is a skilled sales person who has a solid grip on the facts and can articulate them convincingly. Whether s/he is raising money, speaking at a seminar in his area of expertise or addressing a faculty meeting, s/he represents and sells the school to everybody s/he encounters. A good head is a leader and an exemplar. His vision is clear and well thought out. His moral values are above reproach. A good head manages effectively. S/he delegates to others and holds them accountable. A good head doesnt have to prove himself. He knows what is required and accomplishes it. Hire a Search Firm The reality is that to find this person, you may have to spend some money and hire a search firm to identify suitable candidates. Appoint a search committee which can include trustees as well as representatives from your school community such as a student, a faculty member and an administrator. The search committee will vet the applicants and present a candidate for the board of trustees approval. Hiring a new headmaster is a process. It takes time. If you do it right, you have charted a path for success. Get it wrong and the results could be just the opposite.

Product Development and Packaging Essay Example | Topics and Well Written Essays - 2000 words

Product Development and Packaging - Essay Example Some of the well-informed customers often figure out what improvements need to be made before other customers are aware. Some ideas are also arrived at by figuring what the products lack and rushing to bridge the gap. Sony is known for its innovative products. With Apple iPod being a tremendous success with a market share of 80% in the digital portable media player market and sold over 30 million iPod devices by 2005. A market research of about 20,000 iPod consumers was undertaken in order to receive a feedback. The sample was random and consisted of subjects surveyed in diverse geographical areas of the country. The target segment included current iPod users and future iPod purchasers as well as those who were planning to purchase a home theatre system or a high-level stereo system within the next year. The fact that emerged most often was that multiple numbers of speakers were utilized to project sound in the room, and this was slightly cumbersome and the positioning required some effort. The separate speakers like the Dolby Surround Sound 5.1 standard based speakers, required several wires to be installed and once the speakers were installed, their positions were fixed and hence the sound was confined to the one spot. Portability was an issue. The survey subjects welcomed the idea of a single integrated speaker doing the work of the multiple ones. Idea generation Brainstorming sessions were held to discuss the gap in the market for such a product. With the spark for an idea generated, the cross-functional team consisting of consisting of engineers, market researchers, financial analysts and advertising agencies met to discuss and develop the concept. The benefits of having a cross-functional team served to bring in expertise from all related departments. The diversity of the team members brought in different cultural viewpoints that added to decision making potential. It helped reduce inefficiencies because problems were addressed in the initial process itself, rather than addressing them afterwards, that might have proved costly at the end of the product development process. The idea generation sessions that were on going, specific and involved, resulted in several viable alternatives. These were carefully screened to see if they aligned closely to the goals and strategy of Sony they were compatible to the existing production and packaging lines could be marketed through the current distribution channels and promotional expenditure that would be required Concept Development and Testing Careful analysis of the concept design, product/packaging prototype, justification, feasibility, delivery model was undertaken. The need for an integrated speaker replacing several speakers capable of throwing sound to various areas in the room was an exciting product idea to pursue. The ability of a transportable speaker that would be versatile and more usable was a stimulating concept. The product would be Sony's new spherical speaker that can be placed in the middle of a room to project sound in all directions. This would be instead of the consumer having to buy many speakers to project the sound inwards. It

Home Health and Hospice Essay Example | Topics and Well Written Essays - 750 words

Home Health and Hospice - Essay Example Medicare is composed of three parts; Part A, Part B, and most recently part D. Part A and B were the initial divisions of the Medicare Program. Part A covers the health care received in hospice and health care without monthly premiums. It is the insurance portion of Medicare. Part B covers doctors’ services as well as other outpatient care absent in part A with an added monthly premium, which in 2008 cost about $96.40 every month (Shi & Singh, 2010). Changes in payment permitted people to make hospice services payment on a prospective basis under four care levels and adjusted by the wage index in an area. The local adjustment was important because it allowed low rates in regions with low wage levels and high rates in regions with high wage levels. This was followed by a new wage index, which comprised of a mix of both new and old wage indexes however; the new index was still based on hospital wage data. The Medicare hospice rates also varied according to the level of care that a beneficiary received. Initially, the payment system by Medicare was linked to the â€Å"Balanced Budget Act of 1997 (BBA)†, and it had a huge influence on the number of home health as well as hospice care agencies. Initially, the implementation of BBA led to the exit of these agencies from the market as it reduced medical reimbursement, and the number of providers. Implementation of the prospective payment system (PPS) generated improved growth and financial stability of agencies. It stopped the decline in the number of home health providers. With the PPS, Medicare paid home health and hospice providers for every 60-day â€Å"episode of care.† The amount paid for the 60-day period was a set amount based on a standard rate and adjusted to the type as well as the intensity of care offered known as a case mix formula. The home health PPS depended on a 153-category case mix adjuster to set payment rates anchored in patients attributes like functional status, clinical ri gorousness, and the requirement for rehabilitative therapy examinations (Shi & Singh, 2010). Initially, Medicare hospice coverage consisted of 290-day benefit periods and an indefinite number of 60-day benefit time. Coverage can extend beyond this period given that a six-month prognosis is the doctor’s best estimate. There is also provision for patients to move out of and back into hospice care. When out of the care, patients regular Medicare or other insurance cover them. Medicare reimburses the providers of home health and hospice care on a per diem basis. This kind of payment covers all services offered by the hospice (Shi & Singh, 2010). There are numerous different rates that vary according to the level and type of care offered. Concerning eligibility for home and health care under Medicare, a patient has to present a medical justification to qualify hospice and home health benefits. Initially, eligibility criteria varied, depending on the hospice program. However, patie nts had to have a progressive, irreversible illness limited life expectancy, and they had to opt for palliative care instead of cure-focussed treatment. The presence of a family member or another caregiver was required continuously when the patient was no longer able to care for him or herself. Initially, for a person to be qualified for Medicare benefits, he or she had to be qualified f