Rheumatoid Arthritis Physiology

Rheumatoid Arthritis Physiology Introduction Rheumatoid Arthritis (RA) is defined as a chronic, autoimmune condition that affects 400,000 people in the UK (Cooney et al. 2010). It is both bilateral and symmetrical in pattern and is typically presented in individuals between 30 to 50 years with females being more afflicted than men (Cooney et al. 2010). Although, RA is of unknown aetiology, causes are said to be both genetic and environmental in nature (Abhishek et al.2010). More specifically, inflammation, inactivity and loss of mechanical stability around joints plays a role in causing pain, stiffness and swelling of multiple joints. Consequently, long-term effects of RA been associated with reduced muscle strength (Ekbolm et al. 1974) and aerobic capacity (Minor et al. 1988). Currently, there is no cure for RA and therefore, management emphasizes on decreasing symptoms and promoting quality of life through either Drug Modifying Anti-Rheumatic drugs (DMARDs) or physiotherapy (Arthritis Research, UK). Indeed, DMARDs are a first line treatment for RA; however, not everyone responds adequately to DMARDs (Smolen and Keystone, 2012) and RA patients usually refrain from using this due to the potential occurrence of life-threatening side-effects (Kinder et al. 2005). Today, physiotherapy for those with RA consist of many passive interventions such as patient education, delivery of heat or cold, massage and electro-magnetic energy (Wasserman,2011). However, despite earlier fear of aggravation of symptoms, increased disease activity and joint damage, there is now scientific evidence showing that exercise is safe and beneficial; making it an imperative part of rehabilitation (Stenstrom and Minor, 2003). Specifically, the most valued by RA patients is Hydrotherapy treatment (Hall et al. 1996) due to its ability to alleviate symptoms suddenly through exercising in water. The use of water properties such as buoyancy and warm temperatures enables patients to move freely through decreased weight bearing on joints, increased range of motion and reduced pain (Campion, 1997). Although, Hydrotherapy is growing significantly in popularity, literature in regards to the effectiveness of Hydrotherapy for RA has not been evaluated adequately. For example, Eversden et al. (2007) concluded that the Hydrotherapy group reported a greater perceived benefit in comparison to the land-based exercise group after six weeks. Importantly, these authors conducted a fairly well-designed study in that they took some precautions to eliminate bias through true randomization and concealment processes. However, these findings were not reflected in the physical functional or pain scores. Alongside this, there was a greater number of participants in the Hydrotherapy group compared to the Land-based group leading to potential biases. Secondly, Hall et al. (1996) found that all groups assessed (Hydrotherapy, Seated Immersion, Land Exercise and Progressive Relaxation) demonstrated joint tenderness and pain relief. However, Hydrotherapy presented the most improvements (26% mean decrease) after 4 weeks treatment. This study demonstrates strengths over Eversden et al. (2007) in that they had assessed disease activity rather than just improvements in functionality. However, it was not clearly stated whether or not improvements in Hydrotherapy group were statistically significant and treatment dosage, if longer (>4 weeks) could have produced a greater therapeutic effect. Thirdly, Bilberg and Mannerkorpi (2005) found significant improvements in muscle function and endurance of upper and lower extremities and grip force. However, this was not supported by an increase in aerobic capacity as indicated by their hypothesis and primary outcome measure (Cycle Ergometer Test; Astrand 2006). Unlike, Eversden et al. (2007) and Hall (1996) this study reported intensity of exercise (70% of HR) and addressed longer term effects (12 weeks). However, sample size was small (46 patients) and temperature of pool was not specified, making it difficult to generalise data. Overall, there was inadequate reporting of depth, temperature of pool, type and intensity of exercises. Although, outcome measures differed between studies, they were appropriate for use (Al-Qubaiessy et al). Therefore, there is some evidence showing that Hydrotherapy plays a role in reducing pain (Hall et al. 1996). Finally, this highlights the importance of using standardised exercise procedures, longer term-interventions especially as RA is a chronic condition. This will help in making specific recommendations. Therefore, in accordance to PICO, my research question is The long term effects of using specific Hydrotherapy exercise protocols: Aqua-Aerobics Programme and The Bad-Ragaz Ring Methods for RA. A randomized Controlled Trial. Research Design From a pragmatic viewpoint, a mixed methods approach will be best-suited for this study as pain is a multi-dimensional phenomenon. However, a positivist would argue that this study should be carried out only objectively as this would allow generalizable conclusions to be drawn (Brooms and Willis, 2007). Alongside this, they would argue that researchers are detached from the investigation, thereby reducing bias (Bryman, 2004). Contrastingly, an interpretivist would support a qualitivate approach which would allow greater and richer insight into patients perceptions of pain (Bryman, 2001). Therefore, yielding both qualitative and quantitative data will help increase findings and reliability of results (Bryman, 2004). For example, this study will be able to assess the subjective nature of pain whilst still observing the relation between pain and disease activity objectively. Thus, taking this stance, will allow to address the biopsychosocial approach rather just a biomedical model of care objectively (Engel, 1977). Finally, an experimental, embedded design will be used in this study. Alternatively, an interpretivist would use a case-study that assesses an individuals experiences; this will have high ecological validity but lacks the ability to produce generalizable conclusions.ÂÂ   By employing a multi-faceted approach, it will strengthen causal inferences by providing the opportunity to observe data convergence or divergence in hypothesis testing (Abowitz and Tool, 2010). Research Method In line with Rogers et al. (2003), the embedded experimental design utilised in this study will involve a two-phase sequential approach (Creswell et al. 2005). This will include qualitative analysis carried out before intervention to inform the development of the treatment and after to help explain treatment outcomes (Figure 1). Figure 1: Experimental Embedded Design. (Creswell 2005). Alongside this, an RCT will be used. In accordance to the hierarchy of evidence an RCT is suggested to be one of the most powerful in research (Akobeng, 2005) due to its ability to reduce risk of bias and systematic error (Bryman, 2004; Suresh, 2011). Contrastingly, a cross-over design would be difficult due potential carry-over effects even with a washout period (Saks and Allsop, 2013). Intervention Details The CONSORT statement will be used in order to enhance completeness and transparency of the study (Schulz et al. 2010). For example, attrition bias will be reduced through reporting drop-outs and reasons for this will also be included (Schulz et al. 2010). Reporting of eligibility criteria is essential to determine whether results can be applied to others in the same condition (Bluml et al. 2011).ÂÂ   In this instance, patients (men and women) aged 18+ (in line with the American College of Rheumatology) with chronic RA who meet Steinbrocker Functional Class I, II, or III (Steinbrocker, 1949) will be recruited from NHS outpatient settings in the West Midlands. Those who sustain a steady drug intake for 30 days in relation to Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) 3 months and DMARDs will be included in the trial. Although injections and corticoid injections in the 4 weeks leading up to the study will not be permitted, drug changes and injections will be during; this reflects the pragmatic nature of this study. Consequently, recruiting in this manner will increase ecological validity as it represents a real-world situation (Broom and Willis, 2007). Those, which have received physiotherapy treatment within 30 days of assessment will be excluded in order to avoid any carry over effects. Also, patients who have had joint-replacement surgery within the last 6 months will be excluded. Likewise, contraindications of exercise and immersion in water needs to be taken into account (e.g. patients with uncontrolled epilepsy or fear of water) will also be excluded. It is true that greater exclusion criteria can reduce generalisability of results. However, such steps have to be taken in order to eliminate occurrence of confounding data which could potentially have a negative impact on the results of the clinical trial (Broom and Willis, 2007) Group Details Patients will be randomized using sealed opaque envelopes with treatment allocation. Random sequence of numbers will be established through flipping a virtual coin (Eversden et al. 1996) to either: Hydrotherapy 1 (Aqua Aerobics Group) (Eccentric, Concentric Exercises). Hydrotherapy 2 (The Bad Ragaz-Ring Group). Home-Exercise group that continue with daily activities. Unlike previous research (e.g. Hall 1996; Eversden et al. 1996), this study will consider intensity at moderate level (70%) as it has been shown to demonstrate physiological improvements (Astrand, 1986); assessed via a heart rate monitor throughout sessions. Additionally, depth of pool will be just under chest height whereby 50%+ of bodyweight is offloaded through buoyancy and hydrostatic pressure has been suggested to reduce swelling at this level (Becker, 2009). Importantly, temperature will range from 33.5-35.5 degrees which is safe and sufficient enough to produce therapeutic benefits (Becker, 2009). Finally, treatment dosage will be twice a week consisting of 30 minute sessions for a 20 week period. This will address longer-term effects. Outcome Measures A research assistant blinded to the treatment allocations will evaluate the outcomes measures in order to reduce detection bias. Bilberg and Mannerkorpi (2005) used a C Reactive Protein (CRP) (i.e. higher levels demonstrates active inflammation) in order to test assess disease activity. However, it is said that more than 40% of RA patients have normal CRP levels (Sokka and Pincus, 2009), thus decreasing validity and clinical applicability. Therefore, this study will use Magnetic Resonance Imaging (MRI) as the primary objective measure due its ability to present visual aspects of inflammation within the synovial membrane; shown to be a superior method and very relevant for RA (e.g. Østergaard, 2009) (Figure 1). This will be taken, baseline and post treatment for all groups. Secondary outcome measures will include Visual Analogue Scale (VAS) (Figure 1) assessed on a 10cm scale, whereby 0cm indicates no pain. This is widely used to assess rheumatic diseases and a number of studies have established data showing that VAS results are very reproducible (e.g. Dixon and Bird, 1981).ÂÂ   Other physical measures will include the Ritchie Articular Index in order to assess joint tenderness; intra-reliability of this test has been shown to be acceptable (Levy and Dick, 1975) and is easy to perform. Finally, aerobic capacity will be analyzed through a submaximal test in accordance to Astrands Principle (Astrand and Rodahl, 1986); shown to have satisfactory reliability in RA populations (e.g. Mannerkorpi and Ekdahl, 1997). Both of which taken pre-post. Statistical Considerations and Analysis Analysis will be completed via the Fishers exact test and continuous variables by Wilcoxon signed rank tests for within group comparisons. Importantly, data analyses will be completed according to the intention to treat principles. Ethical Considerations In line with Beauchamp and Childress (2001) it will be essential to have respect for autonomy. Respecting this value, means to protect participants through data protection/confidentiality and ensuring they are adequately informed about what is proposed. In order to keep data anonymised personal details of quantitative data sets will be replaced with numbers. Most importantly, informed consent will be obtained before commencing the study to ensure participants are not subject to an intervention they do not want. To further fulfil these requirements, an information sheet for participants will be written which will also state risks as well as what data will be used for. Conclusion The main advantage of this study is that is assesses disease activity on a physiological level objectively and also observes the impacts subjectively via VAS scale; an unpopular approach in the Hydrotherapy literature (E.g. Hall, 1996, Bilberg et al. Eversden et al, 2007). Findings from this study, will hopefully assist in creating structured and standardised exercise programmes that could be used throughout healthcare systems. Finally, limitations of this study include the high costs that are associated with MRI scans and Hydrotherapy facilities. Nevertheless, this will address the longer term effects of Hydrotherapy for RA. Referenced Material Abhishek, A., Butt, S., Gadsby, K., Zhamg, W. Deighton, C.M. (2010). Anti-TNF-alpha agents are less effective for the treatment of rheumatoid arthritis in current smokers. Journal of Clinical Rheumatology. 16(1): 15-8. Abowitz, D.A. and Toole, T.M. (2010). Mixed Method Research: Fundamental Issue of Design, Validity, and Reliability in Construction Research. Journal of Construction Engineering and Management. 136 (1). Akobeng, A.K. (2005). Understanding Randomised Controlled Trials. Archives of Disease in Childhood. 90. 840-844. Ã…strand, P.O. Rodahl, K. (1986) Textbook of Work Physiology, 4th edition. New York: McGraw- Hill, 1986. Beauchamp T. and ChildressÂÂ   (2001). Principles of medical ethics. Fifth Edition. New York: Oxford University Press Becker, B. (2009). Aquatic Therapy: Scientific Foundations and Clinical Rehabilitation Applications. American Academy of Physical Medicine and Rehabilitation. 1. 859-872. Bilberg, A., Ahlmen., M. Mannerkorpi, K. (2005). Moderatley Intensive Execise in a Temperate Pool for Patients with Rheumatoid Arthritis: A Randomized Controlled Study. Rheumatology. 44: 502-508. Blumle, A., Meerpohl, J.J., Rucker, G., Antes, G., Schumacher, M. and Elm, E.V. (2011). Reporting of Eligibility Criteria of Randomised Trials: Cohort Study Comparing Trial Protocols with Subsequent Articles. British Medical Journal. 342. 18-28. Broom, A., and Willis, E. (2007). Competing paradigms and health research. In Mike Saks and Judith Allsop (Ed.), Researching health: Qualitative, quantitative and mixed methods (pp. 16-31) London: Sage. Bryman, A. (2001) Social Research Method, 1st Edition. Oxford: Oxford University Press. Bryman, A. (2004) Social Research Methods. 2nd ed. Oxford: Oxford University Press Campion, M.R (1997). Hydrotherapy: Princples and Practice. Oxford: Butterworth-Heinemann. 3-24. Cooney, J.K., Law, R.J., Matschke, V., Lemmey, A.B., Moore, J.P., Ahamd, Y., Jones, J.G., Maddison, P. and Thom, J.M. (2011). Benefits of Exercise in Rheumatoid Arthritis. Journal of Aging Research. 1-14. Creswell, J.W., Clark, V.I., Gutmann, M. and Hanson W. (2003). Advanced Mixed Methods Research Designs. In A. Tashakkori, A. and Teddlie, C. (Eds). Handbook of Mixed Methods in Social and Behavioural Research (pp. 209-240). Thousand Oaks, CA: Sage. Dixon, J.S. and Bird, H.A. (1981). Reproducibility along a 10 cm vertical visual analogue scale. Annals of the Rheumatic Diseases. 40. 87-9. Ekblom, B., Lovgren O., Alderin, M., Fridstrom, M. Satterstrom G. (1974). Physical Performance in Patients with Rheumatoid Arthritis. Scandinavian Journal of Rheumatology. 3(3): 121-5. Eversden, L., Maggs, F., Nightingale., P. Jobanputra, P., (2007). A pragmatic randomised controlled trial of hydrotherapy and land exercises on overallÂÂ   well being and quality of life in rheumatoid arthritis. BMC Musculoskeletal Disorders, 8(1), p.1. Hall, J., Skevington, S.M., Maddison, P.J. Chapman, K., 1996. A randomized and controlled trial of hydrotherapy in rheumatoid arthritis. Arthritis Rheumatism, 9(3), pp. 206-215. Kinder, A.J., Hassell, A.B., Brand, J., Brownfield, A., Grove, M. and Shadforth, M.F. (2004). The treatment of inflammatory arthritis with methotrexate in clinical practice: treatment duration and incidence of adverse drug reactions. Rheumatology.44 (1): 61-66. Minor, M.A., Hewett, J.E., Webel, R.R., Dreisginer, T.E. Kay, D.R. (1988). Exercise Tolerance and Disease Related Measures in Patients with Rheumatoid Arthritis and Osteoarthritis. The Journal of Rheumatology. 15(6): 905-11. Saks,M. and Allsop,J. (2013) Researching Health: Qualitative, Quantitative and Mixed Methods. 2nd ed. London: Sage Schulz,K., Altman,D. and Moher,D. (2010) CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials. British Medical Journal, 340:698-702 Smolen, J. and Keystone, E.C. (2012). Rheumatoid Arthritis: Where are we now? Pathogenesis, treatment response and tailored therapy. Rheumatology. 51(5). 18-20. Steinbrocker 0, Traeger C.H. and Batterman RC. (1949). Therapeutic criteria in rheumatoid arthritis. Journal of The American Medical Association. 140: 659-662. Stenstrom, C.H. and Minor, M.A. (2003). Evidence for the benefit of aerobic and strengthening exercise in Rheumatoid Arthritis. Arthritis Care Research. 49(3). 428-434. Sokka, T. and Pincus, T. (2009). Erythrocyte Sedimentation Rate, C-Reactive Protein, or Rheumatoid Factor Are Not Normal at Presentration in 35%-45% of patients with Rheumatoid Arthritis Seen Between 1980 and 2004: Analyses from Finland and the United States. The Journal of Rheumatology. 36(7). 1387-1390. Suresh,K. (2011) An overview of randomisation techniques: An unbiased assessment of outcome in clinical research. Journal of Human Reproductive Sciences, 4(1):8-11 Ostergaard, M. (2009). Magnetic Resonance Imaging in Rheumatoid Arthritis. Quantitative methods for assessment of the inflammatory process in peripheral joints: Summary of Thesis. Scandinavian Journal of Rheumatology. 28. 265.ÂÂ   Wasserman, A.M. (2011). Diagnosis and Management of Rheumatoid Arthritis. American Family Physician. 84(11). 1245-1252.

Developing Marketing Strategies and Plans MCQS Essay

1. A key ingredient of the marketing management process is insightful, ________ marketing strategies and plans that can guide marketing activities. a. creative b. measurable c. macro d. micro e. niche Answer: a 2. According to a chapter story about H&M clothing stores, H&M is able to put products out quickly and inexpensively by all of the following EXCEPT ________. a. having few middlemen and owning no factories b. buying large volumes c. having extensive experience in the clothing industry d. having a great knowledge of which goods should be bought from which markets e. having total control of its distribution channel from the time the goods are produced until the time they are sold Answer: e 3. The task of any business is to deliver ________ at a profit. a. customer needs b. products c. customer value d. products and services e. improved quality Answer: c 4. In a hyper competitive economy such as ours, a company can win only by fine-tuning the value delivery process and choosing, providing, and ________ superior value. a. communicating b. selecting target markets with c. composing d. developing e. researching Answer: a 5. The traditional view of marketing is that the firm makes something and then ________ it. a. markets b. sells c. distributes d. prices e. services Answer: b 6. Today, the â€Å"mass-market† is actually splintering into numerous ________, each with its own wants, perceptions, preferences, and buying criteria. a. micro markets b. market targets c. macro markets d. customer cliques e. demographic units Answer: a 7. The first phase of the value creation and delivery sequence is ________ that represents the â€Å"homework† marketing must do before any product exists. a. choosing the value b. market research c. target marketing d. service consideration e. projective thinking Answer: a 8. The last step in the value creation and delivery sequence is ________ the value where the sales force, sales promotion, advertising, and other communication tools announce and promote the product. a. developing b. distributing c. communicating d. reversing e. researching Answer: c 9. The Japanese have refined the value delivery process to include a component that emphasizes ________. a. zero servicing b. zero customer feedback time c. zero promotion d. zero dependency on intermediaries e. zero marketing costs Answer: b 10. The ________ is a tool for identifying ways to create more customer value. a. value chain b. customer survey c. brand loyalty index d. promotion channel e. supplier database Answer: a 11. The ________ identifies nine strategically relevant activities that create value and cost in a specific business. a. value proposition b. value chain c. mission statement d. annual report e. manager’s log Answer: b 12. The ________ in the value chain cover the sequence of bringing materials into the business (inbound logistics), converting them into final products (operations), shipping out final products (outbound logistics), marketing them (marketing and sales), and servicing them (service). a. operations process b. manufacturing process c. primary activities d. secondary activities e. tertiary activities Answer: c 13. Procurement, technology development, human resource management, and firm infrastructure are handled in certain specialized departments and are called ________. a. materials handling b. support activities c. inventory activities d. primary activities e. benchmark activities Answer: b 14. The firm should estimate its competitors’ costs and performances as ________ against which to compare its own costs and performance. a. competition b. standards c. challenges d. benchmarks e. moveable standards Answer: d 15. The firm’s success depends not only on how well each department performs its work, but also on how well the various departmental activities are coordinated to conduct ________. a. core strategies b. satellite businesses c. core values d. core business processes e. core technologies Answer: d 16. With respect to core business processes, all the activities involved in gathering market intelligence, disseminating it within the organization, and acting on the information is referred to as the ________. a. market sensing process b. market research process c. target marketing process d. market pulse process e. deployment process Answer: a 17. With respect to the core business processes, all the activities involved in researching, developing, and launching new high-quality offerings quickly and within budget are referred to as the ________. a. new product process b. new offering realization process c. product development process d. product launch process e. return on investment process Answer: b 18. With respect to the core business processes, the ________ is considered to be all the activities involved in defining target markets and prospecting for new customers. a. customer acquisition process b. customer relationship management process c. fulfillment management process d. customer prospecting process e. customer equity process Answer: a 19. A good way to describe the ________ would be discuss all the activities involved in building deeper understanding, relationships, and offerings to individual customers. a. customer acquisition process b. customer relationship management process c. customer prospecting process d. customer fulfillment management process e. customer equity process Answer: b 20. Another way to describe a value delivery network (partnering with specific suppliers and distributors) is to call it a ________. a. teamwork group b. cabal c. domestic power center d. link to relationships e. supply chain Answer: e 21. The key to utilizing organizational core competencies is to ________ that make up the essence of the business. a. make the competencies pay for themselves b. own all intermediaries who come in contact with your goods and services c. own and nurture the resources and competencies d. emphasize global promotions e. segment workforces Answer: c 22. We can say that a ________ has three characteristics: (1) It is a source of competitive advantage in that it makes a significant contribution to perceived customer benefits, (2) it has applications in a wide variety of markets, and (3) it is difficult for competitors to imitate. a. core competency b. business strategy c. core technology d. strategic business unit e. winning strategy Answer: a 23. Core competencies tend to refer to areas of special technical and production expertise, where ________ tend to describe excellence in broader business processes. a. process benchmarks b. distinctive capabilities c. core business values d. value statements e. mission statements Answer: b 24. George Day sees market-driven organizations as excelling in three distinctive capabilities: ________, customer linking, and channel bonding. a. target marketing b. market research c. fulfilling customer needs d. market sensing e. customer service relationships Answer: d 25. Competitors find it hard to imitate companies such as Southwest Airlines, Dell, or IKEA because they are unable to copy their ________. a. product innovations b. distribution strategy c. pricing policies d. activity systems e. logistics system Answer: d 26. One conception of holistic marketing views it as â€Å"integrating the value exploration, ________, and value delivery activities with the purpose of building long-term, mutually satisfying relationship and co-prosperity among key stakeholders.† a. value creation b. value proposition c. value management d. value research e. value chain Answer: a 27. Holistic marketers achieve profitable growth by expanding customer share, ________, and capturing customer lifetime value. a. undermining competitive competencies b. building customer loyalty c. milking the market for product desires d. renewing a customer base e. inspecting all market share data Answer: b 28. The holistic marketing framework is designed to address three key management questions. Which of the following is one of those questions? a. Value claims—how does the company deal with value erosion? b. Value proposition—how can value propositions be made profitable? c. Value chain—are there weak links in the company’s value chain d. Value network—how can a company effectively network? e. Value exploration—how can a company identify new value opportunities? Answer: e 29. The customer’s ________ reflects existing and latent needs and includes dimensions such as the need for participation, stability, freedom, and change. a. competence space b. resource space c. emotional space d. relationship space e. cognitive space Answer: e 30. The companies ________ can be described in terms of breadth—broad versus focused scope of business; and depth—physical versus knowledge-based capabilities. a. business mission b. core strategy c. cognitive space d. competency space e. resource space Answer: d 31. The collaborator’s ________ involves horizontal partnerships, where companies choose partners based on their ability to exploit related market opportunities, and vertical partnership, where companies choose partners based on their ability to serve their value creation. a. resource space b. competency space c. cognitive space d. rational space e. service space Answer: a 32. Business realignment may be necessary to maximize core competencies. Which of the following would be one of the steps in this realignment process? a. Reviewing all macro relationships. b. Reviewing global outreach projections. c. Redefining the business concept (the â€Å"big idea†). d. Reviewing successes from e-commerce (if any). e. Revamping the ethics statement. Answer: c 33. ________ allows the company to discover who its customers are, how they behave, and what they need or want. It also enables the company to respond appropriately, coherently, and quickly to different customer opportunities. a. Network management b. Strategic management c. Marketing management d. Customer relationship management e. Total quality management Answer: d34. To respond effectively and provide value delivery, the company requires ________ to integrate major business processes (e.g., order processing, general ledger, payroll, and production) within a single family of software modules. a. human resource management b. internal auditing management c. internal resource management d. strategic management e. marketing management Answer: c 35. With respect to value delivery, ________ allows the company to handle complex relationships with its trading partners to source, process, and deliver products. a. a value matrix b. a global distribution policy c. a business development strategy d. business partnership management e. total quality management Answer: d 36. Successful marketing requires having capabilities such as understanding ________, creating customer value, delivering customer value, capturing customer value, and sustaining customer value. a. customer loyalty b. customer per c. customer retention d. customer value e. customer benefits Answer: d 37. According to a McKinsey research study, which of the following is one of the main challenges that marketing must face in the twenty-first century? a. The threat of ethics-based lawsuits. b. Doing more with less. c. Hostile takeover attempts. d. Increasing control by big government. e. Being independent of the distribution process. Answer: b 38. Strategic planning in the twenty-first century calls for action in three key areas. Which of these key areas deals specifically with devising a long-term game plan for achieving long-run objectives? a. Creating a viable business opportunity. b. Producing a strategic fit. c. Developing an investment portfolio. d. Expanding core competencies. e. Establishing a strategy. Answer: e 39. Most large companies consist of four organizational levels: the ________, the division level, the business unit level, and the product level. a. board of director level b. major stakeholder level c. management team level d. corporate level e. strategic level Answer: d 40. The ________ is the central instrument for directing and coordinating the marketing effort. a. strategic plan b. marketing plan c. tactical plan d. customer value statement e. corporate mission Answer: b 41. The ________ lays out the target markets and the value proposition that will be offered, based on an analysis of the best market opportunities. a. organizational plan b. strategic marketing plan c. corporate tactical plan d. corporate mission e. customer value statement Answer: b 42. In which of the following plans would we most likely find directions for implementing and addressing daily challenges and opportunities in product features, pro motion, merchandising, pricing, sales channels, and service areas. a. The tactical marketing plan. b. The target marketing plan. c. The deployment plan. d. The product launch plan. e. The product development plan. Answer: a 43. If you wanted to find out more about target markets and the organization’s value proposition, which of the following types of plans would most likely contain information that might be useful to you in your quest? a. The marketing plan. b. The organizational plan. c. The strategic marketing plan. d. The tactical marketing plan. e. The marketing mix plan. Answer: c 44. The ________ process consists of corporate, division, business, and product planning. a. implementing b. controlling c. innovation d. planning e. competitive Answer: d 45. All corporate headquarters undertake four planning activities, the first of which is ________. a. defining the corporate mission b. establishing strategic business units and assigning resources (SBUs) c. assigning resources to each SBU d. assessing growth opportunities e. understanding target markets Answer: a 46. A clear, thoughtful mission statement provides employees with a shared sense of purpose, direction, and ________. a. profitability b. target market feasibility c. opportunity d. continuous improvement e. quality products Answer: c 47. Mission statements are at their best when they reflect a ________. a. market b. strength c. competency d. vision e. value Answer: d 48. Which of the following terms matches to the phrase â€Å"it is a single business or collection of related businesses that can be planned separately from the rest of the company†? a. Strategic business unit. b. Diverse business unit. c. Growth business unit. d. Niche market unit. e. Specialized business unit. Answer: a 49. Market-penetration, product-development, and market-development strategies would all be examples of ________ strategies. a. concentric b. conglomerate c. horizontal d. intensive growth e. integrative growth Answer: d 50. A(n) ________ is when a company might seek new businesses that have no relationship to its current technology, products, or markets. a. concentric strategy b. conglomerate strategy c. horizontal strategy d. intensive growth strategy e. integrative strategy Answer: b 51. Which of the following terms most closely matches to â€Å"the shared experiences, stories, beliefs, and norms that characterize an organization†? a. Organizational dynamics. b. A business mission. c. An ethical/value statement. d. Customer relationships. e. Corporate culture. Answer: e 52. The first step in the business unit strategic-planning process deals with which of the following? a. Goal formulation. b. Business mission. c. Strategy formulation. d. Program formulation. e. SWOT analysis. Answer: b 53. When a business gets to know market segments intimately and pursues either cost leadership or differentiation within the target segment it is referred to as a ________. a. defined strategy b. focused strategy c. value-added strategy d. competitive advantage strategy e. customer-focused strategy Answer: b 54. If a firm pursues a ________ strategy, it must be good at engineering, purchasing, manufacturing, and physical distribution. a. differentiation b. overall cost leadership c. focus d. domestic customer relationship e. market share Answer: b 55. To keep their strategic alliances thriving, corporations have begun to develop organizational structures to support them and have come to view the ability to form and manage partnerships as core skills. This is called ________. a. value managed partnership b. synergistic partnership c. centralized partnership d. partner relationship management e. win-win relationship management Answer: d 56. Traditionally, most businesses focused on stockholders. Today, the focus is on what are called ________. a. stakeholders b. partners c. regulators d. consumer triads e. supply-chain relationships Answer: a 57. A ________ is a written document that summarizes what the marketer has learned about the marketplace and indicates how the firm plans to reach its marketing objectives. a. strategic plan b. marketing plan c. sales plan d. target market plan e. competitive analysis plan Answer: b 58. Which of the following permits senior management to grasp the marketing plan’s major thrust? a. The situation analysis. b. The marketing strategy. c. The executive summary and table of contents. d. Financial projections. e. Implementation and controls. Answer: c 59. Most marketing plans cover ________. a. one year b. two years c. three years d. four years e. five years Answer: a 60. The most frequently cited shortcomings of current marketing plans, according to marketing executives, are lack of realism, insufficient competitive analysis, and a ________ focus. a. long-term b. profit c. short-run d. product e. price Answer: c

Essay on The Negative Effects of Imperialism in Africa

Imperialism is a policy of extending a country’s power and influence through diplomacy or military force. In the 20th century many European countries attempted to colonize the great continent of Africa. Europeans saw Africa as an area they would be able to profit from, as it had a great climate, good size, and some phenomenal natural resources. While the Europeans divided the continent of Africa they failed to see the possible negative effects on themselves, and the indigenous people of Africa. Their foresight was limited to only the positive outcomes. After the Europeans began to colonize Africa, they saw great results rather quickly. European influence had caused the opening of many lumber, mining,and planting corporations, as well as†¦show more content†¦The indigenous people of Africa suffered many setbacks, when the Europeans arrived. When the Europeans arrived in Africa they made the indigenous people feel inferior, lack self-confidence, and be stripped of their responsibility. As shown by Document 2, when it says, â€Å"...convince us that our civilization was nothing less than savagery, thus giving us complexes which led to our being branded as irresponsible and lacking in self-confidence.† Some people may agree, that this seems like something out of a genocide. Originally the indigenous people of Africa were supposed to be cheap labor. However, this soon changed when the Europeans enslaved the African people. This is portrayed in Document 6, when it says, â€Å"...Beneath the noonday sun, My brother was st rong†¦Ã¢â‚¬  By doing this they stole all of the human rights from the Africans, who had done nothing wrong. This is shown in Document 3, when it says, â€Å"Whereas fundamental human rights...are denied to Africans.† During this extremely horrific time in African history men were worked to death, and women were raped. This is found in Document 6, when it says,†The White Man killed my father,My father was proud, The White Man seduced my mother, My mother was beautiful.† This shows the negative effects are much worse for the Africans, than for the Europeans. But, there are some positives in this dark hour. When the Europeans arrived in Africa, they provided theShow MoreRelatedEuropean Imperialism - Dbq Essay804 Words   |  4 Pagesthe history of the world, imperialism has played a major role. Imperialism is one country’s complete domination of the political, economic, and social life of another country. Imperialism has many positive and negative effe cts. The Age of Imperialism is considered 1800 - 1914. During this time Europe became a major world leader. European countries set up colonies all over Africa, Latin America, and Asia, and encouraged their citizens to populate them. European imperialism boosted Europe’s economyRead MoreEssay on Africa vs European Imperialism841 Words   |  4 PagesDBQ: Imperialism In AfricaAzra Azvar Period 3 2/21/10 Whites vs Blacks In the late 19th and early 20th centuries European imperialism caused its countries to divide up the rest of the world, each country claiming bits as its own. Due to its large amounts of resources, Africa was one of the main areas European nations invaded in the cause if imperialism. In Africa, there were positive and negative effects towards the Africans and the invaders. Some positive effects on Africans were thatRead MoreSummary : European Imperialism Dbq1278 Words   |  6 Pages Courtney Sloan 3/4/13 1st European Imperialism DBQ Part A 1. According to the author, the colonies received benefits from the â€Å"modern progressive nations† such as being able to yield tropical produce, receiving foodstuffs and manufactures they need, and having their territory developed by the addition of roads, railways, canals, and telegraphs. They also have theRead MoreNegative Effects Of Imperialism1139 Words   |  5 Pagesevents are talked about. That just shows what imperialism causes. Imperialism is when a dominant country seeks to increase their size and forces (either by war or diplomacy) a smaller country to submit to their rule. The Age of Imperialism began in the 1870s and went until World War 1. During this time imperialism was very prevalent and the events that took place during this time had lasting effects and still affect us to this day. While imperialism could be seen as beneficial, especially to theRead MoreImperialism in South Africa1078 Words   |  5 PagesDuring Imperialistic times South Africa was a reg ion of great resources that was greatly disputed over (Ellis). Europe’s main goal during these times was to compete against each other and played a â€Å"game† of which country can imperialize more African countries than the other. Imperialism was a curse to South Africa, because many wars, laws, and deaths were not necessary and would not have happened if South Africa were not imperialized. Imperialism is the domination by one country of political, economicRead MoreImpact Of Imperialism On The Middle East, Africa, And Asia1287 Words   |  6 PagesImperialism is defined as a policy of extending a country s power and influence through diplomacy or military force. Countries during the Industrial Revolution wanted to imperialize due to social, political, and economic reasons. As early as the mid 1800’s, the European countries craved the idea of power and conquering new lands in order to obtain resources/raw materials. They took over Africa, the Ottoman Empire, India, and Southeast Asia due to this as well as for their convenient location. TheyRead MoreA New Concept Of Foreign Affairs1477 Words   |  6 Pagescentury a new concept of foreign affairs was introduced to Asia and Africa: New Imperialism. New Imperialism began in the 19th century when Europeans, mainly Great Britain, began colonizing Asia and Africa. Europeans used military, political, and economic powe r to take over weaker countries. Imperialism had an overall negative effect on the indigenous people of Asia and Africa. Economic motives were a major cause of New Imperialism. By the late 1870’s countries were industrializing rapidly. GreatRead MoreImperialism in the 19th century1746 Words   |  7 Pagesgreat deal of Imperialism in the 19th century, led by mostly westerners from Europe. Imperialism is the act in which one nation extends its rule over another. Imperialism had a substantial effect on the 19th century throughout the entire world by bringing upon changes to many different countries, for better and for worse, especially to Africa. Prior to the nineteenth century, westerners did interfere with many of the affairs of nations outside of their boarders, so signs of imperialism are shown manyRead More Imperialism in Africa Essay953 Words   |  4 PagesImperialism in Africa Imperialism is defined as one country’s domination of the political, economic, and social life of another country. In Africa in the nineteenth and twentieth centuries, imperialism was present and growing. The main countries involved in the imperialism in Africa were the French, German, and Great Britain. The French’s empire was mainly in North and West Africa while Britain’s colonies were scattered throughout the continent. Germany ruled over such countries as TanganyikaRead MoreImperialism and South Africa1440 Words   |  6 PagesImperialism’s Effect on South Africa Imperialism was a movement that affected all parts of the world, beginning as early as the 19th century. Wealthy and established nations would annex and take control of underdeveloped nations and civilize them. This may sound good in theory, but Imperialism seemed to take advantage of the so-called â€Å"inferior† nations more than truly help them. The economic superpowers seized the land of the territories they thought to be subordinate, using it as trading depots

Economics On The Fuel Economy - 1375 Words

I have researched the economics on the fuel economy in the United States. Supply and demand are key topics that will be touched dealing with the fuel economy. Since there has been an increase and decrease in price, I will further investigate the reasoning for this. Also, I will examine the overall number economic impacts relating to oil spills and the overall oil producing economy. The United States economy is highly dependent upon fuel. Fuel is a major source that come from fossil fuels from all around the world. Fossil fuels are used to fuel cars and airplanes, power electricity plants, and heat our homes. So this lies around the question, where does fuel come from? There are 3 forms of fuel, coal, oil, and natural gas. Coal is found in many of the lower 48 states of United States and throughout the rest of the world. Oil and natural gas is located under porous rock deep within the earth’s surface. Oil was formed millions of years ago. It is mined from the ground and is not as easy to find as coal. There is also as a higher demand of fossil fuels. Due to the high demand, oil is transported by pipelines and trains from around the world. In the Middle East, there are new discoveries of natural gas that is also known as Methane. After the process of crude oil has been refined into gasoline or other products, they are then distributed to the consumer. The gasoline is transported through pipelines, which then, delivery trucks are able to get the gasoline from the storageShow MoreRelatedCurrency Devaluation And Fuel Subsidy Removal1185 Words   |  5 PagesCurrency devaluation and fuel subsidy removal are policies that are phenomena to the Nigerian economic environment. This research study identifies that the implementation of the policies has further caused more challenges in the pursuit for economic development than remedy to alleviate the crisis. 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