Factors Affect Supply and Demand of Acuvue Essay

This report’s focus is on analyzing the factors that affect the supply and demand of the products. There are several variables that can affect the supply and demand of a product, including consumers’ income, prices of substitute products, costs of inputs and so on. The product discussed for this report is Acuvue, I will analysis how the factors affect the supply and demand of Acuvue. Acuvue is Johnson & Johnson’s Vision Care Product. It is one of the most popular eye contact lenses products for nearsighted correction and eye color alteration. Acuvue has a serial of products that depend on different replacement schedule, such as daily disposable, two weeks disposable, colors and so on. All ranges of the lenses of Johnson & Johnson’s are regarded as comfortable, convenient and good eye health product. (Johnson & Johnson, 2008 )1 In 2007, as a leader and pioneer of eye contact lens producer, there was a sales increase by 17. 6% prior to 2006. The annual expense for normal glasses is $200 dollars but the Acuvue daily disposable is about $480. Take China for example, the GDP of 2007 increased 11. 4% (Wiki, 2008)1, people earned more than before. When people’s income increased, those who could not afford to buy the Acuvue in the past can had enough money to afford it. Moreover, as income increased, people tend to replace their contact lenses much more frequently than before, and the demand of Acuvue increased accordingly. Also, nearsighted people may have much higher requirement for their life quality; so, for those who are tired of wearing glasses or who seek convenience by wearing eye contacts may try to change to use eye contact lenses, therefore, demand for the eye contact lenses will increase. Consumer Preferences Consumer preference is a significant factor which affects the demand of the Acuvue. People have different preference for lenses for nearsightedness correction, such as replacement schedule, material (hard/ soft), and safety. Some people prefer Acuvue Daily for its convenience, and it has no daily maintenance like other types of contact; the user can just throw it away after one day. (Bausch & Lomb, 2008) For some people, they prefer soft contact lenses to hard lenses. In addition, many people care about the safety of eye contact lenses, and daily contact lenses are regarded as the safest and healthiest way, so those people may choose the Acuvue Daily, and thus, the demand of the Acuvue increases. On the contrary, people who are afraid of getting keratitis (wiki, 2008)2 by wearing contacts will buy the glass, and then the demand of the Acuvue will decrease. Moreover, if the nearsightedness’ preference is more favorable to Acuvue, which probably means they have more loyalty to the products, so the existing consumers will seldom change to alternatives and more and more people will buy Acuvue. Price of Substitutes The Substitutes of Acuvue eye contact lenses are glasses and surgery. As compared before, wearing glasses is a more economical way to correct nearsightedness, and there will be lower risk of being involved in keratitis(wiki,2008)2 or other eye problems. Moreover, in the recent years, correcting nearsightedness by taking an eye operation became more popular in many countries. The costs for the surgery are high, and the average for getting the LASIK nearsightedness correction surgery is $2105 in 2008. (All about Vision, 2008) If the price of the surgery decreases, there will be more people choosing eye surgery instead of wearing inconvenient glasses or eye contact lenses; so, there will be less demand of Acuvue. Price of Complementary Goods If the complementary goods of Acuvue increase, the price of the Acuvue will increase accordingly. Complementary goods for Acuvue are the solution of the eye contact lenses or drops for eyes. For the past two years, with the rapid economic growth in China, people have more money to purchase eye contact lens, but if the average prices of the solutions increased dramatically, people who could afford to buy the lenses felt burdened to buy the solution. Advertising Promotion Advertising is a way of communication, Johnson & Johnson get more advertising is to try to persuade potential customers and consumer to purchase more Acuvue(wiki, 2008)3. Johnson & Johnson has released a series of advisements and promotions for Acuvue. They provide free trial pairs of eye contact lens for the potential consumers who can just fill a Free Trial Pair Certificate (Vision Care Inc. , 2008) from the Acuvue official website. In addition, when the â€Å"Acuvue 2 colours† entered the mainland China market, they chose an unknown model to perform the advertisement first, and the sales for the Acuvue 2 was unfavourable. However, then the Johnson & Johnson invite Chinese pop singer Angela Zhang for promotion on TV, then, this product became familiar with lots of youth in China, and more and more people known about the Acuvue and bought it. Consumer Expectations Johnson & Johnson is a well known and trusted company by millions of consumers all around the world. It pays much attention to the safety of their products. So consumers are confident with the Acuvue and more and more people buy it. When the AMO Complete Moisture Plus Muti-Purpose Solution (Anapol Schwartz, 2008) was recalled in May, 2007, people were concerned about the eye safety. From that time, people tented to buy less and use less eye contact lens in order to avoid infection. Number of Buyers If there are more and more potential consumers of Acuvue, demand for Acuvue will increase. For recent years, more and more people in the world have access the computer, and they use computers much more frequently and longer than the past. People are more prone to get nearsightedness. From Johnson & Johnson’s research, there are about 3 million new eye contact wearers in the US every year (Vision Care Inc. )2, so the number of potential buyers is increasing for consuming eye contact lenses year by year. In addition, with the development of technology, the material of contact lenses is getting better and safer, so more people will be confident with the eye-contact lenses so more potential buyers will buy the Acuvue, then the demand for buyers will increase. But if there is new technology that can take place of eye contacts lenses, the nearsighted may give up wearing contacts, so the number of potential buyers decrease which indicates the demand of Acuvue will decrease. Variables of Supply Costs of Inputs The world economy was very unstable since last year, and the price of raw materials kept on rising. Fortunately, there is no news about the raw material price fluctuation for eye contact lenses. If the price of storing contact lenses increases, the Acuvue’s producer Johnson & Johnson must find ways to control the production costs. The company may choose to reduce the production volume of the product and wait for producing that good when the price goes down, therefore the supply of Acuvue will decrease. However when the materials for making the eye contact lenses decreases, Johnson & Johnson will have more capacity to produce more eye contact lenses to increase its supply. Number of competitors The more competitors there are, the less the supply. Due to the property of the vision care industry, the requirement for entering this business field is fairly high. For the current market, there are four main producers and other several smaller producers which produce eye contact lenses. Johnson & Johnson is the largest eye contact lens producer in the world, making sales of $2. billion around the world (Johnson & Johnson, 2008) 3. In China, eye contact lens manufactures are increasing in the market, competition became fierce, raw material for making the contact lenses increased, and the market share became dilute, so although sales of Acuvue increase in China very year, the growth is not as large as expected. New Technology As we know Johnson & Johnson Vision Care first introduced the soft disposable eye contact lens for the world (Wiki, 2008), and this revolutionary product helped the Johnson & Johnson opened a new product field and access to expand their market to over 50 countries in the world. If there is new cheaper material for producing Acuvue, Johnson and Johnson will be capable of producing more Acuvue by the same investment as in the past, which means the supply of the Acuvue will increase. However, in the future, with the development in technology, some existing materials for making eye contact lensse may have potential risks for our eyes. When the Johnson & Johnson found that potential risks really do exist, in order to guarantee the product safety, they had to pay more for preventing the risks harmful to contacts wearer, or even reduce the supply of those products. Suppliers Expect that Future Sales Prices In recently years, there is a trend that more and more reports show that wearing daily disposable eye contact lens is much more comfortable, healthier and safer, because daily replacement lenses are healthier than other replacement schedule. With the expectation, the market for the Acuvue Daily disposable has much more potential than other Acuvue disposable lenses, and Johnson & Johnson will decide to produce more Acuvue Daily in according with the potential increase of the demand for Acuvue. Conclusion To sum up, those variables discussed above with the supply and demand of Acuvue finally affect the price of the Acuvue. As we know, the market price is the equivalent of the supply and demand. It is determined by an â€Å"invisible hand’ of both supply and demand. Therefore, it is impossible for those factors discussed before to singly handedly affect the supply and demand, because the market is complex, all those variables together contributed to our market price.

Alternative Fuels Essay

For decades, since modern transportation had been in existence vehicles engines have required fuel that has always been created with fossil fuels. The use of fossil fuels to create fuel has not been a major problem until recently. Recently the price of fuels created by fossil fuels has sprung and we are now just beginning to notice the effect it has on the environment. In fact, studies have shown that 1/4 of energy- related green house gasses are a direct result of transportation pollution1. In this essay, I will look into alternative fuels, which are not created using fossil fuels. Our dependence on fossil fuels had caused a global problem. Over the years, our environment had suffered in areas such as global warming, air quality deterioration and acid rain. Over the past 150 years, our use of fossil fuels has resulted in an increase of carbon dioxide of over twenty-five percent2. When combustion takes place, harmful gases are released into the air, which cause our air quality to worsen in condition. Some examples of fuels that are released are carbon monoxide, nitrogen dioxide, nitric oxide. Different types of sulfur oxides and hydrocarbons are released from the combustion of these fossil fuels 2. When these gases are released into the environment, they cause smog and other signs of pollution. These are two major problems that are caused by burning fossil fuels. I will now look into a few alternative fuels that do not involve the burning of fossil fuels. I will look into each ones advantage and its limitations. Non- fossil fuels are clearly have their advantages to fossil fuels although they are not perfect. Fuels that are not made with fossil fuels are clearly better for the environment although many are not yet produced at a fast enough rate for normal use, are too expensive or do not allow you to get the same performance you get out of petrol, our current fuel of choice3. In this essay, I will look into hydrogen, ethanol and an interesting concept of using compressed air to power motor vehicles. I will start by outlining some of the positives and negatives aspects of Hydrogen. Hydrogen is a gas, recently it has been discovered to have a second purpose, which is a fuel. However, Hydrogen is not easily available in its uncombined state, it can only be found un- disturbed in our earth’s exosphere. Therefore, hydrogen must be manmade. Hydrogen is a very expensive fuel and is roughly ten times as much as petrol. Although this it is more environmentally friendly as its only byproduct is water, it is more efficient then petrol and over time the price will decrease with feature research4. Studies have been conducted on how it would be easier to transport and one main suggestion was to bond hydrogen with nitrogen to make ammonia, which could simply be transformed into a liquid for easy transport5. The second fuel that I will look into is ethanol. Ethanol is in the Bio- Fuels family and is made from very common materials such as corn6. Ethanol is the most well known and widely used alternate fuel in today’s market. Many countries have already implemented plans to start introducing ethanol into their cars. Brazil is a leading example where almost all cars and trucks run exclusively on ethanol7. An advantage to ethanol is that cars that have been built within the past five or so years should be compatible with ethanol. This eliminates the need to either buy a new car or retrofit your current existent car. In fact, countries such as Brazil the transformation had lead to gad stations adding separate stations for ethanol as seen in the picture to the right8. The third and final fuel I will be investigating is a new and in my mind upcoming idea, compressed air. Compressed air is new technolgly, which is still being researched. An air car looks great on paper but is harder to put this type of car into action than it looks, in fact, there are very few air cars that have been released to this date but many are in the late stages of development. An air car offers inexpensive prices and releases zero emissions into the air. In fact, a gallon of gas will likely be more expensive than a complete refill of air for your car as it will cost around $2.50 to refill the car with air9. The air will have to be stored in 300-liter tank that attaches to the bottom of your car. This option is the most eco- friendly alternant fuel that I have looked into in this essay. The fuels that I have looked into in this essay all look very promising, it is now just a matter of time before we begin to implement these alternative fuels into our various types of transportation. When I look over all these the one that stand out the most to me is hydrogen, when I look at it I am also able to see all the other uses as well and see the very little impact that it has on the environment. How I do believe that any of the three mentioned fuels would be a satisfactory answer to the fuel crisis we are facing today. Bibliography 1. Chalacuna. â€Å"Biofuels and Bio-Additives.† Green Fuel Power. 16 Oct. 2007. 1 Nov. 2007 . 2. Luhnow, David, and Geraldo Samor. â€Å"As Brazil Fills Up on Ethanol, It Weans Off Energy Imports.† WSJ/ Yale. 17 Jan. 2006. Yale Uni./ WSJ. 1 Nov. 2007 . 3. N/A. Brazil Has Run Cars on Alcohol for Decades. 2005. Somebodys Camara, Brazil. Wikipedia. Fuel Station. 1 Nov. 2008 . 4. N/a. â€Å"Myth: Alternative Fuels Will Come to the Rescue.† PTUA. 28 Sept. 2007. 1 Nov. 2007 . 5. N/a. â€Å"The Car That Runs on Air.† BBC News. 24 Oct. 2000. 1 Nov. 2007 . 6. N/a. â€Å"The Hiden Cost of Fossil Fuels.† UCS. 10 Aug. 2005. 1 Nov. 2007 . 7. N/a. â€Å"They Hydrogen Economy.† E. Jan.-Feb. 2003. 1 Nov. 2007 . 8. Various. â€Å"Ethanol Fuel.† Wikipedia. 1 Nov. 2007. 1 Nov. 2007 .

Chilean Copper Mine Collapse Essay Example | Topics and Well Written Essays - 500 words

Chilean Copper Mine Collapse - Essay Example That is our unwavering commitment to you, and we will not rest until each and every last one is recovered from the mine shaft. As this process unfolds, a company representative will be available to you around the clock, and will be issuing regular pieces of communication to family members at pre-determined intervals. In addition, representative from the Chilean government will be arriving on site shortly to oversee the rescue effort and I am confident that they will be available to answer any of your questions as well. May we all take time to pray for the safe rescue of each miner beneath us. I will be in touch with you again shortly. It is with much sadness that I join each of you in expressing my utmost regret at the recent accident that has best our mine. While the mining business is certainly one of the most dangerous industries in Chile, we pride ourselves on taking measures to ensure the safety and security of each and everyone of our employees. In this case, however, a great tragedy has befallen us and I assure you that, in due course, we will determine what happened and find out to avoid this in the future. We will grow stronger as a result. In the meantime, however, we are 100% focused on the safe recovery and rescue of each of your co-workers, so please understand that our attention is needed in this endeavor. Each of you no doubt has numerous questions. In addition to be considered for your brother’s below us, you may be feeling uncertainty about the future direction that company will be headed. I assure you that we will be addressing your concerns in due course. A company representative will so on be available to you to answer questions related to compensation and when you can expect to return to work. Naturally, as of now, the mine will not be operational for the foreseeable future. We do have contingency plans in place for such an occurrence, and we will act in accordance

Case study Example | Topics and Well Written Essays - 500 words - 26

Case Study Example There are appropriate strategies, times, and efforts that could instigate a more appropriate resolution to the problem in Darfur. 2. The dangers of delaying the prosecution of al-Bashir include the continued genocide within the country and the possibility of a civil war that could re-ignited as Arab militias continue to battle with the remaining members of the rebel groups. Likewise, as indicated by a member of the humanitarian organization, delaying prosecution is indicative of undermining the jurisdiction of the ICC and showing to the world that their sovereignty is being compromised. 3. One shares the same contention that the U.S. should take a softer approach in handling the Sudanese situation. The decision that was apparently arrived at could be deemed to go through a collaborative and comprehensive negotiation process; as such, the softer approach was deemed more beneficial to both countries in the long run. As disclosed, by taking a softer approach, there is more possibilities in arriving at a future negotiation with al-Bashir regarding disarming the Arab militia and bringing back humanitarian workers to provide the much needed humanitarian aid to their people. The strategy brought lesser bloodshed through peaceful techniques. 4. One strongly believes that there is a possibility that the United States and other governments would strive in restoring peace and security by negotiating directly with the government of Sudan. In more negotiation cases and scenarios, it is always ethically, morally, and legally viable to forge an agreement directly with parties that are involved in conflicts and dilemmas. Since leaders of the Sudan government were instrumental in creating conflict and chaos in their region, the resolution to these conflicts would also be decided by these leaders. Assistance would only be provided by other nations when solicited and approved by the Sudan government. As such, restoring peace and security should be worked out

Unknown and Undiluted Titration Date Essay Example | Topics and Well Written Essays - 500 words - 6

Unknown and Undiluted Titration Date - Essay Example Furthermore, the concentration of Cca2+ is again subtracted from all the total concentration, in addition, the Mg2+ concentration is 0.0227+-0.005M after calculation. After Na2H2EDTA.2H2O is prepared and goes in contamination by water in 0.3 percentage the standard solution has to be corrected. Here below are the equations that analyses and further determines the EDTA solution concentration. Mass without impurity is the mass corrected and the mass actual is the dried chelating agent; EDTA concentration bears the name as CEDTA; the initial MW represents molecular weight, and the volume of the solution (500 ml) is V solution. Propagation of the errors calculates the uncertainty. The balance of uncertainty is +- 0.0001g and that of volumetric flask’s uncertainty is +-0.15 ml. the standard relative deviation is initialized by SRD. Calculation of results is in tabulation in the table. Results show that both relative derivation volume and relative derivation balance is +-0.0003.Moreso, after calculating using the values above EDTA concentration solution is 0.0018+-0.0004M. 1.00ml Ca/Mg solution in the spike is contained in the blank titration, Ph 10 buffer solution, water in conjunction with the indicator. From all the titration, the data in trial one from all the titrations undergoes nullification due to it being carried out hastily. Additional of 1.00ml in dilution of the unknown sample to the blank titration is put in a performance. The equation below is used to calculate V total: Both the standard deviation and the mean of part one and part two titrations are as follows and in illustration in table 4.Concentration of Mg2+ and Ca2+ can be identified from the values in the unknown sample.  

Organizational Business Essay Example | Topics and Well Written Essays - 500 words

Organizational Business - Essay Example Furthermore, the study disclosed that if the employees were given more say in decisions pertaining to their jobs, it will create more satisfaction and generate harmony in the workplace. Another major finding of the research is that job content is not one of the factors which influence organizational culture. The second article on organizational culture is â€Å"The Transformation of Nissan – The Reform of Corporate Culture† by Yasuhiro Ishizuna. This article presents the story of Nissan and how the change in its corporate culture transformed the company (Ishizuna 9). In the story of Nissan, the greatest factor that affected the organizational culture is the leadership, more specifically; it was the President Mr. Yutaka Kume who introduced changes in the traditional views and attitudes of the employees. The reforms in the culture which he introduced paved the way for Nissan to become more competitive globally. Organizations†. This exploratory study examined the relationship between leadership and organizational culture in nineteen nonprofit human service organizations. The research revealed that â€Å"organizational culture can be influenced: through the beliefs and experiences of its members, through beliefs and values of leaders, and through organizational practices† (Jaskyte 164). The articles on Nissan and the study by Jaskyte both share the idea that leadership plays an important role in the shaping of an organizational culture. Nissan’s experience showed how its president became the driving force in successfully transforming its culture starting from the grass-roots level and moving on throughout the company. In the same manner, Jaskyte’s study of non-profit organizations concluded that leaders must undergo changes in their leadership practices to shape the culture of their organizations (Jaskyte 164). As

Review of A Worn Path by Eudora Welty Essay Example | Topics and Well Written Essays - 250 words

Review of A Worn Path by Eudora Welty - Essay Example Subsequent to that, she begins to consider it a ghost. Later, she concludes that it was a scare crow. After moving from there, she goes to the ravine and she drinks water. While meditating, a big black dog attacks her. Interestingly, that big black dog does not further chase Phoenix as soon as she throws a cane at the dog. Subsequently, a white man appears with a chained dog. He talks to her. And, at some point of time, she becomes so courageous to face the threat of a pointed gun raised by the white man. In the later part of story, she comes to meet her grandson. This entire story does not depict a reality. Had she wanted to meet her grandson, what caused her to go to hill, go to the field of dead corn, and the ravine? At some point, she becomes so bold to push away an attacking dog! Works cited Welty, Eudora, â€Å"A Worn Path†, New York Times, 1941, Available at: http://www.theatlantic.com/past/docs/issues/41feb/wornpath.htm [accessed on 20 July, 2011]

Monopoly Essay Example | Topics and Well Written Essays - 1750 words

Monopoly - Essay Example Another is the absence of any other company with products or services that can be compared to that offered by the monopolist. And lastly, there are factors that can contribute to the action of monopoly such as the barriers to the entry of other products or company (Klein; Sowell 80-87). Another important characteristic of the monopolistic company is the capability to control the price of the product in the market. This can be one of the main reasons that anti-monopoly policies are being implemented to be able to protect the consumers with regards to the uncontrollable increase in the prices of products and services. There are different products and utilities that can be classified in a monopolistic market which include gas or fuel, electricity, water, cable TV and telephone serve companies. To be able to achieve an understanding of the principles of monopoly in the market, the study of the different companies in the global market is undertaken. These companies are involved in the service and manufacture of the products classified under monopolistic market. In the UK, one of the current issues though there is a deregulation with regards to monopolization is the perceived control of the National Express over the train routes as a result of the recent take over of the Greater Anglia trains franchise in September 2008 (This is London Website). The said example can be attributed to the result of competition that favored a particular company to excel. Basically, the competition that initially occurred can be stopped due to different factors such as failure of competitors or achievement of better market share of leading companies resulting to greater advantage and can ultimately arise to monopolization. Another influential company in the British market is the British Telecom which is involved in a wide variety of telecommunication services initially in UK and then expanded to the global market. The said company had

Direction of the Company Avid Technologies Inc Essay

Direction of the Company Avid Technologies Inc - Essay Example From the aforementioned arguments, it is clear that the scope of the organization’s business for development is bright as the efficiency of the organization to develop digital media for not only commercial purposes but also for marketing communication opens the doors for corporate business development for the organization. This is in line with the arguments of Gerry Johnson and Kevan Scholes 92003)who say that the level of innovation retaining the core business strategy will leverage competitive advantage and new market development for an organization. The company’s involvement in the marketing communication and its position in the games industries are the key areas for development to accomplish for future development. The key objectives set above can be measured against the company’s accomplishment in the form of market share for the organization in the aforementioned market segments. The company generates revenue mainly through the production and distribution o f digital media to clients in the film industry, games industry and other media related commercial business markets. The fact that the company pioneers in the postproduction media management and manipulation of the video in using a computer are the key to the company’s revenue generation. The range of products sold by the company mainly depending upon the requirements of the customers and their specific needs with respect to the projects they handle like the movies and visual effects for a given movie project makes it clear that he company’s core strategy of producing, managing and distributing digital media is the generator of revenue for the  organization.  

Bold and defiant ironic Essay Example for Free

Bold and defiant ironic Essay As Act Two begins, Gerald is made to admit his crimes and confront the consequences of his actions. This in time leads to great amounts of hard feeling and tension felt between Gerald and Sheila. We hear of Geralds affair with Daisy Renton. This shows us many ideas of women and society. Whilst Eva is treated like dirt and dismissed because of her actions, Gerald is more or less just patted on the back and told well done. He is now viewed as with higher status and respect, yet the females reputation is dashed. Sheila is expected to put up with her husbands actions, to be a good girl, yet Gerald is congratulated. There is no question of him being punished. Instead Sheila is expected to pick up their ruined relationship, and marry him. Mrs Birlings entrance during act two is also comical. It causes heightened tension as in contrast to the situation in the room, Mrs Birling is bold and defiant- ironic when compared to what is happening in the dining room. Sheila is perceptive and can see that Mrs Birling is yet another suspect on Inspector Gooles list. When Mrs Birling begins, we dont think we can help you much. Sheila is adamant that her mother must stop then, as she is afraid youll say or do something that youll be sorry for afterwards. Her panic and emotional outburst gives rise to tension and allows us to see her social responsibility in contrast to other members of the family who remain insistent that they have done nothing wrong. In Act Two many secrets are revealed for the first time. To start with, we find out about Geralds affair and lies to Sheila. As if that is not bad enough, we also find out about the part Mrs Birling plays in Daisy/Evas suicide. The scene becomes extremely tense when we find out about Erics drinking problem, because whilst Gerald and Sheila already knew of it, Mrs Birling did not. She is adamant that it did not happen, and denies it three times, ignoring her daughter, but then believing Gerald, her daughters fiancà ¯Ã‚ ¿Ã‚ ½. Sheilas line, he hasnt started on you yet is rather telling. This strikes a feeling of doom in the audience. As the Inspector interrogates Mrs Birling the scene is very uptight and tense. Whilst Mrs Birling has clearly played a part in Evas death, she is consistently saying that it has nothing to do with her. It was her decision that resulted in Eva being left without money or a home, yet she will not admit to having a part to play in the suicide. Mrs Birling is quick to point the blame at the father of the unborn child. Mrs Birling retains her airs and rude gestures. Hes entirely responsible he ought to be dealt with very severely If we have not already realised, it is about now that we as the audience realise that Eric is the father of the unborn child and his own mother is writing his punishment. The scene is incredibly tense. When Mrs Birling realises that Eric is the father she is again in denial, But surely I mean its ridiculous I dont believe it, I wont believe it Act two ends as Eric enters the room to silent stares and hysterical faces. At this moment in the play the tension has not reached this level before. Act three begins where act two left off, You know, dont you? Inspector Goole proceeds to ask many quick questions: who, what, where, when, why? This barrage of questions gives Eric little time to think. The situation is already tense and this doesnt help his case. Eric shows remorse to his actions, although, out of the family, they must be the most serious. We find out he was drunk, has little recollection of events, and even stooped low enough to steal money from his fathers office. He honestly feels regret for his actions, but Mr Birling does not and is eager to cover up Erics mistakes. This is somewhat comical considering whats just happened, yet all he cares about is what other people think. The Inspector sums up the chain of events, in turn placing blame on each person present. He concludes that If men will not learn their lesson, then they will be taught it in blood fire and anguish. He exits quickly, leaves the family confused, angry and irritated.  Gerald re-enters shortly after the Inspectors exit, bringing a whole new perspective on the current events. That man wasnt a police officer. As soon as this news is delivered, tension rises again as the family consider they may have been tricked. Gerald begins to explain his theory tension falls. The family begins to question his existence; who he really was, and if he wasnt real, was the death real? They consider that the picture may well have been a fake, although then the hoax would have been very well planned. It is then that Gerald decides to call the Infirmary. This reveals that in fact their theory is correct, and no girl has died that day. Whilst this is great news and tension has greatly dropped, both Sheila and Eric arent ready to forget what has just happened. They both represent the views felt by Priestley, that you have to change because of what has happened, you cant just forget and go on pretending. Someone, somewhere, has been badly treated by each of them. Maybe this is why the phone rings again. Mr Birling answers the phone and is clearly shocked by what he hears at the other end. A girl has just died- on her way to the Infirmary- after swallowing disinfectant. And the police inspector is on his way here- to ask some- questions- This is a rather fitting ending and tension shoots straight up. The audience is left with many things to think about- this is exactly what Priestley had hoped to achieve. This play is all about social responsibility and by ending this way the audience has so many unanswered questions. An Inspector Calls will be on their mind for a long while as they consider countless things such as who the inspector really was. Could he be the personification of morality and justice? Perhaps if everyone had accepted their shortcomings and progressed with lessons learnt the ending would be different.  Throughout An Inspector Calls Priestley has manipulated the audience using tension. He has made them think, caused them to question. People must learn lessons from their mistakes just as Sheila and Eric did before its too late. Priestley is teaching us to be socially responsible.

Antibiotics Before Cultures in Septic Suspected Patients

Antibiotics Before Cultures in Septic Suspected Patients No More Waiting Antibiotics Before Cultures in Septic Suspected Patients Shannin Pierce Introduction Identifying the Issue September, 21 2013 was an abnormally busy day at Northeast Clark Hospital. At 6:45 AM, 63 year old Mr. Davis Jones, present to the emergency department with a fever of 102.6, heart rate of 110 beats per minute, and a respiratory rate of 22. His blood pressure is 91/63. He is weak and lethargic. His wife tells staff that during the past week he has been sleeping more than usual and not eating or drinking much. She suspects he has come down with the flu that has been going around. Mr. Jones is sent to a room and asked to put on a gown and informed that the doctor will be right in to see him. At 7:00, the night shift nurse reports off the dayshift nurse of all of her patients, but fails to inform the dayshift nurse that Mr. Jones has yet to have cultures collected. At 7:15, the dayshift nurse checks on Mr. Jones who is comfortably sleeping in the hospital bed with his wife by his side. Vital have not changed since admission. She continues to the next patient. At 7:30 AM she rechecks on Mr. Jones and realizes that he has yet to have cultures drawn and collects the supplies. Cultures are collected at 7:45 AM and sent to the lab. At 8:00 lab results show WBC 16,000. The nurse reports the findings immediately to the attending physician, who orders intravenous (IV) antibiotics and fluids. Pharmacy sends up the antibiotics at 8:30 AM and the nurse begins infusion at 8:45 AM. At 9:00 AM, Mr. Joness blood pressure drops to 58/42, heart rate soars to 160 beats per minute, and he is unconscious and unresponsive. The staff frantically rushes to infuse IV fluid into Mr. Jones but he goes into cardiac arrest. All resuscitation attempts are made, but at 9:45, Mr. Jones is pronounced dead. Sepsis and bloodstream infections have become a major cause of hospitalization and death in the United States. In these situations it is a standard protocol to collect blood cultures before administration of antibiotic, however, this can often delay the treatment needed to reduce the chance of death of patients with septicemia. With new advances in culture collection technology, blood culture collection containers now contain antimicrobial removal media, which makes it no longer necessary to delay treatment of antibiotics in order to wait for untreated blood specimens to be collected. By using the antimicrobial removal media enriched blood collection containers for all patients with suspected sepsis, antibiotic treatment can be initiated faster, hospital stays will be shorter, cost of care will be decreased, and fewer people will die due to septicemia. Analysis of the Current Situation Currently, standard protocol for septic suspected patients is for blood cultures to be collected from two different ventipuncture sites before the initiation of any antibiotic therapy using aseptic technique. It is also recommended that antibiotic therapy be initiated within one hour of onset of septicemia. According to a research study by Anand Kumar (2006), every hour of delay in antimicrobial therapy result in an increase in mortality of 7.6%. While the majority of hospital facilities strive to achieve the goal of cultures and antimicrobial therapy within the one hour time frame, the reality is that very few are actually successful. It is estimated that only about 12% of patients actually receive the antimicrobial therapy within the first hour (Daniels, 2011). To make matters worse, emergency departments struggle with overcrowding. According to hospitalstats.org, the median emergency department wait time in the Clark County Valley is 3 hours 25 minutes (Hospital Stats, 2014). Identifying the signs and symptoms of sepsis is a huge barrier to providing timely treatment. Another huge problem with the standard protocol for cultures before antibiotic therapy is that 50% to 82% of patients presenting to the emergency or intensive care facilities with suspected septicemia have already been given an antibiotic before admission and culture collection (Zadroga et al., 2013). However, with the initiation of facilities using antimicrobial removal resin blood culture containers, such as BACTEC PLUS, many of the barriers to providing timely care to septic suspected patients can be overcome. BACTEC PLUS has been proven to recover 95.1% of bacterial pathogens in blood culture samples with therapeutic levels of antimicrobial agents present, and 100% of strains in control bottles (Flayhart, Borek, Wakefield, Dick, Carroll, 2007). Leading Change It is estimated that 20,000 people die worldwide every day from sepsis (Daniels, 2011). While the use of blood culture analysis is and always will be one of the most important evidence-based microbial testing procedures for determining diagnosis of septicemia, the need to wait for cultures to be drawn before administering life saving antimicrobial therapy is unnecessary. Patients with suspected septicemia need to be receiving antimicrobial therapy within the one hour time frame, whether or not cultures have been drawn. It needs to become standard protocol that the antimicrobial therapy be initiated in that one hour time frame, and move away from the standard being cultures first. To initiate this change, it is proposed that implementation of antimicrobial therapy be initiated immediately in septic suspected patients. The Process of Change Change will being in the emergency department. All medical staff, including physicians, nurses, LPNs, CNAs, and technicians will be informed of the change to take place by having multiple conferences and training sessions over a period of time, no less than four weeks, with a minimum of three different time slots occurring near shift change to accommodate all shifts for all employees to be able to attend. All attending staff will sign an agreement contract, including the understanding of the new policy to be implemented. Once they have been fully informed and have had the opportunity to express all misunderstanding and concerns with the new policy, implementation of the policy in the department will ensue. The emergency department will be fully stocked with BACTEC blood collection containers. Quality control agents will monitor compliance of the policy to record all valid data associated, including time frames of initiation of the antimicrobial agent and blood culture analysis using the antimicrobial removal media. Most importantly, infection control will assess the outcome of patients with confirmed septicemia and will closely evaluate the new treatment plan to verify if the policy is proving to be helpful in improving the outcome of patient survival rates. Impact of Change If outcomes are positive, the facility can being to implement the policy, following the same steps already stated, to more departments and continue to evaluate the effectiveness of the policy on each department until the entire facility is using the policy. In order to initiate the change it will take a team effort. All staff will need to comply in ensuring that all septic patients are receiving the antimicrobial therapy within the one hour time frame, regardless if cultures have been drawn first or not. This will be imperative for analysis as to if the new policy is effective in reducing the mortality rate of septic patients. Conclusion Sepsis infections are going to continue to be a major cause of hospitalization, but with new protocols including ensuring administration of antibiotics in septic suspected patients within the one hour time frame of onset regardless if cultures have been collected first, we can reduce the chance of death for these patients. As medical staff, we need to use the advances in culture collection containers like BACTEC to initiate faster treatment, which will make hospital stays shorter, decrease cost of care, and most importantly, save more lives. References Daniels, R. (2011). Surviving the first hours in sepsis: getting the basics right an intensivist’s perspective. Journal of Antimicrobial Chemotherapy, 66(2), ii11-ii23. Retrieved from http://jac.oxfordjournals.org/content/66/suppl_2/ii11.full#ref-36 Flayhart, D., Borek, A., Wakefield, T., Dick, J., Carroll, K. (2007). Comparison of BACTEC PLUS blood culture media to BacT/Alert FA blood culture media for detection of bacterial pathogens in samples containing therapeutic levels of antibiotics. Journal of Clinical Micrbiology, 45(3), 816-821. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829095/?report=reader Hospital Stats (2014). ER wait times in Clark County hospitals. hospitalstats.org. Retrieved from http://www.hospitalstats.org/ER-Wait-Time/Clark-County-NV.htm Kumar, A., Roberts, D., Wood, K., Light, B., Parrillo, J., Sharma, S. (2006, June). Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine, 34(6), 1589-1596. Retrieved from http://cel.webofknowledge.com/InboundService.do?product=CELSID=2DqQrrN9uYLqpUXhgpgUT=000237884300001SrcApp=Highwireaction=retrieveInit=YesSrcAuth=HighwirecustomersID=HighwireFunc=FrameIsProductCode=Yesmode=FullRecord Uzodimma, C., Njokanma, F., Ojo, O., Falase, M., Ojo, T. (2013, ). Bacterial isolates from blood cultures of children with suspected sepsis in an urban hospital in Lagos: a prospective study using BACTEC blood culture system. The Internet Journal of Pediatrics and Neonatology, 16(1). Retrieved from http://ispub.com/IJPN/16/1/1623 Zadroga, R., Williams, D., Gottschall, R., Hanson, K., Norberg, V., Deike, M., Hansen, G. (2013). Comparison of 2 blood culture media shows significant differences in bacterial recovery for patients on antimicrobial therapy. Oxford Journals Clinical Infectious Diseases, 56(6), 790-797. Retrieved from http://cid.oxfordjournals.org/content/56/6/790.full