Criminal Justice

Gangs: The Societies within the Society

Article and Ideas

       Martin Sanchez-Jankowski’s 2010 article, ‚ÄúGangs and Social Change,‚ÄĚ seeks to reexamine traditional and/or commonly held perceptions regarding gangs and gang activity.  The author notes at the outset the immense study devoted to the subject, but he loses no time in citing the typical approaches made in all such research; namely, that gangs are viewed as groups of individuals brought together because of similarly deviant or antisocial tendencies, or as groups gathering to engage in some form of criminal or deviant behavior.  What is evident, then, is that the author disputes the motivational cores so frequently relied upon, for he believes that gang structure indicates something more inherently reflective of society as a whole.  This point of view is seen in the two claims, or hypotheses, Sanchez-Jankowski puts forth: that gangs are not viewed correctly when they are approached as randomized assortments of deviant individuals, for their organizational aspect consistently defines them; and that this organizational or structural component is both traditionally successful and necessary in comprehending how gangs function (Sanchez-Jankowski, 2010,  p. 136).  The author then indicates that he will support these ideas through investigating and citing the drawbacks in the greater part of gang research, and subsequently presenting in greater depth the rationales behind his theories.

Prior Literature

       As Sanchez-Janlowski responsibly explores, there is a great deal of research and literature regarding the subject, and he examines important facets of it in turns.  Focusing more on work done in recent decades, the author turns to research which, as he points out in his introduction, promotes the basis for gang activity as resulting from displaced individuals coming together due to the commonality of marginalized experience.  He cites Horowitz and Vigil, for example, whose studies on Mexican American gangs are based on the formations as occurring from loss of individual or cultural identity within the mainstream society; the gang provides a sense of self-worth not afforded by the dominant culture.  Sanchez-Jankowski also presents the thinking in regard to African American and Puerto Rican gangs as evolving due to unstable home environments, typically marked by absent fathers.  The author challenges both schools of thought through identifying similarities employed to validate the gang formations which exist for untold numbers of youths not affiliated with gangs (Sanchez-Jankowski, 2010,  p. 137).  Put another way, the author disputes the validity of the approaches, in that determining factors are attached ‚Äúafter the fact.‚ÄĚ  This literature cited, then, relates to the author’s hypothesis only in terms of substantiating his own theories.  Evincing consistent integrity, Sanchez-Jankowski presents multiple theories going to deprivation and deviance as virtually accidentally enabling the gang, just as he systematically points out the shortcomings. 

       More pertinent to the author’s thinking is the work cited by Fromm, which explores how distinctive and intelligent personalities, possessed of strong senses of economic and cultural capital, goes to gang formation.  This ‚Äúdefiant individualist‚ÄĚ type, the author asserts, is both typically found from low-income backgrounds and a gang fixture.  Literature and research is only just emerging on this approach, which connects strongly to the author’s theories.  Evidence, nonetheless, exists; Sullivan’s study of Brooklyn gangs reveals a consistent and active presence of this calculating ‚Äúdefiance,‚ÄĚ in that intelligence and cooperation within the gang is both structured and a means of ‚Äúgetting over,‚ÄĚ or achieving perceived success (White, 2001,  p.  249). 

Furthermore, other work supports Sanchez-Jankowski’s claim that gang study typically relies on results and behaviors of the groups as wholes, ignoring the critical component of individual entry and motivation, aside from the standard rationales of deprivation and deviance.  Most gang research, even today, does not take into account those key variables (Katz, Jackson-Jacobs,  2004,  p. 111). 

Methods, Results

       Sanchez-Jankowski employs a qualitative approach, and one largely observational in nature.  More exactly, to establish his reasoning as to the social validity of the gang as a reflection of organizational strategy, he explores gang trends and activity through a trajectory of eras.  Setting aside the traditional focuses on deviant pathology and specific marginalization as bases for gangs, the author asserts that gangs more ordinarily represent rational forms of human agency prompted by adverse circumstances.  This is then supported by his examinations of gangs as arising under specific and widespread social conditions: immigration, blue-collar expansion, drug deregulation, mass incarceration, and monopoly behavior.  In each circumstance, and citing extensive research pertinent to each, the author makes a strong case for the integral structural aspect, if not impetus, of gangs.  He notes, for instance, that early 20th century immigration virtually encouraged gang formation through its emphasis on the defiant and aggressive individualism necessary to survive in environments typically poor and facing extreme discrimination.  Interestingly, the blue-collar expansion of the mid-20th century is presented by the author as generating an actively intelligent motive going to gang formation, in that the young men comprehended the blue-collar work of their parents as unsatisfying, and organized to create leisure for themselves.  The same processes of an organizational response fused with defiant individualism are presented as evident in the Italian Mafia’s loss of drug trade control; essentially, the young men of the neighborhoods organized in ways calculated to weaken the control and thus secure participation for themselves (Sanchez-Jankowski,  2010,  pp. 136-139).   Drawing upon documented fact and reports, the author traces an irrefutable commonality in regard to gangs over multiple eras and in differing conditions; namely, that the unique social and economic circumstances serve to generate the coming together of the more defiant young people, and in ways pointing to strategic thinking and motivations of actual advantages. 

Assessment and Implications

       It is important in assessing Sanchez-Jankowski’s article to comprehend several factors.  To begin with, and to his credit, the author detaches himself from the moral aspects so inevitably associated with gang study.  This is not to suggest that prior research is tainted, but rather that the violence and criminality of gang activity inevitably influences perspectives and approaches; given the prevalence of deviant activity of gangs, it then follows that this largely fuels investigation, and motivation becomes narrowed.  Admirably, Sanchez-Jankowski distances himself from these associations, which enables him to more clinically examine the organizational elements which, as he proposes, are very much within the motivations.  Then, the author is careful to acknowledge his own reliance upon elements common to gangs and non-gang individuals.  He notes that, as he is dissatisfied with approaches that define gangs in randomized ways, most ‚Äúdefiant individuals‚ÄĚ do not join gangs.  More important, however, is that

gangs often contain these types, which indicates a coming together of organizational and individual interests (Sanchez-Jankowski, 1991, p. 29).  Through a uniform commitment to scholarly integrity and what must be termed insight, the author ultimately presents a persuasive and somewhat novel approach to gang study, observing inescapable traits and patterns within gangs reflective of societal organizations of all kinds. 

       It seems clear, based on the quality of this article, that the intended audience encompasses serious students of criminology, as well as experts in the field.  Sanchez-Jankowski has certainly provided me with a new perspective, as his thorough examination of gangs in differing eras and conditions convinces me that structure and ambition are as pivotal to the gang, if not more so, than the traditionally held motives of disenfranchisement and deviant personality.  No matter what criminal or violent activities are undertaken, I now perceive a ‚Äúmethod to the madness,‚ÄĚ and understand that viewing gangs as gatherings of weak, sociopathic, or socially deviant young individuals vastly underestimates the constructions themselves.  This being the case, the implications for the criminal justice system seem to me extraordinary.  In a sense, gangs are more challenging as seen by Sanchez-Jankowski because the formations of them are far more complex ‚Äď and reflective of normal organizational processes ‚Äď that has been believed.  These are, criminality notwithstanding, organizations in place to pursue agendas, and consequently no blanket criminal justice policy may be effective in dealing with them.  The crime must be addressed, but it may be that efforts to eradicate the gangs themselves will be seen as futile, for the social conditions will enable them whenever two or more ‚Äúdefiant individuals‚ÄĚ choose to defy circumstances in a collective fashion.


Katz, J., & Jackson-Jacobs, C.  (2004).  The Criminologists‚Äô Gang.  In  Summer, C., The            Blackwell Companion to Criminology.  (pp. 91-124).  Hoboken: John Wiley & Sons.

Sanchez-Jankowski, M.  (2010).  Gangs and Social Change.  In Walsh, A., & Hemmens, C.,       Introduction to Criminology: A Text/Reader.  (pp. 135-142)Thousand Oaks: Sage      Publications.

Sanchez-Jankowski, M.  (1991).  Islands in the Street: Gangs and American Urban Society.       Berkeley: University of California :Press. White, S. O.  (2001).  Handbook of Youth and Justice.  New York: Springer.


Medicaid and Medicare for the Organization

Currently, the responsibilities as the CEO of the healthcare facility to provide essential information on the critical importance of Medicaid and Medicare for our healthcare facility. In providing this information to the new board members, they will be able to fully access the significance that these programs provides for the patients, the public, and more importantly to the organization. In absorbing this information, the board members will be more effective in handling the roles and responsibilities of their duties to the organization and to the patients.

Medicare and Medicaid

            Healthcare in the United States has gone through dramatic changes that have left millions without proper healthcare, and organizations without the proper technology, tools, and funding to care for these patients. Only in the last 60 years has there been readily available healthcare insurance for a majority of Americans that were for non-profit. However, once private insurers saw the tax incentives that were available from the government, many private insurance flooded the market, only insuring young, employed, and health individuals, which cause premiums to rise and millions were excluded. Although a national healthcare system has always been a favorable option it has not yet come into fruition. Up until President Kennedy‚Äôs presidency was congress mobilizing in that direction, after Lyndon B. Johnson step into the presidency, millions were without healthcare coverage include the poor, the old, and more importantly the children. The best way to go about the process to national healthcare was to step the first steps in insuring the old, low income, and children.

President Lyndon B. Johnson signed the Social Security Act on July 30, 1965 that created the Medicaid and Medicare federal enacted programs. (Medical News Today, n.d)  Medicare is an entitlement program that was created in order to provide insurance for citizens that are over the age of 65 or who are disabled in any capacity regardless of their level of income. Medicare is a social insurance program that serves more than 48 million enrollees (as of 2011). The program costs over $549 billion. (Gov, n.d) The services they provide include, Part A, hospital insurance, Part B, supplementary insurance that covers home health and outpatient services, Part C that gives seniors the option to enroll in private plans like, Medicare Advantage, and Part D, that covers prescription costs. Medicare is essential in providing insurance for the growing number of seniors who are left without insurance, healthcare bills, and no money to pay for prescriptions or services. The current issues are however that the price of healthcare is increasing, and it is estimated the number of people enrolled will continue to increase. Fraud, waste, and mismanagement are rampant issues with this program. According to Forbes fraud in both programs cost taxpayers billions of dollars. (Matthews, 2012) ‚ÄúOriginal Medicare isn’t designed to achieve outcomes beyond paying beneficiaries’ claims and guarding against fraud and abuse in the program. Lawmakers built the Medicare program on this limited model in 1965 – and little has changed.‚ÄĚ (Humana, 2013)

 Medicaid is another entitlement program that is generally referred as a social welfare program that provides healthcare insurance services for low income individuals, children and families, elderly, and people with disabilities. ‚ÄúThis entitlement program is means-tested which means that eligibility for benefits requires the beneficiary to be at or near the Federal poverty level.‚ÄĚ (Concord Coalition, 2013)  This program covers over 55 million citizens and costs over $350 billion. (Gov, n.d) There services include providing insurance for children to cover all healthcare expenses, pre-natal care, physician services, family planning services, ambulance services, lab and x-rays, clinic services, and other healthcare services. These services provide a great strength in ensuring that children and their families, along with other groups have access to premium healthcare services for their medical needs.  Issues with Medicaid are similar to Medicare, fraud and the increase in costs are essential in deciding the longevity of the program. ‚ÄúMedicaid is a particular burden on states, consuming on average 22 percent of state budgets‚Ķ states will be forced to spend another $60 billion on Medicaid through 2021, while another tally estimates the costs to state could reach at least $118 billion through 2023.‚ÄĚ (Senate, 2012)

Both government programs are managed by the Centers for Medicare and Medicaid Services, which is a division held by the U.S Department of Health and Human Services. Medicare is funded by Federal payroll taxes paid by most employees and employers, beneficiary premiums, and general tax revenues paid on Social Security benefits.  The funds are authorized by Congress which are set aside in trust funds to be used as reimbursements for hospitals, private clinics and insurance companies, and doctors. Medicaid is a joint initiative of the State and Federal governments that are delegated at the state-level. Medicaid is funded by both levels of governments from general tax revenues, where the Federal government matches Medicaid spending dollar for dollar of State spending. Medicaid operates by sending direct payments to the healthcare providers, based on state fee-for-service agreement and pre-arrange payments through HMO‚Äôs. States are able to be reimburse from the Federal government of their share of the expenditures, which are dependent on the FMAP or Federal Medical Assistance Percentage and average per capita income level. (Gov, n.d)

Healthcare costs are continuing to rise, and millions are still without healthcare coverage due to lack of affordability and access. Quality care is essential in healthcare organizations, providing the same care to all patients is a significant duty that healthcare officials must make. Quality care is dependent on the share practices and mission of the organization. The way that patients are treated, and the recommend care is a testament of quality care. It is measured in the feedback from patients, the outcome of patients, and the way the staff is treated and treat others. In providing quality care, the organization must remember to put the patients’ needs first in getting to them quickly, accessing the problem, recommending the correct procedures, and ensuring they get the best outcome. Within healthcare organizations quality care needs to consistently monitored, accessed, reevaluated, and drilled into staff on a continual basis in order to ensure that patients receive the best quality care from the organization.


How is Medicare Funded? (2013). Medicare.Gov. Retrieved from

Matthews, Merril. (2012). ‚ÄúMedicare and Medicaid Fraud Is Costing Taxpayers Billions.‚ÄĚ Forbes. Retrieved from

Medicare РHumana Government Relations. (2013). Humana.  Retrieved from

Medicaid and Medicare – Tom Coburn. (N.d.). Senate. Gov. Retrieved from

Medicare and Medicaid Funding Challenges | The Concord Coalition. (N.d.). Concord Coalition. Retrieved from

What is Medicaid/Medicare? (2013). MNT. Retrieved from Health Care Quality. (2013). AHRQ.  Retrieved from

Creative Writing

Michigan Criminal Justice Budgeting Issue

An online article reports that an average prisoner is spending more time behind bars in Michigan which only worsens the financial burden on taxpayers. While the national average is 2.9 years, an inmate in Michigan spends 4.3 years behind bars on the average, according to Pew Charitable Trust. The number is even greater for violent criminals at 7.6 years versus national average of 5 years. This is a worrisome trend for two main reasons. First of all, it is an unnecessary financial burden on states and the taxpayers. In addition, prison stints do little to reduce the probability of returning to life of crime, according to some experts (Campbell, 2013). I have chosen this article because Michigan has been hit hard by the financial crisis and has been faced with some of the highest unemployment figures in the nation. Given the current circumstances, it is unfortunate that the state is wasting money on keeping prisoners behind bar, a significant proportion of whom may be serving sentences for non-violent crimes such as drug offences. If this trend could be reversed, the freed-up resources could be invested in education and in providing job-related training to those looking for work.

The author seems to agree with the experts he interviewed for this article that much of this has been due to politics because it helps elected officials project tough image. One of the experts interviewed by the author for this article was Eric Lambert who is a professor of criminal justice at Wayne State University. Lambert drew attention to the fact that despite lengthy prison times, Michigan has one of the highest crime rates in the nation. The author also implies by pointing out to Pew’s report that Michigan should go the way of Illinois which has taken the opposite route and yet has succeeded in lowering the crime rate. Illinois reduced average prison time by about seven months to 1.7 years between 1990 and 2005 and saved almost $476 million in the process. The author also reminds us that many politicians are weary of tackling the issue anytime soon because the public also views severity of punishment as an effective means of deterring crime. The author also seems disappointed at the current trend of politicians going tough on criminals including those with non-violent offences but the author also realizes that without a change in public perceptions, it will be difficult to persuade politicians to change their course.

I agree with the author and the experts mentioned in the article that the current criminal justice system in Michigan is in a great need of reformation. But I also realize politicians often put their own interests in front of public interests, thus, one of the best solutions to reducing the financial burden on taxpayers may be to decriminalize drugs such as marijuana. The social costs marijuana imposes on the society are more similar to cigarettes than other harmful drugs such s heroin and marijuana users account for a significant proportion of nonviolent crimes in the nation. Not only this will lower the burden on Michigan’s criminal system but may also help the state create another valuable revenue stream in the form of tax receipts. In fact, some other states have already chosen this path including Vermont (Wing, 2013) and there is growing public support for decriminalization of marijuana. One another course of action that Michigan’s criminal justice system can pursue is to refer offenders to education and rehabilitation programs whenever possible except for the most violent crimes. This course of action may also be more effective in lowering the probability of return to life of crime than prison stints.


Campbell, K. (2013, April 26). Longer sentences fuel big budget for Michigan prisons. Retrieved June 13, 2013, from

Wing, N. (2013, June 6). Vermont Marijuana Decriminalization Signed Into Law, Reduces Penalties For Possession Up To An Ounce. Retrieved June 13, 2013, from

African-American Studies

Zombie Culture: From African Legend to Modern Movies

In the 1960s, the movie ‚ÄúNight of the Living Dead‚ÄĚ introduced a new kind of monster in horror movies: the zombie (Kay, 2008). Over the last several decades, movies and television shows featuring zombies have become more and more popular. The zombies that are depicted in most modern horror movies and shows are dead bodies that somehow have come back to life, usually from some sort of contagious virus or an environmental catastrophe (Kay). These zombies do not speak or even think; the only thing they care about is eating living things ‚Äďusually human beings. In most zombie movies and shows, the bite from a zombie will turn the victim into a zombie as well, thereby spreading the zombie plague (Kay). These zombies may only exist in the movies, but the idea of the dead coming back to life as zombies has actually existed for centuries, and is rooted in the religious histories of Africa and Haiti.

            The earliest stories and traditions about zombies originated in parts of Africa, where some people believed that witch doctors had the power to bring the dead back to life (Davis, 1988). Some researchers believe that these witch doctors may have used various plants and herbs to create potions and poisons that could temporarily simulate death in those who took them. Other researchers have theorized that witch doctors and shaman used psychoactive chemicals derived from various botanical sources to induce trancelike states in people. When under the influence of these psychoactive drugs, it has been claimed, the victims would be very open to suggestion, in much the same way as someone who was in a hypnotic trance. The witch doctors would supposedly control the spirits of their victims, and would offer to bring them back to life or to release their spirits from captivity in the victims or their families paid for their release from the witch doctor‚Äôs control.

            The word ‚Äúzombie‚ÄĚ is believed to have come from the word Nigerian word ‚Äúnzambi,‚ÄĚ which can mean ‚Äúgod‚ÄĚ or ‚Äúspirit‚ÄĚ (Davis). The religious practice of the witch doctors that created zombies was known as Vodun (rhymes with low-dun) (Davis). During the centuries where African slaves were shipped to the West by the thousands, many of the religious traditions of their homelands were brought over as well. The descendants of African slaves who lived in Haiti kept the many of their ancestor‚Äôs traditions alive, and the practice of Vodun in Africa gave birth to the Vodu (rhymes with low-doo) traditions that still exist today in Haiti (Davis).

            Vodu, which is still sometime referred to as Vodun, is a religious practice involving shamans who use drums and psychoactive drugs to enter into trance states. During these trance states the shaman can commune with the spirit world and bring back messages to the living. Some people believe that these shaman, like the shaman and witch doctors in Africa, have the power to bring the dead back to life, and to enslave these zombies until they decide to return them to the grave (Brown, 2010).

            Researchers who have studied Vodu and Vodun in Haiti believe that the zombie legends there are similar to the zombie legends from African history. Vodu shaman may use psychoactive plants or trance-inducing poisons to send victims into a state of partial paralysis and suggestibility. The strong influence of the cultural beliefs associated with Vodu may help to reinforce the state of suggestibility, meaning that the poisoned or drugged victims may actually believe that they are dead, and willingly follow the orders they are given by the shaman (Davis). Some researchers have doubts, however, about how long a shaman could actually induce such a state in a victim (Davis). The zombie legends of Haiti describe shaman who have raised people from the dead and kept them in a zombie-like state for years, though most experts believe that this is impossible, or at least very unlikely. What is more likely is that some shaman have induced trance states in victims for a matter of hours or even days, and the legends and stories told about these supposed zombies have been exaggerated over time.

The television shows and movies that depict zombies as the victims of some sort of pandemic or other disaster may not be exactly like the zombies of Haitian Vodu, but it is clear that stories of the dead coming back to life capture the imagination of people from all different cultures and backgrounds. In an age where the threats of nuclear attacks, biological warfare, and terrorism are a reality of life, the idea of a ‚Äúzombie apocalypse‚ÄĚ reflects our deepest fears about a world gone mad (Kay). Just like zombies themselves, the legend of zombies looks like it will be very hard to kill.


Brown, N. R. (2010). The complete idiot’s guide to zombies. New York, NY: Penguin.

Davis, W. (1988). Passage of darkness: The ethnobiology of the Haitian zombie. Chapel Hill, NC: University of North Carolina Press. Kay, G. (2008). Zombie movies: The ultimate guide. Chicago, Ill: Chicago Review Press


Request for Proposal Response


Reviewing the opportunities on the Federal Business Opportunities website my small business is in search for a particular opportunity to support Microsoft applications.  This support would encompass both technical support and project management opportunities.  Solicitation Number: HC1028=13-D-0023 encapsulates the core business model my company offers.  The synopsis is ‚ÄúMicrosoft Enterprise Technical Support Services (METSS) necessary to obtain highly- trained “Microsoft Blue Badge Cardholder-support”. These services require access rights to Microsoft’s proprietary (closed-source) code, which is licensed under exclusive legal right of Microsoft. The core requirements are for the contractor to provide Microsoft Consulting Services that include software developers and product teams to leverage a variety of proprietary resources and source code, and Microsoft Premier Support services such as tools and knowledge bases, problem resolution assistance from product developers, and access to Microsoft source code when applicable to support Department of Defense’s mission. The period of performance is a one-year base period and four one-year option periods for a total period of five years. Performance will predominantly be within the continental United States; however, support services may also be required at multiple overseas locations.‚ÄĚ

The level of support and sustainment activities will extend beyond the normal customer support functions and will require hands on management of the core Microsoft technical support.  This level of support will rely heavily on project management best practices to implement the appropriate support services as well as develop and launch the sustainment model that will lead to first in class support.  The key members of the team will range from functional and technical subject matter experts, project managers, programmers and business analysts.  This mixture of IT and business experts will ensure that the requirements from the business are properly translated and implemented into the technical solution required by the business.

Cover Sheet

Administrative Business Lead:

Tamaste Jones

1313 Mockingbird Lane

Marengo Falls, Idaho

Phone: 812-898-5555

[email protected]

Technical Lead:

Cathy Jenkinson

7474 Julius Orange Lane

Sacramento, California

Phone: 812-798-5555

[email protected]

Solicitation Number


Name of Project

 ‚ÄúMicrosoft Enterprise Technical Support Services (METSS) Program‚ÄĚ



Estimated Cost



5 years (1 plus optional year by year extension for 4 years)

Key Staff Members


Tamaste Jones


University of Arkansas March 2004

Master of Science, Operations Management

University of Louisville May 2001

College of Business and Public Administration, Finance Major

Project Management Professional (PMP) certified through PMI

ITIL Foundation Certified


Digitization Program Manager

May 2011-Present

  • Program Manager for Financial Management and Sourcing programs
    • Sourcing Financial Reporting
      • Improved 7 day financial review to instantaneous through continual process improvement and lean management techniques
      • Increased accuracy and precision of financial reporting by eliminating non-value add inputs and review
    • Reduced amount of unclassified financial data from $500M to $20M allowing enterprise wide cost allocation to specific operating units
    • Train, implemented and sustain quoting and bidding tool reducing overall costs for goods and services by 17% in first six months
  • Sourcing functional leader for Enterprise Resource Planning project for total revitalization and improvement of Procure to Pay business practices and function

Continual Service Improvement Program Manager

2007- 2011

  • Continuous Service Improvement Project for family delivery business
    • Reduced downtime of delivery downtime by 50%
    • Diminished worker overtime hours spent outside of delivery duties by 12.5% resulting in increased productivity for dollar spent
  • Financial Statement Review/Reconciliation and Budget Preparation
    • Review of Income Statement, Budget Sheet and Cash Flow Documentation
    • Streamlined process of financial management review by setting up a continuity folder and scheduled conferences with stakeholders to review budget and projections
  • Computer Repair/Upgrade/Utilization for small home businesses and individuals
    • Software/Hardware installation and maximization
    • Training on how basic computer skills
    • Training on Microsoft Office applications and internet use
    • Website Design/Enhancement

Cathy Jenkinson


University of Kentucky March 2005

Master of Science, Information Technology

University of Idaho May 2001

College of Business and Public Administration, Basket Geneology

Microsoft Certification

ITIL Foundation Certified

ITIL Service Management Certified

IT Project Manager


The project manager is responsible for the ability to initiate, formulate, and deliver on a project which is fundamental to business achievement.  The Technology Project Manager supports business position by designing, planning, and executing innovative technology solutions in a dynamic environment.  The PM role understands IT strategy, development lifecycle and application/infrastructure maintenance.  Understanding of IT service and support processes promote a strategic advantage, create efficiencies and add value to business. 

  • Responsible for managing and leading enterprise wide IT projects which have a direct impact on  the IT Operations environment that support Humana‚Äôs business units
  • IT Service Management Program Manager for all current CSIP/ITIL initiatives
  • Established new processes to allow the free flow of communication alleviating silos of information and allowing updates to senior leadership with real time information
  • Performed Gap Analysis, product roll out schedule, project plan and integration schedule
  • Project Leader for IT Perfect Service
    • Formed a team of director and higher leaders from all three VP‚Äôs
    • Planned and executed the initial IT Perfect Service Summit
  • 85% (186/212) of all the Voice of the Customer concerns were resolved with ITIL initiatives, Communication efforts in which I lead as Project Manager
  • Served as the Project Manager for the enterprise wide adoption of three ITIL initiatives
    • The original roll out date was June 2009 with the criteria of all three scoring a three on an ITIL based Maturity assessment. All three scored above a three and all three were at least five months ahead of schedule
  • Service Catalog-Security Access Front End
    • Project Manager for the entire lifecycle of the product from initiation to software implementation utilizing Agile Project Management methodology
    • In charge of 12-15 programmers during 1.5 year project resulting in enterprise wide adoption of forward facing web portal to address Role Based Access Control and Segregation of Duties to comply with SOX and industry requirements
  • In charge of vendor relations, requirements gathering, system integration, risk management, scope, schedule and cost management of multiple projects ranging in complexity, cost and schedule

Cyril Leroy

DoD Financial Manager

February 1998-Present 

  • Financial manager for multiple acquisition programs with budgets exceeding $50M while leading and managing five team members
  • Duties include planning, programming, budgeting and execution funds
  • Directs and formulates funding strategies/execution for squadron programs
  • Provides scheduling support for project planning and forecasting for 60-70 projects annually
  • Initiates and maintains communication with Major Commands, HQ Air Combat Command, Secretary of the Air Force and Air Logistic Centers
  • Ensures resources are effectively managed to meet war-fighter‚Äôs requirements-delivering on time and on cost
  • Identifies requirements and works with program managers to submit on time and on target budgets supported by estimates to funding Major Commands
  • Prepares funding program reviews for all levels of management up to Air Force level
  • Implements Earned Value Management (EVM) for projects to ensure project performance is on track in relation to technical, schedule, and cost performance
  • Identifies requirements and works with program managers to submit on time
    and on target budgets supported by estimates to funding Major Commands

Executive Summary/Approach (Technical/Business)

A project is by definition a temporary endeavor to produce a unique deliverable at the conclusion of the endeavor (PMI 2008).  Just as the foundation of a house supports the entire home to stand the test of time the definition of the scope of a project establishes the entire trajectory of the project and determines what resources and schedule will be needed to accomplish all of the requirements that constitute the scope.  Understanding what is needed within the project helps define the scope of the project and what will be needed to complete all of the requirements outlined by the customer.  My company‚Äôs focus on the principles of project management and ensuring the deliverables meet the quality expectations of the customer allows for a superior level of support and sustainment services.  The planning phase of project management includes developing the project management plan, collecting the requirements, defining the scope, assigning resources in a work breakdown structure and defining the activities.  Planning in a project establishes the ground work for the entire project‚Äôs lifecycle and will inherently become the foundation for success or failure when the project comes to a close.  In order to understand what is to be delivered at the end of a project there must be boundaries and guidelines established to set the parameters or scope of the project.  Defining scope is the process of determining a common understanding of what the project will include in or exclude out of the final deliverable (Magal and Word 2011).  Before the work is initiated a thorough review of the requirements are conducted and if possible the end user or customer is contacted to discuss in detail the specific details of the project. 

Scope management is a key success factor in completing any project.  Prior to submitting the proposal for this project a preliminary request for information (RFI) was sent to the Defense Information Systems Agency to ensure the requirements were interpreted correctly by my organization and the level of support and project management was understood by both parties.  With any project my company undertakes the process becomes a partnership at which both parties benefit from the relationship. This type of symbiotic engagement creates an environment for success and encourages open communication and understood expectations.

The business approach will ensure that project management best practices outlined by the Project Management Book of Knowledge (PMBOK) are utilized during the project management phases of the obligation but there is also a technical support aspect of the project.  As part of the project team there are multiple highly skilled and certified technical resources that provide the insight and intellectual horse power to service and support the closed-source Microsoft code.  The Microsoft Consulting Services will also be provided by the certified Microsoft representatives that are employed by my company and will be assigned to the project to address any necessary development, support and resolution assistance that is required around the key Microsoft applications.  The ultimate objective is to provide project and technical resources to leverage the proprietary resources of Microsoft to benefit the Department of Defense‚Äôs mission.

            Through the utilization of the key functional leaders the sustainment and support levels required by the Defense Information Systems Agency will achieve their outlined key performance metrics which are outlined in the request for information.  Each one of these key metrics such as project inputs and outputs, service level agreements, functional and technical ability as well as accessibility to closed-source Microsoft application code is not only achievable but also can be met or exceeded by the current talent pool my company already employs.  The current business model utilized by my organization meets or exceeds all the required delivery and sustainment metrics outlined by the DoD and DISA.

Goals and Impact

            In order to meet the requirements of the project there must be a clear understanding of the key performance metrics, requirements and the desired end state expected by the Department of Systems Agency.  There also should be a clear and distinct factor or factors that provide that level of separation between this organization and that of its competitors.  The competitive advantage offered by this organization is the purpose driven tactics and the strategic intent for fulfilling the contract effectively and efficiently not only for the guaranteed one year opportunity but for the entire five year term of the proposal. 

The requirements of the project include:

  • Provide Project Management Oversight to METSS projects
  • Provide trained/certified Microsoft Blue Badge Cardholder-Support
  • Access/Service to Microsoft Closed-Source Proprietary Code
  • Licensed under legal right of Microsoft
  • Consult on Software Development
  • Program Software implementation/ Code Reviews
  • Provide Knowledge Base/Knowledge Transfer
  • Access to Source Code for DoD use

Each one of these requirements includes a breadth and depth of knowledge not only in the Microsoft applications and access but also key skills in programming and technical prowess.  The goals of the project are to meet the desired quality standards set forth by the customer and to meet the expectations of those quality standards.  To ensure that expectations are established and set prior to the project award, my organization took the additional forethought and requested a detailed listing of each requirement and walked through the details with the program manager listed on the solicitation.  This level of detail and purpose driven actions can be expected throughout the life cycle of the project.

After understanding the requirements my organization created a detailed response to each requirement with an outline of the organization’s ability to meet the defined requirements.

  • Provide Project Management Oversight to METSS projects

My organization applies the best practices outlined in the PMBOK.  These project management best practices transcend the nature of the project and can be applied to each project management initiative.  As a supplement to the best practices framework there are multiple subject matter experts on the team that cover project management, information technology systems, Microsoft applications, code/quality review, implementation and sustainment activities.

  • Provide trained/certified Microsoft Blue Badge Cardholder-Support

Once the project is awarded there will be four (4) Microsoft Blue Badge Cardholder leads assigned specifically to the METSS project.  These will be assigned 100% to the project and there will be four (4) additional certifications obtained within 6 months contract award.  While the certifications take longer than 6 months to obtain my organization‚Äôs focus is on Microsoft programming and our core business model includes maintaining the leading edge in education, access and ability.  The proactive approach to education and preparedness allows my organization to provide the leading edge experience while also maintaining the agility and flexibility to meet customer demands.

  • Access/Service to Microsoft Closed-Source Proprietary Code

            As part of the agreement between my organization and Microsoft there is a review process for access, modification and support of the proprietary code they provide.  The process is a documented and effective utilization of the change management process outlined in the Information Technology Infrastructure Library‚Äôs framework.  This framework is another best practice tool my organization utilizes to provide superior service and deliverables.  The access to the proprietary code is only awarded to those that utilize the best practices and adhere to the change management process.  All of which my organization utilizes and fully understands.  This facilitation will provide the seamless integration between requirements, project implementation and technology development that is unparalleled in the industry.

  • Licensed under legal right of Microsoft

As outlined in the legal agreement between Microsoft and my organization, only those certified will conduct code review, change, modification or other changes outlined in the change management charter.  This charter outlines all technical and operations changes that are allowed and the process for making those changes. 

  • Consult on Software Development

As part of the sustainment activities there is a level of consultation between my organization and the Defense Information Systems Agency.  This consultation is inherently limited to the METSS project.  While the limitation is specific to the METSS project all consultation regarding development is included in the contract.

  • Program Software implementation/ Code Reviews

The software development lifecycle will be managed from beginning to end by my organization as outlined in the project charter.  The project, from inception to closure, requires management of the scope, cost and schedule to be effective and promote the best environment for success.  This is included in the contract as the project management ability is a key and distinct aspect of my organization‚Äôs ability.

  • Provide Knowledge Base/Knowledge Transfer

My organization specializes in Microsoft based applications and programming.  This alignment with project management execution creates a unique competitive advantage for my organization.  This knowledge base is unparalleled in the industry when integrating DoD projects.  During the project my organization will generate and sustain until project completion and knowledge management database that can be referenced during the course of the project.

  • Access to Source Code for DoD use

The access to the source code for DoD use is available through the appropriate requests, processes and procedures through a tri-lateral agreement between my organization, the Department of Defense and Microsoft.  This is an agreement that has been accomplished by my organization in the past and the established process to obtain such access is within the realm of the project team‚Äôs ability.

Technical Plan

The technical plan outlines the approach my organization will take in regard to the project‚Äôs outlined in the requirements.  There are two major frameworks utilized by my organization with regard to project management and information technology projects.  That includes the use of the PMBOK for project management and ITIL for IT support and services.  These technical and business tools allow for best practices to forge the path to successful project implementations.  The technical framework provides the clear guidance on change, incident, problem and service management.  All of which will be required for this project.  The technical plan will outline the key milestones of the project that will focus on support, sustainment, enhancements and development of functionality for the DoD.  These key focus areas will be limited to the Microsoft applications outlined in the requirements documentation.

Management Plan

The team will consist of the following:

1-Program Manager

3-Project Managers

3-Technical Leaders

3-Business Analysts

4-Certified Programmers

4-Certification in Process Programmers (transitioned after 6 months to certified)

2-Hardware/Configuration Leaders

1-Logistic Coordinator

1-Service Support Team Leader

10-Service Support Representatives

Each member of the team will play a critical role in implementation, sustainment or support.  There are multiple aspects of the project lifecycle that will take place over the course of the initial contract award as well as the following option four year period.  My organization focuses on low turnover of personal which allows for organizational continuity and sustainment of the integrity of the knowledge base.

The Program manager is the overall responsible and accountable individual for the entire program.  This includes three distinct areas of the program.  The first is the enhancements, next is knowledge base creation and lastly is the sustainment and support of the applications.  Each area will have a veteran project manager leading these functions.  To support the project manager there will be a technical leader that works in conjunction with the programmers and developers to facilitate the project‚Äôs development efforts.  Each one of these members provides key inputs and efforts to provide the necessary deliverables per the customer‚Äôs requests.

The business analysts are trained professional leads that help develop the requirements and user stories required for the sub-projects of the contract.  The business analysts take the burden of project requirement development off of the primary organization so that they can focus on their primary objectives.  The objective of the project managers, business analysts, developers and other project members is to create the necessary changes or enhancements to the applications so that the Defense Information Systems Agency can perform to the DoD‚Äôs expectations.

Cost Management

Within the project there will be costs associated with meeting the goals and objectives of the project.  In order to provide the highest quality for the most reasonable cost there are certain tools and techniques required to monitor and control costs. Project cost controls are vital in managing and establishing a framework for success of any project.  Depending on the complexity and intricacies of the project there are multiple ways to manage and control the costs.  The important aspects of managing and controlling costs include establishing a baseline, determining the tools necessary to manage and control the variations and taking corrective actions to keep the project on track regarding schedule and cost variance.  This project is utilizing a bottom-up cost estimation analysis which provides a cost and duration for specific work packages.  With this information we can use Earned Value Management to help monitor the cost and schedule variances.  Using the baseline project cost and implementing the EVM tool my organization can provide a superior level of monitoring and controlling ability.  To do this my organization will use key performance indicators and best practices to manage the project.

Throughout the project execution there will be multiple tollgates the project must proceed through in order to not only level set the stakeholders on the process of the project but to also ensure the project track the team is on is still on track for delivery of the expect results.  Through the project management life, the business will go through operating cycles, budget cycles and project evaluation.  Through the use of project cost management and the tools of monitoring and controlling the project by documenting and utilizing EVM, the stakeholders will have a fair and accurate depiction of the project‚Äôs scope, schedule and cost as well as areas that have meet, exceeded or missed meeting their intended objectives.  Each functional area will report up their costs associated to each work package and it will individually be measured against the scope, schedule and costs associated to that work package.  The overall project will then include all of the individual tasks brought together into an overall project budget, including overhead and other associated costs that are necessary for the project as a whole but not necessarily attached to a specific task.  If each of the functional areas are moving along according to the project plan, meeting their specified deliverables while also meeting their intended schedule requirements there are no necessary changes.  If there are areas that need adjustment the project manager must take action and make the appropriate changes to scope, schedule or costs.  It is ultimately the responsibility of the project manager to identify and flag risks to the project (Cooper, Grey, Raymond, & Walker. 2005).


The project requirements will be met by my organization by providing key leadership ability; functional expertise and the access to the key develop resources required by the Defense Information Systems Agency.  The management of cost, schedule and scope will be managed by project management professionals and will be held accountable not only up my organization‚Äôs chain of command but will be held to the highest standards to ensure the entire contact is fulfilled to the specifications outlined in the requirements document.  The balance and integration between technical expertise and adherence to project management best practices establish a unique and absolute distinction for my organization.  This ability to meet the goals and objectives of the contract as well as provide the key metrics and measurable achievements provide solid quantifiable results as well as a transparency into the management of the program.


Budd, C. I., & Budd, C. S. (2009). Earned value project management. (2nd ed.). Vienna, VA: ManagementConcepts.

Cooper, D. F., Grey, S., Raymond, G., & Walker, P. (2005). Project risk management guidelines, managing risk in large projects and complex procurements. John Wiley & Sons

Dobson, M. (2004). The triple constraints in project management. Vienna, VA: ManagementConcepts.

Fleming, Q. W., & Koffleman, J. M. (2010). Earned value project management. Project Management Institute.

Magal, S. R., & Word, J. (2011). Integrated business processes with erp systems. RRD/Jefferson

            City: Wiley.

Project Management Institute, P. M. (2008). A guide to the project management body of

            knowledge. (4th ed.). Newtown Square: Project Management Inst.


Making a Case for Corporate Social Responsibility ‚Äď Carpeteria


Corporate Social Responsibility has become an important facet in business activities during the last few decades. However, not all companies have embraced what is known as the ‚Äėtriple bottom line‚Äô ‚Äď Carpeteria included. Therefore, as part of a new initiative, the company will undergo some major changes in the designing and implementation of corporate social responsibility throughout each and every area of the company; from the supply chain to customer relations. The importance of such an initiative, and what it means for company in terms of corporate culture and overall management implementation, is discussed herein.   

Corporate Social Responsibility Explained

The main purpose of corporate social responsibility is to serve society in a positive way in addition to the pursuits of profitability and legislative requirements undertaken by the company. Usually embraced by larger companies, smaller companies have come to understand the importance and benefits of implementing corporate social responsibility initiatives in all parts of business. The main benefits are a result of what is known as the triple bottom line.    

The three points in the triple bottom line are people, planet and profit. Though the traditional type of companies usually were driven by the bottom line, that is profit, the turn to people and the planet as equally important is a realisation that is necessary for every business. People are the company; without any employees, a company cannot function well.

Therefore, employee practices and human resource management should be efficiently and effectively handled in relation to fair labour, recruitment and retention improvements, and similar initiatives. Planet refers to environmental practices and how the company disposes of waste, engages in recycling, and makes the location in which the company operates and even beyond, a better place for future generations and the future of the company as well.

It is important to note that when companies invest in corporate social responsibility; the investment is recovered many times over. This is because the organisation undergoes a change for the better, and driven by this change, the company becomes more profitable and more receptive to customers, employees, stakeholders and stockholders alike.

Therefore, it is necessary for a business to embrace corporate social responsibility, so long as there is a lasting change and the effects of implementation are noticed by all those involved.

Furthermore, corporate social responsibility is not a new concept, although it is a recent move for the company regarding a step in the right direction. Many companies have incorporated corporate social responsibility previously, as seen by our main competitor, Interface.

The main difference between our competitor’s implementation of corporate social responsibility and our own, is that we are undertaking an initiative that will be efficient, effective, and long-term. It will be visible in all parts of the business, and its benefits will assist in making Carpeteria expand and become a pioneer in carpet manufacturing.

Strategy Outline

When outlining the need for corporate social responsibility, the strategy behind this new initiative is five-fold. It requires creating balance, effective management, opportunity identification, development of business practices and organisational capacity.

Contrary to popular belief amongst business managers, corporate social responsibility is not simply an add-on to company objectives. It requires a holistic investment on the part of the company, and only then will it have holistic rewards. Therefore, the first step in using a strategic approach to corporate social responsibility is creating balance; in terms of economic value and societal value.

These are not mutually-exclusive alternatives, and both can be achieved. However, both of these objectives need to be maintained by operating the business with economic value as an underlying purpose, and societal value as a powerful driving force.

The second step is effective management, in regards to business relationships that are of high importance to the company. Usually, there are a few that are not worth retaining if incorporating corporate social responsibility. 

Therefore, it is necessary that those business relationships that do not embrace our new company initiative or refuse to comply with the company’s focus on positive societal impact should be severed from further business dealings. Any individual or business that does not partner with the company on this front is not worth having.

The third step is identification of opportunities, as well as responding to any threats the business may have. In terms of opportunities, there are several avenues that the company can consider when implementing corporate social responsibility initiatives; whether it is investing into community projects, using environmentally-friendly products and services, or spearheading increased corporate quality testing and certification in the manufacturing stages of operation.

The possibilities are endless, and will be covered in context later on. However, there are always some threats to the business, in terms of competition. To prevent our corporate social responsibility initiative being labelled a copycat scheme in opposition of Interface and other related competitors, our company should be able to find ways of differentiating in order to create a lasting competitive advantage, as will be discussed in the corporate culture section.

The fourth step is the development of sustainable business practices. Sustainable refers to long-term changes that can be readily measured and identified by all those involved. These practices should be in the best interests of the company itself and society at large. It is unnecessary to implement changes that are not foreseeable as beneficial for the future. Therefore, all changes should be in line with the direction of the company, the customers we interact with, and the surrounding environment in which we operate.

Lastly, the capacity of the organisation, in regards to engaging in charitable causes, should be considered. Philanthropy is a good part of re-investment into the community, especially for those who need it most.

There are major clients and individual customers who should be rewarded for their loyalty and also their need, and this will be a major driving factor for our philanthropic cause. This will be in addition to any charitable activity that we may be involved with currently, with a focus to expand on this area for the long-term.

Business Implementation

The implementation of corporate social responsibility in regards to the way the business is operated spans a numbers of key stages. Highlighted here are four stages of the corporate social responsibility design and implementation process, including: engagement, conduct, creation and establishment (Maon, Lindgreen and Swaen, 2009).

Stage one requires the engagement of employees to whom corporate social responsibility applies. Since the company is taking a holistic approach to this initiative, all staff will be initiated into the new policies and procedures.

These will also be written into company manuals and documentation. It is also our duty to inform all those who have business relationships with the organisation of any and all changes to our company outlook for the present and the future.

For the conduction of corporate social responsibility training in stage two, both management and employees will be briefed on how the company plans to carry out changes in the workplace, and also the operating environment. This will consist of various informative corporate meetings over the span of a few months, in order to roll out changes efficiently and effectively.

Stage three is the creation of internal and external communication plans. This will consist of improving the consistency between employees who operate out of the office and those who interact directly with customers. In addition, any communication channels that have any inherent issues are to be fixed within a relatively short period of time within the timeframe of the changes being implemented.

For the establishment of mechanisms which allow the business to operate smoothly, there will be improvements to all business divisions, in terms of streamlining processes and introducing the corporate social responsibility initiatives. This will ensure that there are no problems later on when the business is experiencing increased productivity and growth.

In regards to some of the new programmes to be implemented as part of the corporate social responsibility initiative, the manufacturing stage of operation will be improved, in terms of higher safety protocols and quality materials used for customer preferences. This will allow for the company to be at the cutting edge of production and ensures that the amount of hazardous waste is significantly reduced.

The type of carpets and other products used in customer residences or professional locations will be used with respect to any physical allergies or customer preferences. In addition, only environmentally-friendly products and services will be used, to reduce our carbon footprint and improve company image in a professional manner.

Finally, the investment into community endeavours and charitable organisations will ensure that we give back to our clients, employees and societal interests at heart. This will also increase customer loyalty and bring in new clients for the business. Furthermore, it will increase the philanthropic activities that we already have in place, making our reinvestment into the community that much more valuable for the long-term.

 Importance of Stakeholder and Stockholder Perspectives

There is a difference between stakeholder and stockholder perspectives, although both are important to the company. Firstly, the stakeholder sees suppliers, employees, customers, and other societal groups are crucial to the operation and management of the company; whereas the stockholder perspective sees shareholders as the owners of the company, and the chief duty is to look out for their interests and therefore increase their value.

Usually, the company cannot serve competing interests, therefore it is in the best interests of this business to take a stakeholder perspective, for three main reasons. The first reason is that many of the stakeholders have a major influence in the operation of the company, in terms of sustainable growth, profitability and environmental impact. Without stakeholders, there would be no foundation for the business at all, and the owners of the company would be rendered almost useless.

The second reason is that stakeholders support the company physically and financially, in regards to employees and support groups. Therefore, if there was no support base for the company, it would be next to impossible for the business to function efficiently and effectively. These stakeholders are needed for both the short-term and long-term.

The third reason is that the stakeholders are heavily involved in the company’s goals and future. Although owners of the company may change, stakeholders often outlast individuals, and are quite loyal to the business in many respects. It is important to maintain stakeholder ties and give them priority and input in company decisions, since the corporate social responsibility initiative is ultimately for their benefit.

Inadvertently, when stakeholders are valued, the owners of the company will also feel valued, because the company will continue to grow and become more profitable. This will become part of the benefits of corporate social responsibility, as stakeholders will be involved in both the giving and receiving end of the new initiative.

Not only is value maximised, but also employees and support groups will be more motivated to invest their time and effort into the company, not just for the sake of the company, but for their benefit as well. This will add to future benefits, as they will be able to reap the rewards, all in due time.

Most importantly, the company reputation and image will also improve as a result of this stakeholder perspective, due to the implementation of the corporate social responsibility initiative. As there have been some issues with customers in regards to our lack of initiative in this area in the past, our new initiative will be able to meet and possibly exceed their expectations.

All major stakeholders will come to embrace this new change, as it will be beneficial to many, and will spark a positive reciprocity, in terms of improved business relationships. As a result, it will be easier to handle customer relations, and employee satisfaction will be set to increase due to the new initiative.

Corporate Culture Change and Competitive Advantage

When incorporating corporate social responsibility into not only the core functions of the business, but every department, there are major changes that will occur as a result, in terms of the corporate culture of the company.

To ensure that the changes that are made are smooth, and the transition if effective, there are six main guidelines that should be followed as a rule of thumb, which also lead to the company’s competitive advantage.

Firstly, there needs to be a clear vision for the company, in regards to how corporate social responsibility will change our outlook for the future. If there is no vision, there can be no visible changes in the company and the way it runs; therefore, this should be clarified as a sustainable move for the sustainability and improvement of the company for the long-run.

Secondly, senior management should display commitment to the goals of the company, especially the new initiative that requires commitment to societal stakeholders. By ensuring that management hold to and believe that corporate social responsibility being the next step forward for the company, it will provide leadership and direction for the rest of the business as well.

Thirdly, modelling the culture change at all levels of the company is important for the building of trust in the new initiative and rapport among those who are involved in the business process. For this to function efficiently and effectively, the new business practices and policies should be reflected by all those who are part of the company.

Fourthly, the company structure should be modified to reflect the new changes. This also includes the company culture as a whole, which is part of the organisational structure. As this takes time, it also requires the cooperation and effort of employees, management and even the owners of the company. This will be discussed further in the organisational restructuring section.

Fifthly, employee engagement is critical to the company, in order for the corporate changes to be successful. There are many ways to engage employees in transition between corporate cultures and when the change takes place; incentivising employees who encourage others to be involved in the corporate social responsibility initiative, making the workplace more suited towards corporate social responsibility by modifying ergonomic design, and also introducing a reward scheme for customers who refer environmentally-friendly products and services related to the company to new clients.

Finally, corporate social responsibility measures should be launched to make sure that all those involved with the business are aware of the changes, understand them, and take up the responsibility of making the changes last. This will ensure that the corporate culture of corporate social responsibility spreads throughout the whole organisation.

If the corporate culture is valued by those who espouse it, it will be a source of sustained competitive advantage for the business. This will become our driving force for spearheading the new initiative, and will ensure that corporate social responsibility is here to stay. In order to differentiate ourselves from our competitors, the new corporate culture should be rooted and sustained by stakeholders and stockholders alike.

Customer Expectations and Global Market Perceptions

As aforementioned, corporate social responsibility is not a new concept in the business world, as many companies have been engaging and using this facet in different areas of business. However, it has only been widely embraced by most companies in the past few decades, and is certainly the newest initiative in regards to our company moving forward in the direction of sustainable, efficient and effective change in the area of social improvement.

Many of our customers have raised concerns about the lack of sustainable and environmentally-friendly practices in our company, as well as the embracing of the concept of corporate social responsibility by many of our competitors, particularly Interface, which has been experiencing rapid growth in recent times.

However, our company takes corporate social responsibility more seriously than just a concept; it is the new face of our company, it will stand for everything that this company represents, and it is a new initiative for the improvement and sustainable direction of our business.

In particular, customers have questioned our company’s environmental impact, fair wages, community involvement and supply chain activities. As outlined above, the business is moving forward in the right direction regarding all voiced concerns by customers, as we have taken these into account and are implementing new changes.

Therefore, our environmental impact will become positive due to the use of environmentally-friendly products and services; the introduction of incentives for workers who embrace the new corporate social responsibility will be implemented; reinvestment back into community projects will move to the forefront of our initiative; and all suppliers and others involved in the company‚Äôs supply chain will be reviewed and monitored for the highest level of quality and the embracing of our new corporate social responsibility‚Äô policies and practices.    

Dynamic interaction between and amongst multiple stakeholders allows for the successful development and dissemination of environmentally sustainable practices (Rusinko, 2010). Therefore, by valuing the stakeholders mentioned earlier, it will be easier to maintain and sustain the changes necessary for corporate social responsibility to take effect in our company for both now and the future. Furthermore, as the carpet industry has taken into consideration such initiatives, it is an important and necessary step for our company to use this new initiative to pave the way for continuous improvement.

On a global scale, corporate social responsibility is having positive effects on all companies involved, especially for those who have realised its value and importance, taking this into account by allowing corporate social responsibility to be the driving force in all areas of the business.

As the push towards globalisation increases, it becomes more and more important for corporate social responsibility to take a central role in the function of a business, especially ours. It has become crucial for companies to endeavour to reduce their carbon footprint, use renewable energy sources, and maintain the competitive edge of green programmes inherent in the business.

            Most companies have embraced corporate social responsibility for three reasons: (1) to increase market potential; (2) creating future opportunities for improvement; and (3) provide products and services that enhance customer service and stakeholder investment. Firstly, tapping into a viable source of sustainability such as corporate social responsibility allows the company to diversify and expand business operations into different avenues, the most obvious being new market niches. With the support of customers and clients, it is possible to increase development into these areas as well as increase profitability simultaneously.

            Secondly, by improving the business processes that are currently in place, it is easier to improve business practices in the future, for the simple reason that change is continuous. By implementing such change, it becomes a socially and culturally viable investment that reaps rewards if correctly implemented. Therefore, the company becomes more sustainable for the long-term.

            Lastly, introducing new and improved products and services to customers and investors allows the company to experiment in more ways than one. By using such test cases and environmentally-friendly initiatives, the general public has come to know the positives and negatives of such a move; and benefits from the former, and limiting the latter.   

As it is expected by the customers and perception is determined by the global marketplace, it becomes that much more important that we as a company are seen to and implement such changes in order to establish our presence in the business environment and increase our social change initiative to become socially and financially stronger.

By doing so, the company will be able to move forward with vision, instead of moving backwards without momentum. It is crucial that we are seen to be doing the right things by stakeholders, and are implementing the correct changes in the company. This will ensure that our company is stepping forward in the right direction. 

Research shows that influence, perception and performance of the organisation rely heavily on the focus of corporate social responsibility (Johnston, Swaen and Lindgreen, 2009). Therefore, it is an important initiative that this company is proud to be making, and one that will not be taken lightly, as it becomes the focus of our business’ function in the marketplace.

Although expectations of the company may change over time, the perception of the company is set to become more positively acquainted with corporate social responsibility on a holistic level. For this to remain a positive change, it will require the support and effort of those both inside and outside the company, which is what the new initiative strives to serve.

Organisational Restructuring

For effective design and implementation of corporate social responsibility throughout the company, it is imperative that the organisation undergoes some critical restructuring for the purposes of efficient and effective functioning in the business environment.

Although the company has been successful in the past, there have been many issues and customer complaints have been increasing to a point where the business is at an impasse: it must change in order to become more sustainable. Therefore, the change from a traditional structure to a flat structure is to be proposed.

Also known as more of a horizontal structure as opposed to a vertical structure, there are many differences to the future model of the organisation in regards to the former. For the most part, the shift from many levels of management to fewer levels of management will allow more autonomy for employees to implement corporate social responsibility at every part of the organisation.

Furthermore, there will be a new division of change management for the purposes of spearheading the new initiatives, with change agents to be mobilised and dispersed throughout the organisation with the responsibility of ensuring that business practices and policies will be smoothly, efficiently and effectively introduced into the business.

The senior management of the company will also be responsible for holding corporate change meetings, as aforementioned, with the highlights of progress for the months and years ahead, with a focus on corporate social responsibility and how it is being embraced throughout the organisation. This will ensure that there is still top direction, but a more bottom-up focus.

This new structure will allow for managers and salespeople to work together on the same level, communicate more effectively, and become more geared toward corporate social responsibility. Understanding that corporate social responsibility challenges the long-established, traditional idea of maximising financial gain alone, and rather turning to positive societal impact, is one that should not be ignored (Carroll and Shabana, 2010).

By streamlining the business process, productivity is set to increase due to the introduction of the new initiative, a more organic corporate culture, and a flat organisational structure. This also removes the threat of a centralised chain of command, as the company wishes to make sure that all those involved in the business are confident that this new direction and vision is in the best interests of the business.

For the company to realise that corporate social responsibility is to be implemented as a core driving force, and not simply as an add-on facet to the business, this organisational restructuring is needed. More importantly, it is completely relevant regarding the current position of the business, and the state of the company is set to rapidly grow and improve once major changes take place.

It should be noted that this organisational restructuring is not to be taken as change for change‚Äôs sake. It is an important move that will have an impact throughout the company, in every area we operate, and with all stakeholders involved. Therefore, this move should be taken with all sincerity, focus and effort for those involved in making this initiative work for the improvement of the company. 

As can be seen, an organic culture and a flat organisational model is part of the new initiative to be more flexible in the functioning of our company and more receptive to our stakeholders. To be effective in the business world, we must be efficient as a company. In this way, we will make a positive impact in our environment and on our society. 

Corporate social responsibility benefits the social stakeholders, employees, customers, and the government on the whole (Turker, 2009). Therefore, it is important that this new initiative begins internally and works externally, so that there is an efficient and effective move towards the sustainable future.


 In summary, Carpeteria has faced some challenges in the face of competition and customer feedback. Therefore, it has begun a new initiative to embrace and implement corporate social responsibility in every area of the organisation. As a result, the corporate culture will change to a more organic form, in compliance with the restructuring of the organisation from a traditional model to a flat organisation. This will ensure that all stakeholders will support and sustain the new policies and procedures of the organisation, that environmentally-friendly products and services will be introduced, that philanthropic reinvestment into social causes will increase, and that the staff and customers of our company will be valued in light of our new direction and vision for corporate social responsibility both now and in and the foreseeable future. 


Carroll, A. and Shabana, K. (2010). The Business Case for Corporate Social Responsibility: A Review of Concepts, Research and Practice. International Journal of Management Reviews, 12(1), 85-105.

Johnston, W., Swaen, V. and Lindgreen, A. (2009). Corporate Social Responsibility: An Empirical Investigation of U.S. Organizations. Journal of Business Ethics, 85(2), 303-323.

Maon, F., Lindgreen, A., and Swaen, V. (2009). Designing and Implementing Corporate Social Responsibility: An Integrative Framework grounded in Theory and Practice. Journal of Business Ethics, 87(1), 71-89.

Rusinko, C. (2010). Evolution of Environmentally Sustainable Practices: The Case of the US Carpet Industry and CARE. International Journal of Sustainable Economy, 2(3), 258-276.

Turker, D. (2009). Measuring Corporate Social Responsibility: A Scale Development Study. Journal of Business Ethics, 85(4), 411-427. 


Current and potential uses of technology for the global success of business objective

In a world where global competition is a common ground for ongoing business operations, technology becomes an element of operational success. Considerably, the modern world of business has began to embrace the fact that it needs to thrive in the constancy of making well established connections with other organizations from all around the globe. Establishing alliances and expanding towards the outskirts of the traditional locations of the organizations has become a sign of growth and business progress. In this case, technology becomes the bridge that connects the gap between business and branches as they entail to accept the mandate of operating globally and expanding their market control through affecting the global response to what they have to offer the public with.

            For organizations like the Microsoft Company, technology plays a primary role in the hope of gaining the attention of the global market while it operates on different parts of the world. The desire to expand has already become a reality for the company. As of now, its retaining power  in the industry still depends on the manner by which it is able to effectively manage technology as a source of its primary strength. To note, it utilizes technology for three primary operations. One is to connect its branches around the globe through a networked system of communication between its people. This way, it is able to establish a common organizational culture amidst the distance of its branches. Another process is that of its marketing. It entails to reach out to the market it hopes to serve through social media and other forms of technological operations such as that cloud computing to be able to make sure that its operation is able to mandate the growth of its market scope to the best of its ability. Third is operating its transaction with the clients it serves through the internet. Microsoft Company hopes to retain its market control through maintaining close control on its assets especially relating to how it functions with the technology it uses to manage major corporate operations.


Gremberge, W. Van , and S. De Haes, ‚ÄúA Research Journey into Enterprise Governance of IT, Business/IT Alignment and Value Creation‚ÄĚ, International Journal of IT/Business Alignment and Governance, Vol. No. 1, 2010, pp. 1‚Äď13.

De Haes, S. and W. Van Grembergen, ‚ÄúAn Exploratory Study into the Design of an IT Governance Minimum Baseline through Delphi Research‚ÄĚ, Communications of AIS, No. 22, 2008, pp. 443‚Äď458.


SWOT analysis for Walmart

¬† Walmart is perhaps one of the most well-known corporations in the world.¬† Although it started from humble origins, the corporation quickly grew to become one of the most formidable retailers in the world.¬† Although some analysts see Walmart‚Äôs rise as meteoric, particularly in the United States, the retailer‚Äôs aggressive overseas expansion has raised concerns regarding Walmart‚Äôs business model and internal controls to survive worldwide.¬† ¬† ¬†Strengths In order to become one of the world‚Äôs largest retailers, Walmart possesses a myriad of strengths.¬† The first main strength is efficiency in operations, particularly in supply chain operations.¬† One may argue that the firm‚Äôs ability to establish ‚Äúlean‚ÄĚ supply chains and superior inventory are the key planks of the firm‚Äôs business model, a business model that has not been replicated by any other retailer.¬† These operational strengths ‚Äúfeed through‚ÄĚ the system to establish another one of Walmart‚Äôs strengths: pricing (low prices). While many believe that retailers establish low prices through aggressive purchasing, one of the largest components in costs for retailers is overhead expenses.¬† By cutting overhead expenses, Walmart has become one of the most efficient operators in the retail space, leveraging its strengths to solidify its competitive position at home and abroad.¬† ¬† ¬† Weaknesses ¬† Although Walmart boasts numerous strengths, recent performance has also revealed important weaknesses.¬† The most important weakness is the company‚Äôs internal control system, particularly in overseas operations.¬† Walmart has been tarred with numerous ‚Äúcorruption‚ÄĚ scandals involving local managers paying bribes to governments in order to secure preferential treatment for store authorization permits and preferential tax treatment.¬† Indeed, although Walmart boasted of increased revenue and profits from overseas, apparently their system of efficiency and internal controls did not follow leading to a larger weakness of overexpansion and inability to replicate their model.¬† At the same time that Walmart is experiencing unprecedented challenges overseas, it is also experiencing reduced sales at home in the United States.¬† Although this slowdown is partially due to remaining economic problems and deleveraging of consumers, there are also questions regarding the ability of Walmart to compete amongst a growing cadre of low-cost retailers.¬† Opportunities Walmart still has several key opportunities to grow its business.¬† First, if the firm can better manage operations abroad, there are numerous emerging middle class consumers (particularly in Africa) where the firm can build its business.¬† There are also numerous locations in the United States, particularly urban ones, where Walmart could expand operations to increase revenue streams and profitability.¬† Another potential opportunity is different ways to sell items. As the sword of Damocles swings over brick-and-mortar retailers, Walmart is expanding online offerings. Threats Due to Walmart‚Äôs (previous) success, it has bred larger and more capable rivals. Firms such as Amazon and Costco have tried to replicate Walmart‚Äôs model; Amazon has arguably been the most successful replicating essentially all of the products Walmart offers in its store.¬† If other competitors emerge and are able to compress margins even more, Walmart could face an existential threat down the line. ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† ¬† References: ¬†
Walmart.  Available at:
Amazon.  Available at:                      

Necessary Justice: The Death Penalty Imperative

       The death penalty, it seems, never rests; controversy surrounds it today as it always has, and arguments rage over the morality and efficiency of it continuously.  If anything has changed, it appears to be a lessening of support, and likely due to media promotion of how minimally capital punishment deters severe crime.  The death penalty is on the wane: ‚ÄúThirty-six percent fewer states carried out executions in 2012 than in 2011‚ÄĚ (DPIC, 2012).  This may also be due to the culture’s determination to see itself as enlightened, which equates to more lenient treatment of extreme offenders.  Added to this is the tendency in people to be unable to fully comprehend the levels of crime that bring the punishment into consideration; when violence is unimaginable, it is then difficult to address such a thing at that level and remain rational.  Nonetheless, and however capital punishment is legislated today,  the reality remains that this is a penalty justified by the very degrees of the crimes calling it into play. 

       The great argument usually opposing the death penalty points to it as failing to deter, and statistics fly back and forth as to the validity of this.   Certainly, many facts indicate that capital punishment does not significantly deter murder.  This, however, ignores the more fundamental issue of degree or state of the deterrence.  On one level, there can be no truly reliable means of determining how many extreme crimes are deterred by the death penalty simply because these crimes do not happen.  Citing a state wherein murder rates are high and capital punishment is imposed by no means translates to an ineffectiveness of the punishment; rather, it may well be that the crimes rates would be even higher without it.  Then, logic dictates that some deterrence occurs whenever a known punishment is attached to a crime (Bedau, Cassell, 2005,  p. 39).  Also, the majority of those who support the death penalty only partially hold deterrence as a reason, and usually express doubts as to the realities of the punishment actually preventing extreme crime (Mandery, 2011,  p. 31).  In all cases and sides, then, deterrence is not a relevant issue in determining the rightness of the penalty, just as some measure of deterrence is inevitable.

       What must be considered is what the public so often avoids confronting, which is that, questions of absolute morality aside, there are actions and behaviors so horrific that they require this form of response.  Kant is helpful here, in that his philosophical approach is both pragmatic and moralistic.  On one level, Kant provides strong support for capital punishment in his view of the scope of what is morally wrong.  That is, even if the act mandating the punishment is not immoral, the forbidding of it by law renders it immoral (Hill, 2000, p. 180).  The society to some extent decides morality by means of law, and the severity of murder, for example, is such that the law must respond to the same degree in order for the morality to be upheld.  More to the point, however, Kant presents retribution, frequently cited as a failing or dubious motive for the death penalty, as a rational and moral drive.  Kantian ideology holds that the evil done by an individual is in some sense inflicted upon that individual, in moral terms; to do evil is to bring evil upon the self (Hill, 2000,  p. 186).  Importantly, Kant here acknowledges the existence of evil as a real force.  This may not be entirely acceptable to modern thinking, but it is nonetheless a view held by a vast variety of cultures of the past and today, and irrespective of religious creeds.  In simple terms, good and evil are real to most minds, and evil at its most active dos not merit the consideration attached to other crimes.

       What is also vital here is comprehending how Kant removes retribution from the modern and negative perceptions of it.  Retribution is only fueled by suspect motives of ‚Äúvengeance‚ÄĚ when it is interpreted as such; otherwise, it exists as a sane and logical form of addressing a great wrong.  Moreover, and even morality aside, it serves to promote the balance necessary in a culture.  If the crime is truly monstrous, then the punishment must be as severe as can be given.  This is society’s way of asserting that certain acts are not subject to debate or validation, which in turn reflects the society’s understanding that some crimes and criminals are completely beyond the realm of normalcy.  It is perhaps an irony, but there is no escaping the fact that what justifies the death penalty is precisely the extremes of crime that call for it.


Bedau, H. A., & Cassell, P. G.  (2005).  Debating the Death Penalty: Should America Have        Capital Punishment?  New York: Oxford University Press.

Death Penalty Information Center (DPIC).  (2012).   The Death Penalty in 2012: Year-End         Report.  Retrieved from

Hill, T. E.  (2000).  Respect, Pluralism, and Justice: Kantian Perspectives.  New York: Oxford University Press. Mandery, E.  (2011).  Capital Punishment in America: A Balanced Examination.  Sudbury: Jones


Global Health Issues

Global health issues affecting undeveloped countries have long been on the radar in the public eye, due to numerous infomercials and televised awareness campaigns to raise money for people in poor countries so that they have access to food, water, and healthcare. These awareness campaigns often report on millions of people in undeveloped countries dying due to the lack of resources and healthcare (Shah, 2011). This is an inequity in life that still exists in many parts of the world.

The World Health Organization (WHO) reports that almost 80 percent of noncommunicable disease deaths occur in lower income countries. In 2008, it is reported that 57 million people, globally, died from noncommunicable diseases such as cancer, diabetes, lung, and cardiovasular diseases, and about 25 percent of these deaths were people under 60 years of age. In addition, it is stated that improved healthcare, detecting diseases early, and getting people treated in time would result in a reduction of these deaths (WHO, 2010).

Scope of the Problem

            According to the Council on Foreign Relations, disease and death in undeveloped countries continues to rise inspite of new medical technologies and improved conditions in sanitation, nutrition, housing, and education. This is not just related to noncommunicable diseases; infectious diseases such as malaria, AIDS, SARS, the flu, and tuberculosis are also culprits and much of these occur in developing countries (CFR, 2013). The scope of this problem involves factors such as environmental health, maternal and child health, nutrition, ethics, and human rights issues.

            As it relates to environmental health, global health issues are often caused or made worse by negative environmental impacts such as pollution and health hazards caused by a lack in adequate sanitation of waste and water supplies. Satisfactory maternal and child health is affected by lack of resources, education, and healthcare access. Nutrition issues stem from low or non-existent food sources and little access to healthy food choices. In addition, ethics and human rights issues are related to all of the above. There is an unfair disparity in access to basic human necessities such as food, water, and healthcare, in undeveloped countries, and this speaks to a lack of ethics on the part of developed countries as well as of the governments of the undeveloped countries.

Solutions to the Problem

            As mentioned, improvements in healthcare access, early detection, and timely interventions are keys to eliminating much of the problems surrounding global health issues. However, most developing countries depend on health system funds from donors, which is not always reliable. Many developing countries receive up to 40 percent of their financial help from donor funds; however, there are times when the developing countries‚Äô governments reduce their resource allocation, by up to 43 percent, to their needy when receiving assistance for health from other countries. Furthermore, many health systems in developing countries are undermined because of a shortage of healthcare professionals (less than 2.3 per thousand people), and this causes disparities in delivery of care (CFR, 2013).


            Unfortunately, it seems that there really is no immediate solution to the problem of global health issues, as long as obstacles such as governments blocking needed help from their countries and issues with poverty, sanitation, nutrition, education, and access exists. Poverty is the main cause of many global health issues. Poorer countries are often victims of the wealthy such as powerful pharmaceutical companies which is an example of a human cause, due to politics. Not all causes are natural causes. Addressing the problem of global health issues, therefore, is more a matter of social, ethical, and political factors that need to be changed before the world sees a reduction in unnecessary poverty, diseases, and deaths.


CFR. (2013, June 6). The Global Health Regime. Retrieved from Council on Foreign Relations:

Shah, A. (2011, September 12). Global Health Overview. Retrieved from Global Issues:

WHO. (2010). Global status report on noncommunicable diseases. World Health Organization.


Heart Disease in Baltimore


            The development of a successful framework for managing heart disease in any community requires an effective understanding of the demographics and the challenges that groups face in support of developing strategies to improve outcomes. In particular, heart disease is a challenging condition that must be considered and evaluated in order to reduce risks and improve outcomes for community members. The following discussion will evaluate heart disease in Baltimore, MD in order to identify different strategies that might be useful in expanding knowledge and information regarding this condition to prevent serious complications.

This discussion will also address the importance of communication within nursing practice as a means of exploring the different dimensions of care and treatment that is required for communities such as Baltimore, MD. Nursing possesses a series of different ideas and expectations within the culture that must be addressed in an effort to produce successful outcomes in the area that emphasizes various communication strategies. These efforts will provide support in determining how to best utilize group communication as well as one-on-one communication to identify and solve problems effectively. These efforts will demonstrate the importance of nursing communication in supporting successful patient care and treatment outcomes at all times.

Part 1: Community/State Demographics     

            Baltimore, Maryland is a very diverse community with many different health concerns and a strong necessity to facilitate health promotion activities. Heart disease is a number one killer throughout the United States and carries a high degree of risk for many communities, including the Baltimore area. With the 2012 Census, the city of Baltimore had approximately 621,342 residents, of which 52.9 percent are females and 63.6 percent are African Americans (US Census Bureau, 2012). Whites make up 31.5 percent of the population and only 4.3 percent are of Hispanic or Latino origin (US Census Bureau, 2012). Almost 80 percent of this population has a high school diploma and 26 percent has earned a Bachelor‚Äôs degree or higher, with 50% owning their own homes (US Census Bureau, 2012). The median household income for 2007-2011 was $40,100 and 22.4 percent of the population is below the poverty level (US Census Bureau, 2012).  

            In the State of Maryland, there are 5,884,563 residents, with females comprising 51.6 percent of the population, while 61.1 percent are White, 30 percent are African American, and 8.4 percent are Hispanic or Latino (US Census Bureau, 2012). Within the State, 88.2 percent of the population has earned a high school diploma and 36.1 percent has earned a Bachelor‚Äôs Degree or higher, with a home ownership rate of 68.7 percent (US Census Bureau, 2012). Finally, the median household income for the State is $35,751 and 9 percent of the population lives below the poverty line (US Census Bureau, 2012). Based on these statistics, the City of Baltimore faces greater socioeconomic challenges than those of the State of Maryland, including the potential for greater health disparities. Therefore, it is important to identify these disparities and to address cardiovascular disease within the City as a serious health issue and a formidable threat to this population.

Part 2: Health Status

            The Baltimore City Health Department routinely provides reports regarding the health status of its local residents and identifies specific health disparities that require further consideration. Although some areas have experienced slight improvement, there continue to be many health disparities that must be addressed to improve outcomes throughout the city (Baltimore City Health Department, 2010). In general, the city fares worse than the State of Maryland in such areas as heart disease and infant mortality; therefore, the City must utilize its available resources in order to accomplish improved health outcomes throughout this community (Baltimore City Health Department, 2010).

Within Baltimore County, cardiovascular disease claims approximately2,000 lives annually; therefore, this community must identify methods to better manage existing disparities and to encourage greater compliance to improve health and wellbeing (Baltimore City Health Department, 2009). An agenda was established by the City Health Department in an effort to reduce the risks associated with cardiovascular disease and included such topics as reducing salt intake, expanding blood pressure screenings, enhancing health education by using Faith-based approaches, and smoking cessation efforts (Baltimore City Health Department, 2009). These efforts demonstrate the important impact of health promotion for this population group in order to reduce disparities and to improve outcomes (Baltimore City Health Department, 2009).

Within the City of Baltimore, there were approximately 200 deaths per 100,000 members of the population as a result of coronary heart disease in 2008, which is 53 deaths above the state average (Maryland Department of Health & Mental Hygiene, 2009).These findings suggest that Baltimore residents do not manage their overall cardiovascular health and face critical challenges that require additional education and guidance from community members (Maryland Department of Health & Mental Hygiene, 2009).Within the City of Baltimore, evidence also demonstrates that African Americans experience higher rates of death as a result of cardiovascular disease as compared to other population groups, thereby mandating additional education and prevention efforts within this community (Johns Hopkins Urban Health Institute). Furthermore, African Americans within the city have a higher rate of obesity than Whites (Johns Hopkins Urban Health Institute). These statistics provide further evidence that cardiovascular disease in Baltimore is higher in some population groups than in others, supporting the belief that these groups experience greater health disparities (Johns Hopkins Urban Health Institute).

In an examination of statistics evaluating specific neighborhoods of Baltimore, every single neighborhood that was evaluated, from wealthiest to poorest, reported heart disease as the leading cause of death (The Baltimore Sun, 2011). Therefore, it is important to identify different methods to promote the expanded delivery of healthcare services and health promotion activities to improve outcomes for this population group (The Baltimore Sun, 2011). In addition, it is important to recognize the value of surveys and discussion groups to identify health disparities in order to improve outcomes and to reflect on existing frameworks to achieve greater results. According to a study conducted by the National Heart, Lung, and Blood Institute (NHLBI) in public housing units in Baltimore, ‚ÄúPublic housing residents had a preexisting knowledge and awareness of heart healthy lifestyles and CVD risk factors‚ĶOne cardiovascular risk behavior, cigarette smoking, is pervasive among the demographic groups probed (excluding teen females) and accordingly smoking cessation is a critical element of any community outreach strategy that would be developed. Stress, from environmental and personal stimuli, is also cited by participants as a major barrier to improving health, including young adults ages 15‚Äď18. In fact, many participants cite stress as a primary risk factor for heart disease and a barrier to heart disease prevention‚ÄĚ (NHLBI, p. 2). Based upon these indicators, it is necessary to evaluate the conditions that are evident within this community in an effort to improve knowledge and prevention strategies to reduce cardiovascular risks (NHLBI). The efforts that are made to conduct interventions throughout Baltimore are likely to be effective in providing knowledge and information to local residents who might improve their own health outcomes in the process.

One of the most staggering discrepancies in Baltimore regarding the health of its population is life expectancy, which differs by 20 years in some communities (Cohn and Marton, 2012). For example, the Roland Park community has a much higher life expectancy rate and a higher median income at $90,000, while Upton has a much lower life expectancy rate and a lower median income at $13,000 (Cohn and Marton, 2012). Nonetheless, heart disease is the number one killer in both communities; however, prevention and awareness of the disease vary dramatically (Cohn and Marton, 2012). These findings suggest that the residents of Baltimore in throughout all communities must be aware of the risks associated with heart disease, but that those in lower income communities must be provided with greater interventions in order to improve their cardiovascular health and wellbeing over time (Cohn and Marton, 2012). It is important to recognize these disparities and how to overcome the discrepancies in the health of Baltimore residents so that the risks associated with heart attack, stroke, and other conditions are reduced as best as possible (Cohn and Marton, 2012). In addition, this population group must be provided with the appropriate level of access to healthcare screenings and services in an effort to produce successful outcomes for individuals and families who are at the greatest risk for cardiovascular disease (Cohn and Marton, 2012).

            Finally, the development of a successful approach to prevent heart disease and improve disease management to prevent high mortality rates requires an effective understanding of the disparities that exist throughout Baltimore, particularly those that occur across minority groups. Since there are significant discrepancies in Baltimore in regards to specific populations, it is important to evaluate these differences and to take the steps that are necessary to provide local residents across different communities with     the tools and resources that are required to improve their health and reduce their risk of heart disease through healthy lifestyle choices and other factors that will improve their health and wellbeing in different ways.

Part 3: Communication Methods

            Nurses must exercise different methods of communication in the workplace and in working specifically with patients. One of the key factors to consider in this practice is time because there is typically limited time to address concerns with patients and with colleagues in the face of significant workload concerns (Hemsley, 2012). Therefore, time is a critical component in managing communication between nurses and patients in different settings and in supporting the development of new perspectives to ensure that patient care is not compromised as a result of time constraints (Hemsley, 2012). These efforts are important because they provide greater evidence of the ability of time to play a substantial role in how communication is addressed between nurses and their patients in different ways (Hemsley, 2012).

            In the context of quality patient care, nurses must demonstrate their willingness to communicate with their patients through the utilization of structure and leadership in supporting effective communication between patients and with colleagues (Baird, 2012). Nurse leaders must recognize that communication is a critical component of nursing practice and that nurses must identify areas of strength and weakness to ensure that patient care is not compromised in any way (Baird, 2012). In addition, nurse leaders must establish the tone and an example for other nurses to follow in their efforts to develop effective communication in group settings and in one-on-one exchanges (Baird, 2012). Also, nurses must develop effective skills to encourage interdisciplinary collaborations with colleagues to promote greater quality of care and treatment in these settings (Coeling and Cukr, 2000). Collaborations of an interdisciplinary nature are designed to strengthen knowledge and address weaknesses within team-based settings to facilitate improved quality of care over time (Coeling and Cukr, 2000). Similarly, team-based environments often encourage new approaches to common patient care problems and facilitate holistic strategies to promote care and treatment that not only support patients, but also clinical staff members in their own learning (Kvarnstrom, 2008).

Effective Communication Strategies

            Communication throughout nursing practice requires an effective understanding of the different elements that support idea sharing and positive outcomes. To be specific, ‚ÄúThe main intention of communication and interaction in the health setting is to influence the patient‚Äôs health status or state of well-being‚Ķ The process of communication is often described with a phase model; communication often happens during other interventions and tasks. In general, influencing factors can be organized into the categories of provider variables, patient variables, environmental and situational variables‚ÄĚ (Fleischer, 2009). From this perspective, it is important to demonstrate that nursing communication strategies are dependent on specific models and indicators that are grounded in other experiences to ensure that patient care experiences and interactions are not compromised (Fleischer, 2009). At the same time, it is important to identify the specific phases of communication that are common in nursing practice in order to accomplish the needs of patient care and treatment in different ways to improve patient wellbeing (Fleischer, 2009).

            Many different communication strategies are available to nurses to enable communication to be effective in their associations with other nurses and with patients. Therefore, one strategy to consider is collaborative communication, whereby ‚ÄúCollaborative communication and teamwork are essential elements for quality care and patient safety. Adverse patient occurrences are an extremely common outcome of communication failures‚ĶAlthough improving communication has been included as a Joint Commission’s National Patient Safety Goal for hospitals since 2003, in 2006, handoff communications were included as a specific communication subset‚ÄĚ (Beckett and Kipnis, 2009). Under these conditions, it is expected that effective nursing care and treatment will be achieved through the continued efforts by nurses and nurse leaders to exercise effective communication at all times and to demonstrate the importance of collaborative communication in supporting all aspects of patient care at all times (Beckett and Kipnis, 2009). In particular, situations involving handoffs of patients to the next shift are particularly important in demonstrating that nurses are capable of handling communication in an effective manner (Beckett and Kipnis, 2009). These efforts are also important because they convey the importance of specific needs and challenges that patients face when nurses are unable to communicate effectively with their colleagues and with patients (Beckett and Kipnis, 2009). For many organizations, the basic task of shifting communication styles is important because it provides significant evidence that there are improvements in patient communication by nurses once these strategies are rolled out (Beckett and Kipnis, 2009). Therefore, it is important to identify the strategies that are likely to be most effective in this process and to ensure that they are executed as best as possible in nursing settings and across all population group (Beckett and Kipnis, 2009). This practice is essential to the discovery of new ideas and techniques to demonstrate the successful impact of patient care and treatment in a manner that is consistent with nurse professionalism and strength (Beckett and Kipnis, 2009).

Barriers to Communication

            In working with specific population groups, nurses must also demonstrate their ability to engage patients by expressing communication with respect to culture and language differences. Therefore, nurses must be able to effectively communicate with all patients and to recognize that in some cases, there are likely to be barriers to this communication unless interventions are conducted for these patients, such as the use of an interpreter for patients who speak a different language (Fatahi, 2010). This is particularly important when providing technical information to patients to remove language barriers whenever possible so patients better understand what is taking place (Fatahi, 2010).

            Oncology nurses, for example, barriers to communication are a common phenomenon that is characterized by the development of specific limitations in communication as a result of the poor translation of information by other healthcare providers, perhaps on different shifts or in different departments, thereby leaving patients and their family members confused regarding the information that they have received (Wittenberg-Lyles, 2013). In addition, the article indicates that ‚ÄúPhysician assumptions about nursing left nurses feeling uncomfortable asking for clarification, creating a barrier to team communication processes. Patient-centered communication and care cannot be actualized for nurses unless team roles are clarified and nurses receive training in how to communicate with physicians, patients, and family‚ÄĚ (Wittenberg-Lyles, 2013). This example demonstrates that there are significant barriers to effective communication by nurses to patients and their family members, often based upon confusion created by other healthcare providers (Wittenberg-Lyles, 2013). These efforts are important because they convey that there are considerable weaknesses in the communication practices of other nurses and physicians, thereby creating much communication across different departments and nursing units (Wittenberg-Lyles, 2013). As a result, it may be difficult for organizations to overcome these barriers unless additional training and clarification is provided to nurses to ensure that these barriers are eliminated or minimized as best as possible (Wittenberg-Lyles, 2013).

            For nurses working with children and parents, there are other types of barriers and challenges that may exist that must be addressed as best as possible. However, some nurses might not possess the appropriate method of working with these patients and should be sensitive to the needs of this specific population group (Redsell, 2010). Therefore, these needs must be met through the understanding of nursing-based perspectives and how these might influence communication in different ways so that the needs of this population are better met during nursing communication practices (Redsell, 2010). The efforts that are made also demonstrate the attitudes of nurses regarding their patients and the treatments that they receive, because in some cases, these perceptions could be distorted by specific beliefs or judgments that are not beneficial to patients (Redsell, 2010). As a result, it is important to identify the specific indicators of communication that are necessary to ensure that patient care is optimized at all times (Redsell, 2010).

            For nurses seeking to improve their communication skills, it is important to recognize the value of developing new perspectives and approaches to nursing practice that will enhance communication in different ways. This may involve interventions that are likely to identify problems in such settings as chronic care, for example, so that there are sufficient opportunities to recognize problems to improve communication as best as possible (Boscart, 2009). In many organizations, ‚ÄĚPositive nurse‚Äďpatient communication in chronic care is crucial to the quality of life and well-being of patients. Despite this, patients are dissatisfied with these interactions and nursing staff indicate the need for additional training‚ÄĚ (Boscart, 2009). Therefore, it is necessary to identify specific areas where communication might be improved to reduce barriers and to expand patient compliance in chronic care settings (Boscart, 2009).

            Collaborative learning requires successful communication and the elimination of barriers through role clarification and trust amongst team members (U.S. Office of Personnel Management). This is best accomplished through flexibility and a full commitment to the team‚Äôs purpose and function (U.S. Office of Personnel Management). Furthermore, the development of effective critical thinking skills is essential in promoting productivity and encouraging a clear approach to a given problem in order to develop an effective solution (Elder and Paul). Higher level thinking and analysis must evolve so that individual contributions to teams and to the patient care experience are effective (Elder and Paul).

Health Assessment

            Baltimore, MD is a large metropolitan community that faces similar health risks to other communities with respect to heart disease and related conditions. It is important to identify the specific population groups that are most affected by this condition and to determine how to best approach disease management in order to facilitate optimal outcomes for this community. The City of Baltimore faces a great risk of heart disease that is not that unique from other communities; however, Baltimore has its own set of population demographics that must be properly identified and addressed so that the proposed action plan will be most effective for this community. Therefore, nurses and other healthcare professionals must take the steps that are necessary to create an action plan that will target this community and provide the necessary benefits as effectively as possible. An effective community-based assessment is critical to the success of a given strategic approach to improve public health initiatives and wellbeing (Williams, 2009; Walker, 2011). Health assessments also require an analysis of specific populations in order to improve health promotion activities across these groups (Harris-Roxas and Harris, 2011).

            From an environmental perspective, it is important to identify specific indicators that may impact health assessments and promotion activities within communities (Collins and Koplan, 2009). Team-based activities are critical during the assessment process and support the expansion of activities for a given purpose (Elder and Paul), while also considering the impact of these activities in the team setting (U.S. Office of Personnel Management). Perhaps one area to consider is specific needs assessments for elderly persons versus younger age groups, with the former more likely to require advanced directives due to age and other factors (Taylor, 2012). Miller (2005) demonstrates that communication within a given setting is critical to the success of a healthcare directive and should be utilized in team settings to facilitate positive outcomes. Furthermore, collaborative efforts in a community-based setting should signify a commitment to the initiative and the people that it serves through effective communication channels, rather than weak ones (Kvarnstrom, 2008; Coeling and Cukr, 2000). Laverack (2006) encourages community empowerment through the development of specific initiatives that are designed to promote health and wellbeing. A successful example is the Kaiser Permanente Community Health Initiative, which has been effective in providing tools to local residents who otherwise might not have access (Cheadle, 2010). Some community members may possess specific beliefs regarding therapies that may support improved health, but these are not always easily understood, including the use of alternative therapies to treat chronic illnesses (Fennell, 2009; Hassan, 2010; Ndao-Brumblay and Green, 2010).

            For the City of Baltimore, approximately 200 deaths occur per 100,000 members of the population resulting from coronary artery disease, which is well above the state average (Maryland Department of Health & Mental Hygiene, 2009). Therefore, it is strongly evident that many residents in Baltimore who face a greater risk of heart disease may not recognize this risk or are not taking the steps that are necessary to improve and maintain their own health (Maryland Department of Health & Mental Hygiene, 2009). In particular, African Americans face the greatest risk as a result of this condition and their needs must be addressed as a key component of a larger community-based effort to promote heart health and wellbeing, including the reduction of obesity rates within this population group (Johns Hopkins Urban Health Institute).

            According to the Baltimore City Health Department, ‚ÄúBaltimore, home to 637,455 people, is located in the wealthiest state in the nation, yet has nearly 20% of its residents living in poverty. Many of these are the working poor who cannot afford health insurance and who are frequent, but inefficient users of the healthcare system‚ÄĚ (Baltimore City Health Department, 2009, p. 4). Under these conditions, it is important to identify the specific factors that play a critical role in the continued growth of the heart disease epidemic within Baltimore, given that poverty impacts approximately one-fifth of the City‚Äôs population (Baltimore City Health Department, 2009). Under these circumstances, outreach and prevention are difficult to accomplish when this population group do not have access to health insurance and services at all, or this access is severely limited (Baltimore City Health Department, 2009). These findings suggest that it is necessary to identify specific indicators that may reduce the risk of heart disease within this population through the development of an action plan that will address these concerns in a comprehensive manner to improve overall awareness of heart disease and the risks associated with this condition throughout the City of Baltimore.

Action Plan

            An action plan to reduce the risk of heart disease for Baltimore residents requires an effective understanding of the specific risks and challenges of this group and their level of understanding of this condition and how it impacts their daily lives. Some of the most important factors to consider include the following: ‚ÄúCardiovascular disease behavioral risk factors include: inadequate physical activity and exercise, poor dietary habits, tobacco abuse and excessive alcohol intake. Community-based approaches seek to understand and address aspects of the socio-cultural environments that impact behavioral risk factors. Using the affected communities as the setting for intervention allows increased awareness and better understanding of the barriers and facilitators to behavior change‚ÄĚ (Baltimore City Health Department, 2009, p. 9). These circumstances coincide with the lack of understanding of the specific factors that contribute to negative outcomes for this population and the challenges that they face, either without any form or health insurance or very limited coverage, both of which may lead to considerable consequences for their health and wellbeing (Baltimore City Health Department, 2009). Under these conditions, it is important to identify the specific factors that are represented by these phenomena in order to determine how to best move forward with action plan that is most appropriate for the needs of this population (Baltimore City Health Department, 2009).

            The utilization of local community-based services and principles is essential to the discovery of new perspectives and strategies to improve the cardiovascular health and wellbeing of Baltimore‚Äôs population. This is challenging because it requires an effective understanding of the limitations placed on residents due to their lack of knowledge and experience with cardiovascular disease and how it impacts their health in different ways. It is likely that a lack of knowledge regarding diet, nutrition, physical activity, tobacco use, and alcohol consumption are key contributors to the elevated risk of heart disease within this community (Baltimore City Health Department, 2009). Therefore, it is recommended that there must be additional factors in place that will promote a successful action plan for widespread implementation throughout this community (Baltimore City Health Department, 2009).

            Baltimore‚Äôs population faces risks that are not that different from other communities with respect to heart disease. Therefore, lessons learned across other populations might be useful in developing a strategy for this community and its people. The action plan that is chosen for implementation must consider the following key areas of development: long-term impact, the capacity for continuous development and expansion, improving policy, moving forward with an action strategy, and expanding collaborations with other communities (CDC). It is known that ‚ÄúThe economic costs of heart disease and stroke rise each year. These costs include the numbers of people requiring treatment for risk factors or early signs of disease; emergency treatment for first or recurrent episodes of heart attack, heart failure, or stroke; and efforts to reduce disability and prevent recurrent episodes‚ÄĚ (CDC, p. 4). These findings suggest that it is more important than ever to develop strategic approaches that will facilitate the support of new ideas and community-based initiatives to encourage cardiovascular disease prevention as best as possible for Baltimore residents (CDC).

            The impact of a strategic action plan to reduce the risk of heart disease also requires an effective understanding of the risks associated with this condition. Behaviors are perhaps the key to understanding how individuals respond to heart disease and in establishing its overall impact on health and wellbeing for a given community. In Baltimore, this appears to be particularly relevant because lifestyle behaviors for many members of the affected population lead to greater risks, including poor dietary consumption, smoking, excessive sodium intake, and limited physical activity, amongst others. Under these conditions, it is important to identify the specific areas where behavioral improvements might occur so that cardiovascular disease risk is significantly reduced.

            An action plan to reduce heart disease risk for Baltimore residents requires a detailed assessment of the population and its current lifestyle behaviors because this practice will facilitate the development of new ideas to promote positive lifestyle behavioral changes for the residents of Baltimore. Due to the costs of prevention programs and their limited impact in many cases, it is necessary to identify the specific factors that are relatively easy to measure and that might have a greater and lasting impact on the community at large. These efforts will demonstrate the importance of specific factors that will support long-term behavioral and lifestyle changes within this population.

            From a public-based perspective, the development of a strategic approach to reduce the risks associated with heart disease requires public support and intervention not only through financial means, but also through the utilization of knowledge and experience that is present within the Baltimore community. This coincides with national public initiatives to improve health and promote awareness of heart disease and other conditions that impact communities throughout the United States. These factors play an important role in reducing these risks and in enabling community residents to better understand how their own behaviors impact their health and wellbeing in different ways. This is an important step towards the discovery of new insights and approaches that will positively influence outcomes for these residents.

            Public health initiatives and other challenges must evolve so that there are significant opportunities for growth and development within communities such as Baltimore. In particular, this community faces significant racial disparities and such factors as low education levels and low incomes that may prohibit access to routine healthcare services (Shaya, 2006). In addition, ‚ÄúPeople with lower socioeconomic status (SES) are more likely to be uninsured, have low-quality heath care, and seek health care less often; when they do seek care, the problem is more likely to be an emergency‚ÄĚ (Shaya, 2006, p. 140). Under these conditions, it is expected that there will be significant problems that continue over time that must be addressed through action plan efforts so that local residents will benefit from these initiatives and will improve their own cardiovascular health by utilizing these offerings (Shaya, 2006).

            Establishing an effective action plan for the Baltimore community also requires an effective screening tool that will be utilized on a regular basis within the community to support long-term growth and wellbeing for this population, and in particular, African Americans (Shaya, 2006). These efforts must coincide with other strategies in place within the community and should also reflect a means of expanding knowledge and growth of specific factors associated with community-based support of these offerings (Shaya, 2006). From a behavioral perspective, enabling this community to recognize the benefits of positive behavioral changes may make an important difference in their ability to remain compliant in these endeavors (Shaya, 2006). These creative approaches must demonstrate the importance of specific interventions and other factors that are instrumental in shaping outcomes for this group of residents (Shaya, 2006).

            From a compliance-based perspective, the ability of local residents to accomplish the objectives of the action plan requires a continuous effort from social service and healthcare providers to motivate residents so that they are able to reduce their risk of cardiovascular disease over time. This is an important and meaningful accomplishment for the community and requires a greater understanding of the different challenges and limitations that exist in supporting the development of new ideas and approaches to facilitate improvements not only in lifestyle behaviors, but also in the ability to access specific healthcare services within the community setting. This is a critical offering that must be provided through the efforts made with the action plan and should be effective in supporting the development of new ideas and approaches to encourage growth and change within the members of this community, and in particular, those who face the highest risk of cardiovascular disease. With these steps in mind, local residents are likely to experience greater benefits and will be empowered to improve their health and wellbeing through specific lifestyle changes and behavioral modifications to accomplish these efforts in an effective manner.

            Key community organizations and professionals, such as nurses, social workers, pharmacists, churches, hospitals, clinics, schools, and others must identify areas where collaboration might be beneficial in supporting the long-term growth and sustainability of the chosen action plan. It is necessary to identify specific factors that are associated with positive outcomes for local residents that also address disparities in healthcare access, screening, and treatment for this population group. With these efforts in mind, it is necessary to also address methods of developing and sustaining an action plan that is cost effective and appropriate for the population in question and the needs of the local community at large. These efforts will provide significant and meaningful benefits to local residents in their efforts to achieve positive health outcomes for the foreseeable future. Since the risk of cardiovascular disease is significant for many residents of Baltimore, it is more important than ever to address these disparities and to consider the challenges of creating an environment that supports these objectives and developments over the long term.


            The disparities in health in Baltimore are best represented by the development of strategic approaches in community ‚Äďbased settings in order to gather data and to develop specific frameworks that will generate healthier outcomes for this group. Within this context, it is important to recognize the value of interventions that provide education and support to those persons at risk for cardiovascular disease in order to improve outcomes and create new opportunities for expanded health. With a diverse range of life expectancy within the City of Baltimore, it is more important than ever to recognize the different concerns associated with lower income communities and how this impacts health over the long term. From this perspective, it is likely that organizations that work collaboratively towards a set of common goals and objectives will achieve greater than anticipated outcomes in different ways to reduce their risk of heart attack, stroke, and other cardiovascular concerns. For the residents of Baltimore, it is more important than ever to provide them with a framework for the achievement of successful outcomes and the development of healthier lifestyle choices to improve general health and wellbeing over time.

            The identification and development of successful nursing-based communication strategies with patients and colleagues requires an effective recognition of the different challenges that exist in expanding communication to improve the quality of care. Recognizing barriers to communication is important in demonstrating the value of taking the steps that are required to improve communication to improve the quality of care. All populations deserve quality care and treatment from nurses at all times; therefore, continuous efforts must be made to accommodate these needs and to eliminate barriers to communication in order to promote successful outcomes and wellbeing for all patients. These contributions to nursing practice are critical because they shape the manner in which nurses identify with their patients and are able to communicate with them in different ways to ensure that patient care and treatment are not compromised in any way.

            The people of Baltimore face significant risks associated with cardiovascular disease and its impact on their lives. In particular, African Americans face a greater risk of cardiovascular disease due to various disparities within the culture itself and in obtaining routine access to quality healthcare services. Community-based initiatives must be established to expand knowledge and awareness of heart disease and its overall impact on local community residents. It is important for local community members with experience in public health and social services to participate in these endeavors to ensure that local residents are taking the steps that are necessary to improve their health and to minimize their risk of cardiovascular disease. Therefore, greater access to healthcare services must be achieved to improve lifestyle behaviors, screening mechanisms, and other factors that are active contributors to the reduction of risk associated with cardiovascular disease within this community. Finally, it is important for local organizations and professionals to identify areas where disparities exist and to address those disparities as directly as possible to reduce the long-term impact of heart disease on the community as a whole. These efforts will demonstrate the importance of specific factors and approaches that will facilitate greater outcomes and that will utilize specific community-based knowledge and experience to develop efforts to improve outcomes for local community members that will be consistent and routine over time.

            The proposed action plan must demonstrate that cardiovascular disease in the Baltimore area is taken seriously and requires a collaborative effort from a variety of community-based sources in order to accomplish the desired objectives and to facilitate successful results in reducing disparities and in shaping a healthier community for all residents. These efforts must utilize existing resources wisely and develop new strategies to facilitate growth and change within the Baltimore community setting. With these practices in place, the people of Baltimore will achieve greater than anticipated health outcomes and improved longevity over time.


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Differential Diagnosis

            The patient in question, a 15 year-old with a persistent dry cough, should be examined thoroughly to determine the nature of the cough and any underlying or accompanying symptoms. Upon review of the patient‚Äôs prior medical history, the problem has been intermittent for approximately one year, but the symptoms are consistent and have not worsened. Performing a detailed assessment is required to determine the extent and cause of the dry cough and to determine if any specific factors might be at work. The patient does not experience wheezing to accompany coughing episodes. Evaluation of the patient must include an examination of lungs, airway, breathing, and overall appearance.

            The patient should undergo a chest x-ray to determine if any physical findings are present in relation to the cough that are significant in nature. In this case, the chest x-ray is the most natural approach because it conveys the importance of any findings that might require additional evaluation and possible treatment. In addition, if the x-ray does not present any significant findings, testing such as examination of the sinus cavities through nasoendoscopy and bronchoscopy might be necessary in this case. Finally, an exploration of iron deficiency through iron testing could be an indicator of coughing symptoms.

            The possible differential diagnoses for this patient include the following: 1) Asthma; 2) Non-Asthmatic Eosinophilic Bronchitis (NAEB); and 3) Gastro-oesophageal reflux disease (GORD). Each of these diagnoses requires its own set of tests to determine if the presenting symptoms correspond with the diagnosis. For example, a diagnosis of Asthma requires physical assessment to determine if wheezing is present. Testing includes spirometry with the use of the bronchodilator to determine if Asthma is the appropriate diagnosis. In this case, since the patient does not present with wheezing to begin with, the diagnosis of Asthma is unlikely.

            Non-Asthmatic Eosinophilic Bronchitis (NAEB) is also a possibility when the patient does not present with any significant symptoms other than a random non-productive cough that is not associated with wheezing episodes or other factors that could indicate the possibility of Asthma. The most common test to determine this condition is the sputum/broncho-alveolar lavage differential count. In addition, testing to evaluate exhaled nitric oxide is a possibility in this case.

            Finally, Gastro-oesophageal Reflex Disease (GORD) is a possibility when there are presenting symptoms of heartburn, acid regurgitation, and associated postural changes in these conditions, accompanied by a random cough without any wheezing symptoms. In this case, the first line of defense and testing is to prescribe proton-pump inhibitors for a period of at least eight weeks to determine their effectiveness in reducing coughing symptoms. In this case, it is likely that since the patient has not complained of a history of heartburn or acid reflux symptoms, this diagnosis is not likely.

            Based upon the information that has been provided through the patient‚Äôs medical history and current assessment, it is likely that the patient is suffering from Non-Asthmatic Eosinophilic Bronchitis (NAEB). Her symptoms indicate a dry cough without accompanying wheezing, along with increased physical activity over the past week due to swim training. Therefore, it is important to begin treatment for the patient to alleviate her persistent dry coughing symptoms, including the use of inhaled corticosteroids to produce antinflammatory properties. The use of an inhaled corticosteroid, particularly after periods of heavier physical activity, such as swim training, serves as an important means of alleviating possible symptoms over a period of time and in ensuring that the patient‚Äôs condition does not worsen beyond the current dry cough, particularly at the time of increased physical activity.


Charles Darwin

Topic:  Charles Darwin

Research sources:  Bowler P. J. Charles. (1996). Darwin: The Man and His Influence. Cambridge University Press

Darwin C. (2010). The Autobiography of Charles Darwin. Bibliolis Books

Holder C F. (2004). Charles Darwin: His Life and Work. Kessinger Publishing.

General purpose:         To inform.

Specific purpose:          To inform the audience on the life and contribution of Charles Darwin       in the field of science

Thesis statement:       From the theory of natural selection Charles Darwin remains one of the   most influential figures in history.


Behavior Analysis

Working with individuals with severe developmental delays is never an easy task.  Working with the developmentally delayed may seem daunting during the diagnostic phase as well as while deciding treatment methods.  The case in field research design that was implemented in the case study of Martin and Sara is a great example of helping individuals with developmental disorders overcome self-destructive behaviors.