Biomechanical differences beetween male and female marathon runners - Free Essay Example

Sample details Pages: 23 Words: 6838 Downloads: 7 Date added: 2017/06/26 Category Sports Essay Type Argumentative essay Did you like this example? More than by brain size or tool-making ability, the human species was set apart from its ancestors by the ability to jog mile after lung-stabbing mile with greater endurance than any other primate. The introductory quotation (Hotz, 2004) simply, yet vividly, expresses the results of a recent study completed by two American scientists, Dennis Bramble and Daniel Lieberman, and released in the journal Nature(2004). Bramble and Lieberman contend that the ability to run long distances was the driving force shaping the modern human anatomy.Hotz’s characterization of early humans as marathon men and women from the tips of their distinctively short toes and long Achilles tendons to the tops of their biomechanically balanced heads (emphasis added) sets the backdrop for this essay—an exploration of the biomechanical differences between male and female marathon runners. After a few additional historical comments, this essay opens with a presentation of anatomical differences between men and women with specific reference to running then continues with definitions and descriptions of the term marathon, as a form of organized running sport, and definitions for the term biomechanics in preparation for a discussion of how the field of biomechanics is applied to running. Don’t waste time! Our writers will create an original "Biomechanical differences beetween male and female marathon runners" essay for you Create order With this information as a foundation, the objective and scope will be articulated followed by presentation of previous methods and findings revealed from a search of the literature on the topic of biomechanical differences between male and female marathon runners and closely-related topics. These findings will be discussed and conclusions drawn. Finally, recommendations for further research will be presented. To return briefly to the research findings of Bramble, a paleontologist and biomechanics expert, and Lieberman, a physical anthropologist, to continue setting the backdrop for the essay, Bramble states: Running made us human, at least in an anatomical sense. We think running is one of the most transforming events in human history (Chui, 2004). Endurance running is an activity that is reserved for humans in the primate world and not common in other mammals with the exception of dogs, horses and a few others. Bramble and Lieberman contend that running permitted humans to scave nge and hunt for food over significant distances and that the high protein food they secured was instrumental in developing larger brains (Wilford, 2004). To facilitate running, humans developed several traits including large buttocks with strong muscles which connect the femur to the trunk of the body preventing the body from over-balancing with each step. In addition, humans have a lengthy arm-swinging stride and [l]ong ligaments and tendons—including the Achilles tendon—[which] serve as springs that store and release mechanical energy during running.(Hotz, 2004). Bramble’s reference to today’s running in the evolutionary context he and Lieberman established provides an appropriate introduction to the exploration of the biomechanical differences between male and female marathon runners (Wilford, 2004): Today, endurance running is primarily a form of exercise and recreation, but its roots may be as ancient as the origin of the human genus. The description of anatomical differences between men and women,which is focused on anatomical features that are involved in running,begins with a gender-neutral discussion to establish a foundation for the more gender-specific information. Rossi (2003) emphasizes the complexity of walking, a precursor torunning. He writes that half of the 650 muscles and tendons in thehuman body are involved in what most people consider to be the simpleact of walking. He suggests that, in the evolution of the human body,there were hundreds of adaptations that had to take place,adaptations that required repositioning of everything in the bodyover several million years. Rossi writes: The arms, no longer needed for branch swinging, became shorter, thelegs longer, the pelvis wider, the shoulders narrower, the neck longerand more slender, the spine changed from C-shape to S-shape. Majorchanges were required in the hip, knee and ankle joints. Hundreds ofmuscles, tendons, ligaments and joints gradu ally shifted in position,size and function. And of course, the new posture and gait requiredimportant changes in the size and position of all the organs of thechest and abdomen. Rossi suggests that some of these changes were extremely significantfrom a biomechanical perspective. For instance, he calls attention tothe blood pumping requirement of the upright human form: Daily in eachindividual, approximately 74,000 quarts of blood must travel through100,000 miles of blood vessels from the brain to the feet and legs in acircular pattern. Rossi emphasizes the human engineering challengethat was required to design a system that would counteract the effectsof gravity in moving blood vertically in this manner. Rossi’s commentsare particularly important in the context of the current discoursebecause they provide some insight into the current state of relevantanatomical features of today’s runners and how those features werederived. The anatomy of humans, unlike that of other living creatures,provides for speed and endurance. The unique characteristics related torunning include (Science in Africa, 2005, citing University of Utah Public Relations, 2004): †¢ Skull features. These features, which include sweating from the scalp and face, cool the blood. †¢ A balanced head. This shape of head with a relatively flat face,small teeth, and short snout moves the center of the mass backwardwhich helps to counter the effects of moving upward and downward duringrunning. †¢ A ligament running from the rear of the skill and neck downward tothe thoracic vertebrae. This feature serves as a shock absorber thataids the arms and shoulders in counterbalancing the head during runningactivity. †¢ Shoulders decoupled from the head and neck. This feature allowsrotation of the body while the head faces forward during running. †¢ A tall body. This feature, which includes a narrow trunk, waistand pelvis, provides for increased sk in surface allowing for enhancedbody cooling and permits the upper and lower body segments to moveindependently. †¢ Short forearms. This feature permits the upper body to act as acounterbalance to the lower body during running activity while reducingthe muscle power required for maintaining flexed arms. †¢ Large vertebrae and disks. This feature permits the human back to accepted heavier loads when runners impact the ground. †¢ Large, strong connection between the pelvis and the spine. Thisfeature supports more stability and shock absorbing capacity duringrunning activity. †¢ Large buttocks. This feature, and the muscles that form it,stabilize the body during running activity. The connection of thesemuscles to the femur prevents the body from pitching forward. †¢ Long legs. This feature allows humans to take large strides duringrunning activity. The tendons and ligaments permit the legs to belighter and less muscular thereby requiring a s maller amount of energyto propel them while running. †¢ Large hip, knee, and ankle joint surface areas. These featuresprovide enhanced shock absorption by reducing the impact in any onespecific area. †¢ Arrangement of bones in the foot. This feature provides for a morerigid foot by creating a stable arch, allowing runners to push off in amore efficient manner and to use ligaments located on the bottom of thefeet as springs. †¢ Large heel bone, short toes, and a big toe. These features providefor enhanced shock absorption and increased capacity to push off duringrunning activity. With the running-related anatomical features applicable to allhumans as a foundation, the focus now turns to the differences inanatomical features between men and women, specifically those featuresthat are involved in running activity. Holschen (2004) writes that,until puberty, males and females are equal in terms of strength,aerobic power, heart size, and weight; they also have similar amountsof body fat. Starting at puberty, according to Holschen (2004), male and female sexhormones begin affecting bone and lean body mass, circulation, andmetabolism in different ways. A female typically has a wider pelvis,femoral anteversion (inward twisting of the femur), genu valgum (kneestouch but ankles are separated), and external tibial torsion (feet donot line up in a straight manner because of out-toeing from outwardrotation of the large calf bone). Center of gravity differences betweenmen and women are minimal, correlating more by body type and heightthan with gender. (Atwater, 1985, cited in Holschen, 2004). Whencompared with males, females typically have smaller bones accompaniedby smaller articular surfaces. They also have proportionately shorterlegs with resulting decreased potential force in certain maneuvers.(Holschen, 2004). At puberty, girls gain both fat and lean muscle mass due to theinfluence of female hormones; boys lose body fat and add muscle massdue to the influence of male hormones (Holschen, 2004). Women inadulthood have about ten percent more body fat than do their malecounterparts (Greydanus, D. and Patel, D., 2002, cited in Holschen,2004). The basal metabolic rate is approximately ten percent lower inwomen than in men. The presence of female hormones mandates that womenrely more on fat metabolism at any given exercise level when comparedto men. In addition, glycogen uptake, storage, and use are increased.(Holschen, 2004, citing Bonekat, H. W. et al., 1987; Dombovy, M. L. etal., 1987; Frankovich, R. J. and Lebrun, C. M., 2000; Nicklas, B. J. etal., 1989; Tarnopolsky, L. J., 1990) Cureton and associates (1988,cited in Holschen, 2004) attribute the differences in muscle strengthbetween men and woman to skeletal and cardiac muscular hypertrophy andmuscle mass percentage; they contend that muscle mass in men is fortypercent compared to twenty-three percent in women. Changes in body composition and circulatory capacit y beginning atpuberty result in approximately twenty percent highercardio-respiratory capacity in men. Men also have comparatively higheroxygen-carrying capacity, larger heart and lung mass, a higher strokevolume, and higher maximal cardiac output which result in greatereffectiveness in aerobic and anaerobic activities, although trainingcan overcome the inherent differences (Williford, H. N. et al., 1993,cited in Holschen, 2004). The results of the current research point to fundamental anatomicaldifferences between men and woman, differences that largely begin toappear during puberty and which have some bearing on runningcapability. The term running can be defined as [moving] swiftly on foot sothat both feet leave the ground during each stride (American HeritageDictionary of the English Language, 2000). The research by Bramble andLieberman (2004, cited in Nature, 2004), which was presented earlier,seems to indicate that running has been part of human existence sinceits beginnings and, in fact, contributed significantly to developmentof human life today. Humans no longer require running for survival, atleast in their normal affairs; that is, typically, humans do not haveto run from danger or run in pursuit of animals to kill for food. Inmodern times, running has taken on a new form—competition foot racing.This competition racing can be against oneself to achieve one’s ownpersonal best or with others. Racing against others can take manyforms ranging from informal competitions between two young friendsracing against one another on a playground to very formal competitionssuch as those in the quadrenn ial Olympics. The more formal runningcompetitions are typically classified by the length of the run: 100,200, 400, 800, 1500, 5000, and 10000 meters as well as marathons(Dollman, 2003). There are many terms that refer to specific forms of foot racing: run,dash, sprint, relay, meet, competitive trial of speed, footrace, andmarathon (Webster’s New World Thesaurus, 1997). Of these, the termsdash and sprint are typically used interchangeably to describe ashort, fast run or race (Webster’s New World Dictionary, 1988) or ashort, swift movement (Webster’s New World Thesaurus, 1997). Organizeddashes and sprints are commonly of 50 meters, 100 meters, 200 meters,50 yards, 100 yards, and 200 yards in length (Webster’s New WorldThesaurus, 1997). Marathons are a form of long-distance running, whichare on- and off-the-track competitions of more than 3000 meters (Hlus,1997). Specifically, a marathon is a footrace of 42 kilometers, 195meters (26 miles, 385 yards) run over an open course, or anylong-distance or endurance contest People who compete in marathons arecalled marathoners (Webster’s New World Dictionary, 1998).Physiologically, there is a fundamental difference between a sprint ordash and a marathon. According to Pritchard (1994), A sprinter canexert maximum force throughout the run, but this is not possible forlonger runs, where propulsive force must be reduced to match energyavailability. Historically, marathons are not new events. According to legend, thename marathon is derived from the Greek city, Marathon, to commemoratePheidippides’s run from that city to Athens to announce Greek victoryover the Persians. The marathon was introduced to the Olympics in 1896and today’s official distance was established in 1908. (Hlus, 1997; TheColumbia Encyclopedia, 2005) Today, in addition to marathon races inthe Olympics, many cities throughout the world serve as sites forannual or other periodic marathons (The Columbia Enc yclopedia, 2005). A new form of marathon race has recently taken form—the ultramarathon,which is any organized footrace extending beyond the standard marathonrunning distance of 42 kilometers, 195 meters†¦[they] typically begin at 50 kilometers and extend to enormous distances (Blaikie, n. d.).Standard distances for ultramarathons are 50 and 100 kilometers and 50and 100 miles (Meyers, 2002) with the longest certified race being theSri Chinmoy, a 2092 kilometer race held annually in New York (Blaikie,n. d.). The research produced numerous and varied definitions for the termbiomechanics. The following are representative of the findings: †¢ The study of the mechanics of a living body, especially of theforces exerted by muscles and gravity on the skeletal structure. (TheAmerican Heritage Dictionary of the English Language, 2000). †¢ [The] application of mechanical engineering principles andtechniques in the field of medicine and surgery, studying naturalstructures to improve those produced by humans (The HutchinsonEncyclopedia, 2003). †¢ [A] science examining the forces acting upon and within a biologicalstructure, and the effects produced by those forces (The University ofCalgary, n. d.). †¢ [T]he science that deals with forces and their effects, applied to biological systems (Freivalds, 2004). †¢ [T]he application of the principles and techniques of mechanics to the human body in motion (Snowden, 2001). †¢ Biomechanics is a specific field which evaluates the motion of aliving organism†¦and the actions of forces on that organism†¦acombination of several different areas of study [including] anatomy andphysiology, kinematics (the study of motion without regard to itscauses), kinesiology (the study of human movement) and kinetics (thestudy of forces acting on a system) (National Endurance SportsTrainers Association, 2005). In furnishing a definition for biomechanics, the Quintic ConsultancyLtd. (2005) provides some additional insight into the origin anddetails of the term, stating that the name is derived from the Greekbios meaning life and mekhaniki meaning mechanics, adding that theseindividual terms are combined to mean the mechanics of life forms.The biomechanics discipline includes research into various life formsincluding plants, insects, reptiles, birds, fish, humans, and others.Within the human specialty, topics include mechanics of bone, tooth,muscle, tendon, ligament, cartilage, skin, prosth eses, blood flow, airflow, eye movement, joint movement [and] whole body movement (TheQuintic Consultancy Ltd., 2005). Historically, according to Knudson (2003), the study of humanbiomechanics has alternated between emphasizing each of its twocomponents—the biological and the mechanical. Atwater (1980, cited inKnudson, 2003) claims that, during the first half of the twentiethcentury, scholars emphasized medicine and anatomy under the termkinesiology. The distinct field of biomechanics was born from the workof biomechanists in the 1960s and 1970s. From that point the fieldbegan to emphasize mechanics over biology. Today, the competing forcesto move the discipline either toward a biological emphasis or toward amechanical emphasis continue (Knudson, 2003). The field of biomechanics, already narrowed in a previous sectionfrom consideration of all life forms to only humans for the purpose ofthis essay, can be focused even further to a sub-field called sportsbiomechanics (The Quintic Consultancy Ltd., 2005): Sports biomechanics uses the scientific methods of mechanics tostudy the effects of various forces on the sports performer. It isconcerned, in particular, with the forces that act on the humanneuromusculoskeletal system, velocities, accelerations, torque,momentum, and inertia. It also considers aspects of the behavior ofsports implements, footwear and surfaces where these affect athleticperformance or injury prevention. Sports biomechanics can be divided upinto two sections: performance improvement [and] injury prevention. The Australian Sports Commission (n. d.) furnishes additionaldescriptive information on the application of biomechanics to sports,using a term the Commission calls applied sports biomechanics whichincorporates techniques from physics, human anatomy, mathematics,computing and engineering to analyse technique to prevent injury andimprove performance. The Commission’s division of sports biomechanicsinto two categoriesâ⠂¬â€performance improvement and injuryprevention—echoes the classifications offered by The QuinticConsultancy Ltd. Williams (2003) describes how biomechanics can help runnerperformance, specifically that of the marathoner. Leading into hisrecommendations, he describes how marathon runners use a simplebiomechanical strategy known as drafting off another runner whenrunning into the wind to reduce the adverse effects of air resistanceand reduce oxygen consumption for the latter part of the race. Hewrites: The goal of the sport biomechanist is to improve movement efficiency,mainly by maximizing propulsive forces and minimizing resistive forces,and thus provide the athlete with a mechanical edge. Using high-speedcinematography, the biomechanist can analyze a runner’s form and detectproblems in running form that may be inefficient, such as overstriding,and that may waste energy. Although most elite and experiencedmarathoners have developed efficient running styles, ev en a smallimprovement in running efficiency may make a significant differenceover the duration of a marathon. In addition to the strategy of drafting off another runner,Williams offers several other biomechanical strategies includingselecting the proper sportswear (i.e. uniform and shoes) and optimizingbody weight and composition. Thus far the topics of anatomical differences between men and womenwith specific reference to running; definitions and descriptions of theterms marathon (as an organized, competitive form of running) andbiomechanics; and the application of biomechanics to running have beenpresented and discussed. With this as a foundation, the focus of thediscourse now turns to the topic of biomechanical differences betweenmale and female marathon runners and closely-related topics. The objective of this portion of the essay will be to explore thebiomechanical differences between male and female marathon runnersthrough a review and analysis of selected literature on the topic andrelated issues. The scope of the literature review will include marathon running withspecific reference to available information on the differences betweenmales and females. Although running of shorter distances (e.g. sprintsand dashes) and longer distances (e.g. ultramarathons) as well as othersports activities are excluded from the specific scope of this essay,references will be made to these activities when they related tomarathon running. Performance improvement and injury prevention werementioned as the two primary areas addressed by applied sportsbiomechanics. Gender-specific issues in each of these areas will beexplored briefly as well. REVIEW OF EXISTING RESEARCH ON METHODS AND FINDINGS One researcher who has studied gender differences in enduranceperformance, including marathon running, is Stephen Seiler (1996) ofThe Institute for Sport, Agder College in Kristianstad, Norway. Hewrites: Some years ago it was proposed by some that women wouldactually perform better [than men] at ultra-endurance type activities.This theory has been disproved in the laboratory and in practice. Aslong as women are women, I don’t think they will surpass men, statesNorways perennial marathon winner Grete Waitz (quoted in Holden,2004). The anatomical differences between females and their malecounterparts, specifically those that affect running, were presented inthe introduction. Now an attempt will be made to show that the generalanatomical differences between men and women extend to biomechanicaldifferences that affect marathon running performance and injury. Holschen (2004) writes that [T]he female athlete remains less wellunderstood and less well studied compared with male a thletes,especially in the areas of performance factors, repetitive stress, andacute injuries. She continues: Logical reasons for this include: (a)a limited two-generation span of the high-profile elite female; (b)fewer females involved in coaching, research, and sports medicine; and(c) limited areas of female youth sports historically (gymnastics,swimming, dance). The reality of Holschen’s findings proved to be truein the current research activity. There were remarkably few availablesources on the biomechanics involved in women’s marathon running. Mostof the research either applied to males or did not identify the gender.Results from a review of selected research literature will be presentedin this section beginning with gender-differentiated research resultson running performance. Following this, results of research into thetwo applied sports biomechanics specialties will be presented with afocus on studies concerning footwear and injuries. Holden (2004) writes abo ut performance in running with specialattention to female runners. She quotes physiologist Henrik Larsen ofthe Copenhagen Muscle Research Centre in explaining women’s marathonperformance vis-à  -vis men: Women had not developed long distance;that’s why the improvement is much greater on the marathon. Larsen,who seems to attribute the performance improvements of femalemarathoners to focused training instead of anatomic factors, claimsthat [w]e don’t see any higher oxidative capacity in women. Holdenalso offers comments by exercise physiologist Timothy Noakes of theUniversity of Cape Town, South Africa who agrees with Larsen’sassessment: A smaller body frame gives women an edge on endurance†¦butmen can run 10% faster even when the difference in body size iscontrolled for. Stephen Seiler (1996), who was quoted at the start of this sectionstating that the proposal that women could perform better inultra-endurance activities has been disproved, confir ms that there aresome physiological differences between the sexes that impactperformance in females independent of age. He notes that there is aten percent difference in marathon times between men and women, addingthat this difference is the same across the distance runningperformance spectrum. He attributes this difference, not to adifference in training, but to physiological differences. He studiedmaximal oxygen consumption, the lactate threshold, and efficiency toanalyze the differences between men and women as these factors mightaffect long-distance running performance: †¢ Maximal Oxygen Consumption. There is a 43 percent differencebetween men and women with men possessing a VO2 max (oxygen-deliveringcapacity measure) of 3.5 liters per minute and women with a capacity of2.0 liters per minute. Seiler attributes this in part to male size; menare larger. But, even when size is factored in, male oxygen consumptioncapacity is still fifteen to twenty percent higher. Males hav e agreater capacity to deliver oxygen to their muscles and organs. †¢ The Lactate Threshold. This is the point at which lactic acidbegins to accumulate at higher than normal levels in the blood streamindicating an exercise intensity boundary at which the level ofintensity can be maintained over a long period and that which willresult in quick fatigue. Seiler does not believe that lactatethresholds are different for men and women as a percentage of their VO2max. †¢ Efficiency. After finding conflicting information comparing theefficiency of males and females—revealing that females are lessefficient, more efficient, or the same as males in terms ofefficiency—Seiler believes that differences in efficiency do notaccount for the differences in endurance performance. Seiler concludes with his determination that the ten percentperformance difference between men and women in endurance running canbe attributed to the first of the three physiological factors hestudied—maximal oxygen consumption. Another researcher who explored gender differences in athletics,and especially in endurance events, is Dollman (2003). Citing Shepard(2000), Dollman writes that there is consistent evidence, based onobservations, that males possess larger measures of the following(quoted): †¢ Heart volume, even when corrected for stature. †¢ Haematocrit, which gives males a 13 percent greater oxygen-carrying capacity than females. †¢ Plasma volume. †¢ Total muscle mass, which means that females perform the sameabsolute task at a higher percentage of maximum voluntary contraction,with concomitant vascular impedance limiting cardiac ejection and peakcardiac output. In addition, male skeletal muscles may have a higher succinatedehydrogenase (an integral membrane protein) concentration (Dollman,2003, citing Costill, et al., 1987). Males may produce bettermechanical efficiency during running (Dollman, 2003, citing Miu ra,1997) although this is arguable as it may be rooted in cultural origins(Dollman, 2003, citing Shepard, 2000). Now attention will turn briefly to a review of selected researchinto the two primary application areas addressed by applied sportsbiomechanics: running performance and injuries. Regarding performance,footwear will be discussed followed by a presentation of selectedfindings on research into injuries. Gender issues will be introduced. Lipsky (2001, citing Hennig, 2001) presented research findings ongender-specific requirements for athletic footwear designed forrunning. The research experiment involved fifteen women and seventeenmen of the same body weights, heights, and ages. Each subject wore thesame shoe size and each tested five types of shoes which included threestyles of men’s shoes and two styles for women. Using Kistler forceplatforms at a set velocity, ground force reactions, tibialacceleration, angular foot motion, and plantar pressures at eightstrateg ic locations on the foot were measured. According to Lipsky, theexperiment revealed that none of the variables demonstrated asignificant interaction among gender and footwear type meaning, Lipskycontends, that women had the same biomechanical dilemmas in men’sshoes as they did in their own footwear. Despite similarity in thetest subjects’ weight and other factors, men exhibited higher pressurerates in all regions of the foot. Men had significantly higher heelloads, but less midfoot loads, indicating that the arches of women donot support the middle of their feet. According to Lipsky, theseresults support the conclusions that women have a stronger collapse ofthe longitudinal arch†¦during weight bearing and have an increasedtendency of pronation and the smaller amount of pressure to theground. The recommendation from this study is that women should selectrunning shoes that protect against overpronation. This, according toLipsky, will help prevent knee injuries. B artold (2004) adds to the literature on the differences inrequirements for athletic shoes for men and women. He claims thatrunning footwear is largely designed and manufactured for malerunners, making little recognition that women have significant injuryissues compared to men. Although Bartold acknowledges that reasons forinjuries are not scientifically established, he indicates thatproposals have been made that known differences in structure maypredispose female athletes to differences in running mechanics, andthese differences may lead to specific injuries, continuing by statingthat [a]necdotally, we have excellent evidence [that] the particularbiomechanics of female athletes and the way they run predisposes themto specific injury patterns. With regard to injuries, Parfit (1994) compared running injuries ofmiddle distance runners and marathon runners, concluding that thelatter incur more injuries when compared to the former (approximatelyeighty-two percent for middle distance r unners compared to ninety-sevenpercent for marathoners). Acknowledging validity questions due to smallrunner populations studied and lack of injury definitions, Parfit foundthat whilst marathon runners suffered from back problems and hipailments, middle distance runners were more susceptible to kneeproblems, stress fractures, and shin splints. Certain types of knee, shoulder and back injuries are more commonin females and can in part be attributed to differences in body shapeand biomechanics, reports Glasgow, Scotland’s Daily Record (2004).Taunton et al. (2002) found that there were significant differencesbetween running injuries incurred by men and women. According to thisstudy, knee injuries seemed to be the most common injury in both sexeswith men experiencing higher incidences of the following injuries (thefirst percentage shown in parenthesis is for men; the second forwomen): †¢ plantar fasciitis, an injury to the fascia connective tissue on the bottom of the foot (54%/46%); †¢ meniscal injury, a condition in the knee cartilage that acts ascushion between the thigh bone (femur) and shin bone (tibia) (69%/31%); †¢ patellar tendinopathy, a rupture in the tendon that connects the kneecap to the tibia (57%/43%); †¢ Achilles tendinopathy, tendon pain or dysfunction in the muscle that connects the calf to the heel of the foot (58%/42%); †¢ gastrocnemius injury, a condition in the largest, most prominentmuscle in the calf which allows for extending the foot and bending theknee (70%/30%); †¢ adductor injury, a condition, such as a tear, in the muscle in the inner thigh (68%/32%); and †¢ osteoarthritis of the knee, a degenerative joint diseasecharacterized by breakdown of the articular cartilage in the joint(71%/29%). The study by Taunton et al. (2002) revealed that women experiencedhigher incidences of the following running injuries (the firstpercentage shown in parenthesis is for women; the second for men): †¢ PFPS, or patellofemoral pain syndrome, a pain behind the kneesometimes known as runner’s knee (62%/32%, does not add to 100%); †¢ ITBFS, or iliotibial band friction syndrome, a conditioncharacterized by injury to the thick band of fibrous tissue that runsdown the outside of the leg beginning at the hip and extending to theouter side of the shin bone just below the knee joint (62%/32%, doesnot add to 100%); †¢ gluteus medius injury, a condition characterized by injury to oneof the muscles that holds the pelvis upright when a step is taken(76%/24%); and †¢ sacroiliac injury, a condition characterized by damage to the smalljoint that lies at the junction of the spine and the pelvis which iscritical in transferring the weight load of the upper body to the lowerbody (91%/9%). Although a trend seems apparent, Taunton and associates hesitate togeneralize such a finding, noting that other studies have notdifferentiated sp ecific injuries by sex and at least one (Macintyre etal, 1991, cited in Taunton et al., 2002) reported that there was littledifference, anatomically, in the sites of injuries in males andfemales. This essay began by placing the topic of biomechanical differencesbetween male and female marathon runners in an evolutionary context.With this context as a backdrop, the focus of the essay turned to apresentation of anatomical differences between men and women withspecific reference to running then continued with definitions anddescriptions of the term marathon as a form of organized running sportand the term biomechanics in preparation for a discussion of how thefield of biomechanics is applied to running. With a general foundationestablished, and after articulating the objective and scope of theresearch, the findings emanating from a search of the literature on thetopic of biomechanical differences between male and female marathonrunners and closely-related topics were presented. A s an introduction to the discussion of the anatomical differencesbetween men and women that affect running, Rossi’s work (2002) was usedto emphasize the anatomical complexity of walking as a precursor torunning and the hundreds of adaptations that were needed to renderthe human body capable of walking. An article in Science in Africa(2005) provided insight into humans’ unique anatomical characteristicsthat support the running activity. The results of Holschen’s research(2004), and cited works of other researchers, indicated that pubertymarks the point at which males and females diverge in terms of factorsthat affect running capabilities. These factors include musclestrength, aerobic power, heart size, lung mass, weight, bone size,articular surface size, leg length, basal metabolic rate and body fat.Holschen attributes these pubescent changes to the differentiatingeffects of male and female hormones. Definitions of the term marathon with comparisons to other t ypes ofrunning were presented. This presentation began with a definition ofthe term running. Dollman’s (2003) work was used to show that formalrunning competitions are typically classified by the length of the run.Several reference sources as well as Pritchard’s work (1994) were usedto identify, then selectively define, types of foot racing todifferentiate marathon running from all other forms of organizedrunning activity for the purpose of this essay. A brief history of themarathon, tracing the name to ancient Greek times and the origins ofthe organized sport itself to the late nineteenth century, was providedusing various reference sources. Based on the works of Blaikie (n. d.)and Meyers (2002), the concept of a new form of extreme marathon—theultramarathon—was described. The review of the literature revealed an assortment of definitionsfor the term biomechanics from reference sources, academicinstitutions, researchers, consultants, and runnersâ€⠄¢ associationsincluding those from The American Heritage Dictionary of the EnglishLanguage (2000), The Hutchinson Encylopedia (2003), The University ofCalgary (n. d.), Freivalds (2004), Snowden (2001), the NationalEndurance Sports Trainers Association (2005), and the QuinticConsultancy Ltd. (2005). Not surprisingly, all definitions in some waylink the disciplines of mechanics and anatomy reflecting the Greekorigin of the term biomechanics—bios meaning life and mekhanikimeaning mechanics (Quintic Consultancy Ltd., 2005). Knudson (2003)explained how the emphasis on anatomy and mechanics has shifted backand forth since the establishment of biomechanics as a discipline. TheQuintic Consultancy’s work (2005) was used to introduce a sub-specialtyof biomechanics known as sports biomechanics, which studies theeffects of various forces on the sports performer. The AustralianSports Commission’s work (n. d.) introduced applied sports biomechanicsfocusing on improving perf ormance and preventing injury. Williams(2003) described how biomechanics can be used in improving theperformance of marathon runners, and he offered various biomechanicalstrategies. The material presented to this point provided a solid foundationfor reviewing existing literature on biomechanical differences betweenmale and female marathon runners with references to other types ofrunning and sports activities as appropriate. The review of theliterature began with the work of Holschen (2004) who explained thereasons for women having received too little attention in athleticresearch. The lack of available research, specifically on womenmarathoners, somewhat constrained the current review of the literature. A summary of Holden’s writings (2004) on performance of female runnersvis-à  -vis male runners was presented first, indicating that a female’ssmaller body provides an edge in endurance, but that men can run tenpercent faster. Seiler (1996) suggested that physiolo gical differencesbetween men and women impact the performance of females in all agegroups, confirming the ten percent edge that men have in marathonrunning times. He researched gender differences between men and womenin terms of maximal oxygen consumption, the lactate threshold, andefficiency finding that the first factor—maximal oxygen consumption—wasresponsible for the performance difference. Dollman’s research findings(2003), which included citing the work of other experts, listedgender-differentiated anatomical features of heart volume, haematocrit,plasma volume, total muscle mass, and others that can affect runningperformance. Following presentation of the results of the literature review on thebiomechanical differences between men and women, specifically thosedifferences that can affect marathon running, selected research intothe two areas of interest in applied sports biomechanics—runningperformance and injuries—was presented. Lipsky†™s work (2001), includingthe citation of Hennig’s research (2001), involved a study ofbiomechanical factors in the design of athletic footwear. The studyrevealed that the impact of running was independent of whether therunning shoes tested were designed specifically for men or for women.The study also indicated that men had significantly higher heel loads,but less midfoot loads. Lipsky’s recommendation was that women shouldselect running shoes that protect against overpronation. Bartold (2004)suggests that running footwear is designed around the biomechanicalrequirements of men and that the design could be responsible forinjuries in women. Parfit’s work (1994) in comparing running injuries of middledistance and marathon runners was used to show that marathoners—bothmale and female—may be more susceptible to injuries such as back andhip problems than are middle distance runners. Taunton et al. (2002)and others considered gender issues in runnin g injuries and identifiedthe most common types with difference percentages of injuries shown formales and females. CONCLUSIONS Despite the common evolutionary development of male and female humans,which the studies of American scientists Dennis Bramble and DanielLieberman indicate involved running as a significant component, theanatomic differences between adult men and woman result in differentperformance capabilities in physical activity, in general, and inmarathon running, specifically. The research reviewed for this essayconfirmed that performance differences between men and women areanatomical in nature and cannot be overcome by training alone. Theresearch indicated that marginal improvements in marathon performanceand reduction in injuries from marathons among women may be facilitatedby biomechanical interventions aimed at designing optimal runningfootwear for women. The conclusion based on the research is that, due to anatomicaldifferences, men will continue to excel over women in marathon runningin terms of better performance and reduced injuries—the two dimensionsof applied sports biomec hanics. This conclusion echoes the quoteattributed to Norways perennial marathon winner Grete Waitz (Holden,2004), as stated earlier: As long as women are women, I dont thinkthey will surpass men. As presented earlier, Holschen (2004) claims that the femaleathlete remains less well understood and less well studied comparedwith male athletes, especially in the areas of performance factors,repetitive stress, and acute injuries, suggesting that the newmillennium demands an increased emphasis on gender equity and thefemale athlete in all respects. An area in which additional attentionis needed is research into the biomechanical effects of running onwomen with the goals of improving performance and preventing injury—thetwo areas of interest in applied sports biomechanics. One opportunity for additional research that flowed from this researcheffort was that more definitive work is needed to confirm or reject theanecdotal evidence that Bartold (2004) claims as indicating that th eparticular biomechanics of female athletes and the way they runpredisposes them to specific injury patterns. If this evidence isconfirmed empirically, experts in the biomechanical field may be ableto recommend changes to footwear designed for running and otherinnovations that will not only reduce injuries to female runners butalso, perhaps, improve their running performance. Another opportunityfor further research would be a study comparing and contrasting thebiomechanical effects of ultramarathons on males and females. REFERENCES American Heritage Dictionary of the English Language, 4th ed. (2000) biomechanics; run. Boston: Houghton Mifflin, 2000. Atwater, A. E. (1985) Biomechanics and the female athlete, in PuhlJ., Brown C. H., Voy, R. O. (eds): Sports Science Perspectives forWomen. Champaign, IL, Human Kinetics Books, 1985. Cited in Holschen,Jolie (2004) The female athlete. Southern Medical Journal, September 1,2004. Atwater, A.E. (1980). Kinesiology/biomechanics: Perspectives andtrends. Research Quarterly for Exercise and Sport, 51, 193-218. Citedin Knudson, Duane (2003) An integrated approach to the introductory biomechanics course. Physical Educator, September 22, 2003. (The) Australian Sports Commission (n. d.) What is biomechanics? Bartold, Simon (2004) Gender issues in sport: The impact on women, time to make a change. Blaikie, David (n. d.) What is an ultramarathon? Bonekat, H. W., Dombovy, M. L., and Staats, B. A. (1987)Progesterone-induced changes in exercise performance and ventilatoryresponse. Med Sci Sports Exerc, 1987. Cited in Holschen, Jolie (2004)The female athlete. Southern Medical Journal, September 1, 2004. Bramble, Dennis and Lieberman, Daniel (2004) Distance running shaped human evolution.’ Nature (2004) Chui, Glennda (2004) Run, Homo sapiens, run. San Jose Mercury News, November 19, 2004. (The) Columbia Encyclopedia, 6th ed. (2005) marathon race. February 24, 2005. Costill, D. L. et al. (1987) Muscle fibre composition and enzymeactivities in elite female distance runners. International Journal ofSports Medicine, 8(Suppl. 2), 103-106. Cited in Dollman, James (2003) A problem-based approach to teaching exercise physiology: genderdifferences in athletic performance. The Journal of Physical Education,Recreation Dance, November 1, 2003. Cureton K. J., Collins M. A., Hill D. W., et al. (1988) Musclehypertrophy in men and women. Med Sci Sports Exerc, 1988. Cited inHolschen, Jolie (2004) The female athlete. Southern Medical Journal,September 1, 2004. Daily Record (2004) Health: Sportsdoc—Closing the gap; your health ishis business: Radcliffe’s display in New York proves that moderntraining methods are now helping the ‘weaker’ sex catch up on men.November 24, 2004. Dollman, James (2003) A problem-based approach to teaching exercisephysiology: gender differences in athletic performance. The Journal ofPhysical Education, Recreation Dance, November 1, 2003. Dombovy M. L., Bonekat H. W., Williams T. J., et al. (1987) Exerciseperformance and ventilatory response in the menstrual cycle. Med SciSports Exerc, 1987. Cited in Holschen, Jolie (2004) The female athlete.Southern Medical Journal, September 1, 2004. Frankovich, R. J., Lebrun, C. M. (2000) The athletic woman: menstrualcycle, contraception, and performance. Clinics in Sports Medicine,2000. Cited in Holschen, Jolie (2004) The female athlete. SouthernMedical Journal, September 1, 2004. Freivalds, Andris (2004) Biomechanics of the upper limbs: Mechanics, modelling and musculoskeletal injuries. CRC Press, 2004. Greydanus, D. and Patel, D. (2002) The female athlete: Before andbeyond puberty. Pediatr Clin N Am, 2002. Cited in Holschen, Jolie(2004) The female athlete. Southern Medical Journal, September 1, 2004. Hennig, E. (2001) Gender differences for running in athletic footwear.Retrieved December 4, 2001, Cited in Lipsky, Samantha (2001) What agirl wants; what a girl needs. Hawkeye Engineer, Fall 2001. Hlus, Carolyn (1997) Long-distance running. The 1998 Canadian Encyclopedia, September 6, 1997. Holden, Constance (2004) An everlasting gender gap? Science, July 30, 2004. Holschen, Jolie (2004) The female athlete. Southern Medical Journal, September 1, 2004. Hotz, Robert Lee (2004) Study: Humans were born to run. The Cincinnati Post, November 18, 2004. (The) Hutchinson Encyclopedia (2003) biomechanics. September 22, 2003. Knudson, Duane (2003) An integrated approach to the introductory biomechanics course. Physical Educator, September 22, 2003. Lipsky, Samantha (2001) What a girl wants; what a girl needs. Hawkeye Engineer, Fall 2001. Macintyre, J. et al (1991) Running injuries: a clinical study of4,173 cases. Clinical Journal of Sports Medicine 1991;1:81–7. Cited inTaunton, J. E. et al. (2002) A retrospective case-control analysis of2002 running injuries. British Journal of Sports Medicine2002:36:95-101. Meyers, Ed (2002) Ultramarathoners dont stop running. The News Journal, December 10, 2002. Miura, H. et al. (1997), Economy during a simulated economy testtriathlon is highly related to Olympic distance triathlon.International Journal of Sports Medicine, 18, 276-280. Dollman, James(2003) A problem-based approach to teaching exercise physiology: genderdifferences in athletic performance. The Journal of Physical Education,Recreation Dance, November 1, 2003. National Endurance Sports Trainers Association (2005) What is biomechanics? Nature (2004) Nicklas, B. J., Hackney, A. C., Sharp, R. L. (1989) The menstrualcycle and exercise: performance, muscle glycogen and substrateresponses. Int J Sports Med, 1989. Cited in Holschen, Jolie (2004) Thefemale athlete. Southern Medical Journal, September 1, 2004. Parfitt, P. (1994) Comparison of running injuries between middledistance and marathon runners. Journal of British Podiatric Medicine,49, (8), pp.133-136. Pritchard, Jonathan K. (1994) Mathematical models of running. American Scientist, November 1, 1994. Quintic Consultancy Ltd. (2005) What is biomechanics? Rossi, William A. (2003) The foot: Mother of humanity—Mankind oweshomage to our uniquely human feet, without which it could not haveevolved to its present state. Podiatry Management, April 1, 2003. Science in Africa (2005) Scientists say endurance running let us evolve to look the way we do, January 2005. Seiler, Stephen (1996) Gender differences in endurance performance and training. Shephard, R. J. (2000). Exercise and training in women, Part 1:Influence of gender on exercise and training responses. CanadianJournal of Applied Physiology, 25(1), 19-34. Dollman, James (2003) A problem-based approach to teaching exercise physiology: genderdifferences in athletic performance. The Journal of Physical Education,Recreation Dance, November 1, 2003. Snowden, Julie (2001) Orthotics 101: The prescription for proper footalignment. Kentuckyania Health Magazine, December 17, 2001. Tarnopolsky, L. J., MacDougal, J. D., Atkinson S. A, et al. (1990)Gender differences in substrate for endurance exercise. J Appl Physiol,1990. Cited in Holschen, Jolie (2004) The female athlete. SouthernMedical Journal, September 1, 2004. Taunton, J. E. et al. (2002) A retrospective case-control analysis of2002 running injuries. British Journal of Sports Medicine2002:36:95-101. (The) University of Calgary (n. d.) What is biomechanics? University of Utah Public Relations (2004) Anatomical features thathelp humans run. Cited in Science in Africa (2005) Scientists sayendurance running let us evolve to look the way we do, January 2005. Webster’s New World Dictionary (1988), dash; marathon; marathoner. January 1, 1988. Webster’s New World Thesaurus, 3rd edition (1997) dash; race; sprint. January 1, 1997. Wilford, John Noble (2004) A long run for humans to get into theirshape: Scientists say body was made by strides. International HeraldTribune, November 19, 2004. Williams, Mel (2003) Can it improve your marathon time? Marathon Beyond, May 2003. Williford H. N., Scharff-Olson M., and Blessing D. L. (1993)Exercise prescription for women. Sports Med, 1993. Cited in Holschen,Jolie (2004) The female athlete. Southern Medical Journal, September 1,2004.

The Australian National Mental Health - 1191 Words

Mental illness has a profound impact on the Australian community, with 45% of Australians expected to experience mental illness at some point in their lives. In 1991, Australian Health Ministers commenced The Australian National Mental Health Strategy, which has since transitioned to its Fourth National Mental Health Plan Agreement. The Australian healthcare policy that has recently received attention in the Australian media is the revised National Mental Health Policy of 2008. The media article, ‘‘Futures will be lost’: Health fears as youth psychosis program dropped,’ has been analysed on its illustration of current structural reform proposed in the Mental Health sector. The role of media is critical in conveying policy to the public and†¦show more content†¦How does the media portray this issue? Author Jane Lee writing for the Sydney Morning Herald, evokes an emotional response within readers from the get-go in true left wing fashion. The doom and gloom heading elicits fear by using bleak words such as ‘lost, fear and dropped’ to describe the future health of young Australians experiencing psychosis. Delving into the first paragraph, the author capitalises on the power of expert opinion, bequeathed by ‘Leading mental health expert’, Patrick McGorry. McGorry is referenced multiple times during the article, expressing a strong opinion opposing the abolishment of funding for the hYEPP. If that alone is not enough to convince a lay person to side with the article, McGorry exclaims ‘almost certainly, lives will be lost’ when referring the closure of the program. This parallels with concerns ‘Futures will be lost,’ if adequate infrastructure is not put in place to facilitate patients with psychosis back into school, social settings or the workforce. Increased rates of suicide within the schizophrenic patient population is a grim reality of the disease and readers will most likely empathize. It is important to note, that Patrick McGorry, ‘Leading mental health expert’ is also the pioneer of Early Intervention in Psychiatry, namely the Early Psychosis Intervention Prevention Model. The is the evidence-based model, to which the hYEPP has been constructed on. Patrick

Persian Gulf War Free Essays

The war was fought very fiercely for Just one year between 1990 and 1991. Its effects can soul be felt In today’s society. The war had quite a large impact on history, particularly modern history. We will write a custom essay sample on Persian Gulf War or any similar topic only for you Order Now The outcome of the war arguably poisoned the minds of many people, crippling relationships between many groups; particularly between the West and the Middle East. Its whole entirety has left a major impact on the lives of many people and will continue to be looked at as a dark time for Middle Easterners and quite the opposite for Westerners. It is often argued that the war was ultimately a fight for oil. Several sources do present their arguments in favor of this statement, and are successful in establishing a case where this statement is true. His real motive was probably to take control of the wealth possessed by Kuwait (Lowe 2005, up. 253). Referring to Sad Hussein, the author has stated that Sad Hussein’s primary motive for the war was to take control of Kuwaiti wealth. Their wealth was their OLL Industry; an Industry that the world relied on heavily, particularly for countries In the Middle East and beyond. Most people take the view that Hussein was short on finances following the Iran-Iraq neighboring countries; this had mostly gone to waste and Hussein would not pay it all back. Additionally, he believed that Kuwait was historically a part of Iraq. Had this been true, he would have already possessed Kuwait for a long time. Several reasons can be produced to support the claim. As Iraq was short on finances, they needed only to claim a nation that had a booming industry. They didn’t need to take over a country that had larger powers, and both the superpowers at the time were neutral awards Iraq. These facts, along with the small size of Kuwait, were in due course the main characteristics for Hussein’s motives. Moreover, it was the West who was also in strife when they realized what was at stake from the invasion of Kuwait. Lowe (2005, p. 253) argues that Iraq and the USA were previously on neutral terms, as USA had helped Iraq in their war with Iran. In contrast to this, USA was threatened by the invasion, as it left Saudi Arabia incredibly vulnerable. Saudi Arabia at the time (and still to this day) have possessed the largest oil industry and production for a long mime. This fact left several Western nations vulnerable as well, as Iraq were very close to invading Saudi Arabia next and this threat was made very clear to the West. If Saudi Arabia were to be invaded, their oil industry would have been controlled by Iraq, and the supply to the West would have been cut. The overwhelming evidence suggests that the war was a fight for oil, and a fight to protect the wealth produced by the oil industry. A variety of viewpoints emerge from political conflict in Iraq, and other Middle Eastern nations. Most people take the view that the poor decisions by politics within Iraq, particularly on the part of Hussein, led to the downfall of the overall position and reputation of the Middle East post-war. ‘International politics of Middle East have long been volatile and unstable’ (Cellophanes 1992, up. 10). Indeed, the politics within the Middle East have been volatile and unstable, and this has led to their national identity becoming weaker. There is evidence to support that there was conflict in national interests, religions and ethnic rivalries post World War Two. These inflicts have led the people to take sides within their own country, and to oppose neighboring countries who they should call their ‘brothers’ or ‘sisters’. The balances of interests have been made harder and harder to achieve and maintain, stemming from the poor decisions made by the leaders of each nation. Therefore, Iraq’s downfall arose from Hussein’s overconfidence and greed for power, ambition, wealth and reputation. There are many reasons in favor for both sides of the issue about economic impacts for Iraq, as well as the U. S. The majority viewpoint is that Iraq was already suffering financially, and the war left them in an even worse position. The financial crisis in Iraq had reached breaking point by early 1990 and Sad Hussein was in a desperate position (Finland 2003, up. 14). It is established that his motive for the war was to gain money, but the war was decisively won by the opposing side, proceeding to the economic suffering of Iraq. Conversely, the U. S. Did not suffer nearly as much. Hancock (2006) argues ‘The Gulf War being the least expensive of all American wars resulted in a cost of only $26. 92 per American citizen’. Comparatively, citizens of U. S. Had suffered a low economic loss and this was loosely opposite to that of Iraqis and other Arab nations. It is unarguable that the Middle East suffered a lot more economically compared to U. S. A. According to many sources, the aftermath of the war has left its mark on many around the world, particularly Iraqis. Common far more in number, but left negativity with Iraq. The Columbia Electronic Encyclopedia (2012) argues that Kuwait and Iraq suffered enormous property damage. This fact presents an argument to support that the huge property damage offered to Iraq applied to quite the rest of the Middle East. They had suffered huge casualties and property damage from the war, but this only created more anger for Iraq. Continued uneasiness and conflict between Iraq and coalition forces; primarily U. S. , led to Second Persian Gulf War (The Columbia Electronic Encyclopedia, 2012). The second war was based off of Hussein’s anger towards the West and ongoing conflict was inevitable from the outcome of the first war. For these reasons, it is established that the aftermath of the war had a major effect on Iraq and the Middle East. Even the most superficial investigation of the war produces the major effects of the war on the Middle East. The weight of public opinion is relied on the fact that most Middle Easterners suffered from the outcome of the war. Kettle (n. D. ) argues ‘Both Kuwait and Iraq†¦ Would have to face a period of turbulence and instability†¦ Both have had their political integrity and independence, as well as their economy and civilian structures, seriously undermined†¦ ‘. The quote conveniently provides the long term effects of the two nations, but has also affected the whole of the Middle East. It is argued that the Middle East has been seen by the West as a permanent battleground. The effects had on the Middle East have even been solely blamed on themselves. Authors Beverly Milton Edwards and Peter Handkerchief (2007, up. 97) collectively argue ‘one recurring theme in academic discourses is that contemporary observers, especially governmental ones, should have anticipated the invasion’. The outcome and aftermath have proved the adversity that the Middle Easterners have had to face, and the way they have responded in the past. As the same time, it is argued that this war has added to the Arab-Israeli conflict. The Persian Gulf War led to overall instability within the Middle East, and it is because of this that there have been effects on the Arab-Israeli conflict. Conclusively, the war had a more of an impact on societies within the Middle East. In conclusion, the First Gulf War has led to ongoing conflict between the Middle East and the West in modern history. The war caused political, social and economic conflict between the nations involved in the war. How to cite Persian Gulf War, Papers

Marketing Business Marketing and Communication

Question: You are required to create the following financial assessment for Portland Fit. Price Build Budget/pro forma RO1/payback Client Lifetime Value Create a new Financial avenues for the organization and a Work Based Structure "WBS". Answer: Financial Assessment of Portland Fit Portland Fit conducts training programs for runners as well as walkers of all abilities. It mainly aims for completing events like Portland Marathon. Price Build Portland Fit renders corporate fitness services in comparison with other high-end fitness centres for the same. Pricing Monthly Annually $100 $150 From the above table, it is easy to understand that Portland Fit charges $100 for the registration purpose in the fitness centre. For lifetime membership of Portland Fit, they charges $150 from the runners on annual basis. Price Build Unit Sales Year 1 Year 2 Year 3 Standard Monthly Membership Fees 23540 54800 65760 Premium Monthly Membership Fees 34540 24560 65870 Registration Fees 23650 45370 25470 Other Revenues 34250 65730 23260 Total Unit Sales 115980 190460 180360 Unit Prices Standard Monthly Membership Fees $2,340 $32,160 $54,600 Premium Monthly Membership Fees $65,760 $87,960 $97,650 Registration Fees $1,230 $3,460 $2,360 Other Revenues $54,600 $32,400 $56,570 $123,930 $155,980 $211,180 Sales Standard Monthly Membership Fees $3,426 $5,460 $2,315 Premium Monthly Membership Fees $3,567 $2,165 $5,674 Registration Fees 34250 65730 23260 Other Revenues 34540 24560 65870 Total Sales $75,783 $97,915 $97,119 Direct Cost of Sales Standard Monthly Membership Fees 34250 65730 23260 Premium Monthly Membership Fees $1,230 $3,460 $2,360 Registration Fees $2,340 $32,160 $54,600 Other Revenues 34250 65730 23260 Direct Cost of Sales $72,070 $167,080 $103,480 Prices are greatly influenced by the quality of equipment as well as services for the same (Winer Dhar, 2011). They enrol general wellness programs for the runners in addition to fitness facilities in an overall manner. Pricing build strategy of Portland Fit depends entirely upon the perception of the runners in an overall manner. Budget Marketing Expense Budget Year 1 Year 2 Year 3 Advertising $34,500 $23,560 $54,600 Sales Promotions $23,650 $65,790 $76,540 Marketing Training $12,430 $23,650 $35,630 Quality Assurance $34,650 $65,780 $21,540 Referral Program $23,650 $65,790 $76,540 Corporate Promotion $34,500 $23,560 $54,600 Public Relations $34,650 $65,780 $21,540 Website and Facebook $12,430 $23,650 $35,630 Total Sales and Marketing Expenses $210,460 $357,560 $376,620 Key Marketing Metrics Key Marketing Metrics Year 1 Year 2 Year 3 Revenue $3,426,500 $6,543,290 $8,754,000 Leads 23430 43500 45000 Leads converted 15% 12% 20% Referrals 91 45 89 PR Mentions 34 36 67 Testimonials 21 56 98 Annual Customer Attrition 15% 22% 32% Return on Investment Portland Fit evaluates efficiency of an investment for comparing various investments. Return on Investment is the measuring factors for relative investment costs in an overall manner. Return on Investment: =Gain from investment- cost of investment/ cost of investment = $235- $125/ $125 = $110/ $125 = 0.88 Payback Period Payback period of Portland fit ensures the length of time for recovering the cost of an investment. Determinant ensures undertaking position for longer payback period and desirable for the various investment positions for the same. Payback Period = Cost of Project/ Annual Cash Inflows = $100000/ $25000 = 4 years Client Lifetime Value Client Lifetime value is one of the important metrics adopted by Portland Fit. It mainly helps in: Understanding the generated return on investment on customer acquisition It mainly focuses on the marketing channels for optimization of lifetime value for the gross profits. It mainly tries for maximizing customer lifetime value for cost in customer acquisition in an overall manner. Ensuring retention marketing strategy It aims for marketing campaign and instant revenue for the targeted runners of Portland Fit. Creation of effective messaging, nurturing as well as targeting It mainly helps in segmentation for customer base in improvement in the personalized messaging system. Improvement in the behavioural triggers It mainly discovers the behavioural triggers for best runners in the Portland Fit. Improving output from the customer support area It mainly focuses on giving special attention for the valuable customers of Portland Fit. Work Based Structure Work-Based Project Start Date End Date Budget Implemmented By Department Advertising 21st January 2016 31st March 2016 $2,300 Photographer Marketing Photo Sessions 22nd January 2016 15th April 2016 $4,500 Ad firm Marketing Create new print ads 12th February 21st May 2016 $320 Ad firm Marketing create new radio sports 21st January 2016 15th April 2016 $230 Ad firm Marketing create new vide ads 22nd January 2016 31st March 2016 $210 Ad firm Marketing Launch and campaign 21st January 2016 21st May 2016 $520 Ad firm Marketing Total Advertising Budget $8,080 PR Create press release focus on new initiative 21st january 2016 31st March 2016 $230 PR Agent Marketing Send press release 12th February 15th April 2016 $540 PR Agent Marketing Follow up calls on press release 21st january 2016 31st March 2016 $540 PR Agent Marketing Total PR Budget $1,310 Direct Marketing 21st January 2016 31st March 2016 $4,340 Marketing Assistant Marketing Create email blast about new referral program 22nd January 2016 15th April 2016 $5,480 Marketing Assistant Marketing Send email blast 12th February 21st May 2016 $2,380 Marketing Assistant Marketing Create corporate offering mailing and target list 21st January 2016 15th April 2016 $3,260 Marketing Assistant Marketing Send corporate offering mailing 22nd January 2016 31st March 2016 $2,370 Marketing Assistant Marketing Total Direct Marketing Budget $17,830 Web Development 12th February 21st May 2016 $54,600 Web Firm Marketing Revise Website 21st January 2016 15th April 2016 $34,700 Web Firm Marketing Create new Facebook application 22nd January 2016 31st March 2016 $23,760 Web Firm Marketing Launch Facebook application 21st January 2016 21st May 2016 $54,300 Web Firm Marketing Total web development budget $167,360 Marketing Loyalty and Referral Programs Create new referral forms 21st January 2016 21st May 2016 $32,500 Marketing Assistant Marketing Staff training on loyalty and referral programs 22nd January 2016 15th April 2016 $34,650 Operation Manager Marketing launch New programs 12th February 31st March 2016 $21,300 Marketing Director Marketing Total Loyalty and Referral Programs $88,450 Totals $283,030 Figure: Work Based Structure of Portland Fit (Source: Blythe, 2012) Work-based structure helps Portland Fit for defining the projects in an accurate manner. It defines the hierarchical structure for smooth functioning of Portland Fit. It mainly ensures monitoring of the project as well as allocation of related resources for the same. This particular company aims at estimating the cost evaluation and risk allocation strategy in the most appropriate way. It mainly checks specified deliverables for the stakeholders of the business organization. It mainly supports execution as well as monitoring process for the runners. Project Name Weekly Timeline Week 1 - 2 Week 3 - 4 Week 4 - 7 Week 8 - 10 Week 9 - 10 Notes: Briefing of the project Product research and development Market research Promotion and advertisement Monitoring and measurement Feedback of the customers Month 1 Month 2 Month 3 Month 4 Month 5 Totals: 13 14 22 21 14 Cumulative Total: From the above analysis, it is easy to collect the reliable information on Portland Fit. It mainly assigns price build strategies for improving in the generation of revenue for future business activities. Capital budgeting techniques will help in understanding the cost estimation for innovative projects selection in an overall manner. Reference List Blythe, J. (2012).Marketing. London: SAGE Publications. Kotabe, M., Helsen, K. (2011).Global marketing management. Hoboken, N.J.: Wiley. Sheehan, B. (2011).Marketing management. Lausanne, Switzerland: AVA Pub. Winer, R., Dhar, R. (2011).Marketing management. Boston: Prentice Hall.

The Importance of Value

How to Get Started as a Freelance Writer in 6 Simple Steps

How to Get Started as a Freelance Writer in 6 Simple Steps How to Get Started as a Freelance Writer in 6 Simple Steps How to Get Started as a Freelance Writer in 6 Simple Steps By Ali Hale Would you love to be a freelance writer? Maybe youre hoping to make a bit of money on the side of your day job, or you want to find some work that fits around being at home with your kids much of the day. Perhaps youre hoping to launch a whole new career. You might well be feeling daunted before youve even begun, though. Theres just so much information out there: where do you even start? These  six steps are all you really need in order to get going: Step #1: Find Out How Self-Employment and Tax Works in Your Country Before you start freelancing, it’s important to figure out how self-employment (and particularly tax) works in your own country. You don’t necessarily need to do anything about it right away, but you do need to know what to expect. Here in the UK for instance, sole traders (the simplest set up for a freelancer) don’t have to register with HMRC (the tax authorities) from the first moment they start freelancing. They do need to be ready to submit a self-employed tax return on time, though – e.g. by the end of January 2020 for the tax year 6th April 2018 – 5th Mar 2019. If your country isn’t on this list, just search for â€Å"register as self-employed† and your country name, and you should find plenty of advice. Step #2: Create a  Gmail Account (for Email and Google Docs) Do you have an email address that looks something one of these? chocolatelover@hotmail.com GameofThronesfan@yahoo.com I’m sure it goes without saying that those aren’t very professional looking! Even if your email address uses your name (or your pen name), free providers like hotmail and yahoo have a bit of an â€Å"unprofessional† reputation. Gmail is much better regarded, perhaps because it started out being very popular with techy types, and is now so ubiquitous. So I’d recommend setting up a professional looking email address with Gmail, for now – something like yourname@gmail.com or yournamewriter@gmail.com. One important reason for having a Gmail address is that it also gives you a Google account, which you can use for Google Docs – I find that many clients want to collaborate in this way. If you prefer to have a really professional looking email address, then you’ll need to register a domain name of your own (e.g. mine is www.aliventures.com) and then set up an email address at that domain (mine is ali@aliventures.com). Step #3: Figure Out What Topics You Want to Write About Before you go any further with freelancing, it’s a good idea to figure out what you want to write about. You might think that it’d be best to write about anything and everything, in the hopes you’ll get plenty of work – but the truth is that clients prefer writers who have prior experience in a particular area. You’ll also probably enjoy freelancing more if you’re writing about topics you’re actually interested in. When you’re figuring out which topics to focus on, you might want to consider: Your personal life and experiences – e.g. if you’re a parent to school-age children, you could write about pregnancy, babies, toddlers, etc. Your professional life – e.g. if you work in IT, you might want to specialise in technical writing or in writing for blogs that cover techy topics. Your hobbies – e.g. if you love to craft, then you might want to look for blogs about craft or companies that sell craft supplies to write for. You can switch or add topics as you go forward in your career, but you’ll find it helpful to have some idea of the areas you want to focus on when it comes to the next two steps. Step #4: (Optional) Create a Website You don’t have to have a website in order to freelance – so if this is just a step too far right now, then feel free to skip it. At some point fairly early in your freelancing career, though, you’re going to want to have a web presence. You’ll want somewhere to direct potential customers, whether those are your current contacts, friends of friends, or people who read your guest posts (see Step #5). If you don’t want to spend any money at this stage, I recommend setting up a free website with WordPress.com (just follow their process step by step). Your website will have â€Å"wordpress† in the address, so it’ll look something like yourname.wordpress.com. While this isn’t the most professional option out there, plenty of freelancers do just fine with a free WordPress site – and I think it’s absolutely fine when you’re just starting out. Alternatively, if you’re fairly confident about techy things and if you have a bit of money to invest, I’d recommend purchasing web hosting, registering your own domain name (e.g. yourname.com) and setting up self-hosted WordPress on that site. Most web hosts have a simple â€Å"one click† installation process for WordPress, as it’s so popular. Step #5: Get Some Published Experience Before you can start landing freelancing clients, you need some experience: published pieces that you can show them as examples of your work. But how do you get that experience when you don’t have any clients? One simple way is to write guest posts for large(ish) blogs: a big advantage of these is that your posts will be online, so it’s very easy to send clients a link to them. You can also create a â€Å"Portfolio† page on your website with screenshots of and links to your work. Ideally, you’ll want to target blogs that fit in with the areas you want to write about, so that you’ve got relevant freelancing clips. Most guest posts are written for free, and although some freelancers feel you should never work for free, I think it makes sense to do so when you’re just starting out. (Don’t spend ages at this stage, though; three to five published pieces should be plenty.) You’ll almost always get the opportunity to write a â€Å"bio† to go along with your guest post (normally at the bottom of it). You can use this to promote your freelancing services, writing something like: Ali Luke is a freelance writer, specialising in blog content for small businesses. You can find out more about her and her services at  www.aliventures.com. If you want to freelance for magazines or print publications, rather than blogs or websites, then you’ll want to look for ways to get some experience with print. A good place to look is local free newspapers and magazines – they probably won’t be able to pay, but they’ll likely be very willing to publish your work. Step #6: Start Finding Clients If there’s one thing you take away from this post, make it this: Don’t use content mills. If you’re not sure what a content mill is, it’s a site where you sign up and get sent writing jobs. They often promise lots of work, or tell you how much writers can make – but the reality is that they pay peanuts. They often call themselves â€Å"article writing services†. Textbroker is a well-known one; Copify and iWriter are other examples. Content mills can’t afford to pay much, because their main selling point to their clients is that they’re a cheap way to get lots of content. So where else can you find work? Let family and friends know that you’re freelancing, and tell them what type of work you’re looking for. You never know when someone will know someone! Look at the ProBlogger jobs boards and Freelance Writing Gigs’ daily round-up of writing work. (There are plenty of other similar job boards online, but I’ve found that between these two, they cover all the good opportunities.) Pitch directly to websites (or magazines, or whatever type of publication you want to write for). Target local clients, perhaps with an ad in a local paper, shop window, or library, or by attending local small business networking events. Browse the website of companies that offer services related to your niche and in case they dont have a regularly updated blog contact them offering your writing services and explaining the benefits that fresh content would bring to their website. Think beyond writing articles. You can offer services such as crafting email marketing campaigns, writing e-books and reports, website editing and proofreading and so. Finding your first paying client can feel like a huge hurdle but once youve found one client, more will follow. In case you want more help, I have a 6-week program that covers all the aspects of getting started as a freelance writer, from improving your writing productivity to landing high-paying gigs, from promoting yourself online to running your freelance business efficiently. The course has been offered for 8 years and over 1300 students enrolled during that time. I offer a complete money back guarantee, and surprisingly no one ever asked for it! In order to celebrate its eighth anniversary we are offering the course for just $29, so check it out below before the promotion ends. Above all, if you decide to try freelance writing, make sure you persevere. Getting results takes time, as with virtually all endeavors in life, and the biggest mistake I see aspiring freelance writers making is giving up too soon. Hang in there for 6 to 12 months before you evaluate your results. Good luck! Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Freelance Writing category, check our popular posts, or choose a related post below:Apply to, Apply for, and Apply withRules for Capitalization in Titles15 Names and Descriptions of Effects

Changes in Financial Reporting for a Nevada Casino in regards to Essay

Changes in Financial Reporting for a Nevada Casino in regards to Regulation 9A and the SarbanOxley Act - Essay Example With this in mind, it can be stated that the influence of the Sarbanes-Oxley Act adoption in 2002 on the financial reporting of the Nevada casinos is quite comparable to that of the other public companies. On the contrary, the impact of the Regulation 6A which was put into effect in 1997 was much more specific in nature. Both of these legislative acts, however, became two more integral parts of extremely complex regulative environment the gambling industry operates in. The major requirements that explicitly affect the Nevada casinos, besides the restrictions on the audit procedures, pension funds blackout periods and restriction on loans to senior management, are corporate responsibility regulations and use of the non-GAAP financial measures in press-releases and reports. The CEO and CFO of each issuer shall prepare a statement to accompany the audit report to certify the "appropriateness of the financial statements and disclosures contained in the periodic report, and that those financial statements and disclosures fairly present, in all material respects, the operations and financial condition of the issuer." A violation of this section must be knowing and intentional to give rise to liability. (AICPA) TheThe issue of the use of non-GAAP financial measures in information releases through mass media or corporate reports is quite important for the casinos because these channels are used not only for communicating data to the investors, but as well for the PR-purposes with the general audience. SEC Regulation G (adopted under 401(b) of the Sarbanes-Oxley Act) regulates this issue and provides that the use of non-GAAP financial measures in press releases or other public disclosures must be accompanied by a presentation of, and reconciliation to, the most directly comparable GAAP financial measure. (Martin 1) The Regulation 6A named "Cash Transactions prohibitions, reporting, and recordkeeping" closely addresses, on the other hand, the very characteristic feature of the casino business - the cash transactions. It is part of the Nevada's regulatory system for currency transaction reporting which, according to the Nevada Gaming Commission and State Control Board consists of the following: NGC Regulation 6A adopted January 1997 effective May 1, 1997 (prior version adopted and effective May 7, 1985). The regulation was amended March 20, 2003 to delete state suspicious transaction reporting requirements and was effective immediately upon adoption. NGC Regulation 6.090 Currency Transaction Reporting Minimum Internal Control Standards (6A MICS). Version 3 required compliance as of May 1, 1997. CPA 6A MICS Compliance Reporting Requirements (CPA 6A MICS Requirements). Version 1 required compliance as of November 1, 1997. Internal Audit Compliance Checklists for Currency Transaction Reporting. Version 1 required usage for any work performed for fiscal years ended April 30, 2001 and thereafter. (Currency Transaction Reporting 1) The restrictions set by the Regulation 6A on the cash transact

The philosophy on educational Essay Example | Topics and Well Written Essays - 500 words

The philosophy on educational - Essay Example The concept of philosophy was influential in helping Myles Horton to start up learning centers for example; in schools people share dreams and interests while living together. This is based on his definition of a democratic society as one with provisions for positive participation by all in equal terms with secure flexibility (Kohl, Myles and Kohl 1905-90). Since he appreciated the value of education he formed different education centers that led to the spread of citizenship schools to most remote parts in the south and thus helping residents mostly Africans to become literate and qualified to vote. This helped in advancing civil rights movements in 1960s by bringing together coal miners and textile workers. Sharing of ideas and use of the knowledge taught enabled people to challenge and face the negative social problems affecting their lives, boosted and advanced of civil rights, helped workers to form trade unions and cooperatives, helped to make homeless people realize, know and achieve their constitutional rights. The value of education helped to fulfill his determination to see the school he envisioned involve, serve and help poor people in employment and ethnic dissension and in finding ways to gain self-esteem, independence and integrity. Horton organized and appreciated immense transformations in political and social philosophy that enabled restoration of economic prosperity and encouraged patriotism and civic responsibility among the people. One does not need to know the answers to people’s problems but that there are a great deal of views and opinions that people can collectively contribute to build the society. This implies that it is quite crucial to discuss problems in a bid to find viable solutions. Highlander concentrated in inviting the poor who needed sponsorship in order to attend the education centers and learn among other things, their rights in order to overcome the oppression and to learn to handle their problems and

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Measuring Performance - Essay Example It comprises of Strengths, weaknesses, Opportunities and threats. Strengths are internal factors that can be concluded as advantages to the business (current advantages). Factors such as a focused management, hardworking employees, low costs are positive points for the firm. For Jengo Ltd, a high regard for their clothes by the customers is an impressive point for the future of the business. Weaknesses are internal factors as well that maybe termed as disadvantages for the firm (current disadvantages). Negative factors like a poorly trained workforce, ageing equipment etc need to be evaluated for a solution to arise. For Jengo Ltd, the failure to produce budgets or forecasts for the financial year hints weak planning on the part of the management. However, Opportunities are potential areas for expansion of the business (advantages that can arise in the future). These areas are obtained after an external audit in the market the firm operates in. Identifying new markets, expansion of t he product portfolio and favorable government policies amalgamates in outdoing competitors. Moreover, threats are not to be forgotten while forecasting future business plans (problems that may arise in the future). These usually comprise of the macro environment factors that alter the economic environment, strength of the competition, globalization etc. Jengo Ltd should be careful about changing customer demands as it operates in a highly uncertain business. SWOT analysis draws the primary sketch for foreseeing the future for any business. It is an effective way of gathering information and generating interest in the business activities quickly, mostly used to plan the marketing strategy (Hall, D et al. 2004) Factors in the macro environment effect decisions by the top management. Demographic change, government laws, trade barriers etc are some examples of macro change (Varoufakis, Y. 2007). These factors can be categorized by the PESTEL (political, economic, social, technological, environmental, and legal factors). Political developments regionally, nationally and internationally might effect a business’s strategy. Political decisions can change vital areas of the company such as education for the employees, health benefits, infrastructure, and subsidies for instance. Economic factors may involve the effect of consumer demand patterns, willingness to spend, inflation, fiscal and monetary policies, exchange rates, fixed and variable costs, and changes in the labour market on the business. Businesses may also need to plan out the effects of government policies to haul out the country from a recession (Hall, D et al. 2004). Changes in social trends can create competitive advantages for businesses. Falling birth rate, ageing population, increase in life expectancy can all effect a business. An ageing population would mean a shift in the sort of products demanded and more pensions paid to employees. Pressure groups can also force a business decision leading to serious consequences. Technology uplifts products and processes. Online shopping, bar coding, CAD and CAM are all technological advancements that aid in the advent of superior products. Furthermore, environmental factors might include a legislation to control pollution or views of certain groups about the ingredients of the product. Major climatic changes due to global warming have significantly impacted many industries and external factors related to a

The Objectives Of Clinical Management Systems Information Technology Essay

The Objectives Of Clinical Management Systems Information Technology Essay CMS stands for Clinical Management System, including the information integration, inventory control, data processing and tools for medical data exchange. Generally the major user for CMS are physicians, and consist of laboratory information system (LIS), radiology information system (RIS), picture archiving and communication system (PACS). 1In medical fields, the application of new CMS mainly develops in the following stages. Automated medical record (AMR) is mainly used for the automation in medical data processing from paper into e-format. Electronic medical record (EMR) ensures a good communication for paperless and image exchange and sets up foundation of medical terminology. Electronic patient record (EPR) ensures the interoperability networking for the data exchange between CMS or other parties by using a single and standard format. Electronic health record (eHR) sustains the medical decision support system. In the medical support system, it conducts data mining skills from getting multiple data from multiple databases to assure the correct medical decision. Recap above stages, the applications of CMS are useful in medical filed. Objectives Due to the following objectives, our team suggests Town Health co Ltd to implement Clinic Management System (CMS). Increasing business opportunity; Connecting medical record with Hong Kong Government regulation standard; Exchanging medical data with Hong Kong Government centralize database. Company Background Town Health Co Ltd. (The Group) Established in 1985, the group has adopted the managed healthcare model to provide high quality and affordable medical services to our corporate clients. THMN has a full range of medical services, including General and Specialists Services, Dental Services, Physiotherapy Services, Laboratories Imaging Services and other auxiliary medical services. The Group has well developed and became one of the largest healthcare services providers, with about 30 medical clinics and specialist outpatient clinics, in Hong Kong. Company network Figure 1.1 http://www.thmn.com.hk/our_locations.asp Company Workflow The Group was operating a standalone medical management system over 10 years. Many problems occur throughout their daily operation. The basic operation workflow is shown as below figures 1.1. Diagnosis New Patient Registration Consultation Medical Record Transfer to Hospital/Other films Treatment Figures 1.1 For our daily operation, a new patient is required to fill in a registration form for his / her personal information in paper format. Then the duty doctor consults and examines the patient based on the background and situation at that moment. The paper medical record and real time observation by the duty doctor will be used as tools to support the diagnosis of the patient. Finally, the staff or nurses will input the finalize treatment formulated and medical record into the existing medical system. Five Force Analysis For The Group Suppliers Industry Competitions Buyer Potential Entrants Substitutes Threat of New Entrants There are many new entrants in Hong Kong healthcare services industry. It is because of the rapid changing of economical scale, such as new investments from PRC. Threat substitutes Since the market demand is changing recently, many different professionals are willing to join together and run their business to provide a 24*7 (24 hours with 7days) services. Besides, they combine their services into a single business firm, such as Chinese medical services, Dental and out patient services. Therefore they can share resources to reduce the operating cost and increase the revenue. Bargaining power of Suppliers Most of suppliers ally their product price due to the increasing price of most original materials. For a healthcare group, they are required for lots of inventory, like drugs and medicate equipment. This is a main reason for their high operating cost. Bargaining power of Buyers The Government regulation was release as benefit to all Hong Kong elders such as health care voucher, eHealth medical record sharing system, and etc. Industry Competitors There are many strong competitors with increasing and steady revenue. Moreover, most professionals quit their job in public sector (Government Hospital) and join the joint venture of healthcare group to start their own business. SWOT Analysis for The Group Strength The group is established for over 25 years, it is a well-known health care services provider with confidence in providing quality services. A wide spread of clinic coverage is convenience to all patients in Hong Kong. The medical management system assists on keeping patients records that ensures the efficiency on daily data processing. Weakness Performance of existing medical management system becomes slower due to the increasing size of data. Increasing numbers of patient records reduce the performance of accuracy. Thus, many errors were found in daily operation which influences the efficiency. The system will become a bottleneck of the Group for the business expansion. Opportunity Modernize on computer system provided a better management on patients data and prevent error to increase efficiency on operation. Also, connectivity to Hospital Authority (HA) and insurance companies database can get advantages on increasing revenue and convenience of data exchange for the Group. Treats The medical industry competition had a huge impact to the Group due to the decreasing market share and revenue while the running cost for equipment and drugs is increasing. Research Methodology Research method Interview for analyzing the current problems The aim of the interview is gathering information about the understanding for the current system and its process. Our team conducted the interview to narrow down the problems one by one. Web survey for capture the industry strategy Due to the rapid change for the market, this survey is aimed to get the most common strategy for our team. Data Gathering This process is mainly used for identify the existing operation problems through the interview with the company partners, managements and customers. Peoples interviewed: Partners Project mangers Customers The questions for Partners What is your corporate vision and mission? What is your corporate development target in long term / short-term? What is your development strategy in long terms / short terms? Do you agree the change of Hong Kong market decreasing revenue of your company? How many resources had been spent on your strategy development projects? What is / are the existing problem(s) that your company is facing now? And how does your company fix it? The questions for Project Managers How do you carry out the CMS? How long do you planned for your project schedule? How the CMS fulfill the development of your company that you had mentioned before? How many resources had been spent on your strategy development projects? The questions for Customers What service(s) do you mainly used in Town Health Corp? Do you comfortable with the current system of Town Health Corp? 3 Do you have any suggestion(s) for Town Health Corp? Through the interviews, our team recognizes the mission of health care group is providing a comprehensive healthcare service. The short term planning is to develop an effective clinical management system, while the long term objective is to build up an exhaustive service for customers, such as medical decision support analysis. To achieve the short term and long term objectives mentioned above, we have to improve: The duties schedule of physician Communication channels with other insurance companies The inventory control and allocation Standardization of e-health medical record Survey result All interviewee thought that the eHealth is useful as it answered them many questions and as a platform to communicate with others. Whats more, over 80% clients having discussion with professional after a year, which is dangerous if they didnt take annual body check. Almost 80% clients thought the Clinical management system should be connected into Hong Kong centralize database. Due to the elderly dont know how to use the high technology (e.g. computers), thus the respondents refuse to use it. There are only 20% of interviewees think that the Clinical management system cant be effectively the diagnosis processing. Almost 80% of respondents has been used the clinical management system, especially most of them used the Google one. The respondents all are educated above the primary school and most of them are in the age group of 30-39. Values Identified from Interview Objective Schedule Management Insurance interface Inventory control e-medical Record The duties schedule of physician Communication channels with other insurance companies The inventory control and allocation Standardization of e-health medical record Problem Definitions The Group was operating a standalone medical management system over than 10 years. However, there are still many problems occur during daily operation. Data formatting out of date The existing medical system was developed in 1989. All clinic offices were allocated a standalone workstation for operating medical system. The medical system database was developed by FoxPro which could not conduct data mapping with other new technology like Microsoft SQL server, MySQL server. Hence each medical system was all recorded year by year until present. Suffering in medical claim to insurance company Every time when different insurance companies transfer some patients data for inquiry, the staff needs to input the patient data one by one manually in order to get the corresponding data from the database. After all required data have been extracted from the database, the staff needs to enter the corresponding data to different systems that provided by insurance companies. Sometime if the data from insurance companies could not match with the database, the staff needs to notify the insurance company for amendment. After receiving the update data, the staff needs to do the inquiry all over again. Cannot manage resources on inventory Existing medical management system can only handle patients records. Inventory of the Group is recorded by using a logbook. Using of pen and paper cannot fulfill the services standard nowadays. That is not a flexible and efficiency way to keep track and monitor inventory, especially for a medical group which owned over thirty clinics. Manpower that used on inventory is also become a challenge on management and costs. Cannot manage customers appointment effectively Many clinics handle their patient appointments by using telephone bookings and marked on the notebook. However, it always has the contrived mistake, for example, marked down the wrong name or contact number. Sometimes the patients need to wait for a long time to check the appointment time or the medicine stuffs. Furthermore, the doctor may not stay in one single clinic; it is inconvenience for the customers who want to consult the same doctor. Based on problems above, managements decide to carry out a new Clinical Management System (CMS) to replace the existing one. Our learning area: Electric Medical Record, Interfaces with Insurance Company, Inventory Control and Book appointment with web interfaces. Successful Stories 2The Hospital Authority (HA) of Hong Kong 3The Hospital Authority (HA) is one of the successful case of implement CMS in Hong Kong. HA set up 15 Chinese medicine outpatient clinics (CM Centres). These 15 CM Centres are served with a fully computerized Chinese Medicine Information System (CMIS). CMIS is developed by HA for managing a large amount of clinical information. The CMIS is aimed to the support for patient administration (example, appointment, registration and payment), clinical modules (example, diagnosis, consultation notes and prescription) and pharmacy management. It can also treat as a platform for data analysis, planning and researches. The Integrative Medicine Information and Research Manager of HA, Tat Tse said, the system can reduce errors and enhance risk management, for example, the emergence of drug incidents, we can trace the patient and arrange examination as soon as possible. 4Union Hospital in Hong Kong Another successful case for CMS implement is Union Hospital and Union Hospital Polyclinic. Union Hospital was established in the year 1994 while Union Hospital Polyclinic (Tsuen Wan) went into service in January 2007. Hospital and polyclinic have an advanced Customer Management System to provide comprehensive patient data and flexible registration service. It is convenience for the clinic and the hospital to access the patient information and medicine history. It is also expediency for the patient to choose the venue for having the follow-up care thought out the network of Union Hospital. Proposed Solutions With the reference to the above successful cases in Hong Kong, the main purpose for the CMS is easy to deliver medical data. It is a centralized system to control and share the resources, like medical information, to related departments, like Pharmacy, Laboratory and front-end clinics department. Besides, CMS can be synchronized all the medical data to both public and private hospitals and other CMS. A brand new CMS become an important milestone in the IS strategy development. Inventory control To improve the inventory control, the implement of inventory control system is required. It can increase the flexibility and efficiency. The new system will include inventory monitoring, stock transfer, out of stock alert and reporting, and other function like expiry date reminder and search. These functions are the daily tasks which are operating manually every day. The implement of new system can help to reallocate manpower to other tasks. Schedule management The system will renew the data periodically. Old records of patients will be found easily. Clinic staff can handle the patients records and the appointments by using an easier way. Insurance interfaces The system can get requests from different insurance companies and reply those insurance companies automatically. A summary report will generate for checking every day. This can save the manpower of processing insurance companies request and prevent missing or wrong information exchange. E-medical standard Since all the new medical data should be matched with international standard, developers change all the new medical data into  [5]  HL7 format. HL7, an international standard medical system, can exchange data with other systems, which will be the main trend for future development. This action may cost lots of resources in transferring to the new CMS, it is still certainly required for the long term strategy of health care industry. Physical Architecture This section describes the physical architecture of the System. The below diagram shows the physical architecture of the System. The CMS is constructed in 3-tiers web based architecture, which includes web server, application server and database server. Web Server The Web Server will be the primary entry point for all users to access the system. All user activity will be limited within the Web Server. Application Server The Application Server will serve the validation process and the using of the stored data in the Database Server. Users will access these functions through the user interface located at the Web Server. Database Server The Database Server will be the central repository of all data. These data will be using for validation purpose. Software requirements Internet Explorer 5.5 above Java web starter 6.0 above MySQL 10.0.1 above Tomcat web server 6.0 above Hardware requirements IBM X3250 M2, Xeon E3110 3.0GHz/ 1333MHz (DC 65w 6MB L2 cache), 8GB 667MHz SDRAM, 160GB Hot-Swap SATA HDD Tape Drive [Prod Servers] IBM Tape Backup Drive Juniper Netscreen-5GT CableCat5 and Cat6 KVM 1U 15 LCD Monitor w/ 8-port PS/s Solution Budget The solution estimated project costs are shown as below: Items Estimated Costs (HK$) 1. Project team staff/development costs# 500,000 2. Project office set up and running costs including rent, telecom costs, mail/courier, etc. 100,000 3. IT costs including PC, software, printer, fax, LAN set up, etc. 100,000 Grand Total 700,000 Workflow of new CMS E-Medical record standard formats (Health level 7) apply in CMS First of all the medical record (HL7) run across multiple module of CMS, the example shown the workflow of e-medical Record useful in multiple modules of CMS. HL7 is mainly use for data exchange in different multiple module. Such as a single medical record it can be data exchange to doctors in clinical departments then transfer information to other lab departments then the lab result can be generate the medical decision support lab test. Finally the doctor can be made the medical decision and prepared the consultation result. The medical can be claim to insurance company directly for patients. Workflow of appointment in CMS The client calls to book the time with the right doctor. The clinical nurses mark down the information of the client and find out the clinic data from the database. The nurse call to remind the client and confirm the booking. When the client comes, then the appointment is done. Phone in to clinic Mark down the client information Call back and remind the clients Appointment done! Workflow of inventory system 1. Medicine, equipment or office supplies delivered to warehouse, information and amount of each product will be updated into the inventory system 2. Staff in clinics will place order for different items in the inventory system, delivery will be arranged. For some critical items like life-saving medicines, order will be automatically placed once the amount dropped to preset minimum quantity 3. Items delivered to each clinic from warehouse Workflow of Medical Claim Enquiry From Insurance Company Insurance company send medical claim request to CMS, CMS will retrieve data automatically from database and return diagnosis result back to that insurance company. Implementation Schedule The following is the paramilitary schedule of the proposed plan: Date Major Milestone Month 1 Launch of the CMS Project Proposal evaluation Month 2-4 Project Initiation User Requirement Collection Mouth 5-6 System Design and Analysis Procurement and Installation of Hardware and Software Interface with external systems Mouth 7-8 Program Development Mouth 9-11 User Acceptance Test Documentation Training Mouth 9-11 User Feedback Collection User Feedback Analysis System Design Revision Mouth 9-12 Program Modification User Acceptance Test Documentation Training Phase 2 Live Run Conclusion Durng the study topcis,all of us exploer our eye on Hong Kong Helthcare business operations.Due to the market change from previous, Hong Kong became stanadardation with international.The government of HKSAR become the leader role on electric health care stanard and regulations. Hence the team regonzine the implementation of cinical management system just the begin electric health care stages. All the industry stakeholders become more international standardization in future! Project Self-evaluation The study of CMS and its functions team completed the target because we can learn Healthcare knowledge during the project. The project management works are fine and the team conducts many discussion points during preparation. Finally I inspirit our teamwork steps until project closure. Tommy Wong @ Middlesex University 2011 During this project, I got the chance to explore and learn about the medical industry, and the relationship between information technology and medical and how they benefit each other. In my own findings using information technology in medical industry especially the outpatient services, is still in a preliminary stage, which mean more I.T. elements can be used to enhance the perform, more efficiency and profit can be archived. Simon Wong @ Middlesex University 2011 During this project, our division of labor is very balance. Everyone tried the best and put many efforts on it. I in charged the parts of findings, included the survey result, interview result and others. However,  some difficulties  encountered in  investigations, for example,  many respondents were  not sure  what  is eHealth, or  send the mail to people have not reply. I think our team spirit is good. But I should do the project more actively. Whats more, after my self-evaluation, I think my work is fair effective and efficient, due to the fair English grammar, I might need the others group mates help to proofread. At the same time, I think my time management can be better, because of my delay, the schedule of work might postpone. I hope I will do it better next time. Eric Pang @ Middlesex University 2011 Medical topic is a totally new topic to me, but to deal with different industries and departments is one of characteristic for Information Technology. Though this project, my skill for handling an unfamiliar topic is improved, which is equipped me to be an Information Technology professional. In this group project, I responsible for research on medical field business model. I found that even in a field of professionalism, the competition between companies still very great. Therefor price war is not a best way for them to increase the revenue. Before this project, I truly believed that price war is always a way to help companies to develop their business, but now I understand that with the information system support and re-engine the process flow, the company still can increase their productivity and achieve the target of increasing revenue. After this project, doing the analysis on the company background and market background become more and more import to me when designing solutions. This is the first time for me to handle an unfamiliar topic, medical health care industry. I had spent a lot of time to search information and catch up the schedule of my teammates. By having thIs experience, I am sure that I can do better for next time. Ben Wong @ Middlesex University 2011 Appendix 1 Interview Questions with Answer Dr Joseph Lee, Partner of Corporate Development Town health Co Ltd 1 Feb 2011 Dear Dr Lee, We are a group of year 3 undergraduate students of Middlesex University, School of Engineering and Information Sciences. As part of our final year studies, we have been asked to contact and interview a strategic manager on a topic related to the use of Information Technology and Information Systems within the organization. The focus of our approach is to look at the strategic reasons why a particular configuration of IT/IS functionality was adopted assuming that competitive advantage was the prime focus of the implementers. The topic we have selected is Clinical Management System implementation for the chain health care group. We approach you because we believe that our topic represents an important strategic use of IT/IS within your organization. We are requesting a short interview with an appropriate strategic manager within your organization. We should only take a short amount of time at your convenience. However, we do have a deadline of early December for this part of our work. If you are available to help, please reply me by email to [emailprotected] Thank you for your consideration of our request. Yours truly, Tommy Wong Attn: Dr Joseph Lee, Partner of Corporate development, Town Health Co. Interview Questions 1. What is your corporate vision and mission? Our group mission is grouping up all the clinic services to provide a comprehensive healthcare place to the public. 2. What is your corporate development target in long term / short-term? Long -term: Our corporate development target will be emphasized on the elderly mansion. We can provide the periodically body check as elderly easy to have the elderly ill. We would like cooperating with them by contractual in the future 5 years. Whats more, they will enjoy the discount by joining our group elderly program. We hoped that we can have over 30 elderly mansion join us. Short -term: Another our consideration is the doctors who wanted save the rent. They can use the place that share with other doctors, thus they still have their own clinic room but share the rent and human resources. It is because we want to keep increasing our shops (about 10 /year) in different area in HK to enhance our brand image. 3. What is your development strategy in long terms/ short terms? Increase the shops of Town Health is the one of the promotion plan. It increases the brand warranty and customer trusting. When the demand increases, the supply should be increased too. In long term, Town Health has to use personal selling to explain the services to the elderly mansion. Therefore we will recruit more sales to demonstrate our job to the elderly to increase our professional image and increase the corporate opportunities. 4. Do you agree the change of Hong Kong market decreasing revenue of your company? No. It was totally opposite with your question. As the citizens in HK becomes older and older, their requirement of the elderly instruments and healthcare in growth rapidly. In fact the target market in our industry is growing, the revenue of our company is in an enhancement. 5. How many resources had been spent on your strategy development projects? A lot! Human resources and Material resources which includes the instruments, medicines, equipments. I think it will over 100 millions. 6. What is / are your existing problem(s) that your company is facing now? And how does your company fix it? We have to find the Corp target carefully as many of them are not the legal one, whatever the mansion or doctor. We want to enlarge our clinic healthcare by a good quality. We would like asking the existing customers opinions and their past experience. Sometimes we need to find the good doctors by the positive word-of mouth. Thanks for your time and attention. Mr Jackson Tam, Project Manager Town health Co Ltd 1 Feb 2011 Dear Jackson, We are a group of year 3 undergraduate students of Middlesex University, School of Engineering and Information Sciences. As part of our final year studies, we have been asked to contact and interview a strategic manager on a topic related to the use of Information Technology and Information Systems within the organization. The focus of our approach is to look at the strategic reasons why a particular configuration of IT/IS functionality was adopted assuming that competitive advantage was the prime focus of the implementers. The topic we have selected is Clinical Management System implementation for the chain health care group. We approach you because we believe that our topic represents an important strategic use of IT/IS within your organization. We are requesting a short interview with an appropriate strategic manager within your organization. We should only take a short amount of time at your convenience. However, we do have a deadline of early December for this part of our work. If you are available to help, please reply me by email to [emailprotected] Thank you for your consideration of our request. Yours truly, Tommy Wong Attn: Jackson Tam, Project Manager, town health Corp. 1. How do you carry out the CMS? I would set up a project team. Most of the members come from functional team. I also recruit external consultant to be the project adviser. 2. How long do you planned for your project schedule? 2 years 3. How the CMS fulfill the development of your company that you had mentioned before? The functions of CMS commit, electronic medical format as connecting with international standard, the platform connecting with insurance company modules and also control inventory and physicians schedule management. 4.How many resources had been spent on your strategy development projects? Over 2 Millions. All are spent on in-house team development works. Thanks for your time and attention. Ms Eva Ma, Deputy Business Development officer. AIA HK Co Ltd 1 Feb 2011 Dear Eva, We are a group of year 3 undergraduate students of Middlesex University, School of Engineering and Information Sciences. As part of our final year studies, we have been asked to contact and interview a strategic manager on a topic related to the use of Information Technology and Information Systems within the organization. The focus of our approach is to look at the strategic reasons why a particular configuration of IT/IS functionality was adopted assuming that competitive advantage was the prime focus of the implementers. The topic we have selected is Clinical Management System implementation for the chain health care group. We approach you because we believe that our topic represents an important strategic use of IT/IS within your organization. We are requesting a short interview with an appropriate strategic manager within your organization. We should only take a short amount of time at your convenience. However, we do have a deadline of early December for this part of our work. If you are available to help, please reply me by email to [emailprotected] Thank you for your