Marketing Services Versus Products Assignment Example | Topics and Well Written Essays - 500 words

Marketing Services Versus Products - Assignment Example In terms of similarities, the marketing of both products and services require the presence of a market segment. A market segment is that specific group of people with the same line of needs that the marketer tries to satisfy (Perreault Jr., Cannon & McCarthy (2014). According, whether a company is marketing a product or a service, it is important to have a specific market segment that the product or service is prepared for. Another similarity is with the use of strategic option. A strategic option is a specialized approach used by companies to gain competitive advantage over their competitors (Fill, 2002). Kotler & Keller (2012) emphasized that both those in the product sector and those in the service sector have need for strategic options that ensures that they are able to gain competitive advantage within the market segment. The third similarity has to do with the use of a marketing mix. Whether a company is marketing a product or a service, Perreault Jr., Cannon & McCarthy (2014) stressed that using the marketing mix, which are commonly identified as product or service, place, promotion, and price all become applicable. Regardless of the similarities identified above, there are some times that differences are identified when marketing products from services. One such difference has to do with the output of what is marketed to customers. This is because whiles the output of products are tangible, the output of services are abstract or intangible (Kvesic, 2008). What this means is that the actual things that marketers sell to customers as products can be seen, felt and handled but those that are marketed as services cannot be seen or handled. A typical example of a product is a car, while banking is an example of a service. The second difference is seen in terms of branding. The difference in branding can however be associated with the differences in outputs of products and services. Kvesic (2008) explained that whereas the use

Conducting situational analysis Assignment Example | Topics and Well Written Essays - 1750 words

Conducting situational analysis - Assignment Example They have had some failures such as targeting to kids; however, they have managed to take that in their stride and now are a bigger and better company than before. Conducting a situational analysis A marketing plan is used to convey the attributes and benefits of a product or service to its potential customers. It comprises of seven steps and one of them is conducting a situational analysis after the introduction stage. This step is one of the essential steps in creating a long term and successful relationship with customers. (Cohen, 1995) Introduction Introduction comprises of the company’s products, prices, placement etc. and what sort of products or services a company sells; essentially the background of the company and what it stands for. (Cohen, 1995) ASOS.com is a UK based website which is the largest online store for beauty and fashion products. It is only online, and it sells its own goods as well as branded goods. Sales have been on the rise since the company started, with profits before tax jumping from 15.7 million pounds to 30.3 million pounds in May 2012. The target market is mainly men and women between the ages of 18 and 34. ASOS headquarters is Camden Town, located in the North of London in a building called the Greater London House. It offers 500,000 product lines ranging from menswear, women’s wear, jewellery, beauty products, accessories and even footwear. The websites target not only UK though, they target other areas such as USA, Germany, Spain, France, Italy, Spain and Australia as well and ships these products to many more countries from UK, which is its central distributor and origin and that is where the headquarters are located. A 2011 report shows that 13.6 million different visitors visit the website every month and there are registered users as well as active users and customers. The fulfillment centre for ASOS is in Yorkshire. ASOS was developed in 2000 in June and its founders are Quentin Griffiths and Nick Robertson . It is UK’s biggest retailer of fashion and beauty products online with more than 2000 employees. The acronym ASOS stands for ‘As seen on Screen’ and it changes stylistically to showcase the image of the brand. It has faced some issues as well, but overall the website has seen success stories. It also developed holdings in 2001 which became part of London Stock Exchange and 2006; it was also the pioneer of online stores launching a catwalk. In 2007, ASOS introduced its ASOS Magazine and it grew to become a lifestyle, and a store as well as launching a mobile and expanding to other areas and eventually opening a new office in Australia. One of the features that ASOS provides its customers is the facility of looking for content on their website with videos of catwalks and pictures and videos of the clothing items. It also runs a fashion blog simultaneously which have articles posted which are related to fashion and beauty topics; such as celebrities and their live s as well as entertaining news and the clothes which they are wearing and available on the site are then provided with links on the blog which leads customers to the main retail page. ASOS also has an outlet which is the discount portion of ASOS and the products that are coming at the end of a line or are from a previous season are at glorious discounts of up to 75%. It is connected to the main site and it is basically a competitor outlet with E-tailers and other discount stores. ASOS also provides the

Langston Hughes “Salvation” Essay Example for Free

Langston Hughes â€Å"Salvation† Essay â€Å"Salvation† is taking from the first of these , The Big Sea ( 1940 ), and written by Langston Hughes who was a brilliant author, poet who wrote fiction, history, autobiography, and he worked at various times as a journalist. You can clearly see in â€Å"Salvation† was taking time at South – country side. From the Title â€Å"Salvation† you can have a guess and you will be right if you were thinking about church, God and so on. -But not really saved? -To bring the young lambs to the fold? -When you were saved you saw a light, and something happened to you inside -So I sat there calmly in the hot, crowded church, waiting for Jesus to come to me -The preacher preached a wonderful rhythmical sermon, all moans and shouts -Then he said: â€Å" Won’t you come? And the little girls cried. And some of them jumped up and went to Jesus right away. But most of us just sat there -Nothing! I wanted something to happen to me, but nothing happened -Oh, Lamb of God! Why don’t you come? -I began to be ashamed of myself, holding everything up so long. -So I got up -Then joyous singing filled the room -I was really crying because I couldn’t bear to tell her that I had lied, that I deceived everybody in the church, that I hadn’t seen Jesus, and that now I didn’t believe there was a Jesus anymore, since he didn’t come to help me. Langston Hughes recalls how he was introduced to religion and the church. He goes to say that at thirteen years old he was brought to his Aunt Reed’s church and was told that he needed to be saved by Jesus Christ. At the ceremony, while all other children went up to accept Jesus, Langston and another child named Westley remained seated. At the congregation prayed and the priest sang psalms, Westley cracked under the pressure and went up to the altar, but Langston still sat. He had literally taken the phrase â€Å" you will see Jesus† and felt bad about lying to the church because, after all, he had still not seen Jesus but was anxious to meet him. Finally, Langston came to the decision that it was getting late and one little lie about seeing Jesus couldn’t hurt. He then went to the altar and accepted Jesus. That night his aunt heard him crying and assumed that it was because he had come to terms with God, But Langston was crying because he felt guilty having to lie to everyone about seeing Jesus and he was even more hurt that Jesus never came to help him. At first, the piece seems to be about naive boy who believes that Jesus would physically appear in front of him. In deeper sense, however, it dives into a questioning of faith. The story could be seen and a very common scenario among people having trouble with identifying there religious inclinations. Sometimes, there so much pressure put on people by their peers to choose a religion. These people often look for signs or aid from a higher power to help guide them. After receiving no signs or guidance, they renounce faith in God and Jesus and blame the higher being. In Langston case; his aunt, the priest, and the congregation put tremendous amount of pressure on him to become a member of the church, instead of explaining to him that â€Å"see† meant to â€Å"understand† and â€Å"accept† that Jesus died to save him and give him eternal life. His aunt could have helped him by explaining that not physically â€Å"see â€Å"Jesus that evening. Instead, he felt alienated possible because this way first that he had ever known of anything having to do with Jesus or the bible, and he was not helped to understand what was going on.

Music And Songs In Teaching English

Music And Songs In Teaching English There is a belief that first musical instruments appeared as early as speech, which means that the language of words and that of music were formed in parallel, completing and enriching each other. That is why language of words shows so much similarity to music. Both speech and music are characterized by rhythm and melody. Close associations of language and music have rooted in peoples mind very deeply. People often use metaphorically the name of one to refer to the other: they call pleasant words music to their ears, face the music when accepting criticism or punishment for something they have done, use the phrase the language of music to describe a way of expressing meaning through sounds. Sound and word are combined to give birth to pieces of vocal music, where music brings to light the internal sense of the text, reveals what is hidden between the lines. So it is natural to teach language with the help of music and songs. Moreover, a great number of scholars consider music and son gs to be the most productive and effective ways of teaching a foreign language. The role of music and songs in teaching English is very important. Using songs and music is one of the tools a teacher can use to teach English to the class, regardless of the age of the learner. Songs and music are a tie that binds all cultures and languages and, therefore, the best way to make learning English fun. Jeremy Harmer in his book How to Teach English emphasizes the importance of music as a learning tool by stating that music is a strong incentive for student engagement because it speaks directly to our emotions while still allowing us to use our brains to analyse it and its effects if we so wish (Harmer 319); and it plays a multifunctional role in the process of learning a foreign language, it has the power of creating a propitious atmosphere, it can amuse and entertain, and it can make satisfactory connection between the world of leisure and the world of learning in the classroom (Harmer 319). Tim Murphey, indicates two chief assets in the usage of music and songs in re lation to language learning: music is highly memorable; it is highly motivating, especially for children, adolescents, and young adult learners (Murphey 4). Nevertheless, the role of songs and music in teaching English is often underestimated, and activities involving them are often neglected by teachers. The usage of music and songs in the classroom: has often been met with ridicule and a cautionary statement that although students were enjoying class, they were not learning (Salcedo, The Effects of Songs in the Foreign Language Classroom on Text Recall and Iinvoluntary Mental Rehersal). Teachers usually think that students will not take music and songs seriously at English classes; they will have too much fun and will not pay any attention to the pedagogical aim of the song. It is not rare to hear teachers ask questions like What do music and songs have to do with language learning?, What do you do with a song besides listen to it and possibly sing with it?, What else can be done with the song besides gap-filling? This testifies to the fact that teachers are often unaware of the opportunities songs and music can present. There are diff erent opinions, but it is for sure that it is a good way to make foreign language learning much more effective to learners of different age and different levels. Teachers who want to keep their students interested and motivated should use songs and music activities, since, according to Larry M. Lynch, it has lots of advantages: Songs almost always contain authentic, natural language; A variety of new vocabulary can be introduced to students through songs; Songs are usually very easily obtainable; Songs can be selected to suit the needs and interests of the students; Grammar and cultural aspects can be introduced through songs; Time length is easily controlled; Students can experience a wide range of accents; Song lyrics can be used in relating to situations of the world around us; Students think songs are natural and fun. (Lynch, 9 Reasons Why You Should Use Songs to Teach English as a Foreign Language.) Songs and music are invaluable in teaching English at elementary level. No other materials give the teacher such a broad range of possibilities for teaching various aspects of English. An illustration of language in action, the song can be subjected to linguistic analysis or turned into an exercise. Through the use of songs English pronunciation, vocabulary and grammar can be effectively taught. According to Cameron there are three stages of a song as a task for elementary level students: preparation stage (it is very important to activate the vocabulary and to form basic sentence structures in this stage); core stage (the best way to involve students and raise their interest in this stage is to sing the song several times in the core, changing pace or volume and making students perform actions and sing along chorally); follow-up stage (attempts to be a successful completion of the core stage ) (Millington, Using Songs Effectively to Teach English to Young Learners). Songs can be used to develop students listening skills. They improve listening skills because they provide students with practice listening to different forms of intonation and rhythm (Millington, Using Songs Effectively to Teach English to Young Learners). Songs can be really helpful in practicing listening skills warm-up work can provide a basis for students to make predictions before listening; listening activities can encourage listening for gist or listening for detail (Hancock 7). Their advantage lies in the fact that they usually go at slower speed than speeches or dialogues; words, phrases, sentences are being sung which usually means that they are uttered more slowly and often more distinctly than in case of speaking. There is a wide range of song-based listening activities for students at elementary level: picture discussion (the teacher presents some key words and/or the title from the lyrics and asks students to predict what the song is about); snippets of information (the teacher plays the first few seconds of the song and asks students to predict from the mood of the music what the song is about); picture selection (the teacher shows students two or more alternative pictures, magazine photos perhaps, and asks them to say which one best matches the contents or mood of the lyric and why); sequencing (the teacher gives students a copy of the lyric with the lines in the wrong order or cut into strips, and students listen and put them in the right order). While listening to songs students hear the language used so that they can both imitate the pronunciation and also subconsciously acquire some of its sounds and patterns. During the process of listening to songs, students subconsciously acquire some of English sounds and patterns. When it comes to singing, they imitate the pronunciation, learning to use rhythm and stress correctly. The task of learning the correct use of stress and rhythm becomes simpler because students are lead by the rhythm of a song. There are a few activities which students at elementary level can do with a song to practice pronunciation. The most effective one is repeating certain parts of the lyric (drilling). Songs are equally suitable for teaching vocabulary at elementary level. Teachers may use them for two purposes: either to present new vocabulary items or to practise the familiar ones. Often songs represent a theme or topic that can provide the context for vocabulary learning (Millington, Using Songs Effectively to Teach English to Young Learners). Neil Millington in the article Using Songs Effectively to Teach English to Young Learners gives examples of two songs: Teaching Practice Head, Shoulders, Knees and Toes serves to review body parts, or I Can Sing a Rainbow which is helpful for reviewing color names (Millington, Using Songs Effectively to Teach English to Young Learners). The repetition of monosyllabic words in childrens songs can help improving vocabulary acquisition (Millington, Using Songs Effectively to Teach English to Young Learners). There are songs which can be used as the basis for dramatization. Tim Murphey states that at elementary level the dramatization of the s ong can be useful to express, through gestures, the meaning of some actions (Murphey 121). The age-old technique of asking students to perform actions with words has become popular because of well-documented research that shows it to be very effective. The idea is that if students can move and do what is said matching words to the actions, language is learnt more deeply. Songs can be a good source of topics for discussion and different classroom activities at elementary level. The plot of the song is a good basis for story telling while characters in the song can serve as a basis for role play. By interpreting and converting song lyrics into prose and discussing the style of the song students have a chance to develop their productive skills speaking and writing. The main speaking activities for elementary level are: role-play (the teacher asks students to imagine that they are characters of the given song); continue the story (students may be asked to imagine how the characters ended up in the situation they are in.); Particular attention should be paid to the choice of songs. Mark Hancock (Hancock 3) thinks that just because a student might not choose to listen to a certain song outside the classroom, does not mean that the student would not enjoy it as part of a learning activity. Teachers are not advised to present the song as something students are supposed to like. Thus, any song could be used for teaching purposes. According to Tim Murphey, any song can be useful and motivating, however teachers should use the students choice of music and song as much as possible (Murphey 14). Another important issue is whether teachers should always use authentic songs or not. According to Jeremy Harmer, listening material as well as the kind of tasks which go with it are determined by the level of students (Harmer 319). Music and songs in English classroom are important and useful tools. This is a great formula for keeping students always interested in the language they learn. With their help students can not only learn English but also relax and enjoy their class. There are benefits to using songs in the classroom; however, more often than not, songs are used relatively ineffective, often as activities between learning. No matter how enjoyable or memorable singing songs can be, it will not teach learners to use the language and will not give them the ability to communicate in another language. Reframing songs into tasks according to preparation, core, and follow-up stages enhance songs potential as teaching and learning tools. Songs and music can be used for practicing different aspects of English, and all learning skills can be improved.

Tri-State Water Wars: Impact on Metropolitan Atlanta’s Future Growth Es

Tri-State Water Wars: Impact on Metropolitan Atlanta’s Future Growth â€Å"Whiskey is for drinking. Water is for fighting.† - Mark Twain Metro Atlanta is on a collision course with reality – and the shock of this collision will have profound political and economic implications for future growth throughout the Southeast. The core problem is that Atlanta’s runaway growth will soon outstrip the available water supply (Corps, 1998). And if Atlanta continues to increase its water consumption until the maximum limits are reached, the effects on downstream users will become catastrophic, both economically and environmentally. Without multi-state agreements concerning changes in usage patterns, this could bring about intervention by the Federal courts that would effectively halt Atlanta’s development until the usage disputes were resolved. By comparison, some western states water lawsuits have lasted for decades, typically freezing usage patterns â€Å"as is†. (Barr, 1999) The southeast can ill afford to have Atlanta – the region’s single largest engine of economic growth – brought to a standstill because of this issue. The root cause of the entire regional problem is the combination of Atlanta’s high growth and an inadequate water supply. No US city as large as Atlanta is founded on a river as small as the Chattahoochee. (NY Times) If Atlanta were the size of Birmingham, there would be no crisis whatsoever. In addition, the lack of a usable underground aquifer system in North Georgia limits the options for expanding the available supply. (ITT) The underlying granite subsurface prevents the formation of large underground water reserves, which are often a significant water source for other large cities. Only by transfe... ...raci. â€Å"Conservation helped avert more severe water limits.† USA Today. July 16, 2002 Web Sites: â€Å"Tri-state pact essential to growth.† Congressman Bob Barr. May 24, 1999, official web site http://barr.house.gov/newsdescr.asp?RI=435 â€Å"Atlanta's Unquenchable Thirst Sparks Dixie Water War.† By Marcello Ballve, Pacific News Service, Mar 11, 2002 http://www.pacificnews.org/content/pns/2002/mar/0311water.html â€Å"Tri-State Water Wars.† Southern Environmental Law Center http://www.selcga.org/originals/water_wars/water_wars.shtml â€Å"The Alabama-Coosa-Tallapoosa Water Deal: The Good, The Bad, and The Ugly.† By Brad McLane, Executive Director, Alabama Rivers Alliance http://www.alabamarivers.org/tristatewars.htm ITT Industries – Guide to Global Water issues Atlanta and the Southeast, by Charles Seabrook http://www.itt.com/waterbook/atlanta.asp

Freedom of Expression Must be Upheld in America Essay -- Argumentative

Freedom of Expression Must be Upheld in America It's the amendment all United States citizens know: the first. This amendment is so huge that there is even an organization dedicated to protecting the rights guaranteed by it called the American Civil Liberties Union (ACLU). Some people nowadays disagree with the idea that freedom of expression is guaranteed, believing only freedom of speech and religious practices are express rights given by the constitution in the first amendment, and that the term "freedom of expression" is too broad an interpretation. Art, clothing, and other forms a person uses to express themselves can be severely limited some people argue; however if they were to take a look at some of the important events in the world's history, they would see that people, if they are not given the right of freedom of expression, don't express their opinion in a pacifistic manner. The Vietnam War is a perfect example of this; it shows many different ways of freedom of expression and how, if suppressed, the can get ugly. For instance, when people were peacefully protesti...

Health Promotions and Disease Prevention Paper Essay

Elder Mistreatment Elder mistreatment is a widespread problem in our society that is often under-recognized by health care professionals. As a result of growing public outcry over the past 20 years, all states now have abuse laws that are specific to older adults; most states have mandated reporting by all health care professionals. The term â€Å"mistreatment† includes physical abuse and neglect, psychological abuse, financial exploitation and violation of rights. Poor health, physical or cognitive impairment, alcohol abuse and a history of domestic violence are some of the risk factors for elder mistreatment. Diagnosis of elder mistreatment depends on acquiring a detailed history from the patient and the caregiver. It also involves performing a comprehensive physical examination. Only through awareness, a healthy suspicion and the performing of certain procedures are physicians able to detect elder mistreatment. Once it is suspected, elder mistreatment should be reported to adult protective se rvices (HHS fact sheet, 2005). It is estimated that over 2 million older adults are mistreated each year in the United States. Elder mistreatment first gained attention as a medical and social problem about 20 years ago, when the term â€Å"granny battering† first appeared in a British medical journal. Since that time, elder mistreatment has become a matter of concern not only in the United States, but throughout the world. This heightened awareness has followed a growing awareness of child and spousal abuse. Nevertheless, because of differing definitions, poor detection and under-reporting, the extent of elder mistreatment is unknown. These same factors make the collection of data difficult and its accuracy questionable. Published studies estimate that the prevalence of elder mistreatment ranges from 1 to 5 percent (Healthy people, 2010). Most health care professionals are reluctant to address domestic violence. However, physicians are in an ideal position to detect and manage mistreatment, as they may be the only person outside the family/caregiver role who regularly sees the older adult. In addition, the  physician is the most likely person to order the testing, hospital admissions and support services that are sometimes needed to correct elder mistreatment. This paper will discuss the clinical, ethical and legal issues regarding elder mistreatment. The various forms of elder mistreatment are defined, including ways to identify patient and caregiver risk factors, and history and physical findings that suggest a diagnosis of elder mistreatment. Finally, a systematic approach to patient evaluation, documentation and reporting of suspected cases will be reviewed. Reasons elder abuse may be missed or not reported by health care professionals include unfavorable attitude toward older adults (ageism), little information in medical literature about elder mistreatment, reluctance to attribute signs of mistreatment (disbelief),isolation of victims (patient not seen often by physicians/health care providers), subtle presentation (i.e., poor hygiene or dehydration), reluctance/fear of confronting the offender, reluctance to report mistreatment that is only suspected, mistreated person requests that abuse not be reported (patient/physician privilege), lack of knowledge about proper reporting procedure, fear of jeopardizing relationship with hospital or nursing facility Types of elder abuse Physical Abuse- occurs when a person is touched in an inappropriate way, such as hitting, punching, kicking, slapping, and pushing. Physical abuse often leaves marks on the person’s body: bite marks, bruises, welts, and burn marks. Marks are often left on arms, wrists, face, neck, and abdomen area; Emotional/Psychological Abuse- occurs when a person is demeaning to another person. A person may treat the elder like a child or call them names. An elder may seem unusually depressed or may talk bad about themselves; Sexual abuse- among an elder occurs when sexual contact is made without consent. It also occurs when an elder is incapable of making such a decision, and is rape; Financial abuse- occurs when a person or persons take advantage of an elderly person financially. This includes stealing money, lying about how much the elder needs for certain care, or cashing the elder’s checks without permission; Neglect/Abandonment- occurs when the elder is not being properly cared for, such as not being fed, bathed, and properly medicated. This is also when the elder is being ignored. The care  giver refuses to give care to the individual (Physical abuse of the elderly, 2005). Elder Mistreatment: Definitions and Classifications In an effort to increase physicians’ awareness, facilitate accurate detection and promote further research, the American Medical Association published a position paper on elder mistreatment in 1987. This paper proposed a standard definition: â€Å"‘Abuse’ shall mean an act or omission which results in harm or threatened harm to the health or welfare of an elderly person. Abuse includes intentional infliction of physical or mental injury; sexual abuse; or withholding of necessary food, clothing, and medical care to meet the physical and mental needs of an elderly person by one having the care, custody or responsibility of an elderly person† (HHS fact sheet, 2005). Elder mistreatment may take many forms. Types of elder mistreatment are often classified as physical abuse and neglect, psychological abuse, financial exploitation and violation of rights. A major obstacle to prevention of and intervention for elder mistreatment is a lack of awareness on the part o f physicians and other health care professionals (LA4Seniors, 2005). Risk Factors and Prevention Cognitive impairment and the need for assistance with activities of daily living are important risk factors for elder mistreatment. Caregiver burnout and frustration can lead to elder mistreatment. Substance abuse by the caregiver or the patient, especially abuse of alcohol, significantly increases the risk of physical violence and neglect. Psychological and character pathology in the caregiver and patient are also major risk factors. Prevention of elder mistreatment is difficult and depends as much on the social support network as on the medical network. Preventing elder mistreatment involves identifying high-risk patients and caregivers, and attempting to address the underlying issues. Screening patients and caregivers before placement can be helpful, when it is feasible. Helping patients obtain county or state assistance can also help reduce some high-risk situations. Risk Factors for Elder Mistreatment Older age, lack of access to resources, low income, social isolation, minority status, low level of education, functional debility, substance  abuse by caregiver or by elderly person, psychological disorders and character pathology, previous history of family violence, caregiver burnout and frustration, and Cognitive impairment. History- Recognizing mistreatment is often difficult. The older adult may be unable to provide information because of cognitive impairment. The history is sometimes difficult to obtain from the victim, for fear of retaliation by the abuser. This retaliation can come in the form of physical punishment or threats of violence and abandonment. Older adults are often fearful of being placed in a nursing facility, and some may prefer to be abused in their own home rather than be moved to such a facility (LA4Seniors, 2005). The mistreated older adult often presents with somatic complaints. Physicians should ask older patients about rough handling, confinement and verbal or emotional abuse. Subtle or confusing complaints may actually be indicative of mistreatment. It is important to recognize that abuse and neglect are most often discovered during routine visits at the physician’s office or in the long term care facility. Generally, the patient should be interviewed without the caregiver(s) present. Cognitive impairment may limit the ability to obtain an accurate history. It is important to ask general questions about conditions in the home or nursing facility. The physician should try to obtain an accurate view of the patient’s daily life, including meals, medication, shopping and social outlets (HHS fact sheet, 2005). It is also important to ask the patient about the nature and quality of the relationship with the caregiver. It may be helpful to ask questions such as, â€Å"How do you and the caregiver get along?† and â€Å"Is the caregiver taking good care of you?† It is critical to assess the patient’s mental status for indicators of depression or alcohol and substance abuse. A discussion of the patientâ €™s financial situation may be appropriate. If issues of mistreatment are raised, the caregiver should be interviewed as well. The physician must be careful not to over interpret or to make suggestive comments, especially when the patient is cognitively impaired. Essential Features of the History in the Assessment of Mistreated Elders Medical problems/diagnoses, detailed description of home environment (adequacy of food, shelter, supplies), accurate description of events related to injury or trauma (instances of rough handling, confinement, verbal or emotional abuse), history of prior violence, description of prior injuries and events  surrounding them, description of berating, threats or emotional abuse, improper care of medical problems, untreated injuries, poor hygiene, prolonged period before presenting for medical attention, depression or other mental illness, extent of confusion or dementia, drug or alcohol abuse, quality/nature of relationships with caregivers. Physical Examination and Laboratory Tests The physical examination is often used as legal evidence of mistreatment. Laboratory and imaging studies should be performed to confirm any suspicious findings in the history and physical examination. The presence of dehydration and malnutrition can be established with simple laboratory tests such as a complete blood count and measurement of blood urea nitrogen, creatinine, protein and albumin levels. Radiographic studies provide evidence of old and new fractures. Unfortunately, proving that a fracture was caused by abuse can be difficult (HHS fact sheet, 2005). Role of advance nurse and nursing intervention strategies- The nurses can play a vital role as a case finder, manager, advocate, educator, researcher and caregiver to physically abused elderly and family or caregiver in a given community. Inform the decision makers about the magnitude, trends and characteristics of violent deaths; and, evaluate and continue to improve by educating the patient and the care giver, and if is necessary reporting the abuser to the authorities. Nurses should involve the case managers and the social workers, document all the findings accurately and report the mistreatment case as soon as possible. Documentation Documentation of all findings may be entered as evidence in criminal trials or in guardianship hearings. Documentation must be complete, thorough and legible. Such circumstances dictate that there is a â€Å"chain of evidence.† This need mandates a careful collection of physical evidence, which is critical in cases of suspected sexual or physical abuse. Laboratory data and, when possible, photographs should be used for verification of written documentation. Management Management of elder mistreatment first involves discussing the situation with the patient, if feasible. The patient should be allowed to play a role  in the ultimate resolution, if he or she is able to do so. First, the competency of the patient should be determined. Local and state social services have different methods of addressing mistreatment. Social workers from hospitals, clinics or long term care facilities are valuable resources and should be able to assist with these services. Multidisciplinary teams can be very effective. These teams typically include geriatricians, social workers, case management nurses and representatives from legal, financial and adult protective services. Multidisciplinary teams are often more effective in problem-solving and provide a forum for discussion with participants involved in the older adult’s care. Senior advocacy volunteer groups are also helpful. A senior advocate can provide information to the abused person and enable access to resources from community programs and social services. Basic Features of the Physical Examination Head- Traumatic alopecia or other evidence of direct physical violence; poor oral hygiene; Skin- Hematomas, welts, bite marks, burns, decubitus ulcers; Musculoskeletal- fractures or signs of previous fractures; Neurological- cognitive impairment that is a risk factor for mistreatment and influences management decisions regarding competency; Genito rectal- poor hygiene, inguinal rash, impaction of feces; General- weight loss, dehydration, poor hygiene, unkempt appearance (LA4Seniors, 2005). Reporting All health care providers (physicians, nurses, social workers, etc.) and administrators are mandated by law to report suspected elder mistreatment. The laws differ from state to state; physicians should determine the specific requirements in their states. Any other person may also report suspected abuse and neglect. All reporters are immune from civil liability if they act in good faith and without malice. They are also protected from termination of employment. Health care providers can be found to be negligent if they fail to report the suspected mistreatment. Penalties can include fines, imprisonment or loss of licensure. Reports of suspected elder mistreatment should be given to the state or county division of adult protective services. In the absence of such services, the reporter should contact the county extension office or the state’s office of child and  family services. In addition, any Area Agency on Aging would be able to provide assistance in reporting suspected mistreatment. The National Domestic Violence Hotline (telephone: 800-799-SAFE) or the Older Women’s League (telephone: 800-825-3695) could also help. Contacting the police is always an option, especially in an urgent situation (HHS fact sheet, 2005). In the event that the older adult is a resident of a long term care facility, a separate mechanism often exists for investigating suspected mistreatment through the state agency that surveys these facilities. Identifying the appropriate avenue for investigation can be done through the available adult protective service agency or the state department of child and family services (Elder Abuse, 2005). Once suspected mistreatment has been reported, the responsible agency will assign a social worker to investigate the case. The social worker will provide an accurate description of the home or nursing-facility environment. After assessment, the social worker may provide insight into some possible solutions to the problem and information about available resources. Unlike cases of child abuse, if the older adult is competent to make decisions, he or she may refuse intervention. If the older adult is not competent to make decisions, a guardian can be appointed by the state. The guardian can then direct care as needed until the problem is satisfactorily resolved. Injury Prevention- In healthy people there is no precise data specific for elder abuse, but these are related data from that site. The target rate for physical assault by intimate partner is 3.3 physical assaults per 1,000, and the baseline is 4.4 physical assaults per 1,000. The target rate for annual rate of rape is 0.7 rapes or attempted rapes per 1,000 persons, and the base line is 0.8 rapes or attempted rapes per 1,000 (Health people, 2010). Objectives from Healthy People 2010 Reduce injuries, disabilities, and deaths due to injuries and violence, and educating the primary care givers about the signs and symptoms of abuse or mistreatment, and educating them about alternative coping mechanisms. Several themes become evident when examining reports on injury prevention and control, including acute care, treatment, and rehabilitation. First, injury comprises a group of complex problems involving many different sectors of society. No single force working alone can accomplish everything  needed to reduce the number of injuries. Improved outcomes require the combined efforts of many fields, including health, education, law, and safety sciences. Second, many of the factors that cause injuries are closely associated with violent and abusive behavior (Health people, 2010). Violence and Abuse Prevention Violence in the United States is pervasive and can change quality of life. Reports of children killing children in schools are shocking and cause parents to worry about the safety of their children at school, and if the problem is untreated the aggression later on will turn on the parents or older adults. Reports of gang violence make people fearful for their safety. Although suicide rates began decreasing in the mid-1990s, prior increases among youth aged 10 to 19 years and adults aged 65 years and older have raised concerns about the vulnerability of these population groups. Intimate partner violence and sexual assault threaten people in all walks of life (Elder Abuse, 2005). Violence claims the lives of many of the Nation’s young persons and threatens the health and well-being of many persons of all ages in the United States. On an average day in America, 53 people die from homicide, and a minimum of 18,000 persons survive interpersonal assaults, and as many as 3,000 persons attempt suicide (Elder Abuse, 2005). Elderly, females, and children continue to be targets of both physical and sexual assaults, which are frequently perpetrated by individuals they know. Examples of general issues that impede the public health response to progress in this area include the lack of comparable data sources, lack of standardized definitions and definitional issues, lack of resources to establish adequately consistent tracking systems, and lack of resources to fund promising prevention programs. Disparities Adults aged 65 years and older are at increased risk of death from fire because they are more vulnerable to smoke inhalation and burns and are less likely to recover. Sense impairment (such as blindness or hearing loss) may prevent older adults from noticing a fire, and mobility impairment may prevent them from escaping its consequences. Older adults also are less likely to have learned fire safety behavior and prevention information,  because they grew up at a time when little fire safety was taught in schools, and most current educational programs target children (Healthy people, 2010). Opportunities To reduce the number and severity of injuries, prevention activities must focus on the type of injury—drowning, fall, fire or burn, firearm, or motor vehicle. Understanding injuries allows for development and implementation of effective prevention interventions. Some interventions can reduce injuries from violence-related episodes. For instance, efforts to promote awareness in society can help reduce the risk of assault, intentional self-inflicted and elder neglect and abuse. Higher taxes on alcoholic beverages are associated with lower death rates for some categories of violent crime, including mistreatment, abuse, and rape (Healthy people, 2010). Healthy People Objectives This organization encourages the Individuals, groups, and other organizations to use this framework and integrate it into their current programs, events, publications, and meetings, schools, colleges, and civic organizations to undertake activities in order to further the health of all members of their community. It is a national initiative that aims to improve the health of all Americans and eliminate disparities in health. Reducing the prevalence and overall number of people who suffer from different variety of diseases, and increase concerns for the nation’s elderly, and to reduce the overall rate of elder abuse, prevent its associated health problems, and educating the care givers and enhancing their coping mechanisms and alternative modalities to deal with the related stress. Health care providers can encourage their patients to pursue healthier lifestyles and to participate in community-based programs. By following the national objectives, individuals and organizations c an build an agenda for community health improvement and can monitor results over time. Healthy People objectives have been specified by Congress as the measure for assessing the progress of the Indian Health Care Improvement Act, the Maternal and Child Health Block Grant, and the Preventive Health and Health  Services Block Grant. Healthy People objectives have been used in performance measurement activities (Healthy people, 2010). Many objectives focus on interventions designed to reduce or eliminate illness, disability, and premature death among individuals and communities, and to educate the care giver regarding recognizing elder abuse, and prevention modalities; others focus on broader issues, such as improving access to quality health care, strengthening public health services, and improving the availability and dissemination of health-related information. Each objective has a target for specific improvements to be achieved by the year 2010. Together, these objectives reflect the depth of scientific knowledge as well as the breadth of diversity in the Nation’s communities. More importantly, they are designed to help the Nation achieve Healthy People 2010’s two overarching goals and realize the vision of healthy people living in healthy communities (Healthy people, 2010). Interim Progress toward Year 2000 Objectives Numerous objectives addressed injury prevention in Healthy People 2010. Twenty-six objectives were specific for unintentional injuries, and 19 objectives were specific for violence prevention. By the end of the decade, targets had been met for 11 objectives. Unintentional injury objectives showing achievement were unintentional injury hospitalizations, residential fire deaths, nonfatal head injuries, spinal cord injuries, nonfatal homicide poisonings, and pedestrian deaths. Violence prevention objectives that met their targets were, suicide, weapon carrying by adolescents, conflict resolution in schools, and child death review systems. REFERENCES Elder Abuse and Neglect Statistics (2005). In search of solutions. Retrieved on 8/20/05 from http://www.apa.org/pi/aging/eldabuse.html Healthy people 2010(2005). Retrieved on 8/20/05 from http://www.healthypeople.gov LA4Seniors (2005). A public service website for seniors and their families. Retrieved on 8/20/05 from www.la4seniors.com/elder abuse.htm National center on elder abuse (2005). Retrieved on 8/20/05 from http://www.elderabusecenter.org HHS fact sheet (2005). US department of health and human services. Retrieved on 8/20/05 from www.hhs.gov/news/press/2000pres/20000503b.html Physical abuse of the elderly (2005). Physical abuse of the elderly: signs, descriptions, and what you can do about it. Retrieved on 8/21/05 from http://de.essortment.com/physicalabusee_rfjb.htm