Satisfying Corporate Shareholders or the Stakeholder as Business Essay

Satisfying Corporate Shareholders or the Stakeholder as Business Priority - Essay Example Adam Smith, an 18th Century theorist, proposed his theory of the invisible hand, which essentially states that business’ thirst for profitability will automatically create positive environmental outcomes for society, hence satisfying corporate responsibility toward the betterment of society (Nickels, McHugh & McHugh, 2005). These outcomes include better economic stability for the region in which the firm operates, as well as providing new jobs and better quality products for citizens. When a firm moves its operations from domestic to the foreign, the outcomes, as measured by the invisible hand theory, would indeed be positive for the foreign nation in which the business thrives. However, moving operations out of the domestic environment, especially in times of national economic crisis, only serves to eliminate career positions for already-struggling citizens in the United States, thus corporate expectations for profitability tend to blind businesses from the needs of its poten tial local workforce. This topic is hotly debated today which is quite obvious in the media and with recent activities of striking workers who fight to ensure that jobs stay local by preventing foreign expansion efforts. Today, Adam Smith might attempt to quiet the barrage of social outcry regarding business shifting its operations overseas by stating that the business had, in some fashion, restored health to the local region while it was domestically in place. Thus, corporate proponents of Smith’s theory might suggest that business had performed ethically...

Wall Street Journal Executive Summary Essay Example | Topics and Well Written Essays - 750 words - 1

Wall Street Journal Executive Summary - Essay Example This lending has brought a new life to Ms. Mathews’ family business and also to her bank. â€Å"For a lot of the big regional banks, the future is a return to the past, â€Å"says Eric Wasserstrom, an analyst at Guggenheim Securities LLC. ’’It’s more like their traditional lending, more balanced† (Sterngold Web). After the recession, some businessmen and lawmakers, said banks were not playing their part in economic growth, although they received a lot of funds from the government. Banks increased their lending across the country in the second quarter of 2012.since then they have increased their lending. However, not all banks accelerated their lending. Some local banks increased their lending to businesses earlier than the national banks in past recession period. The volume of commercial and industrial loans at the major street banks is larger in dollar terms than at regional lenders, although the loans only make a small amount of their total share. For example, Bank of American Corp. made $233.6 billion in loans in 2014 which was 26.5 percent of its total and Citigroup Inc. 6.4 percent of its total. Large banks are mostly concentrating on giving the other types of loans; smaller banks put much emphasis on loaning business persons. KeyBank, for instance, increased its commercial and industrial loan by 12.3 percent in 2014, taking a lion share among its peers in 2014. Fifth Third Bancorp increased its bank loan by 4 percent last year and PNC Financial Services grew hers by 10 percent. KeyBank is established in 12 states, from Maine to Alaska. In July it announced that it had agreed to own Pacific Crest Securities, a technology focussed investment bank. The stock price for KeyCorp, the holding company which consists almost entirely of the banking operation has out competed most of its competitors. During the recession of 2008 and 2009, KeyBank just like the other banks was affected by the economic crisis. It

Nurse-led Clinics in Respiratory Care: a Literature Review

Nurse-led Clinics in Respiratory Care: a Literature Review INTRODUCTION 1. What is a nurse-led clinic? As the coined term suggests, a nurse-led clinic is a health care centre in which nurses are involved in high level specialist procedures and assessments. In such centres, nurses are the critical decision makers, being involved in patient care at the micro-, meso-, and macro-levels. While the role of the physician in the provision of health care is undisputable, the deity-like status that medical practitioners typically have in the mind of patients, coupled with the limited time available for individual patient consultations, make it hard for these group of health care professionals to tackle the ‘softer’ side of patient care. Nurses, on the other hand, defined by the Oxford Medical Dictionary as health care professionals that are trained and experienced in nursing matters and entrusted with the care of the sick and the carrying out of medical and surgical routines, are better placed to provide this essential follow-up, especially in the care of patients with chronic dise ases. According to Hatchett (2003), a nurse-led clinic is a clinic in which nurses have their own patient case loads of whom they take complete charge. Hatchett broadly describes the components of such a clinic. There would be an increase in autonomy associated with the nursing role in the nurse-led clinic, with the power to admit, discharge or refer patients, as appropriate. In Hatchett’s own words, the roles which nurses adopt in these revolutionary settings can be broadly classified as follows (Hatchett, 2003): Education Psychological support Patient monitoring The initiation of nurse-led initiatives probably owes its origins to the rise in nursing specialties in the United Kingdom. Throughout primary and secondary care, nurses are taking senior positions in health care institutions, such as nurse specialists, nurse practitioners, nurse consultants, nurse prescribers, etc, leading to a marked change in service delivery and the profile of the nursing profession. In addition to the usual registered nurse training, nurses working at higher levels of practice receive training to acquire a range of other medical skills such as physical examination and medical history taking in order to recognise abnormal clinical findings. In a two-phase exploratory study to evaluate the domains of structure, process and outcome of nurse-led clinics in supporting intermediate care after the acute phase of disease, Wong et al (2006) interviewed nurses from 34 clinics and 16 physicians and observed 162 nurse-led clinic sessions. Their findings demonstrated the high level of skill and experience of the nurses who ran the clinics. Their work involved skills such as adjusting medications and initiating therapies, and diagnostic tests according to protocols. Interventions included assessments and evaluations, and health counselling. All patients studied showed improvement after the nurse clinic consultation, with the best rates reported in wound and continence clinics; satisfaction scores for both nurses and clients were high. However, although physicians valued their partnership in care with the nurses, they were concerned about possible legal liability resulting from the advanced roles assumed by these nurses. Ultimately, nurse-led clinics provide an integral and invaluable patient-centred approach to the management of chronic disease which build upon skills such as counselling, teaching and health promotion which are key to contemporary nursing practice, as well as newly acquired medical skills. The advent if nurse-led clinics provides an opportunity for nurses to develop enhanced roles in which they can achieve more autonomy in their practice. This can be made a reality if adequate training and education, as well as effective leadership are in place (Wiles et al, 2001). 2. The general roles of nurses in chronic care management The chief nursing officer, Sarah Mullally has proposed ten key roles for nurses in autonomous patient care. These are outlined below as cited by Hatchett (2003): Order diagnostic interventions: just like a medical practitioner would, the present-day nurse is able to ask for laboratory or clinical diagnostic tests to aid the process of diagnosis. Furthermore, a well-trained nurse will also be able to read and interpret laboratory results effectively Make and receive referrals directly: while the all-important roles of nurses are recognised, the need for a multidisciplinary approach to patient care remains key in order to optimise patient outcomes. Accordingly, nurses should be able to recognise the patients’ needs and refer them to the appropriate health care service as required. Similarly, nurses should be ready to accept referrals from other health care disciplines as necessary. Admit and discharge patients for specified conditions, within agreed protocols: in order to make the best use of the often limited hospital resources, a nurse should have the power to recommend patients for hospital admission and subsequent discharge Manage patient case loads: in nurse-led clinics, nurses are also responsible for managing their individual case loads. It is important to delegate patient cases to other members of the team, when necessary to ensure that patients receive the best care possible. Run clinics: the autonomous role of the nurse in a nurse-led clinic includes all aspects of the management and day-to-day running of the clinic. Prescribe medications and treatments: nurse prescribers are able to advise patients on appropriate treatment, based on diagnosis of ailment and individual characteristics and laboratory findings. Carry out a wide range of resuscitation procedures, including defribillation Perform minor surgery and outpatient procedures: especially in injury clinics. While nurses are probably not equipped to carry out full-fledged surgical operations alone, they are trained to conduct emergency processes as appropriate. Triage patients, using the latest information technology, to the most appropriate health care professional Take a lead in the way local health services are organised and in the way they are run Nurses have always been considered as a supplement to the fundamental care provided by medical doctors. In fact, in some geographical regions, nursing roles are limited to menial tasks such as changing bedpans etc. In the new age, the nursing role as we know it is becoming increasingly important with nurses taking on infinitely more clinical roles. This has led to controversial debates with critics arguing that nurses cannot replace doctors in the provision of health care services. As Richard Hatchett very astutely pointed out (2003), the increased autonomy being acquired by nurses is not a bid to compete with medical doctors. Instead, â€Å"it is a case of considering who can provide the most appropriate service to the patient† (Hatchett, 2003). Thus, it is clear that the roles of nurses in chronic care management is very diverse and can be integrated into any nurse-led clinic intervention to the utmost benefit of the patient and all stakeholders. There have been numerous studies on the role of nurses in the care of patients with chronic diseases. In addition, and more specifically, the feasibility and benefits of implementing nurse-led clinics in practice have also been investigated to some extent. In the subsequent sections, we will review the evidence to support these innovative nursing interventions in an attempt to make the best use of health care resources. 3. Nurse-led clinics in the management of chronic care diseases: the evidence The World Health Organization (2002) defines chronic diseases as health care problems that require ongoing management over a period of years or decades. The nature of these disease conditions make it necessary to provide long term care and follow-up for the afflicted patients. Nurse-led interventions have been investigated a wide range of chronic diseases. It could be a logical, user-friendly, cost-effective and practical approach to improving long-term patient outcomes and should be explored fully to maximise the contributions of nurses to the chronic care management. Although this review aims to analyse the effectiveness of nurse-led clinics in the treatment of respiratory diseases, a prior look at the role of these interventions in the management of other chronic care diseases will provide an insight to the general contributory roles of nurses and will serve as a foundation for complete understanding of this state of the art intervention. 3.1 Nurse-led interventions in the management of diabetes Numerous studies have evaluated the benefits and practicalities of nurse-led clinics in the long-term management of diabetes. The renal diabetic nurse specialist is described as an â€Å"essential player† in organising the management of, and to meet, all aspects of need of this group of patients (Marchant, 2002). An unintended benefit of a nurse-led clinic to reduce cardiovascular risk is improved glycaemic control, HbA1c (Woodward et al, 2005). In particular, nurse-led diabetic clinics have been shown to benefit specific ethnic groups. Matthias et al (1998) identified the needs of diabetic patients from minority ethnic groups, such as blacks and Asians and postulated that nurse-led clinics were of particular benefit in this patient group. As epidemiological data show that diabetes is most common in minority ethnic groups (Carter et al, 1996), the importance of these innovative interventions is further emphasised. 3.2 Nurse-led interventions in the management of cardiovascular disease Care of patients with cardiovascular diseases is broad and involves many aspects, from risk factor management (non pharmacological interventions), primary and secondary prevention of clinical events, pharmacological therapy, surgical procedures, etc. Through a large well-designed randomised controlled trial in Scotland, Campbell et al (1998) showed that nurse-led clinics were practical to implement general practice and led to an significant increase in various aspects of the secondary prevention of coronary heart disease. Significant improvements were noted in aspirin management, blood pressure management, lipid profile management, diet and physical activity, regardless of the individual patient’s baseline cardio performance or status. However, surprisingly, there was no recorded improvement on smoking cessation, which would have been a beneficial intervention in most acute and chronic disease states, including respiratory diseases. In addition to the apparent effectiveness of the nurse-led clinics in the long-term primary and secondary prevention of coronary heart disease, the optimal use of nurses in the care of these patients has been shown to be cost-effective in terms of quality adjusted life years (QALYs) (Raftery et al, 2005). In this large cost-effectiveness analysis, although the cost of the nurse-led clinic intervention was  £136 higher per patient, the differences in other National Health Service (NHS) costs was not statistically significant. Furthermore, there were 28 more deaths in the non-intervention group leading to a gain, in the intervention group, in mean life-years per patient of 0.110 and of 0.124 QALYs. 3.3 Nurse-led interventions in rheumatology The role of clinical specialist medical doctors in the care of their patients is unquestionable; however, the role of nurses in the therapy area of rheumatology (i.e. in patients with rheumatoid arthritis) is also well documented. Hill and colleagues (1994) clearly demonstrated the effectiveness, safety and acceptability of a nurse practitioner in a rheumatology outpatient clinic. Although this was a small study with a sample size that only included 70 patients, the statistical significance of the findings of this randomised controlled trial cannot be ignored. In patients managed in the Rheumatology Nurse Practitioner clinic, pain, morning stiffness, psychological status, patient management and satisfaction all improved significantly (p = 0.001; p = 0.028; p = 0.0005; p In addition, patient satisfaction is frequently higher in patients who are allocated to nurse care than those allocated to standard medical care (Hill, 1997). In yet another study by Dr Jackie Hill, a registered nurse at the Academic and Clinical Unit for Musculoskeletal Nursing in the Chapel Allerton Hospital in Leeds, the researchers concluded that a nurse-led clinic is effective and safe and is associated with additional benefits, such as greater symptom control and enhanced patient self-care, compared with standard outpatient care. 3.4 Nurse-led interventions in cancer care The effectiveness of nurse-led care in different common cancer afflictions has been researched variously. An extensive review article by Loftus and Weston (2001) discussed the patient needs that could be met by nurses working in nurse-led clinics and highlighted the experience and skills of advanced nursing practice that make such innovative care a reality. The types of nurse-led interventions are as varied as the different types of cancers for which they are used. These range from nurse-led telephone clinics in patients with malignant glioma (Sardell et al, 2001); nurse-led follow up in patients receiving therapy for breast cancer (Koinberg et al, 2004); and nurse-led screening programmes in Hong Kong Chinese women with cervical cancer (Twinn and Cheung, 1999). In a randomised controlled trial in a specialist cancer hospital and three cancer units in southeastern England, Moore et al (2002) assessed the effectiveness of nurse-led follow-up in the management of patients with lung cancer. The findings of the study showed high levels (75%) of patient acceptability. This negates the possibility of patients’ reduced confidence in nurses’ ability and preference for standard medical doctor care. Clinical outcomes were also greatly improved as shown by less severe dyspnoea at three months (p=0.03), better scores for emotional functioning (p=0.03), and less peripheral neuropathy at 12 months (p=0.05). 3.5 Nurse-led interventions in the management of HIV infection Using a rigorous model of comprehensive care nurse-led clinic in genitourinary medicine to compare nurse-led and doctor-led clinics at a central London medicine clinic, Miles and colleagues (2003) reported reliable and valid results to support the use of the nurse-led variety as an acceptable alternative to the existing doctor-led clinics. More specifically, the British HIV Association (BHIVA)/British Association for Sexual Health and HIV (BASHH) advocate the benefits that can be accrued from a nurse-led educational intervention in the care of patients with HIV infection (Poppa et al, 2003). A small pilot study that investigated the effects of a 6-month nurse-led educational programme reported that improved virological responses were seen in treatment-experienced patients (Alexander et al, 2001). While a majority of the studies on nurse-led clinics in other chronic diseases can be broadly applied to nurse-led care in patients with respiratory diseases, differences in the nature of these diseases and the necessary care pathways mean that the extent to which these tested interventions can be applied to other therapy areas is, in actual fact, limited. Government policies that advocate the clinical and economic effectiveness of nurse-led interventions frequently pool together evidence from all therapeutic areas. Indeed, it can be hypothesised that, if nursing interventions are shown be practical alternatives for medical care in complex diseases with poor prognoses, such as cancer, HIV and coronary heart diseases, care of patients with respiratory diseases which generally have better prognoses should be easily, effectively and safely undertaken by qualified and well-trained nurses. Nevertheless, these findings of the effectiveness of nurse-led interventions in the numerous chronic diseases explored in previous sections, should be applied to the different patient population with respiratory diseases. As much as possible, research findings from similar patient groups should be applied in clinical practice in order to ensure that evidence-based practice in this case is relevant. 4. Government policies influencing the establishment of nurse-led clinics Government health policies in the United Kingdom actively support the extension of nurses’ skills into areas such as nurse prescribing and the development of nurse practitioner posts (NHS Plan 2000; Department of Health). Government initiatives that that strive to reduce consultation waiting times and optimise the use of medical practitioners indirectly support the establishment of nurse-led clinics. The Government has endorsed the implementation of nurse-led clinics as a means of increasing access to specialist health care and treatment more quickly and also as an effective way to manage chronic conditions (Hatchett, 2003). In the Department of Health (1999) document, ‘Making a difference’, government plans for strengthening nursing contribution to health care is presented. The Government has launched an ambitious programme of measures to improve the National Health Service and the health of the public, and the role of the nursing profession in this initiative cannot be overemphasised. The key nurse-related points of the document are outlined below: To extend the roles of nurses, midwives and health visitors to make better use of their knowledge an skills – including making it easier for them to prescribe To modernise the roles of school nurses and health visitors in supporting the new health strategy and other policies To see more nurse-led primary care services to improve accessibility and responsiveness The document highlights numerous nurse-led initiatives that have been effectively implemented all around the United Kingdom. A nurse-led minor injury service in rural Cornwall has provided patients with a number of benefits: easier accessibility, reduced waiting times, reduced need for on-site medical; attendance, increased patient satisfaction and reduced need for transfers to local Accident and Emergency departments. Similarly, a nurse-led rapid response team in Peterborough responds to acute crisis cases and allows patients to be nursed at home. Evaluation has shown that 71% of patients referred to this ‘hospital at home’ service would have been admitted to hospital if the service did not exist. Other effective live nurse-led services include a nurse-led rheumatology service in Merseyside and a nurse-led intermediate care unit in Liverpool. Furthermore, several nurse interventions are advocated in the document for contributing to the management of cardiovascular disease. Several of these are also applicable to respiratory diseases; these include: Smoking cessation clinics using national smoking cessation guidelines Healthy lifestyle clinics in collaboration with other health professionals to address factors such as diet, nutrition and exercise, thus improving overall health Care for patients with congestive cardiac failure under ‘home-based’ initiatives Nurse-led chest pain clinics or risk factor screening and reduction clinics Nurse-led blood pressure clinics to identify and help manage blood pressure disorders and medication adherence 5. Review objectives The objectives of this review are: To briefly summarise various studies on effectiveness and cost-effectiveness of nurse-led interventions in common respiratory diseases To critically appraise the methods employed by these studies To evaluate, interpret, and where possible, compare the findings of the various studies To explore the applicability and generalisability of the results to practice in the appropriate patient population To make suggestions for future studies in this area. METHODS Literature search A search of two major databases, MEDLINE and EMBASE, was conducted to identify articles published from 1990 through 2008. Search terms that were used include nurse, nurse-led clinic, nurse-led interventions, respiratory diseases, asthma, chronic obstructive pulmonary disease, bronchiectasis, tuberculosis, cystic fibrosis, cost-effectiveness analysis, cost-benefit analysis, and economics. A secondary search of the reference lists was then conducted to identify relevant articles, editorials, and other unoriginal reports that may have been missed in the primary search. Some studies were excluded based on the following criteria: They were not conducted in patient populations with respiratory diseases Independent nurse-led interventions were not investigated The study populations being investigated were mixed in terms of diagnosis, which would affect the integrity of the study findings for respiratory diseases The methodology and/ or statistical analysis methods were not clearly elucidated 6. Nurse-led clinics in the management of respiratory diseases: a review of the evidence The role of the specialist respiratory nurse has evolved since the early 1980’s with the support of the Royal College of Physicians (RCP 1981). The possible complexity of respiratory patients’ regimens necessitates support with various aspects of their care plans, such as: Supervising nebuliser and inhaler techniques Monitoring progress, i.e. by periodical assessment of lung function and exercise capacity Education on the specific disorder, medications, potential adverse events, etc Counselling and education on positive lifestyle, or non-pharmacological, changes Adherence support and monitoring The role has developed further with nurses providing nurse-led clinics in chronic obstructive pulmonary disease (COPD) and asthma along with nurses providing early supportive discharge and ’hospital at home’ for patients with COPD (French et al, 2003). Some schools of thought argue that nurse-led clinics would culminate in the neglect of the more traditional nursing roles, as nurses focus on a more medical-focused aspect of patient care. However, research in other therapy areas, such as rheumatology (Hill et al, 1994) and mental health (Reynolds et al, 2000) shows that nurses can effectively combine the medical role with the traditional nursing approach. Nursing care strives to provide a holistic approach to care through practical management of disability, education and counselling and referral to other health care services as required (Rafferty and Elborn 2002). 6.1 Bronchiectasis Nurse-led clinics have been evaluated, compared with regular doctor-led clinics, in a single randomised controlled trial in patients with bronchiectasis, a respiratory condition in which there is widening of the bronchi or their branches (Sharples et al, 2002). The study was a randomised controlled crossover trial including 80 patients in a bronchiectasis outpatient clinic. Patients received 1 year of nurse led care and 1 year of doctor led care in random order, and were followed up for 2 years. Various outcome indicators were used in the comparison, including lung function and exercise capacity, infective exacerbations, hospital admissions, quality of life and cost-effectiveness of the intervention. The results of this study are illustrated in Table 1 below. Table 1: Nurse-led and doctor-led care in care of patients with bronchiectasis (Sharples et al, 2002) Measurement outcome Nurse-led Doctor-led Mean difference (95% CI) p-value Forced expiratory volume in one second (FEV1) (%) 1.87 1.86 0.01 (-0.04 to 0.06) Forced expiratory volume in one second (FEV1) (L) 69.7 69.5 0.2 (-1.6 to 2.0) Forced vital capacity (FVC) (%) 87.6 87.6 -0.02 (-1.5 to 1.4) 12 minute walk distance (m) 765 746 18 (-13 to 48) Infective exacerbations (patient years of follow up) 262 (79.4) 238 (77.8) 0.34 Hospital admissions attributable to patient’s bronchiectasis 43 23 0.22 As the table above clearly shows, there was no statistical difference in FEV1/FVC percent predicted or distance walked between nurse led and doctor led care in the two treatment periods. Furthermore, 262 episodes of infective exacerbations were recorded by patients in the nurse practitioner-led care group in 79.4 patient years of follow up, compared with 238 in 77.8 years in the doctor-led care group. Thus, nurse practitioner-led care is associated with a relative rate of exacerbations of 1.09 (95% CI 0.91 to 1.30), p=0.34. Using the St Georges Respiratory Disease questionnaire to assess differences in health-related quality of life between the two groups, there was no statistically significant differences in each of the scores for Symptoms, Control, Impact or total score. Also, the study showed that nurse-led care resulted in significantly higher costs per patient compared with doctor-led care; this was largely due to the difference in the number of hospital admissions and intravenous and nebulised antibiotic costs. The authors concluded that nurse practitioner-led care for stable patients within a chronic chest clinic is safe and is as effective as doctor led care, but may use more resources. This study has several potential limitations which could invalidate the findings. As the study relied on patient report to record the prescriptions issued by general practitioners, these may have been underestimated and could grossly affect the cost analysis. Conversely, the nurse practitioner was required to record prescriptions and tests issued at the clinic, and thus these records are probably more reliable and she would be more likely to have ensured that patients left with supplies of routine treatment. Another possible drawback of this study is the use of a crossover design in the methodology. Unless a wash-out period is incorporated in the study design, there is the possibility of a carryover effect with crossover study designs, with the danger that the effects of the earlier treatment is falsely attributed to the final experimental treatment. In this study, there was no allowance for a washout period and thus this could affect the reliability and validity of the study results. This order and time effect needs to be checked for within the analyses but it can rarely be excluded as potential biasing factors (Pocock 1983). However, as recruited patients received the interventions in random order, this may negate the carryover effect. Despite the possible limitations of the study that could potentially hinder its applicability in practice, the findings support the implementation of a nurse-led clinic in patients with chronic cases of bronchiectasis as an alternative to the standard rigid medical care. 6.2 Asthma Similar to the findings in the study by Sharples and colleagues (2002) in patients with bronchiectasis, Nathan et al (2006) more recently compared the effect of follow-up by a nurse specialist with follow-up by a respiratory doctor following an acute asthma admission. In a single centre prospective randomised controlled trial, 154 patients admitted with acute asthma were randomly assigned to receive an initial 30-min follow-up clinic appointment within 2 weeks of hospital discharge with either a specialist nurse or respiratory doctor. The intervention comprised a medical review, patient education, and a self-management asthma plan. Further follow-up was then arranged as was deemed appropriate by the corresponding doctor or nurse, and all patients were asked to attend a 6-month appointment. Despite hospital outpatient follow-up, there was a significant proportion of patients in both groups who had exacerbations. However, there was no statistically significant difference between the two groups (Table 2). In the same manner, there was no statistically significant difference in quality of life assessed with two different validated questionnaires, the Asthma Questionnaire and the St George Respiratory Questionnaire. Mean change in peak flow at 6 months was similar between the two groups, probably indicating equivalence of the two tested interventions. Nathan et al (2006) concluded that follow-up care by a nurse specialist for patients admitted with acute asthma can be delivered equivocally with comparable safety and effectiveness to that traditionally provided by a doctor practitioner. Table 2: Nurse-led and doctor-led care in follow-up care of patients admitted with acute asthma (Nathan et al, 2006) Measurement outcome Nurse-led Doctor-led Odds ratio (95% CI) Mean difference (95% CI) p-value Change in peak flow 1.39 (-3.84 to 6.63) 0.122 Infective exacerbations (%) 45.6 49.2 0.86 (0.44 to 1.71) 0.674 Quality of life 87.6 87.6 -0.02 (-1.5 to 1.4) Asthma Questionnaire 0.78 (-0.64 to 2.19) 0.285 St George Respiratory Questionnaire 1.08 (5.05 to 7.21) 0.891 The possible limitations associated with this study is the large amount of missing data for some outcomes, especially peak flow and quality of life

Anne Hutchinson and the Consequences of Misreading :: Anne Hutchinson Essays

Anne Hutchinson and the Consequences of Misreading METHODOLOGY Literary historicism, in the context of this discussion, describes the interpretation of literary or historical texts with respect to the cultural and temporal conditions in which they were produced. This means that the text not only catalogues how individuals respond to their particular circumstances, but also chronicles the movements and inclinations of an age as expressed in the rhetorical devices of its literature. Evaluating the trial of Anne Hutchinson within such a theoretical framework means speculating on the genesis of her theological beliefs with recourse to prevailing theories of gender, class, and interpretation. Because texts are self-contained spheres of discourse, nuanced interpretations of them can be undertaken with greater assiduity than in the case of individuals whose private experiences remain largely concealed from the interpreter's knowledge. A historical analysis of Anne Hutchinson herself is hence, in the present discussion, secondary to the analysis of ho w she comes across in textual discourse as a palimpsest of seventeenth century gender controversy. According to David M. Carr, the history of Scriptural interpretation indicates that religious texts are popular candidates for reinterpretation and, as such, are spaces wherein the personal identity of the reader frequently inscribes itself at length: It is the reader and his or her interpretive community who attempts to impose a unified reading on a given text. Such readers may, and probably will, claim that the unity they find is in the text, but this claim is only a mask for the creative process actually going on. Even the most carefully designed text can not be unified; only the reader's attempted taming of it. Therefore, an attempt to use seams and shifts in the biblical text to discover its textual precursors is based on a fundamentally faulty assumption that one might recover a stage of the text that lacked such fractures (Carr 23-4). I do not so much wish to emphasize the deconstructive rhetoric of this approach as the fact that religious texts lend themselves to creative readings that originate in the reader's experiences or historical circumstances. In other words, the history of Scriptural interpretation exemplifies the text's role as a space where emerging ideologies may be refigured and incorporated into an authoritative cultural tradition. One may think of the genesis of such readings in terms of Harold Bloom's notion of literary succession as "an act of creative correction," the difference in this case being that Anne Hutchinson's creative act involves reviewing the Scripture itself and deriving spiritual knowledge from a finite textual canon (Bloom 30).

Bloodlines Chapter Twenty-Four

IT'S WEIRD how you react in moments of immediate danger. Part of me was pure panic, complete with racing heart and rapid breathing. That hollow feeling, the one that felt like a hole had opened in my chest, returned. Another part of me was able to still inexplicably think along logical lines, mostly something like, Yup, that's the kind of knife that could slit a throat. The rest of me? Well, the rest of me was just confused. I stayed where I was and kept my voice low and even. â€Å"Lee, what's going on? What is this?† He shook his head. â€Å"Don't pretend. I know you know. You're too smart. I knew you'd figure it out, but I just didn't expect you to do it so soon.† My mind spun. Once again, someone thought I was smarter than I was. I supposed I should be flattered by his faith in my intelligence, but the truth was, I didn't know what was going on yet. I didn't know if betraying that would help or hinder me, though. I decided to play cool for as long as I reasonably could here. â€Å"That's you in the picture,† I said, careful not to make it a question. â€Å"Of course,† he said. â€Å"You haven't aged.† I dared a quick look at the picture, just to ascertain that for myself. It still baffled me. Only Strigoi were ageless, staying immortal at the age they'd turned. â€Å"That's†¦ that's impossible. You're Moroi.† â€Å"Oh, I've aged,† he said bitterly. â€Å"Not a lot. Not enough that you can really spot it, but believe me, I can. It's not like how it used to be.† I was still clueless, still not sure of how we had reached a point where Lee – starry-eyed and lovesick for Jill – was suddenly threatening me with a knife. Nor did I understand how he looked exactly the same as he did in a five-year-old picture. There was only one terrible thing I was beginning to be certain of. â€Å"You†¦ killed Kelly Hayes.† The fear in my chest intensified. I lifted my gaze from the blade to look into his eyes. â€Å"But surely†¦ surely not Melody†¦ or Tamara†¦Ã¢â‚¬  He nodded. â€Å"And Dina. But you wouldn't know her, would you? She was only human, and you don't keep track of human deaths. Only vampires.† It was hard not to look at the knife again. All I kept thinking about was how sharp it was and how close it was to me. One swipe, and I'd end up just like those other girls, my life bleeding away before me. I groped desperately for something to say, wishing again I'd learned the social skills that came so easily to others. â€Å"Tamara was your cousin,† I managed. â€Å"Why would you kill your own cousin?† A moment of regret flashed across his features. â€Å"I didn't want to – I mean, I did†¦ but, well, I wasn't myself when I came back. I just knew I had to be awakened again. Tamara was there at the wrong place and the wrong time. I went for the first Moroi I could get†¦ but it didn't work. That's when I tried the others. I thought for sure one of them would do it. Human, dhampir, Moroi†¦ none of them worked.† There was a terrible desperation in his voice, and despite my fear, some part of me wanted to help him†¦ but I was hopelessly lost. â€Å"Lee, I'm sorry. I don't understand, why you'd need to ‘try others.' Please put the knife down, and let's talk. Maybe I can help you.† He gave me a sad smile. â€Å"You can. I didn't want it to be you, though. I wanted it to be Keith. He certainly deserves to die more than you do. And Jill†¦ well, Jill likes you. I wanted to respect that and spare you.† â€Å"You still can,† I said. â€Å"She – she wouldn't want you to do this. She'd be upset if she knew – â€Å" Suddenly, Lee was on me, pinning me to the chair with the knife at my throat. â€Å"You don't know!† he cried. â€Å"She doesn't know. But she will, and she'll be glad. She'll thank me, and we'll be young and together forever. You're my chance. The others didn't work, but you†¦Ã¢â‚¬  He trailed the knife's blade near my tattoo. â€Å"You're special. Your blood is magic. I need an Alchemist, and you're my only chance now.† â€Å"What†¦ chance†¦ are you talking about?† I gasped out. â€Å"My chance for immortality!† he cried. â€Å"God, Sydney. You can't even imagine it. What it's like to have that and then lose it. To have infinite strength and power†¦ to not age, to know you'll live forever. And then, gone! Taken away from me. If I ever find that bastard spirit user who did this to me, I'll kill him. I'll kill him and I'll drink from him since after tonight, I'll be whole once more. I'll be reawakened.† A chill ran down my spine. In light of everything, you would have thought I'd already be at maximum terror level. Nope. Turns out there was still more to come. Because with those words, I began to put together a fragile theory of what he might be talking about. â€Å"Awakened† was a term used in the vampire world, under very special circumstances. â€Å"You used to be Strigoi,† I whispered, not even sure if I believed it myself. He pulled back slightly, gray eyes wide and glittering feverishly. â€Å"I used to be a god! And I will be again. I swear it. I'm sorry, I really am. I'm sorry it's you and not Keith. I'm sorry you found out about Kelly. If you hadn't, I could have found another Alchemist in LA. But don't you see? I have no other options now†¦Ã¢â‚¬  The knife was still at my throat. â€Å"I need your blood. I can't go on like this†¦ not as a mortal Moroi. I have to be changed back.† A knock sounded at the door. â€Å"Not a word,† Lee hissed. â€Å"They'll go away.† Seconds later, the knock repeated, followed by: â€Å"Sage, I know you're in there. I saw your car. I know you're pissed off, but just listen to me.† Dingdong, distraction calling. â€Å"Adrian!† I screamed, jumping up from the chair. I made no attempt to disarm Lee. My only goal was safety. I pushed past him before he could react, heading for the door, but he was more prepared than I'd expected. He leapt toward me and tackled me to the ground, the knife catching me in the arm as I fell. I yelped in pain as I felt the tip of the blade dig into my skin. I struggled against him, only succeeding in making the knife tear into me more. The door suddenly opened, and I was grateful that I'd left it unlocked after letting Lee in. Adrian entered, coming to a standstill as he took in the scene. â€Å"Don't come closer,† warned Lee, pushing the knife against my throat again. I could feel warm blood oozing from my arm. â€Å"Shut the door. Then†¦ sit down and put your hands behind your head. I'll kill her if you don't.† â€Å"He's going to do it anyway – ahh!† My words were cut off as the knife pierced my skin, not enough to kill me yet but enough to cause pain. â€Å"Okay, okay,† said Adrian, holding up his hands. He looked more sober and serious than I'd ever seen. When he was settled on the floor, hands behind his head as directed, he said gently, â€Å"Lee, I don't know what you're doing, but you need to stop it now before it goes any further. You don't have a gun. You can't really hold us both here under the threat of a knife.† â€Å"It's worked before,† Lee said. Still keeping the knife on me, he reached into his coat pocket with his other hand and produced a pair of handcuffs. That was unexpected. He slid them over to Adrian. â€Å"Put these on.† When Adrian didn't react right away, Lee pushed on the knife until I yelped. â€Å"Now!† Adrian put the handcuffs on. â€Å"I'd meant them for her, but you coming by might be a good thing,† said Lee. â€Å"I'll probably be hungry once I'm reawakened.† Adrian arched an eyebrow. â€Å"Reawakened?† â€Å"He used to be Strigoi,† I managed to say. â€Å"He's been killing girls – slitting their throats – to try to become one again.† â€Å"Be quiet,† snapped Lee. â€Å"Why would you cut their throats?† asked Adrian. â€Å"You have fangs.† â€Å"Because it didn't work! I did use my fangs. I drank from them†¦ but it didn't work. I didn't reawaken again. So then I had to cover my trail. The guardians can tell, you know. Moroi and Strigoi bites? I needed the knife to subdue them anyway, so then I cut their necks to hide the trail†¦ make them think it was a crazy Strigoi. Or a vampire hunter.† I could see Adrian processing all this. I don't know if he believed it or not, but he had the potential to roll with crazy ideas regardless. â€Å"If the others didn't work, then Sydney won't either.† â€Å"She has to,† said Lee fervently. He shifted so that I was rolled onto my back, still pinned by his greater body weight. â€Å"Her blood's special. I know it is. And if it doesn't†¦ I'll get help. I'll get help reawakening, and then I'll awaken Jill so we can always be together.† Adrian jumped to his feet, full of a surprising fury. â€Å"Jill? Don't hurt her! Don't even touch her!† â€Å"Sit down,† barked Lee. Adrian obeyed. â€Å"I wouldn't hurt her. I love her. That's why I'm going to make sure she stays exactly the way she is. Forever. I'll awaken her after I'm reawakened.† I tried to catch Adrian's eye, wondering if I could pass some silent message. If we both surged at Lee together – even with Adrian cuffed – then maybe we had a chance at subduing him. Lee was seconds away from tearing into my throat, I was certain, in the hopes that†¦ what? That he could drink my blood and become Strigoi? â€Å"Lee,† I said in a small voice. Too much movement in my throat would result in a bite from the knife. â€Å"It didn't work with the other girls. I don't think the fact that I'm an Alchemist matters. Whatever that spirit user did to save you†¦ you can't go back now. It doesn't matter whose blood you drink.† â€Å"He didn't save me!† roared Lee. â€Å"He ruined my life. I've been trying to get it back for six years. I was almost ready for the last resort†¦ until you and Keith came along. And I've still got that last option left. I don't want it to come to that, though. For all our sakes.† I wasn't the last resort? Honestly, I didn't really see how any other alternative plans here could be much worse for me. Meanwhile, Adrian still wasn't looking in my direction, which frustrated me – until I realized what he was trying to do. â€Å"This is a mistake,† he told Lee. â€Å"Look at me, and tell me you really want to do this to her.† Cuffed or not, Adrian didn't have the speed and strength of a dhampir, someone who could leap over and disarm Lee before the knife could do its damage. Adrian also didn't have the power to wield a physical element, say, like fire, one that could be used as a concrete weapon. Adrian did, however, have the ability to compel. Compulsion was an innate ability all vampires had and one that spirit users in particular were adept at. Unfortunately, it worked best with eye contact, and Lee wasn't playing ball. His attention was all on me, blocking Adrian's efforts. â€Å"I made my decision a long time ago,† said Lee. With his free hand, he dabbed his fingers in the bloody patch on my arm. He brought his fingertips to his lips, a look of grim resignation on his face. He licked the blood from his hand, which wasn't nearly as gross to me as it would've been under other circumstances. With so much going on right now, it was honestly no more terrible than the rest and just rolled off of me. A look of total shock and surprise crossed Lee's features†¦ soon turning to disgust. â€Å"No,† he gasped. He repeated the motion, rubbing more blood on his fingers and licking it. â€Å"There's something†¦ there's something wrong†¦Ã¢â‚¬  He leaned his mouth to my neck, and I whimpered, fearing the inevitable. But it wasn't his teeth I felt, only the lightest brushing of his lips and tongue at the wound he'd created, like some sort of perverse kiss. He jerked back immediately, staring at me in horror. â€Å"What's wrong with you?† he whispered. â€Å"What's wrong with your blood?† He made a third attempt to taste my blood but was unable to finish. He scowled. â€Å"I can't do it. I can't stomach any of it. Why?† Neither Adrian nor I had an answer. Lee sagged in defeat for a moment, and I suddenly allowed myself to think he might just give up and call all this madness off. With a deep breath, he straightened up, new resolve in his eyes. I tensed, half-expecting him to say he was going to try to drink Adrian now, even though a Moroi – two, if you counted Melody – had apparently been on the menu of his past failures. Instead, Lee pulled his cell phone out of his pocket, still keeping the knife at my throat and preventing me from attempting any sort of escape. He dialed a number and waited for an answer. â€Å"Dawn? It's Lee. Yes†¦ yes, I know. Well, I have two for you, ready and waiting. A Moroi and an Alchemist. No – not the old man. Yes. Yes, still alive. It has to be tonight. They know about me. You can have them†¦ but you know the deal. You know what I want†¦ yes. Uh-huh. Okay.† Lee rattled off our address and disconnected. A pleased smile crossed his face. â€Å"We're lucky. They're east of LA, so it won't take them long to get here – especially since they don't care much about speed limits.† â€Å"Who are ‘they'?† asked Adrian. â€Å"I remember you calling some Dawn lady in LA. I thought she was one of your hot college friends?† â€Å"They're the makers of destiny,† said Lee dreamily. â€Å"How delightfully enigmatic and nonsensical,† muttered Adrian. Lee glared and then carefully studied Adrian. â€Å"Take off your tie.† I realized I'd spent so much time with Adrian now that I was ready for some comment like, â€Å"Oh, glad to know things aren't so formal anymore.† Apparently, the situation was dire enough – and the knife at my throat serious enough – that Adrian didn't argue. He'd handcuffed his wrists in front of him and, after some complex maneuvering with his hands, was finally able to undo the tie he'd donned for Jill's show. He tossed it over. â€Å"Careful,† Adrian said. â€Å"It's silk.† So, not completely devoid of snark. Lee rolled me over to my stomach, finally freeing me of the knife but giving me no time to react. With remarkable skill, he soon had my hands tied behind my back with Adrian's tie. Doing so required some pulling and restraining of my arms, which hurt quite a bit after the stabbing. He backed off when finished, allowing me to gingerly sit up, but an experimental tug of the tie showed that I wasn't going to undo those knots anytime soon. Uneasily, I wondered how many girls he'd tied up before in his sick attempt to become Strigoi. Weird, awkward silence fell as we waited for Lee's â€Å"makers of destiny† to show up. The minutes ticked by, and I frantically tried to figure out what to do. How long did we have until the people he'd called arrived? From what he'd told me, I'd guess at least an hour. Feeling bold, I finally attempted communication with Adrian, again hoping maybe we could covertly team up on Lee – even though our success rate had just become that much lower with both our sets of hands bound. â€Å"How did you even get here?† I asked. Adrian's gaze was fixed on Lee, still hoping for direct eye contact, but he did spare a quick, wry glance at me. â€Å"Same way I get around everywhere, Sage. The bus.† â€Å"Why?† â€Å"Because I don't have a car.† â€Å"Adrian!† Amazing. Even with our lives in danger, he could still infuriate me. He shrugged and returned his focus to Lee, even though his words were obviously for me. â€Å"To apologize. Because I was a total asshole to you at Jailbait's show. Not long after you left, I knew I had to come find you.† He paused eloquently and glanced around. â€Å"No good deed goes unpunished, I guess.† I suddenly felt at a loss. Lee turning psychopathic certainly wasn't my fault, but it troubled me that Adrian was now in this situation because he'd come to apologize to me. â€Å"It's okay. You weren't†¦ um, that bad,† I said lamely, hoping to make him feel better. A small smile played over his lips. â€Å"You're a terrible liar, Sage, but I'm still touched you'd attempt it for my sake. A for effort.† â€Å"Yeah, well, what happened back there seems kind of small, in light of the current situation,† I muttered. â€Å"It's easy to forgive.† Lee's frown had been growing as he listened to us. â€Å"Do the others know you're here?† he asked Adrian. â€Å"No,† said Adrian. â€Å"I said I was going back to Clarence's.† I didn't know if he was lying or not. For a moment, I didn't think it would matter. The others had heard me say I was coming here, but none of them would have any reason to come seeking us. No reason, except the bond. I caught my breath and met Adrian's eyes. He looked away, perhaps for fear of betraying what I'd just realized. It didn't matter if the gang had known where I was earlier. If Jill was connected to Adrian, she would know now. And she would know that we were in trouble. But that was assuming it was one of the times when she could see into his mind. They'd both admitted it was inconsistent and that high emotion could bring it out. Well, if this didn't count as a highly emotional situation, I couldn't think what would. Even if she realized what was happening, there were a lot of if's involved. Jill would have to get here, and she couldn't do it alone. Calling the police would bring the fastest response, but she might hesitate if she knew this was vampire business. She'd need Eddie. How long would it take to get him if they were back in their dorms? I didn't know. I just knew that we had to stay alive because if we did, one way or another, Jill would get help here. Only, I no longer knew our odds of survival. Adrian and I were both confined, trapped with a guy who wasn't afraid to kill with a knife and who desperately wanted to become a Strigoi again. That was a bad combination, and it threatened to get worse†¦ â€Å"Who's coming, Lee?† I asked. â€Å"Who did you call?† When he didn't answer, I made the next logical leap. â€Å"Strigoi. You have Strigoi coming.† â€Å"It's the only way,† he said, tossing his knife from hand to hand. â€Å"The only way left now. I'm sorry. I can't be like this anymore. I can't be mortal anymore. Too much time has already passed.† Of course. Moroi could become Strigoi in one of two ways. One was by drinking the blood of another person and killing them in the process. Lee had tried that, using every combination of victims he could get ahold of, and had failed. That left him with one last desperate option: conversion by another Strigoi. Usually, it happened by force, when a Strigoi killed someone and then fed their own blood back to the victim. That was what Lee wanted done to him now, trading our lives to the Strigoi who would convert him. And then he wanted to do it to Jill, out of some crazy misguided love†¦ â€Å"But it's not worth it,† I said, desperation and fear making me bold. â€Å"It's not worth the cost of killing innocents and endangering your soul.† Lee's gaze fell on me, and there was a look of such chilling indifference in it that I had a hard time connecting this person before me to the one I'd smiled indulgently on as he courted Jill. â€Å"Isn't it, Sydney? How would you know? You've deprived yourself of enjoyment for most of your life. You're aloof from others. You've never let yourself be selfish, and look where it's got you. Your ‘morals' have left you with a short, strict life. Can you tell me now, just before you're about to die, that you don't wish you'd maybe allowed yourself a little more fun?† â€Å"But the immortal soul – â€Å" â€Å"What do I care about that?† he demanded. â€Å"Why bother living some miserable regimented life in this world, in the hopes that maybe our souls go on in some heavenly realm, when I can take control now – ensure that I live forever in this world, with all of its pleasures, staying strong and young forever? That's real. That's something I can put my faith in.† â€Å"It's wrong,† I said. â€Å"It's not worth it.† â€Å"You wouldn't say that if you'd experienced what I have. If you'd been Strigoi, you never would've wanted to lose that either.† â€Å"How did you lose it?† asked Adrian. â€Å"What spirit user saved you?† Lee snorted. â€Å"You mean robbed me. I don't know. It all happened so fast. But as soon as I find him I'll – ahh!† A yearbook is not the greatest of weapons, particularly one the size of Amberwood's, but in a pinch – and with surprise – it'll do. I'd noted earlier that I wasn't going to be able to undo the knots in the tie anytime soon. That was true. It had taken me this whole time, but I'd done it. For whatever reason, knot-making was a useful skill in the Alchemist curriculum, one I'd practiced growing up with my father. As soon as I was free of Adrian's tie, I reached for the first thing I could: Kelly's junior yearbook. I sprang up and slammed it into Lee's head. He cringed back at the impact, dropping the knife as he did, and I used the opportunity to sprint across the living room and grab Adrian's arm. He needed no help from me and was already trying to get to his feet. We didn't get far before Lee was right back on us. The knife had slid somewhere unseen, and he simply relied on his own strength. He caught hold of me and ripped me from Adrian, one hand on my wounded arm and one in my hair, causing me to stumble. Adrian came after us, doing his best to hit Lee, even with bound hands. We weren't the most efficient fighting force, but if we could just momentarily delay Lee, there was a chance we might make it out of here. Lee was distracted by both of us, trying to fight and fend us off at the same time. Unbidden, Eddie's lesson came back to me, about how a well-placed punch could cause serious damage to someone stronger than you. Sizing up the situation in seconds, I decided I had an opening. I closed my hand the way Eddie had taught me in that quick lesson, positioning my body in a way that would direct the weight in an efficient way. I swung. â€Å"Ow!† I yelled in pain as my fist made contact. If this was the â€Å"safe† way to punch, I couldn't imagine how much a sloppy one hurt. Fortunately, it seemed to cause just as much – if not more – pain to Lee. He fell backward, hitting the comfy chair in a way that made him lose his balance and collapse to the ground. I was stunned at what I had done, but Adrian was still in motion. He nudged me to the door, taking advantage of Lee's temporary disorientation. â€Å"Come on, Sage. This is it.† We hurried to the door, ready to make our escape while Lee shouted profanities at us. I reached for the knob, but the door opened before I could touch it. And two Strigoi entered the room.

Management Information Systems Essay

This paper will discuss the local business of Fascinations Beauty Salon, and the internet strategic model to help develop this company. This business will have to have a new strategy that set up for the viable benefits. Fascinations Beauty Salon will need to be equipped in order to benefit from creating a website. This paper will also discuss the functions of the business through the internet website. Management Information Systems Fascinations Beauty Salon has been in business for quite a long time, like fifty years. It is located in the residential area down the street from an Elementary school and a Baptist Church. The owner Mrs. B. has been doing hair for the majority of her life in the same place and she still has plenty of clients. These clients have been her business for quite some time, and she shares her salon with another beautician that only works certain days. Just recently, Mrs. B. had been trying to research into expanding her business services and was asking about having her business on the internet. Mrs. B. had just realized that she wanted to be in the race with her competitors in the Galveston County area. I spoke to Mrs. B. he other day informing her that Fascinations Beauty Salon could expand the products that she sells on a regularly basis and as well as her services. Between the women that work at this place and the students that have been in the business to get a feel, or trained with internships that she should have a website. So that when people want or need some sort of hairstyle or needs a clip or maybe even a product that only she carries that, they could send a quick electronic email out to the business or they could go to her place of business to receive such services and products. I explained to her that E-commerce is a way that patrons and businesses are getting fast admission to the internet global market. E-commerce is spreading like a wildfire, in the areas of exporting and advertising of manufactured goods and benefits by the usage of central processing units and systems. I advised her that she could triple her business and that I would set up her business with an electronic commerce with a certain type of internet industry example like (B2C) industry-to-customer: which means that ustomers can buy immediately with her company instead of trading with any liaisons. Mrs. B. inquired about the ways that a web site could assist her in benefitting, and I informed her that a web site could assist her company receive a viable gain with a planned effect on her business. With the planned effect on her business implemented as having the lowest assembly or in service expenses, offering distinctive commodities, aiming a definite section of the marketplace, increasing new ways of liability dealing, increasing commodities, or benefits, and starting collections that labor jointly. With electronic storefronts, consumers can shop on the virtual web site via electronic files and shopping pushcart replicas. Also by moving your stock franchise business on the internet, it can improve productivity and increase the buyer overhaul. Here the business can develop an electronic exchange with a combination to contenders and dealers with the benefit of supercomputers and Web sites to purchase and vend merchandise, exchange market statistics, and manage the rear organization procedures, such as monitoring the supplies. The Fascinations Beauty Salon serviceable qualifications for the use of the internet and the web could subsidy it with the physical address of business, telephone number, e-mail, hours of functions, beauty salon overhaul proposed, such as (extensive overhaul shop, loveliness merchandise, waxing, alterations, facials / make-up / skin-care, perms, spirals, haircuts). Also shows advertisements, present documentations, brands suggestions, (Rusk, Nexus, CHI, Matrix, Logics, Red- kens), with exclusive overhaul proposals ( appointments, walk-ins welcome, free parking, group bookings, and clientele performances (all ages, children, men, women, wedding parties). The technological specifications for the chosen business consist of the listed hardware as the following: the case to holds the computer, and a CPU or central processing unit, (also known as a tower) along with drives like CD and DVD drives that can transfer information onto the CD’s and the DVD’s. A monitor the shows the information on the screen along with a keyboard that is used to type information into the computer and a mouse device as a pointing cursor that shows on the monitor. A printer used to print the information as displayed on the monitor. The server domain that I suggest for Fascinations Beauty Salon is Go Daddy. Com, it can be very useful with an SSL Certificate, offers many templates for the business, and is user friendly for everything that pertains to this business. As far as the software, I would recommend that this business would try Hair-Max Salon Software that offers many different optional tabs to assist the business and make it more profitable.