United Kingdom sports policy Essay Example | Topics and Well Written Essays - 2500 words

United Kingdom sports policy - Essay Example Sports have been promoted in the United Kingdom as a modern public sector service by successive governments. (Henry. 2001, 19). Being a competitive activity between individuals, groups and states, it is but natural that sports will come within the purview of state policy for smooth promotion as well as to ensure steady growth of sporting abilities in the country to generate a strong feeling of nationhood through better performance in international competitions. Governments thus invariably indulge in formulating sports policies that will earn laurels for the individual and the country in the international arena. Sports policies are also deemed significant to ensure equity in dispensation to afford equal opportunities for weaker sections of society. Notwithstanding the above, it is commonly noticed that public policy is influenced by practical politics, power relations, resources and technical considerations. (Veal.2002, 11). United Kingdom has been at the forefront of sports over the years. The famous quote attributed to the Duke of Wellington that the Battle of Waterloo was won on the sports fields of Eton and Harrow has justifiably highlighted the importance of sports in British national life. The UK sports policy is contained in Game Plan: A Strategy for Delivering Government's Sports and Physical Activity Objectives developed by the UK Strategy Unit under the British Prime Minister's Office published in 2002. (Game Plan, 2002). The policy and strategy laid down in this document has been followed up rigorously and is reviewed every year. The salient facets are discussed as per succeeding paragraphs. Game Plan: A Strategy for Delivering Government's Sports and Physical Activity Objectives The importance to sports policy in general and the policy document in particular is evident with the Foreword being written by the Prime Minister Mr. Tony Blair. Mr. Blair highlights the significance of sports as a powerful tool to achieve a number of goals for governments and the need for being adequately equipped to take advantage of the means for nation building. (Game Plan, 2002). The Report has been focused as per Blair on the importance of increasing grass roots participation in sports for health benefits so that the current health costs of 2bn a year or 54,000 lives lost prematurely could be cut down. A government - sports bodies partnership is sought to be created to achieve these aims. (Game Plan, 2002). The Prime Minister has also highlighted the need to cut down on sports bureaucracy. The focus is on the younger generation and it is envisaged that at least 75 percent youth should participate in sports in the coming years. The Secretary Of State RT Hon Tessa Jowell has also emphasized the need for greater focus on participation in sports as only 32 percent of adults in England were doing more than 30 minutes of moderate exercise five times a week which is the recommendation of health professionals. (Game Plan, 2002). The disparity in the population with limited participation by the lower income groups and fall in involvement with increasing age has been noted with concern. Ms Jowell has bench marked British performance with nations as Finland and Australia which have a large participation in sports and also one which is increasing with age. Britain's performance has been highlighted as the best in Olympics since 1920, with world champions in more than 50 sports but most of these are not in sports carrying a high profile

Captain Corellis Mandolin Essay Example for Free

Captain Corellis Mandolin Essay Carlo asserts War is a wonderful thing, in movies and in books. By close reference to the novel, explore how war shows people at their worst and their best. The novel Captain Corellis Mandolin, written by Louis De Bernieres in 1994, explores humanity; we sigh at their suffering as they are ripped apart and forever changed by war.1 The quotation in the title is spoken by Carlo quite early on in the novel, at the end of chapter 15, titled LOmosessuale (4). He is referring to the idea that war is repeatedly shown to be patriotic, heroic, and indeed wonderful especially in film and literature. However, from Carlos experiences in Albania, he knows the true reality of war, as he has seen and experienced the suffering. We can trace Carlos progression of thought through his personal chapters; all entitled LOmosessuale. He begins saying, How wonderful it was to be at this war(p.119) We hear him describe crossing the foreign border as exhilarating, and he and his comrades view themselves as the new legionaries of the new empire that would last ten thousand years.(p.119) This was his view at the very beginning of war, before he had really experienced any suffering. As he is yet to encounter any conflict, it is likely he has been influenced by the propaganda at the time, organised by the Italian leader, Mussolini. The next quotation is said slightly further on during Carlos experience, How wonderful it was to be at war, until the weather turned against us.(p.120) It is here that we begin to hear of some of the suffering that Carlo and his comrades had to endure, such as we were ten thousand men soaked to the bone(p.120). The real tragedy of war is death, and Carlo has had direct experience of this. He says, War is wonderful until someone is killed(p.122). This is when De Bernieres chooses to use graphic images to show the suffering that Carlo and his comrades endure. I realised that I was covered with gory scraps of human flesh that were freezing fast to my uniform(p.122). Finally, Carlo says the quotation in the title, War is a wonderful thing, in movies and in books on page 124. It is here that Carlo has realised the actuality of war, and can see that this idealised version is fictitious and can only be seen in movie and in books. War scorches a trail through all of their lives. What seems, at the beginning of the novel, like a game, a challenge to manhood, a matter of honour, an occasion for political satire, becomes an appalling reality.2 Carlo asserts that war is shown to be wonderful in movies and in books. However, De Bernieres does not follow this trend, and shows the war for what it is. De Bernieres characters starve and die slowly with their entrails hanging out; he depicts the horror that they have to endure to fight for their country, and the suffering that they are put through. In Albania, Carlo says It was as though a portion of my mind has disappeared, or as though my soul had diminished to a tiny point of grey light(p.138). De Bernieres also shows the gore and bloodshed caused by the war, when he describes the death of Francesco. In chapter 19, LOmosessuale (6), De Bernieres uses Carlos narrative to tell the reader the true details of Francescos death, and then the sanitised version for his mother. As well as this showing Carlos considerate nature, it also confirms that many people did view the war in a very different light from its reality, including Francescos mother. He died on a fine day, Signora, with the sun shining and the birds singing. (He died on a day when the snow was melting and when, beneath that carapace, there were emerging a thousand corpses, knapsacks, rusted riffles, water bottles, illegible unfinished letters drenched in blood) (p.148). Corelli wrote the novel, after falling in love with the Island of Cephallonia, and wanting to inform readers about what happened to this Island during World War II. For this reason, he has depicted a very real and veritable account of atrocities that occurred during the Second World War. Everyone is shot, without regard for rank or role, even the medics and the chaplains.3 However, in the film adaptation of Captain Corellis Mandolin, directed by John Madden, war is viewed in a very different light. De Bernieres has said of the film The problem is that film-makers take out all your good ideas and replace them with a load of stupid ones.4 The depiction of war in the film is very different and many scenes seem to have been watered down5, in order to appeal to far wider audience. The movie has been widely criticised, after changing the story line drastically from a tragic story of the destruction and consequences of war, to a love story between Corelli and Pelagia. Where de Bernià ¯Ã‚ ¿Ã‚ ½res book makes it clear from the start that war is unforgivingly ugly, for a long time the films only hint of this is a glimpse of Mandrass battle-scarred feet.6 Although much of De Bernieres novel depicts the horror of war, some of the consequences of war are indeed wonderful. Corelli and Pelagia would have never found love without the intervention of war in their lives, and although ultimately war destroys their love, the moments spent together made the war endurable. The prefatory poem at the beginning on the novel shows Louis De Bernieres hinting, even before the novel has begun, that war will be an important theme throughout. The Soldier by Humbert Wolfe describes the waste of war, and the loss of lives and of youth. Links are evident between this poem and Captain Corellis mandolin as they both explore the way in which war has an effect on different people. The presence of war on the Island of Cephallonia has various effects on different characters and can expose peoples flaws and merits. An excellent example of this is the contrast shown between Mandras and Antonio Corelli. Corelli has been drawn into a war that he really has no heart for. You mean youre a soldier by mistake? (p. 206, Pelagia). He has no desires to be a soldier and his character is often seen as anti-military. When giving punishments he does not follow the rules that are expected of him, To everyones surprise the captain pointed his pistol straight into the face of one of the culprits(p.324). However, although he had no intention of doing so, Corelli proves to be an excellent comrade and shows morality throughout the war. This is my morality, I make myself imagine that it is personal(p.351). This is greatly contrasted with the character of Mandras. He has very high expectations about the life of a soldier and feels he has to prove himself to Pelagia and the rest of the Island. He resents those who know more than him, yet does not want to prove himself intellectually, as he believes no man is a man until he has been a soldier(p.80) Carlos assertion that war is wonderful in movies and in books reflects a idealised view of the war. However, Mandras believes that this view was the reality of war and he felt that becoming a soldier would make him more worthy as a man. Ill come back and everyone will say, Thats Mandras, who fought in the war. We owe everything to people like him. He is indoctrinated by what is expected of him, and is predicted to conform. However high Mandras expectations were, the war does not elevate him, it brings him down. During his experiences in war he saw others abuse their power, and now feels he has a right to do the same, The war de-humanises him, and instead of changing him for the better it changes him for the worse. The war in Cephallonia showed the best and the worst in people. In Antonio Corellis case it displays his merits as he has the opportunity to exercise his humanity in the treatment of others. From the beginning of the novel, Corelli is represented as a laid-back, light-hearted leader. Although he has a great talent as a leader, he is very modest and introduces Carlo as one of our heroes, He has a hundred medals for saving life and none for taking it(p.202). He proves himself as an excellent comrade and Captain by being faithful to his men until the very end. There is no honour in this war, but I have to be with my boys(p.392). His introduction of La Scala also shows good comradeship, as it is a humorous and practical solution to having to use communal toilets. This is also a crucial element of the novel, as before they go to join the shooting line up, they sing to maintain their composure. He also shows his forgiving nature when he chooses to forgive Gunter for what he has done. I forgive you. If I do not, who will?(p.397). He says of himself I am not a natural parasite(p.305) and this is seen clearly when he avoids any confrontation with Pelagia. He is uncomfortable about living with Pelagia and her father Tonight I shall sleep in the yard and tomorrow I shall request alternative accommodation(p.204). Corellis fondness for animals is De Bernieres way of showing positive traits in a character. The fact that Corelli is so attached to Psipsina shows that he is an admirable man and the reader feel connected to him. The captain had some engaging traits. He tied a cork to a piece of string, and sprinted about the house with Psipsina in hot pursuitand if the animal happened to be sitting on a piece of music, he would go away and fetch another sheet rather than disturb her(p.250) Corelli also shows fondness for children in his relationship with Lemoni. Although there is a language barrier, the two are able to communicate on a different level, and are able to enjoy each others company. The child was whooping and laughing, and it appeared that what was transpiring was a lesson in Italian. Bella fanciulla, the captain was saying. He was waiting for Lemoni to repeat it. Bla fanshla, she giggled. (p. 211) He also appears to have a very different attitude than other soldiers, when he arrives in Cephallonia with his mandolin strapped to his back, and not a gun, as you would expect from a soldier. The mandolin that was called Antonia because it was the other half of himself. This love for music is another engaging trait that the captain has, and is one of the reasons Pelagia falls in love with him. We also see this originality to his character when Gunter Weber, a german soldier, introduces himself. Weber says Heil Hitler, yet Corelli says Heil Puccini, showing he has a very different attitude to the war, and will not be led by anyone. This again shows his love for classical music, as Puccini was a great composer, whom Corelli was an admirer of. His relationship with Pelagia is clearly one of great love and admiration, however it also contains sexual desires, which are never consummated. Such slender fingers, such pink nails. He imagined them engaged upon amorous and nocturnal things, and realised that he was disturbing Psipsina.(p.259, Corelli) This shows ongoing respect for Pelagia and her father, and also shows Corellis caring and considerate temperament. In contrast to Corelli, the character Mandras is brutalised by war. He believes that war will change him for the better, yet it changes him for the worse. He becomes a victim of propaganda and a victim of his insecurities. Before he leaves for war he tells Pelagia Im a Greeknot a Fascist(p.214) War changes him for the worse as he is very easily led and allows others to influence him. This may have had a positive effect on Mandras if he had chosen Iannis to guide him, yet he chooses Hector, the leader of a branch of the ELAS. Joining this group causes him to abandon his personal values, and this is seen when he whips the old man. Mandras did not even notice that the man had stopped moving, had stopped screaming and whining(p.233). He manages to blank out the emotions that he should be feeling, and begins to enjoy the power he holds over this old man. If you didnt think about what it was, it sounded weirdly beautiful(p.234) After returning from the war, he becomes much more manipulative, especially towards Pelagia and Drosoula. Mandras had begun his exile into inaccessibility by dramatising the idea of death(p.180). Pelagia was convinced that he was doing it on purpose as an act of vengeance or punishment.(p.180). This shows a very cruel side to Mandras that we have never seen before, and it clearly takes the war to bring out this negative side of his character. He has clearly been indoctrinated by the propaganda of the war, and this is seen in chapter 63, when he recites communist slogans. The party is never wrong. Whoever is not with us is against us(p.447) He does not seem to be questioning what he has been told, he just repeats it. He has experienced others abusing their power during his time with the ELAS and now sees this as an approved way of behaving. De Bernià ¯Ã‚ ¿Ã‚ ½res explores power and its abuse7 He insults and belittles Pelagia after he returns from fighting and tortures her further, even though he should see that she has suffered enough during the war. De Bernieres shows a side to Mandras that readers have never seen before. He represents him as evil and sadistic, and we see Mandras refer to Pelagia as a slut. His morals have disintegrated following his fighting with the ELAS, and feels that he can do whatever he wants. This is due to the fact that the ELAS would make up their own rules for their comrades to follow. The war de-humanises Mandras and he represents the damage that can be inflicted by extreme politics. In Mandras death, De Bernieres wants readers to feel pity for him, as it is clear the communist party has seriously indoctrinated him. He dies as a victim of the war, and a desire to prove himself worthy, and this also evokes compassion in the reader Carlo is a character in the novel who shows how war can bring out the best in people. He is a very honourable character, and has to live with the secret that he is homosexual. He puts aside his desire for Corelli in order to help the romance between Pelagia and Corelli develop. I have loved you with the same surprise and gratitude that I see in your own eyes when you are with Pelagia(p.384). He shows true bravery in front of the firing squad when stepping in front of Corelli to save his life. Antonio Corellihad found in front of him the titanic bulk of Carlo Guercio(p.399). De Bernieres uses Carlos narrative in the chapters entitled LOmosessuale, and this allows the readers to sympathise further with the silent suffering that Carlo has to endure during the war. His writings are eloquently written and his language is poetic and beautiful, showing the gentle side to his character. He died on a fine day, Signora, with the sun shining and the birds singing.(P.148, Carlo) Father Arsenios was saved by the war(p.292). De Bernieres absolves Arsenios after the war and liberates him from his former self. However, the characters perceive him as a mad man and cannot see that war has brought about his finest hour. He is referred to as the crazy priest yet he feels he is a saviour and it is probable that, had he lived, Arsenios might have become a saint(p.295). De Bernieres chooses to depict war in a graphic and realistic light in his novel, Captain Corellis Mandolin. Although in many films or books war is shown to be wonderful, this idealised version is proved wrong in De Bernieres novel, as he shows the suffering that the soldiers were forced to endure. He shows that the war has different effects on different people, and it can expose their faults or their merits. Mandras is forever changed by the war, as he returns indoctrinated by the communist party. His death proves that his natural environment is the sea, where he can be accepted and does not have to prove himself. In contrast Corellis merits are shown to be more prominent as the war develops, and also as his love for Pelagia develops. The reader is drawn to the character of Corelli, even though he is an occupying soldier, as he shows compassion, kindness and respect during his time in Cephallonia.

Potentially Inappropriate Medication at a Private Hospital

Potentially Inappropriate Medication at a Private Hospital Abstract The use of certain medications in geriatrics when potential risks outweigh the potential benefit and an effective alternative is available is called as Potentially Inappropriate medication. Because geriatrics are more sensitive towards adverse effects of medications. Beers criteria which is updated and reviewed by American Geriatric society list out 53 medications/therapeutic classes of drugs to be avoided in geriatrics. Methodology: A prospective observational study was conducted for 9 months in a 650 bed private corporate hospital, South India. All geriatric patients admitted in the hospital during the study period was included. Beers Criteria 2013 were used to identify potentially inappropriate medications. Result: The prevalence of PIM use (52%) was significantly higher in study population. An avg of 10 drugs were taken by the study population. A total of 215 medications were identified as PIMs. Among them 195(90%) medications should be avoided by the geriatrics independent of th eir condition (category I). 66(60%) of the study population had used more than one PIMs. 91(83%) of the PIM users had atleast one DRPs and the mean DRPs value of the PIM users were 1.59à ¯Ã¢â‚¬Å¡Ã‚ ±1.3. Conclusion: High prevalence of PIMs in the study population signifies the need of monitoring geriatric prescriptions. Key words: PIMs, Beers Criteria, Geriatrics Introduction In recent years proportion of geriatric hospital admission with comorbidity and polypharmacy has been increasing continuously (1, 2). Adverse drug events (ADRs) are the most common reason for hospital admission, but sometimes it’s not identified. Medication errors (MEs) or conventional adverse drug reactions (ADRs) are the common reason for adverse drug events which ends in clinical symptoms. Overall, elderly patients need greater attention to drug therapy and safety parameters (1, 3-5). Greater attention is needed for geriatric population due to age related pharmacodynamics and pharmacokinetic changes. But appropriate pharmaceutical care for elderly are determined on the basis of clinical trial conducted with adult population.(6) The burden of harm resulting due to the use of multiple drugs in geriatric populations is a major health related problem in developed countries. A research study reveals that around one in four geriatrics admitted to hospitals are prescribed with at least one inappropriate medication and potentially preventable adverse drug reactions accounts for nearly 20% of all inpatient deaths (7). The assessment of potentially inappropriate medication (PIM) in geriatric is a challenging work and there is a need for considering many factors which influences the prescribing as well as outcome. Eight well known tools are available to identify the PIMs and studies reports that Beers criteria is the best and easy one to assess the PIMs. Beers criteria also has the advantage over others because it is periodically updated (8).This study therefore aimed to investigate the prevalence of PIM use on geriatric population using Beers criteria 2012 and its association with Drug Related Problems (DRPs) . Methodology Study Site: The work entitled â€Å"A study on prevalence and impact of Potentially Inappropriate Medication use in geriatrics at a private corporate hospital† was carried out in a 640 bedded private corporate hospital, South India. Study Design: Prospective –Observational study. Study Period: Nine months. Inclusion criteria: Patients above age of 65 yrs. Exclusion criteria: The patients who are unwilling to participate in the study and out patients METHOD: A regular ward rounds was carried out in all the wards of General medicine. Each patient’s medication profile was reviewed. Patients who met the inclusion criteria were briefed on the project with the help of patient information form and if they are willing to participate in the study their consent was obtained. The data from medical chart were recorded in customized data entry form. The prescribed drugs were evaluated and PIMs use were identified with the help of Beer’s criteria. The drugs which are identified as PIM are categorized into following: Potentially inappropriate medications /classes to avoid in geriatrics, Potentially inappropriate medications /classes to avoid in geriatrics with certain pathological condition that the listed PIM use can exacerbate Medications to be used with caution in geriatrics. ADRs associated with PIMs use were assessed. Drug interaction and ADR was monitored and reported. DRPs and Drug Risk Ratio (DRR) were calculated for PIMs. DRPs were the sum of ADR, drug interaction and drug allergy.DRR was calculated as the number of DRPs in relation to how often the drug was used (DRPS/number of times used). Results and Discussion In the study period, 212 patients were included in the study as per inclusion criteria and exclusion criteria. 110 (52%) patients were found to be prescribed with PIMs listed in Beers criteria (fig no: 01). A similar study conducted by Birader K et al (2013) (9) reported that PIM prevalence were 38% in their study population. Increased anxiolytics use as a prophylaxis for hospital related anxiety might be the reason for high prevalence of PIM than the later study. The total number of patients in study population were 110. Among them 62(56%) were males and 48(44%) were females.The study result reveals that PIMs user are mostly males. A similar study conducted by Birader K et al (2012) (9) reported that prevalence of PIM use is more among males than females. The age categorization of PIM users was done. The maximum age of PIM users was 93 years and mean age of PIM users was found to be 70.2 ±5.77. The median age for PIM users was 68.5 years. The result indicated that age group of (65-69) were commonly prescribed by PIMs. This results compared with a previous study carried out by Birader K et al (2012) (9) which also reports that PIMs were frequently prescribed in the age group of 65-69 years. The social habit of the PIM users shows that 8(7%) patients were smokers and alcoholics, 14(13%) patients were alcoholics, 21(19%) patients were smokers and 67(61%) patients were teetotalers in PIM users. The comorbidities of the PIM users was analyzed. There were 52 (47%) suffering from hypertension and 32(29%) were suffering from DM. The results shows that most of the study group had comorbidities of hypertension followed by DM and CVDs. A similar study conducted by Fouquet A (11) also reported that most common diagnosis among their study population was hypertension and diabetes. The number of drugs prescribed for the PIM users were calculated (fig no: 2). The mean number of drugs per prescription was 9.9 ±2 with the maximum of 16 drugs and minimum of 5 drugs prescribed. The above results signifies that all prescriptions were in polypharmacy category. A similar study conducted by Blozik E (12) concluded that one of the main factor for PIM use is â€Å"polypharmacy†. The number of PIM drugs per prescription in the study population was calculated (Fig no: 3). The result reveals that 44(40%) were using one PIM drug, 50(45%) were using two PIMs, 14(13) were using three PIMs, 1(1%) were using 4 PIMs and the maximum of 5 PIMs use were found in 1(1%) of the study population. 66(60%) of the study population consumed more than one PIM. The mean was found to be 1.8 ±0.78 and an avg of 2 PIM was used by the study population. A similar study conducted by Dormann H (2013) (13) were reported that 87% of the study population consumed at least one PIM. Among the PIM users the total number of PIM drugs was calculated and it was found to be 215 drugs. PIM users were categorized into three groups according to Beers criteria. (Table no: 2) There were 195(90%) belongs to category I, 12(6%) were in category II and 8(4%) were in category III. The individual categories of PIM was analyzed. It was found that alprazolam 57(52%), clonazepam 17(15%), hyocyamine 10(9%), Lorazepam 10(9%), hydroxyzine 10(9%), zolpidem 10(9%), ketorolac 10(8%) were prescribed in category I (table no: 3). A similar study conducted by Birader K et al (2013) (16) reported that alprazolam and cimetidine were frequently used PIM among their study population. Use of hyocyamine in constipation 3(25%) accounts for the most frequent inappropriate drug use in category II (table no: 4). Hydroxyzine in constipation 2(17%), cyproheptidine in constipation 2(17%), ketorolac in PUD 2(17%), clonazepam in frequent fall 1(8%), ketorolac in CHF 1(8%) and theophylline in insomnia 1(8%) were other category II inappropriate medication use. Use of escitalapram 3(40%), mirtazapine 2(30%), fluoxetine 1(10%), sertraline 1(10%) and Duloxetine 1(10%) were the category III PIMs (table no:5). The DRP among the PIM users were analyzed (fig no: . It was found that 19(17%) of the PIM users were free from DRPs. Majority of the study population had at least one drug related problems. The mean value of DRP in the study population was found to be 1.59 ±1.3. The minimum observed number of DRP per patient was one and maximum observed number of DRP per patient was six. The ADR use was monitored in the study population. A total number of 40 ADR associated with PIM use (Fig no:5) and 14 ADR associated with nonPIM use were identified. The study result reveals that one among three PIM users were found to have at least one ADR. A similar study conducted by N. Nixdorff et al (2008) were also reported that PIM users were found to experience ADR most frequently than nonPIM users. As a part of our study, screening of drug interactions were done. A total number of 131 major drug interactions were identified, in that 111 were unique. Among the drug interactions found 16(12%) were PIM-PIM drug interactions, 39(30%) were PIM-other drugs drug interactions and 76(58%) were caused by non PIM drugs (table no: 6). Drug risk ratio were calculated for the study population (table no:7). It was observed that prochlorperazine had the highest DRR (4) followed by phenobarbitone (2), digoxine (2), pentazocine (2) and duloxetine (2). The statistical analysis of obtained results has been done using statistical tools. The association of different variables are analyzed using à ¯Ã‚ Ã‚ £2 test. On assessment of association between â€Å"number of comorbidities† with â€Å"number of drugs† and â€Å"number of PIMs† (table no:8), the result proved that â€Å"number of comorbidies† are statistically associated with â€Å"the number of drugs† at 0.001 level of significance and â€Å"number of PIMs† at 0.05 level of significance. It means that as number of comorbidity increases polypharmac and PIM use also increases. On assessment of association between â€Å"number of drugs† and â€Å"number of PIMs† (table no: 9), the result proved that â€Å"number of drugs† are statistically associated with â€Å"number of PIMs† at 0.05 level of significance. This result proves that polypharmacy is one of the reason for PIMs. On assessment of association between â€Å"number of DRPs† with â€Å"number of drugs† and â€Å"number of PIMs† (table no:10), the result proved that â€Å"DRPs† are statistically associated with â€Å"number of PIMs† at 0.01 level of significance but not associated with â€Å"number of drugs† at 0.05 level of significance. This result proves that DRPs is more associated with PIMs than polypharmacy which means it not the number of drugs contributing to DRPs but the use of PIMs. Conclusion Our study identified a high prevalence of PIMs use and associated DRPs in the study population. DRPs due to PIMs is preventable. Development and implementation of new criteria or modification of already existing criteria such as Beers criteria, START STOPP criteria which will helps in safe prescribing practice can reduce the PIMs use. References Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 2011; 365: 2002–12. Budnitz DS, Shehab N, Kegler SR, Richards CL: Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007; 147: 755–65. Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG: Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med 2005; 165: 68–74. Pirmohamed M, James S, Meakin S. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329: 15–9. Chrischilles EA, VanGilder R, Wright K, Kelly M, Wallace RB. Inappropriate medication use as a risk factor for self-reported adverse drug effects in older adults. J Am Geriatr Soc 2009; 57: 000–6 Avorn J, Shrank WH. Adverse drug reactions in elderly people: A substantial cause of preventable illness. BMJ. 2008;336:956–7 Minimizing Inappropriate Medications in Older Populations: A 10-step Conceptual Framework. Ian A. Scott, MBBS, MHA, MEd,a Leonard C. Gray, MBBS, MMed, PhD,b Jennifer H. Martin, MBChB, MA (Oxon), PhD,c Charles A. Mitchell, MBBSd Opondo D. Inappropriateness of Medicationth Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review, plos one, aug 2012, volume 7, issue 8 Biradar K; assessment of potentially inappropriate medication in elderly patients at Basavehwar teaching hospital;IJPP 2012dec, vol 5,issue 4, 73-5 Denys TL (2011) Functional Decline Associated With Polypharmacy and Potentially Inappropriate Medications in Community-Dwelling Older Adults With Dementia, Am J Alzheimers Dis Other Demen. 2011 December ; 26(8): 606–15. doi:10.1177/1533317511432734 Fouquet A, Zegbeh H, Krolak-Salmon P, Mouchoux C. Detection of potentially inappropriate medication in a French geriatric teaching hospital: A comparison study of the French Beers criteria and the improved prescribing in the elderly tool. J Eurger 2012 3: 326-29 Blozik E, Rapold R, von Overbeck J, Reich O. Polypharmacy and potentially inappropriate medication in the adult, community-dwelling population in Switzerland. Drugs aging. 2013;30:561-8 Dormann H, Sonst A, Mà ¼ller F, Vogler R, Patapovas A, Pfistermeister B, Plank-Kiegele B, Kirchner M, Hartmann N, Bà ¼rkle T, Maas R. Adverse drug events in older patients admitted as an emergency the role of potentially inappropriate medication in elderly people (PRISCUS). Dtsch Arztebl Int 2013; 110(13): 213–9. DOI: 10.3238/arztebl.2013.0213 N. Nixdorff et al. Potentially inappropriate medications and adverse drug effects in elders in the ED. AJEM 2008 26: 697–700 Tables and figures NO. of PIM/prescription Number of patients N=110 Percentage 1 44 40 2 50 45 3 14 13 4 1 1 5 1 1 Table no:1 Number of PIM per Prescription sl no category no. of PIMs percentage 1 PIM drugs/classes to be avoid in geriatrics (category I) 195 90 2 PIM to be avoided in certain pathological condition (category II) 12 6 3 PIMs to be used with caution (category III) 8 4 Table no:2 Categories of PIM sl no Drugs No. of Patients sl no Drug No. of Patients 1 Alprazolam 57 (29%) 16 Nitrofurentoin 3(1.5%) 2 Clonazepam 17(9%) 17 Mirtazapine 2(1%) 3 Hyocyamine 10(5%) 18 Cyproheptidine 2(1%) 4 Lorazepam 10(5%) 19 Diazepam 2(1%) 5 Hydroxyzine 10(5%) 20 Piroxicam 2(1%) 6 Zolpidem 10(5%) 21 Prochloperazine 2(1%) 7 Ketorolac 10(5%) 22 Chlorphemiramine 2(1%) 8 Aceclofenac 9(4.5%) 23 Trihexylphenedine 2(1%) 9 Propoxyphene 8(4%) 24 Digoxin 2(1%) 10 Diclofenac 7(3.5%) 25 Phenobarbitone 1(0.5%) 11 Spironolactone 6(3%) 26 Naproxen 1(0.5%) 12 Prazosin 5(3%) 27 Clinidium-chlordiazepoxide 1(0.5%) 13 Clonidine 5(3%) 28 Indomethacin 1(0.5%) 14 Chlordiazepoxide 3(1.5%) 29 Metachlopramide 1(0.5%) 15 Amitriptyline 3(1.5%) 30 Pheniramine 1(0.5%) 31 Pentazocine 1(0.5%) Table no: 3 Category 1(PIM drugs/classes to be avoid in geriatrics) Sl no Drug Disease No. Patients Percentage 1 Ketorolac CHF 1 8 2 Hydroxyzine Constipation 2 17 3 Hyocyamine Constipation 3 25 4 Ketorolac PUD 2 17 5 Cyproheptidine Constipation 2 17 6 Clonazepam Frequent Fall 1 8 7 Insomnia Theophyllin 1 8 Table no: 4 Category II (PIM to be avoided in certain pathological condition) sl no Drug No of Patients percentage 1 Mirtazapine 2 30 2 Fluoxetine 1 10 3 Sertraline 1 10 4 Duloxetine 1 10 5 Escitalapram 3 40 Table no: 5 Cateegory III (PIMs to be used with caution) NO OF INTERACTION PERCENTAGE PIM-PIM 16 12 PIM- OTHER DRUGS 39 30 OTHER DRUGS 76 58 Table no:6 Categories of Drug Interactions Sl No Drug DRPs Total Drug Risk Ratio 1 PROCLORPERAZINE 8 2 4.00 2 PHENOBARBITONE 2 1 2.00 3 DIGOXIN 4 2 2.00 4 PENTAZOCINE 2 1 2.00 5 DULOXETINE 2 1 2.00 6 NAPROXEN 2 1 2.00 Table no.7 Drug Risk Ratio Sl no Varience No. of comorbidities Chi squire value P value 1 2 ≠¥ 3 1 No. of PIMs 1 5 21 13 12.76* 0.05 2 10 12 15 ≠¥ 3 7 15 12 2 No. of drugs 6-8 13 16 4 26.77* 0.001 9-11 8 25 17 ≠¥ 12 1 7 19 Table no:8 Association of no. of comorbidities with no. of drugs and PIMs . varience No. of Drugs Chi squire value P value 6-8 9-11 12-14 ≠¥15 No. of PIMs 1 16 21 4 3 21.76* 0.001 2 14 24 8 4 ≠¥ 3 2 5 5 4 Table no: 9 Association of no. drugs and no. PIMs Sl no Varience No. of DRPs Chi squire value P value 0 1 2 ≠¥3 1 No. of PIMs 1 11 21 10 2 21.76* 0.001 2 7 23 8 12 ≠¥ 3 1 4 2 9 2 No. of drugs 6-8 9 15 11 1 11.77 0.05 9-11 4 25 6 12 ≠¥ 12 6 8 3 10 Table no:10 Association of DRPs with no. of drugs and PIMs Fig no:1 Prevalence of PIMs Fig no:2 Number of Drugs Prescribed per Patient Fig no:3 Number of PIM per Prescription Fig no: 4 Adverse Drug Events and Its frequency Fig no:5 Adverse Drug Events and Its Frequency

The English Reformation Essay -- Literary Analysis, Dickens

The book I chose to review for this assignment is entitled The English Reformation by author A. G. Dickens. The book describes the processes that led to religious transformations and provides an excellent overview on the Reformation in England. The work thoroughly analyzes the political, economical and social aspects of the Reformation in the sixteenth century. The English Reformation, first published in 1964 is a great source of information for anyone who is interested in the history of the religious transition and change. The author of The English Reformation aims to analyze and explain the complex processes that have taken place during the reign of Henry VIII and his successors. He investigates the background and defines conditions for the religious transformation. A. G. Dickens set out to carefully examine the complex processes of the English Reformation by describing the state of the religious affairs in the late medieval England. He believes that traditional catholic religion was to some extent based on superstitious beliefs and folk‘s legends. He begins his book by telling a story of a knight who robs passing travelers but maintains a pious vigil to Virgin Mary. His devotion to Holy Mother professed by his daily prayers saves him physically and spiritually. The knight is warned of the mortal danger and allowed to change his conducts. It seems that these kinds of legends mixed with Christian sentiments were commonly absorbed by people. A. G. Dickens writes: â€Å"†¦its e ffort to attain salvation through devout observance, its fantastic emphasis on saints, relics and pilgrimages...† (4). These views were contrasted with the ideas of Lollards and the teachings of John Wycliffe. Their emphasis on sole aut... ...n that Lollardy consists mainly of artisans and tradesmen. It seems that the rebellious ideas might have originated with educated individuals but were propagated by commoners. A. G. Dickens proves that social and economic prominence was significant in spreading the protestant ideas. He writes: â€Å"Tudor provincial society contained large mobile elements and the part played by wandering cloth-workers in the dissemination of heresy has already been observed.†(33). The English Reformation by A. G. Dickens is an extensive and thorough account of the political and religious reality of sixteenth century England. The work examines and describes all processes that led to the religious transformation. The great events of the Henry’s reign are explained carefully, comprehensively and clearly, making the work highly regarded analysis of the English Reformation.

Week 3

What was Francis Henry Galton's major contribution to forensic science? Francis Henry Galton’s major contribution to forensic science was fingerprinting. Although he wasn’t the first person with the idea of fingerprinting, he was more successful with the idea and the scientific knowledge that he knew. 2. Who is known as â€Å"the father of forensic toxicology† and why? Mathieu Orfila is known and â€Å"the father of forensic toxicology†. In 1814 he published the first book on poisons and how they affect animals.He is also known to be the creator of criminalistics. 3. Name two major contributions to forensic science made by Hans Gross. Hans Gross wrote the first book on scientific disciplines in criminal investigation. He also wrote a journal on forensics that is used to detect crime. 4. With what area of forensic investigation are Karl Landsteiner and Dr. Leone Lattes associated? Landsteiner and Dr. Lattes both associated in Forensic Medicine. Landsteiner discovered that blood could be put in different groups.After Landsteiner’s discovery Dr. Lattes established that different bloods could be used to identify people. 5. Who was the first person to apply the principles of forensic science to a working crime laboratory? 6. What is Locard's exchange principle? Locard’s exchange principle is a cross-transfer that happens when two objects come into contact with each other. When two objects hit each other materials are exchanged. For example when two cars collide into each other the paint transfers to the other car.He believed that particles from a crime scene would be transferred to the criminal. 7. With what instrument did Dr. Walter C. McCrone make significant contributions to forensic science? McCrone brought the microscope into the forensic science field. The microscope is a great use for close up examination of objects used. McCrone ended up becoming the world’s preeminent microscopist. He was very dedicated to hi s work and knew what he was doing.   

Maersk Group (Maersk) Human Resource Development

Introduction My 48 hour exam project is a case study of A. P. Moller – Maersk Group (Maersk); the objective of my assignment is to elaborate on Maersk`s talent management challenge, focused on development. Furthermore I will describe the cosmos of Maersk learning and competence development and provide alternative angles of conducting in this cosmos, in accordance with my own perspective. My ontological standpoint for this exam is constructivism (Olsen & Pedersen, 2005). The reality perceived is therefore not objective but created, or constructed, by man’s interpretation.This does not signify that I will avoid handling theories that are ontological objectivistic in order to discuss and compliment the various learning and competence development challenges of Maersk; but rather discuss the objective views and theories, and its contrasts to my standpoint. Organizational Change at Maersk Maersk have developed from a very standardized, family run company with certain and spec ific ways of running things; to a worldwide organization that have had to change in order to keep up with the time and trends.The major change in Maersk way of dealing with their learning and competence development occurred in 2008; Maersk had before 2008 a very objective approach to learning which were aimed towards trainees (Case, Page 7). In 2008 the People Strategy Sessions (PSS) is created and a shift towards a more individual development process has begun. PSS is developed to identify individuals, primarily in top management positions, that have a necessity for learning and competence development. These individuals is identified via Key Performance Indicator (KPIs) Learning and Competence developmentHolt Larsen defines competence as a result of a learning process (Holt Larsen, 2010). Competence development is therefore the learning process where the Maersk employees’ know-how and skills are improved; where the employee becomes good at what is required, and not just real ly good, this is what Holt Larsen believes falls under qualifications (Holt Larsen, 2010). Competence development therefore results in the employee’s knowledge, within a specific area of expertise, growing deeper and more elaborate.This knowledge is then transferred into actions, the employees ability to use his or hers knowledge in concrete and unknown situations is therefore an indication on whether or not the employee is competent, hence; good at what is required. Holt Larsen elaborates on this by stating that an employee can be qualified to do his job, but if the attained knowledge cannot be transferred into action due to, for example; the company culture, what the employees are allowed or what the employee’s experience allow him to have the courage to do.Then the employee can be defined as incompetent, since the assignment is not completed (Holt Larsen, 2010). Holt Larsen mentions three learning barriers (company culture, rules and confidence) that affect some emp loyee’s ability to complete their assignment in tasks where their competences fall short. When an employee began his or her career in Maersk, they would possess formal competencies (Ellstrom & Kock, 2008) in the form of, for example, a high school or a college degree (Case, page 8).Maersk’s old way of providing learning and competence development to their employees can through my perspective be seen as a very universal, or objective, way of providing competence development. The standardized development programs were, in Maersk’s defence, designed for employees who did not possess competencies that exceeded the formal kind. The Maersk learning and competence development strategies that came after 2008 were also designed to include experienced individuals (Case, Page 7) who already possessed actual competencies.An example, based on the theory, of an employees’ actual competence development (Ellstrom & Kock, 2008) could be a result of; job rotation in the fo rm of assignments in various different Maersk departments. Furthermore internal evaluations, on the job training; informal learning in work and mentoring by superiors (Ellstrom & Kock, 2008) would be advisable to Maersk. The latter mentioned experiences can be seen as a way of developing the Maersk employee’s competences (Wahlgreen, 2002).Which one of the latter mentioned experiences that works best, is according to my standpoing depending on the individual employee that it is applied on; this correlates with the Maersk initiative â€Å"talent intimacy†, where the managers were encouraged to acquire the knowledge on how each of their individual employees learns best (Case, Page 10) In order to understand the terms learning and competence, one has to understand the similarities and contrasts between them. According to Hermann learning is a process were competencies is enabled. Learning is consequently he most important part of the competence development process (Hermann , 2003). In the case of talent intimacy Maersk is therefore able to archive competence development by the managers acting on behalf of Maersk, to learn about the individual employees; hence, the organization is learning. The latter correlates with Argyris & Scons theory of Organizational Learning (Argyris & Scons, 1996); the talent intimacy process encouraged the managers to act as agents (Argyris & Scons, 1996) which enabled Maersk to learn as an comprised entity, containing individuals.This can be seen as a shift away from the more objective way of evaluating and developing the employees that Maersk made use of before 2008, and is very much aligned with my standpoint. The learning is therefore facilitated vertically by means of the subjective way that Maersk observes its employees. In contrast, Maersk has developed an increased focus on KPIs when evaluating their employees. This objective way may hinder learning and the division of knowledge to spread horizontally throughout the o rganization. They KPIs of Maersk is linked to a reward system; according to Elkj? (2005) it can â€Å"hinder a productive organizational learning, if the behaviour in the organization influenced by defensive communication forms† (Elkj? r, 2005, Page 41). The managers can perceive that they have something to lose by sharing knowledge horizontally in the organization, if sharing could have a negative consequence on their own KPIs, or a positive influence on the KPIs on they co-workers/†competitors†. Elkj? r elaborates â€Å"win/loss behaviour draws attention away from finding and correcting errors. And instead moves the attention towards the individuals protection of themselves† (Elkj? r, 2005, Page 42).This problem can be worsened or alleviated by group size (Laezear & Gibbs, 2009), individual performance evaluation will have a tendency to distort the incentives of the individuals and therefore create fewer incentives for the Maersk employees to cooperate wi th their co-workers (Laezear & Gibbs, 2009). Regrettably measuring group or business unit’s performance increases the risk and decreases the controllability of the measurement. This learning process at Maersk, it seems, is either facilitated or hindered by the New HR processes; depending whether the processes subjective or objective.On the basis of this it would therefore be advisable for Maersk to use other angles, dimensions and parameters when identifying, evaluating and categorizing their employees, with the purpose of learning and competence development What should Maersk do with their high- and low performing employees? Concerning identifying, evaluating and categorizing; Since the development plans of the Maersk employees is based on evaluation and categorizing, it is relevant to look into various theory and ways of doing just that.Employees are often divided into top performers and poor performers, or A- and B employees (Naqvi, 2009). In the Case of Maersk the employe es are categorized as High Performers, Successful and Less Successful (Case, Page 6). According to Naqvi (2009) employees should not only be retained, but also nurtured for elevated responsibilities. Correspondingly, the mass of B employees should continuously be developed and trained for better performance, making optimal use if the employees competencies (Naqvi, 2009).The theory of Naqvi therefore corresponds with the process created by Maersk to analyse which leaders that underperform and therefore is in need of learning and competence development (Case, page 9 and 10). According to Stevens (2008) it is important to identify the skills that distinguish top- and poor performers from each other. By doing so it will become possible to; get an accurate job match with the right people getting the right jobs, to advance in succession planning, to provide a high level of job satisfaction and to accurately identify training- and competency development needs.The objective perspective; whe re talent is objectified as a size that can be measured, grouped and categorized, is very similar to the concept, talent management as fit tool (Schuler and Jackson, 2008).. Through this perspective talent is reduced to pieces of a puzzle, where it is up to the management to select, measure and assemble all the pieces in a manner that conform with the business strategy; subjectivity is thus ignored. I will elaborate on this concept later on.If the necessity to divide the employees of Maersk into groupings is inevitable due to; for example, the need to ease the top managements evaluations and discussions regarding the employees or to lower evaluation costs: A less simplified and general model could be utilized (appendix: 1) (Haskins and Shaffer, 2010). The 9 grid talent matrix is a more advanced, but still a straightforward way of evaluating an organizations talent pool. The horizontal axis considers the performance while the vertical axis considers the leadership potential. The 9 gr id alent matrix is an excellent method of identifying development needs amongst the employees. In addition it promotes dialog amongst the management team and consequently provide an adequate assessment, compared to if it was one person who evaluated the employee, as well as calibrating the different manager’s ratings and expectations. Both Maersk evaluation approach and the 9 grid talent matrix has the advantage that they are relatively easy to approach and rather inexpensive. The disadvantages of them is that they are very one-dimensional, in the sense that it the person being evaluated is only being evaluated by his or her superiors.A potential multidimensional evaluation approach at Maersk could be a 360 degree performance evaluation (Burton & Delong, 1998). In this approach the subject is being evaluated by both his superiors, co-workers, subordinates, costumers/suppliers and by himself. This evaluation system should consequently portray are more complex and adequate eval uation compared to the one-dimensioned evaluations. The 360 degree system essentially facilitates and creates individual development plans for the subject.Another advantage to the 360 degree evaluation is that it uncovers good performers that may not do well in the act of promoting themselves. Furthermore it uncovers individuals that might be a little too good at promoting themselves. A general disadvantage with subjective evaluations, one-dimensional as well as multidimensional, is that they suffer from grade inflation (Laezear & Gibbs, 2009); this implies that people are reluctant to give low ratings; it is therefore hard to distinguish performance and to show the best and worst performers.The disadvantage of the 360 degree evaluation is that it is time consuming and therefore the evaluations costs are higher, compared to the subjective ways of evaluating. This is arguable a fact that should be acceptable to Maersk to ignore, since the PSS evaluations only comprise of the top 120 positions in the company (Case) What seems obscure is that Maersk chooses to move away from the objective approach when it concerns competence development. But when choosing who to actually provide with learning and competence development they make use of something as objective as performance indicators.As one Maersk employee puts it; â€Å"Maersk Line is incredibly driven by objective settings and Key Performance Indicators (KPIs) and schemes that dictate behaviour† (Case, Page 7). Concerning the high performing employees at Maersk; Maersk emphasizes a great deal on performance when evaluating the individuals in the top positions of the company, but could other parameters be applied in conjunction with performance? And how should they act towards their high performing employees? It is an interesting actuality that almost all high-potential (HIPO) employees are high performers.But only approximately 29% of high performers have the potential to succeed in higher senior positio ns (Corporate Leadership Council, 2005). In correlation 47% of high performers is not HIPO`s due to shortcomings in aspiration (Corporate Leadership Council, 2005). These low performers have the highest, 44%, probability of succeeding at the next level. In comparison high performers with shortcomings in engagement consist of 48% of the high performers who are not HIPO`s, and they do only have 13% probability of succeeding at the next level.The high performers, who have shortcomings in ability, have a 0% probability of succeeding at the next level (Corporate Leadership Council, 2005). On the basis of this it would therefore be advisable for Maersk to explore the development opportunities and increase the ambition levels, amongst the high performers with short comings in aspiration. With the remaining high performers it would be advisable for Maersk to keep them motivated in their current positions.Concerning how Maersk should act regarding, improving the performance, through developm ent, amongst the employees where it is needed; Under Allen (Case) the idea for a more individualized employee training, that is applied due to low performance has been a process used by Maersk since 2008. It is a commonly expressed proposal and notion, that all companies will be able to enhance their operational and fiscal performance by developing and incorporating HRM practices with the aim of an increased performance (Kaufman, 2010).The Strategic HRM processes that are perceived as being able to increase the performance are described as high-performance work practices (HPWPS) (Kaufman, 2010). The HPWP entail various ways of increasing the employees performances as a result of providing better work conditions, by means of; introducing compensation incentives, by providing the employees with job training which will enable them in performing new ssignment, do better in their existing assignments and give the employees a greater sense of belonging at Maersk, additionally a higher lev el of job flexibility, amongst other things, should help increase the employees satisfaction, motivation and decreasing the employee turnover, thus retaining them, these aspect would all lead to a higher performance and productivity. By attempting to differentiate between the different theoretical aspects and their link between the HRM processes and the organizational performance, they are separated into three perspectives (Kaufman, 2010).Pfeffers Universalistic perspective has identified seven HRM practices that will succeed in increasing performance when implemented, in all situations, due to the fact that they are universal: employment security, selective hiring of new personnel, decentralized decision making and self-managed teams, pay-for-performance, extensive training, reduced status differentials and information sharing. The universalistic perspective can be perceived as a very objective view.The truth discovered in the factors effects are therefore according to ontological objectivity (Christensen, 2002) seen as a final, universal, absolute and concluding truth and knowledge, which cannot be distorted by the individuals subjective way of considering the findings. Via the Configurational perspective (Kaufman, 2010) the combination of the various practices and the impact of these is lesser simplified than with the universalistic perspective and would therefore enable the possibility to better grasp the angle that is required in order to archive performance enhancement amongst the employees at Maersk.The concept behind the configurational perspective is that some of the practices have a synergetic link with some of the other practices which will lead to an increased performance enhancement when combined. The practices will as a result perform better if they are equally aligned in a synergetic and parallel package, which will therefore fit horizontally. Correspondingly the practices will implement in a more optimal way if they complement and are aligned w ith Maersks business strategy in a vertical fit.The concept of fit is therefore relevant from my standpoint, as opposed to the universalistic perspective; it is meaningful in the case of Maersk to mention the proposition of the Best Fit (BF) model (Kaufman, 2010). The concept of the BF model is that the optimal practices and practice combinations vary in accordance with the unique and concrete in the specific situation. The concept of BF correlates with Allen`s and Maersk HR idea of individualized employee training the concept of talent intimacy; and consequently correlates with my standpoint. Maersk Talent management – perceived as a fit toolMaersk have through their newly developed People Strategy Session (PSS), attempted to create a process that ensures â€Å"getting the right people in the right jobs at the right time† (Case, Page 5). The talent management (TM) in Maersk can therefore be perceived as a Fit tool. According to Schuler and Jackson (2008) one of the ma in ways that international companies can archive and maintain a global competitive advantage is by effectively meeting the challenges in global TM, in core warranting that they have the right people, with the right competencies and motivation at the right time and in the right position (Schuler and Jackson, 2008).TM used as a fit tool can therefore help Maersk to archive; an optimal utilization of Maersks resources (their employees), a most advantageous productivity and a competitive advantage. According to Schuler and Jackson (2008) the concept of TM is about planning for, attaining, choosing, motivating, developing and maintaining the individuals with the right skill combinations and levels of motivation, both internally and externally, in coherence with the strategic course of the multinational organization in a vibrant and very competitive global environment (Schuler and Jackson, 2008).TM is spoken of as a part of the fit that transients throughout the entire corporation. TM ena bles the possibility to secure that the right talents are placed at the right locations – and this placement of talents should be coherent with Maersks overall strategy. In correlation with the latter mentioned, Maersk should therefore be seen as a puzzle or a jigsaw, where the objective is to get all the different pieces to fit perfectly together.In order to do so, Maersk should make use of HRM processes that can measure the talents competencies, output and abilities, and subsequently find out where they fit. In Maersk the individuals were reviewed and divided based on their performance (Case). When TM is used as a process that assures that the right employee is linked to the right job, TM can be seen as a fit-facilitator. The talent is simplified into performance and objectified as a component that has a certain and transparent internal, that can be measured and matched to a ertain job description. This assumption is only possible if one has a perspective that assumes that competences are measurable and therefore transparent; in the case of Maersk they are measured by performance. Maersk does therefore not take the intangibles or latent (Bramming, 2001) competencies into account. The latent competencies, of the individual Maersk employees, are extremely harder, more time consuming and therefore more costly to plot out. To elaborate, the intangibles (Laezear & Gibbs, 2009) are much harder to quantify.For example, the initial revenues and profit from a business unit may be high, but if the general customer satisfaction is low, it will damage the organization in the long run. A less objectivistic perspective could be that a perfect fit does not exist. No matter what position an employee is put in, he will always have shortcomings and will probably also have skills that exceeds what is required of him. The situation that demands competences that the employee does not possess will therefore drive the Maersk employee to learn (Chambers et al. , 1998) and th erefore develop his or hers competencies.If a perfect fit is avoided Maersk would therefore facilitate the employees learning and developing in their positions, and at the same time the positions would develop with the employees; thus the Maersk as an organization will learn and develop. Conclusion The optimal way of Maersk to act concerning learning & competence development is to provide it in a manner and at a time that the management and the individual employee perceives it as needed; Either in order for the employee to expand its role or performance; within its position, or when the possibility to rise to the next level occurs.It is not recommendable to provide competence development solely on the basis of unsatisfactory performance; the learning and development processes may be at a risk to be seen as a punishment, rather than a privilege and opportunity. Furthermore the increased focus on individuals KPIs will inevitably create internal competition, which will consequently hin der learning, throughout the organization.Regarding identifying, evaluating and categorizing in order to decide which high ranking employees that is in need of employee training, a more complex and adequate evaluation system is recommendable. Furthermore it should not only be the bad performers that is selected for development, through the 360 degree evaluation and dialogue a development plan should be created amongst all participants The high performing employees that do not have the ability or engagement to be a high potential, should be acknowledged for being a high performer, and encouraged and motivated to stay in their role.Concerning the high performers with lack in ambition, the development possibilities and professional reasons for lack of aspiration should be explored. Concerning increasing the performance though development amongst the employees were it is needed, it is advisable to continue to focus on the individuals reasons, the specific situation, what drives and moti vates the employee to learn and develop, and if nothing of the latter is successful, consider if the individual is the right person for Maersk.Regarding placing the right employees, in the right position at the right time; some competencies might be measurable, but some are definitely not. In order for Maersk to grow, positions should not be seen as fixed or static, of course an employee has to live up to certain qualifications in order to do the work demanded by the position. Beyond that, a slight mismatch between the employee and the position will probably lead to a growth and development of the position, as well as the employee; hence will Maersk learn and develop. ——————————————- [ 1 ]. Original text †forhindre produktiv organisatorisk l? ring, hvis adf? rd i organisationen er pr? get af defensive kommunikationsformer† [ 2 ]. Original text †En †vinde/tabe-adf ? rd† tr? kker opm? rksomheden v? k fra †at finde of rette fejl†. Og flytter den i stedet hen pa individers beskyttelse af sig selv† [ 3 ]. A survey of more than 11,000 employees at 59 global organizations