Celiac Disease Presenting as Unexplained Infertility

Celiac Disease Presenting as Unexplained Infertility Title- Celiac disease presenting as unexplained infertility and pancytopenia- A Case Report Abstract – Celiac disease is an autoimmune disorder of the small intestine significant association with several extraintestinal features, such as reproductive disorders in women with undiagnosed celiac disease. Worldwide, CD prevalence is approximately 1%. Several studies suggest a higher prevalence of undiagnosed CD in patients with infertility. A 21 years old Indian woman who presented with history of primary amenorrhea, diminished secondary sexual character, asthenia, history of weight loss and chronic diarrhea. On admission her hemoglobin (Hgb) was 4.2 g/dL. Laboratory investigations confirmed a Immunoglobulin A (IgA) anti-tissue transglutaminase antibodies (IgA-tTG) was markedly elevated to more than 300 u/ml, colonoscopy was normal, Bone mass densitometry revealed osteopenia and hypercellular bone marrow on bone marrow biopsy. Celiac disease diagnosis was made multivitamins, mineral, intravenous iron replacement and gluten free diet replacement treatment was initiated. In order trilineage hematopoiesis, iron deficiency anemia, granulocytic hyperplasia and mild megakaryocytic hypoplasia. Both her platelet counts and white blood cell recovered uneventfully with continuing iron, calcium, vitmine D3 and folic acid supplementation. The possible mechanism for this phenomenon is discussed in this report. Introduction Celiac disease (CD) is a multifactorial chronic autoimmune systemic disease, triggered by gluten consumption in genetically predisposed individuals [1]. Classically the disease is manifested by symptoms of diarrhea, flatulence and malabsorption, however, it is also associated with variable systemic manifestations, including metabolic bone disease, diabetes, thyroid dysfunction and lympho-proliferative malignancies [2]. Worldwide, the prevalence of CD in the general population is approximately 1%; female: male ratio is 2 : 1 [3-7]. Several studies have confirmed the implications of celiac disease on the reproductive health of women. Celiac disease Development in cases of acute leukemia after allogeneic bone marrow transplantation (BMT) from Human leukocyte antigen identical siblings who suffered from celiac disease [11,12]. We report the first case of celiac disease presented as pancytopenia with unexplained infertility in woman Case report A 21 year old Indian woman presented with primary amenorrhea, diminished secondary sexual character, asthenia, history of weight loss and chronic diarrhea. On admission her hemoglobin (Hgb) was 4.2 g/dL (normal range: 11.0–15.1 gm/dL), red cell distribution width (RDW) was 39% (normal range: 11.3–15.5%) and mean corpuscular volume was 63.6 fL (normal range: 79–97 fL). Reticulocyte count was low at 9000/mm3(normal range: 25–100 Ãâ€" 103/mm3), total iron binding capacity of 486 ÃŽ ¼g/dL (normal range: 250–450 ÃŽ ¼g/DL), percentage saturation of 5 and a ferritin level of 3/mcL (normal range: 150 – 400 Ãâ€" 103/ÃŽ ¼L), white blood cell (WBC) count was 3.2 Ãâ€" 103/ÃŽ ¼L (normal range: 4–11 Ãâ€" 103/ÃŽ ¼L) with 4-6 segmented neutrophils. On the bone marrow core sections ring sideroblasts was not found. Bone marrow iron store showed decreased amounts of storage iron. Total colonoscopy was normal. Upper gastrointestinal endos copy showed a loss of folds in the second part of the duodenum and a biopsy from the second part of duodenum showed intraepithelial lymphocytes, flattening of duodenal mucosa, lymphoplasmacytic infiltration in lamina propria, and crypt hyperplasia (Marsh class 3). Immunoglobulin A (IgA) anti-tissue transglutaminase antibodies (IgA-tTG) was markedly elevated to more than 300 u/ml. Bone mass densitometry revealed osteopenia. He was under observation in short intervals at the Oncology clinic with abnormal finding as hypercellular bone marrow on bone marrow biopsy. Celiac disease diagnosis was made multivitamins, mineral, intravenous iron sucrose complex given at a dose of 100 mg twice weekly. Replacement and gluten free diet replacement treatment was initiated. On day 14th of treatment hemoglobin increase upto 6.1 g/dL , WBC count to 6.4 Ãâ€" 103/mcL, and platelets were 195 Ãâ€" 103/mcL. We present the first case of celiac disease that presented as primary amenorrhea with pancytopeni a. Discussion – A patient came to medicine OPD presenting primary amenorrhea, diminished secondary sexual character, asthenia, history of weight loss and chronic diarrhea. However, celiac disease is also associated with variable systemic manifestations, including metabolic bone disease, diabetes, thyroid dysfunction and lympho-proliferative malignancies [2]. Given the extreme anemia and the marginal thrombocytopenia and leucopenia. In to improve erythropoiesis she was initiated on iron replacement therapy. Initially which led decrease in WBC counts and platelet. Even though iron deficiency is related with a reactive thrombocytosis [13], when the severity of the iron deficiency increases lead to normalization [14,15] and infrequently even decrease in platelet counts [16,17,18]. Still The precise mechanism of this is indistinct. Cause of pancytopenia in our patient may be related to decrease density of bone and increase free radical damage to hemopoetic stem cell in bone marrow. Extremely low levels o f estrogen hormone observed in our patient which is associated with bone demineralization and infertility, poor secondary sexual character in female. Conclusion Undiagnosed celiac disease is a jeopardy of infertility and pancytopenia. Pancytopenia may be due to decrease bone density result of that more exposure bone more ( haemopoetic stem cell) to free radical. Due to lack of proper nutrition, ovarian capsule could not protect newly growing follicle which lead to poorly development of estrogen hormone dependent secondary sexual character. Women seeking medical advice for this meticulous situation should be screened for celiac disease and bone density (DEXA scan). Adoption of a gluten-free diet could have a positive knock on fertility in such kind of patients. It may be a potentially modifiable (and treatable) risk factor. Futher, a large scale study prospectively study for bone density and ovarian capsule composition to evaluate association between celiac disease and infertility in woman, pancytopenia to clarify these hypothesis. References – Sà ¡nchez E, de Palma G, Capilla A, et al. Influence of environmental and genetic factors linked to celiac disease risk on infant gut colonization by Bacteroides species. Applied and Environmental Microbiology. 2011;77(15):5316–5323. 1b. Green PH, Cellier C. Celiac disease. N Engl J Med. 2007;357:1731–1743. Rashtak S, Murray JA. Review article: coeliac disease, new approaches to therapy. Alimentary Pharmacology Therapeutics. 2012;35(7):768–781. Ravikumara M, Tuthill DP, Jenkins HR. The changing clinical presentation of coeliac disease. Archives of Disease in Childhood. 2006;91(12):969–971. Rossi M, Bot A. Celiac disease: progress towards diagnosis and definition of pathogenic mechanisms. International Reviews of Immunology. 2011;30(4):183–184. Aggarwal S, Lebwohl B, Green PHR. Screening for celiac disease in average-risk and high-risk populations. Therapeutic Advances in Gastroenterology. 2012;5(1):37–47. Megiorni F, Pizzuti A. HLA-DQA1 and HLA-DQB1 in Celiac disease predisposition: practical implications of the HLA molecular typing. Journal of Biomedical Science. 2012;19, article 88 Bargetzi MJ, Schà ¶nenberger A, Tichelli A, Fried R, Cathomas G, Signer E, et al. Celiac disease transmitted by allogeneic non-T cell-depleted bone marrow transplantation.Bone Marrow Transplant.1997;20:607–9. Borgaonkar MR, Duggan PR, Adams G. Differing clinical manifestations of celiac disease transmitted by bone marrow transplantation.Dig Dis Sci.2006;51:210–2 Schloesser LL, Kipp MA, Wenzel FJ. Thrombocytosis in iron deficiency anemia.J Lab Clin Med.1965;66:107–114. Dincol K, Aksoy M. On the platelet levels in chronic iron deficiency anemia.Acta Haematol.1969;41:135–143. Choi SI, Simone JV, Jackson CW. Megakaryocytopoiesis in experimental iron deficiency anemia. Blood.1974;43:111–120. Lopas H, Rabiner SF. Thrombocytopenia associated with iron deficiency anemia.Clin Pediatr.1966;5:609–616. doi: 10.1177/000992286600501008. Berger M, Brass LF. Severe thrombocytopenia in iron deficiency anemia.Am J Hematol.1987;24:425–428. doi: 10.1002/ajh.2830240412. Mubarak AA, Awidi A, Rasul KI, Al-Homsi U. Thrombocytopenia responding to red blood cell transfusion.Saudi Med J.2004;25:106–109.

Hamlet Essay -- essays research papers

The phrase "there is a hero to every story" has been heard of by almost all. But can this be true if the hero doesn't survive through the story? It all depends on the definition of hero. A person can still be classified as a hero even if they do not live to see the good that they have done or accomplished in their lifetime. This type of hero is a tragic hero. A tragic hero is a good and admirable man of high position who falls to destruction as a result of some great error he commits or some flaw in his character. This meaning can be broken down into three parts. The first is that the person must be in some way distinguished as an honorable person of high stature. The next feature they must possess is some sort of fault or flaw in their character that is often referred to as a tragic flaw. The third quality is the destruction of character due to this tragic flaw, which usually means death. These three characteristics join together to create the framework for a tragic hero. The Character Hamlet, from William Shakespeare's novel Hamlet fits the mold of a tragic hero perfectly as he meets all three of the requirements. The first characteristic, a good and admirable man of high position, is easily covered by Hamlet. He was definitely an honorable person as he was looked up upon by all of the people of Denmark as their prince and next to rule (I.ii.113). This is not the only reason for him to be admirable. His mother found security in him ...

Change Management Essay -- Sustainable Development, Corporate Sustaina

This assignment will discuss the response of the Canadian business market to the force of sustainability. Sustainability includes both sustainable development and corporate sustainability. When sustainable development and corporate sustainability are valued in a company, it aligns the views of various stakeholders, which can lead to financial success. In the past, sustainability was not valued, mainly because of a lack of knowledge and an aversion to the costs of sustainability reporting. However, with increased consumer awareness and the promotion of environmental and social value, more companies are moving towards a state of sustainability. In Canada there has been some adoption of sustainable development. Regulating bodies and third party evaluators have implemented systems to promote a triple bottom line in corporations. TELUS Corporation is an example of a company that is focused on sustainable development. Their vision, policies, and practices all display the company’s s upport for the community, the environment, and the shareholders. While there are still barriers to the adoption of sustainable practices, the market will naturally shift towards a state of corporate sustainability through sustainable development. Assignment #1 Introduction In the business world, there are four forces of change. These are innovation, customer focus, globalization, and sustainability. Innovation involves technological and non-technological advances that create new value for a company. Customer focus entails directing an organization’s efforts towards increasing the value given to customers as opposed to the value kept in the organization. Globalization has lead to integrated markets and has exposed businesses to new risks, such as pol... ...). Conclusion It is evident that sustainability is becoming a strong force in the business world. Environmental issues, such as greenhouse gas emissions, and corporate social responsibility are becoming increasingly important to internal and external stakeholders. Companies can no longer focus solely on financial measures, but must incorporate the triple bottom line into their performance metrics. This will give a company a long-term focus that supports future growth and profitability through sustainable development. Adoption of sustainable initiatives is varied in the market. While companies such as TELUS Corporation can be labeled as a sustaining corporation, others remain in a state of non-responsiveness or compliance due mainly to costs. However, as environmental and social awareness increases, the market will naturally progress towards a sustainable state.

Little Richard’s Influence on Rock ‘N’ Roll History Essay

Rock and roll music emerged as a part of American teen culture during the notably conservative time period in the country’s history which shortly followed the traumatic events of World War II. Being that the genre’s target audience was white teenagers, many Americans- already overwhelmed and on-edge due to the anti-communist movement inspired by the Cold War- were apprehensive about the influence that this up-and-coming style of music might have on their country’s future. America’s youth openly accepted rock and roll’s racially integrated culture of performers and embraced the relatively lewd nature of many songs and performances associated with the genre, much to the dismay of their elders. Richard Wayne Penniman (better known by his stage name, Little Richard) had an important influence on the history of rock and roll music because of his unconventional stage presence and explicit sexuality. Artists such as Little Richard aggressively pushed the envelope, defied social norms and generated controversy. Richard, along with a few fellow pioneers, helped to define rock and roll in its early years, and paved the way for rock and rollers of future generations. Penniman’s work left an everlasting impression on the musical genre and culture that is rock and roll. Considering the time in America’s history during which Little Richard appeared on the rock and roll scene, it is completely appropriate to attribute much of his fame and influence to his unconventional stage presence. The rising popularity of television during the 1950’s fundamentally changed the music industry by presenting artists with an entirely new way to market themselves (or be marketed). Being televised meant that the overall look and presence of an artist played a more crucial role in stimulating audiences; the focus of listeners was no longer solely the sound of the music being produced. Prior to T. V. , music fans were only able to enjoy the sounds of their favorite artist by way of radio and the purchasing of records. In many cases, this meant that if a fan had never seen a live performance or record-jacket photo of a particular artist, it’s possible that they had never seen said artist at all and possessed only a general idea (if any) of what that artist looked like. As television sets became an increasingly popular household item for middle-class American families, â€Å"live performances assumed a new importance for performers of rock ‘n’ roll music, and individual artists and vocal roups sought to cultivate visual characteristics or mannerisms that would set them apart from others and encourage listeners to remember them†¦ but no performer in the early years of rock ‘n’ roll was as visually flamboyant as Little Richard,† (Schloss, Starr, and Waterman 1-75). A fan’s perception of an artist or group became subject to their opinion of the overall image of the performance. At this point in time, listening to the music of a completely respectable, clean cut, well dressed African-American was still considered inappropriate by a sizeable portion of white American society- particularly those living in the South and those beyond their teenage years. Many of these people were hesitant to accept racial integration, and tended to proceed cautiously when (or, more appropriately, if) they chose to do so. These are the same people that were unrightfully, but understandably, so frightened by performers like Little Richard. In order to differentiate himself from other rockers of the time, Richard usually wore heavy make-up and sported his famous pompadour hair style. As a former drag queen, Richard was fully aware of the type of reaction his look would draw from audiences; it’s the reaction he hoped to receive. Though, at the time, society as a whole was unsure of how to react to the statement his image made, â€Å"the†¦ ambiguity of Little Richard’s sexual identity†¦ paved the way for the image of performers such as David Bowie, Elton John, and Prince,† (Schloss, Starr, and Waterman 1-75). Just in case his eccentric outward appearance was not enough to gain the disapproval of parents across the nation, Little Richard put on an absolutely wild stage performance which included dramatic eye rolling and his simultaneous hip gyrating and piano playing. In order to dance and play piano at the same time, Little Richard stood (not sat) in front of the instrument- yet another feature of his performance that was specific to him. Little Richard aimed to gain the attention of his fans by creating an entirely original and exciting performance act. In order to do so, Richard created an image that was totally outside of society’s definition of normal, respectable, and safe. His image was only half of his act, though. It’s unlikely that there were many ‘respectable’ white, American parents around in the 1950’s that were comfortable with the idea of Little Richard having any type of influence over the generation deemed the ‘future’ of their country, much less over their specific children. If there had been anyone left straddling that fence, however, contemplating just how harmful a 24-year-old performer with a whacky haircut and face full of make up could really be, it would be safe to assume that they had never actually heard the man sing. The lewd, scandalous lyrics that completed Little Richard’s unorthodox self-presentation would have provided the final push that landed the aforementioned fence straddler on the opposite side of Richard’s performance, and confirmed the popular idea that â€Å"rock’s musical characteristics indicated a general decline in American taste,† (Schloss, Starr, and Waterman 1-75). While teenagers danced to the sounds of the modified twelve-bar blues accompanying Richard’s shouting vocal style and countertenor whoops, parents instinctively cringed in disapproval of the blatantly suggestive lyrics. Hit songs by Little Richard such as â€Å"Tutti-Frutti,† (Penniman, 1955) and â€Å"Long Tall Sally,† (Penniman, 1956) contained lyrics that were generally non-specific, but overall relatively sexual for the time. Richard’s scandalous appearance, behavior, and song lyrics embodied a sexual tension that managed to both intrigue teenage audiences, and inspire fellow performers. It is this same sexual tension that made society at large not only generally uncomfortable, but also concerned about what other ludicrous notions rock and roll would try to impose upon American culture in the future. Little Richard used rock and roll as a platform to rattle the cages of the music industry, and change society’s concept of what was acceptable, what was normal, and most of all what was popular. It was Richard’s unique image and abrasive song content that simultaneously intrigued and shocked American society in the early 1950s. American teenagers of this time appreciated the power of Little Richard’s performance and embraced Little Richard as the new spirit of rock and roll. Unfortunately, â€Å"in 1957 Richard denounced his work and joined the church†¦clos[ing] his most creative period,† (Oxford University Press). Although the momentum of his influence eventually slowed, it never quite stopped. Rock and roll performers such as Jerry Lee Lewis, the Beatles, and the American Creedence Clearwater Revival all provide examples of music inspired by the work of Little Richard, proving the power of his influence and solidifying the lasting impression that he left on rock and roll.

Marketing & Innovation

Marketing & Innovation â€Å"Because the purpose of business is to create a customer, the business enterprise has two—and only two—basic functions: marketing and innovation. Marketing and innovation produce results; all the rest are costs. † Peter Drucker (The Father of Management Theory) INTRODUCTION Marketing is the activity, set of institutions, and processes for creating, communicating, delivering, and exchanging offerings that have value for customers, clients, partners, and society at large. American Marketing Association 2007) An innovation is the implementation of a new or significantly improved product (good or service), or process, a new marketing method, or a new organizational method in business practices, workplace organization or external relations. (OECD 2005) Four types of innovations are distinguished: product innovations, process innovations, marketing innovations and organizational innovations. (OECD 2005) * A product (service) innovation is th e introduction of a good or service that is new or significantly improved with respect to its characteristics or intended uses.This includes significant improvements in technical specifications, components and materials, incorporated software, user friendliness or other functional characteristics. * A process innovation is the implementation of a new or significantly improved production or delivery method. This includes significant changes in techniques, equipment and/or software. * An organizational innovation is the implementation of a new organizational method in the firm’s business practices, workplace organization or external relations. A marketing innovation is the implementation of a new marketing method involving significant changes in product design or packaging, product placement, product promotion or pricing. The OCED’s definition is too narrow : it reduces the scope of marketing by separating between marketing, product innovation and delivery. If we mixed t he two definition we can propose that with a marketing lenses an innovation is : â€Å"the implementation of a new or significantly improved method, process or practices in creating, communicating, delivering, and xchanging offerings that have value for customers, clients, partners, and society at large† * Innovation in marketing could be related to : * The creation (Iphone), * The communication (Web2. 0), * The delivery (Internet), * Or exchanging (Michelin) * offerings that have value 2 Main objective: Understanding and mastering the process from new ideas generation to new value offering for the stakeholders Degree of differenciation of consumer expectations| Degree of improvement in technology | | Low | High| Low | Continuous innovation(cordless phone)| Market breakthroughts (parabolic skis)| | High| Technology breakthroughts (passage from video players to DVD player)| Radical innovation(cell phone)| Innovation continuum Continuous innovation * Modification to an existing product that does not require a change in learning * Improvement of an existing product without major changes Dynamically Continuous Innovations * Modification to an existing product that requires a modest amount of learning or change in behavior to use it Discontinuous innovation (radical innovation) Major changes in the way we live * Product innovation which break the rules and the norms * New consumption behaviors and use * Technology Example: Sharing documents on Internet, Downloading musics, E-business and virtual stores, Free software, Hybrid cars New product development process 3 Phase 1: Idea Generation Sources of new ideas * Internal idea sources: * Formal research and development * â€Å"Intrapreneurial† programmes * External idea sources: * Customers * Pilot customers : Pilot customers methodsThe estimated annual sales of new products developed based on ideas generated by pilot customers are eight times higher than estimated sales of innovations developed from mor e traditional methods. Pilot Customer: users †¢Brainstorming  : Characteristics of brainstorming | 1. | Write a clear, focused objective | 2. | Select participants for the team | 3. | Prepare for the session | 4. | At the session – Rules for brainstorming. | Rules: * A conversation at the same time * Be focused on the subject * Be visual (drawing) * Encourage crazy ideas * The quantity is more important than the quality * Negative comments have to be avoided No interruptions from outside Role of the team leader: * Contribute to, but not inhibit the flow of ideas * Don’t be too controlling * Encourage participation from everyone * Introduce creative games * Call the â€Å"time out† to review and evaluate ideas that have been generated Method * Write a list of ideas (uses) * Classify ideas thanks to criteria * Find common points between application : â€Å"pseudo segments† 4 Interviews Motivation * Focus group / individual interviews Characteristics of focus group | Group size | 8 to 12 | Group composition | Homogeneous: respondents prescreened | Physical setting | Relaxed, informal atmosphere |Time duration | 1 to 3 hours | Recording | Record all the discussion with sound an video | Moderator | Observational, interpersonal, communication skills | * Individual interview  : Type of interview | Required skills | Structured interview | Neutrality, no prompting, no improvisation | Semi-structured interview | Some probing, rapport with interviewee, understanding the aims of the project | Open-ended interview or depth interview | Flexibility, rapport with interviewee, active listening | Focus group | Facilitation skills, flexibility, ability to stand back from the discussion so that group dynamics can emerge |Characteristics of semi-structured individual interviews | Group size | Face to face, one-one-one basis | Interview structure | Semi-structured, direct, personal interview. Use of an interview guide | Physical setting | Relaxe d, informal atmosphere | Time duration | One hour | Recording | Use of audiocassettes and videotapes | Moderator | Observational, interpersonal, communication skills | * 5 Focus on semi-structural individual interview Questioning style * Open ended, non-directive * Little or no direction on how to answer * Relate to topic in own way * Use own language Probing – for detail, depth, clarification – Prompting – encouraging respondent to answer * Non-verbal, repeating, rephrasing, summarising * Salespeople * Service providers * Anyone with direct customer contact * Competitors  : Companies watch competitors’ ads and other communications (new-product pre-announcements) to get clues about their new products * Distributors, suppliers and others  : Companies watch competitors’ ads and other communications (new-product pre-announcements) to get clues about their new products Example of Brainstorming: anti-odor product First step: write a list of uses * D irty socks, Ashtrays, Changing rooms, Refrigerators, Elevators, Subway tunnels†¦ * Second step: classify ideas * Development of a notation system * A Possible today * B possible soon * C difficult and risky * Criteria * Technicity faisability, cost, market accessibility, competitors, time of solution * Third step: Find common points How customers can use the product| Passage from 80 ideas to 8  « pseudo-market segments  »| What is its added value? | Deodorization public places| Types of customers| Chemicalplants| Places| Household odors†¦. |Phase 2: Product development * Expand ideas into more complete product concepts * Describe features the product should have and benefits those features will provide * 6 Evaluate chance for success * Develop a marketing strategy that can be used to introduce the product to the market place After more than a decade of development, Daimler begins to commercialize its experimental fuel-cell-powered- electric car Next step: to develop th is new product into alternative product concepts – Concept 1: A moderately priced subcompact designed as a second family car to be used around town Concept 2: A medium-cost sporty compact appealing to young people – Concept 3: An inexpensive subcompact green car – Concept 4: A high-end sport –utility vehicle (SUV) appealing those who love the space Phase 3: Marketing strategy development * Develop a marketing strategy that can be used to introduce the product to the market place * Identify the target market * Estimate its size * Determine how the product can be positioned * Plan pricing, distribution and promotion expenditures Phase 4: Technical development * The product moves into product develop RD or engineering develops the product concept into a physical product â€Å"Look beyond simply creating products that satisfy consumers needs and wants†¦ Companies work to fashion products that are both satisfying and easy to manufacture. † Phase 5: Marketing Test * It lets the company test the product and its entire marketing programme – positioning, advertising, distribution, pricing, branding and budget levels Phase 6: Commercialization Launch the product! * Full scale production * Distribution * Advertising * Sales promotion * and more 7 INNOVATING BY SERVICESInnovation and Marketing Decision: The customers’ values issue An economic opportunity exists for an innovation when a new value proposition to customer is possible Agreeing the PSS statement (Product Service System)  «Ã‚  What is important is not our offer but what our customers do with it  Ã‚ », there are three kinds of value propositions for an innovation. Innovation and the first customer’s value proposition: * Customer Values are embedded in a three stages consumption scenario. * These stages define three kinds of value. * Stage 1: Decision (potential value) * Stage 2: The exchange (value in exchange) Stage 3: usage (value in use) Innovat ion in potential value First innovative value proposition: Innovation concerning the facilities The facilities include all company resources: employees, know-how, technology, nominal goods †¦ and other facilities that must be accessible (before offer provision is feasible). Make perceptible the strength of a promise POTENTIAL VALUE from facilities stage in an offer provision scenario, ex IBIS Hotel 8 POTENTIAL VALUE from facilities stage in a service provision scenario: ex vending machine Innovation in value in exchange Second innovative value proposition :Innovation concerning the transformation process This is the stage in which company resources are combined with other companies’ resources in order to transform them. Companies act as prime resources integrators and the innovation consists of new ways of co-operating, collaborating, co-branding†¦Ã¢â‚¬ ¦ In this case, these values in exchange will have to be new values in use for the customers †¦ to be success ful VALUE IN EXCHANGE from the exchange stage in an offer provision scenario: ex Senseo, Nike+ iphone app This transformation stage can also exhibit innovation concerning CUSTOMER VALUE in EXCHANGE.Offer provision can include a transformation of customer resources in terms of persons (surgery, hair cuts†¦), physical objects (e. g. car repairs†¦), nominal good (e. g. investment banking, rights (e. g. lawyers.. ) and/or data (tax advisors†¦)†¦ It contains elements which are either pre-prepared within producers’ facilities, or are co-produced by customer and provider during the integration and the transformation of customer resources. Innovation consists of changing the way of integrating the customers’ resources with those of the producers’ VALUE IN EXCHANGE. Innovation in producers-customers co-production: ex WikipediaInnovation and the third Customer’s Value proposition. Innovation in customer’s value in use The usage stage exhi bits CUSTOMER VALUE IN USE. Innovation consists of proposing to customer new values in use, perceived as new solutions. Ex: Wii for the seniors Definition of servicization The key idea behind product service systems is that consumers do not specifically demand products, per se, but rather are seeking the utility these products and services provide. By using a service to meet some needs rather than a physical object, more needs can be met with lower material and energy requirements. A product service system is a competitive system of products, services, supporting networks and infrastructure. The system includes product maintenance, parts recycling and eventual product replacement, which satisfy customer needs competitively and with lower environmental impact over the life cycle. â€Å"A Product-Service System can be defined as the result of an innovation strategy, shifting the business focus from designing and selling physical products only, to selling a system of products and serv ices which are jointly capable of fulfilling specific client demands. Meeting consumers’ needs with a mix of products and services is not a new concept. House rentals, hotels, taxis and restaurants are good examples based on economic interest. There are other new and innovative applications of product service systems that have developed as a response to make business more sustainable. The main difference between product service systems and the classic examples is that the preference of consumers is influenced by environmental, as well as economic interests.Source: UNITED NATIONS ENVIRONMENT PROGRAMME DIVISION OF TECHNOLOGY, INDUSTRY AND ECONOMICS 10 Innovation by servicization : an attractive way to Innovate on the markets Three ways to develop innovation by servicization : 1- Product oriented services Provided to increase or optimize the product life cycle, these supplementary services are offered to guarantee functionality and durability of the product (e. g. maintenance an d repair, upgrading and substitution services over a specified time period, advise and consultancy for use optimisation, etc. ). 2- Usage oriented servicesThe product is made available in a different form to the customer, is sometimes shared by number of users, but stays in ownership with the provider. It is the usage of the product rather than the product itself that is invoiced, without transfer of ownership (e. g. car sharing or car pooling, tools location, financial leasing, etc. ). Ex: http://www. lamachineduvoisin. fr/ 3- Result-oriented services (functional economy) Result-oriented services (or functional services): in this most accomplished form of servicization, the seller does not sell a product anymore to the customer, but the desired result rendered by the product.Rather than selling pesticides to farmers for example, the seller decides to offer a global service contract that guarantee a maximal acceptable loss on crops. A BM based on the sold products quantity A BM base d on a service rate Sell a maximum loss rate on crops Firm in functional service is looking for less costly alternating solutions as the reintroduction of parasitics predatories or the earth reoxygenation by earthworms or using R&D in biology, agronomy, entomology.. The competitiveness of the seller depends on its ability to optimise the PSS implemented to reach this goal and to use the least possible resources and energy to reach the targeted acceptable loss. Such functional services are implemented with great success by companies such as Xerox (Xerox Global Services) or Michelin (Michelin Fleet Solutions) for example.

Hebrew Covenant Essay

The most insightful and genuinely inspired notion of the Hebrew world view is the concept of the berit involving God and His chosen people. Interpreted into English as â€Å"covenant,† the term denotes a little closer to â€Å"promise,† or â€Å"pledge. † In the â€Å"promise† to Abraham, God picks Abraham and his offspring as a particular people, in fact, as the only people of God. He assures Abraham that his progeny will inhabit and possess the lands of Palestine, that they will be immeasurable, and that they will benefit from the security and attention of God over all their enemies. It is this promise and the relationship it entails concerning Yahweh, the one and only God, and His people that characterize the Hebrew cultural and historical distinctiveness. The bond implied by the word â€Å"berit† is the relationship involving a lord and his servants, for in Hebrew, a â€Å"berit† is a pledge that is made unilaterally by a lord to his servants that he will defend and provide for those servants. The promise is not compelled by law nor affected on the lord by his servants—it is utterly voluntary. The term â€Å"covenant† stands for â€Å"business deal,† or â€Å"contract,† and suggests a promise to provide one end of the contract if the other end is met. But a covenant is a two-sided arrangement; it obtains the participation of both parties and they are obligated only by the stipulations of the covenant or agreement. God’s berit, on the other hand, is carried out unilaterally exclusive of the involvement of Abraham or his people in the agreement. Abraham is merely chosen. As implied in the word, the relationship of God to his chosen people is a connection of a lord to his servants; the chosen people, as servants, owe to God first and foremost obedience. In this sense, the Abrahamic berit is open-ended; by picking Abraham’s offspring, God is requiring of that offspring absolute submission and deference for all the rules to come in the future. For God has not bared His regulations to His chosen people in the time of Abraham; that will appear centuries later when the Hebrews are set free from Egypt. Reference: 1. Hooker, Richard, World Civilizations, 1996.

Talking About Your Period in French

Talking About Your Period in French This happens to every woman. Yet, books are quite shy when it comes to this vocabulary, a skill that we thought could be useful for women traveling to France. First, let’s explore some French expressions to say to have your period. Avoir Ses Rà ¨gles The most common way to say to menstruate is â€Å"avoir ses rà ¨gles†. Les rà ¨gles is a feminine plural word.   Avoir des rà ¨gles douloureuses: to have painful periodAvoir des crampes menstruelles: to have menstrual crampsLes dernià ¨res rà ¨gles: last menstrual periodLe dà ©but / la fin des rà ¨gles: beginning/end of the periodUn cycle d’ovulation: menstrual cycle Note that the word les rà ¨gles is always feminine plural when used for menstruation. Une rà ¨gle is a rule or a ruler (a plastic piece used to draw lines). The context will make it clear which one you are talking about. Tu as tes rà ¨gles: Do you have your period?Tu as une rà ¨gle: Do you have a ruler? Être Indisposà ©e This means to be indisposed, unwell. But it the chosen expression to say in a subtle way to you have your period. Cette jeune fille ne peut pas aller la piscine, elle est indisposà ©e.This young girl cannot go to the swimming pool, she is indisposed. Avoir Ses Ragnagnas I have no idea where this one comes from, but â€Å"ragnagnas† sounds like someone complaining, protesting†¦ which women often do when they menstruate. So that would be my personal interpretation of the expression! Les Anglais ont Dà ©barquà © Definitely one of the strangest French idiom out there. It translates as â€Å"The English have landed† (from a boat). So, what is the relation between English and menstruating? Well, this expression dates back to Napoleon and the British army, then called the redcoats. Go figure! Although this expression is somewhat old-fashioned, it is still used, often kind of as a joke. Dà ©solà ©e, je nai vraiment pas envie daller faire cette randonnà ©e. Je ne me sens pas trà ¨s bien... enfin, pour tout te dire, les anglais ont dà ©barquà ©. Bref, jai mes ragnagnas, jai des crampes et je nai quune envie : rester au lit!Sorry, I really dont feel like going on this hike. I dont feel very well... Well, to tell you everything, Aunt Flo called. In other words, Code Red, I have cramps and I just want one thing: stay in bed! French Vocabulary for Period Products Les protections hygià ©niques: sanitary protectionsUn tampon: a tamponAvec/sans applicateur: with/without applicatorUne serviette hygià ©nique: a sanitary pad / a pantylinerAvec ailettes: with wingsUne coupe menstruelle: a menstrual cupSaigner: to bleedUn saignement: a bleedingUne tà ¢che: a spot Cultural Note About Menstrual Pain As in many countries, speaking about ones period is not considered a proper conversation. French women seldom disclose to girlfriends that they are on their period or discuss their menstrual pains. We would just say that we are tired. Of course, everybody is different.