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Incidence is highest during the months immedi ately following the procedure chronic gastritis guideline cheap imodium 2mg with visa, and the majority of zoster cases occur within a year of transplantation (130132) chronic gastritis mild best purchase imodium. Sex Results from a large gastritis diet buy 2 mg imodium mastercard, randomized gastritis diet juice discount 2 mg imodium with visa, controlled vaccine trial in the United States (4) indicated that the incidence of confirmed zoster cases in a cohort of immunocompetent persons aged >60 years was 11% higher among the women (11. A prospective cohort study in the Netherlands documented 38% more cases among women than men (odds ratio = 1. Other studies (13,102104,112) using a variety of methods also demonstrated an age-standardized excess of zoster among women. Other Co-morbidities the risk for zoster appears to be elevated in persons with inflammatory diseases; however, for most of these condi tions, data are insufficient to determine how much of the risk is attributable to the underlying disease versus its treat ment. The risk for zoster also is increased among persons with rheumatoid arthritis (adjusted hazard ratio = 1. For all these conditions, zoster is gen erally not life-threatening, although cutaneous dissemina tion is more common, and deaths have been reported in such patients (138,141,142). Certain studies have evaluated the risk for zoster in per sons with other noninflammatory co-morbid conditions, although findings have not been consistent. Two studies have documented an association between zoster and diabe tes mellitus (148,149). Another study documented an increased risk for zoster in persons who subsequently had multiple sclerosis diagnosed (152). In addition, zoster does not have a seasonal pattern to suggest it is spread directly from vari cella (13,28,38,92,105,117). An analysis of surveillance data from the United Kingdom indicated an inverse relation between annual varicella incidence in children aged <5 years and zoster incidence in adults aged 1544 years (117). A casecontrol study in the United Kingdom (15) documented a graded reduction in zoster risk as a function of number of varicella contacts over a 10-year period. Multivariate analy sis suggested a 74% reduction in risk for zoster among per sons with three to four varicella exposures compared with those with no exposures, with a significant trend suggest ing some reduction with fewer than three exposures. Social contacts with children (as a proxy for varicella exposure) and occupational contact with sick children were protec tive (15). A cohort analysis based on data from a sentinel physician network in the United Kingdom (155) suggested that adults living with children had both increased vari cella exposure and a 25% decrease in zoster incidence. However, persons living or interacting with children might have different underlying health compared with persons without expo sure to children, which might be a confounder in these studies. Other evidence that varicella exposure might pro tect against zoster includes possible effects household exposure to varicella had against subsequent development of zoster among children with leukemia (156). Contrary evidence also exists that varicella exposure does not reduce the risk for zoster. Women are at greater risk for zoster (13,102,103,110,111) despite the fact that women probably have more exposure to young children who expe rience varicella. A Japanese study indicated that the risk for zoster in children was not diminished by repeated varicella exposures (92). However, only two rigorous evaluations of the role of psychological stress on zoster have been conducted. A case-control study documented a sig nificant association with number of stressful life events within 6 months of reported zoster (p = 0. Such a development would seem to be specific and easily ascertained, and certain reports and case series describe such events (158161). One case-control study collected information about recent trauma and/or surgery in patients who developed zoster and in matched controls. The basis by which these stimuli provoke zoster is unclear, but they suggest that nonimmunologic factors can play important roles in the pathophysiology of zoster. Finally, one study indicated that dietary micronutrient intake was protective against zoster. Observed rates have varied substantially on the basis of methods for case ascertainment, access to health care, and case definitions. The age distribution in the population being studied also is an important consideration when com paring these studies because zoster can vary dramatically across study sites.
We provided relevant insights for scholars and managers focalizing in a specific and less explored business context using the logistics service quality model gastritis and esophagitis imodium 2mg for sale. Whereas logistics traditionally has referred to the physical flow connecting production with customers gastritis remedy food generic 2mg imodium free shipping, modern research in logistics aims at integrating marketing notions and addressing the role of logistics in delivering quality and improving customer service and satisfaction gastritis symptoms belching buy imodium with amex. Companies can achieve success by not only providing good products but also offering effective services and developing good relationships with supply chain members gastritis healing time discount 2 mg imodium mastercard. To enhance their competitiveness, many companies outsource some activities, which enable them to improve their operational efficiency, to reduce costs, to focus more on their core competencies and to improve their innovation capabilities (Wagner and Sutter, 2012). Outsourcing thus spans multiple business functions, such as information technology management, service, logistics, manufacturing, financial services, and human resource management. Companies use their logistics network to deliver products to their customers, and therefore, it can significantly impact firm performance. As an important service sector in all developed economies, third-party logistics offers a pertinent empirical context. We also considered two more constructs: returns management and customer value anticipation. The main issue was to understand what the drivers of logistics service quality are to deliver satisfaction and word of mouth in 3pl-customer relationships. One dimension that appears increasingly relevant for customer satisfaction is returns management (Mollenkopf et al. This can be reached through the understanding of future requests for particular products and services from the demand. Second, the evaluation of nine multi-item constructs was requested: personnel contact quality, information quality, order procedure, order accuracy, order condition, order discrepancy, timeliness, returns management, customer value anticipation about the service provided by the supplier. All items were evaluated on a seven-point Likert scale (1 = highly dissatisfied, 7 = highly satisfied). This confirms also in the B2B context how positive referral behavior does depend on previous positive experience with the supplier. Further studies should investigate perceived overall satisfaction in different industry sectors, such as electronics, fashion, or furniture. Due to the specific business context of the analysis, this research serves to guide further research on inter-organizational relationships that encompass both third party logistics and manufacturer/retailer side and loyalty. Keywords: outsourcing logistics, order placement and distribution, logistics service quality, third-party logistics, satisfaction, business-to-business relationships, word of mouth. Leveraging logistics capabilities: the effect of logistics service on market share. Creating consumer durable retailer customer loyalty through order fulfillment service operations. Service quality and its relation to satisfaction and loyalty in logistics outsourcing relationships. Moreover, the shifts from transaction to relationship and from product to service are becoming always more evident as key success factors in the markets. In such a context, sales is gaining importance in the organizations shifting to a more strategic and cross-functional activity. Among the several strategic elements to be considered in this changed sales paradigm, we choose to focus on one in particular which is becoming increasingly more relevant: the process of returns management that touches numerous functions within a firm. The main objective of this research is to analyze how returns management influences the selling process and how it is perceived across different business functions. From an explorative prospective, a qualitative research was performed to fill in the gap around the phenomenon. We adopt an inductive approach using a multiple case study, interviewing 13 senior managers from five firms of the shoes sector. The main findings show how returns management seems to have an important impact on the selling process because it allows firms to put the customer at the center of their organizations, to improve customer service and after-sales service, and to enhance the relationship through a consultative and/or partnering approach. Most importantly, returns management is becoming an integral part of solution offering. Yet, research shows that many firms underestimate, misunderstand, or overlook these customer expectations. Moreover, the sales function is moving away from this independent role towards a more cross-functional disposition (Storbacka et al. In this regard, at firm level, it is important to find out how companies can best manage the intra- and inter-firm coordination processes effectively and efficiently (Zhang et al. In marketing, the shift has been from transaction to relationship orientation, and the focus has turned to service and relationships instead of products and exchange (Vargo and Lusch, 2011).
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The audiologist serves as a distribution channel for hearing aids manufacturers gastritis diet buy imodium with a mastercard, who produce them gastritis nec imodium 2 mg on-line. Post-fitting of a hearing aid gastritis diet purchase imodium 2mg without a prescription, the person requires education and hearing rehabilitation gastritis diet cheap 2mg imodium with mastercard, and whilst rehabilitation is available, its quality and extent have been reported as both limited and variable (Kelly et al. All these practitioners operate largely in isolation to each other, so that a fragmented structure emerges, where the customer is the only who gets a overall vision of the process. In other words, due to the absence of an effectively functioning service network between the different healthcare professionals, people with hearing loss in Italy must access five different health professionals in order to create the value of the hearing service they require (Vargo and Lusch, 2008). As a consequence, we consider the structure of audiology industry as provider determined and highly controlled, being one of the variables explaining low levels of hearing aids adoption. Importantly, the literature evidences that the technical features of the product are of secondary importance to the person with hearing loss, as opposed to the service and support they require. Audiologists must work independently of other health practitioners and cannot influence the prescription process. Most work in small community-based private practices with their main source of income derived from selling the product rather than providing a service. As a consequence, this creates confusion in their roles and effectively equates them to pharmaceutical companies along with restricting interaction with other health professionals. The absence of coordination and communication among all the actors involved in the hearing aids provision process can result in misunderstanding and distrust in customers and caution and skepticism in prescribers. We contend that industry cultural issues influence consumer access to audiology services and, in turn, hearing aids. To increase adoption, inter-professional collaboration and co-operation is desperately needed, to create a spectrum of holistic consumer-centric hearing services. Thirdly, the operational issues relate primarily to the public financing arrangements which determine the prescribing process and are based on a complex procurement procedure with emphasis on the physical good and its technical features. Further, the prescriber is required to give the consumer a list of all the hearing centers in their area and is forbidden to specify any. There is no stipulation with regards to the quality of the fitting or to the standard of service provided by the resellers. Additionally, up-to-date technologies are almost totally excluded from the listings and those which are listed are usually being superseded. Italian regulation does not however allow the prescription beneficiary to choose an unlisted higher-level product and to pay the additional cost difference to the reseller. The tying of public financing to product supply therefore impacts on the quality of the service and cost to the consumer and arguably influences hearing aid uptake. Figure 1 depicts that structural, cultural and institutional issues act as antecedents of audiology services quality, their ability to meet consumer needs and ultimately consumer hearing aid adoption behavior in Italy. Given the existing industry structure, hearing health service performance does not depend only on one single health professional, but on all those involved in the service chain. Since value creation is interactional (Vargo and Lusch, 2008) arguably, the quality of the existing service process can only be improved through a focus on maximizing the interrelationships and dependencies between all of the members of this "service network". The fitting of a hearing aid should involve not only the product itself but also concomitant diagnostic and rehabilitation service elements. This is supported by the work of Vargo and Lusch (2004), who argue that goods only derive their value through use, that is through the services associated with them (Vargo and Lusch, 2004 and 2008). Whilst people are usually aware of their hearing difficulties and they are not concerned about the quality or cost of hearing aids, it is their uncertainty about the quality of the assistance and the availability of rehabilitation programs, once a hearing aid has been fitted, that is the main barrier to hearing aid adoption. As a consequence, industry changes must consider the development of a service culture that addresses consumer needs, rather than a provider-product focus. Hearing aids themselves should have only a marginal role in industry structure and financing. Primarily the focus should be on the service assess and long-term assistance and support for people with hearing loss, especially given that age-related hearing loss is progressive. Any hearing health program must inform and reassure people with a hearing impairment that there is a network of interconnected professionals willing to work together with them from diagnosis to rehabilitation, to meet their hearing health needs. Essentially, improving the co-operation of all these service network participants is paramount to improving service provision.
A senior civilian official will convert this into a draft for the minister gastritis diet gastritis symptoms discount imodium 2mg online, which the military will be invited to look at gastritis diet zucchini 2mg imodium sale. If the draft is inaccurate gastritis food to eat generic imodium 2 mg, the military will seek to correct it gastritis diet 7 up calories generic imodium 2mg fast delivery, although they will ultimately give way to the civilians on issues of style and structure. The draft will then be submitted to the minister as the collective advice of the department. Thus, the health ministry will have medical advisers, the transport ministry will have engineers, and so forth. The administrative civil servants will deal with their advisers in much the same way as their colleagues in the defence ministry deal with the military officers attached to the ministry. Although there are practical differences when it comes to defence, both of type and degree, it is helpful to bear this essential similarity of principle in mind. In particular, it should be clear to all that the departmental secretary is the head of the department and does therefore have a position of authority over the military staff working for him. A military officer posted to the ministry is, for that term of office, a servant of government, the minister and the secretary. Whilst he will continue to fall under the military chain of command as regards pay and administration, he is for all purposes a temporary civil servant. However, if the breach related only to military law, or had occurred before he joined the ministry, then the matter might be handled by the military chain of command. Designing a well-functioning ministry of defence is probably more difficult than designing any other type of government department, given the huge range of tasks and the wide range of actors involved, as well as the difficulties of coordinating them. Some elements are effectively universal: clarity of roles and functions, minimisation of overlap and duplication, clear reporting lines and unity of effort and purpose. But in the defence area there are in addition some specific questions to be asked, notably: 103 the functions, organisation and working methods of a ministry of defence Which functions will be carried out in the ministry and which elsewhere? Differences between ministries, and indeed relative success and failure, have a great deal to do with how these questions are answered. However, the purpose of the decision-making process in any defence and security system is to develop and implement polices. In the next few chapters I will cover some of the areas that require policy development and implementation. Nothing is more fundamental to the development of a national security policy than accurate information and assessment, particularly as regards the intentions and likely actions of foreign states and other actors. Indeed, there is probably no single capability more valuable to a state than the skill of predicting the likely responses of other states to a given course of action. A classic example is the rather naive Iraqi assumption in 1990 that Western support given during the Iran-Iraq war would continue once that war was over. Logically, this chapter should largely be confined to defence intelligence issues and how defence policy and planning make use of intelligence. However, so much sheer nonsense has been written about intelligence that it is necessary to go back to first principles before moving on to the larger issues. Since the orientation of this book is towards defence, I have structured the discussion towards intelligence about the outside world. In a democracy it is unusual and probably unacceptable for the military to be involved in domestic intelligence collection and analysis, and a military counter-intelligence organisation is probably not very effective in any case. Governments need information as cars need 105 Intelligence petrol if they are to react to events and attempt to determine what could happen in the future. Some of this information will be available from open sources, some from the normal relations between governments, some from privileged relations between specific governments, some from external sources, and so forth. But there is usually an irreducible minimum of information that cannot be acquired in this way and will have to be acquired by covert means if considered important enough. Thus, we can say that Intelligence is the process of acquiring and making use of information from an entity (not necessarily a state) that does not want you to have that information and which does not realise that you have acquired it. First, intelligence is basically nothing more than information collected in a covert fashion and is inherently no more or less reliable than information found in open sources. National security policy planners have to make use of intelligence without giving it a status it does not deserve. As the Butler Report noted sagely Intelligence merely provides techniques for improving the basis of knowledge. As with other techniques, it can be a dangerous tool if its limitations are not recognised by those who seek to use it.
The term literally means "a self that has self-contained goals gastritis cure discount imodium 2mg on line," and it reflects the idea that such an individual has relatively few goals that do not originate from within the self gastritis symptoms after eating imodium 2 mg fast delivery. For most people eosinophilic gastritis diet order 2 mg imodium mastercard, goals are shaped directly by biological needs and social conventions symptoms of gastritis back pain discount 2mg imodium with mastercard, and therefore their origin is outside the self. For an autotelic person, the primary goals emerge from experience evaluated in consciousness, and therefore from the self proper. Therefore the rules for developing such a self are simple, and they derive directly from the flow model. If I decide to learn tennis, it follows that I will have to learn to serve, to use my backhand and forehand, to develop my endurance and my reflexes. Or the causal sequence may be reversed: because I enjoyed hitting the ball over the net, I may develop the goal of learning how to play tennis. As soon as the goals and challenges define a system of action, they in turn suggest the skills necessary to operate within it. If I decide to quit my job and become a resort operator, it follows that I should learn about hotel management, financing, commercial locations, and so on. Of course, the sequence may also start in reverse order: what I perceive my skills to be could lead to the development of a particular goal that builds on those strengths-I may decide to become a resort operator because I see myself as having the right qualifications for it. To become a good resort operator, I have to interpret correctly what the bankers who might lend me money think about my business proposal. I need to know what features of the operation are attractive to customers and what features they dislike. Without constant attention to feedback I would soon become detached from the system of action, cease to develop skills, and become less effective. One of the basic differences between a person with an autotelic self and one without it is that the former knows that it is she who has chosen whatever goal she is pursuing. On the one hand, having a feeling of ownership of her decisions, the person is more strongly dedicated to her goals. On the other hand, knowing them to be her own, she can more easily modify her goals whenever the reasons for preserving them no longer make sense. After choosing a system of action, a person with an autotelic personality grows deeply involved with whatever he is doing. Whether flying a plane nonstop around the world or washing dishes after dinner, he invests attention in the task at hand. To do so successfully one must learn to balance the opportunities for action with the skills one possesses. Some people begin with unrealistic expectations, such as trying to save the world or to become millionaires before the age of twenty. When their hopes are dashed, most become despondent, and their selves wither from the loss of psychic energy expended in fruitless attempts. At the other extreme, many people stagnate because they do not trust their own potential. They choose the safety of trivial goals, and arrest the growth of complexity at the lowest level available. For instance, suppose a person walks into a room full of people and decides to "join the party," that is, to get acquainted with as many people as possible while having a good time. If the person lacks an autotelic self he might be incapable of starting an interaction by himself, and withdraw into a corner, hoping that someone will notice him. Or he may try to be boisterous and overly slick, turning people off with Mihaly Csikszentmihalyi / 211 inappropriate and superficial friendliness. A person with an autotelic self, upon entering the room, would shift his attention away from himself to the party-the "action system" he wishes to join. He would observe the guests, try to guess which of them might have matching interests and compatible temperament, and start talking to that person about topics he suspects will be mutually agreeable. People who suffer from attentional disorders, who cannot keep their minds from wandering, always feel left out of the flow of life. Yet it is amazing how little effort most people make to improve control of their attention. If reading a book seems too difficult, instead of sharpening concentration we tend to set it aside and instead turn on the television, which not only requires minimal attention, but in fact tends to diffuse what little it commands with choppy editing, commercial interruptions, and generally inane content.
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