Right Ventricular and Left Ventricular Cardiogenic Shock

Right Ventricular and Left Ventricular Cardiogenic Shock Cardiogenic shock is a major and often fatal complication of a variety of acute and chronic disorders whereby the heart muscle fails to effectively pump blood forward and is unable to maintain adequate tissue perfusion. This ongoing clinical problem of cardiogenic shock often results from cardiac failure. Nurses and physicians need to work together to develop a rapid and well-organized treatment approach to this devastating condition. Acute myocardial infarction (AMI) is the most common cause and early recognition of cardiogenic shock is essential to saving the patient and functional organ perfusion. To help discuss the differences between right ventricular and left ventricular cardiogenic shock as a result of AMI, a case study format has been chosen. Priority nursing diagnoses, interventions and outcomes will also be addressed. Case Study Mrs. Rudd, a 53-year-old woman, is walking her two golden retrievers in Central Park when she starts to develop a nagging left arm pain radiating up her neck and down to her fingers along with diaphoresis, flushing and shortness of breath. She loses grip of the leashes and the dogs, sensing something wrong, get the attention of a young couple sitting under a tree. They see her in distress and call 911 to get an ambulance. Paramedics arrive on the scene within minutes and transport her to the emergency department at Mt. Sinai Hospital. On arrival, Mrs. Rudd continues to complain of the pain getting more intense and a new onset of substernal pain. The paramedics note her to be pale and clammy with cool and mottled extremities. Her vital signs in the ED are heart rate 56 beats/minute, blood pressure 78/53, respiratory rate 24 breaths/min and labored, pain level of 9/10 and temperature 96.9* F orally. The nurse provides supplemental oxygen at 100% via non-rebreather mask and administers 325mg of chewable aspirin, but holds the nitroglycerin because of her already low HR and BP. Then the cardiac monitor leads are placed, which shows sinus bradycardia;18g IV access is obtained in both arms and blood chemistry, CBC and cardiac enzymes are drawn and sent to the lab. A stat 12-lead electrocardiogram is run which indicates that Mrs. Rudd is having ST elevations in leads II, III and aVF suggesting acute inferior wall myocardial infarction. This explains the bradycardia due to damage to the right ventricle and likely an occlu ded right coronary artery. Tachycardia is seen in anterior and lateral wall MI where the circumflex and/or LAD coronary arteries are blocked. The nurse may also see ST depression instead of elevation in leads II, III and aVF with either of these infarcts. Her signs and symptoms upon presentation to the hospital suggest that she is in the early stages of cardiogenic shock, a life-threatening complication of AMI associated with high mortality. Early and aggressive treatment is necessary for her to survive this condition (Lenneman, 2011). Etiology and Pathophysiology With cardiogenic shock, perfusion is affected and delivery of oxygen to the tissues is markedly decreased. Various conditions can lead to cardiogenic shock besides AMI. It can occur as a complication of open heart surgery, myocarditis, valve failure, severe dysrhythmias or from any disease or injury that leads to mechanical failure of the bodys pump. With AMI, the myocardium is starved of oxygen and nutrients and dies (Lenneman, 2011). This leads to diminished contractility, reduced ejection fraction (the percentage of blood present in the ventricle at end-diastole that is pumped out with each heart beat) and disruption of hemodynamic measurements including persistent hypotension, high filling pressures, such as PAWP, PAP, high CVP and SVR, and most importantly reduced stoke volume and cardiac output. As a result of the reduced ventricular emptying, pressure rises within the ventricles, causing dilation of the ventricles, eventually leading the one initially injured to fail and if no t corrected both ventricles. In cases of heart failure in both ventricles, the patient will probably require transplantation and an LVAD to keep them alive while on the list awaiting a donor heart (Holcomb, 2002). Signs and symptoms Clinical signs and symptoms that are associated with cardiogenic shock depend on the ventricle affected. In right heart failure the nurse may observe jugular vein distension, peripheral edema and weak pulses, altered mental status, elevated ICP. Venous congestion and bradycardia are possible due to the heart slowing to allow adequate blood return and filling before pumping, which can be heard on auscultation as a split second heart beat. With left ventricular failure a pathological S3 or ventricular gallop can be auscultated, and pulmonary edema and congestion will likely be present, evidenced by labored breathing, dyspnea, course crackles and wheezing leading to ineffective gas exchange. To improve oxygenation, respiratory rate increases and the patient hyperventilates as manifested by hypocapnia and alkalosis (PaCO2 less than 35 or pH greater than 7.45) measured by arterial blood gases (Holcomb, 2002). Since the heart is unable to recover and maintain adequate perfusion to the kidn eys, they also will fail and subsequent ABGs reveal a shift indicating a worsening condition of both respiratory and metabolic acidosis. Sustained hypotension (systolic blood pressure less than 90mmHg for longer than 30 minutes) and adequate left ventricular filling pressure with signs and symptoms of tissue hypoperfusion are less common definitions for cardiogenic shock. This hypoperfusion may be exhibited by such signs as cool extremities, altered mental status, oliguria (urine output less than 30mL/hour or less than 0.5mL/kg/hour) or all three. Another helpful measurement utilized in assessing shock is drawing a serum lactic acid level, a diagnostic tool for detecting occult tissue hypoperfusion. Even if a patient does not exhibit low blood pressure at onset, a lactic acid value above 4mmol/L can identify organ dysfunction at the cellular level before the patient becomes hypotensive. This can be assessed by the nurse observing skin becoming cool, pale, and clammy as blood is shunted away from the periphery and skeletal muscles back to the vital organs. As a consequence, wasting and lactic acid buildup occur. The ef fects of blood being shunted away from the gastrointestinal tract initially lead to decreased bowel sounds and eventually progress to absent bowel sounds or paralytic ileus (Farwell, 2006). Hemodynamics In the case of Mrs. Rudd, her initial presentation reveals signs of the early compensatory phase of shock. The physicians and nurses need to collaborate and respond promptly to limit permanent damage to her organs and ensure her survival. In the early stage of cardiogenic shock the sympathetic nervous system is activated to respond to a failing heart. The renin-angiotensin-aldosterone system (RAAS) is stimulated to cause vasoconstriction and sodium and water retention to maintain blood pressure (Porth, 2006). To evaluate the effectiveness of organ perfusion cardiac output needs to be monitored and controlled. This is initially sustained with fluid replacement and volume expanders in right heart failure resulting from inferior AMI, to in essence replace oil in the engine to keep it running. In response to heart failure from a lateral or anterior AMI, the patient will exhibit increases in heart rate and/or stroke volume defined as the amount of blood pumped out with each ventricular contraction or the difference between the end-diastolic and end-systolic volumes (Eliott, Aitken, Chaboyer, 2007). The physician often prescribes vasopressors and inotropic medications such as milrinone or dobutamine to improve contractility and pumping efficiency of the damaged heart as well as reduce afterload. In cardiogenic shock, the values of cardiac output (normal range of 4-8L/min) and the more accurate measurement, cardiac index (2.5-4.0L/min), can significantly drop in response to heart failure and the pump not being able to adequately circulate blood through the body. In some cases the physician may order a diuretic such as furosemide to be administered to decrease preload by reducing pulmonary (LV) or systemic (RV) congestion and stasis of blood. Another measurement of end organ perfusion that clinicians rely on is mean arterial blood pressure (MAP) which has a normal range of 60 to 110mmHg. When the body is in a state of shock, at first the body attempts to compensate, however as the condition prolongs the values gradually drop below 60 mm Hg along with a decreasing cardiac output (Holcomb, 2002). Together these hemodynamic values are used to determine if the patient has inadequate organ perfusion and to evaluate the adequacy of interventions by both the physicians and nurses. Subsequently, the body attempts to compensate by increasing heart rate, which decreases diastolic filling time. This faster rate increases the oxygen demand of already damaged heart muscle, which negatively impacts cardiac output even further. Unable to keep pace with the increase in volume, hemodynamic values worsen as the heart fails to perfuse the body. This eventually leads to MODS and unfortunately, as a result, death in around 50% of all patients affected by cardiogenic shock (Babaev, Frederick, Pasta, 2005). Even in cases where the patient is recovered and stabilized, sometimes the damage may be too great for the patient to overcome and within days or weeks they irreversibly deteriorate. Treatments The best chance of recovery for Mrs. Rudd relies on rapid percutaneous or surgical revascularization. While awaiting revascularization there are nursing interventions and pharmacologic measures that can be started to optimize her cardiac output. As mentioned earlier, rapid infusion of fluids is the first line of defense to improve cardiac output and stroke volume in right AMI. Diuretics may be used in left heart failure to decrease preload and improve the hearts pumping ability, however it is contraindicated with right AMI as in the case of Mrs. Rudd. Tachycardia is a common compensatory mechanism of cardiogenic shock to improve perfusion, yet beta-blockers, although they can lower rapid heart rates, are another class of drugs that should be avoided for Mrs. Rudd since they also have a hypotensive effect and could counter the positive effects of fluid resuscitation and further perpetuate severe hypotension, having a bottoming out effect. Therefore beta-blockers should be used careful ly and only in early stages of uncomplicated AMI without heart failure (Eliott, Aitken, Chaboyer, 2007). Providing inotropic support and improving systemic vascular resistance are important in the management of cardiogenic shock. To increase contractility and consequently cardiac output, inotropes, such as dobutamine, dopamine and milrinone, might be started and gradually increased to obtain adequate perfusion. However, because they can increase myocardial oxygen demand in an already ischemic heart, they must be used cautiously in patients, as they may lead to the incidence of fatal dysrhythmias. To treat life-threatening ventricular dysrhythmias (VT or VF), antiarrhythmic medications such as amiodarone or lidocaine are indicated. Additional considerations to treat dysrhythmias or heart block include defibrillators and transcutaneous pacing, or depending on the damage present, a permanent pacemaker (ECC Commitee, American Heart Association, 2005). Another complication of cardiogenic shock that increases oxygen demand is hypoxemia from pulmonary edema and backflow; common in left AMI and often a secondary complication in right AMI. As the patient deteriorates and stops responding to compensatory mechanisms, mechanical ventilation may be warranted to provide adequate oxygenation. By instituting mechanical ventilation the workload of breathing is decreased as the machine takes over. Also anxiety and metabolic demands are decreased when the patient is sedated and intubated. Unfortunately, sedation may cause a further drop in blood pressure and needs to be closely monitored. Maintenance of adequate MAP is also vital to prevent end-organ damage. To increase MAP, norepinephrine may be added to the medication regimen, but it may have a negative effect on cardiac output. Through means of combination therapy in severe hypotension, catecholamines are mainly administered in cardiogenic shock along with monitoring urinary output and calculating cardiac output, to sustain functioning of the patients organs and optimistically to buy time before revascularization and the return of adequate pump function (Eliott, Aitken, Chaboyer, 2007). Unless contraindicated, it is protocol to treat any patient admitted with a diagnosis of acute coronary syndromes, including patients in cardiogenic shock, with aspirin and IV anticoagulation (heparin) to slow the progression of the infarct. Fibrinolytics are not recommended in patients requiring percutaneous coronary intervention (PCI) or surgery, however, improvement in hospital mortality with the use of the glycoprotein IIb-IIIa inhibitor abciximab (ReoPro) has recently been shown to reduce mortality from 40% to 50% down to 18% to 26% in cardiogenic shock treated with stent implantation (ECC Commitee, American Heart Association, 2005). Hospitals have adopted the PTCA guidelines set forth by The American College of Cardiology and the American Heart Association aiming to provide reperfusion of the infarct artery within 90 minutes after arrival to the hospital. These new guidelines also assist in decision making regarding PCI, a nonsurgical coronary revascularization procedure that r elieves the narrowing or obstruction of the coronary artery or arteries to allow more blood and oxygen to be delivered to the heart muscle. This ensures patient safety and improves patient quality of care (ECC Commitee, American Heart Association, 2005). Another intervention that is used to prevent or manage cardiogenic shock is an intra-aortic balloon pump (IABP) which improves coronary artery perfusion and reduces afterload. This mechanical device consisting of a 34- to 40-mL balloon catheter, is placed during PCI and operates by using counterpulsation therapy. The IABP inflates during ventricular diastole (increasing coronary artery perfusion) and deflates during ventricular systole (decreasing afterload or the resistance against which the heart has to pump). By increasing coronary artery perfusion with this device, the patients cardiac output, ejection fraction, and MAP are increased, ultimately improving end-organ perfusion. Heart rate and pulmonary artery pressures, especially pulmonary artery diastolic and wedge pressures are lowered, which essentially decrease the hearts oxygen consumption, blood volume and workload (Holcomb, 2002). Now an hour and fifteen minutes from onset, Mrs. Rudds status continues to worsen and the physicians, noting that they are still within the 90 minute timeframe, rush her directly to the cardiac catheterization laboratory and she undergoes PCI with drug-eluting stent placement in the right coronary artery. During the procedure the surgeon places an IABP to increase coronary artery perfusion and decrease workload of the heart. She is transferred to the surgical intensive care unit for further management and monitoring with a pressure dressing to the femoral artery where the catheter was inserted. After recovery of her strength and hemodynamic stabilization, she is transferred to a medical-surgical unit, then discharged four days later on a new medication regimen prescribed to avoid complications and recurrence of an AMI or lethal dysrhythmias. Nursing Diagnoses Outcomes Prioritizing nursing diagnoses and care depends on which side of the heart is affected. With LV failure, respiratory complications are a primary consideration, whereas with RV failure, presentation of systemic signs and symptoms occur early on. Eventually as the patients condition deteriorates their bodys compensation mechanisms fail and cardiogenic shock worsens. Nursing interventions vary based on what stage of shock the person is in, their etiology and presentation, what procedures are planned or have been performed and when care is assumed. The nursing diagnoses for Mrs. Rudd consist of (in priority): Risk for decreased cardiac output related to altered cardiac rate and rhythm; reduced preload and increased systemic vascular resistance; infarcted muscle. Ineffective tissue perfusion related to reduction or interruption of blood flow. Risk for excess fluid volume related to decreased organ perfusion; increased sodium and water retention; sequestering of fluid in interstitial space and tissues. Acute pain related to ischemic myocardial tissue. Anxiety and fear related to change in health status. Activity intolerance related to imbalance between myocardial oxygen supply and demand; presence of ischemia; cardiac depressant effects of certain drugs, such as beta blockers, antidysrhythmics. Ineffective protection related to the risk of bleeding secondary to thrombolytic therapy. Deficient knowledge regarding cause and treatment of condition, self-care, and discharge needs related to lack of information, misunderstanding of medical condition or therapy needs Some expected outcomes for Mrs. Rudd include: Maintain an adequate cardiac output during and following reperfusion therapy. Demonstrate no signs of internal or external bleeding. Rate chest pain as 2 or lower on a pain scale of 0 to 10. Verbalize reduced anxiety and fear. To recap, cardiogenic shock is a life-threatening complication of AMI. It is important to acknowledge that patient survival and recovery rely on early recognition of signs and symptoms of cardiogenic shock and rapid assessment and interventions by the nurse and treatment team.

Company comparison: Tesco and Panda

After doing some research, I decided to choose two companies as the organizations to be compared in the written submission, which are Tesco and Panda. In this log-book, the information I gather will be printed in italic, and my personal opinion will be written in 14 point font size with underline. I get most of the information from the internet, besides, I get some information from the email which the companies' official website, press and the magazines. Tesco operates 2,291 stores around the world and employs 296,000 people. We have grown from a domestic retailer, to an International Group, through our organic growth programme. This year, all four parts of the Tesco strategy, the core UK business, non-food, retailing services and international, have increased in profitability. Retailing services Tesco personal finance, established in 1997, now has over 3.4 million customer accounts and 15 products and services. It achieved profits of à ¯Ã‚ ¿Ã‚ ½96m in 2003 (Tesco share à ¯Ã‚ ¿Ã‚ ½48m). Tesco.com is the largest grocery e-tailer in the world and achieved a profit of à ¯Ã‚ ¿Ã‚ ½12m in 2003. We announced recently that we would launch a fixed line phone service in the summer of 2003. Non-food Half of our UK new space opened this year has been for non-food and the result has been to grow our market share to 5%. By analyzing the above information, we can have an overview of the company. It is clear that Tesco is a large-sized organization, which has grown from a domestic retailer, to an International Group. How did Tesco make it? This is the question I have got after reading above information. This part shows some operational details of the company, for example, the employee numbers, age structure, the ownership of the firm, etc. STATEMENT OF APPLICATION OF PRINCIPLES OF THE COMBINED CODE The Group is committed to high standards of corporate governance. This statement describes the manner in which the company has applied the principles set out in the Combined Code on Corporate Governance. DIRECTORS AND THE BOARD The Board of Tesco PLC comprises eight Executive Directors and six independent Non-executive Directors. The Chairman, Mr. J A Gardiner, is an independent Non-executive Director who has a primary responsibility of running the Board. The Chief Executive, Sir Terry Leahy, has executive responsibilities for the operations, results and strategic development of the Group. Clear divisions of accountability and responsibility exist and operate effectively for these positions. In addition, Mr. G F Pimlott is the senior Non-executive Director. The Board ensures that no one individual or group dominates the decision-making process. Since the year-end, the Board has announced its succession plans for the retirement of Mr. J A Gardiner in March 2004. The full Board meets at least ten times a year and annually devotes two days to a conference with senior executives on longer-term planning, giving consideration both to the opportunities and risks of future strategy. The Board manages overall control of the Group's affairs by the schedule of matters reserved for its decision. In so far as corporate governance is concerned, these include the approval of financial statements, major acquisitions and disposals, authority levels for expenditure, treasury policies, risk management, Group governance policies and succession plans for senior executives. To enable the Board to make considered decisions, a written protocol exists and has been communicated to senior managers ensuring that relevant information is made available to all Board members in advance of Board meetings. All Directors have access to the services of the Company Secretary and may take independent professional advice at the company's expense in the furtherance of their duties. The need for Director training is regularly assessed by the company. The above information shows a part of operational details of the organization. This part explained the board of Tesco and its operation, for example, the full board meet at least ten times a year and have some more conference as well, this is very logical, All Directors may take independent professional advice at the company's expense in the furtherance of their duties. GOVERNANCE STRUCTURES The following paragraphs describe the key governance structures operating in the Group under the overall direction of the Board. Executive Committee The Board delegates day-to-day and business management control to the Executive Committee, which comprises the Executive Directors. This meets formally every week and its decisions are communicated throughout the Group on a regular basis. The Executive Committee is responsible for implementing Group policy, the monitoring and performance of the business and reporting to the full Board thereon. Nominations Committee Appointments to the Board for both Executive and Non-executive Directors are the responsibility of the Nominations Committee which is chaired by Mr. J A Gardiner and whose members are set out in the table at the bottom of this page. As exemplified by the section on ‘Directors and their interests' within the Directors' report on pages 5 and 6 of the 2003 annual report, the company's Articles of Association ensure that on a rotational basis Directors resign every three years and, if they so desire and are eligible, offer themselves for re-election. Remuneration Committee The Remuneration Committee, composed entirely of Non-executive Directors, is chaired by Mr. C L Allen. The members are set out in the table at the bottom of this page. The responsibilities of the Remuneration Committee, together with an explanation of how it applies the Directors' remuneration principles of the Combined Code, are set out in the report of the Directors on remuneration on pages 12 to 21 of the 2003 annual report. Audit Committee The Board has an Audit Committee, chaired by Mr. G F Pimlott and consisting entirely of Nonexecutive Directors, which meets a minimum of three times a year. Membership of the Audit Committee is set out in the table at the bottom of this page. Its terms of reference are reviewed annually and represent current best practice. The Committee's primary responsibilities include monitoring the system of internal control throughout the Group, approving the Group's accounting policies and reviewing the interim and annual financial statements before submission to the Board. The Committee will be undertaking an assessment of the Group's position in relation to the Financial Reporting Council guidelines for strengthening the Combined Code, issued recently as the ‘Smith Report', although it is believed that the Group already comply substantially with the proposals. The review will also cover the role and effectiveness of the Non-executive Directors as set out in the ‘Hi ggs Report'. Compliance Committee The Compliance Committee ensures that the Board discharges its obligations to comply with all necessary laws and regulations. It has established a schedule for the regular review of the Group's operational activities to ensure compliance with accepted practices and policies. The Committee, comprising two Executive Directors and three members of senior management, normally meets four times a year. Some functional details are given in this part: the structure of management. There are five kind of committee; each one has its own duty, and they operate very well when they work together. The logical structure is another reason of Tesco's success. As different type of organizations, there must be differences between the management structure of Tesco and Panda, I will compare them in the written submission. INTERNAL CONTROL AND RISK MANAGEMENT The Board has overall responsibility for internal control, including risk management, and sets appropriate policies having regard to the objectives of the Group. Executive management has the responsibility for the identification, evaluation and management of financial and non-financial risks and for the implementation and maintenance of control systems in accordance with the Board's policies. The Board, through the Audit Committee, has reviewed the effectiveness of the systems of internal control for the accounting year and the period to the date of approval of the financial statements, although it should be understood that such systems are designed to provide reasonable but not absolute assurance against material misstatement or loss. Internal control environment The Group operates an objectives-driven approach aimed at satisfying its core purpose that translates into a rolling five-year business plan. The plan covers both revenue and capital expenditure and forms the basis of business plans for all our business entities. From this the Board, together with monitoring regimes based upon our Steering Wheel, agrees the annual revenue and capital budgets. The Steering Wheel is the term used to describe our balanced scorecard approach, which we believe is the best way to achieve results for our shareholders. It sets out a broad range of targets under quadrant headings of customers, operations, people and finance. This allows the business to be operated and monitored on a balanced basis with due regard for all stakeholders. The Board undertakes a formal review of progress on a quarterly basis and any resulting actions considered appropriate are communicated throughout the business. The capital investment programme is subject to formalised review procedures requiring key criteria to be met. All major initiatives require business cases to be prepared, normally covering a minimum period of five years. Post-investment appraisals are also carried out. Risk management process At the highest level, the Board considers strategic risk every time it meets. The two-day Board Conference, referred to earlier, considers where future opportunities and risks lie and helps shape our corporate strategy going forward. Accountabilities for managing operational risks are clearly assigned to line management. Internal controls have been developed over all risks in line with the risk appetite determined by the Board and are subject to review. Formal risk assessments are carried out routinely throughout the business. Procedures exist to ensure that significant risks and control failures are escalated to senior management and the Board, as necessary, on a daily, weekly and periodic basis. What is the aim of these strategies? Does Panda have the similar management process? If not, how does it deal with the same problem? Monitoring The monitoring of strategic and operational risks are responsibilities of the Board and line managers respectively. The Board maintains the Key Risk Register and considers at their formal risk assessments whether the actions being taken in mitigation are sufficient. The Internal Audit function also operates on a risk-based approach helping managers with their risk responsibilities and advising on appropriate controls. PricewaterhouseCoopers LLP, our external auditors, contribute a further independent perspective on certain aspects of the internal financial control system arising from their work. Independence is strengthened by an agreement to rotate audit partners every five years. The engagement of auditors is considered annually by the Audit Committee. Annual statements received from CEOs further support the monitoring of key subsidiary operations. These statements confirm that the Board's governance policies have been adopted in practice and spirit. Overall, the Audit Committee seeks to ensure that the whole management process provides adequate control over all major risks to the Group. This is achieved through consideration of regular reports from internal and external audit alongside discussions with senior managers. Other specialist functions within the Group, notably Trading Law and Technical and Company Secretariat, provide assurance and advice on health and safety, regulatory and legal compliance and social, ethical and environmental issues. These functions report their findings on a regular basis to the Compliance Committee. What are the advantages of these responsibilities? How could they be taken in Panda? I will try to find the answer when I am doing Panda's research. At present, I think the company can prevent from risk; at least it can reduce the bad effect. Communication A programme of communication exists and is constantly being developed, to ensure that all staff is aware of the parameters that constitute acceptable business performance and the expectations of the Board in managing risk. This provides clear definition of the Group's purpose and goals, accountabilities and the scope of permitted activities of companies, executive functions and individual staff. Communication is an important part of organizational culture, what are the communication channels of Tesco and Panda? How does it work? The programme of communication is constantly developed and it is proved necessary. CORPORATE SOCIAL RESPONSIBILITY The Board regards Corporate Social Responsibility (CSR) as an integral part of the overall corporate governance framework and is fully integrated into existing management structures and systems. Therefore, the risk management policies, procedures and monitoring methods described above equally apply to our CSR activities, including the management of social, ethical and environmental (SEE) risks. Many investors take an interest in how companies are managing non-financial risks as these can, under certain circumstances, have an impact on shareholder value. For example, The Association of British Insurers (ABI) has published disclosure guidelines on social responsibility, including SEE matters, for investors and companies. Last year, we published our first CSR Review on our website, www.tesco.com/everylittlehelps. This reflects the importance that Tesco has placed on CSR over the past 10 years. More details of our CSR strategy can be found in the Tesco Corporate Social Responsibility Review 2002/03 and on our website. We have an established cross-functional CSR Committee that meets a minimum of four times a year. The CSR Committee is chaired by the Group Corporate Affairs Director, and its membership is made up of senior managers from all parts of the business. One of its objectives is to identify threats and opportunities for the coming year and to highlight emerging issues. The CSR Committee has established a set of CSR Key Performance Indicators (KPIs), and these KPIs are used to track performance quarterly and annually. The KPIs feed directly into the Steering Wheel monitoring system explained earlier and thus contribute to the overall monitoring of Group performance and control evaluation by the Board. The Chairman of the CSR Committee makes regular reports to the Executive Board on CSR matters. The CSR KPIs and the related management system are available in the CSR Review 2002/03 and on-line. Actually there is a relationship between environment and the companies. Environmental factors influence the development of companies and create opportunities and threats for them; it influences and determines the way the company must operate and how it has to accomplish its marketing objectives. Parts of environmental details have been shown by the information. Tesco made a great effect on Corporate Social Responsibility and the company gets a strong support by its customers. I will explain the reason in the written submission. This year sales in our core UK market have grown by 7.9% and underlying operating profit by 6.9% reinforcing our position as the number one food retailer in the UK. Our strong UK performance allows us to expand into retailing services and international markets. Number of stores In the UK we opened 62 new stores this year adding a further 1.4 million sq ft. We also acquired 1,202 T&S Stores, a leading convenience retailer, giving us an additional 1.8 million sq ft. This brings the total number of stores in the UK to 1,982. Four store formats we tailor our stores to meet our local customers' needs. We have four different store formats: Extra, Superstore, Metro and Express. All formats provide a different shopping experience for our customers, but all offer the same outstanding value. Store development we listen to customer and staff feedback to continually improve our stores. This year our UK development plan has seen refresh and extension programmes, tailored to local customer requirements, improve over 200 stores. Staff our loyal and committed staff have helped make us Britain's biggest supermarket. This year we have taken on an additional 9,000 people, with a further 5,000 over Christmas, to help serve our customers better. 104,000 of our staff are shareholders. The above data prove Tesco to be the biggest retailer in UK; does it only locate in UK? If not, what about its international market? What have Panda done? As I know Panda is the biggest electronic company in China at present, and it is also facing to the international market. Between the two different types of companies, is there any similar idea when they are dealing with the global market? In our European business sales have grown by 22.5% and underlying operating profit by 56.7%. We have opened 18 hypermarkets in the year, making us the largest hypermarket operator in Central Europe. Five countries Tesco now operates in five countries in Europe as well as the UK; Republic of Ireland, Hungary, Czech Republic, Slovakia and Poland, accessing 68 million people. Number of stores we now have a total of 230 stores across Europe and this year we became the leading hypermarket retailer in Central Europe. Our ongoing plans for the region will see us expand next year to over 100 hypermarkets, growing our market share even further. Sales area our expansion programme has seen our total European sales area increase to 10.6 million sq ft in the past 12 months, a rise of 31% on last year. This includes the 13 hypermarkets acquired from the HIT chain in Poland. Staff This year we have taken on 6,500 extra staff and we now employ 47,500 people across our European operation. In Hungary we are the country's second biggest private employer, with 11,000 members of staff working across our operation. This year our Asian operation has delivered sales growth of 45.5% and underlying operating profit growth of 144.8%. We operate in four countries across South East Asia including our latest market, Malaysia. Four countries this year we opened our first stores in Malaysia. We continue to build a business of scale in our developing markets of Thailand, South Korea, Taiwan and Malaysia, accessing a population of 155 million. Store development a total of 28 new stores were opened across the four countries, including seven Home plus stores in South Korea. These new stores have boosted our total floor space across Asia to 7.5 million sq ft, a rise of 34% on last year. Store formats we have continued to develop our formats to suit our different customers' needs. In Taiwan, plans are in place to open our first city-format store in the capital Taipei later this year. In Thailand we now have eight Express stores, a supermarket, and our first Value store. Staff this year we recruited a further 4,000 local managers and staff to deliver for our customers. We now employ a total of 28,000 people across Asia. In Thailand we had over 600 internal promotions last year. As the biggest retailer in UK, in order to have further development, Tesco has to entry to the international market, and it has already had some progress now. Now its store are located in 9 countries, and number will be still increasing. It has a large number of stores, employees, and loyal customers as well. It has different strategies in different locations. In the written submission, I will compare the data of the two companies. To complete it, I need to search more information about the functional advantages or disadvantages to location, type of property, running costs, time at location etc. Every day, more than 11 million people visit our stores knowing they can pick what they want, when and where they want it Tesco's product/service details are clearly shown in its homepage. It has a big range of product/service so it can make customers feel satisfied. The nature is simple: let customers know they can pick what they want, when and where they want it. Now I will move on to Panda, a Chinese electronic company. This part will also contain organizational details which are shown in Tesco's. As the cradle of China's electronics industry, Panda Electronics Group Co., Ltd. (PEG) was founded in 1936, with a history of sixty-eight years. Brand ‘Panda' is the first Chinese electronics products brand entered into international market and also the first ‘Well-Known Brand' of electronics industry in China. PEG is one of the largest electronics comprehensive backbone enterprises, 120 pilot enterprise groups, 512 key enterprises, six largest groups of electronics industries in China. Since the 50's of 20th century, more than 30 Chinese leaders including Mao Zedong, Deng Xiaoping and Jiang Zemin had inspected PEG. With the great concerns of leaders of the government and the Party, PEG has developed rapidly. Recently, major products of PEG covers HF communication, satellite communication system, mobile communication system, macaronis production equipment, base station, program control exchangers, mobile phones, TV sets, washing machines, DVD players, computers, monitors, system integration, network, software and radio receivers. Technology force of PEG is in leading position in China's electronics industry. With its own power, PEG has created many â€Å"first in China† and won national honors. PEG has not only five national engineering research centers (engineering research centre for A/V digital products, national technology development centre, mass production technology centre, micro-electronics technology design centre, and engineering research centre for mobile satellite communication technology), but also post doctoral scientific research station. PEG cooperates with 12 large international companies entered into the top 500 largest companies in the world and more than 10 key universities and research institutes in domestic in technology fields to jointly develop new products. The speeds of renew of products has been increased greatly. Up to now, PEG has subscribers of 70,000,000 people, and is a famous brand electronics company possesses the most subscribers in china. Adhering to regard subscribers' standard as the top standards of enterprise, PEG is responsible for subscribers, services for subscribers and obtained the certificate for ISO 9001 international quality standards assurance. While self-developing, PEG made great efforts to exploit the international market and actively joint venture with the international large companies, such as Sweden's ERICSSON, Japan's SHARP and Korea's LG, made good economic efficiency. It became a new growth point of economic efficiency of the company. Nanjing Panda Electronics Co., Ltd. was founded in 1996. H shares and shares were issued to the public in Hong Kong and Shanghai respectively. The Company was listed on The Stock Exchange of Hong Kong Limited and the Shanghai Stock Exchange respectively. In 1999, the Company carried out the policy of reconstructing of the assets, realized the reform of multi-element property rights. As the cradle of China's electronics industry, Panda Electronics Group Co., Ltd. was founded in 1936. Brand ‘Panda' is the first Chinese electronics products brand entered into international market and also the first ‘famous Brand' of electronics industry in China. Panda Electronics Group Co., Ltd. is one of the top 520 national key enterprises, one of the top 120 enterprises under experiment and one of the key enterprise groups in Nanjing Municipality and Jiangsu Province. The Company established 5 national R & D centers and a postdoctorate research work station. The Company established marketing networks spreading over nationwide, more than 40 countries and regions in the world. Users and consumers are up to 70,000,000. The Company was honored ‘First Grade Stated-Owned Enterprise' in the first batch, ‘National Key New High-Tech Enterprise' and ranked among the top 500 largest industrial enterprises in China for 10 years running. Now I have an overview about Panda's company profile, from a simple point, what is the difference between Tesco and Panda? This would be an important part I which I should explain in my essay. It also shows some operational and locational details, which I can compare to Tesco's directly in the essay. The operational details I have got is not as many as Tesco's, although I sent the company an email, they replied me with few information. However, I find more locational details of Panda, so I can have a detailed discussion about its advantages/disadvantages in the essay. There are both common points and differentia between the two companies' operational details, but all the information proved the locational details of the two companies are quite distinct from each other. These discussions will take an important part in the following written submission. Then I found Panda's functional details on its website and the magazine, in the essay, I can compare this with Tesco's functional details to point out their feature. They also sent me some more details with email, shown in the next page. Board of Directors Position Name Chairman, President and CEO Ni Runfeng Vice-Chairman and COO Wang Fengchao Director and CFO Liu Tibin Director and Vice-President Li Kexing Zheng Guangqing Wu Jiang Board's Secretary and Vice-President Tan Mingxian Director He Mingfen Director and Minister of Planning & Development Dept Lang Fengwei Director and International Business Dept Wu Jiang Director and General Manager of Air-conditioner Com Li Jin Senior Management Executive Officers President and Chief Executive Officer(CEO) Ni Runfeng Executive President and Chief Operation Officer(COO) Wang Fengchao Chief Financial Officer(CFO) Liu Tibin Vice Executive Presidents Li Kexing Zheng Guangqing Wu Jiang Tan Mingxian As a comprehensive multinational corporation, what is the characteristic of its structure? What is the difference between the two companies' structure? Why do they have differences? This is the main part I am going to explain in my essay. Panda Management Conceptions In our understanding, management of an enterprise denotes the administrator's thoughts and ideological level. It is the process through which the administrator does his management work with a clear and dedicated aim to advance the prospects of the company. In doing something new, we will certainly meet some obstacles. If we are reluctant to have a try or even to make plans for innovations, we will surely not succeed in making progress. Furthermore in making innovations, we might struggle or even fail sometimes, but we feel we can make progress gradually by learning from our mistakes. An administrator's ideological level has a great effect on the management efficiency. We feel he needs to be open and aboveboard, and should manage the company with strong ideals of justice and fairness. An administrator should always set up a new aim for the company to operate with as a goal in mind. A new aim stimulates all of the staff to work harder. We need to always bear in his mind that only the fittest will be able to survive in the tough market competition. Market competition is like sailing against the current: either you keep forging ahead or you keep falling behind. Thus, an administrator should always work with a new goal in mind. Only in this way can he continue to take new action and to deal with new situations with foresight which will allow the company to make useful progress. So, the characteristics of Panda management depend on the philosophy that people are treated as the foundation of the company's success and that while the management rules are always strictly adhered to, the employees are nevertheless an integral part of and always regarded as essential to the company's continued progress and success. Panda Ideas The purpose of the company is to serve people with technology. In our business operations, we have a clear management concept that we will win the market so long as we produce on a large scale at a leading pace. We have taken a market-and-order-orientation attitude toward the market. All we are doing in our work is for the services of customers and market. We are constantly improving the quality of our products. We are trying to reach the highest level in quality control. In personnel management, we firmly believe that the company should on the one hand offer employees' opportunities to expand their abilities and that on the other hand the employees will earn profits for the company. Thus we consider the relationship between company and employees as a reciprocal one from which both can benefit. Now I understand Panda's management conceptions/ideas, as parts of its organizational culture, it contains many differences with Tesco's. I will explain what the differences are in the essay. Since the 50's of 20th century, more than 30 Chinese leaders including Mao Zedong, Deng Xiaoping and Jiang Zemin had inspected PEG. With the great concerns of leaders of the government and the Party, PEG has developed rapidly. Monopolization is forbidden in China, so Chinese government gives some help to other smaller competitors of PEG. As a huge market, China attracts many foreign companies, some large-sized companies, such as Sony, Samsung, and National, join in to the competition, to encourage the foreign enterprises, Chinese government constituted some policy for them as well, for example, low tax. Without the support from the government, PEG is not too strong to win the competition. International marketing has become a major issue for companies. In the twentieth century, world trade has been more and more important. All over the world; companies are aiming at penetrating new foreign markets. As a large company which can not get enough market shares in its own country, PEG planed to entry the international market as well. When entering international business it is necessary to take into account the political system of the target country. It is much more risky to operate in absolutism or anarchy than in democracy. Political stability is a basic requirement. The legal environment of the target country is also essential to consider. China has free trade agreements with several countries, making it less expensive and easier to export Chinese products and to import foreign products. These circumstances contribute to the increase of foreign trade by providing an environment, in which it is easy for Chinese companies to export their products to international markets. In case of an export company, the most important legal factors are the export-import regulations, requirements, restrictions and the rate of tariffs. When establishing a subsidiary in another country, other legal factors become important. The company law, competition policy and tax regulations determine the everyday operations of the company. Along with foreign investment regulations, environment-protection requirements etc., they set the legal environment for the firm. It is important to carefully examine and consider these factors. The threat posed by them can be reduced if the management is aware of them and understands these regulations well. PEG did get this great chance and it exported a large amount of its products to the developing countries and some western countries, unfortunately it did not deal with the regulations very well, for example, in Chinese advertisements it is usually allowed to compare competing productions, but it is not allowed in many European countries, PEG did not realize this when it first entry a foreign market, as a result, in some countries the company was indicted as export dumping. In order to review an organization or individual services, it is important to understand the external factors that influence the organization. An effective way to identify these external influences is to carry out a PESTEL analysis. Because of the different situation of China and UK, it is no doubt that the impacts of environmental factors for the two companies are different. By using the information I have, I can do a ‘PEST' analysis of both Tesco and Panda in my essay by taking some examples. It manufactures many kinds of products including the following series: Color TV series: CTV, PTV, Applied TV series (Hotel TV, Huge Projection TV Wall, CRT TV Wall, TV-PC, Playback TV, etc)†¦ Air-conditioner series: all kinds of Windows, Wall-mounted, Cabinet, Floor-mounted, and small Central Air-conditioners†¦ AV product series: all kinds of DVD, VCD, DVD+AMP, Amplifier, Voice speaker Box, CD, MP3†¦ Network series: DVB-C, DVB-S, ADSL, C-LAN, and Family Information-resolution System†¦ Battery series: High Quality Environmental Protection Battery, Rechargeable Battery, Nichrome Storage Battery and kinds of Chargers†¦ Electronic Component series: PCB, FBT, Tuner, kinds of Transformers and Coils, Inductance, Conduct-electricity Rubber, Spring†¦ Protection for Safety series: Finance Band System, Hotel System, Traffic Management, Public Place, Family Protection for Safety, Individual Protection System for Safety†¦ LCD series: LCD-TV, LCD-M and other LCD applied products†¦ White Household Appliance and small Household Appliance series: Washing Machine, Water-heater, and Fuel Gas Canteen†¦ Technology Equipment series: kinds of Assembly Line, Frock of Assembly Line, Meters of Assembly Line, and Tools of Production†¦ These are information which relates to Panda's product/service details. As same as Tesco, Panda have many different kinds of products, and it also develops in some other industries. Comparing to each other, the two companies' product/service are totally in different area, however, they may have the common management conceptions/ideas, it will be interesting to compare this part in the essay. Now I have collected the two companies' details about their operation, location, function, environment and product/service. All the information will be used to prove my opinion in the written submission.

Oedipus Fate Essay - 1478 Words

Are people responsible for their actions or is it fate? Is fate inescapable? A persons fate is the events that are destined to happen to them. Fate is decided the moment someone is born. People cannot change their fate and it is unavoidable. Throughout the Greek tragedy, Oedipus the King, the hero, Oedipus often tries to run away from what he is destined to do only because of his ignorance to his situation. Throughout the entire play, the conflict of Man versus Fate is often seen as everyone tries to avoid what is fated upon them. Oedipus’s parents, Jocasta and Laius, were told by the gods that their son, Oedipus, would grow up to kill his father and marry his mother, a terrible fate. In the play, Jocasta tells of a prophecy given to†¦show more content†¦While talking to Jocasta, Oedipus tells of Polybus and Merope who he had believed to be his parents, â€Å"At a fest, a drunken man/Cries out that I am not my father’s son/The next day I visited/My father and mother, and questioned them/calling it all the slanderous rant of a fool† (1.2.251-56). Oedipus heard of a man saying that Polybus and Merope were not really Oedipus parents when Oedipus tried to confront his adoptive parents the lied to him telling him it was untrue and let Oedipus believe that he was really their son. Oedipus believed his adoptive parents to be is true birth parents. He had no idea who his real birth parents were due to Polybus and Merope deceiving him. Oedipus was oblivious to who he was and where he was f rom he was unknowing to the fact he was supposed to be killed at birth by his true parents to prevent a prophecy. Oedipus learned of the prophecy then ran away from Corinth as he did not wish to harm his adoptive parents. Oedipus tells of the time he went to the a shrine to ask if Polybus and Merope were really his parents, he said, â€Å"I went to the shrine of Delphi/the god dismayed my question/he spoke of other things/full of wretchedness/that I should lie with my own mother, breed/and that I should be my fathers murder/I heard all this, and fled† (1.2.261-68). When Oedipus went to ask of his parents he insead learned that he was fated to kill his own father and breed with his mother,Show MoreRelatedOedipus Fate And Fate Essay777 Words   |  4 PagesFate as defined by the Merriam Webster dictionary is ‘an inevitable and often adverse outcome, condition, or end’. Sophocles discusses fate vs free will in his plays. In the play Oedipus Rex there was a prophecy that Oedipus was destined to kill his father and marry his mother, he attempts to escape his destiny by running a way to Thebes where he meets his fate. In the play Antigone, that main character Antigone decides to go against Creon’s (her uncle who has inherited the throne) decree and buryRead MoreOedipus Fate Essay843 Words   |  4 PagesOedipus the King is a story about a prominent king torn by fate and the effect his own actions have upon his destiny. Much can be learned from the catastrophic story of Oedipus, who was prophesied to kill his father, to marry and have children with his own mother. As soon as Oedipus learns of this prophecy, he tries desperately to escape it, by running from his hometown, and even avoiding his supposed parents. Despite the fact that fate may have played some role in Oedipus demise, it ultimatelyRead MoreOedipus Fate Essay956 Words   |  4 Pagestragedy, Oedipus the King, fate is a predetermined course of events and is also an important factor that caused Oedipus’s downfall. Oedipus is ultimately a victim of his own fate because, despite his a nd Jocasta’s efforts, he could not escape the prophecies. Though others say that Oedipus created his own fate because he had the free will to handle the prophecies in becoming his own outcome, in the end, there was no chance that Oedipus could escape the prophecies. It was the fate for Oedipus gettingRead MoreOedipus Fate Essay840 Words   |  4 PagesIn Oedipus the king the Prophets tells Oedipus how his life will pan out and that there is nothing that he can do about it. Oedipus, however thinks he can prove them wrong being the self righteous person that he is. 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Essay962 Words   |  4 PagesFate the un-avoidable Throughout the vast history of literature, various concepts have come and gone. The idea of fate or fatalism has been a concept that has survived the test of time. Numerous characters have succumbed to the power of fate and the character of Oedipus from Sophocles’ Oedipus the King is a prime example of the vast power of fate within literature. Sophocles effectively depicts the wrath of fate as he portrays how Oedipus fell victim to fate and his efforts to disregard fate wereRead MoreOedipus Victim Of Fate Essay876 Words   |  4 PagesIs Oedipus a victim of fate or does he possess free will? Explain your reasoning. Do you think free will is a reality or an allusion? I find Oedipus to be a victim of fate rather than having free will. â€Å"()†. Free will could be seen to be more of an illusion than a reality. People and society like to make you think you have control over your own life while in you really do not. While it seems he could have tried harder maybe vowing to never sleep with a women or to never kill a man but is whatRead MoreFate in Oedipus the King Essay1065 Words   |  5 Pagesat least in â€Å"Oedipus the King† in which the protagonist, Oedipus calls forth his doom unwillingly. Fate is defined as something that unavoidably befalls a person. The author of â€Å"Oedipus the King,† Sophocles, writes a tragic fate that Oedipus was born to experience. Fate is what is meant to happen and cannot be avoided or unchanged. Furthermore, events that lead to other events could be the result for one to meet their fate. In â€Å"Oedipus the King,† Sophocles expresses the nature of fate to be determinedRead MoreOedip us: Destiny and Fate Essay1333 Words   |  6 Pagesis by fate. Those who believed it is by choice follow the directions and guidance of their elders. For example, they will try to hold on to the values that their parents instilled in them and use them to guide their entire lives. Others who believed that destiny is by fate, believe that the outcome of their lives is determined by luck, and that no matter what they do or how careful they are, whatever has to happen to them must happen. These proponents that emphasize that destiny is by fate may haveRead MoreParallels of Fate in Crash and Oedipus the King Essay1046 Words   |  5 Pages Fate to most people is something that will inevitably happen in their lives, something that they are destined to have or to be. According to Dictionary.com, fate is defined as something that unavoidably befalls a person, but to others, fate is merely coincidence. The debate whether fate is apart of our everyday lives have been going on since the ancient greeks to today. The movie Crash parallels to the play, Oedipus the King, in that both of the characters experience some form of fate in their lives

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