Internet fame Essay Example | Topics and Well Written Essays - 250 words

Internet fame - Essay Example Although I personally never experienced a breach of privacy or leakage of important information, I’ve known friends who had thus suffered. A friend of mine had the most embarrassing experience, as her pajama party photographs got leaked into the public domain. She posted the pictures in her Facebook profile, setting access to only those who are her friends. But perhaps as a result of someone hacking into her profile and downloading these pictures, they got out into the public domain of the Internet. A big fan of social networking sites like Facebook, my friend is yet to overcome the embarrassment caused by the leak. She is now very hesitant to post or share any sensitive information in these sites and is regretful that she trusted them in the past. It makes sense for her to exercise caution from now on, for these leaks could prove very costly. In this instance she only has to bear through minor social embarrassment. But there are leaks that could prove more damaging, as in hav ing one’s credit card details hacked or professional accounts becoming accessible to miscreants. If this were to happen, she could face severe monetary loss or a dent to her professional reputation. Hence, she has to take all precautions in the future to avoid these

Financial and Strategic Planning M2C Essay Example | Topics and Well Written Essays - 500 words

Financial and Strategic Planning M2C - Essay Example Since Franklin Healthcare is a non-profit making entity, Williams Foundations should not consider profit as the sole criteria of decision making. It should also consider the quality of services provided by the healthcare facility. Moreover it should also scrutinize that whether the money it is contributing for the welfare of the people is actually benefitting the deserving people. Or is the management of the Franklin Healthcare is merely making up the statements and in reality the health status of the people had not improved in the area. In view of this, Williams Foundation should set up an independent audit of the financial statements of the Franklin Healthcare in order to ensure that its financial statements are portraying a true picture of the entity. Once when the Williams Foundation is satisfied with the credibility of the financial statements it should base its decision on the meticulous analyses of the financial statements. Upon the analysis of the income statement it is evident that Franklin Healthcare is on the way of making profit. While its revenue remained steady, its expenses declined in 2011 as compared to 2010. Due to decrease in operating expenses the profit in 2011 rose by 0.02% as compared to the profit of 2010. The reasons cited for the decrease in operating expenses are the lay offs and subsequent reorganization of operating expenses. Another reason for this decline can be the decrease in the number of patients visiting Franklin Healthcare in 2011. As in 2010 almost 500 patients came to the healthcare facility and in 2011 the number plunged to 400. In 2011 the healthcare facility is earning profits and at the same time reorganization of the operating expenses is a sign that the healthcare facility is seriously concerned about the efficient running of the organization. If I base my analysis purely on the given information then I would recommend that Williams Foundation should continue giving

Marketing Plan For Renault Twingo

Marketing Plan For Renault Twingo According to our class, MC 600, Business Policy, we have to write a business plan about a product of our company. In this case it is supposed we are working for Renault Car Company, and we prepare the business plan for one of our products, which is Renault Twingo, regarding the Greek market. To develop successful strategies and action programs, we need up-to-date information about the environment, the competition, and the market segments to be served. Often, analysis of internal data is the starting point for assessing the current marketing situation, supplemented by marketing intelligence and research investigating the overall market, the competition, key issues, and threats and opportunities issues. As the plan is put into effect, we will use advertising and other forms of research to measure progress toward objectives and identify areas for improvement, if results fall short of projections. Finally, we will use marketing research to learn more about their customers requirements, e xpectations, perceptions, and satisfaction levels. This deeper understanding will provide a foundation for building competitive advantage through well-informed segmenting, targeting, and positioning decisions. Thus, the marketing plan should outline what marketing research will be conducted and how the findings will be applied. EXECUTIVE SUMMARY In the first section we have to summarize the main goals, recommendations and points of our project in order to be accepted by the managers. Our project will target in reclaiming Renaults superiority in Segment A by positioning Twingo as one of the best overall proposals in the segment. It will be placed between mainstream, e.g. Fiat Panda and trendy cars such as Smart, and FIAT 500, targeting mainly style-oriented, younger customers, who are more willing to buy a 3-door car. Moreover we can get a competition advantage by differentiate the target groups by multiple versions. Authentic to Expression: Refers to a mainstream target group, practical. Dynamic: Refers to female group with several dynamic characteristics. GT: More Sporty and masculine profile. We will exploit connectivity and customization features to enhance youth appeal and trendy factor (Dynamic, GT).We will promote practicality and versatility to enhance its mainstream appeal (Authentic, Expression).Systematically attract first-time-buyers and exploit opportunities to up-sell them within the brand. Finally we will use competitive fleet policy (10% discount on retail price) to support retail sales (despite lack of 5 doors). Generally we will exploit limited editions for conquest sales and for maintaining trendyness. By these actions we target at about 1500 sales, both retail and fleet, for the year 2010 in Greece. This is a partition of 7, 6% and 1, 4%, respectively, as shown in the image below. CURRENT MARKET SITUATION In order to analyze the current marketing situation, we will discuss about the overall Greek Market, identify the market segments we will target and provide information about the companys current situation. Renault: The Company (briefly) In 1899 Renault Frà ¨res is founded by Marcel and Fernand Renault. In 1903 the sales network expands and the first subsidiaries are set up outside France. In 1975 managed by Bernard Vernier-Palliez, Renault comprises the state-owned Rà ©gie (104,000 employees) and the subsidiaries set up through diversification (118,500 employees) and by 1980 Renault was Europes leading vehicle manufacturer. In 1997 Twingo arrives in the market. Range Segmentation MARKET DESCRIPTION We will examine the target segments and provide context for the marketing strategies. We will examine the economic position and the general situation of Greek Market, MAVA which is the official Renaults representatives, the Purchase Behavior of the target group in which we are interesting in and the current situation of the Competition. EXTERNAL ENVIRONMENT: Greek Market Situation Real GDP average growth 4,1% (10yr), 4.2% (3yr). Slowing growth in 2010 reflects weakening growth in fixed investment and exports, due to strong Euro. Consumer spending even if slower growing retains its momentum and will continue to be the main contributor to 2010 GDP growth driven by real wage growth (4%) and employment growth. Spending on consumer durables, in particular, remains strong (sales of household equipment increased by 5.6%, as did car sales). Household debts account for 37.8% of GDP vs 61.6% for EU-13. Consumer credit growth remains strong at a (stabilized) 20%. Deposit growth reached 14.4% in 2007 vs 10.5% in 2006 Greek economic climate index in rise from mid-2005 to September 2007, decreasing slightly in October; remains higher than European index. Greeks more willing to buy a car in 2010 than EU-27 or EU-13 average. The positive effect of direct tax reductions is expected to be compensated by the increase of VAT by 1-2 percentage units in 2010 or 2011. Internet penetration at 40% of ages 13-70 years old (13-24: +60%, 25-44: +30%). Broadband connection penetration currently at 6.9% of households (EU-27avg at 16.2%).Average monthly cost at à ¢Ã¢â‚¬Å¡Ã‚ ¬28.3 (vs à ¢Ã¢â‚¬Å¡Ã‚ ¬25.4 in France and à ¢Ã¢â‚¬Å¡Ã‚ ¬46.8 in Spain). Average speed at 6,6 Mbps (vs 44,1 in France and 6.9 in Spain). A change in the registration tax is not considered feasible for the time being. Liberalization of diesel car market (in Athens and Thessaloniki) remains stagnant, AMVIR (Greek Association of Importers) now pushes for freeing up the diesel LCV market. AMVIRS (Greek Association of Importers) current position to the Government is for a gradual and mid-term alignement of the taxation system with the emissions norms. All data: European Commission, Eurostat, National Bank of Greece, except Internet data (independent surveys). All data: European Commission, (*) Ministry of Economics Finance. INTERNAL ENVIRONMENT: Renault in Greece MAVA Implement ready, in-house software to track real-time MAVA/Dealer stock, order, invoice and registration data. Based on the above, specify and implement a new monthly marketing reporting system, specified with and covering the needs of Management, Renault and Marketing. Exploit Renault-specified PER4 Dealer training program (analytic proposal to be submitted by end of March 2010) to provide a business case for dealers to endorse change, total customer satisfaction and a new culture vis-avis Renaults forthcoming product assault. Budget 50.000à ¢Ã¢â‚¬Å¡Ã‚ ¬. Starting from 2011 (along with new Megane), consider an extensive communication plan to change current perceptions of Renault and gradually establish it among top-of-mind brands in Greece. Given approval, Marketing will provide a comprehensive route map by end of June 2010 to be finalized by end of 2010 and be implemented starting from 2011. This will include a thorough proposal on the approach and process leading to an action plan by end of 2010. Deployment of the new brand identity graphic guidelines within the company and to the dealer network (core elements, stationery, printed forms, advertising, local communication -publications, events etc), starting with the new Twingo launch campaign, including follow-up and evaluation on the extent of deployment, according to time-plan imposed by Renault (12 months). The PURCHASE BEHAVIOR of the target group Stage 1: Initial interaction with the brand At this stage, customer has not fully developed the need to purchase a new car and collects information / perceptions / impressions by various channels that result in top-of-mind awareness of specific brands. Brand Influence at this stage comes from creating impressions and emotional territories through: Advertising: emotional positioning. Press relations: word of mouth is especially important for the small Greek society and especially women, who mostly turn to friends and family for advice. B-T-L Promotions: help relate the brand to values and behaviors. Stage 2: Actual investigation At this stage, customer assesses technical and tangible factors (however still through an emotional process), identifying possible solutions to his/her needs. This results to the shortlist. Provided that the brand has passed the test of the first stage, the choice criteria are: Performance (20-28) Roominess and reliability (29-45), with price and equipment as common denominators. Customers first choose a brand and, subsequently, the model it offers in the segment they need. French Cars in general provides to their customers: Elegance Alternative Focused in comfort Luxury Feminine Unreliable Weak USP Design Progression Affordability Customers Character Twingo Characteristics Renault Twingo differentiates its target group depending on the version: Twingo Authentic to Expression Mainstream, practical Twingo Dynamic Feminine Twingo GT Sporty, masculine In general its target group is men and women 20 35 years old. Twingo means fan, joy, entertainment combined with all the above characteristics of a French Car. PRODUCT REVIEW In continue, we have to outline the main characteristics and summarize extra information needed about our product, Renault Twingo. Renault Twingo is characterized by: Modern, Pleasing Design Roomy, practical and occupant-friendly An assertive personality underpinned by dynamic styling Communicative and occupant-friendly: New Twingo features an Audio Connection Box (in UK we will be calling this system multi-functional Tune Point) which enables personal music collections stored on USB keys, portable MP3 players or iPods ® to be played through the cars audio system and operated via the steering wheel-mounted controls. My Twingo philosophy: buyers can customize their new car inside and out thanks to a range of decorative decals for the exterior and a selection of innovative accessories such as the Organizer Box and Makeup Box for the interior. Appeal to young clientele, essentially urban-dwellers hooked on new technologies Chassis derived from the B-segment and a power train range featuring the new TCE (Turbo Control Efficiency) 100hp petrol engine, which offers class-leading performance and fuel consumption, New Twingos superior dynamics, set it apart from its predecessor. Optimizing cabin space and interior versatility, by making full use of the cars compact dimensions (length: 3.60m). Interior is extremely modular thanks to its four independent sliding seats. Safety was at the forefront of the New Twingo design teams priorities. New Twingo is the first model to be renewed within the framework of Renault Commitment 2011 and had to meet an extremely exacting brief in terms of quality and profitability. Supplementary information about models: A. TWINGO Twingos agile handling makes it perfect for nipping in and out of city traffic. With its compact length of just 3.60 m, Twingo is a cinch to park and a delight to drive. It also stands out with its pure, contemporary styling. Twingo brings drivers a dynamic and pleasant drive. Our primary consumer target is middle- to lower-income people who need a car with pleasing desing but also comfortable and easy to use. All versions of Twingo carry the Renault eco ² signature. They emit less than 140 g/km of CO2, contain renewable materials and recycled plastic, and are produced at the ISO 14001 certified Novo Mesto plant in Slovenia. B. TWINGO SPORT Renault has produced an affordable high-performance car which sits alongside Clio and Mà ©gane Renault Sport in the Renault Sport range. Renault Twingos existing lines are underpinned by a more curvaceous, athletic stance and the newcomers sporty calling is further emphasized by its wider front and rear wings, profiled sills and spoiler. Twingo Renault Sport is the response of Renault Sport Technologies experts to a two-pronged challenge, namely to deliver sports performance while at the same time ensuring that the new car is easy to use on a day-to-day basis. Twingo Renault Sports chassis is both responsive and finely tuned to provide precise, balanced sports handling, while specific work on the pitch of its new 133hp 1,598cc engine reveals its punchy temperament. C. TWINGO GORDINI R.S. The return of the Gordini name is to be marked by the introduction of a new chic and sporty version of Renault Sports pocket rocket which takes a current-day stance on the cues long associated with the Gordini world. Twingo Gordini R.S. features a gleaming Malte Blue lacquered metallic finish, plus two white racing stripes, in keeping with tradition. The front and rear bumpers are enhanced by gloss black details, while the fog lamp surrounds, exterior mirror housings and lip spoiler are all picked out in a contrasting white finish. Gordini Series badging either side refers back to the heyday of the Gordini Cup when the qualifying heats of the different meetings were known as sà ©ries. This exclusive exterior styling package is rounded off by a choice of either blue or black diamond-effect 17-inch aluminum alloy wheels. To ensure that it befits Gordinis glorious motor sport heritage, the latest addition to the Twingo range is based on the same performance/equipment package as the Renault Sport version: Sport chassis with 17-inch wheels for outstanding road-holding performance that is equally suited to everyday motoring, a feisty, responsive 1.6-litre 133hp petrol powerplant with a distinctive, specially-tuned engine pitch under acceleration, precise, incisive steering for even greater fun at the wheel, powerful, durable braking performance. The fashionable and sporty label of the Renault Sport range with its elegant finish and strong design codes, the Gordini label builds on the renowned expertise of Renault Sport, and offers a fresh interpretation of its values. Renault naturally opted to build on the reputation of Renault Sport Technologies (RST) in order to transform the Gordini legend into a reality. Renaults sports branch has prolonged the Gordini heritage through its renowned expertise in motor sport and the development of its sports models. COMPETITIVE REVIEW The direct completion for Renault Twingo in Greece is FIAT Panda, CHEVROLET Matiz, HYUNDAI Atos, PEUGEOT 107, SMART ForTwo, TOYOTA Aygo, KIA Picanto, CITROEN C1, VOLKSWAGEN Fox, DAIHATSU Cuore, FORD Ka, OPEL Agila. The Total Market Sales are showed below: As we can see, the segment dominated by Panda Koreans (low price models, therefore strong in fleet sales) followed by TPCA trio (Toyota, Peugeot, Citroen Automobile), upward indication for ForTwo and Cuore and downward indication for Matiz, Atos and Fox. The 3-Door Sales Direct Competitors VS Renault Twingo 3-door versions appeal to first-time buyers, seeking for looks and style, who are willing to spend more for differentiation. Fleet Sales VS Retail Sales Direct Competitors VS Renault Twingo Segment leaders retain significant contribution on both fleet and retail sales. The ForTwo, Fox and TPCA trio appeal more to retail buyers. Despite drop of fleet sales, Picanto compensated with strong retail sales. MARKETING STRATEGY As a volume carmaker, Renault has long been recognised for the quality and inventiveness of its products in the small car segment and New Twingo is no exception. Since its unveiling at the 1992 Paris Motor Show, Twingo has revolutionised the world of city cars. In response to shifts in customer demand across the span of its 14-year life, Twingo took the form of seven different collections and a long list of striking special and limited editions. The European small car market has been reasonably stable since 2000, yet that hasnt prevented it from being extremely competitive, owing to the presence of the traditional European makes and, more recently, the advent of newcomers from Asia. Even so, Renault stands out as a major player in the segment and New Twingo reinforces the brands line-up with a view to optimising its coverage of this end of the market. With a length of 3.60 metres, New Twingo is a practical, communicative, compact car. New Twingos mission is twofold, the first being to build on its ever-growing reputation as Twingo owners were loyal to the car and replaced it with another Twingo. The second aspect of the models mission involves reaching out to a new clientele seeking a safe, versatile, practical and feisty package with compact dimensions. One-third of European small car buyers are aged under 35, including 11 per cent who are under 25. Amongst its new targets, New Twingo seeks to appeal to this young clientele, essentially urban-dwellers hooked on new technologies and for whom the car is seen as a symbol of freedom, as well as an extension of the world in which they live. New Twingo covers all these criteria thanks to its unique personality and unprecedented connectivity for its segment, not to mention its inherent versatility, driver appeal, travelling comfort and dynamic, reassuring handling. Strategy and Marketing employs 150 people from diverse backgrounds, including 12 different nationalities. The five key functions in Renaults Marketing Department 1. Marketing product and services manager Their role is to develop the most attractive selection of products and services for a given range of vehicles. They adapt their choice to each national market without overlooking the brands identity and sales targets. They help elaborate marketing strategy, analyse sales figures for their models, and constantly look for ways to sell more. 2. Product positioning consultant They draw on different surveys and studies to propose ways to improve the brands positioning and image. Working with the different range managers, they decide how a model should be positioned and what audiences to target. They then adapt this positioning to each country. 3. Price consultant They draft a price strategy for each model in every country. Another of their functions is to examine across-the-board pricing methods and procedures. Strong interpersonal skills are important as they are in daily contact with the markets and other marketing experts. 4. Trend forecaster Their task is to analyse market trends and sales forecasts for each vehicle in a range of countries. Their conclusions help the factories plan production in line with the dealerships probable needs for vehicles to satisfy customer demand. 5. Planning studies manager They pilot the sales and marketing planning system, assess Market Areas needs for economic modelling, and adapt planning tools accordingly. They train the national plan coordinators in the use of planning tools and methods. They also analyse each countrys budget and strategy plans to then compile a group-wide synthesis. Positioning The new Renault Twingo hopes to appeal to the small car segment and the initial first car buyer segment while also appealing to families who wish to acquire a second car, or to those using their car in urban or city areas. This car interests distinct and different groups of car buyers so there is a need for careful product positioning in the mind of the consumer. Some considerations when positioning a new car might include: first car or small car users who expect specific design qualities from a car families who want a second car to get them from A to B or to complete the school run twice a day and who will also want different features young people looking for personality from their car perhaps more sporty features or individual and distinctive design finishes. New Twingos key target market is young dynamic people. Renault has a marked advantage in this area because it is known for its keen pricing and is also an established, highly recognisable brand that young people can relate too. Price Strategy Renault has a clear understanding of its key target market (young people and other price-conscious car buyers) and has designed pricing strategies to best address their needs and the positioning of the New Twingo. In the case of the New Twingo it is imperative that it be keenly priced and also that running costs are low. The price quoted by Renault is the price you will pay at the dealership. The starting price is 8790à ¢Ã¢â‚¬Å¡Ã‚ ¬ and it can reach the 13100à ¢Ã¢â‚¬Å¡Ã‚ ¬ depending to the model and the equipment included. All the dealers provide the option to buy the car with a small amount in advance and then with monthly installments. Price Positioning by Model Direct Competitors VS Renault Twingo 8k: Koreans (high contribution of fleet sales). 9k: Panda (has also the widest coverage). 9-11k: Twingos core competition. 12k: Smart. 13-14k: Twingo GTs main competition (Panda 100 C2 VTS). Distribution Review In this level we have to analyze Renaults distribution network around the world and specifically in Greece. Renault its an international industrial organization with 38 industrial sites in 17 countries which ensure that production occurs close to markets and unique standardization which guarantees the same level of quality throughout the world. International production capacities are expanding rapidly. Major projects of development are in Russia (a partnership signed with the AvtoVAZ automaker), and Morocco (work began on a new industrial complex in Tangiers). A launch to the dealers is different to launching a car to the public. Increased demand for a car is also known as a pull factor as it essentially pulls the product through the distribution channel from the manufacturer toward the consumer. In order to succeed at getting the product to the consumer, Renault has an International network of agents or dealers who carry its cars in the companies stable. This means that support is given to the Renault dealers around the world to promote the new model in a way that generates demand for the new car. Our channel strategy is to use selective distribution all over Greece. During the first year, we will add channel partners until we have coverage in all major greek markets and the product is included in the major car catalogs and even Web sites. The Renault Production Way: Guarantees the same quality standards throughout the world, Enhances Group performance (plant specialization according to car segment, development of plant capacity to produce different vehicles on the same production line, continuous improvement of the workstation, etc.), Ensures the Groups commitments to the environment (100% of Renaults production sites are committed to ISO 14001 (environmental management standard) certification processes), Reinforces safety throughout the world. Renault has a distribution network all over the world-Americas, Europe, Eurasia, Asia and Africa. The official sales partnership in Greece is PGA motors at Marousi, Athens. Moreover Renault motors are sold by almost 31 agents-sales points all over the country. SWOT ANALYSIS In the next step of our marketing plan, is the SWOT analysis. SWOT analysis is a strategic planning method used to evaluate the Strengths, Weaknesses, Opportunities, and Threats involved in our project. It involves identification of the internal and external factors that are favorable and unfavorable to achieve our objective. Strengths: Strengths and strong points of our car. Weaknesses: Internal weaknesses of Renault Twingo. Opportunities: external conditions which are helpful to achieving our objective. Threats: external conditions which could do damage to the objective. Identification of SWOTs is essential because subsequent steps in the process of planning for achievement of the selected objective may be derived from the SWOTs. STRENGHTS My Twingo philosophy-Modern, Pleasing Design Roomly, Vertisile interior 1.2-litre TCE (Turbo Control Efficiency) engine. WEAKNESSES Evidence of cost cutting Thrashy, and engine noise is intrusive at motorway speeds. Disputed wheel positioning OPPORTUNITIES Increase fleet sales Are there emerging trends on which we can capitalize? Increased demand in segment A THREATS Pure fleet sales Extreme competition in segment A- Fiat 500, C2, Smart Many offers and uprising Car industries with cheap products Marketing Communication Strategy Pre-publicity in the form of motoring reviews and test drives are critical to the success of a trade launch as this activity must generate sufficient consumer curiosity and interest in the new model. In this way, we will give the opportunity to experts and driving correspondents or journalists, to assess the merits of the new Twingo before the rest car-buying public. We will also try to hold open weekends in dealers garages where customers can come along to test drive the new car. By getting potential car buyers to test drive a car, product usage increases. This will have a knock on sales of the new car. The primary above the line medium we are going to use to promote and communicate the new car is through advertising. In the case of the New Twingo, the main advertising mediums going to be used, aside for those used when communicating with the trade, are outdoor billboard advertising and TV and radio advertising. New Twingo advertising themes and images include ideas of surprise, independence, spontaneity and versatility. Key factual messages that need to be also included are the smart design of the car, the value for money and cost of the car and the low running costs. Advertising Expenditure Evolution During Jan-Oct 2010, the advertising expenditure of the segment has decreased by 33,3% since all major competitors launches have been conducted before 2010. Share of Spending Chevrolet Matiz is, by far, the leader of the segment. Smart has no TV investment (only magazines and BTL activities). MediaMix TV and Magazines are the main media during Jan-Oct 2011 Large increase of TV against Magazines in 2011 is due to launches having taken place in 2010, reflects tactical advertising in 2010. Share of Voice Adults 18-34 8 Matiz acquire, by far, the highest SOV due to small average duration of spots. COMMUNICATION OBJECTIVES 2010 Create a buz among young potential customers to support Twingos positioning as a trendy choice. Differentiate creative and media mix according to target group ( mainstream, women, men). Draw on the values of Twingo I to retain existing customers (modular design, simplicity of entry versions). Implement an integrated launch campaign (adaptation of international launch) to fight clutter by competitors launches and spice-up brand image. Media Use Use of TV as main medium (MAD TV included as the only youth music channel). Use short TVCs to increase SOV. Creative use of magazines (lifestyle advertorials photo shootings etc): lifestyle, womens, youth titles. Creative use of radio (lifestyle testimonials). Joint events (Asterix movie sponsorship). Use of Internet and New Media with creative penetration (ambient media). Use of outdoor at urban regions (5 major cities). Content Communicate the accessories youth-targeting features (personalization connectivity). Communicate price affordability. Use GT version to communicate TCE USPs. Press Maintain a Press test-drive fleet of 2 cars (Dynamique GT). 2011: Communicate RS and limited editions (ATL and Press). 2012: Introduce tactical communication. Competition Launching Media Plans 2010 2012 Media Plan Marketing research Using research, we are identifying the specific features and benefits that our target market segments value. Feedback from market tests, surveys, and focus groups will help us develop the next model of the new Twingo. We are also measuring and analyzing customers attitudes toward competing brands and products. Brand awareness research will help us determine the effectiveness and efficiency of our advertising and promotion. Finally, we will use customer satisfaction studies to provoke positive reactions to future buyers. Controls There is no planning without control. Marketing control is the process of monitoring the proposed plans as they proceed and adjusting where necessary. If an objective states where you want to be and the plan sets out a road map to your destination, then control tells you if you are on the right route or if you have arrived at your destination. Control involves measurement, evaluation, and monitoring. Resources are scarce and costly so it is important to control our marketing plans. Control involves setting standards. We are planning tight control measures to closely monitor quality and customer service satisfaction. This will enable us to react very quickly in correcting any problems that may occur. GLOBAL Quality and profitability at the core of the X44 project As part of the new model offensive set out in Renault Commitment 2009, New Twingo had to meet an extremely specific brief in terms of quality and profitability. Renaults latest small car will be produced at the Novo Mesto factory in Slovenia. Upon his arrival as President of Renault in May 2005, Carlos Ghosn instructed engineers to optimise the cost effectiveness of the X44 project. Twingos replacement needed to meet a raft of quality- and appeal-related targets at an extremely competitive cost. Initially delayed to ensure it responded even more closely to customer demand, the project then picked up speed and the cars development was completed within 21 months of the new designs approval. Controlled production-related costs The technique of carry-over served as a powerful lever in achieving this feat. Certain components from previous projects noted for their reliability and effectiveness were incorporated into the new vehicle. In addition to being a pledge of quality, this approach also eliminated unnecessary design costs and lead-times. Although an entirely new car in its own right, New Twingo incorporates parts from the chassis used for Clio II whose quality earned it recognition in 2006. Constraints associated with the adaptation of production plant were similarly m

The Desire to Conquer in Jesusville :: Character analysis, Jessy Belle the Second

The interlude in which Vee visits the museum of exotic dancers is quite interesting; I think one of the purposes of the scene was too reinforce the idea of rape that runs throughout the novel. Specifically with this idea of rape, I refer to the desire/need to conquer and to be conquered. This idea can be illustrated by several of the characters. The first character I will begin with is Jessie Belle. At the beginning of their adventure into the mountains, Jessie introduces her truck to Trace as â€Å"Jessie Belle the Second. My shadow Self† (pg 84). Trace then adds the comment, â€Å"Kind of like an alter ego† (pg 84). This becomes an interesting statement when we later receive a description of Jessie Belle with her truck. Cioffari writes that Trace was â€Å"impressed, too, by the skill she used to maneuver the old jeep, forcing it to do her will† (pg 85). If we consider Jessie Belle the Second as an extension of Jessie, then we can see a connection as to how Jessie is in need of conquering something within her. This need to conquer is manifested in her search for Joshua and the Salvia Divinorum. In finding the plant, Jessie is able to see Joshua for a final time through her hallucinations, and at the end of the novel seems to have â€Å"conquered† what she needed in order to move on. A second i nstance that reinforces this idea is the interlude which describes Jessie’s hallucination. Under the â€Å"influence† of the Salvia, Jessie dances and touches herself. It is through this act that we see Jessie’s consciousness, as it is under the influence of the plant, â€Å"conquering† her unconscious self –another illustration of Jessie’s need to conquer something within her. A second character that we see this idea manifested through is Father Martin. He, like Jessie, is in need of conquering something within. In his case it is his own doubts and fears. Attempting to calm his nerves, Father Martin paces to tire himself. He describes the night as having an â€Å"overpowering silence† and that the night â€Å"mocked his efforts† (pg 75). Father Martin hears the night taunting him, â€Å"Walk from here to kingdom come. For the next six hours I own you. I’ll do with you what I will.† A few pages later we see an encounter (arguably sexual) in which Martin conquers the silence through his act of ringing the bells.

Poetry †Pablo Neruda Essay

1. The speaker in this poem is the persona, because first person is used (â€Å"I†). 2. The character of the speaker changes from the beginning of the poem to the end. At the beginning the character is unsure in his words and actions, can’t find an answer to his questions: â€Å"I don’t know, I don’t know where it came from, from winter or a river. I don’t know how or when†, â€Å"I did not know what to say†. The character has also lost his identity: â€Å"there I was without a face†, â€Å"my eyes were blind†. By the end of the poem, the speaker ‘finds himself’ as part of something, part of the â€Å"void†, â€Å"mystery†, â€Å"part of the abyss†. He finds himself going with the flow, wheeling â€Å"with the stars†, â€Å"my heart broke loose on the wind†. 3. a) The kind of images used most often after the line, â€Å"and suddenly I saw† in stanza two are connected with the nature and its flow: â€Å"palpitating plantations†, â€Å"shadow perforated†. They are also connected with how the world opens for the speaker: â€Å"the heavens unfastened and open†. b) This imagery contributes to our understanding of the speaker’s thoughts and feelings when he first encounters poetry, because the reference to nature helps the reader to understand the idea of the poem. Nature is something everybody understands regardless of nation or education. 4. The speaker’s first lines of poetry could be â€Å"pure nonsense, / pure wisdom†. They could be nonsense because he is not guided by his thoughts, but the poetry simply flows in him and he writes it. The lines can be wisdom as well because of the way the poet receives his ideas and puts them into words.

Johnny Cupcakes Essay

Johnny Cupcakes is a multi-million dollar clothing brand. The brand was founded in 2001 by Johnny Earle. One of Johnny’s acquired nicknames was Johnny cupcakes. He â€Å"thought it would be funny to make a couple random shirts that said ‘Johnny Cupcakes’ on them for the fun of it† (Earle, 2012). After massive interest in these shirts, he decided to continue to make more and change up the designs. In 2001, Johnny stated, â€Å"the band I was in, On Broken Wings, finally got signed to a record label and we began to tour full time† (Earle, 2012). This opened up Johnny and his t-shirts to a larger crowd of customers in different parts of the country. This boosted the brand’s popularity and Johnny decided to quit the band and focus all of his time, effort, and attention on his t-shirts. Johnny ended up going to trade shows in Las Vegas and eventually â€Å"ended up getting carried by shops in Japan, Europe, and Canada in addition to a few other US locations† (Earle, 2012). Johnny had a turning point moment at that very same trade show later on that year. He realized people didn’t like having the same things as others and that they enjoyed uniqueness. At this point Johnny made the decision to pull all his shirts from retail stores. Earle 2012 stated that he â€Å"decided to make all of his t-shirts limited edition and exclusive, only selling them through his website† and later on in his own retail stores. As the Johnny Cupcakes brand grew, Johnny opened up stores in Hull, MA; Boston, MA; Las Angeles, CA; and London, England. Johnny states that â€Å"Above all, I’ll continue to focus on enhancing my customers’ experiences through my stores, events, website, designs, and packaging. I will never ever sell my brand to investors for all the money in the world. I think you’ll find that things will only get more interesting from here†¦Ã¢â‚¬  (Earle, 2012). The Johnny Cupcakes brand to some can be described as streetwear. Hundreds, 2011 defines streetwear as â€Å"a genre of contemporary apparel, united between sportswear and military looks, and is one that speaks to a spectrum of subcultures (skateboarding and hip-hop mostly).† Some of Johnny Cupcakes major competitors are also streetwear brands such as Us Versus Them, Reason, Benny Gold, Situationormal, Flying Coffin, Clot, Diamond, Fuct, Alife, The Hundreds, A Bathing Ape, Supreme, and Rebel8 among others. These companies not only produce unique designs and clothing, they have a fan base, and what some might call a cult following. They represent more than just a t-shirt. They differentiate themselves by their designs, material, limited edition collections, and the customer experience. Johnny Cupcakes top products are his limited edition t-shirts, but the company also sells sweatshirts, hats and accessories. One of the things that make JC stand out is their packaging. The suppl ies the company needs and uses are not just clothing/accessory based, but just as important is their packaging. Johnny Cupcakes uses bakery style boxes with their cupcake and crossbones logo on it. The company also uses specially made tissue paper to wrap the bought goodies up in. The tissue paper is also marked with the JC logo. The are two major external factors that greatly influence Johnny Cupcakes as a company and those are the economy and trends. Since Johnny Cupcakes offers â€Å"luxury† items (those items that consumers don’t need, but rather want), the economy can play a significant role in their profits. When times are tough, like in an economic recession, the majority of people watch their money more closely. These people may choose to only buy things out of necessity rather than splurge on things they want. Another big obstacle that JC has to stay on top of is the trends of their market. Clothing styles and designs come and go, therefore, Johnny Cupcakes needs to stay at the forefront of what their target market likes otherwise they could easily become extinct. One way JC battles these two external factors is making every shirt limited edition. The limited edition status gives the feel of exclusiveness. People not only crave exclusiveness, but will pay top dollar for it. â€Å"Because they’re collectibles and not just apparel, customers are willing to pay $60 for a Johnny Cupcakes shirt–and even stand in line for a new release like kids waiting for concert tickets† (Spaeder 2007). This exclusiveness plays off of our cultures social classes. Most Americans want to be in a better social class. Exclusiveness is a trait that is common in the highest of classes. The limited edition shirts not only sets the standards for someone’s social status, but also keeps inventory at a low, making sure the products that are produced are sold. Having limited edition shirts erases much of the risks and fears of the changing trends of JC’s market. Since there are only a handful of the shirts available, they are long gone befo re the design and style gets soggy. Also, this allows the company to be very flexible with the changing market. The two major internal factors that impact the organization are how they enhance the customer experience and their product packaging. These are two very important factors that help create the Johnny Cupcakes brand. They are part of the JC culture and without them, the brand wouldn’t be what it is today. Part of the customer experience lies in JC’s three retail store locations. â€Å"They’re set up just like bakeries, complete with glass display shelves, employees wearing aprons and the smell of vanilla frosting in the air† (Spaeder 2001). During big releases or setting up weekend pop-up stores, Johnny himself will be there to greet and talk with everyone of the customers that walk through his store. This again is part of the experience and connection he wants his fans to feel when they think of the Johnny Cupcakes brand. Johnny thinks â€Å"nice packaging sets an experience, a memory, or a safe-keeping that is sometimes just as important as the product it self. I’m a sucker for nice packaging† (Earle, 2012). When conducting a SWOT analysis of Johnny Cupcakes, some of the company’s strengths, weaknesses, opportunities, and threats have already been discussed. JC’s major strengths are the exclusiveness it personifies by selling limited edition shirts and the customer experience it provides. One of its major weaknesses is the fact that it only has three retail stores and an online store. If it were to grow (and being a multi-million dollar business it has the resources to do this) it could reach more of a customer base and increase not only its fan following, but its sales as well. A huge opportunity that Johnny Cupcakes has is the fact that it has done several successful collaborations with other companies including Nickelodeon and Hello Kitty, which expands its customer and fan base. As with all companies, a threat is competition. If JC can stay authentic to its audience then it will overcome the competition. As stated earlier, since JC is a luxury brand, the economy and trends are another threat. Listening to their market will definitely help subdue these threats. One of Johnny Cupcakes biggest resources and assets are its customers. Johnny Cupcakes has not only been able to acquire customers, but also fans and audiences (which is much more powerful). The reason the JC brand has been able to do this is because of the experience a customer gets when going into a store or a pop-up shop. When a customer sees their Johnny Cupcakes shirt they remember an experience they had when purchasing the shirt. I personally have two JC shirts (one was given as a gift so I don’t have an experience to associate with that but my parents, who bought the shirt for me do). I do have a vivid recollection of an experience I had when purchasing my first Johnny Cupcakes t-shirt at a pop-up shop on Martha’s Vineyard. There was a line of people waiting at a small bakery for it to open its doors. Everyone was unsure of what the t-shirts would look like because the designs had not yet been released. Not knowing what shirts will be sold definitely gives a little sense of excitement and surprise; and being excited about a brand goes a long way with customer loyalty. The waiting fans were given diner-like menus to see what shirts would be available. This definitely embodies the Johnny Cupcakes culture and experience. Once the doors were open to the bakery only a few people were allowed in at a time. This also gave the impression of exclusiveness. The limited edition shirts available were all Martha’s Vineyard related. Not only is MV a huge tourist location, but being a resident of the island I had a sense of pride and being able to wear something relating to the island meant something to me, as I am sure it did to others, whether they were residents or tourists gaining a unique souvenir. After purchasing the shirt and leaving the bakery, I was greeting outside by Johnny Earle himself who not only took a picture with me, but also signed my shirt. My parents had a similar experience, telling me what a meaningful conversation they had with Johnny. Every time I pull out my JC t-shirt, I remember my unique experience of t-shirt buying. Johnny Cupcakes is a differentiation strategy user that sells an experience, along with his products. The way the business is run creates fans. JC leverages the company’s resources, the customer experience, to create fans and a following of the brand. There are a handful of such loyal fans that fly out to all his releases to be able to experience them and not miss out on any product or â€Å"show.† JC, on a smaller scale, reminds me of the cult following of The Grateful Dead. Deadheads knew each show was unique and didn’t want to miss out on any one of them. There are many Johnny Cupcakers who feel the same way. On March 24 of 2011, Johnny Cupcakes went international and opened up a store in London. Johnny had previously tested the waters in London by way of pop-up stores. His store in London was a huge hit, and he plans on a huge one-year celebration. Johnny opened up his store in London the same way he started is brand and opened up his other stores in the USA, with no investors, partnerships, or alliances. He started off small and threw his profits right back into his brand. One of the things Johnny Cupcakes prides itself on is not having to use investors or other companies to grow their brand. Part of this is what makes the brand who and what they are today. By staying authentic and listening to their market, Johnny Cupcakes will be continue to be successful in the years to come. With more years of success under his belt, Johnny may want to fur ther expand his brand in the global market. References Earle, J. (2012). Story. Retrieved from: http://www.johnnycupcakes.com Hundreds, B (2011). The 50 Greatest Streetwear Brands. Retrieved from: http://http://www.complex.com/style/2011/06/the-50-greatest-streetwear-brands Spaeder, K. (2007). By Popular Demand. Retrieved From: http://www.entrepreneur.com/article/177912

Theory of Personality Development essays

Theory of Personality Development essays Describe and evaluate Freuds theory of personality development Sigmund Freud was without doubt one of the most controversial psychologists of the twentieth century. His theories of psychoanalysis-personality structure, dynamics, psychosexual development, mechanism, and psychotherapy technique were really accepted at the time. However he did have his critics. Not only opposing psychologists doubted his theories but also some of his own followers. Within this essay we shall look at certain theories that Freud had and also look at some of the opposing ideas from his critics. According to Freud the mind or personality included the ID, EGO and SUPEREGO, and mans behaviour relies on a balance of these structures. The id contains those basic instincts which require satisfaction, known as the pleasure principle. For example, a baby wants something and will cry until he gets it; this basic instinct is with us from birth. The superego is essentially the persons conscience. This is made up of values and ideals that are taught from the world about, in the first instance the parents. Superego develops in response to parental rewards and punishments. The ego differentiates between the basic instincts of the id and the reality of the real world, also known as the reality principle. All objects of consciousness abide in the ego; the superego is an unconscious screening mechanism which seeks to limit the blind pleasure seeking drives of the id by imposing restrictive rules. What must be remembered is that this model is only a theoretical model rather than a descript ion of an observable object; it only serves as a frame of reference to explain the link between experiences of early childhood and the mature adult personality. The ego is frequently in conflict with the id. The id wants gratification; the superego strives for what is morally right. The ego acts as arbitrator in this conflict and will try to find a compromise. A key idea ...

Charles Willard Moore - essays

Charles Willard Moore - essays Moore "mixed high architecture and high camp with gleeful abandon" (Filler 52). When he died in 1993 of a heart attack at age 68, friends and admirers praised his work and accomplishments saying that he left a "living legacy" in the thousands of architects he trained and inspired. He was also described as the most influential architecture professor (most notably Yale for ten years and the University of California at Los Angeles) of his generation. "Unlike many other star architects he was also a great teacher, and for over forty years he imparted his vast knowledge and passionate beliefs with unparalleled intelligence, gentleness, and merriment to generations of students" (Filler-1994 52). For more than forty years, Moore shared his vision with students that there is no higher purpose for an architect than to create homes and public places that have the ability to satisfy and comfort people, as well as provide a benefit atmosphere in which one's inner life can be satisfied along with the physical need for shelter and comfort. During his career, he produced twelve books, and unlike most books on architecture written by architects, he illustrated that it was possible to have a larger vision about building other than the desire to be new, different, or unique. He was a writer who was also an architect rather than the usual architect who thinks he can write. The most memorable and interesting of his books is "The Place of Houses," written with Gerald Allen and Donlyn Lyndon (his books always had co-authors) and published in 1974 (Filler-1996 80). Moore was the typical California and is best-known work for his "major" work found along the coast of California from Los Angeles to his Sea Ranch on the Mendocino coast north of San Francisco, a landmark of ecologically sensitive design built in the 1960s. His work ranges from the nonconformist Faculty Club at the University of California at Santa Barbara to the University of California a...

1984 Themes, Symbols, and Literary Devices

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This naturally stifles freedom of expression and makes change within the system impossible. In democratic societies, opposition groups can form political parties, express their ideas freely, and force the state to address concerns or be replaced. In a totalitarian society, this is impossible. Orwell’s Oceania goes further than even most existing totalitarian states. Where real-world authoritarian leaders seek to restrict information and control their populations in terms of their physical movements and spoken or written communication, Orwell’s government of the future seeks to inhibit thought itself and alter information at the source. Newspeak is a language invented by the state specifically to make independent thought literally impossible, and even Winston’s physical surroundings are designed to inhibit his freedoms, like the way his small apartment is dominated by the enormous two-way television screen, crowding him into a corner he incorrectly believes offers him some degree of privacy. That illusion is crucial to Orwell’s theme, as he strives to demonstrate that in a truly totalitarian society all freedom is in fact an illusion. Winston believes he finds ways to resist and meaningfully fight back against repression, all of which turn out to be gambits controlled by the state. Orwell argues that people who imagine they would heroically resist such a repressive regime are kidding themselves. Control of Information A crucial aspect of Oceania’s control over the citizenry is its manipulation of information. 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He has no idea if any of it is true- if the Brotherhood even exists, if there is even a man named Emmanuel Goldstein. Destruction of the Self Winston’s torture at the end of the novel is not simply punishment for his Thoughtcrimes and incompetent attempts to rebel; the purpose of the torture is to eradicate his sense of self. This is the ultimate goal of totalitarian regimes according to Orwell: A complete subservience to the goals, needs, and ideas of the state. The torture Winston undergoes is designed to destroy his individuality. In fact, every aspect of life in Oceania is designed to achieve this goal. Newspeak is designed to prevent negative thoughts or any thought that is not approved or generated by the state. The Two-Minutes Hate and the presence of Big Brother posters promote a sense of homogeneous community, and the presence of Thought Police- especially the children, who have been raised in the poisoned environment of the totalitarian state and who function as credulous and uncritical servants of its philosophy- prevents any sort of trust or true kinship. In fact, the Thought Police do not have to actually exist to achieve this goal. Simply the belief that they do is sufficient to inhibit any individual expression, with the ultimate result that the self is subsumed into Groupthink. Symbols Big Brother. The most powerful and recognizable symbol from the book- recognized even by people who have not read it- is the looming image of Big Brother on posters everywhere. The posters obviously symbolize the power and omniscience of the party, but they are only ominous to those who retain any kind of individual thought. 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Cognative Development Theroy Essay Example | Topics and Well Written Essays - 1000 words

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Capital Punishment Research Paper Example | Topics and Well Written Essays - 2000 words

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The baby boom generation - Essay Example Because advertisers are trying to gain the attention of their target consumer group, they work hard to depict the ideals of the society. If young and slim is attractive, they will work that into their presentation in as many ways as they can. If macho and hard is the current fashion, this, too, will be reflected in the way a product is marketed. At the same time, by changing the way they combine different types of visual clues, these same media outlets can help to redefine a culture, to make it more tolerant of ecological issues, for example, or to change the way a society views gender roles. Studies are utilized by advertising agencies to identify potential buying demographics. This information is then used to target specific markets and to learn about public attitudes, why they buy specific products and what sort of promotions would most appeal to their desires to purchase. To some companies, marketing is about generating sales, period. It is therefore surprising to discover how li ttle advertising is actually targeted toward the baby boom generation. Although our culture seems to worship youth above all else, the reality is that the baby boom generation, now entering retirement, remains a large and greatly viable market. Baby Boomer is the term used to designate a specific age group in American society, generally defined as those who were born between the years 1946 and 1964. The generation is named this in recognition of the ‘boom’ of births that took place immediately following the return of soldiers home from World War II (Jones, 1981). These individuals shared a number of experiences during their generation that serves to unite them, including the murder of a president, the first footsteps on the moon, the ‘rebirth’ of the ‘60s and the large-scale introduction of psychedelic drugs into the marketplace. The Civil Rights Movement occurred during many baby boomers’ early

Capital Punishment Research Paper Example | Topics and Well Written Essays - 2000 words

Capital Punishment - Research Paper Example Although the United States remains the only western country imposing the death penalty, the issue is subject to much public debate. Much of the debates surrounding capital punishment entail moral and ethical issues in the society as well as in the lives of individuals. This is because capital punishment involves a state-authorized termination to an individual’s life (Grover, 2011). The perceptions of many people opposed to capital punishment rests on the value of life, and the wrongness in executing murder. These arguments take different forms including the deficiency of revenge as a motivation, the unreliability of the criminal justice system, an alleged racial prejudice in executions, a supposed lack of statistically confirmable deterrence, extreme governmental power, the likelihood of executing a blameless person, and among some Christians, the dissolution of Christian love (Charles, 1994). Discussion For the proponents of death penalty, the main reason for advocating for capital punishment is that it deters prospective criminals. In this case, capital punishment advocates have a belief that when people in the society realize that if they commit murder they will face the same, then most people will avoid committing murder. Conversely, the reality is that there is no reduction in murder cases due to imposing capital punishment. This brings out the difference between perception and reality. It is true, there is a perception that imposing capital punishment will deter prospective murders but on the other hand, the reality is that there is no much deterrence in that there is no real reduction of murders after executing murderers (Grover, 2011). The opponents of capital punishment deem that by imposing capital punishment, it is possible to execute blameless people, without giving adequate time for investigation. Moreover, these opponents assert that there exists error in the criminal j ustice system that may render killing of innocent people due to various reasons. Conversely, justice asserts that someone has to suffer the consequences of the murder committed. This implies that the issue of executing an innocent person does not override the issue of justice. In addition, the perception of the criminal justice system making errors is not realistic and opponents should not solely base their arguments in this. This is because it is always possible that any legal system will have errors and that there could not be any perfect legal system (Charles, 1994). The main major reason of supporting capital system rests of the moral responsibility of the society to safeguard the safety and interests of its citizens. The assertion in this case is that those people who murder other people deprive the society of this safety and people interests. This assertion extends to the perception that the only way for the society to ensure safety of its citizens is through imposing capital punishment on murderers, which ensures that these killers do not kill again. In addition, this assertion claims that death penalty is very beneficial in the society since it deters future and more aggressive violent crime. Although there is no direct proof to support this assertion, the perception and outlook of the issue deem that when people realize that they will face murder after executing a particular crime, they will most likely restrain from committing such an act (Andre & Velasquez, 2010). Many of the

Gone with the Wind Essay Example for Free

Gone with the Wind Essay Gone with the Wind is an adaptation of an historical romance. The film, set in Civil War-era southern United States, tends to be highly sentimental. Paradoxically, the circumstances in which it is set are often harrowing and serve to highlight the bravery required to survive during that time. The frothiness of the plot is in stark contrast to the utter seriousness of its context. The film opens in the antebellum South, on a Georgia plantation where the heroine entertains two gentlemen callers. The talk is of imminent war, a theme which guests carry through the subsequent picnic. Talk then turns to action and the men depart to enlist in the Confederate Army. Confidence and jubilation quickly become disappointment which gives way to horror as the realities of war intrude upon the genteel tableau. Under assault, the Southerners struggle to keep their society together in the face of poverty, filth, and chaos. We see the major historical points of the period, especially Shermans march through Georgia and the burning of Atlanta, a scorched earth policy. The women are the main characters in the film. In the effects of war and its aftermath we see destitution, famine, terror, desperation. The wounded are legion and supplies dwindle and disappear. The war ends and the soldiers come home to regroup. Carpetbaggers descend and begin an uneasy alliance with enterprising individuals, notably Scarlett. She casts aside honor to regain prosperity, marrying for money and using her combination of feminine wiles and shrewdness to rise above abject poverty. Finally she marries Rhett, a selfish opportunist like her. At the end he realizes that she will never love him and leaves Scarlett with that which has sustained her; an abiding love for Tara. This narrative is history seen from the womens perspective. They are alternately brave, childish, and childlike, treading on the line between what they are and what they must be. They do it for the men of the South, themselves, and for the South itself. The depiction of the war and the events surrounding it is largely consistent with the historical record. The factual portions of the film are in part accurate. For instance, at a benefit supporting the war, the ladies are asked to relinquish their jewelry. Such a depiction is consistent with the account in The American Civil War by Peter J. Parish and it highlights one of the sacrifices women made during this time. George A. Trenholm, who replaced Secretary of the Confederate Treasury Memminger, asked for these concessions as the finances of the South became particularly desperate. This detail concerns one of the points at which Gone With the Wind succeeds as history. †¦wealthy female slaveholders escaped significant disruption in their lives at the outset of the war, for they had money to maintain their antebellum lifestyle and the slaves to maintain plantation production. (Frank 514) Thus the sheltered experience depicted in the film is wholly consistent with rich womens lives until the last stages of the period. In opposition, several events as depicted in Gone with the Wind are inaccurate. At the end and after the war, black people did not leap to the aid of their former masters as the film asserts. The character Mammy would have sought paid employment rather than stay on a ruined plantation. In reality, the vast majority of the planters used violence to subjugate their property. In one scene, the character Ashley Wilkes chides Scarlett for treating the convict workers in her lumber mill cruelly in supposed contrast with their treatment of the slaves. It is true that in the darkest days for the South they did choose to prevail upon the Negroes to fight for their own oppression. There was no greater irony in all the efforts of the Confederacy to find adequate means to match its ambitious goals than the proposal to arm Negroes. (Parish 561) But the slaves did not fight for the South as much for a newfound and cherished liberty, greater than they had ever known. And once they had tasted that liberty, they did not willingly acquiesce in the imposition of a terrible, unjust burden. The importance of the Civil War and its aftermath can hardly be overstated. The struggle has been the only armed conflict fought on our territory. It consumed nearly 500,000 lives, the largest wartime death toll in American history. It also was a first step in remedying the shame of slavery which Americans had perpetrated in a country which largely had been the realization of a vision of freedom and equality. They fought with not only the political reality of the Souths secession of 1861, but with the regions separate psychology. By 1860 the South was a state of mind as well as a place on the map. A definition of Southernness was and is at least as much a task for the psychologist as for the geographer. (Parish 303) This enduring mindset notwithstanding, had the South won, not only would the crime of slavery have been continued, it is doubtful that the U. S. would have grown into the superpower it is today. The war determined that an integral part of the union would remain. The significance of the war for the world at large in the mid-nineteenth century †¦belongs in part to the realm of might-have-beens; its long-term consequences derived less from what did happen from what did not. (Parish 381) Among the events that very well might have happened were interference from foreign governments, international recognition of the Confederacy, and the widening of this internecine war into a general conflagration abroad. Such luck for the union was due to the relative isolation the U. S. has enjoyed throughout its history. Americans fought their war amid constant threats from abroad. There was nothing inevitable about the fact that it remained a domestic†¦affair. It remained a purely American affair through a combination of good fortune and great skill on the part of those who wished to keep it so, gross errors on the part of those who did not, and canny calculations of national and self-interest on the part of those who might have been caught in its toils. (Parish 381) Although some continue to fight this war in their minds, they benefit from over 200 years of federal association and its attendant largess. As I stated earlier, with regard to the historical accuracy of the film as document, it is a womens narrative. Though there was no Scarlett OHara per se, the things we see her experience and perpetrate on others is consistent with the accounts of those who actually lived in that time and place. The threat of starvation was indeed present in all households in the later stages. Domestic production and ingenuity staved off a state of crisis for slaveholding women for a while, but, by the end of the war starvation and material deprivation shook even the most affluent households. (Frank 515) When Scarlett was forced to hide her wagon under a bridge with three highly vulnerable people in it while Northern soldiers passed overhead, she was surviving a circumstance familiar to many Southern women. †¦many faced the hazards of living in the path of the Union army. Those who resided near the battlefront risked having their property commandeered, stolen, or destroyed by Northern soldiers. (Frank 515) Such dangers were in addition to the threat, both potential and realized, of bodily violation. Scarlett valiantly, not to say desperately, defends herself and her loved ones against a looting Union soldier when she shoots him in the face. It is an act not uncommon to those willing and able to defend themselves. The depiction of slave and ex-slave loyalty is highly romanticized to say the least. Gone with the Wind depicts Negroes as possessing a childlike innocence. They seem to be a rich vein of merriment instead of the human beings upon which the horrors of bondage had been visited. Nowhere do we see slaverys pain and degradation. The black characters in the film are even more a caricature than even the heroine is at times. The films tendency toward opaque sentiment at first glance is a terrible injustice to a period quite painful to the American psyche be it black or white, Northern or Southern. Certainly the film is nowhere near the caliber of slave narratives, Ken Burns the Civil War, or Uncle Toms Cabin. However, it is important as hitherto all-too-often neglected genre of womens history. Seldom in mainstream culture is the womens perspective represented so faithfully. And equally seldom is it given the attention and resources devoted to this film. It is simply not taken seriously enough and shunted off into womens studies classes rather than included in the mainstream of scholarship. Valuable though they are, the womens studies classes or gender studies courses tend to attract the favor of those predisposed to appreciate them. Gone With the Wind, for a long while a staple of popular culture, has reached a much wider audience. In many ways this movie is indeed an historical romance, ladies fiction. However it is also a significant historical document. Many more people have learned about the Civil War from the womens point of view by means of viewing this film than from any other source. This fact, in addition to its inclusion of important data, renders it deserving of attention and respect. For instance, it highlights the worthlessness of the Confederate currency, a situation which underscores the sheer lack of administrative competence displayed in the South at all stages of the war. Not only did the Confederates fight the North, they also had to contend with the inherent weaknesses of their fledgling nation, as they sought to envision it. Many things weakened The Cause, most notably slaverys lack of long-term viability as an economic model. The South was heavily invested in a system which had no hope of succeeding beyond a few years. To a great extent, the Confederacy fell under its own weight, much to the past and continuing chagrin if its champions and much to the edification of the nation of which it is a part as well as humankind in general. If only the proof of that assertion would not have required the death of so many and the maiming of still more. Bibliography Frank, Lisa Tendrich. Women in the American Civil War Vol. II. Santa Barbara: ABC-CLIO, Inc. , 2008 Parish, Peter J. American Civil War, the. New York: Holmes and Meier, 1975.

Chronic Low Back Pain (CLBP) Literature Review on Treatment

Chronic Low Back Pain (CLBP) Literature Review on Treatment INTRODUCTION Chronic low back pain (CLBP) is a major health issue in the western world and is a significant burden on health care; Americans spend $37 billion annually with a further $19.8 billion lost in absenteeism [1]. There is 58% life time prevalence of back pain in the UK, a 22-65% 1-year prevalence and 6-7% of all adults have constant back problems [2]. Although CLBP is usually benign ( Modern (Verum) acupuncture originates in ancient Chinese philosophy which claims pain and disease manifest because of imbalances in bodies forces of Yin and Yang. It is believed these forces flow through specific courses (meridians) and can be manipulated using specific acupuncture points to regain the balance. Acupuncture has evolved from the traditional Chinese application and some styles incorporating adjuncts such as electrical stimulation of the acupuncture needle [4], A recent systematic review of articles published between 1966 and February 2003 [4] concluded that the efficacy of acupuncture on CLBP was inconclusive due to the low methodological quality of selected studies. They found acupuncture had some short-term improvements in pain and function compared to control or sham but due to low methodological quality they concluded a need for higher quality studies. This review updates that study [4] by including articles published after February 2003 or studies that were published prior but were of high relevance and methodological quality. The objective is to provide firm conclusions about the efficacy of acupuncture therapy for CLBP. METHODS Study Selection Criteria Only randomised controlled trials (RCTs) available in English and available free of charge were included. Search Strategy In October 2009 the MEDLINE database (period 1950 to date) was searched for RCTs published after February 2003 and matching the search string Chronic low back pain AND acupuncture OR dry needling OR Sham OR Placebo AND randomised controlled trial OR randomized controlled trial. Further searches using PEDro, Web of Science (using ISI Web of Knowledge) and Cinahl (period 1982 to date) (see appendix A). Each articles reference list was also used as a source of relevant publications. Participants For inclusion the studies participants needed to be =18-years old with non-specific CLBP. Non-specific CLBP was defined as pain between the 12th costal margin and the inferior gluteal folds =12-weeks. If radiating leg pain was present this must be secondary to the lumbosacral region pain. RCTs that included participants with specific pathologies as the root cause of their CLBP, such as malignancy, prolapse of =1 inter-vertebral disc or spinal fracture were excluded. Interventions Studies that investigated the effects of traditional (Verum) acupuncture, trigger-point acupuncture and dry needling were reviewed. RCTs were included regardless of hand of electro-stimulation. Studies investigating non-needle based acupuncture, such as laser acupuncture, were excluded. Control interventions included sham, usual care, Transcutaneous Electrical Nerve Stimulation (TENS) or conservative orthopaedic therapy. Outcome measures There are four outcome measures considered to be important when assessing CLBP Pain intensity (e.g. visual analogue scale (VAS-P), numerical rating scale (NRS-P)) A global measure (e.g. Overall improvement, proportional recovery of patients) A back specific functional status measure (e.g. Roland-Morris Disability Questionnaire (RMDQ)) Return to work (absenteeism, speed of return) RCTs must include =1 of the above. The primary outcomes were pain and function. Study selection A total of 544 studies were found through the searches with 17 potentially eligible RCTs identified. Of these 5 were excluded due to study duplication (n=1), sole inclusion of participants with specific CLBP (n=2) or use of non-needle based acupuncture (n=2). The remaining 12 articles were reviewed using the Critical Appraisal Skills Programme (CASP) to determine their methodological quality. CASP enables the systematic review of an RCT for validity, design, execution and reasoning. Assessment criteria included randomization and allocation of participants, blinding of participants and assessors, identification of potential observer bias, participant numbers at RCT start and conclusion, presentation and accuracy of results, and any identified limitations. Results were recorded and documented (Appendix B). RCT commonalities: Participants were excluded: if they exhibited contraindications to acupuncture, had received acupuncture for their CLBP previously, previous spinal surgery, infectious spondylopathy, malignancy, congenital spine deformity, compression fracture due to osteoporosis or spinal stenosis. No differences in demographic variables or baseline levels of pain and disability were detected between the groups at baseline (P >0.05). Randomization was computer-generated with random number tables. All participants gave informed consent. Each RCT received ethical approval Usual care is defined as a combination of drugs, physiotherapy and exercise. RESULTS [5] 298 participants with CLBP =6-months randomised to 12 sessions of acupuncture (n=146) or sham acupuncture (n=73) over 8-weeks, administering therapists had =140 hours training and 3-years experience, with a third delayed acupuncture group (n=79) who received no acupuncture for the initial 8-weeks followed by the acupuncture groups protocol. Outcome measures were VAS-P and back function using the validated German Funktionsfragebogen Hannover-RÃ ¼cken (FFbH-R) questionnaire. At 8-weeks VAS-P decreased from baseline in all groups; after 26 and 52-weeks the acupuncture groups results were better than sham however differences were not significant. Results from the delayed acupuncture group followed the acupuncture groups pattern. The trial had good methodological quality: outcome measures were assessed independently with participants completing questionnaires, attrition was reasonable (18%) but the acupuncture group was double the size of the others which may have influenced results. [6] 638 participants with CLBP =3-months randomised to standard acupuncture (n=185), individualised acupuncture (n=157), sham acupuncture (n=162) or usual care (161) groups. Acupuncture groups received 10 treatments over 7-weeks by acupuncturists with =3 training. The Primary outcome measure was RMDQ. Compared to baseline all groups showed improved function and pain at 8-weeks. Mean values for RMDQ were consistent up to 52-weeks with the usual care group having greater dysfunction than all acupuncture groups (P=.001). There was no significant difference between real and sham acupuncture groups (P>0.05). All forms of acupuncture had beneficial and persisting effects over usual care for CLBP treatment with clinically meaningful functional improvements. There were no significant differences between acupuncture groups. Outcome measures were gathered by blinded telephone interviewers and attrition was low (6%) resulting in good trial internal validity [7] 1162 participants with CLBP =6-months randomised to 5-weeks of twice-weekly acupuncture (n=387) or sham acupuncture (n=387), performed by acupuncturists with =140 hours training. A third group received usual care (n=387). Outcome measures were Von Korff Chronic Pain Grade Scale (GCPS) and Hanover Functional Ability Questionnaire (HFAQ). Results were presented as a percentage of improvement in function and pain at 6-month follow-up. At 6-months both acupuncture groups had significant improvements in pain and function compared to baseline and usual treatment. There was no difference between acupuncture groups (p=0.39). The trial was methodologically strong with good internal validity: the control group was an active multimodal conventional therapy, had high power with stated calculation, follow-ups at 1.5, 3 and 6-months, low attrition (4%) and balanced dynamic randomisation. This was a good, highly relevant, large, rigorous trial. [8] 35 participants, =65-years, with CLBP =6-months randomised to 1 of 3 groups receiving 2 3-week phases of 30-minute acupuncture sessions, with a 3-week interval between. Group A (n=12) received standard acupuncture, Group B (n=10) superficial trigger-point acupuncture and Group C (n=13) deep trigger-point acupuncture. Outcome measures were VAS-P and RMDQ score. Group C showed a statistically significant VAS-P and RMDQ reductions from baseline after phase 1 with VAS-P reduction persisting over 12-weeks. There was no significant reduction in VAS-P or RMDQ for either other groups. The RCTs methods are described well however small sample size, high dropout (27%), short-term follow-up and potential bias limited internal validity [9] 26 participants, =65-years, with CLBP =6-months randomised to 2 groups. Over 12-weeks each group received 1 phase of trigger-point acupuncture and 1 phase of sham acupuncture with a 3-week break between. Group A (n=13) received trigger-point phase first followed by sham, Group B (n=13) vice-versa. Acupuncturist had =4-years training and =7-years clinical experience. Outcome measures were VAS-P and RMDQ score. After phase 1 Group A had significantly lower VAS-P (P [10] 60 participants with CLBP =6-months randomised them to 6-weeks of 30-minute weekly sessions of either acupuncture (n=30) or placebo TENS (n=30). No details of administering therapists were given. The primary outcome measure was VAS-P. Although acupuncture showed highly significant differences in all the outcome measures between pre- and post-treatment, the differences between the 2 groups were not statistically significant. Generally the RCT was poor: therapists were not blinded, high noncompliance (23.3%), cointerventions might have influenced results, the dropout rate was not explained and there was no intention-to-treat analysis. [11] 131 participants 18-65 years old with CLBP =6-months were randomised to groups receiving 20 30-minute sessions of traditional and auricular acupuncture (n=40), physiotherapy (n=46) or sham acupuncture and physiotherapy (n=45), over 12-weeks. Outcome measures were VAS-P and pain disability index (PDI). After 12-weeks of treatment the acupuncture group showed significantly reduced pain and disability compared to the physiotherapy group but not compared to the sham group. At 9-months the acupuncture group was more effective than physiotherapy in reducing disability only and not different to sham. The trial was methodologically strong but short-term dropout was 24% and long-term 37%. The treatment scheduled was five-a-week for 2-weeks then weekly for 10-weeks which may not be clinically practical. [12] 55 participants =60 yrs, with CLBP =12-weeks were randomised to 2-weeks of twice-weekly acupuncture and electrical stimulation alongside usual care (n=31) or usual care alone (n=24). Primary outcome was RMDQ. At 6-weeks results indicate clinically and statistically significant improvements in the acupuncture group for pain and disability compared to control. Effects remained and only diminished slightly at 9-weeks follow-up. The trial was methodologically strong: balanced randomisation, clear methods, low attrition (14%). Participant inclusion criteria included prior imaging limiting generalisability. [13] 186 participants aged between 20 and 60 with CLBP =6-week were randomised to 4-weeks of usual care alone (n=60) or with either acupuncture (n=65) or sham acupuncture (n=61). Acupuncturists were experienced doctors trained in Beijing. Primary outcome measure was VAS-P. Immediately after treatment 65% of the acupuncture group reported a =50% reduction in VAS-P compared to 34% of the sham group and 43% of the usual care group. At 3-months 79% of the acupuncture group, 29% of the sham group and 14% of the usual care group reported a =50% VAS-P reduction. Methodological quality was high: balanced (stratified) randomisation and excellently described methods however there was 30% attrition at 3-month follow-up and data collection was from general practitioners leading to potential performance bias. [14] 241 participants, aged 18-65, with CLBP for 4 to 52-weeks were randomised to 10 sessions of acupuncture (n=160) or to usual care (n=81) over 3-months. Acupuncturists were training for =3-years and =12.8-years clinical practice. Outcome measures were SF-36 pain scores and Oswestry low back pain disability questionnaire (ODI) taken at baseline, 3, 12 and 24-months. A power calculation stated a required 100 participants per group to detect a 10-point difference on SF-36 (90% power and 5% significance level). A 5 point difference in SF-36 was deemed significant. The number of participants in the acupuncture group was increased to 160 to allow for between-acupuncturist effect, usual care group decreased to 80 participants without power loss. Results were presented as point differences between randomisation, 12 and 24-months. At 12-months a 5.6 point intervention effect difference in SF-36 pain was found and 8 point at 24-months. No treatment effect was found for any other dimension o f SF-36 or ODI. Participants were representative of UK population, randomisation was balanced, methods were thoroughly documented and acupuncture treatments were individualised resulting in high methodological quality and generalisability. However 25% of participants were unaccounted for at conclusion reducing internal validity. [15] 11630 participants with CLBP =6-months were allocated to three groups. Group A were received 15 individualised acupuncture sessions with usual care as needed (n=1549). Group B received delayed acupuncture with usual care as needed (n=1544). Group C declined to be randomised but received 15 individualised acupuncture sessions with usual care (n=8004). Treatment was over 3-months. Outcome measures were FFbH-R and SF-36 pain scores. At 6-months the acupuncture group showed significant improvements in FFbH-R and SF-36 pain compared to routine care alone. The large sample size and broad inclusion criteria meant results were generalisable however groups were different at baseline and findings identified a degree of randomisation selection. [16] 52 participants with CLBP =6-months were randomised to 4-weeks of physiotherapy with daily 1-hour electro-acupuncture sessions (n=26) or standard physiotherapy (n=26). Outcome measures were pain (NRS-P) and function using the Aberdeen-LBP. There was a significant reduction in NRS-P and Aberdeen-LBP scores in the acupuncture group immediately after treatment and at 1 and 3-months follow-up. Methodological quality was limited by possible breach of blinding integrity due to lack of patient blinding and subjective outcome measures. DISCUSSION Acupuncture vs. no treatment Two high quality studies (11928 people) [5] and [15] found acupuncture more effective in short-term pain reduction and functional improvements than no (delayed) treatment. However both studies were weakened by insufficient blinding and participants were recruited from newspaper adverts [5] or an insurance company [15] limiting generalisability; both of which reduce results confidence. Acupuncture vs. sham Studies comparing acupuncture and sham acupuncture (2460 people) ([5], [6], [7], [11] and [13]) found both effective at reducing pain and increasing function compared to baseline measures; however no study found a clinically significant difference between groups With five methodologically sound trials all reporting similar results clinicians can have confidence in the effectiveness of acupuncture or sham-acupuncture in pain and functional improvements. However with no clinically significant difference between groups, placebo effect seems to be a substantial contributing factor. Acupuncture vs. usual care Five RCTs comparing acupuncture and usual care (12164 people) ([12], [13], [14], [15] and [16]) concluded that acupuncture was more effective at reducing pain. Increased function in the acupuncture group compared to control was reported in 1 RCT [12] at 6- and 9-weeks, [15] at 6-month and another [16] investigated effect immediately after treatment and 1- and 3-months follow-up; however 1 RCT [14] found no significant improvement in function in their longer-term study at 12 or 24-month. Unlike other papers reviewed, Thomas and colleagues used UK based participants who received treatments in private or GP clinics adding confidence to their conclusions when applied to the general UK population. From study findings clinicians can have confidence that the addition of acupuncture to their treatment of CLBP will be more effective than usual care alone. Acupuncture vs. deep and superficial trigger-point acupuncture One study ([8] 35 people) found greatest improvements in pain and function using deep trigger-point-acupuncture. However this study, while being methodologically thorough and having patient and assessor blinding, was limited by small size, high dropout (23%), short-term follow-up and possible centre bias leading to reduced clinical confidence. Acupuncture vs. TENS One RCT ([10] 60 people) found significant improvements using both TENS and acupuncture but no significant intergroup difference over 6-months. However, confidence in results are limited because participants also received usual care and exercise so may have improved regardless; furthermore the study had no therapists blinding, high noncompliance (23.3%), unexplained dropouts and no intention-to-treat analysis. Trigger-point acupuncture vs. sham In 1 cross-over trial ([9] 26 people) trigger-point acupuncture was found to be more effective than sham however small sample size, high attrition (23%), restricted to short-term follow-up and possible bias due to centre location (Department of Orthopaedic Surgery, Meiji University of Oriental Medicine) limit confidence in findings. LIMITATIONS Studies were commonly limited by being unrepresentative: of the 12 studies 2 were UK based ([10], [14]), six restricted participants by age ([8], [9], [11] [12], [13], [14]), 2 used participant recruitment methods which may have introduced expectation bias (newspaper adverts, [5], insurance company [15]) and five had underpowered sample sizes or non-stated power calculations ([8], [9], [11], [12], [13]). Without representative sample groups the outcome measures cannot be applied to the general population with any reliability. Discrepancies were noted in treatment frequency with control group participants receiving less attention than intervention participants [16]. Blinding was inconsistent across studies: 1 study ([5]) blinded participants in the acupuncture groups but not the delayed group, 1 study ([6]) blinded participants only, four ([7], [8], [9], [13]) blinded assessors and participant, 1 ([10]) blinded assessors only, 1 ([11]) blinded assessors and participants but not acupuncturists, three ([12], [14], [15]) had no blinding and 1 ([16]) blinded assessors but not participants. CONCLUSIONS There is some evidence for the efficacy of acupuncture for CLBP; compared to no treatment there was short-term ([5] 8-week and [15] 3-month) pain reduction and functional improvements. Compared to sham therapy both showed similar improvements in pain and function at short-term ([5] 8-week, [6] 8-week, [11] 12-week and [13] 3-month) and mid-term ([5] 6-month and 1-year, [7] 6-month, [11] 9-month) follow-up but no significant difference was detected between groups. Compared to usual care acupuncture showed significant improvements in primary outcome measures at treatment, short- ([12]6- and 9-week, [13]3-month, [16]1- and 3-month) and long-term ([15]6-month, [14]1- and 2-year) follow-up. Compared to superficial and deep trigger-point all treatments showed improvements but none were significantly different from each other. Both acupuncture and TENS were found to produce long-term ([10] 6-month) improvements but no significant difference was found between interventions. Comparing trigger -point therapy to sham, trigger-point was found to be more effective although benefits were not sustained. There is evidence that acupuncture alongside other treatments relieves pain and increases function better than individual therapies alone. Further research needs to be conducted to determine treatment frequencies and sustainability of treatment effects. Effective sham treatments need to be developed to establish placebo effect compared to acupuncture and other therapy types. Additional Resources Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. (2003). Lost productive time and cost due to common pain conditions in the US workforce. JAMA;290(18):2443-2454. Maniadakis, N. and Gray, A. (2000) The economic burden of back pain in the UK. Pain, 84, 95-103. Koes BW, van Tulder MW and Thomas S (2006). Diagnosis and treatment of low back pain. BMJ; 332, p1430-1434 Furlan AD, van Tulder M, Cherkin D, Tsukayama H, Lao L, Koes B, Berman B. (2005). Acupuncture and Dry-Needling for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Collaboration. Spine 2005;30:944-963 Reviewed Journals Brinkhaus B, Witt CM, Jena S, Linde K, Streng A, Wagenpfeil S, Irnich D, Walther HU, Melchart D, Willich SN. (2006) Acupuncture in patients with chronic low back pain: a randomized controlled trial. Archives of internal medicine. 166: 450-457. Cherkin et al (2009) A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Haake M, Muller H, Schade-Brittinger C, Basler HD, Schafer H, Maier C, Endres HG, Trampisch HJ, Molsberger A. (2007). German Acupuncture Trials (GERAC) for chronic low back pain- randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. 167(17):1892-1898. Itoh E, Katsumi Y, Hirota S, Kitakoji H. (2006). Effects of trigger point acupuncture on chronic low back pain in elderly patients a sham-controlled randomised trial. Acupuncture in Medicine. 24(1):5-12 ItohK. Katsumi Y. Kitakoji H. Acupuncture in Medicine. (2004) Trigger point acupuncture treatment of chronic low back pain in elderly patients: a blinded RCT. 22(4):170-7, Kerr DP, Walsh DM, Baxter D. (2003) Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial. The clinical journal of pain. 19: 364-370 Leibing E, Leonhardt U, Koster G, Goerlitz A, Rosenfeldt JA, Hilgers R, Ramadori G. (2001). Acupuncture treatment of chronic low-back pain a randomized, blinded, placebo-controlled trial with 9-month follow-up. Pain 96 (2002) 189-196 Meng CF, Wang D, Ngeow J, Lao L, Peterson M, Paget S. (2003). Acupuncture for chronic lower back pain in older patients: a randomized, controlled trial. Rheumatology. 42:1508-1517 Molsberger AF, Mau J, Pawelec DB, Winkler J (2002). Does acupuncture improve the orthopedic management of chronic low back pain a randomized, blinded, controlled trial with3 months follow up. Pain 99 (2002) 579-587 Thomas KJ, MacPherson H, Thorpe L, Brazier J, Fitter M, Campbell M J , Roman M, Walters S J, Nicholl J. (2006). Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. British Medical Journal.doi:10.1136/bmj.38878.907361.7C Witt CM, Jena S, Selim D, Brinkhaus B, Reinhold T, Wruck K, Liecker B, Linde K, Wegscheider K, Willich SN. (2006). Pragmatic Randomized Trial Evaluating the Clinical and Economic Effectiveness of Acupuncture for Chronic Low Back Pain. American Journal of Epidemiology 2006;164:487-496 Yeung CKN, Leung MCP, Chow DHK. (2003). The Use of Electro-Acupuncture in Conjunction with Exercise for the Treatment of Chronic Low-Back Pain. The Journal Of Alternative And Complementary Medicine..2003:9:4:479-490