Carrefour Hypermarket Essay Example for Free

Carrefour Hypermarket Essay A hypermarket or multi department store is a superstore which combines a supermarket and a department store. The result is a very large retail facilitywhich carries an enormous range of products under one roof, including full linesof groceries and general merchandise. When they are planned, constructed, andexecuted correctly, a consumer can ideally satisfy all of his or her routine weeklyshopping needs in one trip. The example of hypermarket have been set up inMalaysia is Carrefour, Tesco, Jusco, and Giant (foreign hypermarkets) besidesother local hypermarket such as Mydin. Following are background of theCarrefour hypermarket and Mydin hypermarket.The first Carrefour store opened on 3 June 1957, in suburban Annecy near a crossroads (carrefour in French). Today it is the smallest Carrefour location inthe world. The group was created by Marcel Fournier and Denis Defforey andgrew into a chain from this first sales outlet. In 1999 it merged with Promodà ¨s,known as Continent, one of its major competitors on the French market.Marce Fournier and Denis Defforey had attended several seminars in theUnited States led by The Pope of modern distribution Bernardo Trujillo, whoinfluenced other famous French executives like Édouard Leclerc (E.Leclerc),Gà ©rard Mulliez (Auchan), Paul Dubrule (Accor), and Gà ©rard Pà ©lisson (Accor).Their slogan was No parking, no business.The Carrefour group pioneered the concept of a hypermarket a large supermarket and a department store under the same roof. They opened their first hypermarket 15 June 1963 in Sainte Genevià ¨ve des Bois, near Paris inFrance.1976 Carrefour introduces  ³produits libres ´ which are unbranded product but ³just as good, and cheaper ´. In 1992, Carrefour creates filiere quality systems,which quarantee product origin and traceability. Carrefour opened their firsthypermarket 1994 in Malaysia. In the 21st century, hundreds of millions of men and women will become part of the consumer society within a globalized economy. Globalization does, however,pose new types of risk for both human society and our planet. Faced with suchrisk,  and in order to improve prospects for future generations, it is crucial tofollow the path of sustainability, which combines economic profitability, respect for the environment and both social and ethical development. mission Carrefour are totally focused on meeting the expectations of their customers. Carrefour mission is to be the benchmark in modern retailing in each of their markets, by offering : * Their customers: the best prices and the best merchandise, in every banner and every country. * Their staff: the possibility of growth and fulfillment in a trusting environment, withinteresting jobs and motivational compensation. * Their shareholders: a sustained return on their investment and the growthprospects of a global, multi format retailer. * Their partners, franchisees or affiliates: leading banners and brands, marketingand sales expertise, purchasing power and constantly improving techniques. * Their suppliers: markets, customer intelligence, and cooperation to improveproducts through long term, mutually beneficial relationships. * Public, local and national authorities: a deep commitment to the community,as a socially responsible economic actor and good corporate citizen. Objectives †¢Improve customer satisfaction †¢Improve profitability †¢Significant reduction in excess inventory Carrefour is a public limited company with a share capital of 1,790,354,427.50 euros divided into 716,141,771 shares and with some 460,000shareholders. Carrefours employees own 2.98% of the Groups share capital.Their attention to social and environmental performance preserves their share price and attracts new investors sensitive to social and environmental issues.Carrefour strives to guarantee to its shareholders the transparency of its corporategovernance. Ethical, social or environmental issues are dealt with by Carrefour’s key decision making bodies : 1. The Board of Directors is Carrefour’s main governing body. It comprises 11members of whom 3 are independent directors, and is assisted by a Strategic Steering Committee, an Audit Committee and a Wages and Salaries Committee. 2. The Executive Committee is the backbone ´ of Carrefour’s managementstructure. Under the impetus of its chairman, it recommends strategic directionsand guidelines and organises their deployment. Its membership reflects the waythe Group is structured per geographic area with cross sector support functions. 3. The Quality Sustainable Development department, which manages thesustainable development programme, reports directly to the CEO and advises theExecutive Committee on sustainability issues. Carrefour products Besides, With its customers needs in mind, Carrefour decided in 1985 toreplace its produits libres, generic product line created in 1976, with an own -brand line, which is produced for the most part by small and medium sizedbusinesses and manufacturers. Today, Carrefour sells over 2,000 products thatmeet very strict specifications with regard to their price / quality ratio, taste,authenticity, food safety, traceability and innovation. Carrefour also sells 5,000 non- food products under its own brand names. Outside laboratories conduct qualityaudits of our non-food products at various stages in their production to make sure theymeet our specifications. Carrefours organic line now offers 130 products in its freshfood, grocery and frozen food aisles. All products in the Carrefour organic lineare inspected and certified by the independent certification organization ECOCERT,and must meet organic farming specifications (no chemical fertilizers, no syntheticpesticides). Everyone who works with Carrefour to produce its organic line makes a long term commitment to adhere to demanding production control and producttracking specifications. Regular inspections are conducted at every stage of themanufacturing process, up to and including inspections of the finished product. Carrefour market positioning Carrefour does business, its stores have further moved its marketpositioning towards the discount end through a policy of low prices andlargescale promotions. The banners concerned by the conversion to the eurolocked in their prices through May 2002 and maintened a freeze on own brandsover the whole year. The price positioning was supported by many promotionalcampaigns. In the first half, Carrefour won back market share in Brazil byconducting three short promotional campaigns a week. In the second half, thegroup’s 40th Anniversary offered a worldwide opportunity to display thecompetitive nature of the product range. Other international promotions such asthe ones in countries involved in the World Football Cup, helped to boostthe stores financial performance. Carrefour branches With operations in 30 countries, Carrefour is the world’s second largestretail group. It is the number one retailer in Europe. Carrefour has  also been present in the Americas since 1975 and in Asia since 1989. This success stems from their ability to adapt their strategy to fit local markets and to make globalisation an Opportunity for progress. Wherever they do business, they striveto raise local standards in terms of quality, service, working conditions and preserving the environment. They also mindful of their contribution to the labour market, in some countries, like Argentina. Carrefour is the largest private sector employer. Market positioning is the act of designing the company’s offerings and image to occupy a distinctive place in the mind of target market for its product, brand, or organization. It is the relative competitive comparison their product occupies in agiven market as perceived by the target market. Market positioning strategy usedby all retail in dustry such as foreign hypermarket. Below type of market positioning strategy used by retail industry . Product offered by Carrefour is a basis to differentiate other hypermarket product. The bases used in Carrefour hypermarket are * Quality Quality is one of Carrefour main source of competitive differentiation and is partof the fundamental policies defining the implementation of the Carrefour’s strategy. It always corresponds to what the customer explicitly or implicitly wantsand must be clearly perceived as such. The value for money must be the best.Controlled products whether banner brands or own brands, offer exemplary qualityand safety. A product must demonstrate the required quality level before it canbe approved for purchase. * Guaranteeing food products safety and quality The best possible value for money is offered at every price level (first priceproducts/ own brand and banner brand products). For own brand and banner brand products, the quality process includes signing a set of specifications,approving production sites and product control plan, processing and archiv ing anycon-compliant products and following up of customers claims. To complete thissystem, Carrefour has deployed in 2005 a Quality Scorecard available on theintranet site, which enable all the Carrefour to track products at every stage of their marketing and to react more efficiently in case of a crisis. * An approach shared with our suppliers To guarantee the quality of its food products and its own brand and banner brand products, Carrefour systematically conducts audits on its suppliers’s production sites, which are audited health and safety conditions. Suppliers’s production sites are audited by Carrefour,  its service providers or certificationagencies. Suppliers are audited with respect to health and safety conditions, riskcontrol, traceability and compliance with specifications. In addition, Carrefour endeavours to verify progress in product development Quality at the best price: first price products First price No1 ´ products launched in Malaysia. Drawing on synergies andpurchasing volumes at the Carrefour, these products are intended to offer consumers quality products at a price that is 5% to 7% below hard discountprices. In addition to meeting existing legal requirements, No1 products alsoreflects the quality and safety approach that characterizes all their own brandand banner brand products. Carrefour has decided to apply the same position for No1 products as for own brand and banner brand products by excludinggenetically modified organisms from the composition of all products. * Quality information on non food products labels To promote the quality of its own brand products and retail brand productsamong consumers, Carrefour hypermarkets decided to optimize the quality of information on the packaging of its Carrefour brand non food products. Four criteria, symbolized by four icons, were adopted, referring to usage, safety, health and the environment or social conditions of production. The packaging points outthe most striking criterion for each product by explaining in one or two sentencesthe product’s added value. This is signed with the commitment logo of Carrefour, which provides Consumer services with evidences of its procedures.Carrefour has already used this method on paints, backpacks, toys and scents. This approach will be extended to include children’s products, paper goods,sporting goods and food containers. * Ensure in store safety and quality The proper upkeep of stores and the respect for the cold chain and food safetyare key elements of the Carrefour’s policy in Malaysia . Thus the Carrefour mobilizes all its employees to ensure respect for health and safety rules. Thisinvolves training, establishing procedures, and systematic hygiene and qualityaudits in stores and warehouses. * Improve nutritional information on food products labels Facing with a disturbing rise in food-related problems and to help customers tocombine food products better for a more balanced diet, in early 2005, Carrefour has optimized the labelling of its Carrefour brand products. The Carrefour’s Commercial Department has worked with the CLCV to develop a more accessibleand helpful presentation of nutritional  information. The packaging has now a ³nutrition box ´ indicating the share of daily needs for six main nutrients ( fats,sugar, carbohydrates protein, fibre and salt) provided by the products. Brand The Carrefour has had successful financial results, has gained market share,and makes customer happy. This is a reward for all employees, as all of themplay a role in this result. In fact, over 90% of the employees work in contactwith customers. That means that customer happiness is closely linked to theemployees’ performance. The Carrefour has developed various tools, depending onthe employee’s position to assess the employee’s performance. For instance,tools for cashiers include such indicators as turnover and absenteeism. A number of teams participated directly in the preparation of the strategicplan through participating. In task forces that brought together people from allstore formats and all geographical areas. Being linked to the global strategy is agreat motivation for store managers. Moreover, the strategy is probably moreappropriate this way, so it is in turn easier for managers to implement theprograms with the employees. Since 2000, hypermarkets have systematized listening to employees toassess their satisfaction. Over 8,000 persons, both managers and employees,used it to express their point of view. It enables the Group to have a fair overview of labour relations, to adjust its management style and to draft actionplans that factor in employees’ recommendations and comments. Besides, general staff benefits include such as * Contractual Bonus * Service Awards Programme * Out Patient Treatment Benefits * Group Personal Accident Plan * Group Health Plan (Cover includes immediate family members) * Structured Skills Career Development (Programmes Structured SkillsCaree) Additional benefits for Non-Executives include allowances for: * Transportation * Attendance * Punctuality * Cashier ( cashier only ) * Festive incentive ( ie: Hari Raya, Chinese New Year, Deepavali) At Carrefour, they constantly strive to be a responsible corporate citizen andundertake various measures to give back to the community and society as awhole. Carrefour strive to make a difference in the lives of the community fromthe urban to the rural and they are driven by the belief that all life is special anddeserves attention. Carrefour believes in operating business with integrity andcommitment to quality. This conviction that begins with us as an individual andthrough this inward conviction, Carrefour will make a difference in the lives of people around Malaysia. Personnel Differentiation The Carrefour Group has formalized its progressive approach based onthree key commitments: quality and safety, respect for the environment andeconomic and social responsibility. Safety commitment on Drug Perfume and Hygiene products (DPH) All suppliers are required to abide by Carrefour’s policy on cleaning,detergent and cosmetic products. No cosmetic product has been tested onanimals by Carrefour’s purchasing office or on its behalf for 10 years. Products and their formulas are rigorously scrutinized by a team of six internal specialists,with the support of an additional team of recognized external experts. Some of the group’s banners are taking this approach even further. Safety commitment on textiles and clothing for babies and children In 2003, Carrefour has developed specifications to improve the safety of clothing and textile products intended for children and babies. In two years, morethan 5,000 textile products involving over 200,000 substances were tested byindependent agencies. This safety requirement has been boosted by regular monitoring conducted with the help of specialists, toxicologists and allergists for all textile products. Based On services Differentiation The Carrefour puts its customers at the heart of everything it does. To thisend, it has simplified its organization, giving more independence to storemanagers to enable them to adapt their business as closely as possible to theneeds of their catchment area. Alongside this, the Carrefour has expandedcustomer choice, adapted its store brand ranges and increased its  serviceoffering. New store concepts have been introduced to respond to evolutions intheir customers’ lifestyles. For some years now, the Carrefour has also beenstrengthening its loyalty programs around this country to ensure that they reflectthe latest consumer and social trends.Over the years, Carrefour has added numerous practical and accessibleservices to its offering. The Carrefour has thus become a competitive player andthe benchmark in several areas of activity outside of its core business line.Carrefour made significant capital expenditures in 2002 to reconfigure its stores tomake them more attractive and im prove customer service. Reorganized salesareas and product staging make the best of the Carrefour’s various areas of expertise. This applies to both the food and non  ± food areas in hypermarkets. At Carrefour, they welcome customer views and comments which will help themimprove their service to customer. As in many other businesses, it is a crucial point for the Carrefour to learnabout their customers and to do everything they can to satisfy them. ThusCarrefour has defined what builds up a positive experience for the customer;apart from the differentiation strategies, price positioning strategies, distributionchannel and marketing mix, can see that the success factors contribute on itsproducts or services. The Carrefour mostly sells consumer goods and servicessuch as: * Convenience goods (food products, gas) which are sold by all formats of retail stores. * Shopping goods and services (household appliances, electronic devices)which are sold by hypermarkets only. * Cash Carry and wholesale stores sell industrial goods (mostly food) asthey sell to businesses (food trade professionals).Carrefour’ s success factors used on its product are: * The Carrefour ¶s product be unique and different from the existingproducts in the market. (CG Home theatre system very unique and different from other Hometheatre at market). * The product has sales in needed and wanted by the consumers.(Carrefour arrange different product in festival seasons such as HariRaya, Chinese New Year, Deepavali and Christmas. Example: LuckyBamboo, cai Shen scoll, honey mandarin and assorted paper card inChinese New Year and Christmas table, Christmas trees and colourfullights  ± in Christmas.) The product have hi gh consumer demand and a high growth rate. ( allkind of product). * The product has to be reasonably priced and affordable to the majorityof consumer. ( all kind of product). * The  Carrefour have sufficient funds to build consumer awareness andcarry on other promotional activities. ( Carrefour Gift Vouchers, Carrefour Bonus ) . Form The products design different from other products, example GC product.QualityCarrefour always guarantee that all products they sales are safety and goodquality. Brand At Carrefour they sales CG brand products, which one mostly unique anddifferent from other brand products at market. Besides Carrefour also sales other product such as TOSHIBA, PENSONIC, ELBA, FABER, SAMSUNG, SHARP, LG,Goldsonic and etc.Durability A product that can last for many years is perceived as a product of goodquality.FeaturesCG products have various attractive features such as CG television set with loudstereo sound, clear picture quality , remote control and a big screen falls into thegood quality product category. Carrefour FreshFOod Carrefour also offer fresh food to consumers which one given the opportunity toconsumer to make many choices, an opportunity which has so far been lacking in Malaysia Carrefour. In terms of fresh produce, choice also pervades. Pursuingthe unconventional, for example, Carrefour will carry those items that other storesshy away from: at Carrefour one can find curved cucumbers, freshly harvestedcabbage (ones that have not gone through any additional processes), and other items that suffer from no real, discernible defect in quality. Besides Carrefour also carry fresh food like fresh chicken, fresh fish, fresh Australia Beef, freshprawn and etc.Differentiation strategies on Carrefour Fresh Food are based on productdifferentiation.QualityThe Quality Way products are the result of the collaboration between Carrefour and chosen producers, who have committed themselves to strictly follow a qualityletter statutes agreement. The aim of the collaboration is to provide consumerswith healthy and safe products. The products certified with the Quality Way signare quality and safety guaranteed, from the first production stage until the finalpositioning on the shelves. Some fresh food in Carrefour certificated as QualityWay are : Halvah quality way, Chicken quality way, Free Range Eggs quality way, Fresh Fish tsipoura quality way, French beef, Salmon, Biological bread, Barrel Feta quality way, Pork quality way, Apples agorin quality way, Peaches and Nectarines Veria quality way, Seabass quality way, Kiwi quality way, Feta Tin quality way Based on services differentiation.Carrefour also provide customer service such as Cutting Service (Scalling / Cuttingservice for meat products upon request). Carrefour Family G oods.  Carrefour also carry family Goods such as Carrefour Baby Goods (Food range,hygiene, perfumery, childcare products, toys, apparel developed under the adviceof a committee of pediatricians and specialists, in order to guarantee the baby’s development from 0 to 36 months with security and comfort.), Carrefour KidsGoods ( Food range, general merchandise, apparel, designed to develop goodhabits (fight against obesity with less fats, sugar and salt), as well as developingautonomy, satisfying the tastes of children between 4 and 10 years old throughadapted packaging and the use of the mascot: Genius), Men’s clothes, Lady’ sclothes (variety of clothes) and etc. Differentiation strategies on Carrefour Family Goods are based on productdifferentiation.QualityCarrefour always guarantee that family goods they sales are safety and goodquality specially Babys Goods. To guarantee the quality of its products and itsown brand and banner brand products, Carrefour systematically conducts auditson its suppliers’ production sites, which are audited health and safety conditions..Suppliers are audited with respect to health and safety conditions, risk control,traceability and compliance with specifications. Distribution Channel The Carrefour as a whole is an efficient channel of distribution: it is a whole setof marketing intermediaries that have joined together to transport and store goodsfrom producers to consumers. The Carrefour acts as a wholesaler as the Groupsells products to franchises. All the retail stores are other intermediaries. Some of the producers are local while other goods  are bought by bulk purchases or global sourcing. That means that Carrefour has to organize the wholetransportation to its retail stores. Carrefour is mainly concerned with outboundlogistics as they manage flows of finished products to ultimate customers (and tobusiness buyers for cash carry). This is a critical activity for Carrefour: they just cannot have empty shelves because that would not make customers happy!Each day, 8 trucks are needed to deliver products to one hypermarket! They usesophisticated software to create an efficient link between sales and purchases.They use  ³push  ± pull push ´ logistics. It means that they both do forecasts andthey also control what is sold in order to adapt. Before the merger Carrefour  ±Promodà ¨s, both firms had their own channels of distribution. After the merger,they decided to organize a common and efficient channel of distribution. It can bedivided into three networks: î€ grocery products which stay a very short time in warehouses for hypermarkets the same products for supermarkets, convenience stores and Promocash î€ products which stay a bit longer in warehouses, and that are delivered toall formats of stores This new system enables to reduce the distance over which the products aretransported (thus reducing the cost), and also shortens the time for the delivery.Moreover, with the  ³multidrop system ´, only one truck is used to transportproducts from a manufacturer to two close warehouses. Carrefour owns manyhuge logistics platforms (also called distribution warehouses). They gather products from different manufacturers (which are suppliers for Carrefour), andredistribute these products to the different stores when they need them. Theyhave introduced technological tools: those who prepare orders are helped by avocal recognition tool, in order to avoid any mistakes. Manufacturers used tostore finished goods in their own warehouse, and then, the goods weretransferred to Carrefour warehouses. Carrefour now wants to transport directly thefinished goods from the manufacturers’s to Carrefour warehouses. Marketing mix The marketing mix looks at the four main factors that go into a marketingprogram (Product , Price , Place , Promotion ) , which are referred to as the 4 Ps. PRODUCT The Carrefour needs to design their stores so that they meet customers need.This includes having the right store format, helpful services, the  appropriateproduct mix , and a reliable private label brand.Carrefour have adapted the kinds of products they sell to the local culture. For instance , Chinese people do not always have a huge refrigerator , so theyappreciate fresh products. Thus , Carrefour , by guaranteeing both prices andquality for lots of fresh products has a real advantage : it is much easier andpractical to buy fresh goods.Moreover , in Carrefour , they also sell western products for the western peopleliving here. This market segment needs were not yet fulfilled, as westernproducts are not sold elsewhere. In Carrefour Malaysia, people can buy suchgoods as chocolates, wine, and even cheese or cookies just like in France. Thegroup also adapted its services to local shopping habits. For instance, inMalaysia , people often drive to hypermarkets , only once a week. They buyeverything they need for the week, and a car is very useful to transport thegoods back home. That is why big parking lots are needed. ( in convenience stores ) Although the Carrefour sells a lot of goods with a manufacturer’s brand names(such as Danone , Yoplai t or Nestlà © ), they also sell dealer (private label)brands: * Carrefour (in Carrefour hypermarkets) , * Champion( in Championsupermarkets ) * Grand Jury ( in convenience stores ). Thus, these products donot carry the manufacturer’s name. The Carrefour product range now includes11,000 mass-market products and miscellaneous household goods.They have paid a special attention to the packaging so that the brand isimmediately recognizable . It has a special colour code , displays the Carrefour’squality commitment, complete labelling information and a display of the Carrefour’s satisfaction or consumer money back ´ policy. In order to improve these brandsequity, they use widely recognized labels to promote trust among customers. The brand loyalty  is very high. The Carrefour brand is the best selling brand inCarrefour hypermarkets, representing 25% of the total sales. Nine out of 10customers fill their shopping carts with Carrefour brand products. Thus, these products donot carry the manufacturerss name. The Carrefour product range now includes11,000 mass-market products and miscellaneous household  goods.They have paid a special attention to the packaging so that the brand isimmediately recognizable . It has a special colour code , displays the Carrefourssquality commitment, complete labelling information and a display of the Carrefourss satisfaction or consumer money back ´ policy. In order to improve these brandsequity, they use widely recognized labels to promote trust among customers. Thebrand loyalty is very high. The Carrefour brand is the best selling brand inCarrefour hypermarkets, representing 25% of the total sales. Nine out of 10customers fill their shopping carts with Carrefour brand pro ducts. PRICE This is a very important P in Carrefour’s strategy, they even talk of the  ³priceimage ´ of the group.The objective of the Carrefour is to reduce prices in all formats of stores.In 2005, the clearly stated objective of each hypermarket was to be the leastexpensive store within its market radius. This is a competition based pricing,their strategy is based on what other competitors are doing (including harddiscounters and informal traders), and the Carrefour tries to set the price belowthe competitors.However, they also seem to have a demand based (or target) pricing  as theyconstantly try to reduce prices to meet or exceed customers expectations, eventhough they are already under their competitors’ price. The objective of this pricereduction strategy is to attract more people to the stores, thus gaining market shares. The objective can be explained as a virtuous circle: the more they sell,the more economies of scale they can do, the more they can lower prices thusattracting more customers. The Carrefour has reduced the necessary time toanalyze the research data and to adjust price displays in each department to 24to 72 hours maximum. They pay a particular attention to the pricing of  ³sensitive ´categories of products (those that the customers notice). They have also studiedwhat factors contributed to this image. The main ones are fresh product pricecompetitiveness, reliability and quality of the price indications, pricecompetitiveness of the private label range. PLACE This P is about putting the product in a place where people will buy it.The  Carrefour adds value to goods or services by different means. Form utility The fresh bakery department in hypermarkets uses variousingredients to make croissants, bread and baguettes on the spot. Other departments such as the butchers’s and the fish department also perform formutility. Time utility. In order to make products available when they are needed, theCarrefour has developed a new format according to consumer needs and wants. Place utility In order to sell products where people want them, the Carrefour has different store formats. For instance, in Malaysia , hypermarkets are intown suburbs easily accessible by cars. Possession utility The group provides credit. With the PASS Card, customerscan spread out their payments and make their purchases on credit. TheCarrefour also helps to take a loan to buy a car for example. When you buybig goods, hypermarkets can deliver them to you. PROMOTION Promotion is the effort to inform and remind people in the market about productson sale in the stores, and to persuade them to buy. Carrefour uses various tools(advertising, public relations, sales promotion) which altogether are called thepromotion mix. It is worth noticing that as other big retailers, they do not usepersonal selling. Advertising Carrefour slogan (Lebih Jimat, Lebih Hemat ) is probably one of the best knownamong Malaysian people. It is quite simple to remember. It just means that withCarrefour, can be very optimistic as everything is so great in these hypermarkets. As they target the local market, it is highly efficient as people see the billboardsmany times. Time to time, they use other medias such as the TV to promotenation  ± wide events. Public relations In order to inform the public of the changes that are being made by Carrefour,and to show how this is a good thing to customers, Carrefour has a veryefficient information programme. Moreover, as Carrefour is one of the biggestfirms, there are many newspaper articles about the Carrefour. Overall, thesepublications are a good publicity for the Carrefour. Sales Promotion is the promotional tool that stimulates consumer purchasing anddealer interest by means of short term activities. Carrefour Hypermarketsregularly send catalogues to all households that live nearby. In each hypermarket, they have a reserved zone where they make special displays to present newproducts. There are also reduction coupons for those who have  the loyalty cardCarrefour. They can have reductions of 20% on most popular products. Specialevents are organized each time they open a store. They also use bonuses (buyone, get one free), especially one they want to get rid of their stock. The Carrefour’s need to attract the greatest possible number of people totheir retail stores. As different market segments have different needs, they needto have different formats of retail shops to fulfill these needs. For instance,elderly person often do not have a car and live alone, so they need a storenear their house, they need district shops. However, large families with childrenare looking for hypermarkets where they can buy goods at a cheap price, justonce a week. So that Carrefour need deploying an ongoing and aggressive low-price policy by expanding its in  ± store promotions and communications.Besides Carrefour need to: Strengthen environmentally conscious product and packaging design anddevelop a range of products with social and environmental added value. * Ensure product safety and quality, and customer and and employee safetyat our store locations. * Guarantee respect for human rights internally and along their productssupply chain. * Promote staff training and development, and inform staff of their view of the world, and their core values, their policies and their approach tosustainability. * Respect customers freedom of choice by offering them a wide range of products at attractive prices with full, factual information. * Making the brand work harder will help Carrefour grow sales and profitsin Malaysia. * Offer a more diversified product mix than traditional with hard discount. Reference * Carrefour Malaysia. (online). Available: www.Carrefour.com.my. * Carrefour Group. (online). Available: * www.Carrefour.com. * Wal-mart store inc. (online). Available: www.Wal-mart.com

Medication Adherence And Treatment Satisfaction In Patients Nursing Essay

Medication Adherence And Treatment Satisfaction In Patients Nursing Essay Abstract Background and Objective: Medication adherence and treatment satisfaction are important for successful therapeutic outcome. The objectives of this study were to (1) assess antipsychotic medication adherence using 8-item Morisky Medication Adherence Scale (MMAS), (2) assess treatment satisfaction using Treatment Satisfaction Questionnaire for Medication (TSQM 1.4), and (3) correlate adherence and satisfaction with psychiatric symptoms measured using 24-item expanded Brief Psychiatric Rating Scale (BPRS-E) in patients with schizophrenia. Methodology: This is a cross sectional study Admin2010-12-25T10:07:00 Also, You should mention your design of study inside the textcarried out at governmental out-patient psychiatric unit in Nablus/ Palestine during summer 2010. Two hundred and sixty seven schizophrenic patients were registered at the clinic. Patients included in the study were those whose medications have not been changed in the past six months and those who did not have an acute attack in the past year. Data were entered and analyzed using SPSS 16 for windows. Results: One hundred and fifty patients Admin2010-12-25T12:46:00 In cross sectional study, you should calculate the sample size to give a good precision for reliability and validity. These terms increase the quality and acceptance rate of articles.out of 267 registered schizophrenic patients met the inclusion criteria. Nineteen patients refused to participate while 131 patients agreed giving a response rate of 87.3%. The mean  ± SD of MMAS was 6.1  ± 1.7 in which 44 patients (33.6%) had low rate, 58(44.3%) had medium rate 29 (22.1%) had high rate of adherence to their antipsychotic medications. The means of satisfaction with regard to effectiveness, side effects, convenience global satisfaction were 72.6  ± 20.5, 67.9  ± 31.47, 63.2  ± 14.3 63.1  ± 18.8 respectively. The mean BPRS score of the patients was 68.4  ± 24.5 with 14.4  ± 6.7 13.7  ± 6.1 means for positive and negative symptoms scores respectively. Pearson correlation showed that there was a positive and significant correlation between effectiveness (P = 0.002, r = 0.27), side effects (0.006, r =0.24), convenience (P Discussion and Conclusion: conclusions can be summarized as follows: First, the majority of the patients had low to medium rate of adherence. Second, adherence was positively and significantly correlated with satisfaction. Third, adherence was significantly but negatively correlated with most psychiatric symptoms. Fourth, no significant difference in adherence was found among patients receiving various antipsychotic therapeutic regimens. Finally, various antipsychotic regimens significantly differ in side effects satisfaction domain only. Key words: adherence, satisfaction, psychiatric symptoms, antipsychotics Introduction Schizophrenia is a chronic psychiatric disorder that impairs the quality of patients life and requires pharmacological and non-pharmacological interventions (Palmer et al., 2002; Pinikahana et al., 2002; Sharma and Antonova, 2003). Antipsychotic drug therapy is considered as the key element in schizophrenia management and has been reported to minimize the frequency of acute schizophrenic episodes and hospitalization (Awad and Voruganti 2004; Campell et al., 1999). Adherence (compliance) to antipsychotic medications is necessary in order to achieve these therapeutic goals. Furthermore, adherence has been reported to lead to considerable cost savings (Damen et al., 2008). However, non-adherence (non-compliance) to antipsychotic medications is common and is considered as an integral barrier to the successful treatment of schizophrenia (Dolder et. al, 2003; Weiden 2007; Byrne et al., 2006; Kim et al., 2006). There are several factors that can cause treatment non-adherence in schizophreni c patients. Such factors include those derived from schizophrenic disorder itself, patient characteristics, those associated with the health-care system, and the antipsychotic treatment regimen (Svestka Bitter 2007; Misdrahi et al., 2002). Patients related factors contributing to non-adherence include gender, age, socio-economic status, race, and religion (Lowry 1998; Borras et al 2007). Cultural differences might be a potential factor for non-adherence. For example, a review article about psychotropic medications found that rates of non-adherence were higher among Latinos than Euro-Americans and clinical and research interventions to improve adherence should be culturally appropriate and incorporate identified factors (Lanouette et al., 2009). Although patients satisfaction with treatment regimen is crucial for medication adherence (Atkinson et al., 2004; Taira et al. 2006), few studies had examined the relationship between adherence, treatment satisfaction and therapeutic outcome in patients with schizophrenia (Fujikawa et al.; 2004; Freudenreich et al., 2004 Watanabe et al, 2004). Therefore, the objectives of this study were to: (1) Assess the degree of adherence to antipsychotic medications among schizophrenic outpatients using eight-item Morisky Medication Adherence Scale (MMAS), (2) Assess the degree of patients satisfaction with their treatment regimen using Treatment satisfaction Questionnaire for medication (TSQM 1.4), (3) Evaluate patients clinical symptoms, Positive Symptom Score (PSS) Negative Symptom Score (NSS) using Brief Psychiatric Rating Scale (BPRS), and finally (4) Investigate relationships and correlations between medication adherence, subjective patients treatment satisfaction and psychiatric symptoms in patients with schizophrenia. Methodology 2.1. Patient selection: This study was conducted between July 2010 September 2010 at Al-Makhfya psychiatric Health Center in Nablus, Palestine. Approval to perform the study was obtained from the Palestinian ministry of health and IRBAdmin2010-12-25T10:09:00 Define this abbreviation committee at An-Najah National University. Patients who met the following criteria were invited to participate in this study: 1) their age was between 20 65 years, 2) they were diagnosed with schizophrenia as defined by DSMAdmin2010-12-25T13:29:00 Define this abbrev.-IV, 3) they had not been suffering from an acute attack of illness during the past year, and 4) their drug regimen had not been changed in the past 4 months. 2.2. Assessment and measures The instrument used in this study consisted of three parts: part one collected socio-demographic and medication data from patients medical files; part two was the Arabic version of the validated eight-item Morisky Medication Admin2010-12-25T13:31:00 . The final version of the Arabic questionnaire should be assessed to know if the Arabic version is reliable and valid to be used in your population. This a routine question by high impact journal Also, I suppose you are the first who use this score in Arab country, and this is good for you because you can write new article related to validity and reliability and it is preferred to be published before this article.Adherence Scale (MMAS) (Morisky et al., 2008, Morisky et al., 1986) and part three was the Arabic version of Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) which the researchers obtained from Quintiles Strategic Research Services. The English version of the MMAS was translated into Arabic and was approved by professor Morisky through e-mail communication. The translation process was carried out according to the following procedure: 1) A forward translation of the original questionnaire was carried out from English to Arabic language to produce a version that was as close as possible to the original questionnaire in concept and meaning. Translation was carried out by two qualified independent translators; both native speakers of Arabic and proficient i n English. Each translator produced a forward translation of the original questionnaire into Arabic language without any mutual consultation. The corresponding author, who is a native Arabic speaker, reviewed the two primary versions and compared them with the original. (2) A back translation from Arabic language to English was carried out by two different translators after lengthy discussion between the translators and the corresponding author. (3) The back translated questionnaire was approved by Professor Donald Morisky through e-mail. The Arabic version of MMAS is an 8-item questionnaire with 7 yes/no questions while the last question was a 5-point likert question. Based on the scoring system of MMAS, adherence was rated as follows: high adherence (= 8), medium adherence (6 The TSQM 1.4 is a 14-item psychometrically robust and validated instrument consisting of four scales [Bahramal et al., 2009]. The four scales of the TSQM 1.4 include the effectiveness scale (questions 1 to 3), the side effects scale (questions 4 to 8), the convenience scale (questions 9 to 11) and the global satisfaction scale (questions 12 to 14). The TSQM 1.4 domain scores were calculated as recommended by the instruments authors, which is described in detail elsewhere (Atkinson et al., 2004; Atkinson et al., 2005). The TSQM 1.4 domain scores range from 0 to 100 with higher scores representing higher satisfaction on that domain. Psychiatric symptoms, positive and negative schizophrenic symptoms were evaluated by a psychiatrist and well trained psychologists using the expanded Brief Psychiatric Rating Scale (BPRS-E) (Overall and Gorham, 1962; Overall 1988; Lukoff et al., 1986; Ventura et al, 1993) at the same visit. The BPRS-E consists of 24 items measuring psychiatric symptoms. It measures four different dimensions: manic excitement/ disorganization, positive symptoms, negative symptoms, and depression/ anxiety (Ruggeri et al., 2005). Positive symptoms were the followings: grandiosity, suspiciousness, hallucinations, unusual thought content and conceptual disorganization. Negative symptoms included disorientation, blunted affect, emotional withdrawal, motor retardation, and mannerism and posturing. 2.3. Data analysis Continuous variables like Morisky score, satisfaction domain scores, BPRS, positive and negative symptoms scores were expressed as mean  ± SD. Correlation between continuous variables was carried out using Pearson correlation test. Difference in means was carried out using one-way ANOVA test. All statistical analyses were conducted using Statistical Package for Social Sciences (SPSS; version 16.0) for Windows. The conventional 5 percent significance level was used throughout the study. Results Demographic and clinical characteristics of patients One hundred and fifty patients out of 267 registered schizophrenic patients met the inclusion criteria. One hundred and thirty one (131) patients agreed to participate giving a response rate of 87.3%. Of the 131 patients, 40 (30.5%) were female and 91 (69.5%) were male. The mean age of the patients was 42.9  ± 10.3 years (range = 20 65 years). The mean duration of illness was 16.23  ± 9.59 years. Eighteen patients (13.7%) had other non-psychiatric diseases mainly diabetes mellitus (10 patients; 7.6%). Smoker schizophrenic patients represented 55% (72 patients) of the sample. None of the patients were reported to have any type of drug abuse. Details regarding demographic and clinical characteristics of the studied patients are shown in Table 1. Regarding treatment regimens, patients were grouped into 7 categories based on the type of antipsychotic medications they were using: Twenty four patients (18.3%) had been treated with oral typical antipsychotics only, 8 patients (6.1%) were using combination oral typical antipsychotics, 19 (14.5%) had been treated with typical depot injections only, 37 (28.2%) had been treated with typical oral and depot injections, 18 (13.7%) had been treated with oral atypical only, 12 patients (9.2%) had been treated with typical and atypical oral antipsychotics, and finally 13 patients (9.9%) had been treated with atypical oral and typical depot injection combination. The most common oral typical antipsychotic used by the patients was chloropromazine while the most common atypical antipsychotic was clozapine. Based on MMASAdmin2010-12-25T13:34:00 It is preferred to classify the characteristic of patients according to the adherence groups. Also, indicate if there is differences between the 3 groups , 44 (33.6%) of patients were rated as having low adherence, 58 (44.3%) were rated as having medium adherence 29 (22.1%) were rated as having high adherence to their antipsychotic medications. The average adherence score (6.1  ± 1.7) for the patients generally indicates medium rate of adherence. Upon investigation using 8-item Morisky scale (questionnaire ), we found that about 33.6% of patients forgot to take their medications; 15.3% of patients missed taking their medication for reason other than forgetting in the past two weeks before the interview; 13.7% stopped taking their medication without doctor counseling when they felt worse upon taking them; 16.8% forgot to take their medications with them when they leave home for long time; 10.7% didnt take their medication in the day before interview; 26% stopped taking their medica tion when they felt that their health is under control; and 55.7% felt hassled about sticking to their treatment plan. As for remembering to take their medications; 27.5% of the patients faced a difficulty in doing this once in a while; 6.1% of the sample sometimes had difficulties in remembering to take their medications; 6.9% of patients usually found difficulties; while 0.8% of schizophrenic patients faced these difficulties all the times. However 58.8% didnt show any difficulty in remembering to take their medication on time. Response to each question in the modified Morisky questionnaire is shown in Table 2. The average score of satisfaction with regard to effectiveness, side effects, convenience global satisfaction was 72.6  ±20.5; 67.9  ± 31.5; 63.2  ± 14.3; 63.1  ± 18.8 respectively. The mean BPRS score of the patients was 68.4  ± 24.5 with 14.4  ± 6.7 13.7  ± 6.1 means for positive and negative symptoms scores respectively Correlation between adherence scores and other variables There was a significant positive correlation between age and adherence (P = 0.028; r = 0.19Admin2010-12-25T13:35:00 As recommended, when correlation is less than 0.25 this considered as no or week correlation, 0.25-0.50 considered fair correlation. You can take this comments in your consideration. ). However, no such correlation was observed with the duration of illness (P = 0.13). Furthermore, no significant difference in the means of adherence was found between male and female (P = 0.76). Patients having other chronic diseases have significantly higher adherence score compared to those who do not, but the significance was at the borderline (P = 0.049). Pearson correlation showed that there was a positive and significant correlation between all satisfaction domains like effectiveness (P = 0.002, r = 0.27), side effects (P= 0.006, r =0.24), convenience (P Adherence, Treatment Satisfaction and type of antipsychotic regimen Adherence score was not significantly different (P = 0.6) among patients having different antipsychotic therapeutic regimens. Analysis of satisfaction based on the antipsychotic drug regimens showed that there was a significant difference in satisfaction with regard to side effects among different antipsychotic regimens ( P = 0.006, F = 3Admin2010-12-25T13:35:00 When you use one way ANOVA, it is recommended to use the Tukey post-hoc test to test the differences in the means between categories. To determine which group or groups are significant. ). Patients on atypical antipsychotic drug therapy showed the highest satisfaction with side effects (86.5  ± 4.8) compared with (51.3  ± 5.17) to those on typical antipsychotic mono-therapy. No significant difference with regard to other satisfaction domains (effectiveness, convenience and global satisfaction) among patients with different psychiatric regimens. Similarly no significant difference was found in BPRS scores (P = 0.6), positive (P = 0.6) and negative symptoms (P= 0.8) among different antipsychotic drug regimens. Details regarding adherence scores, BPRS, positive and negative symptoms with different antipsychotic drug regimens are shown in Table 4. Discussion This studyAdmin2010-12-25T13:36:00 This study is the first of its type in Palestine and the first study used an Arabic version for Morisky. You can add this points as originality of the article was conducted to assess medication adherence and treatment satisfaction among schizophrenic outpatients. The conclusions of the study can be summarized as follows: First, the majority (78%) of the patients had low to medium adherence rate. Second, adherence was positively and significantly correlated with treatment satisfaction. Third, adherence was significantly correlated with positive but negative psychiatric symptoms. Fourth, no significant difference in rate of adherence was found between patients using typical or atypical antipsychotic therapeutic regimens. Finally, patients on typical or atypical antipsychotic medications had similar scores in all domains of satisfaction except for that of side effects. Regarding rate of adherence, several studies have shown that up to 80% of all schizophrenic patients discontinue antipsychotic medications and that non-adherence rates ranging from 20% to 89%, with an average rate of approximately 50%, have been reported (Fenton et al, 1997; Lacro et al 2002, Young et al, 1986). Differences in rate of adherence among different reports might be attributed to different instrument used to assess adherence, social and cultural differences among different countries and differences in healthcare systems (Breen et al., 2007). In our study, younger patients had significantly lower adherence score than elderly patients. This finding is in agreement with other researchers who reported that younger schizophrenic patients have lesser adherence than older patients (Sajatovic et al 2007; Hui et al reported that younger age is a predictor for discontinuation of antipsychotic therapy (Hui et al.; 2006). However, other researchers reported equal non adherence among m iddle aged and elderly patients (Jeste et al., 2003) . Many factors have been cited as a potential cause for poor adherence. Side effects are key factors influencing compliance with antipsychotic medication (Weiden et al., 2004). (Liu-Seifert et al., 2005; Fleischhacker et al., 2003). There are few reports suggesting that treatment satisfaction is positively associated with antipsychotic medication adherence [Gharbawi et al., 2006,], improved clinical outcomes [Masand and Narasimhan, 2006], and quality of life [Hofer 2004,]. Our results give further support that treatment satisfaction is positively associated with adherence and symptom improvement, particularly psychotic positive symptoms. A study by Maneesakorn 2008 indicated that antipsychotic medication adherence has positive impact on psychiatric symptoms and satisfaction with medication (Maneesakron et al., 2007). Furthermore, Mohamad et al 2009 demonstrated an association between positive attitudes toward medication among schizophrenia patients and lower rates of study discontinuation (Mohamed et al., 2009). Thus, it is important to accurately evaluate patient satisfaction with medication treatment using validated instruments that can be utilized in clinical trials and practice. Medication non-adherence had a significantly negative impact on treatment response, highlighting the importance of adherence to achieve satisfactory treatment outcome (Lindameyr et al., 2009). A study by Liu-Seifert et al 2005 has found that discontinuing of treatment may lead to exacerbation of psychiatric symptoms and undermining therapeutic progress (Liu-Seifert et al., 2005). In these studies, poor response to treatment and worsening of underlying psychiatric symptoms, and to a lesser extent, intolerability to medication were the primary contributors to treatment being discontinued. Fewer extrapyramidal symptoms and tardive dyskinesia of atypical compared to typical antipsychotics led researchers to speculate that patients receiving atypical antipsychotics will show greater adherence, satisfaction and psychiatric improvement compared to patients receiving typical antipsychotics (Kane et al., 1988; Tollefson et al., 1997; Marder et al., 1994; Small et al., 1997 Jeste et al., 1999; Marder SR, 1998). However, our findings regarding adherence, satisfaction and psychiatric symptoms measured by BPRS-E were similar between patients on typical and atypical antipsychotic medications. Rosenheck and colleagues evaluated medication continuation and regimen adherence in 423 patients taking haloperidol or clozapine as part of a double-blind, randomized trial. Although the patients who received clozapine continued their medication significantly longer, the treatment groups did not differ in the proportion of pills returned each week (Rosenheck et al., 200). Olfson and colleagu es examined the effect of antipsychotic type on adherence 3 months after 213 inpatients with schizophrenia or schizoaffective disorder were discharged while receiving typical (84.5% of patients) or atypical (14.5% of patients) antipsychotics. A non-significant trend toward increased adherence was reported among patients with prescriptions for atypical antipsychotics (Olfson et al., 2000). Cabeza and colleagues retrospectively studied the relationship of adherence to antipsychotic type in 60 inpatients with schizophrenia. No significant association was found between adherence and type of antipsychotic (Cabeza et al., 2000). Dolder reported that patients on either typical or atypical had similar low rates of adherence (Dodler et al., 2002). Gianfransessco et al 2006 indicated that none of the atypicals showed treatment durations significantly different from the typical (Gianfransessco et al 2006). A study by Jones et al, 2006 has found that in people with schizophrenia whose medicatio n is changed for clinical reasons, there is no disadvantage across 1 year in terms of quality of life, symptoms, or associated costs of care in using FGAs rather than nonclozapine SGAs (Jones et al., 2006). Schulte et al concluded that, in general, very few or no advantages are to be gained from using SGAS rather than FGAS and the clinical effectiveness is not increased, but the side-effects are different. (Schulte et al 2010). In contrast, Al-Zakawani reported that atypical antipsychotic users were significantly more adherent to therapy, and had lower rates of office, hospital and emergency room utilization (Al-zakawani 2003). Actually, efficacy variations within SGAs and FGAs result in overlaps between the two groups and classification of antipsychotics into the two groups is no longer useful (Volvoka 2009). One might argue that cost of atypical antipschyotics is the barrier for medication adherence (Gibson et al., 2010). However, in our study, all patients had governmental insura nce and therefore cost of medications was not a reason of poor adherence of atypical antipsychotics. Regarding results of depot IM antipsychotic injections, we found no difference between oral and long acting antipsychotics with regard to adherence, satisfaction or psychiatric symptoms. Some researchers reported similar or better adherence, satisfaction and outcome with long acting injection than oral antipsychotics (Olivares et al., 2009; Gutierrez et al., 2010; Kane and Garcia 2009; Haddad et al., 2009). In contrast, vehof reported that patients on depot antipsychotics were less adherent and have more side effects than oral antipsychotics (Vehof et al., 2008). Our study has few limitations. The sample size might be relatively small to draw conclusions for assessing adherence, satisfaction and psychiatric symptoms. Instruments that we used to assess adherence, satisfaction and BPRS are might not be the gold standard for this purpose. A third Admin2010-12-25T13:16:00 Must be preceded by first and secondpotential limitation of our study is that the patients selected were homogenous in that all of them had governmental insurance and tends to use similar medications. Non-adherence among schizophrenic patients might be inherent in the context of the disease itself. Despite these limitations, results of this study were useful in understanding adherence, satisfaction and psychiatric symptoms. ReferencesAdmin2010-12-25T10:45:00 The number of references is too much, after delete the repeating ref. the number still 75 Al-Zakwani IS, Barron JJ, Bullano MF, Arcona S, Drury CJ, Cockerham TR. Analysis of healthcare utilization patterns and adherence in patients receiving typical and atypical antipsychotic medications. Curr Med Res Opin. 2003;19(7):619-26. Arana GW: An overview of side effects caused by typical antipsychotics.J Clin Psychiatry 2000; 61:5-11 Atkinson MJ, Kumar R, Cappelleri JC, Hass SL: Hierarchical construct validity of the treatment satisfaction questionnaire for medication (TSQM version II) among outpatient pharmacy consumers. Value Health 2005, 8(Suppl 1):S9-S24. Atkinson MJ, Sinha A, Hass SL, Colman SS, Kumar RN, Brod M, Rowland CR. Validation of a general measure of treatment satisfaction, the Treatment Satisfaction Questionnaire for Medication (TSQM), using a national panel study of chronic disease. Health Qual Life Outcomes. 2004 Feb 26;2:12 Awad AG, Voruganti LN. Impact of atypical antipsychotics on quality of life in patients with schizophrenia.. CNS Drugs. 2004;18(13):877-93. Review Bharmal M, Payne K, Atkinson MJ, Desrosiers MP, Morisky DE, Gemmen E. Validation of an abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9) among patients on antihypertensive medications. Health Qual Life Outcomes. 2009 Apr 27;7:36 Borras L, Mohr S, Brandt PY, Gillià ©ron C, Eytan A, Huguelet P. Religious beliefs in schizophrenia: their relevance for adherence to treatment. Schizophr Bull. 2007 Sep;33(5):1238-46 Breen A, Swartz L, Joska J, Flisher AJ, Corrigall J. Adherence to treatment in poorer countries: a new research direction? Psychiatr Serv. 2007 Apr;58(4):567-8 Byrne MK, Deane FP, Caputi P. Mental health clinicians beliefs about medicines, attitudes, and expectations of improved medication adherence in patients. Eval Health Prof. 2008 Dec;31(4):390-403 Cabeza IG, Amador MS, Lopez CA, Chavez MG: Subjective response to antipsychotics in schizophrenic patients: clinical implications and related factors. Schizophr Res 2000; 41:349-355 Campbell M, Young PI, Bateman DN, Smith JM, Thomas SH The use of atypical antipsychotics in the management of schizophrenia.. Br J Clin Pharmacol. 1999 Jan;47(1):13-22. Review Clinical and resource-use outcomes of risperidone long-acting injection in recent and long-term diagnosed schizophrenia patients: results from a multinational electronic registry. Curr Med Res Opin. 2009 Sep;25(9):2197-206 Cost-sharing effects on adherence and persistence for second-generation antipsychotics in commercially insured patients. Manag Care. 2010 Aug;19(8):40-7 Damen J, Thuresson PO, Heeg B, Lothgren M. A pharmacoeconomic analysis of compliance gains on antipsychotic medications. Appl Health Econ Health Policy. 2008;6(4):189-97. De Hert M, McKenzie K, Peuskens J. Risk factors for suicide in young people suffering from schizophrenia: a long-term follow-up study. Schizophr Res. 2001 Mar 1;47(2-3):127-34 Dingemans PM, Linszen DH, Lenior ME, Smeets RM. Component structure of the expanded Brief Psychiatric Rating Scale (BPRS-E). Psychopharmacology (Berl). 1995 Dec;122(3):263-7 Dolder CR, Lacro JP, Dunn LB, Jeste DV. Antipsychotic medication adherence: is there a difference between typical and atypical agents? Am J Psychiatry. 2002 Jan;159(1):103-8. Erratum in: Am J Psychiatry 2002 Mar;159(3):514 Dolder CR, Lacro JP, Jeste DV. Adherence to antipsychotic and nonpsychiatric medications in middle-aged and older patients with psychotic disorders. Psychosom Med. 2003 Jan-Feb;65(1):156-62. Dolder CR, Lacro JP, Leckband S, Jeste DV. Interventions to improve antipsychotic medication adherence: review of recent literature. J Clin Psychopharmacol. 2003 Aug;23(4):389-99. Review Fenton WS, Blyler CR, Heinssen RK: Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophr Bull 1997; 23:637-651 Fleischhacker WW, Oehl MA, Hummer M. Factors influencing compliance in schizophrenia patients. J Clin Psychiatry. 2003;64 Suppl 16:10-3 Freudenreich O, Cather C, Evins AE, Henderson DC, Goff DC. Attitudes of schizophrenia outpatients toward psychiatric medications: relationship to clinical variables and insight. J Clin Psychiatry. 2004 Oct;65(10):1372-6 Fujikawa M, Togo T, Yoshimi A, Fujita J, Nomoto M, Kamijo A, Amagai T, Uchikado H, Katsuse O, Hosojima H, Sakura Y, Furusho R, Suda A, Yamaguchi T, Hori T, Kamada A, Kondo T, Ito M, Odawara T, Hirayasu Y. Evaluation of subjective treatment satisfaction with antipsychotics in schizophrenia patients. Prog Neuropsychopharmacol Biol Psychiatry. 2008 Gharabawi GM, Greenspan A, Rupnow MF, Kosik-Gonzalez C, Bossie CA, Zhu Y, Kalali AH, Awad AG. Reduction in psychotic symptoms as a predictor of patient satisfaction with antipsychotic medication in schizophrenia: data from a randomized double-blind trial. BMC Psychiatry. 2006 Oct 20;6:45 Gianfrancesco FD, Rajagopalan K, Sajatovic M, Wang RH. Treatment adherence among patients with schizophrenia treated with atypical and typical antipsychotics. Psychiatry Res. 2006 Nov 15;144(2-3):177-89. Epub 2006 Sep 27. Gibson TB, Jing Y, Kim E, Bagalman E, Wang S, Whitehead R, Tran QV, Doshi JA. Gutià ©rrez-Casares JR, Caà ±as F, Rodrà ­guez-Morales A, Hidalgo-Borrajo R, Alonso-Escolano D. Adherence to treatment and therapeutic strategies in schizophrenic patients: the ADHERE study. CNS Spectr. 2010 May;15(5):327-37. Haddad PM, Taylor M, Niaz OS. First-generation antipsychotic long-acting injections v. oral antipsychotics in schizophrenia: systematic review of randomised controlled trials and observational studies. Br J Psychiatry Suppl. 2009 Nov;52:S20-8. Herings RM, Erkens JA. Increased suicide attempt rate among patients interrupting use of atypical antipsychotics. Pharmacoepidemiol Drug Saf. 2003 Jul-Aug;12(5):423-4. Hofer A, Kemmler G, Eder U, Edlinger M, Hummer M, Fleischhacker WW. Quality of life in schizophrenia: the impact of psychopathology, attitude toward medication, and side effects. 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The Allegory in Hawthornes Young Goodman Brown Essay -- Young Goodman

The Allegory in â€Å"Young Goodman Brown†      Ã‚  Ã‚   It is the purpose of this essay to show that Nathaniel Hawthorne’s â€Å"Young Goodman Brown† is indeed an allegory. M. H. Abrams defines an allegory as a â€Å"narrative, whether in prose or verse, in which the agents and actions, and sometimes the setting as well, are contrived by the author to make coherent sense on the ‘literal,’ or primary, level of signification, and at the same time to signify a second, correlated order of signification† (5).    Yvor Winters in â€Å"Maule’s Curse, or Hawthorne and the Problem of Allegory† says that Hawthorne is essentially an allegorist (11). Stanley T. Williams in â€Å"Hawthorne’s Puritan Mind† states that the author was always â€Å"perfecting his delicate craft of the symbol, of allegory† (42). A. N. Kaul states : â€Å"In an effort to apprehend and adequately reflect the new complexity of man’s life, he [Hawthorne] molded the venerable – in his case directly inherited – allegorical method into the modern technique of symbolism† (3). It is quite obvious from the names of the characters in the short story that their names are contrived to give a secondary signification. Goodman is on the primary level a simple husband who is following his curiosity about evil; on the level of secondary signification he is Everyman or the new Adam: R. W. B. Lewis in â€Å"The Return into Rime: Hawthorne† states: Finally, it was Hawthorne who saw in American experience the re-creation of the story of Adam and who . . . exploited the active metaphor of the American as Adam – before and during and after the Fall† (72). Goodman responds in this way to the fellow-traveller when the latter implicates the governor in devilish deeds:    "Can this be so!" cried Goodman Brown, with... ...t/nh/nhhj1.html    Kaul, A.N. â€Å"Introduction.† In Hawthorne – A Collection of Critical Essays, edited by A.N. Kaul. Englewood Cliffs, NJ: Prentice-Hall, Inc., 1966.    Leavis, Q.D. â€Å"Hawthorne as Poet.† In Hawthorne – A Collection of Critical Essays, edited by A.N. Kaul. Englewood Cliffs, NJ: Prentice-Hall, Inc., 1966.    Lewis, R. W. B. â€Å"The Return into Time: Hawthorne.† In Hawthorne – A Collection of Critical Essays, edited by A.N. Kaul. Englewood Cliffs, NJ: Prentice-Hall, Inc., 1966.    Williams, Stanley T. â€Å"Hawthorne’s Puritan Mind.† In Readings on Nathaniel Hawthorne, edited by Clarice Swisher. San Diego, CA: Greenhaven Press, 1996.    Winters, Yvor. â€Å"Maule’s Curse, or Hawthorne and the Problem of Allegory.† In Hawthorne – A Collection of Critical Essays, edited by A.N. Kaul. Englewood Cliffs, NJ: Prentice-Hall, Inc., 1966.   

Platos The Republic and The Old Testament Essay -- Philosophy Buddhis

Plato's The Republic and The Old Testament A Buddhist teaching suggests that practicing Buddhism is like taking a raft over a great river. One riverbank represents the realm of ‘samsara,’ the cycle of suffering that we are all spinning around in. On the other side is ‘wakefulness,’ or ‘nirvana,’ an enlightened state of awareness characterized by an infinite sense of unity and bliss. The raft symbolizes Buddhism; its purpose being to help us cross over from samsara to nirvana. According to the teaching, however, a curious thing happens to the individual who manages to reach the ‘banks of enlightenment.’ Having climbed off of the raft, she turns around to discover that she cannot now see any riverbank on the side from which she departed. In fact, she realizes that there is no river, no raft, and – to her pure astonishment – no Buddha at all! (Zimmer, 82-90) The story is a way of reminding us that the state of wakefulness involves an experience of reality so utterly beyond linear comprehension, so overwhelming and indescribable, and so categorically unlike anything one could possibly imagine or articulate in finite terms, that even the means of achieving it are, at best, illusory roadmaps – roadmaps that use boundaries in an attempt to help people grasp a condition of being that has no boundaries. Thus, in essence, it would never be possible to attain a complete understanding of wakefulness using Buddhism or any other practice or paradigm arising out of the substrate of finite consciousness. It could be said that systems like Buddhism are limited to pointing us in an appropriate direction or helping us to look in places where we might be more likely to become enlightened. They may embody or convey truth in one form or ... ...ntext, but this does not prevent us from encountering the Ultimate in the writings of the Old Testament as well. The texts each approach the subject from foreign perspectives, describing unique facets of the same idea. If we work from that point of view, we can see unity between them, and develop a broader, more encompassing understanding of the world. Works Cited: Plato. â€Å"from The Republic.† In: Benton, Janetta Rebold and DiYanni, Robert. 1998. Arts and Culture: An Introduction to the Humanities. Upper Saddle River, NJ: Prentice Hall. 152-154. Wilber, Ken. â€Å"The Perennial Philosophy.† In: Wilber, Ken. 1998. The Essential Ken Wilber: An Introductory Reader. Boulder, CO: Shambhala Publications. 7-8. Zimmer, Heinrich (trans). â€Å"Buddhahood.† In: Eastman, Roger. 1999. The Ways of Religion. 3rd Ed. New York, NY: Oxford University Press. 82-90.

Blending Reality and Fantasy in Going After Cacciato Essay -- Going Af

Blending Reality and Fantasy in Going After Cacciato by O'Brien As O'Brien's third novel, Going After Cacciato is one of his most acclaimed works. The book brings to the reader many chilling aspects of war while developing a connection between the reader and the narrator. After many years, Going After Cacciato still dominates over more recent war novels by providing a unique glimpse into the soldiers mind. O'Brien reflects upon his wartime experiences in Vietnam while successfully blending reality and fantasy in an original war story. In the first chapter of the book, the relationship between the story and its title is quickly made. As the character who encites the chase, Cacciato embarks on the seemingly ludicrous journey to Paris. A voyage of eighty six hundred miles on foot is not one to be taken lightly. To get an idea of the distance that Cacciato is planning to transverse, imagine walking across the United States four times bringing only what one can carry. Paul Berlin, to whom Cacciato has divulged his travel plans, and his unit begin on a mission to retrieve Cacciato. Told from Berlin's viewpoint, the story is revealed from the experiences of a person who questions his own purpose in the war. The soldiers are literally walking away from the war as they follow Cacciato through the jungles of Vietnam. Paul's journey with the others is occasionally broken up by sudden lapses into the past. Such unexpected transitions have positive and negative affects on the reader. The latter result is immediate; the quick t opic changes add an element of confusion as to what exactly is happening in the novel. However, the divisions also attribute to increased interest during these flashbacks as they break up the monotony of the mar... ...he war. This war is not one only fought by weapons but is fought inside the soldier's mind. The minds, which O'Brien creates, reveal the convoluted aspects of war. Going After Cacciato succeeds because the story is written to create a link between the reader and the characters in a familiar, yet fictional world. Works Cited 1. "O'Brien, Tim." Current biography Yearbook. 1995 ed. 2. "Tim O'Brien's Homepage, Novelist." 24 April, 1997. <http://www.illyria.com/tobhp.html> (10 May 1997). 3. Chisdes, Jonathan. "Moral Questions In Tim O'Brien's Going After Cacciato: How To Do Right In An Evil Situation." 10 August 1995. http://www.nightmare.com/~jon/cacciato2.html (9 May 1997). 4. Devine, Mary. "Love and War in the Land o' Lakes." MPLS-St. Paul Magazine Oct. 1994: 179. O'Brien, Tim. Going After Cacciato. New York: Dell Publishing, 1978. Blending Reality and Fantasy in Going After Cacciato Essay -- Going Af Blending Reality and Fantasy in Going After Cacciato by O'Brien As O'Brien's third novel, Going After Cacciato is one of his most acclaimed works. The book brings to the reader many chilling aspects of war while developing a connection between the reader and the narrator. After many years, Going After Cacciato still dominates over more recent war novels by providing a unique glimpse into the soldiers mind. O'Brien reflects upon his wartime experiences in Vietnam while successfully blending reality and fantasy in an original war story. In the first chapter of the book, the relationship between the story and its title is quickly made. As the character who encites the chase, Cacciato embarks on the seemingly ludicrous journey to Paris. A voyage of eighty six hundred miles on foot is not one to be taken lightly. To get an idea of the distance that Cacciato is planning to transverse, imagine walking across the United States four times bringing only what one can carry. Paul Berlin, to whom Cacciato has divulged his travel plans, and his unit begin on a mission to retrieve Cacciato. Told from Berlin's viewpoint, the story is revealed from the experiences of a person who questions his own purpose in the war. The soldiers are literally walking away from the war as they follow Cacciato through the jungles of Vietnam. Paul's journey with the others is occasionally broken up by sudden lapses into the past. Such unexpected transitions have positive and negative affects on the reader. The latter result is immediate; the quick t opic changes add an element of confusion as to what exactly is happening in the novel. However, the divisions also attribute to increased interest during these flashbacks as they break up the monotony of the mar... ...he war. This war is not one only fought by weapons but is fought inside the soldier's mind. The minds, which O'Brien creates, reveal the convoluted aspects of war. Going After Cacciato succeeds because the story is written to create a link between the reader and the characters in a familiar, yet fictional world. Works Cited 1. "O'Brien, Tim." Current biography Yearbook. 1995 ed. 2. "Tim O'Brien's Homepage, Novelist." 24 April, 1997. <http://www.illyria.com/tobhp.html> (10 May 1997). 3. Chisdes, Jonathan. "Moral Questions In Tim O'Brien's Going After Cacciato: How To Do Right In An Evil Situation." 10 August 1995. http://www.nightmare.com/~jon/cacciato2.html (9 May 1997). 4. Devine, Mary. "Love and War in the Land o' Lakes." MPLS-St. Paul Magazine Oct. 1994: 179. O'Brien, Tim. Going After Cacciato. New York: Dell Publishing, 1978.

Night World : Huntress Chapter 9

No. This can't be happening. Jez had never felt anything like this before, but she knew instinctively that it was dangerous. She was being pulled into Morgead's mind. She could feel it surrounding her, enfolding her, a touch that was light but almost irresistible, that was trying to draw out the most secret part of herself. And the most frightening thing was that Morgead wasn't doing it It was something outside both of them, something that was trying to mix them together like two pools of water being stirred. Jez could feel that Morgead was as startled and astonished as she was. The only difference was that he didn't seem to be resisting the force. He didn't seem terrified and unhappy about it, as Jez was. He seemed†¦ exhilarated and wondering, like somebody skydiving for the first time. That's because he's crazy, Jez thought dizzily. He loves danger and he enjoys courting death- I enjoy you, a voice said in her mind. Morgead's voice. Soft as a whisper, a feather-touch that shook Jez to her soul. It had been so long since she'd heard that voice. And he had heard her. Sharing blood made even humans telepathic. Jez hadn't been able to talk mentally since- She managed to cut the thought off as panic surged through her. While one part of her mind gabbled desperately, â€Å"He's here, he's here, he's inside, what are we going to do now?† another part threw up a smokescreen, flooding her thoughts with visions of mist and clouds. There was something like a swift gasp from Morgead. Jez. don't. Don't hide from me- You're not allowed here, she snapped back, this time directing the thought straight at him. Go away! I can't. For just a moment his mental voice sounded confused and scared. She hadn't realized Morgead could be confused and scared. I'm not doing this. It's just-happening. But it shouldn't be happening, Jez thought, and she didn't know whether she was talking to him or just to herself. She was beginning to shake. She couldn't resist the pull that was trying to bring her soul to the surface and intermingle it with Morgead's-she couldn't. It was stronger than anything she'd ever experienced. But she knew that if she gave in, she was dead. Don't be afraid. Don't, Morgead said in a voice she had never heard from him before. A voice of desperate gentleness. His mind was trying to wrap around hers protectively, like dark wings shielding her, touching her softly. Jez felt her insides turn to water. No. No†¦ Yes, Morgead's voice whispered. She had to stop this-now. She had to break the contact. But although Jez could still feel her physical body, she seemed powerless to control it. She could sense Morgead's arms supporting her and his lips on her throat and she knew that he was still drinking. But she couldn't so much as move a finger to push him away. The muscles that she'd trained so ruthlessly to obey her under any circumstances were betraying her now. She had to try another way. This shouldn't be happening, she told Morgead, putting all the energy of her terror behind the thought. I know. But that's because you're fighting it. We should be somewhere else by now. Jez was exasperated. Where else? I don't know, he said, and she could feel a tinge of sadness in his thought. Some place-deeper. Where we'd really be together. But you won't open your mind†¦. Morgead, what are you talking about? What do you think is going on? He seemed genuinely surprised. Don't you know? It's the soulmate principle. Jez felt the floor drop away beneath her. No. That's not possible. That can't be. She wasn't talking to Morgead anymore; she was desperately trying to convince herself. I'm not soulmates with Morgead. I can't be. We hate each other †¦ he hates me †¦ all we ever do is fight. . . He's impossible and dangerous and hotheaded and stubborn†¦ he's crazy†¦ he's angry and hostile . . . he's frustrating and infuriating and he loves to make me miserable . .. And I don't even believe in soulmates. And even if I did, I wouldn't believe it could happen like this, just bang, out of the blue, like getting hit by a train when you're not looking, without any warning or even any attraction to the person beforehand†¦. But the very hysteria of her own thoughts was a bad sign. Anything that could tear away her self-control like this was powerful almost beyond imagination. And she could still feel it pulling at her, trying to strip off the layers of cloud she was hiding behind. It wanted Morgead to see her as she truly was. And it was trying to show her Morgead. Flashes of his Me, of himself. Glimpses that hit her and seemed to cut cleanly through her, leaving her gasping with their intensity. A little boy with a mop of tousled dark hair and eyes like emerald, watching his mother walk out the door with some man-again. Going to play alone in the darkness, amusing himself. And then meeting a little redheaded girl, a girl with silvery-blue eyes and a flashing smile. And not being alone anymore. And walking on fences with her in the cool night air, chasing small animals, falling and giggling†¦. A slightly older boy with longer hair that fell around his face, uncared-for. Watching his mother walk out one last time, never to come back. Hunting for food, sleeping in an empty house that got messier and messier. Learning to care for himself. Training himself. Getting harder, in mind and body, seeing a sullen expression when he looked in the mirror†¦ A boy even older watching humans, who were weak and silly and short-lived, but who had all the things he didn't have. Family, security, food every night. Watching the Night People, the elders, who felt no responsibility to help an abandoned vampire child†¦. I never knew, Jez thought. She still felt dizzy, as if she couldn't get enough air. The images were dazzling in their clarity and they tore at her heart. A boy who started a gang to create a family, and who went first to the little girl with red hair. The two of them grinning wickedly, running wild in the streets, finding others. Collecting kids the adults couldn't control or wouldn't miss. Walking around the worst parts of town, unafraid-because they had one another now. The images were coming faster, and Jez could hardly keep up with them. Dashing through the metal scrap yard†¦ with Jez †¦ Hiding under a fish-smelling wharf†¦ from Jez†¦ His first big kill, a stag in the hills of San Rafael.. . and Jez there to share the hot blood that warmed and intoxicated and brought life all at once. Fear and happiness and anger and arguments, hurt and sadness and exasperation-but always with Jez interwoven into the fabric. She was always there in his memories, fire-colored hair streaming behind her, heavy-lashed eyes snapping with challenge and excitement. She was everything bright and eager and brave and honest. She was haloed with flame. I didn't know†¦ how could I know? How could I realize I meant so much to him†¦ ? And who would have thought it would mean so much to her when she found out? She was stunned, overcome-but something inside her was singing, too. She was happy about it. She could feel something bubbling up that she hadn't even realized was there; a wild and heady delight that seemed to shoot out to the palms of her hands and the soles of her feet. Morgead, she whispered with her mind. She could sense him, but for once he didn't answer. She felt his sudden fear, his own desire to run and hide. He hadn't meant to show her these things. They were being forced out of him by the same power that was dragging at Jez. I'm sorry. I didn't mean to look, she thought to him. I'll go away†¦. No. Suddenly he wasn't hiding anymore. No, I don't want you to go. I want you to stay. Jez felt herself flow toward him, helplessly. The truth was that she didn't know if she could turn away even if he'd wanted her to. She could feel his mind touching hers-she could taste the very essence of his soul. And it made her tremble. This was like nothing she'd ever felt before. It was so strange†¦ but so wonderful. A pleasure that she couldn't have dreamed of. To be this close, and to be getting closer, like fire and bright darkness merging †¦ To feel her mind opening to him†¦ And then the distant echo of fear, like an animal screaming a warning. Are you insane? This is Morgead. Let him see your soul†¦ pry open your innermost secrets†¦ and you won't live long enough to regret it. He'll tear your throat out the instant he finds out†¦ Jez flinched wildly from the voice. She didn't want to resist the pull to Morgead any longer. But fear was shivering through her, poisoning the warmth and closeness, freezing the edges of her mind. And she knew that the voice was the only rationality left in her. Do you want to die? it asked her point-blank. Jez, Morgead was saying quietly. What's wrong? Why won't you let it happen? Not just you dying, the voice said. All those others. Claire and Aunt Nan and Uncle Jim and Ricky. Hugh†¦ Something white-hot flickered through her. Hugh. Whom she loved. Who couldn't fight for himself. She hadn't even thought of him since she'd entered Morgead's mind-and that terrified her. How could she have forgotten him? For the last year Hugh had represented everything good to her. He'd awakened feelings in her that she'd never had before. And he was the one person she would never betray. Jez, Morgead said. Jez did the only thing she could think of. She threw an image at him, a picture to stir his memories. A picture of her walking out, leaving the gang, leaving him. It wasn't a real picture, of course. It was a symbol. It was bait. And she felt it hit Morgead's mind and clash there, and strike memories that flew like sparks. The first meeting of the gang with her not there. Questions. Puzzlement. All of them searching for her, trying to find a hint of her unique Power signature on the streets. At first laughing as they called for her, making it a game, then the laughter turning into annoyance as she stayed missing. Then annoyance turning into worry. Her uncle Bracken's house. The gang crowded on the doorstep with Morgead in front. Uncle Bracken looking lost and sad. â€Å"I don't know where she is. She just-disappeared.† And worry turning into gut-wrenching fear. Fear and anger and sorrow and betrayal. If she wasn't dead, then she'd abandoned him. Just like everyone else. Just like his mother. And that grief and fury building, both perfectly balanced because Morgead didn't know which was the truth. But always with the knowledge, either way, that the world was cold because she was gone. And then†¦ her appearing in his room today. Obviously alive. Insultingly healthy. And unforgivably casual as she told him he would never know why she'd left. Jez felt Morgead's outrage swelling up, a dark wave inside him, a coldness that felt no mercy for anyone and only wanted to hurt and kill. It was filling him, sweeping everything else away. Just being in contact with it started her heart pounding and shortened her breath. Its raw violence was terrifying. You left me! he snarled at her, three syllables with a world of bitterness behind them. I had to. And I'll never tell you why. Jez could feel her own eyes stinging; she supposed he could sense how it hurt her to say that. But it was the only thing that would work. The pull between them was weakening, being smashed away by his anger. You're a traitor, he said. And the image behind it was that of everyone who'd ever betrayed a friend or a lover or a cause for the most selfish of reasons. Every betrayer from the history of the human world or the Night World. That was what Morgead thought of her. I don't care what you think, she said. You never cared, he shot back. I know that now. I don't know why I ever thought differently. The force that had been trying to drag them together had thinned to a silver thread of connection. And that was good-it was necessary, Jez told herself. She made an effort and felt herself slide away from Morgead's mind, and then further, and then further. You'd better not forget it again, she said. It was easier to be nasty when she couldn't feel his reactions. It might be bad for your health. Don't worry, he told her briefly. I can take care of myself. And you'd better believe I'll never forget. The thread was so fine and taut that Jez could hardly sense it now. She felt an odd lurch inside her, a pleading, but she knew what needed to be done. I do what I want to, for my own reasons, she said. And nobody questions me. I'm leader, remember? Snap! It was a physical sensation, the feeling of breaking away, as Morgead was carried off on a wave of his own black anger. He was retreating from her so fast that it made her dizzy†¦. And then her eyes were open and she was in her own body. Jez blinked, trying to focus on the room. She was looking up at the ceiling, and everything was too bright and too large and too fuzzy. Morgead's arms were around her and her throat was arched back, still exposed. Every nerve was quivering. Then suddenly the arms around her let go and she fell. She landed on her back, still blinking, trying to gather herself and figure out which muscles moved what. Her throat stung, and she could feel dampness there. She was giddy. â€Å"What's wrong with you? Get up and get out,† Morgead snarled. Jez focused on him. He looked very tall from her upside-down vantage point. His green eyes were as cold as chips of gemstone. Then she realized what was wrong. â€Å"You took too much blood, you jerk.† She tried to put her usual acidity into the words, to cover up her weakness. â€Å"It was just supposed to be a ritual thing, but you lost control. I should've known you would.† Something flickered in Morgead's eyes, but then his mouth hardened. â€Å"Tough,† he said shortly. â€Å"You shouldn't have given me the chance.† â€Å"I won't make the same mistake again!† She struggled to a sitting position, trying not to show the effort it cost her. The problem-again-was that she wasn't a vampire. She couldn't recover as quickly from loss of blood†¦ but Morgead didn't know that. Not that he'd care, anyway. Part of her winced at that, tried to argue, but Jez brushed it aside. She needed all her strength and every wall she could build if she was going to get past what had happened. It shouldn't have happened, whatever it had been. It had been some horrible mistake, and she was lucky to have gotten away with her life. And from now on, the only thing to do was try to forget it. â€Å"I probably should tell you why I'm here,† she said, and got to her feet without a discernable wobble. ‘I forgot to mention it before.† â€Å"Why you came back? I don't even want to know.† He only wanted her to leave; she could tell that from his posture, from the tense way he was pacing. â€Å"You will when I tell you.† She didn't have the energy to yell at him the way she wanted. She couldn't afford the luxury of going with her emotions. â€Å"Why do you always think you know what I want?† he snapped, his back to her. â€Å"Okay. Be like that. You probably wouldn't appreciate the chance anyway.† Morgead whirled. He glared at her in a way that meant he could think of too many nasty things to say to settle on one. Finally he just said almost inaudibly, â€Å"What chance?† â€Å"I didn't come back just to take over the gang. I want to do things with it. I want to make us more powerful.† In the old days the idea would have made him grin, put a wicked sparkle in his eyes. They'd always agreed on power, if nothing else. Now he just stood there. He stared at her. His expression changed slowly from cold fury to suspicion to dawning insight. His green eyes narrowed, then widened. He let out his breath. And then he threw back his head and laughed and laughed and laughed. Jez said nothing, just watched him, inconspicuously testing her balance and feeling relieved that she could stand without fainting. At last, though, she couldn't stand the sound of that laughing anymore. There was very little humor in it. â€Å"Want to share the joke?† ‘It's just †¦ of course. I should have known. Maybe I did know, underneath.† He was still chuckling, but it was a vicious noise, and his eyes were distant and full of something like hatred. Maybe self-hatred. Certainly bitterness. Jez felt a chill. â€Å"There's only one thing that could have brought you back. And I should have realized that from the instant you turned up. It wasn't concern for anybody here; it's got nothing to do with the gang.† He looked her straight in the face, his lips curved in a perfect, malevolent smile. He had never been more handsome, or more cold. â€Å"I know what it is, Jez Redfern. I know exactly why you're here today.†

James Dean

A Rebel With A Cause â€Å"Wash the dishes, and clean your room. Be home by 7:00, don’t be late. Study, study, study. † We have all heard these words uttered from the authoritative lips of our parents sometime in our life, however, these days most teenagers aren’t afraid to disobey their parents by responding with, â€Å"no. † James Dean was one of the first people to defy the strict rules of parents, and he did so on screen for the entire nation. Some sources claim that he is a label; a label that is intended for the sole purpose of resisting authority.He is not a label, rather more of an icon used to show that in certain circumstances it is okay to disobey the various rules that society has unwillingly placed upon us. Whether it be in black and white, or vibrant colors, the emotions in this picture speak loud enough for color not to be an issue. People perceive Dean as â€Å"trapped,† and after gathering some background information about him and h is career, I can clearly see why he is portrayed as this. His career peaked for three years, and then abruptly came to an end. However, for those three years Dean had to be everything that America wanted to see and idolize.Cameras surrounded him 24/7, paparazzi always wanted a comment from him, and fans simply couldn’t get enough. In the photograph that I have attached, it is as if Dean is trying to keep a hold on himself and his emotions; trying not to get too caught up in the crazy world he had been thrown in to. The â€Å"Torn Sweater† series was taken by photographer Roy Schatt. Schatt told Dean to pose as if he was trying to escape something that comes from within, a feeling perhaps, that only he himself is aware of – hence the attempt at tearing his sweater off.It is ironic in a sense that he’s standing in front of a camera, completely alone with a solid background looking into the distance. Being in front of a camera he had grown completely accusto med to, but he was never alone, and the background of his life is more chaotic than just a solid color. Dean is pictured gazing into a vastness that only he could imagine, imagining his life on the complete opposite end of the spectrum that he ended up being on. Even with his fame and stage-presence, Dean was an average guy who struggled to trying to get by with life.It is possible I’m biased due to myself being a teenager, struggling to get through this crazy thing we call life that I am able to relate to him. This photo stands out to teenagers in the sense that not everyone is perfect, nor knows how to be. At this time period, for many American teenagers, it must have been difficult to stand up to parents, and disobey the overbearing rules they had set-in-stone. Dean gave inspiration to them to stick up for what they believe in, regardless of the fact that they are younger and seen as less knowledgeable.Some people may know Dean from various old-time movies. He starred in E ast of Eden, Giant, and is most recognized for his rebellious character in Rebel Without a Cause. He was considered a good actor in the 1950s for the diverse character roles he took part in, and of course for his legendary sex-appeal. For half a century, he has captured the world with his casual style, fearless look, and rebel attitude. James Dean has defied the essence of â€Å"cool† and â€Å"without-a-cause† for generations.Rebel Without a Cause may be one of the most famous due to the fact that Dean got into a fatal car accident on September 30 1955, one month before the release date. Dean wasn’t only a sexy symbol of rebellion, he represented an every-day teenager that goes through social issues without having a clear direction for his life. In Rebel Without a Cause, he was shown as a delinquent in an urban slum. It is the story of a rebellious teenager who arrives at a new school, falls for the girlfriend of a school jock, and disobeys his parents trying t o defy the meat-head’s bulling.The directors of the movie casted him as a rebel, realizing that his attractive, edgy self would appeal to many teens being as they can relate. Dean was a product of this 1950s ideology. Percieving Dean as a good guy, desperately wanting to do the right thing, yet constantly getting caught up in doing the wrong, was appealing to teenagers around the entire nation. Teens didn’t challenge their parents rules back then, they listened to their elders, and did as they were told. People who did backlash and resist the authority were considered outlaws, who would never be successful.Making this movie and being allowed to see the inside world of a â€Å"true† rebel was one of the first opportunities both teens and parents had to see the two sides of a story. Dean’s performance spoke powerfully on behalf of teenagers going through this type of scenario themselves, and gave them a hero they could admire and respect. In today’s society, arguing with parents, or going against the rules trying to break the idea of a norm isn’t unusual. Yet, in the era that this movie was made, it was extremely against anything society really knew.The case isn’t about whether teens should, or shouldn’t argue, it’s the fact of respecting elders so much. His movies, all three of them, show that it isn’t necessarily bad to stick up for what you believe in whether you’re younger than the opposing factors or not. Going against society in ways that not a lot of people were brave enough to endure was something that really stood out, and made him recognizable for decades to come. Being a super-star is something that ordinary people like myself can only dream about.Not necessarily dream as in wanting it so badly it hurts, but dreaming in the sense that living the life of a celebrity would be such an out-of-body experience. Dealing with cameras constantly on a day-to-day basis isn’t some thing that I could put up with. Sure, all the money and fame would be nice for maybe a year or so, by eventually a person reaches a point where privacy is more important than materialistic items. Getting to know someone through the media could possibly be the worst way to get the true story. In pictures, you only get to see one thing, one significant moment that happened to be captured by someone’s Kodak.Gathering background information and searching a little deeper into something that interests you is really beneficial not only for yourself, but also the someone who is getting perceived as a single story. One of his most famous quotes is â€Å"Dream as if you’ll life forever. Live as if you’ll die today. † That’s exactly what he succeeded in doing in his life. â€Å"James Dean lived fast – and died young. † (Gilmore 32. ) Although his life was cut short by an unexpected car crash that ended up being fatal, Dean established a name for himself within the few years that he was an actor.That is astonishing. He has an outrageous amount of fans, and still continues to become known throughout the world today. Works Cited Gilmore, John. ^ John GiLive Fast – Die Young: Remembering the Short Life of Ja. New York City: Thunder's Mouth, 1998. Print. Herndon, Venable. James Dean: a short life. Garden City, NY: Doubleday, 1974. Print. Hofstede, David. James Dean: a bio-bibliography. Westport, CT: Greenwood P, 1996. Print. Springer, Claudia. James Dean Transfigured: the Many Faces of Rebel Iconography. Austin: University of Texas, 2007. Print.