Case study 2-2 Essay Example for Free (#2)

Case study 2-2 Essay Case Project 2-2 I would determine whether an investigation is required for this type of situation. I would make am initial assessment about the case that I will be investigating. Meanwhile, determining the type a design of approach for this particular case. I would then estimate the time of each step, when the check was issued and as the amount. I would ask Jonathan to interview the other individual who has access to the company’s accounting program. I would review the company computer as well as the accounting program and see if there are any significant documents; which would including the company checkbook and ledger, as well as contact the bank for the most current bank statement. Any type of information pertaining or related to that particular check, which was issued during that time. However, if cleared, then further investigation has to be done. I would examine that employee’s email for anything suspicious as well as surveillance cameras within that office. I would also study the suspects work habits as well. I would ask Jonathan to locate and itemized any details of the subcontractor’s job amounting to $10,750 and the facts of the check for the amount $12,750. I would try to find the facts of the $2,000 difference, if available by comparing bank statements, and the accounting program. I will inform him to be very watchful of any relevant information that may eventually be evidence in this type of criminal case, which could be employee theft or embezzlement. If this other person beside Jonathan is involved in this crime and not being an  accounting error, has taken place, I would recommend Jonathan to allow me to further my investigation with this company. Case study 2-2. (2016, Apr 11). We have essays on the following topics that may be of interest to you

Management Assignment Example | Topics and Well Written Essays - 500 words - 7

Management - Assignment Example The company also has strong marketing and advertising capabilities; it spends its advertising money more efficiently that its rivals are thereby getting greater returns in terms of revenue and product awareness (Böhm, 58). Such strong marketing and advertising capabilities have provided the company with a competitive advantage in the market than its closest rival. The market share of the company I likely to increased due to increased demand for glass products, necessitated by rising need for scientific research as well as education. The company, therefore, should aim at increasing its productivity to meet that demand. This will help  the  R&H Filter Company to use the opportunity as a competitive advantage. The R&H Filter Company mostly used waste glasses as raw materials; it recycles glass products. The company has a positive attitude towards green environment, which has offered it a positive public image. It has been seen as conserving and preserving the environment. Therefore, a new wave for stricter regulations regarding emission of CO2 and carbon monoxide would positively affect the company. The company should put the rapid changes in technology into use to develop high-quality and innovative products so as to be able to tackle the intense competition in glass products. Even though, the company’s high investment in research and development lead to high revenue volumes, The R&H Filter Company still has a high cost structure, the costs are driven by their generous employee compensation, benefits and pension plans (Ferrell and Michael,

INTERNSHIP REPORT Essay Example | Topics and Well Written Essays - 4500 words

INTERNSHIP REPORT - Essay Example I will be elaborating my job role in this report as it is only due to the job role, I have been able to learn numerous new things, which I believe will help me throughout the professional career. While working with the organization, I came to know about the significance of organization culture and the role it plays in shaping the organization function. In this context, the thrust and emphasis will be on the aspirations of the labour force, the behavioural pattern of the employees and customers and management attitude. Hence, I will be highlighting about the culture of our organization. Apart from that, I will be analysing the external business environment of the country of operation and the general environmental overview. Lastly, on the basis of the findings I will be drawing a relevant conclusion by highlighting the relevant points from the study. Then I will be also enumerating my personal experience with the company and how I will be making use of those learning in the future. Junior Chamber International (JCI) is a non profit organization based in Monaco. The organization came into existence in the year 1944 and was founded by Henry Giessenbier, Jr. The organization, during its inception was deemed as Service/NGO firm. JCI is basically a membership-based non-profit organization. Currently, the organization has over 200,000 members of age 18-40 years. The members are spread over 100 countries and belongs from 5000 different countries. Junior Chamber International (JCI) is currently headquartered at St. Louis, Missouri, USA and the headquarter employs around 20 individuals. These individuals are responsible for overseeing the activities of JCI, administering the overall organizational finances and provide members with optimum tools and resources so as to help them improve projects on national and local level. The company is also regarded as the world’s largest non-sectarian and non-political youth service organization. The members of

Math Essay Example | Topics and Well Written Essays - 1250 words

Math - Essay Example ) accounted for a fifth of homicides and gang killings accounted for one twentieth. About a third were of unknown motive and the other 10% were miscellaneous motives (Best n.d.). One third of all victims know their attacker well enough to get into an argument with them. Felonies, gang related deaths, and other unknown motives make up the reason for all homicides. This does not include just the death penalty cases, but all homicides. The death penalty varies from state to state, but death penalty cases have certain criteria. Table 1 shows the exact criteria for each state. The victims must be killed during a felony in most cases. This would include robberies, rape, or drug related homicides. The pro death penalty advocates always give the statistics portraying the victims in the most sympathetic light, with the murderer in the worst light. These statistics are used to show how bad death row inmates can be. This should be a given. Only people that are criminals commit homicides during a felony. These facts are given to scare people into becoming pro death penalty. These statistics can be manipulated for the anti death penalty individuals. Out of the homicides 91.6% are first time murderers ¸ 95.1% were not incarcerated or escaped from incarceration, and so forth. Statistics are only as good as the source they come from. Anti death penalty advocates always give statistics giving race and education levels of death row inmates. Blacks are considered to be more likely to get the death penalty. This makes the death penalty racists. The facts are only 37% of blacks compared to 57% of whites are executed (The Death Penalty in the U.S. 2008). Current death row statistics show 45% white and 42% black. Race is an emotional issue. This is due to Jim Crow laws in the South. For many years white juries would not convict a white man of killing a black, but black men would be executed for the same crime on whites. This is where the myth that more black men is

Roles Of Investment Banks In Mergers And Acquisitions Finance Essay

Roles Of Investment Banks In Mergers And Acquisitions Finance Essay BACKGROUND: Â  Mergers and Acquisitions which can also be abbreviated as MA, relates to the corporate strategy, company finance and management of buying, selling and combining of different firms which can assist, finance or help a developing company in a particular sector develop more without generating a need to create different business entity. The history of MA has evolved in five stages. The process of MA is triggered by the economic factors such as growth in GDP, interest rates and monetary policies which brings the companies and organizations to emerge in the transactions of MAs. The first stage is known as the first mergers wave which was commenced from 1897 to 1904. During this phase merger occurred between the companies who are in the line of productions of heavy manufacturing products like railroads, electricity, etc. All the mergers that happened during these phase are of horizontal type. The companies and organizations that are merged had enjoyed monopoly in the market because of their same kind of manufacturing business of heavy machineries and industrial goods. At the end of the first merger wave those companies that are involved in mergers and acquisitions have tasted bitter failures because of non achievement of desired efficiency. These failures were highly fuelled by the economic slowdown and stock market crash in 1903 and 1904 respectively. Those companies were further more retaliated by the legal frameworks, which are even not in their favour. The Supreme Court had passed a mandate stating the possibility of halting of the anticompetitive companies using the Sherman Act an act which was passed in 1890 by the US government against the combination of companies who creates the potential harm to the competitive markets by their cartels and monopolies. (William L. Letwin, Congress and the Sherman Antitrust Law: 1887-1890, 23 U.Chi.L.Rev 221 (1956)) The second wave merger took place from 1916 to1929. During this period the mergers between oligopolies had taken place rather than monopolies. The economic boom after the World War I had given rise to these mergers. The technological advancement in railroads and transportations by motor vehicles had given a proper infrastructure to these mergers and acquisitions. The government encouraged the companies to work united and the policy was implemented in 1920s. The second mergers wave was mainly a horizontal or conglomerate type. Mergers happened during this phase were mainly between the companies producing petroleum, food products, metals, transportation equipments and chemicals. Investment banks had a vital role in facilitating mergers and acquisitions during this phase. The end of second wave mergers happened due to sudden crash in stock market in 1929. The tax relief provided by the government helped mergers to start again in 1940s. The third wave merger took place between 1965 and 1969 which was of conglomerate in nature. These mergers were inspired by the high interest rates, rise in stock markets and strict antitrust policies. The interesting fact about these mergers is, the bidder firms were smaller in size than the target firms. These mergers were financed from equities and investment banks have no more vital roles in those mergers. The third wave mergers ended by the plan of the Attorney General to split the conglomerates in 1968 and also due to a poor performance by the conglomerates. The fourth wave mergers took place between 1981 and 1989 which was a kind of acquisitions. These mergers were not big in size as compared to those in third wave mergers. Mergers were happened between the oil and gas companies, airline and banking companies and pharmaceuticals. This wave ended due to anti takeover laws, financial reforms and Gulf war. The fifth wave mergers took place between 1992 and 2000. During this period mergers were inspired by globalization and rise in stock market. Mergers were financed by the equity and not by the debt. The motives of mergers have changed from short term to long term profits. This merger wave ended with the burst of stock market bubble. To sum up, the process of mergers and acquisitions is coming from all the way long and has passed through lots of economic and geographic barriers. It is being developed by the various economic factors. Many other factors have contributed in its growth and as long as these economic units of production exist, MA will continue to spread and develop. As this paper is all about the financing of MAs, firstly, we must know about the ways in which the transactions of MAs are financed. You can finance an acquisition by borrowing money based on assets you own yourself or you can borrow money based on the business value and assets of the company you wish to purchase. Mergers are also frequently financed by stock swaps or by issuing new stock in your company to use as payment to the target companys shareholders.( http://www.ehow.com/how_2119515_finance-buyout-merger.html) If a company takes on debt to make an acquisition and the deal goes sour, it runs into financial trouble and the executives are replaced. But if an equity-backed deal goes wrong, the stock price simply underperforms and nobody can be sure why. One thing is certain unwise acquisitions abound in this market. Michael H. Lubaktin and Peter J. Lane Acquisitions can be financed by cash purchase, an exchange of stocks of shares or a combination of both cash and shares. However, from all these stated mediums, cash is considered as a most preferred mode of financing. It has started taking pace during 1970s, when the percentage of takeovers grew from 20% in 1960s to over 50% during 1970s. (D. A. Blackmon, 1997. WorldComs massive bid shakes up little town. Wall Street Journal, October 13: Bl, B9; P. Elstrom, C. Yang, and S. Jackson, 1997. WorldCom + MCI: How it all adds up. Business Week, November 4: 44.) Whenever a company decides it wants to merge or acquire another firm, they use the services provided by the professionals outside the company. It may include the Investment banks, accountants and valuation experts. There is variety of services provided by the Investment banks like helping to select the target, target valuation, advising on strategy and raising the required finance to complete the transaction. We have seen the origin of Mergers and Acquisitions and even various ways of financing it. But in this paper we are going to talk more about the role of Investment banks in the entire procedure of MA. So, before we move on further, lets just see how these Investment banks came into existence. We will see their origin, a bit of services they offer and finally their extreme importance in the transaction of mergers and acquisitions. In the true sense, Investment Banking is investing in the securities of the issuing companies, i.e. buying their shares and then to resale them to the general public. (Fleuriet, Michel, 2008, p.1). Investment banking is originated in 1792 outside the Wall Street and under a Buttonwood tree. This is the only known origin of investment bank by number of investment bankers. However, there is no exact report of truth of its origin. Anyways as nobody knows where Investment banking came from; let alone what it actually is. There are various other services apart from reselling the securities that investment banks provide. But it is believed that most of them are much older than the Investment banks themselves. Lets begin with the financial products the Investment banks offer. Investment banks deal with the underwriting and trading government bonds. They trade in international bond syndications. They develop new instruments of structured finance; one of them is mortgage-based securities. The major functions of Investment banks are: Raising Capital Trading Securities Advising on Corporate Mergers and Acquisitions. In general terms Investment banks act as intermediaries between the sellers and the buyers of securities. Moreover, they do more than just that. The scope of investment banking include all major capital market activities such as underwriting, private placement, MA, venture capital, market making, proprietary trading, financial engineering, clearing and settlement, and financing and money management. K.T. Liaw, The Business of Investment Banking (New York: Wiley, 1999). Apart from the rest of the duties of Investment banks, we are going to see more about its duties towards advisory on deals of Mergers and Acquisitions. Investment banks are nowadays having become more focused on taking the deals of MAs which are of logically planned to think deeply and apply thoughtful logic in the whole merger transaction. If an Investment bank is on the buy side of the transaction, it will spend lot of time to analyze the situation, strategic setting of the acquirer and of the target. It will help them to identify potential strategic aims for the transaction. AIMS and OBJECTIVES: The main aim of this paper is getting a legitimate understanding of the entire process of MA as well as an extreme vital role of Investment banks in the entire process of MAs. Moreover, by doing this research work, I would try to find out various strategies and methods that the Investment banks use according to the companys situations. Furthermore, I would also try to find out the ways the Investment banks use their arbitragers in taking higher risks to get the maximum amount of profit out of the entire merger transactions. There are several other objectives and questions that are needed to be answered that I would try to find and present my best possible outcome of the research in this paper. In recent trend, the transaction of mergers and acquisition requires a strategic plan to create a successful merger. There are several ways that the companies involved are applying nowadays. Firstly, the acquirer company makes a tender offer which means, it makes a takeover bid in public like an open offer or an invitation to all the shareholders of the target company. It offers the stock for sale at a specific price during a stipulated time period. That offer may be for a minimum or maximum number of shares. And in this case the acquirer firm directly contact the shareholders through the medium of newspaper advertisements and the directors of the target firm may not have endorsed the proposal of the tender offer. The price which the acquirer firm offers to the target firms shareholders usually have included premium over the current market price of the target companys shares. Acquirer firm does so to induce the shareholders to sell their maximum number of shares to them. There is an extreme importance to study both the perspectives of the entire process of MA. It means the process consists of both the buyers perspective and the sellers perspective. Here, we are going to study these perspectives and try to conclude the outcomes of the entire research. First of all we will see the transaction from the buyers point of view. How a buyer of the firm gathers all required materials, assemble the team, recruit the internal team to go on for further details, getting things done by the outside teams, etc. Secondly, we will go for the sellers perspective of the deal. What made the seller to sell his business, preparations made to close the bid, keeping in mind the needs of prospective buyer, gathering the decisions of the sellers entire team, preparing financial terms, taking help from the outsiders, etc. Moreover, we will also focus on the importance of the advisory teams which plays a vital role in closing the deals. They may be accountants, attorneys, investment banks or other financial institutions. As this paper is made to get insight on workings of the Investment banks as an advisor to both the parties in the deal, we will see more on the entire work done in the past by various Investment banks from all over the world. We will also take some examples of the Investment banks and their financial advisory terms and structures to get exact and insight knowledge of the Investment banks as an advisor. Finally, we will conclude on the basis of ethics, the working of both sides of the merger deals and the ethics used by the Investment banks in its advisory role to the process of mergers and acquisitions. Methodology and Data: Research methods are the techniques for gathering data (Aldridge and Levine, 2001). It is a systematic and orderly approach for collecting and analyzing data and obtaining particular information from collected data (Jankowicz, 2000). The research I am doing on is a topic that can be discussed a lot. Because of its increasing importance, the data regarding my research can be available in ample quantity from number of sources like journals, articles, magazines and some research papers, electronic search engines from college, World Wide Web, documentary data, Survey based data etc which helps to develop a good literature and synthesize and analyze primary data. Secondary data analysis provides higher quality data than could be obtained by collecting on your own (Stewart and Kamins, 1993). Re-analyzing secondary data can lead to unforeseen or unexpected new discoveries (Saunders et al, 2003). These available secondary data can give me that information that is at least a basic idea giving and can be my first approach to initiate my research work. Because of the day to day financial news is available in Financial News Papers, lot of information regarding investment banks are available from it. Along with that the inter net is considered as the best source of getting information on almost every topic we wish to work on. So, my first move to start research would be secondary data available from above mentioned sources. Data collection through interviews has been the prime source of this research. An interview is a purposeful discussion between two or more people (Kahn and Cannell, 1957). It is a type of social interaction between a researcher and an interviewee, who serves as the potential source of information relevant to the research. The use of interviews helps the researcher to collect valid and reliable data that are significant so as to the research questions and objectives (Saunders et al, 2003). Bryman and Bell (2007) says that the research interview is an important data collection strategy in any type of research whether it is quantitative or qualitative. The major merit of interview to be used as a data collection tool is that it focuses predominantly on the researchers topic along with being more insightful. The objective behind conducting interview is to collect relevant information required to the respondents knowledge in particular field (Merriam, 1994, pp. 86 87). Structure of the Study: This study has been divided into five chapters: Chapter two describes empirical literature based on past studies conducted on single and panel countries and an overview of Investment banks working towards the finalizations of merger deals with description of recent trend and progress of MA deals. Chapter three explains the methodology and data used in this study together with the description of variables. Chapter four states the analysis of the collected data and findings. Finally, chapter five provides the results and conclusion derived from the given study. CHAPTER TWO: LITERATURE REVIEW Introduction: An acquisition is a transaction where one company buys shares of another company, by issuing its own new shares, cash, debt or a mixture of these forms of consideration. A merger transaction is where both parties agree to combine their business, and for this purpose form a new company that issues shares which replace the shares of both businesses (Reuvid, Jonathan, 2007). Mergers and Acquisition activities have been circled from long time, which is based on various macro economic factors. The overall economic state of the nation and abroad. Stock prices of public listed companies. Liquidity levels in the financial markets. The level of pressure by antitrust on Mergers and Acquisitions. The level of regulation in accurate checking of certain industries, such as airlines, telecommunication, banking and other financial services. If the conglomerates or pure play companies are in favour of market experts and analysts. There are so many differences in aspects of the number of companies bought and sold, as well as prices paid for these deals, as time has passed. Firstly, we will see the examples of the merger transactions that had failed due to lack of proper preparations and over spending of money in transaction. Here is the case of Conseco Finance, which was trading near its highest level at $50 per share in June 1998. The CEO of the company, Stephen Hilbert, and the public market were very confident about the companys prospects. However, Hilbert announced the acquisition of Green Tree Financial, a subprime mortgage and consumer lending company, for a whopping $7.6 billion, that same month. The offered price was more than seven times the net worth of Green Tree, or a $6.6 billion premium to the tangible book value. Then the disaster had started to happen over the next two years. The stock price of the company dropped to $below $10 per share from $50 per share. The company was declared bankrupt in the spring 2003. Moreover, the analysts attributed the companys long and painful downfall to its overpayment for the Green Tree assets and the subsequent adverse impact of that purchase on Consecos operations. This disaster not only resulted in loss of job to Hilbert, but also drove a very successfu l company out of business. The popular

Intrinsic Motivation is Ideal Essay -- Learning Education Motives Ess

Inquisitive and self-directed learning is a natural behavior for young children. They marvel at each new discovery and strive to understand the meaning behind every question in their world. However, older children seem to be resistant to learning unless directed by teachers or parents with various forms of external recognition (Deci and Ryan, 1981). Their enthusiasm and inner desire for understanding has diminished. Learning, to older children has become directly connected to demands, controls, and rewards. In order to understand why this attitude toward learning develops, the concept of motivation in education must be defined and examined in a theoretical sense. "Motivation is an essential condition of learning" (Ray, 1992, p.3). A motivating condition may be defined as an emotion, desire, physiological need, or similar impulse that acts as an incitement to action. Ray (1992) comments that "motivation in education is concerned with students’ motivation to learn" (p.3). With the understanding of these defined concepts in hand, we can begin to examine the reasons behind school age children losing their enthusiasm for learning. In order to comprehend the reason for the undermining of this intrinsic behavior, we must acknowledge the basic theories of motivation from an eclectic standpoint. By embracing the concepts of learning from both a behaviorist and cognitive point of view, a teacher can tailor the use of reinforcement in the classroom to commit the students to achieving acad emic excellence with enthusiasm and devotion. Findings Motivational Theories Humanistic behavior and learning techniques are viewed from many different positions of psychological theories (Ramirez, 1983). In order for a teacher to effectively apply these psychological principles in their classroom, they must become knowledgeable in the various conflicting theories. Looking at the theoretical aspect of motivation to learn provides background information about the basic nature of different learning processes (Ericksen, 1974). The locus of control in motivation is the subject area where separate theoretical views come into play. People have either an internal locus of control, an external locus of control, or are simply amotivated. "Intrinsic motivation is a state where the relevance for the learner of the content of the material is the main reason for learning. Extrinsic... ...istrators who respond to their initiations and support their practicing methods to remain intrinsically motivated in the same way that students need teachers to respond to their initiations and mastery attempts to remain enthusiastic about learning (Deci and Ryan, 1981). School administrators, and the community in general, need to be supportive of teachers’ efforts to try new things, to respond to the challenges, and to teach according to their preferred methods. "Deci and Ryan propose that if the climate of the educational system were more informational and autonomy-oriented in nature, this would foster teachers’ intrinsic motivation for teaching. In turn, teachers would be better able to foster intrinsic motivation in their students" (Deci and Ryan, 1981, p. 17). The art of skillfully implementing reinforcement, in a tailored fashion, for the students’ development of intrinsic motivation to learn is a difficult task for a teacher to master. Even though the school administration and community should be responsible for setting precedence of intrinsic motivation throughout the schools, the obligation of effectively facilitating this concept is in the possession of the teacher.

Oxfordshire Go Active Project Health And Social Care Essay

Over the old ages a positive correlativity between physical activity and wellness has been shown in many surveies. Physical activity has been known to forestall certain medical conditions like cardiovascular diseases, non-insulin-dependent diabetes mellitus ( NIDDM ) , Colon malignant neoplastic disease and it likely gives protection against osteoporosis and mental unwellness ( USDOHHS 1996 ) . There is 1.2-2.0 fold comparative hazard of mortality in sedentary people than in physically active population USDOHHS 1996 ) . There is a greater hazard of being unfit than being fit in populating a sedentary life style ( Blair et al 1989 ) . A five fold hazard of mortality in unfit adult females and a threefold hazard in inactive and unfit work forces compare to does that are most fit has been shown by Blair et Al. ( 1989 ) . Harmonizing to the WHO ( 2002 ) 6 % of all deceases for work forces and 6.7 % for adult females are cause by physical inaction in the developed universe. Too small phys ical activity has been shown to be the cause of 3.3 % and 3.2 % of all lost DALY every bit good as an estimated 33 % of all deceases from Coronary bosom disease ( CHD ) , colon malignant neoplastic disease and NIDDM ( Powell and Blair, 1994 ) . The bulk of population in most developed states like the UK is non as physically active as necessary from a wellness position point ( Engstrom, 1997 ) . Obviously there are several grounds for a society to advance physical activity and from a public wellness position PA has the potency to better the state ‘s wellness. Sedentary life has become a public wellness job particularly in the developed universe. This is chiefly due to people passing tonss of clip driving autos watching telecasting, playing electronic games and so on. Until of recent PA has non been in the bow forepart of national policy, nevertheless in the last decennary it is going recognized and it is mentioned in most of the national service frame works ( DOH 1999, DOH 2000 and DOH 2001 ) . Peoples are hence progressively encouraged and advised by the primary wellness attention in England to acquire involved in visible radiation or heavy physical activity plans through referral strategies ( Fox et al 1997, Riddock et al 1998 ) . In the UK it is the primary attention trusts ( PCT ) in coaction with Sports England who are the chief boosters and suppliers of such referral strategies and Oxford PCT is no freedom to this. Objectively the strategy is designed to assist keep the wellness and good being of the public and they recommend all grownups ( 16years and supra ) to accomplish at least a sum of 30 proceedingss a twenty-four hours of moderate to intensive physical activity on 5 or more yearss a hebdomad. In 2004 the Oxford shire PCT in acknowledging this vision made a corporate determination to travel towards a new county Sports partnership: ( a partnership which jointly includes a web of bureaus, groups and persons who are committed to accomplishing a shared vision for the county ) which is to better the physical activity degrees of their public through PA referral strategies. Sports England who was the first provokers of this alteration was willing to financially and logistically back up all the 49 counties ‘ athleticss partnerships within England under the umbrella of †GO Active † . The chief purpose of the Oxford shire Go active undertaking is to better the wellness and good being of the dwellers of Oxfordshire by increasing and widening engagement by grownups ( 16+ ) in athletics and active recreational plans. The partnership nucleus squad was approached by the Oxfordshire PCT in June 2007 for them to work together to debar the increasing dainty of fleshiness i n the community due to inaction. As a start the PCT allocated funding for two stations to this undertaking to acquire started in 2008 which will co-occur with the launch of the new †Oxfordshire Fleshiness Strategy Program † . The logic was to pull the two plans together under one streamer to maximise added value and impact while minimising cost on undertaking direction, selling every bit good as the cost monitoring and rating. This brings us to the chief subject of this thesis which is intended to measure the cost effectivity of this physical activity referral strategy: †The Oxfordshire Go-Active Undertaking † over a period of a twelvemonth since it was commissioned. The potencies of physical active to better the wellness of the state from a public wellness position have been copiously manifested and yet at that place have non been equal economic ratings of such PA intercessions. From experience, Jackie and Jane ( 2006 ) , have shown that people working in the wider field of public wellness does non see rating as their chief precedence and may even see it striping them of valuable clip that could be better utilized in bettering wellness. However late economic rating has become an built-in portion of most undertakings little or large due to the fact that most undertakings have legion interest holders all with different dockets, involvements and positions about what result constitutes a successfu l undertaking. Evaluation is designed to find the value or worth of an activity ( Graney 2002 ) .Chapter 2: LITERATURE REVIEW2.1 IntroductionThis chapter gives an overview of cardinal literature on the economic rating of physical activity referral strategies ( PARS ) or Exercise referral Schemes ( ERS ) . Over the past decennary the United Kingdom and most industrialized states have progressively recognized the function of physical activity in bettering public wellness and this resulted in a big figure of research and policy development aimed at physical activity publicity ( DOH 2004, DOH 2005, NICE 2006 ) . The function primary health care in undertaking increasing degrees of physical activity within the general population has late been reemphasized by the UK authorities ( Taylor A 2003 ) . US surgeon general ( 1996 ) reported on the chief effects of physical activity ( PA ) on wellness and disease and the effects highlighted were: lower entire mortality rates and lessening hazard of cardiovascula r mortality, colon malignant neoplastic disease and non insulin dependant diabetes ( NIDD ) . It was stipulated that regular PA besides delays or prevents high blood force per unit area ( HBP ) , reduces blood force per unit area in hypertensive sick persons and relieves the symptoms of depression and anxiousness. A meta analysis of PA in relation to the bar of coronary bosom disease ( CRD ) concluded that the comparative hazard of CRD in the least active compared to the most active is 1.9, Berlin et Al. ( 1990 ) . Physical activity in bettering the wellness and well-being of the people can non be ignored. The rational for this reappraisal is to determine what is known about such plans as respect to what benefits are gained, cost effectivity of intercessions and what indexs are used to mensurate effectivity ; qualitatively, quantitatively, morbidity or mortality rates or economically. The relevant literature will besides be used in all subdivisions of this thesis which is chiefly ge ared to measuring the cost effectivity of â€Å" Oxfordshire GO Active undertaking † run by Oxfordshire Primary Care Trust ( PCT ) . Literature from all facets and changing signifiers of PARS and or Erbiums from assorted parts of the universe were looked at and the sum of literature was poetry. The reappraisal standard was based on the PICOS system, Greenhalph ( 1997 ) and Oxman et Al. ( 1994 ) , so as to guarantee lucidity, quality, truth and cogency. In this reappraisal a sum of 15 undertaking documents on physical activity referral strategies were studied and a mix March of assorted survey types and plans were considered runing from: randomized control tests, systematic reappraisals, cost effectiveness Socio-demographic patterning of referral surveies, strategies to advance physical activity in grownups, community based exercising programmes, primary attention based referral strategies, ethnically based referral strategies and so on. Due to the big figure of research documents found the reappraisal for the intent of thesis sweep from 1998 to 2010. A survey by Stevens et Al. ( 1998 ) did a cost-effectiveness analysis of a primary attention based physical activity intercession in the 45-74 twelvemonth old work forces and adult females in London. In the survey two west London general patterns ( GP ) together with an exercising development officer ( EDO ) invited 714 inactive people aged 45-74 to their audiences and offered them a individualized 10 hebdomad physical activity ( PA ) plan to increase their degree of exercising ; through combined place based and leisure Centre activities. The chief aim was to measure the cost effectivity of the intercession ; by comparing the cost of the PA in intercession group to that of the control group. The control group was merely sent information on local leisure centres. The initial choice procedure involved directing self assessment questionnaires to everyone in the surgery list aged between 45-74 old ages. The questionnaire asked for basic demographic informations ; ( instruction, ethnicity, matrimonial position and socioeconomic activity ) and a self appraisal of the figure of episodes of either mild or vigorous PA undertaken for at least 20 proceedingss per hebdomad in the last 4 hebdomads. A list of moderate activities including alert working, heavy horticulture, cycling for pleasance. Heavy DIY and swimming for leisure were given and vigorous activities like jogging/running, competitory athleticss, swimming lengths briskly, mounting stepss and fast cycling were included in questionnaire. Out of 2253 baseline questionnaires sent 1288 ( 57 % ) were returned of these 63 % were adult females and 46 % work forces, 827 were inactive, 113 excluded on medical evidences and the 714 left were randomized into 363 for intercession and 351 as control. Exercise development officer ( EDO ) through the GP invited the intercession group to a audience in a local leisure Centre. At the first audience merely 126 attended, 2nd audience 91 came and after 8 months 200 returned the follow up questionnaire. The control group, ( who were merely sent exercising publicity stuffs but non invited for any audiences ) , returned 215 questionnaires for the 8 months follow up appraisal. The consequences after 8 hebdomads showed a net 10.6 % ( 95 % Confidence Interval ( CI ) 4.5- 16.9 ) decrease in sedentary life and a corresponding increased 1.52 episodes of PA ( 95 % , CI 1.14 -1.95 ) among the intercession group. Response rate was highest in topics aged 65-74 old ages old ( 64 % ) followed by 55-64 twelvemonth olds ( 54 % ) and the youngest group 45-54 twelvemonth olds ( 37 % ) Stevens et Al. ( 1998 ) calculated the cost of each single intercession to be about ?650 pieces the cost of traveling person from the control group to the recommended degree of PA would be about ?2500, a difference of ?1750. However Steven et Al. ( 1998 ) realized the cost of the enlisting procedure is the highest hence a high uptake rate of participant would cut down cost markedly. However the bettering wellness additions of PA reduced mortality rate ( particularly from cardiovascular conditions, colon malignant neoplastic disease and diabetes ) , Regular PA besides delayed HBP, reduced BP in hypertensive sick persons and releases symptoms of depression and anxiousness. Statistically the Two by Two tabular arraies applied to compare the sedentary topics for intercession and the control group in the survey. The 95 % CI calculated utilizing the formulary: antilog ( log OR + 1.96SE ) where the standard mistake ( SE ) = ( 1/A+1/B +1/C +1/D ) 1/2 for a standard two by two tabular array. In ciphering the cost effectivity three steps were used: First the cost of bring oning one sedentary individual to set about more physical activity ( the chief intended out semen of the test ) was calculated and found to be ?623 per individual. Second the cost of traveling person who is active but below the lower limit needed PA degree was calculated and cost at merely under ?2500 per individual. Third the cost of accomplishing any addition in an persons degree of PA cost ?327 to motion to a higher group or less so ?200 for an absolute addition in PA. The survey undertaken by Steven et Al. ( 1998 ) has shown that it is possible to cut down sedentary life at a moderate PA strength in work forces and adult females between 45-74 through a primary attention trust based intercession. The enlisting procedure has besides been observed as the most of import facet of the intercession and they concluded that maximising cost effectivity is reciprocally relative to a higher uptake rate, the higher the uptake the more cost effectual the intercession. Another cost effectivity survey carried out by Munro et Al. ( 2004 ) at the university of Sheffield, was a clustered randomised test of a community based exercising plan in the over 65 twelvemonth olds in Sheffield. The chief aim of this survey is to measure how cost effectual a community based exercising plan for older grownups is as a population broad public wellness intercession. The survey was based on the rule that those with active life styles enjoy better physical and mental wellness than sedentary people, Fentem et Al. ( 1998 ) and Nicholl et Al. ( 1994 ) . The benefits of exercising in the aged over 65 old ages were assumed to include improved cardiovascular position, functional ability and mental operation every bit good as decreased hazards of ; CHD, shot, hip breaks, mortality rate, type II diabetes and depression, ( Paffenbarger et al. 1993, Morris et Al. 1973, Solonen et Al. 1982, Herman et al. 1983, Boyce et Al. 1988 and Wickham et Al. 1989 ) . In add-on to some of the expected additions in mortality and nest eggs from reduced usage of wellness services there is an estimated cardinal cost per Quality Adjusted Life Years ( QALY ) of a‚ ¬17,172, ( Raftery J. NICE:2001 ) . Twelve pattern list all patients with day of the month of birth before 1/4/1930In this survey 13 patterns in Sheffield were ab initio approached to take part but one opted out. The staying 12 patterns who agreed to take part, four were indiscriminately selected as intercession group ( through a computing machine random totaling plan ) and the staying eight patterns were allocated as vitamin E control. All people aged 65 or over were sent a base line postal physical activity Questionnaires ( PAQ ) , for the aged ( Vorrips et al. 1990 ) to find their current degree of accustomed PA and general wellness position utilizing ( SF-36 ) . Those with PA mark of fewer than 20 % were notified and allowed to take part. Letterss from the research squad were sent to respondents run intoing the inclusion standards ask foring them to bespeak an involvement in go toing local exercising Sessionss twice hebdomadally. To get down with 9897 people ( those born on the 1st of April 1930 ) were sent the baseline study letters, 8117 ( 82 % ) of them completed the studies, 126 ( 1.2 % ) went off, there was no response from 1461 ( 14 % ) and 192 ( 2 % ) refused to finish the study signifiers. Out of the 8117 people who completed the studies 29 of them died before the 1st of August 1995, the most active 1612 and an 56 losing active mark were excluded go forthing 6420 least active people to be randomized as 2283 topics in intercession group and 4137 people in the control group. By the terminal of the intercession period 590 ( 26 % ) of those invited attended at least one session and the staying 74 % ( 1693 ) attended nor session at all. However it is of import to observe that the test had twice every bit many controls as intercessions and the ground for this is because the comparative cost of including controls was much smaller. After the survey design was in topographic point and allotments done to put to death the survey a timetable was arranged and a 2nd missive sent to all respondents ask foring them to the first session. This survey was similar to the 1 by Steven et Al. ( 1998 ) but the difference was the manner the intercession was introduced to the participants. It really clearly spelt out as a locally organized free twice hebdomadal exercising categories for the participants for two old ages. Besides the benefits to be derived and the chief purpose of the undertaking were clearly stated. The scope of activities on offered were clearly noted in with a specified clip edge ( 75minutes ) ; 45 proceedingss allocated for physical activity and the staying 30 proceedingss spent on other leisure and gratifying activities like: bowling, swimming, state walking, and tea dances. The locale for most categories were to be held in church halls, community centres and or sometimes in residential places. In a nut shel l the intercession was matter-of-fact, specific, inexpensive and easy organized for a big population by a public wellness bureau. The economic analysis was taken from a wellness service position and designed to make a wellness use analysis ; comparing costs and benefits of the intercession, as sing QALY, to other purchased wellness services on offer. The result nevertheless provided adequate counsel to the policy shapers in offering exercising to the aged with the apprehension that most of the cost involved was from enlisting, disposal, payment to exercising leaders, the locale, participant ‘s clip spent and refreshment. The one-year cost of the exercising was about ?128,302 giving a average cost of about ?125.78 and a cost per attendant per session of ?9.06 ( i.e. a sum of 2040 Sessionss were done in the two old ages, ensuing into 27 800 individual Sessionss with an estimated cardinal cost of ?267,033 ) . There was purpose to handle ( ITT ) for no topic was to be excluded from the survey by their general practicians. However QALY benefits were merely calculated based on 3149 participants who completed the SF-36 at all three appraisals ( 2097 control and 1052 intercession ) so in ciphering QALY three different attacks were examined: Entire cost of plan divide by the QALY gained for study completers merely ( i.e. n = 1052 ) ; Entire cost for study completers merely divided by their QALY addition ( i.e. n = 1052 ) , and the entire cost divided by QALY gained presuming all the participants in the intercession arm experience the mean addition ( i.e. n = 2283 ) . The entire cost of â€Å" merely the study completers † divided by QALY gained ( n=1052 ) was assumed to be the cardinal estimation and when combined with the cardinal cost estimation it yields a average cost per QALY of ?17,172 ( 95 % ) CI = ( 8300 – 87115 ) . When these premises were changed it resulted into the cost effectivity of the exercising plan varying between ?4 739 and ?32 533 per QALY, Munro et Al. ( 2004 ) , Mortality rate was down following the 2-3 old ages intervention period but non by a important border, statistically ( p = 0.50 ) Munro et Al. ( 2004 ) . Between the intercession and control group there was no important difference in the usage of wellness services and the intercession group were estimated to hold less diminution in wellness than the control, ( Munro et al. 2004 ) . To reason it was recommended that for a more accurate appraisal of the plan to be undertaken the follow up period has to be extended and the trouble in quantifying the cost of QALY must be appreciated for merely a good estimation can be made. However it is believed that the cost uncertainness could be reduced with higher degrees of participants and lower degrees of losing informations ( Munro et al. 2004 ) . The plan farther supported Morris ‘ contention that †exercise is a best bargain † in public wellness footings ( Morris, 1994 ) and besides as envisaged by the UK ‘s National Services Framework for older people ( DOH 2001 ) and it might be developed into a worthwhile consequence. Another more recent survey on the cost effectivity of a community-based physical activity intercession was carried out in the United States by Larissa et Al. ( 2008 ) . The background of this survey emphasized the association of PA with the addition hazard of many chronic diseases and with the premise these hazards lessening with increasing physical activity. The survey was a PA publicity intercession among American grownups, conducted from a social position and intended to gauge the life-time costs, wellness additions and cost effectivity ( Dollars per QALY gained ) compared to no intercession. The difference between the sum expected cost of intercession and the sum expected cost of no intercession would be the cost effectivity ; which is the ratio of the incremental costs ( dollars ) to incremental QALY. The incremental QALYs are the differences between entire expected QALYs associated with the intercession and those associated with no intercession. The cost effectivity analysis was of a cohort survey of US grownups who were aged 25 -64 by 2004 and were stratified by age, gender and degree of physical activity. The standard for inclusion is for: All cohort members at the beginning of the survey to be good ( i.e. to be free from the five most common diseases associated with physical inaction ( i.e. CHD, Ischemic shot, type 2 diabetes, chest malignant neoplastic disease and colorectal malignant neoplastic disease ) USDHHS ( 1996 ) , Kasaniemi et Al. ( 2001 ) ; An elaborate survey protocol for bing must be available ; PA outcome step must be available and a survey period of at least 3 months must be carried out. Seven intercession surveies were chosen: usage of personal trainers, standard behavior-therapy Sessionss, fiscal inducements, phone calls to participants to increase PA, school based plans or the 6years Stanford five metropolis integrated community based wellness instruction intercession for bettering PA through mark poster, media, community walking events and worksite were used. The cost effectivity of each intercession was estimated utilizing methods consistent with the guidelines established by the panel on cost-effectiveness in wellness and medical specialty Gold et Al. ( 1996 ) . The life-time costs were projected in both life-years ( endurance ) and QALYs associate with the seven evaluated PA publicity intercessions and with the non intercessions scenario. The mean comparative public presentation of each intercession was assessed compared to no intercession utilizing the ration of any extra expected cost of each plan. The figure of disease averted were besides estimated and one-way, bipartisan and probabilistic sensitiveness analysis conducted to assist find the hardiness of the concluding consequences. The mean individual old ages cost effectivity of the seven wellness publicity intercessions cumulated over a 40 twelvemonth clip skyline for the whole US population, aged 25-74years were summarized and reported. The deliberate norm discounted quality adjusted life anticipation ( QALE ) was 14.77 old ages and the entire life clip costs were approximately $ 195,000. Engagement in the intercessions per hebdomad improved the mean QALYs by 0.7 to 5.3. and these are tantamount to 0.014 to 0.102. ( i.e. 14.781-14.767 to 14.869-14.767 ) comparison to no intercession. Those participants in the enhanced entree intercession group by Linenger ( 1991 ) with the highest ( 0.102 ) and those in the community broad run survey by Young ( 1996 ) with the least addition ( 0.014 ) addition QALYs. The Participants of the societal support schemes intercession group, studied by Lombard ( 1995 ) had QALE of 14.79 old ages and a cost of $ 27,370 per QALY gained comparative to no intewrvention. In another inte rcession ; PA constituent of diabetes bar group ; â€Å" separately adapted wellness behaviour changed † studied by Knowler ( 2002 ) had a cost effectivity ratio of $ 46,910 when compared to no intercession. It was evident all the intercessions reduced diseases incidence and the decrease ranged from 5 to 15 instances per 100,000 for colorectal malignant neoplastic diseases ; 15 to 58 instances per 100,000 for chest malignant neoplastic disease ; 59 to 207 instances per 100,000 for type 2 diabetes and to every bit many as 140 – 476 instances per 100,000 for CHD. Ischemic stroke which is really much age related did non follow the same decrease tendency, likely due to increase in length of service by the intercessions. One interesting observation was that as the analytical clip skyline was shortened the higher the cost of QALY gets eg cost of QALY ( when the clip skyline reduced from 40-years to 10-years, in Lambard ‘s societal support intercession ) increased form $ 27,000 to $ 147,000. This literature reappraisal found illustrations of cost effectual analysis intercessions from assorted parts of the universe and they all seem to be based on either advice, behavior alterations, exercising or a combination of them. Evidence of cost effectivity in intercessions aimed at those whose merely hazard factor for unwellness was sedentary life style was missing. However, even though limited, there is more grounds for the cost effectivity of intercessions aimed at bad groups or those who manifest hapless wellness related to physical wellness. For a much better and a complete cost effectual analysis of publicities of PA intercessions to be achieved it is indispensable to near it from a social position ; e.g. is the intercession gratifying, is it making new friends, and is it bettering the mental and physical wellness of the people every bit good as their socioeconomic well-being. This becomes hard and more or less impossible due to miss of resources ; quantitative and qualitati ve informations and non plenty follow up clip is usually allotment.