Placebos Essays (1376 words) - Clinical Research, Medical Ethics

Placebos Why we need placebos English/ History By Jj wallis A placebo is defined as an inactive substance resembling a medication, given for psychological effect or as a control in evaluating a medicine believed to be active. However the placebo only fits this description under the restraints it has been given by the U.S. Food and Drug Administration, which refers to the placebo as an investigational new drug. In actuality, up until the present much of medicine was built on placebos. Not very long ago, the rituals and symbols of healing constituted the bulk of the physicians armamentarium. In the early decades of the 20th century, most of the medication that doctors carried in their little black bags and kept in their office cabinets had little or no pharmacological value against the maladies for which they were prescribed. Nevertheless, their use in the appropriate clinical context was no doubt frequently beneficial.(Brown, 6) Even though placebos have been proven effective medicine time and time again the FDA remains reluctant to approve them for anything more than clinical research. The FDA stands on their disapproval of placebos as medicine on the basis that patients are to be given the best treatment available. Who is to say that a placebo is not as, if not more effective than the accepted remedy? There are an endless variety of cases that have proven placebos inconclusively effective. Among the most famous of these cases is the story of Mr. Wright, who was found to have cancer and in 1957 was given only days to live. Hospitalized in Long Beach, California, with tumors the size of oranges, he heard that scientists had discovered a horse serum, Krebiozen, that appeared to be effective against cancer. After Wright begged to receive the serum, his physician, Dr. Philip West, finally agreed and gave wright the injection on a Friday afternoon, not telling Wright that injection consisted only of water. The following Monday the doctor was astonished to find that the patient's tumors were gone. Dr. West later wrote the tumors, had melted like snowballs on a hot stove. At Tulane University, Dr. Eileen Palace has been using a placebo to restore sexual arousal in women who say they are nonorgasmic. The women are hooked up to a biofeedback machine that they are told measures their vaginal blood flow, an index of arousal. Then they are shown sexual stimuli that would arouse most women. The experiment then tricks the women by sending a false feedback signal, within 30 seconds, that their vaginal blood flow has increased. Almost immediately after they become genuinely aroused. In another case a study was carried out in Japan on 13 people that were extremely allergic to poison ivy. Each individual was rubbed on one arm with a harmless leaf and told that it was poison ivy and then rubbed on the opposite arm with poison ivy and told that it was harmless. All thirteen broke out in a rash where the harmless leaf had contacted their arm. Only two reacted to the poison ivy leaves. (Blakeslee, 2) In yet another example, patients with angina pectoris, chest pain, associated with heart disease, have been shown to improve substantially following an operation that involved nothing more than a simple skin incision. Angina also improved following a type of artery surgery once thought to be effective but later found to be ineffective. (Turner, 1) These are just a few of a great number of cases that prove the effectiveness of placebos. How do placebos work? There are many theories on how placebos work but really no definite answers. Many believe that the response to placebos is one of conditioning. That is that the site of a doctor, his white coat, the sterile smell, and a prescribed medication is equated with being cured, and because we think that we will get better we do. Some think that a placebo might reduce stress, allowing the body to regain some natural optimum level of health. Others believe that special molecules in the brain help carry out the placebo effect. A recent study found that stressed animals could produce a valium like substance in their brain if they have some control over the source of the stress. People must certainly share

How to Conjugate the French Verb Adorer (to Adore)

How to Conjugate the French Verb Adorer (to Adore) The French verb  adorer  means exactly what it looks like: to adore. Its a regular verb and that means that it follows a simple pattern when conjugating it to fit the subject and tense of your sentence. This is an easy French lesson and by the end, youll know exactly how to conjugate  adorer. Conjugating the French Verb  Adorer In French, verbs are conjugated in order to match the tense and subject pronoun of the sentence. The pronouns are the I, you, he, she, we, and they that act as the subjects. These are the basic pronouns like  j, tu, il, nous, vous, and ils that you learn in basic French lessons. Adorer  is a  regular -er verb  and it follows a simple pattern for changing the ending as we conjugate it from tense and subject. Once you are familiar with the pattern, you can conjugate any number of similar verbs. The following chart explains how  adorer  is conjugated into the  present, future, imperfect past, and present participle tenses. You will match the word with the subject your speaking about. For instance, to say, I adore, you would simply say jadore in French. Its actually quite easy when you put it to practice. Subject Present Future Imperfect j' adore adorerai adorais tu adores adoreras adorais il adore adorera adorait nous adorons adorerons adorions vous adorez adorerez adoriez ils adorent adoreront adoraient Adorers Present Participle The  present participle  of  adorer  is  adorant. The -ant  ending is used in a similar manner to the -ing in English. In this form,  adorant  can be used as a verb. You may find it helpful as an adjective, gerund, or noun as well. Adorer  in Past Tense Beyond the imperfect past tense, you can also use the common  passà © composà ©Ã‚  to express that you adored something.   In order to do this, you will need to add the  auxiliary verb, or helping verb,  avoir  in a conjugated form. Also, rather than changing the  adorer  verb to match the subject, you can simply use the  past participle  of adorà ©. For example, to say I adored, you can simple say jai adorà ©. Likewise, to say we adored in French, you will say nous avons  adorà ©. In these phrases, ai and  avons are conjugates of the verb  avoir. More Conjugations of  Adorer Those are the easy conjugations and the ones that you will use most often in French. There are special circumstances when you will need to use another form of  adorer. The subjunctive is a verb mood that expresses that an action is subjective or uncertain. The conditional verb mood tells you that the adoration only applies under certain conditions. You may never use the passà © simple or imperfect subjunctive as these are used in formal writing. However, its a good idea to be aware of how they are used. Subject Subjunctive Conditional Passà © Simple Imperfect Subjunctive j' adore adorerais adorai adorasse tu adores adorerais adoras adorasses il adore adorerait adora adorà ¢t nous adorions adorerions adorà ¢mes adorassions vous adoriez adoreriez adorà ¢tes adorassiez ils adorent adoreraient adorà ¨rent adorassent The imperative form of  adorer  is the last conjugation that you may use from time to time. This is also a verb mood and it allows you to refrain from using the subject pronoun. For instance, instead of saying tu adore, you can simply say  adore. Imperative (tu) adore (nous) adorons (vous) adorez More Ways to Express Love and Adoration in French French is often called the language of love. While you are studying the conjugations of  adorer, you might want to expand your vocabulary to include other French words for love. Its fun and a lesson that youre sure adorer.

Business Law (6) Assignment Example | Topics and Well Written Essays - 750 words

Business Law (6) - Assignment Example (C) My own example relating to the definition given above is; If an employer wants to recruit employees and in that regard, the employer states that the job will be paying $1,000 a month with no allowances and that the engagement period is 5 years terms that is renewable based on the performance of the employee, the employer will also not be obliged to explain the reasons as to why the an employee is dropped or considered for the next term. The terms can continue base on what the employer is interested in. The terms expressed here in relation to job defines what a vacancy. (B) In my own definition, acceptance can be considered to be; the evaluation of the terms contained in the offer and yielding to them in a bid to considered being engaged in the contract qualifying it to be a legal obligation. (C) As I have stated in the above explanation, if an employer stipulates the terms of the contract and them the prospective employees ratifies the terms and get to be engaged in the contract legally by appending their personal signature and having unconditionally read and understood the content of the offer, it is said that acceptance has taken place. After acceptance, the employee is legally bound to operate within the stipulations. (D) The website http://www.thefreedictionary.com/acceptance provides step wise definition of the term from the general English version to the legal definition. In this regard, it gives an array of the definition that foster further understanding of the term. (B) According to my own definition, consideration is that resonance that results after the employer and the employee strikes a balance by ratifying legal obligation of each side given satisfaction of their side of bargain. I other words we say that the offer has been ratified by the prospectus in legally required manner and thus acceptance of the offer to undertakes to the needs and responsibilities as stated in the offer. (C) An example relating to the above is when an offer is

Financial Management and Credit Risk Essay Example | Topics and Well Written Essays - 2750 words

Financial Management and Credit Risk - Essay Example This can significantly both increase the interest rate that is charged to the company as well the additional strain to the company’s earnings. While the company proves to be profitable, other financial measures show its many weaknesses, especially on the part of its working capital and cash conversion cycle. By probing at the current financial standing of the company, the company’s financial position is seen. With this, the implications of the subsequent financing activities can be determined as regards the overall health of the firm. The company is then faced with a decision of whether to pursue the additional debt financing. If Butler Lumber Company is not going to avail of the financing, it has to at least address and avail of some options of financing to meet its financing need. These alternatives are explored in the subsequent portions of this case study, which include strengthening cash generation from the profitable operation of the company through better working capital management, as well as other equity financing means. Butler Lumber Company’s main line of business is in retailing lumber products within the local area of a large city in the Pacific Northwest. Mark Butler, the company’s sole owner and the president is contemplating an increase in debt financing for its expansion. Butler Lumber Company currently has an existing relationship with Suburban National Bank, where it gets its additional funding in the form of loans. However, as Mr. Butler reaches the loan limit of 250,000, he is pondering on availing additional financing for his company’s expansion with a revolving credit line of 465,000 from Northrop National Bank through George Dodge. This is in order for him to secure financing that will address his company’s shortage of funds. As the loan has not yet been approved, Butler Lumber Company’s financial position is yet to be determined by Northrop National Bank before Mr. Dodge can decide on giving the additional financing to Mr. Butler.

Assessment and Accountability in Nursing

Assessment and Accountability in Nursing Mentors have responsibility to assist students to develop their clinical skills and knowledge on placements. As well as developing clinical skills, students also develop their interpersonal skills and as a result of this experience gain maturity. (NMC, 2008) .To determine students have achieved the professional standards or competence, mentors must make assessments while their placement. This is vital to protect the public from unsafe and incompetent practitioners. Assessment is an essential role of a mentor. A good assessment process gives the students valuable feedback, it helps them to identify where they are, highlights, deficits in their learning ,identifies what they need to do and enables them to set realistic future goals.(Danny Walsh 2010). A good assessment process help us to predict future behaviour of the nurse we train. However we can cut down the risks by ensuring that the assessment processes itself meets certain standards and criteria which are considered best practice. Proper assessments of students are essential because, they are the future nurses are responsible for protecting the public in patient care, (Necklin and Kenworthy, 2000:108).Through assessment mentor can identify the strength and weakness, knowledge and practical skill of a student. According to (Walsh 2010) student nurses are assessed for variety of reasons in their clinical practice. Examples of this; to monitor the students’ progress to give feedback, to discover learning needs, to encourage students, to monitor their progress, to assess students level of competence, to assess knowledge, skills and attitudes, to measure the effectiveness of the teaching and to safeguard the patient and protect the public. As students work alongside with mentors, need to encourage students to perform patient care through instructions, guidance and supervision. While they are caring the patients mentors can observe and give feedback, this means while student is learning she is being assessed. Managing the process of assessment and feedback is hugely important. Students fail their placements for a wide range of reasons, but certain key factors can help minimise this happening. The student needs to feel welcomed and wanted to be able to perform into the placement quickly and so get on with meeting their competencies. Duffy (2003) cited several reasons for students failing and the key aspect was the lack of a good mentor/student relationship. Mentors must be meeting with students regularly can identify the problems or deficits the students going through. Learning needs should then be identified and action plan must be put in place. Mentors and assessors have the right and responsibility of making professional judgements about the performance of their student. (ENB and department of Health, 2001).Students needs to be respected while maintaining their professional standards, it is important to recognise the rights and to be supported to succeed in clinical practice. Monitoring progress is about finding the students quality and quantity of learning and any difficulties students may experiencing that can be identified and action plan to be applied. There are different methods of assessment like observation of patient care, questions and answers, reflection, briefing, self assessment peer assessment, testimonies, portfolios.(Stuart 2003). Duffy and Hardicre (2007) identify the reasons of a failing student are lack of insight, lack of interest poor communication or interpersonal skills, personal issues, being over confident. The Nursing and Midwifery Council (NMC2004a) states that nurses are accountable for their own practice. The public has a right to expect competence from the qualified professional in healthcare. With the purpose of assessment as a form of quality control for the healthcare professions, assessors should be able to identify failing students and provide enough support and resources to overcome the difficulties. As Maria was a first year student the initial priority was observations of the patient. At the beginning, I asked the questions about blood pressure ,heart rate(pulse) ,respirations, oxygen saturations ,pain scores etc†¦Then explained to Maria the theory, significant changes and if she notice any changes who to inform, then I demonstrated how to check observations and how to enter in a patient track or observation chart. The procedure was repeated in many situations under supervision which made her confident and also Maria received constructive feedback from other staff. A high level of a motivation and assessment is necessary for learning, (Gipps1994). During mid interview it was identified that student has achieved the skills to do the observations by using dyne map or manually, and also able to understand the significant changes and to report to the staff nurse. The Nursing and Midwifery Council (NMC 2006a) specifies the responsibility and accountability of NMC registrants who supports and make summative assessment decisions are referred to as assessors. As part of summative assessment (Stuart 2003), I arranged final interview with Maria on last day of her placement. I reviewed all her progress and evidences recorded in her practice book. Maria’s portfolio, feedbacks from other colleagues and Maria’s behaviour while her placement in the unit, attitude towards the patients and colleagues, knowledge , skills and performance in order to determine whether, she is fit for practice without supervision. Constructive feedback has an impact not only on the teaching/learning process but also gives messages to students about their effectiveness and self esteem (Gipps1994).Feedback sessions should be designed to help students grow in their clinical skills and professional competence. It is not possible for the named assessor to work with the student on enough occasions to monitor the progress of students with validity and reliability, so that it is important that the mentor seeks the views of other practitioners who have worked with the student. The assessment activities of working alongside the student and observing practice, discussion with the student and examination of the student’s portfolio, discussion with other assessors are done both informally and formally to monitor progress (Phillips et al 2000). Lifelong learning is the term used to refer to the planned or unplanned learning occurs throughout the life ,usually the working life ,of an individual (Hinchliff1998).The mentor is advised not to give all the answers ,which deprive the student of the opportunity of carrying out some of the problem –solving and decision making activities (Stengelhofen1993).These cognitive processes foster deep learning ,and thus help the student extract more meaningful learning through experiences.Dreyfus model (Benner 1989) describes the five levels of proficiency the students pass during their placement .They are novice, advanced beginner competent, proficient and expert .The author believes that this model can be applied in assessing the students in placement area because this will help students to access frequent feedbacks that can help to improve clinical skills and become more self- aware. Every good placement should be gathering feedback from the student’s inorder to improve the student experience and enhance learning opportunities. Accountability involves responsibility, knowledge and being able to justify actions. It is always challenging for mentors to deal with failing student’s .However if planned in advance and strategies in place, it can be overcome without too much pressure on the student .In the mid-interview, if the student is not performing up to the standard it’s important to provide the student more support and inform the personal tutor. It is essential to note that few students unable to meet the criteria whatever the circumstances are, the mentor should act appropriately in order to fail the poor performing students rather than the fail to fail situation which may affect the public (Duffy2007). To succeed in placement assessments and achieve competencies the student cannot afford to leave it until later in the placement .It is the responsibility of the mentor to ensure that they give the student regular reviews and feedback to ensure that they keep on top of meeting their learning objectives (Walsh2010).Mentors needs to evaluate students time to time and it is important to provide constructive feedback .Mentors should focus to create a safe learning environment for the students and it is their accountability. When Maria started placement in my unit I ensure she has done all the mandatory trainings like moving and handling, fire training, health and safety, infection control. If Mentor takes the decision to fail a student, it should not come like a surprise to the student. Students who are not progressing or failing their placement mentors need to identify the learning needs and support them with available resources. Discuss any issues or concerns with the student and inform university tutor, and also make sure student understands the problem.

A Study in Scarlet Essay

The great author Sir Arthur Ignatius Conan Doyle was born on the 22nd May 1859 in Edinburgh Scotland. He had graduated with a degree in medicine at Edinburgh University in 1881. His first short story was published in1879 however the first mystery featuring Sherlock Holmes and Dr. John Watson, ‘A Study in Scarlet’, was not until 1887. He had married twice and fathered five children. Conan Doyle had died in 1930. People are drawn to the Sherlock Holmes mystery as Conan Doyle is able to make the reader feel part of the story. The suspense and tension in his stories raise questions in the readers mind. This piece of course work will trace why Conan Doyle writings are popular in the 21st century. One key feature that helped the popularity of Sherlock Holmes stories is Conan Doyle’s use of language, style of writing and its simplicity. In the man with the twisted lip, Mr. Boone was a horrific looking beggar described as â€Å"a broad wheel from an old scar ran right across it from an old scar ran right across it from eye to chin, and by contraction had turned up one side of the upper lip, so that three teeth were exposed in a perpetual snarl. A shock of very bright red hair grew low over his eyes and forehead. † Conan Doyle’s use of descriptive language enables the reader to put together a picture of this revolting beggar. In the Red Headed League John Clay, also known as Vincent Spaulding, the criminal had asked to be called with respect â€Å"Have the goodness also, when you address me always say ‘sir’ and ‘please’. † The use of language to introduce humour can be picked up from such comments. Also the idea that a red headed man had died and he wanted to give his inheritance to any other red headed man. Conan Doyle starts to put questions in the readers mind ‘Why would someone want to do this? ‘ This seems virtually impossible and farfetched; such reference continually adds flavour to his writing. In the speckled band Dr. Roylott tried to threaten Sherlock Holmes and called him names â€Å"I know you, you scoundrel! I have heard of you before. You are Holmes, the meddler†¦ Holmes, the busybody†¦ Holmes the Scotland Yard Jack-In-Office†. Through dialogue we are able to deduce the character of Dr. Grimsby Roylott and his aggressive attitude towards people. The reader begins to understand why Helen stoner was afraid of her step father and had come to Holmes without his permission. Sherlock Holmes was able to speak fluent Latin â€Å"omne ignotum pro magnifico†; in the Victorian era you had to be well educated to be able to articulate a word of Latin. Conan Doyle has used this technique to show the reader Holmes accomplishments and status in society. Language plays a very important role in all Conan Doyle’s stories which in many ways have added to the never ending success. It has helped to transform the stories the stories into pleasant readings for a wide range of audiences. In all the stories a similar pattern seems to emerge which helps create the perfect recipe for a mystery. The stories unfold in the most unusual way leaving the reader intrigued up to the very end. The themes in Conan Doyle’s stories are directed towards acts of injustice, crimes, the clever villains and innocent victims; all spiced with greed. In the speckled band the victim was Helen stoner, who had come to seek help relating to the sudden death of her sister Julia. The villain to the readers surprise was Dr. Grimsby Roylott. Mrs. Stoner, mother of Helen and Julia Stoner, had received â€Å"not less than 1000 pounds a year† she gave this money to Dr. Roylott. â€Å"a certain annual sum should be allowed† to each daughter after marriage; due to Dr. Roylott’s selfish needs he was responsible for the death of Julia and attempt to murder Helen. In the red headed league Mr. Jabez Wilson had consulted Sherlock Holmes to look into an advert that seemed peculiar. Mr. Jabez Wilson had taken a job because it offered double a normal wage, â€Å"4 pound a week†. To the readers it seemed a shock that Vincent Spaulding, who was the loyal employee, had been the criminal John Clay. John clay had planned to steal the French napoleons from the bank. He was a con man â€Å"he’ll crack a crib in Scotland one week, and be raising money to build an orphanage in Cornwall the next. † In the man with the twisted lip Mrs. Neville StClair, the victim, had approached Holmes because she needed help finding her husband. Boone, the beggar, was able to earn â€Å"700 pounds a year† where as Mr. Neville StClair, a journalist, earned â€Å"two pounds a week. † Mr. Neville StClair was the victim of his own deeds as he was not able to meet the expectation of society within the Victorian era. In the 21st century many people are not able to find time to read long novels. Conan Doyle’s Sherlock Holmes stories are short and simple to read, anyone can find time for them. You can pick up a story and read it on your way to work or school. The stories start in a similar way; we are first introduced to the innocent victims who are always reassured by Sherlock Holmes with his sympatric and caring nature and in most cases in the company of Dr. Watson. There is always a mention of the residence of Sherlock Holmes. This is to create a make believe situation in the readers mind. The setting is always dark and gloomy when the client comes to seek for advice; this gives a cosy and calm atmosphere. Conan Doyle was taught how to make deductions about patients by observing them closely; this skill was transferred to his stories and injected into his main character Sherlock Holmes. Holmes carries out his investigation using simple means. His use of knowledge allows him to give an insight in the red headed league. Vincent Spaulding had worked for half wage; he was always â€Å"diving down into the cellar like a rabbit† and he was the one who showed Mr. Jabez Wilson the advert. When Sherlock Holmes went to ask for directions, under pretence just to come in contact with the so called assistant Vincent Spaulding, he was reassuring himself that what he was thinking was actually possible. Holmes was able to conclude on the note that Vincent Spaulding and John Clay was the same person. Sherlock Holmes has a special essence which draws the reader towards him. Sherlock Holmes is known as one of the world’s greatest detectives. His mission was always to help gain justice for his clients. He is an individual who is never after money but more interested in solving the crime â€Å"my profession is its own reward†. He was a guardian angel to all and everyone had total trust in his skill. There are two sides of Holmes, one which is the never quitting crime solver and other which just likes to relax. He also has many weaknesses â€Å"cocaine injections and all the little weaknesses†. In these three stories Conan Doyle has used Watson to narrate the story. We are able to learn what is in the Dr. Watsons mind towards Holmes. John Watson is a very close friend and assistant of Holmes. He has full trust in friend’s skills and has the same thirst for mysteries as Holmes; â€Å"Your cases have indeed been of the greatest interest to me† The mystery in most cases concludes on the note that Sherlock Holmes has solved the case. In the speckled band Helen stoner was able to live without fear of her stepfather. This pattern of a constant happy ending allows the reader to look forward to the end and they know that they can always rely on Holmes. In the 21st century Conan Doyle still rubs shoulder with many other famous detective stories such as â€Å"murder she wrote† and â€Å"C. S. I†. None of them however can beat Sherlock Holmes!!! Conan Doyle has out done himself. The Sherlock Holmes stories are suitable for all age groups. Worldwide he is an accomplished writer as the stories have been translated into over 60 different languages. Even today the famous residence 221b baker street is still known as the fictional home of Sherlock Holmes and Dr. Watson. Now it is the site of the Sherlock Holmes museum. Such tributes have helped keep the stories alive to date. Neelam Hirani Page 1 Show preview only The above preview is unformatted text This student written piece of work is one of many that can be found in our GCSE Miscellaneous section.

A tale of two airlines case Essay

As Professor Roger McPherson’s wait to go through the security process a second time dragged on into its third hour on this Spring day in 2002, (all passengers had to be rescreened upon the discovery that one of the airport screening machines was unplugged) he was reminded of another delayed business trip and the role that information technology played in the story. At 5:30pm on February 15, 1995, 200 feet off the ground, Professor Roger McPherson gazed anxiously through the fog as his airplane moved to touch down at Hartsfield Airport in Atlanta, more than 1 hour and 15 minutes late. He had 30 minutes to catch his 6:00pm flight to London, where he would be meeting with the executive leadership of a major British power company to discuss their information strategy. He felt fortunate, however, to be flying this carrier, which had a reputation for outstanding service. He was even more comfortable because he had a full-fare first-class ticket and was a Gold Card member. Professor McPherson was always uneasy about the large premium charged for full, first-class tickets, but knew that in a crunch it often meant the difference between a making a connection and missing one. He well remembered a decade ago flying this airline from Milan to London to connect to a flight to New York. Bad weather then had also reduced his 1-hour-and-30-minute connect time to 10 minutes. A discussion of the problem with the first-class cabin attendant had resulted in a phone call from the pilot to London (the airline’s hub city), and a car to whisk him and one other passenger to the New York flight, which took off only one minute late. That extraordinary service had made Professor McPherson a 10-year devotee of the airline. In the network age, he knew it would be different and he was secure. The airline flying to London would have identified him off their computer as a close-connecting passenger. It would have noted he checked no bags through, and it would be anxious to capture his $2,500 fare—about 10 times that of the average passenger—on an only moderately loaded flight. As his plane pulled into the gate at 5:40pm, he knew it would be tight but he would make it, particularly given the fact that all planes were coming in late. Moving his 57-year-old frame into a dim recollection of a high school 400-meter specialist, he set off. Two escalator rides and one train ride later, the gate came into sight and he braked to a halt at 5:53pm. It was close, but he had done it. Looking through the airport window, however, he was stunned to see the air bridge detached from the plane with splendid teutonic efficiency 7 minutes early. The door to the bridge was closed, no agent was in sight, and he was reduced to waving his bags through the window to the pilot 20 yards away (it had, after all, worked once in a similar situation on Continental Airlines). Alas, by 5:58pm the plane was pushed back, and the agents emerged and quite cheerfully (and unregretfully; they had no clue who he was) booked him onto another airline that would leave 1 hour and 45 minutes later. He would be 30 minutes late for his meeting in London, but the executives would understand. Distinctly irritated, he straggled off to the new airline’s first class lounge to begin a frantic series of phone calls and faxes to the United Kingdom. As he trudged through the airport, McPherson began to see the beginning of a lecture on service in the network economy and the fact that technology is only a small enabling piece of a total service concept. At 7:50pm, comfortably seated in the first-class cabin of his new carrier, McPherson jerked to attention as the captain came on to announce that because of a leak in the hydraulic system, there would be an aircraft change and a two-and-one-half-hour delay. Sprinting off the plane, McPherson realized that the meeting with the power company executives, planned three months ago, would be over before he got there. The following day he was due in Frankfurt to give the keynote address at a major information systems conference. Flying to the United Kingdom to connect to Frankfurt would be a hassle and unnecessary since the purpose of stopping in the United Kingdom   was now totally negated. Glancing up at the departure board, McPherson was surprised to see a 7:55pm boarding departure for a plane to Frankfurt, nine gates away. Pulling into the gate at 8:02pm, he discovered several things: 1. The plane was at the gate, and with commendable dispatch the gate agent relieved him of his London boarding pass and his London-to-Frankfurt ticket and hustled him onto the plane minutes before the door closed. 2. The cabin attendant, giving him his favorite drink, explained that because of favorable tail winds across the Atlantic and the fact that eight passengers (plus now McPherson and one other) had very tight connections, they had decided to hold the plane for 15 minutes to get the extra passengers and still arrive on schedule. The note of pride in the cabin attendant’s voice was evident. One-and-a-half hours later, appropriately wined and dined, McPherson drifted off to sleep, reflecting on what a remarkable case study had played out in front of him in the previous two hours. Information technology, operations strategy, management control, an empowered (also unempowered) work force, and service management had been interwoven into a tableau. A revised format for his speech in Frankfurt began to emerge. Best of all, he would not have to go through a case release process because it had all happened to him.