Fast Food Industry Essay

â€Å"Fast food † this term was recognized in dictionary by Merriam-web star in year 1951 mostly we need small capital requirement to start a fast – food restaurant; small individually owned fast – food restaurant have become common throughout the world. Franchises are the part of restaurant chains which operations is to provide standardize food stuffs to the different locations for examples Pizza Hut, KFC, McDonald, Dunkin Donets, and many others. For starting any fast food business the capital requirement are relatively low than any other business. That is the reason all over the world individually owned fast food restaurant are increasing. The term fast food is use for which can be prepared and served quickly than other meal, minimum preparation time is considered for fast food, generally this term refers to food sale in restaurants and stores with low time preparation and served to customers in form of packaged for take away / takeout. This research was conduct to find out the factors for customer satisfaction. The feeling of pleasure and disappointment is known as Satisfaction. If the product was not satisfied person feelings then it will be dissatisfied, and if product satisfied person feelings after the use they will be satisfied. Customer is the key role in any business, without any customer it’s difficult to do business, and that the fact it’s the necessary work closely with your customer. Because customer can also create your business. Business runs though customer, without the customer there is no business. Satisfaction is an individual feeling of pleasure or the disappointment, if their expectation level meets, their level of satisfaction also increasing but if not then disappointment comes. Customer satisfaction is very important for every organization; either they are service sector or the private sector. It’s not every time to satisfy your customer. Since there are so many customers using products. And every customers uses it differently, take it differently, and speak it differently. The most dangerous part for any organization is word of mouth. You can’t stop every person’s mouth, even if you give your best of best, they still argue on your products which are not good for some time. Some customers likes your product and after use they speak good words for the product. But some use your product, and speak wrong word of mouth for the product. MAJOR PLAYERS. There are certain main players of fast food industries. Which are as follows. 1. McDonald corporation 2. Burger king 3. Wendy’s/Arby’s group 4. Starbucks corporation 5. Pizza hut 6. Dominos corporation 7. Yum! Brands, Inc 8. Popeye’s SWOT ANALYSIS Strengths: 1. Quick Service: – one of the biggest strengths of fast food is that it provides quick service. The biggest advantage of this is that it saves a lot of time. And in this modern world time is money hence quick service is the biggest strength. 2. Affordable: – Usually fast food is priced at a very affordable rate which starts from rupees 2. Though the prices are low in the fast food industry, the quantity is more and hence value for money. 3. Attraction: – The advertisements of fast food are very flashy and appealing especially to the youth and the younger generation. One of the most important people in the buying decision are the kids who are influenced by ads on TV who in turn influence their parents. Hence it boosts the sales. Weakness: Different Preferences: – India is a land of diversity. People in India have different preferences and taste. The fast food industry cannot cater to all the tastes and preferences of people. For e. g. some people eat Non – Veg and some don’t eat non – veg, thus creating a problem. Such problems have risen at KFC and McDonalds. Another difference in preference can be seen in the choice of the type of food. Some people prefer South Indian while some prefer North Indian. So a south Indian joint selling masala dosa , cannot start selling chole nature as per customers’ preference. 1. Lack of customization: – Fast food is usually pre-made and pre-packed and not fresh from the oven. So once the dish is made it cannot be altered according to the customer’s choice or preference. For e. g. a McDonalds burger is prepared much before the customer purchases it and he has to buy it as it is. Even if the customer wants the burger without onion or cheese still he has to purchase it due to lack of customization. 2. Unhygienic and unhealthy: – Most of the times though being tasty the oil content in fast food is very high. Hence people are now moving away from fast food. The fast food prepared is also unhygienic especially at the road side joints. Hence these are considered weaknesses to the fast food industry. Opportunities: 1. Growing nuclear families: – nowadays it is said to be the age of fast food. Parents and kids especially prefer fast food due to its quick service and for it’s satisfying appetite at affordable prices. This is a growing opportunity for the industry because families nowadays prefer eating out, rather than cooking at home. 2. Urban lifestyle: – The growth story of India is not limited to metro cities. Now it has also found its way into some rural areas and some semi – urban cities. Fast food joints are not a thing of big cities now. People in cities and towns are now having additional incomes in their pockets. Eating out now is a normal thing for the homely people in the semi urban areas. Threats: 1. Oppositions from various organizations: – Due to the various preferences in the food some opposition is received by the fast food industry. As reported in the papers organizations like PETA are opposing the use of beef fat in the items of McDonalds. There was also a huge hullabaloo when Kentucky Fried Chicken (KFC) was being introduced to India. This is a major threat to the fast food industry. 2. Location: – One of the major threats in India is from the location point of view. Fast food joints can’t be opened in certain locations even though there might be evidence of major consumer demand in the area. For e. g. A Hindu dominated area might pose a threat to joints serving beef related products since the cow is considered sacred to them. 3. Ready- to-eat: – Nowadays ready to eat products are more in demand in the market owing to the fact that consumers have to take minimum trouble in preparation out of which the results are healthy food, rich nutritional value, easy on pockets and higher value for money as compared to the foods available in a fast food joint. 4. Health Concerns: – Due to the low quality ingredients used in the majority of local fast food joints, the sanitation and the hygiene factors which are mostly not maintained, have given cause to various medical and other health related organizations and certain NGO’s who have taken it up to voice these issues and bring it to the attention of the general public. Thus directing the attention of the public to change the tastes to foods that are more hygienic and safe. Here canned foodstuffs stand to gain advantages. LITRETURE REVIEW. Customer Satisfaction: According to Zairi (2000) the feeling of pleasure and expectation fulfillment is known Satisfaction. If the product will not satisfied customer feelings they will be dissatisfied. and if product satisfied them after the use customer will be satisfied and become loyal to that product or brand. In other words customer satisfaction is goods or services which fulfill the customer expectation in terms of quality and service for which fulfill the customer satisfaction in terms of quality and services for which he paid. If customer satisfaction develops they will become loyal to that product and brand or their loyalty will be good for the company in the sense as a profit. Customer satisfaction is the part of marketing and play important , because if your customer is satisfied with your services or products, your position will be good in the market. Oliver (1981) describe in his study that customer satisfaction is the part of marketing and play important role in the market. In any organization satisfaction of customer is more important, because if your customer is satisfied with your services or products. Your position will be good in the market. In old times customers satisfaction was not too much important and people were not focused on the quality. But now a days competition is taught and customer is aware of all the products and companies due to education and learning environment and this is the reason that every business is concern to fulfill properly customers need and wants. Concerning all types of business organization customer satisfaction is the most important issue, and considered as most reliable feedback, for the excellence of any business organization (T .W . , 2001). Veloutsou (2005) describes in his study regarding customer satisfaction tangible products and services, there is a distinction . The distinction between tangible and intangible goods becomes coz different factors of customers satisfaction, and that is why they should be treated separate and distinct. Churcill (1982) customer satisfaction has overall reaction of expectation of consumption with a product or service on the base of perception, evaluation and psychological reaction. According to Kottler. (2000) satisfaction is the sum of attributes of products and services. Kurniawan (2010) customer satisfaction can change over the period of time, it is a dynamic process. The individual’s perception about the product’s or service’s performance leads to customer satisfaction Tat, Sook-Min , Ai-Chin, Rasli , & Hamid, (2011). Determinants of customer satisfaction: Huang (2011) promotions is different form of activities for attracting and getting attention of customer to purchase the product and services through personal selling and public relations, sales promotions and advertising. According to kurniawan (2010) promotion of product or services helps in the best way to builds relationship with customers, because everyone is looking for the best suitable deal for them. Athanasspoulos (2000) describe that customers want to see for what they are looking for. Myers (1998) promotion is reducing the feeling of guilt which is associated with the use of different product and service which result to customer satisfaction. Schefter (2000) another common factor which is useful for device customer satisfaction is website. Website is the advanced way use for the promotion, to aware the customer and satisfied them with offering vast array of functions and feature. Before making choice of product offering, potential customer has opportunity through website to make a detailed comparison Khatibi (2007). When information like discounted products travels in the public, could increase the level of customer satisfaction Kandampully (2002). Takeuchi (1983) quality is standard of something which consumer measure against the other different things; quality can be measured by giving grade, merit, attributes etc to the products and services. Consumer cannot differentiate between quality and its requirements. Service quality is evaluated when the out customer compare his/her perception and expectation of service delivery Gronroos (1984) By recognized the need of measures of service quality many researchers most often use service quality to measure customer satisfaction Zeithami (1985). For evaluating and estimating various dimension of service quality is the instrument accepted as standard Kurniawan (2010). Zeithami (1985) it is a scale with multiple items goods validity and reliability, many researchers use this instrument to understand and find the service expectation and consumer perception for improving the service quality. The expectation of the customer is important factor. The more service quality near to customer expectation more satisfaction and vice a versa Ayse Ozfer Ozcelik (1998). Customer satisfaction is reflected when he recognized the quality. While using the web, the (user interface) web is service and customer is user. They surf the internet retrieve the information and share the information when interact over the internet with others. The quality of internet service plays a greater role than service quality providing to the customers in other sectors, like hotel and hospital Kurniawan (2010). Schwager (2007) describe in his study that in the new millennium providing customers a unique experience is major key to capture the market and their heart and mind. Satisfaction or dissatisfaction is the consequences of customers consumption or experiences of services or expectation. Kurniawan (2010) Branding is one of the factor which has been identified repeatedly customer selection in selected product. Branding has impact on purchase decision of customers. The more a brand is succeeded in their earlier period the more value for its brand can be generated. Kuaniawan (2010) company formal introduction is today is branding. Brand is a set of guidelines or promise in customers mind. Brand is a product which adds other dimensions some way to differentiate it from other product Boukili (2008). Brand helps the customers the product and how he describe the company to others, opportunities can avail by branding. Branding by the American marketing association as a â€Å"Name†, sign, symbol or combination of them to identify and to differentiate the goods and services and seller, or from their competitors† . Lim (2010) customers ultimate satisfaction may have significant affect of atmosphere. Physical surroundings are helpful to create image in the mind of customer and to influence their behavior. Physical atmosphere of restaurant have the significant impact on the customer satisfaction. Lightning, furnishing, sent, music and different other atmospheric factors among them influence on customer satisfaction. Skinders(2009) there are millions of product in the world having different prices. Pricing a product is difficult thing to do. Prices are set according to the value of the product. Price from marketing mix Han (2009) state that one of the most flexible element that change quickly. In the literature of Khan (2011) marketing the most important factor indicated the customer satisfaction is price. Because the most of the customer estimate the value of the product or obtain service through price. Lim (2010) for the customer it is not necessary that a better quality can be better taste, If customer like the taste of food he/she will be willing to pay for it. Based on previous researches, in customer satisfaction and taste, there is a significant correlation found between them. Researchers found good taste of food have positive influence on customer satisfaction and it also increase the customer retention rate which is also depends on customers satisfaction. Therefore, restaurant focus on the taste of the food and services that has influences on customers satisfaction. RESEARCH FRAMEWORK Figure 1 influence show the theoretical framework of the study. There are two variables discussed in this study, i. e. independent and dependent variables. Customers satisfaction on fast food industry showing dependency on promotion, service quality, customer expectation, Brand, Physical Environment, Price and Taste of the product. Independent VariablesDependent Variable.

Three Main Learning Styles

There are around three main learning styles. These are visual, which include those who learn by watching and seeing; auditory and interpersonal, including those who learn by listening and discussing; and kinaesthetic or tactile, which comprises of those who learn through activity. For the purpose of this essay I choose to compare my learning style with my classmate, Melissa Horner’s.Melissa Horner’s style is definitely auditory and interpersonal. She learns best within an environment where the teaching is verbal in nature. Even when studying, although Melissa likes a quiet time for study, she will still read aloud to enable her to absorb the information better.My style is different. I would say my learning style falls into the kinaesthetic category, because I find it difficult to be still for long periods of time and learn best when there is a lot of activity around me. I also find that I am very active when I am studying. I need to express myself physically, for exampl e I will use objects such as a pencil to help me whilst I am thinking.The most effective ways in which Melissa can produce the best quality work is by working within a group or class and listening to others explaining the situation. It is also helpful to Melissa to make notes in her own words and them reading those notes aloud so that a full grasp of the subject is achieved. For me to produce the best paper, it is necessary to be active. I do best when I am able to physically explore the subject being discussed.My opinion is that by combining the learning styles of Melissa and myself, we can produce a really effective paper. This can be achieved by utilizing Melissa’s note taking and need for vocalization of a project or study together with my need for activity in study. As these aspects of learning complement each other, the quality of the paper produced would be better than one that is produced using only one of the styles in isolation.Work citedRiding, Richard and Rayner, Stephen (1998) Cognitive Styles and Learning Strategies: Understanding Style Differences in Learning and Behavior. David Fulton Publishers Ltd. UK

Analysis of the Continental Army, the Oneida People and Thomas Hutchinson

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Literary Analysis Essay Example for Free

Literary Analysis Essay To write a good story, not only ideas take place. You need to use literary devices in order to provide a good story. The best mentor to look up is Sue Monk Kidd. She used a lot of literary devices in her story which is called The Secret Life of Bees. The three main literary devices which she used throughout her story are: epigraphs, character development and allusions. â€Å"Heat would make a person do strange things.†(112).Specially we see this when is described Lily’s hard life without the main person of her, without her mother. Since her mother died she is an orphan and her father doesn’t care for her even though she has her nanny that loves her. Not only she needs her mother to care for her or love her, but also she needs her in daily life to help her going through her childhood and teenage problems that every single person goes through. The most common literary device which you will see, while you read the book are epigraphs. This is shown in the beginning of every chapter, giving the readers many hints and some sort of warning of what might be happening in the story. This is an optional device which you choose to use. But it put epigraphs to give you clues on what she will talk next. This is one example: â€Å"A worker [bee] is just over a centimeter long and weighs only about sixty milligrams; nevertheless, she can fly with a load heavier than herself.† –The Honey Bee (257) The Secret Life of Bees. This foreshadows you that the main character who is Lily, a 14-year-old girl, is carried too much responsibility on her shoulders, about what she’s going through. Other device that develops ones story, being the most important device in my opinion, is the character development. It pictures the things that the character goes through and how they change throughout the story, most of the characters change a lot during the whole book .Character development explains every detail, until the final touch that that character goes through. We see the main character Lily develops so much through this story. In the beginning we see her as an innocent girl, which she does everything to find out more about her mother. Last but not least†¦allusions. Why is it important to put them in your story? Allusions as you know, is the reference of something that has happened in history,that everybody knows about. If you put them in your story, you make  your story real. You make the readers feel it, actually live it. Sue Monk Kidd uses allusions to help you understand what is going on in more details. That’s what you should do. Some of the allusions which are very important to be named is where the author put in THE CIVIL RIGHTS ACT. This automatically touches your brain by telling you that this was in the 60’s and that the colored people where fighting to win their rights. Also adding, it brings you that feeling that you think you’re living in the story, being able to relate in anyone’s everyday life. Another allusion is the WAILING WALL which May writes on it every time somebody dies. In conclusion to this, Allusions help the story by allowing the audience to relate and apply these reasoning’s in their lives. Briefly explained, the three literary devices which would be good to include in stories are: epigraphs, character development and allusions. This brings your story to a point that the reader believes they are actually living the story, feeling every single detail of it. So, all in all, literary devices increase more use of detailed writing and allows people to understand what is going on.

Scrotal PNET in an Adult Patient

Scrotal PNET in an Adult Patient TITLE: Scrotal PNET in an Adult Patient: Radiologic-Pathologic Correlation. AUTHORS: M ª Gabriela Tirapu-de-Sagrario, Sandra Baleato-Gonzà ¡lez, Elena Pintos-Martà ­nez and Roberto Garcà ­a-Figueiras KEY WORDS: Neuroectodermal Tumors, Scrotum, Sarcoma, Groin, Inguinal Canal INTRODUCTION We report a, histologically confirmed, rare case of a peripheral primitive neuroectodermal tumor (pPNET) originating from the scrotal sac in an adult patient. This report emphasizes the important role of pathology examination to reach final diagnosis on the basis of immunohistochemistry and electronic microscopy findings. Outcome depends upon the localization and staging of the tumour, age of the patient, histologic classification, extent of surgical resection and time to treatment. CASE REPORT An 84-year-old man was admitted to our hospital with an inguinoscrotal, irreducible, painless mass with a hard consistency, which had progressed over the last six months. There was no presence of urinary or intestinal symptoms. Alpha-Fetoprotein, beta-HCG and LDH values were found to be normal. The patient was subsequently referred to the Urology Departament and he underwent a pelvic MRI. It confirmed a 12x11x19 cm solid mass, which demonstrated central areas of necrosis and subtle amounts of haemorrhage (Figure 1). This mass demonstrated marked and heterogeneous enhancement after intravenous gadolinium administration as well as evidence of internal vascular flow. Both testes showed a normal morphology and signal on T2-weighted sequences (Figure 1). Surgical excision was performed by the Urology Service and they reported that the spermatic cord, femoral vessels and testes were displaced but not infiltrated by the mass (Figure 2A). Despite the fact that a sarcoma was the suggested dia gnosis on imaging, this case exhibited microscopic pathology features of a rare pPNET tumor in an unexpected location. The presence of neurosecretory granules in the electron microscopy (Figure 3) and the EWS-FLI1 traslocation confirmed the diagnosis. DISCUSSION pPNET is an uncommon tumor that belongs to the Ewing’s Sarcoma family of tumors (1-4). It is an aggressive neoplasm, with large size at presentation, which metastasizes rapidly and predominantly affects children and adolescents (1,3,5).The most common locations are: the chest wall, paraspinal area in the chest, abdomen and pelvis (7,8). Ellinger J, et al (1), performed a MEDLINE search identifying renal, bladder, prostate, ureter and seminal cord PNETs, Hari S et al (3) and Kim MS et al (9) also described kidney and retroperitoneum cases and even an uterus case was described by Peres E et al (10) but, to our knowledge, this is the first pPNET case which originated in the scrotal sac, independent of any organ. This tumor is extremely rare in adults and the clinical findings (large painful mass) do not help to distinguish a benign from a malignant tumor (11). At the presentation most of them grow as scrotal masses rather than inguinal masses because they usually originate just b elow the external inguinal ring (12). PNET tumor shows no specific imaging features, but radiological studies are useful to rule out other possible etiologies, to define the location of the tumor and its morphological characteristics as well as its distance extension (1,3,4). In order to diagnose PNET, and differentiate it from other tumors of the Ewing family, we need to demonstrate the expression of some neural markers on the inmunohistochemical stains, including neurofilament, NSE, Leu-7, vimentin, S-100, CD-56, chromogranin and synaptophysin (2). A definitive finding is the EWS-FLI1 traslocation and the presence of neurosecretory granules in electron microscopy (7,8). In conclusion, we present a histologically confirmed case of an extratesticular peripheral scrotal PNET, which possibly originated from a remnant of neuroectodermic cells of the neural crest. In a case like this one, with a huge genital mass, ultrasound and MRI are very useful modalities to assess the location of the mass, its dependency on any other organ and the tumoral internal structure. These will help us to suggest a possible differential diagnosis however the definitive diagnosis requires histopathological and immunohistochemical examination. REFERENCES Ellinger J, Bastian PJ, Hauser S, et al. Primitive Neuroectodermal Tumor: Rare, highly aggressive differential diagnosis in Urologic Malignancies. J Urol 2006; 68(2):257-262 Gurung P,Attar K andPeters J. Primitive neuroectodermal tumorof thespermatic cord. Int J Urol.2010 Jul;17(7):679-80. Hari S,Jain TP,Thulkar S, et al. Imagingfeaturesofperipheral primitive neuroectodermal tumours. Br J Radiol.2008 Dec;81(972):975-83. Javery O,Krajewski K,ORegan K,el al. A to Z of extraskeletal Ewing sarcoma family of tumors in adults: imaging features of primary disease, metastatic patterns, and treatment responses. AJR Am J Roentgenol.2011 Dec;197(6):W1015-22. Ibarburen C, Haberman JJ, Zerhouni EA. Peripheral primitive neuroectodermal tumors. CT and MRI evaluation. Eur J Radiol. 1996 Feb;21(3):225-32. Fontaine C,Schots R,Braeckman J, et al. Long-term survival in an adult metastatic renal peripheral primitive neuroectodermal tumor (PPNET) with multimodality treatment including high-dose chemotherapy. Ann Oncol.1997 Jul;8(7):691-4. Khong P.L, Chan G.C.F, Shek T.W.H, et al. Imaging of Peripheral PNET: Common and uncommon locations. Clinical Radiology. 2002;57:272-277 Hoffer FA, Gianturco LE, Fletcher JA, et al. Percutaneous Biopsy of Peripheral Primitive Neuroectodermal Tumors and Ewing’s Sarcomas for Cytogenetic Analysis. AJR. 1994;162:1141-1142 Kim MS, Kim B, Park CS, et al. Radiologic Findings of Peripheral Primitive Neuroectodermal Tumor Arising in the Retroperitoneum. AJR. 2006; 186:1125-1132. Peres E, Mattoo TK, Poulik J, et al. Primitive Neuroectodermal Tumor (PNET) of the Uterus in a Renal Allograft Patient: A Case Report. Pediatr Blood Cancer. 2005;44:283-285. Lioe TF and Biggart JD. Tumours of the Spermatic Cord and Paratesticular Tissue. A Clinicopathological Study. British Journal of Urology. 1993; 71:600-606 Rodrà ­guez D and Olumi AF. Management of spermatic cord tumors: a rare urologic malignancy. Ther Av Urol. 2012: 4(6): 325-334 FIGURE LEGENDS Figure 1 A) Axial T2 TSE shows a large heterogenous inguinoscrotal mass that displaces the penis (void arrows) but apparently not infiltrates it. B) Axial T1 after intravenous contrast Maximum relative enhancement. It shows central hypoperfusion (black arrows), which is hyperintense on T2 sequences, probably due to necrosis or hemorrhage, and a solid hypervascularized periphery (white arrows). Figure 2 A) Surgical photograph shows the spermatic cord (white arrows), which is displaced but not affected by the large mass. B) A long axis section of the mass. Its observed an heterogenous tumor of mottled appearance with partially embossed, clear brownish areas, which are the solid ones (black asterisks). It also has extensive necrotic and hemorrhagic component (white asterisks). Figure 3 Electronic Microscopy. The presence of neuroendocrine granules (white circles) of various sizes (from 80 to 120 nm) in the cytoplasm of the tumor cells is confirmed. This finding demonstrates the neuroendocrine differentiation of the neuroectodermal tumor.