Blood Clotting Essay

Coagulation, or thrombogenesis, is the process by which blood clots in an attempt to restrict blood loss from an injury site, and repair the damaged vessel. Most of the time clotting is a good thing, however there are circumstances when a clot can form abnormally, leading to heart attack, stroke, or other serious medical problems. A blood clot forms almost immediately after the bleeding occurs, which is possible through enzymes and other substances in blood that respond to breaks in vessel walls. The clot is a temporary fix preventing further blood loss. There are four major parts of blood clot formation. The first step in clotting is the formation of the platelet plug. Platelets are the smallest of the three major types of blood cells whose primary function is to prevent bleeding. When encountering a damaged blood vessel, the platelets become stimulated and rush to the injury site where they clump together, forming a plug and restricting the bleeding. They also release substances to begin the chemical reaction of the clotting process. These chemical reactions are responsible for growing the blood clot. Dissolved proteins, also referred to as clotting factors, are contained within the blood for the purpose of promoting blood clots. These proteins send signals to each other and enhance each other’s activity exponentially at the site of injury, resulting in a rapid chemical chain reaction which produces fibrin, the main protein forming clots. This blood clot formed with fibrin is tougher and more durable than the platelet plug. Once the blood clot forms, it is important that it not grow and spread to the rest of the body, which can cause serious damage. This is where â€Å"anti-clotting† comes in to play. Proteins such as antithrombin, protein C, and protein S, are known anti-clotting proteins and exist in a natural balance with the clotting factors. These substances work to neutralize excess clotting factors, preventing the clot from going to places it should not. The final part of the process is where the clot is slowly broken down by the body. Once the damaged tissue heals, the body gradually degrades the clot and reabsorbs it. The tough fibrin strands in a blood clot are dissolved by an enzyme called plasmin. Plasmin is activated by other substances working together to help the clot break down. The whole process of blood clotting is whenever the blood is exposed to certain substances. These are known as thrombogenic substances because they promote the formation of thrombus (clot). Many of these substances, such as tissue factor, collagen, and von Willebrand factor, are located in the skin or in the blood vessel walls, typically separated from flowing blood. If they come into contact with flowing blood, this typically means the blood vessel wall is ruptured and bleeding. A clot may also form when blood is not flowing properly. http://www.hematology.org/patients/blood-disorders/blood-clots/5233.aspx http://www.webmd.com/a-to-z-guides/blood-clots

Patriot Act, Pros and Cons

The Patriot Act was signed into law by President Bush in response to the tragedy of the events of 9/11. This report explains the issues that warranted this law, as well as the advantages and disadvantages of the Patriot Act of 2001. Passed in the weeks after the Sept. 11 attacks, the law expanded the government's powers in anti-terrorism investigations. And as expected, controversy is always an issue when such laws are passed. The Patriot Act in no exception. Although the law was designed to counter terrorism within the borders of the United States, some provisions of this law are controversial due to infringements on civil liberties. The following are a list of pros and cons based on information provided by the United States Department of Justice, and ACLU. The Pros: †¢Allows law enforcement to use surveillance against more crimes of terror †¢Law enforcement can conduct investigations without tipping off terrorists †¢Federal agents ask a court for an order to obtain business records in national security terrorism cases †¢The Patriot Act facilitates information sharing and cooperation among government agencies so that they can better â€Å"connect the dots. †¢The Patriot Act reflects new technologies and new threats †¢Law enforcement officials may obtain a search warrant anywhere a terrorist-related activity occurs The Cons: †¢FBI can demand â€Å"any tangible thing,† including books, letters, diaries, library records, medical and psychiatric records, financial information, membership lists of religious institutions, and genetic information without your knowledge or conse nt a. The FBI needs only to tell a judge (no need for evidence or probable cause) that the search protects against terrorism. The judge has no authority to reject this application. †¢Section 213: a. It expands the government's ability to search private property without notice to the owner †¢Violates the 1st and 4th Amendments to the Constitution †¢Does not work: a. 0 out of 5,000 suspects detained for terrorism have been convicted Opponents of the Patriot Act argue that this law was pushed through Congress with some measure of haste and opportunistic tones. The debate and controversy will obviously continue as is with most laws passed within the halls of the United States Congress. As guaranteed by the Constitution of the United States with respect to the right of protest, the Patriot Act will continue and amendments will sure to follow. The act’s own framers admit that it reduces peacetime liberties but argue that it is must continue in order to fight terrorists. As is the case with a law such as the Patriot Act, once it is implemented the government is always reluctant to relinquish its additional powers regardless of whether or not the original threat that prompted the act still exists. Such laws are sometimes viewed as too harsh or simply appalling and sometimes a person feels that his or her privacy is being violated. Sometimes all one has to do is to remember the tragic events of 9/11 to renew their sense of well being, security, and the freedom that is afforded by this great nation, the United States of America.

Cars Produced at Eros Motors

At Eros Motors, we provide safe, stylish, green and a cutting edge form of individual mobility to our customers. We have been successful in offering what customers feel is important to them. Our cars also come with all the options, which are asked by our customers. We planned our strategy taking into consideration all the aspects of marketing, H. R, finance and operations. Marketing plays a very crucial role in this modern world so we promoted our products through various forms of media. We spent heavily at the start just because we wanted to make our presence felt in the market.We always believed that our team is of utmost importance to us, so we made sure that there is a balance between automation and workforce to maximize production. We also paid them well so that they remain motivated at all times and work towards the goal of the company. Training of employees is a must and this is necessary for the quality of the cars. We noticed that our Warranty claims were high, so by proper training this could have only been reduced. Research and Development is an important area and a good amount of money was spent over the years so that we develop better and environment friendly cars in the times to come.We made sure that the money is not spent on general R&D rather we identified some key areas and invested in those constantly. Finance was an area of concern as we were incurring huge losses; we took necessary steps to improve this. We priced our products aggressively and planned production efficiently. As a result this gave us better sales. We also tried to cut down on costs, which gave us a better gross margin over the years. We started to make profits in the later years and this shows that our products have been well accepted by the market.We offered Alpha (medium) and Beta (large) cars in the beginning then we came up with Delta (city – hybrid) and lastly with Zeta (diesel – luxury). The luxury market was untapped and we thought we could do well by se lling a small number of cars because the margins in a luxury car are huge. The offering was based on the market research and the demand in the market. The design of the cars kept on changing as requested by the customers. This showed that we were catering to all segments of the market in terms of offering and pricing.Our aim is to be a leading car manufacturer by creating stylish, reliable, eco friendly cars by following the principles of enhancing our team, extending our business and enlarging our market. To sustain in this competitive market we have to take into account what the competitor is doing and react accordingly by delivering a better product. The need of the hour is to connect with the customers. The world is moving towards alternative fuels and we will also try to come up with products that are environmental friendly keeping in mind the needs of the customer yet giving stylish, value for money and fuel efficient cars.

The British Economy Essay Example | Topics and Well Written Essays - 1500 words - 1

The British Economy - Essay Example Eichengreen, B. (1995) stated that Britain's sterling devaluations in 1949 were a continuation of the effect of World War-II. After the war both Britain and Germany imposed exchange control. In 1949 Britain joined the NATO1, when it was a founding member of the UN. The most important significance of the year in world politics was rise of the CPG2 in China. Chinese Communist Leader Mao Zedong and Soviet President Joseph Stalin signed a Sino-Soviet Treaty that endow with economic and military aid from the Soviet Union to the new state of communist. Simultaneously the Chinese Nationalists established a new regime in the island of Taiwan after defeated on mainland by the military forces of Communists. Britain was concerned in this region foe colonial economic interest with Hong Kong. 3 Clement, P. (2006) mentioned that the Labour Government was in the power at the period of devaluations in 1949 and endorsed a political agenda entrenched in collectivism such as nationalisation of industries and state tracked economy. Both wars had learnt the lesson of the potential benefits of greater state attachment. The post war economy emphasise the future direction and was by the Conservatives. Nevertheless, the initiatives of nationalisation were not successes due to lack of more degree of understandings the economic management emerged. The economy practiced theories of Keynes and sustained state involvement such as state direction rather than state ownership. Reason of 1949 Devaluation Kaplan, J. J. and Schleiminger, G. (1989) added that both the world wars had serious effect on the British Empire. The Indian independence in 1947 has introduced decolonisation and the wave of independence followed in many countries of the British Empire. Colonies helped the British Empire in the wars with commitment of independence. British power was failed to resist the tide of independence that began within the Labour Government4 and sustained up to the Conservatives.5 With the exclusion of Suez Crisis, the Conservative government introduced a central feature of foreign policy expression with wind of change. Raghuram, G. R. and Zingales, L., (2003) and Schenk, C. R., (1994) agued that the breakdown of Empire, war expenditures and the material losses incurred in the both world wars had seriously injured the Britain economy. The prime effect was that British long-established markets were altering as Commonwealth states and finished mutual trade measures with regional countries other then Britain. Secondly the preliminary growths made by Britain in the world economy were relatively turn down to repairing some of countries infrastructure was gravely damaged in war. As well as they reclaimed a stake in world markets.6 Thirdly the British economy had shifted its structure to a service sector economy other then its industrial origins that caused some regions economically depressed. Finally part of political consensus supported

Abortion Essay Example | Topics and Well Written Essays - 500 words

Abortion - Essay Example There is little freedom of choice for women who are experiencing an unwanted pregnancy. The women themselves usually wish to bring their baby to full term. Other powerful influences in her life such as husbands/boyfriends, parents and friends are generally the forces that exact pressures on her to terminate the pregnancy. â€Å"Eight out of 10 women surveyed after abortion said they would have given birth if they’d had support and encouragement from family and friends† (Reardon, 2002). Legal abortion enables fathers to force their will on mothers. Some women resort to abortion in desperation because they fear continued abuse. That fear is substantiated as women who refuse to abort have been subjected to serious abuses which have escalated to murder if the women still persists in her refusal. Murder is the leading cause of death for pregnant women and for what other motive could there be? â€Å"Sixty-four percent of women surveyed report being pressured by others into unwanted abortions† (Reardon, 1992).   Ã‚  Immediately following an abortion, the one(s) coercing the decision are relieved and seldom, if ever, give the inconvenient issue another thought. Women, on the other hand, suffer long afterwards, racked by overwhelming guilt and agonizing over their irreversible decision. This pain may last a lifetime as they are never able to forgive themselves (Elliot Institute, n.d.). ‘Pro Choice’ activists argue that women should have access to safe abortions, that ‘a nation founded on and dedicated to civil liberties could allow its citizens to resort to dangerous self-abortion procedures.’ That too is a false premise. Ninety-seven percent of women who have had abortions describe intense pain experienced during the procedure despite the use of local anesthetics. â€Å"Compared to other pains, researchers have rated the pain from abortion as more painful than a bone fracture, about the same

Financial Reporting Essay Example | Topics and Well Written Essays - 1000 words

Financial Reporting - Essay Example The recent financial crisis as well as the leading corporate scandals of past however, cast a doubt over the information presented in the financial statements. It has been argued that the financial statements do not provide the information which can satisfy the requirements of the shareholders and investors. The overall quality of reporting and the loopholes in the existing regulations and standards therefore provide an opportunity to the managers to report the matter in a manner which may not satisfy the overall requirements of the shareholders and investors.( Weil,2011). This paper will discuss as to whether the annual report of a limited company satisfy the needs of shareholders and other investors. Annual Reports and Financial Reporting Every limited liability company is required to present its annual financial statements outlining the position of its assets and liabilities, profit and loss as well as the cash flow position. Apart from the three key financial statements, annual r eports of the firms also include notes to the accounts which provide different estimates and explanations of how different estimates were made and under what assumptions and standards. Standards set out by International Accounting Standards Board as well as the US GAAP are two of the major standards which are being followed by the firms internationally. Except US Generally accepted accounting principles, standards outlined by IASB are followed internationally where US GAAP is followed by American companies. Though there are some critical differences between the two set of standards however, there are extensive efforts being undertaken to converge both the standards and develop a unifying and single standards to be followed by all the firms globally. It is also important to note that the every limited liability company has to submit its annual accounts to the regulatory body as well as to present them to the shareholders. As such annual reports serve as the most important document th rough which shareholders can actually assess the performance of the management and assess the long term and short term future of the firm. (Jones, 1998). The recent financial crisis as well as the corporate scandals like Enron and WorldCom however, created an strong debate as to whether the financial reporting made in the annual reports actually serves the interests of the shareholders and other investors or not? Financial Reporting and Shareholders’ Interests Despite the fact that there are extensive set of rules and regulations under which annual accounts of the limited liability companies are made however, the failure of the firms to disclose all the information has initiated a debate as to whether the annual reports provide the kind of information which serves the interests of the shareholders and other investors. One of the important concepts to be explored in this regard is the agency problem which outlines that the managers make decisions which may not necessarily be i n favor of shareholders and add value to the firm. Under this assumption, the information presented in the annual reports therefore may entirely represent the interests of

Finance accounting Essay Example | Topics and Well Written Essays - 1500 words

Finance accounting - Essay Example Lastly, the reserves of the company is estimated and their modes of utilization so that the write-down of the company can be avoided. Impact of Australian Accounting Standards When the net realizable value for all of the subsequent period. Due to a certain circumstances the inventories of the company needs to be written down below the cost that no longer exists or with the evidence related to the net realizable value caused as a result of the changed economic circumstances (Walton & Aerts, 2006, p.120). This leads to the reversing of the write-down where the amount if restricted to original write-down, so much so, the new carrying amount of the company will be lower than the revised net realizable value along with its associated cost. With the selling of the inventories the carrying cost of the inventories is treated as the expense in the period in which the revenue is recognized. This result in the written down value of the inventory is considered as the cost or occurrence of losses . The concept of reversal write-down value generally occurs from the increase in the net realizable value of the concerned company; which is recognized as a fall in the amount of inventory as an expense in the period of reversal write-down occurrence (Johnston & Johnston, 2005, pp.62-63). Reversal write-down The concepts of the reversal write-down under the Australian Accounting Standards will have a great impact on the current situation of BHP Billiton’s US Shale Gas assets related to the financial statements of the company. The inventory cost of the company will reduce thus reducing the carrying cost of the Shale Gas assets to a remarkable extent. Thus the increase in the net realizable value of the company will be projected at a low rate than now. This in turn will lower the intrinsic value of the company resulting in the valuation of the company being similar to the market value of the company or lower than the market value. Hence the company will be in the condition to r evive of the present condition to a certain extent (Australian Government, 2009, p.17). Current and non-current assets and methods of valuation Yes, the current and non-current assets of the company, BHP Billiton’s have been valued in the financial statements of the company. The income and the deferred tax of the company accounted under the head of other assets of the company has taken the deductible temporary differences resulting in the deferred tax of the company amounting to US$3119 million as against US$2195 million in 2010. These amounts have not been recognized due to the probable future taxable profits as the deductible temporary differences do not expire under the tax legislation. The trade receivable of the company is the considered as the impaired assets of the company. All the financial assets of the company are computed at the fair value price under the consideration of payment and receipt. The fair value method is the not a completely independent process. It is based on the results of weighted average value of the items of the company. In spite of providing a balanced figure of valuation yet its limitation the valuation of the business model still persists. However, the fair value accounting process conveys important information related to

Iraq war Research Paper Example | Topics and Well Written Essays - 1750 words

Iraq war - Research Paper Example For a long time the United States and the Soviet Union were engaged in a Cold War (1946-1991) as they manifested their rivalry as superpowers economically, politically, militarily. The reasons it was termed as â€Å"Cold War† is because there was nothing like direct military engagement between the two superpowers. The Cold War included continuous bloody proxy wars that were directed to the developing countries of the Global South by the superpowers. The wildly recognized war of Cold War included - the Soviet-Afghan War 1979-1989, here the U.S. forces majorly concentrated â€Å"in the ground† while Soviet forces concentrated â€Å"on the ground.† In the American-Vietnam War 1959-1975, here while the Soviet forces were engaged â€Å"in the background,† the U.S. forces were engaged â€Å"on the ground.† However, in Afghanistan and Vietnam, both the United States and Soviet forces were defeated. Negative effects such as economic hardship, political turm oil, human devastation as well as ideological argument became the subject of discussion within the developing countries of the Global South contrary to the peaceful atmosphere that existed within the countries of the Global North. Like, the aftermath of the American-Vietnam war left 3 to 4 million Vietnamese dead and the same to 1.5 to 2 million Cambodians and Laos as well as many more million of them rendered homeless turning to be refugees, while only 58,000 U.S. soldiers were killed and 300000 were left with wounds. A number approximated to be 700,000 and 1.3 million Afghans were killed in the Soviet-Afghan War and left 4.5 million of them in refugee camps mainly in Iran and Pakistan while only 15,000 Soviet troops were left dead and 37,000 got wounds. Among the strategic goals of Israel when the Cold War was at its peak was to influence the Western powers into forcing the Soviet Union to allow Soviet

Term Papers in the Educational System Essay Example | Topics and Well Written Essays - 750 words

Term Papers in the Educational System - Essay Example However, the term papers posted on the Internet have played significant roles such as helping students to advance their research writing skills since most of these term papers are done by professional experts. These papers also encourage faculties to modify term paper subjects instead of providing students with similar work now and then. Although term papers are helpful, citing or acknowledging the work done by someone else is ethically acceptable because academic dishonesty is high in most academic environments. There is nothing unethical about the service in general provided by term paper online sites. This is because these sites have also provided many of the unemployed professors the means of living. From the utilitarian ethical perspective theory of John Stuart Mill, the basic principle is that the action, which offers the greatest amount of good over bad or evil are ethically or morally right (Shafer-Landau, 2007). For instance, in case one tells a lie to protect the life of so meone from danger, this would be considered as a good ethical choice under the utilitarian ethical theory. ... however, it is not the action that generates the greatest goodwill in a certain situation but rather than action, which generates the greatest goodwill in a society. However, going back to the example of a lie and saving lives, it is vital, to tell the truth, because the truth is less harmful than the lie in the long run. Additional, there is nothing unethical with term papers services provided online because these papers are posted to help student accomplish their research effectively and also help faculties to modify their term papers rather than providing repeated term papers every time. It can only be unethical in case students can use these term papers without acknowledging the work of other authors or fail to cite since this can automatically lead to plagiarism. Plagiarism is one of the greatest offences and it is one of the greatest academic dishonesty; thus it can contribute to cancellation or discontinuing of a student from the university. From the ethical principle of the r ight approach by Emanuel Kant, Kant argued that individuals have the right to make their own choices. These choices would be the right to truth, privacy and right not to be injured (Arthur, 2000). Therefore, students have the right to provide academic honest work and term paper providers also have the right to protect their privacy since everyone’s action can impact one another; thus those actions will be viewed as unethical. On the other hand, term papers posted on the Internet are ethically wrong because they expose or attempt students to academic dishonest because many students do not have a time of completing term papers, so they will copy from this online term paper sites. Aristotle and Plato proposed an ethical approach to the common good by arguing that people should act according to the common good which benefits the society.     Ã‚  

Management Overview Essay Example | Topics and Well Written Essays - 4000 words

Management Overview - Essay Example These approaches are preferred because companies have little control over external factors in their environment, including their competition, but have a great deal of control over internal factors within the firm. This is especially true with PLCs seeming to shorten over time, most notably in technology fields. With all this taken into account, it makes sense for organizations to focus internally to attempt to gain a competitive advantage, rather than being reactionary and responding to external factors consistently (Teece, 1997), which should help them not only get a competitive advantage in the first place but also sustain it over the long term. In this paper, the writer will attempt to analyze changes that have occurred in the field of strategic management. Dell Corporation will serve as the model for this analysis, as its business model has been praised recently due to its unique approach to markets. 1.2 Dell Computers Product Lie Spans have been shortening from some time in Dell ’s sector (computing), which obviously can create problems for a corporation in terms of creating a long term sustained advantage. This is because any advantage gained from innovation is unlikely to last more than one product life cycle, after which competitors will adapt or copy such innovations, meaning that without constant innovation, a company will quickly lag behind. This also means that a company must display excellent flexibility, and be able to change their strategic focus quickly: in Dell’s case, for instance, a weakening desktop market might be inevitable, so they would need to be able to quickly capitalize on other business such as laptops or accessories. Competition in this sector changes frequently, as new firms enter, and new technologies redefine the expectations of the consumer base. While this leads many firms to jump head first into this sector, it has also led to some existing it, when they cannot compete with their competitors, cope with external d ynamics, or maintain enough innovation to keep them competitive with their competitors in the long term. Failed companies within such organizations also frequently do not possess the necessary resources to create or maintain competitive posture: thus the problem can be viewed as both resource based and externally driven. HP, for instance, could not maintain competitive advantage in the tablet market or the PC business because of competition from firms like Apple and Google (Cellan-Jones, 2011), making the company rely solely on its printer/scanner division to stay afloat. Lawson and Samson (2011) show that competitive advantage in this field depends on organizational asset positions as well as strategic flexibility and strategic decisions; there are distinctive flavors of strategic paths that seem to lead to success in this field. This flavor touches on the way the firm is put together and operated, and has a lot to do with organizational culture including working conditions, expect ation, management systems and so on. Samson and Lawson create a definition of the dynamic corporation – which will maintain competitive advantage, which includes things like cross-functional resources and management fascilities, which spans research

Violent Video Games Contribute to Violence Research Paper

Violent Video Games Contribute to Violence - Research Paper Example This is especially in the schools where some after falling out with their peers have resulted to shootings. Conversely, studies have contended contrary to violence emanating from the violent videos mainly among the children. They contend that, aggression especially among teenage usually emanates from the environment, which nurtures them to maturity or due to mental disorder of an individual. Hence, reshaping one’s character where one becomes violent due to the belief that this is the only way others can understand own situation. Studies have proved that violent gamers normally depict characteristics of antagonism chiefly in their behavior (Craig & Karen 778). This usually extends even long after the turning off the game where the players’ inner emotions become numbed and merciless contrary to those who have not watched. Since, the current, sophisticated media allows the players actively interact with the scenes where with other peers they can compete to prove possessed remarkable expertise to outdo the other. This brews aggression among the players and especially if they are teens, where their control immensely relies on emotions and not intellect because of their immaturity (Craig & Karen 779). Consequently, they turn hostile especially when they are in the midst of other students and when irritated result to killing; similarly the way they see and do while playing during their video sessions. Psychology claims that youngsters develop â€Å"Behavioral scripts† where life’s experiences usually record themselves. According Michael Rich, children use this to respond to the external environment, and especially when it seems hostile, they counteract it with the same measure or extra (Craig & Karen 780). Alternatively, they act to outdo or outwit the predicament that is depriving them the comfort they are experiencing via either inflicting pain, which is the environment comprising of their peers. Consequently, they result to hurting them and regretting afterwards of their actions when they sober up. The motivator of all these is what they attain from the violent video games (Craig, Katherine & Gentile 3). Since, most normally place the player on the side of the aggressor. It makes the player start having the feelings of hostility, and one expects the same from those he engages who are ready to fight and resist, but one’s peers are contrary. Primarily, the game offers rewards to the aggressor due to achievements made in pursuance of their opponent while in their mission. Owing to constant urge in playing these games, they normally offer the player to rehearse the entire process involving provocation to the absolute resolution of the conflict, which is death (Ferguson & Rueda 102). Additionally, since these games are addictive, they augment the learners’ skills and embed aggression in their character as they continue maturing. Hence, become part of them, which it may be hard to amend their behavior once they are adults. According to studies, youths’ exposure to video games has resulted to numbing their feelings against horror or both the human and property destruction. Youths emulate numerous sadistic actions evident in these videos and assume that, the only and effective way to deal with life predicaments is via violence (Ferguson & Rueda 105). In this way, youths may not be aware until other people notice and with proper

Imprint of Italian and Irish Americans on the American Culture Essay Example for Free

Imprint of Italian and Irish Americans on the American Culture Essay On July 4th 1776, Congress adopted the Declaration of Independence. Carefully written on this scribe and on the foundation of this nation are the unalienable rights to â€Å"Life, Liberty and the pursuit of Happiness.† (Declaration of Independence, n.d.) While some of the values and ideas of this document come from America’s motherland, England, the promised rights to the free world are shared by no other nation. For this reason, The American Dream is dreamt not only by natural born citizens of this nation, but by many people all around the world. Over twelve million immigrants during the late 1800s and early 1900s passed through Ellis Island, the first federal immigrant inspection station of the free world. Of the newcomers, a portion of them consisted of Italian Americans and Irish Americans. Throughout history, these groups have contributed to what is termed multiculturalism. Being the minority, these two groups have also experienced power-conflicts through their quests of assimilation. The two ethnic groups faced many challenges that helped create what is believed to be the melting pot to many ethnicities and racial groups. For The Journey While the American Dream is a common value, the aspirations of the idea come from different motives. In Italy, a strong, and unfair class structure created such severe conditions that led to 1/3 of the nation’s population to immigrate to the new world. While the majority of this fraction came permanently for a new life, some came temporarily to make enough money to return to Italy and buy land. Simply owning land in Italy automatically escalated Italians within the class structure. Many Italian Americans settled in Chicago Illinois, one of the largest growing cities in America at the time. Chicago offered much opportunity for work, as it was the ideal producer of steel and aider to America’s industrial growth. Back in Ireland,  the Irish had much more to deal with than just a harsh class structure. Under English rule, Irish religious practices were repressed along with many other basic freedoms the Irish came to experience in America. A poor economic situation due to chaos of rebellious battles led to much of Ireland’s population living an unsanitary lifestyle in mud huts well into the late 1800s. These living conditions led to diseases of more than half the population. When the Irish Americans first settled in Boston, they lived crammed into small, single-home houses with at least a couple more families. Many shared cellar, attic, and crawl spaces for living quarters (Youtube, 2011). Overall Assimilation Assimilation in reference to the Italians and the Irish is much more complex and has become an identity reference in itself. Being the weak minority has demanded the Italians and Irish to accept and disregard many of their own practices to satisfy the dominate. Unlike the Irish, many Italians did not stick together, but lived spread-out and separated from others. In fact, some tensions developed between some Italians groups based on what streets and neighborhood they lived on and in. Inside conflicts like this led to outside conflicts as Americans began to depict Italian Americans as a dark and devious group within press. Italian Americans worked hard to reverse this depiction and to adhere to the dominate rule of society. When Mussolini began to restore Italy to what many people believed that to the equivalent of the Roman Empire eras, Italian Americans felt sense of pride. Mussolini knowing that he needed the approval of Italians worked hard to earn their respect. The world viewed Mussolini as a strong leader, and this view reflected off of the proud Italian Americans. However, when Mussolini declared war on the U.S. by joining forces with other fascist leaders, Italian Americans began to receive much ridicule from the dominate social class again. Meanwhile, Irish Americans needed little effort to complete the process of assimilation. Having many of the same physical characteristics as the dominate groups of America, made it easier to focus on progression up the social ladder. The first generation, while working factory jobs like the Italian Americans, led a more togetherness of a lifestyle with one another in their group, which created a better support system. The support system created a stronger group and led to management positions. The second  generation focused heavily on education as much as the dominate class did. Higher education led to political offices within just the third generation of Irish Americans, which led to the Irish becoming part of the dominate group in America. A great example of this would be the Kennedy Family. Power-Conflicts Predicted to be the minority by the middle of the 21st century, the dominate white has been accused of trying to oppress the minority through tactics summarized by power-conflict theories. (Feagin Feagin, 2011). When the Italians and Irish first immigrated to America, the first jobs they assumed were factory and railroad jobs. Running these factories were members of the dominate class. It is commonly believed that money is the result of success in America, just as the sum of money and success are equal to power. The contrast between the dominate and the minority was very much defined as there was not much of a middle class. It was without effort for the dominate factory runners and railroad heads to pay the minority the minimum for the dangerous work they provided, after all, the only thing factory workers had to provide was their labor while factory runners had the product of the factories. For a long time this was a recurring issue in terms of power-conflicts. This issue created so much unrest until the two groups gained support from within their own groups to develop labor unions. Multiculturalism Multiculturalism is a term that to this day produces many unsettled feelings of both unrest and excitement. America, regarded as the Melting Pot of many cultures is not even a fully multicultural nation, as this country has taken almost three hundred years to see the first African American president. While the Italians and the Irish have worked hard to assimilate to the ways of this nation, they have also brought their culture onto this nation as well. Christopher Columbus day is proudly recognized by Italians as he was always considered the son of Italy. His finding of the new world has been an amazing accomplishment for the Italians. When the Italians finally had a voice in congress, they pushed to make the day a federal holiday (Youtube, 2011). Meanwhile, the strong religion practice as Catholics has also prompted holidays in favor of the Irish, such as St. Patrick’s Day. Without  the push by these groups to recognize these days, America may have not done so otherwise. It is important that days that attribute much to other cultures be recognized by America to promote multiculturalism. For example another federal holiday that reminds America of equal rights among equal groups is Martin Luther King Day. Conclusion In the late 1800s and early 1900s Italian and Irish Americans came to American to take advantage of the opportunities. The Italians settled primarily in Chicago, while the Irish settled in Boston. The two groups worked hard to assimilate through the trials and tribulations of power-conflicts and the everlasting multiculturalism. While the groups assimilated well by becoming an American version of their ethnicity, they also left an imprint on the overall culture of America. When both groups achieved political offices, days that were influential to their groups became federal holidays. References Declatation of Independence. (n.d.). Retrieved from http://www.archives.gov/exhibits/charter/declatation_transcript.html Feagin, J. R., Feagin, C. B. (2011). Racial and Ethnic Relations (9th ed.). New York, NY: Prentice Hall. Library of Congress. (2014, May). ImmigrationIrish. Retrieved from http://www.loc.gov/teachers/classroommaterials/presentationssandactivities/presentations/immigration/irish6.html Youtube. (2011, December). And they Came to Chicago: The Italian American Legacy. Retrieved from http://www.youtube.com/watch?v=vqeikaWQCyo Youtube. (2011, July). The Irish in America Part 1. Retrieved from http://www.youtube.com/watch?v=r0sZ_jWcyl

Rise of Diplomacy in US foreign Policy

Rise of Diplomacy in US foreign Policy INTRODUCTION Waging a war against any opponent has a huge impact on any nation. Its adverse effects are psychological, social, moral and economical. Although objectives if achieved through the war might prove to be beneficial in the long term but its takes decades to erase the memories of atrocities of war from the minds of general masses, especially those who are directly exposed to active warfare. Each injured soldier, demolished building and death anniversary deepens the agony of a common man. It is said a nation is pushed decades backwards in terms of economic growth after a war. In short, affording a war is not a cheaper option for any nation, irrespective of its economic power and USA is not an exception to this fact. Doctrine Change The rise in diplomacy than the military force in US foreign policy is also a by-product of economic burden that is showing its toll on US economy. According to US doctrine, America could have active engagements anywhere in the world for her interests. Previously the figure for armed conflict around the world was two full and one partial engagement. But after the economically expensive conflicts in Iraq and Afghanistan, they are forced to reduce that number one only. This change in doctrine is clearly evident from the reluctance displayed by Obama administration after the use of chemical weapons in Syria and Russian invasion of Ukraine. Pull out of Afghanistan is also a consequence of same change in doctrine. Financial Implications of Wars in Afghanistan and Iraq Lawrence Lindsay, National Economic Council Director of President George Bush’s administration, in an interview to â€Å"The Wall Street Journal†, estimated expenses of war in Afghanistan and Iraq between $100 billion to $200 billion. Later, he was highly criticized by his own administration for being over optimistic and had to resign due to immense pressure from within government. He also claimed that wars will be funded out of oil revenue from Iraq but instead, the Bush administration had to borrow $2 trillion from various lenders to support the wars. According to a study carried at Harvard University’s Kennedy School of Government, following are few financial implications of War chiefly financed by US: (a) 20% of total national debt of US government was added from 2001 to 2012. (b) A total of $260 billion has been paid as interest on war debt by US government. (c) In the coming years, only the interest would amount to trillion of dollars. (d) These wars are would result in amounting as high as $6 trillion as the cost of the wars. (e) These calculations include the expenditures on 1.56 million veterans who are and will be a financial burden on US economy for their lives. Rise in diplomacy than the military force The statistics and research depict that the Obama administration does have an option but to resort to diplomacy. Liberal use of military might is not a luxury available to United States anymore. Time and again the demonstrations and anti war rallies are held in multiple US cities. The common American is not concerned with what is happening outside his small world. According to Harvard University’s Kennedy School of Government, $6 trillion is equivalent to $75000 for each household. This figure is more disturbing for general masses and the government is bending to the political pressure being exerted. As a consequence, Obama’s administration, after coming into office, had to shift the focus to resources in Asia. This new dimension was well supported by within government as well as by the neutral scholars and thinkers. The republicans based their election campaign on criticizing over spending on war in Asia. In the same continuation, the governments decisions to initiate exit from Afghanistan, close the war in Iraq and counter al Qaeda with more accurate antiterrorism strategies has been welcomed and appreciated by all political entities in the country. This step has also enabled the state to cut short on budget and bring major shift in foreign policy towards diplomatic result oriented strategies US Military Dimension Focusing on its military dimensions alone, it was aimed at boosting the United States defense ties with countries throughout the world and expanding the US presence. Yet these objectives are only a small chunk of the overall strategy. Actually it has economic, diplomatic, and security objectives. The new strategy intends to reallocate resources not only toward the region but also within it, by engaging more with partners in Southeast Asia. The state department realizing the strategic importance of Indian Ocean has initiated and strengthened ties with India. This has also helped to achieve the goal of countering and controlling China as a mighty power in the region. Military drawdown in Afghanistan The U.S.-Afghanistan negotiations over keeping U.S. troops in the country after the â€Å"end of combat† in 2014 have hit a new snag. With elections scheduled for next spring, Karzai is eager to remain a player so he can help elect his chosen candidate. That may be the most significant reason for his recent rejection of an almost-completed deal with Washington, which would allow around 15,000 U.S. troops to remain in the country after the official end of combat in 2014. Karzai has now staked out a position refusing to grant the U.S. forces immunity from prosecution in Afghan courts for any crimes they might commit. And the U.S. is adamant that without immunity, the troops go home. This isn’t a new idea – it’s the same issue that scuttled the potential for keeping U.S. troops in Iraq after the official withdrawal of combat troops. And it led to the complete pull-out of all U.S. troops and all Pentagon-paid contractors in 2011. In Afghanistan, we might actually see the withdrawal of all U.S. troops after more than twelve years of war and occupation. Although the military aspects of the rebalancing strategy have garnered the most attention in the media, civilian departments and agencies have also begun to shift their priorities and resources to Asia. Under the guidance of Clinton and Kurt Campbell, the assistant secretary of state for East Asian and Pacific affairs, the State Department has deepened U.S. diplomatic engagement throughout the region. The glamorous aspects of the rebalancing toward Asia the geopolitical maneuvers and machinations, the high-stakes diplomacy, the grand strategy are only part of what will be required to make the policy successful. Just as crucial will be Washingtons focus on budgets, bureaucratic institutions, and personnel decisions, as well as its ability to continually assess the policys progress and identify areas for improvement. In an era of fiscal tightening, coming up with the necessary resources for such an ambitious program will not be easy. But because the Asia-Pacific region is fundamental to U.S. national security and the health of the U.S. economy, the rebalancing is the most valuable investment in U.S. foreign policy today

Eindhoven Model Of Incident Causation Nursing Essay

Eindhoven Model Of Incident Causation Nursing Essay Patient safety is the foundation stone and one of the central concerns in quality improvement for the health care institution. Keeping our patients safe is a challenging issue because errors and mistakes can and do occur any time. Human error is inevitable, reducing error and minimizing the consequences of error is best achieved by learning from mistake, rather than blaming attitude. Over the years, nurses have assumed roles in various quality improvement and health care risk management activities. Learning from errors and near misses helps to provide opportunities to overcome system gaps, design solutions and modify management systems can reduce the chances of future errors and prevent disaster. According to U.S Agency report (2001) patient safety practice is a type of process or structure whose application reduces the probability of adverse events resulting from exposure to the health care system across a range of diseases and procedures. The Institute of Medicine (IOM) reported that between 44,000 and 98,000 patients die in hospitals setting in 1997 in the United State of America (USA) each year as a result of health care errors which includes, transfusion of incompatible blood products, medication errors, foreign objects left in bodies, equipment failures, mistaken identities of patients or body parts. These errors occurred at any phase of the health care delivery system, errors with serious consequences were observed in most vulnerable clinical settings. Department of health (2001) An Australian study reported adverse event rates of 16.6% of which 13.7% resulted in permanent disability (Wilson, 1995). The Institute of Medicine (IOM) released (2001) a report on To Err Is Human: Building a Safer Health System On the basis of two research studies: one conducted in Colorado and Utah found that 6.6 percent of adverse events led to death, as compared with another study conducted at New York, found that adverse events occurred in 13.6 percent in New York hospitals. In both of these studies over half of these adverse events resulted from medical errors and could have been prevented. When extrapolated to the over 33.6 million admissions to U.S. hospitals in 1997, the results of the study in Colorado and Utah imply that at least 44,000 Americans die each year as a result of medical errors. The results of the New York Study concluded that deaths due to medical errors exceed the number attributable to the 8th leading cause of death. Scenario During my clinical experience, I encountered a situation where I received call from hospital incharge and reporting one sentinel event, series of e-mail exchanged and on call administrator requested me to terminate assigned staff who did an error. I have utilized my leadership knowledge and skills to the best of my understanding. The scenario was an 11 years old boy (Patient A) presented to hospital with the complaint of fever, headache and vomiting. 40 years obstetrics (Patient B) was admitted through emergency department for induction of labour. Both Patients blood was arranged and both have different blood groups. At night physician order to transfused blood to Patient A. Assigned nursing staff went to the laboratory with correct transfusion request slip and blood releasing form but unfortunately Patient B blood pack was picked instead of Patient A from the blood refrigerator at laboratory. Blood checked by same nurse with on call assigned physician before transfusion but again fa iled to check for correct identification at the bed side. Transfusion started to Patient A at 0700 hours. Shift changed at 0800 hours, over taken from night staff with blood transfusion but again verification was not done as a result unrecognized transfusion reaction occurred and ultimately Patient A expired at 13:00 hrs. I have investigated the case and requested respective assigned team and stake holders for root cause analysis. The situation was very painful and challenging as an eleven years old child died due to error but it gave me lots of opportunity to identify the system gaps in order to prevent from re-occurrence in future. As a management position, I requested multidisciplinary team to do the root cause analysis. Root cause analysis is a process for identifying the factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event. A root cause analysis focuses primarily on systems and processes, not on individual performance. The analysis progresses from special causes, clinical processes, organizational processes and systems, identify potential improvements in these processes or systems. After did a root cause analysis the incidence was categorized as sentinel event. A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. Such events are called sentinel because they signal the need for immediate investigation and response. Sentinel events are identified under the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and emphasized those policies helps organization to develop preventative measures. (The Joint Commission, 2011). The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has placed considerable emphasis on promoting patient safety through a variety of mechanisms, including the reporting and analysis of sentinel events that can lead to modifications and improvements in policy and practice within health care settings. We must apply the same principles learnt from our experiences. When a sentinel event occurs in a health care organization, it is necessary that appropriate individuals within the organization be aware of the event, investigate, understand the causes that underlie the event, and make changes in the organizations systems and processes to reduce the probability of such an event in the future. As a key management position it is my prime responsibility to work as a team with multidisciplinary approach, take as an opportunity to improve the system and ensure the compliances of the institution policies and procedure by nursing division. An organized approach for identification, analysis and evaluation of risks and the devising a plan to decrease the occurrence of accidents, incidents and injuries (Sullivan Decker, 2000). The Institute of Medicine has designed six aims for improving the delivery of care in the United States which includes; Safe, effective, efficient, timely provision, equitable and Patient centered approach in order to provide safe and quality health care services. (Institute of Medicine, 2001). According to Pelletier and Beaudin (2004) The Institute of Medicine defines healthcare quality as the extent to which health services provided to individuals and patient populations improve desired health outcomes. The care should be based on the strongest clinical evidence and provided in a technically and culturally competent manner with good communication and shared decision making. During root cause analysis I came across lots of areas which was identified for areas of improvement that, leadership needs to provide resources in order to provide quality services as evidence by provision of resources was absent in laboratory which resulted that in night shift staff went to receive blood by herself and no check and balance of patient identification was done. However, it is not clearly defined in the policy that what will be the mechanism of check and balance at laboratory end. At secondary hospital laboratory services timing is from 0800 hours to 2300 hours, but what if need arises after wards. It was taken as a granted that services will not require in night timings. In addition, it was not clearly defined in the blood transfusion policy which defines the first steps of checking blood for correct identification at laboratory level. According to Daniel (2004) Clinical Management refers to diagnosis, treatment planning and delivery and ensuring the correct identific ation of each patient and procedure. As a nursing departmental heads the need was identified to review the policies and procedure, structured quality assurance program and Total Quality Management system (TQM) is required in order to prevent from reoccurrence. TQM is a management philosophy that emphasizes a commitment to excellence throughout the organization (Sullivan Decker, 2000). Total Quality Management (TQM) is a sub-discipline of management science which deals with the issue of standardization and enhancement of organizational performance. According to Khan (personal communication November 20, 2012) research was carried out in 2006-2009 by for critical analysis of TQM implementation in Pakistani organizations located on geographical basis. This study explores the factors influencing the success and failure of the TQM program in the organizations. It particularly explores how these programs work within the context of various organizational profiles, dynamics and culture. The study found that TQM implementation is heavily dependent on various factors related to organizational context and culture. It also identified that the end results and changes expected by organizations from TQM implementation are not only dependent on its own framework but on many other cultural related intermediate impacts. These intermediate impacts are mostly related to organizational dynamics and culture and are ignored in most of the firms, resulting in early failure of TQM. Based on the findings of this research and the practical experience of implementing TQM in different organizations, the author also proposes a new framework of TQM implementation named as MSAC cycle i.e. Mobilization (trial phase), Standardization (Short term phase), Acclimatization (mid-term phase) and Culturization (long term phase). This study and the proposed TQM implementation framework is quite valuable for the organization who are presently implementing or desirous to implement TQM more effectively and successfully. The Aga Khan University Hospital started its operation in 1985. Basic quality assurance methodologies were introduced and from 1994 onwards, the continuous quality improvement (CQI) model of AKUH fostered a positive culture of change by establishing lots of core quality activities across the clinical and managerial disciplines; which includes, quality circles, basic quality control tools, education and training in quality, monitoring of quality indicators, health care professionals credentialing, Patient complaints, Patient satisfaction, morbidity and mortality reviews, nursing quality assurance program and quality grand rounds. Finally in 2006, AKUH acquired the gold seal of international accreditation in health care by the Joint Commission International Accreditation (JCIA) with the unique distinction of being the first hospital in Pakistan and among few universities based hospitals in the world to get the quality recognition. AKUH is now on the expansion and integration phase of i ts quality journey, the central driving force towards its quality vision is improvement of processes and outcomes and achieving a strong customer orientation towards both external and internal customers. This will be achieved through concentrating on the goals and strategies of the hospital and all its departments to these three major themes that is improvement in quality of care, services and cost-effectiveness. It is widely recognized that quality indicators or performance indicators can give a valuable insight into the quality of care being provided to patients. Performance indicators are best way to learn and improve, but to instill ownership in the heart of every individual is the key to having meaningful indicators. Thus making performance indicators a part of a physicians and nursing performance evaluation not only ensure that they actively participate in improving their own performance, but also ensure that, quality of care provided to the patients is always and continuously improving. In this clinical situation I also participated in developing the policies with multidisciplinary team and tool in order to control quality system and to evaluate the compliances of practice for sustainability. Fostering a culture of safety requires more than introducing new policies and procedures. Developing a culture of safety requires critical thinking, problem solving, risk identification management and human factor training. The relevant literature and websites on patient safety program has suggested many safety related performance indicators and sy stems of check and balances which can ensure patients safety during patients stay at hospital. A systematic and multidisciplinary approach is, therefore, very imperative to pick-up medical errors and devise strategies to reduce them as it defiantly plays an important part in patient safety. Literature Review The literature review will address overall concept of patient safety and its related issues and concerns, international perspective of error occurrences, safety related performance indicators and measures to create positive safety culture. Several studies are carried out on measuring and evaluating patient safety and outcomes at several health care institutions (Baker 2003; Arah, 2004; Colla, 2005; Karsh, 2006). According to Colla (2005) Achievement of a culture conducive to patient safety may be an admirable goal in its own right, but more effort should be expended on understanding the relationship between measures of safety climate and patient outcomes. The Luxembourg Declaration on Patient Safety (2005) has observed that the health sector is a high-risk area because adverse events, arising from treatment rather than disease, can lead to death, serious damage, complications and patient suffering. Although many hospitals and healthcare settings have procedures in place to ensure patient safety, the health care sector still lags behind other industries and services that have introduced systematic safety processes. Almost fifty percent of joint commission standards are directly related to safety, addressing such issues as medication usage, infection control, surgery and anesthesia, blood transfusions reactions, staff credentialing, fire safety, medical equipment, disaster management, risk identification and management, sentinel event monitoring, safety and security structures. These standards address a number of significant patient safety issues, including the implementation of patient safety programs; the response to adverse events when they occur; the prevention of accidental harm through the prospective analysis and redesigning of vulnerable patient systems and its the organizations responsibility to transparent and take ownership and accountability. Agency for Health Research and Quality (AHRQ) reports (2001) has suggested the same that to review best practices from scientific literature, Redesign care based on best practices through collaboration of multiple departments, Evaluate technology solutions, Implement performance measurements and Monitor selected measurements and present summary reports to senior leadership. Moreover, the Advisory Board Research document supports the type of error mentioned in the AHRQ 2000 reports that the most common errors per 1,000 visits are: 65 incidents per due to adverse drug events, 60 incidents due to hospital acquired infections, 51 incidents related to procedural complications and 15 incidents related to falls. Besides analyzing the common errors in terms of patient safety, Mrayyan and Huber (2003) discussed three aspects of patient safety issues. First is the fear that is whenever any unfortunate incident happens and it is publicized; it creates fear and apprehension among team members. Second issue is errors as a system problem, which involves repetition of same type of error that requires close and immediate interventions. Third is the link between errors and inadequate resources that means inadequate number of staffs or inadequate trained staff that can jeopardize patient safety. The medical error and harm to patient safety does not only let the patient suffer but brings an impact on society at large. The Danish Society for Patient Safety (2005) discussed the effects that adverse events can have on patients; health care personnel and society at large are significant. Patients may suffer both physically and psychologically from sufferings created by the injury itself, but also by the way the incident is handled. Health care personnel on the other hand may experience shame, guilt and depression, with litigations and complaints imposing an additional burden. Society at large suffers from a lower quality of life of its members, with associated extra health care costs but also costs caused by a lower productivity of the society. After root cause analysis I also felt that it is necessary to have interaction one is to one basis to relevant health care personal who did an error in order to sensitized them and mentored through education path rather than terminating the employee, give them insight that the will be the future ambassador for patient safety because, I personally believe that quality reflect when person itself willing to do so, it should be our constant commitment towards organization that patient safety should be our top priority, which infuses the entire organization, for that it is mandatory that first we should acknowledge the error then promote blame-free environment where individuals are empowered to report errors without any fear and punishment so they can willingly address safety concerns. Daniel (2004) explains that, what can be done today to improve patient safety while we are waiting for evidence on effective interventions. First, we need leaders those at the top of organizational charts as well as leaders at all level, second, we need to focus on comprehensive systems of safety rather than attempting to address safety one problem at a time. Three elements comprise comprehensive patient safety: active case finding, methodical analysis, and system redesign. Patient safety initiatives and programs vary from institution to institution but the aim remains the same that is reducing errors and promote safety. Klazinga and Arah (2004) said it is evident that current efforts focus too narrowly on the patient with little explicit linkage to wider aspects of health system safety. Risks management entails reducing harm not just to patients but also to staff, visitors and the environment including society. Some of the patient safety alternatives and solutions proposed by Mrayyan and Hubber (2003) are emphasizing on strengthening system of error reporting and correction that is error detection and reporting system within organization to reduce medical error, patient education in all aspects of care and applying risk management skills by healthcare personnel. In addition, creating an information system and building evidence base for patient safety, analyzing the impact of various management practices like staffing, increasing of medical errors and high risk population and monitoring error rates with necessary actions can reduce medical errors and also use of information technology can work towards enhancing patient safety. Besides all this, commitment of the healthcare professional to reduce errors and promote safety in any organization enhances safety not only for patients but also for the healthcare staff and society in general. This position paper related to sentinel event also gives me insight to do a self-reflection of my job related competencies as a key management representative. I personally believe that, Knowledge can be achieve by reading literature but the art of utilizing that knowledge and skills will give confidence to fulfill job in an effective way. According to (Barker, Sullivian Emery 2006). describe three key roles organized in to three categories called interpersonal roles, informational roles and decisional roles. In interpersonal roles manager has lots of job responsibilities in order to full fill organizational goals, informational roles comprises of monitor and disseminator as that manager is the focal person and considered an as nerve center. Third category is decisional roles which consist of entrepreneur, disturbance handler, resource allocator and negotiator. The first two categories are related to day to day operation However, the third category need that how manager use his/her c ompetency in clear direction which meet the organization vision and mission. Integration of Model There are number of the clinical theories and models regarding the human error are discussed in management. Among which I have selected the Eindhoven model of incident causation. Eindhoven Model of Incident Causation: This model was originally developed to identify root causes of safety related incidents in the Netherlands and has since been tested in industrial and health care settings. The Eindhoven Model of incident causation identifies three main causes of error: human operator, organizational and technical failure. These failures, alone or in combination, are through responsible for reinitiating a chain of events that may ultimately lead to an adverse patient outcome. In performance improvement terminology, such a failure would be considered the root cause of an incident. According to this model, high risk situations will develop into incidents if inadequate system defenses are available to remediate the problem. The Eindhoven Model of Incident Causation served as the theoretical basis for developing the Eindhoven Classification Model, which has since been adapted for the health care domain (Jacob Cherry 2011). This classification model claims that errors occur either because of active failu res or latent conditions. Human Operator Error: (Active failure): Human operator errors are those made by individuals at the sharp end by health care workers. They are also referred to as active failures or active errors. Active failures fall into three major categories; skill based, rule-based or knowledge-based. Skill based error occur when an individual makes an error during the performance of a routine task that requires little conscious effort as evidence by its routine practice of nurses to bring blood from laboratory or its routine to take daily over from upcoming shift but in different intervals but nurse fails to check for correct identification with patient name and medical record number. An example of a skill based error would be a nurse forgetting to push the start button on an IV pump after priming the tubing. A rule based error occurs when an individual fails to perform a procedure or protocol correctly or chooses the wrong procedure as in this sentinel event nurse and physician fails to compliance with policies and procedure as a res ult wrong blood was transfused. An example of a fuel-based error is a phlebotomist failing to check the patients identification before obtaining a blood specimen. A knowledge based error refers to the conscious but incorrect application of existing knowledge to a new situation. An example of a knowledge-based error would be when first patient develop fever or sign of reaction she took as an granted and stop blood for time being neither nurse or physician utilized their knowledge and integrated theory in to practice or critically analyze that what would be the possible reasons for fever. Human errors have typically been the focus of traditional incident report monitoring because they are more obvious that latent conditions. Although some of the factors leading to human error are amenable such as knowledge deficit, staffing shortages, work over load etc. Technical or organizational error (Latent Condition/ Latent error): Technical and organizational errors are referred to as latent condition or latent errors. Latent conditions result from sanctions or decisions made by administrators or others in leadership positions that affect technical issues, organizational policy or the allocation of resources. These errors are called latent because of the delayed and unintended consequences that may affect patient safety at a later point. Technical error occurs when there are problems with equipment, forms, labels, etc. (e.g. a computer does not print out patient identification labels in a timely manner). Organizational error can be related to various, often complex issues involving management priorities and organizational culture. An Example of a latent error would be an organizational decision not to use a computerized provider order entry system which results in a high number of medication errors related to illegible handwriting. Other Error (Unclassified): A third category in the Einhoven Classification Model accounts for errors that cannot be classified as active or latent. In health care, such errors are generally due to patient-related factors that contribute to error, for instance, if patient gave the history of allergy and this can lead to potential medication error. An error whose cause cannot be placed in any category (i.e. latent, active, or patient-related) is termed unclassifiable. In order to continuous quality improvement and promote patient safety culture it is necessary to promote culture of reporting of errors is the first step along with a constructive process towards understanding that what factors within a system enable an error to take place. This systems approach is gaining ground and many hospital administrators are becoming well versed in its theory and practice. To promote a culture of safety the leadership of an organization promulgates an atmosphere in which the reporting of errors is welcomed, so that others may benefit from knowledge of the situation and can develop strategies based on the data. A major element of this framework is a non-punitive stance towards the individual who reports or who has involved in an incident. In a just culture an organization lets its employee know that they will not be disciplined for making mistakes and that the leaders value the importance of learning from mishaps and seek to improve the system that allowed the m to occur. Recommendation Based on sentinel event which I address in my position paper and in light of literature, I would like to recommend few suggestions/ recommendations to strengthen our quality system. First in order to promote in healthcare organization, major emphasis required in order to create non-punitive environment where health care workers can report events, errors and near misses without fear of reprisal or disciplinary action. Next, the risk management forum should be structured at organizational level where relevant multidisciplinary key stake holders should identified in order to take ownership and facilitate clinicians and organizational managers at all levels, the in order to create such an atmosphere which promotes patient safety culture in an organizations. Needs to develop and implement a reporting system that encourages and enhances reporting by all department and staff. Educate all clinicians, staff, and management personnel on the nature and importance of the event reporting process, including disclosure and discovery issue. Needs to do timely and accurate documentation of sentinel events help organizations improve their safety and quality of care and learn from other organizations unexpected outcomes, which allow other health care organizations to be aware of the possibility of certain sentinel events, thus giving staff the time and knowledge to develop strategies to avoid these events before they actually occur. Utilization of event report data to trend and analyzes organizational risks and distributes this information to appropriate staff of the organization so that risk-prevention measures can be developed and implemented. Last but not least provide clinicians and staff ongoing feedback on their risk-reduction efforts, results of event reporting should be discussed at the departmental level, and input on corrective actions/process improvements should be solicited. Conclusion: In conclusion, I must say that errors can occur at any point in the health care delivery system. Acknowledging that errors, learning from those errors, and working to prevent future errors represents a major change in the culture of health care, a paradigm shift from blame and punishment to analysis of the root causes of errors and strategies to improve systems and processes by implementing patient safety measures which provide an objective, validated measure for identifying Potential Safety Issues. Management should make an effort to break down barriers by adopting non-punitive cultures based on industry best practices. This will sheds new light on traditional methods for removing reporting barriers, develop employee commitment to recognize and report errors or incident occurrences. When the staff proactively participates in reporting, the reporting process becomes a vehicle for making practices improvements in the delivery of patient health care and management receives information that otherwise would not be available. As one manager said, if nobody reports it, you dont know. When some occurrences are not reported, management receives limited information on which to base their decision. It goes without saying that better data mean better decisions. According to Daniel (2004) the goal should be not only to increase the number and quality of reports but also to increase their usefulness as rich sources of information for the generation of strategies tactics aimed toward medical-error reduction (p. 27). According to Minesota Alliance for Patient Safety (2005) safety culture is not blame-free approach; it is an approach that balances the need to promote open reporting and the need to hold practitioners accountable for their behavioral choices. Hospitals should identify potential safety issues, having proactive approach, measure baseline performance, and set priorities for process improvement efforts. Using this methodology, hospitals can implement patient safety program with minimal investment on their part. Informational reports can be generated and disseminated to proactively identify safety issues and drive improvements for the better health care outcomes.

Irish Campaign in America :: essays research papers fc

Early Modern Scotland Darien Company: A Necessary Disaster?   Ã‚  Ã‚  Ã‚  Ã‚  The 1690s were a time of much unrest in Scotland. The Glencoe massacre had served to discredit the monarch somewhat. Recent crop failures had led to a famine which was affecting much of the country. There was also a serious downturn in Scottish trade which greatly affected the economy. In the aftermath of this came the Darien Expedition. The Darien Scheme, as it is commonly referred to today, is one of the greatest failures in Scottish history. It was poorly planned, over ambitious and doomed, not from the start as one may think, but from the moment it was taken over by Scottish businessmen. The Scottish turned what could have been an extremely successful and lucrative company into a massive controversy which was to change the face of Scottish politics forever. Despite its massive failure, it can be argued that it was a necessary disaster. This episode was the talk of Scotland from its conception until its failure. It was the controversy of the day, and it undoubt edly contributed to the necessity of the Union. As will be explained below this tragic, yet farcical, episode in Scottish history made it obvious for both the English and the Scottish, that a re-evaluation of their relationship was required. While it would be an exaggeration to claim that the Darien incident alone led to the formation of the Union, it can be said to have been the icing on the cake, the straw that broke the camel’s back or numerous other clichà ©s. Either way the importance of the Darien Company in Scottish history cannot be denied.   Ã‚  Ã‚  Ã‚  Ã‚  As mentioned above, Scottish trade had seriously begun to deteriorate. Past trade links were hampered by new foreign policies. Scotland currently had no choice but to follow England’s lead. As a result of purely English interests, the Scottish took part in wars to the determent of their own economy. The Scottish found that two of their best customers; France and the Netherlands, were now their enemies. The three Dutch wars of the seventeenth century and the two more recent wars with France had made it difficult for Scotland to maintain friendly trade with either. This greatly affected the Scottish economy which was already fragile to say the least. Also England had drawn Scotland into their economic war. Since 1660 the English had forbidden foreigners to take part in trade with English colonies, under their Navigation and Staple Acts. Irish Campaign in America :: essays research papers fc Early Modern Scotland Darien Company: A Necessary Disaster?   Ã‚  Ã‚  Ã‚  Ã‚  The 1690s were a time of much unrest in Scotland. The Glencoe massacre had served to discredit the monarch somewhat. Recent crop failures had led to a famine which was affecting much of the country. There was also a serious downturn in Scottish trade which greatly affected the economy. In the aftermath of this came the Darien Expedition. The Darien Scheme, as it is commonly referred to today, is one of the greatest failures in Scottish history. It was poorly planned, over ambitious and doomed, not from the start as one may think, but from the moment it was taken over by Scottish businessmen. The Scottish turned what could have been an extremely successful and lucrative company into a massive controversy which was to change the face of Scottish politics forever. Despite its massive failure, it can be argued that it was a necessary disaster. This episode was the talk of Scotland from its conception until its failure. It was the controversy of the day, and it undoubt edly contributed to the necessity of the Union. As will be explained below this tragic, yet farcical, episode in Scottish history made it obvious for both the English and the Scottish, that a re-evaluation of their relationship was required. While it would be an exaggeration to claim that the Darien incident alone led to the formation of the Union, it can be said to have been the icing on the cake, the straw that broke the camel’s back or numerous other clichà ©s. Either way the importance of the Darien Company in Scottish history cannot be denied.   Ã‚  Ã‚  Ã‚  Ã‚  As mentioned above, Scottish trade had seriously begun to deteriorate. Past trade links were hampered by new foreign policies. Scotland currently had no choice but to follow England’s lead. As a result of purely English interests, the Scottish took part in wars to the determent of their own economy. The Scottish found that two of their best customers; France and the Netherlands, were now their enemies. The three Dutch wars of the seventeenth century and the two more recent wars with France had made it difficult for Scotland to maintain friendly trade with either. This greatly affected the Scottish economy which was already fragile to say the least. Also England had drawn Scotland into their economic war. Since 1660 the English had forbidden foreigners to take part in trade with English colonies, under their Navigation and Staple Acts.

Over the Rhine Essay -- Music Musicians Bands Essays

Over the Rhine   Ã‚  Ã‚  Ã‚  Ã‚  It is a rare occurrence in today’s over-amplified, bass-kicking sound world to leave a concert feeling as if you actually heard the music. Over the Rhine provided one of those concerts on Thursday October 2nd at Birdys Bar and Grill in Indianapolis. My personal congratulations to the sound guy, who’s mixing allowed the audience to really hear all the different layers of music and different instrumentation really being played.   Ã‚  Ã‚  Ã‚  Ã‚  Another rare occurrence; real songwriters and musicians playing their own music! The five-piece band is led by vocalist, Karin Barquist, and her husband Linford Detweiler, keyboardist and collaborator. The rest of the band consists of Paul Moak who played the sitar during the opening song and lead guitar during most of the others, Will Seyles on drums, and Rick Plant on bass guitar. But Barquist seems to be the key member in the band. She has all the qualities a good lead singer should have; great voice, good-looking, poised, mature and confident. She really runs the show up there, and makes it look effortless in the process.   Ã‚  Ã‚  Ã‚  Ã‚  The style of music cannot really be defined as one genre. The audience made it even harder to discern the kind of music being played. The people ranged in ages, gender, race, and dress. They just seemed like â€Å"real† people, not trying to be any part of one group, just like their music.   Ã‚  Ã‚  Ã‚  Ã‚  This mix of folky, pop, one attempt at a slowly spoken rap song, and country music produced all different kinds of songs. The songs have the type of lyrics that make you relate your own life to every single one of them. They’re deep, and well thought out. Barquist doesn’t just repeat the same nonsense lyric over and over. Her voice, to me, sounds a little like my favorite artist, Sarah McLaughlin. But it could really go any way she wanted; hard, soft, loud, weak, whiny, smooth, short and breathy. I have also heard her compared to singer Norah Jones. It seems like the marital bond between Barquist and Detweiler might have served as a source for lyric material.   Ã‚  Ã‚  Ã‚  Ã‚  On Thursday night, the stage at Birdys was adorned with oriental rugs, candles, and vases of flowers to create ambiance. It was nice, but they wouldn’t have needed it, the music spoke for itself. They played songs from two of their albums, Good Dog Bad Dog, but mostly their latest, Ohio. This album is the one that drew the crowd ... ...never articulate.   Ã‚  Ã‚  Ã‚  Ã‚  A couple of other songs they played were â€Å"Bothered,† â€Å"Cruel and Pretty† and â€Å"Changes Come.† If you had never heard the band before tonight, this is where you would probably think all the songs sounded very similar. Slow, piano and sad. The variety lies in the songwriting, if you start paying attention to the lyrics now, you’d have a different opinion. I almost think what they say is so poignant sometimes it should be in a book or poem by itself. But on the other hand, if you took away the way Barquist sings it, or the accompanying instrumentation, I doubt you would get the same idea. They can even make an acoustic guitar sound like it’s in pain and crying.   Ã‚  Ã‚  Ã‚  Ã‚  They performed two songs during a much appreciated encore, the title track to their new album, â€Å"Ohio,† and a freestyle guitar solo. Even though all their songs are pretty much slow and sad, I left the concert feeling as if I had just experience every emotion or feeling there was. There style is so soft and bare. They lay it all on the table, take it or leave it. Not interested in mainstream, happy with their underground following, and plus one more fan after the show in Indianapolis.   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  

The macroenvironmantal forces affect the banking industry are socia…

Social forces include the demographic features of the population and its value.DemographicAge constructionOne of import tendency is the shifting age construction of the universe ‘s population, as aging is now a phenomenon realized by people around the universe.Families and FamilyThe figure of families has been turning, as the family size has correspondingly been worsening. Besides, there appears to be an addition in the figure of double-income household.Population ShiftsAs a consequence of the over-development and congestion of the metropolis centre, antecedently rural country are been urbanised which caused big proportions of Asiatic population reallocated from metropolis centres to suburbs. Shifts from place to foreign states are besides common.CultureA 2nd societal force, civilization, incorporates the set of values, thoughts and attitudes that are learned and shared among the members of a group.The altering attitudes and Roles of Men and WomenResearch suggests that the bulk or grownups today believe work forces and adult females should every bit portion most duties.Beliefs, Values and HabitsThe values of the population alteration with the demographics of the people who hold these values. Peoples who are more educated live a busy life style which indicates that they place great importance on efficiency and the up-to-date information. The increasing average age population implies the bulk would be more mature when apportioning incomes. The addition in the figure of double-income twosomes consequences in turning accent on the togetherness of a household which implies higher values on leisure clip spent as household. A alteration in ingestion orientation is besides evident. Today, and for the foreseeable hereafter, value consciousness will drive ingestion behaviour.Economic and Regulatory ForcesThe economic system pertains to the income, outgos, and resources that affect the cost of running a concern and family. Regulation consists of limitations that Torahs in different Asiatic states place on concern with respect to the behavior of its activities.Business and Consumer ExpectationsOf peculiar concern at the macroeconomic degree is the inflationary or recessive province of the economic system. During the most recent fiscal crisis started in 2007, the banking industry suffered immense losingss. Although a batch of marks indicate that the economic system is retrieving, people presents are still non so confident about the hereafter.LiberalizationAs a consequence of globalisation, liberalisation in trade and investing is encouraged in order to ease international interactions in economic and societal spheres by diplomatic coordination of ordinances and criterions. As a consequence, the economic system is more dynamic and efficient which becomes easier for states to pull foreign direct investing.Increasing Regulations on Banking IndustryDue to the fiscal crisis, many states are set uping more ordinances that decrease the potency to gain net incomes from investings and other activities at Bankss in order to protect both the clients and the Bankss.Technological ForcesTechnology refers to innovations or inventions from applied scientific discipline or technology research. Each new moving ridge of technological invention can replace existing merchandises and companies.Electronic Business TechnologiesIn the past two decennaries, consumers are going much more reliant on on-line direction of their bank histories as the figure of places and concerns basking broadband entree to the Internet has reached true mass-market range. With the increasing universe ‘s cellular telephone endorser base, the lower phone monetary values and the expand of cellular service, a genuinely radical moving ridge of nomadic phones that can pull off fiscal histories is easy taking root all over the universe. However, with the edification of the Internet has arisen the issue of cyber security, another technological alteration to which the banking industry has had to react.DeductionObviously, the indicant of an aging population has brought about significant growing in nest eggs and retirement programs. Smaller families and double-income households lead to higher discretional incomes that can be saved or invested. Therefore, in the banking industry, sellers should offer more nest eggs and investing history options which enables consumers to choose the most appropriate program that can be personalized to outdo suit themselves. Due to the alone attitudes, lineage, communicating penchants and life styles of different groups harmonizing to coevals cohorts, genders and so on, the banking industry may develop different selling plans. As, the engineering develops, Bankss should see offering a comprehensive scope of services, such as screening and doing minutess, paying measures, online and by cell phone in order to supply convenience for clients so as to derive clients. Furthermore, for clients ‘ histories safety, Bankss should make more unafraid systems and give instructions on how to protect one ‘s history. Sing population displacements, set uping more subdivisions decently with respect to the bank size and mark clients would be a wise pick. One of import scheme can be offering clients foreign currency histories reacting to the addition in foreign currency usage. Another notable scheme would be developing on-line nest eggs histories for the adolescents due to the increasing degree of instruction. From this, Bankss can farther educate the young person and promote fiscal direction, and develop future trueness clients Banks should develop low-risk investing plans as people are still non so confident about the future economic system. An epoch of much lower risk-taking by traditional loaners has begun that will last for old ages. As consumers are going more value witting, the banking industry will go more competitory. Banks have to vie on value of their services in order to acquire clients who are necessitating more transparence when taking merchandise. Greatly increased regulative inadvertence will curtail loaners and investing companies of all types. Alternative loaning beginnings will be used to a turning grade by little concerns and some consumers unable to acquire loans elsewhere. 2.Responses and remarks:Maybank has done the following in response to the macroenvironmental alterations. Deciding whether the response is appropriate or non, we need to see whether there are demands and wants for it, whether it is aiming the right group, whether there are points of difference, and whether Maybank would be more likely to make its end by executing the response. Offering a figure of nest eggs and investing history options such as the Gold Savings Passbook Account and Flexi Plan 2. This response is appropriate as it responded to growing in nest eggs and retirement programs. Furthermore, different options can provide to different group of people which will broaden the bank ‘s mark clients. Pioneering on-line nest eggs histories for the teenage market by developing the â€Å" imteen † history. â€Å" imteen † history is a good thought as through Multi-tiered involvement rate, Passbookless, Convenient ATM entree, Online entree, Free Personal Accident ( PA ) coverage, Academic Cash wagess, Maybank will pull parents who want their kids ( 12-18y ) to larn to pull off their finance with little hazard, and earn future clients. Establishing subdivisions throughout Asia part every bit good as the universe. As Maybank ‘s concerns are chiefly in South East Asia, it is non advisable for it to establish a batch of subdivisions outside Asia as it will non be profitable in the short tally. In add-on, since the universe is still in the shadow of crisis, Maybank should concentrate more on regain trusts from clients alternatively of spread outing its concerns rapidly. Developing the low-maintenance Premier Club history for â€Å" persons who are invariably on the spell † This response is appropriate since it satisfies the demands of people who are busy and in demand of current events and state of affairss. Offering its clients its scope of foreign currency histories which minimize the hazard of foreign exchange rate fluctuations. This action is appropriate as it sets clear targeted sections and attempts to fulfill their demands and wants of interchanging foreign currency easy and often. Offering a comprehensive scope of services that is accessible online while implementing the Transaction Authorisation Code system to make a more unafraid environment. These responses are evidently right as they meet clients ‘ demands and wants of doing minutess and other services online handily and safely. Offering many services accessible by cell phone. Using M-money to carry on services which is promoted to be unafraid and convenient. Maybank needs to be careful when implementing the engineering. Although nomadic banking makes banking services possible everyplace, there are still a batch of challenges. First, Maybank have to happen ways to fulfill clients with different nomadic phones since it is really hard for Bankss to offer nomadic banking solution on any type of device. Second, security of fiscal minutess, being executed from distant locations and transmittal over the air, need to be addressed jointly by nomadic application developers, radio web service suppliers and the Bankss ‘ IT sections. Third, another challenge for Maybank is to scale-up the nomadic banking substructure to manage exponential growing of the client base as Bankss unable to run into the clients ‘ increasing outlooks from the solution may lose client assurance.Other responses:Reacting to the altering attitudes and functions of work forces and adult females, Maybank should develop banking services catering to both genders. As indicated in the text edition, in Singapore, the United Overseas Bank launched a recognition card merely for ladies under the advertisement subject, â€Å" The Men Do n't Get It. † Maybank should spread out its female client group by supplying particular services like publicities on watering place, shopping, dining, and traveling and so on. The tendency of value consciousness leads to Maybank analysing the market more carefully. Maybe it should add low-fee recognition cards in response to this new orientation. In order to gain money and minimise the hazard when loaning, Maybank should seek to develop new ways to do loans to clients. For illustration, enabling loaning by and between members of loaning nines, or between friends and household. 3. Some of the macroenvironmental forces impacting other industries are the similar to those in the banking industry, while some are different.Similarities:For societal environment, demographic forces about affect every industry greatly. For illustration, age construction will act upon vesture industry by make up one's minding what manners of apparels to bring forth, and will impact nutrient industry on their scheme about what facet should they concentrate on, gustatory sensations, Calorie, or eating environment. It will besides impact computing machine industry by clients ‘ demands and wants altering among different age groups. With respect to economic forces, globalisation is an of import tendency. It has led to the rise of monolithic transnational nutrient processing companies, which frequently sell their nutrients under local names in local linguistic communications, after bring forthing them in regional mills worldwide. Due to globalisation, more and more local apparels trade names are known to the universe and design, production, and merchandising can be done in different states. The Computer industry is a genuinely globalized sector, where research, development and fabrication of constituents and systems have grown in the labs and fabrication workss of chiefly Asia states. When it comes to political environment, political hazards matter likewise to about all industries, as they need licences, protection for belongingss in foreign states, and turning away of societal agitation. In footings of engineering forces, about every industry is affected greatly nowadays. In vesture industry, the sweeping alteration in dress retailing is the lifting success of e-commerce which increases efficiency. Meanwhile, in nutrient industry, engineering has revolutionized the manner that we grow, conveyance, procedure, bundle, purchase and cook nutrient. There is no difference in banking industry as indicated above. Most significantly, engineering is indispensable to computing machine industry, non merely because of its ain development, but besides the other matching techniques such as Wi-Fi, and Internet contraptions.Differences:From my point of position, all macroenvironmental forces will impact all industries. The difference lies in to what widen they affect the industry. Some may be bantam and sellers do non necessitate to alter schemes, some may immense which force sellers to react. As for political environment, different Torahs impact otherwise to different industries. On one manus, Patent jurisprudence, copyright jurisprudence and other related Torahs are really of import to many industries as they give discoverers or author the right to protect their rational belongingss. It is particularly of import in computing machine industry, as the nucleus of InfoTech is creative activity and wisdom. Besides, in vesture industry, the increasing accent on right of first publication would forestall others from copying the design. However the consequence would non be so important in banking and nutrient industry. On the other manus, the Torahs and ordinances sing wellness are really important to nutrient industry. Sing societal forces, civilization plays an of import function in many industries. However, they may non be as powerful in banking industries as they are in other industries. For nutrient industry, people ‘s purchases of nutrient mostly depend on their eating wonts. However, as people are paying more attending to wellness and fittingness, it may necessitate to alter its focal point from gustatory sensation to take down Calorie or full nutrition. In vesture industry, civilization chiefly determines what a group of people would have on. Besides, as the addition concern on wellness, people have developed a acute involvement in athleticss dress and exercise cogwheel. On the other manus, for banking and computing machine industries, the consequence of civilization may non be that important.Deduction:Before doing determinations on market schemes, sellers should first transport out a careful environmental scanning analysing the chief forces that affect the industry significantly and t hat should concentrate on. It is besides advisable for sellers to detect all the other undistinguished forces in instance as the society develops, they become important adequate to impact the industry.