Chechnya and its People Essay examples -- War Europe Essays

Chechnya and its People The continuous common war between the semi-self-ruling republic of Chechnya and Russia has significantly grabbed the eye of the world †a world that sees the contention principally through the contorted focal point of Russian purposeful publicity, and the repudiating pictures of Chechen enduring on the free media. On the off chance that the West appears to be fair or even unconcerned with the Chechen clash, it is on the grounds that there is small comprehension of this individuals, of their battle, or of the immense complexities of the more prominent North Caucasian district where the Chechens are a section. This absence of comprehension stretches out to the cloudy Western view of the job of Islam in Chechen society. The expansive speculations that have been made by those in the media, by help associations, by the Russians, by Islamic gatherings, and by those in the American government are completely politicized misrepresentations which try to carry the center of the contention t o its most minimized shared factor. A significant number of the cases spin around Islam; yet, not many trouble to consider the more prominent character of Chechen society, or of the more extensive authentic extent of progress that Islam has followed in Chechnya. Regularly, Islam has changed in light of a Russian upgrade, yet a significant number of the Russian activities and reasons in this contention are very much reported. This investigation intends to dissect the Chechen job in the common war †and the job of Islam in Chechnya †instead of the Russian job, which has been broke down many occasions over. The North Caucasus It is hard for Englishmen to take a clever enthusiasm for the interior issues of Russia, attributable to the immense number of issues included, all of which rely on differing nearby conditions, and on the grounds that similarly not many of us, ev... ...I International Magazine. 16 Oct. 2003 <http://www.azer.com/aiweb/classifications/magazine/74_folder/74.articles/74_aliyev_collapse.html> 18. Menon, Rajan. â€Å"After Empire: Russia and the Southern ‘Near Abroad.’† The New Russian Foreign Policy. Ed. Micheal Mandelbaum. New York: Council on Foreign Relations, 1998. 100-167 19. Chechnya : Tombstone of Russian Power 20. Islam in Chechnya. 13 March 1998 Univ. of California, Berkeley. 15 Oct. 2003 <http://ist-socrates.berkeley.edu/~bsp/caucasus/bulletin/1998-06_walker.pdf> 21. Kagarlitsky, Boris. Russia Under Yeltsin and Putin. London: Pluto Press, 2002. 22. Russia Under Yeltsin and Putin 23. Russia : Islamic Countries Unlikely to Help Chechnya. 19 Nov. 1999 Radio Free Europe, 19 Oct. 2003 <http://www.rferl.org/> 24. Kagarlitsky, Boris. Russia Under Yeltsin and Putin. London: Pluto Press, 2002.

Serial Killer Research Paper Example | Topics and Well Written Essays - 500 words - 1

Sequential Killer - Research Paper Example There are numerous investigates done on the brain science of sequential executioners by different scientists everywhere throughout the world. It is astonishing to take note of that reasons for sequential murdering approach all the more regularly in western social orders when contrasted with eastern social orders. There are two primary approaches to explore about the brain science and considering sequential executioners. One is to consider comprehended cases by police and encounters of researching officials. Data gave based on proof and legitimate examination gives a decent method to do explore on the subject of sequential executioners or sequential murdering. In the event that open door is accessible one should attempt to meet/meet a sequential executioner. Contemplations of sequential executioners with respect to sex, generalization and mutilation are significant mental focuses that can be dissected during meeting and entire research (TRUTV; Vaknin). The vast majority of the sequential executioners feel that to murder and to be got slaughtered is one of the fundamental impulses that a human has. Early discovered skull of people had hints of being assaulted by some weapon. As per them, if chance accessible each individual would execute somebody. Sequential executioners are regularly viewed as individuals who accept that slaughtering is a piece of custom and considered as objectifiers. Objectifiers are the individuals who treat others as their subjects, the vast majority of the rulers, pioneers political or military are regularly viewed as individuals that have fallen in the classification of objectifiers (Vaknin). Distinction between straightforward homicides and sequential executioners can be clarified by a well established certainty. A basic killer slaughters because of certain necessities like sex, property, strife that exists between him/her and others. Then again the individuals called as sequential executioners are driven by consistent urge that is available in them from birth. Eric Hicky deduced in his examination that around forty eight percent of the sequential executioners accessible to him as subjects were denied by their folks as youngsters. The greater part of the sequential executioners live in their own universe of imagination

Physical Therapy Pathophysiology

Question: 1. Are the five components of patient administration incorporated into the contextual investigation? The five components are: Examination, Evaluation, Diagnosis, Prognosis, and Interventions. Clarify your answer. 2. Give a case of how each were exhibited or not, inside the data introduced for the situation study. 3. Look into substantial and instinctive torment. 4. What type or kinds of agony are distinguished in this investigation? (2pts) 5. Characterize alluded torment. What was the wellspring of agony for this situation? For what reason did the torment show itself in the gonad district? 6. In what manner can the data introduced for the situation report be of incentive to you as a physical advisor rehearsing in an immediate access setting? Answer: Indeed, the five components of patient administration that are assessment, assessment, analysis, visualization and mediations are incorporated into the given contextual analysis. Preceding his PT assessment, he was alluded to an orthopedic specialist and after reasonable assessment; he is alluded to PT for moderate administration. During the time of PT assessment various types of different inconveniences were discovered dependent on which appropriate analysis, guess, and intercessions were done. One month before the PT assessment, he was noted with a sharp right upper butt cheek torment followed by 1) right testicular agony and 2) back leg paresthesias. It was noticed that his side effects declined, and he was additionally given treatment by utilizing non-steroidal provocative prescriptions and was then given reference for an orthopedic specialist for the low back and butt cheek side effects. With different sorts of clinical conclusion, he was additionally alluded to PT for preservationist the executives on account of his proceeding back and right lower furthest point side effects. During the hour of assessment related with the PT, the patient was not having the option to situate appropriately and was likewise not having the option to run. He was likewise confronting exceptional torment and the testicular side effects with an incitement of dynamic, sharp developments into augmentation. After reasonable assurance, the patient was given proper traditionalist administration, wh ich falls under the analysis partition. During the conclusion time frame, he was dealt with multiple times by physical advisor for a quarter of a year with the fundamental goal for limiting the cutoff points on the spinal line and hip adaptability. During the fourth visit, it explicitly included thoracolumbar intersection and extending of hip, which thusly decreased the butt cheek torment and the testicular agony of the patient. Activation included evaluation IV focal and right one-sided that managed developments of the T-10 to L2 vertebrae along the foremost back course with sufficient reiterations. The determination additionally included extending of the psoas muscle by holding the patient in the level position that gave pelvic steadiness. During the staying eight visits, the treatment included distinguishing the limitations and the essential spotlight was on tending to the succeeding trunk and the lower edge quality. Utilizing a reasonable Stabilizer pressure gadget, decrease of the neuromascular torment for the lower abs was likewise actualized. The program of trunk decrease included activities for fortifying the physical exercises of the patient. At the point when improvement was found in the pelvic position, reinforcing of the storage compartment musculature that incorporated the impartial spine position was likewise presented that underlined further fortifying. Along these lines, different sorts of adjusted developments were performed by applying a medium thickness froth tangle. Physical agony alludes to the torment of the musculoskeletal framework (Labus et al., 2016). Since, the greater part of the nerve is related with the gracefully of drive to various sort of muscles, bones and other related tissues of the body it is a lot simpler to find the physical agony than the instinctive torment. The level of substantial torment is likewise serious. The physical torment condition that emerges in light of the substantial agony explicitly incorporates ceaseless back torment, pelvic torment, pelvic joint precariousness (Wegner et al., 2013). Substantial agonies can be either profound or shallow that especially emerges from different sorts of nociceptive receptors that stay present in the skin, films and various joints of the body. Instinctive torment alludes to the inside torment. It especially alludes to the agony that originates from veins and the different organs related with the body (Wegner et al., 2013). Instinctive torment causes the body to feel dull, unclear and might be more diligently to pinpoint (Cervaro, 2016). The regular sorts of instinctive torment incorporate prostate torment, bladder torment. It explicitly alludes to summed up pressing that is especially brought about by pressure in and around the organs. The kinds of agony distinguished in this investigation are: Sharp Right Upper Buttock Pain Hurting Right Testicular Pain Low Back Pain Alluded torment identifies with the agony that is seen at the other area instead of the site where the excruciating boost is delivered. The agony explicitly came about because of lower back wounds just as the wounds brought about by the muscle and the issues that are caused around the pelvis. The agony additionally rose in light of the impenetrable coat that he used to wear and the torment showed itself in the testicular area as a large portion of the torment was identified with his lower locale and therefore, the torment amassed in the testicular district The data will assist me with understanding the issues that remain related with the patient experiencing ventricular agony. It additionally incorporates better administration of the patients by understanding the state of the patient that the individual is experiencing and as a PT; it will help me in managing progressively exact and successful route with patients who has been determined to have different sorts back torment. Differential Diagnosis for Physical Therapists (Chapter-1) The three factors that make a requirement for screening are: Clinical Specialization With the expansion in the specialization of medication, the customer remains related with the assessment by a clinical advisor who isn't having the option to distinguish the reason for the malady or the authority may likewise accept that offering reference to the key consideration doctor has additionally been related with administering different causes. Movement of time and malady Specifically, instances of screening, determination of early signs and side effects of orderly illness gets testing and thus, it gets hard to distinguish until the sickness has advanced enough by making upsetting or observable indications. In specific cases, the patient and the customers logical introduction in the doctor office may likewise get unique, from which the examiner sees when the days separate the two arrangements. Therefore, for appropriate screening, it is essential to give time and comprehend with respect to the procedure of the illness that will help them in the better comprehension of the side effects. Persistent/Client Disclosure The patient customer divulgence is another significant factor that causes the specialist to think about the status of the wellbeing dependent on the social history that will help them in giving the present screening strategy. The substance of the reasonable discussions in this manner holds a fundamental screening piece of information from calling attention to the orderly ailment or the reason for the musculoskeletal or neuromuscular impedance. Answer to address 2 These days it is getting hard for the physical advisors to screen patients in this day and age in light of the way that now daily's PT runs in a deficiency of time and, thus, they skip in knowing the customer history. Therefore, right conclusion by the PT isn't made in light of the fact that the finding isn't done, and in this manner, data isn't extricated appropriately that will help them in the better comprehension of the patient's situation on the sort of malady from which the customer is languishing. The solid and the organized apparatuses are not contemplated nowadays in light of the fact that the physical specialists are not getting appropriate training that encourages them to the better comprehension of the patient's condition. As of late, the sorts of information that are created from a customer history are not additionally deciphered and therefore legitimate data about the social history and the other related variables are not taken as an appropriate result. Answer to address 3 The System Review is characterized as the compact or the inadequate assessment managing anatomic and the physiological status of the cardiovascular/aspiratory, musculoskeletal and neuromuscular frameworks. The System audit has likewise mulled over the assessment of the customers articulation that concentrated on capacity, comprehension, learning and language style. The System Review likewise helps in looking past the key issue that constrained the client to bring to the advisor in the principal moment. The System Review likewise encourages the specialists to respond to the inquiry appropriately. The Review of Systems then again shapes a piece of the screening procedure that fills in as a significant apparatus in perceiving the groups of signs and indications that remaining parts related with it. It is in this manner utilized as a compelling instrument that causes the advisors to think back and mull over of all the introducing factors that recommends that the customers issues is outside the ability to comprehend of the physical specialists practice. References Cervero, F. (2014). Pathophysiology of instinctive pain.Revista Dor,15(2), 133-138. Goodman, C. C., Snyder, T. K. (2013).Differential conclusion for physical advisors. Elsevier Health Sciences. Labus, J. S., Naliboff, B., Kilpatrick, L., Liu, C., Ashe-McNalley, C., dos Santos, I. R., ... Tillisch, K. (2016). Agony and Interoception Imaging Network (PAIN): A multimodal, multisite, cerebrum imaging storehouse for ceaseless substantial and instinctive torment disorders.Neuroimage,124, 1232-1237. Wegner, An., Elsenbruch, S., Maluck, J., Schedlowski, M., Benson, S. (2013). 150. Physical torment affectability during tentatively initiated irritation in humans.Brain, Behavior, and Immunity

Secret Facts About Short Essay Topics for 5th Graders Uncovered by an Old Pro

Secret Facts About Short Essay Topics for 5th Graders Uncovered by an Old Pro A seasoned professional will make an error-free assignment very quickly and can help you boost your grades. Everybody should have to exercise daily. Write about a day you want to forget. The school day needs to be shorter. Your class is likely to devote a day cleaning up at a neighborhood park. A minumum of one parent should work at home. Imagine your teacher is truly your parent. Persuade your sister or brother to aid you with your homework. Attempt to find something unusual to create your writing more effective. The very first thing you've got to realize searching for an ideal topic is that your opinion is the thing that matters the most. A dragon has produced a nest in a massive tree in your backyard, and the both of you have just started becoming friends. You still have to make an outstanding bit of writing. Short Essay Topics for 5th Graders: the Ultimate Convenience! Snow days are excellent for family quality time. Describe one vivid memory with that day. Write about your day in the life span of that individual. There are some straightforward guidelines to follow as a way to be in a position to compose an excellent persuasive essay. The value of research in persuasive writing can't be overstated. Persuasive essays are a fantastic means to encourage the reader to check at a particular topic in a different light. Always bear in mind an ideal persuasive essay ought to be persuasive. You, naturally, may opt to use one or more of these at whatever time you enjoy. If you are thinking about purchasing an item you will still have next calendar year, look at pulling out the card but you need to be careful. Write about what you believe you will be like and what you'll be doing 10 decades or 20 years from now. Imagine that you live either 100 years previously or 100 years later on. Therefore, you can take a simple topic and surprise everyone with your wide means of thinking and your individual values. Just be sure that it is something which you require, not just something which you desire in the brief term. When you're permitted to write about whatever you want, never rely on a person's thoughts about this issue you like as a pivotal criterion for your choice. Never miss an opportunity to discuss something you genuinely like or truly feel passionate about. Begin a list of questions which you'd love to have answered. Don't neglect to get a Kibin editor review your final paper to ensure it's on the right path. Before actually beginning to compose your essay, you need to choose an issue to write about. Okay, now you have the fundamentals about how to select an informative essay topic, let's dig into some fantastic ideas! In these instances, you need to compose an essay or report to go over your ideas about the subject. Possessing fantastic research abilities and selecting a superb topic is essential. Therefore, you've got to come across enough substantial evidence for the specific topic. Write down your ideas and ideas. How to Outline a Short Story Here's a handy way to check at these. Kids should have the ability to vote. Freedom of choice is excellent. Choosing our service, you will understand that studying can be simple if you gain from the help of capable experts. SATs ought to be eliminated. PaperCoach will be able to help you with all your papers, so take a look at the moment! School tests aren't effective. Pets should be permitted in school. Books should not be banned. Children should have the ability to use cellphones in school. They should be required to read more.

Asias Worst Natural Disasters

The Authoritarian Leadership Of A Authoritarian Leader

His behavior resulted in his creating shallow relationships with his executive peers, strong handing negotiations, and appearing arrogant. Had Jeff Shanley had a more guided approach to his leadership style, he may have been able to curtail the behavior and give Nick more of a purpose. As stands, the character of Nick himself held authoritarian leadership traits influenced by poor interpersonal relationships with his followers. This is expressed by Nick himself as he explains is has been a problem for him since college, â€Å"I can be sarcastic and rude at times, and sometimes I come across sounding like I think I’m smarter than everyone else† (Lencioni, 2007.) Despite this, his behavior alone is not enough to classify him as an authoritarian†¦show more content†¦By pursing the acquisition, Nick was expressing his need and individual thoughts for company greatness unilaterally outside of the other executive member’s thoughts and considerations. When conf ronted by the group facilitator, Nick reverts back to his self terminology saying, â€Å"I think it’s a good idea† (Lencioni, 2007.) Schuh et al (2013) relate authoritarian behavior to leadership â€Å"strive to maintain the distance† between leader and followers.† Referring back to the Hackman and Johnson (2015) authoritarian leadership, Nick Farrell also strives to modify some of his fellow executive board members’ behavior. In an intense conversation among the executive board about where the company’s priorities are dissected, Farrell called out Mikey for a lack of group minded behavior. This particular instance was both, an example of his authoritarian attributes, but also a turning point of growth for his leadership skills. Nick does react swiftly to his companion in an attested way digressing

Digital Communication Strategies for Bridge- myassignmenthelp.com

Question: Discuss about theDigital Communication Strategies for Bridge International. Answer: Introduction Many organizations in the world today have realized the benefit that a good communication system bears to the business and its operations in general. Good communication system refers to the one that makes it possible for the workers and the organization in a more efficient, fast and reliable way. Therefore, in this paper, I will write a report on the implementation of digital media particularly on the use of social media to communicate basing my report on an organization called Bridge international-a business consultant organization. This report aims at discussing various types of social media platforms used in the organization, its impact and my recommendations on the use of social media to communicate at the place of work. Discussion The use of social media in the place of work to communicate Social media refers to different avenues or platforms that people use to interact, communicate and share ideas with one another.Most of these social media platforms are informal in that everyone is included unless an organization sets up its own for official purposes.Use of social media to communicate has become the most common means of communication for in many organizations in the globe.One of such organizations being Bridge international company whereby the workers in different departments communicate across the department mainly through the use of social media. It has been found that this means of communication has found a great support by most workers in the organization since it appears to be simple and unique unlike the analog systems of communication.(Stark Crawford, 2015) Types of social media platforms The investigation found out that there are many different types of social media platforms used in the organization.They include instagram, watsapp,facebook pages and groups and twitter .Workers are connected on every platform by linking them on groups, creating facebook pages for the organization where all the workers will get updated on any new aspect that emerges within the organization and also the outside world.It was found out that the most utilized social media platform in the organization is watsapp.A large number of the staff demonstrated greater interest on watsapp more than on any other platform.(Derks Bakker, 2013) Reasons for the use of social media to communicate at Bridge international It was found out that the company had tried by all means to phase out the analog systems of communication and embrace digital systems particularly the social media as a means of communication in the organization. There were many reasons found during the investigation as to why the company preferred to use social media over other digital communication systems. Convenience The very first reason is the convenience of the means.It was found out that social media is the most convenient platform to use. This is because, unlike other systems where the communication devices need to be supplied by the organization, social media devices can be acquired by individuals and even owned individually without any difficulty. It is also convenient to carry around most of social media communication devices unlike other bulky, immobile devices used in the analog era. Examples of such devices include mobile phones and computers .The communication system was also found to be convenient in terms of the time taken to deliver information.For instance whenever a message is posted on facebook, whatsapp group and instagram it reaches the recipient within the shortest time possible irrespective of time and the location of the recipient. Affordability .Secondly is the affordability of the devices used in social media to communicate. The social media devices are the cheapest means compared to other devices .It was also found out that they are the simplest devices ever that one can own.The organization can also facilitate with ease the use of these devices for example, Bridge international company offers free Wi-Fi networks, computers and other communication gadgets to its workers. Therefore, the company chose to embrace this new system of digital communication since it was not much expensive to the organization and its workers (Vaast Kaganer, 2013) Age factor It was also found out that most of the workers in the organization are young people who in most cases are available on social media and therefore prefer that the company uses it in communication. This indicated that all and if not all most of the young generation have embraced the new technological changes and shift from the analog ones. Impacts of Use of Social Media to Communicate in Place of Work As much as the positive impacts of use of social media to communicate at place of work may seem conspicuous, we cannot overlook on its adverse effects(McFarland, 2014) .It was found out that if not regulated, social media can be harmful in that most workers may overspend time in social media at the expense of work .This is due to the enticing and adventurous nature of the social media Conclusion According to the report therefore, it is evident that implementation of digital media in business is becoming real .In particular, this has been mostly witnessed in communication sector where most organization are shifting from the analog system to the modern digital systems(Walden, 2016).The main reason for the shift is that organizations and individuals have realized the advantages of the new technology over the old ones.The idea also has been fully promoted by the young people who are well versant with the modern technology.However, as much use of social media may be the most used communication channel, it also has its adverse effects on the workers and the organization also.Therefore, just like any other communication channels, social media should have regulations regarding its uses (Bucher, Fieseler Suphan, 2013) Recommendation According to the findings in the report, it is therefore recommended that organizations should embrace digital communications in business since it is the most convenient system of communication. It is also recommended that workers should be keen on time spent in social media to avoid overindulgence. It is recommended that employers and organizations should come up with policies on the use of social media to help their workers use the channels rightfully and also protect their privacy References Walden, J. (2016). Integrating Social Media into the Workplace: A Study of Shifting Technology Use Repertoires. Journal of Broadcasting Electronic Media, 60(2), 347-363. https://dx.doi.org/10.1080/08838151.2016.1164163 McFarland, V. (2014).Workplace Communication Quality.SSRN Electronic Journal.https://dx.doi.org/10.2139/ssrn.2827217 Bucher, E., Fieseler, C., Suphan, A. (2013).THE STRESS POTENTIAL OF SOCIAL MEDIA IN THE WORKPLACE. Information, Communication Society, 16(10), 1639-1667. https://dx.doi.org/10.1080/1369118x.2012.710245 Stark, L., Crawford, K. (2015). The Conservatism of Emoji: Work, Affect, and Communication. Social Media + Society, 1(2), 205630511560485. https://dx.doi.org/10.1177/2056305115604853 Vaast, E., Kaganer, E. (2013). Social media affordances and governance in the workplace: An examination of organizational policies. Journal Of Computer-Mediated Communication, 19(1), 78-101. https://dx.doi.org/10.1111/jcc4.12032 Derks, D., Bakker, A. (2013).The psychology of digital media at work.Hove, East Sussex: Psychology Press.

Best Decision free essay sample

â€Å"I have something to tell you guys.† My father brought up a new subject while I and my sister were having a dinner. I was hoping he would talk something humorous. â€Å"We will go to Thailand and there is no Japanese high school.† he insisted. After a while these words were circling my brain. No Japanese high school? How come? How can we study then†¦? While my brain was virtually full of these questions, he whispered, â€Å"International school† This word was absolutely fresh for me and made me perplex. Consequently I asked my father what kind of school it is and he introduced me it is a school that involve foreigners. â€Å"Do they speak Japanese?† I inquired. â€Å"No!† He returned. At once I was shocked and blamed him. Since he knew English was my weakest subject, he let me enroll to the International school. Moreover, before he informed me about that, I would like to take a course that is no connection with English because I had no sen se of English at all. We will write a custom essay sample on Best Decision or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Furthermore, I did not want to go far away from my friends because I did not feel lonely at anytime. Hence, I began to afraid of my near future. It was a first semester of grade nine; everyone started to think about their high school live. Therefore, my homeroom teacher made an appointment with each student to know which school they want. When my turn was come I launched to inform him what I would do after graduate. But suddenly he wedged my voice. â€Å"Are you sure that you will go to Thailand?† he asked me with a doubt. â€Å"Yes!!† I answered him with a no hesitation. â€Å"What about school?† he gave another question so I promptly replied him, â€Å"well†¦ after graduate this school I planning to enroll to the international school in Thailand.† As I responded his face began to cloud by embarrassment. â€Å"I think it is better to talk with your English teacher.† he said hurriedly and led me take to the school office. I was waited for my English teacher, Tap! Tap! I heard the sound of high heels was approaching. â€Å"Clack!† door was open and teacher walked heading to me. â€Å"Tell me your problem† she inquired to me. I told my plan and asked her, â€Å"May I have extra help from you for preparing my high school.† Then she replied me. â€Å"OK† and said, â€Å"Anytime you have a free at after school come to my class.† and she added, â€Å"Good for you!! English would be necessary for your future and it was a time you make yourself to be advantage.† Her expression were encouraged me. It was first time that I confided my high school plan to someone. I was thinking they would laugh at me. However, they are always boosted and encouraged me. Last day of the school she said to me, â€Å"Your English skill are improving so only thing that you need is don’t give up and try hard to everything as you can.† When I heard her assert it made me motivated therefore I decide d to go to school in Thailand and enrolled to the international school. First day at international school, I had some confidence because I had extra help from my English teacher. Everything was new and different from Japanese school and I was exited for this new environment. I set on the chair and waited for what would teacher say next. But soon I noticed that I totally could not understand what teacher said before. There was no more than me who reminded sitting on the chair. I realized that I interpreted by my way. At that time lose my confident and started feel embarrassment. When I went back to home and heading to my room I could not refrain from tears. As I tasted my tears I recalled my teacher’s expression and that was helped me to feel calm and stopped my tears. I was bent on do not give up to studying English. From that moment changed my consciousness for English and gave me high motivate for studying English. I was afraid to being alone in the class so I stay with a lien. It was a first year of my international school life. I stay with foreigner friends even I did not understand the English and tried to listen what my friends talked about. Everyday I set on next to them and just listen what they talk about. One day at canteen when I tried to bay a water one Thai girl came to me and asked me, â€Å" What you want?† then I replied her, â€Å" I want water.† this time I realized that I understand the English and also it was a first time I used English. As I please myself she said, â€Å"Oh!! You speak English, it was a first time I hear your voice.† And she introduces herself and gave me a high-five and to me. From this experience I enjoy to speak English and conquest about awareness for weak point with English. For this experience shows me that it was good choice that I came to Thailand and study in International school because now English is one of my talent and I like English. Therefore, now I have a future goal that is to get a job which is using English. Furthermore, I became hard worker and self-direct-learner by learning English because by using English I study a lot of vocabulary and grammar by myself. I think it was a best decision that I make in my life and must be best pride experience.

Get a Certified Copy of Your Birth Certificate

Get a Certified Copy of Your Birth Certificate A certified copy of an original birth certificate is becoming increasingly important as a required form of identification. A certified birth certificate copy is required for getting a US passport and when applying for Social Security benefits. It is also  considered valid proof of US citizenship by federal, state and local government agencies. A birth certificate may be required when applying for some jobs and may, in the future, be required when getting or renewing a drivers license. Best to Get a 'Certified' Copy of Your Birth Certificate In most cases, a simple photocopy of your original birth certificate will not be considered as a sufficient form of identification. Instead, you will be required to have a certified copy of your birth certificate issued by the state in which your birth was recorded.   A certified copy of a birth certificate has an official state registrars raised, embossed, impressed or multicolored seal, registrars signature, and the date the certificate was filed with the registrars office, which must be within one year of the persons date of birth. NOTE: A certified  copy of the applicant’s birth certificate is required when applying for the Transportation Safety Administration’s (TSA) popular  PreCheck  program, which allows members to pass through the security lines at more than 180 airports without needing to remove their shoes, laptops, liquids, belts, and light jackets. The importance of having a certified copy of your birth certificate should never be understated. Indeed, in the United States, it is considered the Holy Grail of proof of identity. Certified copies of birth certificates are one of the four vital records (birth, death, marriage, and divorce) that can be used to prove U.S. citizenship. How to Get a Certified Birth Certificate The federal government does not provide copies of birth certificates, marriage licenses, divorce decrees, death certificates, or any other personal vital records. Copies of birth certificates and other personal vital records can only be obtained from the state or US possession where the documents were originally filed. Most states provide a centralized source from which birth certificates and other vital records can be ordered. Each state and US possession  will have its own set of rules and fees for ordering certified birth certificates on other vital records. Rules, ordering instructions and fees for all 50 states, the District of Columbia and all US possessions can be found on the Where to Write for Vital Records web page, helpfully maintained by the US Centers for Disease Control. Do Not Order the 'Abstract' Version When ordering, be aware that shortened (abstract) versions of birth certificates offered by some states may not be acceptable when applying for a US passport, drivers license, Social Security benefits or many other purposes. Be sure to order only the full, certified copy of the original birth certificate bearing the registrars raised, embossed, impressed or multicolored seal, registrars signature, and the date the certificate was filed with the registrars office. If You Need to Replace Your Original Birth Certificate In some cases, you may need to replace your original birth certificate. Find the website of the vital records office in the state where you were born and follow their walk in, write in, or online application instructions. You will probably need a state-issued form of photo ID, like driver’s license. If you don’t have a state-issued photo ID, call and see what options may be available. One solution some states offer is to have your mother or father whose name is on the birth certificate submit a notarized letter with a copy of their photo ID for the request.

The Articles of Confedration Essay Example | Topics and Well Written Essays - 2000 words

The Articles of Confedration - Essay Example The Articles of Confederation served as the actual system of government which was used by the Congress till the time it became de jure by final sanction in the year 1781. It was then that the Congress became the Congress of the Confederation at that time. The Articles of Confederation basically prescribed the rules that went in the different operations of the US Confederation. What these Articles of Confederation did were to plan different issues like the aspects of discussing war and ordering the army to go ahead with the attack processes, negotiating different matters pertaining to diplomatic agreements and the like as well as resolving the problems that came in the way of the western territories and this indeed was a huge issue if seen in the proper contexts. Also what the Articles of Confederation did was to undertake proper measures which could understand the borrowing aspects related with the inside and outside of US that were taking place. There were some criticisms as well which came in the way of the Articles of Confederation. One such was that the critics raised different viewpoints in the wake of the creation of a mighty central state as it was thought of to be lacking a taxing authority and related basis. Thus the role of the federal government in such a situation is to ask for more and more funds from the different states. Then there was another ambiguity in the form of a concern that the one-state, one-vote aspect was somewhat mind-boggling to state the least and it created problems for the Articles of Confederation’s basis by all measures and means. There needed to be a change within the relevant basis so that the Articles of Confederation could be thought of as being pretty easier and less ambiguous than anything else. The larger states were requested to offer more than what the smaller states had to give at the end of the

Psychology in Practice Essay Example | Topics and Well Written Essays - 1500 words

Psychology in Practice - Essay Example Others have mentioned the idea of similarity and relatedness, indicating that a person is more likely to help another based on a genetic appraisal of the situation and the desire to help those of his or her specific gene pool. Another prosocial idea is that persons behave according to the theory of reciprocal altruism, in which persons help others in the expectation of receiving something in return. Persons might also help others when faced with guilt or the need to repay a good deed that was previously done to them. This is known as guilt or reparative altruism (Wetering). On the other hand, situations exist in which persons might not be inclined to help. Situations of moralistic aggression may arise, in which people feel that others are taking advantage of their altruistic tendencies, and in such cases they might not be inclined to help. Such is often the case in larger cities where cheaters are apt to exist. Subtle cheating and mimicry abound, through which people might pretend to be in distress in order to elicit altruistic behaviour. Such situations are likely to cause moralistic aggression to arise in persons as a protective mechanism (Wetering). The social setting also determines the type of behaviour one can expect from a person. According to the Darley and Latanà © study done in 1968, a person is more likely to help another if he or she is the only available helper in the situation. This theory is akin to others concerning crowds. Areas that are crowded or busy tend to contain people who are less likely to help in a dire situation. This might be due to their being in a hurry or it might hinge on the idea that crowds or busier areas are more likely to contain opportunistic persons. In such cases patterns might also obtain so that despite such variables as cultural or societal norms, in a crowd, the bystander

Summary The Health Care Quality Book Essay Example for Free

Summary The Health Care Quality Book Essay Chapter 1: science and knowledge foundation Two notable contributions to the industry from the Journal of American Medical Association: 1. Assessment of the state of quality ïÆ'   serious and widespread quality problems 2. Categorization of three defects: a. Underuse: many scientifically sound practices are not used as often as they should be b. Overuse: can be seen in areas such as imaging studies for diagnosis in acute asymptomatic low back pain or prescription of antibiotics when not indicated for infections. c. Misuse: when the proper clinical care process is not executed appropriately, such as giving the wrong drug to a patients. To Err Is Human: publication that shows the severity of the quality problems in a way that captured the attention of all key stakeholders for the first time ïÆ'   this report spoke about the negative, not how it should be improved. Crossing the quality chasm: provided a blueprint for the future that classified and unified the components of quality through six aims for improvement, chain of effect and simple rules for redesign of health care. Six dimensions of quality (Berwick): Outcome measures and goals (IOM) = Institute of Medicine’s Safe Percentage of overall mortality rates/patients experiencing adverse events or harm Effective: science and evidence should be applied and serve as the standard for delivery of care. How well are evidence based practices followed? Percentage of time diabetic patients receive all recommended care at each doctor visit.. Efficient: Care and service should be cost effective, and waste should be removed. Analyzing the costs of care by patient, organization, provider or community Timely: no waits or delays in receiving care Measured by waits and delays in receiving needed care, service, and test results. Patient centered: system should revolve around the patient, respect its preferences and put the patient in control Patient or family satisfaction with care and service Equitable: Disparities should be eradicated. Examining differences in quality measures by race, gender, income or other factors. The underlying framework for achieving these aims depicts the health care system in four levels: Level A: what happens with the patient Level B: the micro system where care is delivered by small provider teams Level C: organizational level: the macro system or aggregation of the Microsystems and supporting functions. Level D: external environment where payment mechanisms, policy and regulatory factors reside (verblijven) Chapter 2: Basic concepts of health care quality The following attributes relevant to the definition of quality of care are important: Technical performance ïÆ'   refers to how well current scientific medical knowledge and technology are applied in a given situation (it is usually assessed in terms of timeliness and accuracy of the diagnosis, appropriateness in of therapy) Management of the interpersonal relationship ïÆ'   refers to how well the clinician relates to the patient on a human level. The quality of this relationship is important because: By establishing a good relationship with the patient the clinician is able to fully address the patient’s concerns, reassure the patient and relieve the patient’s suffering It can affect technical performance: the clinician is better able to elicit from that patient are more complete and accurate medical history, which can result in a better diagnosis Amenities (voorzieningen) ïÆ'   refers to the characteristics of the setting in which the encounter between patient and clinician takes place, such as comfort, convenience and privacy. Amenities are valued both in their own right and for their effect on the technical and interpersonal aspects of care. Amenities can yield (opleveren) benefits that are more indirect. Access ïÆ'   refers to the degree to which individuals and groups are able to obtain needed services. Responsiveness to patient preferences ïÆ'   respect for patients’ values, preferences and expressed needs affects quality of care as a factor in its own right. Equity ïÆ'   the amount, type or quality of health care provided can be related systematically to an individual’s characteristics, particularly race and ethnicity, rather than to the individual’s need for care or healthcare preferences, have heightened concern about equity in health care. Medicine does not fulfill its function adequately until the same perfection is within the reach of all individuals. Efficiency ïÆ'   refers to how well resources are used in achieving a given result. Cost-effectiveness ïÆ'   how much benefit, typically measured in terms of improvement in health status, the intervention yields for a particular level of expenditure. For each stakeholder in health care, quality can be differently defined: page 30 + 31. These definitions have a great deal in common: Each definition emphasizes different aspects of care Definitions conflict only in relation to cost-effectiveness All evaluations of quality of care can be classified in terms of one of the three aspects of caregiving they measure: Structure: when quality is measured in terms of structure, the focus is on the relatively static characteristics of the individuals who provide care and of the settings where the care is delivered. These characteristics include the education, training and certification of professionals. Process: refers to what takes place during the delivery of care, also can be the basis for evaluating quality of care. Outcomes: Outcome measures, which capture whether healthcare goals were achieved, are another way of assessment of quality of care. Outcome measures have to include the costs of care as well as patients’ satisfaction with care. Which one is better to use? ïÆ'   none of them, all depends on the circumstances. To assess quality using structure, process or outcome measures, we need to know what constitutes good structure, good process and good outcomes. We need criteria and standards we can apply to those measures of care: Criteria = specific attributes that are the basis for assessing quality Standards = express quantitatively what level the attributes must reach to satisfy preexisting expectations about quality. For example ïÆ'   type of measure: structure and focus on primary care group practice: Criterion: percentage of board-certified physicians in internal or family medicine – Standard: 100% of physicians in the practice must be board certified in internal or family medicine. Optimal standards: denote the level of quality that can be reached under the best conditions, typically conditions similar to those under which efficacy is determined ïÆ'   useful as reference point. Structural measures are well suited to detecting lack of capacity to deliver care of acceptable quality. They are also only as good and useful as strength of their relation to desired processes and outcomes. To evaluate structure, process and outcome measures criteria and standards are essential. Whereas the formulation of criteria is expected to be evidence driven (efficacy). The setting of standards is not similarly tied to scientific literature. The decision to set standards at a minimal, ideal or achievable level is most meaningful if driven by the goals behind the specific quality of care evaluation for which the standards are to be used. Chapter 3: Variation in medical practice and implications for quality Variation ïÆ'   the difference between an observed event and a standard or norm. Without this standard, or best practice, measurement of variation offers little beyond (biedt niet meer dan) a description of the observations. Random variation = physical attribute of the event or process, adheres to the laws of probability and cannot be traced to a root cause. (houdt zich aan de wetten van waarschijnlijkheid en kan niet worden herleid tot een oorzaak). It is not worth to study it in detail. Assignable variation = arises from a single or small set of causes that are not part of the event or process and therefore can be traced, identified, and implemented and eliminated ïÆ'   subject to potential misunderstanding because of complexity of design and interpretation. 1. Process variation = the difference in procedure throughout an organization (use of various screening methods for colorectal cancer) Technique ïÆ'   multitude of ways in which a procedure can be performed within the realm of acceptable medical practice. 2. Outcome variation = difference in the result of a single process (mostly focus on this measure) the process yielding optimal results ïÆ'   outcomes research 3. Performance variation = the difference between any given result and the optimal ideal result. This threshold or best practice is the standard against which all other measurements of variation are compared. Performance variation tells us where we are and how far we are from where we want to be, and suggests ways to achieve the desired goal. Variation can be desirable? ïÆ'   a successful procedure that differs from other, less successful procedures is by definition variation. The objective then for quality improvement is not simply to identify variation but to determine its value. How can the variation be eliminated or reduced in the ways that focus on the variation rather than on the people involved? So, understanding the implications for quality of variation in medical practice is not simply learning how eliminate variation but learning how to improve performance by identifying and accommodating good or suboptimal variation from a predefined best practice. Variability plays a role in identifying, measuring and reporting quality indicators (effective, efficient, equitable..) and process-of-care improvements. Some hospitals are reluctant to use quality improvement measures (they perceive them as biased towards academic medical research centers or large health care organization) ïÆ'   untrue! Quality improvements efforts can be and have been successfully applied to small organization and practices. The size of an organization also effects the ability to disseminate (verspreiden) best practices. Large organization tend to have rigid frameworks or bureaucracies; change is slow and requires perseverance (doorzettingsvermogen) and the ability to make clear to skeptics and enthusiasts the value of the new procedure in their group and across the system. An organization ‘s commitment to paying for quality improvement studies and implementation is equally affected by its size and infrastructure, but there are some minimum standard levels of quality and linked reimbursement schemes to achieving goals established by the Joint Commission, CMS and Medicare ïÆ'   all organizations obligated to meet these standards. Quality improvement effort must consider organizational mind-set, administrative and physician worldviews, and patient knowledge and expectations. Physician buy-in is critical to reducing undesired variation or creating new and succesfull preventive systems of clinical care, therefore: training physician champions and inciting (aanzetten) them to serve as models, mentors and motivators and it reduces the risk of alienating (vervreemden) the key participants in quality improvement efforts. Patient education in quality of care is equally subject to variation; patients are aware of the status of health care providers in terms of national rankings, public news of quality successes and so on. Educating patients about a health care organization and its commitment to quality makes variation and process-of-care measures available to the public. Organizational mind set ïÆ'   organizational infrastructure is an essential component in minimizing variation, disseminating best practices and supporting a research agenda associated with quality improvements. Economic incentives may be effective in addressing variation in health care by awarding financial bonuses to physicians and administrators who meet quality targets or withholding bonuses from those who do not. Goals of incentives: to help people understand that their organization is serious about implementing quality changes and minimizing unwanted variation to ensure alignment with national standards an directions in quality of care and to encourage them to use the resources of the organization to achieve this alignment . Chapter 4: Quality improvement: the foundation, processes, tools and knowledge transfer techniques Different leaders of quality improvement systems: page 63 – 67 Quality improvement approaches (derivatives and models of the ideas and theories developed by thought leaders): PDCA/PDSA, Associates for Process Improvement’s Model for Improvement, FOCUS PDCA, Baldrige criteria, ISO 9000, Lean, Six Sigma. PDCA/PDSA cycle Basis for planning and directing performance improvement efforts. 1 Plan: Objective: what are you trying to accomplish? What is the goal? Questions and predictions: What do you think will happen? Plan to carry out the cycle: Who? What? When? Where? 2 Do Educate and train staff Carry out the plan (try out the change on a small scale) Document the problems and unexpected observations? Begin analysis of the data 3 Study/Check Assess the effect of the change and determine the level of success as compared to the goal/objective Compare results to predictions Determine what changes need to be made and what actions will be taken next 4 Act Act on what you have learned Determine whether the plan should be repeated with modifications or a new plan should be created Perform necessary changes Identify remaining gaps in process or performance Carry out additional PDCA/PDSA cycles until the agreed-upon goal or objective is met API improvement model Simple model for improvement based on Deming’s PDSA cycle. The model contains three fundamental questions that form the basis of improvement: What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will results in improvement? FOCUS/PDCA model Building on de PDCA cycle the FOCUS PDCA model is created: more specific and defined approach to process improvement. The key feature of this model is the preexistence of a process that needs improvement. The intent of this model is to maximize the performance of a preexisting process, although the inclusion of PDCA provides the option of using this model for new or redesign process. F: FIND a process to improve O: ORGANIZE a team that knows the process C: CLARIFY current knowledge of the existing or redesigned process U: UNDERSTAND the variables and causes of process variation within the chosen process S: SELECT the process improvement and identify the potential action for improvement Baldrige criteria The criteria can be used to assess performance on a wide range of key indicators: health care outcomes; patient satisfaction; and operational, staff and financial indicators. The Baldrige healthcare criteria are built on the following set of interrelated core values and concepts (page 70). The criteria are organized into seven interdependent categories: Leadership Strategic planning Focus on patients, other customers, and markets Measurement, analysis and knowledge management Staff focus Process management Organizational performance results Baldrige’s scoring system is based on a 1000 point scale. Each of the seven criteria is assigned a maximum value ranging from 85 to 450 maximum points. The most heavily weighted criterion is the results category (450). The weight of this category is based on an emphasis Baldrige places on results and an organization’s ability to demonstrate performance and improvement in the following areas: Product and service outcomes, customer-focused outcomes, financial and market outcomes, workforce-focused outcomes, process effectiveness outcomes, leadership outcomes. ISO 9000 The international Organization for Standardization (ISO) issued the original 9000 series of voluntary technical standards in 1987 to facilitate the development and maintenance of quality control programs in the manufacturing industry. In 2000, ISO made major changes to the standards to make them more relevant to service and health care settings. Focused more on quality management systems, process approach, and the role of top management, the most recent standards include eight common quality management principles: Customer-focused organization Leadership Involvement of people Process approach System approach to management Continual improvement Factual approach to decision making Mutually beneficial supplier relationships Lean thinking Lean ïÆ'   to describe production methods and product development that, when compared to traditional mass production processes, produce more products, with fewer defects, in a shorter time. The focus of Lean methodology is a ‘back to basics’ approach that places the needs of the customer first through the following five steps: 1. Define value as determined by the customer, identified by the provider’s ability to deliver the right product or service at an appropriate price. 2. Identify the value stream: the set of specific actions required to bring a specific product or service from concept to completion 3. Make value added steps flow from beginning to end 4. Let the customer pull the product from the supplier, rather than push products 5. Pursue perfection of the process Six sigma The aim of six sigma is to reduce variation (eliminate defects) in key business processes. By using a set of statistical tools to understand the fluctuation of a process, management can predict the expected outcome of that process. Six sigma incluses five steps, commonly known as DMAIC: Define: Identify the customers and their problems. Determine the key characteristics important to the customer along with the processes that support those key characteristics. Identify existing output conditions along with process elements. Measure: Categorize key characteristics, verify measurement systems and collect data Analyze: Convert raw data into information that provides insights into the process. These insights include identify the fundamental and most important causes of the defects or problems. Improve: Develop solutions to the problem, and make changes to the process. Measure process changes and judge whether the changes are beneficial or another set of changes is necessary. Control: If the process is performing at a desired and predictable level, monitor the process to ensure that no unexpected changes occur. The primary tool of six sigma is that focus on variation reduction will lead to more uniform process output. Secondary effects include less waste, less throughput time and less inventory. Quality tools: three categories (also six categories distinguishing on page 74) Basic quality tools Control chart: upper and lower control boundaries that define the limits of common cause variation. It is used to monitor and analyze variation from a process to determine whether that process is stable and predictable or unstable and not predictable Histogram Cause-and-Effect/Fishbone diagram: the problem is stated on the right side of the cart, and likely causes are listed around major headings that lead to the effect. It can help organize the causes contributing to a complex problem. Pareto chart: 80% of the variation of any characteristic is caused by only 20% of the possible variables. Management and planning tools (75) Affinity diagram: a list of ideas is created, and then individual ideas are written on small note cards. Team members study the cards and group the ideas into common categories. The affinity diagram is a way to create order of a brainstorm session. Matrix diagram: helps us to answer two important questions when sets of data are compared: Are the data related? How strong is the relationship? Priorities matrix: uses a series of planning tools built around the matrix chart. Other quality tools Benchmarking: compares the processes and successes of you competitor of similar top-performing organizations to your current processes to define, through gap analysis, process variation and organizational opportunities for improvement. Benchmarking defines not only organizations that perform better but also how they perform better. Failure mode and effect analysis: examines potential problems and their causes and predicts undesired results. FMEA normally is used to predict product failure form past part failure, but it also can be used to analyze future system failures ïÆ'   both in patient safety toolbox. 5S: is a systematic program that helps workers take control of their workspace so that is actually works for them instead of being a neutral or, as is quite common, competing factor. Sort: means to keep only necessary items Straighten: means to arrange and identify items so they can be easily retrieved when needed. Shine: means to keep items and workspaces clean and in working order Standardize: means to use best practices consistently Sustain: means to maintain the gains and make a commitment to continue the first four S. Theory of Transfer of Learning ïÆ'   page 77 Rapid cycle testing/improvement Developed by IHI, rapid cycle testing/improvement was designed to create various small tests involving small sample sizes and using multiple PDSA cycles that build on the lessons learned in short period while gaining buy-in from staff involved in the change. It is designed to reduce the cycle time of new process implementation from months to days. Read 78/79/80/81 Chapter 5: Milestones in the quality measurement journey Many health care providers struggle to address the measurement mandate proactively, which leads organizations to assume a defensive posture when external organizations release the data. In such cases, the provider usually responds in one of the following ways: data are old, data are not stratified and do not represent appropriate comparisons, our patients are sicker than those in other hospitals. A more proactive posture would be to develop an organization-wide approach to quality measurement that meets both internal and external demands. This approach is not a task, but a journey that has many potential pitfalls and detours. Key milestones exist that mark your progress and chart your direction. Milestone 1: Develop a measurement philosophy (strategic step): What is/should be the role of performance measurement in the organization? Should it be done periodically or a day-to-day function? The first step toward this milestone should be the creation of an organizational statement on the role of measurement. Three simply questions should be explored when developing a measurement philosophy: 1. Do we know our data better than anyone else does? 2. Do we have a balanced set of measures that encompasses clinical, operational, customer service and resource allocations? 3. Do we have a plan for using the data to make improvements? Milestone 2: Identify the concepts to be measured (types and categories of measures) (strategic and operational step) The second milestone consists of deciding which concepts the organization wishes to monitor. There are three basic categories of measures: structure (s): represents the physical and organizational aspects of the organization processes (p): every activity, every job, is part of a process. outcomes (o): structure combine with processes to produce outcomes. The relationship between these categories usually is shown as follows: s + p = o Another categorization that can be made is (more specific) according to the six aims for improvement: 1 Safe, 2 Effective, 3 Patient centered, 4 Timely, 5 Efficient, 6 Equitable Regardless of the method used, an organization must decide which concepts, types, or categories of measures it wishes to track. Milestone 3: Select specific measures What aspect of (patient safety) do we want to measure? What specific measures could we track? Choose a specific indicator In this step you need to specifying what aspect of for example patient safety you intend to measure and the actual measures. Within the patient safety, you could focus on medication errors, patient falls, wrong site surgeries etc. Within the medication error you can measure different things: number of medication orders that had an error, total number of errors caught each day, percentage of orders with an error etc. Milestone 4: Develop operational definitions for each measure An operational definition is a description, in quantifiable terms, of what to measure and the specific steps needed to measure it consistently. A good operational definition: Gives communicable meaning to a concept or an idea Is clear and unambiguous Specifies the measurement method, procedures and equipment Provides decision-making criteria when necessary and Enables consistency in data collection The problem created by poor operational definitions should be obvious: if you do not use the same operational definition each time you record and plot data on a chart, you will either miss a true change in the data or think a change has occurred when in fact one has not. Using the same operational definition becomes even more critical if you are trying to compare several hospitals or clinics in a system. Milestone 5: Develop a data collection plan and gather data (giving special consideration to stratification and sampling) Direct start with data collection may cause teams to collect the wrong data in the wrong amounts. The data collection phase consists of two parts: Planning for data collection: what process will be monitored? What specific measures will be collected? What are the operational definitions of measures?.. The actual data gathering: how will you collect the data? Will you conduct a pilot study? Who will collect the data? (page 94) Once you have resolved these issues, the data collection should go smoothly. Sometimes improvement teams do not spend enough time on data collection plans. This can lead to the following problems: (1) collect too much, or too little data (2) collect the wrong data (3) become frustrated with the entire measurement journey. Consequences can be: the team tends to (1) distort (verdraaien) the data (2) distort the process that is produced the data or (3) kill the messenger. Two key data collection skills – stratification and sampling enhance any data collection effort. Stratification = the separation and classification of data into reasonably homogeneous categories. The objective of stratification is to create strata, or categories, within the data that are mutually exclusive and facilitate discovery of patterns that would not be observed if the data were aggregated. Stratification allows understanding of differences in the data caused by different factors (page 95). If you do not think about how these factors could influence your data you run the risk of making incorrect conclusions and having to filter out the stratification effect manually after you have collected the data. Sampling (steekproef) ïÆ'   the most important thing you can do to reduce the amount of time and resources spent on data collection. There are four conditions for developing a sampling plan: accuracy, reliability, speed and economy. Sampling consists of a series of comprom ises and trade-offs. The basic purpose of sampling is to be able to draw a limited number of observations and be reasonably confident that they represent the larger population from which they were drawn. There are two basic approach to sampling: Probability sampling techniques: based on statistical probability (systematic sampling, simple random sampling, stratified random sampling, stratified proportional random sampling) Non-probability sampling techniques: should be used when estimating the reliability of the selected sample or generally applying the results of the sample to larger population is not the principal concern. The basic objective is of this type of sampling is to select a sample that the researchers believe is typical of the larger population. (convenience sampling, quota sampling and judgement sampling) 99-102 Milestone 6: Analyze the data using statistical process control methods (especially run and control charts) Translate data into information. Milestone 7: Use the analytic results to take action (implement cycles of change, test theories and make improvements) Chapter 6: Data collection Quality measurements can be grouped into four categories: Clinical quality Financial performance Patient satisfaction Functional status To report on each of these categories, several spate data sources may be required. The challenge is to collect as much data as possible from the fewest sources with the objectives of consistency and continuity in mind. Retro prospective data collection: involves identification and selection of a patient’s medical record or group of records after the patient has been discharged. Prospective data collection: relies on medical record review, but it is completed during a patient’s hospitalization or visit rather than retrospectively. Disadvantage: time consuming and can distract nurse from their direct patient care responsibilities, expensive method, mostly full time data analyst needed. Source for data for quality improvements: Administrative databases: are information collected, processed and stored in automated information systems. Excellent source of data for reporting on clinical quality, financial performance, and certain patient outcomes. Advantages: less expensive source of data, they incorporate transaction systems, moest of the code sets embedded are standardized, the database are staffed by individuals who are skilled, the volume is great, data reporting tools are available.. Disadvantages: some argue that these data is less reliable than data gathered by chart review. Patient surveys: especially when teams are interested in the perceptions of patients, either in terms of the quality of care or the quality of service provided. A team can design the survey itself, hire an expert to design a survey, or purchase an existing survey/survey service. Functional status surveys: usually measured before and at several points following the treatment or procedure. (for example a baseline before the knee procedure and then assessments are made at regular intervals after the surgery) Health plan databases: excellent source of data for quality improvement projects, particularly projects that have a population health management f ocus. These databases are valuable because they contain detailed information on all care received by health plan members. It provides a comprehensive record of patient activity and can be used to identify and select patients for enrollment in disease management programs. Used properly: rich source of data for population management, disease management and quality improvement projects. Health plan databases limitations: considerations include accuracy, detail and timeliness. Recoding may make some data inaccurate, they do not contain detailed information on outcomes of care . Patient registries: powerful source of quality improvement data. Advantages: rich source of information because they are customized, can collect all the data that the physician or health system determines are most important, can be used for quality improvements, they are not subject to the shortcomings of administrative or health plan databases, collection techniques can be combined to provide a complete picture of the patient experience. They are versatile and flexible. Example case study in clinical reporting: page 123-127 Conclusion: there are many sources and data collection approaches from which to choose. Rarely does one method serve purposes, so it is important to understand the advantages and disadvantages of all methods. A combination is also possible. Knowledge of different sources and techniques will help you to use data more effectively and efficiently in your clinical improvement effort. Chapter 7: Statistical tools for quality improvement Three fundamental purposes for performance measurement: Assessment of current performance: identify strengths and weaknesses of current processes Demonstration and verification of performance improvement And control of performance Performance measurement benefits organizations in several ways: provides factual evidence of performance, promotes ongoing organization self-evaluation and improvement, illustrates improvement, facilitates cost-benefit analysis, helps to meet external requirements and demands for performance evaluation, may facilitate the establishment of long-term relationships with various external stakeholders. May differentiate the organization from competitors, may contribute to the awarding of business contacts and fosters organizational survival. .. Chapter 13: Leadership for quality Leadership = working with people and systems to produce needed change. Individual leadership = this set of leadership is about what people must be and what they must know how to do, if they are to influence others to bring about needed changes. Both being and doing are needed, especially when the changes required for quality improvement involve reframing core value or remaking professional teams. Many improvements in health care will require these kinds of deep changes in values. These changes are sometimes labeled as transformational changes to distinguish them from transactional changes, which do not require changes in values and patterns of behavior. Organizational leadership = about creating a supportive organizational environment in which hundreds of capable individual leaders’ work can thrive (groeien). One way to view this level (system-of-leadership level) is as a complex set of interrelated activities in five broad categories: Set direction: every organization has a sense of direction, a future self-image. A leader should set that direction. Establish the foundation: leaders must prepare themselves and their leadership teams with the knowledge and skills necessary to improve systems and lead change (and reframe values) Build will: to initiate and sustain change takes will, which seem to be highly sensitive to discord and often grind to a halt because of one loud voice opposing change ïÆ'   therefore making logical and quantitative links should be made between improvement and key business goals. Generate ideas: quality challenges require innovation. Page 313 Implementing quality as the core organizational strategy Implementing a culture that has quality improvement at its core is an important goal for providers who want to serve patients better, gain the support of healthcare providers, stay ahead of government regulation, meet consumer’s demand for transparent information on quality and costs, an gain a competitive advantage in the marketplace. Recent history: many efforts have not resulted in the sustainable quality improvements that the leaders hoped to see. Quality improvement strategy should start with leadership from the board of trustees, the CEO and the executive team, but it is a challenge for health care organizations because of the many internal competing agendas, the rapidly changing environment, employees and so on. First step: to establish an organizational culture that will support the hospital on their journey to quality ïÆ'   starting point: leadership! Kaplan Norton: Balanced Scorecard ïÆ'   this approach includes the perspective of the patient and family, internal processes such as clinical pathways, learning and growth opportunities that focus on employees and financial performance. Role of leadership: leaders ask financial questions about market share, margins and quality implications. They raise questions related to the satisfaction of their internal and external customers and the way in which business processes must change to improve and sustain quality. Primary focus on creating a culture of quality. Baldrige National Quality Program Creating the change towards quality starts with leadership. Road map for change Eight stage change process, modified form Kotter’s seminal work (Leading Change 1996) serves as a realistic and viable framework to guide leaders who are managing a change to quality: 1. Unfreezing the old culture This is the most difficult step because of culture’s influence on employee behavior and some employee’s to desire to resist change and impede progress. 2. Forming a powerful guiding coalition 3. Developing a vision and strategy 4. Communicating a vision and strategy 5. Empowering employees to act on the vision and strategy 6. Generating short-term wins 7. Consolidating gains and producing more change 8. 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Antibiotic Usage Essay -- Biology, DNA

This optimism has been dissipated long before the 20th century when the proliferation of antibiotic resistance bacteria became evident as Fleming predicted earlier. With the rapid development of infectious disease associated with antibiotic resistance forced us to change the way we view disease and the way we treat patients. However, antibiotic use has not been without consequence and several factors had contributed to the development of resistance. Some resistances are due to spontaneous mutation and these mutations are for select antibiotic resistance whilst other bacteria tend to steal the deoxyribonucleic acid (DNA) from their counterparts who are already familiar with antibiotics (Mims, 2004; Tenover, 2006). Antibiotic remained effective against most bacterial infection, however these bacterial cells develop resistance and continue to divide resulting in a resistant population and some are no longer effective against infectious disease that was killed few years ago (Levy, 2000). The impact of antibiotic resistance could lead to more infectious diseases that are hard to treat and could result in a global threat making it difficult as mutation and evolutionary pressure cause increase in antibiotic resistance (Strelkauskas et al, 2010). Antibiotics are extremely important medicine but unfortunately bacteria become resistant make it problematic as antibiotic resistance had posed problem around the world people continued to travel and modern technology and sociology exacerbated the development of resistant strains, these strains are transferred from infected people causing a repeat in cycle as they moved from one place to the next (WHO, 2001). Increased globalisation is responsible for res istance, in large overpopulat... ...odified penicillin binding proteins. Some resistant bacteria could be dangerous for example; MRSA and the vancomycin resistant staphylococcus auerus that are virulent in human pathogens (Strelkauskas, 2010) by reducing the permeability of their membranes as a way of keeping out antibiotic by turning off production of porin and other proteins (Weston, 2008), for example; the multi-drug resistant mycobacterium tuberculosis. In pathogens such as Escherichia coli and staphylococcus aureus, efflux pumps played a major role in multi-drug resistance likewise Klebsiella species becoming resistance and other bacteria producing enzymes from Extended Spectrum Beta-lactamase (Livermore and Hawley, 2005; Tenover, 2006) also multi-drug resistance antibiotics Acinetobacter Baumanii and the New Delhi Metallo-1(NDM-1) causing havoc amongst the healthcare setting (HPA, 2010).

Impact of Computer on Our Society

Ilorin Being a paper presented at the closing ceremony of the 1st computer training and issuance of certificate by Ascetic Computer Centre on the 15th September 2007 Introduction At this closing ceremony of the 1st computer training and issuance of certificate by Ascetic Computer Centre, let us lift our eyes toward the challenges that await us in the years to come.It is our great good fortune, as organisers, that time and chance have put us not only at the edge of a chapter in the lives of these graduands, but on the edge of a bright new prospect in their affairs —a moment that will define their course, and their character, for many years to come. Guided by the ancient vision of a promised future, let us set our sights upon a set of graduands of new promise. However, our march to this new future seemed less certain than it did yesterday. We must vow to set a clear course to renew our generation.We should thank the organisers for their vision towards the creation of new Nigeria ns who will appreciate problems, exhilarated by challenges, and strengthened by achievements, Nigerians with better employment opportunities, who will be job creators. Computer is gaining vast popularity globally in recent years. Its use, which extended information-processing capabilities, are influencing organizations of all types and sizes bringing about changes in institutional goals, relations and operations.A large percentage of the activities in any institution or organisation comprise the processing of communicating information in the production and distribution processes. In the developing countries, computers are becoming part of everyday activities because of the kind of information they generate and their speed of delivery (Award 1988). 1 What is a Computer A computer is an electronic device, which accepts and processes data by following a set of instructions (PROGRAM) to produce an accurate and efficient result (INFORMATION). Since the ultimate aim of computer is to prod uce information, the art if computing is often referred o as information processing. The values of the computer lie solely on its high speed (due to its electronic nature), ability to store large amount of data, the unfailing accuracy and precision. These account for its supremacy over manual computation. The computer industry began in the late forties with a very small initial investment, and has been increasing both in strength and importance. When one looks back with analytical mind, we can conclude that computer technology keeps on advancing with remarkable increase in speed, accuracy and reliability.Computing in whatever field, science, business, and industry is reaching directly or indirectly into various aspects of our society thereby, without loss of generality has shrunk the world into such a compactness that no part can afford to lack behind or live in isolation. The advent of electronic computer was hailed by the world as a great revolution, like any industrial revolution , it promised to free man from simple routine jobs of repetitive nature by providing computing power. The first to have exploited this facility was the search for scientific enquiries.This was not unconnected with the fact that the designers of these systems were scientists themselves. Several problems have been eluding satisfactory solutions, though numerical methods of solutions exist but involved a very huge accomplished. Not only did computer make reliable solutions possible it equally opened new application methods or areas. To quote but a few are the optimization techniques of Operations Research (OR), the awe-stricken field of space research, the molecular restructuring in Biochemistry etc. It would have been tedious inexhaustible, incomplete and inaccurate to list all the possible applications of computer. There is no limit tot he uses and applications of computer; hence there is hardly a branch of science that can resist computer invasion.After science was business. Because of the natural conservatism, oppressive and exploitative nature of this class coupled with their cautions approach to things, did not deem the computing machine fit until its worth and capabilities had been proved. What came to be recognized and embraced by this class was the importance of computer for decision aking and data processing, for these reasons, elaborate mathematical tools like Operations Research (OR), Critical Path Method (CPM), and Program Evaluation and Review Techniques (PERT) which were developed in the early fifties attained respectable height in the eyes of this class. Common examples of data processing are payroll, accounting, inventory management, banking, airline seat reservation etc. These required a lot of input and output and relatively little computing. Hence the costs of computing in such areas tend to be closely bound by inputting the data and outputting the results.Some applications like airlines seat reservation, banking business and inventory control , call for real-time systems, which are dedicated to a particular application. They furnish â€Å"immediate† responses to input signals. For examples, it is easier today for one to know his statement of account in a bank the moment signals for such requests are sent to the computer. Similarly debited or credited accounts are updated almost immediately for further transactions. The Need for Computer Most of our national projects could better be accomplished with the use of computers.Consider the registration of voters for election, common entrance examination into Nigeria Secondary Schools and conducting head counts (census) to mention only a few. These involve a huge volume of data, and would naturally be unwise if accomplished manually as it would be tiring, inaccurate and full of errors. 3 Going through the history/evolution of computers, the search for a realistic head count by the United States census bureau in 1890 led to the development of an electro-mechanical machine that helped greatly during the census by cutting down the man-hour required for the processing of the census data.The accuracy of computer cannot be over-emphasized and it conforms to the objective of using the computer. A cashier in a departmental store would definitely find life boring if all calculations, issuance of receipts and giving of change would be done manually for each customer after each transaction. But with the aid of an adding machine the job is done accurately and he feels relieved. Going from the adding machine to the computer itself, the ability of the computer to perform repetitive tasks makes things easier.Once the computer is programmed using the adequate software the whole job is done with ease. The need for computer in our banking system cannot be underrated because of the huge amount of transactions and the accuracy desired. Similarly in the data processing environment where the bulk of the job is either sorting, merging files, updating information, searchin g for a particular key in a pile of data etc. , all these the computer does with ease and accurately too. In a developing economy like ours, the speed of the computer is again one of the distinguishing factors that make it inevitable.From the saying that â€Å"Time is Money†, speed is equally synonymous to time, and since computers work as a phenomenal speed coupled with its ability to access records or information directly from remote locations, efforts should be directed towards introducing computer into every facets of human endeavour. Computer and Unemployment The extent to which the computer has come to permeate all levels of our society is immeasurable. In fact, it does not matter, what you plan to do for a living, you will encounter the computer.Its impact is analogous to that of the automobile and television. Things could be quite different with computers, but it has become part 4 of our society. The automobile is largely responsible for the air pollution and congesti on of our cities today. The television has been accused of literally â€Å"rotting our minds†. Technology is usually a bit of mixed blessing and the computer is no exception. There is a popular slogan and fear that computer causes unemployment. From a professional point of view, it is untrue.The problem therefore is the ability to distinguish between unemployment and job displacement. Hence with a thorough distinction between the two, computer should be seen as a saviour from slavery. Before considering the question of displacement and unemployment, it might be necessary once again to define computer. Computer as earlier defined, is an electronic device or machine, which accepts data, following some sets of logical instructions to produce the needed results. Therefore we have to ask ourselves, can this so-called computer operate without the full assistance of human being?Can we just go to the computer for a complaint and have our problems solved without having to call on some pre-written programs meant for specific assignments, and written by programmers of course? The answer to these questions is NO. It is true that behind every successful man there is a woman, also behind the successful operations of computers there is a brain (the man). Computer on its own is just an empty box or a junk, and can in no way do any intelligent job, but with programs written the jobs are done.Therefore if a computer is given a job with the logical step to follow, it can do it better, faster and more accurately than human beings and these are some of the advantages. Consider the developed countries like Japan, USA, UK etc. , where their industries are filled with Robots. The word Robot means labour. Robots are no human beings but rather are machines that can be programmed to carry out complex and tedious task without getting bored or tired. Robots are blind, deaf and have no sense of touch. Therefore jobs that are hazardous, tedious, that could be left undone are done by these Robots.Considering an assembly plant where the 5 only thing a man does in such a plant is just to take the assembled goods out of the plant to give chance for the Robots to start assembling another. What a miracle it is to know that if a Robot breaks down in the course of its duty, almost immediately a fellow Robot (Doctor Robot) will attend to it to put it back to work. Think of the most dangerous tasks, which for the love of our dear lives we cannot do, these Robots do them. Ample examples are, blast furnace, disaster area (caused by poisonous gas) marshy areas etc. of course Robots do these jobs not thinking of any relations or parents and in fact, at a faster speed enhancing productivity. How does computer displace people and who are those displaced? As earlier mentioned, computer can only do a routine job and cannot think in any form. Now come to think of some well-structured organizations, UAC, SCOA and Leventis etc. , there are skilled personnel and unskilled workers/cl erks. The daily job of these unskilled workers are mere routine jobs like accounting procedures, oading and assembling goods which can be taken over by computers that will do it better, faster and in fact, more reliable thereby enhancing greater productivity. These labourers so displaced by computer can be taken to such areas as sales since more articles are produced. These workers should go out soliciting for markets. While the managers, engineers and technician can not be displaced because they as skilled in their job, they do real thinking. Therefore to supplement these greater efficiency and productivity of the computer, these skilled workers should be kept in an airconditioned office, and in fact, think of things yet to happen.No wonder the United States of American sees nothing left on earth again and hence proceeded to exploit the outer space. With these productive forces in operation, the prices of goods and the workers conditions of service would be improved. 6 Recently, th ese big time companies embarked on agriculture. These unskilled workers could be better utilized there, and more of them is needed for such jobs. In Africa, there are popular terms like laziness, redundancy, unproductively, etc. These are happening because there are no challenges to face.What we do mostly are routine jobs which could be boring thereby creating unhappiness and in such a situation we become less productive. The routine jobs should be given to computers while a conducive atmosphere be created for the skilled workers to think of ways of making the continent self reliant. Computer and Job Creation Let us consider a particular case study of an information system, the effect of computer and how it helps creating jobs. An information system means the collection and processing of data to yield useful information for decision making.To collect data, enumerators are needed to actually go to the field for data collection, typist are needed too and other people employed in the c ourse of recording the data and finally statisticians computer operators use the computer for processing the data to give useful results (information). Again think of the case of our consultancy services. Any company going into such ventures like agricultural business needs a consultant having in his service Agricultural scientists, soil scientists and host of other professionals in allied discipline to perform the feasibility studies.They give useful information to customers are regards the type of crops to plant, the planting seasons, the fertilizers to apply and when, the type of pests attracted by such plants etc. , all these lead to greater productivity and this is one of the things the attention of our professionals should be directed to. Come to think of the perennial problems of Cancer, AIDS and some other deadly diseases, which we have no solutions to. Our scientist and medical personnel should use most of their time addressing their minds through intensive research towards providing a remedy to such ills of the society while the computer is left to do their routine jobs for them. History has it that the early jobs where computers were employed were in accounting, payroll, ledger etc. , all of which had fixed procedures or routine hence it was easier to computerize these systems to enhance productivity and save workers from boredom. However, it must be recognized that computer requires lesser number of personnel, it can produce more and it is not likely to go on maternity leave, nor go on strikes, nor demand overtime or old age pension etc.Also the use of computer creates more jobs such as consultancy, developing and selling of software and hardware while the displaced workers could be trained as salesmen to market the goods or taken to such areas like agriculture where they can serve humanity. Therefore computer will lead to re-arrangement in the organizational set up and this will lead to greater productivity. Conclusions Computer offer innumerable benefits in enriching the quality and quantity of goods and services in any organisation.Despite the prevalent nature of computer in virtually every aspect of human endeavours, it has not been widely integrated into the production and distribution processes in Nigeria. Its integration will not only revolutionize the economy, it will engender the development of individual’ innate scientific inquiry mind and their critical thinking abilities. COMPUTER PROVIDES LONGER LIFE, REDUCES WORKING HOURS AND GREATER REMUNERATION IN RETURN.REFERENCES Ayo, C, K. (1994). Computer literacy: Operations and appreciation. Egbe: Alanukitan Press Walton, D. (1984). Blob (Computer Program): Applied system knowledge (ASK). London: Unwin Ltd 8

How to promote yourself in different Social Media Sites.

As a continuation to the previous post, there are also social media web-sites, which can be very useful for you. Promoting yourself in Social Media Sites like Facebook.com, Twitter.com, Answers.yahoo.com and others is another good way of gaining more orders. Register yourself to the Top Social Media Sites. The most appropriate sites for you, where you could have more chance to meet targeted visitors are the following: answers.yahoo.com, freelancer.com, craigslist.org, facebook.com. To read how you should proceed on each of these web-sites, login and go to the News section. Best Regards, ThePesnters.com team