Managing Paediatric Illness and Injury Essay

1. Describe the common types of fractures and how to manage them. Broken bone. Based on the location and severity of the fracture, a broken bone usually must be set into position and supported until it is strong enough to bear weight. Your physician will recommend the most proven treatment approach, usually casting or surgery 2. Describe how to manage a dislocation Relieve pain around the dislocation by applying a cold pack to the area; this will also reduce swelling that can add to discomfort injury. Keep joint immobile and do not try to push the bone back in place. Offer ibuprofens if in severe pain, monitor the patient until the professionals arrive. 3. Describe how to recognise and manage the following head injuries: A concussion: you get dizziness, nausea, loss of memory, mild headache, seeing â€Å"stars†, double vision, numbness and lack of hand-eye coordination. B skull fracture: you will probably see an external wound or bruise on the head and there may be a depression visible on the scalp. Check behind the ears for swelling or bruising. There may be loss of clear fluid or watery blood through an eye or nostril, blood in the white of the eye, a black-eye, and the symmetry of the head or face may be disrupted. The responsiveness of the victim may deteriorate C cerebral compression: levels of response deteriorate; headaches tend to be intense; noisy, slowed, or irregular breathing; pupil sizes unequal; paralysis or weakness on one side of the body or face; drowsiness; temperature spike, fever, or flushed face; personality changes 4. Describe how to manage an infant and a child with foreign bodies in their eyes, ears and nose. If a child gets sand, dust, or paint in their eyes, then we can try removing it ourselves, firstly wear clean pair of disposable gloves, and gently pull the bottom eye lid down, and with a clean wet tissue try to clean the eye, and if that don’t work, then try to wash the eye out with water, position the child’s head over the sink or bowl with eye open and wash the eye out using plastic cup, try to pour the water for the side of the eye, if this still don’t work then go to the nearest walking centre. There are several things that can get stuck in  ears and nose, common ones like batteries, beads, nuts. If a child does get anything small stuck in their nose or ear, unless it can easily be pulled out with a firm grip then go for it, if not don’t try because you may end up pushing it further back and making it difficult, in these kind of situations you need to call a first aider, or take the child to the nearest walking centre to get it removed. 5. Describe how to recognise and manage common eye injuries Eye injuries can range from relatively trivial, such as irritating the eye with shampoo, to extremely serious, resulting in permanent loss of vision. Common causes of eye injuries include, something like a small particle of grit or a twig damages the transparent front part of the eye known as the cornea – this type of injury is known as a corneal abrasion. A foreign body such as a small piece of wood or metal gets stuck in the eye. A sudden blow to the eye, from a fist or a cricket ball for example, causes the middle section of the eye (the uvea) to become swollen – this type of injury is known as traumatic uveitis. Wash your eyes out for 20 minutes if you think they have been exposed to a chemical. Ideally, you should wash the eye with saline solution, but tap water will be fine if saline is unavailable. Use plenty of water. Water from a garden hose or water fountain is okay if you’re outside. Then go immediately to your nearest A&E department. It’s also important to go to A&E if you cut your eye and it starts bleeding or if you have something stuck in your eye. Never try to remove anything from your eye as you could damage it. 6. Describe how to recognise and manage chronic medical conditions including:a. Sickle cell anaemia. Sickle cell disease is an inherited disorder in which red blood cells are abnormally shaped. This abnormality can result in painful episodes, serious infections, chronic anaemia, and damage to body organs. These complications can, however, vary from person to person depending on the type of sickle cell disease each has. Some people are relatively healthy and others are hospitalized frequently. But thanks to advancements in early diagnosis and treatment, most kids born with this disorder grow up to live relatively healthy and productive lives. b. Diabetes The main symptoms of diabetes are: feeling very thirsty urinating frequently, particularly at night feeling very tired weight loss and loss of muscle bulk Type 1 diabetes can develop quickly, over weeks or even days. Many people have type 2 diabetes for years without realising because early symptoms tend to be general. The amount of sugar in the blood is usually controlled by a hormone called insulin, which is produced by the pancreas (a gland behind the stomach). When food is digested and enters your bloodstream, insulin moves glucose out of the blood and into cells, where it is broken down to produce energy. However, if you have diabetes, your body is unable to break down glucose into energy. This is because there is either not enough insulin to move the glucose, or the insulin produced does not work properly. c. asthma Asthma is caused by inflammation of the airways. These are the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal. When you come into contact with something that irritates your lungs, known as a trigger, your airways become narrow, the muscles around them tighten and there is an increase in the production of sticky mucus. This leads to symptoms including: Difficulty breathing Wheezing and coughing A tight chest. While there is no cure for asthma, there are a number of treatments that can help effectively control the condition. Treatment is based on two important goals: Relieving symptoms Preventing future symptoms and attacks from developing Treatment and prevention involves a combination of medicines, lifestyle advice, and identifying and then avoiding potential asthma triggers. Read more about living with asthma. 7. Describe how to recognise and manage serious sudden illnesses including a. Meningitis Viral meningitis usually gets better within a couple of weeks, with plenty of rest and painkillers for the headache. Bacterial meningitis is treated with antibiotics (medication that treats infections caused by bacteria). Treatment will require admission to hospital, with severe cases treated in an intensive care unit so the body’s vital functions can be supported. The best way to prevent meningitis is by ensuring vaccinations are up-to-date. Children in the UK should receive the available vaccines as part of the childhood vaccination programme. b. Febrile convulsions Febrile seizures are also sometimes called febrile convulsions. During most seizures the child’s body becomes stiff, they lose consciousness and their arms and legs twitch. Some children may wet themselves. This is what’s known as a tonic colonic seizure. If your child is having a febrile seizure, place them in the recovery position. Lay them on their side, on a soft surface, with their face turned to one side. This will stop them swallowing any vomit. It will keep their airway open and help to prevent injury. Stay with your child and try to make a note of how long it lasts. If it is your child’s first seizure, or it lasts longer than five minutes, take them to the nearest hospital as soon as possible or call 999 for an ambulance. While it is unlikely that there is anything seriously wrong, it is best to be sure. If your child has had febrile seizures before and the seizure lasts for less than five minutes. Try not to put anything, including medication, in your c hild’s mouth during a seizure as there is a slight chance that they might bite their tongue. Almost all children make a complete recovery, and there is not a single reported case of a child dying as the direct result of a febrile seizure. 8. Describe how to recognise and treat the effects of extreme cold and extreme heat for an infant and a child. When a child has an extreme cold the signs and symptoms are Shivering in the early stages Cold, pale and dry skin Low temperature 35 degrees or less Irrational behaviour, slow shallow breathing Cold to touch Unusually quite Refuses to feed Treatment for this will be to remove and replace wet clothing, wrap in a warm blanket cover their head place in a warm room. Give them a hot drink only if they can hold the cup. If it’s a baby then warm them up slowly and place them in a warm room, use your body heat to warm them, and seek for medical advice. When a infant or child has an extreme heat the signs and symptoms could be Gradual onset Sweating, cold, clammy skin Dizziness, confusion, headache Cramps in limbs and or abdomen Shallow rapid breathing, nausea Treatment for this is Reassure, remove casualty to cool place Lie down with legs raised If conscious encourage to sip plenty of fluids If recovery is rapid advise them to see the doctor If unconscious put them in recovery and call 999 for ambulance

Principles Of Teaching And Learning In Teaching Math Essay

Students learn mathematics through the experiences that teachers provide. Teachers must know and understand deeply the mathematics they are teaching and understand and be committed to their students as learners of mathematics and as human beings. There is no one â€Å"right way† to teach. Nevertheless, much is known about effective mathematics teaching. Selecting and using suitable curricular materials, using appropriate instructional tools and techniques to support learning, and pursuing continuous self-improvement are actions good teachers take every day. The teacher is responsible for creating an intellectual environment in the classroom where serious engagement in mathematical thinking is the norm. Effective teaching requires deciding what aspects of a task to highlight, how to organize and orchestrate the work of students, what questions to ask students having varied levels of expertise, and how to support students without taking over the process of thinking for them. Effective teaching requires continuing efforts to learn and improve. Teachers need to increase their knowledge about mathematics and pedagogy, learn from their students and colleagues, and engage in professional development and self-reflection. Collaborating with others–pairing an experienced teacher with a new teacher or forming a community of teachers–to observe, analyze, and discuss teaching and students’ thinking is a powerful, yet neglected, form of professional development. Teachers need ample opportunities to engage in this kind of continual learning. The working lives of teachers must be structured to allow and support different models of professional development that benefit them and their students. Mathematics Principles and practice What can learning in mathematics enable children and young people to achieve? Mathematics is important in our everyday life, allowing us to make sense of the world around us and to manage our lives. Using mathematics enables us to model real-life situations and make connections and informed predictions. It equips us with the skills we need to interpret and analyse information,  simplify and solve problems, assess risk and make informed decisions. Mathematics plays an important role in areas such as science or technologies, and is vital to research and development in fields such as engineering, computing science, medicine and finance. Learning mathematics gives children and young people access to the wider curriculum and the opportunity to pursue further studies and interests. Because mathematics is rich and stimulating, it engages and fascinates learners of all ages, interests and abilities. Learning mathematics develops logical reasoning, analysis, problem-solving skills, creativity and the ability to think in abstract ways. It uses a universal language of numbers and symbols which allows us to communicate ideas in a concise, unambiguous and rigorous way. To face the challenges of the 21st century, each young person needs to have confidence in using mathematical skills, and Scotland needs both specialist mathematicians and a highly numerate population. Building the Curriculum 1 Mathematics equips us with many of the skills required for life, learning and work. Understanding the part that mathematics plays in almost all aspects of life is crucial. This reinforces the need for mathematics to play an integral part in lifelong learning and be appreciated for the richness it brings. How is the mathematics framework structured? Within the mathematics framework, some statements of experiences and outcomes are also identified as statements of experiences and outcomes in numeracy. These form an important part of the mathematics education of all children and young people as they include many of the numerical and analytical skills required by each of us to function effectively and successfully in everyday life. All teachers with a responsibility for the development of mathematics will be familiar with the role of numeracy within mathematics and with the means by which numeracy is developed across the range of learning  experiences. The numeracy subset of the mathematics experiences and outcomes is also published separately; further information can be found in the numeracy principles and practice paper. The mathematics experiences and outcomes are structured within three main organisers, each of which contains a number of subdivisions: Number, money and measure Estimation and rounding Number and number processes Multiples, factors and primes Powers and roots Fractions, decimal fractions and percentages Money Time Measurement Mathematics – its impact on the world, past, present and future Patterns and relationships Expressions and equations. Shape, position and movement Properties of 2D shapes and 3D objects Angle, symmetry and transformation. Information handling Data and analysis Ideas of chance and uncertainty. The mathematics framework as a whole includes a strong emphasis on the important part mathematics has played, and will continue to play, in the advancement of society, and the relevance it has for daily life. A key feature of the mathematics framework is the development of algebraic thinking from an early stage. Research shows that the earlier algebraic thinking is introduced, the deeper the mathematical understanding will be  and the greater the confidence in using mathematics. Teachers will use the statements of experiences and outcomes in information handling to emphasise the interpretation of statistical information in the world around us and to emphasise the knowledge and skills required to take account of chance and uncertainty when making decisions. The level of achievement at the fourth level has been designed to approximate to that associated with SCQF level 4. What are the features of effective learning and teaching in mathematics? From the early stages onwards, children and young people should experience success in mathematics and develop the confidence to take risks, ask questions and explore alternative solutions without fear of being wrong. They will enjoy exploring and applying mathematical concepts to understand and solve problems, explaining their thinking and presenting their solutions to others in a variety of ways. At all stages, an emphasis on collaborative learning will encourage children to reason logically and creatively through discussion of mathematical ideas and concepts. Through their use of effective questioning and discussion, teachers will use misconceptions and wrong answers as opportunities to improve and deepen children’s understanding of mathematical concepts. The experiences and outcomes encourage learning and teaching approaches that challenge and stimulate children and young people and promote their enjoyment of mathematics. To achieve this, teachers will use a skilful mix of approaches, including:  planned active learning which provides opportunities to observe, explore, investigate, experiment, play, discuss and reflect modelling and scaffolding the development of mathematical thinking skills learning collaboratively and independently  opportunities for discussion, communication and explanation of thinking developing mental agility  using relevant contexts and experiences, familiar to young people making links across the curriculum to show how mathematical concepts are applied in a wide range of contexts, such as those provided by science and social studies using technology in appropriate and effective ways  building on the principles of Assessment is for Learning, ensuring that young people understand the purpose and relevanc e of what they are learning developing problem-solving capabilities and critical thinking skills. Mathematics is at its most powerful when the knowledge and understanding that have been developed are used to solve problems. Problem solving will be at the heart of all our learning and teaching. We should regularly encourage children and young people to explore different options: ‘what would happen if†¦?’ is the fundamental question for teachers and learners to ask as mathematical thinking develops. How will we ensure progression within and through levels? As children and young people develop concepts within mathematics, these will need continual reinforcement and revisiting in order to maintain progression. Teachers can plan this development and progression through providing children and young people with more challenging contexts in which to use their skills. When the experience or outcome spans two levels within a line of development, this will be all the more important. One case in point would be the third level outcome on displaying information. The expectation is that young people will continue to use and refine the skills developed at second level to display charts, graphs and diagrams. The contexts should ensure progression and there are clear opportunities to use other curriculum areas when extending young people’s understanding. What are broad features of assessment in mathematics? (This section should be read alongside the advice for numeracy.) Assessment in mathematics will focus on children and young people’s abilities to work increasingly skilfully with numbers, data and mathematical concepts and processes and use them in a range of contexts. Teachers can gather evidence of progress as part of day-to-day learning about number, money and measurement, shape, position and movement and information handling. The use of specific assessment tasks will be important in assessing progress at key points of learning including transitions. From the early years through to the senior stages, children and young people will demonstrate progress in their skills in interpreting and analysing information, simplifying and solving problems, assessing risk and making informed choices. They will also show evidence of progress through their skills in collaborating and working independently as they observe, explore, experiment with and investigate mathematical problems. Approaches to assessment should identify the extent to which children and young people can apply their skills in their learning, in their daily lives and in preparing for the world of work. Progress will be seen as children and young people demonstrate their competence and confidence in applying mathematical concepts and skills. For example: Do they relish the challenge of number puzzles, patterns and relationships? Can they explain increasingly more abstract ideas of algebraic thinking? Can they successfully carry out mathematical processes and use their developing range of skills and attributes as set out in the experiences and outcomes? As they apply these to problems, can they draw on skills and concepts learned previously? As they tackle problems in unfamiliar contexts, can they confidently identify which skills and concepts are relevant to the problem? Can they then apply their skills accurately and then evaluate their solutions? Can they explain their thinking and demonstrate their understanding of 2D shapes and 3D objects? Can they evaluate data to make informed decisions? Are they developing the capacity to engage with and complete tasks and  assignments? Assessment should also link with other areas of the curriculum, within and outside the classroom, offering children and young people opportunities to develop and demonstrate their understanding of mathematics through social studies, technologies and science, and cultural and enterprise activities. How can I make connections within and beyond mathematics? Within mathematics there are rich opportunities for links among different concepts: a ready example is provided by investigations into area and perimeter which can involve estimation, patterns and relationships and a variety of numbers. When children and young people investigate number processes, there will be regular opportunities to develop mental strategies and mental agility. Teachers will make use of opportunities to develop algebraic thinking and introduce symbols, such as those opportunities afforded at early stages when reinforcing number bonds or later when investigating the sum of the angles in a triangle. There are many opportunities to develop mathematical concepts in all other areas of the curriculum. Patterns and symmetry are fundamental to art and music; time, money and measure regularly occur in modern languages, home economics, design technology and various aspects of health and wellbeing; graphs and charts are regularly used in science and social studies; scale and proportion can be developed within social studies; formulae are used in areas including health and wellbeing, technologies and sciences; while shape, position and movement can be developed in all areas of the curriculum. The Teaching Principle Effective mathematics teaching requires understanding what students know and need to learn and then challenging and supporting them to learn it well. Students learn mathematics through the experiences that teachers provide. Thus, students’ understanding of mathematics, their ability to  » use it to solve problems, and their confidence in, and disposition toward, mathematics are all shaped by the teaching they encounter in school. The improvement of  mathematics education for all students requires effective mathematics teaching in all classrooms. Teaching mathematics well is a complex endeavor, and there are no easy recipes for helping all students learn or for helping all teachers become effective. Nevertheless, much is known about effective mathematics teaching, and this knowledge should guide professional judgment and activity. To be effective, teachers must know and understand deeply the mathematics they are teaching and be able to draw on that knowledge with flexibilit y in their teaching tasks. They need to understand and be committed to their students as learners of mathematics and as human beings and be skillful in choosing from and using a variety of pedagogical and assessment strategies (National Commission on Teaching and America’s Future 1996). In addition, effective teaching requires reflection and continual efforts to seek improvement. Teachers must have frequent and ample opportunities and resources to enhance and refresh their knowledge. Effective teaching requires knowing and understanding mathematics, students as learners, and pedagogical strategies. Teachers need several different kinds of mathematical knowledge—knowledge about the whole domain; deep, flexible knowledge about curriculum goals and about the important ideas that are central to their grade level; knowledge about the challenges students are likely to encounter in learning these ideas; knowledge about how the ideas can be represented to teach them effectively; and knowledge about how s tudents’ understanding can be assessed. This knowledge helps teachers make curricular judgments, respond to students’ questions, and look ahead to where concepts are leading and plan accordingly. Pedagogical knowledge, much of which is acquired and shaped through the practice of teaching, helps teachers understand how students learn mathematics, become facile with a range of different teaching techniques and instructional materials, and organize and manage the classroom. Teachers need to understand the big ideas of mathematics and be able to represent mathematics as a coherent and connected enterprise (Schifter 1999; Ma 1999). Their decisions and their actions in the classroom—all of which affect how well their students learn mathematics—should be based on this knowledge. This kind of knowledge is beyond what most teachers experience in standard preservice mathematics courses in the United States. For example, that fractions can be understood as parts of a whole, the quotient of two integers, or a numb er on a line is  important for mathematics teachers (Ball and Bass forthcoming). Such understanding might be characterized as â€Å"profound understanding of fundamental mathematics† (Ma 1999). Teachers also need to understand the different representations of an idea, the relative strengths and weaknesses of each, and how they are related to one another (Wilson, Shulman, and Richert 1987). They need to know the ideas with which students often have difficulty and ways to help bridge common misunderstandings.  » Effective mathematics teaching requires a serious commitment to the development of students’ understanding of mathematics. Because students learn by connecting new ideas to prior knowledge, teachers must understand what their students already know. Effective teachers know how to ask questions and plan lessons that reveal students’ prior knowledge; they can then design experiences and lessons that respond to, and build on, this knowledge. Teachers have different styles and strategies for helping students learn particular mathematical ideas, and there is no one â€Å"right way† to teach. However, effective teachers recognize that the decisions they make shape students’ mathematical dispositions and can create rich settings for learning. Selecting and using suitable curricular materials, using appropriate instructional tools and techniques, and engaging in reflective practice and continuous self-improvement are actions good teachers take every day. One of the complexities of mathematics teaching is that it must balance purposeful, planned classroom lessons with the ongoing decision making that inevitably occurs as teachers and students encounter unanticipated discoveries or difficulties that lead them into uncharted territory. Teaching mathematics well involves creating, enriching, maintaining, and adapting instruction to move toward mathematical goals, capture and sustain interest, and engage students in building mathematical understanding. Effective teaching requires a challenging and supportive classroom learning environment. Teachers make many choices each day about how the learning environment will be structured and what mathematics will be emphasized. These decisions determine, to a large extent, what students learn. Effective teaching conveys a belief that each student can and is expected to understand mathematics and that each will be supported in his or her efforts to accomplish this goal. Teachers establish and nurture an environment conducive to learning mathematics through the decisions they make, the conversations they orchestrate, and the  physical setting they create. Teachers’ actions are what encourage students to think, question, solve problems, and discuss their ideas, strategies, and solutions. The teacher is responsible for creating an intellectual environment where serious mathematical thinking is the norm. More than just a physical setting with desks, bulletin boards, and posters, the clas sroom environment communicates subtle messages about what is valued in learning and doing mathematics. Are students’ discussion and collaboration encouraged? Are students expected to justify their thinking? If students are to learn to make conjectures, experiment with various approaches to solving problems, construct mathematical arguments and respond to others’ arguments, then creating an environment that fosters these kinds of activities is essential. In effective teaching, worthwhile mathematical tasks are used to introduce important mathematical ideas and to engage and challenge students intellectually. Well-chosen tasks can pique students’ curiosity and draw them into mathematics. The tasks may be connected to the  » real-world experiences of students, or they may arise in contexts that are purely mathematical. Regardless of the context, worthwhile tasks should be intriguing, with a level of challenge that invites speculation and hard work. Such tasks often can be approached in more than one way, such as using an arithmetic counting approach, drawing a geometric diagram and enumerating possibilities, or using algebraic equations, which makes the tasks accessible to students with varied prior knowledge and experience. Worthwhile tasks alone are not sufficient for effective teaching. Teachers must also decide what aspects of a task to highlight, how to organize and orchestrate the work of the students, what questions to ask to challenge those with varied levels of expertise, and how to support students without taking over the process of thinking for them and thus eliminating the challenge. Opportunities to reflect on and refine instructional practice—during class and outside class, alone and with others—are crucial in the vision of school mathematics outlined in Principles and Standards. To improve their mathematics instruction, teachers must be able to analyze what they and their students are doing and consider how those actions are affecting students’ learning. Using a variety of strategies, teachers should monitor students’ capacity and inclination to analyze situations, frame and solve problems, and make sense of mathematical concepts and procedures. They  can use this information to assess their students’ progress and to appraise how well the mathematical tasks, student discourse, and classroom environment are interacting to foster students’ learning. They then use these appraisals to adapt their instruction. Reflection and analysis are often individual activities, but they can be greatly enhanced by teaming with an experienced and respected colleague, a new teacher, or a community of teachers. Collaborating with colleagues regularly to observe, analyze, and discuss teaching and students’ thinking or to do â€Å"lesson study† is a powerful, yet neglected, form of professional development in American schools (Stigler and Hiebert 1999). The work and time of teachers must be structured to allow and support professional development that will benefit them and their students.

Australian Foreign Policy Essay Example | Topics and Well Written Essays - 2000 words

Australian Foreign Policy - Essay Example It is argued, however that the media is too influential on public opinion; and it is the proprietors of the industry making all of the decisions.world. What role does Public opinion and media play in the making foreign policy in Australia is the central research question of this paper. It is in relation to this debate that it becomes crucial to analyse the critical political economy of the news media. The critical political economy is the power and influence exerted by media owners, government and culture for the forming of country's foreign policies.The content and information presented in this paper is based on research and survey conducted by leading agencies to study the media and public opinion influence of foreign policy decision making in Australia. The media is an extremely influential factor in society. Is the media a political institution, in that it decides who gets what, when and how through formal organizations and procedures Or is it a business The radical theory suggests that 'the media generates content that garners the greatest profit'1 (Ranganathan, 2002) The liberal theory of the media suggests that it is not just what interests the public, but what is in the best interest of the public. News is the reporting of facts, or news otherwise not known. ... 'The Australian Broadcasting Commission felt that in those days to use pictures, was to descend to the levels of the popular press.'(Mason & Lean, 1992:42) Today, on the other hand, findings from various surveys conclude that television is the most popular news source and the one in which the majority of the public lay their trust.A survey conducted on 60 Australia all- party political decision makers from both Federal and State Governments showed the great influence that mass media and public opinion exert on foreign policy decision making in Australia. The survey can be summarized as follows2: Media + Community= Highest Influence on Government The findings reveal that Australian politicians are most influenced by the public opinion and media. Use of local newspaper and politician's local community is known to be considered as two main critical points to influence their decision-making. Timely data + Active public engagement= Effective tool for influencing on Government. Provision of timely & accurate market and direct, active public engagement are considered as most effective and powerful communication tools for making a point to government. The role of media is reporting of facts, events or news otherwise not known. . Originally, news was broadcasted on radio, always with one white, male presenter reading the entire bulletin. 'The use of pictures in those days was considered as descending the levels of the very much popular press. .Today, on the other hand, findings from various surveys conclude that television is the most popular news source and the one in which the majority of the public lay their trust. In terms of television media as a whole, it is

Luca Signorelli and His Work at Orvieto Essay Example | Topics and Well Written Essays - 1500 words

Luca Signorelli and His Work at Orvieto - Essay Example From this paper it is clear that  every artist reveals a certain theme in any given work. From the works of Luca, themes such as strength of youths, the strict austerity of middle life, and the resolute seriousness of the old age were depicted. He showed dignity in appreciating human life. Among the remarkable works of Luca, only two were executed before Luca approached forty years. These are the Madonna and Flagellation. The execution of Flagellation though done skillfully, it depicted the strength in youths. This vital work inspired the youths and encouraged them to bring out the power in them.This study discusses that later works showed strict austerity in middle age, and the resolute seriousness of the old life. The theme of inspiration came out of all the work that Luca did. For example, in some of the decorations, in the Chapel, Luca showed several famous poets and scenes taken from their work; to clarify the theme of inspiration. In his work, in Orvierto, Luca portrayed them es chosen for decoration of the chapel. The main themes chosen were ruling of the antichrist, last judgment, redemption, damnation, and the resurrection of the dead. These themes helped other artists and readers to fathom the culture of Renaissance.  Luca is known to have done numerous paintings in different cities. It may not be possible to mention all the works that he did, but some of his principal works can be analyzed.... Luca worked in Cortona, where some paintings, which he painted, remains still. He began painting in the Cathedral of Perugia, then Monte Oliveto before being commissioned to undertake the decoration of Cappella Nuova in the Cathedral of Orvieto. In the Cathedral, he represented the prophetic series story of the Anti-Christ; End of the World; Resurrection of the body, Paradise; Inferno, and the Divine comedy (Henry 45). The inferno scenes about End of the World scene indicate tortures of Hell. This layout of work influenced many artists in the field of painting. His later work ended in Vatican, where he sacrificed to make way for Raphael’s work. Luca returned to his native land, Cortona, after the Vatican contract where he continued to do his paintings, but in small bits. His painting career ended in his native land of Cortona (Henry 46). Theology of Luca Signorelli Through the Church art work, an artist portrays religious views or teachings. Most of the art work done by Luca p ortrayed his views regarding Christian teachings. He seemed dedicated in knowing the truth about Christ’s teachings, and described the truth teaching through the paintings, which he created. His desire to enquire the truth about Christ can be seen when he got a contract to paint the Cathedral of Orvieto. In this contract, he sought theological advice from masters of theology. In most of his paintings, he created images representing the true view of the religious books. According to him, true representation of religious matters was a crucial aspect in helping people to discover the truth (Gilbert 55). He represented in art form, the consequences or the end results of preaching and embracing antichrists. In his paintings, he started with

Patient Privacy Policy Research Paper Example | Topics and Well Written Essays - 750 words

Patient Privacy Policy - Research Paper Example Patient Privacy Policy Evaluation process of the policy involves using questionnaires to different departments in hospitals: workers, patient, and tests on the responsibilities that are played to observe the policy. The evaluation is in terms of the responsibility of each individual, the release of information, employee related information and enforcement of the policy (Danis, Clancy & Churchill, 2002). Evaluation on responsibilities tests the understanding on the importance of respecting the rights of patients by keeping the information on their health private and the need to be sensitive to the concerns when using or disclosing the health related information. The evaluation process also focuses on understanding the policy concerning the protection of confidential information in public areas. Evaluation also is on understanding the accountability for maintaining the privacy of its patient and the confidentiality that is in the information. There are situation that the policy to keep the information of the patients private as it is disclosed in some situations such as those for law information officials as part of an investigation when the patient is a victim of a crime. Once the information is disclosed, the information of the patient is not private as it is to the public and can be known to other people. This is a problem in implementing the policy, as there is no surety in using the information only for investigation purposes.

Answer questions Assignment Example | Topics and Well Written Essays - 500 words - 4

Answer questions - Assignment Example Furthermore, this might apply if the internal expertise is not conversant with the location of the target market (Fernie and Leigh 59). This would aim at increasing the reliability, an aspect that would increase the customers’ loyalty towards the products. The approach of developing a strategy, and then employ the specific suppliers to carry out well-defined portions of the strategy would be effective when the company knows the location of the target market, but does not have the necessary resources to carry out the supply work (Fernie and Leigh 45). On the other hand, the approach may work where the suppliers have the resources but has not specialized in information gathering. Therefore, they depend on the information given by the client. The approach to develop the strategy with third-party logistics provider would be effective when the company has little information about logistical issues but want to be part of the supply management. In addition, it may apply when the third-party logistical companies provide warehousing and transportation services. In addition, it may apply when the firm is involved in value addition. This is to ensure that its strategy does not distort the quality of the products. IBM needs both a private and a consortia based e-marketplace in order to be able to deal with B2B, B2C, and Online market. As a global business it’s hard to concentrate on all these logistical aspects. As a result, divulging to the two areas enables the business to reach the target market on time, while at the same time focusing on producing high quality products according to the tastes and preferences of the customers. On the other hand, the emergence of e-marketing brought a new opportunity to expand its market size. However, traditional market was still significant to the business. Therefore, the strategy has ensured that the company maintains its initial supply strategy while upholding changes brought by online platform. As a

Analysis project Essay Example | Topics and Well Written Essays - 1750 words

Analysis project - Essay Example The second source that I picked is â€Å"Decline in Snow Cover Spells Trouble for Many Plants, Animals† and is written by Terry Devitt. This source is a news article that was published on May 7, 2013. Terry Devitt is a research scientist and the Science Research Communications Director at the University of Wisconsin-Madison. This article details the results gathered from his personal and academic research. This source is credible due to Devitt’s extensive background in both researching the causes and effects of global warming and his contribution to the efforts in understanding and preventing global warming. The third source that I picked is â€Å"We Need Some Symptomatic Relief† and is written by Ken Caldeira. This source is a journal article that was found in the GreenFile database via Academic Search Premier, and was published in the Spring of 2013. Ken Caldeira is an atmospheric scientist with the Carnegie Institution for Science's Department of Global Ecolog y at Stanford University. Caldeira’s background and position as a scientist that focuses on changes in the atmosphere is what gives this source credibility. The fourth source that I picked is â€Å"National Institutes of Health Explore Impact of Climate Change on Human Health† and is written by Christine Jessup and John Balbus. This source is a short article found on the Global Change government website and was published on April 22, 2013. This source is credible as the website where it was found is moderated solely by the United States government’s Global Change Research Program. The information on this website is published based on authenticity, authority of its writers, and its relevance to the website’s purpose. In â€Å"Rain Will Get More Extreme Thanks to Global Warming, Says NASA Study,† Carl Franzen reveals how the steadily increasing temperature of the globe is leading to wetter locations receiving more rain and dryer locations experiencin g lengthier droughts. While most studies have focused on the effects of global warming on specific regions, the study detailed in this article looks at the globe as a whole. Regardless of the location, â€Å"for every single degree Fahrenheit the global average temperature climbs, heavy rainfall will increase in wet areas by 3.9 percent, while dry areas will experience a 2.6 percent increase in time periods without any rainfall† (Franzen par. 3). This increase in rain and periods of drought are believed to be caused by the warming globe enabling the atmosphere to retain more water vapor as moisture, which causes the moisture to be withheld from the dry areas, denying these locations of moisture that would otherwise end their droughts (par. 4). The specific evidence in this source that I find convincing are the details of how much rain is released or withheld from certain locations, depending on its temperature. This information is convincing since the facts were presented by atmospheric scientists directly involved in the study. There is no bias present in this source. In â€Å"Decline in Snow Cover Spells Trouble for Many Plants, Animals,† Terry Devitt discusses how global warming is causing the snow to melt more quickly in the Northern Hemisphere, which is proving to be damaging to the animals and plants that rely on the thick cover of snow to protect them from the chill of winter. â€Å"

Resolving Ethical Business Challenges Essay Example | Topics and Well Written Essays - 250 words

Resolving Ethical Business Challenges - Essay Example In this situation, Marry is also facing an ethical problem that either she should care for the customers to lie or to speak the truth. On the other side, it is also important that if she lies to the building owner and the buyer then what would be the benefit of it. In the business world, the ethics program may also include the true and sincere involvement of the employees with their business and the business parties and stakeholders. If Mary lies to the building owner and hides the reality of her negotiation with the owner of the buyer then it also indicates that she is trying to fulfill her duty. However, she may face a little problem after the negotiation when both parties will come to know the truth. At least until that time, the building will be sold and this sale is actually beneficial for both parties. The building is not considered for many years and now the only customer who wants to own this building is here. Therefore, if Mary put her efforts to make this purchase possible then it will not be considered as unethical. However, it is quite possible that if Mary is successful in her efforts to convince Ted that the buyer is purchasing that building for a noble cause and he cannot arrange the required down payment because of the charity funds. Then it will not be a problem for the buyer and the seller that there is an issue with the agreement.

Fashioning Responsibly Essay Example | Topics and Well Written Essays - 1500 words

Fashioning Responsibly - Essay Example The essay "Fashioning Responsibly" discovers the Fashioning Responsibly. The operations of sweatshops usually pose grave risks to the people working in them, as well as, fail to compensate them adequately. Under most circumstances, sweatshops abuse all labor laws in existence. The fashion industry has to shoulder all the responsibilities that result from their production activities. The fashion industry is the most thorough department of the economy in employing poor economic conditions, as well as, harassment of the workers who power the production systems of these companies. Most of these fashion houses have manufacturing plants whereby it employs a number of workers to produce a given product within the right time. The short deadlines between launching of a product and the growth and expansion of market spheres makes some fashion houses not to adhere to the policies and laws set to govern the delivery of labor in the society. These fashion industries operate sweatshops in order to meet their market demands, as well as, provide formidable competition for the activities and practices undertaken within their production lines. In addition, these stringent working conditions also result from the tight deadlines that they have to meet both in the industry as well as in the market. The conditions in sweatshops operated by fashion houses usually relate to a number of characteristics, key among them being overworking its workers for long periods of the day and sometimes in the night. In addition, these sweat shops also pay these workers below the required minimum wage, as well as, way below the set market standards in the fashion industry. This is in complete disregard and total defamation of the laws and regulations mandating payment of overtimes to employees who work for long hours, or those legal laws pertaining minimum wages. The operators of sweatshops in most cases simply abuse their employees. They see their employees as a means to achieve their goals and obje ctives. They do not consider their social well-being and other financial status and needs the employees in this fashion sweatshops end up working on fabric for long hours, without the right working conditions that may also jeopardize their health conditions, and still get the lowest payments at the end of the day.3 This abuse of labor in sweatshops especially in the fashion industry occurs mainly because of the poor economic standards in which these industries are located. For instance, most fashion industries in the United States and other developed countries have their headquarters at leafy and affluent locations in major cities and towns in the United States. These headquarters of a given line of fashion, or design and brand of fashion, work hard to promote their brand, as well as, coming up with the best designs to meet market demands. However, they do not host their manufacturing plants in these leafy locations and town premises. Due to the intensive requirement of labor in the production of these fabrics, as most of the fashion industry is not well techno developed, they locate their industries in countries

Public Sector vs Private Sector Research Paper Example | Topics and Well Written Essays - 750 words

Public Sector vs Private Sector - Research Paper Example In practice, the method chosen for the evaluation of a project can highly vary depended on the project’s targets, the resources available and the environment in which the project was first developed. For example, if the project has been developed in the private sector its evaluation will be based on a method that will be different from those used in the public sector. Cost Benefit Analysis/ Cost Effectiveness Analysis The specific method of project evaluation is ideal for projects that have both economic and non-economic effects (Simic, Vratonjic & Beric 2011, p.114). When the costs involved in a project are difficult to be precisely estimated, then the Cost Effectiveness Analysis would be preferred. The Cost-Effectiveness Analysis has an important benefit: it gives the chance to choose among alternative projects so that the project related to the lowest costs is identified (Simic, Vratonjic & Beric 2011, p.115). ... Effectiveness Analysis (Simic, Vratonjic & Beric 2011, p.117) Setting project’s goals and purpose Setting ‘the conditions for the achievement of goals’ (Simic, Vratonjic & Beric 2011, p.117) Introducing alternatives; for each goal at least two alternatives need to be available, meaning alternative strategies/ methodologies for achieving a particular goal Introducing evaluation criteria; for example: ‘feasibility and availability’ (Simic, Vratonjic & Beric 2011, p.117) Introducing evaluation criteria related to costs; fixed cost criteria are preferred since they refer to a wide range of costs, including ‘research and development, project implementation and maintenance’ (Simic, Vratonjic & Beric 2011, p.117) Deciding on the quality/ appropriateness of alternatives Evaluating each alternative in terms of its sensitivity, i.e. whether it is vulnerable to changes. Evaluating each alternative in terms of its content, meaning especially the accu racy of costs involved The findings of the research over the quality of a project are further discussed and analyzed aiming to present all aspects of the project and of the alternatives available A different process for the evaluation of a project can be chosen, taking into consideration the economic and social environment and the project’s targets. For example, the African Development Bank Group tends to use a specific process for evaluating its projects; this process is presented in Figure 2 below. Figure 2 – Evaluation process of projects developed by ADBG (ADBG 2004, p.iii) Evaluation of project – Costs The costs of a project are usually categorized according to the nature of the project and its targets. In the case of BlueJay, costs would be divided into two major categories. A. Total ownership costs These are

Paul’s Missionary Journey Essay Example for Free

Paul’s Missionary Journey Essay The Apostle Paul was the great leader in the momentous transition which characterized the apostolic age, the transition from a prevailingly Jewish to a prevailingly gentile Christianity. Under his guidance Christianity was saved from atrophy and death, which threatened it if it remained confined in Palestine. At the same time, by reason of his insight into the truth of the Gospel and fidelity to it, as well as by his devotion to the Old Testament and loyalty to the highest Jewish ideals in which he had been reared, he saved Christianity from the moral and religious degeneracy to which it would surely have been brought if it had broken with its past, and had tried to stand alone and helpless amid the whirl of Greek religious movements of the first and second Christian centuries. In Paul a great force of onward movement and a profound and conscious radicalism were combined with fundamentally conservative principles. Paul appears to have been born at not far from the same time as Jesus Christ. According to Acts, Paul was born in Tarsus (Acts 9:11; etc. ), received the double name Saul/Paul (13:9), and through his family possessed Tarsian and Roman citizenship (22:25-29 (Murphy-OConnor 32-33). Overall, Paul can be described as an able and thoroughly trained Jew, who had gained from his residence in a Greek city that degree of Greek education which complete familiarity with the Greek language and the habitual use of the Greek translation of the Scriptures could bring. At bottom he ever remained the Jew, in his feelings, his background of ideas, and his mode of thought, but he knew how to make tolerably intelligible to Greek readers the truths in which, as lie came to believe, lay the satisfaction of their deepest needs. At Jerusalem Paul entered ardently into the pursuit of the Pharisaic ideal of complete conformity in every particular to the Law. He was, he tells us, found blameless (to every eye but that of his own conscience), and, he says, I advanced in the Jews religion beyond many of mine own age among my countrymen, being more exceedingly zealous for the traditions of my fathers. With fiery passion he entered into the persecution of the Christian sect, was present and took a kind of part at the murder of Stephen, and undertook to carry on the work of suppression outside of Palestine at Damascus, whither he journeyed for this purpose with letters of introduction from the authorities at Jerusalem (Murphy-OConnor 52-57). At this time took place his conversion. That he was converted, and at or near Damascus, his own words leave no doubt. I persecuted, he says in writing to the Galatians, the Church of God. . . But when it was the good pleasure of God, who separated me, even from my mothers womb, and called me through his grace, to reveal his Son in me, that I might preach him among the gentiles; straightway I conferred not with flesh and blood: neither went I up to Jerusalem to them which were apostles before me: but I went away into Arabia; and again I returned unto Damascus (Gal i. 13-17). The change evidently presented itself to Pauls mind as a direct divine interposition in his life. It came to him in a revelation of Jesus Christ, whereby (and through no human intermediary) he received the Gospel which he preached, and the commission to be an apostle. He refers to it as to a single event and an absolute change of direction, not a gradual process and development; the two parts of his life stood sharply contrasted, he did not conceive that he had slid by imperceptible stages from one to the other. What things [i. e. his advantages of birth and Jewish attainment] were gain to me, these have I counted loss for Christ . . . or whom I suffered — as if in a single moment —the loss of all things (Phil. iii. 7. 8). From Pauls own words, then, we know that he was converted from a persecutor to a Christian, at a definite time and at or near Damascus, by what he considered to be the direct interposition of God; and it seems to be this experience of which he thought as a vision of the risen Christ (Hubbard 176-77). After Pauls conversion, which took place in the latter part of the reign of Tiberius (14-37 a. d. ), about fifteen years passed before the missionary career began of which we have knowledge from Acts and from Pauls own epistles. During this time Paul was first in Arabia, that is in some part of the empire of which Damascus was the most famous city, then in Damascus, and later, after a brief visit to Jerusalem, in Cilicia, doubtless at his old home Tarsus. In this period we may suppose that he was adjusting his whole system of thought to the new centre which had established itself in his mind, the Messiahship of Jesus. With the new basis in mind every part of his intellectual world must have been thought through. Especially, we may believe, will he have studied the relation of Christian faith to the old dispensation and to the ideas of the prophets. The fruit of these years we have in the matured thought of the epistles. They show a steadiness of view and a readiness of resource in the use of the Old Testament, which testify to through work in the time of preparation. Epistles written years apart, like Galatians, Romans and Philippians, surprise us by their uniformity of thought and unstrained similarity of language, in spite of the richness and vivacity of Pauls thought and style. So, for the most part, the characteristic ideas even of Epliesians and Colossians are found suggested in germ in Corinthians and the earlier epistles. Pauls epistles represent the literary flowering of a mind prepared by years of study and reflection (Murphy-OConnor 90-95). At Pauls missionary journey and the beginning then made of churches in Asia Minor we have already looked in a previous chapter. After his return to Antioch followed that great and pivotal occasion of early Christian history, the so-called Council, or Conference, at Jerusalem, described in the fifteenth chapter of Acts and by Paul in the second chapter of Galatians. At that time Paul established his right to carry on the work of Christian missions in accordance with his own principles and his own understanding of the Christian religion. His relation with the Twelve Apostles seems then and at all times to have been cordial. His difficulties came from others in the Jewish Church. To this we know of only one exception, apparently somewhat later than the Conference, the occasion at Antioch when Peter under pressure from Jerusalem withdrew from fellowship with the gentile brethren, and called out from Paul the severe rebuke of which we read in Galatians. There is reason to believe that the rebuke accomplished its purpose. At any rate, at a later time there is no evidence of a continued breach. The idea of missionary travel had evidently taken possession of Paul, for after returning from Jerusalem to Antioch he soon started out again, and was incessantly occupied with missionary work from now until the moment of his arrest at Jerusalem. Leaving Antioch on his second journey he and his companions hurried across Asia Minor, stopping only, it would appear, to revisit and inspect churches previously established. They were led by the Holy Spirit, as the writer of Acts believed, to direct their course westward as rapidly as possible to Greece, which was to be the next stage in the path to the capital of the world. In Macedonia and Achaia Paul and his companions worked with varying success at Philippi, Thessalonica, Ber? a, Athens, Corinth. At Corinth, the chief commercial city of Greece, the Christians arrived in the late autumn. The work opened well, and Paul remained at that important centre until a year from the following spring. The date of his arrival cannot be exactly determined, but is probably one of the five years between 49 and 53 a. d. While at Corinth he wrote the First and (if it is genuine) the Second Epistle to the Thessalonians. Somewhere about this time, perhaps before leaving Antioch for this journey, the Epistle to the Galatians was written. The churches of Galatia, to which it is addressed, were probably the churches known to us in Acts as Pisithan Antioch, Iconium, Lystra, and Derbe. After a flying trip to Syria and perhaps to Jerusalem Paul returned to Ephesus in Asia Minor, where he settled down for a stay of three years. A few incidents of this period have been recorded in the Book of Acts, and are among the most striking and realistic that we have. They include a remarkable number of points of contact with facts known to us from archeological discoveries, and in no chapters of Acts is our confidence more fully reassured in the contemporary knowledge and the trustworthiness of the writer of the book. While at Ephesus Paul had much communication with Corinth, and wrote I Corinthians, which had clearly been preceded by another letter. There are indications in II Corinthians that after this he found the difficulties in the church at Corinth such that he wrote them at least one letter which has been lost, and made a short, and in its outcome exceedingly painful, trip to Corinth and back to Ephesus. Finally he was impelled by danger to his life to leave Ephesus, and went through Macedonia to Corinth. On the way he wrote, to prepare for his own presence, the epistle we call II Corinthians. Arriving at Corinth in the early winter he stayed until spring. His literary impulse continued active, and to this winter we owe the Epistle to the Romans. Earlier letters had been called out by special need in one or another church; in Romans Paul comes nearer to a systematic exposition of his theology than in any of his earlier writings. He knew the importance that would surely belong to the Christian Church of Rome. He had made up his mind to go there. But first he must go to Jerusalem, and there were dangers both from the risks of travel and from hostile men. Of each hind his life had had many examples. Accordingly he provided for the Roman Christians a clear statement of his main position, together with a reply to several of the chief objections brought against it, notably the allegations that his presentation of Christianity involves the abrogation of Gods promises to his chosen people, and that it opened the way to moral laxity. This letter Paul sent as an earnest of his own visit to Rome. He had been for a year or more supervising the collection by the churches of Asia Minor and Europe of a contribution for the poor Christians at Jerusalem; the gentile churches should thus make a repayment in carnal things to those who had made them to be partakers of their spiritual things. This contribution was now ready, and Paul himself with a group of representatives of the chief churches took ship at Philippi and Troas for Jerusalem. The voyage is narrated in detail in Acts, evidently by one who was a member of the company. At last Paul reached Jerusalem, and was well received by the church; but, followed as he was by the hatred of Jews from the Dispersion who had recognized the menace to the Jewish religion proceeding from the new sect, he was set upon by a mob, rescued only by being taken in custody by the Roman authorities, and after a series of exciting adventures which will be found admirably told in the Book of Acts, was brought to C`sarea. There he stayed a prisoner for two years and more until on the occasion of a change of Roman Governor his case was brought up for trial, when he exercised the right of a Roman citizen to appeal from the jurisdiction of the Governor to that of the imperial court at Rome. It was late autumn, but he was dispatched with a companion whom we may well believe to be Luke the beloved physician, and from whom our account certainly comes. The narrative of Pauls voyage and shipwreck, of the winter on the island of Malta, and the final arrival at Rome early in one of the years between 58 and 62 a. d. is familiar. It is the most important document that antiquity has left us for an understanding of the mode of working an ancient ship, while the picture which it gives of Paul as a practical man is a delightful supplement to our other knowledge of him(Murphy-OConnor 324). In Rome, while under guard awaiting trial, Paul probably wrote Philippians, Colossians, Philemon, and the circular letter, seemingly intended for churches in Asia Minor, known to us as Ephesians. They show some new development of ideas long present with him, and some new thoughts to which his other writings give no parallel, and the style of some of them has changed a bit from the freshness of Galatians and Romans; but these are not sufficient reasons for denying that Paul wrote the letters. They are, indeed, as it seems to me, beyond reasonable doubt genuine. The Book of Acts ends with the words, And he [Paul] abode two whole years in his own hired dwelling, and received all that went in unto him, preaching the Kingdom of God, and teaching the things concerning the Lord Jesus Christ with all boldness, none forbidding him. This period of two years is sufficient to include the composition of the four epistles to which reference has just been made, Philippians, Colossians, Philemon, and Epliesians, the so-called Epistles of the Captivity. What happened at the expiration of the period? Apparently Pauls case, long postponed, then came to trial. Did it result in his release or his execution? The evidence is meager and conflicting, and opinions differ. It is perhaps a little more likely that he was released, and entered on further missionary work, probably carrying out his original purpose of pushing on with the proclamation of his Gospel to the west, and establishing it in Spain; but of this period there is no narrative. If after two years Pauls imprisonment at Rome ended with his release, as the absence of well-founded charges against him would lead us to expect, he must have been later again apprehended, probably in connection with the persecution artfully turned against the Christians at the time of Neros fire in July of the year 64. It is probable that he was beheaded, to which privilege his Roman citizenship entitled him, and that he was ultimately buried on the Ostian Way at the spot where now stands the splendid basilica of St. Paul Outside the Walls.

Illegal Immigration Essay Essay Example for Free

Illegal Immigration Essay Essay Almost all of us can say we are children of immigrants. Either our great grandparents or grandparents came to America for a better life. We know that the Statue of Liberty and Ellis Island are the symbols of that great dream that so many sought so many years ago. During a visit to Ellis Island last summer I learned that during the early 1900’s we encouraged immigration because it was a time when our country’s territory had grown and we needed more people to help with the continued development of our country. Today, however, we find that immigration is not seen as a positive for our country, but rather it is unquestionably considered a problem today in America. Immigration law is in the news a lot and immigration policy is a big topic discussed in congress; it is even a major issue for Obama’s administration. Some people in government believe that we should â€Å"close the door† and reduce the amount of people coming into our country; especially as it relates to the problems we have had with terrorist activities. But, I believe that the main problem with immigration is not the legal immigrants who come here following the rules, but rather it’s the illegal immigrants who sneak into our country over borders and then put a burden on our social services and do harm to our country. So, what is the solution? Currently there are almost 12 million illegal immigrants in America and that makes it just too expensive and a big project to just deport all of them at one time, so we need a better plan; something must be done. Illegal immigration inflicts a great threat to America. Aside from the belief that illegal immigrants are stealing jobs from our own citizens and the legal immigrants, but some illegal immigrants are causing crimes. In a 2006 study from January 1999 to April 2006 about 260,000 illegal immigrants committed almost 1 million sex offenses in America. Also illegal immigrants today make up 30% prison population in America. A topic that has been on the news often in other states where there is a lot of illegal immigrant crime is overcrowding of prisons. Many illegal immigrants are coming over and cause crimes and endangering the American citizens. But not all illegal immigrants are bad some illegal immigrants are here because they are trying to make a better live for themselves. Illegal immigration also has a great cost as well. Illegal immigrant households imposed, in total, costs exceeding $26 billion for the federal government, while these immigrants paid only 16 billion dollars in federal taxes, therefore creating a fiscal deficit of $10. 4 billion per year at the federal level. The largest contributors to this deficit were Medicaid with $2. 5 billion, medical treatment for the uninsured with $2. 2 billion, food-assistance programs with $1. billion, the federal prison and court systems with $1. 6 billion, and federal aid to schools with $1. 4 billion. While I believe there are too many illegal immigrants to have them all deported, I do think that those illegal immigrants who are taking up criminal activities are the ones that should be deported; rather than put in our already overcrowded jails. I think the other illegal immigrants who actually want to become a citizen and make a life for themselves should be able to come forward, and if they pass criminal background checks and pay fees and penalties, they can then be eligible for a provisional legal status. Agricultural workers and those who entered as children should also be eligible for the same program. This would provide a process and a way to control the amount of people coming to the country. These individuals would wait until existing legal immigrations become citizens, then they can get in line to become a legal immigrant. I think another thing that could be done is have a startup visa for immigrants who want to come here and start a business. If their business does grow further and is successfu, they should then have the option to stay permanently. This would create more jobs and strengthen the community. I think we should also have programs set up that would help new immigrants coming over find jobs or a list of people to call for work. I also think we should have programs to verify the eligibility of a worker to help employers find people who are available to work. In the president’s plan he had a program called E-verify . I agree with his plan to expand the use of this program. One of the last things I think we should have in our immigration policy is something that encourages education. For example, immigrant children who attend college could also earn credit toward citizenship. I also believe that all immigrants filing for permanent status should also be required to learn English within 5 years of their arrival. It’s crazy that our country spends all that money and time with â€Å"English as second language† classes in schools and in communities. If I decided to go live in Italy, that government would not start to translate all their signs and advertising so that I could understand it. Nor would they pay for me to attend special classes to learn their language. If I decided to live and work in Italy, it would be my responsibility to learn the Italian language before I go there or attempt to become a citizen there. Unfortunately, immigration continues to be a problem mainly because our country can’t handle the huge influx of people wanting to come here. Although our country was founded by â€Å"immigrants†, we no longer are capable of dealing with all the other issues like education, jobs, healthcare and housing, that come with allowing more people to come to our country, I understand there is no easy answer, but I do think we need to make sure we are protecting our country and our citizens first.

Pacs Implementation Within A Radiology Department Information Technology Essay

Pacs Implementation Within A Radiology Department Information Technology Essay Information technologies and systems have revolutionised the way people think and act in many spheres of life. Information systems are deemed to be one of the major tools available for business managers for achieving operational excellence, developing new products and services, improving decision making and achieving competitive advantage (Laudon Laudon, 2009). The domain of information systems is an exciting evolution creating digital content in their products and services and delivering them over digital networks as being practiced widely in businesses, including in the healthcare enterprise. In the healthcare industry, information systems have created opportunity to restructure both the operational and architectural aspects in general, particularly in the radiology department (Rostenberg, 2006, p. 15). Perhaps as Jalaludin et al. (2005, p. 56) stated, no other specialty in medicine has benefited as greatly as in radiology with respect to advances in electronics and computers. The transformation of digital radiology will strive on giving way from the expensive and time-consuming endeavour of film and paper based methods to the faster and simpler computer based ones. As radiology continues to grow and evolve, paradigm changes such as reengineering information storage and delivery, as well as refining the overarching data repositories and access systems that support the healthcare consumer is required in order to be competitive. In keeping with the challenges, a prominent feature of evolution would be the proliferation of enterprise-wide electronic Picture Archiving and Communication Systems (PACS), which has changed the face of radiology by radically altering the core drivers of traditional film-based imaging facilities. Filmless image management systems will become popular in all hospitals in the near future (Furukawa et al., 2004). Therefore one should investigate the merits demerits of implementing this system effectively taking into consideration the productivity improvements and cost reductions while providing better patient care. 2.0 Purpose The purpose of this report is to propose PACS implementation within a radiology department in a public sector medical centre located in Kuala Lumpur, Malaysia, as part of a strategic business plan to create competitive advantage in the ever increasing patient demand. The author will conduct an analysis of the competitive environment and resources evaluating the strategic options in implementing PACS. Apart from this, an outline of the MIS requirements for the successful implementation of the selected PACS strategy and the associated plan needed to be undertaken will also be highlighted. This will lend a hand in securing funding and to provide a roadmap for its implementation within the timeline of one (1) year. The judicious planning of PACS strategy business plan will aim towards reengineering information storage and digital delivery as part of fulfilling the departments goals and objectives in creating a filmless environment, thus adding value and improving the business of radiology. 3.0 Organisational and Environmental Audit. The development of PACS strategy in the evolving field of radiology, as stated by Chan (2002) consists of two main interrelated processes such as: gaining insight into the organisation and its environment; and positioning the organisation for sustained competitive advantage Organisations need to respond to changes in their environment by continuous adaptation, which warrants making decisions on how to adjust and develop their products and services by keeping pace with environmental changes; otherwise they will lose their competitiveness (Chan, 2002). In addition, government regulation such as Health Insurance Portability and Accountability Act (HIPAA) has driven many to demand improvements in the management of the information systems within the healthcare system with PACS being one of the primary components of this requirement (Smith Hirschorn, 2006, p.157). As such, it is important to answer three essential strategic questions and develop the framework for PACS strategy, thus focusing on few elements that relatively contribute to sustained competitive advantage (Table 1). Strategic Questions Framework Where is our organisation right now? Wide range of information is collected. Where do we aim to go in the future? Insight developed and options generated. How do we get there? Implementation of new strategy. Table 1: Strategic questions and framework in PACS strategy development (Chan, 2002) As part of gathering wide range of information to set the framework for PACS strategy development, strategic analysis such as external environment and organisational audit is required as shown in Table 2. Strategic Analysis Outcome Development in radiology context External Environment Review events and trends that have occurred, occurring or anticipated to occur. Changes in economic, governmental, technologic, physical, cultural and managerial process. Mandate the conversion from the analogue paper and film based systems to a purely digital department. Organisational Evaluate the structure, operations, resources and culture of the organisations. Identify the current capabilities and the availability for the future strategic initiatives. The support of personnel from all levels will bring it closer to the department goals of going filmless. Capabilities enhanced through proper training and coaching sessions. Table 2: Strategic Analysis in PACS development (Chan, 2002) In addition, it is also imperative to gain information regarding the interrelationships between the two. As such, a simple integrative analysis, known as SWOT is performed to highlight the inherent strengths and weaknesses, as well as opportunities and threats about the organisation and the relevant environmental factors facing the organisation in implementing PACS strategic business plan, as shown in Table 3. STRENGTHS: The development of an organisations particular set of resources, which leads to sustainable competitive advantage. Collective organisational learning that results in superior performance, especially in coordinating and integrating new activities and workflows. New strategy and initiatives fosters new views of the role of radiology in the health care industry, thus adding value to the services rendered. WEAKNESSES The resulting strategy may fall out of favour as a result of plans becoming too detailed and cumbersome to implement. Different divisions may be inflexible in the face of changing business conditions and new competition. Should this be unsuccessful, the managers and employees who were responsible for the implementation of the chosen strategy may feel disempowered. OPPORTUNITIES Building new capabilities and inventive in the use of limited resources to close gap should there be misfit between available resources and the resources needed for the desired goal. The push to possess leadership qualities along the new development path and change management. Room to exercise imagination and creativity throughout the development and implementation of new strategy. THREATS External events or environmental trends that cannot be foreseen by observers could affect or even invalidate the viability of each strategic option that is considered. High costs of increased government regulations in radiology practices may deter the implementation. Table 3: Authors framework of SWOT analysis about the organisation and the relevant environmental factors in implementing PACS strategic business plan 4.0 Competitive Analysis Once the insight of an organisation and its environment is gained, it is fundamental to undertake competitive analysis. These include a definition of the immediate radiology market, a description of competitors and the status of their PACS implementations (Levine, 2006, p. 37). In creating the framework to help determine industry competition, arguably the most widely used model will be Porters five forces model (Figure 1). Figure 1: The five competitive forces that shape strategy (Porter, 2008) According to Porters five competitive forces model, the strategic position of the firm and its strategies are determined by competition with its traditional direct competitors and also greatly affected by new market entrants, substitute products and services suppliers and customers (Laudon Laudon, 2009, p. 107). A market research conducted by Frost and Sullivan (2010) stated that the radiology markets in Southeast Asia have considerable potential, regardless of their maturity. In addition, the analyst further reiterated that with the decline in costs and advancements in PACS applications, smaller hospitals have begun to implement PACS in radiology and also in various medical disciplines such as the cardiology and dentistry departments that produce medical images too; thus enabling better image management. Therefore, the strategic plan should note any PACS advertising done by local competitors in order to highlight any potential threat to market share, then perform the market share at risk if PACS is not implemented at this institution to estimate the amount of additional revenue that may be shifted to or from a competitor that has respectively superior or inferior radiology services. However Levine (2006, p. 39) stated that, a potent argument for PACS in the strategic plan will be to compare capacity and productivity gains that can be expected to accrue from the implementation to the future increases in demand for radiological services due to the normal growth and increased market share. As such, applying Porters five forces competitive analysis in PACS strategy would generate a framework as shown in Table 4. Competitors: Government hospitals Teaching hospitals Private medical centres Potential competitors: All radiology businesses Substitute products: Advances in hardware and software Breakthrough products in other emerging imaging technology with built-in information systems Networking only a few workstations together from radiology department to a particular department Buyers: Individual hospitals or medical centres Regional health care networks and integrated delivery systems Government programmes Managed care organisations Suppliers: Information technology providers (HIS, RIS, PACS, Application Service Providers) Manufacturers of imaging devices and supplies Table 4: Authors framework using Porters five forces competitive analysis applied in PACS strategy 5.0 Strategic Implications There are three basic strategic options available to organisations for gaining competitive advantage, according to Porters Generic Competitive Strategies model (Figure 2), namely, cost leadership, differentiation and focus, thus developing the edge, which brings revenue for the organisation and takes it away from ones competitor (Mind Tools, 2011). Figure 2: Porters Generic Competitive Strategies model (MBA Knowledge Base, 2011) With the implementation of PACS, this organisation aims to provide low-cost, thus achieving cost leadership by gaining market share, whilst maintaining profitability and pursue a differentiation-based strategy by offering unique product and services; thus offering a greater value package to customers and competitors. In addition, it is imperative to use technology, where possible, to create or enhance customer value and satisfaction. As such, Porters value chain model (Figure 3) can be generalised to the practice of radiology to identify the key value drivers to build customer satisfaction through the implementation of PACS as a new strategy. Figure 3: Porters value chain generalised to the practice of radiology (Schomer et al., 2000) The model views a series of primary and support activities that add value to the organisations products or services (Laudon Laudon, 2009). In radiology practice, these include four support activities; namely, the organisation infrastructure, human resources, technology development and procurement, which is straightforward, focusing on reducing costs in these areas for both customers and organisation. On the other hand, the five primary activities, namely, inbound logistics, operations, outbound logistics, marketing and service are quite specific and leveraging using technology, such as the PACS, can often significantly enhance each of these activities. Each activity has an associated cost and therefore the residual margin (black area in Figure 9) will be retained as the shareholder earnings (Schomer et. al., 2000). 6.0 PACS Strategic Plan Recommendation What is PACS and why choose this strategic plan in a radiology set-up? PACS include computers or networks with dedicated storage, retrieval, distribution and image management, which are stored in an independent Digital Imaging Communications in Medicine (DICOM) format (Amber Diagnostics, 2010). PACS can eliminate many of the time-consuming processes associated with film-based medicine and enable the practice of filmless medicine (Figure 4). This adds value to the radiological services, which not only provides services by generating diagnostic reports, but also expedites the timely delivery of results (Levine 2006, p. 27). PACS completely reengineers radiology practices by enabling ubiquitous availability of images to be electronically viewed virtually anywhere and simultaneously, resulting in improved clinical care and productivity throughout the healthcare enterprise. Figure 4: Film-based medicine and filmless medicine (Furukawa et al., 2004). The current set-up of the radiology department encompasses of digital multi-modalities such as, Computed Tomography (CT) Scan, Magnetic Resonance Imaging (MRI), Digital Angiography and others performing approximately 180,000 200,000 examinations per year. As part of aiming towards creating a digital environment, besides procuring these digital modalities, the department has also established connectivity to a Radiology Information System (RIS) and Hospital Information System (HIS). The HIS feeds verified patient demographics to the RIS, which in turn is responsible for scheduling orders, capturing relevant clinical information and providing a platform for radiologists to prepare examination reports. However, currently hard-copy medical images are the only image capture, display and storage medium. Besides radiology, view boxes are found in diverse locations such as wards and clinics in order to view the radiological images. There is usually only one copy of film to be displayed at any one time, thus reducing the efficiency and effectiveness of patient management. The image management in a conventional environment involves exceedingly complex, high manual and work-intensive processes involving as many as eight (8) different types of personnel performing up to ten (10) different tasks and takes about 1 to 4 hours to generate results [Figure 5(a)]. However in a fully electronic environment, this can be reduced to approximately eight (8) tasks, many accomplished by computers, allowing the number of people involved to be reduced to four (4) and results to be generated within 45 minutes to 1 hour [Figure 5(b)]. As such, the implementation of PACS will foster stronger development of consolidated delivery networks at not only the departmental level but also at the organisational level. Figure 5: Workflow process from radiological examination request to final report in a (a) conventional environment and in an electronic (b) RIS and PACS environment [distrib. = distributed, Dx = diagnosis, Phys. = Physician, Sched. = schedule] (adapted from Bryan, 2003) With the need for increased quality, clinical effectiveness and meeting the pressure of market competition in the digital world, PACS is seen as an opportunity to provide patients with clinical services that could never be provided in the analogue world. The scope and benefits of PACS reach beyond the radiology department, whereby, it also greatly expands the exposure, expense and operational impact; hence the need to be comprehensive and include all key players in the decision making process, planning and the development of new strategy is crucial (Chaney Cotter, 1998). Implementing and integrating PACS requires significant planning, workflow redesign, system configuration and training. However a common problem in implementing PACS will be recognising the mix of image generation technologies or modalities and identifying different types of interfaces (Chaney and Cotter, 1998). With regard to this, older equipment already installed in this radiology department may require specialised protocol conversion to talk to the new PACS equipment although the established communication standards can be supported by the newer equipment in the market today. As such, the PACS and modality vendor input is crucial to identify the required number of modalities to be linked and whether any licensing or implementation costs attached to each modality connection will be required. An enterprise-wide strategic planning methodology for PACS, which involves a broad cross section of the imaging and user community, proposed for this medical centre is outlined as in Figure 6. Figure 6: Development of an enterprise-wide PACS strategic plan (adapted from Chaney and Cotter, 1998) Once a structured PACS strategy planning process to establish a sound business case has been undertaken, the next step will be developing a Request For Proposal (RFP) and conducting the PACS vendor selection process. The PACS equipment needs and archive size requirements are instrumental in preparing an effective RFP. The RFP will include detailed specifications for the locations and types of required equipment and a high-level project plan in order to specify the installation accurately as shown in Figure 7. Figure 7: PACS life cycle overview (adapted from Chaney and Cotter, 1998) In addition, it is also imperative for vendors to be able to specify all devices required during the vendor quotation phase of the project. Finally, establishing connections to the already existing RIS-HIS, computed radiography, digital radiography and results reporting may consume months prior to the roll-out of the system as shown in Gantt Chart (Appendix 1). 7.0 Financial analysis The financial analysis plays an integral part of the business case development and is crucial to the assessment of the economic viability of the proposed PACS initiative. This would set the stage for the technical and performance specifications prior to the establishment of a procurement exercise. Lim (2008) stated that the budgets for PACS acquisition project are usually identified as capital budget estimate, which encompasses the probable costs to purchase and implement the technology and recurrent budget estimate that represents the projected future costs of managing and maintaining the system in a sustainable operational state. The capital and recurrent costs descriptive items are as shown in Table 5. Types of costs Descriptions of items Capital costs Capital purchase costs of PACS Installation and commissioning costs Any costs associated with imaging equipment upgrades Infrastructure costs (e.g. data centre, network, computers for image distribution) Change management Recurrent costs Staff and accommodation Consumables Ongoing training Upgrade costs Table 5: Capital and recurrent costs for PACS acquisition project (Lim, 2008) With regards to the PACS acquisition, Lim (2008) further stated that there are a few financial models to be considered when acquiring PACS, namely: The traditional purchase, where purchase is outright and owned and managed by the institution, with vendor providing technical support under a service contract agreement, which is a common method in public sector; Application Service Provider (ASP), where the facility purchases a service from the vendor with charges based on fee-per-service arrangements; Leasing models, which can have some financial incentives in private sector context. The proposed budgetary costs for PACS implementation recommended for this public sector medical centre is based on a traditional purchase acquisition model, which illustrates how a capital and recurrent budget may be established amounting to costs assumption of RM 3,487,000 presented in Appendix 1. However, calculating the purchase, upgrade and running costs is only half of the budgeting task, the other side of the equation is the cost savings, efficiencies and service improvements that this technology can bring to an imaging facility. These savings include film and stationery costs such as jackets, chemistry costs, film storage and handling including space and file room staff, processor purchase and running costs. Therefore it is important to undertake a cost-benefit analysis to see whether an individual option has financial or economic merit. A study conducted by Van Genip et al., (1994, cited in Becker and Arenson, 1994) stated that the overview of data from 15 cases collected with CAPACITY (Cost and Critical Analysis of PACS Indicating its Yield) cost-modelling software suggests that, when the cost of hardware components is allowed to drop 5% to 25% per year, some hospital-wide systems will become less expensive than film in the future with breakeven between 4-8 years, which is applicable for this scenario. As such, with the fast decreasing price of digital storage in the current market, it is deemed that PACS will provide cost and space advantage as compared to film archives. However, a downtime contingency plan, where costs for backup film printing using laser printers is also crucial to support successful implementation. Cost benefit analysis will provide useful information, but not all the answers. Therefore, one should also consider the intangible benefits such as the service efficiencies and quality improvement that PACS can generate, particularly with fast throughput of images; hence these factors should be taken as part of any economic justification. 8.0 Conclusion The informed decision to select, implement and operate PACS begins with a sound, business oriented approach and judicious planning up front in implanting PACS as a strategy. As such building a documented business case and report is the first step to establish baseline expectation for system implementation throughout the enterprise as well as providing an accountability structure and project leadership as has been presented in this report. In this age of high information density and the necessity of its efficient and rapid dissemination through the integrated delivery of networks in healthcare, enterprises should see the decision to implement PACS as a necessary step in maintaining their market position. The greater value of a secure and fast repository of images provided by PACS, will improve the detection of disease through improved patient outcomes. These factors will have a huge impact on the way medicine is practiced and the quality of care patients receive. As such it is important for the radiology department to adopt PACS considering the service efficiencies, cost savings and service quality improvements that it can generate; thus creating a competitive advantage in the business of radiology. 9.0 References AMBER DIAGNOSTICS. 2010. Radiology Management System RIS / PACS. Amber Diagnostics [WWW] http://www.amberusa.com/ris/ris-index.asp (29 October 2010). Becker, S. H. and Arenson, R. L. 1994. Costs and Benefits of Picture Archiving and Communication Systems. Journal of the American Medical Informatics Association. [Online journal]. 1(5). pp. 361-371. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC116218/ (10 April 2011). Bryan, R. N. 2003. The Digital rEvolution: The Millennial Change in Medical Imaging. Radiology. [Online journal]. http://radiology.rsna.org/content/229/2/299.full. (22 March 2011). Chan, S. 2002. The Importance of Strategy for the Evolving Field of Radiology. Radiology. [Online journal]. http://radiology.rsna.org/content/224/3/639.full. (25 March 2011). Chaney, D. M. and Cotter, N. K. 1998. Comprehensive business planning for PACS. Applied Radiology. [Online journal]. 27(12). (http://www.appliedradiology.com/uploadedfiles/Issues/1998/12/Articles/v0027i12/00801387/main.pdf (25 March 2011). Furukawa, H., Endo, M. Aramaki, T., Morimoto, N., Uematsu, T., Yukizawa, S. and Yuen, S. 2004. Picture Archiving and Communication System Introduced to a New Japanese Cancer Center Hospital. Japanese Journal of Clinical Oncology. [Online journal]. 34 (7). pp. 425-428. http://jjco.oxfordjournals.org/content/34/7/425.full (20 March 2011). Frost and Sullivan. 2010. Overview of Total Southeast Asian RIS-PACS Market. 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H. 2008. Budgeting for PACS. Biomedical Imaging and Intervention Journal. [Online journal]. http://www.biij.org/2008/4/e32/e32.pdf (12 April 2011) Appendix 1 PACS Implementation Strategy Plan Gantt Chart (activities based on PACS life cycle overview presented in Figure 7) Phase Activities Month Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 1 PACS comprehensive planning (business technical, functional) 2 PACS vendor selection signing of contract 3 PACS system implementation, training testing 4 PACS implementation system support and enhancement