The Environement and It’s Problems

Paper The Environment and its issues nature is the spot that encompasses us. It is an endowment of nature and it is the normal universe of water, land, air and change. The earth is the thing that we call home. Did you realize that consistently nature is some way or another getting harmed or decimated? There are numerous instances of natural issues that influence our condition. E. g. a dangerous atmospheric devation There are additionally a few different ways people impact our condition. For instance the expulsion of fish from the seas and lumber from tropical forests.There are such a significant number of new things to find out about the earth thus numerous approaches to make a move for our eco-framework by ensuring it, why pause? Dazzled? Peruse on to find out about the earth and what you can do to ensure it. Let’s begin! There are a few natural issues that we have to make a move for. They all influence the world and mischief the eco-framework. A portion of the natural issues on the planet are corrosive downpour, air contamination, vitality, a worldwide temperature alteration, perilous waste, contamination, and exhaust cloud. A portion of these issues are man-made and a portion of these issues are regular disasters.Environmental contamination is the most serious issue on Earth today. It is genuine our trees are getting chopped down quickly and the earth is getting hotter however on the off chance that contamination proceeds with our earth will fell like a bubbling desert or secured with seawater. There are three kinds of contamination which are air contamination, sound contamination and water contamination. Air contamination is when exhaust cloud is noticeable all around and it’s difficult for us to relax. Sound contamination is when there’s such a major clamor by a vehicle that occasionally individuals lose their hearing. That is the reason we should walk or ride a bicycle anyplace near where you are and a mile distance.Water contaminatio n is the point at which the water gets dirtied with waste and synthetic compounds There are likewise numerous legislators who have planned something for help the earth. For instance, Theodore Roosevelt. Theodore Roosevelt was the 26th leader of the United States of America and was a legislator and progressive. He is known for saving area for national woods, building up untamed life asylums, building up the farmlands of the American West, and supporting insurance of regular assets. Theodore Roosevelt is a solid good example for hippies of the future.He utilized his political abilities to impact individuals and to help the reason for protection, reliably concentrating on the express nature and on its impact on people in the future. Making a future in which the earth is perfect is a difficult undertaking. Dealing with the earth includes support from governments, associations and your locale. It might give the idea that natural issues are too difficult to even consider taking considerat ion of however the choices we make, the moves we make and the words we express impact the choices that we make about the environment.There are numerous manners by which you can adjust your day by day life to contemplate the eventual fate of the situations and untamed life. Sparing vitality, rationing assets, and reusing are only a couple of ways you could have any kind of effect. The most significant thing to consider is the decisions you make identified with the earth. Something your school can do is become an eco-school! Ontario EcoSchools is a natural instructive program for grades K-12 that helps school networks assist kids with turning out to be earth mindful residents and lessen the biological impression of schools.Ontario EcoSchools' assets offer an ecological point of view to the decisions we make in working our schools and in arranging homeroom programs dependent on the Ontario educational plan. It comprises of four segments: natural literacy| squander minimization| vitalit y conservation| school ground greening| The leaf inside each figure represents thinking and acting in light of the earth. It additionally outwardly associates the four zones, an update that nature is significant. Here are a few different ways you can deal with the earth. 1. Diminish your driving (walk, bicycle, ride, take open vehicle, or carpool).Choose a more eco-friendly vehicle. 2. Try not to leave your TV, PCs, and DVD/VCD players on reserve; it utilizes more power than the little red LED light! 3. Pick more vitality productive machines, particularly significant ones like fridges, forced air systems and water warmers. 4. Reuse all that you can; papers, jars, glass jugs and containers, engine oil, salvaged material, and so forth 5. Try not to utilize electrical machines for things you can without much of a stretch do by hand, for example, opening jars. 6. Fitting off your mobile phone charger when charging is finished. 7. Re-use bread sacks and the packs you bring your produce h ome in. . Store food in re-usable holders, rather than saran wrap or aluminum foil. 9. Take undesirable, re-usable things to a beneficent association or second hand store. 10. Try not to leave water running unnecessarily. Spare a portion of your clothes washer water. Rinse your mouth with some water. 11. Set your forced air system temperature to 24-26C rather than beneath 23C. 12. Mood killer the lights, TV, or other electrical apparatuses when you are out. 13. Fill a 1. 5/2L drink plastic jug and leave it inside the Water Closet; this will spare you that equivalent sum each time you flush the can. 4. Try not to utilize the water radiator on a sweltering evening! Utilize cold water in the washer at whatever point conceivable. 15. Print or duplicate on the two sides of the paper. (In addition utilize the opposite side of this paper. ) the earth, the Earth, is our home. It is the place we live, inhale, and eat. It is significant so I figure we should take great consideration of it and ensure it! Keep in mind, we would all be able to make a move for this by doing seemingly insignificant details that will help. E. g. reusing! I delighted recorded as a hard copy this article. I learned numerous new things that I didn’t know previously and I trust you have too!Also, make sure to keep the Earth perfect however much as could be expected. â€Å"Do what you can, with what you have, where you are. † Theodore Roosevelt Bibliography:1. Ontario EcoSchools. (2002). Recovered from www. ontarioecoschools. org2. Theodore Roosevelt. (1999). Recovered from www. library. thinkquest. organization/26026/People/theodore_roosevelt. html3. Ecological issues. (1999). Recovered from www. library. thinkquest. organization/26026/Environmental_Problems/environmental_problems. html4. Bowden, Rob. Conditions. Miami: KidHaven Press, 2004. Print. |

Building compstract The Pazzi Chapel Essay Example | Topics and Well Written Essays - 4750 words

Building compstract The Pazzi Chapel - Essay Example Il Gesu (Church of the Gesu) of the Piazza del Gesã ¹ is arranged in the focal point of Rome, Italy and a lot greater than Pazzi Chapel. Built by Vignola from 1568 to 1580 and supported by Allessandro Cardinal Farnese. This proposal thinks about the examination that has been done on the Pazzi Chapel and, thusly, look at it the Il Gesu Church. Theory articulation While the Pazzi Chapel is picking up fame continuously, there have been various endeavors to ruins it notoriety dependent on highlights, for example, setting, building mass, exteriors inside, development, materiality, style and hues. The nearest examination that the Pazzi house of prayer building can have is the Il Gesu. Be that as it may, is the Pazzi better than Il Gesu? The development arrangement of the house of prayer was stacked bearing stone work, made of solid brick work squares. Concrete and engineered glues are utilized as mortar to bond the workmanship. The setting of the church was planned to be a section house for strict instructing purposes. The inside and outside of Pazzi Chapel are constrained by column type, which is well known during the Renaissance time frame. The draftsman wisely utilizes column type structure inside Pazzi Chapel to partition the front corridor at veneer into five, and the center one is the greatest to isolate the corridor into two sections, and to feature the middle . The Pazzi Chapel, this little however stunning structure arrives at the vertex of the early Renaissance style.3. This house of prayer is loaded with sane and harmony air and the consistent difference in the sanctuary causes a brilliant stand out from gothic design structure. An attribution to the special stepped area that was put inverse to the passage reflected from within, situated at the focal point of the house of prayer that is obvious from the exterior. Six solid Corinthian sections even to one another bolstered the veneer of the sanctuary, and a semi-circle opening is situated in the upper piece of the exterior. There were no adornments on the section itself, however on the upper piece of the exterior, strict images were cut on the divider and around the vault. There were two tight coves to the either side of the focal straight. Four rectangular boards are situated at the either side of the crescent archivolt. The upper piece of the exterior was intended for the arrangement of revetment. The essential balanced geometric type of testimony was utilized on the veneer that was proceeding with planned on the inside. In an unexpected way, Brunelleschi not just utilized straightforward geometric from to plan the inside piece of the house of prayer, yet additionally re-orchestrated these geometrical removal. For instance, roundabout arches were worked over the rectangular structure. The roof of the house of prayer was uniformly separated into twelve triangle shapes. The dividers of the house of prayer are related with six fluted Corinthian pilasters. These pilasters were parallel to the limited straights. The tight narrows support as the medium to the angled window. Also, there was a huge rectangular window was based on the back side of the divider. The window itself mirrors the veneer. The enrichments of the church were significantly made in earthenware, twelve earthenware Apostles were circled by the roundels, and twelve specialty formed moldings were under th e Apostles of the sheep. These Apostles were masterminded in a gathering of three put on the four corners of the church faces the compass and the shade of every one of these pilasters, vaults, even the house of prayer were significantly white. These mastermind represented Florence as a great city. Despite the fact that the sanctuary is little,

Get Quality Physics Help With Online Tutoring

Get Quality Physics Help With Online Tutoring Get Quality Physics Help With Online Tutoring Get Quality Physics Help With Online Tutoring Physics is one of the most headache inducing subjects there is. It’s the natural science that is perhaps the most relevant to the everyday world around us, but it is also one of the hardest to understand. So getting a good explanation for a physics principle can go a long way. Textbooks can do a good job of explaining physics. But having physics explained to you 1-on-1 by someone who understands it just adds that extra dimension to your learning. It puts the human element in it, something which is very lacking in the typical physics textbooks, and often in classroom instruction too. You can spend hours looking up the explanation behind a physics principle and still come up short. Alternatively, you can get someone to explain it to you and save you a lot of time. When it comes to physics, brevity is key, and sometimes the best way to get the direct answer is by talking to an expert on the subject. You get the explanation, and if that leads to other questions you just ask them right away. This is unlike a textbook which gives you the explanation, and if thats not good enough you have to look elsewhere. The classroom setting is not that much different. The instructor cannot just stop and address individual questions, or at least not do that very much. The instructor must deliver the material in a certain time frame, and then leave it up to you to catch up later on. But with 1-on-1 tutoring you can stop and reflect on the subject matter being explained to you. It can more closely follow your learning curve than either a textbook or an instructor can, because it is a dynamic process which adapts to your learning progress. The optimal situation is where you have learned the background material as best as you can, from the textbook and instructor, and then the holes in your knowledge can be filled with a private tutoring session. The physics experts at Homework Help Canada can help you fill in the gaps in your physics knowledge and save you lots of time chasing after answers. With online tutoring we can help you anywhere that’s convenient for you, including right from the comfort of your own home. Let us help you with physics with 1-on-1 tutoring over Skype. We can easily be reached and we can set up a time to suit your schedule. References: Allain, R. (2015, August 5). Learning Physics Is Tough. Get Used to It. Wired. Retrieved August 24, 2015, from learning-physics-tough-get-used Get Quality Physics Help With Online Tutoring Get Quality Physics Help With Online Tutoring Get Quality Physics Help With Online Tutoring Physics is one of the most headache inducing subjects there is. It’s the natural science that is perhaps the most relevant to the everyday world around us, but it is also one of the hardest to understand. So getting a good explanation for a physics principle can go a long way. Textbooks can do a good job of explaining physics. But having physics explained to you 1-on-1 by someone who understands it just adds that extra dimension to your learning. It puts the human element in it, something which is very lacking in the typical physics textbooks, and often in classroom instruction too. You can spend hours looking up the explanation behind a physics principle and still come up short. Alternatively, you can get someone to explain it to you and save you a lot of time. When it comes to physics, brevity is key, and sometimes the best way to get the direct answer is by talking to an expert on the subject. You get the explanation, and if that leads to other questions you just ask them right away. This is unlike a textbook which gives you the explanation, and if thats not good enough you have to look elsewhere. The classroom setting is not that much different. The instructor cannot just stop and address individual questions, or at least not do that very much. The instructor must deliver the material in a certain time frame, and then leave it up to you to catch up later on. But with 1-on-1 tutoring you can stop and reflect on the subject matter being explained to you. It can more closely follow your learning curve than either a textbook or an instructor can, because it is a dynamic process which adapts to your learning progress. The optimal situation is where you have learned the background material as best as you can, from the textbook and instructor, and then the holes in your knowledge can be filled with a private tutoring session. The physics experts at Homework Help USA can help you fill in the gaps in your physics knowledge and save you lots of time chasing after answers. With online tutoring we can help you anywhere that’s convenient for you, including right from the comfort of your own home. Let us help you with physics with 1-on-1 tutoring over Skype. We can easily be reached and we can set up a time to suit your schedule. References: Allain, R. (2015, August 5). Learning Physics Is Tough. Get Used to It. Wired. Retrieved August 24, 2015, from learning-physics-tough-get-used

Mac Computers vs. Personal Computers - 700 Words

Mac Computers vs. Personal Computers Starting in the 1980s computer systems have become an essential part of our lives. Steve Jobs created the first personal computer called the Altair 8800 costing 379 US dollars and later on Bill Gates created Microsoft Disk Operating System which would grow to become Windows Operating System. Throughout the year’s computers have been an ever growing market and have officially changed the way we work. Still to this day people clash at which computer system is better Mac or PC. Is it because the flexibility the PC has? Or the low prices PC offers to the public? But the biggest front is which system has the best protection against viruses? Most Windows PC’s allow the user to buy and upgrade their systems†¦show more content†¦Why would they spend thousands of dollars or more on a computer system to just do those type of task when you could spend half that. Mac computer have always been the more expensive computer system to buy, b ut since Apple has been coming out with more and more products like the iPod, iPad, and iPhone and many PC users are converting over to Apple products because they like to have the ability to share music, photos, and documents easily through all the systems. Mac computer have also been designing their system to be small and elegant. For example, when you’re going to class you don’t want to sit there and have a big bulky computer that ways close to four pound, you want a computer that is slim and light and easy to transport. Mac computers have always made their products easy to carry around. Like everyone says you get what you pay for. The biggest question now is which system has the best virus protection. For many years PC computer have fallen victim of viruses and Microsoft has been combating these and providing services to prevent viruses from spreading throughout every house hold. Microsoft also handles security issues and computer problems better than ever now. Fo r example Microsoft offers free updates to their Microsoft and Windows products and recently they came out with a free anti-virus product that can be easily downloaded and works alongside the Firewall protection system calledShow MoreRelatedMac vs. PC: The Debate and the Dilemma Essay1320 Words   |  6 PagesMac vs. PC: The Debate and the Dilemma Background of the Debate The debate between whether to buy Macintosh or buy a PC has been ongoing since Microsoft first introduced Microsoft Windows in November 1984. Apple Macintosh had developed its first personal computer, mouse and graphical user interface (GUI) in January of 1984. The debate has grown and has been the subject of many articles and even is the main high light of various websites. 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The Islamic State Of Iraq And Syria - 1702 Words

Introduction In what has quickly evolved into a post-Al Qaeda era in the Middle East, a new threat has emerged from the ashes of the 2003 invasion of Iraq and later in the 2011 war in Syria. The Islamic State of Iraq and Syria (ISIS, ISIL or Daesh) has rapidly become the most pressing foreign policy concern in the Middle East for the United States. In the last four years, Daesh has gathered swaths of territory in both Iraq and Syria, although it has been driven back thanks to coalition efforts to counter the group. The coalition in place to combat ISIS has allowed the US to take a supporting role through the use of airstrikes, military advising and intelligence sharing to the local forces on the ground. However, major shortcomings†¦show more content†¦With divisions becoming prevalent regarding the modus operandi for AQI, Abu Omar al-Baghdadi broke off from the group to form the Islamic State of Iraq (ISI). (Hashim 2014) While both the ISI and AQI had similar interests in co mbating foreign intervention and developing an Islamic caliphate in the region, the two groups sought two different means of achieving it. In Iraq in particular, Daesh was bolstered by a new interim Iraqi government that was particularly repressive towards the Sunni majority, which in turn drove disillusioned Sunnis towards the extremist group. Ultimately, ISI would expand into Syria in 2010 and splinter off from the Al-Qaeda affiliated group Al-Nusra, forming the Islamic State of Iraq and Syria. Since then it has expanded into parts of Jordan and Libya as well. Current Strategy In the latest edition of the National Security Strategy, President Obama outlined his primary objective in dealing with the Islamic State of Iraq and Syria. â€Å"We [The US partners] are leading a comprehensive counterterrorism strategy to degrade and ultimately defeat ISIL. At the same time, we will continue to pursue a lasting political solution to the devastating conflict in Syria.† (White House 2015) While these represent carefully crafted talking points, the complexity of the situation is evidently clear and the challenged of an accomplished goal is not lost. The United States

Hospital Organization Free Essays

string(48) " a number of state-based cost control programs\." Hospitals continue to be the largest segment of the health care industry, measured by economic volume and delivery of a wide range of professional services. HEALTH CARE SERVICES The different segments of the health care delivery system provide various combinations of services. The specific combination offered depends on a variety factors that prevail in a location, including state and local licensing laws, reimbursement structures, availability of medical personnel and facilities, and the demographic details (such as age and industrial distribution) of the potential patient population. We will write a custom essay sample on Hospital Organization or any similar topic only for you Order Now The unique aspect of the health care industry from an audit perspective is the health care delivery system – the revenue cycle. The other cycles are essentially similar to those in manufacturing or selling enterprises. Services are generally described by a six-level classification. Those levels indicate, but do not strictly define, the type of organization, the level of medical treatment involved, or the severity of, or prognosis for, the medical situation. The levels are: †¢Preventive – Health education and prevention programs provided by business and other organizations, such as schools and family planning clinics. Primary – Early detection and routine treatment of health problems, such as are often provided by physicians’ offices, industrial and school health units, and hospital outpatient and emergency departments.†¢Secondary – Acute care services, typically provided by medical personnel, through hospitals, using elaborate diagnostic and treatment procedures. †¢Tertiary – Highly technical services, such as for psychiatric and chronic diseases, provided through specialty facilities and teaching hospitals. †¢Restorative – Rehabilitative and follow-up acre, typically provided by home health agencie s, nursing homes, and halfway houses. Continuing – Long-term, chronic care, typically provided by geriatric day care centers and nursing homes. The growing economic magnitude of the health care system has led to increased regulatory activities focusing on health care. This increase in regulation interacts with a growing demand for more health care and for increasingly technical and complex methods of providing it. The largest and most evident regulatory activity involves reimbursement by state governments. Other regulatory activities are concerned in varying degrees with the availability and quality of health care.There are continued initiatives by state government to link such regulations to reimbursement in order to enforce compliance. The presence of multiple regulatory systems influences the demand for and the nature of professional accounting services required by health care institutions. Those systems often emphasize reporting requirements, and health care institutions tend to view compliance reporting as a major use of accounting data. Auditing services in particular are affected because the regulatory agencies rely heavily on the attest activities of the health care institution’s independent accountant.STRUCTURE AND ORGANIZATION Patient care is the essential function of a hospital. Other vital roles include medical education and research. Recently, many larger general hospitals have become total community health centers, providing a wide range of outpatient services in addition to traditional impatient care. One characteristic of the growth of the health center concept is the emergence of such diverse related organizations as real estate holding companies and medical management companies.These organizations are a response to changes in the reimbursement, regulatory, tax and financial environment facing hospital management. Such nontraditional organizational structures and patterns of activity are needed to provide adequate financial resources to support the delivery of health care by hospitals. Some observers see these changes as leading to major multihospital systems, so that in the future a few major health entities may control the majority of the hospital beds in the country. Hospitals may be classified by type of ownership and mode of operation, as follows: Government – Hospitals operated by governmental agencies and providing specialized services to specific groups and their dependents, such as the military, veterans, government employees, the indigent and the mentally ill. †¢Investor-owned (proprietary) – Hospitals owned by individual proprietors or groups of proprietors or by the public through stock ownership. The objective of such hospitals is to operate for profit. †¢Voluntary nonprofit – Hospitals operated under the sponsorship of a community, religious denomination, or other nonprofit entity.This is the largest category (in number of hospitals), comprising two major types: teaching hospitals and community hospitals. a. Teaching hospitals – Generally university-related hospitals, their health care service activities combine education, research and a broad range of sophisticated patient services. Large community hospitals affiliated with medical schools and offering intern and resident programs are also considered teaching hospitals. b. Community hospitals – Hospitals that traditionally are established to serve a specific area, such as a city, town, or county, and usually offer more limited services than teaching hospitals do.Hospitals may also be categorized by the type of care provided, as short-term (acute), general, long-term general, psychiatric, and other special care. The mode of a hospital’s operation and type of care occur in various combinations, such as government psychiatric or short-term pediatric. THIRD-PARTY REIMBURSEMENT OR PAYMENT A major difference between health care entities and commercial enterprises is that the recipient of health care services – the patient – in most cases does not pay directly for the services. Instead, payment is made by some other organization.The payment is often referred to as a â€Å"third party†. Typically, a hospital’s most significant patient revenue sources are its reimbursement contracts with third parties. In each case, there is an identifiable group of patients whose health care services are paid for, in whole or in part, by the third party. The amount of the reimbursement, as well as the eligible class of patients and other administrative matters, is covered by regulations or contracts. The major third parties are governmental agencies. Of these, the state government is the largest. Medicard is state-administered third-party reimbursement program designed to underwrite hospital costs of the medically indigent and those eligible for certain types of public welfare. Medicare is a third-party reimbursement program administered by the Health Care Financing Administration of the Department of Health and Human Services. State governments have long been involved in reimbursement for health care services, and their involvement has increased through participation in the Medicard Program. Recently, the continued growth of third-party expenditures for reimbursement has fostered a number of state-based cost control programs. You read "Hospital Organization" in category "Papers"Of increasing importance are a wide variety of controls at the state level, usually referred to by terms such as state rate control. The state government has been quite active in encouraging or supporting such programs. The impact of governmental and commercial third parties on hospital is affected by when the reimbursement or payment is determined and the basis of the reimbursement or payment. Third-party reimbursement systems are either retrospective or prospective. Retrospective refers to third-party reimbursement systems that determine the amount to be paid after the services have been performed.In prospective payment systems, the amount is determined before the services have been performed. Reimbursements or payments are usually based on either the costs (to the hospital) of services performed for eligible patients or the amounts charged by the hospital for such services. The regulations or contracts of the third party contain specific provisions designed to ensure that only certain costs or charges enter into the determination of the reimbursement or payment. There are also provisions to ensure that reimbursement or payment is made only for services to eligible patients.Third-party payers can be expected to continue to refine their approach as the volume of payments increases. The difference between the hospitals established rates for services rendered and the amounts received or receivable from third-party payers known as a contractual allowance and is shown as a deduction from gross patient revenues on the statement of revenues and expenses. PAYMENTS AND SETTLEMENTS Under many retrospective reimbursement and prospective payment contracts, the hospital is paid throughout the year on an interim basis.The payment is based on estimates of costs expected to be incurred during the year in serving patients. At the end of the fiscal year, a reimbursement report is filed with each third party, and any difference between the final cost settlements, by providing an independent basis for third-party reliance on the hospital’s accounting records. Reimbursement reports typically include cost-finding calculations that segregate direct costs by cost centers and allocate overhead costs from indirect or nonrevenue-producing centers to revenue-producing centers, us ing one of several allocation methods.Departments that provide direct patient services such as nursing, laboratory, and radiology are examples of revenue-producing centers, while support or overhead units such as laundry, dietary, and administrative services are typical nonrevenue-producing cost centers. This allocation produces an operating cost for each revenue-producing center, consisting of its direct costs plus its share of indirect costs. After all costs have been assigned to revenue-producing centers, they are apportioned to the various third-party payers. STATISTICSDepartmental activity or usage statistics are employed in most cost-finding methods used to allocate overhead costs to revenue-producing centers. Some statistics, such as square feet of space, may remain unchanged from prior years. The auditor should, however, inquire whether changes have occurred. Simple observation is helpful; a new wing, department, or floor plan means that statistics must be updated. Certain statistical information is generated by the various transaction cycles. Examples of statistics that are generated in the buying cycle are: Payroll pesos – Used to allocate employee benefits, health and welfare costs, and other compensation costs. †¢Hours worked – Used to allocate nursing administration costs and sometimes employee cafeteria costs. †¢Full-time equivalent employees (FTE) – Sometimes used to allocate employee cafeteria costs. Other statistics utilized in cost-finding and third-party reimbursement are generated by departmental activity studies and surveys. Examples of such statistics are pounds of laundry, housekeeping hours of service, social service hours, and cost of drugs and medical and surgical supplies issued to nursing stations.Medicare regulations require a study of at least four 2-week periods annually. FUND ACCOUNTING The audit guide prescribes the use of fund accounting for the external financial statements of nongovernment, not-for-profit hospitals. Fund accounting entails the maintenance of separate or group accounts for hospital resources according to the spending objectives set by donors, other outside sources, or the board of trustees. (Investor-owned hospitals are regarded as business enterprises and report as such. ) Two broad classes of funds are used: †¢Unrestricted funds, which encompass assets other than those that are restricted, as defined below.Many authorities believe that this class of funds should be referred to as general and that the term unrestricted is misleading, since restrictions other than those imposed by donors or grantors may be placed on assets of these funds. A reserve account maintained under a bond indenture provision is an example of an asset that is included in unrestricted funds but is restricted as to use. †¢Restricted funds, which encompass assets that are subject to restrictions imposed by specified external parties, that is, donors or grantors. Examples are plant replacement and endowment funds. AUDIT STRATEGY AND RISK ASSESSMENTIn many ways, the accounting systems and controls that operate in health care institutions are the same as those in any other industry. Because of regulation by governmental agencies and consumer group pressures, however audit concerns for hospital client is expanded considerably. Those concerns, fee pressures because of the nonprofit nature of many institutions, and competition among firms all create a need for this audit analysis to streamline audit procedures and improve audit efficiency as much as possible. In developing an audit strategy for a hospital engagement, the auditor had a thorough understanding of the patient mix.The geographic location of the hospital, the range of service it provides, and state regulations influence the age, financial status, and insurance coverage of the patient population. In particular, the audit strategy will vary depending on whether the services are rendered on a charge-paying or cost-reimbursement basis. If most of the hospital’s services will be paid on a cost-reimbursement basis; the propriety of costs incurred is a primary concern of the auditor. The accuracy of dep artmental revenue classification is also important in the cost apportionment process. The payment is made either directly by the patient or by third parties based on actual charges billed; auditing statistical data and departmental cost classification is deemphasized since those data do not affect revenue. In planning hospital audit, it is important to have an understanding of the hospital’s current financial position and financial trends. Analyzing financial ratios may lead to a fuller understanding of the hospital’s operations and problems than could be obtained from reviewing raw data. It is also helpful to compare the hospital’s operations and financial position with those of the other institutions.Inherent risk in considerations in the health care industry revolves around the third-party reimbursement structure. A key concern is billing procedures, which are complicated by the very significant involvement of third parties. TYPICAL TRANSACTIONS, INTERNAL CONTROLS, AND AUDIT TESTS PATIENT REVENUE CYCLE The major source of revenues in a hospital is services provided to patients. Revenue was recorded, at hospital’s established rate, on the accrual basis at the time services are performed. Patient service revenues are recorded separately by source (laboratory revenues) and by patient type (inpatient or outpatient).Additionally, the source of payment of each patient is essential information that was captured by the accounting system. Hospitals generally billed inpatients after completion of a patient’s stay in the hospital. The actual amount received by the hospital may vary depending on contractual arrangements between the hospital and the patient or a third-party payer. Services rendered to private-paying patients are billed at the established rates, except that courtesy allowances may be granted to doctors, employees, or members of religious orders and charity allowances may be granted as determined by patient needs and hospital policy.To understand the hospital’s patient revenue cycle, the auditor should become familiar with the variou s functions and departments that may serve patients and should also understand how those functions and departments relate to accounting for patient revenue. SUBSTANTIVE TESTS OF ACCOUNTS RECEIVABLE Hospital receivables have several characteristics not normally found in receivables of commercial organizations. First, full-rate charges to patients for services received may be settled for an amount less than the full rate because of contractual arrangements with third-party payers courtesy, charity, or other policy discounts.In addition, large amounts of receivables are paid by third-parties, and payment may be made by a single payer or combination of payers (e. g. , commercial insurance, Medicare, Medicard, workers’ compensation and the patient. ) Since a patient may have more than one insurer, it is possible for duplicate payments to be made on the patient’s account. This results in credit balances in accounts receivable, which are characteristic of hospitals with aggressive billing procedures. The auditor should review the components of these credit balances, and if they are significant, consider reclassifying them. Since the hospital must refund duplicate payments, the auditor should review controls over issuance and use of refund checks to determine that they are for valid credit balances and that they are payable to the proper payee. In most hospitals, accounts receivable are classified according to the patient’s billing status, generally using the following categories: †¢Inpatient:Admitted but not discharged (commonly referred to as â€Å"in-house patients†) Discharged but not billed (accounts awaiting final or â€Å"late† charges, or unbilled as a result of a backlog in billing procedures – which might indicate a control weakness) Discharged and billed †¢Outpatient: Unbilled Billed These categories of inpatients and outpatients may be expanded further to indicate private-paying status or third-party responsibility for payment. The existence and accuracy of accounts receivable are normally tested by reviewing subsequent cash receipts.The validity of admitted-but-not discharged patient receivables can be tested by comparing accounts with the daily census report or by relying on compliance tests of admitting function. Confirming balances with patients may be difficult, and the auditor should consider confirming other items, such as number of days spent in the hospital, types of insurance coverage, or, at least, the policy number and insurance company. This information confirms that the patient was in the hospital. Negative confirmations generally produce adequate results for the â€Å"self-pay† or patient portion of the bill.Typical responses for the third-party portion state that the patient believes the bill will be paid by the insurance company or that the patient is unable to confirm because of insufficient information. NONPATIENT REVENUES Revenues from sources other than patient charges consist of interest on invested funds, unrestricted gifts and grants, transfers from restricted funds, and expenditures of restricted fund assets for the benefit of unrestricted (general) funds. Audit steps for material nonpatient revenues should include, but not limited to: †¢Confirming investment activity with banks or an external trustee. Reviewing date and documents underlying gifts, grants, and bequests, such as board minutes, correspondence, and acknowledgement receipts. †¢Reviewing research or grant documentation. †¢Confirming pledges (or otherwise obtaining satisfaction as to their existence) and evaluating their collectability. BUYING CYCLE Payroll. Hospital employees may be classified as professional and nonprofessional. Examples of professional staff are registered nurses and licensed vocational nurses. Nonprofessional employees include orderlies, housekeeping and maintenance personnel, and kitchen staff.Control over both professional and nonprofessional time is critical since salary costs constitute a significant portion of hospital costs. Generally, the same payroll audit procedures used in other organizations of comparable size also apply to hospitals. Compliance testing of total payroll costs should include tests of controls over classification of costs by department, which is important for purposes of reimbursement and also for cost reporting. Misclassification of a reimbursable cost to a no reimbursable cost center could result in failure to receive reimbursement for that cost.The auditor typically reviews the appropriateness of the account distribution and traces amounts to the payroll register or distribution summaries. Those registers or summaries are tested for mathematical accuracy and then agreed to the appropriate general ledger accounts. Other Expenses. Hospital expenses are typically classified by departmental function (such as nursing services and laboratory services). Proper classification of costs by department is important for financial statement purposes as well as cost reporting and reimbursement.The auditor should test the propriety of the general ledger account distribution by reference to purchasing documentation. Fixed Assets. Controls over the acquisition of property, plant, and equipment by a hospital should be the same for a commercial enterprise. Some hospital departments own and use expensive, highly specialized equipment, such as nuclear magnetic resonance devices. Department heads should, of course, but that involved in capital budgeting and purchasing decisions, but that involvement should not extend to overriding controls that have been instituted for purchases generally. How to cite Hospital Organization, Papers

Reflection free essay sample

This reflection will be separated in to subheadings which are; Reflective Practice, confidence, qualifications and training, academic writing and IT skills Reflective Practice In my professional role I have encountered situations that have not been as successful as I would have liked. From studying the module becoming an effective, reflective practitioner I have been able to gain the confidence, knowledge and better understanding of how to reflect and the importance of reflecting In a professional practice (Appendix 4). There are a number of reflective theorists; I personally can relate my situations to Kolas (1984) Reflective Cycle as cited in (Clifford, J. Thorpe, S. 2007). After taking an intervention I can use the reflective cycle to help me evaluate in depth how the session went and if needed implement changes to benefit the situation if arises again. Reflection has allowed me to give accurate feedback to my peers as well as being beneficial to the children and my own personal development and learning. We will write a custom essay sample on Reflection or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page According to Jasper, M. 2003) reflective practices are one of the key ways in which a practitioner can learn from their own experiences. Confidence Confidence was down in appendix 3 as one of my weaknesses, this was shown through both my studies and professional practice. When struggling with both my academic studies and also on my intervention lessons I was not asking for the help when needed to support me when studying. This was fleeted in the outcome of both mine and the pupils learning as significant standards were not met which was shown in my assignment marks and feedback and also the progress of the childrens learning.Since improving my confidence up dating my appendix 4 1 have gained the confidence to ask for further support and advice when needed in both my professional practice and academic studies. Qualifications and Training Given that I have completed the primary stage of the Foundation Degree and have achieved a level four qualification in higher education, my education ability has improved since appendix 1 . This has allowed me the opportunity to apply for higher job roles, and has given me a better kn owledge and understanding of safeguarding and mufti-agencies (appendix 2).As a professional who works alongside multi agencies it is important to gain a greater understanding of their roles and responsibilities and also understand the importance Of communication within multi agencies and the effect it can have it not carried out appropriately. Carrying out research on communication has lead to (appendix 4) better communication skills, leading to being able to express ideas and also listen attentively to others. Academic Writing and IT Skills Since studying in higher education my IT (information technology) and writing skills have dramatically improved (appendix 4).More competent writing skills can be seen in my updated version of my C.V. (appendix 2), which shows a paragraph on my profile to be written using an academic writing style in order to produce a shortened and more precise statement In my older C.V. (appendix 1) I have noticed the use of the same words throughout and my paragraph was very wordy this has also been reflected in previous pieces Of work. From reflecting on my old SOOT analysis (appendix 3) it has become apparent that my IT skills have improved this can be seen in my new C.V. (appendix 2) where it is set out in a more professional manner, compared to appendix 1 edition.I am also able to demonstrate my knowledge of IT both at work when presenting reports on children who I teach which has led to positive feedback. IT has allowed me to research and locate resources for both college and supported me in locating resources for work that important to my role (appendix 4). In conclusion, by reflecting on an old and updated C.V. and SOOT analysis is has shown how much progress and change has been dad over the year both academically and professionally.The main section that as a professional I have progressed is within my professional and academic skills is being able to reflect. I feel personally this is a skill that will constantly be improved on whilst studying and through my work-life. Although areas of my knowledge and learning have developed It still remains that further development be made for the future. While ever I am in education and in a professional role were further training is required, aspects of my C.V. and SOOT will require updating. Word count 961 Reference page Ackerman. Reflection free essay sample My trip to the museum was educational, eye opening and a greatly appreciated experience. Before I visited the museum, I developed a preconceived notion that our National Museum was old, smelly and had little artifacts of interest. However, this was caused by me listening to stories about it and not actually experiencing it for myself. When I finally did, I was more than grateful for this building that held so much heritage and history of our nation’s monuments. I walked through the building with awe and surprise and took pictures with my camera phone of nearly every artifact in the building. I was blown away by the paintings, murals, sculptures and crafts done by our local artistes. I never knew Trinidad and Tobago held such intensely talented individuals. I was even more intrigued by the room with preserved animals, slave days, Amerindian artifacts and last but not least, the blue throne. We will write a custom essay sample on Reflection or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page On the second floor of the building held one of the most majestic and striking object I had ever seen in my life; a throne that was built for Prince Kofi Nti of Ashantee, West Africa who visited Trinidad on July 1, 1881. Prince Kofi Nti, arrived in Trinidad on July 1,1881, having become a ward of the British Government after a war against the Ashantees in 1872 and was given a job to lead the â€Å"Works Department†. This stood out to me the most because it represented a monumental royal aspect of my country and the only thrones I had ever seen before this were the fake ones Santa Claus sat on in the malls at Christmas time. It was a very exciting opportunity for me when I was allowed to sit on the throne. The cushion of the seat was soft and plush and the hand rests felt like clouds under my hands. It is a tall, majestic chair fit for a king and I was allowed to sit on this royal monument. The beautifully handcrafted wood that the throne was made of had engraved symbols on it. In my opinion, this visit was life changing and exhilarating. After learning about so many things I never even thought existed; had wrongful ideas about and seeing a real throne for the first time in my life, I do believe that I left with a better idea of the importance of royalty and a more empathetic approach to understanding what the royal figures actually have to do in order to be where they are. Reflection free essay sample As I reflect back on my life, I realize how much I’ve grown over the years, not only physically but psychologically. I continue to learn new things about myself on a daily basis. It can be as simple as liking coffee or as complex as determining what learning strategy works best for me. Characteristics like being responsible, punctual and having the courage to stand up for myself and others, has helped to make me feel better about myself. All of these things have played a role in making me the person I am today. I believe this will help to determine the path ahead for me in my journey through college and my future.Being responsible isn’t always easy. There are choices to make that sometimes seem a little less appealing, but are necessary to be successful. For example, I have to be at school on time but in order to do that—I need to make sure I have gas in my car. We will write a custom essay sample on Reflection or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Prior to having the gas in my car, I have to make sure I have enough money to pay for that gas. One responsibility seems to always depend on a previous choice or decision I’ve made. I have set standards for myself based on my goals and beliefs so these responsibilities are upheld. By doing so, I have been able to accomplish each set goal along the way.I am a full-time high school student and also have a part-time job working at Walgreens. Adding a job onto my current set of responsibilities has made me become even more responsible. I have to make sure I have my work schedule documented so I am there as required. I also have to make sure I balance my school duties and my work so my studies don’t suffer. I have learned how to manage my daily schedule and it has become second nature for me.Every day I am faced with having to be a leader, standing my ground and saying what I feel in order to show that I am not a follower. I am my own person and throughout my life I have taken pride and ease in following my own agenda and standing by my own set of beliefs and values. As a high school student the peer pressure can be heavy at times and it has been important to me not to cave under those pressures. Being able to express my true feelings has become as easy as reciting the alphabet for me. I have found that communication and a strong will and sense of who I am, has proven to strengthen my relationships. I feel that if you are able to communicate effectively with others and express yourself, you can be successful in just about anything you do.Personality traits and characteristics like being responsible, punctual, a good communicator and a leader are all skills that I can bring to your university. Over the past four years of my life I have matured both academically and psychologically. I have also grown to learn more about myself and the others around me. This has helped me to prepare as I near graduation and move onto the next step in life, college. I am excited and determined to continue my journey of learning and growth. Reflection free essay sample Matthews (2004) explains that reflection is an important tool for clinical development. Rolfe (2011) provides the argument that reflection is just as important and works alongside evidence based practice. Schon (1991) cited in Howatson-Jones (2011) describes the link between professionals reflecting in and on action and how this leads to increased efficiency in working through problems and issues. In order to adhere to the objectives governing nurses and midwives, through the NMC Code of Conduct (2008), the names and service providers mentioned within this discussion have been replaced by a pseudonym. This discussion with utilise Gibbs’ model of reflection as it provides simple headings within which thoughts and feelings can be collated effectively. Also Gibbs provides a section for which to plan for further or future action which is an important part of reflecting. Gibbs’ model differs from other simpler models such as Borton’s REFERENCE in that it offers that final stage on what to do with reflective ideas in order to formulate an action plan for future events. We will write a custom essay sample on Reflection or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Description George Wilson, an 80 year old gentleman with Parkinsons, was admitted in the early hours of the morning onto my placement area. While my mentor observed I began to assess George using an ABCDE approach, whilst the nurse transporting him handed over his notes and care plan. It became apparent that his medication was not properly prescribed. Parkinsons medication is a very important aspect of treatment and must be given on time everyday. Parkinson’s disease is a neurodegenerative condition which affects the production of dopamine in the brain stem causing motor and cognitive mpairments. (Mattox, et al. , 2001) Evidence suggests that the impacts of missed, incorrect or delayed doses affects the Parkinson’s patient greatly. Leopold et al, (2004) state that it can result in lowered mobility including swallowing and can put them at risk of falls. Another issue was that in the move some of George’s medication had been misplaced. In order to be given his medication in th e morning on time it would need to be prescribed correctly and retrieved from pharmacy.

Wearing a Helmet essays

Wearing a Helmet essays A quiet humming sound caused by the neon lights dominated the room. This sound was accompanied by the low rumbling of the nurses talking with each other about the latest gossip, and whatever else it is that nurses talk about. Occasionally this noise would be rudely interrupted by the chirping telephone screaming annoyingly for someone to answer it. It was an extremely slow Sunday afternoon in the Utah Valley Regional Medical Center Emergency Room for Dr. Roberts and his team of medical professionals. It was the type of day that a person has when they at work and there is nothing to, and all that you can think about is going home early and enjoying the wonderful summertime atmosphere. Meanwhile, while this atmosphere of doing nothing but organizing the medical supply crash carts existed, somewhere on the local freeway, a group of friends were out riding their motorcycles, and getting away from the pressures of life. One of the friends was a twenty-two year old named Taylor. He is a student, attending the University of Utah, who had just recently been married. He was also anticipating on attending medical school later on in his future. Even though he had a lot of things going for him, for one reason or another Taylor decided to not wear his helmet that day. Taylors friends began showing off to one another by popping wheelies, standing on the seats of their bike, and weaving in and out of traffic, at speeds of over ninety miles per hour. Taylor was riding behind the pack of bikes and decided that he should catch up to the rest of the group. He shifted gears and darted ahead into an opening in between the cars. Suddenly he collided with a car that moved into the op ening the same time that Taylor did. Taylor and his motorcycle were knocked over, and were both sent hurdling into the air, flipping end over end. Soon the team of paramedics, who had been dispatched to attend to the wreck, arrived on the scene of the motorcycle acci...

The Post Office is Kitty-corner to the Court House

The Post Office is Kitty-corner to the Court House The Post Office is Kitty-corner to the Court House The Post Office is Kitty-corner to the Court House By Maeve Maddox Cassandra Marx writes: In the last few weeks, I have seen or heard numerous references to something being catty-cornered, katty-cornered, and kitty-cornered to something else. Would you please tell me what the correct usage/spelling is? Although I have included this expression in a previous post on cat words, I think it deserves a post of its own. Heres what I had to say the first time around: Catty-corner is a directional word, meaning that something is diagonally across from something else. The word started out as cater-corner. Cater is an English dialect word meaning â€Å"to set or move diagonally.† When the word cater with its meaning of to set or move diagonally dropped out of the language, folk etymology got busy and now we have all kinds of â€Å"cat† variants for this concept: catty-cornered†¨ kitty-corner†¨ kitty-cornered†¨ catty-corner†¨ cat-a-corner kitty-corner†¨ kit-a-corner This time I have my brand-new copy of Brewers Dictionary of Phrase Fable (17th edtion) to consult. This is what I find under the entry cater-cornered: Cater-cornered. Placed diagonally, as of a badly parked car in a parking space. Cater is an old word for the four dots on dice, which form diagonals, from French quatre, four. Other spellings of the term are catty-cornered and kitty-cornered, as if somehow to do with cats. Apparently the dialect word with the meaning to set or move diagonally, derived from quatre. As for the correct usage/spelling, the usage seems to be universal as to meaning. Something that is catty-cornered to something else is diagonally opposite. Until some authority decrees otherwise, I suppose that spelling and pronunciation are a matter of local usage. I grew up with kitty-corner. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Expressions category, check our popular posts, or choose a related post below:100 Mostly Small But Expressive Interjections15 Words for Household Rooms, and Their Synonyms20 Ways to Cry

Chinese Trade Profile Research Paper Example | Topics and Well Written Essays - 500 words

Chinese Trade Profile - Research Paper Example China is essentially the globe’s second-largest trading country after the United States of America. Statistics has it that she is the world’s leading exporter and comes second regarding imports. Between the years 2009 and 2011, the GDP ratio of China was about 53.1%, whereas her per capita was about $2,413 (Mion & Linke p 208). The output growth of China reached the highest value at 10.4% in 2010 for the period between 2009 and 2013 as shown in figure 2. Today, many countries all over the world prefer China to be their most vital bilateral trading partner. By 2011, China had become the largest exporter and importer by trading with 32 and 34 nations respectively (Mion & Linke p 208). The total value of Chinese exports is estimated to be $2.05 trillion.Her principal or primary export commodities include electrical and other machinery. These include data processing equipment, radio, telephone handsets, apparel and integrated circuits.  Ã‚  Export Markets Her major export second-large stong Kong, the US, Japan, Germany and South Korea. The US trades with 17.2% of the total exports (Mion & Linke p 208). Hong Kong has a statistic of 15.8% as Japan trades with 7.4% of the exports. China exports 4.3% and 3.4% of her goods to South Korea and Germany. The rest goes to other parts of the world like Africa. China exports were highest in the year 2010 for the period between 2009 and 2012 as shown in figure 2. The total value of Chinese leading import goods is $1.817 trillion.

What the main factors of party choice were in the visegrad countries Assignment

What the main factors of party choice were in the visegrad countries - Assignment Example Voters then cast their votes not on the base of political parties but rather on the performance of their leaders that could be categorized as clientelistic and leader centered political culture compared to a majoritarian or consensus-oriented political system. It can be contrasted to Czech Republic where it manifests an extreme party-centric behavior of its voters. This can be attributed to their highly organized political parties as it manifests strongest ideological voting than the Nordic countries or the Netherlands. Unlike in Hungary where voters casts their ballots based on the performance of their leaders, Czech Republic on the other hand vote base on party ideology regardless of its leaders. This can also be partially attributed to the retention of orthodox communist party in the electoral arena making the electorate ideologically conscious. Poland on the other hand is neither of the two and this can be attributed to its highly fragmented political parties and institutional design whereby its institutions are closest to the consensus democracy type. The combination of diaspora among its political centers and consensus base political system among its political parties made it the only European country that is similar to that of the hybrid type constituted by Mexico and United States compared to Scandinavian-Israeli-Czech end-point differentiation. This results to a voting pattern that shows variance from the other countries in Visegrad such as Czech Republic and Hungary (Slovakia is not extensively covered in the study). Slovakia may not have been extensively covered in the study but its political system shares the same attribute with Poland which is also highly fragmented where its numbers are â€Å"excessive†. Thus, one can surmise that Slovakia will tend to be more consensus type in its voting pattern inferring to the factor that

Importance of Nursing Informatics in Nurses Daily Practice

Importance of Nursing Informatics in Nurses Daily Practice Introduction Data is the basic and the fundamental concept that this study focus on. Since there is no information can be acquired without availability of data (Ahsan and Shah, 2006). The data that we are talking about in this context is the clinical data, which is the data that gathered about patients in practice by clinicians (Millar et al., 2009). Pressure ulcer (PU) data is one of these data that collected by nurses in clinical settings, these involve all the elements of PU data, like; prevalence, incidence, risk assessment, ulcer grading, and prevention data. Data is a concept being of high interest in the discipline of nursing informatics. (Graves and Corcoran, 1989) define nursing informatics as a combination of computer science, information science and nursing science to assist in the management and processing of nursing data, information and knowledge, to support the practice of nursing and delivery of nursing care. So, the nursing informatics as a speciality begins with the basic concept data, as the present research did. Indeed, nursing informatics can be applied in four areas, that are summarised in the word CARE; clinical, administration, research and education areas (Hannah et al., 2006). In this study, the nursing informatics concepts chosen to be applied in a clinical oriented subject, which is PU. PU as one of the important clinical areas has been selected due to the importance of this problem, in term of its size and the costs of preventing and treating such problem, from one side, and due to limited numbers of previous works that relate the concept of nursing informatics to PU field, from other side. More specifically, this research has related the concept of nursing informatics on PU data. Nursing informatics deal with the data, that processed to support nursing care, and PU data is one of these data that should be processed to support the delivery of patient care. In this thesis, the recording of PU data in recording systems, either paper or electronic was explored, and the uses of these data in these records were identified. As has been recommended, more researches are needed to realize what need to be recorded in the recording systems and how this will be used (Urquhart et al., 2009). Personal motivations toward the research The researchers interest in this subject arose from the importance of nursing informatics in nurses daily practice. The nursing informatics specialists have a special role in using the information technology (IT) to enhance the safety, effectiveness, and quality of health care (Murphy, 2010). It is acknowledged that all providers of healthcare assumed to be skilled in exercising the IT to make decisions that lead to better care (Saba and McCormick, 2006). PU topic investigated due to its great importance. As a nurse used to work in clinical practice caring for PU patients, and observing the magnitude of the physical and psychological impacts of this problem on patients and their families life, the researcher decide to choose this area to be studied. Noticing many patients die because complications of this problem is an enough motivation to start digging in this area. First, to understand how PU data is recorded and used in practice, in effort to understand the difference between recording this data on paper and electronic record. Then, to realise the size of this problem in the researcher country Jordan, to make a reference data for health policy makers to adopt prevention programs in Jordan, there is no one in action yet. Statement of the problem PU is one of the health problems that are very common and prevalent, without accurate portrait of PU data, the problem will continue to grow. Nurses in clinical practice collect and record large volume of PU data every day. This data should be recorded and used appropriately in practice. Taken into considerations that recording and utilising of patients data is the fundamental role of any healthcare provider (Millar et al., 2009). Further, and in the second study, urgent identification of prevalence and prevention data in Jordan is necessary, especially that there is no previous works have been located. So, the primary focus of this study was on the problem of PU, identifying its size, the preventive measure provided to PU patients, and how its data recorded and utilised in practice. Overall Research Aim The overall research aim is to explore how PU data are recorded and utilised in clinical settings. This is the overall aim of the study, with many other secondary objectives for each study and method of the research, but all these objectives are come under the main aim of the study. The objectives of each method will be presented in the methodology chapter (chapter 3). Definition of terms From the general aim of the study, the reader can note that many terms have been used in formulating the aim. The following represent the operational definitions of each term presented in the study aim: PU data: raw facts that related to PU concept, like prevalence, risk assessment, ulcer grading, and prevention data. For instance; a prevalence rate for a specific ward is 5%, Waterlow risk assessment score is 10, patients PU grade is 4, and patient repositioned on his bed every 2 hours. All these are clinical data related to the PU problem. PU Data recording: recording and documenting of PU data that specified above into patients medical record, either this record held on paper or electronic format. PU Data utilization: the uses of the collected and recorded PU data in practice, what they are make of this data, what they are benefit from it. Clinical settings: the different care settings that usually collect, record and used patients clinical data, including PU data. Most commonly, it is composed from primary and secondary settings. Background to the study problem Scope of the problem European Pressure Ulcer Advisory Panel (EPUAP), are group has been lunched to guide all Europe nations in preventing and treating PUs. They define PU as: an area of localised damage to the skin and underlying tissue caused by pressure, shear, friction and or a combination of these (EPUAP, 1998). These ulcers, regardless of their basis, represent negative outcomes for patients; these negative outcomes may include pain (Reddy et al., 2003, GÃ ¼nes, 2008), longer hospital stays, where it can add about 7 days to a hospital admission (Anthony et al., 2004), decreased quality of life (Price, 1998, Neil and Munjas, 2000), and increased the spending of care provider time and costs (Alterescu, 1989, Clough, 1994, Severens et al., 2002a, Bennett et al., 2004). PUs have been regarded as the most physically debilitating complications in the twentieth century (Burdette-Taylor and Kass, 2002), and it is the third most costly problem after cancer and cardiovascular diseases in the Netherlands (Shahin et al., 2008). In fact, there are many complications for PUs, including infection, sepsis, and osteomyelitis (Thomas, 2001). It has been found that more than half (51%) of long term care patients with PUs have Methicillin-Resistant Staphylococcus Aureus (MRSA) infection (Capitano et al., 2003). Furthermore, PUs are linked with two-fold rates of increased mortality, regardless of the origin of the ulcer (Brem and Lyder, 2004). This is consistent with Landi et al (Landi et al., 2007) study, who investigated the connection between PU and the risk of one year all reasons mortality in a community of very elder people, and found a significant difference between the PU group and non-PU group in mortality rate, 29% vs. 14% (p

Lennie is mourning the death of his puppy Essay

At the beginning of the extract, Lennie is mourning the death of his puppy – by his own hand – when Curley’s wife enters the barn and attempts to comfort him and she allows Lennie to stroke her hair. When ‘Lennie’s big fingers fell to stroking her hair’ we see that something is going to happen as the mood changes and the tension is heightened. We have an inclination to what is about to happen as we have seen the inevitability of the scenario with Lennie’s strength and Curley’s wife’s desire for affection and attention. When Curley’s wife tells Lennie not to ‘muss it up’, Lennie strokes ‘harder’, as he is overcome with the pleasure of the experience, this shows that Lennie doesn’t listen to anyone except from George, thus reinforcing what we already know. Curley’s wife says ‘ you stop it now’ and ‘jerks her head sideways’ and Lennie then panics and automatically his ‘fingers close on her hair and hung on’, this is because it is the only thing he can think to do, this emphasises his child-like mentality as his reaction is physical as opposed to psychological. ‘Lennie was in a panic’ and ‘his face was contorted’, these two short simple sentences portray the innocence and naivety of Lennie’s actions as well as reflecting the way Lennie’s mind works, short and simple. He ‘begs’ Curley’s wife to stop screaming because ‘George’ll be mad’ and ‘ain’t gonna let him tend no rabbits’ showing that he has a one-track mind, much like a child. Lennie then gets angry and tells Curley’s wife ‘I don’t want you to yell’, this again shows his child-like mindset and his anger leads him to shake her. So he’s shaking her, not in an aggressive manner, but to protect his part in the dream, ‘her body flopped like a fish’ and ‘she was still, for Lennie had broken her neck’. At this point we see Lennie, not just kill Curley’s wife, but kill the dream too. Lennie does not realise he has killed her as he continues to speak to her, he ‘lifts her arm and lets it drop’ and is, for a moment, ‘bewildered’. His mind can’t capacitate why she is not responding, all he thinks he did was shake her, showing just how unaware he is of his own strength. Animal imagery is used to describe how Lennie ‘pawed up the hay until it party covered her’, this connotes Lennie’s clumsiness and density. In the concluding paragraph of the extract we see Lennie become ‘conscious of the outside’ ‘for the first time’, he recalls what George told him to do if he gets into trouble and goes to ‘hide in the brush’, taking the dead puppy with him to ‘throw it away’ because ‘it’s bad enough like it is’. Here we see Lennie make a decision himself, be it the right one or not, he seems to have matured slightly because of the situation at hand and this event could be something that changes Lennie’s childish behaviour. Throughout the death of Curley’s wife, we still feel more sympathy for Lennie, because he is so unaware of the danger his actions can cause and he is still a naive and innocent character, despite the unintentional harm he has brought to many things. Show preview only The above preview is unformatted text This student written piece of work is one of many that can be found in our GCSE John Steinbeck section.

Relationship Management Strategies in Dells Supply Chain

Executive Summary This paper discusses, using the multinational corporation Dell, Inc, existing and suggested Relationship Management Strategies applied to both Upstream and Downstream members of a supply chain. It also examines and gives an analysis of, using several diagrams, tables and models, Dell’s product range – and the customers who buy them. This paper also examines several Key Issues associated with maintaining positive relationships with supply chain members, and how they may be worked out, besides providing an in-depth analysis of the relationships between Dell and its suppliers, customers and competitors. Dell’s customers are many and come from many segments, but for this paper the focus will be on its biggest and most†¦show more content†¦Due to its exemplary business practices, Dell Incorporated has been the subject of many case studies and reports ranging from Customer Service to Human Resources to Logistics. For the same reason, the author thinks that Dell is a prime candidate of discussion for this paper’s given topic. This paper will examine and discuss, among other things, Dell’s vast product line catering to various business segments, the structure of Dell’s supply chain – parts and peripherals suppliers, distributors and business customers, competitors, and (most importantly,) its methods and policies of dealing with and maintaining good relations with its suppliers and business customers. 1.1 Background Information on Dell Dell, Inc is a multinational corporation formed in the 1980s by founder and college dropout Michael Dell. What sets Dell apart from other firms operating within the same category is that Dell was the first company to offer Built-to-Order computers, which were different from the norm of buying ready-made computers at that time. 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Gender And Gender Inequality - 1084 Words

For ages it was believed that the different characteristics, roles and status accorded to women and men in society are determined by sex, that they are natural and therefore not changeable. Gender is seen closely related to the roles and behavior assigned to women and men based on their sexual differences. As soon as a child is born families and society begin the process of gendering. The birth of the son is celebrated, the birth of a daughter filled with pain; sons are showered with love, respect, better food and proper health care. Boys are encouraged to be tough and outgoing; girls are encouraged to be homebound and shy. All these differences are gender differences and they are created by society. The society/media has put an image in†¦show more content†¦In childhood a female must be subject to her father, in youth to her husband, when her lord is dead to her sons; a woman must never be independent. Womens lives are shaped by customs that are centuries old. May you be the mother of a hundred sons is a common Hindu wedding blessing. Statistics reveal that in India, males significantly outnumber females and this imbalance has increased over time. The sex ratio according to 2001 census report stands at 933 per 1000 males. Out of the total population, 120 million are women who live in abject poverty. The maternal mortality rate in rural areas is among the worlds highest. From a global perspective India accounts for 19% of all live births and 27% of all maternal deaths. The deaths of young girls in India exceed those of young boys by over 300,000 each year and every 6th infant death is specifically due to gender discrimination. Women face discrimination right from the childhood. Gender disparities in nutrition are evident from infancy to adulthood. 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