Art Of Portraiture Essay Example For Students

Specialty Of Portraiture Essay The three works that I picked that are specialty of likeness are Head of a King, Mask of a Lyoba, and Mother Goddess. The initial two pictures are West African Art from two distinct clans, Ife, who made the Head of a King and Benin, whom made the Mask of a Lyoba. The Mother Goddess is an Aztec piece. These gatherings of individuals are from various societies, timespans, and share diverse strict convictions. The closeness of the gatherings is the emblematic importance the representations brought to its kin. The primary work is the Head of a King. This Ife creation changed the recognition that researchers had of the clan. It was realized that the Ife clans didn't do representations in view of the spirits that could hurt the subjects. The models that were found all appeared to take after rulers, so the end was that the establishment of majesty and the need to worship regal precursors were sufficiently able to conquer concerns. Additionally the figures were naturalistic. The extents of the couple of knownful figures are typically African.. The heads may have been taken from life models, however appear to be progressively similar to glorified pictures. A model is of the extents of the leader of the figure. These extents most likely mirror a faith in the heads significance as the home of the soul, and the focal point of the individual personality. Life is the sacrosanct city of the Yoruba individuals, were naturalistic figure started. The Benin clan emerged after the Ife, and was incredibly affected by their specialty. Their pictures were additionally naturalistic, however as they developed increasingly educated in workmanship, they drew away from the naturalistic works of the Ife individuals into adapted works of their own. The Mask of a Lyoba is a delightful fancy cover of eminence. This works shows that the individuals no longer utilize the naturalistic methodology, however an intense, progressively glorified, portrayal of its kin. The specialty of Benin is an imperial craftsmanship, just the oba could commission the works. This work was appointed in ivory, yet a large portion of the works were authorized in metal. The Benin change from naturalistic to adapt is better clarified in the metal heads. It ranges from little, meagerly cast, and naturalistic to huge, thickly cast, and exceptionally adapted. The finish of researchers is that in their Early Period, their heads were little and naturalistic from the Ife impact. Heads at that point became progressively adapted during the Middle Period. At that point in the Late Period, the heads were exceptionally enormous and substantial, with rakish adapted highlights and an expand beaded crown. In Mexico there was likewise likenesses. Explicitly in the Aztec Empire were the Mother Goddess was made. This was a solid and ground-breaking realm that was partitioned in classes. The religion depended on an intricate pantheon that consolidated the Aztec divinities with progressively old ones that had for quite some time been adored in Central Mexico. As indicated by the Aztec conviction, the divine beings made the current universe at the old city of Teothhuacan. Which is like the Ife conviction that Gods descended and made the individuals. The way of life and reason for the individuals is then to love and respect their divine beings until the end of time. This was finished by penance and in their craft. We know about the religion and the convictions of the Aztec individuals on account of their craft. The divine beings were spoken to in sculptures and artistic creations that were accounts to encourage their kin and demonstrate regard to the divine beings. The Mother Goddess was a wide carried figure with ripped at hands and feet has a skirt of curved snakes. A couple of snakes, images of spouting blood, ascend from her neck to frame her head. Their eyes are her eyes; their teeth, her tusks. The squirming snakes of her skirt additionally structure her body. Around her stump of a neck balances a neckband of conciliatory contributions hands, heart, and a dangling skull. .u1bef6b597f94eee8bcfc903ebcb43e9d , .u1bef6b597f94eee8bcfc903ebcb43e9d .postImageUrl , .u1bef6b597f94eee8bcfc903ebcb43e9d .focused content zone { min-stature: 80px; position: relative; } .u1bef6b597f94eee8bcfc903ebcb43e9d , .u1bef6b597f94eee8bcfc903ebcb43e9d:hover , .u1bef6b597f94eee8bcfc903ebcb43e9d:visited , .u1bef6b597f94eee8bcfc903ebcb43e9d:active { border:0!important; } .u1bef6b597f94eee8bcfc903ebcb43e9d .clearfix:after { content: ; show: table; clear: both; } .u1bef6b597f94eee8bcfc903ebcb43e9d { show: square; progress: foundation shading 250ms; webkit-change: foundation shading 250ms; width: 100%; obscurity: 1; progress: murkiness 250ms; webkit-progress: mistiness 250ms; foundation shading: #95A5A6; } .u1bef6b597f94eee8bcfc903ebcb43e9d:active , .u1bef6b597f94eee8bcfc903ebcb43e9d:hover { haziness: 1; change: darkness 250ms; webkit-change: haziness 250ms; foundation shading: #2C3E50; } .u1bef6b597f94eee8bcfc903ebcb43e9d .focused content region { width: 100%; position: relative; } .u1bef6b597f94eee8bcfc903ebcb43e9d .ctaText { outskirt base: 0 strong #fff; shading: #2980B9; text dimension: 16px; textual style weight: striking; edge: 0; cushioning: 0; text-embellishment: underline; } .u1bef6b597f94eee8bcfc903ebcb43e9d .postTitle { shading: #FFFFFF; text dimension: 16px; textual style weight: 600; edge: 0; cushioning: 0; width: 100%; } .u1bef6b597f94eee8bcfc903ebcb43e9d .ctaButton { foundation shading: #7F8C8D!important; shading: #2980B9; fringe: none; outskirt sweep: 3px; box-shadow: none; text dimension: 14px; textual style weight: intense; line-tallness: 26px; moz-outskirt span: 3px; text-adjust: focus; text-beautification: none; text-shadow: none; width: 80px; min-stature: 80px; foundation: url(https://artscolumbia.org/wp-content/modules/intelly-related-posts/resources/pictures/straightforward arrow.png)no-rehash; position: supreme; right: 0; top: 0; } .u1bef6b597f94eee8bcfc903ebcb43e9d:hover .ctaButton { foundation shading: #34495E!important; } .u1bef6b59 7f94eee8bcfc903ebcb43e9d .focused content { show: table; tallness: 80px; cushioning left: 18px; top: 0; } .u1bef6b597f94eee8bcfc903ebcb43e9d-content { show: table-cell; edge: 0; cushioning: 0; cushioning right: 108px; position: relative; vertical-adjust: center; width: 100%; } .u1bef6b597f94eee8bcfc903ebcb43e9d:after { content: ; show: square; clear: both; } READ: Al GORE for President EssayDespite the surface multifaceted nature, the figures basic, striking, and blocky structures make a solitary visual entirety. This sensational effect was additionally elevated by the shading. This representation is emblematic. Dissimilar to the past two works it isn't of the rulers or the individuals at that point, it is of a divine being. In any case, much like the initial two works it is additionally glorified. This is the thing that their mom god that guides them should resemble. The Ife individuals made works that were profound and uncovering their gatherings character. The Benin individuals, when understanding workmanship made adapted works that additionally communicated their character, definitely more than anything naturalistic. Every one of the three works speaks to the individuals and what is essential to them. For the Aztec individuals it was their divine beings, and speaking to them in a sensational and ground-breaking approach to show their kin. While the Ife individuals accepted that the divine beings made them in resemblance to themselves, so the representations were additionally of their kin in the perfect structure that the divine beings needed. The Benin culture were intrigued by workmanship, and needed to demonstrate regard to their rulers by their portrayal of them.

Dangerous Effects of Alcohol and Cannabis

SHRED case investigation Paper Hal was named to lead a bookkeeper group on November 15 His Job was to report the review progress There are commonly 4 situations in a review group: Partner-in-control: in general the most dependable one Manager: oversees the entire examining process In-control senior: does the evaluating plan Staff individuals: perform errands Frank is the accomplice in-control Although new, Hal gets one of the four seniors, yet after Richard signs, Hal becomes in-control senior, Audit report should be finished by January 15 There were numerous explanations that couldnt be given to Hal. Hal and Linda both experience unordinary things. Stage 3: Write the difficult explanation. A. First rundown the manifestations of the general issue that is causing the side effects. The other senior inspectors act in their own specific manner as opposed to together. Honest has poor hard working attitudes. Franks hard working attitudes influences the entire examining process The cutoff time is close. B. At that point name the shopping center hidden Issue?the center issue Due to Franks poor work trustworthiness, it influences Halls occupation and position as the in-control Enron. C. Compose the difficult articulation. Express the most critical issue in 3 to 5 sentences. Hal, the reviewing In-control senior of Reheard Company, was alloted to review the ABA Group Ltd. Because of Franks, the accomplice in-control, poor hard working attitudes, Halls position as the in-control senior and the entire task gets risked. Hal must move toward Frank inside the following day to fix things and to converse with him about the groups discoveries, in any case, Halls positions, the firm, and ABA will confront terrible results. Stage 4: State a target for the chief Involved. Momentary target (s): 1. To fix things with Frank 2. We will compose a custom exposition test on SHRED case investigation explicitly for you for just $16.38 $13.9/page Request now We will compose a custom exposition test on SHRED case examination explicitly for you FOR ONLY $16.38 $13.9/page Recruit Writer We will compose a custom exposition test on SHRED case examination explicitly for you FOR ONLY $16.38 $13.9/page Recruit Writer To introduce the groups discoveries and to ensure the examining group is in the same spot. Long haul objective (s): 10 present a distressing rep 2. To cooperate as a group. Rotor Step 5: Identify and rank request basic issues (fundamental issues) identified with the issue. Were concentrating on one hidden issue much of the time, however there can be mutiple. 1. Because of Franks poor hard working attitudes, it influences Halls Job and position as the in-control senior. 2. The group isn't cooperating, nor are they on the same wavelength. 3. A review report for the ABA is expected on January 15. Stage 6: Consider significant data (realities) and fundamental suspicions identified with the issue. The other senior inspectors act in their own specific manner as opposed to together. Straight to the point has poor hard working attitudes. Stage 7: List potential answers for the issue. 1 . ) Hal can proceed report his discoveries Advantages It will manage the circumstance with Frank The best thing would be done/hard working attitudes and respectability. Burdens It makes him a little snitch story for uncovering Frank It will make the reviewing bunch look awful, as though they can not cooperate. Potential Outcomes Best: The gathering changes and works with trustworthiness. In all likelihood: The Frank circumstance will be managed. Most unrealistic: The gathering will look terrible. 2. ) Hal can oblige his groups report There will be a report to present to ABA Even however the Frank circumstance wont be brought to consideration, it will make the gathering look as though they cooperated, expertly. Detriments It isn't the proper activity Frank will keep on acting like this Best: ABA will never get some answers concerning the issues with respect to Frank Most Likely: They will have something to present to ABA Most improbable: ABA get some answers concerning all the issues occurring inside the reviewing bunch step B: select ten Test arrangement. I think the best answer for Hal is to report his own discoveries. With work, trustworthiness and having great hard working attitudes is completely significant. It is significant for the own individual and obviously the organization. Straight to the point may imagines that he is profiting by it, yet it truly is going to influences him. In addition to the fact that it affects him, however it additionally influences his associates, the ABA, and Reheard Company. Stage 9: Decide how to actualize the arrangement. Hal should converse with Frank actually first. In the event that that doesn't work I think Hal ought to carry the thoughtfulness regarding possibly the manager of Reheard Company. It may make Hal appear to be a snitch story, yet toward the day's end it is extremely about making the best choice. Stage 10: Explain how to convey the arrangement. Hal should converse with Frank first and attempt to work through the issue. They ought to talk about his discoveries and afterward attempt to understand it at that moment. Ideally Frank will change and see what the better decision and course is for him, the organization, and his associates.

HER BODY AND OTHER PARTIES Defies Genre to Create Original, Unforgettable Stories

HER BODY AND OTHER PARTIES Defies Genre to Create Original, Unforgettable Stories Grace Lapointe is a writer from MA who has cerebral palsy and often writes on disability themes. Her fiction has recently appeared in Kaleidoscope, Deaf Poets Society, and Mobius: The Journal of Social Change. Her essays have appeared in Wordgathering, as part of Grub Streets Why I Write series, and in The Body is not an Apology, with one forthcoming on Monsterings blog. You can find her on her website, Facebook, or  Twitter. In the bowdlerized, Disney versions of fairy tales that are so prevalent in our culture, the warnings from the original tales are almost absent. Reductive morals (such as “Don’t judge by appearances”) have replaced the visceral sense of fear and the moral ambiguity of the original stories. This leads some adult readers to dismiss fairy tales, fables, and ghost stories as exclusively for children. Similarly, our culture tends to categorize certain forms of entertainmentâ€"such as genre fiction, comedy, and crime procedural TV showsâ€"as lowbrow, with realistic literary fiction as highbrow. Carmen Maria Machado’s story collection  Her Body and Other Parties  combines elements of science fiction, fantasy, magic realism, erotica, and folk tales to create stories that are riveting and remarkably inventive. I immediately recognized the basic plot of the opening story, “The Husband Stitch.” A woman always wears a green ribbon around her neck. She refuses to let her husband remove itâ€"until it’s finally removed, and her head falls off! In elementary school in the ‘90s, I’d read a children’s version of this story in Alvin Schwartz’s collection In a Dark, Dark Room. (I remember my cousin reading Schwartz’s Scary Stories to Tell in the Dark to me on a sleepover.) Yet Machado turns this classic, creepy storyâ€"which predates both her and Schwartz’s renditionsâ€"into a sexually explicit exploration of bodily autonomy, including sexual agency and consent. The most obvious questions that I had as a child remain unanswered: was the woman a zombie and/or decapitated for most of her “life”? Were there any others like her? Rather than seeming derivative, the familiar elements in Machado’s stories make them shocking, immediate, and even universal. “The Husband Stitch” also reminded me of The Bloody Chamber, Angela Carter’s 1979 feminist retelling of classic fairy tales. As a reader and writer, it doesn’t matter to me whether Machado has read either of these books or considers them influences. What matters to me is that Machado, like Carter, is following in a literary tradition of feminist re-imaginings. Carter’s heroines have more agency than in the originals: they save themselves instead of waiting for men to save them. She brings the latent sexuality in stories like “Little Red Riding Hood” to the foreground. The titular story is a retelling of the Grimms’ “Bluebeard,” where a woman discovers that her husband has murdered several previous wives. The title “The Bloody Chamber,” which literally refers to the chamber where the bodies are hidden, can also be interpreted as symbol izing a vagina, in the tradition of Sigmund Freud or Julia Kristeva. In contrast to a 1970s school of feminism, which focused exclusively on cisgender, heterosexual women and sometimes defined them by their genitals, Her Body and Other Parties contains several lesbian and bisexual protagonists. The title of one story, “Real Women Have Bodies,” is a sly pun on the outdated 2000s saying “Real women have curves.” It avoids essentializing women and their bodies in any way and updates first-wave feminist tropes for third-wave, LGBT-inclusive feminism. In this story, when women’s bodies gradually fade away, a male newscaster quips, “I don’t trust anything that can be incorporeal and isn’t dead” (146). It’s darkly funny, but anyone who’s heard the misogynist joke “I don’t trust anything that can bleed for five days without dying” will feel a shock of recognition. I doubt that I’ve ever watched an entire episode of Law and Order: Special Victims Unit, but even I recognized the tagline referenced in the title of Machado’s “Especially Heinous.” It starts with simple, TV Guideâ€"like synopses for hypothetical episodes, but diverges into a stunningly original story filled with humor, doppelgängers, ghosts, and unique characters. It even incorporates the distinctive theme music of the show, “dum-dum,” as a kind of recurring “Telltale Heart” motif (87). This story takes risks, defies categorization, and blends parody, horror, and pathos. Her Body and Other Parties synthesizes many possible influences to blend genres, causing me to wonder why they’re usually kept separate. The protagonist of “The Resident,” a writer on an artists’ retreat, describes the feeling of “defamiliarization; of zooming in so close to something, and observing it so slowly, that it begins to warp, and change, and acquire new meaning” (198). Her Body and Other Parties forces readers to re-examine their assumptions and well-known stories in a similar way. Near the end of “The Husband Stitch,” the narrator apologizes to the reader: “I’m sorry. I’ve forgotten the rest of the story” (29). Instead of merely going on a pointless tangent, she seems like she needs to tell us something urgently but has forgotten it. Machado reminds us that horror is often indescribable, and that the moods and morals of stories often haunt us, even if we forget all the details. Sign up to Unusual Suspects to receive news and recommendations for mystery/thriller readers. 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The Cost Of Attending College Essay - 1356 Words

The cost of attending college has risen drastically over the years. Statistics show that there has been a 260% increase in tuition costs since 1980. The increase in tuition cost equates to an increase in money borrowed to fund higher education. An increase in money borrowed results in an increase in debt accumulated over time. As a result of the rising figures, the economy as a whole has also suffered because of the restricted financial space many graduates find themselves in upon completion of their degree. In this paper, we will discuss college costs, reasons why they have risen, and the best way for students to pay for it. College costs and their recent increases cannot be discussed entirely without first examining the importance of the topic. It is common for people without student loan debt to overlook the topic due to their perceived lack of relativity it is has to their life. This thought process is harmful because much of our society does not quite understand the ways in which student loan debt affects our nation’s economy. Student loan debt directly effects how soon many people begin to make life’s larger purchases, which in turn slows down the flow of the economy. Many Americans are also more inclined to base their career selection on how well they will be able to repay their student loans. With this in mind lower paying jobs, like those in social work, are suffering from a shortage of employees while jobs with higher pay, such as technical work, have seen a majorShow MoreRelatedThe Cost Of Attending A College2262 Words   |  10 PagesThe cost of attending a college, university, or any other higher education institution in the United States is becoming increasingly more expensive every year. The United States ranks as third highest in the western world, only behind Mexico and Japan, for cost of college tuition (Taylor, Adam. â€Å"Here’s What†). With the growing divide in wealth in America between the elite and working or lower class, many students and their families are finding entry into higher education more unattainable than everRead MoreCost Benefits of Attending College1082 Words   |  5 PagesCollege is one of the better investments a person can make to enhance their life. Attending college sets you in the right direction to become a successful individual in the future. Yes, college takes time, and a great deal of money, but in the end it is all worth it. People who graduate from college are more likely to obtain a high end paying job than a person with just a high school education. The cost of attending college may be expensive, bu t, the outcome of it all is worth the wait. The mostRead MoreIs College Still A Good Investment?958 Words   |  4 PagesIn Does College Still Pay, Lisa Barrow explores that even though the college tuition costs are increasing rapidly, is college still a good investment. Barrow states that college still worth wild and there is no evidence of a downward trend to students attending college due to increasing college tuition. Barrow also claims that by getting a bachelor s degree today, a college student can expect to regain all of their investments they have put towards their education within 10 years after graduationRead MoreWhat Do They Do When They Graduate?903 Words   |  4 Pagesdecide to go to college what do they want to major in? As well as what college do they want to go to? Many even have to decide on junior college verse a university and how can they benefit from either one. Many students think about going to a junior college just to start off their college career. As well as getting their basic courses out the way , while saving money. And other never think they would ever go to a junior college because of the myths. There are myths about junior college such as theyRead MoreThe Rising Cost of Education1737 Words   |  7 PagesThe cost of higher education in the United States has skyrocketed over the past decade or so, leading to a number of social problems including deep debts among graduates. As a result, the value of higher education is being increasingly called into question. Earnings and job outlooks for graduates has grown grimmer over the past decade or two, while those same graduates are more in debt than their parents would have been for the same educational program. Greater debt plus fewer options for payingRead MoreStudent Loan Debt1074 Words   |  5 Pagesguidance that is available concerning student loans. The purpose of this paper is to illustrate how prospective and current college students are ill prepared in their education and understanding of student loans. Three major issues that will be outlined in this paper include the large majority of college students are no longer abl e to pay for college out of pocket due to the rising costs, the effect that national debt has on students degrees, and finally the lack of early financial education to make crucialRead MorePositives And Negatives Of College Students1518 Words   |  7 Pagesinstitutions. The number of colleges has decreased in since 1930, as the trend was to consolidate small schools. In the fall of 2015, there is an estimated 20.2 million students expected to attend American colleges and Universities (Fast Facts, 2016). This is an increase of about 5 million since the fall of 2000. Females are expected to account for the majority of college students; about 12 million students are female while 9 million students are male (Statistics about College Students, 2016). WhileRead MoreWhat Does a College Education Buy An1281 Words   |  6 Pagesï » ¿ The Virtues of Higher Education In the essay â€Å"What A College Education Buys† written by Christopher Caldwell, the author questions whether or not the value of a college education today supports the high cost of obtaining a degree. Having a college degree is viewed as having achieved some measure of accomplishment. People think you are more intelligent for having gone to college. Employers seem to be more eager to hire college graduates. Certainly we have been told that having a degree will helpRead MoreTwo Year College versus Trade School816 Words   |  3 PagesCollege (Two year) vs Trade School For some students, the question of what to do after high school may be a burden to even contemplate as it approaches quicker and quicker. The pressure to continue another four (or more) years of education after high school can be overwhelming considering twelve years of schooling has already been completed; why go right back to school again? When’s break time? Some people are simply just not ready for college and they know it, or at least until afterRead MoreMaking A Decision For A Higher Education Essay1729 Words   |  7 Pagesfinancial outlay once a decision is made.   I made a decision to attend Ashford University in January of 2014.   I am pursuing a BA in Operational Management and Analysis with a set graduation date of January 2018.   This paper is a financial report on my college education and projected future employment utilizing an ROI calculation. The reason I select to pursue a BA in Operational Management and Analysis is the personal gain of financial status.   Society has a growing need for business educated individual

Gambling in The Bahamas Should it Be Legalized - 1821 Words

The right to gamble is a right given to several matured persons living in the United Sates for the purpose of amusement. The Oxford dictionary defines the word ‘gamble’ as playing games for a chance of winning money. Last year, the current Government of the Bahamas proposed a referendum that asked Bahamians about their views on gambling. The referendum asked Bahamians if they supported the regularization and taxation of web shop gaming. As noted in the results, the mass of the Bahamian people voted no against the referendum. Today, the gambling issue has reawakened and Bahamians are now in a fight against the laws of their country. Several Bahamians believe that the law discriminates against Bahamians because it prohibits Bahamians from owning and legally gambling in casinos within in their homeland. Although any form of gambling is illegal in the Bahamas, there are abundant web houses that allow Bahamians to participate in a few forms of gambling. Gambling in The Bahama s propose that legalized gambling can result in job creation, revenue generation and prevent discrimination of Bahamians however, Harms of Legalized Gambling suggest that gaming can lead to poverty, increased and pathological gambling. Numerous web houses and casinos are found throughout the islands of the Bahamas. In the film Gambling in The Bahamas, Acct John Bain stated; that during the time that the Progressive Liberal Party was under the leadership of Sir Linden Pindling, casinos in theShow MoreRelatedGambling Legalization1808 Words   |  8 PagesGerika Arthur Professor McPhee English 300-01 March 14, 2011 Gambling legalization for a promising future Gambling is the act of playing for stakes in the hope of winning (including the payment of a price for a chance to win a prize). (Oxford dictionary) Many have their own opinions about gambling and at this time gambling is not legally practiced here in The Bahamas. â€Å"Such a move would bring an end to an illicit industry that makes tens of millions of dollars a year and which employs hundreds;Read MoreGambling No Matter The Stake Gambling Essay1555 Words   |  7 Pagesa loser, this being very prevalent in gambling no matter the stake. Gambling regulations exist all over the country as there is a basis of set laws that are put forth by the government, such as the ability to not buy a lottery ticket until the age of 18 and not being able to fully access a casino until the age of 21. On the topic of individual state, states have the power to control who gambles and how by setting forth regulations on the topic of gambling, such as recent applications that involve

Swastikaâ€a Symbol of Good and Evil Free Essays

SOCS350-ON November 7, 2008 THE SWASTIKA-A SYMBOL OF GOOD AND EVIL The hackenkreuz, gamma cross, gammadion, St. Brigit’s cross, fylfot cross and swastika are all references to one symbol, the oldest cross in the world. This symbol is represented several thousand years B. We will write a custom essay sample on Swastika–a Symbol of Good and Evil or any similar topic only for you Order Now C. in multiple cultures. It is not until the 1900’s that the term â€Å"swastika† elicits such a fervor of emotions. It is interesting to contrast the viewpoints of the Chinese community versus the enormity of human passion that ensues in a Jewish community when the symbol is displayed. As cited in Chinese Symbols – Common Five Asian Attributes,http:symbolic-meanings. com/2007/11/01chinese-symbols-commonAncient Chinese symbols and their meanings are a product of a very savvy people who understood the human need to progress in their conjunction with their propensity to link positive change with visual/allegorical concepts. The Chinese believe that crises in one’s life bring the opportunity for change. Symbolism is incorporated in the kanji, more commonly referred to as Chinese characters. Kanji, itself means both crises and opportunity. As many people of China embrace the Buddhist religion, it is an opportunity to discuss the swastika from this point of view. As cited in ReligionFacts; â€Å" The Swastika Symbol in Buddhism† htt//symbolic-meanings. com/2007/11/01chinese-symbols-common Page 2 Swastika In Buddhism, the swastika signifies auspiciousness and good fortune as well as the Buddha’s footprints and the Buddha’s heart. The swastika is said to contain the whole mind of the Buddha and can often be found imprinted on the chest, feet or palms of Buddha images. It is also the first of the 65 auspicious symbols on the footprint of the Buddha. The swastika will also be found in homes, on the doorways to temples, at the beginning of books, in decorative borders and in clothing as well as being carved into Chinese coins. The swastika is seen as a symbol of luck and life. As cited in NewsFinder. org/site/more/swastika â€Å"The Oldest Known Symbol† In Nazi Germany, the swastika became the national symbol. In 1910, a poet and nationalist, Guido von List suggested that the swastika be a symbol for all anti Semitic organizations. On August 7, 1920, at the Salzburg Congress, this flag became the official emblem of the Nazi Party. The actual drawing of the thousands of year old swastika remained the same with one exception after the adoption by the Nazi’s—the exclusive use of the colors black, red and white. The swastika holds a vivid, powerful vision for those of the Jewish community. The impact though now changes from positive and serene as seen with the Chinese community to that of conjuring up memories of the holocaust, a time of horror and hate. The brief appropriation by the Nazi’s of the swastika has forever destroyed the positive a Page 3 Swastika and serene interpretation of this symbol for much of the world but especially for those of Hebrew belief. So deeply imbedded in the minds of those with an ancestry to Judaism that to merely see the swastika is to re-live the stories of the holocaust, the inhumanity and despair. So powerful a symbol is that the swastika can create havoc on one’s limbic system. Though fewer victims are left now from this reign of terror, the legacy lives on to this day and assuredly shall for many generations to come. Two cultures, two moments in time, two opposing interpretations as related to a simple drawing have been discussed. The power is of course not in the drawing, but in the meaning perceived by the drawing. In one culture we see the swastika as life, in the other we see the swastika as a vile destruction of life. How to cite Swastika–a Symbol of Good and Evil, Papers

Managing People & Organisations Samples for Students †MyAssignmenthel

Question: Discuss about the Managing People Organisations. Answer: Introduction Due of globalization, there is a fast increment in changing methodologies and operational strategies and methodology of associations. As the associations change from household to worldwide associations developing future worldwide directors turns into an essential segment of an effective worldwide business (Appannaiah, Reddy and Putty, 2010). To execute a worldwide methodology for business needs the opportune individual at the correct place and for this reason, individual administration ability examination is fundamental. It is imperative to perceive what the global managers are before breaking down the abilities and capacities fundamental enemy the powerful global administration. Global managers are the people that have a comprehension about the distinctive cross-societies of various nations and lead groups around the world. Global components affect the individual administration aptitudes. Abilities and Capacities of worldwide administration help to keep up an upper hand and guarantee the achievement of an association in the dynamic and complex global market. The global administration is a capacity of the nearby or universal director to empower, impact and motivate people to assume a part for the accomplishment of the objectives and goals of the organization. A globalmanagement capacity is an aptitude, learning or capacity that empowers, impact and inspires people to contribute to the accomplishment of the objectives of organization crosswise over limits (Bhimani and Dai, 2008). The motivation behind the GlobalManagement is to bolster worldwide directors in enhancing their administration framework and help them to meet the necessities adequately and effectively of their organization to make an estimation of the organization around the world. As per physiological affiliation, identity can be characterized as an individual's qualities like feeling, carrying on and thinking contrasts from different people. The five major measurements of identity are utilized to judge the attributes of somebody's identity these are uprightness, pleasantness, neuroticism, openness to understanding and extroversion. Literature review Themanagement plays a significant role in managing all the operations. It is necessary for the administrators to have a globalized environment to work and perform in a globalized situation of business adequately and effectively. Global managers can be able to approach the globe by utilizing diverse strategies that are connected with individual qualities, abilities, and skills of people. Six worldwide outlooks are view life as a test, accept challenges as an open door, search for conditions, concentrates on the procedure, assorted collaboration, and battle for adapt to vulnerability. The individual attributes that are identified with these attitudes are adaptability, affectability, flexibility, learning, conceptualization, judgment and reflection (Britton and Waterston, 2013). Managing with the many-sided quality, rivalry, instability, groups, and learning are the abilities and capacities that are required by the worldwide administration. The capacity of associations in sharing their insight in and outside the association for the achievement of the elements of the associations and analyzed the connection between sharing of learning and aptitudes for the global accomplishment of the business. The Global administration capabilities and audit and talk about the past research identified with Global authority abilities to be viable worldwide pioneer individual ought to have social judgment aptitudes, mindfulness, self-control, organizing abilities, and acknowledgment of unpredictability (Dauber, 2005). Global authority abilities are fundamental for the accomplishment of a business and furthermore talk about the lacks in the past reviews and incorporate the capacities of people to perform work universally. The impact of coordination process on the conduct of peace making and global execution of groups and found that dealing with the groups' performance execution can decrease internal conflict of groups and the achievement o f the business internationally. The requirement for a chief to be a global manager is crucial because globalization is expanding in all organizations to a great extent. The worldwide point of view to be a worldwide chief comprise of the proper information and abilities of global mentality. To end up noticeably a viable global there is a prerequisite of building up the worldwide outlook. The possibility of worldwide worldview developing in current open administration and found that there is have to change thoughts regarding people in general administration to be effective in the globe (Hall, 2007). The worldwide attitude of chiefs in the articulation of contextualization and conceptualization capacities is illustrated. The discoveries demonstrated that conceptualization scored higher than contextualization in material ventures and suggested that partnerships that work their business all around ought to accentuation more on preparing for learning and abilities before appointing assignment to the administrators intern ationally (Horngren, 2013). Mindfulness portrayed as understanding the qualities picture and part of an individual show character and investigates the presumptions qualities and shortcomings. Self-awareness is a capacity to deal with the anxiety related circumstances and adapt to the indeterminate circumstance. Personality Personality is characterized as a tolerably steady practices show and inward conditions of a person which can clarify the propensity of somebody's conduct. Identity incorporates two sorts of practices inward and outer. External behaviors can be seen to recognize the identity of a person (Horngren, 2013). For example, one can easily observe the method for association of a person with others. The internal practices incorporate qualities, considerations, and such attributes that we couldn't watch effortlessly. Since 100 years back researchers were attempting to develop identity qualities records. Numerous specialists attempted to create characteristics of identity and discovered a great many groups of identity qualities. After contracting they extricate theoretical five identity measurements. Late examinations utilize these five measurements to judge the characteristics of somebody's identity. The primary measurement is conscientiousness that depicts the general population who are self-taught, depend-capable, assurance to disorganized and careless. Individuals who have low faith are considered as flippant, less precise, reckless, and disordered. Second appropriateness which is alluded to the people who are minding, confiding in, considerate, empathic, inviting, excusing and disorganized (Horngren, 2014). Individuals who have low suitability are considered as irascible, bad-tempered, and uncooperative. Third neuroticism that is inversed to the passionate dependability and this measurement i ncorporates the qualities of individuals having nervousness, sadness, hostility, shaky, and reluctance. Individuals who have low neuroticism are considered as adjusted, quiet, and secure. Fourth is an openness to experience which is portrayed as the adaptable, inventive, inquisitive, and sensitive individuals. Individuals are having a low openness to encounter considered as resolute, less inventive, and responsive. Costa and McCrae, 1992 depict that the extroversion as power and amount of vitality which coordinated people outwards into the social world (Kew and Watson, 2012). Extroversion alludes to as qualities of individuals who are loquacious, cordial, self-assured and sociable. The general population who have low extroversion are considered as modest, careful, agreeable and calm. The examination of globalmanagement and identity qualities and discussion about the connection between individual attributes learning capacities, relational and behavioral capacities that are basic to finish a task. The writing about the capacities required for Global Management substantial learning and aptitudes and behavioural capacities for instance confidence, self-control and mindfulness that are important to finish an undertaking and to exploit the knowledge to complete task effectively and central individual attributes good faith, pleasantness, neuroticism, openness to involvement and extroversion that significantly affect confidence, self-direction and mindfulness and abilities and learning advancement of global mangers (McMillan, 2010). It is essential for global management to break down the three personality attributes that are identified with multifaceted practices, for example, Extroversion and Openness to Experience help in the effectiveness of the global management diverse communications. The key to the business achievement universally relies on the mix of identity attributes and global management abilities (Merna and Al-Thani, 2008). They prescribe that the worldwide abilities can be resolved through the four qualities of identity attributes: intellectual capacity, openness, self-esteem and emotional stability to involvement. Global administration capacities incorporate social affectability, social capacities, and stress dealing with capacity. Evaluation of the personality impacts on the global management capabilities Principal individual attributes scruples, pleasantness, neuroticism, openness to understanding and extroversion that significantly affect confidence, self-control, and mindfulness, organize aptitudes and behavioral capacities and tangible information improvement of worldwide troughs. The survey is created to assess the effect of identity qualities on the worldwide administration capacities of the confidence, self-control and mindfulness and substantial learning organizing abilities like; to build up your worldwide administration aptitudes (Naoum, 2011). What is your preference? Which are global management personality attributes seen to be steady in the accomplishment of objectives successfully? Do you think identity characteristics impact the confidence, Self-mindfulness, and self-controls of global mangers? Which strategies are seen to be best in building up each global management capacity Self-awareness, self-esteem and self-controls? What challenges do you believe are confronted by global management in accomplishing the organization objectives? Is there a positive effect of honesty on the global management capacities? Examine the Impact of agreeableness neuroticism openness to involvement and extroversion on the global management abilities? For an effective global manager, it is significance to have a worldwide mentality. Global managers ought to be able to comprehend and examinations the conditions confronted by the business internationally. Identity-characteristics openness to involvement and scruples are critical to adapt to the complexities and difficulties confronted in worldwide administration. The inter correlation of honesty, openness to involvement and extroversion are emphatically related with the global administration abilities confidence, self-direction and mindfulness and system aptitudes and substantial learning while the suitability, neuroticism, are contrarily identified with the global administration capacities (Olive, 2012). The need of the management is depicted as an important factor which is being used for showing the appropriate management of the work and also the increment of the business is largely made. The distribution of the appropriate skills is illustrated to be important for the management with considering the global perspectives. The need of the management is represented to be showing the appropriate enhancement of the goals which are depicted to be crucial for the global perspectives and also the effective global management is requisite for showing the enhancement of the structure (Powers and Needles, 2012). It also shows the appropriate management of the expressions which are conceptualized by showing the incorporation of the operations that are involved in showing the global emphasis. The growth of the knowledge and the training is very much crucial for the management of the skills which are essential for showing the appropriate assigning of the works and also the international managers a re conducted by showing the enhancement of the work force. The development of the awareness programs is included in the form of showing the internal skills executions which are involved in showing the awareness showing the understandings of the values and the image (Scott, 2015). This clearly explains the structure of the skills which is important for the establishment of the roles and the values that enables the establishment of the standards which is enabled in showing the appropriate work for the assumptions of the self-evaluation and also the enhancement of the work is being made by showing the stress related to the uncertain situations which are being made to cope with the focusing on the uncertain situations. The personality is being defined by showing the focus on the constant behavior models and also the internal states of the person which explains the tendency of the behaviors that are being made by showing the enhancement of the work. Thus the explanations which are provid ed are belonging to the consideration of the values and also the thoughts that show the enhancement of the shows and also the explanation of the study. The study also explains the enhancement of the values which are constructed by showing the internal behaviors and also the explanation of the values can be illustrated by showing the enhancement thoughts which are related to the study (Rao, 2010). This shows the appropriate explanation of the study and also the explanation of the stress related to the situations and also the uncertain situations and also the explanation of the study. Thus it also the explanation of the work is being made by showing the enhancement of the interactions and also the personality which is included in the part of behavior and also the explanation is being identified by showing the enhancement interaction of the person. Plan to determine the objectives To become a global manger, there is an extraordinary need for the reflection and identity examination of the administrative abilities and capacities of people in a global environment. When assembling a global administration, it is proposed to utilize the advancement arranging base on the individual qualities and global management capacities. Learning and improvement arrange in light of the examination as per the capacities. The survey of the identity attributes and global management abilities are important to become a global manger. It is key to perceive what the global managers are before breaking down the aptitudes and capacities fundamental enemy the viable global management. The global managers are the people that have a comprehension about the distinctive cross-societies of various nations and lead groups around the world (Spiceland, 2010). Global factors affect the individual administration aptitudes. Aptitudes and abilities of global management help to keep up competitive advantage and guarantee the accomplishment of an association in the dynamic and complex global market. Identity characteristics and global management capacities for turning into a global manager not have the fixation on the sort and size of the association however assessment of trough's learning, part, values, and business related capacities and experience are required. In general, the point of view was on identity qualities and global management capacities that reliability openness to involvement and was clearly the top of the line identity characteristic in turning into the global manger. Suitability was evaluated as second in the identity qualities to wind up noticeably a worldwide trough (Stein, 2010). Neuroticism has a negative critical effect on the worldwide administration abilities to wind up noticeably a global manger. At last, extroversion was a detached most loved identity characteristic to turning into a worldwide trough. The primary capacity of global management is to expand the viability and proficiency in the execution of authoritative exercises that leads and support to accomplish the objectives and targets of the association. The essential worry of Manager is to have the learning, aptitudes and behavioral capacity to break down the individual qualities to be a global manger. Another concern of the global management is to discover that all capacities confidence, mindfulness, self-direction, substantial learning, organize aptitudes and behavioral capacities are basic to be a global manger. In spite of the fact that these abilities are required by the local and also worldwide supervisors yet these capacities are critical for global management than local administration (Stice and Stice, 2014). Once the global management capacities are obviously characterized then the learning and improvement work decides the proper learning and advancement techniques. This incorporates a push to create mindfulness, self-control, confidence and learning and abilities to be a global manager. The determination of the plan is being made by showing the enhancement of the characteristics which is being made by showing the appropriate construction of the work and also the explanation of the work is being made by showing the global managers which is being made by showing the circumstances which is being faced by showing the experiences which are used to cope the objectives. Conclusion It is presumed that Global Management is a capacity of local or worldwide manager to empower, impact and rouse people to assume a part for the accomplishment of the objectives and targets of the organization. A Global management capacity is an aptitude, learning or capacity that empowers, impact and spurs people to contribute to the accomplishment of the objectives of organization across over limits (Weil, 2017). The examination of the reflection and individual management aptitudes show relationships of reliability, openness to understanding and extroversion are decidedly related with the worldwide administration abilities confidence, self-direction and mindfulness and system abilities and tangible learning. The suitability and neuroticism are contrarily identified with the Global management capacities. References Scott, W. (2015).Financial accounting theory. Toronto: Pearson. Spiceland, J. (2010).Intermediate accounting. Toronto, ON: McGraw-Hill Ryerson. Stein, G. (2010).Managing people and organizations. Bingley, UK: Emerald. Stice, J. and Stice, E. (2014).Intermediate accounting. Mason: South-Western/Cengage Learning. Thampi, S. (2014).Managing Trust in Cyberspace. Boca Raton: Chapman and Hall/CRC. Weil, R. (2017).Financial accounting. [Place of publication not identified]: Cengage Learning. Appannaiah, H., Reddy, P. and Putty, R. (2010).Financial accounting. Mumbai [India]: Himalaya Pub. House. Horngren, C. (2013).Financial accounting. Frenchs Forest, N.S.W.: Pearson Australia Group. Horngren, C. (2014).Accounting. Toronto: Pearson Canada. Kew, J. and Watson, A. (2012).Financial accounting. Cape Town: Oxford University Press. McMillan, E. (2010).Not-for-Profit Accounting, Tax, and Reporting Requirements, 2nd Edition. John Wiley Sons. Merna, T. and Al-Thani, F. (2008).Corporate risk management. Hoboken, NJ: Wiley. Naoum, S. (2011).People and organisational management in construction. London: Ice Publishing. Olive, C. (2012).Accounting Management. Delhi: University Publications. Oppermann, H. (2009).Accounting standards. Lansdowne: Juta. Powers, M. and Needles, B. (2012).Financial accounting. [Mason]: South-Western, Cengage Learning. Rao, P. (2010).Management and Organisational Behaviour. New Delhi: Himalaya Pub. House. Bhimani, A. and Dai, T. (2008).Management and cost accounting. Harlow: Prentice Hall/Financial Times. Britton, A. and Waterston, C. (2013).Financial accounting. Harlow: Financial Times Prentice Hall. Dauber, N. (2005).2006 Auditing standards. Canada: Thomson. Hall, A. (2007).Managing People. Maidenhead: McGraw-Hill International (UK) Ltd. Horngren, C. (2013).Accounting. Frenchs Forest, N.S.W.: Pearson Australia.

Biography of Bobby Seale, Black Panther Party Co-founder

Biography of Bobby Seale, Black Panther Party Co-founder Bobby Seale (born October 22, 1936) co-founded the Black Panther Party with Huey P. Newton. The organization, which was the most well-known group launched during the black power movement, stood out for its free breakfast program and emphasis on self-defense- a departure from the nonviolent philosophy advocated by civil rights activists. Fast Facts: Bobby Seale Known For: Co-founder, along with Huey P. Newton, of the Black Panther PartyBorn: October 22, 1936 in Dallas, TexasParents: George and Thelma SealeEducation: Merritt Community CollegeSpouse(s): Artie Seale, Leslie M. Johnson-SealeChildren: Malik Seale, Jaime SealeNotable Quote: â€Å"You dont fight racism with racism, the best way to fight racism is with solidarity. Early Life and Education Bobby Seale, the first child of George and Thelma Seale, was born on October 22, 1936. He grew up with a brother (Jon), a sister (Betty), and a first cousin (Alvin Turner- the son of his mother’s identical twin). In addition to Dallas, the family lived in other Texas cities, including San Antonio. Seales parents had a rocky relationship, separating and reconciling repeatedly. The family struggled financially and sometimes rented out parts of their home to other families to earn additional income. Seales father, George, was a carpenter who once built a home from the ground up. He was also physically abusive; Bobby Seale later described being whipped with a belt by his father at age 6. When the family moved to California, George Seale struggled to get carpentry work or join a union, as unions often excluded African Americans during the Jim Crow era. When George Seale did manage to enter a union, he was one of just of three black men in the state with union membership, according to Seale. As a teenager, Seale hauled groceries and mowed lawns to earn extra cash. He attended Berkeley High School but dropped out to sign up for the US Air Force in 1955. After a conflict with a commanding officer, Seale was dishonorably discharged. However, this setback did not deter him. He earned his high school diploma and made a living as a sheet metal mechanic for aerospace companies. He also worked as a comedian. In 1960, Seale enrolled in Merritt College, where he joined a black student group and his political consciousness took hold. Two years later, he met Huey P. Newton, the man with whom he would start the Black Panthers. Founding the Black Panther Party At a 1962 demonstration against the Kennedy Administrations naval blockade of Cuba, Seale befriended Huey Newton. Both men found inspiration in black radical Malcolm X and were devastated when he was assassinated in 1965. The next year, they decided to form a group to reflect their political beliefs, and the Black Panthers were born. The organization reflected Malcolm X’s philosophy of self-defense by any means necessary. The idea of armed African Americans proved controversial in the broader United States, but as the civil rights movement waned following the assassination of the Rev. Martin Luther King Jr., many young black Americans leaned towards radicalism and militancy. The Black Panthers were particularly concerned about racism in the Oakland Police Department, but before long, Panthers chapters sprang up nationwide. The Black Panther Party became most well known for their 10-point plan and free breakfast program. The 10-point plan included culturally-relevant teaching, employment, shelter, and exemption from military service for African Americans. Legal Battles In 1968, Bobby Seale and seven other protesters were charged with conspiring to incite a riot at the Democratic National Convention in Chicago. When the trial date arrived, Seales lawyer was ill and unable to appear; the judge denied the request to delay the trial. Seale claimed the right to defend himself in order to advocate for his own constitutional rights, but the judge did not allow him to give an opening statement, cross-examine witnesses, or speak to the jury. Seale contended that the judge had denied him his right to counsel, and he began to speak out in protest during the proceedings. In response, the judge ordered him bound and gagged. Seale was chained (later strapped) to a chair, with his mouth and jaw strapped shut, for several days of the trial. Ultimately, the judge sentenced Seale to four years in prison for contempt of court. That sentence was later overturned, but it did not mark the end of Seale’s legal troubles. In 1970, Seale and another defendant were tried for killing a Black Panther believed to be a police informant. The hung jury resulted in a mistrial, so Seale was not convicted of the 1969 murder. As his court battles unfolded, Seale wrote a book tracing the history of the Black Panthers. The book, published in 1970, was titled Seize the Time: The Story of the Black Panther Party and Huey P. Newton. But the time Seale spent behind bars awaiting the outcomes of various court cases had taken a toll on the group, which began to fall apart in his absence. The settling of the court cases saw Seale take charge of the Panthers again. In 1973, he changed focus by putting his bid in to become the mayor of Oakland. He placed second in the race. He left the Panthers the following year. In 1978, he wrote his autobiography, A Lonely Rage. Later Years In the 1970s, the black power movement subsided, and groups like the Black Panthers ceased to exist. Deaths, prison sentences, and internal conflicts spurred by initiatives like the FBI’s Counterintelligence Program played a role in the unraveling process. Bobby Seale remains politically active, giving talks on his life and activism at college campuses and other venues. More than 50 years after the Black Panthers formed, the group continues to influence politics, pop culture, and activism. Sources â€Å"Bobby Seale.† PBS.org.Bennett, Kitty. Bobby Seale: Black Panther leader was one of the Chicago Eight. AARP Bulletin, 27 August, 2010.Glass, Andrew. Kennedy imposes naval blockade of Cuba, Oct. 22, 1962. Politico, 22 October, 2009.Seale, Bobby. â€Å"Seize the Time: The Story of the Black Panther Party.† 1970.

Trouble Sleeping Learn How Long Caffeine Stays in Your System

Trouble Sleeping Learn How Long Caffeine Stays in Your System SAT / ACT Prep Online Guides and Tips How long does caffeine stay in your system? What is the half-life of caffeine? How does caffeine half-life differ between individuals? In this quick guide, we'll go over how long caffeine stays in the average person's body, what factors impact how long you'll feel the effects of caffeine, and what you can do to combat the caffeine jitters. Ultimately, we'll help you answer the key question: how long does caffeine stay in your body? How Long Does Caffeine Stay in Your Body? The Average Person Caffeine is absorbed by the membranes of your body incredibly quickly. Once you take in caffeine, you'll feel its full effects within 15-45 minutes. After that, your liver will start breaking down the caffeine into caffeine metabolites, which you will eventually excrete in urine. In the average adult, the half-life of caffeine is about 5-6 hours. This means that once take a dose of caffeine, you'll break down about half of that caffeine after 5-6 hours. So if you take in 200 mg of caffeine at 9 am, you'll still have about 100 mg left in your body between 2 and 3 pm. How Long Does Caffeine Affect You Specifically? So now you know that the average person experiences a caffeine half-life of about 5-6 hours. But how long after drinking that cup of coffee or downing that Mountain Dew will you still be feeling a buzz? How long does caffeine stay in your body in particular? That depends on a few factors. Your Unique Metabolism Caffeine is processed and broken down by a set of enzymes in the liver. How much of that enzyme you produce is determined by genetics. This means that some people metabolize (or break down) caffeine extra-slowly, and some people break it down so quickly they barely feel the stimulating effects of caffeine. The only way to really know how you metabolize caffeine is to have some and see what happens. If you are hypersensitive to caffeine, even small doses (think half a cup of coffee) may give you the "coffee jitters"- which can include feelings of anxiety, restlessness, nausea, diarrhea, heart palpitations, and general discomfort. If you are hyposensitive, you won't feel much of a stimulating effect from caffeine at a normal dose, even if you've never had it before. Note also that pregnant women metabolize caffeine much more slowly, with an average caffeine half-life of up to eight hours. Size of Caffeine Dose Whatever caffeine half-life you have, the size of the dose you take will make a big difference in how long you still feel the impact of caffeine. If you drink one espresso shot (which has about 50-65 mg of caffeine) and your personal caffeine half-life is about five hours, you'll have a pretty negligible amount of caffeine in your system ten hours after ingestion. However, if you drink four eight-oz. cups of coffee in a row, taking in about 400 mg of caffeine, you'll still have 100 mg of caffeine in your system after 10 hours- enough to keep you pretty buzzed. Any amount of caffeine in your system about 50 mg may be enough for you to still feel some effects. (Or even less if you're hypersensitive!) Note too that different products have different caffeine dosages. Coffee has more caffeine than black tea, which has more caffeine than green tea. Additionally, not all coffee brewing methods make equally strong coffee. For example, drip coffee has more caffeine than instant coffee. Even coffee from the same shop may have different caffeine content on different days! Your Caffeine Tolerance The more often you consume caffeine, the more tolerant you become to its effects. Regular coffee drinkers need to drink more and more coffee over time to get the same stimulating effects from caffeine that they did initially. If you're a new coffee drinker, expect to feel the impact of caffeine much more strongly than if you're a coffee veteran. (If you are a big coffee drinker, keep in mind that super-high caffeine doses are toxic. Try to moderate your intake so that you aren't constantly taking bigger and bigger doses.) Other Drugs You Take Other substances that you take into your body can impact how you metabolize caffeine and change the half-life of caffeine in your own body. For example, hormonal birth control can slow down how quickly you process caffeine, making you more sensitive to its effects. By contrast, regular smokers have a caffeine half-life of about three hours, making them less sensitive to the effects of caffeine. Other drugs can also impact how you process caffeine, so look up how caffeine interacts with any prescription drugs or other substances you are taking. Can You Speed Up the Half-Life of Caffeine? Feeling the caffeine jitters? Are you anxious, panicked, or nauseated? Can you speed up your body's processing of caffeine to make yourself feel better? In short, not really. There's not actually a reliable way to speed up the processing of caffeine in your liver in the short-term. However, here are some things you can do to help you feel better while you process the caffeine: Drink Water Drinking water won't "flush" your system of caffeine, in spite of the commonsense wisdom. However, caffeine is a diuretic, which means that it can cause dehydration. Drinking plenty of water will help minimize dehydration and help alleviate some of the symptomatic effects of the caffeine jitters. Eat Food Caffeine can suppress your appetite, so you may feel the impacts of low blood sugar, including nausea and headache, if you don't make a conscious effort to eat. Taking your caffeine with a meal will also slow down your processing of caffeine, which will make you less likely to have the jitters. Exercise While exercise won't make you metabolize caffeine any faster, it will help you to burn off some of the extra energy caused by caffeine's adrenaline release. This may help you feel better. Bottom Line: How Long Does Caffeine Stay in Your System? How long does caffeine stay in the body? Well, the average person will experience the half-life of caffeine at about 5-6 hours. But how long does caffeine stay in the body such that you still feel its effects? This depends on a few factors: Your unique metabolism: genetics plays a role in how fast your liver can metabolize caffeine. Size of caffeine dose: A larger dose will impact your body for longer. The average person will feel some impact of caffeine at about 50 mg or above. Your caffeine tolerance: The more often you take in caffeine, the less you'll feel its effects. Other drugs you take: Other substances you take can speed up or slow down your caffeine metabolizing processes. There's no way to actually process caffeine any faster in the short-term. But if you've had too much and you're uncomfortable, these things might help you feel better: Drink water: Caffeine can dehydrate you, so water will make you feel better. Eat food: Caffeine can suppress your appetite, so be sure to eat! Exercise: Exercise can help you burn off some of the excess energy caused by taking caffeine.

Revelation by Flannery O'Connor Essay Example | Topics and Well Written Essays - 1000 words

Revelation by Flannery O'Connor - Essay Example Through her interactions with other characters in the room, the real character of Mrs. Turpin is well brought out, and consequently, the central theme of the story is advanced. Mrs. Turpin is a self-opinionated woman who believes to be superior and of a higher social class. The experiences of life cause her to reflect on her life, and correct the errors of the past, and finally realize that she isn’t as righteous as initially thought. While at the doctor’s office, the attitudes and characteristics of Mrs. Turpin are clearly brought out. First, Turpin is portrayed to be a judgmental individual with a negative perception of others. For example, while at the waiting room, she looked at the boy and the old woman and â€Å"could tell by the way they sat- kind of vacant and white-trashy, as if they would sit there until Doomsday†. Through such thoughts, it is clear that Turpin never thought positively of those around them but instead was quick to pick out the real or perceived negativities about them. Her hate for others is further illustrated by her choice of either being white or black. If she had been given a choice by Jesus of either being a nigger or a white trash, she would have chosen â€Å"a nigger then-but that don't mean a trashy one†. Here, one can clearly see that she disliked white people to the extreme. She is intolerable and looks down upon everyone around her. Second, the story furth er reveals Turpin to be an egoistic woman with an extreme worldview. She perceives herself to be a very important person, belonging to an elite class of only a few. For instance, she spent most of her time at night putting people into various categories. The colored and the white-trash people were ranked lowly. She felt that she wouldn’t want to be in this category. However, for her and the husband, they belonged to a higher class of â€Å"the home-and-land owners†.

STD Education Campaign Case Study Example | Topics and Well Written Essays - 250 words

STD Education Campaign - Case Study Example 4. Public education: The campaign should be able to teach the students how transmission of STDs occurs and the potential preventive measures. The campaign should also teach the students the importance of knowing ones HIV status. Hygiene should also be part of the teaching during sexual activities (Aral, Fenton, & Lipshutz, 2013). 5. Promoting openness: Most of the people that have contracted STDs feel shy to seek doctors’ help. The campaign team should make the students understand that keeping STD as a secret is risky to an individual’s life. They should be encouraged to seek a doctor’s help as soon as they realize some of the symptoms. By doing that cure would be easier than waiting for the disease to worsen. 6. STD patients care: During the campaign‚, the students should accomplish services such as STD, HIV and pregnancy test. The campaign team should advance health care to STD, HIV and Pregnant patients. Moreover, the team should provide the patients with medicine to fasten the healing process and preventive process. 7. Motivating the students; Notably, students would always appreciate and remain motivated when given gifts. For a student, issuance of a participation certificate could be the most precious thing in the campaign. The certificate would assist them remember the teachings about STD and act as a professional

Strategic Planning, Mintzberg

Strategic Planning, Mintzberg Roll of strategic planning and implementation Introduction According to Mintzberg et al (2003, p.10) ‘A strategy is the pattern or plan that integrates an organisations major goals, policies, and action sequences into a cohesive whole. A well formulated strategy helps to marshal and allocate an organisations resources into a unique and viable posture based on its relative internal competencies and shortcomings, anticipated changes in the environment, and contingent moves by intelligent opponents. Likewise Haberburg and Rieple (2008, p.6) defined strategy as ‘ a strategy is the set of actions through which an organisation , by accident or design, develops resources and uses them to deliver services or products in a way which its users find valuable, while meeting the financial and other objectives and constraints imposed by key stakeholders. In contrast White (2004, p.5) defined strategy as ‘a coordinated series of actions which involve the deployment of resources to which one has access for the achievement of a given purpose. Furthermore strategy ‘is a process of translating perceived opportunity into successful outcomes, by means of purposive action sustained over a significant period of time. Lynch (2000, p.8) defined corporate strategy as ‘ it is the pattern of major objectives, purposes or goals and essential policies or plans for achieving those goals, stated in such a way as to define what business the company is in or is to be in and the kind of company it is or is to be. Morden (2007, p.14) revealed, Strategic Management is concerned with the character and direction of the enterprise as a whole. It is concerned with basic decisions about what the enterprise is now, and what it is to be in the future. It determines the purpose of the enterprise. It provide the framework for decisions about people, leadership, customers or clients , risk, finance, resources, products, systems, technologies, location, competition, and time. It determines what enterprise should be capable of achieving, and what it will not choose to do. It will determine whether and how the organisation will add value, and what form that added value should take. Strategic management is also concerned with management planning and decision making for the decision making for the medium and long-term future. It is considered with the anticipation of that future and with the establishment of a vision or view of how the enterprise should develop into the future that it must face. Strategic Planning According to Marios I.Katsioloudes (2006) â€Å"Strategic planning is the process by which a system maintains its competitiveness within its work environment by determining where the organization is, where it wants to go, and how it wishes to get there. In other words, strategic planning involves examining what strategies will enable to corporation or association to prosper in future† Strategic planning is a process where you determine the strengths and weakness of your business. You also can set your companys goals, objective and mission statement during this process. We can say this that strategic planning is a management tool for organizing. Its also lead an organizing from where is now to future. A good definition is strategic planning is â€Å"the process of determining a companys long-term goals and than indentifying the best approach for achieving those goals.† Without a strategic planning an organization will never know where it going. Importance Strategic planning is a very important for an organization. And its help to achieve An organizations goals and its also helps to provide direction and focus for all employees. It points to specific results that are to be achieved and establishes a course of action for achieving them. A strategic plan also helps the various work units within an organization to align themselves with common goals. Strategic planning Process In the earlier 1970s, various large firms adopted an official top-down strategic planning model. With this model, strategic planning became a planned process in which top executives from time to time would prepare the firms strategy, and then communicate it down the organization for implementation. The following strategic planning process model discuses below. Mission | V Objectives | V Situation Analysis | V Strategy Formulation | V Implementation | V Control This process is most appropriate for strategic management at the business unit level in organization. For large corporations, strategy at the corporate level is more concerned with managing a selection of businesses. In the process outlined here, company or firm will be used to signify a single-business firm or a single business unit of a diversified firm. Mission A mission is important key factor of any organization. The mission often expressed in the form of a mission statement of any organization, which conveys a sense of purpose to employees and projects a company image to customers. In the strategy formulation process, the mission statement sets the mood of where the company should go. Objectives Objectives are actual goals that the organization will achieve, for example, an earnings growth target. The objectives should be challenging but achievable. They also should be considerable so that the company can monitor its progress and make corrections as needed. Situation Analysis Once the firm has specified its objectives, it starts with its current situation to set up a strategic plan to fulfil those objectives. Changes in the external environment and make new opportunities and new ways to achieve their objectives. An environmental scan is performing to find out the available opportunities. The situation analysis therefore involves an analysis of both the external and internal environment. The external environment has two dimensions: the macro-environment affects all firms and a micro-environment that affects only the firms in a particular industry. The macro-environmental analysis includes political, economic, social, and technological factors and sometimes is called PEST analysis. An important part of the micro-environmental analysis is the industry in which the firm operates or is considering operating. Michael Porter devised a five forces framework that is useful for industry analysis. We also can use SWOT Model to Analysis Companys internal and external situation. Strength and weakness use for internal analysis and opportunity and threats use for external analysis of any organisations as show in the diagram below. Strategy Formulation Once we get a clear image of the organization and its environment in hands, exact strategic alternatives can be applied. Infect different firms has different alternatives depending on their situation, there also exist generic strategies that can be applied across a wide range of firms. Control Once we applied the strategy, the results of the strategy need to be calculated and evaluated, with changes need to be required to keep the idea on path. Strategy implementation De Wit and Meyer (2005, p.278) revealed, the implementation of the strategy comprises a series of sub activities that are primarily administrative. If purpose is determined then the resources of a company can be mobilized to accomplish it. An organisational structure appropriate for the efficient performance of the required tasks must be made effective by information systems and relationships permitting coordination of subdivided activities. Furthermore the role of personal leadership is important and sometimes decisive in the accomplishment of strategy. Although we know that organisational structure and processes of compensation, incentives, control and management development influence and constraint the formulation of strategy, we should look first at the logical proposition that structure should follow strategy on order to cope later with the organisational reality that strategy also follows structure. When we have examined both tendencies, we will understand and to some extent be prepared to deal with the interdependence of the formulation and implementation of corporate purpose. According to Henry (2008, p.10) ‘effective implementations of strategies require the organisation to be sufficiently flexible in its organisational culture and design. Strategies need to be communicated, understood, and properly coordinated with the stakeholders inside and outside the organisation. In an age of collaboration, this may involve discussions with suppliers and partners. Although the leader of the organisation will ultimately be responsible for a strategys success or failure, their role should be to encourage and create an organisational culture which empowers managers to respond to opportunities. In this way each employee will be confident to try out new ideas and innovate without fear of reprisals. White (2004, p.618), the implementation of a successful strategy is to focus on the five Cs as the basic requirement needed to keep the separate units in any organisation to achieve the objectives of strategy. The five Cs are: Coordination, Communication, Command, Control and Conflict/consensus. Coordination: There should be coordination at every step of strategy making, certainly in the process of formulation and implementation between the stakeholders, different cooperating enterprises and organisational levels, and between different internal units within the enterprise itself. Communication: Coordination is only possible with the help of proper communication of information concerning objectives and threats, capabilities and threats, risks and threats. The accurate information must be communicated. Command: â€Å"It is passed downward, reflecting the hierarchy of authority which characterizes every organisation. It should be rarely given and only when absolutely necessary, in crises or to resolve a particular conflict. It is held in reserve for when is needed. Everyone should be aware of possibility of command but it does not have to be used. There are some occasions when decisive action is necessary, but most the time staff should be aware of what they need to do without being prompted. Control: It is often exercised indirectly and discretely, through incentive structures and globalization of a corporate culture. There are direct control systems in certain areas such as finance. It is better that all become committed to following the broad directions of the strategy without explicit instructions. The outlines of strategy provide the guidelines are internalized and do not require endless repetition. Each decision maker has their own domain or is of control, all well understood, and obtains from intervention on other domains unless invited or if there is a crisis. Conflict / Consensus: Honest disagreements are certain in any organisation. It is a vital aspect of any creative activity, since creative thinking means thinking outside the normal boundaries. If a new idea is to change behaviour, it needs to be argued out in the forum of enterprise where there will inevitably by those who cannot agree. Any proposal for change for change almost always invites conflict of kind, hostility from those opposed to a new way of thinking or to change.† Strategic Management Process Thompson and Strickland (2003, p.6) defined term strategic management â€Å"it refers to the managerial process of forming a strategic vision, setting objectives, crafting a strategy, implementation and executing the strategy, and then over time initiating whatever corrective adjustment in the vision, objectives, strategy, and execution are deemed appropriate. Strategic Vision: A strategic vision of a company reflects managements aspirations for the organisation and its business, providing a panoramic view of ‘what we are doing and giving specifics about its future business plans and giving specifics about its future business plans. It brings out long-term business purpose and shape the organisational identity. A strategic vision helps an organisation in a particular direction and in a strategic path for it to follow. Setting Objectives: ‘The purpose of setting objectives is to convert managerial statements of strategic vision and business mission into specific performance targets, i.e. results and outcomes the organisation wants to achieve. Crafting a Strategy: Strategy making brings into the critical managerial issue of how to achieve the targeted results in light of the organisations situation and prospects. Objectives are ends and the strategy is the means of achieving them. Implementing and Executing the strategy: Strategy implementation concerns the managerial exercise of putting a freshly chosen strategy into place. Likewise ‘strategy execution deals with the managerial exercise of supervising the ongoing pursuit of strategy, making it work, improving the competence with which it is executed, and showing measurable progress in achieving the target results.† Case: British Airways Airline industries and carriers are facing very hard time, because recession has affected the business and the industries have to reduce their prices and are not making well profit as compared to the past. As it is a worldwide fast growing industry making airlines more complex and challenging. Because of recession and increased number of unemployments in airline industries. British Airways is the UKs largest international airline, flying to 6 domestic destinations over 148 international destinations at multiple times, to the all best located airports. The major place of business is Heathrow, one of the worlds premier airport locations. BA also operates a worldwide air cargo business. But still British Airways had to restructured and make some serious strategic changes to avoid the bankruptcy or the closure. BA had his vision to achieve their goal and took effective and reasonable steps to compete in the market with its performance and operation under the last couple of years. Market fell from more than 30 per cent in 1998 to about 20 per cent in 2005. This year, BA announced the worst half-year losses in its history. During the six months to September 2009, the company face a  £292m ($485m) loss, compared with  £52m profits during the same period a year earlier. In order to survive and to make an easy recovery in this competitive environment and to attain a leadership in the industry BA has taken strong steps to upgrade the systems and technology, In order to increased the fleet size British Airways ordered 36 new long haul Aircraft on 27th September 2007 which includes 12 A380s,and 24 Boeing 787s. British Airways also ordered on 1st February 2008 Airbus A318s to run a premium services out from London City Airport to New York. This fitted luxury 32 lie flat beds in business class cabin. The increase in technology like online ticketing, online checking also enhances the BA business. Because customer has no need to stand in queue. Innovative flight service such as sleeper service will attract more customers. Introduction of the terminal 5 on the HEATHROW AIRPORT will help increasing of the flig hts of the BA and able to provide more relaxed environment to its customers. Possible merger of the BRITISH AIRWAYS and QANTAS AIRLINE could be the great opportunity to become absolute market leader of the world. Willie Walsh stated that British Airways had reduced 1,450 staff members since March 2009. They also reduced the overtime and 500 redundancies were made. Twenty percent of future capital expenditure is reduced this year from 725 million pounds to 580 million pounds and it will be the same through out this year. Mr. Willie Walsh also admitted that this structural change of British Airways is necessary for survival and long term success. British Airways managed with its comprehensive and proactive strategy to accelerate its return to profitability and economic welfare well in advance of its rivals. The airline announced that it is planning to raise  £680 million of liquidity through a  £350 million convertible bond issue and by gaining access to bank facilities which are currently used to provide guarantees to its pension funds. This will increase liquidity to approximately  £2 billion. Conclusion A successful and well-organized strategic plan can recognize the organisations strength, and related weaknesses, determining the new opportunity and with useful action resolve the problems. These can be either from the capabilities and expertise of an organisation or from the actual market demand. Successful strategy plan is when there is a continues perfection and effective use of time and resources. The role of manager is very important to make organisation profit-making or non- profit making with taking right decisions. He should think strategically rather than operationally. The main factor of strategic planning is that how the information gained, implement and used. References Mintzberg, H., Lampel, L., Quinn, J. Ghoshal, S. (2003) The Strategic Process, 4th edition, Prentice Hall publishing, New Jersey. White, C. 2004, Strategic Management, 1st edition, Palgrave Macmillan, New York Lynch, R., 2000, Corporate Strategy, 2nd edition, Prentice Hall, Harlow Morden, T. 2007, Principles of Strategic Management, 3rd edition, Ashgate Publishing, Aldershot. Haberberg, A. Rieple, A. 2008, Strategic Management: theory and application, 1st edition, Oxford University Press, New York. De Wit, B. Meyer, R. 2005, Strategic Synthesis: Resolving strategy paradox to create competitive advantage, 2nd edition, Thompson, London. Henry, A. 2008, Understanding Strategic Management, 1st edition, Oxford University Press, New York. Thompson, A., Strickland A.J., 2003, Strategic Management: concepts and cases, 13th edition, McGraw-Hill, New York. Marios I.Katsioloudes Ph. D, (2006) Strategic Management, Global Cultural perspectives for profit and non-profit organisation, p 2, 6 Lynch, R., 2003, Corporate Strategy, 3rd edition, Prentice Hall, Harlow URL Source: www.investorwords.com/4774/strategic_planning.html Date of Access: 25th February 2010 URL Source: http://www.onlinebusadv.com/index.php?PAGE=14 Date of Access: 25th February 2010 URL Source: http://www.netmba.com/strategy/process/ Date of Access: 25th February 2010 URL Source: http://hrmadvice.com/assets/images/swotanalysis.jpg Date of Access: 25th February 2010 URL Source: http://www.britishairways.com/travel/about-british-airways/public/en_gb Date of Access 25th February 2010

Alcohol And Brine Shrimps

Abstract Alcohol catches the interest of many scientists because of its different effects on human, especially during pregnancy. These effects can also be seen in lower forms of organisms, such as that of the crustacean brine shrimp. By studying these, the scientists can get a better understanding on the mechanisms underlying the alcohol’s effects. When other conditions are held constant, a very high amount of alcohol should inhibit the growth or hatching of these brine shrimp eggs.By growing brine shrimp eggs exposed to different concentrations of alcohol and observing the larvae afterwards, the effects of alcohol on these organisms can be revealed in a quantified manner. To do so, volumes of 0. 0 mL. 0. 1 mL, 0. 25 mL and 0. 5 mL of a 100% alcohol were placed in different Petri dishes containing 10 mL of brine solution each. Brine shrimp eggs were then placed and left for a week before the eggs and larvae were obtained and counted. Results show that there are more eggs hatch ed on the system with no alcohol in it.Though the plate with higher alcohol content showed a relatively large number of hatched eggs, it has a higher amount of dead larvae compared to the dishes having lower alcohol content. This shows that alcohol works in two ways, preventing the hatching of brine shrimp eggs and causing deaths to the larvae. I. Introduction Brine shrimps (Artemia) are small crustaceans, and not closely related to the common shrimp. They are usually termed as â€Å"sea-monkeys† and sold in pet stores as fish food.They are very resistant in adverse conditions, and their eggs are able to stay dormant until the right environment induces their birth. Many of these are seen in large bodies of water, for they serve as food for the larger fish and other organisms present in the ecosystem. One interesting fact of these crustaceans is the ability of their eggs to undergo cryptobiosis, a characteristic where they exhibit a â€Å"hidden life† by maintaining a m etabolically inactive state. This happens during adverse conditions that inhibit the growth of the organism.In this case, brine shrimp eggs stay dormant as long as there are large fluctuations in the environment caused by factors such as temperature, oxygen content, and acidity. Because of this, brine shrimps are excellent to be test subjects for this experiment regarding the effects of alcohol on early development. Brine shrimp eggs can also hatch at a short span of time, and grow into larvae capable of swimming by themselves in just a matter of days. Furthermore, there are no known ethical issues regarding the use of these organisms. In fact, a number of studies using this genus have been performed throughout history.One of these is the research of Antonio Marquez’s group, where they tested the effects of bacteria on Artemia franciscana. They cultivated the organism in 10 different strains of bacteria together with some major feeds. The treatment resulted to the Artemis sur vivors having a longer length. The bacteria added played an important role in providing direct feed for the Artemia. They provided essential proteins, vitamins, amino acids, and inorganic nutrients (Marques, 2005). These results can be taken into consideration when designing this experiment.Since the experiment aims to determine the effects of alcohol only, the medium on which the brine shrimp are to be grown must be free of other substances, especially bacteria that might contribute additional nutrients for the organism to grow. The experiment by Marquez also shows the versatility of these brine shrimps in data gathering experiments done on the lab. They are easy to cultivate and grow. Another research, which can complement the purpose of this experiment, is the one tackling about the toxicity of the chemical diisopropyl fluorophosphate (DFP) when exposed to Aremtia salina The group of S.Sanchez-Fortun and M. V. Barahona found out that on high concentrations of DFP, a longer develo pment time is evident on Artemia larvae. A more concentrated solution even showed death on some of the larvae. Several treatments were tested, including addition of the compounds atropine, physostigmine pyridostignime. But only the compound 2-pyridine aldoxime methoiodide (2-PAM) proved to be effective in preventing intoxication due to DFP (Sanchez-Fortum, 2007). These results show the lethal effects of some chemicals to the larvae of some organisms.Aside from DFP, alcohol is another substance that is believed to have bad effects on organisms during their pre-birth stage. In higher animals, such as humans, alcohol is usually blamed for miscarriages, prematurity, and many other defects on birth. This alarming substance caught the attention of many, and efforts have been made to make the public aware of the dangers posed by alcohol. Such effects of alcohol are made notice by Brimacombre and his team. Sometime before the year 2007 ended, they conducted a study to asses the knowledge of health professionals regarding fetal alcohol spectrum disorders or FASD.They conducted several presentations, lectures and demos to health professionals across New Jersey over a four-month period. The groups were then asked to answer a series of 20 questions to determine the depth of their understanding regarding FASD. The results showed that though they are well versed with the basics of FASD, these health group professionals reveal weaknesses in some important areas. One of these is the lack of knowledge on some core diagnosis and treatment of FASD. It was then concluded that more efforts must be done to further increase the awareness of the public to the facts of alcoholism (Brimacombe, 2008).If alcohol has a severe effect on humans, then it is safe to assume that it would also have a devastating impact on lower creatures such as the brine shrimps. This experiment is designed to illustrate the possible threats of varying concentration of alcohol to Artemia. The alcohol’s effects will be determined by adding varying amounts of it to the culture of unhatched brine shrimp eggs. The eggs and possible young hatchlings from the different treatments will then be manually counted and compared with each other.Taking into consideration prior knowledge and previous studies made, high alcohol content would not be optimum for the brine shrimps to live. The treatment containing the most alcohol would then probably have less or no brine shrimp larvae present compared to those cultures with little or no alcohol in it. II. Methodology Prior to the experiment, the solutions and equipments to be used were prepared. Four Petri dishes, brine solution, 100% alcohol, some toothpicks and a brine shrimp egg solution were placed close by for easy access.The Petri dishes were then marked with numbers â€Å"1†, â€Å"2†, â€Å"3† and â€Å"4†. A volume of 10 mL of brine solution was then added to each Petri dish. In the Petri dish labeled â€Å"1â € , 0. 1 mL of alcohol was added and mixed. In the same manner, 0. 25 mL of alcohol was added to Petri dish â€Å"2† and 0. 5 mL of it to Petri dish â€Å"3†. No alcohol was added to Petri dish â€Å"4†, as this is be used as the control system. A clean toothpick was then taken, wetting it by dipping it in a brine solution first, and then in the container with brine shrimp eggs.The eggs were then transferred to Petri dish â€Å"1† by slowly stirring the toothpick in the brine solution contained in the Petri dish until all eggs are dislodged from the toothpick. A new toothpick is then used to transfer eggs in the same manner to Petri dishes â€Å"2†, â€Å"3† and â€Å"4†, using a fresh toothpick for each Petri dish. The eggs were allowed to sit for a week and then they were observed. The eggs and larvae were counted using a toothpick and viewed with a microscope. The data were then recorded and compared.

Electronic Medical Records

Electronic Medical Records Essay Cynthia Jones Grand Canyon University: HCA 450 November 11, 2012 Electronic Medical Records Essay Medical record keeping has change in the last couple of decades. In the past patients records were kept in a file on paper taking up excessive room. In the past, paper charts were the only means of keeping a patient’s medical diagnoses documented. Some of these charts are still used today in healthcare facilities, however they are slowly being replaced with a more advance method; electronic medical records (EMR’s).This virtual data–information center can serve as a vehicle to promote and to disseminate standardized data definitions and best practices to providers, consumers, and others interested in quality improvement efforts nationally and internationally (Varkey, 2010). The Electronic Medical Records is an advance computerizes medical record system that delivers medical data for physician’s office and hospitals within a matt er of seconds while offering care. This system allows the healthcare staff and physicians to modified, store and retrieves patient’s medical records.Electronic medical records are legible and organized. The Electronic Medical Record (EMR) has been around since the late 1960‘s, when Larry Weed introduced the concept of the Problem Oriented Medical Record into medical practice (NASBHC, 2012). Weeds innovation introduces the concept of the Problem Oriented Medical Record into the medical practice, which verifies the diagnosis (NASBHC, 2012). However, it wasn’t until 1972 when the Regenstreif Institute developed the first medical records system. Although it was a great invention, physicians didn’t seek to use it right away.This new system would help physicians improve patients care. Although, $19 billion in stimulus funds have been invested into the Electronic health record (EHRs) another name for EMRs; the Obama administration highly suggested that health car e and hospitals facilities start to digitize patient data and start making better use of the advance technology(Greenemeier, 2010). The health care industry has been slow to adapt to this new system. Although the EMR system is intended to make patients records more accessible for the physicians and staff, still many have not implemented it yet.Given the lack of EMR adoption throughout the health care industry, less than 10 percent of U. S. hospitals have adopted electronic medical records. Cost is the primary reason many have resisted or are unwilling to adopt the EMR system and shortage on staff as well. In a recent interview on November 9, Jessica in human resource at Vineville Internal Medicine, with Dr. Mary Bell Vaughn presiding as the physician over the practice. The practice has been using electronic medical records systems since the practice open in 2002. Dr.Vaughn thought patients and staff needed easy access to their records when needed. Some of her other reasons are as fo llow: †¢ Paperless, Less storage †¢ No physician running around ( Patient info available at finger tips) †¢ Saves time spent with patient †¢ Good for tracking information †¢ Financial Good This system is web based and uses an E-Clinical program through a portal. This system also allows prescriptions to be sent to the local pharmacy as well. Blood work results are also put into the patients charts as well.Recently, the practice took on new patients with paper charts, because their physician retired. In this cause their most recent charts were converted over to EMRs. However those paper charts still exist in a small storage area if further information is needed on the patient. Though the practice implements the EMRs system from the very beginning, the physician and staff are very happy with the system. Most patient information is put into the system via computer on the spot while the patient is telling the nurse or physician what is ailing them.Although there system is a web based system, it has two backup systems in two different locations just in case the systems go down or power outage. The EMR system has had great quality impact on the practice. The patients care has been improve by the system. It allows the physician to track and effectively treat the patient. In some cases if the patient is located at another healthcare facility this system allows them to send information to multiply people for care, no matter where they are. Dr.Vaughn’s practice is already looking into the future to implement sending out text message to patients to inform them of appointments. Patients have access to their care anytime. EMR adoption is slow to be implemented into some practices. Although there is some disapproval of the electronic medical records today, it is merely a digitized version of paper chart. This system will reduce medical errors and help put information in front of researchers This new form of technology is here to stay and the s ooner healthcare facilities start using it the more efficient results they will receive.References Prathibha Varkey (2010). Medical Quality Management, Sudbury, Massachusetts: Jones and Bartlett Publishers. History of the Electronic Medical Record system (2012) Retrieved November 8, 2012 www. nasbhc. org Will Electronic Medical Records Improve Health Care? (2009) Retrieved November 8 2012 http://www. scientificamerican. com/article. cfm? id=electronic-health-records Electronic Medical Records Engineering Management Field Project Electronic Medical Records: A Case Study to Improve Patient Safety at Royal Victoria Teaching Hospital By Annie Bittaye Spring Semester, 2009 An EMGT Field Project report submitted to the Engineering Management Program and the Faculty of the Graduate School of The University ofK. ansas in partial fulfillment of the requirements for the degree of Master's of Science )= †¢ , , Tom Bowlin Cotntnittee Member ‘~k Committee Member Date accepted: _ _&-4–_':'†/~,,,,,,†1_-. -Q:;,,.. r5c—-_ _ Table of ContentsTable of Contents †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 2 List of Figures †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 3 List of Tables †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3 Acknowledgments†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ Executive Summary †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 5 1. 1. 1. 2. 3. 3. 1. 3. 2. 3. 3. 3. 4. 4. 4. 1. 4. 2. 5. 6. 7. Introduction†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 Background of Royal Victoria Teaching Hospital †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 Literature Review †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 Procedure and Methodology †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 17 Exp erimental Design †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 17 Survey Procedure †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 18 Data Analysis †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 9 Limitations of the study †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 19 Resultsâ⠂¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 20 Reasons why EMR is not being used at RVTH †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 23 Benefits and challenges of EMR†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 24 Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 0 Conclusion †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã ¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 30 Suggestions for Additional Work †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 32 References †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 34 Glossary †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5 Appendix †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 36 2 List of Figures Figure 1: Sources of funding, RVTH 2008 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 22 Figure 2: Averages ofEMR functions in order of relevance to work at RVTH †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 29 List of Tables Table 1: Number of patients seen at RVTH in 2008 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 7 Table 2: List of Professionals, RVTH 2009 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 0 Table 3: Computer ownership and previous computer training received by the respondents at RVTH †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 28 Acknowledgments My journey towards my Master's degree was a long and fruitful one. The Engineering Management (EMGT) program has not just exposed me to much information and ideas but also opened a way towards my career path. Thank you to my parents, Ebrima and Lucy who have always been a source of great inspiration and strength to me. They taught me the value ofeducation and their prayers has always been with me.Thanks to my brother, Baboucar who encouraged me to pursue my Master's degree and the never ending support I receive from him. Special thanks to my six year old son, Ebrima for his understanding that I'm at school when I'm not home to read him a bedtime story. I also want to thank all my EMGT instructors especially Professor Herb Tuttle, Dr Tom Bowlin and Ray Dick who worked with me recently, for the wonderful information and feedback they provided on this project. Thanks to Parveen Mozaffar for her extreme support and encouragement during the course of my studies.Thanks to the staff at Royal Victoria Teaching hospital for providing me with all the needed information for this project. Last but not least, my gratitude goes out to Dr Don Anthony Woods. It is because of his influence that brought me where I am today. He always had my best interest at heart and I want to thank him for that. May God bless you! Executive Summary Most countries in Europe and the USA are increasingly using an electronic medical record (EMR) system to help improve healthcare quality. Unfortunately, The Gambia government faces a series of health crises including but not limited to HIVIAIDS, malaria, diabetes and tuberculosis.These diseases threaten the lives of thousands of people. Lack of infrastructure and trained, experienced staff are considered important barriers to scaling up treatment for these diseases. The contribution of this field proj ect outlines the benefits of an EMR system at Royal Victoria Teaching Hospital (RVTH) and how it will improve patient safety. This is a descriptive study using interview questionnaires from officials at the Royal Victoria Teaching Hospital. The study also looks into other facilities in similar developing countries with advanced systems, but not so advanced as to be at the level of state-of-the ­ art facilities in the U.S. Results from this study indicates the importance of an EMR system at RVTH to facilitate effective and efficient data collection, data entry, information retrieval and report generation. As a catalyst for development, the implementation of an EMR system at RVTH may make it one on the best hospitals in the West African region. 5 1. Introduction According to Dick and Steen, Electronic Medical Record (EMR) is the compilation of patient medical information in a computer-based format that allows the collection, storage, retrieval, and communication of this data.An electronic medical record replicates a paper chart and contains both clinical information (diagnoses, allergies, drug resistance and treatments) and demographic information about a patient; it provides a comprehensive medical picture and can be used by clinicians as a tool to determine appropriate treatment for patients. EMR is not only being welcomed by healthcare providers as a way to improve care delivery but also serves as a catalyst and gold standard for development (porter, Kohane, & Goldman; Reifsteck, Swanson, & Dallas).Unfortunately, Africa, a continent faced with many challenges ranging from epidemics, civil wars, and disasters, lacks robust healthcare infrastructure in the form of computerized h ealth care systems. For instance, Ghana has one the best health institutions in the region, Korle-Bu Teaching Hospital. This Hospital, for example, is currently the only institution in the West African sub-region which performs surgery. Due to the quality of outcome, it now receives referrals from most parts of the continent namely the Gambia, Sierra Leone, Liberia, Togo Benin, Tanzania, Nigeria, Cameroon, Cote d' Ivoire, and Ethiopia.Despite its exemplary performance, the hospital has no computerized information system which can help improve care delivery in the region. Therefore, the purpose of this study is to examine the potential benefits of EMR and its ultimate contribution to improving healthcare delivery development in less developed countries like The Gambia. 6 1. 1. Background of Royal Victoria Teaching Hospital The Gambia is a small country in West Africa, with a population of approximately 1. 5 million. RVTH has been in existence for over 100 years in The Gambia's capita l, Banjul.It used to be called Royal Victoria Hospital until in the late 1990s, when its name was changed to RVTH. The Gambian Government decided that it had to reduce its dependency on foreign doctors by establishing a medical school in the University of The Gambia (UTG). The UTG now uses RVTH to teach its clinical students. In recent years, The Gambia has been doing much on its own initiative to take to improve the healthcare of the nation. There are 540 beds in the hospital and the two largest Departments are Pediatrics and Maternity.The biggest â€Å"killer† disease in The Gambia is malaria, with young children and pregnant women being particularly vulnerable to this disease. Diabetes, high blood pressure, pneumonia and eye problems such as trachoma and cataracts are also major health problems. The following table provides an estimation of how many patients were seen at RVTH in the year 2008. Procedure Inpatient Admissions Children admitted to Pediatrics Patients treated in the Eye Center Out-Patient Appointments Out-Patients in the ER Number of Patients 25,281 9,352 986 over 184,365 24,334 Table 1: Number of patients seen at RVTH in 2008 7Unfortunately, RVTH does not have any EMR system in place to facilitate patient safety. As noted by participants, â€Å"EMR software is not used at RVTH because administration keeps complaining of money. It looks expensive to them and also they are more used to the paper folder†. Currently, information is very fragmented and therefore does very little to help patient safety and consistency in care. Another important issue here is that a large number of these patients are illiterates. To ensure they receive the appropriate treatment, they will have to explain to the physician current medications they are taking etc.This can be a very challenging and fatal to the patient sometimes. The typical paper medical record contains sections including information on demographics, admissions, discharge summaries, progre ss notes, protocols, laboratory results, radiology results, surgical and pathology reports, orders for, treatment and nursing notes. Most documentation regarding treatment of a patient is written directly in the patient's medical chart. On a given day a patient arrives at the hospital for care, sign in his name and waits anywhere from 30 minutes to six hours o get their records pulled depending on the day. Physicians, nurses, medical residents who need access the information in the medical record must wait till it's available. Typically, medical records are transported to the outpatient clinic where the patient would be seen, and then returned to storage center to be filed again. It is necessary for the medical record to follow the patient throughout their visit. If the patient was seen in one clinic where orders were written, it was necessary to physically transport the record when the patient moved to the medicine room for treatment. The purpose of this field project is to examine the potential benefits of an EMR system and its ultimate contribution to improving patient safety at the Royal Victoria Teaching Hospital in The Gambia. 9 2. Literature Review The first generation of EMRs was extensions of medical billing systems in large US hospitals. Over the last four decades, they have been used as tools to organize and store medical data. EMRs are widely accepted as important tools to support high quality health care in the US, Europe and other developed countries.Evidence shows that using EMRs that include decision support systems improves quality of care and both reduce medical errors and unnecessary medical investigations (Partners in Health), Experience with the use of EMRs in developing countries, if available, is much more limited than it is in the US and Europe. Now there is considerable interest in using medical information systems to support the treatment of HIV and TB in Africa, Latin America, and Asia. In most African countries, healthcare informati on systems have been driven mainly by the need to report aggregate statistics for government or funding agencies.Such data collection can be performed with simple paper forms at the clinic level, with all electronic data entry done centrally, but that approach tends to be difficult and time ­ consuming and may provide little or no feedback to the staff collecting data. Individual patient data that are collected and accessible at the point of care can support clinical management. Clinicians can easily access previous records, and simple tools can be incorporated to warn of potential problems such as incompatible drugs.Physicians or nurses can check on the outcomes of individuals or groups of patients and perform research studies. Many of these functions will work well on paper or with simple spreadsheets for up to 100 patients but become very time-consuming and potentially unreliable with more than 1,000 records, and virtually impossible with 10,000 or more. 10 Experience with the use ofEMRs in developing countries is much more limited than it is in the US and Europe, but there is now considerable interest in using medical information systems to support the treatment of HIV and TB in Africa.Some examples of EMR use in Africa include: †¢ The Regenstrief Institute in collaboration with Moi University in Kenya developed an EMR for general patient visits to clinics in western Kenya. This system was subsequently modified to support the care of several thousand HIV patients. †¢ Baobab Health Partnership in Malawi has developed an EMR system using innovative, low-power touch-screen PCs for data entry and display. This system is now used to support the care of more than 7,000 HIV patients in the Lighthouse clinic in Lilongwe and has been chosen by the national HIV program for use throughout the country. [email  protected], an HIV medical information system developed for US patients, has now been deployed in Uganda and is planned for use in other African c ountries and in Latin America. (Partners In Health) A wide-ranging literature review of electronic medical record implementation over the past decade reveals that clinical, workflow, administrative, and revenue enhancement benefits of the EMR outweigh barriers and challenges. Among other key efforts, organizations must train and motivate users to navigate EMR systems, as well as develop a common structured language.Clinicians who used CPRs found that electronic 11 access to clinical infonnation saves time and provides a thorough and efficient way to manage patient information To reap the full benefits of an EMR, organizations must redesign current workflows and practices to evolve into efficient providers of care. EMR systems are developed to meet the following goals: improve quality of care, reduce organizational expense, and produce a data stream for electronic billing. (Dassenko and Slowinski).The EMR meets these goals through workflow automation, connectivity, and data mining. ( Gaillour) The Computer-based Patient Record Institute's (CPRI) definition concurred with the other researchers, but added that the EMR provides protection of patient and provider confidentiality, has a defined vocabulary and standardized coding, produces documentation as a by-product of patient care, connects local and remote systems and provides electronic support for secondary users (payers, policymakers, researchers). Fromberg and Arnatayakul) Unfortunately, most EMR systems are unable to offer all of the components defined by the CPRI because †the technology is too complex and too expensive, doctors won't use computers, and standards don't exist. â€Å"(Gaillour) The advantages associated with implementing EMRs are well documented and are straightforward. The difficulty comes with placing a dollar figure to these advantages; consequently, few organizations have published studies describing the actual costs and benefits attained from implementing EMRs. Bingham) The benefit s associated with CPRs are organized into four categories: clinical, workflow, administrative, and revenue enhancement. Renner, states that measuring all the benefits associated with EMRs is 12 virtually impossible, and that it is probably safe to select those that can make the greatest financial difference, and incorporate them into a financial model.Clinical benefits seen after implementing an EMR include: better access to the chart, improved clinical decision making and disease management, enhanced documentation, simplified patient education, and increased free time to spend with patients, accompanied by improved perception of care and quality of work life. These benefits ultimately result in better delivery ofpatient care and safety. Despite all of these benefits, EMRs are not a standard in today's healthcare systems. It is evident that EMR technology is still a hot topic for discussion when browsing through current healthcare technology and management journals.The following bar riers have kept healthcare leaders discussing EMR technology instead of adopting it: cost, leadership, ROI, vendors keeping up with users' needs, and deficits in the following categories: public policy, standards, security, and a true definition. First of all, cost has kept organizations from implementing EMR systems. These costs can be organized into the following categories: software, hardware, infrastructure development and maintenance, implementation, education, planning, and administration.Software costs include development or purchase, maintenance, and upgrades over time, while hardware costs include purchase of workstations. (Mohr) Infrastructure development and maintenance costs include servers, interfaces, workstations, network cables, network maintenance, and help desk operations. Planning costs include development of an implementation plan, identifying measurable outcomes, and choosing meaningful metrics and goals, while implementation costs include training, overtime 13 ssociated with entering patient data, business disruption during transition, employee resistance to change, and lost productivity. Drazen, suggested that leadership was probably a more significant barrier than cost because, in the past, healthcare leaders have raised capital for essential business initiatives such as major building programs, acquiring a physician network, or starting up a managed care organization. This amount of capital is on the same scale as an EMR. Next, Drazen stated that a lack of government support is a major issue holding up EMR implementation.Unfortunately, the federal government does not contribute fmancially to EMR implementation projects. Without standards and structured data definitions, computer systems are not guaranteed to interface easily with each other, and databases are not easily developed. Most individual departments within a healthcare system have already invested in computerized patient information systems; however, these systems are isolated and do not communicate well with one another. Getting these systems to interface is one challenge facing EMRs. Data security continues to be an ongoing challenge.Bergman, found that politicians, consumer advocates, and the general public have voiced concerns about risks to the privacy and confidentiality of patient information. However, when compared with the security of the paper chart, the EMR's electronic audit trails and passwords actually improves internal security. The EMR may be more secure for internal breeches of confidentiality, but must also be protected from external breeches such as hackers, who could potentially enter the EMR from an off-site location and download volumes of 4 confidential information. Firewalls and encryption software are methods used to protect patient data from these violators. Clinicians who use EMRs recognize two benefits: First, electronic access to clinical information saves time. Second, electronic access provides a thorough and efficient way to manage patient information. With EMR systems, comprehensive information can be located and presented in a way that is relevant to the task at hand. Dassengko and Slowinski) The obstacles identified have thus far been insurmountable, but the considerable achievements identified in the benefits section of this discussion suggest that the advantages are well worth the effort. As Lenhart et al state, â€Å"Success comes at the price of considerable effort, persistence and optimism, as well as dedicated leadership. † (p. 114) some organizations that invested in early EMR systems are struggling to show the qualitative benefits promised by vendors because an electronic version of current work processes is not cost effective. Sandrick) â€Å"If the ROI were a function of the information tool itself, the financial benefits would be experienced universally. † (ROI: The White Paper. A Business Case for Electronic Medical Records) To get the most value out of an EMR, healthcare organizations must reengineer the following work processes to make full use of the system: Healthcare organizations must first train and motivate their users on how to navigate and operate the EMR tools. To optimally use the EMR, it must be implemented from registration through billing, thus allowing the organization to realize full potential benefits across the delivery system.These benefits include clear, concise, and comprehensive documentation, greater efficiency, care consistent with best practice guidelines and improved claims processing. 15 It is difficult to measure the economic value associated with less tangible benefits such as higher quality of care, patient service, provider and employee satisfaction, and competitive advantage. It is even more difficult to allocate necessary resources and commit to institutional change when the paper chart is â€Å"getting the job done,† even if it is not in the most efficient style.However, Carlon, suggests that all providers s hould embmce the EMR to deliver safe medical care. The information in the EMR can reduce medical errors to avoid dangerous, sometimes lethal, mistakes. If organizations can't show that EMRs have a positive ROI, they may decide that the EMR is just another expense of running a business. The expense is to improve patient safety and reduce medical errors. This review of literature emphasizes that the use of EMR systems contributes to the ultimate goal of delivering effective care while improving patient safety. 16 3.Procedure and Methodology The study is an exploratory study conducted in Banjul, The Gambia, to examine the potential benefits ofEMR and its contribution to improving patient safety. For the most part, this study is descriptive and categorized as a non-experimental qualitative study. Initial contacts were made with the Chief Medical Director, Development Officer and the Head of Medical Records at the RVTH to solicit participants for the study. 3. 1. Experimental Design Surv ey approach was used to gather data from healthcare professionals who are considered potential users of EMR.Copies of the questionnaires were sent through e-mail to participants. A total of 50 surveys containing 15 questions were sent out and 30 of them were returned. The content of the survey designed was open-ended questions based on the following areas: knowledge of EMR, benefits and challenges of EMR, transition from paper-based system to EMR, security issues associated with EMR use and assistance given to developing countries by developed nations to implement or use EMR. Other areas include, demographic details of respondents based on profession, length of practice, age and sex.The survey questions can be found in the Appendix. Participants were selected based on their level of healthcare training. The population set for the study was healthcare professionals from the RVTH, which includes physician consultants, surgeons, pharmacists, nurses, midwives, pathologists, radiologists , and laboratory technicians. Study participants were limited to these previously mentioned health professionals, since they would be the principle users of an EMRsystem. 17 RVTH has a total population of about 500 professionals and a sample size of 50 was chosen for the study.Since this was the first time such a study was being conducted in the country, there was limited knowledge of professionals on the subject as well as difficulty in getting volunteers to participate. 3. 2. Survey Procedure Survey questionnaires were converted into a PDF file and mailed electronically to all 50 participants on February 2, 2009. Unfortunately, five medical professionals who were initially contacted to participate in the study later declined to take part due to lack of understanding of the survey questions. As a result, different participants were contacted to replace the five individuals to make up the sample size.Since the researcher could not travel to Gambia to facilitate the survey, one of th e administrative officers at the hospital was contacted and helped to distribute hard copies of the questionnaire to all participants. Participants were requested to fill out the attached survey and return it in a sealed envelope to this person or the chief administrator. After three weeks, on February 23, 2009, a first reminder was mailed asking for their cooperation and the importance of returning the survey. A final reminder was sent out on March 9, 2009, to those who might have forgotten to return the survey. 8 3. 3. Data Analysis The 30 completed surveys were coded, sorted, and organized into themes. A spreadsheet was created in MS-Excel to enter all data for analysis. All responses were placed into themes and summarized. The survey responses and themes generated were used to determine result interpretation, recommendation, and future research direction. Despite initial difficulties to get volunteers to participate in the study, 30 out of the 50 surveys mailed were returned on March 16,2009, thus representing 60% response rate. 3. 4. Limitations of the studyDue to the difficulty of getting other hospitals in the area involved, the study was limited to RVTH only_ The findings represent views ofthat hospital alone. However, the research would have been more interesting and challenging if more professionals from other hospitals were involved in the study. Secondly, due to cost of air travel between the United States and Gambia, the researcher was not able to travel to Gambia to collect the necessary data for the study. The inability of participants to respond to some important questions on the survey skewed the data.Finally, due to the six hour time difference between Kansas and Gambia, it was hard to reach the participants at during business hours. Lack of high speed internet or sometimes no connection at all caused the delay in receiving all the responses on time. It was also really difficult to get people to cooperate because the survey was not on their l ist of priorities. 19 4. Results Based on the methodology, surveys were mailed to 50 participants at the RVTH in Banjul, The Gambia. Thirty completed surveys were received which included 15 questions.The results from all participants are as follows: The 30 respondents consisted of 17 males, 11 females and two people who did not indicate their gender. The age range of the group was 25-56. Table 2 presents the professional distribution of participants. No Response represents people who did not include their profession. The five students, however, included final year medical and dentistry students, as well as nursing, and medical laboratory students. Professional experience ranged between 1 and 20 years.Profession Surgeon Pharmacist Physician Radiologist Midwife Nurse Laboratory Technician Student No Response Total Table 2: List of Professiona is, RVTH 2009 Number 3 2 3 2 5 6 2 5 2 30 20 To analyze this result, key words such as computerized, storage and retrieval, were used to determi ne respondents' understanding of the concept of an EMR system. Subsequently, one-third of respondents (33. 3%) who included these three key words were marked as right. While nine people representing 20% who said it is a mechanism for storing patient medical record on a computer were classified as partially right and approximately half respondents (46. %) who just said the use of machine to keep patient medical data were classified as having an idea or understanding of the system. In addition, implementing and running a successful EMR system requires a number of key elements. Accordingly, 15 people identified technical elements such as (electricity, hardware, software, etc. ), 10 stated patient data, while four said adequate trained personnel, and one person indicated the need for money to train staff on EMR. Also availability of adequate infrastructure such as experts to support and train care providers on EMR is very crucial when implementing EMR system.However, more than half resp ondents agreed that enough infrastructures are not available in Gambia to support EMR implementation. On the other hand, 10 people believed that infrastructures are available, while four said available infrastructures are only few. Despite unavailability of infrastructures, 16 respondents reported there are enough computer experts in Gambia to train healthcare providers to use EMR. Seven reported experts are not available; six stated experts are available but too few to meet the demand and needed training requirement of the healthcare sector.Lastly, one person indicated he has no idea of the subject. Responses concerning how much developed nations are assisting less developed countries like Gambia with Health Information Management (HIM) system infrastructure 21 implementation showed diverse opinions. Nine people said developed countries are helping, 15 responded no. However, six indicated that â€Å"the help given from developed nations are not enough and sometimes electronic devi ces sent to less developed countries like the Gambia are inferior and lack quality†.Still others think â€Å"some form of assistance comes in to support the country on information management systems but not much is channeled towards the health sector†. Lastly, seven people reported they have no idea â€Å"if developed nations are helping† and one person did not respond to this question at all. This pie chart below shows the sources of funding and the amounts received for the year 2008. Sources of Funding 2% †¢ Gambia Government †¢ Patient User Charges †¢ Donation Fund †¢ Internally Generated Fund †¢ Global Fund Severe Malaria in African Children FundFigure 1: Sources of funding, RVTH 2008 22 The majority of funds come from the Gambia Government in the fonn of subvention received monthly or quarterly in advance. However, about 70% of the amount goes towards payment of salaries and allowances to approximately 1,200 staff. Other donations re ceived are in the fonn of drugs, equipment, supplies and services which made considerable contribution to the hospital. (RVTH) 4. 1. Reasons why EMR is not being used at RVTH Paper records are bulky and can take up costly space.Filing, retrieval of files, and the re-filing of paper records are very labor-intensive methods with which to store patient infonnation. Plus if a record is checked out for one department, another department cannot access the chart. The impact of not having immediate access to key infonnation in emergency situations can be serious. Paper medical charts also cannot be effectively searched and used to track, analyze, and/or chart voluminous clinical medical infonnation and processes. They cannot be easily copied or saved off-site.Also physician's orders and the corresponding results such as medications and labs can be issued and saved in a comprehensive EMR system. Our literature review and results have proven that paper records are costly, cumbersome, misinter preted, easily misplaced and cannot be used for any meaningful decision analysis. Unfortunately, RVTH does not have any EMR system in place to improve patient safety. As noted-by participants, â€Å"EMR software is not used at RVTH because administration keeps complaining of the lack of money. It looks expensive to them and also they are more used to the paper folder†.Nevertheless, four key issues were identified by participants as the main reasons why RVTH does not have an EMR system in use. 23 Overall, 36% of respondents attributed the problem to lack of resources in terms of personnel and infrastructure, 29% blamed it on lack ofleadership initiative and priority. While 18% reported cost in terms of equipment and training personnel, 15%, however, stated lack ofEMR importance or awareness and fear to change. Lastly, 2% respondents did not give any reason. 4. 2. Benefits and challenges of EMR There are both benefits and challenges to EMRs.Many argue that positive aspects of u sing an EMR system outweigh the challenges. Even though the investments in EMR systems are costly, most argue that over time this outset cost will result in greater savmgs. As well as cost saving, many agree that one advantage of EMR system is that they save space. Instead of keeping huge paper files on patients, all records are kept on computer files. Though someone must store these records in computers, this still represents a small percentage ofthe space required to store physical records. Along with saved space is reduction of paper used by hospitals.Although EMR systems do not render paper obsolete, but they certainly do reduce needed paper significantly. Another advantage of electronic medical records is the ability for all in a health care team to coordinate care in terms of monitoring and treating diseases. This helps avoid duplication of testing, prescribing medicines that in combination might be dangerous and the ability for anyone on the medical team to understand the app roaches taken to a condition. A person with complex health issues may see several specialists, and can easily become confused by overlapping or contrary advice.When specialists and primary care doctors use the same system for electronic medical records, then everyone on the team would be aware of all the other team members' actions and recommendations. Electronic medical records may save time as well. Though faxing and email may assist one doctor to get information from another doctor or a laboratory, there is generally a wait time to receive this information. When a doctor has instant access to all of a patient's information, including things like x-rays, lab tests, and information about prescriptions or allergies, he or she is ready to act right away, thus saving time.This may be particularly helpful in emergency situations where a patient cannot answer questions about medical history or allergies due to extreme illness or injury. Generally, doctors are often considered to have th e worst handwriting, though this is just a generalization, unclear writing can lead to misinterpretations and mistakes. Typed notes and prescriptions are more legible and less likely to create misunderstandings. However, electronic medical records do not rule out the occasional typo. One of the main disadvantages to EMR system is that start up costs is enormous.Not only must you buy equipment to record and store patient charts (much more expensive than paper and file cabinets), but efforts must be taken to convert all charts to electronic form. Patients may be in the transitional stage where old records haven't yet been converted and doctors don't always know this. Further, training on EMR software adds additional expense in paying people to take training, and in paying trainers to teach practitioners. In fact, one concern about the use of electronic medical records is that doctors may have a significant learning curve when these programs are first implemented.A poor 25 typist may a ctually take a long time to input information. Doctors often have to be their own medical clerks especially during an office visit, and a doctor distracted by confusing technology may not be as alert to a patient's symptoms or needs. There is no single electronic medical records source or system, so different hospitals and individual clinicians may not all be using the same program. This negates the possibility of instant information for all on the medical team, since one program may not communicate with another.Another concern is that electronic medical record systems might be hacked and exploited by others. Since one of the first considerations of medical treatment is confidentiality, it may remain a concern about how many people may have access to other medical records which they are not authorized to do so. Misuse of private medical information could create problems for people who have conditions they wish to keep private. Despite these concerns, it appears many hospitals are no w attempting to use EMR systems.It remains unclear how long it will take for hospitals to transition completely from the traditional paper-based systems to a complete paperless environment. As shown from the survey results, it is clear that many participants believe that implementation ofEMR will tremendously improve upon patient in the country. For instance, as noted by one respondent, â€Å"availability of patient past history in electronic format will enable health care workers have information about patients in seconds and with ease which will facilitate quick diagnosis and treatment hence reducing the rate of mortality. 26There is always some level of fear and resistance to change, especially in the healthcare industry. A question concerning the level of acceptability from the traditional paper-based system to EMR system shows that such change will be met with some difficulties. More than half of respondents said the process would be challenging initially, but eventually care providers will accept the system because it will improve patient safety and work performance. Although the majority may still prefer the paper-based system, â€Å"they will change when they see the importance or need for EMR† stated a participant.Others also believe it would be a â€Å"welcome idea†. The adequate protection of patient health record requires limitations at all levels, such as: collection, use, access, and disclosure. Therefore, development of privacy, confidentiality, and security principles is necessary to protect patients' interests against inappropriate access to their health data. Unfortunately, 14 respondents (47%) did not respond to this important question regarding measures necessary to maintain patients' privacy, security, and confidentiality at RVTH.However, 16 people representing (53%), did state that all health records must be securely protected by use of password, data encryption, and access restrictions to users. It is obvious from the surv ey results that effective implementation and utilization ofEMR can improve patient safety in developing countries. Considering training as one of the key elements to EMR success, a question was asked to determine length of time required to train care providers in Gambia on EMR.Almost 50% of respondents indicated it might take 6-18 months depending on â€Å"practitioners' ability to understand the concepts ofEMR as well as the user friendliness of the software†. Others believe â€Å"for 27 current medical students who are already computer literate may take about two weeks, but the older practitioners will take longer time (approximately over a year)†. Table 3, below shows the number of respondents that own a computer or has had some form of computer training in the past. Computer Training Profession Own a Computer 1 1 1 0 1 2 1 2 I Yes 1 1 1 0 2 3 1 7 16